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Journal of Abnormal Child Psychology, Vol. 26, No.

4, 1998, pp 257-268

The Revised Conners' Parent Rating Scale (CPRS-R):


Factor Structure, Reliability, and Criterion Validity
C. Keith Conners,1,4 Gill Sitarenios,2 James D. A. Parker,3 and Jeffery N. Epstein1

Received June 19, 1997; accepted September 8, 1997


The Conners' Parent Rating Scale (CPRS) is a popular research and clinical tool for ob-
taining parental reports of childhood behavior problems. The present study introduces a
revised CPRS (CPRS-R) which has norms derived from a large, representative sample of
North American children, uses confirmatory factor analysis to develop a definitive factor
structure, and has an updated item content to reflect recent knowledge and developments
concerning childhood behavior problems. Exploratory and confirmatory factor-analytic results
revealed a seven-factor model including the following factors: Cognitive Problems, Opposi-
tional, Hyperactivity-Impulsivity, Anxious-Shy, Perfectionism, Social Problems, and Psycho-
somatic. The psychometric properties of the revised scale appear adequate as demonstrated
by good internal reliability coefficients, high test-retest reliability, and effective discriminatory
power. Advantages of the CPRS-R include a corresponding factor structure with the Con-
ners' Teacher Rating Scale—Revised and comprehensive symptom coverage for attention
deficit hyperactivity disorder (ADHD) and related disorders. Factor congruence with the
original CPRS as well as similarities with other parent rating scales are discussed.
KEY WORDS: ADHD; CPRS-R; rating scale; parents; childhood.

The initial Conners' Parent Rating Scale (CPRS) studied. The original scoring procedure required
was developed as a comprehensive checklist for ac- grouping of items according to rationally derived
quiring parental reports of the basic presenting prob- problem groups. Though this scoring procedure was
lems for children referred to an outpatient psychiatric face valid, it was not until a series of factor-analytic
setting (Conners, 1970). This scale was used to form studies of the CPRS were conducted (Blouin, Con-
the basis for a detailed parental interview about the ners, Seidel, & Blouin, 1989; Conners, 1970, 1973)
child's problems. In its original form, the CPRS con- that an empirical scoring methodology was em-
tained items grouped in terms of problems with sleep, ployed. These factor analyses of the CPRS (Blouin
problems eating, problems with temper, problems et al., 1989; Conners, 1970) utilized 316 clinic pa-
with keeping friends, problems in school, etc. Later, tients and 367 normal controls whose parents were
an "additional" problems category was added that in- recruited from Baltimore-area public schools. Using
cluded items covering the cardinal symptoms of at-
the 93 CPRS items as the unit of analysis, eight fac-
tention deficit hyperactivity disorder (ADHD): hyper-
tors were identified: Conduct Disorder, Anxious-Shy,
activity, impulsivity, and inattention.
Restless-Disorganized, Learning Problems, Psychoso-
Since its introduction (Conners, 1970), the psy-
chometric properties of the CPRS have been well matic, Obsessive-Compulsive, Antisocial, and Hyper-
active-Immature. The factor structure and norms
from this sample have been used for scoring the 93-
item CPRS (Conners, 1989).
1Duke University Medical Center, Durham, North Carolina 27710. With time, the CPRS has developed into a
2York University, Toronto, Ontario, Canada, M3J-1P3. popular instrument for screening and assessing be-
3Trent University, Peterborough, Ontario, Canada K9J-7B8.
4Address all correspondence concerning this article to C. Keith
havior problems and has become a useful and effec-
Conners, Box 3431, Duke University Medical Center, Durham, tive parent rating scale for assessing psychosocial
North Carolina 27710. (e.g., Horn, lalongo, Popovich, & Peradotto, 1987)

