presentation outline author introductions multidimensional adjustment and assessment ...

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, PhDProfessor

The College of William & MarySchool of EducationP.O. Box 8795Williamsburg, VA 23187-8795

(757) 221-1712babrac@wm.eduhttp://babrac.people.wm.edu/

CAB Author

Lori K. Keith, PhDStaff Psychologist

The University of Tennessee2348 Hickory Forest DriveMemphis, TN 38119

keith1504@bellsouth.net

Multifaceted Nature of Adjustment

GLOBAL ADJUSTMENT

AFFECT

SOCIAL

PHYSICAL

COMPETENCE

ACADEMIC

FAMILY

Multidimensional, context-dependent Multidimensional, context-dependent model of adjustment, with six primary model of adjustment, with six primary life domains:life domains:

Three intra-personal domainsThree intra-personal domains •Affect•Competence•Physical

Three interpersonal domainsThree interpersonal domains •Social•Academic•Family

Developmental Nature of Adjustment

• Adjustment becomes increasingly differentiated with age

• Life domains differentiate as a function of exposure

Triangulation:Multi-source, Multiple

Context Assessment

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,

Behavioral and PsychosocialAdjustment

Other Sources- Direct Observation - Indirect Approaches (e.g., Projective Techniques) - Background Information - Clinical Interview

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narrow in age range - - (e.g., Preschool and kindergarten) Limited technical adequacy – (e.g., rater-rater reliability) Outdated norms Multiple forms across age span – limiting longitudinal follow up Poor content match between Parent and Teacher forms Critical items not easily identified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

CABCAB

Clinical Assessment Clinical Assessment of Behaviorof 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 Developmentand 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 Males Females TotalParent Forms

- ages 2 – 6 309 291 600- ages 7 – 12 455 422 877

- ages 13 – 18 318 319 637Teacher Form

- ages 5 – 6 145 95 240- ages 7 – 12 471 288 759

- ages 13 – 18 391 299 690

Race/Ethnicity (Percent Representation) Whites Blacks Hispanics Other 65 – 71% 12 – 17% 9 – 12% 6 – 8%

CABNormative Sample

Education Level CAB-P CAB-T

< 11 years 3.9% 3.2%12 years 23.9% 2.5%

13 - 15 years 38.7% 11.4%16 years 14.6% 17.5%

> 17 years 18.8% 65.2%Unknown 0.1% 0.2%

Geographic Region

Midwest 21 – 25% 17 – 22%

Northeast 13 – 22% 22 – 25%South 35 – 45% 36 – 39%West 19 – 22% 17 – 20%

Scale Variance AssociatedWith Demographic Variables

Age Gender Race Parent Ed CAB-PX

Clinical .19 - 4.93% .08 - 2.82% .01 - .59% .21 - .72%Adaptive 1.44 - 49.70% 1.80 - 2.96% .01 - .03% .03 - .81%

CAB-PClinical .45 - .49% .25 - 2.76% .08 - .38% .31 - .37% Adaptive .08 - 2.02% 2.82 - 3.39% .00 - .02% .62 - .74%

CAB-TClinical .71 - .76% 1.66 - 8.35% .30 - 3.17% -- --Adaptive .74 - 1.61% 8.24 - 9.24% 1.35 - 2.62% -- --

Scale Variance AssociatedWith Demographic Variables

Age Gender Race Parent Ed CAB-PX

Clinical .19 - 4.93% .08 - 2.82% .01 - .59% .21 - .72%Adaptive 1.44 - 49.70% 1.80 - 2.96% .01 - .03% .03 - .81%

CAB-PClinical .45 - .49% .25 - 2.76% .08 - .38% .31 - .37% Adaptive .08 - 2.02% 2.82 - 3.39% .00 - .02% .62 - .74%

CAB-TClinical .71 - .76% 1.66 - 8.35% .30 - 3.17% -- --Adaptive .74 - 1.61% 8.24 - 9.24% 1.35 - 2.62% -- --

