Transcript Using the Conners 3 and Conners CBRS

© E.P.Sparrow, 2007
Using the Conners 3 and Conners CBRS:
Identification and Intervention
• Clinical context: Knowledge and identification
– Important issues in school-aged youth
– Focus on ADHD
• Introduction to the Conners 3rd Ed. (Conners 3)
• Introduction to the Conners Comprehensive
Behavior Rating Scales (Conners CBRS)
• Clinical context: Intervention planning
• Special topic: Individuals With Disabilities
Education Act (IDEA) 2004 and Conners scales
• Application of skills: Case studies
© E.P.Sparrow, 2007
Overview of Workshop
• Retrospective study: 74% of adults with mental disorders
have a history of a childhood diagnosis.
• Longitudinal study (youth ages 9-16 years in NC)
– At any time, 1 in 6 youth has a psychiatric disorder.
– At least 1 in 3 youth has one or more psychiatric
disorders by age 16 years.
• 2002 U.S. survey (youth ages 6-14 years)
– 7% have difficulty doing regular schoolwork.
– 2% have difficulty getting along with others.
• In the 2005-2006 school year, 14% of students received
services under IDEA.
© E.P.Sparrow, 2007
Prevalence
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Specific learning disability (LD) = 6% (increase from 2% in 1976)
Speech/language = 3% (steady)
Mental retardation (MR) = 1% (decrease from 2% in 1976)
Emotional disturbance (ED) = 1% (steady)
Hearing impairment = <1% (steady)
Orthopedic impairment = <1% (steady)
Other health impairment (OHI) = 1% (slight increase from 0.3%
in 1976)
Visual impairment = <1% (steady)
Multiple disabilities = <1% (steady)
Deaf-blindness = <1% (steady)
Autism and traumatic brain injury (TBI) = <1% (slight increase
from 0.1 to 0.4)
Developmental delay = <1% (slight increase from 0.1 to 0.6)
All disabilities = 14% of total enrollment
(increase from 8% in 1976)
© E.P.Sparrow, 2007
Prevalence
(% of total enrollment)
• Academic/Cognitive
– Subject-specific difficulties
– Inattention
– Executive deficits
• Behavioral
– Aggressive or oppositional behaviors
– Hyperactive or impulsive behaviors
• Emotional
– Irritability, worrying, separation fears, perfectionism
– General distress, symptoms of depression, physical
symptoms
• Social
– Social skills, lack of social interests, social isolation
© E.P.Sparrow, 2007
Clinical Context:
Common Issues
Clinical Context:
Rare But Critical
Key = Identify and intervene
(the earlier the better)
© E.P.Sparrow, 2007
• Severe conduct problems and risk for violent
behaviors
• Self-mutilation
• Suicide
• Exposure to extremely stressful event(s)
• Substance abuse/dependence
Clinical Context: DSM-IV
© E.P.Sparrow, 2007
In the public schools, you are faced with a dilemma:
• Often you are the first to recognize emerging
symptoms of an undiagnosed disorder
• Must discuss and review past diagnoses
• May question outside diagnoses at times
• But, in most states, you cannot assign a DSM
diagnosis.
• 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 (PDDs): Asperger’s
disorder, PDD not otherwise specified (PDD-NOS), high
functioning autism
© E.P.Sparrow, 2007
Clinical Context: DSM-IV (cont.)
• ADHD has three types
– Predominantly inattentive type
– Predominantly hyperactive-impulsive type
– Combined type
• Major depressive episode and manic episode are two
building blocks for mood disorders
– Major depressive episode without any mania is the
foundation for major depressive disorder.
– Major depressive episode and manic episode are the
building blocks for one type of bipolar disorder.
© E.P.Sparrow, 2007
DSM-IV Building Blocks
Prevalence of
DSM-IV Disorders
© E.P.Sparrow, 2007
• ADHD
• Disruptive behavior disorders
– CD
– ODD
Prevalence of
DSM-IV Disorders (cont.)
© E.P.Sparrow, 2007
• Mood disorders
– Major depressive disorder
– Bipolar disorder
Prevalence of
DSM-IV Disorders (cont.)
© E.P.Sparrow, 2007
• Anxiety disorders
– GAD
– SAD
– Social phobia
– OCD
Prevalence of
DSM-IV Disorders (cont.)
© E.P.Sparrow, 2007
• PDDs
– Autistic disorder
– Asperger’s disorder
– PDD-NOS
– High functioning autism
• Attention-deficit/hyperactivity disorder (ADHD)
is the current term used by the DSM-IV (and
DSM-IV-TR)
• Past DSM terms include:
– ADD+H, ADD-H
– Hyperactive
– Hyperkinetic disorder
– Minimal brain damage
© E.P.Sparrow, 2007
What is ADHD?
