Family APGAR: Family functioning screen

What this assessment is

Family APGAR is a five-item questionnaire about one person's satisfaction with family functioning.

It produces a total from 0 to 10. Higher scores indicate greater reported satisfaction with how the family responds to needs and change.

The name APGAR is a memory aid for five areas: Adaptation, Partnership, Growth, Affection, and Resolve.

The score is a screen. It is not an objective diagnosis of a family or a judgment about whether a family is good or bad.

It records one view.

Who it was designed for

Gabriel Smilkstein introduced Family APGAR in a 1978 primary-care article.

The original proposal defined family broadly. It focused on the people from whom a person usually receives emotional support, care, and help.

Later studies have used the questionnaire with adolescents, adults, older adults, and people living with chronic illness. Evidence from one group does not establish the same interpretation in every culture, household, or family structure.

This page covers the original five-item form.

Version matters.

How it is administered

The person rates satisfaction in each of the five family-function areas using three response levels.

Each response receives 0, 1, or 2 points. Completion usually takes about two minutes.

The standard questionnaire does not set a fixed recent recall period. The result reflects the respondent's current general view unless a protocol states otherwise.

All five responses are needed for the standard total. The original article does not give a general rule for replacing a missing response.

Use complete data.

What it measures

The five areas are:

• adaptation: whether the family can use resources when help is needed
• partnership: whether decisions and communication feel shared
• growth: whether the family supports change and development
• affection: whether emotional responses feel caring and acceptable
• resolve: whether time, space, and practical commitments feel shared

The questionnaire records one person's satisfaction. Other family members may report a different experience.

The MSPSS separates perceived support from family, friends, and a significant other. The ZBI-12 focuses on the personal impact of caregiving.

How scoring works

Score each response from 0 to 2 and add the five values.

The total ranges from 0 to 10. Higher scores indicate greater satisfaction with family functioning.

There are no reverse-scored questions and no standard subscale totals. The five named areas help organize discussion, but each contains only one response.

Do not calculate a standard score from fewer than five valid responses unless a selected protocol has validated a missing-response rule.

How to interpret a Family APGAR score

The original article labels totals of 7 to 10 as highly functional, 4 to 6 as moderately dysfunctional, and 0 to 3 as severely dysfunctional.

These are the original screening descriptions. They should not be presented as a formal diagnosis of the family system.

Do not assign blame.

A score near a boundary can change because of one response. Use the total to open a conversation about the five areas, not to assign blame.

Population, culture, household structure, illness, and current stress can all affect the result. For repeated use, keep the wording, language, and administration consistent.

What the score cannot tell you

Family APGAR cannot identify the cause of family strain.

Ask what changed.

It cannot determine whether a relationship is safe, whether practical care needs are met, or whether every family member agrees with the respondent.

A high total does not rule out conflict, abuse, isolation, or unmet needs. A low total does not show that every relationship in the family is poor.

The score cannot diagnose depression, anxiety, caregiver burnout, or another condition.

Evidence and limitations

The original article proposed a very brief way for primary-care clinicians to ask about family support and functioning.

A later validation study found that Family APGAR scores were associated with other measures of family function, while also showing that the questionnaire captures an individual perception rather than a complete family assessment.

Its brevity makes it easy to use. It also means each area rests on one response, so the total can miss important detail.

Five answers are not a full family assessment.

Record the version, language, respondent, context, missing-response handling, and any interpretation labels used.