What Is The Conners ADHD Rating Scale? ADHD Assessment And Diagnosis
The Conners Comprehensive Behavior Rating Scale (CBRS) is a tool doctors use to help them determine whether a child or adolescent may have attention-deficit/hyperactivity disorder (ADHD). This neurodevelopmental disorder is common, affecting 9.8% of children between the ages of three and 17. Read on to learn more about this leading ADHD assessment and how it’s used, plus what you can do if you’re looking for support in parenting a child with ADHD.
What is attention-deficit/hyperactivity disorder (ADHD), and what are its symptoms in children?
First, it can be helpful to take a quick overview of what ADHD is and how it typically manifests so that you, as a parent, caregiver, or teacher, can understand what may suggest evidence of ADHD in your child. An individual with ADHD may primarily show signs of inattention, hyperactivity, or a combination of both.
Inattentive ADHD symptoms
Those with the inattentive form of ADHD will typically demonstrate six (or five, for those over 17 years old) of the following behaviors:
- Forgetting important tasks and events (such as daily chores or homework)
- Not actively listening when someone is talking
- Not following directions; making careless mistakes during monitored tasks
- Becoming easily distracted
- Difficulty keeping workspaces and tasks properly organized and/or difficulty managing time
- Losing focus during important tasks before giving up
- Losing or misplacing important daily items (such as glasses, books, or keys)
- Avoiding or ignoring tasks that require mental focus because they become unenjoyable
Hyperactive-impulsive ADHD symptoms
Those with the hyperactive form of ADHD will typically demonstrate six (or five, for those over 17 years old) of the following behaviors:
- Having trouble staying seated
- Having trouble waiting their turn in an activity
- Talking too much; having thoughts and/or conversations that are scattered
- Always moving on to the next thing quickly
- Taking over activities, interrupting conversations, or taking and using people's things without permission
- Not being able to play or do other activities quietly or calmly
- Running, climbing, or playing in areas where it’s not appropriate
- Blurting out responses and/or finishing other people’s sentences
- Squirming or fidgeting
Note that some individuals may display signs of both inattention and hyperactivity.
ADHD assessment: How the Conners Comprehensive Behavior Rating Scale is used for diagnosis
Note that only a qualified mental health professional can make an accurate, clinical diagnosis of any such condition. They will typically compare your child’s behaviors to diagnostic criteria for ADHD, and the Conners CBRS is a key tool often used in this process.
The Conners ADHD Rating Scale: One of several ADHD rating scales to evaluate mental health symptoms
The CBRS is a behavior assessment system used to evaluate a range of behavioral, cognitive, and emotional challenges, which may be related to ADHD. There is a long- and short-form version of the CBRS. A practitioner may choose to use the long version or short version based on the specific symptoms they’re evaluating or the amount of detailed information they’re seeking. The CBRS was partially developed based on the ADHD criteria from the fourth edition of the DSM (DSM-IV-TR), though recent versions have direct links to the fifth edition (DSM-V-TR). The CBRS is designed to help clinicians identify signs of ADHD in children and young adults aged six to 18, as well as other potential behavioral, academic, or social issues, including:
- Difficulty with certain subjects (possibly pointing to behavioral issues or learning disabilities)
- Emotional distress or self-esteem concerns
- Perfectionism
- Compulsive behaviors
- Anxiety or separation anxiety
- Difficulty making or keeping friends
- Severe conduct that may require immediate attention, such as aggressive behavior and the potential for violence
The CBRS, a comprehensive assessment, takes the form of a 25-question survey with three different versions: one each for the child’s parents/caregivers and teacher to fill out, and a self-report form for the child to fill out. Getting information on the child’s behavior from all three sources can help the mental health professional get a more accurate picture of any challenges they may be experiencing so they can make a proper diagnosis, if applicable. After they’ve made one, they may have all three parties fill out a shorter version of the questionnaire again after a few months of treatment to survey what progress has been made.
