Dr. Cindy Taylor

Clinical Psychologist

  • Increase font size
  • Default font size
  • Decrease font size
Home CDDAP Manual

CDDAP Manual

E-mail Print PDF

CDDAP Manual



Checklist for Differential Diagnosis of Attentional Problems (CDDAP)


Administration, Scoring and Procedures Manual


Cindy J. Taylor, Ph.D.






Acknowledgements

                       Use of the Checklist for Differential Diagnosis of Attentional Problems (CDDAP) is fully protected by copyright and all rights to the CDDAP and accessory materials are reserved.  Adaption, translation, or reproduction of these materials by any process either totally or partially is unethical and illegal.  No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the author.

 Computer Scoring Manual

 First Edition

 Copyright 2010 by Cindy J. Taylor, Ph.D.

 All rights reserved

 Printed in U. S. A.



TABLE OF CONTENTS


I.    HISTORY AND INTRODUCTION                             

3

II.  THE CDDAP:  A DESCRIPTIVE PROFILE               

4

     Test Administration and Instructions

4

     Administration Time

4

III   DEFINITION OF THE CDDAP CLINICAL SCALES         

5

       ADD-Inattentive                                    

5

       ADD-Hyperactive-Impulsive                                        

5

       Obsessive Compulsive                

6

       Borderline Personality                            

6

       Dependent Personality                

7

       Antisocial Personality                 

7

       Depression          

8

       Manic                                                      

9

       Anxiety                                       

10

       PTSD                                                                  

10

      Psychotic                                                  

11

      Alcohol                                                    

11

IV.  COMPUTER SCORING OF THE CDDAP    

13

V.   RELIABILITY OF THE CDDAP        

14

VI.  VALIDATION STUDIES        

15

Convergent Validity with the SCL-90          

15

Correlations between SCL-90 and CDDAP Scales  

16

Criterion Validity                   

17

Discriminant Function Analyses:  Scales and Final Diagnoses

18

VII.  INTERPRETATION OF THE CDDAP          

19

VIII.  CHARACTERISTICS OF THE NORMATIVE SAMPLES

19

         Demographic Characteristics of Normative Samples   

19

         Normative Data by group on ADHD Symptoms         

20

         Normative Means and S.D.'s for CDDAP Dimensions

21

References                 

22

Appendix:  Breakdown of DSM-IV Diagnoses in the Clinical Groups                    

23


Page 3

CHECKLIST FOR DIFFERENTIAL DIAGNOSIS OF

ATTENTIONAL PROBLEMS (CDDAP)

 I.  HISTORY AND INTRODUCTION

            The CDDAP is a self-report measure developed to be a more accurate screening measure for use as a tool in the diagnosis of ADHD in adults.  This measure is intended to be relatively brief and to alert the clinician to difficulties other than ADHD.  The CDDAP is also intended for use as a screening instrument in other settings where formal psychological testing is not available. 

            Although measures such as the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and the revised Symptom Checklist (SCL-90-R; Derogatis, 1992) may be appropriate for ruling out other conditions, they either lack a coherent grouping of ADHD symptoms, or contain symptoms of ADHD within scales or subscales which may signal the presence of depression or anxiety (e.g. Mental Dullness subscale on the MMPI-2).  Because these instruments do not include the necessary cluster of items specifically related to ADHD, it has been necessary to give additional rating scales for the measurement of these symptoms.  Conversely, when using checklists of ADHD symptoms, it has been necessary to administer additional measures to rule out other disorders.  The CDDAP 1) includes the symptoms of ADHD; 2) is brief enough to hold the client’s attention, and to administer quickly as a screening instrument in referral settings, and 3) can signal the presence of other disorders which contain symptoms overlapping with ADHD, and in so doing, assists the clinician in making dual and differential diagnoses in this population. 

            The development of this instrument came out of over 500 evaluations of adults referred for ADHD.  Patterns emerged in the evaluations of these individuals and self reported symptoms seemed to cluster into coherent groupings of other symptoms and disorders -- some unrelated to ADHD.  The CDDAP was designed to measure ADHD as well as those disorders most commonly seen in outpatient referrals for ADHD.  

            Research indicates that a large percentage of individuals with ADHD also experience other psychiatric disorders.  One study of ADHD in adulthood found that of 56 subjects presenting with symptoms of residual ADHD, only 7 had a diagnosis of ADHD alone (Shekim, 1990).  According to Shekim's research, 86% of the subjects with ADHD also had another psychiatric condition.  One possible explanation for the extremely high comorbidity in this population could be that most adult ADHD is not severe enough to seek treatment for on its own; therefore the clients seen in outpatient clinics for diagnosis of ADHD actually have additional psychiatric problems which exacerbate their symptoms. However, another examination of comorbidity included both referred and non-referred adults with ADHD. Although only 36 non-referred adults were included in this study, findings were very similar with fully 77% of the subjects with ADHD having another psychiatric diagnosis (Biederman, et al., 1993).  Taylor and Miller (1997) found only 14 percent of the subjects to have a diagnosis of ADHD alone, with an overall total of approximately 45% receiving a diagnosis of ADHD, but most of those (68%) also received at least one other axis I diagnosis.  Therefore, evaluating self referred adults for ADHD requires caution and a comprehensive assessment.  The CDDAP was developed to be a part of a thorough psychological evaluation.


