1 National School Social Work Conference 2011 Annual Conference – Myrtle Beach, SC Presenter: Penny Koepsel, PhD, LSSP Clinical and Educational Consultant, MHS Introduction to the Conners 3 rd Edition Contact Information Penny H. Koepsel, PhD, LSSP Assessment Consultant Multi Health Systems (MHS) [email protected](281) 844-9156 www.mhs.com Customer Service: 1-800-456-3003 Helpful Contact Information • Janice Sneath: [email protected]• Research and Development: r&[email protected]• Customer Service: [email protected]• MHS Website: www.mhs.com • Software Support: [email protected]• Website Assistance: [email protected]Overview of Training • Discussion of clinical and educational context ~ Important issues in school-aged youth ~ ADHD and comorbid conditions • Identify linkage between IDEA 2004, DSM-IV TR, & Conners 3 rd • Knowledge of the Conners 3 rd Edition and its essential features and changes from Conners Rating Scales-Revised to Conners 3 rd Edition • Confidence in the psychometric properties and utility of the Conners 3 rd Edition • Familiarity with Conners 3rd administration, scoring options, and interpretation • Awareness of Conners 3rd results in data-based identification and decision making • Use of Conners 3rd results to guide intervention planning • Use of Reliable Change Index to help monitor progress • Case Studies Why is it critical to assess social, emotional, and behavioral functioning in addition to academic functioning in school aged youth?
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• Discussion of clinical and educational context~ Important issues in school-aged youth
~ ADHD and comorbid conditions • Identify linkage between IDEA 2004, DSM-IV TR, & Conners 3rd
• Knowledge of the Conners 3rd Edition and its essential features and changes from Conners Rating Scales-Revised to Conners 3rd
Edition• Confidence in the psychometric properties and utility of the
Conners 3rd Edition• Familiarity with Conners 3rd administration, scoring options, and
interpretation• Awareness of Conners 3rd results in data-based identification and
decision making • Use of Conners 3rd results to guide intervention planning• Use of Reliable Change Index to help monitor progress • Case Studies
Why is it critical to assess social, emotional, and behavioral functioning in addition to academic functioning in school aged youth?
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Just A Few Reasons Why…
• Retrospective Study: 74% of adults with mental disorders have a history of a childhood diagnosis (Kim-Cohen et al., 2003)
• Longitudinal Study: At any given time, at least one in six youth meets criteria for one or more psychiatric diagnosis (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003)
• 1/3 of all youth has experienced a psychiatric condition by the age of 16 (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003)
• 2005: 5.5 million youth aged 12 to 17 years received treatment for emotional or behavioral problems (SAMHSA, 2006)
• In the 2005-2006 school year, 14% of students received services under IDEA –an increase from 8% in 1976 (US Department of Education, 2006)
• Behavioral (most noticeable)– Aggressive or oppositional behaviors– Hyperactive or impulsive behaviors
• Emotional (often “slip through the cracks initially)– Irritability, worrying, separation fears, perfectionism– General distress, symptoms of depression, physical symptoms
• Social: – Social skills, lack of social interests, social isolation
Prevalence of IDEA Eligibility Categories(% of total enrollment)
– Specific LD = 6% (increase from 2% in 1976)– Speech/language = 3% (steady)– MR = 1% (decrease from 2% in 1976)– ED = 1% (steady)– Hearing impairment = < 1% (steady)– Orthopedic impairment = < 1 % (steady)– OHI = 1% (slight increase from 0.3% in 1976)– Visual impairment = < 1% (steady)– Multiple disabilities = < 1% (steady)– Deaf-blindness = < 1% (steady)– Autism and TBI = < 1% (slight increase from 0.1 to 0.4)– Developmental delay = < 1% (slight increase, 0.1 to 0.6)
All disabilities = 14% of total enrollment (increase from 8% in 1976)
DSM-IV TR Disorders Most Commonly Encountered in School Settings
• Tics: (Tourette’s Disorder, Chronic Motor or Tic Disorder, Transient Tic Disorder, Tic Disorder, NOS)
• Learning Disorders
DSM-IV TR AND SCHOOLS
Even though you are not required by IDEA to diagnose students, knowledge of DSM-IV is important
