CAT Author Bruce A Bracken Ph D Professor

CAT Author Bruce A. Bracken, Ph. D Professor The College of William & Mary School of Education P. O. Box 8795 Williamsburg, VA 23187 -8795 (757) 221 -1712 babrac@wm. edu www. psychoeducational. com

CAT Author Barbara S. Boatwright, Ph. D Licensed Clinical Psychologist Psychology Associates of Mt. Pleasant 1041 Johnnie Dodds Blvd. Suite 14 B Mt. Pleasant, SC 29464 barbarasboatwright@comcast. net

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

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

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.

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.

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.

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).

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

CAT-C and CAT-A Clinical Assessment of Attention Deficit

CAT Features CAT-C ‘Kiddy CAT’ Ø Ages Ø 8 to 18 years Ø Forms ØSelf Report ØParent Report ØTeacher Report CAT-A Ø Ages Ø 19 to 79 years Ø Forms Ø Childhood Memories Ø Current Adult Symptoms

CAT Features • Employs a four-point Item response format • • Strongly 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

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

Constructing the CAT A Multidimensional, Multi-Step, Multi-Year Process

Content Identification 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. Wrote 144 item adult scale according to diagnostic criteria and content analysis

Item Development and Refinement 5. 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 6. 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% 7. 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)

Item Tryout, Norming, and Finalization 8. 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 9. CAT-C forms were piloted and validated (N = 50), resulting in 83% to 88% correct classification of ADHD and control students 10. CAT-A and CAT-C scales were normed, validated, finalized, and published

CAT Scales and Clusters • Clinical Symptoms • Inattention • Impulsivity • Hyperactivity

CAT Scales and Clusters • Clinical Symptoms • Inattention • Impulsivity • Hyperactiity • Contexts • Personal • Academic/Occupational • Social

CAT Scales and Clusters • Clinical Symptoms • Inattention • Impulsivity • Hyperactivity • Contexts • Personal • Academic/Occupational • Social • Locus • Internal • External

CAT Blueprint

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)

CAT-C Internal Consistency* CAT-C Scale/Cluster Clinical Scale Inattention Impulsivity Hyperactivity Context Cluster Personal Academic/Occupational Social Locus Cluster Internal External Clinical Index Self Parent Teacher . 85. 82. 77 . 91. 88. 85 . 94. 92. 90 . 82. 84. 75 . 88. 89. 85 . 91. 93. 89 . 86. 87 . 91 . 94 . 92 . 95 . 97 * Reliabilities are also reported by age, gender, race/ethnicity

CAT-C Stability Coefficients* CAT-C Scale/Cluster Clinical Scale Inattention Impulsivity Hyperactivity Context Cluster Personal Academic/Occupational Social Locus Cluster Internal External Clinical Index Self Parent Teacher . 87. 82. 66 . 88 77. 75 . 67. 74. 78 . 81. 73. 80 . 82. 70. 68. 77 . 74. 83 . 71. 86 . 77. 69 . 82 . 83 . 73 * Corrected for restriction or expansion in range

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

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)

CAT-C ADHD / LD Contrast ADHD Self Ratings LD Self Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

CAT-C ADHD / LD Contrast ADHD Self Ratings LD Self Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

CAT-C ADHD / LD Contrast ADHD Self Ratings LD Self Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

Administration 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 • CAT-A includes only a self-report scale – Both Childhood Memories and Current Symptom Scales should be completed by the adult

CAT Administration & Scoring

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

CAT-C Self and Teacher

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

Administration 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 • CAT-A includes only a self-report scale – Both Childhood Memories and Current Symptom Scales should be completed by the adult

CAT-A Internal Consistency* CAT-A Scale/Cluster Clinical Scale Inattention Impulsivity Hyperactivity Context Cluster Personal Academic/Occupational Social Locus Cluster Internal External Clinical Index Total Scale Clinical Index Childhood Memories Current Symptoms . 89. 85 . 86. 85. 76 . 84. 90. 78 . 80. 68. 81 . 89. 90. 94 . 83. 91. 96 * Coefficients also are reported for age, gender, and race/ethnicity

CAT-A Stability Coefficients* CAT-A Scale/Cluster Clinical Scale Inattention Impulsivity Hyperactivity Context Cluster Personal Academic/Occupational Social Locus Cluster Internal External Clinical Index Total Scale Clinical Index Childhood Memories Current Symptoms . 77. 83 . 82. 84. 83 . 79. 84. 78 . 83. 81. 83 . 86. 81. 86. 83. 87. 88 * Coefficients are corrected for restriction and expansion in range

CAT-C ADHD / LD Contrast ADHD Adult Ratings LD Adult Ratings