257
0091-0627/98/0800-0257$15.00/0 C 1998 Plenum Publishing Corporation
258 Conners, Sitarenios, Parker and Epstein
and drug treatment outcomes in children with dis- ably not representative of the wide range of children
ruptive behavior problems (e.g., Fischer & Newby, for whom the CPRS is applied today. Second, as dis-
1991). Several versions of the CPRS are currently in cussed above, the factor structure of the CPRS has
use including a 48-item questionnaire resulting from varied across studies. No studies to date have ever
a restandardization of a subset from the original tested and confirmed the CPRS factor structure us-
scale (Goyette, Conners, & Ulrich, 1978). A 10-item ing cross-validation, replication, or confirmatory fac-
abbreviated questionnaire was also constructed from tor analysis. Therefore, a definitive factor structure
the items with the best factor loadings (Conners, has not been established.
1994). Third, the original item content was developed
Some factor analytic research with the CPRS to provide a comprehensive and broad assessment of
and its related scales on clinical samples have sug- childhood behaviors, including feeding, eating, and
gested slightly differing CPRS factor structures (Co- sleeping problems among others. But many of these
hen, DuRant, & Cook, 1988; O'Connor, Foch, items are unrelated to the most common behavior
Sherry, & Plomin, 1980) than was reported originally. problems typically encountered. The scale has also
For example, Cohen (Cohen et al., 1988) found that been criticized for lacking sufficient emphasis on in-
Learning Problems did not form a separate factor in ternalizing states such as anxiety and depression. Ex-
his clinic sample but instead loaded on the Impul- tensive use has shown that a briefer and more focused
sive-Hyperactive factor, thereby forming an overall scale would be useful. Scale brevity and focus is rele-
ADHD factor. Cohen argued that this factor struc- vant for ease of use and increasing parent compliance.
ture was consistent with some investigators conten- This becomes increasingly important when repeated
tions that attention (Learning Problems) and hyper- administration is necessary (i.e., when monitoring be-
activity (Impulsivity-Hyperactivity) tend to present as havioral or pharmacologic interventions ).
a single disorder in clinical populations (Cohen & Last, item content of the CPRS has not been
Hynd, 1986; Werry, Sprague, & Cohen, 1975). updated to reflect the accumulating body of knowl-
Despite some differences in factor structure edge about behavior disorders. The original item
across studies, the psychometric properties of the content was reflective of conceptualizations of behav-
CPRS have made this scale an attractive research ioral problems during the 1960s-1970's. Some
and clinical tool. Good reliability of the CPRS as as- ADHD-related behaviors (e.g., academic problems)
sessed by test-retest (Glow, Glow, & Rump, 1982) and ADHD symptoms (e.g. excessive talking) were
and interrater reliability (Conners, 1973) has been not included because neither well-developed ADHD
established. In addition, the CPRS's concurrent va- criteria nor information about comorbid disorders
lidity is well established by high correlations with were available at the time of scale development.
similar factors on other parent rating scales, such as Thus, the goal of the present study was to revise
the Child Behavior Checklist (Achenbach & Edel- the CPRS by (1) deriving norms using a large, rep-
brock, 1983; Mash & Johnston, 1983) and Behavior resentative sample of North American children; (2)
Problem Checklist (Arnold, Barnebey, & Smeltzer, using confirmatory factor analysis to develop a defini-
1981; Campbell & Steinert, 1978). Further evidence tive factor structure; (3) focusing the revised scales
of its validity comes from research demonstrating the on behaviors that are directly related to ADHD and
discriminatory power of the CPRS in differentiating its associated behaviors; and (4) updating the item
behaviorally disordered children from normal chil- content to reflect recent knowledge and develop-
dren (Prior & Wood, 1983; Ross & Ross, 1976, 1982) ments concerning ADHD. In addition, the reliability
and between differing types of behavioral disorders and validity of this revised scale was examined.
(Conners, 1970; Kuehne, Kehle, & McMahon, 1987;
Leon, Kendall, & Garber, 1980).
Though the CPRS continues to experience wide- STUDY 1: SCALE DEVELOPMENT
spread use by both clinicians and researchers, several
issues indicate that an update and restandardization Method
of the CPRS is necessary. First, current norms for
the CPRS are based on normative data from a rela- Subjects
tively small sample of Baltimore-area school children
gathered in the 1960s. The size, geographical repre- Subjects consisted of 2,200 students (1,099 males
sentation, and demographics of this sample are prob- and 1,101 females) ranging in age from 3 to 17 years.
Revised Conners' Parent Rating Scale 259
Females had a mean age of 10.43 years (SD = 3.73) of factors for rotation (Cattell, 1978). In addition, we
and males a mean age of 10.09 years (SD = 3.68). employed the split-half factor comparabilities
The median annual household income of the stu- method (Everett, 1983) to determine the most reli-
dents rated by their parents was between $40,001 and able factor solution.
$50,000. Eighty-four percent of the students were The factor structure for the CPRS-R was tested
European American, 5% African American, 4% His- in the replication sample (n = 1,100) using confir-
panic, and 7% other. matory factor analysis with EQS for Windows (ver-
sion 5.1; Bentler, 1995). As recommended by Cole
(1987) and Marsh, Balla, and McDonald (1988),