• You are often the first to recognize emerging symptoms of an undiagnosed disorder
• You must discuss and review past diagnoses; sometimes question these diagnoses
• You cannot assign a DSM-IV-TR diagnosis in many states• But it is not going away, DSM-V – 2013, 14, 15??• It is a method of categorizing – so is IDEA 2004 • Comorbidity, differentiation
DSM-IV-TR and IDEA 2004: Similarities
√√Developmentally inappropriate
√√Abnormal response
√√Exclusionary criteria (rule outs)
√√Duration of symptoms
√√Symptoms in more than one setting
√√Symptoms cause impairment
IDEADSM-IV-TRCriterion
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√√√√√√√√√√√√√√√√Annoying
√√√√√√√√√√√√√√√√Mistakes
√√√√√√√√√√√√√√√√Temper
√√√√√√√√√√√√Fidgety
√√√√√√√√√√√√√√√√Noncompliance
√√√√√√√√Hyperactivity
BPDCDODDADHD
COMORBIDITY AND BEHAVIORS
Wilkins, 2007 FASP Conference
State Prevalence of ADHD (CDC 2008)
Comorbidity: ADHD
• Around 45% of children with ADHD have at least one co-occurring disorder
• Around 33% of children with ADHD have two co-occurring disorders
• Around 10% of children with ADHD have three co-occurring disorders
• 25 to 50% of children with ADHD also have a Learning Disability
• Older children 12-17 years of age more likely to have ADHD with LD
• Those with ADHD and LD more likely to use health care and educational services
• More likely to have expressive language deficits• Boys more likely than girls (2.3%) to have each of the
disorders• Hispanic children less likely than non-Hispanic children to
have ADHD with and without LD• Children with low birth weight more likely to have LD with and without ADHD
Pastor, P. N. and Reuben, C. A (2008) “Diagnosed Attention Deficit Hyperactivity Disorder and Learning Disability: United States, 2004-2006”
ADHD Complications
• Medical – more ER visits, hospital admissions, outpatient admissions, more severe injuries, twice the medical costs
• Adolescent drivers have more car accidents• Smoking: earlier and more often• More family conflicts and social difficulties• More school retentions and high school drop outs• More likelihood of future Antisocial Personality Disorder
in adulthood• More STD’s, substance abuse, legal problems, higher
divorce rates, earlier parenthood, more work failure
“Has difficulty playing or engaging in leisure activities quietly” ( CRS-R Parent - verbatim from DSM-IV)
“Is noisy or loud when playing or using free time” (C3 Parent)
Conners 3-Parent 4.9 (CPRS-R was 9th – 10th grade)Conners 3-Teacher 5.3 (CTRS-R was 9th grade)Conners 3-Self Report 3.0 (CASS was 6th grade)
Simplified Items Spanish Forms Development
• A Cultural Translation, not just a literal translation. Goal was to ensure that the Conners 3 would be valid for use in both Spanish-and English-speaking populations within the Hispanic population of the United States.
1. Translations first created by three Spanish-speaking staff at MHS
2. Translations reviewed by Dr. Sam Ortiz to ensure that content, cultural sensitivity, and readability were appropriate
3. Translated forms were then submitted to independent bilingual school psychologists for an English back-translation
4. All parties reviewed back translations with the original English forms
Conners 3Technical Details
• Normative sample:
– Large
• 1200 youth rated by parents and teachers
• 1000 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
Conners 3Age and Gender Affects
• Age and gender significantly affected the majority of scales across all forms.
• As a result, norms for the Conners 3were separated by age and gender (except for the validity scales)
• Separate norms for each age year are provided. This allows for more accurate and precise results.
Norming by Age
• Historically, the CRS has used 3-year age groups
• Problem: 6-year-olds, e.g., may not be comparable to 8-year-olds
• 1-yr age norms allow
– for smooth development trends to be captured
– but also for sharper changes to be reflected
• BASC presents ages in clusters, e.g., 6-7, 8-11, 12-14, 15-18 – not one year age norms
1-yr age bands improve assessment accuracy
Ethnic Representation
Group Census C3-P C3-T C3-SR
Asian 3.8 4.6 6.0 5.1
AfricanAmerican
15.7 15.1 15.6 15.2
Hispanic 15.1 15.1 17.5 15.0
Caucasian 61.9 61.3 57.5 61.1
Other 3.5 3.8 3.3 3.6
Ethnic representation closely matches census figures.
