Transcript Slide 1

Author
Bruce A. Bracken, PhD
Professor
The College of William & Mary
School of Education
P.O. Box 8795
Williamsburg, VA 23187-8795
(757) 221-1712
[email protected]
www.itc2004.com
www.psychoeducational.com
Author
Karen K. Howell, PhD
Senior Research Scientist
Emory University School of Medicine
Department of Psychiatry and Behavioral Sciences
Maternal Substance Abuse and Child Development
Project
1256 Briarcliff Road N.E., Suite 324W
Atlanta, GA 30306
Phone: 404-712-9829
Fax: 404-712-9809
Email: [email protected]
Multifaceted Nature
of Adjustment
Multidimensional, context-dependent
model of adjustment, with six primary
life domains:
ACADEMIC
FAMILY
S O CIAL
• Three intra-personal domains
• Affect
• Competence
• Physical
• Three interpersonal domains
• Social
• Academic
• Family
GLOBAL
ADJUSTMENT
AFFECT
PHYS ICAL
COMPETENCE
Developmental Nature
of Adjustment
• Adjustment
becomes
increasingly
differentiated
with age
• Life domains
differentiate
as a function
of exposure to
different contexts
Triangulation:
Multi-source, Multiple
Context Assessment
Other Sources
- Direct Observation
- Indirect Approaches
(e.g., Projective Techniques)
- Background Information
- Self Statements
Psychosocial
Adjustment
Self-Report
- CAD
- RADS
- BDI
Third-Party Report
- Clinical Assessment of
Behavior (CAB)
- DSMD
- BASC
Constructing the CAD:
A Multidimensional,
Multi-Step, Multi-Year Process
Depression
Approximately 2.5 percent of children and 8 percent of
adolescents in the U.S. have depression.
An NIMH-sponsored study of 9 to 17-year-olds, more than 6
percent in a 6-month period were depressed and 4.9 percent
having major depression.
Research indicates that depression onset is occurring earlier in
life today than in past.
National Institute of Mental Health
Content
Identification
Identification of relevant content was accomplished through:
1. A review of the literature pertaining to child, adolescent,
and adult development and depression
2. A review of item content from existing instruments
3. An examination of current diagnostic criteria based
on the DSM-IV
4. Consideration of item content to reflect depressed mood
among individuals across a wide age range
5. Suggestions from colleagues
6. Wrote 175 items across 16 content domains based on
literature and DSM diagnostic criteria
Features
• Uses a Four-point Item response format
• Strongly Agree
• Agree
• Disagree
• Strongly Disagree
• Comes with CAD-SP that scores, profiles, reports data, and
facilitates interpretation
• Standard scores (T-scores)
• Percentile ranks
• Confidence intervals
• Qualitative classifications
• Graphical profile display
Features
• Single form appropriate for ages 8 to 79 years
• Easily administered 50 item scale
• Ten minute completion time
• Multidimensional view of depressions
- Four Symptom Scales
- Twelve Major Depressive Symptoms
- Six Clinical Clusters
- Three Veracity Scales
• Easily hand scored or optional software scoring system
• Based on DSM-IV diagnostic criteria and clinical literature
Features
• Critical Item clusters identify risk factors for potential
self-harm
• Exceptional psychometric qualities
• Large, diverse, national normative sample
• Content appropriate, children, and adolescents without
sacrificing face validity
Normative Sample
Normative Sample
Normative Sample
Normative Sample
Scale Variance and
Demographics
Four Clinical Scales
1. Depressed Mood (DM)
• 23 items - - feelings of extreme unhappiness,
sadness, loneliness, lack of personal significance,
poor self-concept, and discouraged outlook on life.