How the Conners ADHD Rating Scale works for ADHD assessment and diagnosis alongside other ADHD rating scales
The Conners Rating Scale asks the parent/caregiver, teacher, or child themselves to rate how often the subject engages in a particular behavior, with zero being “never true” and three being “always true”. Questions are phrased to reveal information about a child’s behavior, physical health, social life, and emotional states. When interpreting the test results, a clinician will often first check the validity scales—in the CBRS, these include the negative impression index, positive impression index, and inconsistency index—which can help them evaluate how reliable an individual’s answers are. Then, they will tally up the total score to determine whether they indicate the potential presence of ADHD.
For those who are taking an ADHD assessment on their own, computer scoring is available through online versions of the test. If you’ve completed the CBRS, a healthcare professional can interpret your results for you and help you understand your T-Score, a number that indicates the severity of your symptoms.
Note that the CBRS can also point toward the presence of other mental health conditions, particularly common co-occurring problems, and the care provider will interpret the results accordingly. Over 50% of individuals with ADHD have a comorbid, or co-occurring, mental health condition. Common comorbid disorders with ADHD include post-traumatic stress disorder (PTSD), panic disorder, or depression, so determining whether another condition may be present instead of or in addition to ADHD is another useful application of the scale. Research shows that the CBRS has solid psychometric properties, including good internal consistency.
Managing attention-deficit/hyperactivity disorder symptoms for improved mental health in children
The recommended treatment for ADHD depends on many factors, including the child’s age, the type of symptoms they’re displaying, the severity of their symptoms, and any comorbid conditions they may have. For children under six, behavioral interventions are usually the first course of action—which may include parent training and/or classroom interventions. For older children and adolescents, stimulant or non-stimulant medication may be recommended as well. Some form of psychotherapy may be also, especially for adolescents and young adults.
Processing your child’s ADHD diagnosis
If a mental health professional diagnoses your child with ADHD, you might initially experience a range of emotions. You’ll likely feel concerned about them and will want to provide support in any way you can. That’s why it can be helpful to do your research to become familiar with this condition. Next, you may want to get in touch with your child’s school/teachers to see whether they may be able to provide them with accommodations or special support as needed. You may also find support in an online forum or group setting made up of other parents with children who have ADHD. Other types of helpful action you may want to consider might be suggested by the diagnosing clinician.
Get support with online therapy
If you’re having trouble coping with your child’s ADHD diagnosis, speaking with a therapist yourself may be helpful. They can provide you with a safe space to express and process your emotions. They can support you so that you can be there to fully support your child. If a busy schedule makes it difficult for you to attend in-person sessions, you might consider online therapy instead. With a platform like BetterHelp, you can get matched with a licensed therapist with whom you can meet via phone, video call, and/or in-app messaging from the comfort of home or anywhere you have an internet connection. See below for reviews of BetterHelp counselors who have supported clients in similar situations.
If your teenager has been diagnosed with ADHD and you believe they could benefit from support as well, you might consider a virtual therapy platform like TeenCounseling, which offers the same services but for individuals aged 13 to 18 with parental consent. Research suggests that online and in-person therapy can be “equally effective”, so you can typically choose the format that works best for you and/or your child.
Takeaway
The Conners Comprehensive Behavior Rating Scale (CBRS) is a diagnostic tool used by qualified providers to determine whether a child may have ADHD or another condition that could be affecting their functioning. If you suspect your child may have a condition like ADHD, the recommended course of action is usually to meet with a qualified mental health care provider so they can be evaluated.
What does the Conners rating scale measure?
The Conners rating scale, now in its third edition, measures youth's cognitive, behavioral, and emotional concerns. While it cannot conclusively determine if a child has ADHD, it is often used as part of an ADHD evaluation and contains specific measures that correlate with possible ADHD symptoms. The full Conners 3 assessment categorizes a child’s symptoms using the following measurement subscales: inattention, hyperactivity/impulsivity, executive functioning, learning problems, defiance/aggression, peer relations, and family relations.
