Presentation Outline
 Author Introductions
 Multidimensional Adjustment and Assessment
 Characteristics of Existing Scales
• Problems and Solutions
 Clinical Assessment of Behavior (CAB); Depression (CAD), Attention
Deficit (CAT-A, CAT-C); Interpersonal Relations (CAIR)
• Development Goals
• Key Features
• Description: Forms, Scales, and Clusters
• Norm Characteristics and Technical Adequacy
• Administration and Scoring
• Interpretation
• Case Studies
Author: CAB, CAD,
CAT, CAIR
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
http://babrac.people.wm.edu/
CAB Author
Lori K. Keith, PhD
Staff Psychologist
The University of Tennessee
2348 Hickory Forest Drive
Memphis, TN 38119
keith1504@bellsouth.net
Multifaceted Nature of
Adjustment
Multidimensional, context-dependent
model of adjustment, with six primary
life domains:
ACADEMIC
FAMILY
 Three intra-personal domains
• Affect
• Competence
• Physical
 Three interpersonal domains
• Social
• Academic
• Family
S O CIAL
GLOBAL
ADJUSTMENT
AFFECT
PHYS ICAL
COMPETENCE
Developmental Nature of
Adjustment
• Adjustment becomes
increasingly
differentiated with age
• Life domains
differentiate as a
function of exposure
Triangulation:
Multi-source, Multiple
Context Assessment
Other Sources
- Direct Observation
- Indirect Approaches
(e.g., Projective Techniques)
- Background Information
- Clinical Interview
Behavioral and
Psychosocial
Adjustment
Self-Report
- Multidimensional Self Concept Scale
- Clinical Assessment of Depression
- Clinical Assessment of Attention Deficit
- Clinical Assessment of Interpersonal Relations
Third-Party Report
- CAB Parent or
Teacher
- CAT Parent/Teacher
- Achenbach,
Behavior Rating Scales:
Common Concerns













Too broad in content - - (e.g., Internalizing/externalizing)
Too narrow in content - - (e.g., Social skills, anxiety, ADD)
Failure to adequately assess adaptive skills and adjustment
Failure to combine educational disorders with psychopathology
Too narrow in age range - - (e.g., Preschool and kindergarten)
Limited technical adequacy – (e.g., rater-rater reliability)
Outdated norms
Multiple forms across age span – limiting longitudinal follow up
Poor content match between Parent and Teacher forms
Critical items not easily identified
Scoring software sold separately or not available
Limited ceilings and floors (i.e., over-pathologizing)
No veracity scale
CAB
Clinical Assessment
of Behavior
“the CAB represents one of the very best additions to the pool
of child behavior rating scales during the past decade or two”
Merrell, K. W. (2007). Behavior, social, and emotional assessment of children and
adolescents (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
CAB Features
 Uses a Five-point Item response format
• Always - Very Frequently
• Often
• Occasionally
• Rarely
• Never
 Comes with CAB-SP that scores, profiles, reports data, and facilitates
interpretation
• Standard scores (T-scores)
• Percentile ranks
• Confidence intervals
• Qualitative classifications
• Graphical profile display
CAB Features
 Critical Behaviors: low-incidence behaviors that define serious
psychopathology and sociopathy
• Psychotic experiences (e.g., Hallucinations)
• Substance abuse
• Satanic worship
• Gang-related behaviors
 Addresses behaviors exhibited in medical and neuropsychological
conditions
• Attention-deficit/hyperactivity disorders
• Learning disabilities
• Executive function strengths and limitations
• Autistic spectrum behaviors
CAB Features
 Assesses behaviors that correspond to IDEA and DSM educational
exceptionalities and conditions
• Mental retardation
• Learning disabilities
• Gifted and talented
• Adaptive behaviors
• Social skills
 Assesses current societal concerns about youth
• Aggression
• Anger management
• Conduct problems
• Bullying http://www.stopbullyingnow.hrsa.gov/
http://www.pta.org/bullying/
http://www.naspcenter.org/factsheets/bullying_fs.html
http://www.psychologymatters.org/bullying.html
Developmental Delay
 (b) Children aged three through nine experiencing
developmental delays. Child with a disability for children
aged three through nine (or any subset of that age range,
including ages three through five), may, subject to the
conditions described in §300.111(b), include a child- (1) Who is experiencing developmental delays, as defined
by the State and as measured by appropriate diagnostic
instruments and procedures, in one or more of the
following areas: physical development, cognitive
development, communication development, social or
emotional development, or adaptive development;
Constructing the CAB:
A Multidimensional, Multi-Step,
Multi-Year Process
Content Identification
1.
Approached the CAB from Bracken’s (1992) context-dependent
model of adjustment
2.
Reviewed and evaluated existing behavior rating scales
3.
Investigated agreement between biological mothers’ and fathers’
ratings
4.
