Ann Arbor Separation Agreement by rqd19206

VIEWS: 42 PAGES: 98

More Info
									                          Presentation Outline

 Author Introductions
 Multidimensional Adjustment and Assessment
 Characteristics of Existing Scales
   • Problems and Solutions
 Clinical Assessment of Behavior (CAB); Depression (CAD), Attention
  Deficit (CAT-A, CAT-C); Interpersonal Relations (CAIR)
   • Development Goals
   • Key Features
   • Description: Forms, Scales, and Clusters
   • Norm Characteristics and Technical Adequacy
   • Administration and Scoring
   • Interpretation
   • Case Studies
Author: CAB, CAD,
   CAT, CAIR

    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
    http://babrac.people.wm.edu/
                              CAB Author


Lori K. Keith, PhD
Staff Psychologist

The University of Tennessee
2348 Hickory Forest Drive
Memphis, TN 38119


keith1504@bellsouth.net
                           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
   • Competence                                    GLOBAL
                                                 ADJUSTMENT
   • Physical

 Three interpersonal domains
                                                                 AFFECT
   • Social                             PHYS ICAL
   • Academic
   • Family                                         COMPETENCE
Developmental Nature of
      Adjustment


           • Adjustment becomes
             increasingly
             differentiated with age

           • Life domains
             differentiate as a
             function of exposure
                                  Triangulation:
                               Multi-source, Multiple
                                Context Assessment
                                      Other Sources
                                     - Direct Observation
                                         - Indirect Approaches
                                             (e.g., Projective Techniques)
                                                - Background Information
                             Behavioral and         - Clinical Interview
                              Psychosocial
                              Adjustment
                                                        Third-Party Report
  Self-Report
- Multidimensional Self Concept Scale
                                                        - CAB Parent or
- Clinical Assessment of Depression                        Teacher
- Clinical Assessment of Attention Deficit              - CAT Parent/Teacher
- Clinical Assessment of Interpersonal Relations        - Achenbach,
                        Behavior Rating Scales:
                          Common Concerns

   Too broad in content - - (e.g., Internalizing/externalizing)
   Too narrow in content - - (e.g., Social skills, anxiety, ADD)
   Failure to adequately assess adaptive skills and adjustment
   Failure to combine educational disorders with psychopathology
   Too narrow in age range - - (e.g., Preschool and kindergarten)
   Limited technical adequacy – (e.g., rater-rater reliability)
   Outdated norms
   Multiple forms across age span – limiting longitudinal follow up
   Poor content match between Parent and Teacher forms
   Critical items not easily identified
   Scoring software sold separately or not available
   Limited ceilings and floors (i.e., over-pathologizing)
   No veracity scale
                                CAB
            Clinical Assessment
                  of Behavior
“the CAB represents one of the very best additions to the pool
of child behavior rating scales during the past decade or two”
   Merrell, K. W. (2007). Behavior, social, and emotional assessment of children and
          adolescents (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
                                  CAB Features

 Uses a Five-point Item response format
   • Always - Very Frequently
   • Often
   • Occasionally
   • Rarely
   • Never

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

 Critical Behaviors: low-incidence behaviors that define serious
  psychopathology and sociopathy
   • Psychotic experiences (e.g., Hallucinations)
   • Substance abuse
   • Satanic worship
   • Gang-related behaviors

 Addresses behaviors exhibited in medical and neuropsychological
  conditions
   • Attention-deficit/hyperactivity disorders
   • Learning disabilities
   • Executive function strengths and limitations
   • Autistic spectrum behaviors
                                      CAB Features


 Assesses behaviors that correspond to IDEA and DSM educational
  exceptionalities and conditions
   • Mental retardation
   • Learning disabilities
   • Gifted and talented
   • Adaptive behaviors
   • Social skills

 Assesses current societal concerns about youth
   • Aggression
   • Anger management
   • Conduct problems
   • Bullying http://www.stopbullyingnow.hrsa.gov/
                 http://www.pta.org/bullying/
                 http://www.naspcenter.org/factsheets/bullying_fs.html
                 http://www.psychologymatters.org/bullying.html
                       Developmental Delay


 (b) Children aged three through nine experiencing
  developmental delays. Child with a disability for children
  aged three through nine (or any subset of that age range,
  including ages three through five), may, subject to the
  conditions described in §300.111(b), include a child--
 (1) Who is experiencing developmental delays, as defined
  by the State and as measured by appropriate diagnostic
  instruments and procedures, in one or more of the
  following areas: physical development, cognitive
  development, communication development, social or
  emotional development, or adaptive development;
   Constructing the CAB:
A Multidimensional, Multi-Step,
     Multi-Year Process
                           Content Identification

1.   Approached the CAB from Bracken‟s (1992) context-dependent
     model of adjustment

2.   Reviewed and evaluated existing behavior rating scales

3.   Investigated agreement between biological mothers‟ and fathers‟
     ratings

4.   Identified relevant content
     • Literature on childhood and adolescence
     • Item content on existing instruments
     • Current diagnostic criteria from DSM-IV
     • Current behaviors of concern and interest
     • Suggestions from colleagues
                              Item Development
                               and Refinement

5. Wrote 1300 items on a diagnostic criteria and content analysis basis

6. Following content analysis, 1300 items were reduced to 528 items

7. Item Assignment to one of six primary scales
     • Internalizing Behaviors
     • Externalizing Behaviors
     • Critical Behaviors
     • Social Skills
     • Competence
     • Adaptive Behaviors
                    Item Tryout, Norming, and
                           Finalization

8.   528-item version CAB was administered to 276 respondents for
     analysis of
      • Preliminary scale reliabilities
      • Inter-parent agreement
      • Item reading level

