Using the Conners 3 and Conners CBRS: Identification and Intervention © E.P.Sparrow, 2007

Overview of Workshop 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

Prevalence 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 (% of total enrollment) 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

Clinical Context: Common Issues 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 Most referrals are some combination of social, emotional, behavioral, and/or academic issues. Academic issues are one of the most common referral reasons, including concerns about: Specific learning disabilities in math, reading, or written language, Inattention, Executive deficits (e.g., disorganization, poor time management, variability in performance, underachievement) Behavioral issues are also common, probably because they are the most disruptive to a classroom. Typical concerns include: Aggression Oppositional behaviors, impulsivity, Hyperactivity Emotional issues tend to be less outwardly disruptive in a school setting, so a referral for these reasons suggests either significant issues or a very observant teacher. Emotional issues that can lead to a referral include: irritability worrying, General distress, separation fears (that are sometimes associated with school avoidance), Perfectionism, symptoms of depression, Sometimes youth express emotional issues via physical symptoms, including headaches and stomachaches, as well as less specific aches and pains. Although this may not be the primary reason for referral, some students are have significant social issues, including getting along with peers and/or adults, lack of social skills, lack of social interests, or social isolation. © E.P.Sparrow, 2007

Clinical Context: Rare But Critical Severe conduct problems and risk for violent behaviors Self-mutilation Suicide Exposure to extremely stressful event(s) Substance abuse/dependence Key = Identify and intervene (the earlier the better) © E.P.Sparrow, 2007

Clinical Context: DSM-IV 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. © E.P.Sparrow, 2007

Clinical Context: DSM-IV (cont.) 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

DSM-IV Building Blocks 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

Prevalence of DSM-IV Disorders ADHD Disruptive behavior disorders CD ODD © E.P.Sparrow, 2007

Prevalence of DSM-IV Disorders (cont.) Mood disorders Major depressive disorder Bipolar disorder © E.P.Sparrow, 2007

Prevalence of DSM-IV Disorders (cont.) Anxiety disorders GAD SAD Social phobia OCD © E.P.Sparrow, 2007

Prevalence of DSM-IV Disorders (cont.) PDDs Autistic disorder Asperger’s disorder PDD-NOS High functioning autism © E.P.Sparrow, 2007

What is ADHD? 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? (cont.) DSM-IV diagnosis begins with: Inattention (9 criteria) and/or Hyperactivity/Impulsivity (9 criteria) Symptoms must occur “often.” © E.P.Sparrow, 2007

What is ADHD? (cont.) 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

Differential Diagnosis of ADHD What possible diagnoses would you consider for the following referral? 12-year-old girl “Seems spacey, daydreams a lot” “Doesn’t follow directions” © E.P.Sparrow, 2007

ADHD and Related Disorders ADHD has high rates of comorbidity. Commonly co-occurring diagnoses include: Disruptive behavior disorders Anxiety disorders Mood disorders Learning disorders Tic disorders © E.P.Sparrow, 2007

What is ADHD? (cont.) 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

Conners 3: History 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: Key Features 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: What Is New? 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 Different? 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: Technical Details 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 (cont.) 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.) 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: Content 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 (cont.) 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: Administration 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 (cont.) 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.) 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) © E.P.Sparrow, 2007

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? 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.) 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

Conners 3: Scoring Ways to score: Hand score Computer score © E.P.Sparrow, 2007

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

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

Conners 3: Interpretation (cont.) Assess validity of the Conners 3 ratings. PI NI IncX © E.P.Sparrow, 2007

Conners 3: Interpretation (cont.) Assess validity of the Conners 3 ratings. Interpret scale scores. Content scales DSM-IV scales and symptom counts © E.P.Sparrow, 2007

Conners 3: Interpretation (cont.) 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). © E.P.Sparrow, 2007

Resolving DSM-IV Discrepancies 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

Conners 3: Interpretation (cont.) Assess validity of the Conners 3 ratings. Interpret scale scores. 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.) 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.) 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

DSM-IV and Conners 3 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

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

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

Conners 3: Summary History Key features What’s new and different Technical details Content Administration and scoring Interpretation and reporting © E.P.Sparrow, 2007