Page 4

II.  THE CDDAP:  A DESCRIPTIVE PROFILE

 Test Administration and Instructions

            Administration of the CDDAP is quite simple, and the instructions are printed on the actual test form.  They read as follows:

             Please answer the following questions by circling the letter which most accurately describes how often you experience each of these statements. 

            Response choices by “letter” are printed on the test form as follows:

            N = Never, S = Sometimes, O = Often, A = Always

Administration Time

             Administration time varies with the individual, however, most subjects would be expected to complete the test in approximately 10 to 15 minutes. 

 Test Characteristics

             The CDDAP contains 124 items primarily composed to reflect DSM-IV diagnostic criteria of various disorders containing symptoms similar to ADHD.  Individual item responses include "Never", "Sometimes", "Often", and "Always" and are assigned point values of 0, 1, 2 or 3 respectively.  The number of possible total scale points varies on each scale due to variation in the number of items on each scale. 

            There are four main summary scores and twelve clinical scales.  The individual scales by item are listed in Appendix D.  Scale names and description are as follows:  ADA:  ADHD, Inattentive symptoms; ADH: ADHD, Hyperactive Impulsive symptoms; OC:  Obsessive Compulsive Personality and Obsessive-Compulsive Disorder symptoms; BPD:  Borderline Personality Disorder; DEP:  Dependent Personality Disorder;  APD: Antisocial Personality Disorder; DE:  Depression; MAN:  Manic; ANX:  Anxiety disorders  (generalized anxiety, PTSD and panic symptoms); PTSD:  Post-traumatic stress disorder; PSY:  Psychotic symptoms; ALC: alcohol related symptoms. 

            The four summary scales are 1) ADHD, which is the combined total of ADA and ADH; 2) the PER scale, which is the total of BPD, DEP, and ANT scales; 3) SC, which is the total number of symptoms positively endorsed and 4) GSI which is the global severity index and is calculated by dividing the total weighted score (described above) by the total number of positively endorsed symptoms.

Page 5 

III  DEFINITION OF THE CDDAP CLINICAL SCALES

 The twelve clinical scales are outlined below with the corresponding item number and content.

 ATTENTION DEFICIT HYPERACTIVITY DISORDER, PREDOMINANTLY INATTENTIVE TYPE (ADA)

             This nine-item scale contains the symptoms of ADHD, Predominantly Inattentive Type as listed in the Diagnostic and Statistical Manual, Fourth Edition.

 ____________________________________________________________________________

 TABLE 1.  ADHD, PREDOMINANTLY INATTENTIVE TYPE (ADA)

 Item No.                                              Content 

 _____________________________________________________________________________

 1          I fail to give close attention to details or make careless mistakes.

5          I have difficulty sustaining attention to tasks.

9          I do not seem to listen when spoken to directly.

13        I don’t follow through on instructions and fail to finish tasks.

20        I have difficulty organizing tasks and activities.

26        I avoid or dislike tasks that require sustained mental effort.

32        I lose things necessary for tasks or activities

37        I am easily distracted by extraneous stimuli

42        I am forgetful in daily activities

 ATTENTION DEFICIT HYPERACTIVITY DISORDER, PREDOMINANTLY HYPERACTIVE-IMPULSIVE TYPE (ADH)

             These are the nine symptoms of the Predominantly Hyperactive-Impulsive Type of ADHD as listed in the DSM-IV.  Symptoms indicate fidgety, restless movement, and impulsive speech and behavior.

___________________________________________________________________________

TABLE 2.  ADHD, PREDOMINANTLY HYPERACTIVE-IMPULSIVE TYPE (ADH)

 Item No.                                  Content

___________________________________________________________________________

 48        I fidget with my hands or feet.

55        I often leave my seat in situations where remaining seated is expected.

Page 6

63        I feel restless.

69        I have difficulty engaging in leisure activities quietly.

76        I am “on the go” or feel as if “driven by a motor.”

81        I talk too much.

89        I blurt out answers before questions have been completed.

99        I have difficulty awaiting my turn.

108      I interrupt others in conversation.

OBSESSIVE-COMPULSIVE (OC)

            This scale contains symptoms of both obsessive-compulsive personality disorder, and obsessive-compulsive disorder.  Items reflect checking and other ritualistic or repetitive behaviors as well as preoccupation with order, lists, and perfectionistic attitudes.