9.   Eliminated items with low internal consistency and low inter-parent
     agreement - - 260 Items were normed

10. Reliability and factor analyses were performed to further refine scales,
    resulting in final parent and teacher forms
                                Final Forms

 170-item Comprehensive CAB-PX
   • 3 Clinical Scales, 10 Clinical Clusters
   • 3 Adaptive Scales, 2 Adaptive Cluster
   • CAB-PX Record Form (15 - 20 minute administration)

 70-item abbreviated CAB-P
   • 2 Clinical Scales, 10 Clinical Clusters
   • 2 Adaptive Scales, 2 Adaptive Cluster
   • CAB-P Record Form (5 – 10 minute administration)

 70-item matching CAB-T
   • Items matched to the CAB-P
   • CAB-T Record Form (5 – 10 minute administration)
CAB Parent and Teacher
       Forms
                                  CAB
                             Normative Sample

Sample Size                Males    Females     Total
   Parent Forms
            - ages 2 – 6    309        291       600
          - ages 7 – 12     455        422       877
        - ages 13 – 18      318        319       637
   Teacher Form
            - ages 2 – 6    145         95       240
          - ages 7 – 12     471        288       759
        - ages 13 – 18      391        299       690

Race/Ethnicity (Percent Representation)
    Whites         Blacks       Hispanics     Other
   65 – 71%       12 – 17%       9 – 12%      6 – 8%
                            CAB
                       Normative Sample
Education Level        CAB-P      CAB-T

         < 11 years      3.9%        3.2%
            12 years    23.9%        2.5%
       13 - 15 years    38.7%       11.4%
            16 years    14.6%       17.5%
         > 17 years     18.8%       65.2%
          Unknown        0.1%        0.2%

Geographic Region

          Midwest      21 – 25%   17 – 22%
         Northeast     13 – 22%   22 – 25%
            South      35 – 45%   36 – 39%
             West      19 – 22%   17 – 20%
                      Scale Variance Associated
                     With Demographic Variables
              Age          Gender        Race          Parent Ed
CAB-PX
Clinical   .19 - 4.93% .08 - 2.82%      .01 - .59%     .21 - .72%
Adaptive 1.44 - 49.70% 1.80 - 2.96%     .01 - .03%     .03 - .81%

CAB-P
Clinical    .45 - .49%    .25 - 2.76%    .08 - .38%     .31 - .37%
Adaptive   .08 - 2.02%   2.82 - 3.39%   .00 - .02%     .62 - .74%

CAB-T
Clinical    .71 - .76%   1.66 - 8.35%    .30 - 3.17%        -- --
Adaptive   .74 - 1.61%   8.24 - 9.24%   1.35 - 2.62%       -- --
                      Scale Variance Associated
                     With Demographic Variables
               Age         Gender           Race       Parent Ed
CAB-PX
Clinical    .19 - 4.93% .08 - 2.82%      .01 - .59%    .21 - .72%
Adaptive   1.44 - 49.70% 1.80 - 2.96%    .01 - .03%    .03 - .81%

CAB-P
Clinical    .45 - .49%   .25 - 2.76%     .08 - .38%    .31 - .37%
Adaptive   .08 - 2.02%   2.82 - 3.39%   .00 - .02%     .62 - .74%

CAB-T
Clinical   .71 - .76%    1.66 - 8.35%   .30 - 3.17%     -- --
Adaptive   .74 - 1.61%   8.24 - 9.24%   1.35 - 2.62%    -- --
     CAB Structure
Forms, Scales, and Clusters
                        CAB Scale Structure and
                           Number of Items
   Scale                     CAB-PX   CAB-P   CAB-T
Clinical Scales
   Internalizing               30      16      16
   Externalizing               30      18      18
   Critical Behaviors          30      --      --

Adaptive Scales
  Social Skills                30      18      18
  Competence                   30      18      18
  Adaptive Behaviors           20      --      --

Total Scale                   170      70      70
                                      Clinical
                                  Scale Definitions

Internalizing Behaviors Scale (INT)
 Assesses behaviors directed toward oneself (e.g., behaviors related to
   depression, anxiety, and somatization
   - cries easily; is easily startled; is emotionally fragile

Externalizing Behaviors Scale (EXT)
 Assesses problematic conduct directed toward others, including rule-
   breaking behaviors
   - insults others; is difficult to manage; ignores rules

Critical Behaviors Scale (CRI)
 Assesses behaviors associated with serious psychopathology and sociopathy
   - uses illegal drugs; hallucinates; expresses an unusual interest in
     Satan
                                         Adaptive
                                     Scale Definitions

Social Skills Scale (SOC)
 Assesses interpersonal interactions with peers and adults
   - listens attentively to others; is considerate of others; annoys others

Competence Scale (COM)
 Focuses on cognitive and language development and ability to get needs met
  - has poor judgment; is easily confused; learns new things easily

Adaptive Behaviors Scale (ADB)
 Assesses developmental progress and degree of independence
  - dresses self; reliably makes simple purchases; prepares simple
    meals for self
                                     CAB Clusters and
                                     Number of Items
   Clusters                            CAB-PX   CAB-P   CAB-T

Clinical Clusters
   Anxiety                               23      11      11
   Depression                            36      16      16
   Anger                                 15       9       9
   Aggression                            25      13      13
   Bullying                              36      13      13
   Conduct Problems                      28       8       8
   Attention Deficit/Hyperactivity       21      20      20
   Autistic Spectrum Behaviors           30      13      13
   Learning Disability                   23      15      15
   Mental Retardation                    25      12      12

