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ASSESSMENTS
Conners CBRS
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Conners Comprehensive Behavior Rating Scales™
A comprehensive overview of behavioral, emotional, academic, and social concerns and disorders in children and adolescents.
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PURPOSE AND DEVELOPMENT The Conners Comprehensive Behavior Rating Scales™ (Conners CBRS ®) was created in response to the growing demand for a wide-ranging assessment which would identify a multitude of disorders and concerns in youth. It helps assess a broad spectrum of behavioral, emotional, social, and academic issues that can cause impairment in a youth’s functioning.
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Quick Reference Age Parent and Teacher: 6–18 Self-Report: 8–18 Number of Items Conners CBRS–Parent: 203 Conners CBRS–Teacher: 204 Conners CBRS–Self-Report: 179 Conners CI–Parent: 24 Conners CI–Teacher: 24 Conners CI–Self-Report: 24 Administration Type Parent-completed Teacher-completed Youth-completed Administration Time Conners CBRS: 25 minutes Conners CI: less than 5 minutes Translations Spanish Qualification Level B-level Formats Online (administration and scoring) Software (scoring) Reading Level Parent, Teacher, and Youth: 3rd through 5th grade
*DSM-IV-TR Scoring still available for online and software options.
Table 1 illustrates the scope of the Conners CBRS. Both Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)* (APA, 2013) diagnostic criteria and Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004) educational eligibility determinations require that reported problems be associated with clinically significant impairment in the youth’s functioning. The Impairment items in the Conners CBRS gauge the level of impairment that is present at home, at school, and with peers. Responses provide preliminary information about whether the problems described by the respondent have a pervasive impact on functioning. The Conners CBRS features direct connections to the DSM-5 so that symptoms can be examined and linked to DSM-5 symptomlevel diagnostic criteria. Elevated T-scores on the Conners CBRS Content Scales indicate potential problems in specific areas. Certain patterns of elevations tend to co-occur with certain DSM-5 diagnoses. In many cases, scale elevations suggest key targets for intervention plans. Results also are linked to possible areas of eligibility under IDEA 2004, providing keys to disability determination as well as Individualized Education Program development. Elevated scores on the Conners CBRS may indicate the need for accommodations in regular education settings or for special education and related services. A youth who has elevated Conners CBRS scores may meet criteria for IDEA 2004 eligibility in
Conners Comprehensive Behavior Rating Scales™ (Conners CBRS ®), C. Keith Conners, Ph.D.
the areas of Autistic Disorder, Developmental Delay, Emotional Disturbance, Specific Learning Disability, Other Health Impairment, and/or Speech or Language Impairment. Validity scales provide a guideline against which the assessor can appraise overly negative, overly positive, or inconsistent responding. The Conners CBRS has many potential uses in schools, special education and regular classrooms, outpatient and inpatient clinics, residential treatment centers, private practice, child protective services, and juvenile detention centers. It can be helpful at both the assessment stage (e.g., diagnosis, classification, screening, research) and the intervention stage (e.g., planning, monitoring progress, program evaluation). After a diagnosis has been established and it has been determined that intervention is required, it is appropriate to use the Conners CBRS to monitor treatment response, regardless of which treatment approach is selected. Regular administration of the Conners CBRS or the Conners Clinical Index (Conners CI ™) is an efficient way to gather data regarding current level of functioning. When medication is used in the treatment plan, repeated administration of the Conners CBRS or the Conners CI can help refine intervention efforts, whether indicating the benefit of a new medication, a change in dosage, or a reduced need for medication. When a non-pharmacological approach is used, results from the Conners CBRS can indicate which symptoms are responding to the intervention, as well as show which areas require additional attention. Repeat administrations of the Conners CBRS can also highlight new symptoms that may emerge as previous symptoms are addressed. The Conners CI is extracted from the Conners CBRS form. It contains the 24 items that best distinguish youth with a
clinical diagnosis from youth in the general population. This index is particularly useful in pre-evaluation screening to determine if further evaluation is warranted in one of the following areas: • Disruptive Behavior Disorders • Learning Disorders and
Language Disorders
• Mood Disorders • Anxiety Disorders • ADHD
Parent ratings reveal the child’s behavior at home and in other environments where the parent has the opportunity to observe the child. Teacher ratings reveal the child’s academic, social, and emotional behaviors in a school setting. Self-report ratings collect a third source of information that can supplement parent and teacher reports by providing the youth’s own insight into his/ her functioning (Collet, Ohan, & Myers, 2003). Self-reports can provide valuable information about feelings and thoughts that might not easily be observable by others. There is consistency in the scales and items across the parent, teacher, and self-report versions, thus facilitating the comparison of information between sources. The development process of the Conners CBRS and Conners CI was divided into three main phases: initial planning, pilot study, and normative study. Development included a comprehensive review of current legislative updates, theory, and literature on the assessment of childhood psychopathology and all relevant childhood assessment tools; focus groups with academics, private practitioners, hospital-based clinicians, and school-based professionals; and all information gathered from these sources was reviewed within the context of clinical experience.