___________________________________________________________________________

TABLE 3.  OBSESSIVE-COMPULSIVE (OC)

 Item No.                                  Content

___________________________________________________________________________

2          I get so preoccupied with details, rules, lists, order, organization, or schedules that I lose

            the major point of the activity.

4          I have thoughts that make me anxious.

15        I am a perfectionist.

21        I am so devoted to my work that I rarely have time for leisure activities.

33        I am overly conscientious and scrupulous.

44        I like for things to be in order.

51        I plan things in my head.

58        I like to count things.

70        I am inflexible about matters of morality, ethics, or values.

80        I can’t seem to throw things away, even when they don’t have sentimental value.

88        I am reluctant to delegate tasks.

92        I would rather save for a rainy day than spend my money.

100      I can be rigid and stubborn.

102      Words and phrases get stuck in my head.

106      I check things.

110      I wash my hands over and over.


BORDERLINE PERSONALITY DISORDER (BPD)

            Items reflect some of the diagnostic criteria for Borderline Personality Disorder, including suicidal gesturing and threats, feelings of emptiness, and mood lability.

Page 7

____________________________________________________________________________

 TABLE 4.  BORDERLINE PERSONALITY DISORDER (BPD)

 Item No.                                  Content

____________________________________________________________________________

 3          I will do almost anything to avoid being abandoned.

16        My personal relationships have been unstable.

34        I think of killing myself.

46        I have threatened to kill myself.

59        I feel empty inside.

71        I am very suspicious of others.

82        I have intentionally hurt myself.

117      My mood changes suddenly.

118      I overreact to little things.

119      I have a bad temper.

DEPENDENT PERSONALITY DISORDER (DEP)

             Items reflect many of the DSM-IV diagnostic symptoms, including lack of confidence in one’s own abilities, and the need for another to take charge of major life areas and decision making.

___________________________________________________________________________

 TABLE 5.  DEPENDENT PERSONALITY DISORDER (DEP)

 Item No.                                  Content

___________________________________________________________________________

 6          I need advice or reassurance from others to make decisions.

17        I like for others to take charge of things.

23        I don’t like to disagree with others.

35        I have difficulty doing things on my own.

47        I lack self-confidence.

60        I volunteer to do things just to please others.

72        I feel uncomfortable when alone.

83        When a significant relationship ends, I urgently look for another.

93        I have a fear of being left to take care of myself.

 Page 8

ANTISOCIAL PERSONALITY DISORDER (ANT)

             Items reflect those most typical of an Antisocial Personality as listed in the DSM-IV.  Symptoms include legal difficulties, lack of impulse control, and thrill seeking behaviors.

_____________________________________________________________________________

 TABLE 6.  ANTISOCIAL PERSONALITY DISORDER (ANT)

 Item No.                                  Content

_____________________________________________________________________________

7          I have been in trouble with the law.

18        I could con people if I wanted to.

24        I act without thinking.

36        I have been physically aggressive.

61        It is hard for me to keep a job.

74        I am a “thrillseeker”.

91        I have been in trouble because of my drinking.

95        I take risks that are potentially dangerous.

96        I have driven a car after drinking.


DEPRESSION (TDE)

                The depression scale is comprised of symptoms of Dysthymic Disorder and Major Depressive Disorder.  This scale reflects problems in sleeping and appetite, mood, and cognitive problems associated with depression.

__________________________________________________________________________

 TABLE 7.  DEPRESSION (TDE)

Item No.                                  Content

___________________________________________________________________________

8          I feel depressed most of the day every day.

10        My appetite is poor.

19        I don’t enjoy doing the things I used to enjoy.

25        I have lost, or gained weight recently.

27        I sleep too much.

34        I think of killing myself

38        I have difficulty falling asleep at night.

39        I feel fatigued.

50        I wake up early and can’t go back to sleep.

52        I feel hopeless.

64        Recently I do things more slowly.

Page 9

65        My self esteem is low.

75        I am very agitated and move quickly.

84        I feel like I don’t have any energy.

94        I feel worthless.

101      I have difficulty making decisions.

107      I feel guilty much of the time.

112      I think of death.

120      It is hard for me to concentrate.


MANIC (MAN)

            The items on this scale are symptoms of a manic or hypomanic episode:  racing thoughts, pressured speech, grandiosity, sleep disturbance, and impulsive behaviors.

_____________________________________________________________________________

TABLE 8.  MANIC (MAN)

Item No.                                  Content

_____________________________________________________________________________

11        I have so much energy I can’t sleep.

28        I feel so good I think I can do almost anything.

37        I am easily distracted by extraneous stimuli.

38        I have difficulty falling asleep at night.

40        I feel rested after only two to three hours of sleep.

54        It is hard for me to stop talking.

57        I have special talents no one else has.

66        My thoughts race.

68        Other people are jealous of me.

73        I have so much to say I can’t get it all out.

77        My activity level can increase rather suddenly.

85        There are times when I am extremely productive.

95        I take risks that are potentially dangerous.

124      I am an impulse buyer.


ANXIETY (ANX)

            This 19-item anxiety scale is quite broad and encompasses symptoms of generalized anxiety disorder, post-traumatic stress disorder, panic disorder, and phobic anxiety.

