CONNER’S RATING

SCALE - REVISED
Introduction
Conners Rating Scale has been the standardised
instrument for the assessment of
Attention-deficit/hyperactivity disorder
(ADHD) and related problem behaviours in
children and adolescents.
The Conners Rating Scale evaluates problem
behaviours by obtaining (and combining, if
possible) reports from teachers, and
parents/caregivers. The revised version
(CRS-R) also added self report adolescents
forms.
Types Of Scales
The original CRS has two types of scales:
• Conners Parent Rating Scale (CPRS)
• Conners Teachers Rating Scale (CTRS)

The revised version of CRS (CRS-R) has three types

of scales:
• Conners Parent Rating Scale (CPRS)
• Conners Teachers Rating Scale (CTRS)
• Conners Adolescent Self Report (CASS)
Along with that, there are Auxiliary scales as
well; ADHD/DSM-IV Symptoms index and
Hyperactivity Index (Global Conner Index)
These subscales are included to help assess not
only ADHD but variety of areas such as
cognitive problems, family problems, emotional,
anger control and anxiety problems.

There are short and long version of each type of

scale.
Why the shorter and longer
version?
The long version contain a group of scales that
were empirically derived to assess a broad
range of problem behaviours such as conduct
problems, anxiety problems, and social
problems.
The long versions take more time to administer
and score, convey more detailed information
and correspond to the official ADHD criteria in
the DSM-IV.
The shorter version of the instruments are used
when administration time is limited or where
multiple administrations over time are desired.

The shorter version comprise only the most

valuable and relevant items from the longer
versions.

The short scales do not contain any DSM-IV

symptoms subscales.
The long forms are divided into numerous
subscales, while the main assessment areas of
short forms covers are:

1. ADHD Index
2. Oppositional
3. Hyperactivity Index (Conner Global Index)
4. Cognitive Problems (Inattention)
• Statements on the test, e,g:
‘Forget things he/she has already learned’
‘Need close supervision to get through assignements’
‘I lose things necessary for tasks or activities’

• Response.
Rating Scale:
‘Not True At All (Never, Seldom)’
‘Just a Little True (Occasionally)’
‘Pretty Much True (Often, Quite a bit)’
‘Very Much True (Very Often, Very Frequent)’
Background
Conners Rating Scale (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 National Institute of Mental Health
(NIMH) adopted the scales as part of the Early
Clinical Drug Evaluation Unit Protocol.

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.
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.
 WHICH FORM SHOULD BE
USED?
There are total 11 forms in CRS-R.
1. Conners Parent Rating Scale Long (CPRS)
2. Conners Parent Rating Scale Short (CPRS)
3. Conners Teachers Rating Scale Long (CTRS)
4. Conners Teachers Rating Scale Short (CTRS)
5. Conners Adolescent Self Report Long (CASS)
6. Conners Adolescent Self Report Short (CASS)
7. Conners’ Global Index – Parent (CGI – P)
8. Conners’ Global Index- Teacher (CGI – T)
9. Conners’ ADHD/DSM-IV Scales – Parent (CADS-P)
10. Conners’ ADHD/DSM-IV Scales – Teacher (CADS-T)
11. Conners’ ADHD/DSM-IV Scales – Adolescent (CADS- A)
Administration
•Age Group
For CRS –R: 3-17 years old.
For Self report: 12-17 years
•Administration time: Not timed test.
Short versions generally take 5-10 minutes
Long versions take 15 - 20 minutes to
complete.
•Mode of Administration: Both individual and
group
Test Materials
• CRS-R Form.
• QuickScore Form (include all the necessary information
for administration and scoring)
• A supply of soft lead pencil (without eraser) or a ball pen
• A calculator (optional)
• Respondent should not use eraser on the QuickScore
form
• Respondent should change or correct answer by marking
an ‘X’ over the incorrect response and circling the
correct response.
Procedure
•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.
 Important Considerations:
i. Purpose of using the CRS-R must be explained along
with the consent from the responded.
ii. When using CTRS, teachers must be acquainted with
the youths and should be administered no earlier than 1
to 2 months after the school year has begun.
iii. Respondents are expected to comment on the youth’s
behaviour and actions over the past month.
iv. All of the scales must be completed in one settings.
v. For treatment effectiveness, test should be administered
at least twice before beginning treatment.
 Cautions of use
1. If the CRS-R are used directly for decision making,
it should be recognized that there is a risk as all
psychological screening instrument are not perfectly
valid and not all problem cases will be identified by
the instrument. (false negative)
Likewise, some children who do not really have
clinically significant levels of problem behaviours
may be identified as clinical problem cases (false
positive).
To minimize this issue, test scores should be
combined with other reliable sources of information
2. The self report measures are not
recommended for person who are unwilling
or unable to respond honestly to
questionnaires.
3. The CRS-R are not recommended for
individuals who are disoriented or severely
impaired.
4. For individuals with poor reading abilities,
the administrator may read the items aloud
while the responders responds.
6. Administrator should not be biased and must
debrief the respondent.
7. One parent or teacher should not discuss or
consult with other parents or teachers as well
as adolescents.
8. The respondent should have necessary writing
utensils and appropriate QuickScore form.
Conner’s Parents Rating Scale
(CPRS-R)
•CPRS is typically used with parents or
guardians when comprehensive information
and DSM IV consideration are required.
•Parent ratings reveal the child’s behaviour at
home and in other environments where the
parent has the opportunity to observe the
child.
•Parents are asked to consider the child’s
behaviour during the PAST month.
Age range: 3 – 17 years
CPRS- R (long) CPRS- R (short)
No. of items = 80 items No. of items = 27 items
No. of subscales = 14 subscales No. of subscales = 4 subscales
Sample items
‘Afraid of being alone’