FORMATS The Conners CBRS can be administered using paper-and-pencil response booklets, or it can be administered online through a secure online website. Scoring is accomplished through desktop software or online. The Conners CI can be administered and scored using the MHS QuikScore™ format. The rater writes on the external layers of the form, and the results transfer through to a hidden scoring grid within the internal layers. The assessor then uses the internal layers for calculating and profiling results. The Conners CI can also be administered and scored online, or administered using the QuikScore form and scored automatically either with the software or online scoring functions.
COMPUTER-GENERATED REPORTS The computer-generated reports make quick, easy work of the complicated Conners CBRS scoring algorithm. Analytic reports can be generated using the software or online scoring options. There are three report types for both the Conners CBRS and the Conners CI. Assessment Reports provide information about the youth’s scores, how he/she compares to other youth, and which scales and subscales are elevated. For the Conners CBRS, results are also reported in relation to DSM-5 diagnostic criteria and to special education eligibility categories, as outlined in IDEA 2004. Feedback handouts (Conners CBRS only) summarize and describe the results in broad and nonthreatening terms that are appropriate for a general audience. Progress Reports combine the results of up to four administrations from the same rater to summarize important changes in reported behavior that have occurred over time.
Comparative Reports combine the results of up to five raters to provide an overview of the youth’s behavior from a multi-rater perspective and highlight potentially important inter-rater differences in scores.
USER QUALIFICATIONS Potential users of the Conners CBRS include psychologists, clinical social workers, physicians, counselors, psychiatric workers, and pediatric or psychiatric nurses, or their assigns. Conners CBRS users should be members of professional associations that endorse a set of standards for the practice of psychology and the ethical use of psychological tests, such as the American Psychological Association. Conners CBRS users must also be familiar with the standards for educational and psychological testing jointly developed by the AERA, APA, & NCME (1999). The test interpreter must meet MHS b-level qualifications, which require that, as minimum, he/she has completed graduatelevel courses in tests and measurement or has received equivalent documented training.