_____________________________________________________________________________

TABLE 9.  ANXIETY (ANX)

Item No.                                  ContentPage 10

_____________________________________________________________________________


4          I have thoughts that make me anxious.

12        Something traumatic has happened to me.

29        Things have happened to me that I avoid thinking about.

31        I feel anxious.

38        I have difficulty falling asleep at night.

39        I feel fatigued.

41        My mind goes blank.

45        I worry about many things.

56        I have nightmares about things that have happened to me.

62        My hands shake.

67        I become frightened or uncomfortable in certain situations.

78        I avoid places that remind me of my past.

86        I feel numb.

90        My muscles feel tense.

97        I don’t expect to live long.

104      I feel detached from others.

111      I sweat a lot.

113      I get so anxious my heart races.

116      I feel irritable



POST-TRAUMATIC STRESS DISORDER (PTSD)


            This 7-item scale includes some of the DSM-IV symptoms of PTSD.

_______________________________________________________________________


TABLE 10.  POST-TRAUMATIC STRESS DISORDER (PTSD)


Item No.                                  Content

_______________________________________________________________________


12        Something traumatic has happened to me.

29        Things have happened to me that I avoid thinking about.

56        I have nightmares about things that have happened to me.

78        I avoid places that remind me of my past.

86        I feel numb.

97        I do not expect to live long.

104      I feel detached from others.






Page 11

PSYCHOTIC (PSY)


            This 10-item scale contains symptoms reflective of psychosis, such as hallucinations, thought broadcasting, and paranoia.

_____________________________________________________________________________


TABLE 11.  PSYCHOTIC (PSY)


Item No.                                  Content

_____________________________________________________________________________


14        I hear my name being called when no one is there.

30        I feel like things are crawling on my skin.

43        People can read my mind.

53        I feel like a camera is filming me.

57        I have special talents no one else has.

68        Other people are jealous of me.

79        I can see things others around me can’t see.

87        I have a “sixth sense” and know things others don’t know.

98        Someone is trying to steal my thoughts.

105      I hear my thoughts being spoken out loud.


ALCOHOL (ALC)

____________________________________________________________________________


TABLE 12.  ALCOHOL (ALC)


            Items on this scale are reflective of alcohol abuse.


Item No.                                  Content

____________________________________________________________________________


91        I have been in trouble because of my drinking.

96        I have driven a car after drinking.

103      I have hangovers.

109      Alcohol helps me relax.

114      I use alcohol and/or drugs.

115      I have tried to quit drinking.








Page 12

IV  COMPUTER SCORING THE CDDAP


Scoring and Directions


            The CDDAP Scoring program can be used instead of the Scoring Sheet and Profile Sheet hand scoring system, although those items are still available for order with the CDDAP questionnaires.  .

            The CDDAP program now allows the user to input the examinee information and add a new assessment record for computerized scoring of Clinical and Global Scales.  Item entry is done by assigning a numeric value to each response:  1 = Never, 2 = Sometimes, 3 = Often, and 4 = Almost Always.  The items are then scored automatically and the user may select a variety of report options and  the report printout allows the user to copy and paste information into a separate report. 


Report Options


Clinical and Global Scales Tables


            These tables reflect Raw Scores, Weighted Scores, T-scores and Percentiles for each scale.  The Raw Score indicates the total number of items endorsed on a particular scale, without regard to the severity of the symptom.  The score is derived by allotting one point for every item that is not answered “Never.”


Weighted Score:


            The next score is the weighted score, which reflects the severity of the responses.  The weighted score is derived from totaling the number value of each response for all scale items.  Although items are more easily input as 1, 2, 3, or 4 when entering the data, the values are changed by the CDDAP scoring program to the following values:  Never = 0; Sometimes = 1; Often = 2; and Always = 3.  Viewing the Raw Score and the Weighted Score provides the user with an indication of the severity of the symptom reported.


T-Scores


            Weighted scores are then converted into a standardized T-Score with a mean of 50 and a deviation of 10.  A T-Score of 65, based on a normal distribution, would have a percentile rank of  94.   Therefore, T-Scores over 65 would be considered elevated, and a T-Score of 70, with a percentile e of 98, would be 2 standard deviations from the mean.


Global Scales


            In addition to the 12 Clinical Scales, the CDDAP also yields 3 Global Scales.  The first is ADHD Total (ADT).  This scale is the combined total weighted score of ADHD, Inattentive and ADHD, Hyperactive-Impulsive symptoms.  The PER scale is the weighted sum of all personality disorder symptoms (BPD, DEP, and ANT).  The next Global Score is SC is the total number of

Page 13


positively endorsed symptoms.  This Symptom Count scale provides a measure of the examinees willingness to report difficulties, and is often high in individuals with ADHD as this disorder is often accompanied by other problems.  The SC is also high in the OP group (individuals with Other Psychiatric problems). 

