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National School Social Work Conference

2011 Annual Conference – Myrtle Beach, SC

Presenter: Penny Koepsel, PhD, LSSP

Clinical and Educational Consultant, MHS

Introduction to the Conners 3rd Edition

Contact Information

Penny H. Koepsel, PhD, LSSPAssessment Consultant

Multi Health Systems (MHS)penny.koepsel@mhs.com

(281) 844-9156www.mhs.com

Customer Service: 1-800-456-3003

Helpful Contact Information

• Janice Sneath: janice.sneath@mhs.com• Research and Development: r&d@mhs.com• Customer Service:

customer.service@mhs.com• MHS Website: www.mhs.com• Software Support: support@mhs.com• Website Assistance: webmaster@mhs.com

Overview of Training

• Discussion of clinical and educational context~ Important issues in school-aged youth

~ ADHD and comorbid conditions • Identify linkage between IDEA 2004, DSM-IV TR, & Conners 3rd

• Knowledge of the Conners 3rd Edition and its essential features and changes from Conners Rating Scales-Revised to Conners 3rd

Edition• Confidence in the psychometric properties and utility of the

Conners 3rd Edition• Familiarity with Conners 3rd administration, scoring options, and

interpretation• Awareness of Conners 3rd results in data-based identification and

decision making • Use of Conners 3rd results to guide intervention planning• Use of Reliable Change Index to help monitor progress • Case Studies

Why is it critical to assess social, emotional, and behavioral functioning in addition to academic functioning in school aged youth?

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Just A Few Reasons Why…

• Retrospective Study: 74% of adults with mental disorders have a history of a childhood diagnosis (Kim-Cohen et al., 2003)

• Longitudinal Study: At any given time, at least one in six youth meets criteria for one or more psychiatric diagnosis (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003)

• 1/3 of all youth has experienced a psychiatric condition by the age of 16 (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003)

• 2005: 5.5 million youth aged 12 to 17 years received treatment for emotional or behavioral problems (SAMHSA, 2006)

• In the 2005-2006 school year, 14% of students received services under IDEA –an increase from 8% in 1976 (US Department of Education, 2006)

Common Concerns in the Classroom

• Academic/Cognitive(most common)– Subject-specific difficulties– Inattention– Executive deficits

• Behavioral (most noticeable)– Aggressive or oppositional behaviors– Hyperactive or impulsive behaviors

• Emotional (often “slip through the cracks initially)– Irritability, worrying, separation fears, perfectionism– General distress, symptoms of depression, physical symptoms

• Social: – Social skills, lack of social interests, social isolation

Prevalence of IDEA Eligibility Categories(% of total enrollment)

– Specific LD = 6% (increase from 2% in 1976)– Speech/language = 3% (steady)– MR = 1% (decrease from 2% in 1976)– ED = 1% (steady)– Hearing impairment = < 1% (steady)– Orthopedic impairment = < 1 % (steady)– OHI = 1% (slight increase from 0.3% in 1976)– Visual impairment = < 1% (steady)– Multiple disabilities = < 1% (steady)– Deaf-blindness = < 1% (steady)– Autism and TBI = < 1% (slight increase from 0.1 to 0.4)– Developmental delay = < 1% (slight increase, 0.1 to 0.6)

All disabilities = 14% of total enrollment (increase from 8% in 1976)

DSM-IV TR Disorders Most Commonly Encountered in School Settings

• Attention-Deficit/Hyperactivity Disorder (ADHD)• Disruptive Behavior Disorders: Conduct Disorder (CD),

Oppositional Defiant Disorder (ODD)• Mood disorders: Major Depressive Disorder, Bipolar

Disorder• Anxiety disorders: Generalized Anxiety Disorder (GAD),

Separation Anxiety Disorder (SAD), Social Phobia, Obsessive Compulsive Disorder (OCD)

• Pervasive Developmental Disorders(PDD): Asperger’s Disorder, PDD Not Otherwise Specified (PDD-NOS), “high functioning autism”

• Tics: (Tourette’s Disorder, Chronic Motor or Tic Disorder, Transient Tic Disorder, Tic Disorder, NOS)

• Learning Disorders

DSM-IV TR AND SCHOOLS

Even though you are not required by IDEA to diagnose students, knowledge of DSM-IV is important

• You are often the first to recognize emerging symptoms of an undiagnosed disorder

• You must discuss and review past diagnoses; sometimes question these diagnoses

• You cannot assign a DSM-IV-TR diagnosis in many states• But it is not going away, DSM-V – 2013, 14, 15??• It is a method of categorizing – so is IDEA 2004 • Comorbidity, differentiation

