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 SOCIAL
Three intra-personal domains

Affect GLOBAL
Competence ADJUSTMENT
Physical

Three interpersonal domains PHYSICAL 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