Identified relevant content
• Literature on childhood and adolescence
• Item content on existing instruments
• Current diagnostic criteria from DSM-IV
• Current behaviors of concern and interest
• Suggestions from colleagues
Item Development
and Refinement
5. Wrote 1300 items on a diagnostic criteria and content analysis basis
6. Following content analysis, 1300 items were reduced to 528 items
7. Item Assignment to one of six primary scales
• Internalizing Behaviors
• Externalizing Behaviors
• Critical Behaviors
• Social Skills
• Competence
• Adaptive Behaviors
Item Tryout, Norming, and
Finalization
8.
528-item version CAB was administered to 276 respondents for
analysis of
• Preliminary scale reliabilities
• Inter-parent agreement
• Item reading level
9.
Eliminated items with low internal consistency and low inter-parent
agreement - - 260 Items were normed
10. Reliability and factor analyses were performed to further refine scales,
resulting in final parent and teacher forms
Final Forms
 170-item Comprehensive CAB-PX
• 3 Clinical Scales, 10 Clinical Clusters
• 3 Adaptive Scales, 2 Adaptive Cluster
• CAB-PX Record Form (15 - 20 minute administration)
 70-item abbreviated CAB-P
• 2 Clinical Scales, 10 Clinical Clusters
• 2 Adaptive Scales, 2 Adaptive Cluster
• CAB-P Record Form (5 – 10 minute administration)
 70-item matching CAB-T
• Items matched to the CAB-P
• CAB-T Record Form (5 – 10 minute administration)
CAB Parent and Teacher
Forms
CAB
Normative Sample
Sample Size
Parent Forms
- ages 2 – 6
- ages 7 – 12
- ages 13 – 18
Teacher Form
- ages 5 – 6
- ages 7 – 12
- ages 13 – 18
Males
Females
Total
309
455
318
291
422
319
600
877
637
145
471
391
95
288
299
240
759
690
Race/Ethnicity (Percent Representation)
Whites
Blacks
Hispanics
65 – 71%
12 – 17%
9 – 12%
Other
6 – 8%
CAB
Normative Sample
Education Level
< 11 years
12 years
13 - 15 years
16 years
> 17 years
Unknown
CAB-P
3.9%
23.9%
38.7%
14.6%
18.8%
0.1%
CAB-T
3.2%
2.5%
11.4%
17.5%
65.2%
0.2%
Geographic Region
Midwest
Northeast
South
West
21 – 25%
13 – 22%
35 – 45%
19 – 22%
17 – 22%
22 – 25%
36 – 39%
17 – 20%
Scale Variance Associated
With Demographic Variables
Age
Gender
Race
Parent Ed
CAB-PX
Clinical
.19 - 4.93% .08 - 2.82%
Adaptive 1.44 - 49.70% 1.80 - 2.96%
.01 - .59%
.01 - .03%
.21 - .72%
.03 - .81%
CAB-P
Clinical
Adaptive
.45 - .49%
.08 - 2.02%
.25 - 2.76%
2.82 - 3.39%
.08 - .38%
.00 - .02%
.31 - .37%
.62 - .74%
CAB-T
Clinical
Adaptive
.71 - .76%
.74 - 1.61%
1.66 - 8.35%
8.24 - 9.24%
.30 - 3.17%
1.35 - 2.62%
-- --- --
Scale Variance Associated
With Demographic Variables
Age
Gender
CAB-PX
Clinical
Adaptive
.19 - 4.93% .08 - 2.82%
1.44 - 49.70% 1.80 - 2.96%
CAB-P
Clinical
Adaptive
.45 - .49%
.08 - 2.02%
.25 - 2.76%
2.82 - 3.39%
CAB-T
Clinical
Adaptive
.71 - .76%
.74 - 1.61%
1.66 - 8.35%
8.24 - 9.24%
Race
.01 - .59%
.01 - .03%
.08 - .38%
.00 - .02%
.30 - 3.17%
1.35 - 2.62%
Parent Ed
.21 - .72%
.03 - .81%
.31 - .37%
.62 - .74%
-- --- --
CAB Structure
Forms, Scales, and Clusters
CAB Scale Structure and
Number of Items
Scale
Clinical Scales
Internalizing
Externalizing
Critical Behaviors
CAB-PX
CAB-P
CAB-T
30
30
30
16
18
--
16
18
--
Adaptive Scales
Social Skills
Competence
Adaptive Behaviors
30
30
20
18
18
--
18
18
--
Total Scale
170
70
70
Clinical
Scale Definitions
Internalizing Behaviors Scale (INT)
 Assesses behaviors directed toward oneself (e.g., behaviors related to
depression, anxiety, and somatization
- cries easily; is easily startled; is emotionally fragile
Externalizing Behaviors Scale (EXT)
 Assesses problematic conduct directed toward others, including rulebreaking behaviors
- insults others; is difficult to manage; ignores rules
Critical Behaviors Scale (CRI)
 Assesses behaviors associated with serious psychopathology and sociopathy
- uses illegal drugs; hallucinates; expresses an unusual interest in
Satan
Adaptive
Scale Definitions
Social Skills Scale (SOC)
 Assesses interpersonal interactions with peers and adults
- listens attentively to others; is considerate of others; annoys others
Competence Scale (COM)
 Focuses on cognitive and language development and ability to get needs met
