The Compensatory ADHD Behaviors Scale (CABS)
Description.
The CABS is a 28-item measure that was designed to assess the use (14 items) and effectiveness (14 items) of compensatory strategies (e.g., to-do lists, planners, etc.) some individuals use to ameliorate executive functioning deficits to improve overall functional impairment (e.g., school/work performance).
Rationale for development.
Several measures are available that assess ADHD symptoms (e.g., inattention, hyperactivity/impulsivity) and executive functioning deficits; however, treatments and skill-based academic interventions for adults with ADHD focus on improving compensatory strategies to ameliorate functional impairment. In an effort to address this gap, the Compensatory ADHD Behaviors Scale (CABS) was developed and validated (Castagna et al., 2019) with the hope it would be useful clinicians to use as a tool to track treatment progress for those with ADHD, as well as researchers aiming to explain the relation between ADHD symptoms and functional impairment. You can find the original validation study here.
Scale development.
The items included on the CABS were derived from ADHD treatment manuals, clinical observations, and scales measuring impairment associated with ADHD (e.g., Safren et al., 2005; Solanto et al., 2008, 2010). First, domains were treated that those with ADHD report having difficulties with (i.e., planning, forgetting, organization, time-management). These domains were chosen because CBT for adult ADHD typically focuses on these domains when teaching compensatory strategies (Solanto et al., 2008). In addition, executive functioning scale items, which relate to compensatory strategies as opposed to emotion regulation, typically cluster around these domains (e.g., Barkley Deficits in Executive Functioning Scale; Barkley, 2011). Next, the CABS use subscale was created utilizing the aforementioned resources within the domains. Following, the CABS effectiveness items were created by changing the language of the use subscale to reflect whether the compensatory behaviors have been helpful to the respondent. The instructions ask the rater to first assess the use of the strategies and then to assess the effectiveness of the same strategies. Participants rate the use and effectiveness, respectively, of a particular behavior as either 0 (not at all), 1 (a little bit), 2 (sometimes), 3 (quite a bit), and 4 (often). Total scores for the use and effectiveness scales, respectively, are a sum of all items.
Psychometric properties.
The exploratory factor analysis indicated two factors on both the use of compensatory ADHD behaviors and the effectiveness of compensatory ADHD behaviors subscales:
1) Compensatory behaviors that aid in functioning in the moment (i.e., present-oriented use and present-oriented effectiveness)
2) Compensatory behaviors that aid in skill deficits related to keeping track of future events and/or activates (i.e., future-oriented use and future-oriented effectiveness).
Reliability & Validity
In our original study, the CABS demonstrated adequate to good internal consistency and normally distributed scores across all subscales. Furthermore, the CABS present-oriented use and effectiveness subscales demonstrated significant negative correlations with the ADHD symptomatology and executive functioning deficits, whereas the CABS future-oriented use and effectiveness subscales were not significantly related to the ADHD symptomatology or executive functioning deficits. The CABS present-oriented use and effectiveness subscales also demonstrated a significant correlation with total functional impairment. In contrast, we found that the CABS future-oriented use and effectiveness subscales were not significantly related to the total functional impairment. Overall, these results revealed a consistent pattern: present-oriented, but not future-oriented, compensatory behaviors were more associated with ADHD symptoms, executive functioning deficits, and total functional ADHD-related impairment.
Clinical Utility
In terms of clinical utility, exploratory results indicated that individuals with ADHD report using more future-oriented compensatory behaviors but reported that they are significantly less effective (when compared with a control sample). In addition, this diagnostic group reported using less present-oriented compensatory strategies but did not differ from the control group on their reported effectiveness.
However, the sample was small (n = 72) and composed of 31 adults who self-reported a primary diagnosis of ADHD. Although the diagnosis was corroborated by their scores on well-validated measures of ADHD symptomatology, executive functioning, and functional impairment, their self-reported diagnoses could not be confirmed, and therefore, these results should be interpreted with caution.
Scoring.
CABS Usesubscale: sum or average of first 14 items.
Present-oriented Use facet (five items): sum or average of items 2, 3, 4, 13, 14
Future-oriented Use facet (seven items): sum or average of items 5, 6, 7, 8, 9, 11
CABS Effectiveness subscale: Sum or average of second set of 14 items.
Present-oriented Effectiveness facet (six items): sum or average of items 1, 2, 3, 4, 10, 14
Future-oriented Effectiveness facet (seven items): sum or average of items 5, 6, 7, 8, 9, 11, 12
Translations.
The CABS has been translated into:
- Mandarin
- Spanish
- German
- Persian
- Arabic
- Czech
To my knowledge, only the Mandarin version of the CABS has been validated through peer-review (Zhang et al., 2024). You can find the study validating the Chinese version of the CABS here.
The original CABS (left) and a modified version (right), where Use and Effectiveness items are asked in tandem, are freely available below.
If used, please cite the original validation paper: Castagna et al. (2018)
The Mandarin and Spanish versions of the CABS are provided below.