CAB Structure

Forms, Scales, and Clusters

CAB Scale Structure and Number of Items

Scale CAB-PX CAB-P CAB-TClinical Scales

Internalizing 30 16 16Externalizing 30 18 18Critical Behaviors 30 -- --

Adaptive ScalesSocial Skills 30 18 18Competence 30 18 18Adaptive Behaviors 20 -- --

Total Scale 170 70 70

ClinicalScale 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 rule-

breaking 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

AdaptiveScale 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 ClustersAnxiety 23 11 11Depression 36 16 16Anger 15 9 9Aggression 25 13 13Bullying 36 13 13Conduct Problems 28 8 8Attention Deficit/Hyperactivity 21 20 20Autistic Spectrum Behaviors 30 13 13Learning Disability 23 15 15Mental Retardation 25 12 12

Adaptive ClustersExecutive Function 17 13 13Gifted and Talented 27 17 17

Theoretical Structure of CAB

CAB PX, P, and TReliabilities

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 r

Internalizing Behaviors (INT) .95

Externalizing Behaviors (EXT) .97

Critical Behaviors (CRI) .91

Social Skills (SOC) .95

Competence (COM) .94

Adaptive Behaviors (ADB) .92

Total (TOT) .98

Clusters r

Anxiety (ANX) .93Depression (DEP) .95

Anger (ANG) .93

Aggression (AGG) .95

Bullying (BUL) .97

Conduct Problems (CP) .92

Attention-Deficit (ADH) .94

Autistic Spectrum (AUT) .92

Learning Disability (LD) .92

Mental Retardation (MR) .91

Executive Function (EF) .91

Gifted and Talented (GAT) .94

CAB-P Internal Consistency

Scales r

Total (TOT) .97

Clusters r

Anger (ANG) .90

Bullying (BUL) .94

CAB-T Internal Consistency

Scales r

Total (TOT) .99

Clusters r

Anger (ANG) .94

Bullying (BUL) .97

Comparative Reliabilities by Ethnic Groups

Caucasian African-American HispanicClinical

Internalizing .94 - .95 .93 - .96 .91 - .96Externalizing .96 - .97 .96 - .97 .93 - .98

Critical Behaviors .71 - .92 .80 - .98 .42 - .92

AdaptiveSocial Skills .92 - .96 .92 - .95 .89 - .96Competence .91 - .95 .92 - .95 .89 - .97

Adaptive Behavior .79 - .89 .82 - .90 .84 - .89

Total ScaleCBI .97 - .99 .98 - .99 .96 - .99Clusters .84 - .97 .85 - .97 .78 - .97

CAB Inter-raterCoefficients

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

CAB Clusters .70 - .90 .64 - .87 .44 - .56* 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

CAB Clusters .83 - .94 .80 - .93 .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 = .952 – 5 Clinical Clusters > 70, p < .056 – 10 Clinical Clusters > 70, p < .01

0 – 1 Clinical Clusters < 30, p = .952 – 5 Clinical Clusters < 30, p < .056 – 10 Clinical Clusters < 30, p < .01

CAB-PX – BASC-PRS Comparable Scales

Scales r

Internalizing .70

Externalizing .80

Social Skills .72

Competence .74 (Adaptability)

Anxiety .57

Depression .77

Aggression .75

Conduct Problems .82

Attention Deficit .76 (Attention)

Attention Deficit .73 (Hyperactivity)

CAB-P – BASC-PRS Comparable Scales

Scales r

Internalizing .69

Externalizing .79

Social Skills .71

Anxiety .53

Depression .75

Aggression .75

CAB-T – BASC-TRS Comparable Scales

Scales r

Internalizing .64

Externalizing .77

Social Skills .63

Anxiety .56

Depression .59

Aggression .75

Learning Disability .62 (Learning Problems)

Gifted and Talented .69 (Study Skills)

CAB-PX – BASC2 PRS Internal Consistency

(Scales) CAB BASC-2

Clinical Scales P C A P C A

Males: Internalizing .94 .95 .95 .86 .91 .91Males: Externalizing .96 .97 .97 .91 .94 .95

Females: Internalizing .95 .96 .96 .88 .90 .91Females: Externalizing .96 .97 .97 .88 .93 .92

