The usefulness of Conners' Rating Scales-Revised in screening for attention deficit hyperactivity disorder in children with intellectual disabilities and borderline intelligence.
Use CPRS-R total score ≥42 to screen for ADHD in kids with ID—teacher forms don’t help.
01Research in Context
What this study did
The team tested if Conners' Rating Scales-Revised can spot ADHD in kids with intellectual disability.
They looked at both parent forms (CPRS-R) and teacher forms (CTRS-R).
A cut-off score of 42 on the parent scale gave the best balance of catching true cases and avoiding false alarms.
What they found
The parent form worked. A total score of 42 or higher flagged ADHD with good accuracy.
The teacher form did not help. It could not tell which kids had ADHD and which did not.
How this fits with other research
Davis et al. (1994) warned that rating scales for kids with delays should use chronological age, not mental age. This study builds on that advice by giving a clear cut-off score.
Koegel et al. (2014) found that broadband scales fail at autism screening in toddlers. The current study shows the same kind of scale can still work for ADHD in older kids with ID. The difference is the target disorder and age group, not a true contradiction.
Smith et al. (1994) validated a cut-off on a different checklist for teens with mild ID. The new work repeats the method for younger children and ADHD.
Why it matters
If you work with children who have intellectual disability, use the CPRS-R total score ≥42 as a quick screen for ADHD. Skip the teacher form for this group. One clear number saves time and keeps kids from slipping through the cracks.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add CPRS-R total score ≥42 as your first ADHD screen for any child with ID
02At a glance
03Original abstract
BACKGROUND: Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) are believed to be common in children with intellectual disabilities (ID). Conners' Rating Scales are widely used for screening ADHD among children who do not have ID, but little is known about their usefulness among children with ID. AIMS: To find cut-off scores for the Conners' Parent Rating Scales-Revised (CPRS-R) and the Conners' Teacher Rating Scale-Revised (CTRS-R) that will give optimum levels of sensitivity and specificity for screening for ADHD among children with ID and borderline intelligence. METHOD: Receiver operating characteristic analysis was used to compare a clinical diagnosis of ADHD according to the Diagnostic and Statistical Manual 4th revision-Text Review criteria with scores according to the CPRS-R and the CTRS-R. RESULTS: Among children with ID, a CPRS-R total score of 42 provided a sensitivity of 0.9 and a specificity of 0.67 with an area under the curve of 0.84. Similarly, a CTRS-R total score of 40 provided a sensitivity of 0.69 and a specificity of 0.67 with an area under the curve of 0.71. There was poor concordance between the CPRS-R and the CTRS-R total scores (Intraclass Correlation; ICC = 0.17). There were statistically significant differences in the total score of the CPRS-R and most of its sub-scores between children with ID with and without ADHD. The CTRS-R total score and its sub-scores did not show any statistically significant difference between two groups. Factor analysis showed three clinically distinct factors for both the CPRS-R and the CTRS-R items, although the CPRS-R factors were better and had less item overlap than the CTRS-R factors. CONCLUSIONS: The CPRS-R scores may distinguish between children with ID with and without ADHD but not the CTRS-R scores. Many items in the CPRS-R and the CTRS-R are not applicable to children with severe and profound ID who do not have speech. The CPRS-R and the CTRS-R scores did not correlate with each other. There is a need to develop an ADHD screening instrument specifically for children with ID.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2007.01035.x