Assessing sluggish cognitive tempo and ADHD inattention in elementary students: Empirical differentiation, invariance across sex and grade, and measurement precision

ADHD and cognitive disengagement syndrome symptoms related to self-injurious thoughts and behaviors in early adolescents

The current study examined attention-deficit/hyperactivity disorder (ADHD) dimensions and cognitive disengagement syndrome (CDS) symptoms in relation to self-injurious thoughts and behaviors (SITBs) in an early adolescent sample. Participants were 341 adolescents ages 10-12 years (52.2% female; 37.8% people of color) recruited from the community. Caregivers reported on CDS and ADHD symptoms. Adolescents completed a rating scale and were administered an interview assessing SITBs. We estimated associations using logistic regression in a stepped fashion: (1) no adjustment, (2) adjustment for sex, race, family income, and psychotropic medication use, and (3) further adjustment for depressive symptoms. In this early adolescent community sample, 22.9% reported a history of suicidal ideation, 8.2% reported a history of a suicide plan, 6.2% reported a history of non-suicidal self-injury (NSSI), and 16.4% met a clinical cutoff for current suicide risk. Across most analyses using rating scale or interview methods, higher mean CDS scores were related to endorsement of suicidal ideation and planning. ADHD inattentive (IN) and hyperactive-impulsive (HI) symptoms were associated with endorsement of NSSI, and ADHD-IN symptoms were associated with thoughts of suicide and/or plan measured via questionnaire, though effects were less robust and not significant, potentially due to low base rates impacting statistical power. This study adds to a growing body of research highlighting the importance of screening for CDS symptoms among individuals with and without ADHD. More research, especially longitudinal work, is needed that examines possible differential pathways to SITBs by ADHD and CDS symptoms to advance SITB prevention, early detection, and intervention.

Personality Traits in Relation to Cognitive Disengagement Syndrome and ADHD Inattention in Two Samples of Children

OBJECTIVE

Cognitive disengagement syndrome (CDS; previously referred to as sluggish cognitive tempo) is a set of behaviors, including excessive mind-wandering, mental fogginess, and hypoactivity, that are separate from ADHD inattentive (ADHD-IN) symptoms and linked to functional outcomes. However, CDS and ADHD-IN symptoms are strongly associated, and our understanding of whether personality correlates are similarly or differentially linked to CDS and ADHD-IN is limited. The objective of the current study was to examine personality correlates of CDS and ADHD-IN symptoms across two independent samples of school-aged youth.

METHOD

Study 1 included 207 school-aged children (ages 7-11; 63% male; 87.9% White) with or without teacher-reported elevations in CDS. Study 2 included 263 school-aged children (ages 8-12; 58% male; 75.3% White) with the full range of CDS symptomatology. Parents and teachers completed ratings of ADHD-IN and CDS, and parents also reported on their child's personality dimensions.

RESULTS

Across two samples and controlling for demographic characteristics as well as ADHD-IN symptoms and other personality traits, higher levels of FFFS-fear/shyness were uniquely associated with higher levels of parent- and teacher-reported CDS symptoms. In most models, lower levels of BAS-drive were also uniquely associated with higher levels of CDS. In contrast, when controlling for demographic characteristics and CDS symptoms, higher levels of BAS-impulsivity/fun-seeking were uniquely associated with higher levels of parent- and teacher-reported ADHD-IN symptoms.

DISCUSSION

The findings provide the clearest evidence to date that personality dimensions are differentially associated with ADHD-IN and CDS symptoms in children, further underscoring CDS as a distinct construct from ADHD-IN.

Preliminary examination of ADHD inattentive and cognitive disengagement syndrome symptoms in relation to probe-caught mind-wandering during a sustained attention to response task

OBJECTIVE

The role of mind-wandering- periods of internally-directed distractibility - among patients with attention-deficit/hyperactivity disorder (ADHD) has recently garnered attention, though few studies have assessed mind-wandering using thought probes during a sustained attention to response task (SART) or examined the possible role of cognitive disengagement syndrome (CDS) symptoms. We examined whether parent- and/or teacher-reported ADHD-inattentive (ADHD-IN) or CDS symptoms were independently associated with probe-caught mind-wandering.

METHODS

Fifty-four children (ages 9-12; 35.2% female) completed a SART with thought probes inquiring about various on- and off-task thoughts, including mind-wandering and distraction. Questionnaires provided information on demographics, medication treatment, and parent- and teacher-reported ADHD-IN and CDS symptoms. Regression models were estimated separately by informant to examine whether ADHD-IN or CDS symptoms were uniquely associated with mind-wandering or distraction frequency during the SART.

