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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 • Individuals with ADHD 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, depression, substance abuse) • 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. DSM-IV ADHDCriteria Six or more symptoms of inattention present for at least 6 months to a point that is disruptive and inappropriate: Inattention • Inattention to details; makes careless mistakes in school, work, and/or other activities. • Has difficulty attending to tasks or other activities. • Does not seem to listen when spoken to. • Does not follow instructions and fails to finish schoolwork,chores, and/or duties in the workplace. • 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.

  6. 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: Hyperactivity • Fidgets with hands or feet or squirms in seat. • Gets up from seat when remaining in seat is expected. • May feel very restless. • Has difficulty enjoying leisure activities quietly. • Is often “on the go” or often acts as if “driven by a motor.” • Talks excessively.

  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: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 impairment from the symptoms is present in two ormore settings (e.g., at school/work, at home). • Clear evidence of significant impairment in social, school, and/orwork 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).

  8. 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.

  9. Clinical Assessment of Attention Deficit

  10. Ages - 19 to 79 years Form – 2 parts - Childhood Memories - Current Adult Symptoms Features

  11. 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 • Graphical profile display

  12. Features (continued) • Assesses behaviors that correspond to DSM-IV • Clinical symptoms: inattention, hyperactivity, impulsivity • Multiple contexts: school/work, social, personal • Differentiates sensations (internal) from actions (external) • Software scoring program scores, profiles, reports, and stores examinees’ data • Multiple applications • Clinical • Educational • Medical • Research

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

  14. Content Identification • 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 • Wrote 144-item adult scale according to diagnostic criteria and content analysis • Piloted adult form (N = 108); 17-48 years of age • reduced to 54 items on Current Symptoms Form • matching 54 items on Childhood Symptoms Form

  15. Item Developmentand Refinement • Validated adult form (N = 369); 17-53 years • 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) • 8. CAT-A scales were normed, validated, finalized, and published

  16. Clinical symptoms Inattention Impulsivity Hyperactivity CAT-A Scales and Clusters

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

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

  19. Final Form • 108-item CAT-A Self-Report Form • 3 Clinical scales, 3 Context clusters, 2 Locus clusters • Part I – Current Symptoms (54 items) • Part II – Childhood Memories (54 items) • (10-15 minute total administration)

  20. Internal Consistency* CAT-A scale/cluster Memories Symptoms Clinical scaleInattention .89 .86Impulsivity .85 .85Hyperactivity .85 .76 Context clusterPersonal .84 .80Academic/Occupational .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. Childhood Current

  21. Stability Coefficients* Childhood Current CAT-A scale/cluster Memories Symptoms Clinical scaleInattention .77 .82Impulsivity .83 .84Hyperactivity .83 .83 Context clusterPersonal .79 .83Academic/Occupational .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.

  22. 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.

  23. Validity • Types of validity investigated • Content validity (DSM, literature) • Concurrent validity (i.e., convergent/discriminant)- Connors Rating Scales- Brown Attention-Deficit Disorder Scales- Clinical Assessment of Depression • Construct validity- Intercorrelations- Exploratory factor analyses • Contrasted groups (i.e., ADHD, LD)

  24. ADHD/LD Contrast ADHD Adult Ratings LD Adult Ratings

  25. Administration • For multiple-source, multiple-context ratings • CAT-A Form (Self-Report) • Both Childhood Memories (Part I) and Current Symptom (Part II) scales should be completed by the adult

  26. Administration (continued) • Test kits Include: • Comprehensive 240-page Professional Manual (contains all information for • CAT-A and CAT-C) • CAT-A Self-Report Form • Part I –Childhood Memories (54 items) • Part II– Current Symptoms (54 items) • CAT-A Score Summary/Profile Form • CAT Scoring Program Software and On-Screen Help are optional

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