2. CAT Author Bruce A. Bracken, PhD Professor
The College of William & Mary
School of Education
P.O. Box 8795
Williamsburg, VA
(757)

3. 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

4. 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

5. Historical Perspective of Attention Deficit
ADHD as a life-long condition - Early conceptualizations were that adults out-grew ADHD
Follow up studies revealed % 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

6. 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.

7. 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 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.

8. DSM-IV ADHD Criteria Hyperactivity
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.

9. 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).

10. 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

11. CAT-C and CAT-A Clinical Assessment of Attention Deficit

12. CAT Features CAT-C ‘Kiddy CAT’ CAT-A Ages Ages Forms Forms
8 to 18 years
Forms
Self Report
Parent Report
Teacher Report
CAT-A
Ages
19 to 79 years
Forms
Childhood Memories
Current Adult Symptoms

13. 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

14. 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

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

16. 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
4. Wrote 144 item adult scale according to diagnostic criteria and content analysis

17. Item Development and Refinement
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
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%
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)

18. Item Tryout, Norming, and Finalization
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
CAT-C forms were piloted and validated (N = 50), resulting in 83% to 88% correct classification of ADHD and control students
CAT-A and CAT-C scales were normed, validated, finalized, and published

19. CAT Scales and Clusters
Clinical Symptoms
Inattention
Impulsivity
Hyperactivity

20. CAT Scales and Clusters
Clinical Symptoms
Inattention
Impulsivity
Hyperactiity
Contexts
Personal
Academic/Occupational
Social

21. CAT Scales and Clusters
Clinical Symptoms
Inattention
Impulsivity
Hyperactivity
Contexts
Personal
Academic/Occupational
Social
Locus
Internal
External

22. CAT Blueprint

23. Final Forms 108-item Self Report CAT-A 42-item CAT-C Self-Report Form
3 Clinical Scales, 3 Context Clusters, 2 Locus Clusters
54-item Current Symptoms Form
54-item Childhood Memories Form
( minute total administration)
42-item CAT-C Self-Report Form
CAT-C Self Report (5 – 10 minute administration)
42-item CAT-C Parent Report Form
CAT-C Parent Report (5 – 10 minute administration)
42-item CAT-C Teacher Report Form
CAT-C Teacher Report (5 – 10 minute administration)

24. CAT-C Internal Consistency*
CAT-C Scale/Cluster Self Parent Teacher
Clinical Scale Inattention Impulsivity Hyperactivity
Context Cluster Personal Academic/Occupational Social
Locus Cluster Internal External
Clinical Index
* Reliabilities are also reported by age, gender, race/ethnicity

25. CAT-C Stability Coefficients*
CAT-C Scale/Cluster Self Parent Teacher
Clinical Scale Inattention Impulsivity Hyperactivity
Context Cluster Personal Academic/Occupational Social
Locus Cluster Internal External
Clinical Index
* Corrected for restriction or expansion in range

26. 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

27. 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)

28. CAT-C ADHD / LD Contrast
ADHD Self Ratings
LD Self Ratings
ADHD Parent Ratings
LD Parent Ratings
ADHD Teacher Ratings
LD Teacher Ratings

29. CAT-C ADHD / LD Contrast
ADHD Self Ratings
LD Self Ratings
ADHD Parent Ratings
LD Parent Ratings
ADHD Teacher Ratings
LD Teacher Ratings

30. CAT-C ADHD / LD Contrast
ADHD Self Ratings
LD Self Ratings
ADHD Parent Ratings
LD Parent Ratings
ADHD Teacher Ratings
LD Teacher Ratings

31. 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

32. CAT Administration & Scoring

33. CAT-C Teacher Scale Raw T %ile Qualitative classification Clinical
Inattention (ATT) > 99 Significant clinical risk
Impulsivity (IMP) Mild clinical risk
Hyperactivity (HYP) Mild clinical risk
Context
Personal (PER) Significant clinical risk
Acad/Occup (A/O) Mild clinical risk
Social (SOC) Mild clinical risk
Locus cluster
Internal (INT) Mild clinical risk
External (EXT) Significant clinical risk
CAT-C Clinical Index (CAT-C CI) Significant clinical risk

34. CAT-C Self and Teacher

36. 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

37. 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

38. CAT-A Internal Consistency*
CAT-A Scale/Cluster Childhood Current Memories Symptoms
Clinical Scale Inattention Impulsivity Hyperactivity
Context Cluster Personal Academic/Occupational Social
Locus Cluster Internal External
Clinical Index
Total Scale Clinical Index
* Coefficients also are reported for age, gender, and race/ethnicity

39. CAT-A Stability Coefficients*
CAT-A Scale/Cluster Childhood Current Memories Symptoms
Clinical Scale Inattention Impulsivity Hyperactivity
Context Cluster Personal Academic/Occupational Social
Locus Cluster Internal External
Clinical Index
Total Scale Clinical Index
* Coefficients are corrected for restriction and expansion in range

40. CAT-C ADHD / LD Contrast
ADHD Adult Ratings
LD Adult Ratings