DSM-IV-TR and IDEA 2004: Similarities

√√Developmentally inappropriate

√√Abnormal response

√√Exclusionary criteria (rule outs)

√√Duration of symptoms

√√Symptoms in more than one setting

√√Symptoms cause impairment

IDEADSM-IV-TRCriterion

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√√√√√√√√√√√√√√√√Annoying

√√√√√√√√√√√√√√√√Mistakes

√√√√√√√√√√√√√√√√Temper

√√√√√√√√√√√√Fidgety

√√√√√√√√√√√√√√√√Noncompliance

√√√√√√√√Hyperactivity

BPDCDODDADHD

COMORBIDITY AND BEHAVIORS

Wilkins, 2007 FASP Conference

State Prevalence of ADHD (CDC 2008)

Comorbidity: ADHD

• Around 45% of children with ADHD have at least one co-occurring disorder

• Around 33% of children with ADHD have two co-occurring disorders

• Around 10% of children with ADHD have three co-occurring disorders

~ Oppositional Defiant Disorder – 25 to 33%~ Conduct Disorder – 26%~ Depressive Disorder – 18%~ Anxiety Disorder – 26%

US Prevalence of ADHD and LD(CDC 2008)

ADHD and Learning Disorders

• 25 to 50% of children with ADHD also have a Learning Disability

• Older children 12-17 years of age more likely to have ADHD with LD

• Those with ADHD and LD more likely to use health care and educational services

• More likely to have expressive language deficits• Boys more likely than girls (2.3%) to have each of the

disorders• Hispanic children less likely than non-Hispanic children to

have ADHD with and without LD• Children with low birth weight more likely to have LD with and without ADHD

Pastor, P. N. and Reuben, C. A (2008) “Diagnosed Attention Deficit Hyperactivity Disorder and Learning Disability: United States, 2004-2006”

ADHD Complications

• Medical – more ER visits, hospital admissions, outpatient admissions, more severe injuries, twice the medical costs

• Adolescent drivers have more car accidents• Smoking: earlier and more often• More family conflicts and social difficulties• More school retentions and high school drop outs• More likelihood of future Antisocial Personality Disorder

in adulthood• More STD’s, substance abuse, legal problems, higher

divorce rates, earlier parenthood, more work failure

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Widely Used ADHD Rating Scales

• Conners 3rd Edition• Conners Comprehensive Behavior Rating Scales• Conners Early Childhood• Achenbach Child Behavior Checklist• BASC-2• Personality Inventory for Children-Second Edition• Brown Attention-Deficit Disorder Scales• Attention Deficit Hyperactivity Test• ADHD Rating Scale-IV

Conners 3rd Edition

Technical Details, Key Features, and

Psychometric Properties

School Psychologists and Best Practices

NASP Principles for Professional Ethics

• School psychologists use assessment techniques and practices that the profession considers to be responsible, research-basedpractice.

• School psychologists select assessment instruments and strategies that are reliable and valid for the child and the purpose of the assessment.

• If using norm-referenced measures, school psychologists choose instruments with up-to-date normative data.

Conners 3: Key Changes

• Modified age ranges - no more CADS• Items more congruent across protocols (P-T-S)• New scales (ODD, CD, EF), Validity Indicators, Severe

Conduct Critical Items, Screener Items, Impairment Items)• Inattention separate from Learning Problems• Some CRS-R content shifted to Conners CBRS

(Anxious/Shy, Perfectionism, and Psychosomatic, Emotional Problems from CASS)

• Links to DSM-IV-TR and IDEA 2004• Simplified language; available in English and

Spanish; cultural translation

Conners 3: Key Features

• Conners 3 ADHD Index (3AI)

• Conners 3 Global Index (3GI)

• Large normative sample representative of

the U.S. population

• One year age norms

• Choice of separate or combined gender

norms

• Easy administration, scoring, and interpretation

• Excellent reliability and validity

Readability Levels for Conners 3rd*

41993.0Self

411155.3Teacher

451104.9Parent

Items Short Form

Items Long Form

Reading Level

Form

CPRS-R = 9th – 10th grade)CTRS-R = 9th grade)CASS = 6th grade)

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“Has difficulty playing or engaging in leisure activities quietly” ( CRS-R Parent - verbatim from DSM-IV)

“Is noisy or loud when playing or using free time” (C3 Parent)

Conners 3-Parent 4.9 (CPRS-R was 9th – 10th grade)Conners 3-Teacher 5.3 (CTRS-R was 9th grade)Conners 3-Self Report 3.0 (CASS was 6th grade)

Simplified Items Spanish Forms Development

• A Cultural Translation, not just a literal translation. Goal was to ensure that the Conners 3 would be valid for use in both Spanish-and English-speaking populations within the Hispanic population of the United States.