- has poor judgment; is easily confused; learns new things easily
Adaptive Behaviors Scale (ADB)
 Assesses developmental progress and degree of independence
- dresses self; reliably makes simple purchases; prepares simple
meals for self
CAB Clusters and
Number of Items
Clusters
CAB-PX
CAB-P
CAB-T
Clinical Clusters
Anxiety
Depression
Anger
Aggression
Bullying
Conduct Problems
Attention Deficit/Hyperactivity
Autistic Spectrum Behaviors
Learning Disability
Mental Retardation
23
36
15
25
36
28
21
30
23
25
11
16
9
13
13
8
20
13
15
12
11
16
9
13
13
8
20
13
15
12
Adaptive Clusters
Executive Function
Gifted and Talented
17
27
13
17
13
17
Theoretical Structure of
CAB
CAB PX, P, and T
Reliabilities
 Internal Consistency (Coefficient Alpha)
• Total Sample
• Age Level
• Gender
• Race/Ethnicity
• Clinical Sample
 Stability Coefficients
• 2 - 4 week interval
 Inter-rater Reliability
• Parent - Parent
• Parent - Teacher
CAB-PX
Internal Consistency
Scales
Internalizing Behaviors
(INT)
r
.95
Clusters
r
Anxiety (ANX)
Depression (DEP)
.93
.95
Anger (ANG)
.93
Aggression (AGG)
.95
Bullying (BUL)
.97
Conduct Problems (CP)
.92
Externalizing Behaviors
(EXT)
.97
Critical Behaviors (CRI)
.91
Social Skills (SOC)
.95
Attention-Deficit (ADH)
.94
Competence (COM)
.94
Autistic Spectrum (AUT)
.92
Learning Disability (LD)
.92
Adaptive Behaviors (ADB)
.92
Mental Retardation (MR)
.91
Total (TOT)
.98
Executive Function (EF)
.91
Gifted and Talented (GAT)
.94
CAB-P
Internal Consistency
Scales
Internalizing Behaviors
(INT)
Externalizing Behaviors
(EXT)
r
.89
.95
Social Skills (SOC)
.92
Competence (COM)
.92
Total (TOT)
.97
Clusters
r
Anxiety (ANX)
Depression (DEP)
.88
.90
Anger (ANG)
.90
Aggression (AGG)
.92
Bullying (BUL)
.94
Conduct Problems (CP)
.90
Attention-Deficit (ADH)
.94
Autistic Spectrum (AUT)
.89
Learning Disability (LD)
.90
Mental Retardation (MR)
.90
Executive Function (EF)
.91
Gifted and Talented (GAT)
.92
CAB-T
Internal Consistency
Scales
Internalizing Behaviors
(INT)
Externalizing Behaviors
(EXT)
r
.92
.98
Social Skills (SOC)
.96
Competence (COM)
.96
Total (TOT)
.99
Clusters
r
Anxiety (ANX)
Depression (DEP)
.92
.93
Anger (ANG)
.94
Aggression (AGG)
.97
Bullying (BUL)
.97
Conduct Problems (CP)
.96
Attention-Deficit (ADH)
.97
Autistic Spectrum (AUT)
.93
Learning Disability (LD)
.95
Mental Retardation (MR)
.95
Executive Function (EF)
.95
Gifted and Talented (GAT)
.96
Comparative Reliabilities by
Ethnic Groups
Caucasian
African-American
Hispanic
Clinical
Internalizing
Externalizing
Critical Behaviors
.94 - .95
.96 - .97
.71 - .92
.93 - .96
.96 - .97
.80 - .98
.91 - .96
.93 - .98
.42 - .92
Adaptive
Social Skills
Competence
Adaptive Behavior
.92 - .96
.91 - .95
.79 - .89
.92 - .95
.92 - .95
.82 - .90
.89 - .96
.89 - .97
.84 - .89
Total Scale
CBI
Clusters
.97 - .99
.84 - .97
.98 - .99
.85 - .97
.96 - .99
.78 - .97
CAB Inter-rater
Coefficients
Scale
CAB-PX*
CAB-P*
CAB-T**
Internalizing
.78
.75
.40
Externalizing
.81
.80
.54
Critical Behaviors
.41
--
--
Social Skills
.62
.66
.44
Competence
.79
.83
.58
Adaptive Behaviors
.53
--
--
CAB Behavioral Index
.82
.81
.55
.70 - .90
.64 - .87
.44 - .56
CAB Clusters
* Parent - Parent ** Parent - Teacher
CAB Stability
Coefficients
Scale
CAB-PX
CAB-P
CAB-T
Internalizing
.89
.82
.93
Externalizing
.90
.90
.93
Critical Behaviors
.77
--
--
Social Skills
.92
.89
.92
Competence
.92
.90
.93
Adaptive Behaviors
.87
--
--
CAB Behavioral Index
.94
.92
.94
.83 - .94
.80 - .93
CAB Clusters
.89 - .95
CAB Validity




Respondent Veracity
Frequency of Extreme Scores in the Normative Sample
Content Validity
Construct Validity
• Factor Analyses
 Convergent Validity
• Correlations with BASC and DSMD Scales
 Contrasted Groups
• Clinical Groups (e.g., Conduct Disordered)
• Exceptional Groups (e.g., Intellectually Gifted)
Respondent Veracity:
Profile Classifications
0 – 1 Clinical Clusters > 70, p = .95
2 – 5 Clinical Clusters > 70, p < .05
6 – 10 Clinical Clusters > 70, p < .01
0 – 1 Clinical Clusters < 30, p = .95
2 – 5 Clinical Clusters < 30, p < .05
6 – 10 Clinical Clusters < 30, p < .01
CAB-PX – BASC-PRS
Comparable Scales
Scales
Internalizing
Externalizing
Social Skills
Competence
Anxiety
Depression
Aggression