Adaptive Clusters
  Executive Function                     17      13      13
  Gifted and Talented                    27      17      17
Theoretical Structure of
         CAB
                            CAB PX, P, and T
                              Reliabilities

 Internal Consistency (Coefficient Alpha)
    • Total Sample
    • Age Level
    • Gender
    • Race/Ethnicity
    • Clinical Sample

 Stability Coefficients
   • 2 - 4 week interval

 Inter-rater Reliability
    • Parent - Parent
    • Parent - Teacher
                                 CAB-PX
                           Internal Consistency
          Scales           r               Clusters          r
Internalizing Behaviors          Anxiety (ANX)               .93
(INT)                      .95   Depression (DEP)            .95
                                 Anger (ANG)                 .93
Externalizing Behaviors    .97
(EXT)                            Aggression (AGG)            .95
                                 Bullying (BUL)              .97
Critical Behaviors (CRI)   .91
                                 Conduct Problems (CP)       .92
Social Skills (SOC)        .95   Attention-Deficit (ADH)     .94
                                 Autistic Spectrum (AUT)     .92
Competence (COM)           .94
                                 Learning Disability (LD)    .92
Adaptive Behaviors (ADB)   .92   Mental Retardation (MR)     .91
Total (TOT)                .98   Executive Function (EF)     .91
                                 Gifted and Talented (GAT)   .94
                                CAB-P
                          Internal Consistency

          Scales          r               Clusters          r
                                Anxiety (ANX)               .88
Internalizing Behaviors   .89
(INT)                           Depression (DEP)            .90
                                Anger (ANG)                 .90
Externalizing Behaviors   .95
(EXT)                           Aggression (AGG)            .92
                                Bullying (BUL)              .94
                                Conduct Problems (CP)       .90
Social Skills (SOC)       .92   Attention-Deficit (ADH)     .94
                                Autistic Spectrum (AUT)     .89
Competence (COM)          .92
                                Learning Disability (LD)    .90
                                Mental Retardation (MR)     .90
Total (TOT)               .97   Executive Function (EF)     .91
                                Gifted and Talented (GAT)   .92
                                CAB-T
                          Internal Consistency
          Scales          r               Clusters          r
Internalizing Behaviors         Anxiety (ANX)               .92
(INT)                     .92   Depression (DEP)            .93
                                Anger (ANG)                 .94
Externalizing Behaviors   .98
(EXT)                           Aggression (AGG)            .97
                                Bullying (BUL)              .97
                                Conduct Problems (CP)       .96
Social Skills (SOC)       .96   Attention-Deficit (ADH)     .97
                                Autistic Spectrum (AUT)     .93
Competence (COM)          .96
                                Learning Disability (LD)    .95
                                Mental Retardation (MR)     .95
Total (TOT)               .99   Executive Function (EF)     .95
                                Gifted and Talented (GAT)   .96
                            Comparative Reliabilities by
                                 Ethnic Groups
                        Caucasian     African-American   Hispanic
Clinical
        Internalizing     .94 - .95        .93 - .96     .91 - .96
       Externalizing      .96 - .97        .96 - .97     .93 - .98
   Critical Behaviors     .71 - .92        .80 - .98     .42 - .92

Adaptive
       Social Skills      .92 - .96        .92 - .95     .89 - .96
       Competence         .91 - .95        .92 - .95     .89 - .97
  Adaptive Behavior       .79 - .89        .82 - .90     .84 - .89

Total Scale
   CBI                    .97 - .99        .98 - .99     .96 - .99
   Clusters               .84 - .97        .85 - .97     .78 - .97
                                               CAB Inter-rater
                                                Coefficients

 Scale                         CAB-PX*            CAB-P*       CAB-T**

Internalizing                            .78         .75         .40
Externalizing                            .81         .80         .54
Critical Behaviors                       .41         --           --
Social Skills                            .62         .66         .44
Competence                               .79         .83         .58
Adaptive Behaviors                       .53         --           --
CAB Behavioral Index                     .82         .81         .55
CAB Clusters                       .70 - .90       .64 - .87   .44 - .56
 * Parent - Parent ** Parent - Teacher
                                    CAB Stability
                                     Coefficients

 Scale                 CAB-PX         CAB-P        CAB-T

Internalizing              .89           .82        .93
Externalizing              .90           .90        .93
Critical Behaviors         .77           --          --
Social Skills              .92           .89        .92
Competence                 .92           .90        .93
Adaptive Behaviors         .87           --          --
CAB Behavioral Index       .94           .92        .94
CAB Clusters            .83 - .94      .80 - .93   .89 - .95
                                CAB Validity


 Respondent Veracity
 Frequency of Extreme Scores in the Normative Sample
 Content Validity
 Construct Validity
   • Factor Analyses
 Convergent Validity
   • Correlations with BASC and DSMD Scales
 Contrasted Groups
   • Clinical Groups (e.g., Conduct Disordered)
   • Exceptional Groups (e.g., Intellectually Gifted)
Respondent Veracity:
Profile Classifications

    0 – 1 Clinical Clusters > 70, p = .95
    2 – 5 Clinical Clusters > 70, p < .05
    6 – 10 Clinical Clusters > 70, p < .01




    0 – 1 Clinical Clusters < 30, p = .95
    2 – 5 Clinical Clusters < 30, p < .05
    6 – 10 Clinical Clusters < 30, p < .01
                    CAB-PX – BASC-PRS
                     Comparable Scales

  Scales               r
Internalizing         .70
Externalizing         .80
Social Skills         .72
Competence            .74 (Adaptability)
Anxiety               .57
Depression            .77
Aggression            .75
Conduct Problems      .82
Attention Deficit     .76 (Attention)
Attention Deficit     .73 (Hyperactivity)
                    CAB-P – BASC-PRS
                     Comparable Scales