Adaptive Scales P C A P C A Males: Social Skills .91 .96 .96 .89 .87 .88

Males: Adaptive Behaviors .89 .84 .80 .93 .95 .95

Females: Social Skills .91 .95 .96 .87 .87 .87Females: Adaptive Behaviors .89 .84 .82 .92 .95 .95

Males: Total Scale Score .97 .99 .99 .94 .95 .95Females: Total Scale Score .98 .98 .99 .93 .95 .94

CAB-PX – BASC2 PRS Internal Consistency

(Clusters: Males) CAB BASC-2

Clinical Clusters P C A P C A

Anxiety .91 .94 .97 .78 .80 .83Depression .94 .96 .96 .87 .87 .87Anger .91 .94 .95 NR NR NRAggression .94 .96 .96 .93 .93 .93Bullying .95 .97 .97 NR NR NRConduct Problems .84 .91 .94 NA .92 .91Attention Deficit/Hyperactivity .90 .95 .95 .92 .95 .95Autistic Spectrum Behaviors .90 .95 .95 NA NA NALearning Disability .89 .93 .93 NA .89 .87Mental Retardation .86 .92 .93 NA NA NA

Adaptive ClustersExecutive Function .84 .93 .93 NR NR NRGifted and Talented .90 .95 .95 NA NA NA

CAB-PX – BASC2 PRSInternal Consistency(Clusters: Females)

CAB BASC-2Clinical Clusters P C A P C A

Anxiety .92 .94 .94 .83 .81 .85Depression .95 .96 .96 .88 .87 .86Anger .90 .94 .94 NR NR NRAggression .93 .95 .95 .91 .91 .93Bullying .95 .97 .96 NR NR NRConduct Problems .91 .90 .94 NA .92 .91Attention Deficit/Hyperactivity .91 .94 .94 .91 .93 .90Autistic Spectrum Behaviors .90 .93 .94 NA NA NALearning Disability .90 .93 .94 NA .89 .86Mental Retardation .86 .93 .93 NA NA NA

Adaptive ClustersExecutive Function .84 .92 .93 NR NR NRGifted and Talented .90 .95 .96 NA NA NA

CAB and BASC-2 Item Gradients: Teacher Forms

for Adolescent Females

Raw Scores

BASC Aggress

CABAggress

BASCConduct

CABConduct

BASCDepress

CABDepress

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)

T 43 T 45 T 47 T 49 T 51 T 52 T 54 T 56

BASC %ile

CAB %ile

Normal %ile

CAB-PX – DSMD Comparable Scales

Scales r

Internalizing .69

Externalizing .70

Critical Behaviors .63

Anxiety .65

Depression .66

Attention Deficit .79

Autistic Spectrum .62

CAB Ability Scales and Clusters by Assessed Ability

(BBCS-R)

Competence

Executive Function

Gifted and Talented

CAB Ability Scales and Clusters by Assessed Ability

(NNAT)

Competence

Executive Function

Gifted and Talented

Conduct DisorderedStudents

Intern

alizing

Extern

alizing

Critical

cial Skills

etence

aptive

ression

gressio

llying

tistic

Gifted

Series1

Gifted and TalentedStudents

SAMPLE

- 45 Gifted Students- 45 Regular Education Students

RESULTS

- High Competence, EF and Gifted- Low pathology scales and clusters

Intern

Extern

etence

ression

gressio

llying

Gifted

GiftedNongifted

Replicated CAB Profiles of Replicated CAB Profiles of Gifted Students (SS > 120) Gifted Students (SS > 120)

(BBCS-R N=65; NNAT N=143)(BBCS-R N=65; NNAT N=143)

BBCS-R

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 ScoringProgram

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 = Normal Range

60 to 69 = Mild Clinical Risk

70 to 79 = Significant Clinical Risk

> 80 = 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 weakness20 - 29 = Significant adaptive weakness30 - 39 = Mild adaptive weakness40 - 59 = Normal range60 - 69 = Mild adaptive strength70 - 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 Clinicalclusters (i.e., Anxiety, Depression)

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)

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

InterpretingCAB

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 6-month 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

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 RetardationMental 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;

difficulty asking for help.

