© 2020 Springer Nature Switzerland AG. Our findings can help clinicians make more informed decisions regarding the selection of the most suitable rating scales for assessments. Conners-3 ADHD Index is included in the full-length Conners-3 or may be purchased separately. CRS-R includes both long and short versions of parent and teacher rating scales as well as various subscales—namely oppositional, cognitive problem or inattention, and hyperactivity subscales—and an ADHD index. To the best of our knowledge, no meta-analyses have reported pooled estimates of the diagnostic accuracy of CBCL-AP and CRS-R. Diagnostic accuracy of the Child Behavior Checklist scales for attention-deficit hyperactivity disorder: a receiver-operating characteristic analysis. Based on the Cook distance, studies conducted by Roessner et al44 and Gargaro et al36 were the most influential (Fig 5) for CBCL-AP and CPRS-R:S, respectively. The Conners’ Teacher Rating Scale – Revised (CTRS-R) is the teacher form of the Conners’ Rating Scales – Revised (CRS-R). DATA EXTRACTION: Bivariate random effects models were used for pooling and comparing diagnostic performance. The CRS-R were designed to address the need for a multimodal assessment of children and adolescent’s behavioral difficulties and contain a parent form, and teacher form, and an adolescent self report form. Part of Springer Nature. CBCL is a parent-rated questionnaire for assessing a wide range of child emotional and behavioral problems. Figure 2 illustrates a forest plot of the coupled sensitivity and specificity with 95% confidence intervals (CIs) for each study included in this meta-analysis. Headache Log Headache Log.pdf Adobe Acrobat document [226.9 KB] Headache Log (Spanish) Headache Log (Spanish).pdf Adobe Acrobat document [222.2 KB] Call to … LR tests were performed to determine the statistical significance of the results. Conners 3–P Assessment Report for John H. Admin Date: 03/24/2014 Conners 3–P Content Scales: Detailed Scores The following table summarizes the results of … In addition, we supplemented the search by carefully identifying appropriate articles from the reference lists of the relevant review articles. Cross-sectional, cohort, and case-control studies were included. The specificity was high in studies with older participants and a high percentage of female participants. Conners 3 Short Forms. Do symptoms of ADHD at ages 7 and 10 predict academic outcome at age 16 in the general population? Influential analysis and outlier detection. Our meta-analysis revealed that CBCL-AP and CRS-R demonstrated moderate sensitivity and specificity in detecting ADHD in children and adolescents. We used a combination of MeSH terms and keywords pertaining to ADHD (“attention-deficit hyperactivity disorder” OR “ADHD” OR “hyperkinetic disorder”), diagnostic accuracy (“sensitivity” OR “specificity” OR “AUC” OR “ROC” OR “predictive value” OR “diagnostic accuracy” OR “diagnostic performance” OR “diagnostic utility”), AND the name of the reviewed scale (“CBCL” OR “Child Behavior Checklist” OR “Conners” OR “CPRS” OR “CTRS” OR “ASQ”). According to the comparable diagnostic performance of all examined scales, ASQ may be the most effective diagnostic tool in assessing ADHD because of its brevity and high diagnostic accuracy. Prevalence of ADHD symptoms among youth in a secure facility: the consistency and accuracy of self- and informant-report ratings. The Conners 3 also gives clinicians the choice of using a short form. The satisfactory diagnostic utility of the ADHD index within CPRS-R:S and CTRS-R:S observed in the current study is consistent with those reported in previous reviews,10,57 suggesting that the ADHD index contains the most favorable set of items for distinguishing children with ADHD from those without ADHD. Furthermore, an abridged version of CRS-R, the Conners Abbreviated Symptom Questionnaire (ASQ), contains 10 identical items for parent and teacher rating scales. We searched for studies in 6 databases: PubMed, Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Web of Science. Attention deficit-hyperactivity disorder in children and adolescents. Conners’ Parent Rating Scale-Revised for parents/caregivers; Conners’ Teacher Rating Scale-Revised for teachers. The Conners' Rating Scales-Revised evaluate problem behaviors as reported by the teacher, parents (or alternative caregivers), and adolescents. Conners 3 Parent and Teacher forms are used to rate youth 6-18 years, and the Self-Report form can be completed by youth 8-18 years. Supplemental Figure 6 shows methodological quality assessments of the reviewed studies according to the QUADAS-2 tool. HSROC curves for the detection of ADHD in children and adolescents. The reviewed scales yielded satisfactory sensitivity and specificity. We conducted this study according to the recommendations of the Cochrane Collaboration Diagnostic Test Accuracy Working Group. The studies were included irrespective of publication status and language. Teacher, Parent and Self-Report rating scales with long and short forms. 