Procedure multiple criteria were used to assess the goodness-
of-fit of the six-factor model: the goodness-of-fit in-
Officials and school psychologists from approxi- dex (GFI; Joreskog & Sorbom, 1986), the adjusted
mately 200 schools throughout Canada and the GFI (AGFI; Joreskog & Sorbom, 1986), and the
United States functioned as site coordinators for the root mean-square residual (RMS). Based on the rec-
present study. Site coordinators were provided with ommendations of Anderson and Gerbing (1984),
consent forms, questionnaires, and forms which out- Cole (1987), and Marsh et al. (1988), the following
lined the background of the study to parents and criteria were used to indicate the goodness-of-fit of
students in the school. Parent who agreed to par- the model to the data: GFI > .85; AGFI > .80;
ticipate were asked to rate as many of their school- RMS < .01.
age children as possible. Children and adolescents
in special education classes were not included in this
study. Results
Many new items were created in order to
strengthen some of the weaker factors (e.g., inter- Scale Development
nalizing behaviors) and those previously underrep-
resented. A preliminary item analysis on approxi- The correlation matrix of the 193 item-pool was
mately 100 ratings was used to remove items with subjected to principal-axis factoring and scree test
restricted variance or comments regarding readabil- and eigenvalue greater than 1.0 criteria (Cattell,
ity, interpretability, or vagueness. Parents were 1978). These criteria indicated the relative suitability
asked to rate each item on the 193 item-pool using of six, seven, and eight factors for rotation. In order
4-point Likert scales (ranging from 0 for not at all to determine the most reliable number of factors to
true to 3 for very much true). Completed forms were retain for rotation, the split-half factor comparabili-
returned to the site coordinators and forwarded to ties method was applied (Everett, 1983). To this end,
the authors. the derivation sample was randomly split into two
subsamples (n = 550 and 550). For each sample six-,
seven-, and eight-factor solutions were rotated to so-
Statistical Analyses lution (varimax rotation). Results indicated that the
seven-factor solution produced the highest factor
The sample was randomly divided into a deri- comparability coefficients. Based on these results, the
vation sample (n = 1,100) and a replication sample entire derivation sample was factor-analyzed and
(n = 1,100). The 193 items from the derivation sam- seven factors were rotated to a varimax solution.
ple were intercorrelated and the resulting matrix sub- Items were eliminated from further analyses because
jected to principal axis factoring. A series of factor they failed to load (above .30) on any one factor, or
analyses was conducted to determine what items because they loaded above .30 on more than one fac-
should be retained. Items were included on the final tor (in several cases items were retained that dou-
version of the scale if the following criteria were met: ble-loaded above .30 because there was a high load-
(1) Items had to load significantly (greater than .30) ing for the target factor and the loading for the
on a given factor and lower than .30 on the other second factor was just above .30). The remaining
factors, and (2) following the rational approach to items were factor-analyzed and seven factors rotated
scale construction, an item was eliminated if it lacked to a varimax solution. This procedure was repeated
conceptual coherence with its factor. Scree test and until 57 items remained. Table I presents the factor
eigenvalues (> 1.0) were used to select the number loadings, eigenvalues, and percentage of variance for
260 Conners, Sitarenios, Parker and Epstein
Table I. Rotated Factor Loadings from a Principal Axis Factor Analysis of Items from the Conners'
Parent Rating Scale— Revised (CPRS-R) (Derivation Sample, n = 1,100)
Factors
CPRS-R items 1 2 3 4 5 6 1
Factor 1: Cognitive Problems
114 Difficulty completing .793 .207 .063 .047 .019 .113 .095
117 Fails to complete .760 .232 .135 .019 007 .048 .078
116 Needs supervision .752 .130 .240 .106 .027 .103 .076
85 Avoids mental effort .737 .280 .230 .161 -.013 .111 .057
78 Trouble concentrating .691 .175 .295 .100 .006 .106 .090
81 Careless mistakes .686 .209 .184 .049 -.062 .144 .073
112 Arithmetic problems .557 .053 .010 .153 .033 .074 .142
111 Sloppy handwriting .604 .119 .074 -.022 -.047 .099 .080
84 Fails to finish .620 .311 .288 .110 -.050 .030 .095
87 Forgetful .600 .294 .269 .100 -.008 .082 .069
175 Loses things .581 .204 .257 .061 -.105 .080 .130
110 Poor spelling .545 .024 .064 .073 -.021 .110 .121
Factor 2: Oppositional
48 Angry .161 .723 .122 .106 .065 .132 .204
43 Argues .194 .638 .187 .049 .057 .049 .117
42 Loses temper .195 .653 .244 .112 .081 .125 .116
20 Irritable .212 .648 .187 .089 .087 .075 .161
44 Defies adults .213 .643 .275 .107 .017 .046 .061
45 Annoy people .210 .611 .200 .069 -.006 .117 .120
47 Touchy .162 .639 .085 .177 .117 .157 .153
46 Blames others .273 .575 .173 .109 .002 .093 .072
24 Spiteful .190 .581 .161 .107 .055 .151 .096
4 Fights .069 .471 .181 .148 -.015 .112 .052
Factor 3: Hyperactivity-Impulsivity
180 Always on the go .192 .121 .708 .012 .123 .024 .030
56 Hard to control .149 .240 .708 .135 -.051 .024 .019
178 Runs excessively .170 .190 .728 .106 -.028 .052 -.006
172 Restless .196 .137 .637 .174 .072 .126 .114
183 Difficulty waiting .228 .275 .644 .105 .055 .138 .056
52 Run around at meals .063 .088 .577 .130 -.012 -.028 .027
179 Difficulty being quiet .225 .284 .627 .117 .023 .219 .003
182 Blurts out answers .230 .218 .506 -.063 .107 .137 .114
60 Excitable .259 .294 .577 .138 .112 .120 .094