What is ADHD? (cont.)
© E.P.Sparrow, 2007
• DSM-IV diagnosis begins with:
– Inattention (9 criteria) and/or
– Hyperactivity/Impulsivity (9 criteria)
• Symptoms must occur “often.”
• DSM-IV diagnosis of ADHD
– Symptoms that occur “often”
• 6 of 9 for inattentive type
• 6 of 9 for hyperactive-impulsive type
– Meet criteria for both inattentive and
hyperactive-impulsive subtypes to
qualify for combined type
© E.P.Sparrow, 2007
What is ADHD? (cont.)
• DSM-IV-TR requires symptoms of inattention,
hyperactivity, and/or impulsivity that are:
– Present in early childhood (evidence before age
7 years)
– Persistent over time (at least 6 months)
– Inconsistent with developmental level
– Pervasive across settings (at least two settings)
– Impairing in everyday life
– Not better accounted for by another diagnosis
(differential diagnosis)
© E.P.Sparrow, 2007
What is ADHD? (cont.)
Differential Diagnosis of ADHD
© E.P.Sparrow, 2007
What possible diagnoses would you consider for
the following referral?
– 12-year-old girl
– “Seems spacey, daydreams a lot”
– “Doesn’t follow directions”
ADHD and Related Disorders
© E.P.Sparrow, 2007
• ADHD has high rates of comorbidity.
• Commonly co-occurring diagnoses include:
– Disruptive behavior disorders
– Anxiety disorders
– Mood disorders
– Learning disorders
– Tic disorders
• Associated features
– Executive deficits, including variability in
performance
– Social functioning deficits
– Lowered self-esteem
– Sensory integration deficits
– Increased use of medical resources
– Positive traits and strengths
© E.P.Sparrow, 2007
What is ADHD? (cont.)
• 1960s: Normed behavior rating scale developed
by Dr. Keith Conners
• 1989: More extensive normative sample
collected; Conners Rating Scales (CRS) were
made available to public
• 1997: CRS was revised (CRS-R)—items added,
sophisticated statistical analyses performed, new
normative data collected
• 2008: Release of the Conners 3
© E.P.Sparrow, 2007
Conners 3: History
• Covers ADHD and associated features
• Includes two commonly co-occurring disruptive
behavior disorders, ODD and CD
• Links to DSM-IV-TR and IDEA 2004
• Multi-informant (parent, teacher, youth)
• Full-length and short form options
• Available in English and Spanish
• Easy administration, scoring, and profiling of
results
• Excellent reliability and validity
© E.P.Sparrow, 2007
Conners 3: Key Features
• Updated, large normative sample, representative
of U.S. population
• Scales for DSM-IV symptoms of ODD and CD
• Executive Functioning scale
• Validity scales
• Severe conduct critical items
• Screener items for anxiety and depression
• Impairment items
© E.P.Sparrow, 2007
Conners 3: What Is New?
• Revised the CRS-R based on recent research
and statistical findings
• Increased similarities across parent, teacher, and
youth self-report forms
• Modified age range
• Simplified language of DSM-IV-TR items
• Created a companion rating scale, the Conners
CBRS, to provide broader coverage of common
childhood disorders and problems
© E.P.Sparrow, 2007
Conners 3: What Is Different?
• Normative sample:
– Large
• 1,200 youth rated by parents and teachers
• 1,000 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
© E.P.Sparrow, 2007
Conners 3: Technical Details
• Normative sample: Large and diverse
• Reliability
– Internal reliability (consistency) is good.
– Test-retest reliability is good.
• Validity
– Factorial validity is solid.
– Convergent and divergent validity are good,
supporting construct validity.
– Discriminant (predictive) validity is good.
© E.P.Sparrow, 2007
Conners 3: Technical Details (cont.)
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Normative sample: Large and diverse
Reliability is good.
Validity is good.
Age and gender effects:
– Significant changes over the course of
development
– Significant differences between males and
females
– T scores take age and gender into account
© E.P.Sparrow, 2007
Conners 3: Technical Details (cont.)
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Content scales
DSM-IV scales and symptoms
Index scores
Critical items
Screener items
Validity scales
Impairment items
Additional questions
© E.P.Sparrow, 2007
Conners 3: Content
• Content scales
– Executive Functioning (not on self-report)
– Learning Problems
– Aggression
– Hyperactivity/Impulsivity
– Peer Relations (called Family Relations on
self-report)
– Inattention
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV content: ADHD, ODD, and CD
– Full-length form only
– DSM-IV symptom counts: Absolute levels
• Each DSM-IV symptom is represented.