School is a source of angst; responds well to structure

Socially Maladjusted (BD) Unwilling to comply;

excessive absences; rejects help

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)

SchoolBehavior

AttitudeToward

School

Emotional Impaired (SED) Misses school due to

psychosomatic issues.

Achievement is uneven; impaired by emotions.

Socially Maladjusted (BD) Misses school due to

truancy.

Achievement is influenced by truancy, attitude toward school.

SchoolAttendance

EducationalPerformance

Emotional Impaired (SED) Ignored or rejected.

Younger friends; pseudo-friends; no real friends.

Socially Maladjusted (BD) Generally accepted by

sociocultural subgroup.

Friends primarily from same delinquent or sociocultural subgroup.

PeerRelations

Friendships

Emotional Impaired (SED) Perceived as bizarre, odd,

source of ridicule.

Poorly developed; immature; difficulty reading social cues; difficulty entering groups.

Socially Maladjusted (BD) Perceived as tough,

charismatic, accepted within subculture.

Well developed; mature; well attuned to social cues.

Perceptions of

SocialSkills

Emotional Impaired (SED) Inability to establish

relationships; avoids people; withdrawn.

Awkward; goofy; odd, may be uncomfortable with physicality.

Socially Maladjusted (BD) Extensive relations;

exploitive and manipulative; charming to achieve ends.

Smooth and agile; sexually precocious; dresses like subgroup (e.g., Goth).

Interper-sonal

Relations

PhysicalPresence

Emotional Impaired (SED) Affective Disorder;

Internalizing

Hurts self or others as an end.

Tense; fearful; manifest anxiety

Socially Maladjusted (BD) Conduct Disorder;

externalizing

Hurts others as a means to an end.

Appears relaxed; ‘cool’; situational anxiety related to consequences faced.

Locus of Disorder

Aggression

Anxiety

Emotional Impaired (SED) Labile; disproportionate

reactions, but not under student’s control.

Guilty; remorseful; self-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.

AffectiveReactions

Conscience

Emotional Impaired (SED) Fantasy; naïve; gullible;

thought disorders; hallucinations.

Inappropriate for age; immature; uneven; regressive

Socially Maladjusted (BD) “Street-wise”; understands

and manipulates facts; distorts rules and expectations.

Age appropriate or above; behaviorally precocious; ‘socially-mature’

Sense of Reality

Develop-mental

Appropriate-ness

ED/SM Scale Reliability

Differences Required for Significance

Magnitude of DifferenceBetween 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

Parent/Teacher Scale Contrasts

Scale Raw score

T score

%ile rank

90% C. I.

Qualitative classification

Clinical scale 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

Adaptive scale 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

CAB Behavioral Index (CBI) 355 57 74 55 - 59 Normal range

Scale Raw score

T score

%ile rank

90% C. I.

Clinical scale Internalizing Behaviors (INT) 22 38 11 33 - 43 Normal range

Externalizing Behaviors (EXT) 71 62 89 60 - 64 Mild CR

Adaptive scale Social Skills (SOC) 64 41 18 38 - 44 Normal range

Competence (COM) 29 62 89 59 - 65 Mild AS

CAB Behavioral Index (CBI) 186 51 55 49 - 53 Normal range

Parent/Teacher Cluster Contrasts

Cluster Raw score

T score

%ile rank

90% C. I.

Clinical cluster 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

Adaptive cluster Executive Function (EF) 29 62 89 58 - 66 Mild AS

Gifted and Talented (GAT) 119 61 87 57 - 65 Mild AS

Teacher

Parent/TeacherProfiles

Parent/Teacher ED/SM

Emotional Disturbance and Social Maladjustment Scales

Scale Raw score

T score

Qualitative Classification

Emotional Disturbance (ED) 57 40 Normal range

Social Maladjustment (SM) 166 68 Mild CR

Scale Raw score

T score

Qualitative Classification

Emotional Disturbance (ED) 20 37 Normal range

Social Maladjustment (SM) 98 69 Mild CR

Case Study SummaryRodney

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

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