What Is The Conners ADHD Rating Scale?

The Conners Comprehensive Behavior Rating Scale (CBRS) is a tool that clinicians may 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 what the scale is and how it’s used, plus what you can do if you’re looking for support in parenting a child with ADHD.

What is ADHD? 

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. 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

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. 

How the Conners Comprehensive Behavior Rating Scale is used 

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 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 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. 

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, 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.

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. 

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.

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.