Conduct Problems
Attention Deficit
Attention Deficit
r
.70
.80
.72
.74 (Adaptability)
.57
.77
.75
.82
.76 (Attention)
.73 (Hyperactivity)
CAB-P – BASC-PRS
Comparable Scales
Scales
Internalizing
Externalizing
Social Skills
Anxiety
Depression
Aggression
Conduct Problems
Attention Deficit
Attention Deficit
r
.69
.79
.71
.53
.75
.75
.72
.76 (Attention)
.73 (Hyperactivity)
CAB-T – BASC-TRS
Comparable Scales
Scales
Internalizing
Externalizing
Social Skills
Anxiety
Depression
Aggression
Conduct Problems
Attention Deficit
Attention Deficit
Learning Disability
Gifted and Talented
r
.64
.77
.63
.56
.59
.75
.61
.76 (Attention)
.66 (Hyperactivity)
.62 (Learning Problems)
.69 (Study Skills)
CAB-PX – BASC2 PRS
Internal Consistency
(Scales)
P
CAB
C
A
P
Males: Internalizing
Males: Externalizing
.94
.96
.95
.97
.95
.97
.86
.91
.91
.94
.91
.95
Females: Internalizing
Females: Externalizing
.95
.96
.96
.97
.96
.97
.88
.88
.90
.93
.91
.92
P
C
A
P
Males: Social Skills
Males: Adaptive Behaviors
.91
.89
.96
.84
.96
.80
.89
.93
.87
.95
.88
.95
Females: Social Skills
Females: Adaptive Behaviors
.91
.89
.95
.84
.96
.82
.87
.92
.87
.95
.87
.95
Males: Total Scale Score
Females: Total Scale Score
.97
.98
.99
.98
.99
.99
.94
.93
.95
.95
.95
.94
Clinical Scales
Adaptive Scales
BASC-2
C
C
A
A
CAB-PX – BASC2 PRS
Internal Consistency
(Clusters: Males)
Clinical Clusters
Anxiety
Depression
Anger
Aggression
Bullying
Conduct Problems
Attention Deficit/Hyperactivity
Autistic Spectrum Behaviors
Learning Disability
Mental Retardation
Adaptive Clusters
Executive Function
Gifted and Talented
P
CAB
C
A
BASC-2
P
C
A
.91
.94
.91
.94
.95
.84
.90
.90
.89
.86
.94
.96
.94
.96
.97
.91
.95
.95
.93
.92
.97
.96
.95
.96
.97
.94
.95
.95
.93
.93
.78
.87
NR
.93
NR
NA
.92
NA
NA
NA
.80
.87
NR
.93
NR
.92
.95
NA
.89
NA
.83
.87
NR
.93
NR
.91
.95
NA
.87
NA
.84
.90
.93
.95
.93
.95
NR
NA
NR
NA
NR
NA
CAB-PX – BASC2 PRS
Internal Consistency
(Clusters: Females)
Clinical Clusters
Anxiety
Depression
Anger
Aggression
Bullying
Conduct Problems
Attention Deficit/Hyperactivity
Autistic Spectrum Behaviors
Learning Disability
Mental Retardation
Adaptive Clusters
Executive Function
Gifted and Talented
P
CAB
C
A
BASC-2
P
C
A
.92
.95
.90
.93
.95
.91
.91
.90
.90
.86
.94
.96
.94
.95
.97
.90
.94
.93
.93
.93
.94
.96
.94
.95
.96
.94
.94
.94
.94
.93
.83
.88
NR
.91
NR
NA
.91
NA
NA
NA
.81
.87
NR
.91
NR
.92
.93
NA
.89
NA
.85
.86
NR
.93
NR
.91
.90
NA
.86
NA
.84
.90
.92
.95
.93
.96
NR
NA
NR
NA
NR
NA
CAB and BASC-2 Item
Gradients: Teacher Forms
for Adolescent Females
Raw
Scores
BASC
Aggress
CAB
Aggress
BASC
Conduct
CAB
Conduct
BASC
Depress
CAB
Depress
20
108
49
103
57
98
36
18
102
47
97
56
93
33
16
96
43
91
54
87
26
14
89
38
85
52
81
< 26
12
83
< 38
80
49
76
< 26
10
76
< 38
74
45
70
< 26
8
70
< 38
68
36
65
< 26
6
63
< 38
62
< 36
59
< 26
4
57
< 38
56
< 36
53
< 26
2
51
< 38
50
< 36
48
< 26
Aggression T-Score to
Percentile Rank
(CAB-T and BASC-2 TRS)
90
80
70
60
BASC %ile
50
CAB %ile
40
Normal %ile
30
20
10
0
T 43
T 45
T 47
T 49
T 51
T 52
T 54
T 56
CAB-PX – DSMD
Comparable Scales
Scales
Internalizing
Externalizing
Critical Behaviors
Anxiety
Depression
Conduct Problems
Attention Deficit
Autistic Spectrum
r
.69
.70
.63
.65
.66
.76
.79
.62
CAB Ability Scales and
Clusters by Assessed Ability
(BBCS-R)
65
60
Competence
Executive Function
Gifted and Talented
55
50
BBCS-R
> 120
BBCS-R
111-120
BBCS-R
90-110
BBCSR
80 - 89
BBCS-R
< 80
45
CAB Ability Scales and
Clusters by Assessed Ability
(NNAT)
65
60
Competence
Executive Function
Gifted and Talented
55
50
NNAT
>120
NNAT
111-120
NNAT
90-110
NNAT
80-89
NNAT
<80
45
Conduct Disordered
Students
70
60
Series1
50
40
30
Gifted and
Executive
MR
LD
Autistic
ADHD
Conduct
Bullying
Aggression
Anger
Depression
Anxiety
Adaptive
Competence
Social Skills
Critical
Externalizing
Internalizing
Gifted and Talented
Students
SAMPLE
- 45 Gifted Students
- 45 Regular Education
Students
RESULTS
65
Gifted
Nongifted
60
55
50
45
40
35
Gifted
EF
MR
LD
Autism
ADD
Conduct
Bullying
Aggression
Anger
Depression
Anxiety
CBI
Competence
Social
External
Internal
- High Competence,
EF and Gifted
- Low pathology
scales and clusters
35
Gifted and Talented