Factor 4: Anxious-Shy
95 Timid .055 .136 .038 .726 .141 .081 .116
90 Afraid of people .051 .165 .027 .710 .105 .114 .053
89 Afraid of new situations .174 .187 .063 .700 .067 .114 .079
91 Afraid of being alone .048 .037 .193 .626 .032 .004 .107
94 Many fears .162 .241 .100 .630 .129 .079 .190
170 Afraid of the dark .015 .055 .205 .521 .144 -.036 .086
138 Shy .084 .053 -.033 .538 .146 .179 .034
156 Clings to parents .111 .037 .274 .481 .061 .145 .140

Factor 5: Perfectionism
130 Everything just so -.114 .078 .072 .117 .740 .070 .075
133 Keeps checking -.028 -.029 .038 .067 .698 .039 .056
135 Fussy .036 -.024 -.008 .099 .570 -.054 -.023
131 Things done same way .002 .096 .148 .218 .694 .095 .041
137 Has rituals .052 .112 .094 .151 .632 .075 .029
132 Sets high goals -.148 -.066 -.032 -.053 .647 .042 .087
136 Upset if things moved .043 .179 -.043 .119 .612 .052 .052
(c.ontinued)
Revised Conners' Parent Rating Scale 261
Table I. (Continued)
Factors
CPRS-R items 1 2 3 4 5 6 7
Factor 6: Social Problems
140 No friends .162 .164 .112 .153 .048 .793 .012
143 Loses friends .203 .212 .192 .046 .045 .725 .043
142 Does not make friends .197 .142 .120 .272 .102 .704 .029
147 Doesn't get invited .137 .180 .115 .070 .075 .636 .133
144 Feels inferior .242 .211 -.004 .215 .096 .424 .162
Factor 7: Psychosomatic
123 Stomach aches .083 .137 .094 .101 .066 .011 .750
124 Aches and pains .091 .154 .032 .144 .095 .055 .616
125 Aches before school .166 .086 .069 .120 .011 -.022 .648
122 Headaches .151 .129 .002 .032 .098 .125 .452
128 Complains .144 .174 .118 .181 -.024 .060 .531
126. Seems tired .187 .243 -.040 .161 .098 .110 .306
Eigenvalues 14.67 4.20 2.59 2.15 2.11 1.86 1.37
% of Variance 25.7 7.4 4.5 3.8 3.7 3.3 2.4

each factor for this analysis. The seven rotated fac- and RMS = .0291).5 All of the parameter estimates
tors accounted for 50.8% of the total variance. The between items and factors were significant: For the
first factor accounted for 25.7% of the total variance Oppositional Factor, the 10-parameter estimates
and the 12 items that loaded on this factor appeared ranged from .603 to .792 (mean = .720); for the Cog-
to tap a "cognitive problems" dimension. The second nitive Problems factor, the 12-parameter estimates
factor accounted for 7.4% of the total variance and ranged from .529 to .866 (mean = .743); for the Hy-
the 10 items that loaded on this factor appeared to peractivity-impulsivity factor, the nine-parameter es-
tap an "oppositional" dimension. The third factor ac- timates ranged from .610 to .791 (mean = .715); for
counted for 4.5% of the total variance and the nine the Anxious/Shy factor, the eight-parameter estimates
items that loaded on this factor appeared to tap a ranged from .518 to .752 (mean = .644); for the Per-
"hyperactivity-impulsivity" dimension. The fourth fectionism factor, the seven-parameter estimates
factor accounted for 3.8% of the total variance and ranged from .528 to .699 (mean = .643); for the So-
the eight items that loaded on this factor appeared cial Problems factor, the five-parameter estimates
to tap an "anxious/shy" dimension. The fifth factor ranged from .597 to .855 (mean = .767); for the Psy-
accounted for 3.7% of the total variance and the chosomatic factor, the six-parameter estimates ranged
seven items that loaded on this factor appeared to from .476 to .751 (mean = .632).
tap a "perfectionism" dimension. The sixth factor ac-
counted for 3.3% of the total variance and the five STUDY 2: RELIABILITY, INTERNAL
items that loaded on this factor appeared to tap a CONSISTENCY, AND AGE AND SEX
"social problems" dimension. The seventh factor ac- DIFFERENCES
counted for 2.4% of the total variance and the six
items that loaded on this factor appeared to tap a Method
"psychosomatic" dimension.
Participants

Factor Replication The sample consisted of the 2,200 students used


in Study 1 (1,101 males and 1,099 females). A subset
The seven-factor oblique model for the 57-item
CPRS-R was tested using confirmatory factor analysis 5
The model had to be slightly modified with the addition of se-
on the cross-validation sample (n = 1,100). All three lected correlated errors (0.9% of possible correlated errors). See
goodness-of-fit indicators suggested that the model Tanaka and Huba (1984) for a discussion of this procedure. The
had good fit to the data (GFI = .863, AGFI = .849, mean for these error correlation was .244 (range = .134 to .399).
262 Conners, Sitarenios, Parker and Epstein
Table II. Internal Reliability Coefficients for Scales on the Conners' Parent Rating
Scale-Revised (CPRS-R)
3 to 7 years 8 to 12 years 13 to 17 years
CPRS-R Scale Male Female Male Female Male Female
Oppositional .89 .88 .92 .91 .92 .90
Cognitive Problems .92 .92 .94 .92 .93 .93
Hyperactivity-Impulsivity .92 .91 .91 .83 .85 .75
Anxious/Shy .86 .86 .85 .85 .81 .82
Perfectionism .86 .88 .82 .83 .84 .82
Social Problems .85 .87 .88 .81 .87 .85
Psychosomatic .77 .83 .75 .79 .82 .75
n 307 286 479 467 315 346

