Conner's Rating Scale - psychometric Assessment

Conner's Rating Scale

1. Background The CRS have been around for 30 years. The first parent and teacher scales originated at the Harriet Lane Clinic of the Johns Hopkins Hospitals in 1960s. The primary purpose of the scales was to provide comprehensive checklist of behavioural problems that could be completed by parents and teachers of school-aged children. The need for these scales first became apparent in the context of controlled studies of psychotherapy and drugs which were initiated by professor Leon Eisenberg.

2. The National Institute of Mental Health (NIMH) adopted the scales as part of the Early Clinical Drug Evaluation Unit Protocol. Numerous studies have examined co-relates of the scales as well as their variations among different cultures and ethnic groups. Although the teacher and parent scales proved quite useful for pre- and post-treatment measures in typical drug trials, it became apparent that more frequent monitoring of children at homes and school was desirable in many studies.

3. In 1989, the scales were formally published after continuous evolutions. The Conner’s Rating Scale have become amongst the most widely used child behavioural rating scales in the world, with their international use extending to places such as Australia, Brazil, Hong Kong, Italy, New Zealand, China, Spain etc.

4. Differences between CRS and CRS-R The original CRS has 6 scales; Three Parents Scales and Three Teachers Scales. The response choices for the original CRS were like ‘Not at All’ ‘Just a Little’ ‘Pretty Much’ ‘Very Much’ However, there are 11 scales in CRS-R; Four Parent Scales, Four Teacher Scales and Three Adolescent Scales. The response options are like ‘Not At All True’ (Never or Seldom) ‘Just a Little True (Occasionally)’ ‘Pretty Much True (Often, Quite A Bit)’ ‘Very Much True (Very Often, Very Frequent)’

5. The CRS are still available and widely used however there are strong similarities between the two, the CRS-R are and the CRS should be treated as separate instruments with all together different psychometric properties.

6. Creation of CRS-R The CRS-R development, in all, encompassed four years (1992 – 1996), thousands of ratings (over 11,000), intensive research, sophisticated statistical analysis and hundreds of data collection sites. It also comply to the joint technical standards of psychological and educational testing, adopted by APA, the American Educational Research Association and the National Counsel of Measurement in Education.

7. Development of the long and short forms of CASS, CPRS-R and CTRS-R was done mainly through factor analysis and conformity factor analysis which are the statistical techniques that facilitate the determination of the best subscales structure and the best items for these subscales.

8. Introduction The Conner’s Rating Scale – Revised evaluates problem behaviours by obtaining reports from teachers, parents and adolescents. It can also help mental health professionals to diagnose and treat youth with behaviour problems. It is used to assess children with behavioural problems/disorders such as ADHD, CD and ODD.

9. The main assessment areas/subscales that Conner’s Rating Scales covers are: ADHD Index Oppositional Hyperactivity Cognitive Problems (Inattention)

10. Scales of CRS- R There are three scales of CR, with addition of ADHD index, Global Conner Index and DSM-IV Symptoms index included in the scales. Each scale is divided into two forms; short version and long version. The short scales do not contain any DSM-IV symptoms subscales and do not have respective indicators on the scoring sheet.

11. Statements on the test, e,g : ‘Forget things he/she has already learned’ Response. Rating Scale e.g : ‘Not At All True’ or ‘Just a Little True

12. 1. Conner’s Parents Rating Scale (CPRS-R) Purpose of CPRS is to form a basis for a detailed parental interview about the child's problems. CPRS- R (short) = 27 items (Oppositional=6, inattention=6, Hyperactivity=6, ADHD=12) CPRS- R (long) = 80 items (14 subscales)

13. 2. Conner’s Rating Teachers Scale (CTRS-R) The  Conners ’ Teacher Rating Scale Revised is one of the most commonly used measures of child behavior problems in which the information is gathered from the teacher. CTRS-R (short) = 28 items (Oppositional=5, inattention=5, Hyperactivity=7, ADHD=12) CTRS-R (long) = 59 items (13 Subscales)

14. 3. Conner Will’s Adolescent Self Report (CASS-R) CASS-R:S No. of items= 27 items Age Range: 12 – 17 years old 4 Subscales: Conduct Problems (6 items) Inattention ( 6 items) Hyperactivity (6 items) ADHD (12 items) CASS-R:L: No. of items = 87 items Age Range: 12 – 17 years old 10 subscales

15. Conner Global Index scales. The CGI is a fast and effective measure of general psychopathology and a helpful tool in monitoring treatment and intervention.  CGI subscales are essentially restored versions of Hyperactivity Index of the original CRS scales, except with the new name and new subscale. CGI is a 10 item index on CPRS and CTRS which is also a part of the CPRS-R and CTRS-R and as a separate revised scales (CGI).

