Thompson et al ^{Reference Thompson, Nadkarni, Nazir, Sorour, Owen and Buggineni1} considered the use of the Paddington Complexity Scale ^{Reference Yates, Garralda and Higginson2} to quantify the case complexity of their child and adolescent mental health service (CAMHS) attenders, but discarded it largely because their study was based on CAMHS records which did not record systematically information on diagnoses or other items relevant to multi-axial formulations, such as physical health and cognitive/developmental status of children and young people seen.

I would like to clarify that - to allow for the fact that CAMHS vary in the extent to which diagnostic and other detailed comprehensive information is obtained on cases seen by different professionals - the Paddington Complexity Scale has, in addition to a summative total score, two complexity subscores and scales: clinical (in itself subdivided into psychiatric, incorporating diagnosis, severity/duration, comorbidity items, and physical/development, scoring information on physical health and intellectual disability) and environmental (with items on family status and attitudes to the use of the service, type of school and multi-agency involvement). These subscales, in particular adaptations of the environmental subscale which is made up of items that will be known to most CAMHS workers, can and have been used on a stand-alone basis, as a measure of psychosocial case complexity. ³