            The final Global Scale is the Global Severity Index or GSI.  It is the weighted sum of all symptoms endorsed divided by the number of positively endorsed symptoms.


Profile Sheet


            Scores in the computer scoring program are based on the normative sample of individuals who did not meet diagnostic criteria for either ADHD or another psychiatric disorder.  The hand scored profile sheet is a bit different, and may provide additional statistical information. 

            In using the hand scored profile sheet, the user gets a visual representation of weighted scores on each scale along with the summary scores.  Only the weighted scores should be plotted on this sheet.  There are two lines on the profile sheet.  Because of the overlap in disorders and multiple diagnoses, the subjects were divided into two groups for each scale:  one group had the disorder and the other did not.  Thus, for the PTSD scale, the entire subject sample was divided into those who either did or did not meet criteria for PTSD.  The bottom line on the profile sheet represents the mean of the group that did not receive a diagnosis of the disorder represented by that scale.  The top line represents the group mean of those who were positive for the disorder.  An example of this is the mean for those without PTSD was 5.41 and the mean for those who did receive a diagnosis of PTSD was 9.16.  Typically there is at least one standard deviation between the two means.  It is important to note when interpreting the profile sheet that there is some overlap between the two means, however, a client whose score is above the top line should be considered extreme.




















Page 14


V.  RELIABILITY OF THE CDDAP


Table 13

 

 CDDAP Scale Characteristics


Scale Name

Alpha

Interitem r Range

Mean Item Correlation

Mean Item SD

Range of Item Means


Range of Item S.D.



ADDT

0.93

.15-.72

0.43

0.07

0.65-1.63

.74-1.07

ADA

0.92

.45-.72

.57

0.06

1.05-1.63

.74-1.07

ADH

.0.86

.25-.66

0.4

0.07

.65-1.47

.81-1.06

OC

0.79

-.09-.47

0.18

0.11

.29-1.99

.65-1.02

MAN

0.82

-.10-.57

0.23

0.15

.48-1.64

.66-1.01

DEP

0.8

.13-.53

0.3

0.11

.67-1.35

.78-.96

ANT

0.79

.15-.69

0.31

0.1

.36-1.35

.62-.96

TDE

0.9

-.03-.68

0.32

0.13

.32-1.69

.57-.98

PSY

0.78

.06-.48

0.27

0.09

.11-.78

.41-.93

BPD

0.82

.18-.67

0.33

0.13

.18-1.25

.51-.98

ANX

0.89

.00-.65

0.3

0.11

.43-1.68

.62-.96

PTSD

0.78

.21-.51

0.33

0.08

.43-1.07

.62-.91

ALC

0.77

.11-.56

0.36

0.13

.38-.81

.66-.78

___________________________________________________________________________


ADDT = ADHD - Total; ADA = ADHD, Inattentive; ADH = ADHD, Hyperactive-Impulsive; OC = Obsessive Compulsive; MAN = Manic; DEP = Dependent Personality; ANT = Antisocial Personality; TDE = Depression; PSY = Psychotic; BPD = Borderline Personality; ANX = Anxiety; PTSD = Post-traumatic Stress Disorder; ALC = Alcohol-related symptoms.










Page 15

VI.  VALIDATION STUDIES


Convergent Validity with the SCL-90

Correlations between CDDAP and SCL-90 Scales


            A correlational analysis was computed to evaluate the relationship between the scales of the CDDAP with corresponding scales of the SCL-90.  Correlations between individual scales range from .16 to .81.  Correlations for total symptom composite scores range from .36 to .77.  Scales believed to measure the same basic construct were highly correlated.  The four scales expected to have greatest similarity between measures were Obsessive-Compulsive, Depression, Anxiety, and Psychoticism.  For the purposes of this study, a correlation of .70 or higher was used as a minimum value for convergent validity.  Correlations between measures on these scales were .57, .80, .73, and .55 respectively.  Correlations among scales on the CDDAP are listed in Table 6.  Interscale correlations on the CDDAP ranged from .14 to .93.   When comparing scales on the two tests, it is important to note that some of the scales on the CDDAP are summary scales and contain symptoms of a variety of disorders (e.g. PER, which is an overall indicator of the presence of a personality disorder and contains symptoms of antisocial, dependent, and borderline personality). This is particularly true of the CDDAP’s Anxiety scale.  The anxiety scale had moderate to high correlations with all of the scales of the SCL-90.  The CDDAP’s 19 item anxiety scale is quite broad and encompasses symptoms of generalized anxiety disorder, post-traumatic stress disorder, and some symptoms overlapping with obsessive compulsive disorder and phobic anxiety.  Additionally, some of the symptoms on this scale are also indicators of depression, such as difficulty sleeping or early morning wakening and therefore, it is not surprising that this scale is highly correlated with the others.  Other clusters would be the personality disorder summary scale (PER) which contains symptoms of Antisocial (ANT), Dependent (DEP), and Borderline Personality disorders (BPD).  (See Table 14 for complete results.)



