of 49 children (23 males and 26 females) were rated tions: .60 (p < .05) for Oppositional, .78 (p < .05)
by their parent on the CPRS-R on two occasions ap- for Cognitive Problems, .71 (p < .05) for Hyperac-
proximately 6 weeks apart. tivity-Impulsivity, .42 (p < .05) for Anxious/Shy, .60
(p < .05) for Perfectionism, .13 (p = n.s.) for Social
Problems, and .55 (p < .05) for Psychosomatic.
Results Means and standard deviations for the various
CPRS-R scales (separately by sex and age group) are
Table II presents the internal reliability coeffi- presented in Table III. A series of (Sex x Age Group)
cients for the CPRS-R scales, separately for 3- to 7- analyses of variance were conducted with each of the
year-olds, 8- to 12-year-olds, and 13- to 17-year-olds. CPRS-R scales as the dependent variable. For the
Coefficient alphas for the seven scales on the CPRS- Oppositional scale, males were rated significantly
R ranged from .75 to .94 for males and .75 to .93 higher than females [F(l, 2,194) = 14.55, p < .001],
for females, suggesting that the scales on the CPRS- but the main effect for age group and the interaction
R have excellent internal reliability. Using Pearson were not significant.
product-moment correlations (n = 50), the CPRS-R For the Cognitive Problems scale, males were
scales had the following 6-week test-retest correla- rated significantly higher than females [F(l, 2,194) =

Table III. Means and Standard Deviations for Scales on the Conners' Parent Rating Scale— Revised (CPRS-R)
3 to 7 years 8 to 12 years 13 to 17 years Total
CPRS-R Scale Females Males Females Males Females Males Females Males
Oppositional Mean 4.89 5.61 4.59 5.89 4.82 5.37 4.74 5.66
SD (4.44) (5.00) (4.88) (5.68) (4.96) (5.53) (4.79) (5.46)
Cognitive Problems Mean 3.84 5.93 4.14 8.33 4.87 8.31 4.29 7.65
SD (5.80) (7.07) (5.69) (8.28) (6.79) (8.29) (6.09) (8.03)
Hyperactivity-Impulsivity Mean 3.60 4.83 1.54 3.18 1.26 1.93 1.99 3.28
SD (4.75) (5.79) (2.65) (4.74) (2.18) (3.28) (3.36) (4.83)
Anxious/Shy Mean 4.78 4.19 2.71 2.89 2.12 1.50 3.06 2.85
SD (4.33) (4.28) (3.45) (3.72) (3.04) (2.66) (3.73) (3.76)
Perfectionism Mean 3.97 3.42 3.73 3.36 4.52 4.15 4.04 3.60
SD (4.23) (3.94) (3.80) (3.56) (4.28) (4.29) (4.08) (3.90)
Social Problems Mean .78 .86 .88 1.2 11.0 11.0 8.89 1.07
SD (1.82) (2.03) (1.77) (2.43) (2.13) (2.32) (1.90) (2.29)
Psychosomatic Mean 1.60 1.24 1.55 1.62 1.92 1.58 1.68 1.50
SD (2.42) (2.04) (2.23) (2.16) (2.32) (2.43) (2.31) (2.21)

n 286 307 467 479 346 315 1,099 1,101


Revised Conners' Parent Rating Scale 263
Table IV. Correlations Among Scales on the Conners' Parent Rating Scale— Revised (CPRS-R)a
1 2 3 4 5 6 7
1. Oppositional .57b .58b .38b .17b .49b .40b
2. Cognitive Problems .50b — .55b .33b .00 .44b .36b
3. Hyperbctivity-Impulsivity .51b .49b .41b .17b .42b .24b

4. Anxious/Shy .37b .30b .36b .27b .40b .34b
5. Perfectionism .13b -.02 .12b .26b .17b .15b

6. Social Problems .43b .45b .35b .39b .12b — .33b
7. Psychosomatic .44b .42b .33b .34b .14b .34b —
aMales (n = 1,101) above the diagonal and females (n = 1,099) below.
b
p < .01.