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Reliability –
“The consistency of scores obtained by
the same person when re-examined with
the same test on different occasions, or
with different sets of equivalent items or
under other variable examining
conditions.”
- Anastasi, 1988
Reliability = Internal Consistency of C3
Content Scales ~ .88 to .91 (P, T, S)
DSM-IV TR Scales ~ .85 to .90 (P, T, S)
Validity Scales ~ .56 to .72 (P, T, S)
.60 to .70 ~ satisfactory
.70 to .80 ~ very good
.80 and above ~ excellent.
2 parents of the same child
Validity Scales = fewer items and seldom endorsed
~ the extent to which all items on the same scale consistently or reliably measure the same dimension
Inter-Rater Reliability of Conners 3 Forms
Content Scales (Teachers, Parents) ~ .71 to .81
DSM-IV TR Scales (Teachers, Parents) ~ .70 to .84
2 teachers of the same child
2 parents of the same child
Temporal Stability – Test Retest
Content Scales (P, T, S) ~ .79 to .85
DSM-IV TR Scales (P, T, S) ~ .76 to .89
Validity –
“What the test measures and how
well it does so”
- Anastasi & Urbina, 1997.
Construct Validity
• Construct validity was examined by administering the Conners 3with various other tools including ... (Total N ≈ 2000)
– Child Behavior Checklist (CBCL)
– Behavioral Assessment System for Children (BASC-2)
– Behavior Rating Inventory of Executive Functioning (BRIEF)
– Children’s Depression Inventory (CDI)
– Multidimensional Anxiety Scale for Children (MASC)
All Conners 3 constructs were tested usinginstruments that assess similar or related constructs
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Construct Validity – Selected Findings
• ADHD
– Conners 3-T DSM-ADHD-Inx CBCL Attention Probs., r = .74
– Conners 3-P DSM-Hyp/Imp x BASC-2 Hyperactivity, r = .58• Executive Functioning
– Conners 3-P EF x BRIEF Plan/Organize scale, r = .72• Learning Problems
– Conners 3-Tx BASC-2 Learning Problems, r = .83– Conners 3-Px BRIEF Meta Cognition, r = .86
• Peer/Family Relations– Conners 3-TPeer Relations x CBCL Social Probs., r = .85
– Conners 3-TPeer Relations x BASC-2Social Skills, r = -.59
Conners 3 scales correlate in meaningfulways with other tools that measure similar things
Conners 3: Executive Functioningand BRIEF
C3 (Parent and Teacher) correlate highly with every BRIEF Scales:
Hyperactivity/Impulsivity : Inhibit, Behavioral Regulation Index, Global Executive Composite
Inattention : Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor, Metacognition Index, Global Executive Composite
Learning Problems/Executive Functioning: Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor, Metacognition Index, Global Executive Composite
Reliable Change Indices: Monitoring Responses to Intervention
and Changes In Behavior
How do I know if a change in Conners scores over time is statistically and/or clinically significant?
C3: Measuring Change
If we have implemented an intervention and are measuring change - how do we know if the difference is significant or not?
Reliable Change Index (RCI)
• Because it is rare for responses on two separate administrations to be exactly the same, statistical procedures can be used to determine whether a change in scores is statistically significant (Jacobson and Truax, 1991)
• The RCI takes into account the difference in test scores for two administrations, as well as the standard error of difference between them.
• These values are based on a 90% confidence interval. p <.10 used to ensure that important increases and decreases in scores are not missed
1. Administer appropriate measure at pre-test
2. Re-administer measure at post test period
3. Calculate difference score
4. Calculate the RCI
5. Compare difference score to the RCI
5 Steps to Assessing Reliable Change
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• A statistically significantscore exceeds the absolute difference between scores as indicated by the RCI
• A clinically meaningfulscore is indicated by a change in classification, i.e. T 75 to a T 50 (Very Elevated to Normal)
• A score can be clinically meaningful and not statistically significant (not exceed absolute difference score)
• A statistically significant change in behavior might not be a clinically meaningful score, i.e. a T 75 to a T 70
• A score can be both statistically significant and clinically meaningful – our overall goal in intervention development!!
