CAD by w07PXmd

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									            Author

Bruce A. Bracken, PhD
Professor

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

(757) 221-1712
babrac@wm.edu
www.itc2004.com
www.psychoeducational.com
                    Author


Karen K. Howell, PhD
Senior Research Scientist

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

Phone: 404-712-9829
Fax: 404-712-9809
Email: khowell@emory.edu
                             Multifaceted Nature
                             of Adjustment

Multidimensional, context-dependent
                                                    ACADEMIC
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
                                                    COMPETENCE
   • Academic
   • Family
Developmental Nature
of Adjustment

          • Adjustment
            becomes
            increasingly
            differentiated
            with age

          • Life domains
            differentiate
            as a function
            of exposure to
            different contexts
                 Triangulation:
                 Multi-source, Multiple
                 Context Assessment
                     Other Sources
                     - Direct Observation
                        - Indirect Approaches
                            (e.g., Projective Techniques)
                              - Background Information
                                  - Self Statements
              Psychosocial
               Adjustment
                                    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
                               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
                            Content
                            Identification
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
                                     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
Normative Sample
Normative Sample
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
        CAD
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
CAD, BDI-II and RADS
 Concurrent Validity
CAD, BDI-II and RADS
 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
Dysthymia
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
Administration
 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
                         Appropriate
                         Populations

• 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
                        Professional
                        Requirements

• 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 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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