  Scales               r
Internalizing         .69
Externalizing         .79
Social Skills         .71
Anxiety               .53
Depression            .75
Aggression            .75
Conduct Problems      .72
Attention Deficit     .76 (Attention)
Attention Deficit     .73 (Hyperactivity)
                      CAB-T – BASC-TRS
                       Comparable Scales

  Scales                 r
Internalizing           .64
Externalizing           .77
Social Skills           .63
Anxiety                 .56
Depression              .59
Aggression              .75
Conduct Problems        .61
Attention Deficit       .76 (Attention)
Attention Deficit       .66 (Hyperactivity)
Learning Disability     .62 (Learning Problems)
Gifted and Talented     .69 (Study Skills)
                                  CAB-PX – BASC2 PRS
                                   Internal Consistency
                                         (Scales)
                                         CAB               BASC-2
Clinical Scales                    P      C    A      P      C          A
    Males: Internalizing           .94   .95   .95   .86    .91     .91
    Males: Externalizing           .96   .97   .97   .91    .94     .95
    Females: Internalizing         .95   .96   .96   .88    .90     .91
    Females: Externalizing         .96   .97   .97   .88    .93     .92
Adaptive Scales                    P     C     A      P     C       A
    Males: Social Skills           .91   .96   .96   .89    .87     .88
    Males: Adaptive Behaviors      .89   .84   .80   .93    .95     .95
    Females: Social Skills         .91   .95   .96   .87    .87     .87
    Females: Adaptive Behaviors    .89   .84   .82   .92    .95     .95
    Males: Total Scale Score       .97   .99   .99   .94    .95     .95
    Females: Total Scale Score     .98   .98   .99   .93    .95     .94
                                     CAB-PX – BASC2 PRS
                                      Internal Consistency
                                        (Clusters: Males)
                                            CAB            BASC-2
Clinical Clusters                     P      C     A     P   C    A

   Anxiety                            .91    .94   .97   .78   .80   .83
   Depression                         .94    .96   .96   .87   .87   .87
   Anger                              .91    .94   .95   NR    NR    NR
   Aggression                         .94    .96   .96   .93   .93   .93
   Bullying                           .95    .97   .97   NR    NR    NR
   Conduct Problems                   .84    .91   .94   NA    .92   .91
   Attention Deficit/Hyperactivity    .90    .95   .95   .92   .95   .95
   Autistic Spectrum Behaviors        .90    .95   .95   NA     NA   NA
   Learning Disability                .89    .93   .93   NA    .89   .87
   Mental Retardation                 .86    .92   .93   NA    NA    NA

Adaptive Clusters
  Executive Function                  .84    .93   .93   NR    NR    NR
  Gifted and Talented                 .90    .95   .95   NA    NA    NA
                                     CAB-PX – BASC2 PRS
                                      Internal Consistency
                                       (Clusters: Females)
                                            CAB            BASC-2
Clinical Clusters                     P      C     A     P   C    A

   Anxiety                            .92    .94   .94   .83   .81   .85
   Depression                         .95    .96   .96   .88   .87   .86
   Anger                              .90    .94   .94   NR    NR    NR
   Aggression                         .93    .95   .95   .91   .91   .93
   Bullying                           .95    .97   .96   NR    NR    NR
   Conduct Problems                   .91    .90   .94   NA    .92   .91
   Attention Deficit/Hyperactivity    .91    .94   .94   .91   .93   .90
   Autistic Spectrum Behaviors        .90    .93   .94   NA     NA   NA
   Learning Disability                .90    .93   .94   NA    .89   .86
   Mental Retardation                 .86    .93   .93   NA    NA    NA

Adaptive Clusters
  Executive Function                  .84    .92   .93   NR    NR    NR
  Gifted and Talented                 .90    .95   .96   NA    NA    NA
                      CAB and BASC-2 Item
                     Gradients: Teacher Forms
                      for Adolescent Females
 Raw     BASC       CAB       BASC      CAB      BASC       CAB
Scores   Aggress   Aggress   Conduct   Conduct   Depress   Depress

 20       108        49        103       57        98        36
 18       102        47        97        56        93        33
 16        96        43        91        54        87        26
 14        89        38        85        52        81       < 26
 12        83       < 38       80        49        76       < 26
 10        76       < 38       74        45        70       < 26
  8        70       < 38       68        36        65       < 26
  6        63       < 38       62       < 36       59       < 26
  4        57       < 38       56       < 36       53       < 26
  2        51       < 38       50       < 36       48       < 26
                            Aggression T-Score to
                              Percentile Rank
                          (CAB-T and BASC-2 TRS)

90
80
70
60
                                                             BASC %ile
50
                                                             CAB %ile
40
                                                             Normal %ile
30
20
10
 0
     T 43   T 45   T 47   T 49   T 51   T 52   T 54   T 56
                     CAB-PX – DSMD
                     Comparable Scales

  Scales               r
Internalizing         .69
Externalizing         .70
Critical Behaviors    .63
Anxiety               .65
Depression            .66
Conduct Problems      .76
Attention Deficit     .79
Autistic Spectrum     .62
                          CAB Ability Scales and
                        Clusters by Assessed Ability
                                 (BBCS-R)

65


60


55                                                     Competence
                                                       Executive Function
50                                                     Gifted and Talented


45
              BBCSR




                          BBCS-R




                                    BBCS-R




                                              BBCS-R
     BBCS-R




                                    111-120
              80 - 89




                           90-110




                                               > 120
      < 80
                      CAB Ability Scales and
                    Clusters by Assessed Ability
                              (NNAT)

