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

5. Historical Perspective of Attention Deficit (continued)
ADHD as a lifelong condition - Early conceptualizations were that adults outgrew 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. 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.

7. 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.

8. 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).

9. 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.

10. Clinical Assessment of Attention Deficit

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

12. 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

13. 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

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

15. 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); years of age
reduced to 54 items on Current Symptoms Form
matching 54 items on Childhood Symptoms Form

16. Item Development and Refinement
Validated adult form (N = 369); 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

17. CAT-A Scales and Clusters
Clinical symptoms
Inattention
Impulsivity
Hyperactivity

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

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

20. 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)

21. Internal Consistency*
CAT-A scale/cluster 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.
Childhood Current

22. Stability Coefficients*
Childhood Current CAT-A scale/cluster 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.

23. 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.

24. 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)

25. ADHD/LD Contrast
ADHD Adult Ratings
LD Adult Ratings

26. 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

27. 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