•Revision of the CRS-R•Thorough assessment of attention-deficit/hyperactivity disorder (ADHD)

•Comprehensive Behavior Rating Scales (CBRS)•Covers a broad range of childhood disorders and problems

Conners:Responding to Assessment

Trends

First: Broad-band assessment used to identify suspected and unknown areas of concern (Conners CBRS).

Second: Once the areas of concern have been identified, a narrow instrument is used to confirm the diagnosis (Conners 3).

Conners

Conners 3Parent

TeacherSelf-report

Conners CBRSParent

TeacherSelf-report

ShortParent

TeacherSelf-report

Clinical IndexParent

TeacherSelf-report

Global IndexParent

Teacher

ADHD IndexParent

TeacherSelf-report

Conners School-AgeScales: Overview

Conners 3

• Streamlined and refined revision of CRS-R• An in-depth, focused assessment of ADHD• Informs differential diagnosis by assessing

and screening for problems and disorders most commonly comorbid or associated with ADHD

• Stratified and representative of U.S. population (2000)

• Streamlined content

• New normative data and updated psychometric properties

• Modified age range

• Increased similarities across forms

• Respondent-friendly translations ofDSM-IV concepts

Key Changes From CRS-R

Key Changes From CRS-R (cont.)

• Shifted some CRS-R content to Conners CBRS – Anxious/Shy, Perfectionism, and Psychosomatic – Conners-Wells’ Adolescent Self-Report Scale

(CASS) Emotional Problems • New scale and item-level content

– DSM-IV symptoms of oppositional defiant disorder (ODD) and conduct disorder (CD)

– Assessment of executive functioning (parent andteacher forms)

– New validity scales (PI, NI, and IncX)– Screener items for anxiety and depression– Severe conduct critical items– Impairment items

• Short form content• No more Conners ADHD/DSM-IV Scales

(CADS)• CASS has been renamed the self-report• ADHD index available as separate 10-item

index • The Conners 3 Global Index features the same

items with new norms

Key Changes From CRS-R (cont.)

Conners 3Full-Length Forms

• Recommended for use when comprehensive information and DSM-IV symptoms are required

• Parent (ages 6-18 years), teacher (ages 6-18 years), and self-report (ages 8-18 years)

• 110 items for parent, 115 for teacher, and 99 items for self-report

• Ratings are based on the past month• The scales of the three forms closely parallel

each other

Conners 3

Empirical scales

Parent (N = 110)

6-18 years

Teacher (N = 115)

6-18 years

Self (N = 99)

8-18 years

Executive Functioning Executive Functioning subscale —

Learning Problems Learning Problems/Executive Functioning

Learning Problems

Aggression Aggression Aggression

Hyperactivity/Impulsivity Hyperactivity/Impulsivity Hyperactivity/Impulsivity

Peer Relations Peer Relations Family Relations

Inattention (Rational) Inattention (Rational) Inattention (Rational)

DSM-IV scalesADHD Hyperactive/ImpulsiveADHD InattentiveConduct DisorderOppositional Defiant Disorder

Conners3 Global Index (3GI) (parent, teacher)

Screener itemsanxiety, depression

Validity scales

Negative Impression (NI) Positive Impression (PI)Inconsistency Index (IncX)

Impairment questions

Conners ADHD Index (3AI)

Severe conduct critical items

Conners 3Short Forms

• Useful when administration of the full-length versions is not possible or practical

• Subset of items from the full-length form, representing concepts from all empirical scales, the rational inattention scale, and the validity scales

• Parent (ages 6-18 years), teacher (ages6-18 years), and self-report (ages 8-18 years)

• Ratings are based on the past month• The scales closely parallel each other

Conners 3 Short Forms (cont.)

Empirical scales

Parent (N = 43)

6-18 years

Teacher (N = 39)

6-18 years

Self (N = 39)

8-18 years

Executive Functioning Executive Functioning subscale —

Learning Problems Learning Problems/Executive Functioning

Learning Problems

Aggression Aggression Aggression

Hyperactivity/Impulsivity Hyperactivity/ Impulsivity Hyperactivity/Impulsivity

Peer Relations Peer Relations Family Relations

Inattention (Rational) Inattention (Rational) Inattention (Rational)

Validity scales: Negative Impression + Positive Impression

Conners 3AI

• A 10-item index within the full-length forms• Also available as a separate, brief, ADHD-focused

measure• Items selected as the best to differentiate people

with ADHD from individuals with no clinical diagnosis• Useful as a quick check to see if further ADHD

evaluation is warranted• Can also be useful for repeated measures • Available for parents, teachers, and as a self-report

Conners 3GI

• An index within the Conners 3 full-length forms• Also available separately as a quick measure of

general psychopathology• Same items, new norms• Useful in determining which direction to take with

further examination• Especially useful for monitoring treatment

effectiveness and changes over time• Available for parents and teachers

Conners 3Psychometrics

6 7 8 9 10 11 12 13 14 15 16 17-18

50 50 50 50 50 50 50 50 50 50 50 50

50 50 50 50 50 50 50 50 50 50 50 50

Parent total N = 1,200 (ages 6-18 years)

Teacher total N = 1,200 (ages 6-18 years)

Norms: Age x Gender

Age (years)

Self total N = 1,000 (ages 8-18 years)

M

F

Gender

Ethnic group CensusConners 3

ParentConners 3 Teacher

Conners 3 Self

Asian 3.8 4.6 6.0 5.1

African

American15.7 15.1 15.6 15.2

Hispanic 15.1 15.1 17.5 15.0

Caucasian 61.9 61.3 57.5 61.1

Other 3.5 3.8 3.3 3.6

Ethnic representation closely matches census figures.