65


60

                                                 Competence
55                                               Executive Function
                                                 Gifted and Talented
50


45
     NNAT




                      90-110




                               111-120
            80-89
            NNAT




                      NNAT




                                         NNAT
                                          >120
                                NNAT
      <80
                               Series1
Conduct Disordered




                                                   Gifted and
    Students




                                                   Executive
                                                   MR
                                                   LD
                                                   Autistic
                                                   ADHD
                                                   Conduct
                                                   Bullying
                                                   Aggression
                                                   Anger
                                                   Depression
                                                   Anxiety
                                                   Adaptive
                                                   Competence
                                                   Social Skills
                                                   Critical
                                                   Externalizing
                                                   Internalizing




                     70
                          60
                                  50
                                         40
                                              30
                                                      Gifted and Talented
                                                            Students

      SAMPLE             65
                                                                                                                  Gifted
                                                                                                                  Nongifted
                         60
- 45 Gifted Students
- 45 Regular Education   55

   Students              50

                         45
     RESULTS
                         40

- High Competence,       35
                              Internal
                                         External
                                                    Social
                                                             Competence
                                                                          CBI
                                                                                Anxiety
                                                                                          Depression
                                                                                                       Anger
                                                                                                               Aggression
                                                                                                                            Bullying
                                                                                                                                       Conduct
                                                                                                                                                 ADD
                                                                                                                                                       Autism
                                                                                                                                                                LD
                                                                                                                                                                     MR
                                                                                                                                                                          EF
                                                                                                                                                                               Gifted
   EF and Gifted
- Low pathology
   scales and clusters
                       35
                            40
                                 45
                                       50
                                               55
                                                    60
                                                         65
      Internalizin g
      Externalizing

       Social Skills
      Competence

               CBI
           Anxiety
       Depression

             Anger
       Aggression

          Bullying
Conduct Problems

       ADD/ADHD

 Autistic Spectrum

                LD
               MR
Executive Function
Gifted and Talented
                                                              (BBCS-R N=65; NNAT N=143)




                                      NNAT
                                      BBCS-R
                                                                                          Gifted Students (SS > 120)
                                                                                          Replicated CAB Profiles of
Administration & Scoring
                                 Administration

For Multiple-Source, Multiple-Context Ratings:
 Forms should be completed by
    • one or both parents/ guardians
    • one or more of the child‟s teachers

 CAB Rating Forms must be completed by:
   • an adult with functional literacy
   • an adult rater who knows the child/adolescent well
   • an adult with at least 4 weeks of home or school contact
                                         Scoring


 For all practical purposes, the CAB must be scored using the
  computerized CAB-SP
   • However, scoring key and norms tables are provided in
     Professional Manual per AERA, APA, NCME standards
 Skipped Items and Missing Responses
   • For skipped items the CAB-SP will prorate raw scores on each
     scale when at least 90% of the items on the scale were completed
   • If more than 10% of the items on a scale are incomplete, CAB-SP
     will not calculate scores for that scale and results will be considered
     invalid
CAB Scoring
 Program
Interpreting the CAB
                            Clinical Interpretation


       Quantitative and Qualitative Interpretation Process
                 5-Step Interpretation Process
1.   Consider CAB total scale score (i.e., CAB Behavioral Index)
2.   Consider CAB scale and cluster scores individually and in combination
3.   Compare scale and cluster scores acquired from different sources (e.g.,
     parents/teachers)
4.   Explore clinically informing items
5.   Contrast student‟s performance on the CAB forms, scales, and clusters in
     light of other available information
                          CAB Behavioral Index
                                (CBI)

 The CBI is a summation of all items, representing the best estimate of
  the examinee‟s overall level of psycho-social adjustment

 CAB CBI, Scales and Clusters employ a T-score metric, with the mean
  set at 50, standard deviations set to 10

 CBI T-Scores
      < 59       =   Normal Range
    60 to 69     =   Mild Clinical Risk
    70 to 79     =   Significant Clinical Risk
       > 80      =   Very Significant Clinical Risk
                        Qualitative Classifications

T-score Qualitative classification for range Clinical scales and clusters
     < 59    = Normal range
    60 - 69 = Mild clinical risk
    70 - 79 = Significant clinical risk
     > 80    = Very significant clinical risk

T-score Qualitative classification for Adaptive scales and clusters
     <19     = Very significant adaptive weakness
   20 - 29   = Significant adaptive weakness
   30 - 39   = Mild adaptive weakness
   40 - 59   = Normal range
   60 - 69   = Mild adaptive strength
   70 - 79   = Significant adaptive strength
    > 80     = Very significant adaptive strength
                                  Clinical Scale
                                  Interpretation


 Internalizing Behaviors (INT)

   • Elevated T-scores indicate a significant number of
     internalizing problem behaviors endorsed

   • Follow up: interpret internalizing-related Clinical
     clusters (i.e., Anxiety, Depression)
                                      Clinical Scale
                                      Interpretation

 Externalizing Behaviors (EXT)

   • Elevated T-scores reflect concerns about examinee‟s anger, aggression,
     acting-out behaviors, behavioral conduct, interactions with others, and
     interaction with, or reaction to, society

   • Follow up: interpret externalizing-related Clinical clusters (i.e., Anger,
     Aggression, Bullying, Conduct Problems)
                                   Clinical Scale
                                   Interpretation

 Critical Behaviors (CRI) - only on CAB-PX

  • High T-scores suggest of clinical risk for serious maladjustment,
    psychopathology, sociopathy, or behavioral disturbance

  • Consider behaviors in light of examinee‟s chronological age and
    developmental stage

  • Follow up: inspect specific items endorsed as problematic
                                     Adaptive Scale
                                     Interpretation