RESULTS

Higher teacher-reported CDS ratings, but not ADHD-IN ratings, were uniquely associated with more probe-caught mind-wandering. No significant findings related to parent-reported symptoms or probe-caught distraction were observed.

CONCLUSIONS

These preliminary findings add to an emerging body of work pointing to CDS as more consistently or strongly associated than ADHD-IN with mind-wandering. Theoretical and clinical implications are discussed.

Examining cognitive disengagement syndrome in a psychiatric outpatient sample: Psychometric support and associations with internalizing symptoms and sleep problems

OBJECTIVE

The internal (structural) and external validity of a self-report measure of cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) relative to a self-report measure of attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with adults from university outpatient psychiatric clinics in Turkey.

METHODS

A total of 274 outpatients (75.9% women; ages 18-64 years; Mage  = 31.06; SDage  = 10.84; 50.4% anxiety disorders; 41.6% depressive disorders; 2.9% ADHD; 1.5% sleep disorders; 0.7% eating disorders; 2.9% no mental disorder) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), sleep problems, depression, and stress.

RESULTS

All 15 CDS symptoms measured by the Adult Concentration Inventory (ACI) showed convergent (moderate to high loadings on the CDS factor) and discriminant (loading close to zero on the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations than ADHD-IN with sleep problems, depression, anxiety, and stress, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI.

CONCLUSION

This is the first study to provide support for the scores from this 15 item self-report measure of CDS by the ACI in a clinical sample of adults, with findings consistent with previous studies examining parent and teacher rating scale measures with the same 15 CDS symptoms. These findings provide additional support for usefulness of these 15 CDS symptoms as measured by the ACI to study CDS across various cultures.

A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome

OBJECTIVE

Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales.

METHOD

Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex.

RESULTS

Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS.

CONCLUSIONS

Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

Cognitive Disengagement Syndrome Symptoms from Early Childhood to Adolescence in a Nationally Representative Spanish Sample

OBJECTIVE

The identification of a common set of symptoms for assessing cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) for early childhood (ages 5-8), middle childhood (ages 9-12), and adolescence (ages 13-16) is needed to advance research on the developmental psychopathology of CDS (i.e. a common symptom set with comparable internal and external validity for each age group).

METHOD

Parents of a nationally representative sample of 5,525 Spanish children and adolescents (ages 5 to 16, 56.1% boys) completed measures of CDS, attention-deficit/hyperactivity disorder-inattention (ADHD-IN), and other measures.

RESULTS

First, the 15 CDS symptoms showed convergent and discriminant validity relative to the ADHD-IN symptoms within each age group. Second, CDS showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, somatization, daytime sleep-related impairment, and nighttime sleep disturbance, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-hyperactivity/impulsivity, oppositional defiant disorder, and academic impairment. Third, CDS showed stronger first-order and unique associations than ADHD-IN with a history of having an anxiety, depression, or bipolar disorder diagnosis, whereas ADHD-IN showed stronger first-order and unique associations with having an ADHD diagnosis.

CONCLUSIONS

The identification of a common set of CDS symptoms spanning early childhood to adolescence allows for the advancement of research on CDS, with a particular need now for longitudinal studies and examination of CDS with other functional outcomes and across other cultural contexts.

Psychometric Properties of the Turkish version of the Child and Adolescent Behavior Inventory Sluggish Cognitive Tempo Scale (CABI-SCT) in Children and Adolescents

Sluggish cognitive tempo (SCT) (cognitive disengagement syndrome) (CDS) describes a cluster of symptoms including slowness, lethargy, and daydreaming. This study aims to evaluate the psychometric properties of the Turkish version of the Child and Adolescent Behavior Inventory (CABI-SCT) scale and its relationship to other psychological difficulties. A total of 328 children and adolescents aged between 6-18 years were included in the study. CABI-SCT, Revised Child Anxiety and Depression Scale (RCADS), Barkley Child Attention Scale (BCAS), ADHD Rating Scale-IV, and Strengths and Challenges Questionnaire (SDQ) were administered to parents of participants. Reliability analysis demonstrated good internal consistency and reliability. Confirmatory factor analysis indicated that the one-factor model of the Turkish version of CABI-SCT is an acceptable construct. This study supports the validity and reliability of the Turkish version of CABI-SCT for use in children and adolescents providing initial data concerning the psychometric properties and difficulties associated with the Turkish version of the CABI-SCT.