110.12, p < .001], a significant main effect was found olds [F(1, 2,194) = 8.03, p < .005] and the 8- to 12-
for age group [F(2, 2,194) = 10.16, p < .001], and year-olds [F(l, 2,194) = 15.43, p < .001].
the interaction of Group Age x Sex was significant For the Social Problems scale, the main effects
[F(2, 2,194) = 4.04, p < .05]. Using univariate analy- for sex and age group, and the effect for the inter-
sis of variance for age group, the 3- to 7-year-olds action, were not significant.
were rated significantly higher than the 8- to 12-year- For the Psychosomatic scale, females were rated
olds [F(l, 2,194) = 13.29, p < .001] and the 13- to significantly higher than males [F(l, 2,194) = 4.78,
17-year-olds [F(l, 2,194) = 18.09, p < .001]. p < .05] and a significant main effect was found for
For the Hyperactivity-Impulsivity scale, males age group [F(2, 2,194) = 3.34, p < .05]; the interac-
were rated significantly higher than females [F(l, tion was not significant. Using univariate analysis of
2,194) = 45.23, p < .001] and a significant main ef- variance for age group, the 3- to 7-year-olds were
fect was found for age group [F(2, 2,194) = 69.70, rated significantly higher than the 13- to 17-year-olds
p < .001]; the interaction was not significant. Using [F(l, 2,194) = 6.67, p < .01].
univariate analysis of variance for age group, the 3- The intercorrelation matrix of the CPRS-R
to 7-year-olds were rated significantly higher than the scales is presented in Table IV , separately for males
8- to 12-year-olds [F(l, 2,194) = 77.31, p < .05] and and females. To examine possible gender differences
the 13- to 17-year-olds [F(l, 2,194) = 131.87, p < in the pattern of intercorrelations, the equality of the
.001], and the 8- to 12-year-olds were rated signifi- correlation matrices was tested using EQS for Win-
cantly higher than the 13- to 17-year-olds [F(l, dows (version 5.1; Bentler, 1995). The criteria for de-
2,194) = 13.93, p < .001]. termining the equality of the correlation matrices
For the anxious/shy scale, females were rated were a nonnormed fit index (NNFI; Bentler & Bon-
significantly higher than males [F(l, 2,194) = 4.81, ett, 1980) greater than .900 and a comparative fit in-
p < .05], a significant main effect was found for age dex (CFI; Bentler, 1990) greater than .900. Results
group [F(2, 2,194) = 87.43, p < .001], and the inter- indicated that the pattern of intercorrelations for the
action was significant [F(2, 2,194) = 3.24, p < .05]. CPRS-R scales was virtually identical across the
Using univariate analysis of variance for age group, sexes (NNFI = .988 and CFI = .989). A similar pat-
the 3- to 7-year-olds were rated significantly higher tern of results was found when the equality of the
than the 8- to 12-year-olds [F(l, 2,194) = 79.22, p < correlation matrices among the three age groups was
.001] and the 13- to 17-year-olds [F(l, 2,194) = tested using EQS (NNFI = .956 and CFI = .962).
171.79, p < .001], and the 8- to 12-year-olds were
rated significantly higher than the 13- to 17-year-olds
[F(l, 2,194) = 29.51, p < .001]. STUDY 3: CRITERION VALIDITY
For the Perfectionism scale, females were rated
significantly higher than males [F(l, 2,194) = 6.17, Method
p < .05] and a significant main effect was found for
age group [F(2, 2,194) = 8.12, p < .001]; the inter- Participants
action was not significant. Using univariate analysis
of variance for age group, the 13- to 17-year-olds Two groups of children were used in the present
were rated significantly higher than the 3- to 7-year- study. The first group consisted of 91 children (68
264 Conners, Sitarenios, Parker and Epstein
Table V. Means and Standard Deviations for the Non-ADHD (n = 91) and ADHD (n = 91)
Groups on the Conners' Parent Rating Scale— Revised (CPRS-R)a
Non-ADHD ADHD
CPRS-R Scale Mean (SD) Mean (SD) t P
Oppositional 4.26 (3.99) 10.83 (6.99) 7.79 <.001
Cognitive Problems 5.17 (6.50) 22.64 (7.97) 16.20 <.001
Hyperactivity-Impulsivity 1.97 (3.43) 10.65 (6.70) 11.00 <.001
Anxious/Shy 2.43 (2.90) 4.14 (3.89) 3.36 <.001
Perfectionism 3.78 (4.21) 2.91 (3.83) 1.45 .149
Social Problems 0.62 (1.19) 3.92 (4.03) 7.49 <.001
Psychosomatic 1.28 (2.07) 3.04 (3.07) 4.55 <.001
aADHD = attention deficit/hyperactivity disorder.

males and 23 females) who met the following crite- bership in the two groups (ADHD vs. non-ADHD).
ria: (a) parent and/or teacher referral to an outpa- Discriminant function scores were subsequently used
tient ADHD clinic due to reported problems with in- to classify the 182 children into ADHD and non-
attention, hyperactivity, and/or impulsivity; (b) ADHD groups. The results of this classification are
independent diagnosis of ADHD by psychologist presented in Table VI. Following the definitions and
and/or psychiatrist using Diagnostic and Statistical procedures outlined by Kessel and Zimmerman
Manual for Neutral Disorders (4th ed.) (DSM-IV; (1993), a variety of diagnostic efficiency statistics
American Psychiatric Association, 1994) criteria for were calculated for the CPRS-R from these classifi-
ADHD. Eighty-four percent of the participants were cation results: sensitivity was 92.3%, specificity was
European American, 8.8% were African American, 94.5%, positive predictive power was 94.4%, negative
1.1% were Hispanic, and 6.1% were other; the mean predictive power was 92.5%, false positive rate was
age was 10.16 years (SD = 3.40). 5.5%, false negative rate was 7.7%, kappa was .868,
The second group (non-ADHD) consisted of 91 and the overall correct classification rate was 93.4%.
children (68 males and 23 females) from Studies 1 and
2 who were randomly selected and matched with the
ADHD sample on the basis of age, sex, and ethnicity. GENERAL DISCUSSION

