Clinical Assessment of Attention Deficit

The Clinical Assessment of Attention Deficit (CAT) consists of two comprehensive assessment tools for the objective evaluation of attention deficit disorder and attention deficit/hyperactivity disorder (ADD/ADHD) symptoms in children, adolescents, and adults between 8 and 79 years of age. The CAT is especially useful in clinical, educational, and research settings because it is theoretically conceived and psychometrically sound. Although the CAT is very comprehensive in the context-related behaviors and experiences it assesses, it is brief (10–20 minutes) and easily administered. The CAT can be (a) administered individually or in groups, (b) mailed to respondents' homes to be completed and returned, or (c) completed in its paper-and-pencil format in a professional's office. The CAT Scoring Program performs all scoring and profiling of the assessment and provides a very thorough interpretative report.

The CAT includes a 108-item instrument for adults (CAT-A) and a 42-item instrument for children and adolescents (CAT-C). These instruments are very similar in structure, format, and item content. Each instrument assesses important clinical behaviors related to ADD with and without hyper-activity (as outlined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev.) via three clinical scales (inattention, impulsivity, and hyperactivity). Both instruments consider these important clinical behaviors within multiple contexts (as suggested by the American Academy of Pediatrics) by means of the CAT context scales (personal, academic/occupational, and social) and within an individual's personal experiences through the CAT locus scales (internal and external). Figure 1 depicts the CAT theoretical model and shows the clinical, context, and locus scales. The CAT-C and CAT-A assess the same clinical behaviors within the same contexts and consider the same internal feelings and external behaviors. [Page 146]

Figure 1 CAT-A Conceptual Blueprint (Sample Items From the Childhood Memories Scale)

The minor differences between the two instruments are primarily age-related considerations. Because adult diagnosis of ADD/ADHD requires evidence of both childhood onset and current symptoms, the CAT-A is composed of two subparts: Part I, Current Symptoms, and Part II, Childhood Memories. In contrast, CAT-C assesses only current ADD/ADHD symptoms and therefore is not divided into age-related subparts. Also, CAT-A includes only a self-report form due to the limited availability of raters who could accurately recall an adult client's childhood behaviors. CAT-C includes forms for self, parent, and teacher because of readily available respondents who can reliably report on a child's current behaviors across multiple settings.

CAT normative samples and total scale (Clinical Index) coefficient alpha reliabilities are quite consistent across instruments and forms. The CAT-C self form was normed on 800 children and adolescents 8 to 18 years old; the CAT-C parent form was normed using the ratings from the parents of the 800 children and adolescents who completed the self form. The CAT-C teacher form also was normed on 550 teachers of the same children and adolescents who completed the self form. CAT-A was normed on 800 adults ranging from 19 to 79 years old. CAT-C Clinical Index internal consistency coefficients range from .92 on the self form to .98 on the teacher form. The CAT-A Clinical Index is .94 for Childhood Memories and .91 for Current Symptoms, with an overall CAT-A Clinical Index (i.e., combining Childhood Memories and Current Symptoms) of .96.

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