Statistically Significant vs. Clinically Significant
• To determine whether a change in scores between test administrations is statistically significant for all scales of the Conners 3rd (long forms, short forms, 3 AI, 3 GI)
• Intervention responses and changes in behavior can be monitored using the RCI
• Therapy or counseling goals and objectives can be monitored using the RCI
• Medication effectiveness can be monitored using the RCI• Using multi-modal assessment techniques, the RCI is one way
to determine intervention efficacy
Uses for Reliable Change Index
Now that you know the Conners 3rd Edition has strong psychometric properties, let’s learn more about the scale and how it can be a valuable tool in your school psychologist tool box.
Validity ScalesNegative Impression Positive ImpressionInconsistency Index
Impairment Items
Additional Questions
Conners 3: Overview
• C3 Content Scales• DSM-IV TR Scales• DSM-IV TR Symptom Counts• Critical Items: Severe Conduct Critical Items• Anxiety and Depression Screener Items• 3 AI Index Scores • 3 GI Index Scores• Validity Scales: PI, NI, IncX• Impairment Items:
– Academic– Home (Parent and Self-Report only)– Social
• Additional Questions:– Other concerns– Strengths or skills
Conners 3: Content Scales
• Conners 3 Content Scales (both long and short forms)
• Scales/subscales focus on key content for ADHD and the Disruptive Behavior Disorders
– Executive Functioning (not on Self-Report)
– Learning Problems
– Defiance/Aggression
– Hyperactivity/Impulsivity
– Peer Relations (not on Self-Report)
– Family Relations (only on Self-Report)
– Inattention
DSM-IV TR Symptom Scales**
• ADHD Inattentive
• ADHD Hyperactive-Impulsive
• ADHD Combined Type
• Conduct Disorder
• Oppositional Defiant Disorder
DSM-IV Symptom Scales: Relative levels of symptomsT-scores compare the student to peers. Help determine if symptoms are atypical for that age and genderHigh score means more symptoms than typically seen
** not on short form
DSM-IV TR Symptom Count**
• ADHD Inattentive
• ADHD Hyperactive-Impulsive
• ADHD Combined Type
• Conduct Disorder
• Oppositional Defiant Disorder
DSM-IV Symptom Counts: Absolute levelsEach DSM-IV symptom is represented You can count these to see if the student has enough symptoms of that disorder to consider a diagnosisGuidance is given for whether a symptom is “indicated,”“may be indicated,” or “not indicated” –(criteria requirements on next slide)
** not on short form
DSM IV TR Symptom CountsSymptom Count Requirements
ADHD Inattentive Subtype: At least 6 out of 9 symptoms
ADHD Hyperactive Impulsive Subtype: At least 6 out of 9symptoms
ADHD Combined Subtype: At least 12out of 18symptoms
Oppositional Defiant Disorder: At least 4 out of 8 symptoms
Conduct Disorder: At least 3 out of 15symptoms
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Index Scales
Conners 3 ADHD Index (Conners 3AI)
Conners 3 Global Index (Conners 3 GI)
** not on short form
We’ll go into more details on the next two slides
• Describes whether a child is more similar to children with a diagnosis of ADHD or to child in general population
• Probability Score – higher score = ADHD sample
• Can be used for monitoring progress, medication efficacy, intervention progress
• Can be used for focused ADHD screener
• Embedded in C3 and also available as a “standalone” form
• Can determine statistically significant change in scores using Reliable Change Index (RCI)
Conners 3 ADHD Index (Conners 3AI)
10 items
• Contains same 10 items as the original CGI
• Good indicator of global concerns about a child’s functioning
• Research found good sensitivity to treatment effects
• Reported as a T-score
• Cannot be used for youth self-report (not supported by research data)
• Can be used for monitoring progress or for global screener
• Not available for self-report
• Can determine statistically significant change in scores using RCI
• Embedded in C3, and available as a “standalone form”
• Two subscales on “standalone form”:
– Conners 3GI Emotional Lability
– Conners 3GI Restless-Impulsive
Conners 3 Global Index (Conners 3GI) Response Style Indicators
Validity Scales/Response Style Indicators
– Positive Impression (PI)– Negative Impression (NI)– Inconsistency Index (IncX): full-length form only
Validity Scales/Response Style Analysis
Elevated scores do not necessarily or absolutely mean the responses are invalid.
