CAT Author Bruce A. Bracken, PhD Professor The College of William & Mary School of Education P.O....

CAT Author

Bruce A. Bracken, PhDProfessor

The College of William & MarySchool of EducationP.O. Box 8795Williamsburg, VA 23187-8795

Phone: (757) 221-1712Email: [email protected]

www.psychoeducational.com

Barbara S. Boatwright, PhDLicensed Clinical Psychologist

Psychology Associates of Mt. Pleasant1041 Johnnie Dodds Blvd. Suite 14 BMt. Pleasant, SC 29464

Email: [email protected]

CAT Author

• Originally referred to as “minimal brain dysfunction”• 1980 DSM-III identified attention deficit with hyperactivity (ADHD)

and attention deficit without hyperactivity (ADD) and based diagnosis on the three core symptoms of - Sustained attention - Impulsivity - Motor activity

• ADHD youth tend to be more disruptive and aggressive than ADD youth

• ADHD youth have more comorbid psychiatric and educational disorders (e.g., conduct problems, LD, poor peer relations)

• More recent developments have focused on separating ADHD from other psychiatric conditions (e.g., bipolar disorder, anxiety, under socialized youth)

• ADHD has 8% to 10% prevalence rate (APA, 2000); more males than females

Historical Perspectiveof Attention Deficit

• ADHD as a lifelong condition- Early conceptualizations were that adults outgrew ADHD

• Follow-up studies revealed - 30% to 80% of children with ADHD continued symptom manifestation into adulthood- Lower adult educational and occupational success- Lower socioeconomic status- More difficulty with co-workers and employers- Higher incidence of psychopathology- Increased likelihood of substance abuse

• ADHD Residual Type (DSM-III-R)- Continuation of ADHD symptoms into adulthood

Historical Perspective of Attention Deficit (continued)

American Academy of Pediatrics (AAP) To confirm a diagnosis of ADHD, related

behaviors must:• Occur in more than one setting, such as home, school,

and/or social situations.

• Be more severe than in other children of the same age.

• Begin before the child reaches 7 years of age.

• Make it difficult for the person to function at school,

home, and/or in social situations.

Historical Perspective of Attention Deficit (continued)

Six or more symptoms of inattention present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

Inattention• Inattention to details; makes careless mistakes in school,

and/or other activities.

• Has difficulty attending to tasks or play activities.

• Does not seem to listen when spoken to.

• Does not follow instructions and fails to finish schoolwork,and/or chores.

• Often has difficulty organizing activities.

• Often avoids, dislikes, or does not want to sustain mental effort for a long period of time.

• Loses things needed for tasks and activities.

• Easily distracted.

• Forgetful in daily activities.

DSM-IV ADHD Criteria

Six or more of the following symptoms of hyperactivity-impulsivity present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Hyperactivity

• Fidgets with hands or feet or squirms in seat.

• Gets up from seat when remaining in seat is expected.

• Runs about or climbs when and where it is not appropriate (adolescents may feel very restless).

• Has difficulty playing or enjoying leisure activities quietly.

• Is often “on the go” or often acts as if “driven by a motor.”

• Talks excessively.

DSM-IV ADHDCriteria (continued)

Six or more of the following symptoms of hyperactivity-impulsivity present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

Impulsivity• Blurts out answer before question has been completed.

• Has difficulty waiting one's turn.

• Interrupts or intrudes on others (e.g., butts into conversations).

• Some symptoms present before age 7 years.

• Some impairment from the symptoms is present in two ormore settings (e.g., at school, at home).

• Clear evidence of significant impairment in social and/orschool functioning.

• Symptoms do not happen only during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder. Symptoms are not better accounted for by another mental disorder (e.g. mood disorder, anxiety disorder).


Based on these criteria, three types of ADHD are identified:

• ADHD, Combined Type: if criteria from inattention, hyperactivity, and impulsivity are documented .

• ADHD, Predominantly Inattentive Type: if inattention is documented, but impulsivity and hyperactivity are not.

• ADHD, Predominantly Hyperactive-Impulsive Type: if hyperactivity and impulsivity are documented, but inattention is not.


Clinical Assessment of Attention Deficit

• Ages - 8 to 18 years

• Three forms - Self-Report

- Parent Report

- Teacher Report

Features

• Employs a four-point item response format - Strongly Agree- Agree- Disagree- Strongly Disagree

• Is accompanied with optional CAT Software Portfolio (CAT-SP) that scores, profiles, reports data, and facilitates interpretation- Standard scores (T scores)- Percentile ranks- Confidence intervals- Qualitative classifications- Graphical profile display

Features (continued)

• Assesses behaviors that correspond to DSM-IV/AAP- Clinical symptoms: inattention, hyperactivity, impulsivity- Multiple contexts: school/work, social, personal- Differentiates sensations (internal) from actions (external)- Normed to address issue of developmentally inappropriate

levels

• Software scoring program scores, profiles, reports, and stores examinees’ data

• Multiple applications- Clinical- Educational- Medical- Research

Features (continued)

A Multidimensional, Multi-Step, Multi-Year

Process

Constructing the CAT-C

1. Approached the CAT from Bracken’s (1992) context-dependent model of adjustment

2. Reviewed and evaluated existing attention deficit scales

3. Identified relevant content• Literature on attention deficit• Item content on existing instruments• Current diagnostic criteria from DSM-IV• Suggestions from colleagues

