CAT Author

Bruce A. Bracken, PhDProfessor

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

Phone: (757) 221-1712Email: babrac@wm.edu

www.psychoeducational.com

Barbara S. Boatwright, PhDLicensed Clinical Psychologist

Psychology Associates of Mt. Pleasant1041 Johnnie Dodds Blvd. Suite 14 BMt. Pleasant, SC 29464

Email: barbarasboatwright@comcast.net

CAT Author

• 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 Perspectiveof Attention Deficit

• ADHD as a lifelong condition- Early conceptualizations were that adults outgrew ADHD

• Follow-up studies revealed - 30% to 80% of children with ADHD continued symptom manifestation into adulthood- Lower adult educational and occupational success- Lower socioeconomic status- More difficulty with co-workers and employers- Higher incidence of psychopathology- Increased likelihood of substance abuse

• ADHD Residual Type (DSM-III-R)- Continuation of ADHD symptoms into adulthood

Historical Perspective of Attention Deficit (continued)

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

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 ADHDCriteria (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 ADHDCriteria (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.

DSM-IV ADHDCriteria (continued)

Clinical Assessment of Attention Deficit

• Ages - 19 to 79 years

• Form – 2 parts - Childhood Memories - Current Adult Symptoms

Features

• 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

Features (continued)

A Multidimensional, Multi-Step, Multi-Year

Process

Constructing the CAT-A

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

Content Identification

Item Developmentand 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

• Clinical symptoms- Inattention- Impulsivity- Hyperactivity

CAT-A Scales and Clusters

• Clinical symptoms- Inattention- Impulsivity- Hyperactivity

• Contexts- Personal- Academic/Occupational- Social

CAT-A Scales andClusters (continued)

• Clinical symptoms- Inattention- Impulsivity- Hyperactivity

• Contexts- Personal- Academic/Occupational- Social

• Locus- Internal- External

CAT-A Scales andClusters (continued)

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 Memories SymptomsClinical scale

Inattention .89 .86Impulsivity .85 .85Hyperactivity .85 .76

Context clusterPersonal .84 .80Academic/Occupational .90 .68Social .78 .81

Locus clusterInternal .89 .83External .90 .83

Clinical Index .94 .91Total Scale Clinical Index .96* Coefficients also are reported for age, gender, and race/ethnicity.

Childhood Current

Stability Coefficients*

Childhood Current CAT-A scale/cluster Memories SymptomsClinical scaleInattention .77 .82Impulsivity .83 .84Hyperactivity .83 .83Context clusterPersonal .79 .83Academic/Occupational .84 .81Social .78 .83Locus clusterInternal .86 .86External .81 .83Clinical Index .86 .87Total Scale Clinical Index .88* Coefficients are corrected for restriction and expansion in range.

• 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.

Veracity Scales

• 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)

Validity

ADHD/LD Contrast

55575961636567

ADHD - Adult

LD - Adult

ADHD Adult RatingsLD Adult Ratings

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