Ethnic Representation (%)

Internal Consistency

  Parent Teacher Self

Content scales .91 (.85-.94) .94 (.92-.97) .88 (.84-.92)

DSM-IV-TR scales .90 (.83-.93) .90 (.77-.95) .85 (.81-.89)

Validity scales .67 (.59-.75) .72 (.70-.73) .56 (.50-.62)

Reliability

• Positive and Negative Impression scales contain only six items each. The fewer the number of items, the lower alpha tends to be.1

• These scales are made up of items not typically endorsed. Therefore, variability of the items is compromised, resulting in lower alphas.

• Given these considerations, the obtained alpha values for the validity scales are considered satisfactory.

Why are internal consistency estimates of validity scales generally weaker than the remaining scales?

1 John, O. P., & Benet-Martinez, V. (2000). Measurement, scale construction, and reliability. In H. T. Reis & C. M. Judd(Eds.), Handbook of research methods in social and personality psychology (pp. 339-369). New York: CambridgeUniversity Press.

  Parent Teacher Self

Content scales .85 (.72-.98) .85 (.78-.90) .79 (.75-.83)

DSM-IV-TR scales .89 (.84-.94) .85 (.83-.87) .76 (.71-.83)

Temporal Stability of Conners Forms

(Test-Retest)

Interrater Reliability

  Two parents Two teachers

Content scales .81 (.74-.84) .73 (.52-.82)

DSM-IV-TR scales .84 (.75-.94) .70 (.55-.77)

  Parent-Teacher Parent-Self Teacher-Self

Content scales .61 (.54-.67) .57 (.53-.62) .51 (.46-.56)

DSM-IV-TR scales .58 (.52-.63) .55 (.49-.60) .46 (.43-.50)

Across-Informant Correlations

Measuring Change

• If we have implemented a treatment program and are measuring change, how do we know if the difference is significant or not?

• Important consideration for RTI programs and evidence-based practice issues in health care

• Jacobson and Truax method of calculating a reliable change index (RCI).2

How do I know if a change in Conners scores over time is statistically and/or clinically significant?

2 Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change inpsychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.

Reliable Change Index

• RCI values are based on a 90% confidence interval.

• A change in scores that meets or exceeds the RCI value can be considered to be a statistically significant change 90% of the time.

• Liberal criteria were used to better ensure that important changes in scores are not missed.

Reliable Change Index: Example

• Johnny’s teacher completed the form at time 1, then again 3 months into an intervention at time 2.

• Johnny’s T score on the Hyperactivity/Impulsivity scale is 85 at time 1 and 75 at time 2 (a 10-point decrease).

• The RCI value for the Hyperactivity/Impulsivity scale is 9.01.

• Johnny’s 10-point decrease is considered statistically significant.

• Clinical significance can be established by looking at what the change means in practical terms. In this case Johnny is still 2.5 standard deviations above the mean, suggesting little clinical significance.

Conners 3and the BRIEF

A sample of participants completed both the Conners and the BRIEF.

The results suggest that the two scales complement each other nicely and that an elevated score on the Executive Functioning scale on the Conners should be followed up with a full administration of the BRIEF to provide a clearer picture of executive functioning deficits.

Conners 3 andthe BRIEF (cont.)

• Conners 3 Hyperactivity/Impulsivity Scale

- Correlates with BRIEF Inhibit scale = .76-.90 (p < .01)

• Conners 3 DSM ADHD Hyperactive/Impulsive Scale

- Correlates with BRIEF Inhibit scale = .78-.92 (p < .01)

Hyperactivity/Impulsivity

Conners 3 andthe BRIEF (cont.)

•Conners 3 Executive Functioning (Teacher)

• Correlates with BRIEF Plan/Organize scale = .87 (p < .01)

• Correlates with BRIEF Organization of Materials scale = .75 (p < .01)

•Conners 3 Executive Functioning (Parent)

• Correlates with BRIEF Plan/Organize scale = .70 (p < .01)

• Correlates with BRIEF Organization of Materials scale = .45 (p < .01)

Learning Problems/Executive Functioning

Making the Transition:CRS-R to Conners 3

• CRS-R long and short forms (ages 3-17 years)– Conners 3 full-length and short forms (ages 6-18 years)– Conners Early Childhood (Conners EC) full-length and short

forms (ages 2-6 years)

• CADS (ages 3-17 years)– Not part of Conners 3 – Can use Conners 3AI (ages 6-18 years) in screening situations– If DSM-IV scores are required, you can use the full-length