1. Translations first created by three Spanish-speaking staff at MHS

2. Translations reviewed by Dr. Sam Ortiz to ensure that content, cultural sensitivity, and readability were appropriate

3. Translated forms were then submitted to independent bilingual school psychologists for an English back-translation

4. All parties reviewed back translations with the original English forms

Conners 3Technical Details

• Normative sample:

– Large

• 1200 youth rated by parents and teachers

• 1000 youth self-reports

• Stratified by age (year) and gender

– Diverse (based on the U.S. census)

• Stratified by race/ethnicity

• Represented all socio-economic status (SES) groups

• Represented all geographic regions

Conners 3Age and Gender Affects

• Age and gender significantly affected the majority of scales across all forms.

• As a result, norms for the Conners 3were separated by age and gender (except for the validity scales)

• Separate norms for each age year are provided. This allows for more accurate and precise results.

Norming by Age

• Historically, the CRS has used 3-year age groups

• Problem: 6-year-olds, e.g., may not be comparable to 8-year-olds

• 1-yr age norms allow

– for smooth development trends to be captured

– but also for sharper changes to be reflected

• BASC presents ages in clusters, e.g., 6-7, 8-11, 12-14, 15-18 – not one year age norms

1-yr age bands improve assessment accuracy

Ethnic Representation

Group Census C3-P C3-T C3-SR

Asian 3.8 4.6 6.0 5.1

AfricanAmerican

15.7 15.1 15.6 15.2

Hispanic 15.1 15.1 17.5 15.0

Caucasian 61.9 61.3 57.5 61.1

Other 3.5 3.8 3.3 3.6

Ethnic representation closely matches census figures.

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Reliability –

“The consistency of scores obtained by

the same person when re-examined with

the same test on different occasions, or

with different sets of equivalent items or

under other variable examining

conditions.”

- Anastasi, 1988

Reliability = Internal Consistency of C3

Content Scales ~ .88 to .91 (P, T, S)

DSM-IV TR Scales ~ .85 to .90 (P, T, S)

Validity Scales ~ .56 to .72 (P, T, S)

.60 to .70 ~ satisfactory

.70 to .80 ~ very good

.80 and above ~ excellent.

2 parents of the same child

Validity Scales = fewer items and seldom endorsed

~ the extent to which all items on the same scale consistently or reliably measure the same dimension

Inter-Rater Reliability of Conners 3 Forms

Content Scales (Teachers, Parents) ~ .71 to .81

DSM-IV TR Scales (Teachers, Parents) ~ .70 to .84

2 teachers of the same child

2 parents of the same child

Temporal Stability – Test Retest

Content Scales (P, T, S) ~ .79 to .85

DSM-IV TR Scales (P, T, S) ~ .76 to .89

Validity –

“What the test measures and how

well it does so”

- Anastasi & Urbina, 1997.

Construct Validity

• Construct validity was examined by administering the Conners 3with various other tools including ... (Total N ≈ 2000)

– Child Behavior Checklist (CBCL)

– Behavioral Assessment System for Children (BASC-2)

– Behavior Rating Inventory of Executive Functioning (BRIEF)

– Children’s Depression Inventory (CDI)

– Multidimensional Anxiety Scale for Children (MASC)

All Conners 3 constructs were tested usinginstruments that assess similar or related constructs

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Construct Validity – Selected Findings

• ADHD

– Conners 3-T DSM-ADHD-Inx CBCL Attention Probs., r = .74

– Conners 3-P DSM-Hyp/Imp x BASC-2 Hyperactivity, r = .58• Executive Functioning

– Conners 3-P EF x BRIEF Plan/Organize scale, r = .72• Learning Problems

– Conners 3-Tx BASC-2 Learning Problems, r = .83– Conners 3-Px BRIEF Meta Cognition, r = .86

• Peer/Family Relations– Conners 3-TPeer Relations x CBCL Social Probs., r = .85

– Conners 3-TPeer Relations x BASC-2Social Skills, r = -.59

Conners 3 scales correlate in meaningfulways with other tools that measure similar things

Conners 3: Executive Functioningand BRIEF

C3 (Parent and Teacher) correlate highly with every BRIEF Scales:

Hyperactivity/Impulsivity : Inhibit, Behavioral Regulation Index, Global Executive Composite

Inattention : Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor, Metacognition Index, Global Executive Composite

Learning Problems/Executive Functioning: Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor, Metacognition Index, Global Executive Composite

Reliable Change Indices: Monitoring Responses to Intervention

and Changes In Behavior

How do I know if a change in Conners scores over time is statistically and/or clinically significant?

