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
• 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)
• 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
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)
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 (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 or
more settings (e.g., at school/work, at home).
• Clear evidence of significant impairment in social, school, and/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).
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
- 19 to 79 years
• Form – 2 parts
- Childhood Memories
- Current Adult Symptoms
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 (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
Constructing the CAT-A
A Multidimensional,
Multi-Step, Multi-Year
Process
Content Identification
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. Wrote 144-item adult scale according to
diagnostic criteria and content analysis
5. 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
6. 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%
7. 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 (continued)
• Clinical symptoms
- Inattention
- Impulsivity
- Hyperactivity
• Contexts
- Personal
- Academic/Occupational
- Social
CAT-A Scales and
Clusters (continued)
• Clinical symptoms
- Inattention
- Impulsivity
- Hyperactivity
• Contexts
- Personal
- Academic/Occupational
- Social
• Locus
- Internal
- External
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*
CAT-A scale/cluster
Clinical scale
Inattention
Impulsivity
Hyperactivity
Context cluster
Personal
Academic/Occupational
Social
Locus cluster
Internal
External
Clinical Index
Total Scale Clinical Index
Childhood
Memories
Current
Symptoms
.89
.85
.85
.86
.85
.76
.84
.90
.78
.80
.68
.81
.89
.90
.94
.83
.83
.91
.96
* Coefficients also are reported for age, gender, and race/ethnicity.
Stability Coefficients*
CAT-A scale/cluster
Clinical scale
Inattention
Impulsivity
Hyperactivity
Context cluster
Personal
Academic/Occupational
Social
Locus cluster
Internal
External
Clinical Index
Total Scale Clinical Index
Childhood
Memories
Current
Symptoms
.77
.83
.83
.82
.84
.83
.79
.84
.78
.83
.81
.83
.86
.81
.86
.86
.83
.87
.88
* Coefficients are corrected for restriction and 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
- Brown Attention-Deficit Disorder Scales
- Clinical Assessment of Depression
– Construct validity
- Intercorrelations
- Exploratory factor analyses
– Contrasted groups (i.e., ADHD, LD)
ADHD/LD Contrast
67
65
63
61
59
57
55
ADHD Adult Ratings
LD Adult Ratings
ADHD - Adult
LD - Adult
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)
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