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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: [email protected] www.psychoeducational.com. CAT Author. Barbara S. Boatwright, PhD Licensed Clinical Psychologist

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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: [email protected]

www.psychoeducational.com


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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: [email protected]


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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


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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


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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.


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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.


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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).


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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.


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Clinical Assessment of Attention Deficit


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Ages

- 19 to 79 years

Form – 2 parts

- Childhood Memories

- Current Adult Symptoms

Features


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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


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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


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Constructing the CAT-A

A Multidimensional, Multi-Step, Multi-Year Process


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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


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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


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Clinical symptoms

Inattention

Impulsivity

Hyperactivity

CAT-A Scales and Clusters


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Clinical symptoms

Inattention

Impulsivity

Hyperactivity

Contexts

Personal

Academic/Occupational

Social

CAT-A Scales andClusters (continued)


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Clinical symptoms

Inattention

Impulsivity

Hyperactivity

Contexts

Personal

Academic/Occupational

Social

Locus

Internal

External

CAT-A Scales andClusters (continued)


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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)


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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


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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.


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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.


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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)


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ADHD/LD Contrast

ADHD Adult Ratings

LD Adult Ratings


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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


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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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