Executive Function
MR
LD
Autistic Spectrum
ADD/ADHD
Conduct Problems
Bullying
Aggression
Anger
Depression
Anxiety
CBI
Competence
Social Skills
Externalizing
Internalizin g
Replicated CAB Profiles of
Gifted Students (SS > 120)
(BBCS-R N=65; NNAT N=143)
65
60
55
50
BBCS-R
NNAT
45
40
Administration & Scoring
Administration
For Multiple-Source, Multiple-Context Ratings:
 Forms should be completed by
• one or both parents/ guardians
• one or more of the child’s teachers
 CAB Rating Forms must be completed by:
• an adult with functional literacy
• an adult rater who knows the child/adolescent well
• an adult with at least 4 weeks of home or school contact
Scoring
 For all practical purposes, the CAB must be scored using the
computerized CAB-SP
• However, scoring key and norms tables are provided in
Professional Manual per AERA, APA, NCME standards
 Skipped Items and Missing Responses
• For skipped items the CAB-SP will prorate raw scores on each
scale when at least 90% of the items on the scale were completed
• If more than 10% of the items on a scale are incomplete, CAB-SP
will not calculate scores for that scale and results will be considered
invalid
CAB Scoring
Program
Interpreting the CAB
Clinical Interpretation
Quantitative and Qualitative Interpretation Process
5-Step Interpretation Process
1.
Consider CAB total scale score (i.e., CAB Behavioral Index)
2.
Consider CAB scale and cluster scores individually and in combination
3.
Compare scale and cluster scores acquired from different sources (e.g.,
parents/teachers)
4.
Explore clinically informing items
5.
Contrast student’s performance on the CAB forms, scales, and clusters in
light of other available information
CAB Behavioral Index
(CBI)
 The CBI is a summation of all items, representing the best estimate of
the examinee’s overall level of psycho-social adjustment
 CAB CBI, Scales and Clusters employ a T-score metric, with the mean
set at 50, standard deviations set to 10
 CBI T-Scores
< 59
60 to 69
70 to 79
> 80
=
=
=
=
Normal Range
Mild Clinical Risk
Significant Clinical Risk
Very Significant Clinical Risk
Qualitative Classifications
T-score Qualitative classification for range Clinical scales and clusters
< 59
= Normal range
60 - 69 = Mild clinical risk
70 - 79 = Significant clinical risk
> 80
= Very significant clinical risk
T-score Qualitative classification for Adaptive scales and clusters
<19
= Very significant adaptive weakness
20 - 29
= Significant adaptive weakness
30 - 39
= Mild adaptive weakness
40 - 59
= Normal range
60 - 69
= Mild adaptive strength
70 - 79
= Significant adaptive strength
> 80
= Very significant adaptive strength
Clinical Scale
Interpretation
 Internalizing Behaviors (INT)
• Elevated T-scores indicate a significant number of
internalizing problem behaviors endorsed
• Follow up: interpret internalizing-related Clinical
clusters (i.e., Anxiety, Depression)
Clinical Scale
Interpretation
 Externalizing Behaviors (EXT)
• Elevated T-scores reflect concerns about examinee’s anger, aggression,
acting-out behaviors, behavioral conduct, interactions with others, and
interaction with, or reaction to, society
• Follow up: interpret externalizing-related Clinical clusters (i.e., Anger,
Aggression, Bullying, Conduct Problems)
Clinical Scale
Interpretation
 Critical Behaviors (CRI) - only on CAB-PX
• High T-scores suggest of clinical risk for serious maladjustment,
psychopathology, sociopathy, or behavioral disturbance
• Consider behaviors in light of examinee’s chronological age and
developmental stage
• Follow up: inspect specific items endorsed as problematic
Adaptive Scale
Interpretation
 Social Skills (SOC)
• Elevated T-scores reflect positive social interactions and behavioral
adjustment
• Scores below normal range indicate adaptive weakness
• Follow up: consider specific behaviors for intervention
 Competence (COM)
• High T-scores reflect good adjustment and adaptive strength in
independence, and cognitive and language functioning
• Low scores imply limitations in independent problem solving
• Follow up: especially important in identifying mentally retarded or gifted
and talented
Adaptive Scale