Validation of the Farsi Version of the Adult Concentration Inventory for Assessing Cognitive Disengagement Syndrome

The internal and external validity of cognitive disengagement syndrome (CDS) relative to attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated herein with Farsi-speaking adults. A total of 837 Iranian adults assessed throughout the whole country (54.72% women, Mage = 23.85; SD = 7.05; age range = 18 to 58 years; 75% between 18 and 24 years old; reporting higher educational training) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), depression, anxiety, and stress. Seven of the fifteen CDS symptoms showed a good convergent (high loadings on the CDS factor) and discriminant (higher loadings on the CDS factor than the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations with depression than ADHD-IN, whereas ADHD-IN showed stronger first-order and unique associations with ADHD-HI and anxiety than CDS. The first-order and unique associations of CDS and ADHD-IN did not differ in relation to stress. This study is the first to support the validity of the self-report of assessing CDS symptoms with the Adult Concentration Inventory with Farsi-speaking individuals residing in Iran, thus further strengthening the transcultural validity of the CDS, and paving the way for further transcultural research in the field of CDS among adults.

Report of a Work Group on Sluggish Cognitive Tempo: Key Research Directions and a Consensus Change in Terminology to Cognitive Disengagement Syndrome

OBJECTIVE

The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients.

METHOD

An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology.

RESULTS

Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected "cognitive disengagement syndrome" (CDS) to replace "SCT" as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science.

CONCLUSION

It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.

Comparison of the Cognitive Disengagement and Hypoactivity Components of Sluggish Cognitive Tempo in Autism, ADHD, and Population-Based Samples of Children

An international Sluggish Cognitive Tempo (SCT) Work Group proposed a new term for SCT, "cognitive disengagement syndrome," that more accurately describes the syndrome than does SCT. According to the Work Group, symptoms of SCT represent a cognitive dimension (cognitive disengagement) and a motor dimension (hypoactivity). Our study determined (1) if distinct factors representing cognitive disengagement and hypoactivity emerged when SCT items were factor analyzed and (2) the degree of differences in cognitive disengagement and hypoactivity within diagnostic groups. Mothers rated 1,177 children with autism, 725 with ADHD-Combined, and 307 with ADHD-Inattentive (4-17 years) and 665 elementary school children (6-12 years) on the Pediatric Behavior Scale (PBS). SCT prevalence rates were autism 32%, ADHD-Inattentive 27%, ADHD-Combined 18%, and elementary school students 7%. Factor analysis of the SCT items yielded two factors reflecting cognitive disengagement (in a fog/confused and stares/preoccupied/in own world) and hypoactivity (sluggish/slow moving/low energy, drowsy/sleepy/not alert, and tires easily) in all diagnostic groups. Cognitive disengagement prevalence rates and scores were significantly higher than hypoactivity in the autism and ADHD-C groups and in the autism and ADHD-C subgroups of children with SCT (but not in the ADHD-I and elementary school total groups and SCT subgroups). Our findings factor analyzing five SCT items support two SCT subfactors: cognitive disengagement and hypoactivity.

Academic functioning in children with and without sluggish cognitive tempo

Sluggish cognitive tempo (SCT) is increasingly conceptualized as a transdiagnostic set of symptoms associated with poorer functional outcomes, although the extent to which SCT is associated with academic functioning remains unclear. This study recruited children based on the presence or absence of clinically elevated SCT symptoms, using a multi-informant and multi-method design to provide a comprehensive examination of academic functioning in children with and without clinically elevated SCT symptoms. Participants were 207 children in Grades 2-5 (ages 7-11 years; 63.3% male), including 103 with clinically elevated teacher-reported SCT symptoms and 104 without elevated SCT, closely matched on grade and sex. A multi-informant, multi-method design that included standardized achievement testing, curriculum-based measurement (CBM), grades, classroom and laboratory observations, and parent and teacher rating scales was used. Children with elevated SCT symptoms had poorer academic functioning than their peers across most domains examined. Specifically, compared to children without SCT, children with elevated SCT had significantly lower grade point average (d = 0.42) and standardized achievement scores (ds = 0.40-0.77), poorer CBM performance including lower productivity (ds = 0.39-0.51), poorer homework performance and organizational skills (ds = 0.58-0.85), and lower teacher-reported academic skills (ds = 0.63-0.74) and academic enablers (ds = 0.66-0.74). The groups did not significantly differ on percentage of time on task during classroom observations or academic enabler interpersonal skills. Most effects were robust to control of family income, medication use, and attention-deficit/hyperactivity disorder inattentive symptoms, although effects for motivation and study skills academic enablers were reduced. This study demonstrates that children with clinically elevated SCT symptoms have wide-ranging academic difficulties compared to their peers without SCT. Findings point to the potential importance of assessing and treating SCT to improve academic outcomes.

