CAT Author

1
(No Transcript)
2
CAT Author

• Bruce A. Bracken, PhD
• Professor
• The College of William Mary
• School of Education
• P.O. Box 8795
• Williamsburg, VA 23187-8795
• [phone]
• babrac_at_wm.edu
• www.psychoeducational.com

3
CAT Author

• Barbara S. Boatwright, PhD
• Licensed Clinical Psychologist
• Psychology Associates of Mt. Pleasant
• 1041 Johnnie Dodds Blvd. Suite 14 B
• Mt. Pleasant, SC 29464
• barbarasboatwright_at_comcast.net

4
Historical Perspective of Attention Deficit

• Originally referred to as Minimal Brain
  Dysfunction
• 1980 DSM-III identified Attention Deficit with
  (ADHD) and without Hyperactivity (ADD) - Core
  Symptoms - 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

5
Historical Perspective of Attention Deficit

• ADHD as a life-long condition- Early
  conceptualizations were that adults out-grew
  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

6
Historical Perspective of Attention Deficit

• American Academy of Pediatrics To confirm a
  diagnosis of ADHD related behaviors must
• Occur in more than one setting, such as home,
  school, and social situations.
• Be more severe than in other children 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.

7
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
• Inattention to details makes careless mistakes
  in school, work, 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, chores, or duties in the workplace.
• Often has difficulty organizing activities.
• Often avoids, dislikes, or doesn't want to
  sustain mental effort for a long period of time
• Loses things needed for tasks and activities
• Easily distracted.
• Forgetful in daily activities.

8
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 or adults 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.

9
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
  Impulsivity
• blurts out answers before questions have been
  finished.
• 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/work and at
  home).
• Clear evidence of significant impairment in
  social, school, or work 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).

10
DSM-IV ADHD Criteria

• 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

11
CAT-C and CAT-AClinical Assessment of
Attention Deficit
12
CAT Features

• CAT-CKiddy CAT
• Ages
• 8 to 18 years
• Forms
• Self Report
• Parent Report
• Teacher Report

• CAT-A
• Ages
• 19 to 79 years
• Forms
• Childhood Memories
• Current Adult Symptoms

13
CAT Features

• Employs a four-point Item response format
• Strongly Agree
• Agree
• Disagree
• Strongly Disagree
• CAT is accompanied with optional CAT-SP that
  scores, profiles, reports data, and facilitates
  interpretation
• Standard scores (T-scores)
• Percentile ranks
• Confidence intervals
• Qualitative classifications
• Graphical profile display

14
CAT Features

• 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)
• Life-span in nature (ages 8 to 79 years)
• Normed to address issue of developmentally
  inappropriate levels
• Software scoring program that scores, profiles,
  reports, and stores examinees data
• Multiple applications
• Clinical
• Educational
• Medical
• Research

15
A Multidimensional, Multi-Step, Multi-Year
Process
Constructing the CAT
16
Content Identification

• Approached the CAT from Brackens (1992)
  context-dependent model of adjustment
• Reviewed and evaluated existing attention deficit
  scales
• Identified relevant content
• Literature on attention deficit
• Item content on existing instruments
• Current diagnostic criteria from DSM-IV
• Suggestions from colleagues
• 4. Wrote 144 item adult scale according to
  diagnostic criteria and content analysis

17
Item Developmentand Refinement

• Piloted adult form (N 108) 17 to 48 years of
  age - reduced to 54 items on Current Symptoms
  Form - matching 54 items on Childhood Symptoms
  Form
• Validated adult form (N 369) 17 to 53 years of
  age - ADHD (N 67) - LD (N 38) - ADHD/LD
  (N 44) - Controls (N 221) - correct
  classification 79 to 88
• Final items selected to include equal numbers of
  items within each of 18 individual cells
• - Three Clinical Scales
• - Three Context Clusters
• - Two Locus Clusters
• (3 Clinical scales x 3 context clusters x 2 locus
  clusters 18 cells)

18
Item Tryout, Norming, and Finalization

• 42 item child form (CAT-C) was developed to match
  item content on the CAT-A - CAT-C Self Report -
  CAT-C Parent Report - CAT-C Teacher Report
• CAT-C forms were piloted and validated (N 50),
  resulting in 83 to 88 correct classification of
  ADHD and control students
• CAT-A and CAT-C scales were normed, validated,
  finalized, and published

19
CAT Scales and Clusters

• Clinical Symptoms
• Inattention
• Impulsivity
• Hyperactivity

20
CAT Scales and Clusters

• Clinical Symptoms
• Inattention
• Impulsivity
• Hyperactiity
• Contexts
• Personal
• Academic/Occupational
• Social

21
CAT Scales and Clusters

• Clinical Symptoms
• Inattention
• Impulsivity
• Hyperactivity
• Contexts
• Personal
• Academic/Occupational
• Social
• Locus
• Internal
• External

22
CAT Blueprint
23
Final Forms

• 108-item Self Report CAT-A
• 3 Clinical Scales, 3 Context Clusters, 2 Locus
  Clusters
• 54-item Current Symptoms Form
• 54-item Childhood Memories Form
• (10 - 15 minute total administration)
• 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)