Interpretation
 Adaptive Behaviors (ADB) – only on CAB-PX
• High T-scores reflect good overall adaptive functioning or adaptive
strength
• Low scores suggest limitations in adaptive functioning
• important in ruling out adaptive behavior problems among children
and adolescents with possible mental retardation
• Follow up: useful for program planning, identifying behaviors for
remediation, and helping set goals for intervention
Interpreting
CAB
Clinical Clusters
Anxiety
CAB Clinical Scale: Anxiety Cluster (ANX)
- is insecure; is very nervous; is fearful
 12 to 20% Incidence Rate for Children and Adolescents
 more prevalent among females than males
“Separation Anxiety Disorder and Specific Phobia are more common in
younger children, about ages 6-9 years old. Generalized Anxiety Disorder
(GAD) and Social Anxiety Disorder (SAD) are more common in middle
childhood and adolescence. Panic Disorder can occur in adolescence as well.
Anxiety Disorders Association of America
 Associated Clinical Clusters: Depression, Learning Disability,
Attention Deficit/Hyperactivity
Depression
 CAB Clinical Scale: Depression Cluster (DEP)
- appears depressed; lacks energy; cries easily
 2 to 8% Incidence Rate for Children and Adolescents
 Similar incidence for both genders in early childhood, in adolescence twice
as many females as males
Depression
“Up to 2.5 percent of children and up to 8.3 percent of adolescents in the U.S.
suffer from depression. An NIMH-sponsored study of 9 to 17-year-olds
estimated that the prevalence of any depression is more than 6 percent in a 6month period, with 4.9 percent having major depression. In addition, research
indicates that depression onset is occurring earlier in life today than in past
decades.”
National Institute of Mental Health
Associated Clinical Clusters: Anxiety, Conduct Problems, Learning Disability,
Attention Deficit/Hyperactivity, Mental Retardation
Anger
 CAB Clinical Scale: Anger Cluster (ANG)
- is argumentative; becomes violent; is easily angered
 Not a diagnosable condition but the failure to manage anger
appropriately has become an increasing concern in our society
 Anger acted out against society occurs more frequently among males
than females
 Cluster includes verbally and physically expressed anger
 Associated Clinical Clusters: Aggression, Bullying, Conduct Problems,
and Depression
Aggression
 CAB Clinical Scale: Aggression Cluster (AGG)
- tries to intimidate others; threatens others; starts fights
 Not a diagnosable condition but aggression is a clinical symptom found in
several clinical disorders (e.g., Oppositional Defiant Disorder, Conduct
Problems)
 Males generally demonstrate more problematic aggression than females
 Clusters include behaviors representing mild, moderate, and severe forms
of aggression and acts of aggression against people and objects
 Associated Clinical Clusters: Anger, Bullying, and Conduct Problems
Bullying
 CAB Clinical Scale: Bullying Cluster (BUL)
- is very abusive; intentionally provokes others; insults others
 Not a diagnosable condition but bullying along with anger and aggression are all
major societal concerns and important symptoms of conditions such as Oppositional
Defiant Disorder and Conduct Disorder.
 26% of boys,14% of girls have been identified as bullies
“Surveys indicate that as many as half of all children are bullied at some time during
their school years, and at least 10% are bullied on a regular basis.”
American Academy of Child & Adolescent Psychiatry
 Associated Clinical Clusters: Anger, Aggression, and Conduct Problems
Conduct Problems
 CAB Clinical Scale: Conduct Problems Cluster (CP)
- breaks curfew; skips school; vandalizes public property
 Estimated 1 to 10% Incidence Rate for Children
 5% to 15% of males, 2% to 10% of females
“The prevalence of Conduct Disorder appears to have increased over the last
decades and may be higher in urban than rural settings. Rates vary widely
depending on the nature of the population sampled and methods of ascertainment.
General population studies report rates ranging from less than 1% to more than
10%. Prevalence rates are higher among males than females.”
