2. 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

3. 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/

4. CAB Author Lori K. Keith, PhD Staff Psychologist The University of Tennessee 2348 Hickory Forest Drive Memphis, TN 38119 keith1504@bellsouth.net

5. Multifaceted Nature of Adjustment • Multidimensional, context-dependent model of adjustment, with six primary life domains: • Three intra-personal domains • Affect • Competence • Physical • Three interpersonal domains • Social • Academic • Family

6. Developmental Nature of Adjustment • Adjustment becomes increasingly differentiated with age • Life domains differentiate as a function of exposure

7. Triangulation:Multi-source, Multiple Context Assessment Other Sources- Direct Observation - Indirect Approaches (e.g., Projective Techniques) - Background Information - Clinical Interview Behavioral and Psychosocial Adjustment Third-Party Report- CAB Parent or Teacher- CAT Parent/Teacher- Achenbach, Self-Report- Multidimensional Self Concept Scale - Clinical Assessment of Depression - Clinical Assessment of Attention Deficit - Clinical Assessment of Interpersonal Relations

8. 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in age range - - (e.g., Preschool and kindergarten) • Limited technical adequacy – (e.g., rater-rater reliability) • Outdated norms • Multiple forms across age span – limiting longitudinal follow up • Poor content match between Parent and Teacher forms • Critical items not easily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

9. CABClinical 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.

10. 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

11. 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

12. 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

13. Developmental Delay • (b) Children aged three through nine experiencing developmental delays. Child with a disabilityfor 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;

14. Constructing the CAB:A Multidimensional, Multi-Step, Multi-Year Process

15. Content Identification • Approached the CAB from Bracken’s (1992) context-dependent model of adjustment • Reviewed and evaluated existing behavior rating scales • Investigated agreement between biological mothers’ and fathers’ ratings • 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

16. Item Developmentand Refinement • Wrote 1300 items on a diagnostic criteria and content analysis basis • Following content analysis, 1300 items were reduced to 528 items • Item Assignment to one of six primary scales • Internalizing Behaviors • Externalizing Behaviors • Critical Behaviors • Social Skills • Competence • Adaptive Behaviors

17. Item Tryout, Norming, and Finalization • 528-item version CAB was administered to 276 respondents for analysis of • Preliminary scale reliabilities • Inter-parent agreement • Item reading level • Eliminated items with low internal consistency and low inter-parent agreement - - 260 Items were normed • Reliability and factor analyses were performed to further refine scales, resulting in final parent and teacher forms

18. 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)

19. CAB Parent and Teacher Forms

20. 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 5 – 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%

21. CABNormative 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%

22. Scale Variance AssociatedWith 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% -- --

23. Scale Variance AssociatedWith 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% -- --

24. CAB Structure Forms, Scales, and Clusters

25. 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

26. ClinicalScale 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

27. AdaptiveScale 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

28. 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

29. Theoretical Structure of CAB

30. CAB PX, P, and TReliabilities • 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

31. CAB-PX Internal Consistency

32. CAB-P Internal Consistency

33. CAB-T Internal Consistency

34. 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

35. CAB Inter-raterCoefficients 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

36. 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

37. 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)

38. 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

39. 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)

40. 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)

41. 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)

42. 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

43. 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

44. CAB-PX – BASC2 PRSInternal 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

45. CAB and BASC-2 Item Gradients: Teacher Forms for Adolescent Females

46. Aggression T-Score to Percentile Rank (CAB-T and BASC-2 TRS)

47. 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

48. CAB Ability Scales and Clusters by Assessed Ability (BBCS-R)

49. CAB Ability Scales and Clusters by Assessed Ability (NNAT)

50. Conduct DisorderedStudents