16. DSM-IV Symptoms Subscale ADHD is one of most frequently diagnosed disorder in childhood. According to DSM-IV, the core feature of this disorder is a persistent pattern of Hyperactivity-Impulsivity and/or Inattention that is developmentally inappropriate. Conners , Parker and Sitarenios (1996) have created an 18-item rating scales for parents and teachers that adapts the criteria for ADHD outined in the DSM-IV among which 9 items asses inattentive symptoms and 9 items asses hyperactive-impulsive symptoms

17. ADHD Index ADHD Index was developed by Conners , Parker and Sitarenios (1996). It is a 12-item measure index which is included on the CASS, CPRS-R and CTRS-R to asses children and adolescents who will probably be diagnosed with ADHD. The brief index works well when screening a large group of children and adolescents to see if further assessment of ADHD is warranted. Additionally, this form can be used to monitor the effectiveness of treatment plans and measure the child’s response to intervention

18. Administration Age Group: CRPS –R and CRTS –R: 317 years old. Self report: 12- 17 years Administration time: Not timed test. Short versions generally take 5-10 minutes and long versions take 15 - 20 minutes to complete. Mode of Administration: Both individual and group

19. Important Considerations: Purpose of using the CRS-R must be explained. The respondent must have given consent. When using CTRS, teachers must be acquainted with the youths and should be adminstered no earlier than 1 -2 months after the school year has begun. Respondents are expected to comment on the youth’s behaviour and actions over the past month. All of the scales must be completed in one settings. For treatment effectiveness, test should be admininstered at least twice before beginning treatmnent .

20. Test Materials Paper and Pencil Format MHS QuickScore Form CRS-R Form A supply of soft lead pencil or a ball pen A calculator (optional) Respondent should not eraser on the QuickScore form Respondent should change or correct answer by marking an ‘X’ over the incorrect response and circling the correct response. Computerized CRS-R form

21. Procedure Administrator should not be biased, take informed consent and debrief the respondent. Each scale should be completed at one sitting if at all possible One parent or teacher should not discuss or consult with other parents or teachers likewise adolescents. The resondent should hane necessary writing utensils and appropriate QuickScore form. Respondent should be comfortable and explain the purpose of CRS-R

22. Make sure that the respondent understand that the responses are to be based on behaviour during the PAST month. Have the respondent complete the demographic information at the top of the forms. Watch the respondent answer the first couple of questions to ensure he or she reads each item carefully and then makes a rating. Before the respondent leaves, scan the test to ensure no items are left unanswered.

23. Psychometric Properties Reliability of CRS was tested through several number of statistical exercises on North American population and it was found that it is quite accurate. Test-retest reliability Internal consistency Standard error of measurement

24. Validation is an on-going process but the CRS-R results to date have shown that they are pertinent and indeed flag childhood and adolescent, ADHD, behavioural problems and psychopathogy . Construct Validity. Discriminant Validity (instrument’s ability to distinguish between relevant subject groups). Convergent Validity Divergent Validity

25. Scoring Different for short and long versions Raw Scores T scores Percentile Ranks

26. Interpretations CASS:

27. Missing Responses Example – A missing reponse on a subscale which consists of 5 items and one is missing. 2 + 2 + 2 + 2 + (missing) = 8 8 x 5= 40 40/4 = 10 10 is the raw score of that particular scale.

28. Uses Assessment of ADHD. As a screening measure Treatment monitor device Research instrument Direct clinical/diagnostic aid

29. Users Potential users of the CRS-R include: Psychologists, Social Workers, Physicians, Counselors , Psychatric Workers, Pediatric Nurses, Teachers, School officials.

30. Setting School Outpatient/Inpatient clinic s Residential Treatment Centres Child Protective Services- both for placement and referral decisions Special education and regular classrooms Juvenile detention centres Private practice offices. (Psychological, Paediatric, Psychiatric and Family Practices)