•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 School-Age
Scales: Overview
Conners
Conners 3
Conners CBRS
Parent
Teacher
Self-report
Parent
Teacher
Self-report
Short
ADHD Index
Parent
Teacher
Self-report
Parent
Teacher
Self-report
Global Index
Parent
Teacher
Clinical Index
Parent
Teacher
Self-report
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)
Key Changes From
CRS-R
• Streamlined content
• New normative data and updated
psychometric properties
• Modified age range
• Increased similarities across forms
• Respondent-friendly translations of
DSM-IV concepts
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 and
teacher forms)
– New validity scales (PI, NI, and IncX)
– Screener items for anxiety and depression
– Severe conduct critical items
– Impairment items
Key Changes From
CRS-R (cont.)
• 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
Conners 3
Full-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 scales
ADHD Hyperactive/Impulsive
ADHD Inattentive
Conduct Disorder
Oppositional Defiant Disorder
Severe conduct critical
items
Conners ADHD Index (3AI)
Conners3 Global Index
(3GI) (parent, teacher)
Screener items
anxiety, depression
Validity scales
Negative Impression (NI)
Positive Impression (PI)
Inconsistency Index (IncX)
Impairment questions
Conners 3
Short 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 (ages
6-18 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 3
Psychometrics
Norms: Age x Gender
Age (years)
Gender
6
7
8
9
10
11
12
13
14
15
16
17-18
M
50
50
50
50
50
50
50
50
50
50
50
50
F
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)
Self total N = 1,000 (ages 8-18 years)
Ethnic Representation (%)
Ethnic group
Census
Conners 3
Parent
Conners 3
Teacher
Conners 3
Self
Asian
3.8
4.6
6.0
5.1
African
American
15.7
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.
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
Why are internal consistency estimates of validity
scales generally weaker than the remaining scales?
• 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.
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: Cambridge
University Press.
Temporal Stability of
Conners Forms
(Test-Retest)
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)
Interrater Reliability
Two parents
Two teachers
Content scales
.81 (.74-.84)
.73 (.52-.82)
DSM-IV-TR scales
.84 (.75-.94)
.70 (.55-.77)
Across-Informant
Correlations
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)
Measuring Change
How do I know if a change in Conners scores over
time is statistically and/or clinically significant?
• 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
2
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in
psychotherapy 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 3
and 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 and
the BRIEF (cont.)
Hyperactivity/Impulsivity
• 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)
Conners 3 and
the BRIEF (cont.)
Learning Problems/Executive Functioning
•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)
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
Conners CBRS
• 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
Parent (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
—
Rational scales
Violence Potential
Physical Symptoms
Clinical Index (CI)
Critical items
Severe conduct
Self harm
Validity scales
Negative Impression (NI)
Positive Impression (PI)
Inconsistency Index (IncX)
DSM-IV scales
Other clinical indicators
Generalized Anxiety Disorder
Separation Anxiety
Social Phobia
Obsessive-Compulsive Disorder
Autistic Disorder (Parent & Teacher)
Asperger’s Disorder (Parent & Teacher)
ADHD Hyperactive/Impulsive ADHD
Inattentive
Oppositional Defiant Disorder
Conduct Disorder
Major Depressive Episode
Manic Episode
Bullying victimization
Bullying perpetration
Enuresis/Encopresis (Parent & Teacher)
Panic attack
Pica (Parent & Self-Report)
Posttraumatic stress disorder
Substance abuse
Specific phobia
Tics
Trichotillomania
Pervasive developmental disorder
(Self-Report)
Linked for mixed episode
Impairment questions
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
Age (years)
Gender
6
7
8
9
10
11
12
13
14
15
16
17-18
M
50
50
50
50
50
50
50
50
50
50
50
50
F
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)
Self total N = 1,000 (ages 8-18 years)
Ethnic Representation
Ethnic group
Census
Conners CBRSParent
Conners CBRSTeacher
Conners CBRSSelf
Asian
3.8
4.8
6.2
5.2
African
American
15.7
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)
Temporal Stability of
Conners CBRS (Test-Retest)
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)
Interrater Reliability
Two parents
Two teachers
Content scales
.76 (.62-.89)
.69 (.50-.88)
DSM-IV-TR scales
.72 (.53-.84)
.67 (.53-.80)
Across-Informant
Correlations
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)
CBRS: Responding
to Market Needs
•Education
- Prevention
- Early identification and intervention
- Individualized education plan (IEP)
•Clinical
- Diagnosis
- Labeling
- Treatment
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