Page16

Table 14 


Correlations between CDDAP and SCL-90 Scale





ADA

ADH

ADT

OC

BPD

DEP

ANT

TDE

MAN

ANX

PSY

ALC

PER

PTSD

SC

GSI

SOM

0.35

0.35

0.39

0.37

0.5

0.42

0.22

0.59

0.32

0.63

0.36

0.16

0.49

0.48

0.5

0.35

OC

0.7

0.59

0.71

0.57

0.63

0.61

0.35

0.74

0.58

0.71

0.44

0.2

0.65

0.55

0.68

0.56

IS

0.53

0.52

0.57

0.45

0.66

0.64

0.32

0.67

0.47

0.69

0.49

0.34

0.66

0.63

0.62

0.51

DEP

0.58

0.5

0.59

0.46

0.68

0.62

0.35

0.8

0.45

0.75

0.37

0.27

0.69

0.65

0.65

0.52

ANX

0.54

0.55

0.6

0.46

0.61

0.55

0.37

0.68

0.53

0.73

0.48

0.25

0.63

0.61

0.63

0.49

HOS

0.39

0.56

0.52

0.43

0.59

0.39

0.42

0.51

0.53

0.54

0.43

0.21

0.56

0.47

0.54

0.45

PHOB

0.33

0.38

0.38

0.36

0.43

0.46

0.23

0.48

0.32

0.49

0.55

0.31

0.45

0.61

0.42

0.36

PAR

0.4

0.46

0.47

0.46

0.59

0.49

0.39

0.52

0.47

0.59

0.56

0.21

0.59

0.56

0.55

0.45

PSY

0.48

0.5

0.53

0.43

0.6

0.54

0.37

0.64

0.47

0.67

0.55

0.31

0.62

0.61

0.57

0.51

GSI

0.61

0.6

0.66

0.55

0.73

0.65

0.41

0.8

0.56

0.81

0.53

0.28

0.74

0.69

0.71

0.58

PSDI

0.62

0.6

0.66

0.56

0.67

0.58

0.34

0.73

0.52

0.71

0.4

0.17

0.65

0.62

0.55

0.68

PST

0.54

0.52

0.58

0.48

0.65

0.59

0.39

0.72

0.51

0.74

0.51

0.28

0.68

0.62

0.77

0.36


ADDT = ADHD - Total; ADA = ADHD, Inattentive; ADH = ADHD, Hyperactive-Impulsive; OC = Obsessive Compulsive; MAN = Manic; DEP = Dependent Personality; ANT = Antisocial Personality; TDE = Depression; PSY = Psychotic; BPD = Borderline Personality; ANX = Anxiety; PTSD = Post-traumatic Stress Disorder; ALC = Alcohol-related symptoms.


Page 17

Criterion Validity


            Discriminant function analyses were used to examine the relationship between scaled scores and final diagnoses.  It should be noted that many of the subjects had more than one diagnosis and therefore, some symptom overlap was present in all of these analyses. For each of these analyses, subjects were classified by the presence or absence of a disorder. An example of this is for the discriminant function analysis computed to determine the test’s ability to predict a diagnosis of ADHD, all subjects were divided into one of two categories - ADHD or Non-ADHD.  Likewise, subjects for the mood disorder analysis were reclassified into one of two groups - either presence or absence of a mood disorder.  Accuracy of predictions ranged from 71% for anxiety disorders to 92% for psychosis.  Results of these analyses are listed below: (Table 15).

            Diagnostic categories examined were ADHD, mood disorders, alcohol abuse, anxiety disorders, personality disorders, Post-traumatic Stress Disorder, and the presence of psychosis.  For each discriminant function analysis, all of the scales were entered and a stepwise analysis was computed.  Scales which would logically be expected to have the highest predictive power for each diagnostic category had the highest F values.  For example, the weighted total of ADHD symptoms most accurately predicted the diagnosis of ADHD, and the weighted depression and manic scales most accurately predicted the diagnosis of a mood disorder. 



























