Date Presented 04/21/2023

This cross-sectional study compares scores on three versions of the Caregiver Strain Questionnaire (CGSQ) using repeated-measures analysis of variance. Practitioners should consider the balance of respondent burden and scale validity when using clinical questionnaires.

Primary Author and Speaker: Ho Ching Lam

Additional Authors and Speakers: Emily Campi

Contributing Authors: Katherine Hayes, Grace Baranek

Caregivers of children with autism and related conditions report elevated stress, which negatively impacts family occupations (Boyd et al., 2014). Long questionnaires about strain, however, induce respondent burden, which may yield less reliable information for research and clinical purposes. The purpose of this study was to investigate the differences in three versions (21-, 11- and 7- items) of the Caregiver Strain Questionnaire (CGSQ) to compare validity across versions. This cross-sectional study analyzed extant data from the CGSQ-21 (Brennan et al., 2021) collected from parents of 134 children (9-48 months old) with autism and/or developmental conditions. The CGSQ-21 and CGSQ-11 have three subscales: objective strain, subjective internalized strain, and subjective externalized strain (Yang et al., 2021). Subjective externalized strain is not included on the CGSQ-7. We calculated total mean scores and subscale mean scores for each of the versions, then compared means using repeated measures ANOVA models. Significant differences were found for total scores (F=150.08; df=2,132; p<.001), subjective internalized strain (F=30.88; df=2,132; p<.001), subjective externalized strain (F=8.46; df=1,133; p=.004), and objective strain (F=39.29; df=2,132; p<.001). The effect sizes were medium for CGSQ-21 versus -7 (d= 0.61) and CGSQ-11 versus -7 (d= 0.65). Other pairs showed small effects (d=0.01-0.25). This study shows a relationship between test length and reliability. Occupational therapy practitioners and researchers need to consider a careful balance between scale validity and respondent burden. Reducing respondent burden by a few minutes may not justify the potential negative effect on validity. Future studies using factor analysis or item response theory are needed to further examine the differences in structure across CGSQ versions.


Brennan, G. M., Babinski, D. E., Waschbusch, D. A. (2021). Caregiver Strain Questionnaire-Short Form 11(CGSQ-SF11): A Validation Study. Assessment. 29(7).

Boyd, B. A., McCarty, C. H., & Sethi, C. (2014). Families of children with autism: A synthesis of family routines literature. Journal of Occupational Science, 21(3), 322-333.

Yang, R., Zhou, H., Liu, J., Wang, Y., Zhang, Y., Wang, Y., Liu, R., Cao, X., Han, D., Yang, S., Yang, J., Kang, C. (2021). Psychometric properties of the Caregiver Strain Questionnaire among Chinese parents of children with ADHD or ASD. General Psychiatry. 34(2).