 Social Skills (SOC)
   • Elevated T-scores reflect positive social interactions and behavioral
     adjustment
   • Scores below normal range indicate adaptive weakness
   • Follow up: consider specific behaviors for intervention

 Competence (COM)

   • High T-scores reflect good adjustment and adaptive strength in
     independence, and cognitive and language functioning
   • Low scores imply limitations in independent problem solving
   • Follow up: especially important in identifying mentally retarded or gifted
     and talented
                                    Adaptive Scale
                                    Interpretation

 Adaptive Behaviors (ADB) – only on CAB-PX

   • High T-scores reflect good overall adaptive functioning or adaptive
     strength

   • Low scores suggest limitations in adaptive functioning

   • important in ruling out adaptive behavior problems among children
     and adolescents with possible mental retardation

   • Follow up: useful for program planning, identifying behaviors for
     remediation, and helping set goals for intervention
  Interpreting
      CAB
Clinical Clusters
                                            Anxiety

CAB Clinical Scale: Anxiety Cluster (ANX)
     - is insecure; is very nervous; is fearful
 12 to 20% Incidence Rate for Children and Adolescents
 more prevalent among females than males
“Separation Anxiety Disorder and Specific Phobia are more common in
younger children, about ages 6-9 years old. Generalized Anxiety Disorder
(GAD) and Social Anxiety Disorder (SAD) are more common in middle
childhood and adolescence. Panic Disorder can occur in adolescence as well.

                 Anxiety Disorders Association of America
 Associated Clinical Clusters: Depression, Learning Disability,
  Attention Deficit/Hyperactivity
                                      Depression

 CAB Clinical Scale: Depression Cluster (DEP)
  - appears depressed; lacks energy; cries easily
 2 to 8% Incidence Rate for Children and Adolescents

 Similar incidence for both genders in early childhood, in adolescence twice
  as many females as males
                                         Depression

“Up to 2.5 percent of children and up to 8.3 percent of adolescents in the U.S.
suffer from depression. An NIMH-sponsored study of 9 to 17-year-olds
estimated that the prevalence of any depression is more than 6 percent in a 6-
month period, with 4.9 percent having major depression. In addition, research
indicates that depression onset is occurring earlier in life today than in past
decades.”

                  National Institute of Mental Health

Associated Clinical Clusters: Anxiety, Conduct Problems, Learning Disability,
Attention Deficit/Hyperactivity, Mental Retardation
                                          Anger

 CAB Clinical Scale: Anger Cluster (ANG)
  - is argumentative; becomes violent; is easily angered
 Not a diagnosable condition but the failure to manage anger
  appropriately has become an increasing concern in our society

 Anger acted out against society occurs more frequently among males
  than females

 Cluster includes verbally and physically expressed anger

 Associated Clinical Clusters: Aggression, Bullying, Conduct Problems,
  and Depression
                                          Aggression

 CAB Clinical Scale: Aggression Cluster (AGG)
  - tries to intimidate others; threatens others; starts fights

 Not a diagnosable condition but aggression is a clinical symptom found in
  several clinical disorders (e.g., Oppositional Defiant Disorder, Conduct
  Problems)

 Males generally demonstrate more problematic aggression than females

 Clusters include behaviors representing mild, moderate, and severe forms
  of aggression and acts of aggression against people and objects

 Associated Clinical Clusters: Anger, Bullying, and Conduct Problems
                                                Bullying

 CAB Clinical Scale: Bullying Cluster (BUL)
  - is very abusive; intentionally provokes others; insults others

 Not a diagnosable condition but bullying along with anger and aggression are all
  major societal concerns and important symptoms of conditions such as Oppositional
  Defiant Disorder and Conduct Disorder.

 26% of boys,14% of girls have been identified as bullies

  “Surveys indicate that as many as half of all children are bullied at some time during
   their school years, and at least 10% are bullied on a regular basis.”

            American Academy of Child & Adolescent Psychiatry

 Associated Clinical Clusters: Anger, Aggression, and Conduct Problems
                                     Conduct Problems

 CAB Clinical Scale: Conduct Problems Cluster (CP)
  - breaks curfew; skips school; vandalizes public property
 Estimated 1 to 10% Incidence Rate for Children
 5% to 15% of males, 2% to 10% of females

 “The prevalence of Conduct Disorder appears to have increased over the last
  decades and may be higher in urban than rural settings. Rates vary widely
  depending on the nature of the population sampled and methods of ascertainment.
  General population studies report rates ranging from less than 1% to more than
  10%. Prevalence rates are higher among males than females.”
                                    DSM-IV-TE
 Associated Clinical Clusters: Aggression, Anger, Bullying, Depression
                                    Learning Disability

 CAB Clinical Scale: Learning Disability (LD)
  - gives up too easily; is easily frustrated with schoolwork; is forgetful
 5 to 10% Prevalence Rate
 2 to 4 males for every female are identified with a learning disability
 “Currently, almost 2.9 million school-aged children in the US are classified as
  having specific learning disabilities (SLD) and receive some kind of special
  education support. They are approximately 5% of all school-aged children in public
  schools. These numbers do not include children in private and religious schools or
  home-schooled children.”
                      National Center for Learning Disabilities

 Associated Clinical Clusters: Elevated ADHD, lower EF, GAT
                                     Autistic Spectrum
                                        Behaviors

 CAB Clinical Scale: Autistic Spectrum Behaviors (ASB)
  - uses bizarre speech; becomes upset if things are out of order
 The prevalence rate is 1 in 200 - 300 individuals
 Males exhibit autistic spectrum behaviors 2 to 5 times more than females
“Every year between 100,000 and 200,000 children are diagnosed with one of the
disorders [Autistic, Asperger’s or other Pervasive Developmental Disorders], or five
out of every l0,000 children born - four times as many boys as girls. The diagnosis
of Asperger's Disorder is generally made later in a child's life, whereas the
diagnosis of Autistic Disorder is generally made between birth and thirty months of
age.