• You can count these to see if the student
has enough symptoms of that disorder to
consider a diagnosis.
• Guidance is given for determining whether a
symptom is likely indicated, may be
indicated, or not indicated.
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV content: ADHD, ODD, and CD
– DSM-IV symptom counts: Absolute levels
– DSM-IV scales: Relative levels of symptoms
• T scores compare the student to peers.
• Helps determine if symptoms are atypical
for particular age and gender.
• High score means more symptoms than
typically seen.
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV scales and symptoms: ADHD, ODD,
and CD
• Index scores: Full-length form only
– Conners 3 ADHD Index (Conners 3AI)
– Conners 3 Global Index (Conners 3GI)
• Not available for self-report
• Two subscales
– Conners 3GI Emotional Lability
– Conners 3GI Restless-Impulsive
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV scales and symptoms: ADHD, ODD,
and CD
• Index scores: Conners 3AI and Conners 3GI
• Critical items: Severe conduct
– Full-length form only
– Severe misconduct that requires immediate
follow-up
– Behaviors that may predict future violence or
harm to others
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV scales and symptoms: ADHD, ODD,
and CD
• Index scores: Conners 3AI and Conners 3GI
• Critical items: Severe conduct
• Screener items: Full-length form only
– Anxiety
– Depression
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV scales and symptoms: ADHD, ODD,
and CD
• Index scores: Conners 3AI and Conners 3GI
• Critical items: Severe conduct
• Screener items: Anxiety and depression
• Validity scales
– Positive Impression Index (PI)
– Negative Impression Index (NI)
– Inconsistency Index (IncX): Full-length
form only
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV scales and symptoms: ADHD, ODD,
and CD
• Index scores: Conners 3AI and Conners 3GI
• Critical items: Severe conduct
• Screener items: Anxiety and depression
• Validity scales: PI, NI, and IncX
• Impairment items: Full-length form only
– Academic
– Home (parent and self-report only)
– Social
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• Content scales
• DSM-IV scales and symptoms: ADHD, ODD,
and CD
• Index scores: Conners 3AI and Conners 3GI
• Critical items: Severe conduct
• Screener items: Anxiety and depression
• Validity scales: PI, NI, and IncX
• Impairment items: Academic, home, and social
• Additional questions
– Other concerns
– Strengths or skills
© E.P.Sparrow, 2007
Conners 3: Content (cont.)
• When is the Conners 3 appropriate to use?
– Initial evaluation
– Re-evaluation
– Screening
– When indicated by Conners CBRS results
– Research studies
• Determine whether a child or adolescent
should be included in the research study
• Measure effectiveness of treatment
© E.P.Sparrow, 2007
Conners 3: Administration
• When is the Conners 3 appropriate to use?
• Who can complete the Conners 3?
– Parents
– Teachers
– Youth (8 to 18 years old)
• Rater requirements:
– Must have known student for at least 1 month
– Cognitive/reading level of at least 5th grade for
parents and teachers; at least 3rd grade for
youth
– Motivated
© E.P.Sparrow, 2007
Conners 3: Administration (cont.)
Conners 3: Administration (cont.)
© E.P.Sparrow, 2007
• When is the Conners 3 appropriate to use?
• Who can complete the Conners 3?
• How do I know which form to use?
– Full-length form
– Short form
– Conners 3AI
– Conners 3GI (not available for self-report)
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When is the Conners 3 appropriate to use?
Who can complete the Conners 3?
How do I know which form to use?
What do I tell the rater?
– General description of the Conners 3
– Reason he/she is being asked to complete it
– Instructions to complete it
– Thank you for your information
© E.P.Sparrow, 2007
Conners 3: Administration (cont.)
Conners 3: Administration (cont.)
When is the Conners 3 appropriate to use?
Who can complete the Conners 3?
How do I know which form to use?
What do I tell the rater?
Is there anything I need to tell the administrator?
© E.P.Sparrow, 2007
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Conners 3: Scoring
© E.P.Sparrow, 2007
• Ways to score:
– Hand score
– Computer score
Conners 3: Interpretation
Assess validity of the Conners 3 ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
Integrate results.
Report results.
© E.P.Sparrow, 2007
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Common Threats to Validity
Response bias
Random responding
Impulsive or careless responding
Comprehension errors
Missing items
Inappropriate use of normative data
Human error
© E.P.Sparrow, 2007
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Conners 3: Interpretation (cont.)