DSM-IV-TE
 Associated Clinical Clusters: Aggression, Anger, Bullying, Depression
Learning Disability
 CAB Clinical Scale: Learning Disability (LD)
- gives up too easily; is easily frustrated with schoolwork; is forgetful
 5 to 10% Prevalence Rate
 2 to 4 males for every female are identified with a learning disability
“Currently, almost 2.9 million school-aged children in the US are classified as
having specific learning disabilities (SLD) and receive some kind of special
education support. They are approximately 5% of all school-aged children in public
schools. These numbers do not include children in private and religious schools or
home-schooled children.”
National Center for Learning Disabilities
 Associated Clinical Clusters: Elevated ADHD, lower EF, GAT
Autistic Spectrum
Behaviors
 CAB Clinical Scale: Autistic Spectrum Behaviors (ASB)
- uses bizarre speech; becomes upset if things are out of order
 The prevalence rate is 1 in 200 - 300 individuals
 Males exhibit autistic spectrum behaviors 2 to 5 times more than females
“Every year between 100,000 and 200,000 children are diagnosed with one of the
disorders [Autistic, Asperger’s or other Pervasive Developmental Disorders], or five
out of every l0,000 children born - four times as many boys as girls. The diagnosis
of Asperger's Disorder is generally made later in a child's life, whereas the
diagnosis of Autistic Disorder is generally made between birth and thirty months of
age.
New York University Child Study Center
 Associated Clinical Clusters: Mental Retardation, Critical Behaviors
Attention-Deficit
Hyperactivity
 CAB Clinical Scale: Attention-Deficit/Hyperactivity (ADH)
- acts impulsively; seems unable to relax; is easily distracted
 3% to 7% Prevalence Rate among school-aged population
 2 to 10 males for every female diagnosed
 “The prevalence of Attention-Deficit/Hyperactivity Disorder has been
estimated at 3% - 7% in school-age children.”
DSM-IV-TR
 Associated Clinical Clusters: Learning Disability,Conduct Problems,
Anxiety, and Depression.
Mental Retardation
 CAB Clinical Scale: Mental Retardation (MR)
- acts immature compared to similar-aged peers; independently
takes care of personal needs
 1% Prevalence Rate and has a childhood onset
 Mental retardation occurs in about 1.5 males for every female
The prevalence rate of mental retardation is approximately 1%. However,
different studies have reported different rates depending on definitions used,
methods of ascertainment, and population studied.
DSM-IV-TR
 Associated Clinical Clusters: Low on EF & GAT Clusters
Serious Emotional
Disturbance Defined

Disabilities Education Act (IDEA), Public Law 101-476 defines SED as: “…one or more
of the following characteristics over a long period of time and to a marked degree that
adversely affects educational performance–
(A) An inability to learn that cannot be explained by intellectual,
sensory, or health factors;
(B) An inability to build or maintain satisfactory interpersonal
relationships with peers and teachers;
(C) Inappropriate types of behavior or feelings under normal
circumstances;
(D) A general pervasive mood of unhappiness or depression;
(E) A tendency to develop physical symptoms or fears associated
with personal or school problems."
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Emotional Impaired (SED)
 Unable to comply; needy;
School
difficulty asking for help.
Behavior
Socially Maladjusted (BD)
 Unwilling to comply;
excessive absences; rejects
help
Attitude  School is a source of
Toward angst; responds well to
School structure
 Dislikes school except as a
social outlet; rebels against
rules and structure
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Emotional Impaired (SED)
 Misses school due to
School psychosomatic issues.
Attendance
Educational Achievement is uneven;
Performance impaired by emotions.
Socially Maladjusted (BD)
 Misses school due to
truancy.
 Achievement is influenced
by truancy, attitude
toward school.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Peer
Relations
Emotional Impaired (SED)
 Ignored or rejected.
 Younger friends; pseudoFriendships friends; no real friends.
Socially Maladjusted (BD)
 Generally accepted by
sociocultural subgroup.
 Friends primarily from
same delinquent or
sociocultural subgroup.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Emotional Impaired (SED)
 Perceived as bizarre, odd,
Perceptions
source of ridicule.
of
Peers
 Poorly developed;
immature; difficulty
Social
reading social cues;
Skills
difficulty entering groups.
Socially Maladjusted (BD)
 Perceived as tough,
charismatic, accepted
within subculture.
 Well developed; mature;
well attuned to social cues.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Emotional Impaired (SED)
 Inability to establish
Interper- relationships; avoids
sonal people; withdrawn.
Relations
Socially Maladjusted (BD)
 Extensive relations;
exploitive and
manipulative; charming to
achieve ends.
 Awkward; goofy; odd,
may be uncomfortable
Physical
with physicality.
Presence
 Smooth and agile; sexually
precocious; dresses like
subgroup (e.g., Goth).
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Emotional Impaired (SED)
 Affective Disorder;
Locus of Internalizing
Disorder
 Hurts self or others as an
Aggression end.
 Tense; fearful; manifest
Anxiety anxiety
Socially Maladjusted (BD)
 Conduct Disorder;
externalizing
 Hurts others as a means to
an end.
 Appears relaxed; ‘cool’;
situational anxiety related
to consequences faced.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Emotional Impaired (SED)
 Labile; disproportionate
Affective reactions, but not under
Reactions student’s control.
