Conners’ rating scales

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

IOWA Conners Rating Scale Private, via author Jan Loney, Ph.D., New York State Psychiatric Institute., Stony Brook University, Stony... 

Conners, C. (1995) Conners Rating Scales. Toronto, CA Multi-Health Systems. 

Conners, C.K. Conners Rating Scales manual. North Tonowanda, New York Multi-Health Systems, 1989. 

Conners, CJC. Conners Rating Scales Mamtal, Conners Teacher Rating Scales, Conners Parent Rating Scales Instruments for Use with Children and Adolescents. Multihealth Systems, North Tonawanda, NY, 1990. 

Conners CK. Conners Rating Scales-revised. Toronto Multi-Health Systems, 1997. 

A double-blind study of the anticonvulsant levetiracetam in 20 autistic children and adolescents failed to detect a significant difference between levetiracetam and placebo with respect to global improvement (CGI) or measures of repetitive behaviors (Children s Y-BOC) and/or hyperactivity (Conners Rating Scales-Revised) (Wasserman et al., 2006). 

Conners, C.K. A teacher rating scale for use in drug studies with children. Am J Psychiatry 126 152-156, 1969. 

Another set of tools that could be utilized are brief rating scales. DSM-IV mandates that ADHD symptoms must be present in at least two settings. For children and adolescents, school is invariably one of the two settings. To get a sense of the comparative problems in school versus those at home, psychiatrists often use rating scales that can be completed by both parents and one or more teachers. The Conners Teacher Rating Scale, Conners Parent Rating Scale, and the Child Behavior Checklist are the most commonly nsed scales to evalnate the symptoms of ADHD. 

Venlafaxine is not FDA approved for use in children below the age of 18 however, it has been used in this population as an antidepressant as well as treatment for ADHD. In 1997, a placebo-controlled trial for children and adolescents (n = 32) diagnosed with major depression failed to show a difference between the control and venlafaxine groups (Mandoki, et al., 1997), possibly because of subtherapeutic doses of venlafaxine. A 5-week open trial of venlafaxine (n = 14) in children and adolescents (ages 8-14) with ADHD yielded significant improvements in parent ratings of hyperactivity and impulsivity on the Conners Parent rating scales (Olvera et ah, 1996). 

There are a number of useful standardized scales to monitor severity and treatment outcomes, (reviewed by Conners [1998] and Barkley [1998]) Because of the overlap with other disorders, an ADHD-specific scale is strongly recommended (such as the Conners, SNAP, Dupaul scales) in which symptom items are based on the DSM criteria and do not include items of other disorders (such as anxiety or mood) or nonspecific functional items. Some ADHD scales provide separate ratings of oppositionality or aggression (SNAP, Conners). It may be helpful to monitor symptoms from non-ADHD conditions as well as functional deficits, and thus a broad-spectrum scale may also be employed but should not be used as the primary measure of ADHD severity or anti-ADHD treatment. Normed rating scales provide comparative information on severity based on age and gender however, such tests are not diagnostic and are not a substitute for the clinical interview. 

Conners, C.K. (1998) Rating scales in attention-deficit/hyperactivity disorder use in assessment and treatment monitoring. / Clin Psychiatry 59 24-30. 

Ideally, assessment measures would be incorporated into the treatment plan to assess baseline symptoms and response to treatment. Such measures include the Clinical Global Impression (CGI) scale, the ten-item Conners Global Index for parents (Conners-P) and Teachers (Conners-T) ( 60), and the SNAP (Swanson, Nolan, and Pelham) rating scale (61). The latter has also been used in surveys of school-aged children ( 62). The results have been used to produce age-adjusted cutoffs that distinguish normal from abnormal degrees of inattentiveness and hyperactive/impulsive behavior. Thus, this scale can also be used to aid in documentation of the diagnosis as well as to monitor response to treatment. 

Rivastigmine Chez et al. (2004) Open-label study. Thirty two children (unspecified age) DSM-IV Improvements in autistic behaviour, particularly verbalization. Assessments done using Childhood Autistic Rating Scale, Gardner s Expressive and Receptive One-Word Picture Vocabulary tests and the Conners Parent Rating Scale. 

Nicolson et al. (2006) Thirteen children (mean age 8.8 years). 12-week open-label trial DSM-IV 61.5% children responded. Improvements in irritability, social withdrawal, emotional lability, inattention, and aggression. ABC, Conners Parent Rating Scale-Revised, Children s Psychiatric Rating Scale and Clinical Global Impressions Scale used. 

Goyette CH, Conners CK, Ulrich RE (1978) Normative data on revised Conners Parent and Teacher Rating Scales. 1 Abnorm Child Psychol 6 221-236. 

Behaviour has been measured by direct observation in a controlled environment (Winneke, 1979 Harvey et al 1984), or more economically by means of short forced-choice questionnaires (several studies, e.g. Yule et al, 1984 Hatzakis et al, 1985 Vivoli et al, this volume, have used the scale adapted by Needleman et al, 1979, or a modification of it) or standardized behavour rating scales completed by the mother or the teacher. The two standardized scales which have been most used are the Conners scales (Conners, 1969, 1973) and the Rutter Scale (Rutter, 1976). The longer the scale the more reliable it is likely to be, and summated scores or factor scores are likely to be more reliable than individual ratings, but practices and methods of factor analysis are also of relevance. In normal populations rarely occurring behaviours, although they may be of great significance, contribute too little to factor solutions, and so are eliminated. 

Where standardized behaviour ratings such as the Conners and Rutter scales have been used some studies have found significant lead-related differences in both mothers and teachers scales (Silva et al, 1984) some with teachers scales only (mothers scales were not administered) (Lansdown et al, 1983). Other studies have not found significant differences on either mothers or teachers scales (Smith et al, 1983 Lansdown et al, 1986) or found none where only a mother s rating was obtained (McBride et al, 1982) (partial scoring only). 

Parents behaviour ratings such as the Conners and Rutter scales are usually found to be independent of broad social indicators, such as social class, so controlling for these would not be expected to have an effect on results. 

Despite the large amount of detailed information on social, environmental and familial factors available from lead studies, there has been little investigation of the relationship of these factors with behaviour measures. For example, factors such as the mother s mental health, and the quality of the parental marital relationship, have been shown to be highly associated with mothers ratings on the Conners scale. Teachers ratings have been shown to be sensitive to the family type (single-parent or not) (Smith, 1988). No studies have controlled for factors such as these. 

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