© E.P.Sparrow, 2007
1. Assess validity of the Conners 3 ratings.
• PI
• NI
• IncX
Conners 3: Interpretation (cont.)
© E.P.Sparrow, 2007
1. Assess validity of the Conners 3 ratings.
2. Interpret scale scores.
• Content scales
• DSM-IV scales and symptom counts
Conners 3: Interpretation (cont.)
© E.P.Sparrow, 2007
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 have
been met in the past).
• Symptom count high, T score low
Although the absolute DSM-IV-TR symptomatic criteria may
have been met, the current presentation is not atypical for this
age and gender. The assessor should give careful consideration
as to whether the symptoms are present in excess of
developmental expectations (an important requirement of
DSM-IV-TR diagnosis).
• Symptom count low, T score high
Although the current presentation is atypical for the youth’s age
and gender, there are not sufficient symptoms reported to meet
DSM-IV-TR symptomatic criteria for this disorder. The assessor
may wish to consider alternate explanations for why the
T scores could be elevated in the absence of this diagnosis
(e.g., another diagnosis may be producing these types of
concerns in this particular setting).
© E.P.Sparrow, 2007
Resolving DSM-IV
Discrepancies
1. Assess validity of the Conners 3 ratings.
2. Interpret scale scores.
3. Examine the overall profile.
• Relative elevations of T scores
• Impairment items
• Conners 3AI
• Conners 3GI
• Conners 3GI Emotional Lability
• Conners 3GI Restless-Impulsive
© E.P.Sparrow, 2007
Conners 3: Interpretation (cont.)
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Assess validity of the Conners 3 ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
• Items from elevated scales (content and DSM)
• Screener items (anxiety and depression)
• Critical items (severe conduct)
• Additional questions
© E.P.Sparrow, 2007
Conners 3: Interpretation (cont.)
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Assess validity of the Conners 3 ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
Integrate results.
• Within a single rater’s Conners 3 responses,
• Across multiple Conners 3 raters, and
• With other sources of information.
© E.P.Sparrow, 2007
Conners 3: Interpretation (cont.)
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DSM-IV diagnosis of ADHD
DSM-IV diagnosis of ODD
DSM-IV diagnosis of CD
Indicators of possible:
– Anxiety disorder(s)
– Mood disorder(s)
– Learning disorders
© E.P.Sparrow, 2007
DSM-IV and Conners 3
Conners 3: Interpretation (cont.)
Assess validity of the Conners 3 ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
Integrate results.
Report results.
© E.P.Sparrow, 2007
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Conners 3: Interpretation (cont.)
Individual interpretation strategy
Other contexts for interpretation
– Change over time (e.g., treatment
monitoring)
– Screening a group of individuals
– Evaluating an intervention program
© E.P.Sparrow, 2007
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Conners 3: Summary
History
Key features
What’s new and different
Technical details
Content
Administration and scoring
Interpretation and reporting
© E.P.Sparrow, 2007
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• Dr. Conners and the MHS team saw the need for
a comprehensive rating scale:
– Guided by clinical experience and research
– Supported by solid psychometrics and
statistical analyses
– Useful to professionals who work with children
and adolescents for:
• Identification of needs/disabilities
• Intervention planning and monitoring
© E.P.Sparrow, 2007
Conners CBRS: History
• Comprehensive behavior rating scales
– Behavioral, emotional, social, and academic issues
– Violence potential, severe conduct, self harm
– DSM-IV-TR diagnoses
• Used to describe youth ages 6-18 years old
• Multi-informant (parent, teacher, youth)
• Available in English and Spanish
• Easy administration, scoring, and interpretation
• Excellent reliability and validity
• Linked to DSM-IV and IDEA 2004
© E.P.Sparrow, 2007
Conners CBRS: Key Features
• Normative sample: Co-normed with Conners 3
• Reliability
– Internal reliability (consistency) is good.
– Test-retest reliability is good.
• Validity
– Factorial validity is solid.
– Convergent & divergent validity are good,
supporting construct validity.
– Discriminant (predictive) validity is good.
© E.P.Sparrow, 2007
Conners CBRS:
Technical Details
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Normative sample: Large and diverse
Reliability is good.
Validity is good.
Age and gender effects:
– Significant changes over the course of
development
– Significant differences between males and
females
– T scores take age and gender into account
© E.P.Sparrow, 2007
Conners CBRS:
Technical Details (cont.)