Conners CBRS: History 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: Key Features 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: Technical Details 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 (cont.) 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: Content 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 (cont.) 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 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 -PDD -Trichotillomania -Tics © E.P.Sparrow, 2007

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

Conners CBRS: Content (cont.) 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.) 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 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: Administration 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 (cont.) 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.) 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) © E.P.Sparrow, 2007

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? 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.) 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 Ways to score: Computer score © E.P.Sparrow, 2007

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

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

Conners CBRS: Interpretation (cont.) Assess validity of the Conners CBRS ratings. PI NI IncX © E.P.Sparrow, 2007

Conners CBRS: Interpretation Assess validity of the Conners CBRS ratings. Interpret scale scores. Content scales and subscales DSM-IV scales and symptom counts © E.P.Sparrow, 2007

Conners CBRS: 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 have been met in the past). © E.P.Sparrow, 2007

Resolving DSM-IV Discrepancies 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

Conners CBRS: Interpretation (cont.) Assess validity of the Conners CBRS ratings. Interpret scale scores. Examine the overall profile. Relative elevations of T scores Impairment items Conners CI © E.P.Sparrow, 2007

Conners CBRS: Interpretation (cont.) 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.) 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.) 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

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 Labeling a problem does not usually solve the problem, unless it leads to a plan for change. © E.P.Sparrow, 2007

Intervention: Guidelines 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

Strategies for Intervention Medical Behavioral Cognitive and cognitive-behavioral Psychosocial Academic © E.P.Sparrow, 2007

Strategies for Intervention (cont.) Behavioral therapies Target a specific behavior Specific interventions Modify environment Goal is to change the behavior © E.P.Sparrow, 2007

Strategies for Intervention (cont.) Behavioral therapies Cognitive and cognitive-behavioral Addresses how people think about things or perceive things © E.P.Sparrow, 2007

Strategies for Intervention (cont.) Behavioral therapies Cognitive and cognitive-behavioral Psychosocial Involves how people interact with others © E.P.Sparrow, 2007

Strategies for Intervention (cont.) 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.) 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 © E.P.Sparrow, 2007

Strategies for Intervention (cont.) Where can these strategies be used? School setting Home setting Community setting © E.P.Sparrow, 2007

Strategies for Intervention (cont.) What are some ideas for strategies? How can I help this student reach the goals? © E.P.Sparrow, 2007

Strategies for Intervention (cont.) Academic Practical Instructional Testing Assignments Social Emotional Behavioral © E.P.Sparrow, 2007

Intervention Ideas Examples of academic recommendations Seating Task directions Organization Testing Progress monitoring Purpose of a task © E.P.Sparrow, 2007

Intervention Ideas (cont.) Academic Examples of social recommendations Social motivation Social awareness Social skills instruction Application of social skills © E.P.Sparrow, 2007

Intervention Ideas (cont.) 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: 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 Individuals with Disabilities Education Improvement Act, also known as IDEA 2004 Assistance to States for the Education of Children with Disabilities © E.P.Sparrow, 2007

Conners and IDEA 2004 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

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. Assess specific areas of educational need: Conners tools provide scores for specific concerns that directly impact education. 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

Overidentification and Disproportionality 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. © E.P.Sparrow, 2007

Conners and Educational Needs 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 Eligibility Determine eligibility for special education and related services Identify possible IDEA category/categories (or areas of developmental delay) that describe the student’s needs © E.P.Sparrow, 2007

Conners and IEPs 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. © E.P.Sparrow, 2007

Positive Behavioral Intervention 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

RTI: A General Model 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

Tiers of RTI © E.P.Sparrow, 2007 Source: National Association of State Directors of Special Education (NASDSE)

RTI and IDEA 2004 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 students, including students with disabilities.”1 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

RTI and IDEA 2004 (cont.) 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

Conners and RTI 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 (cont.) 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.) Tier III: Comprehensive evaluation Tier II: Target and monitor skills/behaviors Tier I: Universal screening Source: National Association of State Directors of Special Education (NASDSE) © E.P.Sparrow, 2007

Conners and Educational Law 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]) © E.P.Sparrow, 2007