5) David J. Purpura and Christopher J. Lonigan (2009) Conners’ Teacher Rating Scale for Preschool Children: A Revised, Brief, Age-Specific Measure. Does not know how to make friends 32. Created Date: 12/12/2014 11:53:11 PM In addition, scoring software is also available. Measuring the accuracy of diagnostic systems. All CRS-R versions exhibited a favorable diagnostic performance, and ASQ demonstrated the highest sensitivity, specificity, and AUC, although the differences were not significant. The current study is the first systematic review and meta-analysis assessing and comparing the diagnostic performance of CBCL-AP and CRS-R in diagnosing ADHD in children and adolescents. The rating scales are available for parent (Conners 3–P), teacher (Conners 3–T) and self-report (Conners 3–SR). Studies in which the study populations were children and adolescents aged 3 to 18 years were included. Conner's Abbreviated Teacher Rating Scale Author: Taneal Bhandari Subject: Conner's Abbreviated Teacher Rating Scale Keywords: Atlanta's premier Adult, Child & Adolescent Psychiatry and Therapy practice. Enter multiple addresses on separate lines or separate them with commas. Measuring inconsistency in meta-analyses. In addition, no previous study has evaluated age and gender differences in the sensitivity and specificity of CBCL-AP; therefore, the present findings should be interpreted with caution. Correspondence between statistically derived behavior problem syndromes and child psychiatric diagnoses in a community sample. Normative data for the revised forms comes from a large community-based sample of children and adolescents collected throughout the … Finally, to increase the number of included studies, the present analyses comparing different diagnostic tools were conducted using studies that have evaluated ≥1 of the tools. Conners’ Scales Developed by Keith Conners PhD Available Tools: Conners’ Parent Rating Scale-Revised for parents/caregivers Conners’ Teacher Rating Scale-Revised for teachers Conners-Wells’ Adolescent Self-Report Scale for teenagers 3rd edition- contains parent, teacher, and self-report both full and short … Healthcare use, social burden and costs of children with and without ADHD in Flanders, Belgium. A Volume in the Educational Psychology Series. No statistical significance in sensitivity or specificity was observed between other subgroups, namely sample sources (clinic versus nonclinic), number of participants (≥200 vs <200), cut-off value (≥65 vs <65), study year (before 2005 vs after 2005), and study quality (high vs low risk), indicating that these subgroups are unlikely sources of heterogeneity. However, the included studies were heterogeneous regarding study design and sample characteristics, which may have confounded the results. There are two forms of the CTRS-R: the Long Form (CTRS-R:L) and the Short Form (CTRS-R:S). Diagnostic data from each study were fitted in a bivariate random effects model,19 which estimates pairs of logit-transformed sensitivity and specificity from studies and considers the correlation between the sensitivity and specificity observed among studies.20 We also estimated pooled sensitivity, specificity, likelihood ratios (LRs), and DORs. Many symptoms of ADHD are not always observed in clinical settings; therefore, information provided by both scales can enhance clinicians’ understanding of children’s symptoms in different settings. The Conners uses T-scores with a mean of 50 and a standard deviation of 10. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. Compared with studies with a lower percentage of female participants (<35%), those with a higher percentage (≥35%) demonstrated a significantly higher specificity (0.64 and 0.83, respectively; P = .04). Path Group of Atlanta. No difference was observed in the diagnostic performance of the various scales. Comparison of parent-completed behavior rating scales: differentiating boys with ADD from psychiatric and normal controls. Regarding index tests, approximately half of the studies (n = 13) had a low risk of bias for not applying a prespecified threshold and interpreting the index test results without a knowledge of the reference standard results. The heterogeneity of the diagnostic test parameters was evaluated by using I2 statistics, with 0% and >50% indicating no observed heterogeneity and substantial heterogeneity, respectively.23 The threshold effect was an essential source of heterogeneity in this meta-analysis. Therefore, we conducted a systematic review and meta-analysis on the remaining 25 articles.13,28–51. Not logged in Conners’ Rating Scales. The parent and teacher short forms of the Conners’ Rating Scales—Revised (Conners, 1997) were designed for repeated and/or brief