4. CAT-C developed after CAT-A (adult form) to match item content on the CAT-A

Content Identificationand Item Development

5. 42-item child form (CAT-C)- CAT-C Self-Report- CAT-C Parent Report- CAT-C Teacher Report

6. CAT-C forms were piloted and validated (N = 50), resulting in 83% to 88% correct classification of ADHD and control students

7. CAT-C scales were normed, validated, finalized,and published

Item Tryout, Norming,and Finalization

• Clinical symptoms- Inattention- Impulsivity- Hyperactivity

CAT-C Scales and Clusters


• Contexts- Personal- Academic/Occupational- Social

CAT-C Scales andClusters (continued)


• Contexts- Personal- Academic/Occupational- Social

• Locus- Internal- External

CAT-C Scales andClusters (continued)

• 42-item CAT-C Self-Report Form- 3 Clinical scales, 3 Context clusters, 2 Locus clusters- CAT-C Self-Report (5-10 minute administration)

• 42-item CAT-C Parent Report Form- 3 Clinical scales, 3 Context clusters, 2 Locus clusters- CAT-C Parent Report (5-10 minute administration)

• 42-item CAT-C Teacher Report Form- 3 Clinical scales, 3 Context clusters, 2 Locus clusters- CAT-C Teacher Report (5-10 minute administration)

Final Forms

CAT-C scale/cluster Self Parent Teacher

Clinical scaleInattention .85 .91 .94Impulsivity .82 .88 .92Hyperactivity .77 .85 .90

Context clusterPersonal .82 .88 .91Academic/Occupational .84 .89 .93Social .75 .85 .89

Locus clusterInternal .86 .91 .94External .87 .91 .94

Clinical Index .92 .95 .97* Reliabilities are also reported by age, gender, race/ethnicity.

CAT-C Internal Consistency*

CAT-C scale/cluster Self Parent Teacher

Clinical scaleInattention .87 .88 .67Impulsivity .82 .77 .74Hyperactivity .66 .75 .78

Context clusterPersonal .81 .82 .70Academic/Occupational .73 .82 .68Social .80 .70 .77

Locus clusterInternal .74 .71 .77External .83 .86 .69

Clinical Index .82 .83 .73* Corrected for restriction or expansion in range.

Stability Coefficients*

• Negative Impression − degree to which an individual consistently responds in a negative manner.

• Infrequency − extent to which an individual endorses items in an extreme manner that the normative sample did not endorse in an extreme manner.

• Positive Impression − extent to which an individual responds in an unusually positive manner.

Veracity Scales

• Types of validity investigated– Content validity (DSM, literature)

– Concurrent validity (i.e., convergent/discriminant)- Connors Rating Scales- Attention-Deficit/Hyperactivity Disorder Test- Clinical Assessment of Behavior- Clinical Assessment of Depression

– Construct validity- Intercorrelations- Exploratory factor analyses

– Contrasted groups (i.e., ADHD, LD)

Validity

48

50

52

54

56

58

60

ADHD - Self

LD - Self 54

56

58

60

62

64

66

ADHD - Parent

LD - Parent

50

52

54

56

58

60

ADHD -Teacher

LD - Teacher

ADHD Self-RatingsLD Self-RatingsADHD Parent RatingsLD Parent RatingsADHD Teacher RatingsLD Teacher Ratings

ADHD/LD Contrast

48

50

52

54

56

58

60

ADHD - Self

LD - Self

54

56

58

60

62

64

66

ADHD - Parent

LD - Parent

50

52

54

56

58

60

ADHD -Teacher

LD - Teacher

ADHD Self-RatingsLD Self-RatingsADHD Parent RatingsLD Parent RatingsADHD Teacher RatingsLD Teacher Ratings

ADHD/LD Contrast(continued)

For multiple-source, multiple-context ratings:• CAT-C Forms should be completed by

– one or both parents/guardians– one or more of the child’s teachers– Child should rate self

Administration

Administration & Scoring

Scale Raw T %ile Qualitative classification

ClinicalInattention (ATT) 47 74 > 99 Significant clinical riskImpulsivity (IMP) 38 64 91 Mild clinical riskHyperactivity (HYP) 43 69 97 Mild clinical risk

ContextPersonal (PER) 44 71 98 Significant clinical riskAcad/Occup (A/O) 43 67 96 Mild clinical riskSocial (SOC) 41 69 97 Mild clinical risk

Locus clusterInternal (INT) 60 65 94 Mild clinical riskExternal (EXT) 68 74 99 Significant clinical risk

CAT-C Clinical Index (CAT-C CI) 128 70 98 Significant clinical risk

Teacher ScoreSummary Table

Self and TeacherProfile Form

Test kits include:• Comprehensive 240-page Professional Manual• 3 Rating Forms:

- 42-item CAT-C Self-Report Record Form- 42-item CAT-C Parent Report Record Form- 42-item CAT-C Teacher Report Record Form

• 3 Score Summary/Profile Forms:- Self-Report- Parent- Teacher

• CAT Scoring Program Software and On-Screen Helpare optional

Administration

CAT Author Bruce A. Bracken, PhD Professor The College of William & Mary School of Education P.O....

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