 Guilty; remorseful; selfConscience critical; overly serious.
Socially Maladjusted (BD)
 Intentional with features of
anger and rage; explosive.
 Little remorse; blaming;
non-empathic; hedonistic;
understands right/wrong,
but chooses wrong.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
Differential Diagnosis of
Emotional Impaired and
Socially Maladjusted
Emotional Impaired (SED)
 Fantasy; naïve; gullible;
Sense of thought disorders;
Reality hallucinations.
 Inappropriate for age;
Developimmature; uneven;
mental
regressive
Appropriateness
Socially Maladjusted (BD)
 “Street-wise”; understands
and manipulates facts;
distorts rules and
expectations.
 Age appropriate or above;
behaviorally precocious;
‘socially-mature’
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
ED/SM Scale Reliability
Differences Required for
Significance
Magnitude of Difference
Between SM and ED
Rodney:
Emotionally Impaired or
Socially Maladjusted?
 Age: 14 Years
 White, Male
 Referred for anger management issues, bullying, and
hostility toward peers, teachers and parents
 Average grades (Mostly B’s with occasional A’s and C’s)
 WISC-III FSIQ = 135
 Instruments:
• CAB-PX
• CAB-T
• Clinical Interview
Parent/Teacher Veracity
Respondent Veracity Scale
Number of clinical cluster scores  70
Profile classification
0
Typical cluster profiles
Number of clinical cluster scores  30
Profile classification
1
Typical cluster profiles
Number of clinical cluster scores  70
Profile classification
0
Typical cluster profiles
Number of clinical cluster scores  30
Profile classification
0
Typical cluster profiles
Parent/Teacher Scale
Contrasts
Raw
score
T
score
%ile
rank
90%
C. I.
Qualitative
classification
Internalizing Behaviors (INT)
49
42
23
38 - 46
Normal range
Externalizing Behaviors (EXT)
94
65
93
62 - 68
Mild CR
Critical Behaviors (CRI)
42
59
83
54 - 64
Normal range
Social Skills (SOC)
91
36
8
33 - 39
Mild AW
Competence (COM)
48
59
81
55 - 63
Normal range
Adaptive Behaviors (ADB)
31
52
58
45 - 59
Normal range
355
57
74
55 - 59
Normal range
Raw
score
T
score
%ile
rank
90%
C. I.
Qualitative
classification
Internalizing Behaviors (INT)
22
38
11
33 - 43
Normal range
Externalizing Behaviors (EXT)
71
62
89
60 - 64
Mild CR
Social Skills (SOC)
64
41
18
38 - 44
Normal range
Competence (COM)
29
62
89
59 - 65
Mild AS
186
51
55
49 - 53
Normal range
Scale
Clinical scale
Adaptive scale
CAB Behavioral Index (CBI)
Scale
Clinical scale
Adaptive scale
CAB Behavioral Index (CBI)
Parent/Teacher Cluster
Contrasts
Raw
score
T
score
%ile
rank
90%
C. I.
Qualitative
classification
Anxiety (ANX)
33
38
11
34 - 42
Normal range
Depression (DEP)
57
41
19
38 - 44
Normal range
Anger (ANG)
42
56
73
52 - 60
Normal range
Aggression (AGG)
73
64
92
61 - 67
Mild CR
Bullying (BUL)
124
69
97
66 - 72
Mild CR
Conduct Problems (CP)
61
68
96
64 - 72
Mild CR
Attention-Deficit/Hyperactivity (ADH)
39
40
17
36 - 44
Normal range
Autistic Spectrum Behaviors (ASB)
56
49
46
45 - 53
Normal range
Learning Disability (LD)
29
30
2
26 - 34
Normal range
Mental Retardation (MR)
41
43
26
39 - 47
Normal range
Executive Function (EF)
29
62
89
58 - 66
Mild AS
Gifted and Talented (GAT)
119
61
87
57 - 65
Mild AS
Cluster
Clinical cluster
Adaptive cluster
Teacher
NR
NR
NR
NR
MCR
NR
NR
NR
NR
NR
MAS
MAS
Parent/Teacher
Profiles
Parent/Teacher ED/SM
Emotional Disturbance and Social Maladjustment Scales
Raw
score
T
score
Qualitative
Classification
Emotional Disturbance (ED)
57
40
Normal range
Social Maladjustment (SM)
166
68
Mild CR
Raw
score
T
score
Qualitative
Classification
Emotional Disturbance (ED)
20
37
Normal range
Social Maladjustment (SM)
98
69
Mild CR
Scale
Scale
Case Study Summary
Rodney
 Referred for anger management issues, bullying, and hostility toward peers,
teachers and parents. Multi-source, multi-context triangulated information
from referral, CAB-PX, CAB-T, MSCS, and KFD consistently show:
• High intellectual functioning
• High academic functioning
• High overall competence and executive function
• Poor social skills and peer acceptance
• Family conflict
• Clinically significant Externalizing behaviors, including Aggression,
bullying, conduct problems, hostility toward others - - Socially
Maladjusted - - Behaviorally Disordered