The assessment also has symptom scales based on the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM), for the following conditions: ADHD (inattentive subtype), ADHD (hyperactive subtype), conduct disorder, and oppositional defiant disorder. The ADHD sections function as a type of ADHD symptom checklist, correlating data from the Conners with the diagnostic criteria listed in the DSM.
How to score Conners rating scale?
Conners rating scales are scored by adding the value of responses in a certain category and comparing that to normative data. The response to each question can be coded as 0, 1, 2, or 3. Adding up the total for each content area reveals a raw score that can be converted into a scaled score using the test manual or scoring software. The scaled scores can then be converted to t-scores, which are standardized scores that compare a child’s scores to those of children in the same age group who were tested when the assessment was normed.
For what age group is the Conners rating scale designed?
The Conners 3 assessment has three forms for the full version: parent, teacher, and self-guided. The parent and teacher forms are filled out by parents or teachers, respectively, and can be used for children as old as 18 or as young as six. The self-guided form is filled out by the child and is appropriate for eight to 18-year-olds. There is also an adult ADHD assessment, developed based on the Conners 3, that can be used for anyone over the age of 18.
How accurate is the Conners test for ADHD?
The Conners 3 assessment has been shown to accurately predict the presence of ADHD in children both at home and at school. It has routinely been considered one of the best available tools to quickly develop a profile of typical ADHD behaviors that can indicate to a clinician whether a diagnosis is likely. The adult version of the Conners ADHD scale, the CAARS, has significantly lower validity but is still useful as part of a larger assessment. ADHD is typically more challenging to diagnose in adulthood, which may be why the accuracy of the CAARS is lower than the Conners 3.
What is the Conners questionnaire for parents?
The Conners 3 assessment has three forms that can be administered: one for parents to fill out, one for teachers, and one for the child being evaluated, if they are old enough. There is a significant overlap between the parent form and teacher form, but the parent form tends to focus on home-based behaviors, and the teacher form focuses more on academic concerns and classroom behavior.
Who can administer the Conners assessment?
The Conners can only be administered by a qualified professional. Scoring and interpreting the Conners requires training and experience. In school settings, school counselors and school psychologists typically administer the assessment. In clinical settings, the assessment can be administered by therapists, psychologists, and psychiatrists. The assessment might also be administered by a psychometrician on behalf of a licensed professional. A psychometrician can typically administer the assessment but is not usually qualified to interpret the results.
What is the Conners test for ADHD in adults?
The Conners’ Adult ADHD Rating Scales (CAARS) measure the presence and severity of ADHD symptoms in those above the age of 18. Like all rating scales, it alone cannot definitively conclude whether a person has ADHD, but it can clarify symptoms and provide a comprehensive clinical picture to a professional performing an evaluation. For adults already diagnosed with ADHD in childhood, the CAARS can monitor and screen for moderately severe symptoms and help clinicians determine how they can best help their clients.
What rating scales are used for ADHD?
Many rating scales used in the diagnosis of ADHD are not specifically for that purpose. The Conners 3 has an ADHD scale, but not all rating scales do. Regardless of whether the rating scale directly compares scores to ADHD diagnostic criteria, all rating scales used in ADHD evaluations measure and quantify behavior.
By building a profile of a child’s - or adult’s - behavior, a professional can identify patterns that point to an ADHD diagnosis. Besides the Conners 3, other common tools include the Conners Clinical Index, the Child Behavior Checklist (CBCL), the Vanderbilt ADHD Rating Scales, the Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS), and the Adult ADHD Self-Report Scale (ASRS).
Is Conners a diagnostic tool?
The Conners scale is a diagnostic tool that can be used as part of a comprehensive evaluation, or as a tool in an initial evaluation to offer clues on what additional details may be necessary. However, it alone cannot diagnose ADHD. To date, no single test or measure can accurately determine whether a person meets diagnostic criteria for ADHD. The Conners and other rating scales are an important part of quantifying data in an evaluation and creating a clear picture for the evaluator, but it is their experience and expertise that determines whether the data indicates ADHD.
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