C3: Measuring Change

If we have implemented an intervention and are measuring change - how do we know if the difference is significant or not?

Reliable Change Index (RCI)

• Because it is rare for responses on two separate administrations to be exactly the same, statistical procedures can be used to determine whether a change in scores is statistically significant (Jacobson and Truax, 1991)

• The RCI takes into account the difference in test scores for two administrations, as well as the standard error of difference between them.

• These values are based on a 90% confidence interval. p <.10 used to ensure that important increases and decreases in scores are not missed

1. Administer appropriate measure at pre-test

2. Re-administer measure at post test period

3. Calculate difference score

4. Calculate the RCI

5. Compare difference score to the RCI

5 Steps to Assessing Reliable Change

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• A statistically significantscore exceeds the absolute difference between scores as indicated by the RCI

• A clinically meaningfulscore is indicated by a change in classification, i.e. T 75 to a T 50 (Very Elevated to Normal)

• A score can be clinically meaningful and not statistically significant (not exceed absolute difference score)

• A statistically significant change in behavior might not be a clinically meaningful score, i.e. a T 75 to a T 70

• A score can be both statistically significant and clinically meaningful – our overall goal in intervention development!!

Statistically Significant vs. Clinically Significant

• To determine whether a change in scores between test administrations is statistically significant for all scales of the Conners 3rd (long forms, short forms, 3 AI, 3 GI)

• Intervention responses and changes in behavior can be monitored using the RCI

• Therapy or counseling goals and objectives can be monitored using the RCI

• Medication effectiveness can be monitored using the RCI• Using multi-modal assessment techniques, the RCI is one way

to determine intervention efficacy

Uses for Reliable Change Index

Now that you know the Conners 3rd Edition has strong psychometric properties, let’s learn more about the scale and how it can be a valuable tool in your school psychologist tool box.

Conners 3rd EditionStructure and Scales

Conners-3

Conners 3:PConners 3:T

Conners 3:SR

ShortConners 3:P(S)Conners 3:T(S)

Conners 3:SR(S)

Global IndexConners 3GI:PConners 3GI:T

ADHD IndexConners 3AI:PConners 3AI:T

Conners 3AI:SR

Hyperactivity/ImpulsivityHyperactivity/ImpulsivityHyperactivity/Impulsivity

--(Executive Functioning subscale)Executive Functioning

Learning ProblemsLearning Problems/Executive FunctioningLearning Problems

AggressionAggressionAggression

Full-length FormConners 3 Scales

Family RelationsPeer RelationsPeer Relations

InattentionInattentionInattention

Self-Report(99 items – 3.0 Reading Level)

Teacher(115 items – 5.3 Reading Level)

Parent(110 items - 4.9 Reading Level)

DSM-IV-TR Symptom ScalesADHD Hyperactive-ImpulsiveADHD InattentiveConduct DisorderOppositional Defiant Disorder

Severe Conduct Critical Items

Screener ItemsAnxiety Depression

Conners 3 Global Index(Conners 3GI; not on SR)

Conners 3 ADHD Index(Conners 3AI)

Validity ScalesNegative Impression Positive ImpressionInconsistency Index

Impairment Items

Additional Questions

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Hyperactivity/ImpulsivityHyperactivity/ImpulsivityHyperactivity/Impulsivity

--(Executive Functioning subscale)Executive Functioning

Learning ProblemsLearning Problems/Executive FunctioningLearning Problems

AggressionAggressionAggression

Short FormConners 3 Scales

Family RelationsPeer RelationsPeer Relations

InattentionInattentionInattention

Self-Report(41 items)

Teacher(41 items)

Parent

(45 items)

DSM-IV-TR Symptom ScalesADHD Hyperactive-ImpulsiveADHD InattentiveConduct DisorderOppositional Defiant Disorder

Severe Conduct Critical Items

Screener ItemsAnxiety Depression

Conners 3 Global Index (Conners 3GI; not on SR)

Conners 3 ADHD Index(Conners 3AI)

Validity ScalesNegative Impression Positive ImpressionInconsistency Index

Impairment Items

Additional Questions

Conners 3: Overview

• C3 Content Scales• DSM-IV TR Scales• DSM-IV TR Symptom Counts• Critical Items: Severe Conduct Critical Items• Anxiety and Depression Screener Items• 3 AI Index Scores • 3 GI Index Scores• Validity Scales: PI, NI, IncX• Impairment Items:

– Academic– Home (Parent and Self-Report only)– Social

• Additional Questions:– Other concerns– Strengths or skills

Conners 3: Content Scales

• Conners 3 Content Scales (both long and short forms)

• Scales/subscales focus on key content for ADHD and the Disruptive Behavior Disorders

– Executive Functioning (not on Self-Report)

– Learning Problems

– Defiance/Aggression

– Hyperactivity/Impulsivity

– Peer Relations (not on Self-Report)

– Family Relations (only on Self-Report)

– Inattention

DSM-IV TR Symptom Scales**

• ADHD Inattentive

• ADHD Hyperactive-Impulsive

• ADHD Combined Type

• Conduct Disorder

• Oppositional Defiant Disorder

DSM-IV Symptom Scales: Relative levels of symptomsT-scores compare the student to peers. Help determine if symptoms are atypical for that age and genderHigh score means more symptoms than typically seen

** not on short form

DSM-IV TR Symptom Count**

• ADHD Inattentive

• ADHD Hyperactive-Impulsive

• ADHD Combined Type

• Conduct Disorder

• Oppositional Defiant Disorder

DSM-IV Symptom Counts: Absolute levelsEach DSM-IV symptom is represented You can count these to see if the student has enough symptoms of that disorder to consider a diagnosisGuidance is given for whether a symptom is “indicated,”“may be indicated,” or “not indicated” –(criteria requirements on next slide)

** not on short form

DSM IV TR Symptom CountsSymptom Count Requirements

ADHD Inattentive Subtype: At least 6 out of 9 symptoms

ADHD Hyperactive Impulsive Subtype: At least 6 out of 9symptoms

ADHD Combined Subtype: At least 12out of 18symptoms

Oppositional Defiant Disorder: At least 4 out of 8 symptoms

Conduct Disorder: At least 3 out of 15symptoms

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Index Scales

Conners 3 ADHD Index (Conners 3AI)

Conners 3 Global Index (Conners 3 GI)

** not on short form

We’ll go into more details on the next two slides

• Describes whether a child is more similar to children with a diagnosis of ADHD or to child in general population

• Probability Score – higher score = ADHD sample

• Can be used for monitoring progress, medication efficacy, intervention progress

• Can be used for focused ADHD screener

• Embedded in C3 and also available as a “standalone” form

• Can determine statistically significant change in scores using Reliable Change Index (RCI)

Conners 3 ADHD Index (Conners 3AI)

10 items

• Contains same 10 items as the original CGI

• Good indicator of global concerns about a child’s functioning

• Research found good sensitivity to treatment effects

• Reported as a T-score

• Cannot be used for youth self-report (not supported by research data)

• Can be used for monitoring progress or for global screener

• Not available for self-report

• Can determine statistically significant change in scores using RCI

• Embedded in C3, and available as a “standalone form”

• Two subscales on “standalone form”:

– Conners 3GI Emotional Lability

– Conners 3GI Restless-Impulsive

Conners 3 Global Index (Conners 3GI) Response Style Indicators

Validity Scales/Response Style Indicators

– Positive Impression (PI)– Negative Impression (NI)– Inconsistency Index (IncX): full-length form only

Validity Scales/Response Style Analysis

Elevated scores do not necessarily or absolutely mean the responses are invalid.

- In addition to the common threats to validity, what are some other reasons these scales could be elevated?

- Critical to integrate with other sources data; multiple raters, clinical interview, observations, etc. – those multi-techniques

Impairment Items

Impairment Items: full-length form onlyAcademic (schoolwork and/or grades)Home (Parent and Self-Report only)Social(Friendships and relationships)

Impairment Requirements: DSM-IV TR and IDEADSM-IV-TR requires evidence of clinically significant impairment in social, academic, or occupational functioning for diagnosis of ADHD, CD, or ODD.

DSM-IV-TR diagnosis of ADHD makes an additional requirement that impairment must be present in at least two settings (e.g., school, home).

IDEA criteria - educationally, a student is not considered “disabled” unless the symptoms impair his or her functioning in the school setting. Regardless of the number of problems described by the parent, teacher, or youth, if the problems are not associated with impairment in academic functioning, it is unlikely that the symptoms will meet criteria for diagnosis or educational need.

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Anxiety/Depression Screener Items “Red Flags”**

• The four anxiety screener items relate to generalized worrying. For example,

– Worries about many things.

• The four depressionscreener items reflect key clinical presentations of depression. For example,

– Has lost interest or pleasure in activities.

