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
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
• 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
• 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
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
Historical Perspective of
Attention Deficit (continued)
American Academy of Pediatrics (AAP)
To confirm a diagnosis of ADHD, related
behaviors must:
• Occur in more than one setting, such as home, school,
and/or social situations.
• Be more severe than in other children of 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.
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,
and/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,
and/or chores.
• 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)
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 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.
DSM-IV ADHD
Criteria (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 for developmental level:
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 symptoms present before age 7 years.
Some impairment from the symptoms is present in two or
more settings (e.g., at school, at home).
• Clear evidence of significant impairment in social and/or
school 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 (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.
Clinical Assessment
of Attention Deficit
Features
• Ages
- 8 to 18 years
• Three forms
- Self-Report
- Parent Report
- Teacher Report
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
Features (continued)
• 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)
Normed to address issue of developmentally inappropriate
levels
• Software scoring program scores, profiles, reports,
and stores examinees’ data
• Multiple applications
-
Clinical
Educational
Medical
Research
Constructing the CAT-C
A Multidimensional,
Multi-Step, Multi-Year
Process
Content Identification
and Item Development
1. Approached the CAT from Bracken’s (1992)
context-dependent model of adjustment
2. Reviewed and evaluated existing attention
deficit scales
3. Identified relevant content
•
•
•
•
Literature on attention deficit
Item content on existing instruments
Current diagnostic criteria from DSM-IV
Suggestions from colleagues
4. CAT-C developed after CAT-A (adult form) to
match item content on the CAT-A
Item Tryout, Norming,
and Finalization
5.
42-item child form (CAT-C)
- CAT-C Self-Report
- CAT-C Parent Report
- CAT-C Teacher Report
6.
CAT-C forms were piloted and validated (N = 50),
resulting in 83% to 88% correct classification of
ADHD and control students
7.
CAT-C scales were normed, validated, finalized,
and published
CAT-C Scales and Clusters
• Clinical symptoms
- Inattention
- Impulsivity
- Hyperactivity
CAT-C Scales and
Clusters (continued)
• Clinical symptoms
- Inattention
- Impulsivity
- Hyperactivity
• Contexts
- Personal
- Academic/Occupational
- Social
CAT-C Scales and
Clusters (continued)
• Clinical symptoms
- Inattention
- Impulsivity
- Hyperactivity
• Contexts
- Personal
- Academic/Occupational
- Social
• Locus
- Internal
- External
Final Forms
• 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)
CAT-C Internal
Consistency*
CAT-C scale/cluster
Clinical scale
Inattention
Impulsivity
Hyperactivity
Context cluster
Personal
Academic/Occupational
Social
Locus cluster
Internal
External
Clinical Index
Self
Parent
Teacher
.85
.82
.77
.91
.88
.85
.94
.92
.90
.82
.84
.75
.88
.89
.85
.91
.93
.89
.86
.87
.91
.91
.94
.94
.92
.95
.97
* Reliabilities are also reported by age, gender, race/ethnicity.
Stability Coefficients*
CAT-C scale/cluster
Clinical scale
Inattention
Impulsivity
Hyperactivity
Context cluster
Personal
Academic/Occupational
Social
Locus cluster
Internal
External
Clinical Index
Self
Parent
Teacher
.87
.82
.66
.88
.77
.75
.67
.74
.78
.81
.73
.80
.82
.82
.70
.70
.68
.77
.74
.83
.71
.86
.77
.69
.82
.83
.73
* Corrected for restriction or expansion in range.
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
• Types of validity investigated
– Content validity (DSM, literature)
– Concurrent validity (i.e., convergent/discriminant)
- Connors Rating 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)
ADHD/LD Contrast
66
64
62
60
ADHD - Parent
60
58
H
yp
er
ac
t
In
at
te
nt
iv
ity
yp
er
ac
t
pu
ls
iv
ity
H
Im
In
at
te
nt
io
n
50
48
iv
ity
56
54
io
n
LD - Self
pu
ls
iv
ity
ADHD - Self
54
52
LD - Parent
Im
58
56
60
58
56
ADHD Teacher
54
LD - Teacher
52
ct
iv
i ty
yp
er
a
H
pu
ls
iv
ity
Im
In
at
te
nt
io
n
50
ADHD Self-Ratings
LD Self-Ratings
ADHD Parent Ratings
LD Parent Ratings
ADHD Teacher Ratings
LD Teacher Ratings
ADHD/LD Contrast
(continued)
60
66
58
56
ADHD - Self
54
52
LD - Self
50
48
64
62
ADHD - Parent
60
58
LD - Parent
iv
ity
yp
er
ac
t
pu
ls
iv
ity
H
H
Im
In
at
te
nt
io
n
iv
ity
yp
er
ac
t
pu
ls
iv
ity
Im
In
at
te
nt
io
n
56
54
60
58
56
ADHD Teacher
54
LD - Teacher
52
ct
iv
i ty
yp
er
a
H
pu
ls
iv
ity
Im
In
at
te
nt
io
n
50
ADHD Self-Ratings
LD Self-Ratings
ADHD Parent Ratings
LD Parent Ratings
ADHD Teacher Ratings
LD Teacher Ratings
ADHD/LD Contrast
(continued)
60
66
58
56
ADHD - Self
54
LD - Self
52
64
62
ADHD - Parent
60
58
LD - Parent
iv
ity
yp
er
ac
t
H
H
Im
In
at
te
nt
ct
iv
i ty
yp
er
a
pu
ls
iv
ity
Im
nt
io
n
In
at
te
io
n
48
pu
ls
iv
ity
56
54
50
60
58
56
ADHD Teacher
54
LD - Teacher
52
ct
iv
i ty
yp
er
a
H
pu
ls
iv
ity
Im
In
at
te
nt
io
n
50
ADHD Self-Ratings
LD Self-Ratings
ADHD Parent Ratings
LD Parent Ratings
ADHD Teacher Ratings
LD Teacher Ratings
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
Administration & Scoring
Teacher Score
Summary Table
Scale
Raw
T
%ile
Qualitative classification
Clinical
Inattention (ATT)
47
Impulsivity (IMP)
38
Hyperactivity (HYP) 43
74
64
69
> 99
91
97
Significant clinical risk
Mild clinical risk
Mild clinical risk
Context
Personal (PER)
Acad/Occup (A/O)
Social (SOC)
44
43
41
71
67
69
98
96
97
Significant clinical risk
Mild clinical risk
Mild clinical risk
Locus cluster
Internal (INT)
External (EXT)
60
68
65
74
94
99
Mild clinical risk
Significant clinical risk
CAT-C Clinical
Index (CAT-C CI) 128
70
98
Significant clinical risk
Self and Teacher
Profile Form
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
• 3 Score Summary/Profile Forms:
- Self-Report
- Parent
- Teacher
• CAT Scoring Program Software and On-Screen Help
are optional