Redevelopment and restandardization of the


Procedure CPRS has produced a revised parent rating scale
with better psychometric properties than previous
For participants in the ADHD sample, the versions. Scale construction was performed system-
CPRS-R information was obtained as part of routine atically, comprehensively, and in accordance with
clinical assessment. psychometric standards (American Psychological As-
sociation, 1985), resulting in a definitive factor struc-
ture and representative normative data. In addition,
Results the revised scale's content contains fewer items, yet
provides a more comprehensive assessment and spe-
Table V presents means and standard deviations cific focus on ADHD-related behaviors than the
for the CPRS-R scales for the ADHD and non-
ADHD groups. The ADHD group was rated signifi-
cantly higher (using Mests) than the non-ADHD Table VI. Classification Results (ADHD vs. Non-ADHD) for
the Conners' Parent Rating Scale— Revised (CPRS-R)a
group on the Oppositional scale, the Cognitive Prob-
lems scale, the Hyperactivity-Impulsivity scale, the Diagnosis
Anxious/Shy scale, the Social Problems scale, and the Test ADHD Non-ADHD Total
Psychosomatic scale; there was no significant differ- Present 84 5 89
ence between the two groups on the Perfectionism Absent 7 86 93
scale.
A direct discriminant function analysis was per- Total 91 91 182
formed using CPRS-R scales as predictors of mem- aADHD = attention deficit/hyperactivity disorder.
Revised Conners' Parent Rating Scale 265
original CPRS. With greater focus on ADHD-related In regards to externalizing behavior factors, the
behaviors and concordance between scale items and factor structure has changed somewhat. A new Cog-
current conceptualizations of ADHD, the CPRS-R nitive Problems factor includes symptoms consistent
provides better discriminatory power for detecting with the DSM-IV ADHD inattentive domain. This
ADHD children than previous scale versions. factor also encompasses academic difficulties with
Examination of the revised scale in terms of its items assessing handwriting, spelling, and arithmetic.
functional uses suggests that the CPRS-R will pro- The clustering of academic difficulties with inatten-
vide researchers and clinicians an effective tool for tion problems on the same factor is supported by the
assessing parental perceptions of ADHD-related be- factor structure derived from a national sample of
haviors. The foremost function of the CPRS-R will parent ratings (Achenbach, Howell, Quay, & Con-
be as a screening tool or as an adjunctive instrument ners, 1991) and is concordant with the factor struc-
to a comprehensive assessment. This study's results ture of the Conners Teacher Rating Scale—Revised
suggest that the CPRS-R is effective at discriminat- (Conners, Sitarenios, Parker, & Epstein, 1998). As
ing ADHD children from normal children. Further, suggested by Conners et al. (1998), this clustering of
ratings of children throughout North America can be academic and inattention problems may be explained
compared to normative data from a large, repre- by the high relation between academic achievement
sentative sample in order to provide a measure of and inattention problems in elementary school chil-
deviance or severity. Reliability estimates also sug- dren (Hinshaw, 1991). The original CPRS did not
gest that accurate measures of parental perceptions adequately assess for either inattention or academic
may be obtained. Consistent with the original forms' achievement; therefore there are no corresponding
use (Conners, 1994), the CPRS-R can also be used factors on the original CPRS. In fact, the lone CPRS
as a clinician checklist when performing a clinical in- inattention item, fails to finish things s/he starts-
terview. Indeed, the factor structure of the CPRS-R short attention span, loads on both the CPRS Con-
represents several categories of behavior which are duct Problem and Hyperactive/Immature factors.
either directly related to ADHD symptoms (e.g., hy- The other domain of ADHD symptoms, hyper-
peractivity) or comorbid with ADHD (e.g., opposi- active/impulsivity, is assessed by the CPRS-R Hyper-
tional behavior) thereby providing a clinician with activity factor. This factor has items covering both
problem domains upon which an interview could be hyperactive and impulsive symptoms. The original
focused. CPRS had two factors which assessed these catego-
The other major use of the CPRS-R will likely ries of behaviors labeled Hyperactive/Immature and
be to monitor treatment and to assess treatment out- Restless/Disorganized. Both factors contained extra-
come. Additional research needs to be conducted to neous behaviors discordant with their label (e.g.,
determine the utility of the CPRS-R in accomplish- "cries easily" on the Hyperactive/Immature factor)
ing this function. However, since the CPRS-R factor and neither comprehensively assessed hyperactive or
structure comprehensively assesses many ADHD-re- impulsive symptoms. However, the CPRS-R Hyper-
lated behaviors, some of which (e.g., Hyperactivity- activity factor contains items which all relate to the
Impulsivity) have proven to be susceptible to change hyperactive/impulsive domain of behavior and which
as a result of typical ADHD interventions (e.g., psy- assess a wide variety of symptoms related to this
chostimulant treatment), it seems likely that the symptom cluster. Thus scores on this scale are much
CPRS-R will provide a behavior-specific measure of more reflective of hyperactive/impulsive symptoms.
treatment outcome. Similarly, the original CPRS had a Conduct Dis-
In comparison to the factor structure used for order factor and Antisocial factor, both of which as-
scoring the original CPRS (Blouin et al, 1989), the sessed symptoms consistent with Oppositional Defi-
CPRS-R factor structure is quite similar, especially ant Disorder and Conduct Disorder diagnoses.
in regard to factors assessing internalizing sympto- However, problems with the CPRS Conduct Disor-
