Historical Perspective of Attention Deficit

2. CAT Author Bruce A. Bracken, PhD 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

3. 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 barbarasboatwright@comcast.net

4. 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

5. 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

6. Historical Perspective of Attention Deficit American Academy of PediatricsTo 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.

7. 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.

8. 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.

9. 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).

10. 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

11. CAT-C and CAT-AClinical Assessment of Attention Deficit

12. CAT-C‘Kiddy CAT’ Ages 8 to 18 years Forms Self Report Parent Report Teacher Report CAT-A Ages 19 to 79 years Forms Childhood Memories Current Adult Symptoms CAT Features

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

14. 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

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

16. 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 4. Wrote 144 item adult scale according to diagnostic criteria and content analysis

17. Item Developmentand Refinement • 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 • 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% • 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)

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

19. Clinical Symptoms Inattention Impulsivity Hyperactivity CAT Scales and Clusters

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

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

22. CAT Blueprint

23. 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)

24. 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

25. CAT-C 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

26. 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

27. 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)

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

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

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

31. 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

32. CAT Administration & Scoring

33. CAT-C Teacher 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

34. CAT-C Self and Teacher

36. 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

37. 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

38. CAT-A Internal Consistency* CAT-A Scale/Cluster Childhood Current 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

39. CAT-A Stability Coefficients* CAT-A Scale/Cluster Childhood Current 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

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