Page 18

Table 15


Discriminant Function Analyses using Scales to Predict Final Diagnosis

 

 

Diagnosis

% Correct

Scales

F

p

ADHD           

No ADHD

78

77

ADDT

PTSD

ALC

 

101.02

5.89

4.48

<.0001

Mood 

No Mood

 

80

76

TDE

MAN

124.70

7.19

<.0001

Sub Abuse

No Sub Abuse

 

74

68

ALC

ANT

13.62

4.40

<.0001

Anxiety

No Anxiety

 

76

71

ANX

ADA

12.64

6.97

<.0001

Personality D/O

No Personality D/O

 

75

74

PER

SC

93.01

8.67

<.0001

Psychosis

No Psychosis  

 

92

71

PSY

PER

 24.01 

16.02

<.0001

PTSD 

No PTSD

77

81

PTSD

DEP

ADA

5.68

7.50

5.33

<.0001

 


___________________________________________________________________________

ADDT = ADHD - Total; ADA = ADHD, Inattentive; ADH = ADHD, Hyperactive-Impulsive; OC = Obsessive Compulsive; MAN = Manic; DEP = Dependent Personality; ANT = Antisocial Personality; TDE = Depression; PSY = Psychotic; BPD = Borderline Personality; ANX = Anxiety; PTSD = Post-traumatic Stress Disorder; ALC = Alcohol-related symptoms; SC = Symptom Count










Page 19

VII  INTERPRETATION OF THE CDDAP


            Because the test was designed to reflect DSM-IV diagnostic criteria for each of the disorders, the evaluator is able to determine whether or not criteria are met for diagnoses by simply looking at the symptoms endorsed on the scoring printout.  For example, for a diagnosis of ADHD, Predominantly Inattentive Type, the subject must have a raw score of 6 on the ADHD, Inattentive scale.  Therefore, if it has been determined through interview that conditions of childhood onset are met, then a diagnosis of ADHD, Predominantly Inattentive Type would be appropriate.  Another great asset of the CDDAP is that the evaluator can view the subject’s impression of severity at a glance.  For example, if symptoms of ADHD are reported to be present “sometimes” and symptoms of anxiety are reported to be present “almost always”, then this response pattern raises the possibility that the subject’s attentional problems are actually due to anxiety rather than to a true attention deficit hyperactivity disorder.  Likewise, if the subject is positively endorsing symptoms congruent with both ADHD and depression, it is possible that both disorders are present.


VIII CHARACTERISTICS OF THE NORMATIVE SAMPLES AND CLINICAL GROUPS


            Demographic Characteristics of Normative Sample and Clinical Groups


            Subjects were 313 adults ranging in age from 16 to 61 years with a mean age of 31.75 (S.D. = 10.89) years.  Of the 313 subjects, 156 (50%) were male and 157 (50%) were female.  Normal subjects were 100 students and nonpatient adults who participated on a voluntary basis and did not receive a formal evaluation.  The normal subject group consisted of 36 males and 64 females whose mean age was 28.6 years (S.D. = 8.83).  The remaining 213 subjects were self-referred for evaluation of ADHD at the ADD Treatment and Research Center, an outpatient clinic specializing in the evaluation and treatment of ADHD, in Dallas, Texas. 

            Of these 213 self-referred subjects, 106 received a diagnosis of ADHD.  Of those remaining 106 subjects who were evaluated and did not meet diagnostic criteria for ADHD, 93 were diagnosed with another disorder, and 13 did not fully meet criteria for any disorder, although most were symptomatic to some degree. 

            Diagnoses for the clinical groups were made by careful examination of self-reported symptoms, objective testing (e.g., MMPI-2, IQ or IQ estimates, and achievement test results when available), and historical information obtained in clinical interview, which was corroborated by a parent or relative of the subjects.  Subjects were also administered several neuropsychological measures of attention.  Distribution of the subjects according to DSM-IV Axes diagnoses is shown in Table 3.

            Inclusion Criteria.  For correlational and test item analyses, all subjects were used.  For discriminant function analyses and ANOVA on ADHD symptoms, subjects were excluded as described below.

            Twenty subjects in the "normal" group were excluded because they had a T-score above 65 on the SCL-90's global severity index.  None of the control subjects reported an existing diagnosis of ADHD on the demographic questionnaire, and therefore, none were excluded on the basis of having been previously diagnosed with ADHD.  A small number of the controls, however, did report having a family member diagnosed with ADHD.

Page 20

            ADHD subjects included 106 subjects who met DSM-IV criteria for some type of ADHD.  Subjects who received a diagnosis of ADHD, NOS were not included in this study.  In order to be included, subjects must have had a history of ADHD symptoms in childhood, and must still meet full criteria for either ADHD, Predominantly Inattentive Type, Predominantly Hyperactive-Impulsive Type, or Combined Type.  Many of the subjects in the ADHD group also had another psychiatric disorder. One subject with a long history of ADHD was also experiencing psychotic symptoms and was excluded from the study leaving 105 subjects in the ADHD group.


