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
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
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
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
Historical Perspective
of Attention Deficit
American Academy of Pediatrics
To 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.
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.
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.
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).
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
CAT-C and CAT-A
Clinical Assessment
of Attention Deficit
CAT Features
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
• 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
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
Constructing
the CAT
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
Item Development
and Refinement
5. 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
6. 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%
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)
Item Tryout, Norming,
and Finalization
8.
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
9.
CAT-C forms were piloted and validated (N = 50),
resulting in 83% to 88% correct classification of
ADHD and control students
10. CAT-A and CAT-C scales were normed, validated,
finalized, and published
CAT Scales
and Clusters
• Clinical Symptoms
• Inattention
• Impulsivity
• Hyperactivity
CAT Scales
and Clusters
• Clinical Symptoms
• Inattention
• Impulsivity
• Hyperactiity
• Contexts
• Personal
• Academic/Occupational
• Social
CAT Scales
and Clusters
• Clinical Symptoms
• Inattention
• Impulsivity
• Hyperactivity
• Contexts
• Personal
• Academic/Occupational
• Social
• Locus
• Internal
• External
CAT Blueprint
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)
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
CAT-C
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
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
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)
CAT-C ADHD / LD
Contrast
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
CAT-C ADHD / LD
Contrast
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
CAT-C ADHD / LD
Contrast
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
• CAT-A includes only a self-report scale
– Both Childhood Memories and Current Symptom Scales
should be completed by the adult
CAT
Administration & Scoring
CAT-C Teacher
Scale
Clinical
Inattention (ATT)
Impulsivity (IMP)
Hyperactivity (HYP)
Context
Personal (PER)
Acad/Occup (A/O)
Social (SOC)
Raw
T
%ile
Qualitative classification
47
38
43
74
64
69
> 99
91
97
Significant clinical risk
Mild clinical risk
Mild clinical risk
44
43
41
71
67
69
98
96
97
Significant clinical risk
Mild clinical risk
Mild clinical risk
65
74
94
99
Mild clinical risk
Significant clinical risk
70
98
Significant clinical risk
Locus cluster
Internal (INT)
60
External (EXT)
68
CAT-C Clinical Index
(CAT-C CI)
128
CAT-C
Self and Teacher
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
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
CAT-A 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
CAT-A
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
CAT-C ADHD / LD
Contrast
67
65
63
ADHD - Adult
61
LD - Adult
59
57
55
ADHD Adult Ratings
LD Adult Ratings
S
S
S
SS CS
S
C
C
C
n
ty vi ty
ty i on
ty
i
i
i
o
v ti
i
v
ti v ent
si
si
nt
l
l
c
e
ac
u
t
a
u
t
r
t
t
r
p
p
e
a
a
e
In
Im yp
In
Im yp
H
H
CM
S
M
S
CM