CAD by w07PXmd



Bruce A. Bracken, PhD

The College of William & Mary
School of Education
P.O. Box 8795
Williamsburg, VA 23187-8795

(757) 221-1712

Karen K. Howell, PhD
Senior Research Scientist

Emory University School of Medicine
Department of Psychiatry and Behavioral Sciences
Maternal Substance Abuse and Child Development
1256 Briarcliff Road N.E., Suite 324W
Atlanta, GA 30306

Phone: 404-712-9829
Fax: 404-712-9809
                             Multifaceted Nature
                             of Adjustment

Multidimensional, context-dependent
model of adjustment, with six primary
life domains:
                                        FAMILY                   S O CIAL
• Three intra-personal domains

   • Affect                                        GLOBAL
   • Competence                                  ADJUSTMENT
   • Physical

• Three interpersonal domains           PHYS ICAL                AFFECT

   • Social
   • Academic
   • Family
Developmental Nature
of Adjustment

          • Adjustment
            with age

          • Life domains
            as a function
            of exposure to
            different contexts
                 Multi-source, Multiple
                 Context Assessment
                     Other Sources
                     - Direct Observation
                        - Indirect Approaches
                            (e.g., Projective Techniques)
                              - Background Information
                                  - Self Statements
                                    Third-Party Report
Self-Report                         - Clinical Assessment of
- CAD                                 Behavior (CAB)
- RADS                              - DSMD
 - BDI                              - BASC
   Constructing the CAD:
     A Multidimensional,
Multi-Step, Multi-Year Process

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
Identification of relevant content was accomplished through:

  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

• 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
• 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

• Critical Item clusters identify risk factors for potential

• Exceptional psychometric qualities

• Large, diverse, national normative sample

• Content appropriate, children, and adolescents without
  sacrificing face validity
Normative Sample
Normative Sample
Normative Sample
Normative Sample
Scale Variance and
                       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
                         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

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
                              Six Critical Item

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

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
Theoretical Structure
Internal Consistency
       by Age
Internal Consistency
       by Age
Internal Consistency
       by Age
Internal Consistency
       by Age
Internal Consistency
     by Gender
Internal Consistency
  by Race/Ethnicity
Internal Consistency
  by Race/Ethnicity
Internal Consistency
  by Race/Ethnicity
Internal Consistency
  by Race/Ethnicity
Internal Consistency
   Clinical Sample
Test-Retest Stability
Test-Retest Stability
Test-Retest Stability
 Concurrent Validity
 Concurrent Validity
Disordered Youth and
Adults 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
Mixed Clinical
CAD four-factor CFA
conceptual model
CAD two-factor CFA
conceptual model
CAD two-factor CFA—
Factor loadings for the
8- 17-year-old sample
CAD two-factor CFA—
Factor loadings for the
18- 79-year-old sample
Summary of Goodness-of-Fit
Statistics for CFA Models
by Age
Summary of Goodness-of-Fit
Statistics for CFA Models
by Age
Summary of Goodness-of-Fit
Statistics for CFA Models
by Age
 and Scoring
                      Test Materials

• Test Kit Includes:
  • Comprehensive Professional Manual
  • CAD Rating Form
  • CAD Profile Form/Score Form
  • CAD Scoring Program Software and Users’ Manual

• Normed, standardized, and validated for
  use 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

• 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

• 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 Score
Summary Report
CAD Score
Summary Report
CAD Score
Summary Report
CAD Score
Summary 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 Range
    60-69   =   Mild Clinical Risk
    70-79   =   Significant Clinical Risk
    ≥ 80    =   Very Significant Clinical Risk

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