• These are “red flags” which may indicate a more detailed evaluation on the CBRS

** not on short form

Conners 3: Critical Items**

• Critical Items: Severe Conduct– Full-length form only

– Severe misconduct that requires immediate follow-up

– Behaviors are those that may predict future violence or harm to others

** not on short form

Uses a weaponCruel to animalsConfrontational stealingForcing someone into sexFire settingTrouble with policeBreaking and entering

Additional Questions

Do you have any other concerns about your child?• Provides opportunity to describe additional concerns• Response may indicate other areas that should be

investigated• May reiterate problems already captured on the scale; this

reiteration may represent high levels of concern about that particular issue

What strengths or skills does your child have?• Encourages consideration of the youth's positive qualities• Recognition of strengths and skills is important when

developing effective interventions• Red flag when parent, teacher, or youth can not identify

any strengths

Conners 3rd Edition

Administration and Scoring

Conners 3

1 minute1 minute2-3 minutes5 minutes Computer scoring(data entry)

5 minutes5 minutes10 minutes20 minutesHand scoring

5 minutes5 minutes10 minutes20 minutesAdministration Time

Conners 3GI

Conners 3AI

C3 ShortC3Average Time Required

Administration and Scoring Times

Methods of Administration*

Self Report Dictation

• Small subset of sample had items dictated to them by the assessor

• Another small subset had items read to them by someone other than the assessor

• Result: no significant differences in scores

*only for Self Report in English, and not for Parent or Teacher Reports

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Methods of Administration

Paper vs. Online

A small subset completed the assessments online via the internet.

Result: no significant differences in scores

The C3 can be generalized across both paper-and-pencil and online administrations.

Scoring Options Computer/USB

• Enter responses from a completed paper and pencil administration

• All forms can be scored using the USB scoring software• Unlimited scoring• Three different types of reports

AssessmentProgressComparative

C3 Report Options

Assessment Report= (provides detailed results from one administration)Progress Monitoring = (provides an overview of change over time by combining results of up to four administrations from the same rater)Comparative = (provides a multi-rater perspective by combining results from up to five different raters)

Scoring Options:MHS Online Assessment Center

• The MHS Online Assessment Center (MAC) offers access to online forms, administration scoring, and report generation (3 different types) at a fraction of the cost of traditional paper or software assessments.

•• Conners 3rd (C3)• Conners Comprehensive Behavior Rating Scales (CBRS)• Conners Early Childhood (EC)• Emotional Quotient Inventory-Youth Version (EQI-YV)• Jesness Inventory-Revised (JI-R)• Children’s Depression Inventory (CDI-R)• Autism Spectrum Rating Scales (ASRS)• Children’s Organizational Structure Scale (COSS)

• ♦ Contact an MHS Client Service Specialist today to:• = Take a “test drive” of the MAC. Receive a temporary ID and

password to access the secure site• = Place an order

C3 Choices for Scales: Full Length vs. Short Form

There are 4 different forms (full length, short form, 3AI, 3 GI) for the Conners 3; each can be completed by different raters (P, T, SR)

Full-length• Nothing is omitted• Recommended for initial evaluation and comprehensive re-evaluations

Short form• Has shorter versions of all the Content scales• Can be used for monitoring progress or for brief screener• Limited time or periodic repeated administrations

Cutting and Pasting

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QWER Data Security All MHS data (including Administrators and test user information, test data, including responses to test items, and report text) are stored in an industry standard database. Access to these data is strictly controlled. A temporary password initially provided by MHS must be changed for first time log-ins to Scoring Organizer. MHS is able to reset a password at therequest of the customer, if necessary.Tests are also scored by a separate secure scoring server controlled by MHS with an advanced level of security protection. Once administered, test reports are returned to the Administrator by using an encryption technology described below.

Personal Data and E-commerceMHS protects the personal data of MHS customers, the data of their clients, and the data collected via electronic commerce transactions with the highest levels of security. Through the e-commerce purchase process, we ask for the purchaser's name, address, license number, credit card information ("Financial Data"), and other personal data required to process requests to purchase and maintain customer accounts. MHS servers use 128-bit industry-standard Secure Sockets Layer (SSL) encryption which is encryption technology that works with the most current web browsers. SSL encrypts the purchaser's personal information, including Financial Data and other personal data as well as test user information, including test data, responses, and reports returned to the Administrator, protecting against disclosure to third parties.

Case Study – Susan S

Conners 3

• Case Study – Susan S– 8 year old girl– “seems spacey, daydreams a lot”– “doesn’t follow directions”– “careless, makes mistakes, misses details”– “immature”– “enthusiastic and energetic”– “rude, interrupts others”

• Sound familiar??