NORMATIVE DATA AND PSYCHOMETRIC DATA Over 7,000 assessments were collected in the development of the Conners CBRS and Conners CI, including ratings of youth in the normative sample, clinical cases, and those included in the validity studies. In the normative study, 3,400 Conners CBRS assessments were collected. The sample was stratified to represent the general U.S. population according to age, gender, and race/ ethnicity (U.S. Bureau of the Census, 2000). The normative sample is also diverse in terms of parental education level and geographic region. Continues on back…
Table 1. Structure and Content of the Conners CBRS Parent, Teacher, and Self-Report Forms CONNERS CBRS–PARENT Form
Conners CBRS–P
Age Range
Conners CI–P
CONNERS CBRS–TEACHER Conners CBRS–T
6–18 Years
Number of Items
203
Conners CI–T
CONNERS CBRS–SELF-REPORT Conners CBRS– SR
6–18 Years 24
204
Conners CI–SR
8–18 Years 24
179
24
Scale/Subscale Emotional Distress
4
Upsetting Thoughts1
4
Worrying 1
4
4
Upsetting Thoughts/Physical Symptoms 2
4
Social Anxiety 2
Conners CBRS Content Scales
4
Defiant/Aggressive Behaviors
4
4
4
Academic Difficulties
4
4
4
Language 3
4
4
Math 3
4
4
Hyperactivity Hyperactivity/Impulsivity
DSM-5 Symptom Scales
Validity Scales Index
Other Clinical Indicators
Impairment Items
Critical Items Additional Questions 1
4
4 4
4
Social Problems 1
4
4
Separation Fears 2
4
4
Perfectionistic and Compulsive Behaviors
4
4
4
Violence Potential Indicators
4
4
4
Physical Symptoms
4
4
4
ADHD Inattentive
4
4
4
ADHD Hyperactive-Impulsive
4
4
4
ADHD Combined
4
4
4
Conduct Disorder
4
4
4
Oppositional Defiant Disorder
4
4
4
Major Depressive Episode
4
4
4
Depressive Episode, with Mixed Features
4
4
4
Manic Episode, with Mixed Features
4
4
4
Generalized Anxiety Disorder
4
4
4
Separation Anxiety Disorder
4
4
4
Social Anxiety Disorder (Social Phobia)
4
4
4
Obsessive-Compulsive Disorder
4
4
4
Autism Spectrum Disorder
4
4
Positive Impression
4
4
4
Negative Impression
4
4
4
Inconsistency Index
4
4
Conners Clinical Index
4
Bullying Perpetration
4
4
4
Bullying Victimization
4
4
4
Enuresis/Encopresis
4
4
Panic Attack
4
4
4
4
Autism Spectrum Disorder
4 4
4
4
4 4
Pica
4
Posttraumatic Stress Disorder
4
4
4
Specific Phobia
4
4
4
Substance Use
4
4
4
Tics
4
4
4
Trichotillomania
4
4
4
Schoolwork/Grades
4
4
4
Friendships/Relationships
4
4
4
Home Life
4
Severe Conduct
4
4
4
Self-Harm
4
4
4
Other Concerns
4
4
4
Strengths/Skills
4
4
4
4
4
Subscale within Emotional Distress Scale on the Conners CBRS–P.
2
Subscale within Emotional Distress Scale on the Conners CBRS–T.
3
Subscale of Academic Difficulties Scale.
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ASSESSMENTS
Both internal consistency and test-retest reliability are very good for the Conners CBRS and the Conners CI. Internal consistency coefficients (Cronbach’s alpha) range from .69 to .97, and 2- to 4-week testretest reliability coefficients range from .56 to .96 (all correlations significant, p < .001). Inter-rater reliability coefficients range from .50 to .89 (all correlations significant, p < .001). Support for the validity of the structure of the Conners CBRS was obtained using factor analytic techniques on derivation and confirmatory samples. Convergent and divergent validity were supported by examining the relationship between Conners CBRS scores and other related measures. Overall, scales that assess similar constructs tended to be moderately to strongly intercorrelated, while scales that did not assess similar constructs tended to have smaller correlations. Results from discriminative validity analyses indicated that the Conners CBRS scores accurately discriminate between relevant groups. Results from a series of multivariate analyses of covariance revealed that, for all scales, the means for the target clinical groups were significantly higher than the means for the general population and other clinical groups. In terms of the classification accuracy of the scores (as determined by a series of discriminant function analyses), the mean overall correct classification rate was 78% across all forms.
ABOUT THE AUTHOR
RELATED RESEARCH
C. Keith Conners, Ph.D., has had an extraordinary and diverse career as an academic, clinician, researcher, lecturer, author, editor-in-chief, and administrator. His dedication to the study of ADHD and other childhood problems has propelled him to the forefront of his field. His intense interest in this topic has led him to write several books on attention disorders and neuropsychology, as well as hundreds of journal articles and book chapters based on his research on the effects of food additives, nutrition, stimulant drugs, diagnosis, and dimensional syndromes. He is highly recognized in the field of psychology by his numerous contributions.