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Content scales
DSM-IV scales and symptoms
Critical items
Other clinical indicators
Clinical index score
Validity scales
Impairment items
Additional questions
© E.P.Sparrow, 2007
Conners CBRS: Content
• Content scales
– Emotional Distress
– Aggressive Behaviors
– Academic Difficulties
– Hyperactivity/Impulsivity
– Separation Fears
– Social Problems (not on self-report)
– Perfectionistic and Compulsive Behaviors
(not on self-report)
– Violence Potential
– Physical Symptoms
© E.P.Sparrow, 2007
Conners CBRS: Content (cont.)
• Content scales
• DSM-IV content
– ADHD
– Disruptive behavior disorders: ODD, CD
– Mood disorder building blocks: Major depressive
episode and manic episode
– Anxiety disorders: GAD, SAD, social phobia, OCD
– Pervasive developmental disorders (not on self-report):
Autistic disorder, Asperger’s disorder
© E.P.Sparrow, 2007
Conners CBRS: Content (cont.)
• Content scales
• DSM-IV content
– DSM-IV symptom counts: Absolute levels
• Each DSM-IV symptom is represented.
• You can count these to see if the student has
enough symptoms of that disorder to consider a
diagnosis.
– DSM-IV scales: Relative levels of symptoms
• T scores compare the student to peers.
• Helps determine if symptoms are atypical for
particular age and gender.
© E.P.Sparrow, 2007
Conners CBRS: Content (cont.)
• Content scales
• DSM-IV scales and symptoms
• Critical items
– Severe conduct
• Severe misconduct that requires immediate
follow-up
• Behaviors that may predict future violence
or harm to others
© E.P.Sparrow, 2007
Conners CBRS: Content (cont.)
Conners CBRS: Content
Content scales
DSM-IV scales and symptoms
Critical items: Severe conduct and self harm
Other clinical indicators
-Bullying
-Enuresis/Encopresis
-Pica
-Panic attack
-Posttraumatic stress
disorder (PTSD)
-Substance use
-Specific phobia
-Trichotillomania
-PDD
-Tics
© E.P.Sparrow, 2007
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Conners CBRS: Content (cont.)
Content scales
DSM-IV scales and symptoms
Critical items: Severe conduct and self harm
Other clinical indicators
Clinical index score (Conners CI)
© E.P.Sparrow, 2007
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Content scales
DSM-IV scales and symptoms
Critical items: Severe conduct and self harm
Other clinical indicators
Clinical index score
Validity scales
– Positive Impression Index (PI)
– Negative Impression Index (NI)
– Inconsistency Index (IncX)
© E.P.Sparrow, 2007
Conners CBRS: Content (cont.)
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Content scales
DSM-IV scales and symptoms
Critical items: Severe conduct and self harm
Other clinical indicators
Clinical index score
Validity scales: PI, NI, and IncX
Impairment items
– Academic
– Home (parent and self-report only)
– Social
© E.P.Sparrow, 2007
Conners CBRS: Content (cont.)
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Content scales
DSM-IV scales and symptoms
Critical items: Severe conduct and self harm
Other clinical indicators
Clinical index score
Validity scales: PI, NI, and IncX
Impairment Items: Academic, home, and social
Additional questions
– Other concerns
– Strengths or skills
© E.P.Sparrow, 2007
Conners CBRS: Content
• When should I use the Conners CBRS?
– Initial evaluation
– Re-evaluation
– Screening
– When indicated by the Conners 3 results
– Research studies
• Determine whether a child or adolescent
should be included in the research study
• Measure effectiveness of treatment
© E.P.Sparrow, 2007
Conners CBRS: Administration
• When should I use the Conners CBRS?
• Who can complete the Conners CBRS?
– Parents
– Teachers
– Youth (8 to 18 years old)
• Rater requirements:
– Must have known student for at least 1 month
– Cognitive/reading level of at least 5th grade for parents
and teachers; at least 3rd grade for youth
– Motivated
© E.P.Sparrow, 2007
Conners CBRS: Administration (cont.)
Conners CBRS: Administration (cont.)
© E.P.Sparrow, 2007
• When should I use the Conners CBRS?
• Who can complete the Conners CBRS?
• How do I know which form to use?
– Full-length form (Conners CBRS)
– Clinical index (Conners CI)
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When should I use the Conners CBRS?
Who can complete the Conners CBRS?
How do I know which form to use?
What do I tell the rater?
– General description of the Conners CBRS
– Reason he/she is being asked to complete it
– Instructions to complete it
– Thank you for your information
© E.P.Sparrow, 2007
Conners CBRS: Administration (cont.)
Conners CBRS: Administration (cont.)
When should I use the Conners CBRS?
Who can complete the Conners CBRS?