Normative Data on ADHD Symptoms by Group


Table 16


 Severity of ADHD Symptoms by Group (Normals, ADHD, and Other Psychiatric diagnoses)

 

 

Normal

(N = 80)

ADH

(N = 105)

OP

(N = 106)

 

 

Mean

SD

Mean

SD

SD

Mean

F

ADA

4.72 a

3.36

16.6 b

5.09

13.38 c

5.27

153.16  ***

ADH

4.81 a

2.98

13.03 b

4.63

10.94 c

5.16

87.04   ***

ADDT

9.52 a

5.49

29.63 b

8.23

24.33 c

9.00

165.56   ***

RADA

4.35 a

2.83

8.49 b

.94

7.92 b

1.55

128.91   ***

RADH

4.17 a

2.36

7.61 b

1.61

6.86 c

1.92

75.27    ***

RADDT

8.52 a

4.52

16.11 b

2.05

14.79 c

2.84

142.51   ***

 

_____________________________________________________________________________

*** p < .0001

Note:  Scores with different subscripts are significantly different.


ADA = ADHD, Inattentive Symptoms (weighted)

ADH = ADHD, Hyperactive-Impulsive Symptoms (weighted)

ADDT = ADHD - Total Symptoms (weighted)

RADA = Raw number of ADHD, Inattentive symptoms

RADH = Raw number of ADHD, Hyperactive-Impulsive symptoms

RADDT = Total number of ADHD symptoms











Page 21

Normative Means and S.D.'s for CDDAP Dimensions


Table 17


 CDDAP Normative data by diagnostic group (ADHD, OP, Normal)

 



ADHD

OP

NORMAL


Mean

SD

Mean

SD

Mean

SD

ADA

16.60

5.09

13.39

5.28

4.72

3.36

ADH

13.04

4.63

10.94

5.17

4.81

2.98

ADT

29.64

8.23

24.33

9.00

9.52

5.50

OC

21.26

5.35

20.51

6.09

13.89

5.08

BPD

11.37

3.89

11.19

5.13

5.38

2.61

DEP

10.90

3.97

10.36

4.70

5.14

3.28

ANT

8.35

4.13

8.23

4.29

4.36

2.88

TDE

21.72

7.67

21.28

8.80

9.30

5.10

MAN

11.88

3.76

10.51

4.11

6.37

3.01

ANX

21.05

7.33

20.81

8.68

10.38

5.14

PSY

5.14

3.48

5.43

4.37

2.14

2.23

ALC

3.30

2.7

3.93

2.71

2.81

2.62

PER

30.61

8.83

29.96

11.62

14.89

6.23

PTSD

6.28

3.28

6.62

3.64

2.64

2.39

SC

87.97

14.08

86.12

17.80

55.18

18.60

GSI

1.62

0.22

1.54

0.30

1.28

0.24


Page 22

References

American Psychiatric Association (1994).  Attention deficit hyperactivity disorder. In Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.


Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B (1989).  Minnesota Multiphasic Personality Inventory (MMPI-2).  Manual for administration and scoring. Minneapolis:  University of Minnesota Press.


Derogatis, L. R. (1992).  SCL-90-R Administration, Scoring, and Procedures Manual II. 

Baltimore: Clinical Psychometric Research.


Shekim, W. O., Asarnow, R. F., Hess, E. & Zaucha, K. (1990).  A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state.  Comprehensive Psychiatry, 31(5), 416-425.


Taylor, C. J. & Miller, D. C. (1997).  Neuropsychological assessment of attention in ADHD adults.  Journal of Attention Disorders, 2(2), 77-88.




Page 23

APPENDIX


Breakdown of DSM-IV Diagnoses in the Clinical Groups

Total ADHD Subjects                                   

106

       ADHD Only                   

34

       ADHD + Adjustment Disorder  

1

       ADHD + Anxiety + Substance Abuse

2

       ADHD + Anxiety Disorder                    

13

       ADHD + Mood + Anxiety                     

12

       ADHD + Mood + Anxiety +Substance Abuse

1

       ADHD + Mood  

19

       ADHD + Mood + Substance Abuse                  

2

       ADHD + Mood + Sub + Psy      

1

       ADHD + Substance Abuse                    

4

       ADHD and Personality Disorder only

17

Other Psychiatric Group Total           

106

       Other Psychiatric Diagnoses                               

93

       No Diagnosis                                                      

13

       Anxiety                                                   

16

       Anxiety + Organic Problem        

1

       Anxiety + Psychotic symptoms  

1

       Anxiety + Substance Abuse                               

2

       Anxiety + Substance Abuse + Tourette’s           

1

       Mood + Anxiety             

16

       Mood + Anxiety + Substance + Psychotic Sx

1

       Mood + Anxiety + Substance Abuse                 

1

       Mood                                                      

14

       Mood + Psychotic Symptoms                 

3

       Mood + Substance Abuse                                   

6

       Mood + Substance + Psychotic  

1

       Organic                                       

1

       Personality Disorder only                       

17

       Psychotic Symptoms                   

1

       Psychotic Symptoms + Substance Abuse           

1

       Substance Abuse                                     

10













Last Updated on Tuesday, 26 August 2014 00:05  


Follow us on Twitter

Newsflash