Marocco, M., & Rzepa, S. R. (2008, February). Conners Assessment System: Construct validity and implications for school psychologists. Paper presented at the annual meeting of the National Association of School Psychologists, New Orleans, LA.
After enjoying a satisfying career, Dr. Conners is now retired and resides in North Carolina. He continues to lecture, conduct workshops on diagnosis and assessment, and serve as a consultant to numerous government and private organizations.
Pitkanen, J., & Conners, C. K. (2008, February). Development and applications of the Conners Assessment System. Paper presented at the annual meeting of the National Association of School Psychologists, New Orleans, LA. Pitkanen, J., Conners, C. K., Rzepa, S. R., Sitarenios, G., & Marocco, M. L. (2007, August). Development of the Conners Assessment System. Poster presented at the American Psychological Association Annual Conference, San Francisco, CA. Sitarenios, G., Conners, C. K., Gallant, S., Rzepa, S. R., Pitkanen, J., & Marocco, M.L. (2007, August). Psychometric properties of the Conners 3 Comprehensive (C3C). Poster presented at the annual meeting of the American Psychological Association, San Francisco, CA. Sitarenios, G., & Wheldon, H. (2008, February). Conners Comprehensive Behavior Rating Scales: Research results and applications. Paper presented at the annual meeting of the National Association of School Psychologists, New Orleans, LA.
Separate norms are provided for males and females, in 1-year age intervals. Combined gender norms also are available. S CONN ER
K-CPT 2 Conners Kiddie
Continuous
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MANUAL
Conners Comprehensive Behavior Rating Scales™ (Conners CBRS ®), C. Keith Conners, Ph.D.
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nd Test 2 Edition Performance
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REFERENCES American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (1999). Standards for Educational and Psychological Testing. Washington, DC: American Educational Research Association. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association. Collet, B., Ohan, J., & Myers, K. (2003). Ten-year review of rating scales. V: Scales assessing attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1015–1037. Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004), Pub. L. No. 108–446, 118 Stat. 2647 (2004). [Amending 20 U.S.C. 1400 et seq.]. Washington, DC. U.S. Bureau of the Census. (2000).
OTHER RELATED MHS ASSESSMENTS • Conners 3rd Edition™ (Conners 3®) • Conners Early Childhood™ (Conners EC™) • Children’s Depression Inventory 2nd Edition (CDI 2®) • Conners Continuous Performance Test 3rd Edition™ (Conners CPT 3™)/ Conners Continuous Auditory Test of Attention® (Conners CATA®) • Conners Kiddie Continuous Performance 2nd Edition™ (Conners K–CPT 2™) • Comprehensive Executive Function Inventory™ (CEFI®) • Multidimensional Anxiety Scale for Children 2nd Edition™ (MASC 2™)
MEET THE OTHER MEMBERS OF THE CONNERS FAMILY The Conners Early Childhood ™ aids in early identification of behavioral, social, and emotional problems of preschoolaged children 2 to 6. It helps measure whether or not a child is appropriately meeting major developmental milestones. The Conners Early Childhood provides: • Multi-informant (parent, teacher/ childcare provider) assessment allows for easy comparison across raters • Full-length, Short, Behavior, Developmental Milestones, and Global Index forms • Validity scales • Clear and direct links to the IDEA 2004 • Excellent reliability and validity • Easy administration, scoring, and results interpretation The Conners 3rd Edition™ (Conners 3®), has proven to be the tool of choice in ADHD assessment. The Conners 3 offers you: • A focused assessment of ADHD while identifying the most common comorbid disorders such as Oppositional Defiant Disorder and Conduct Disorder • Direct and clear links to the DSM-5* and the IDEA 2004 • Addition of Executive Functioning assessment • Addition of Validity scales • Excellent reliability and validity • Guidance for intervention and treatment planning and monitoring • Spanish versions of the parent and self-report Scoring forms still available for online and *DSM-IV-TR • Straightforward software options. administration and scoring of results • Online, Software, and Handscoring available
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