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J Pediatr Psychol. 2018 Aug 1;43(7):749-757. doi: 10.1093/jpepsy/jsy014.

Psychometric Evaluation of the Caregiver Burden Inventory in Children and Adolescents With PANS.

Author information

Intramural Research Program, National Institute of Mental Health.
Stanford PANS Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University School of Medicine.
Child & Adolescent Psychiatry, Stanford University School of Medicine.
Pediatric Divisions of: Allergy, Immunology, & Rheumatology, Stanford University School of Medicine.
Tufts University School of Medicine.



To establish the psychometric properties of the Caregiver Burden Inventory (CBI) in patients with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), which is characterized by the abrupt onset of obsessive-compulsive disorder and/or restricted eating and at least two additional psychiatric symptoms. Parents of patients with PANS have reported high caregiver burden. However, no validated instrument of burden exists for this population.


Study took place at a community-based PANS clinic where the CBI is administered as part of routine clinical care. The first CBI available during an active disease flare was analyzed (N =104). Construct validity was evaluated within a confirmatory factor analytic framework. Associations between the CBI and patient/family characteristics were explored, and preliminary normative data for this population are presented.


Item-factor loadings were strong, and the overall fit of the model was good (root mean square error of approximation = .061). Strict/metric measurement invariance was demonstrated across age. The mean Total Score in this sample was 36.72 ± 19.84 (interquartile range 19-53). Total Scores on the CBI were significantly elevated for parents of children who switched schools because of their illness (Cohen's d = 0.75, 95% confidence interval [CI] 0.28-1.22) and for those who had reduced work hours to accommodate the child's illness (Cohen's d = 0.65, 95% CI 0.10-1.20). However, in this relatively high-status sample, socioeconomic variables did not predict Total Scores.


Parents of patients with PANS experience high caregiver burden. The CBI may be confidently used to assess caregiver burden in this population.

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