Katz Adjustment Scale (KAS-R)

Abstract

The Katz Adjustment Scale (KAS-R), developed by Martin M. Katz and Samuel B. Lyerly in 1963, is a widely utilized instrument in psychological assessment designed to measure the social and behavioral adjustment of individuals, often those recovering from psychiatric illness, within their community settings. The scale is distinctive because it employs a relative report format, obtaining critical observations from family members or close caregivers. The KAS-R is structured around several forms, most notably Form R2 and Form R3, which capture two distinct but related dimensions: the individual’s actual social adjustment performance and the family’s expectations regarding that performance. This dual perspective provides a nuanced view of the patient’s reintegration into daily life.

Keywords

Katz Adjustment Scale, KAS-R, Social Behavior, Adjustment Assessment, Relative Report, Psychiatric Outcome, Performance Level, Social Expectation, Schizophrenia, Community Functioning.

Authors

Martin M. Katz, Samuel B. Lyerly

Purpose

The primary purpose of the Katz Adjustment Scale is to provide a standardized, reliable method for quantifying the level of social and behavioral adjustment exhibited by an individual who has been treated for, or is currently experiencing, a psychological disorder. It is particularly valuable for longitudinal studies tracking patient outcomes following treatment or hospitalization, especially concerning their ability to function effectively within their home and community environment.

The scale achieves this by utilizing forms that capture both the objective reality of the patient’s behavior (Form R2: Level of Performance of Socially Expected Activities) and the subjective standard held by the relative (Form R3: Level of Expectations for Performance of Social Activities). By comparing the performance score (R2) against the expectation score (R3), clinicians can identify areas of conflict, discrepancy, or successful reintegration that might be missed by self-report measures alone.

Construct

The KAS-R measures the construct of **community and social adjustment**, defined through a set of observable behaviors and activities that are socially expected within a typical household or community environment. The scale operationalizes this construct across several domains, including household responsibilities, social engagement, self-care, and occupational functioning.

The instrument is fundamentally a **relative report measure**, meaning the construct of adjustment is assessed through the perspective of a close family member who has intimate knowledge of the patient’s daily life. This method is crucial in populations where self-report may be compromised due to cognitive impairment or lack of insight, such as individuals with schizophrenia or traumatic brain injury. The core dimensions measured are the frequency and quality of engagement in activities (R2) versus the caregiver’s normative expectations (R3).

Validity

Early validation studies, such as the seminal work by Katz and Lyerly (1963), established the **discriminative validity** of the KAS-R, demonstrating its ability to differentiate between groups of individuals with varying degrees of psychiatric impairment. The scale has shown strong **criterion validity** by correlating significantly with other measures of social functioning and clinical severity.

Subsequent research has confirmed its utility in diverse populations. For instance, studies modifying the scale for victims of traumatic brain and spinal injury (Jackson et al., 1992) supported its **construct validity** in measuring functional outcomes beyond traditional psychiatric contexts. The scale’s ability to capture caregiver burden and the discrepancy between expected and actual functioning further strengthens its validity as an outcome measure in rehabilitation and long-term care planning.

Reliability

The reliability of the Katz Adjustment Scale has generally been reported as satisfactory to high across various clinical samples. Studies utilizing the KAS-R in samples of individuals with epilepsy (Vickrey et al., 1992) specifically assessed its psychometric properties, finding acceptable levels of internal consistency.

Because the KAS-R relies on relative report, **inter-rater reliability** is a critical consideration. While high inter-rater reliability can be challenging to achieve perfectly due to subjective differences among relatives, the standardized format and clear behavioral anchors of the items help maintain consistency. The internal consistency (measured by coefficient alpha) typically meets acceptable standards for a behavioral rating scale, especially within the subscales derived from factor analysis.

Factor Analysis

Factor analytic studies of the KAS-R have consistently identified several underlying dimensions of adjustment, reflecting the multidimensional nature of community functioning. These factors generally group the 16 items into conceptually meaningful domains. Common factors extracted often include:

• **Social Isolation/Withdrawal:** Items related to visiting friends, entertaining, and social activities.
• **Instrumental Role Performance:** Items related to working, supporting the family, and helping with budgeting or chores.
• **Interpersonal Conflict:** Items related to getting along with family members and neighbors.
• **Self-Care and Responsibility:** Items related to dressing, self-care, and remembering important things.

These factors allow researchers and clinicians to assess specific deficits in adjustment rather than relying solely on a single global score, enhancing the scale’s clinical utility.

Instrument

Test Type: Behavioral Rating Scale (Relative Report)

Format: Paper-and-pencil questionnaire with multiple forms (R2 and R3 detailed here).

Language Available: Primarily English; translated versions are often utilized in international clinical trials.

Population Group: Clinical populations, including individuals with chronic psychiatric illnesses (e.g., schizophrenia), neurological disorders (e.g., epilepsy, traumatic brain injury), and those undergoing community reintegration.

Age Group: Adults.

Population Details: Administered to a relative, caregiver, or someone intimately familiar with the patient’s daily activities and behavior.

Test Methodology: The relative rates the patient’s behavior based on two distinct sets of criteria using a three-category response scale for each form. Form R2 assesses actual performance: “is not doing,” “is doing some,” and “is doing regularly.” Form R3 assesses expectation: “did not expect him to be doing,” “expected him to be doing some,” and “expected him to be doing regularly.”

Keywords

Psychological Assessment, Community Reintegration, Behavioral Outcome Measures, Mental Health Research, Relative Report Form, Functional Status, Social Activities.

Authors

Author ORCID Identifier: Not publicly available for original authors.

Affiliation Email addresses: Not provided in source material.

Correspondence Address: Refer to Western Psychological Services for current distribution and manual information (Katz & Warren, 1998).

Permissions & Fee and Test Year

The Katz Adjustment Scale was originally developed in 1963. The updated relative report manual was published in 1998 by Western Psychological Services (WPS), which typically holds the copyright and distribution rights. Users should contact WPS for current licensing, permissions, and fee structures required for clinical or research use.

The original PDF containing information about the instrument can be downloaded here: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf

Reference’s

• Katz, M. M. & Lyerly, S. B. (1963). Methods for measuring adjustment and social behavior in the community: 1. Rationale, description, discriminative validity, and scale development. Psychological Reports, 13, 503-535.
• Jackson, H.F., Hopewell, C.A., Glass, C.A., Warburg, R., Dewey, M., Ghadiali, E. (1992). The Katz Adjustment Scale: modification for use with victims of traumatic brain and spinal injury. Brain Inj, 6(2):109-127.
• Vickrey, B.G., Hays, R.D., Brook, R.H., Rausch, R. (1992). Reliability and validity of the Katz Adjustment Scales in an epilepsy sample. Quality of Life Research, 1(1):63-72.
• Katz, M. M., & Warren, W. L. (1998). Katz adjustment scales relative report form manual. Los Angeles: Western Psychological Services.
• McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS.

Items of the Katz Adjustment Scale (KAS-R)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Helps with household chores
2. Visits his friends
3. Visits his relatives
4. Entertains friends at home
5. Dresses and takes care of himself
6. Helps with the family budgeting
7. Remembers to do important things on time
8. Gets along with family members
9. Goes to parties and other social activities
10. Gets along with neighbors
11. Helps with family shopping
12. Helps in the care and training of children
13. Goes to church
14. Takes up hobbies
15. Works
16. Supports the family