Author Bruce A. Bracken, PhD Professor The College of William & Mary School of Education P.O. Box...

Author

Bruce A. Bracken, PhDProfessor

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

(757) [email protected]

Author

Karen K. Howell, PhDSenior Research Scientist

Emory University School of MedicineDepartment of Psychiatry and Behavioral SciencesMaternal Substance Abuse and Child Development Project1256 Briarcliff Road N.E., Suite 324WAtlanta, GA 30306

Phone: 404-712-9829Fax: 404-712-9809Email: [email protected]

Multifaceted Natureof 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

•AffectAffect•CompetenceCompetence•PhysicalPhysical

• Three interpersonal domainsThree interpersonal domains

•SocialSocial•AcademicAcademic•FamilyFamily

Developmental Natureof Adjustment

• Adjustmentbecomesincreasingly differentiatedwith age

• Life domains differentiateas a functionof exposure to different contexts

Triangulation:Triangulation:Multi-source, MultipleMulti-source, MultipleContext AssessmentContext Assessment

Self-Report - CAD - RADS - BDI

Third-Party Report - Clinical Assessment of Behavior (CAB) - DSMD - BASC

PsychosocialAdjustment

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

Constructing the CAD:Constructing the CAD:A Multidimensional,A Multidimensional,

Multi-Step, Multi-Year ProcessMulti-Step, Multi-Year Process

Depression

Approximately 2.5 percent of children and 8 percent of adolescents in the U.S. have depression. An NIMH-sponsored study of 9 to 17-year-olds, more than 6 percent in a 6-month period were depressed and 4.9 percent having major depression.

Research indicates that depression onset is occurring earlier in life today than in past.

National Institute of Mental Health

ContentIdentification

1. A review of the literature pertaining to child, adolescent, and adult development and depression

2. A review of item content from existing instruments

3. An examination of current diagnostic criteria based on the DSM-IV

4. Consideration of item content to reflect depressed mood among individuals across a wide age range

5. Suggestions from colleagues

6. Wrote 175 items across 16 content domains based on literature and DSM diagnostic criteria

Identification of relevant content was accomplished through:

Features

• Uses a Four-point Item response format • Strongly Agree• Agree• Disagree• Strongly Disagree

• Comes with CAD-SP that scores, profiles, reports data, and facilitates interpretation• Standard scores (T-scores)• Percentile ranks• Confidence intervals• Qualitative classifications• Graphical profile display

Features

• Single form appropriate for ages 8 to 79 years

• Easily administered 50 item scale

• Ten minute completion time

• Multidimensional view of depressions - Four Symptom Scales - Twelve Major Depressive Symptoms - Six Clinical Clusters - Three Veracity Scales

• Easily hand scored or optional software scoring system

• Based on DSM-IV diagnostic criteria and clinical literature

Features

• Critical Item clusters identify risk factors for potential self-harm

• Exceptional psychometric qualities

• Large, diverse, national normative sample

• Content appropriate, children, and adolescents without sacrificing face validity

Normative Sample

Scale Variance and Demographics

Four Clinical Scales

1. Depressed Mood (DM)• 23 items - - feelings of extreme unhappiness,

sadness, loneliness, lack of personal significance, poor self-concept, and discouraged outlook on life.

2. Anxiety/Worry (AW)• 11 items - - increased anxiety, worry, fear, and related

symptoms

Four Clinical Scales

3. Diminished Interest (DI)• 6 items - - loss of interest in activities that previously

were enjoyable, diminished excitement, lack of enjoyment, and not wanting to participate in daily routines

4. Cognitive and Physical Fatigue (CPF)• 10 items - - somatic issues, fatigue, sleeplessness,

insufficient energy, lack of mental of physical clarity, clumsiness or slowness, and inability to complete tasks

Six Critical Item Clusters

1. Hopelessness• 5 items - - sense that current conditions are

permanent and with no promise for improvement, extreme unhappiness, having given up on the future, and inability to continue the current level of suffering

2. Self-Devaluation• 5 items - - sense of self-loathing, failure, extreme

loneliness, and loss of personal meaning

3. Sleep/Fatigue• 3 items - - feelings of fatigue, lack of energy, and

desire to do little other than sleep

Six Critical Item Clusters

4. Failure• 3 items - - sense of limited personal competence or

an overwhelming sense of failure

5. Worry• 3 items - - feelings of generalized worry and worry

that bad things may happen

6. Nervous• 3 items - - feelings of anxiety, nervousness, and

limited ability to relax

CADTheoretical Structure

Internal Consistency by Age

Internal Consistencyby Gender

Internal Consistencyby Race/Ethnicity

Internal ConsistencyClinical Sample

Test-Retest Stability

CAD, BDI-II and RADSConcurrent Validity

Disordered Youth andAdults Corresponding Scales

Groups of disordered youth and adults perform in mild critical range on appropriate scales

Major Depression n = 48

Dysthymia n = 33

Mixed Clinical n = 108

Dysthymia

Mixed Clinical

CAD four-factor CFAconceptual model

CAD two-factor CFAconceptual model

CAD two-factor CFA—Factor loadings for the8- 17-year-old sample

CAD two-factor CFA—Factor loadings for the18- 79-year-old sample

Summary of Goodness-of-FitStatistics for CFA Models by Age

AdministrationAdministrationand Scoringand Scoring

Test Materials

• Test Kit Includes:• Comprehensive Professional Manual

• CAD Rating Form

• CAD Profile Form/Score Form

• CAD Scoring Program Software and Users’ Manual

AppropriatePopulations

• Normed, standardized, and validated foruse with children through adults:• ages 8 to 79 years

• both genders

• all racial/ethnic backgrounds

• all geographical regions and residential communities

• all socio-economic strata

• all disability subgroups

• all linguistic or cultural backgrounds

ProfessionalRequirements

• Individuals with adequate training may administer and score the CAD with supervision

• CAD interpretation requires formal training and/or graduate degree in:

• clinical psychology

• school psychology

• counseling psychology

• developmental/behavioral pediatrics

• or a related behavioral field

Scoring

• The CAD can be hand-scored or scored using the computerized CAD-SP

• Hand-scoring is accomplished using a carbonless form• Skipped Items and missing responses

• CAD-SP prorates scores when at least 90% of items on a scale are completed

• If more than 10% of the items on a scale are omitted,

CAD-SP treats scale as invalid

Score Report

Obtaining the Score Report• Administer CAD Rating Form• Open CAD Scoring Program (CAD-SP) on computer• Enter basic demographic data• Enter item responses

CAD-SP automatically calculates and provides• T-Scores• Percentile ranks• Confidence intervals• Clinical classifications• Graphical display of results

CAD ScoreSummary Report

Clinical Interpretation

Quantitative and Qualitative Interpretation Process

5-Step Interpretation Process

1. Interpret CAD Total Scale (CAD TS)

2. Interpret CAD Symptom Scales, Validity Scales and Critical Item Clusters

3. Interpret CAD Individual Items

4. Interpreting the follow-up Clinical Interview

5. Compare performance on the CAD in light of other test and background information

CAD Total Score(CAD TS)

• The CAD TS is best measure of “General Affectivity”• T Score Metric (i.e., Mean = 50, SD = 10)• Percentile Ranks• Confidence Intervals• Qualitative Classifications

≤ 59 = Normal Range60-69 = Mild Clinical Risk70-79 = Significant Clinical Risk≥ 80 = Very Significant Clinical Risk

Author Bruce A. Bracken, PhD Professor The College of William & Mary School of Education P.O. Box...

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