How do I know which form to use?
What do I tell the rater?
Is there anything I need to tell the administrator?
© E.P.Sparrow, 2007
•
•
•
•
•
Conners CBRS: Scoring
© E.P.Sparrow, 2007
• Ways to score:
– Computer score
Conners CBRS: Interpretation
Assess validity of the Conners CBRS ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
Integrate results.
Report results.
© E.P.Sparrow, 2007
1.
2.
3.
4.
5.
6.
Common Threats to Validity
Response bias
Random responding
Impulsive or careless responding
Comprehension errors
Missing items
Inappropriate use of normative data
Human error
© E.P.Sparrow, 2007
•
•
•
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•
Conners CBRS: Interpretation (cont.)
© E.P.Sparrow, 2007
1. Assess validity of the Conners CBRS ratings.
• PI
• NI
• IncX
Conners CBRS: Interpretation
© E.P.Sparrow, 2007
1. Assess validity of the Conners CBRS ratings.
2. Interpret scale scores.
• Content scales and subscales
• DSM-IV scales and symptom counts
Conners CBRS: Interpretation
© E.P.Sparrow, 2007
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 have
been met in the past).
• Symptom count high, T score low
Although the absolute DSM-IV-TR symptomatic criteria may
have been met, the current presentation is not atypical for this
age and gender. The assessor should give careful consideration
as to whether the symptoms are present in excess of
developmental expectations (an important requirement of
DSM-IV-TR diagnosis).
• Symptom count low, T score high
Although the current presentation is atypical for the youth’s age
and gender, there are not sufficient symptoms reported to meet
DSM-IV-TR symptomatic criteria for this disorder. The assessor
may wish to consider alternate explanations for why the
T scores could be elevated in the absence of this diagnosis
(e.g., another diagnosis may be producing these types of
concerns in this particular setting).
© E.P.Sparrow, 2007
Resolving DSM-IV
Discrepancies
Conners CBRS: Interpretation (cont.)
© E.P.Sparrow, 2007
1. Assess validity of the Conners CBRS ratings.
2. Interpret scale scores.
3. Examine the overall profile.
• Relative elevations of T scores
• Impairment items
• Conners CI
1.
2.
3.
4.
Assess validity of the Conners CBRS ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
• Items from elevated scales (content and DSM)
• Clinical indicators
• Critical items (severe conduct, self harm)
• Additional questions
© E.P.Sparrow, 2007
Conners CBRS: Interpretation (cont.)
1.
2.
3.
4.
5.
Assess validity of the Conners CBRS ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
Integrate results.
• Within a single rater’s Conners CBRS
responses,
• Across multiple Conners CBRS raters, and
• With other sources of information.
© E.P.Sparrow, 2007
Conners CBRS: Interpretation (cont.)
Conners CBRS: Interpretation (cont.)
Assess validity of the Conners CBRS ratings.
Interpret scale scores.
Examine the overall profile.
Consider item-level responses.
Integrate results.
Report results.
© E.P.Sparrow, 2007
1.
2.
3.
4.
5.
6.
Conners CBRS: Interpretation (cont.)
Individual interpretation strategy
Other contexts for interpretation
– Change over time (e.g., treatment
monitoring)
– Screening a group of individuals
– Evaluating an intervention program
© E.P.Sparrow, 2007
•
•
Conners CBRS: Summary
History
Key features
Technical details
Content
Administration and scoring
Interpretation and reporting
© E.P.Sparrow, 2007
•
•
•
•
•
•
Conners: Interventions
© E.P.Sparrow, 2007
Labeling a problem does not usually
solve the problem, unless it leads to a
plan for change.
Intervention: Guidelines
2.
3.
4.
Identify and prioritize treatment targets.
Include current level of functioning.
Create specific, measurable, meaningful
treatment goals.
Develop individualized strategies to reach
these goals.
Track progress. Regularly review and revise
targets, goals, and strategies.
© E.P.Sparrow, 2007
1.
Strategies for Intervention
Medical
Behavioral
Cognitive and cognitive-behavioral
Psychosocial
Academic
© E.P.Sparrow, 2007
•
•
•
•
•
Strategies for Intervention (cont.)
© E.P.Sparrow, 2007
• Behavioral therapies
– Target a specific behavior
– Specific interventions
– Modify environment
– Goal is to change the behavior
Strategies for Intervention (cont.)
© E.P.Sparrow, 2007
• Behavioral therapies
• Cognitive and cognitive-behavioral
– Addresses how people think about things or
perceive things
Strategies for Intervention (cont.)
