Bruce A. Bracken, PhD


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Bruce A. Bracken, PhD

  • Bruce A. Bracken, PhD

  • Professor

  • The College of William & Mary

  • School of Education

  • P.O. Box 8795

  • Williamsburg, VA 23187-8795

  • Phone: (757) 221-1712

  • Email: babrac@wm.edu

  • www.psychoeducational.com



Barbara S. Boatwright, PhD

  • Barbara S. Boatwright, PhD

  • Licensed Clinical Psychologist

  • Psychology Associates of Mt. Pleasant

  • 1041 Johnnie Dodds Blvd. Suite 14 B

  • Mt. Pleasant, SC 29464

  • Email: barbarasboatwright@comcast.net



Originally referred to as “minimal brain dysfunction”

  • 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



ADHD as a lifelong condition - Early conceptualizations were that adults outgrew ADHD

  • ADHD as a lifelong condition - Early conceptualizations were that adults outgrew ADHD

  • Follow-up studies revealed - 30% 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



Six or more symptoms of inattention present for at least 6 months to a point that is disruptive and inappropriate:

  • 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.


Six or more of the following symptoms of hyperactivity-impulsivity present for at least 6 months to an extent that is disruptive and inappropriate:

  • 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.


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

  • 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).


Based on these criteria, three types of ADHD are identified:

  • 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.




Ages

  • Ages

  • - 19 to 79 years

  • Form – 2 parts

  • - Childhood Memories

  • - Current Adult Symptoms



Employs a four-point item response format

  • 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
    • Graphical profile display


Assesses behaviors that correspond to DSM-IV

  • 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




Approached the CAT from Bracken’s (1992) context-dependent model of adjustment

  • 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); 17-48 years of age

    • reduced to 54 items on Current Symptoms Form
    • matching 54 items on Childhood Symptoms Form




Clinical symptoms

  • Clinical symptoms

    • Inattention
    • Impulsivity
    • Hyperactivity


Clinical symptoms

  • Clinical symptoms

    • Inattention
    • Impulsivity
    • Hyperactivity
  • Contexts

    • Personal
    • Academic/Occupational
    • Social


Clinical symptoms

  • Clinical symptoms

    • Inattention
    • Impulsivity
    • Hyperactivity
  • Contexts

    • Personal
    • Academic/Occupational
    • Social
  • Locus

    • Internal
    • External








Negative Impression − degree to which an individual consistently responds in a negative manner.

    • 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.


Types of validity investigated

  • 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)









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