               New York University Child Study Center
 Associated Clinical Clusters: Mental Retardation, Critical Behaviors
                                  Attention-Deficit
                                   Hyperactivity

 CAB Clinical Scale: Attention-Deficit/Hyperactivity (ADH)
  - acts impulsively; seems unable to relax; is easily distracted

 3% to 7% Prevalence Rate among school-aged population

 2 to 10 males for every female diagnosed

 “The prevalence of Attention-Deficit/Hyperactivity Disorder has been
  estimated at 3% - 7% in school-age children.”

                                 DSM-IV-TR

 Associated Clinical Clusters: Learning Disability,Conduct Problems,
  Anxiety, and Depression.
                                  Mental Retardation

 CAB Clinical Scale: Mental Retardation (MR)
  - acts immature compared to similar-aged peers; independently
    takes care of personal needs

 1% Prevalence Rate and has a childhood onset

 Mental retardation occurs in about 1.5 males for every female

  The prevalence rate of mental retardation is approximately 1%. However,
  different studies have reported different rates depending on definitions used,
  methods of ascertainment, and population studied.

                                  DSM-IV-TR

 Associated Clinical Clusters: Low on EF & GAT Clusters
                                      Serious Emotional
                                     Disturbance Defined

   Disabilities Education Act (IDEA), Public Law 101-476 defines SED as: “…one or more
    of the following characteristics over a long period of time and to a marked degree that
    adversely affects educational performance–

     (A) An inability to learn that cannot be explained by intellectual,
        sensory, or health factors;
     (B) An inability to build or maintain satisfactory interpersonal
         relationships with peers and teachers;
     (C) Inappropriate types of behavior or feelings under normal
        circumstances;
     (D) A general pervasive mood of unhappiness or depression;
     (E) A tendency to develop physical symptoms or fears associated
         with personal or school problems."
                                                      Differential Diagnosis of
                                                      Emotional Impaired and
                                                       Socially Maladjusted

               Emotional Impaired (SED)                                         Socially Maladjusted (BD)
                Unable to comply; needy;                                        Unwilling to comply;
        School
                 difficulty asking for help.                                       excessive absences; rejects
      Behavior
                                                                                   help




        Attitude  School is a source of                                         Dislikes school except as a
        Toward angst; responds well to                                            social outlet; rebels against
         School structure                                                         rules and structure
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
                                                      Differential Diagnosis of
                                                      Emotional Impaired and
                                                       Socially Maladjusted

              Emotional Impaired (SED)                                          Socially Maladjusted (BD)
               Misses school due to                                             Misses school due to
       School psychosomatic issues.                                                truancy.
   Attendance




   Educational Achievement is uneven;
                                                                                 Achievement is influenced
  Performance impaired by emotions.
                                                                                  by truancy, attitude
                                                                                  toward school.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
                                                    Differential Diagnosis of
                                                    Emotional Impaired and
                                                     Socially Maladjusted

                      Emotional Impaired (SED)                                  Socially Maladjusted (BD)
                       Ignored or rejected.                                     Generally accepted by
           Peer                                                                    sociocultural subgroup.
       Relations




                Younger friends; pseudo-                                        Friends primarily from
                                                                                  same delinquent or
    Friendships friends; no real friends.
                                                                                  sociocultural subgroup.



Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
                                                    Differential Diagnosis of
                                                    Emotional Impaired and
                                                     Socially Maladjusted

               Emotional Impaired (SED)                                         Socially Maladjusted (BD)
                Perceived as bizarre, odd,                                      Perceived as tough,
   Perceptions
                 source of ridicule.                                               charismatic, accepted
            of
                                                                                   within subculture.
         Peers




                   Poorly developed;                                            Well developed; mature;
           Social   immature; difficulty                                          well attuned to social cues.
           Skills   reading social cues;
                    difficulty entering groups.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
                                                    Differential Diagnosis of
                                                    Emotional Impaired and
                                                     Socially Maladjusted

                 Emotional Impaired (SED)                                       Socially Maladjusted (BD)
                  Inability to establish                                        Extensive relations;
       Interper- relationships; avoids                                             exploitive and
           sonal people; withdrawn.                                                manipulative; charming to
       Relations                                                                   achieve ends.




                  Awkward; goofy; odd,                                          Smooth and agile; sexually
                   may be uncomfortable                                           precocious; dresses like
         Physical                                                                 subgroup (e.g., Goth).
                   with physicality.
         Presence
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
                                                    Differential Diagnosis of
                                                    Emotional Impaired and
                                                     Socially Maladjusted

                Emotional Impaired (SED)                                        Socially Maladjusted (BD)
                 Affective Disorder;                                            Conduct Disorder;
       Locus of Internalizing                                                      externalizing
       Disorder


                Hurts self or others as an                                      Hurts others as a means to
     Aggression end.                                                              an end.

                  Tense; fearful; manifest                                      Appears relaxed; „cool‟;
          Anxiety anxiety                                                         situational anxiety related
                                                                                  to consequences faced.
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
                                                    Differential Diagnosis of
                                                    Emotional Impaired and
                                                     Socially Maladjusted

               Emotional Impaired (SED)                                         Socially Maladjusted (BD)
                Labile; disproportionate                                        Intentional with features of
      Affective reactions, but not under                                           anger and rage; explosive.
      Reactions student‟s control.