‘Does not get involved

to friends’ house’

‘Clings to parents or
other adults’
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.
•The teacher scales provide the most economical
and objective way to obtain relevant assessment
information because they provide an ideal
means for describing academic, social, and
emotional behaviours in the classroom.
 Age range: 3 – 17 years
CTRS-R long CTRS-R short

No. of items = 59 items No. of items 28 items

No. of subscales = 13 No. of subscales = 4
Subscales Subscales

Subscales are similar to

parents form except
psychosomatic subscale is
not present in teacher form.
Sample items
‘Poor in spelling’

‘Lacks interest in
schoolwork’

‘Leaves seat in classroom

or in other situation in
which remaining seated in
expected’
Conner Will’s Adolescent Self Report
(CASS)
• The revised scale include a brand new component – a
self report scale for adolescents.
• These scales collects a third source of information that
can be used along with parents and teacher reports.
• As children grow older they develop more comorbid
internalizing symptoms that is investigated via self
report.
• They are easy for any typical adolescent to be able to
understand and complete the form (if they have a
reading level of at least grade 6).
 Age Range: 12 – 17 years

CASS - Long CASS- Short

• No. of items = 87 items • No. of items = 27 items
• No. subscales = 10 • No. subscales = 4
subscales
Auxiliary CRS- R Scales
They are brief and preferred for treatment monitoring and
in situations where extremely short measures are needed.

1. Conners’ Global Index – Parent (CGI – P)

2. Conners’ Global Index – Teacher (CGI – T)
3. Conners’ ADHD/DSM-IV Scales – Parent (CADS-P)
4. Conners’ ADHD/DSM-IV Scales – Teacher
(CADS-T)
5. Conners’ ADHD/DSM-IV Scales – Adolescent
(CADS- A)
Conner Global Index.
• The CGI is a fast and effective measure of general
psychopathology and a helpful tool in monitoring
treatment effectiveness and changes over time.
• 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 scale in the CRS- R.
CGI contains two
separate factors:

• Emotional lability
• Restless-Impulsive
ADHD/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 outlined in the DSM-IV among which:

i. 9 items asses inattentive symptoms and

ii. 9 items asses hyperactive-impulsive symptoms
Each of the longer version of CPRS- R, CTRS-
R and CASS contain rationally derived
subscales that relate directly to DSM – IV
criteria along with the norm-based criteria.

Norm based criteria provides balance between

the categorical and dimensional assessments.
ADHD Index
• ADHD Index was developed by Conners, Parker
and Sitarenios (1996).
• It is a 12-item measure index which is included on
the CPRS-R, CTRS-R and CASS to asses children
and adolescents.
• The ADHD Index contains the best set of items for
disguising ADHD children from nonclinical
children. This index is helpful in screening
children and adolescents who may merit a clinical
diagnosis of ADHD.
Conners’
ADHD/DSM-I
V Scales –
Adolescent
(CADS- A)
• A items are ADHD
Index

• B items are
DSM/IV Symptoms
Subscale
Advantages of CRS- R
1. It has a large normative database (collected throughout US
and Canada from 1993 – 1996).
2. It is a multidimensional scale that assess ADHD and
comorbid disorders
3. It links to DSM-IV
4. Clinical and Diagnostic relevance
5. Teacher, parent and self report scales in long and short
formats
6. Externalizing (Conduct problems, aggression) and
Internalizing items (anxiety and depression)
7. Conners’ Global Index and ADHD Index
 8. Easy administration, and profiling for results
9. Forms for providing feedback – enables the
practitioner to summarize the scores for the
child or adolescent in broad terms: ‘better
than average’, ‘average’ and ‘need for
improvement’
10. Excellent reliability and validity
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.
• In terms of reliability internal consistency
coefficients range around 0.75 to 0.90 and
• 6 to 8 week test-retest reliability coefficients range
from about 0.60 to 0.90
In terms of validity, support for the validity of the structure of
the CRS-R forms was obtained using factor analysis techniques
in derivation and cross—validation samples.

The CRS-R subscales have been compared to each other and

have even manage to achieve the same calibre of results as the
CRS.
Despite these fine results more work in this area is expected in
the future.

Validation is an on-going process, but the CRS-R result to date

have shown that they are pertinent and indeed flag childhood and
adolescent ADHD behaviour problems and psychopathology.
Uses
1. Assessment of ADHD along with comorbidity of other
problems with the help of subscales.
2. As a screening measure – to help identify children and
adolescents who may have ADHD or a related problem on a
regular basis in school or clinic.
3. Research instrument
4. Direct clinical/diagnostic aid – Although it remains true that
rating scales alone cannot be used to ascertain a diagnosis,
inclusion of subscales that link directly to DSM-IV and place
emphasis on multimodal assessment make the CRS-R
directly relevant to clinical assessment and diagnosis.
 Users
Potential users of the CRS-R include:
i. Psychologists,
ii. Social Workers,
iii. Physicians,
iv. Counsellors,
v. Psychiatric Workers,
vi. Paediatric Nurses,
vii. Teachers,
viii. School officials.
 Setting
i. School
ii. Outpatient/Inpatient clinics
iii. Residential Treatment Centres
iv. Child Protective Services- both for placement and
referral decisions
v. Special education and regular classrooms
vi. Juvenile detention centres
vii. Private practice offices. (Psychological, Paediatric,
Psychiatric and Family Practices)