Revision of the CRSR Thorough assessment of attentiondeficithyperactivity

• 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 3 Conners CBRS Parent Teacher Self-report Short ADHD Index 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 Inc. X) – 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 subscale — Learning Problems/Executive Functioning Learning Problems Aggression Hyperactivity/Impulsivity Peer Relations Family Relations Inattention (Rational) DSM-IV scales ADHD Hyperactive/Impulsive ADHD Inattentive Conduct Disorder Oppositional Defiant Disorder Severe conduct critical items Conners ADHD Index (3 AI) Conners 3 Global Index (3 GI) (parent, teacher) Screener items anxiety, depression Validity scales Negative Impression (NI) Positive Impression (PI) Inconsistency Index (Inc. X) 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 subscale — Learning Problems/Executive Functioning Learning Problems Aggression Hyperactivity/Impulsivity Hyperactivity/Impulsivity Peer Relations Family Relations Inattention (Rational) Validity scales: Negative Impression + Positive Impression

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

Conners 3 Components • Quik. Score – Handscore kit, all short versions, Conners 3 AI and Conners 3 GI • 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 Academic Difficulties (Language, math) Academic Difficulties Hyperactive/Impulsive Separation Fears subscale Separation Fears Social Problems subscale Social Problems — Rational 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 (Inc. X) DSM-IV scales 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 Linked for mixed episode Other clinical indicators 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) 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 F 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 • Quik. Score – 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