© E.P.Sparrow, 2007
• Behavioral therapies
• Cognitive and cognitive-behavioral
• Psychosocial
– Involves how people interact with others
•
•
•
•
Behavioral therapies
Cognitive and cognitive-behavioral
Psychosocial
Academic
– Modified general instruction
– Small-group or individual instruction
– Specialized instruction techniques
– Specific skill instruction
© E.P.Sparrow, 2007
Strategies for Intervention (cont.)
Strategies for Intervention (cont.)
© E.P.Sparrow, 2007
• Who can implement these strategies?
– School staff (teachers, aides, assistants,
therapists, coaches, bus monitors)
– Parent(s) or other family member(s)
– Community member(s)
– Student
Strategies for Intervention (cont.)
© E.P.Sparrow, 2007
• Where can these strategies be used?
– School setting
– Home setting
– Community setting
Strategies for Intervention (cont.)
© E.P.Sparrow, 2007
• What are some ideas for strategies?
• How can I help this student reach the goals?
– Academic
• Practical
• Instructional
• Testing
• Assignments
– Social
– Emotional
– Behavioral
© E.P.Sparrow, 2007
Strategies for Intervention (cont.)
Intervention Ideas
© E.P.Sparrow, 2007
• Examples of academic recommendations
– Seating
– Task directions
– Organization
– Testing
– Progress monitoring
– Purpose of a task
Intervention Ideas (cont.)
© E.P.Sparrow, 2007
• Academic
• Examples of social recommendations
– Social motivation
– Social awareness
– Social skills instruction
– Application of social skills
• Academic
• Social
• Examples of emotional recommendations
– Recognizing emotions in others
– Regulating extreme emotions
– Expressing emotions appropriately
– Self-help sessions
– Accepting mistakes
© E.P.Sparrow, 2007
Intervention Ideas (cont.)
•
•
•
•
Academic
Social
Emotional
Examples of behavioral recommendations
– Prompt before a situation
– Cue for the appropriate behavior
– Catch the student being good
– Give the student acceptable choices
– Time-outs and self-help sessions
– Supportive structure
© E.P.Sparrow, 2007
Intervention Ideas (cont.)
• General recommendation ideas
• Using Conners 3 and Conners CBRS data,
– Consider profile elevations.
– Review individual items with high ratings.
– Establish baseline before beginning treatment.
– Monitor progress over course of treatment.
– Evaluate need for continuation, modification,
or termination of intervention services.
© E.P.Sparrow, 2007
Intervention Ideas (cont.)
Intervention: Summary
Think about context/setting.
Be specific in your goals. Prioritize.
Increase external structure and support.
Reinforce appropriate behaviors.
Respond immediately.
Think about how this skill fits into life, and make a
recommendation that will go far.
© E.P.Sparrow, 2007
•
•
•
•
•
•
Conners CBRS and
Educational Law
© E.P.Sparrow, 2007
• Individuals with Disabilities Education
Improvement Act, also known as
– IDEA 2004
– Assistance to States for the Education
of Children with Disabilities
• The Conners 3 and Conners CBRS help you with
IDEA 2004.
– Evaluation procedures
– Overidentification and disproportionality
– Educational needs
– Eligibility for special education and related
services
– Individualized education plan (IEP)
development, review, and revision
– Positive behavioral interventions
– Response to intervention (RTI)
© E.P.Sparrow, 2007
Conners and IDEA 2004
Evaluation Procedures
• Use assessment tools that are not racially or culturally
discriminatory: Representative normative sample of the
Conners tools reduces racial and cultural bias.
• Select assessment materials in the child’s native language:
Conners tools are available in English and Spanish versions.
• Do not determine an appropriate educational program
based on a single procedure: Conners tools are designed to
be used with multiple informants across multiple settings within
the context of a multimodal evaluation.
© E.P.Sparrow, 2007
• Assess specific areas of educational need: Conners tools
provide scores for specific concerns that directly impact
education.
Overidentification and
Disproportionality
© E.P.Sparrow, 2007
The federal government has mandated that we
must work together to reduce disproportionate
representation of racial and ethnic groups in special
education and related services, to the extent that
the representation is the result of inappropriate
identification.
• The Conners tools help you fulfill the requirement
to determine the nature and extent of special
education and related sevices needed, including
academic and behavioral services.
