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  1. 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.itc2004.com www.psychoeducational.com Author

  2. Author Karen K. Howell, PhD Senior Research Scientist Emory University School of Medicine Department of Psychiatry and Behavioral Sciences Maternal Substance Abuse and Child Development Project 1256 Briarcliff Road N.E., Suite 324W Atlanta, GA 30306 Phone: 404-712-9829 Fax: 404-712-9809 Email: khowell@emory.edu

  3. Multifaceted Natureof Adjustment • Multidimensional, context-dependent model of adjustment, with six primary life domains: • Three intra-personal domains • Affect • Competence • Physical • Three interpersonal domains • Social • Academic • Family

  4. Developmental Natureof Adjustment • Adjustmentbecomesincreasingly differentiatedwith age • Life domains differentiateas a functionof exposure to different contexts

  5. Triangulation:Multi-source, MultipleContext Assessment Other Sources- Direct Observation - Indirect Approaches (e.g., Projective Techniques) - Background Information - Self Statements Psychosocial Adjustment Third-Party Report- Clinical Assessment of Behavior (CAB) - DSMD - BASC Self-Report- CAD - RADS - BDI

  6. Constructing the CAD:A Multidimensional,Multi-Step, Multi-Year Process

  7. Depression Approximately 2.5 percent of children and 8 percent of adolescents in the U.S. have depression. An NIMH-sponsored study of 9 to 17-year-olds, more than 6 percent in a 6-month period were depressed and 4.9 percent having major depression. Research indicates that depression onset is occurring earlier in life today than in past. National Institute of Mental Health

  8. ContentIdentification Identification of relevant content was accomplished through: • A review of the literature pertaining to child, adolescent, and adult development and depression • A review of item content from existing instruments • An examination of current diagnostic criteria based on the DSM-IV • Consideration of item content to reflect depressed mood among individuals across a wide age range • Suggestions from colleagues • Wrote 175 items across 16 content domains based on literature and DSM diagnostic criteria

  9. Features • Uses a Four-point Item response format • Strongly Agree • Agree • Disagree • Strongly Disagree • Comes with CAD-SP that scores, profiles, reports data, and facilitates interpretation • Standard scores (T-scores) • Percentile ranks • Confidence intervals • Qualitative classifications • Graphical profile display

  10. Features • Single form appropriate for ages 8 to 79 years • Easily administered 50 item scale • Ten minute completion time • Multidimensional view of depressions - Four Symptom Scales - Twelve Major Depressive Symptoms - Six Clinical Clusters - Three Veracity Scales • Easily hand scored or optional software scoring system • Based on DSM-IV diagnostic criteria and clinical literature

  11. Features • Critical Item clusters identify risk factors for potential self-harm • Exceptional psychometric qualities • Large, diverse, national normative sample • Content appropriate, children, and adolescents without sacrificing face validity

  12. Normative Sample

  13. Normative Sample

  14. Normative Sample

  15. Normative Sample

  16. Scale Variance and Demographics

  17. Four Clinical Scales • Depressed Mood (DM) • 23 items - - feelings of extreme unhappiness, sadness, loneliness, lack of personal significance, poor self-concept, and discouraged outlook on life. • Anxiety/Worry (AW) • 11 items - - increased anxiety, worry, fear, and related symptoms

  18. Four Clinical Scales 3. Diminished Interest (DI) • 6 items - - loss of interest in activities that previously were enjoyable, diminished excitement, lack of enjoyment, and not wanting to participate in daily routines 4. Cognitive and Physical Fatigue (CPF) • 10 items - - somatic issues, fatigue, sleeplessness, insufficient energy, lack of mental of physical clarity, clumsiness or slowness, and inability to complete tasks

  19. Six Critical Item Clusters 1. Hopelessness • 5 items - - sense that current conditions are permanent and with no promise for improvement, extreme unhappiness, having given up on the future, and inability to continue the current level of suffering 2. Self-Devaluation • 5 items - - sense of self-loathing, failure, extreme loneliness, and loss of personal meaning 3. Sleep/Fatigue • 3 items - - feelings of fatigue, lack of energy, and desire to do little other than sleep

  20. Six Critical Item Clusters 4. Failure • 3 items - - sense of limited personal competence or an overwhelming sense of failure 5. Worry • 3 items - - feelings of generalized worry and worry that bad things may happen 6. Nervous • 3 items - - feelings of anxiety, nervousness, and limited ability to relax

  21. CADTheoretical Structure

  22. Internal Consistency by Age

  23. Internal Consistency by Age

  24. Internal Consistency by Age

  25. Internal Consistency by Age

  26. Internal Consistencyby Gender

  27. Internal Consistencyby Race/Ethnicity

  28. Internal Consistencyby Race/Ethnicity

  29. Internal Consistencyby Race/Ethnicity

  30. Internal Consistencyby Race/Ethnicity

  31. Internal ConsistencyClinical Sample

  32. Test-Retest Stability

  33. Test-Retest Stability

  34. Test-Retest Stability

  35. CAD, BDI-II and RADSConcurrent Validity

  36. CAD, BDI-II and RADSConcurrent Validity

  37. Disordered Youth andAdults Corresponding Scales Groups of disordered youth and adults perform in mild critical range on appropriate scales Major Depression n = 48 Dysthymia n = 33 Mixed Clinical n = 108

  38. Dysthymia

  39. Mixed Clinical

  40. CAD four-factor CFAconceptual model

  41. CAD two-factor CFAconceptual model

  42. CAD two-factor CFA—Factor loadings for the8- 17-year-old sample

  43. CAD two-factor CFA—Factor loadings for the18- 79-year-old sample

  44. Summary of Goodness-of-FitStatistics for CFA Models by Age

  45. Summary of Goodness-of-FitStatistics for CFA Models by Age

  46. Summary of Goodness-of-FitStatistics for CFA Models by Age

  47. Administrationand Scoring

  48. Test Materials • Test Kit Includes: • Comprehensive Professional Manual • CAD Rating Form • CAD Profile Form/Score Form • CAD Scoring Program Software and Users’ Manual

  49. AppropriatePopulations • Normed, standardized, and validated foruse with children through adults: • ages 8 to 79 years • both genders • all racial/ethnic backgrounds • all geographical regions and residential communities • all socio-economic strata • all disability subgroups • all linguistic or cultural backgrounds