24
CAT-C Internal Consistency

CAT-C Scale/Cluster Self Parent Teacher
Clinical ScaleInattention .85 .91 .94Impulsiv
ity .82 .88 .92Hyperactivity .77 .85 .90 Context
ClusterPersonal .82 .88 .91Academic/Occupational
.84 .89 .93Social .75 .85 .89 Locus
ClusterInternal .86 .91 .94 External .87 .91 .94
Clinical Index .92 .95 .97 Reliabilities are
also reported by age, gender, race/ethnicity
25
CAT-C Stability Coefficients

CAT-C Scale/Cluster Self Parent Teacher
Clinical ScaleInattention .87 .88 .67Impulsiv
ity .82 77 .74Hyperactivity .66 .75 .78 Context
ClusterPersonal .81 .82 .70Academic/Occupational
.73 .82 .68Social .80 .70 .77 Locus
ClusterInternal .74 .71 .77 External .83 .86 .69
Clinical Index .82 .83 .73 Corrected for
restriction or expansion in range
26
CAT-A and CAT-C Veracity

• CAT Veracity Scales
• Negative Impression - - degree to which
  individual consistently responds in a negative
  manner
• Infrequency - - extent to which individual
  endorses items in extreme manner to items
  infrequently endorsed in extreme manner by
  normative sample
• Positive Impression - - extent to which
  individual responds in an unusually positive
  manner

27
CAT-A and CAT-C Validity

• Forms of validity investigated
• Content Validity (DSM, Literature)
• Concurrent Validity (i.e., Convergent/Discriminant
  )- Connors Rating Scales- Brown
  Attention-Deficit Disorder 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)

28
CAT-C ADHD / LD Contrast
ADHD Self Ratings LD Self Ratings ADHD Parent
Ratings LD Parent Ratings ADHD Teacher Ratings LD
Teacher Ratings
29
CAT-C ADHD / LD Contrast
ADHD Self Ratings LD Self Ratings ADHD Parent
Ratings LD Parent Ratings ADHD Teacher Ratings LD
Teacher Ratings
30
CAT-C ADHD / LD Contrast
ADHD Self Ratings LD Self Ratings ADHD Parent
Ratings LD Parent Ratings ADHD Teacher Ratings LD
Teacher Ratings
31
Administration

• For Multiple-Source, Multiple-Context Ratings
• CAT-C Forms should be completed by
• one or both parents/ guardians
• one or more of the childs teachers
• Child should rate self
• CAT-A includes only a self-report scale
• Both Childhood Memories and Current Symptom
  Scales should be completed by the adult

32
CAT Administration Scoring
33
CAT-C Teacher

• Scale Raw T ile Qualitative classification
• Clinical
• Inattention (ATT) 47 74 gt 99 Significant clinical
  risk
• Impulsivity (IMP) 38 64 91 Mild clinical risk
• Hyperactivity (HYP) 43 69 97 Mild clinical
  risk
• Context
• Personal (PER) 44 71 98 Significant clinical
  risk
• Acad/Occup (A/O) 43 67 96 Mild clinical risk
• Social (SOC) 41 69 97 Mild clinical risk
• Locus cluster
• Internal (INT) 60 65 94 Mild clinical risk
• External (EXT) 68 74 99 Significant clinical
  risk
• CAT-C Clinical Index(CAT-C CI) 128 70
  98 Significant clinical risk

34

CAT-C Self and Teacher

35
(No Transcript)
36
Administration

• 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
• CAT-A Includes 2 Self-Report Scales
• 54-item Childhood Memories Scale
• 54-item Current Symptoms Scale
• CAT Scoring Program Software and Users Manual
  are optional

37
Administration

• For Multiple-Source, Multiple-Context Ratings
• CAT-C Forms should be completed by
• one or both parents/ guardians
• one or more of the childs teachers
• Child should rate self
• CAT-A includes only a self-report scale
• Both Childhood Memories and Current Symptom
  Scales should be completed by the adult

38
CAT-A Internal Consistency

• CAT-A Scale/Cluster Childhood Current
  Memories Symptoms
• Clinical ScaleInattention .89 .86Impulsivity .85
  .85Hyperactivity .85 .76
• Context ClusterPersonal .84 .80Academic/Occupati
  onal .90 .68Social .78 .81
• Locus ClusterInternal .89 .83 External .90 .83
• Clinical Index .94 .91
• Total Scale Clinical Index
  .96
• Coefficients also are reported for age, gender,
  and race/ethnicity

39
CAT-A Stability Coefficients

• CAT-A Scale/Cluster Childhood Current Memories Sy
  mptoms
• Clinical ScaleInattention .77 .82Impulsivity .83
  .84Hyperactivity .83 .83
• Context ClusterPersonal .79 .83Academic/Occupati
  onal .84 .81Social .78 .83
• Locus ClusterInternal .86 .86 External .81 .83
• Clinical Index .86 .87
• Total Scale Clinical Index
  .88
• Coefficients are corrected for restriction and
  expansion in range

40
CAT-C ADHD / LD Contrast

ADHD Adult Ratings LD Adult Ratings