CAT Author Bruce A. Bracken, PhD Professor The College of William & Mary School of Education P.O. Box 8795 Williamsburg, VA 23187-8795 Phone: (757) 221-1712 Email: babrac@wm.edu www.psychoeducational.com

CAT Author Barbara S. Boatwright, PhD Licensed Clinical Psychologist Psychology Associates of Mt. Pleasant 1041 Johnnie Dodds Blvd. Suite 14 B Mt. Pleasant, SC 29464 Email: barbarasboatwright@comcast.net

Historical Perspective of Attention Deficit Originally referred to as “minimal brain dysfunction” 1980 DSM-III identified attention deficit with hyperactivity (ADHD) and attention deficit without hyperactivity (ADD) and based diagnosis on the three core symptoms of - Sustained attention - Impulsivity - Motor activity Individuals with ADHD have more comorbid psychiatric and educational disorders (e.g., conduct problems, LD, poor peer relations) More recent developments have focused on separating ADHD from other psychiatric conditions (e.g., bipolar disorder, anxiety, depression, substance abuse) ADHD has 8% to 10% prevalence rate (APA, 2000); more males than females

Historical Perspective of Attention Deficit (continued) ADHD as a lifelong condition - Early conceptualizations were that adults outgrew ADHD Follow-up studies revealed - 30% to 80% of children with ADHD continued symptom manifestation into adulthood - Lower adult educational and occupational success - Lower socioeconomic status - More difficulty with co-workers and employers - Higher incidence of psychopathology - Increased likelihood of substance abuse ADHD Residual Type (DSM-III-R) - Continuation of ADHD symptoms into adulthood

DSM-IV ADHD Criteria Inattention Six or more symptoms of inattention present for at least 6 months to a point that is disruptive and inappropriate: Inattention Inattention to details; makes careless mistakes in school, work, and/or other activities. Has difficulty attending to tasks or other activities. Does not seem to listen when spoken to. Does not follow instructions and fails to finish schoolwork, chores, and/or duties in the workplace. Often has difficulty organizing activities. Often avoids, dislikes, or does not want to sustain mental effort for a long period of time. Loses things needed for tasks and activities. Easily distracted. Forgetful in daily activities.

DSM-IV ADHD Criteria (continued) Six or more of the following symptoms of hyperactivity-impulsivity present for at least 6 months to an extent that is disruptive and inappropriate: Hyperactivity Fidgets with hands or feet or squirms in seat. Gets up from seat when remaining in seat is expected. May feel very restless. Has difficulty enjoying leisure activities quietly. Is often “on the go” or often acts as if “driven by a motor.” Talks excessively.

DSM-IV ADHD Criteria (continued) Six or more of the following symptoms of hyperactivity-impulsivity present for at least 6 months to an extent that is disruptive and inappropriate: Impulsivity Blurts out answer before question has been completed. Has difficulty waiting one's turn. Interrupts or intrudes on others (e.g., butts into conversations). Some impairment from the symptoms is present in two or more settings (e.g., at school/work, at home). Clear evidence of significant impairment in social, school, and/or work functioning. Symptoms do not happen only during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder. Symptoms are not better accounted for by another mental disorder (e.g. mood disorder, anxiety disorder).

DSM-IV ADHD Criteria (continued) Based on these criteria, three types of ADHD are identified: ADHD, Combined Type: if criteria from inattention, hyperactivity, and impulsivity are documented . ADHD, Predominantly Inattentive Type: if inattention is documented, but impulsivity and hyperactivity are not.   ADHD, Predominantly Hyperactive-Impulsive Type: if hyperactivity and impulsivity are documented, but inattention is not.

Clinical Assessment of Attention Deficit

Features Ages Form – 2 parts - 19 to 79 years - Childhood Memories - Current Adult Symptoms

Features (continued) Employs a four-point item response format Strongly Agree Agree Disagree Strongly Disagree Is accompanied with optional CAT Software Portfolio (CAT-SP) that scores, profiles, reports data, and facilitates interpretation Standard scores (T scores) Percentile ranks Confidence intervals Qualitative classifications Graphical profile display

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

A Multidimensional, Multi-Step, Multi-Year Process Constructing the CAT-A A Multidimensional, Multi-Step, Multi-Year Process

Content Identification Approached the CAT from Bracken’s (1992) context-dependent model of adjustment Reviewed and evaluated existing attention deficit scales Identified relevant content Literature on attention deficit Item content on existing instruments Current diagnostic criteria from DSM-IV Suggestions from colleagues Wrote 144-item adult scale according to diagnostic criteria and content analysis Piloted adult form (N = 108); 17-48 years of age reduced to 54 items on Current Symptoms Form matching 54 items on Childhood Symptoms Form

Item Development and Refinement 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% Final items selected to include equal numbers of items within each of 18 individual cells Three Clinical scales Three Context clusters Two Locus clusters (3 Clinical scales x 3 Context clusters x 2 Locus clusters = 18 cells) 8. CAT-A scales were normed, validated, finalized, and published

CAT-A Scales and Clusters Clinical symptoms Inattention Impulsivity Hyperactivity

CAT-A Scales and Clusters (continued) Clinical symptoms Inattention Impulsivity Hyperactivity Contexts Personal Academic/Occupational Social

CAT-A Scales and Clusters (continued) Clinical symptoms Inattention Impulsivity Hyperactivity Contexts Personal Academic/Occupational Social Locus Internal External

Final Form 108-item CAT-A Self-Report Form 3 Clinical scales, 3 Context clusters, 2 Locus clusters Part I – Current Symptoms (54 items) Part II – Childhood Memories (54 items) (10-15 minute total administration)

Internal Consistency* CAT-A scale/cluster Memories Symptoms Clinical scale Inattention .89 .86 Impulsivity .85 .85 Hyperactivity .85 .76 Context cluster Personal .84 .80 Academic/Occupational .90 .68 Social .78 .81 Locus cluster Internal .89 .83 External .90 .83 Clinical Index .94 .91 Total 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 Symptoms Clinical scale Inattention .77 .82 Impulsivity .83 .84 Hyperactivity .83 .83 Context cluster Personal .79 .83 Academic/Occupational .84 .81 Social .78 .83 Locus cluster Internal .86 .86 External .81 .83 Clinical Index .86 .87 Total Scale Clinical Index .88 * Coefficients are corrected for restriction and expansion in range.

Veracity Scales Negative Impression − degree to which an individual consistently responds in a negative manner. Infrequency − extent to which an individual endorses items in an extreme manner that the normative sample did not endorse in an extreme manner. Positive Impression − extent to which an individual responds in an unusually positive manner.

Validity Types of validity investigated Content validity (DSM, literature) Concurrent validity (i.e., convergent/discriminant) - Connors Rating Scales - Brown Attention-Deficit Disorder Scales - Clinical Assessment of Depression Construct validity - Intercorrelations - Exploratory factor analyses Contrasted groups (i.e., ADHD, LD)

ADHD/LD Contrast ADHD Adult Ratings LD 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