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CAT Author

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: babrac@wm.edu www.psychoeducational.com. CAT Author. Barbara S. Boatwright, PhD Licensed Clinical Psychologist

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CAT Author

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  1. 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: babrac@wm.edu www.psychoeducational.com

  2. 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 Email: barbarasboatwright@comcast.net

  3. Historical Perspectiveof 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

  4. Historical Perspective of Attention Deficit (continued) • 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

  5. 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.

  6. DSM-IV ADHDCriteria 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.

  7. 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: 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.

  8. 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).

  9. DSM-IV ADHDCriteria (continued) 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.

  10. Clinical Assessment of Attention Deficit

  11. Ages - 8 to 18 years Three forms - Self-Report - Parent Report - Teacher Report Features

  12. Features (continued) • 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

  13. 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

  14. Constructing the CAT-C A Multidimensional, Multi-Step, Multi-Year Process

  15. Content Identificationand Item Development • Approached the CAT from Bracken’s (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. CAT-C developed after CAT-A (adult form) to match item content on the CAT-A

  16. 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

  17. Clinical symptoms Inattention Impulsivity Hyperactivity CAT-C Scales and Clusters

  18. Clinical symptoms Inattention Impulsivity Hyperactivity Contexts Personal Academic/Occupational Social CAT-C Scales andClusters (continued)

  19. Clinical symptoms Inattention Impulsivity Hyperactivity Contexts Personal Academic/Occupational Social Locus Internal External CAT-C Scales andClusters (continued)

  20. Final Forms • 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)

  21. CAT-C Internal Consistency* 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 .94 External .87 .91 .94 Clinical Index .92 .95 .97 * Reliabilities are also reported by age, gender, race/ethnicity.

  22. Stability Coefficients* 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 .77 External .83 .86 .69 Clinical Index .82 .83 .73 * Corrected for restriction or expansion in range.

  23. Veracity Scales • 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.

  24. Validity • 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)

  25. ADHD/LD Contrast ADHD Self-Ratings LD Self-Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

  26. ADHD/LD Contrast(continued) ADHD Self-Ratings LD Self-Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

  27. ADHD/LD Contrast(continued) ADHD Self-Ratings LD Self-Ratings ADHD Parent Ratings LD Parent Ratings ADHD Teacher Ratings LD Teacher Ratings

  28. 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

  29. Administration & Scoring

  30. Teacher ScoreSummary Table Scale Raw T %ile Qualitative classification Clinical Inattention (ATT) 47 74 > 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

  31. Self and TeacherProfile Form

  32. 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 • 3 Score Summary/Profile Forms: • Self-Report • Parent • Teacher • CAT Scoring Program Software and On-Screen Helpare optional

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