- In addition to the common threats to validity, what are some other reasons these scales could be elevated?
- Critical to integrate with other sources data; multiple raters, clinical interview, observations, etc. – those multi-techniques
Impairment Items
Impairment Items: full-length form onlyAcademic (schoolwork and/or grades)Home (Parent and Self-Report only)Social(Friendships and relationships)
Impairment Requirements: DSM-IV TR and IDEADSM-IV-TR requires evidence of clinically significant impairment in social, academic, or occupational functioning for diagnosis of ADHD, CD, or ODD.
DSM-IV-TR diagnosis of ADHD makes an additional requirement that impairment must be present in at least two settings (e.g., school, home).
IDEA criteria - educationally, a student is not considered “disabled” unless the symptoms impair his or her functioning in the school setting. Regardless of the number of problems described by the parent, teacher, or youth, if the problems are not associated with impairment in academic functioning, it is unlikely that the symptoms will meet criteria for diagnosis or educational need.
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Anxiety/Depression Screener Items “Red Flags”**
• The four anxiety screener items relate to generalized worrying. For example,
– Worries about many things.
• The four depressionscreener items reflect key clinical presentations of depression. For example,
– Has lost interest or pleasure in activities.
• These are “red flags” which may indicate a more detailed evaluation on the CBRS
** not on short form
Conners 3: Critical Items**
• Critical Items: Severe Conduct– Full-length form only
– Severe misconduct that requires immediate follow-up
– Behaviors are those that may predict future violence or harm to others
** not on short form
Uses a weaponCruel to animalsConfrontational stealingForcing someone into sexFire settingTrouble with policeBreaking and entering
Additional Questions
Do you have any other concerns about your child?• Provides opportunity to describe additional concerns• Response may indicate other areas that should be
investigated• May reiterate problems already captured on the scale; this
reiteration may represent high levels of concern about that particular issue
What strengths or skills does your child have?• Encourages consideration of the youth's positive qualities• Recognition of strengths and skills is important when
developing effective interventions• Red flag when parent, teacher, or youth can not identify
5 minutes5 minutes10 minutes20 minutesAdministration Time
Conners 3GI
Conners 3AI
C3 ShortC3Average Time Required
Administration and Scoring Times
Methods of Administration*
Self Report Dictation
• Small subset of sample had items dictated to them by the assessor
• Another small subset had items read to them by someone other than the assessor
• Result: no significant differences in scores
*only for Self Report in English, and not for Parent or Teacher Reports
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Methods of Administration
Paper vs. Online
A small subset completed the assessments online via the internet.
Result: no significant differences in scores
The C3 can be generalized across both paper-and-pencil and online administrations.
Scoring Options Computer/USB
• Enter responses from a completed paper and pencil administration
• All forms can be scored using the USB scoring software• Unlimited scoring• Three different types of reports
AssessmentProgressComparative
C3 Report Options
Assessment Report= (provides detailed results from one administration)Progress Monitoring = (provides an overview of change over time by combining results of up to four administrations from the same rater)Comparative = (provides a multi-rater perspective by combining results from up to five different raters)
Scoring Options:MHS Online Assessment Center
• The MHS Online Assessment Center (MAC) offers access to online forms, administration scoring, and report generation (3 different types) at a fraction of the cost of traditional paper or software assessments.
• ♦ Contact an MHS Client Service Specialist today to:• = Take a “test drive” of the MAC. Receive a temporary ID and
password to access the secure site• = Place an order
C3 Choices for Scales: Full Length vs. Short Form
There are 4 different forms (full length, short form, 3AI, 3 GI) for the Conners 3; each can be completed by different raters (P, T, SR)
Full-length• Nothing is omitted• Recommended for initial evaluation and comprehensive re-evaluations
Short form• Has shorter versions of all the Content scales• Can be used for monitoring progress or for brief screener• Limited time or periodic repeated administrations
Cutting and Pasting
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QWER Data Security All MHS data (including Administrators and test user information, test data, including responses to test items, and report text) are stored in an industry standard database. Access to these data is strictly controlled. A temporary password initially provided by MHS must be changed for first time log-ins to Scoring Organizer. MHS is able to reset a password at therequest of the customer, if necessary.Tests are also scored by a separate secure scoring server controlled by MHS with an advanced level of security protection. Once administered, test reports are returned to the Administrator by using an encryption technology described below.