2. Anxiety/Worry (AW)
• 11 items - - increased anxiety, worry, fear, and related
symptoms
Four Clinical Scales
3. Diminished Interest (DI)
• 6 items - - loss of interest in activities that previously
were enjoyable, diminished excitement, lack of
enjoyment, and not wanting to participate in daily
routines
4. Cognitive and Physical Fatigue (CPF)
• 10 items - - somatic issues, fatigue, sleeplessness,
insufficient energy, lack of mental of physical clarity,
clumsiness or slowness, and inability to complete
tasks
Six Critical Item
Clusters
1. Hopelessness
• 5 items - - sense that current conditions are
permanent and with no promise for improvement,
extreme unhappiness, having given up on the future,
and inability to continue the current level of suffering
2. Self-Devaluation
• 5 items - - sense of self-loathing, failure, extreme
loneliness, and loss of personal meaning
3. Sleep/Fatigue
• 3 items - - feelings of fatigue, lack of energy, and
desire to do little other than sleep
Six Critical Item
Clusters
4. Failure
• 3 items - - sense of limited personal competence or
an overwhelming sense of failure
5. Worry
• 3 items - - feelings of generalized worry and worry
that bad things may happen
6. Nervous
• 3 items - - feelings of anxiety, nervousness, and
limited ability to relax
CAD
Theoretical Structure
Internal Consistency
by Age
Internal Consistency
by Age
Internal Consistency
by Age
Internal Consistency
by Age
Internal Consistency
by Gender
Internal Consistency
by Race/Ethnicity
Internal Consistency
by Race/Ethnicity
Internal Consistency
by Race/Ethnicity
Internal Consistency
by Race/Ethnicity
Internal Consistency
Clinical Sample
Test-Retest Stability
Test-Retest Stability
Test-Retest Stability
CAD, BDI-II and RADS
Concurrent Validity
CAD, BDI-II and RADS
Concurrent Validity
Disordered Youth and
Adults Corresponding Scales
Groups of disordered
youth and adults perform
in mild critical range on
appropriate scales
Major Depression n = 48
Dysthymia n = 33
Mixed Clinical n = 108
Dysthymia
Mixed Clinical
CAD four-factor CFA
conceptual model
CAD two-factor CFA
conceptual model
CAD two-factor CFA—
Factor loadings for the
8- 17-year-old sample
CAD two-factor CFA—
Factor loadings for the
18- 79-year-old sample
Summary of Goodness-of-Fit
Statistics for CFA Models
by Age
Summary of Goodness-of-Fit
Statistics for CFA Models
by Age
Summary of Goodness-of-Fit
Statistics for CFA Models
by Age
Administration
and Scoring
Test Materials
• Test Kit Includes:
• Comprehensive Professional Manual
• CAD Rating Form
• CAD Profile Form/Score Form
• CAD Scoring Program Software and Users’ Manual
Appropriate
Populations
• Normed, standardized, and validated for
use with children through adults:
• ages 8 to 79 years
• both genders
• all racial/ethnic backgrounds
• all geographical regions and residential communities
• all socio-economic strata
• all disability subgroups
• all linguistic or cultural backgrounds
Professional
Requirements
• Individuals with adequate training may administer
and score the CAD with supervision
• CAD interpretation requires formal training and/or
graduate degree in:
• clinical psychology
• school psychology
• counseling psychology
• developmental/behavioral pediatrics
• or a related behavioral field
Scoring
• The CAD can be hand-scored or scored using the
computerized CAD-SP
• Hand-scoring is accomplished using a carbonless form
• Skipped Items and missing responses
• CAD-SP prorates scores when at least 90% of items
on a scale are completed
• If more than 10% of the items on a scale are omitted,
CAD-SP treats scale as invalid
Score Report
Obtaining the Score Report
• Administer CAD Rating Form
• Open CAD Scoring Program (CAD-SP) on computer
• Enter basic demographic data
• Enter item responses
CAD-SP automatically calculates and provides
• T-Scores
• Percentile ranks
• Confidence intervals
• Clinical classifications
• Graphical display of results
CAD Score
Summary Report
CAD Score
Summary Report
CAD Score
Summary Report
CAD Score
Summary Report
Clinical Interpretation
Quantitative and Qualitative Interpretation Process
5-Step Interpretation Process
1. Interpret CAD Total Scale (CAD TS)
2. Interpret CAD Symptom Scales, Validity Scales and
Critical Item Clusters
3. Interpret CAD Individual Items
4. Interpreting the follow-up Clinical Interview
5. Compare performance on the CAD in light of other
test and background information
CAD Total Score
(CAD TS)
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•
•
•
•
The CAD TS is best measure of “General Affectivity”
T Score Metric (i.e., Mean = 50, SD = 10)
Percentile Ranks
Confidence Intervals
Qualitative Classifications
≤ 59
60-69
70-79
≥ 80
=
=
=
=
Normal Range
Mild Clinical Risk
Significant Clinical Risk
Very Significant Clinical Risk