Conners 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. 

Conners Global Index Iowa Conners Scale SWAN... 

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. 

No significant lead-related differences in behaviour have been found in studies where behaviour was measured by direct observation. This includes the simple observational adaptation of the Conners scale made by Winneke... 

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. 

Wechsler Intelligence Scale for Children - Revised British Ability Scales - Word Reading - Mathematics Conner Scales - parents - teachers... 

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

Conners Parent Questionnaire. Conners Parent Questionnaire (PQ) is a 94-item checklist of symptoms that evaluates common behavior disorders using a four-point scale in children up to 15 years of age and takes 15 to 20 minutes to complete. It is used once pretreatment and may be repeated but is often replaced after the first use by the 11-item Conners Parent-Teacher Questionnaire (PTQ). There are eight subscales conduct problem, anxiety, impulsive-hyperactive, learning problem, psychosomatic, perfectionism, antisocial, and muscular tension. 

Conners Teacher Questionnaire. The TQ form was designed to obtain teacher evaluations of children up to age 15 in terms of their interactions with peers and their ability to cope with the school environment and requirements. There are 41 items, and the first 39 have a four-point scale. Question 40 deals with the teacher s evaluation of the child s severity of illness, and question 41 deals with global improvement in four different areas. This test is used once at pretreatment and as needed afterwards. It takes about 15 minutes to complete and covers either the present or any interval period up to one month. A shorter 11-item PTQ is often used after the initial use of the 41-item TQ. The five subscales included are conduct, inattentive-passive, tension-anxiety, hyperactivity, and social ability. 

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). 

Conners-Wells Adolescent SR, HA factor Revised Children s Manifest Anxiety Scale (RCMAS)... 

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

With various scale data in electronic form, another option for deriving a global scale is to sum, average, or otherwise composite across all scales covering all the relevant domains. Conners et al. (2001) and Swanson et al. (2001) have illustrated how such a strategy can yield an overall outcome measure of high reliability... 

Conners, C.K., and Wells, K. (1995) Conners-Wells Adolescent Self-Report Scale item selection and replication of the factor structure. Unpublished. 

March, J.S., Conners, C.K., Arnold, L.E., Epstein, J., Parker, S., Hinshaw, S., Abikoff, H., Molina, B., Wells, K., Newcorn,/., Schuck, S., Pelham, W.E., and Hoza, B. (1999) The Multidimensional Anxiety Scale for Children (MASC) confirmatory factor analysis in a pediatric ADHD sample./ Attention Disord 3 85-90. 

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

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. 

Rapoport, J., Conners, C.K., and Reatig, N. eds. (1985) Clinical Global Impression (CGI) Scale. Psychopharmacol Bull 21 839-843. 

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. 

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. 

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

Leonard, R. A., D. B. Chamberlain, and C. Conner. 1997. Centrifugal Contactors for Laboratory-scale Solvent Extraction tests. Sep. Sci. Technol. 32(1-4), 193-210. 

Leonard, R. A., C. Conner, M. W. Liberatore, et al. 1999. Evaluation of an Alkaline-Side Solvent Extraction Process for Cesium Removal from SRS Tank Waste Using Laboratory-Scale Centrifugal Contactors. Argonne National Laboratory Report ANL-99/14, Argonne, IL. 

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