assessment of symptoms relevant to ADHD and related disorders. The percentage of female participants ranged from 0% to 54%. We also excluded 4 studies that included various modified versions of CRS-R. Estimates of the Utility of Child Behavior Checklist/Teacher Report Form Attention Problems Scale in the diagnosis of ADHD in children referred to a specialty clinic. The total number of participants ranged from 18 to 763, ages 5.50 to 14.59 years. Conners' Student's Name/ID: Teacher Rating Scale - Data Entry Sheet by C. Keith Conners, Ph.D. CRS927 Revised (L) Gender: M F (Circle One) Age: Year School Grade: Birthdate: Month Teacher's Name: Day Day Year Today's Date: NOT TRUE AT ALL (Never. Naglieri, J. Fourteen and 11 studies reported accuracy estimates for CBCL-AP and CRS-R, respectively; 1 study applied CPRS-R:S alone, 2 applied CTRS-R:S alone, 5 applied ASQ alone, and 3 applied both CTRS-R:S and CPRS-R:S for ADHD assessment in children and adolescents. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. The short forms of the Connors' Rating Scales-Revised (CRS-R) system are used for quick assessment of characteristics and behaviors that are indicative of Attention-Deficit/Hyperactivity Disorder. In addition, the Conners 3 also includes two auxiliary scales: the Conners 3 ADHD Index (Conners 3AI™) and the Conners 3 Global Index (Conners … Conners 3 Short Parent, Teacher, and Self-Report forms closely parallel each other, and are a subset of items from the full-length forms. Attention-deficit/hyperactivity disorder (ADHD), the most prevalent neurodevelopmental disorder among children and adolescents, affects ∼5 in 100 children in the United States.1 The prevalence of ADHD increased by an average 3% annually from 1997 to 2006 and an average ∼5% annually from 2003 to 2011.2 ADHD symptoms can cause functional impairments in numerous settings, such as schools, homes, and communities.3 For example, several negative outcomes, such as poor peer relationships,4 high risk of injury,5 and low academic performance,6 have been associated with ADHD. These studies evaluated the diagnostic accuracy of the reviewed behavioral rating scale in assessing ADHD in children and adolescents in comparison with a defined reference standard. Address correspondence to Pei-Shan Tsai, PhD, School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei 110, Taiwan. Relationships between the WISC-III and the Cognitive Assessment System with Conners’ rating scales and continuous performance tests. Furthermore, no previous meta-analysis has evaluated the utility of the CBCL and CRS-R in assessing ADHD. Conners Teacher Rating Scale Conners Teacher.pdf Adobe Acrobat document [239.1 KB] Headaches. Therefore, in this study, we identified and compared the diagnostic accuracy of these 2 ADHD diagnostic tools in children and adolescents. Diagnostic utility of two commonly used ADHD screening measures among special education students. Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J. N. (1998). The search results allowed us to conduct meta-analyses only for the Conners Parent Rating Scale–Revised Short Form (CPRS-R:S), Conners Teacher Rating Scale-Revised Short Form (CTRS-R:S), and ASQ, each of which was used in >3 studies. Received May 14, 2004; revisions received July 27, 2004 and November 30, 2004; accepted February 2, 2005 It has been well demonstrated in the literature that survivors of childhood acute lymphocytic leukemia (ALL) and brain tumors (BT) are at significant risk for cognitive late effects of their treatment, primarily because of central nervous system-directed chemotherapy and cranial irradiation (Brown et al., 1998; Mulhern et al., 1999; Ris & Noll, 1994). No difference was observed in the diagnostic performance of the various scales. The usefulness of Conners’ Rating Scales-Revised in screening for attention deficit hyperactivity disorder in children with intellectual disabilities and borderline intelligence. The following criteria were considered for study inclusion: type of study, participants, index test, target condition, and reference standards. Publication bias was detected by regressing log DORs on the inverse root of the effective sample size26 to examine funnel plot asymmetry, with P < .10 for the slope coefficient indicating significant asymmetry. Figure 3 shows HSROC curves and associated AUCs for the included diagnostic tools. After we excluded this study and refitted the model for CBCL-AP, we observed no changes in specificity (0.75 vs 0.75); however, the sensitivity dropped from 0.77 to 0.74. Different results may be observed when other potential sources of heterogeneity are simultaneously considered in regression models. Seldom) Month JUST A LirrL.E TRUE Usually, 0 means never, and 3 or 4 means very often and the higher the score, the more severe the symptom. DATA SOURCES: PubMed, Ovid Medline, and other relevant electronic databases