Conners 3

• Conners Global Indexes (ages 3-17 years)– Conners 3GI (ages 6-18 years)– Conners EC Global Index (ages 2-6 years)

Conners 3 Components

• QuikScore– Handscore kit, all short versions, Conners 3AI

and Conners 3GI

• Response booklet– Computer kit–full-length form only

• Unlimited-use scoring program– Scoring–no administration– USB–portable, requires USB to be installed

to run

• Online available only from MHS

• Comprehensive measure of several childhood disorders and problems

• Useful as the first step in testing

• A high scale score on this test can be followed by further testing by other, more focused instruments

• Parent, teacher (ages 6-18 years), and self-report (ages 8-18 years)

• Ratings are based on the past month

• The scales of the three forms closely parallel each other

Conners CBRS

Conners CBRSParent (N = 203)

6-18 years

Teacher (N = 204)

6-18 years

Self (N = 179)

8-18 years

Emotional Distress

(Upsetting thoughts, worrying, social problems)

Emotional Distress

(Upsetting thoughts/physical symptoms, separation fears, social anxiety)

Emotional Distress

Aggressive Behaviors Aggressive Behaviors Aggressive Behaviors

Academic Difficulties (Language, math)

Academic Difficulties (Language, math)

Academic Difficulties

Hyperactive/Impulsive Hyperactive Hyperactive/Impulsive

Separation Fears Separation Fears subscale Separation Fears

Social Problems subscale Social Problems —

Rational Perfectionistic and Compulsive Behaviors

Perfectionistic and Compulsive Behaviors —

Validity scalesNegative Impression (NI)Positive Impression (PI)Inconsistency Index (IncX) Impairment questions

Rational scalesViolence Potential Physical Symptoms

DSM-IV scalesGeneralized Anxiety DisorderSeparation Anxiety Social PhobiaObsessive-Compulsive DisorderAutistic Disorder (Parent & Teacher)Asperger’s Disorder (Parent & Teacher)ADHD Hyperactive/Impulsive ADHD InattentiveOppositional Defiant Disorder Conduct DisorderMajor Depressive EpisodeManic Episode

Other clinical indicatorsBullying victimizationBullying perpetrationEnuresis/Encopresis (Parent & Teacher)Panic attackPica (Parent & Self-Report)Posttraumatic stress disorderSubstance abuseSpecific phobiaTicsTrichotillomaniaPervasive developmental disorder (Self-Report)

Linked for mixed episode

Clinical Index (CI)

Critical itemsSevere conduct Self harm

Conners Clinical Index

• A screener for general clinical issues

• Derived from the CBRS items

• 24 (Parent) and 24 (Teacher) items that best separate the clinical from the nonclinical population

• Can be used as a screener or for treatment monitoring/follow-up

Conners CBRS

Psychometrics

Norms: Age x Gender

Parent total N = 1,200 (ages 6-18 years)

Teacher total N = 1,200 (ages 6-18 years)

Self total N = 1,000 (ages 8-18 years)

6 7 8 9 10 11 12 13 14 15 16 17-18

50 50 50 50 50 50 50 50 50 50 50 50

50 50 50 50 50 50 50 50 50 50 50 50

Age (years)

M

F

Gender

Ethnic Representation

Ethnic group CensusConners CBRS-

ParentConners CBRS-

TeacherConners CBRS-

Self

Asian 3.8 4.8 6.2 5.2

African

American15.7 15.1 16.2 15.7

Hispanic 15.1 15.6 16.6 14.8

Caucasian 61.9 60.3 49.2 61.0

Other 3.5 4.2 11.9 3.2

Internal Consistency

  Parent Teacher Self

Content scales .91 (.85-.94) .94 (.92-.97) .88 (.84-.92)

DSM-IV-TR scales .90 (.83-.93) .90 (.77-.95) .85 (.81-.89)

Validity scales .67 (.59-.75) .72 (.70-.73) .56 (.50-.62)

  Parent Teacher Self

Content scales .85 (.70-.96) .86 (.80-.96) .69 (.58-.82)

DSM-IV-TR scales .85 (.66-.95) .85 (.76-.94) .65 (.56-.76)

Temporal Stability of Conners CBRS (Test-Retest)

Interrater Reliability

  Two parents Two teachers

Content scales .76 (.62-.89) .69 (.50-.88)

DSM-IV-TR scales .72 (.53-.84) .67 (.53-.80)

  Parent-Teacher Parent-Self Teacher-Self

Content scales .53 (.29-.67) .54 (.43-.61) .41 (.23-.51)

DSM-IV-TR scales .53 (.34-.64) .49 (.33-.57) .38 (.26-.48)

Across-Informant Correlations

•Education

- Prevention

- Early identification and intervention

- Individualized education plan (IEP)

•Clinical

- Diagnosis

- Labeling

- Treatment

CBRS: Responding to Market Needs

Conners CBRS Components

• QuikScore– Only available for Clinical Index

• Response booklet– Computer Kit–no hand scoring for CBRS

• Unlimited-use scoring program– Scoring–no administration– USB–portable, requires USB to be installed

to run

• Online available only from MHS