Sluggish Cognitive Tempo among Iranian Children and Adolescents: A Validation Study of the Farsi Child and Adolescent Behavior Inventory (CABI)–Parent Version

Background: Sluggish cognitive tempo (SCT), recently renamed cognitive disengagement syndrome (CDS), is a set of behavioral symptoms that includes excessive daydreaming, mental confusion and fogginess, being lost in one’s thoughts, and slowed behavior and thinking. Symptoms of SCT show overlap with a broad range of other symptoms such as attention-deficit/hyperactivity disorder inattention, anxiety, and depression, or oppositional defiant disorder (ODD). To measure SCT, one of the optimal measures is the Child and Adolescent Behavior Inventory (CABI). Here, we report the psychometric properties of the Farsi version of the CABI Parent Version, including the CABI SCT scale and its subscales. Methods: The participants were the parents of 209 children and adolescents (53.9% girls; ages 8–19 years; M_age = 14.23, SD_age = 2.72). Parents completed the SCT, ADHD inattention (ADHD-IN), ADHD-hyperactivity/impulsivity (ADHD-HI), oppositional defiant disorder (ODD), limited prosocial emotions (callous-unemotional (CU) traits), anxiety, depression, social impairment, and academic impairment scales of the Child and Adolescent Behavior Inventory (CABI). Parents also completed four dimensions of the Strengths and Difficulties Questionnaire (SDQ: emotional problems; conduct problems; peer problems; prosocial behavior), and five dimensions of the Kidscreen questionnaire (physical health; psychological well-being; autonomy and parental well-being; peers and social support; school environment). Results: SCT symptoms demonstrated strong discriminant validity from the ADHD-IN symptoms. SCT showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, and ODD, whereas ADHD-IN showed stronger first-order and unique associations than SCT with ADHD-HI, CU, and social and academic impairment. Further, SCT showed stronger first-order and unique associations than ADHD-IN with more emotional problems, peer problems, and with lower prosocial behavior, as assessed with the SDQ. Higher scores for SCT were associated with lower psychological well-being, autonomy and parental relations, and lower peer and social support, as assessed with the Kidscreen. Higher ADHD-IN scores were associated with lower peer and social support, and a lower school environment. Conclusions: The Farsi version of the CABI–Parent Version has very good psychometric properties for assessing SCT and other dimensions of psychopathology/impairment and replicates the findings from similar studies with children and adolescents from South Korea, Spain, Turkey, and the United States. Accordingly, the present study provides further support of the transcultural validity of the sluggish cognitive tempo construct.

Multisource Network and Latent Variable Models of Sluggish Cognitive Tempo, ADHD-Inattentive, and Depressive Symptoms with Spanish Children: Equivalent Findings and Recommendations

Multisource network and latent variable models were used to examine the construct validity of sluggish cognitive tempo (SCT) symptoms relative to attention-deficit/hyperactivity disorder-inattentive (ADHD-IN) and depressive symptoms. The five objectives were to determine the (1) distinctiveness of SCT, ADHD-IN, and depressive symptom communities, (2) similarity of the three symptom communities across mother, father, and teacher ratings, (3) individual symptoms with the strongest influence on other symptoms, (4) individual symptoms with the strongest relations to academic and social impairment, and (5) similarity between network and latent variable model results. Mothers, fathers, and teachers rated SCT, ADHD-IN, and depressive symptoms for 2,142 Spanish children (49.49% girls, ages 8-13 years, third to sixth grade). Walktrap community analysis resulted in SCT, ADHD-IN, and depressive symptom communities with three SCT symptom communities within the overall SCT symptom community (daydreams, mental confusion, and hypoactive communities). The symptom networks were also similar across mothers, fathers, and teachers, especially mothers and fathers. Finally, for all three sources, the same two SCT and two ADHD-IN symptoms showed unique relations with academic impairment and the same depressive symptom showed unique relations with social impairment. A latent variable model yielded equivalent results. Both models thus supported the validity of SCT symptoms relative to ADHD-IN and depressive symptoms. Complexities are noted in the selection of network and latent variable models to study child and adolescent psychopathology with recommendations for their selection.