Conners 3: Interpretation Steps

1. Assess validity of the Conners 3 ratings 2. Interpret scale scores. (Conners 3, DSM-IV)3. Examine the overall profile. (relative elevations of T-scores;

Impairment items; Conners 3 ADHD Index; Conners 3AI)4. Consider item-level responses. (items from elevated scales

[Content, DSM]; Screener Items [Anxiety and Depression]; Critical Items [Severe Conduct]; Additional Questions

5. Integrate results. (within a single rater’s Conners 3 responses; across multiple Conners 3 raters; with other sources of information)

6. Report results

Conners 3: Types of Scores

• T-scores(Conners 3 Content scales, DSM-IV-TR Symptom scales, Conners 3GI)

• Clinical Probability scores (Conners 3AI)• Cut-off scores(DSM symptom count, validity

scales)• Raw scores(screener, impairment, critical)• Index Scores(3 AI, 3 GI)

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Guidelines for T-Scores and Percentiles

Elevated Score (More concerns than are typically reported)

93-9765-69

Low Score (Fewer concerns than are typically reported)

<16<40

Average Score (Typical levels of concern)16-8340-59

High Average Score (Slightly more concerns than are typically reported)

84-9260-64

Very Elevated Score (Many more concerns than are typically reported)

98+70+

GuidelinePercentileT-score

Step 1: Assess the Validity/Response Style of the

Raters– Susan S

Step 2: Interpret scale scoresContent Scales – Susan S (Metry)*

* Conners 3-T (Long)

Step 2: Interpret scale scoresDSM-IV Scales – Susan S (Metry)*

* Conners 3-T (Long)

DSM IV TR Symptom CountsSusan S – Teacher Report

DSM-IV TR Scales & DSM-IV-TR Symptom Count Requirements

Conners 3: Interpretation

DSM-IV Symptom Counts and T-scores:– Agreement between symptom count and

T-score:

• Both scores high: this diagnosis should be given strong consideration.

• Both scores low: it is unlikely that the diagnosis is currently present (although criteria may been met in the past)

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Step 3: Examine Susan’s Overall Profile

◄ Impairment

• Academic – Severe Impact

• Social – Mild Impact

• Home – not on teacher form

◄ Conners 3 ADHD Index◄ Conners 3 Global Index◄ Screener Items(2 endorsed)

Irritable when anxious: “Just a little true”

Trouble controlling worries: “Very much true”

◄ Severe Conduct Items(none endorsed)

Impairment Items Susan S – Teacher Report

Conners 3 ADHD Index – Susan S Teacher Report

Conners 3 Global Index – Susan S Teacher Report

Susan S – Global Index

• Item analysis • Critical Items (Severe Conduct) • Additional Questions

Step 4 Susan – Teacher Report

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Screener Items Susan S – Teacher Report

Elevated Items Susan S – Teacher Report

Elevated Items Susan S – Teacher Report

Elevated Items Susan S – Teacher Report

Elevated Items Susan S – Teacher Report

Susan S – Screener Items

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No Critical Items Endorsed

Susan S – IDEA Eligibility Considerations

Progress Report – Susan S

Review Slide:Conners 3rd Edition: Measuring Change

• If we have implemented an intervention and are measuring change - how do we know if the difference is significant or not?

• RCI values are based on a 90% confidence interval; a change in scores that meets or exceeds the RCI value can be considered to be a statistically significant change 90% of the time.

• Liberal criteria (90%) was used to better ensure that important changes in scores are not missed.

How do I know if a change in Conners scores over time is statistically significant?

Review Slide:Conners 3rd Edition: Measuring Change

• A clinically meaningful score is indicated by a change in classification

• A score can be clinically meaningful and not statistically significant

• A statistically significant change in behavior might not be a clinically meaningful score

• A score can be both statistically significant and clinically meaningful – our overall goal in intervention development!!

How do I know if a change in Conners scores over time is clinically meaningful?

Response to Intervention: Monitoring Susan’s Changes

Using the Reliable Change Index

Yes9.317485 Inattention

Sig.Change?

Change Needed for Significance

Intervention 1/24/07

T-Score

Baseline 9/26/06

T-Score

Scale

Yes9.0183110Hyperactivity

No9.316067Aggression

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Conners 3–T Content ScalesProgress Comparison across Administrations

Conners 3–T DSM-IV TR ScalesProgress Comparison Across Administrations

Impairment Progress Comparisons Across Administrations

Conners 3 ADHD Index Progress Comparisons Across Administrations

Conners 3 Global Index Progress Comparisons Across Administrations

Case Study: Mary Lamb

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Response Style Analysis

(Validity Indicator)

Positive Impression: the Positive Impression score (raw score = 0) does not indicate an overly positive response style

Negative Impression: the Negative Impression score (raw score = 4) does not indicate an overly negative response style