                                                                                 Little remorse; blaming;
                Guilty; remorseful; self-                                        non-empathic; hedonistic;
     Conscience critical; overly serious.                                         understands right/wrong,
                                                                                  but chooses wrong.



Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
                                                   Differential Diagnosis of
                                                   Emotional Impaired and
                                                    Socially Maladjusted

                 Emotional Impaired (SED)                                       Socially Maladjusted (BD)
                  Fantasy; naïve; gullible;                                     “Street-wise”; understands
         Sense of thought disorders;                                               and manipulates facts;
          Reality hallucinations.                                                  distorts rules and
                                                                                   expectations.



             Inappropriate for age;                                             Age appropriate or above;
    Develop-                                                                      behaviorally precocious;
              immature; uneven;
      mental                                                                      „socially-mature‟
              regressive
 Appropriate-
        ness
Adapted from Social Maladjustment: A guide to differential diagnosis and educational options (Wayne County Regional Educational
Service Agency - Michigan – 2004)
ED/SM Scale Reliability
Differences Required for
      Significance
Magnitude of Difference
Between SM and ED
                           Rodney:
                   Emotionally Impaired or
                    Socially Maladjusted?
 Age: 14 Years
 White, Male
 Referred for anger management issues, bullying, and
  hostility toward peers, teachers and parents
 Average grades (Mostly B‟s with occasional A‟s and C‟s)
 WISC-III FSIQ = 135
 Instruments:
   • CAB-PX
   • CAB-T
   • Clinical Interview
                             Parent/Teacher Veracity


Respondent Veracity Scale
  Number of clinical cluster scores  70   Profile classification
                    0                       Typical cluster profiles

  Number of clinical cluster scores  30   Profile classification
                    1                       Typical cluster profiles



  Number of clinical cluster scores  70   Profile classification
                    0                       Typical cluster profiles

  Number of clinical cluster scores  30   Profile classification
                    0                       Typical cluster profiles
                                         Parent/Teacher Scale
                                              Contrasts
                                 Raw       T     %ile   90%        Qualitative
                 Scale
                                 score   score   rank   C. I.     classification
Clinical scale
 Internalizing Behaviors (INT)    49      42      23    38 - 46    Normal range
 Externalizing Behaviors (EXT)    94      65      93    62 - 68      Mild CR
 Critical Behaviors (CRI)         42      59      83    54 - 64    Normal range
Adaptive scale
 Social Skills (SOC)              91      36      8     33 - 39     Mild AW
 Competence (COM)                 48      59      81    55 - 63    Normal range
 Adaptive Behaviors (ADB)         31      52      58    45 - 59    Normal range
CAB Behavioral Index (CBI)        355     57      74    55 - 59    Normal range


                                 Raw       T     %ile   90%        Qualitative
                 Scale
                                 score   score   rank   C. I.     classification
Clinical scale
 Internalizing Behaviors (INT)    22      38      11    33 - 43    Normal range
 Externalizing Behaviors (EXT)    71      62      89    60 - 64      Mild CR
Adaptive scale
 Social Skills (SOC)              64      41      18    38 - 44    Normal range
 Competence (COM)                 29      62      89    59 - 65      Mild AS
CAB Behavioral Index (CBI)        186     51      55    49 - 53    Normal range
                                         Parent/Teacher Cluster
                                               Contrasts

                                         Raw       T     %ile   90%        Qualitative
                 Cluster
                                         score   score   rank   C. I.     classification
                                                                                           Teacher
Clinical cluster
 Anxiety (ANX)                            33      38      11    34 - 42    Normal range     NR
 Depression (DEP)                         57      41      19    38 - 44    Normal range     NR
 Anger (ANG)                              42      56      73    52 - 60    Normal range     NR
 Aggression (AGG)                         73      64      92    61 - 67      Mild CR        NR
 Bullying (BUL)                           124     69      97    66 - 72      Mild CR        MCR
 Conduct Problems (CP)                    61      68      96    64 - 72      Mild CR        NR
 Attention-Deficit/Hyperactivity (ADH)    39      40      17    36 - 44    Normal range     NR
 Autistic Spectrum Behaviors (ASB)        56      49      46    45 - 53    Normal range     NR
 Learning Disability (LD)                 29      30      2     26 - 34    Normal range     NR
 Mental Retardation (MR)                  41      43      26    39 - 47    Normal range     NR
Adaptive cluster
 Executive Function (EF)                  29      62      89    58 - 66      Mild AS        MAS
 Gifted and Talented (GAT)                119     61      87    57 - 65      Mild AS        MAS
Parent/Teacher
   Profiles
                                  Parent/Teacher ED/SM


Emotional Disturbance and Social Maladjustment Scales
                                      Raw       T      Qualitative
                    Scale
                                      score   score   Classification
     Emotional Disturbance (ED)        57      40      Normal range
     Social Maladjustment (SM)         166     68        Mild CR



                                      Raw       T      Qualitative
                    Scale
                                      score   score   Classification
     Emotional Disturbance (ED)        20      37      Normal range
     Social Maladjustment (SM)         98      69        Mild CR
                              Case Study Summary
                                    Rodney

 Referred for anger management issues, bullying, and hostility toward peers,
  teachers and parents. Multi-source, multi-context triangulated information
  from referral, CAB-PX, CAB-T, MSCS, and KFD consistently show:
       • High intellectual functioning
       • High academic functioning
       • High overall competence and executive function
       • Poor social skills and peer acceptance
       • Family conflict
       • Clinically significant Externalizing behaviors, including Aggression,
         bullying, conduct problems, hostility toward others - - Socially
         Maladjusted - - Behaviorally Disordered

								
To top