Personal Data and E-commerceMHS protects the personal data of MHS customers, the data of their clients, and the data collected via electronic commerce transactions with the highest levels of security. Through the e-commerce purchase process, we ask for the purchaser's name, address, license number, credit card information ("Financial Data"), and other personal data required to process requests to purchase and maintain customer accounts. MHS servers use 128-bit industry-standard Secure Sockets Layer (SSL) encryption which is encryption technology that works with the most current web browsers. SSL encrypts the purchaser's personal information, including Financial Data and other personal data as well as test user information, including test data, responses, and reports returned to the Administrator, protecting against disclosure to third parties.
Case Study – Susan S
Conners 3
• Case Study – Susan S– 8 year old girl– “seems spacey, daydreams a lot”– “doesn’t follow directions”– “careless, makes mistakes, misses details”– “immature”– “enthusiastic and energetic”– “rude, interrupts others”
• Sound familiar??
Conners 3: Interpretation Steps
1. Assess validity of the Conners 3 ratings 2. Interpret scale scores. (Conners 3, DSM-IV)3. Examine the overall profile. (relative elevations of T-scores;
• If we have implemented an intervention and are measuring change - how do we know if the difference is significant or not?
• RCI values are based on a 90% confidence interval; a change in scores that meets or exceeds the RCI value can be considered to be a statistically significant change 90% of the time.
• Liberal criteria (90%) was used to better ensure that important changes in scores are not missed.
How do I know if a change in Conners scores over time is statistically significant?
• A clinically meaningful score is indicated by a change in classification
• A score can be clinically meaningful and not statistically significant
• A statistically significant change in behavior might not be a clinically meaningful score
• A score can be both statistically significant and clinically meaningful – our overall goal in intervention development!!
How do I know if a change in Conners scores over time is clinically meaningful?
Response to Intervention: Monitoring Susan’s Changes
Using the Reliable Change Index
Yes9.317485 Inattention
Sig.Change?
Change Needed for Significance
Intervention 1/24/07
T-Score
Baseline 9/26/06
T-Score
Scale
Yes9.0183110Hyperactivity
No9.316067Aggression
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Conners 3–T Content ScalesProgress Comparison across Administrations
Conners 3–T DSM-IV TR ScalesProgress Comparison Across Administrations
Impairment Progress Comparisons Across Administrations
Conners 3 ADHD Index Progress Comparisons Across Administrations
Conners 3 Global Index Progress Comparisons Across Administrations
Case Study: Mary Lamb
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Response Style Analysis
(Validity Indicator)
Positive Impression: the Positive Impression score (raw score = 0) does not indicate an overly positive response style
Negative Impression: the Negative Impression score (raw score = 4) does not indicate an overly negative response style
Inconsistency Index: the Insistency Index (raw score = 7, number of differentials >2 = 2) does not indicate an inconsistent response style
Mary Lamb Self Report Content Scores (Baseline)
Mary Lamb Self Report
DSM-IV Scale Scores (Baseline)
Mary Lamb Self Report
ADHD Probability Index (Baseline)
Screener Items Severe Conduct Critical Items
• Based on Mary’s endorsements on Anxiety and Depression items, further investigation may be indicated
• No endorsement of any Severe Conduct Critical Item
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Screener ItemsMary Lamb Assessment-SR Mary Lamb C3 SR
Learning Problems
Mary Lamb – Conners 3rd
Assessment Report
Conners 3rd Edition Feedback Handout Report
(Mary Lamb)INTERVENTIONS
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• Check frequently for understanding of instructions• Assign a “study buddy” with whom Mary can confirm directions
• Color code assignment/classwork folders with books for each academic area
• Proximity seating: seat Mary close to the front of the classroom and within the teacher’s view. Avoid a seat assignment that is close to windows or doors
• Provide Mary with a copy of the daily math problems displayed on the overhead
• When presenting multi-step directions visually, include a verbal statement of steps as well
Classroom InterventionsMonitoring intervention response with the Reliable Change Index
How can we tell if her interventions have worked?
PROGRESS REPORT REVIEW – MARY LAMB
Mary Lamb Progress Report Response Style Analysis/Validity Indicators
Mary Lamb Self Report - Content Scales T-Score Comparisons Across Administrations