Inconsistency Index: the Insistency Index (raw score = 7, number of differentials >2 = 2) does not indicate an inconsistent response style

Mary Lamb Self Report Content Scores (Baseline)

Mary Lamb Self Report

DSM-IV Scale Scores (Baseline)

Mary Lamb Self Report

ADHD Probability Index (Baseline)

Screener Items Severe Conduct Critical Items

• Based on Mary’s endorsements on Anxiety and Depression items, further investigation may be indicated

• No endorsement of any Severe Conduct Critical Item

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Screener ItemsMary Lamb Assessment-SR Mary Lamb C3 SR

Learning Problems

Mary Lamb – Conners 3rd

Assessment Report

Conners 3rd Edition Feedback Handout Report

(Mary Lamb)INTERVENTIONS

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• Check frequently for understanding of instructions• Assign a “study buddy” with whom Mary can confirm directions

• Color code assignment/classwork folders with books for each academic area

• Proximity seating: seat Mary close to the front of the classroom and within the teacher’s view. Avoid a seat assignment that is close to windows or doors

• Provide Mary with a copy of the daily math problems displayed on the overhead

• When presenting multi-step directions visually, include a verbal statement of steps as well

Classroom InterventionsMonitoring intervention response with the Reliable Change Index

How can we tell if her interventions have worked?

PROGRESS REPORT REVIEW – MARY LAMB

Mary Lamb Progress Report Response Style Analysis/Validity Indicators

Mary Lamb Self Report - Content Scales T-Score Comparisons Across Administrations

Administration 1 = 11/3/08 Administration 2 = 1/27/09

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Mary Lamb Self Report – DSM-IV TR Scales T-Score Comparisons Across Administrations

Administration 1 = 11/3/08 Administration 2 = 1/27/09

Mary Lamb Progress Report Levels of Impairment

Self Report

Mary Lamb Progress Report Conners 3 ADHD Index

Self Report

Mary Lamb Progress Report

Reliable Change Index ValuesSelf Report – Conners 3

10.91

9.59

12.31

12.53

11.40

11.40

9.59

11.63

10.91

T-Score

4.96Oppositional Defiant Disorder

3.61Conduct Disorder

7.45ADHD Hyperactive-Impulsive

8.21ADHD Inattentive

5.80Family Relations

5.73Aggression Defiance

4.60Learning Problems

9.17Hyperactivity/Impulsivity

7.90Inattention

Raw Score

C-3 Scale Reliable Change Index Value

Content Scales

DSM-IV Symptom Scales

Reliable Change Index – Content ScalesSelf Report – Mary Lamb

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Reliable Change Index – DSM-IV TR ScalesSelf Report – Mary Lamb

Billy Buffalo Conners 3 ADHD Index

Assessment Report

Conners 3 AI Items – Billy Buffalo Assessment -Teacher Report

Conners 3 ADHD Index.

Probability Score

Conners 3 ADHD Index

T-score Billy Buffalo Interventions

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Billy Buffalo Interventions

♦ Parents took results of school report to child psychiatrist and he recommended a trial of Ritalin and school interventions

♦ Proximity seating for prompting and redirection, not, away from other “challenging students.”

♦ Stickers for on target behaviors for Bobby and other students

♦ Establish small play groups of 2 to 4 students to help Bobby and other students develop more effective social skills

Billy Buffalo Conners 3 ADHD Index

Progress Report

Billy Buffalo – Teacher Progress Report

Conners 3 ADHD IndexProbability Score

2/5/09 4/17/09

Billy Buffalo – Teacher Progress Report

Billy Buffalo – Teacher Progress Report

Conners 3 ADHD IndexT-Score

2/5/09 4/17/09

Billy Buffalo – Teacher Progress Report

Comparison Across Administrations

*Determined by Reliable Change Indices (RCI)** Statistical significant change in scores between administrations 1 and 2

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Overview of Training

• Discussion of clinical and educational context~ Important issues in school-aged youth

~ ADHD and comorbid conditions • Identify linkage between IDEA 2004, DSM-IV TR, & Conners 3rd

• Knowledge of the Conners 3rd Edition and its essential features and changes from Conners Rating Scales-Revised to Conners 3rd

Edition• Confidence in the psychometric properties and utility of the

Conners 3rd Edition• Familiarity with Conners 3rd administration, scoring options, and

interpretation• Awareness of Conners 3rd results in data-based identification and

decision making • Use of Conners 3rd results to guide intervention planning• Use of Reliable Change Index to help monitor progress • Case Studies

“Children are our most

valuable natural resources.”

Herbert Hoover