were searched for articles published up to May 2015. RESULTS: We identified and evaluated 14 and 11 articles on CBCL-AP and CRS-R, respectively. Studies evaluating CBCL-AP or CRS-R were included. Manual for the ASEBA School-Age Forms and Profiles, University of Vermont, Research Center for Children, Youth & Families, Conners’ Rating Scales-Revised Technical Manual. Titles and abstracts were independently screened by 2 reviewers (Drs Chang and Wang). Ten-year review of rating scales. The American Academy of Pediatrics Diagnostic Guidelines52 does not recommend using a broadband rating scale, such as CBCL, for diagnosing ADHD, because the broad domain factors do not distinguish young people referred for ADHD from their nonreferred peers. The rating scales— each available in long and short form—are completed by teachers, parents, and adolescents. FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. The teacher form, the CTRS-R, is appropriate for use with teachers of children and adolescents ages 3 through 17. As well, the Connors 3 is available in short version. Conners 3 Short . Parent and teacher rating scales in the evaluation of attention-deficit hyperactivity disorder: contribution to diagnosis and differential diagnosis in clinically referred children. Systematic review of measures used to diagnose attention-deficit/hyperactivity disorder in research on preschool children. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Various cutoff values were used for each included scale. Of these potentially eligible articles, 31 were excluded for lack of sufficient information to construct 2 × 2 tables, 6 were excluded for reporting unrelated diagnostic tools, and 4 were excluded for involving different reference standards. (Short Forms) 20 min. Among the 25 analyzed studies, 10 recruited participants from clinical settings only, 11 recruited participants from community or school settings only, and the rest recruited participants from both communities and clinical settings. Regarding specificity, 84% of participants without ADHD were accurately identified by using ASQ and CTRS-R:S (95% CI 0.68–0.93 and 0.69–0.93, respectively), whereas 75% were identified using CPRS-R:S (95% CI 0.64–0.84). Despite the availability of several comprehensive reviews on the psychometric properties of CBCL and CRS-R,10,15–18 the sensitivity, specificity, and diagnostic odds ratio (DOR) of these tools, indicative of their diagnostic performance, have been rarely examined. The prediction region, which indicates the area most likely to contain the true mean test accuracy values of the sensitivity and specificity for each diagnostic tool, can be used as a means of illustrating the extent of statistical heterogeneity. Multi-Heath Systems; North Tonawanda, NY. Study location, age of participants, and percentage of female participants explained the heterogeneity in the specificity of the CBCL-AP. A recent focus of studies in this population has centered o… Conner’s CBRS Teacher Rating Scales Conner’s CBRS teacher forms assess behaviors, concerns and academic problems in children between 6 and 18 years old and are reported by teachers. (2005). This tool comprises 4 key domains: patient selection, index test, reference standard, and flow and timing. These instruments are available in long or short versions for parent, teacher, and adolescent completion. Not affiliated There are both full-length and short forms available for manual administration and scoring. Finally, potential sources of heterogeneity were identified by adding covariates to the bivariate metaregression models. When studies reported different cutoff values for an index test, data from the optimal cutoff value were extracted. If a study presented different index test cutoff values for male and female participants, the data of the different genders were analyzed separately. Or Sign In to Email Alerts with your Email Address, Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis, Protocol for measuring indoor exposure to coal fly ash and heavy metals, and neurobehavioural symptoms in children aged 6 to 14 years old, Risk of Psychosis With Stimulant Use for ADHD, Aberrant Structural Brain Connectivity in Adolescents with Attentional Problems Who Were Born Prematurely, Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis, Improving Care for Children With ADHD: The Information is Just a Rating Scale Away, DOI: https://doi.org/10.1542/peds.2015-2749, Diagnostic and Statistical Manual of Mental Disorders, Associated cognitive, developmental, and health problems, Attention-Deficit Hyperactivity Disorder: A Clinical Workbook. Psychometric properties of the Chinese version of the Conners’ parent and teacher rating scales-revised: short form. Assessment of attention-deficit/hyperactivity disorder: an evaluation of six published rating scales. All search processes were conducted from January 30, 2015, to