Editorial: A Review of Sluggish Cognitive Tempo Measures That Will Benefit Researchers and Clinicians

Over the past few decades, research on sluggish cognitive tempo (SCT) has grown at an exponential rate, with the number of published studies mentioning SCT doubling between 1985 and 2000, doubling again between 2000 and 2010, and doubling again between 2010 and 2014.¹ As Becker² described in the review published in this issue, ad hoc measurement of SCT hindered early research, but this began to change in 2009 with the publication of the first rating scale specifically designed to measure SCT and developed using empirically supported principles.³ In the decade since, Becker's (as well as numerous others') efforts have meaningfully and significantly contributed to improving the measurement of SCT in several ways.^4-6 His latest review study is an important addition to this line of research. Specifically, in the review article published in this issue, Becker comprehensively searched for measures of SCT and then systematically reviewed the psychometric and other properties of the identified measures.

Validity of Sluggish Cognitive Tempo in Turkish Children and Adolescents

The internal and external validity of sluggish cognitive tempo (SCT) relative to attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with Turkish children and adolescents. Parents completed the SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), callous-unemotional (CU), anxiety, depression, social impairment, and academic impairment scales of the Child and Adolescent Behavior Inventory (CABI) on 1015 Turkish children and adolescents (56% girls; ages 6-15 years; M_age = 10.05, SD_age = 2.32), including 762 recruited from the community and 253 recruited from outpatient psychiatric clinics. SCT symptoms demonstrated excellent internal validity with the ADHD-IN symptoms. SCT symptoms also showed invariance across boys and girls as well as across community and clinical samples. SCT showed stronger first-order and unique associations than ADHD-IN with anxiety and depression whereas ADHD-IN showed stronger first-order and unique associations than SCT with ADHD-HI, ODD, and academic impairment. SCT and ADHD-IN showed equal associations with CU behaviors and social impairment. The current study is the first to support the validity of CABI SCT scores with Turkish children and adolescents and also replicates the findings from similar studies with children from South Korea, Spain, and United States. These findings thus further strengthen the transcultural validity of CABI SCT scale scores.

Convergent and Discriminant Validity of the Child and Adolescent Behavior Inventory Scale Scores With Well-Established Psychopathology and Academic Achievement Measures in Adolescents With ADHD

The convergent and discriminant validity of the parent version of the Child and Adolescent Behavior Inventory (CABI) symptom and impairment scale scores were evaluated with the scale scores from multiple methods including a semistructured diagnostic interview, rating scales, and an academic achievement test. Participants were 82 adolescents (70% male, 78% non-Hispanic White) aged 13 to 17 years (M = 15.01) diagnosed with attention-deficit/hyperactivity disorder (77% predominantly inattentive presentation) and parents. CABI scale scores showed moderate (rs = .42 to .49) to substantial (rs = .62 to .91) convergent correlations with scores from similar measures. CABI scale scores also showed significant discriminant validity (convergent correlation significantly larger than discriminant correlation) with the scores on the other measures. These findings provide additional support for use of the CABI in research and clinical practice, and copies of the scale and norms are freely available.

Psychometric and Normative Information on the Child and Adolescent Behavior Inventory in a Nationally Representative Sample of United States Children

Objective: Psychometric and normative information is provided for the Sluggish Cognitive Tempo, Attention Deficit/Hyperactivity Disorder (ADHD) Inattention, ADHD Hyperactivity/Impulsivity, Oppositional Defiant Disorder, Callous-Unemotional Behaviors (Limited Prosocial Emotions specifier), Anxiety, Depression, Social Impairment, Friendship Difficulties, and Academic Impairment Scales of the Child and Adolescent Behavior Inventory (CABI) with a nationally representative sample of U.S. children.Method: Mothers of 2,056 kindergarten to sixth-grade children (M ± SD_age = 8.49 ± 2.15 years; 49% girls) completed the CABI, and 307 randomly selected mothers completed the CABI again 4 weeks later.Results: The 10-factor model (one factor for each CABI scale) provided a close fit for the total sample as well as for boys and girls separately. Each scale showed invariance of like-item loadings and thresholds for boys and girls across a 4-week interval with excellent test-retest factor correlations and no significant factor mean changes. Normative information (T-scores) is provided for the 10 scales separately for boys and girls, with test information functions supporting the use of the scales for screening purposes.Conclusion: The normative information on the CABI provides support for the use of the 10 scales to inform the clinical care of individual children, with the positive psychometric properties of the scores providing additional support for the use of the scales for research. Copies of the scale and norms are available for free to clinicians and researchers.