CAT Author

Bruce A. Bracken, PhD Professor The College of William & Mary School of Education P.O. Box 8795 Williamsburg, VA 23187-8795 Phone: (757) 221-1712 Email: [email protected]

www.psychoeducational.com

Barbara S. Boatwright, PhD Licensed Clinical Psychologist Psychology Associates of Mt. Pleasant 1041 Johnnie Dodds Blvd. Suite 14 B Mt. Pleasant, SC 29464 Email: [email protected]

CAT Author

Historical Perspective of Attention Deficit

• 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 Perspective of Attention Deficit

(continued)

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

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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

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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:

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Occur in more than one setting, such as home, school, and/or social situations.

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

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Begin before the child reaches 7 years of age.

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Make it difficult for the person to function at school, home, and/or in social situations.

DSM-IV ADHD Criteria

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

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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

(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: Hyperactivity

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Fidgets with hands or feet or squirms in seat.

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Gets up from seat when remaining in seat is expected.

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

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Has difficulty playing or enjoying leisure activities quietly.

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

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Talks excessively.

DSM-IV ADHD Criteria

(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

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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 or more settings (e.g., at school, at home).

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Clear evidence of significant impairment in social and/or school functioning.

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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).

DSM-IV ADHD Criteria

(continued)

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

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ADHD, Combined Type are documented .

: if criteria from inattention, hyperactivity, and impulsivity

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ADHD, Predominantly Inattentive Type and hyperactivity are not .

: if inattention is documented, but impulsivity

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

Clinical Assessment of Attention Deficit

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Ages - 8 to 18 years

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Three forms - Self-Report - Parent Report - Teacher Report

Features

Features

(continued)

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Employs a four-point item response format

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Strongly Agree Agree Disagree Strongly Disagree

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Is accompanied with optional CAT Software Portfolio (CAT-SP) that scores, profiles, reports data, and facilitates interpretation

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Standard scores (T scores)

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Percentile ranks Confidence intervals Qualitative classifications Graphical profile display

Features

(continued)

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Assesses behaviors that correspond to DSM-IV/AAP

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Clinical symptoms: inattention, hyperactivity, impulsivity

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Multiple contexts: school/work, social, personal Differentiates sensations (internal) from actions (external) Normed to address issue of developmentally inappropriate levels

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

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Multiple applications

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Clinical Educational Medical Research

Constructing the CAT-C

A Multidimensional, Multi-Step, Multi-Year Process

Content Identification and Item Development

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

Item Tryout, Norming, and Finalization

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

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Clinical symptoms

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Inattention Impulsivity Hyperactivity

CAT-C Scales and Clusters

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Clinical symptoms

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Inattention Impulsivity Hyperactivity

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Contexts

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Personal Academic/Occupational Social

CAT-C Scales and Clusters

(continued)

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Clinical symptoms

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Inattention Impulsivity Hyperactivity

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Contexts

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Personal Academic/Occupational Social

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Locus

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Internal External

CAT-C Scales and Clusters

(continued)

Final Forms

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42-item CAT-C Self-Report Form

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3 Clinical scales, 3 Context clusters, 2 Locus clusters

CAT-C Self-Report (5-10 minute administration)

• •

42-item CAT-C Parent Report Form

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3 Clinical scales, 3 Context clusters, 2 Locus clusters

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CAT-C Parent Report (5-10 minute administration)

42-item CAT-C Teacher Report Form

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3 Clinical scales, 3 Context clusters, 2 Locus clusters

CAT-C Teacher Report (5-10 minute administration)

CAT-C Internal Consistency*

CAT-C scale/cluster

Clinical scale Inattention Impulsivity Hyperactivity Context cluster Personal Academic/Occupational Social Locus cluster Internal External

Self

.85

.82

.77

.82

.84

.75

.86

.87

Parent

.91

.88

.85

.88

.89

.85

.91

.91

Teacher

.94

.92

.90

.91

.93

.89

.94

.94

Clinical Index .92

.95

* Reliabilities are also reported by age, gender, race/ethnicity.

.97

Stability Coefficients*

CAT-C scale/cluster

Clinical scale Inattention Impulsivity Hyperactivity Context cluster Personal Academic/Occupational Social Locus cluster Internal External

Self

.87

.82

.66

.81

.73

.80

.74

.83

Clinical Index .82

* Corrected for restriction or expansion in range.

Parent Teacher

.88

.77

.75

.82

.82

.70

.71

.86

.83

.67

.74

.78

.70

.68

.77

.77

.69

.73

Veracity Scales

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

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

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

Validity

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Types of validity investigated

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Content validity (DSM, literature)

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

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Construct validity - Intercorrelations - Exploratory factor analyses

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Contrasted groups (i.e., ADHD, LD)

60 58 56 54 52 50 48 In at te nt io n Im pu ls iv ity H yp er ac tiv ity 60 58 56 54 52 50 In atte nti on Im pu ls iv ity H yp er ac ti vi ty ADHD - Self LD - Self ADHD Teacher LD - Teacher

ADHD/LD Contrast

66 64 62 60 58 56 54 In at te nt io n Im pu ls iv ity H yp er ac tiv ity ADHD - Parent LD - Parent ADHD Self-Ratings LD Self-Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

60 58 56 54 52 50 48 In at te nt io n Im pu ls iv ity H yp er ac tiv ity 60 58 56 54 52 50 In atte nti on Im pu ls iv ity H yp er ac ti vi ty ADHD - Self LD - Self ADHD Teacher LD - Teacher

ADHD/LD Contrast

(continued) 66 64 62 60 58 56 54 In at te nt io n Im pu ls iv ity H yp er ac tiv ity ADHD - Parent LD - Parent ADHD Self-Ratings LD Self-Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

60 58 56 54 52 50 48 In atte nti on Im pu ls iv ity H yp er ac ti vi ty 60 58 56 54 52 50 In atte nti on Im pu ls iv ity H yp er ac ti vi ty ADHD - Self LD - Self ADHD Teacher LD - Teacher

ADHD/LD Contrast

(continued) 66 64 62 60 58 56 54 In at te nt io n Im pu ls iv ity H yp er ac tiv ity ADHD - Parent LD - Parent ADHD Self-Ratings LD Self-Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

Administration

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

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one or both parents/guardians

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one or more of the child’s teachers

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Child should rate self

Administration & Scoring

Teacher Score Summary Table

Scale Raw Clinical Inattention (ATT) 47 Impulsivity (IMP) 38 Hyperactivity (HYP) 43

T

74 64 69 %ile > 99 91 97 Qualitative classification Significant clinical risk Mild clinical risk Mild clinical risk Context Personal (PER) Acad/Occup (A/O) Social (SOC) 44 43 41 71 67 69 98 96 97 Significant clinical risk Mild clinical risk Mild clinical risk Locus cluster Internal (INT) External (EXT) 60 68 65 74 94 99 Mild clinical risk Significant clinical risk CAT-C Clinical Index (CAT-C CI) 128 70 98 Significant clinical risk

Self and Teacher Profile Form

Administration

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Test kits include:

Comprehensive 240-page Professional Manual 3 Rating Forms:

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42-item CAT-C Self-Report Record Form

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

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3 Score Summary/Profile Forms:

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Self-Report Parent Teacher

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CAT Scoring Program Software and On-Screen Help are optional