May 21, 2015. A., Goldstein, S., Delauder, B. Y., & Schwebach, A. The heterogeneity observed in CBCL-AP among the included studies was explained by the age of participants and percentage of female participants. DORs, defined as the odds of obtaining a positive test result in patients with a disease compared with the odds of obtaining a positive test result in participants without a disease, were computed as positive LRs (LR+) divided by negative LRs (LR−).21 Statistical differences in sensitivity, specificity, and DORs between different scales were further examined to compare the diagnostic performance of the selected diagnostic tools. (Long Forms) A cross-cultural comparison between samples of Brazilian and German children with ADHD/HD using the Child Behavior Checklist. This version provides comprehensive results, and is recommended for initial evaluations if … Biomarkers for attention-deficit/hyperactivity disorder (ADHD). NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2015-4450. Rating scales will ask you to score behaviors, typically on a point scale of 0-3 or 4. The Conners 3rd Edition-Teacher (Conners 3–T) is an assessment tool used to obtain the teacher’s observations about his/her student's behavior in a school setting. Diagnostic criteria for identifying ADHD are based on behavioral symptoms, because of the lack of reliable biological markers for diagnosing ADHD.9 Behavior rating scales, which comprise checklists that examine various behaviors and symptoms, are the most common ADHD assessment tools in schools and communities because of their uncomplicated administration and high time- and cost-efficiency.10 The Child Behavior Checklist (CBCL)11 and Conners Rating Scale–Revised (CRS-R)12 are commonly used diagnostic tools for identifying ADHD in children and adolescents because of their adequately established reliability and validity. Assessing ADHD and comorbid disorders in children: the Child Behavior Checklist and the Devereux Scales of Mental Disorders. 18.104.22.168. Conversely, a higher heterogeneity was observed in specificity than in sensitivity for CTRS-R:S and ASQ. The CBCL-Attention Problem (CBCL-AP) subscale, 1 of the 8 empirically derived clinical syndrome subscales of the CBCL, is frequently used as a diagnostic tool for ADHD and has strong discriminatory power for detecting ADHD in children and adolescents.13,14 In contrast to CBCL, CRS-R is specifically designed for assessing ADHD and its related behavioral problems in children and adolescents (ages 3 to 17 years). Our study has several limitations. The 2 reviewers individually conducted a quality assessment for each included study by using the revised version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Screening for attention-deficit/hyperactivity disorder (ADHD): can high-risk children be identified in first grade? Figure 4 illustrates funnel plots with superimposed regression lines for each included diagnostic tool. Thank you for your interest in spreading the word on American Academy of Pediatrics. Analysis of the Conners’ Teacher Rating Scale-28 (CTRS-28). Conners' Teacher Rating Scale - Revised (L) NOT TRUE AT ALL (Never Seldom) JUST A LITTLE TRUE (Occasionally) PRETTY MUCH TRUE (Often, Quite a bit) VERY MUCH TRUE (Very Often, Very frequent) Not Ticked 31. For CRS-R, 83% of participants with ADHD were accurately identified using ASQ (95% CI 0.59–0.95), whereas 75% were identified using CPRS-R:S (95% CI 0.64–0.84) and 72% using CTRS-R:S (95% CI 0.63–0.79). CONCLUSIONS: CBCL-AP and CRS-R both yielded moderate sensitivity and specificity in diagnosing ADHD. University of Vermont, Department of Psychiatry. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. This instrument is designed to assess Attention Deficit/Hyperactivity Disorder (ADHD) and its most common co-morbid problems in children and adolescents aged 6 to 18 years old. Because of the limited number of studies examining the diagnostic performance of CRS-R, diagnostic accuracy estimates were extracted and pooled only from the ADHD index within CPRS-R:S and CTRS-R:S. Information from other CRS-R subscales were not used for generating the pooled diagnostic performance. A 2016 meta-analysis of 25 cross-sectional, cohort, and case-control studies evaluated the accuracy of the Child Behavior Checklist–Attention Problem Scale (CBCL-AP) and three versions of … This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. The Conners’ Parent Rating Scales: a critical review of the literature. FUNDING: This study was supported by a postdoctoral training grant from the Ministry of Science and Technology of the Republic of China (MOST 103-2811-B-038-021). Screening for DSM-IV externalizing disorders with the Child Behavior Checklist: a receiver-operating characteristic analysis. The child behavior checklist together with the ADHD rating scale can diagnose ADHD in Korean community-based samples.