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

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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 author3
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

historical perspective of attention deficit
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
historical perspective of attention deficit continued
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
dsm iv adhd criteria
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.
dsm iv adhd criteria continued
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.
dsm iv adhd criteria continued8
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).
dsm iv adhd criteria continued9
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.
features
Ages

- 19 to 79 years

Form – 2 parts

- Childhood Memories

- Current Adult Symptoms

Features
features continued
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
features continued13
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
content identification
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
item development and refinement
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
cat a scales and clusters
Clinical symptoms

Inattention

Impulsivity

Hyperactivity

CAT-A Scales and Clusters
cat a scales and clusters continued
Clinical symptoms

Inattention

Impulsivity

Hyperactivity

Contexts

Personal

Academic/Occupational

Social

CAT-A Scales andClusters (continued)
cat a scales and clusters continued19
Clinical symptoms

Inattention

Impulsivity

Hyperactivity

Contexts

Personal

Academic/Occupational

Social

Locus

Internal

External

CAT-A Scales andClusters (continued)
final form
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)
internal consistency
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

stability coefficients
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.

veracity scales
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.
validity
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)
adhd ld contrast
ADHD/LD Contrast

ADHD Adult Ratings

LD Adult Ratings

administration
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
administration continued
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