• IDEA 2004 (and commentary in the Federal
Register) indicate that needs may include:
– Parent counseling and training
– Facilitation of social-emotional learning
© E.P.Sparrow, 2007
Conners and Educational Needs
Conners and Eligibility
© E.P.Sparrow, 2007
• Determine eligibility for special education and
related services
• Identify possible IDEA category/categories (or
areas of developmental delay) that describe the
student’s needs
Conners and IEPs
© E.P.Sparrow, 2007
• The Conners tools can help you:
– Develop goals for initial IEP,
– Measure progress toward goals during regular
review of the IEP, and
– Suggest new or updated goals for IEP
revisions.
• The Conners tools can help you:
– Identify the need for positive behavioral
interventions,
– Establish baselines for the behaviors,
– Suggest targets for intervention plans,
– Monitor progress in behaviors, and
– Support decisions to discontinue or increase
positive behavioral supports.
© E.P.Sparrow, 2007
Positive Behavioral Intervention
• High quality, research-based instruction and behavioral
supports in general education
• Universal screening of academics and behavior
• Scientific, research-based interventions for individual
student difficulties (delivered with appropriate intensity)
• Collaborative approach to develop, implement, and
monitor interventions
• Frequent data collection and analysis
− Student RTI
− Consistent implementation of interventions by staff
• High levels of parent involvement
© E.P.Sparrow, 2007
RTI: A General Model
© E.P.Sparrow, 2007
Tiers of RTI
Source: National Association of State Directors of Special Education (NASDSE)
RTI and IDEA 2004
1
National Association of State Directors of Special Education & Council of Administrators of Special Education. (2006,
May). Response to intervention: NASDSE and CASE white paper on RTI. Retrieved May 14, 2009 from
http://nasdse.org/Portals/0/Documents/Download%20Publications/RtIAnAdministratorsPerspective1-06.pdf
© E.P.Sparrow, 2007
• IDEA 2004 mentions RTI in two contexts:
– Determination of specific learning disability
– Early intervening services (Grades K-12)
• Overarching goal of including RTI in IDEA 2004:
“Utilize RTI to address the challenges and
potential of NCLB for improving outcomes for all
1
students, including students with disabilities.”
• Determination of specific learning disability can be based
on the following:
• Student does not meet age- or grade-level
standards when provided with learning experiences
and instruction appropriate for age (in 1/8 academic
areas).
• Student does not make sufficient progress in 1/8
academic areas when using a process based on his
or her response to scientific, research-based
intervention.
• Student shows a pattern of strengths and weaknesses
in performance/achievement relative to age, grade, or
intellectual development.
© E.P.Sparrow, 2007
RTI and IDEA 2004 (cont.)
• Determination of specific learning disability
• Develop and implement early intervening
services in Grades K-12, including:
– Professional development for staff to deliver
scientifically-based academic and behavioral
interventions
– Educational and behavioral evaluations,
services, and supports
© E.P.Sparrow, 2007
RTI and IDEA 2004 (cont.)
• General model of RTI is broader than that
represented in IDEA 2004 (not just limited to LD)
and includes the concept of universal screening.
• IDEA 2004 references RTI in two ways:
– Determination of specific LD (as an alternative
to the discrepancy model).
– Important for early identification of academic
and behavioral struggles in students in Grades
K-12, including intervention and monitoring.
© E.P.Sparrow, 2007
RTI and IDEA 2004 (cont.)
• Suggest need for comprehensive evaluation to
determine the existence of a specific LD.
• Identify students (Grades K-12) who require
academic and/or behavioral supports in order to
succeed in the general education setting.
• Clarify targets for interventions.
• Provide an objective way to monitor student RTI.
• Provide an objective way to identify at-risk
children without bias due to race or ethnicity.
© E.P.Sparrow, 2007
Conners and RTI
• Within the context of IDEA 2004:
– Suggest which students need comprehensive
evaluation for a specific LD.
– Identify students who need early intervening services.
– Develop and monitor early intervening services.
• Within the broader context of the RTI model:
– Use in universal screening to identify students who are
at risk for academic, social, emotional, and/or
behavioral problems.
– Target symptoms for treatment.
– Monitor progress in treatment.
– Indicate areas to be addressed in a comprehensive
evaluation.
© E.P.Sparrow, 2007
Conners and RTI (cont.)
Conners and RTI (cont.)
Tier III: Comprehensive evaluation
Tier II: Target and monitor skills/behaviors
Tier I: Universal screening
© E.P.Sparrow, 2007
Source: National Association of State Directors of
Special Education (NASDSE)
Conners and
Educational Law
© E.P.Sparrow, 2007
• IDEA 2004; Assistance to States for the
Education of Children with Disabilities
• Section 504 of the Rehabilitation Act of 1973
• No Child Left Behind Act of 2001 (NCLB;
Elementary and Secondary Education Act
[ESEA])