matology. The CPRS-R factor structure retains the der factor included the fact that it assessed a wide
Psychosomatic and Anxious/Shy factors from the variety of externalizing symptoms other than those
original scale both in form and name. The CPRS-R behaviors associated with Conduct Disorder includ-
Perfectionism factor is largely the same as the origi- ing items associated with ADHD. Thus, this factor
nal Obsessive/Compulsive factor except that the label was more a measure of externalizing behavior than
has been modified to more accurately reflect the be- CD specifically. The CPRS-R has a single Opposi-
havioral symptomatology encompassed by this factor. tional factor that more accurately and specifically
266 Conners, Sitarenios, Parker and Epstein
assesses behaviors consistent with ODD and CD and sex differences in our normative sample, especially
excludes those externalizing behaviors associated on Externalizing factors, were quite large and suggest
with ADHD thus providing a more useful and dis- a normative trend for males to express a far greater
tinct measure of oppositional behavior. amount of externalizing symptoms than females.
The last factor on the CPRS-R is the Social Age differences were found on several factors
Problems factor, which was absent on the original with children receiving lower ratings with age on the
CPRS. Since social problems are often present in Cognitive Problems, Hyperactivity/Impulsivity, Anx-
children with externalizing behaviors, this symptom ious/Shy, and Psychosomatic factors. Similar declines
category is extremely important to assess. Indeed, in problem scores have been found in other studies
several investigators have suggested the relevance of (Achenbach & Edelbrock, 1981; Achenbach, Hen-
social difficulties in the long-term outcome and prog- sley, Phares, & Grayson, 1990). This finding likely
nosis of ADHD children (Barkley, 1990; Landau & reflects normative developmental trends in which
Moore, 1991). However, the relatively low test-retest certain behaviors (e.g., excitable) generally decrease
reliability of this scale suggests caution in its use and with age. The CPRS-R Perfectionism factor showed
the need to develop a more reliable version of this an opposite effect, with higher ratings with increased
scale. age. This reverse effect possibly reflects the phe-
A useful advantage of the CPRS-R factor struc- nomenon that many developmentally sanctioned ob-
ture is that it is similar in factor content to the revised sessive-compulsive behaviors occur in early child-
Conners Teacher Rating Scale (CTRS-R; Conners et hood (e.g., elaborate bedtime rituals) and are not
al., 1998). All of the CPRS-R factors correspond with likely to be rated by parents as inappropriate or
CTRS-R factors.6 Corresponding factors across these problem behavior (March, Leonard, & Swedo, 1995).
two scales provide the opportunity to directly com- However, as children grow older, ritualistic and per-
pare parent and teacher ratings of a specific behav- fectionistic behaviors become less socially accepted,
ioral domain, using norms obtained on the same chil- thus resulting in higher ratings on this factor for
dren, thus providing measures of cross-informant older children.
consistency and possibly providing information about In comparison to other parent rating scales, the
situation-specific behavioral patterns across school CPRS-R has comparable psychometric properties yet
and home environments. Indeed, assessing problems measures ADHD and its associated behaviors more
across multiple environments is a requirement for a specifically and comprehensively. Specifically, in
DSM-IV ADHD diagnosis. comparison to two of the more popular parent rating
Gender differences on the CPRS-R revealed scales, the Child Behavior Checklist (CBCL) and Re-
higher ratings for males on the Cognitive Problems, vised Behavior Problem Checklist (RBPC), the
Hyperactivity-Impulsivity, and Oppositional factors CPRS-R is the only checklist that contains scales re-
while girls were rated higher on the Anxious/Shy, lated to both domains of ADHD behaviors, inatten-
Psychosomatic, and Perfectionism factors. These gen- tion and hyperactivity/impulsivity. The CBCL has a
der differences on the CPRS-R corroborate the com- single factor labeled Hyperactivity and the RBPC has
mon finding that boys tend to be rated higher on Ex- an Attention Problems-Immaturity factor. Measuring
ternalizing factors while girls are rated higher on the severity of both domains of ADHD behaviors
Internalizing factors (Achenbach et al., 1991; Ander- seems necessary for both comprehensive descriptive
son, Williams, McGee, & Silva, 1987; Costello et al., and diagnostic purposes.
1985; Offord, Boyle, Szatmari, Rae, et al., 1987; The CBCL includes factors not found in the
Velez, Johnson, & Cohen, 1989). Achenbach et al. CPRS-R, including Depressed, Immature, Sexual,
(1991) pointed out that sex differences on rating and Uncommunicative. Despite attempts to enlarge
scales are small in normative samples, but that, in the CPRS-R item pool so as to reveal a factor of
troubled children, these differences become large depression, those items repeatedly became subsumed
since there is a large degree of externalizing prob- under the Anxiety factor. Items relating to immatur-
lems in troubled boys and internalizing problems in ity typically attached themselves to the Cognitive
troubled girls. While this may be true, the observed Problems factor or were unstable in replication stud-
ies. Social communication problems are included in
6
There is no corresponding Psychosomatic factor on the CTRS-R
the Social Problems factor. Long experience with
since teachers were not asked to rate these items because of ex- items regarding precocious or inappropriate sexuality
perience suggesting that they did so unreliably. in the original parent scale indicated limited clinical
Revised Conners' Parent Rating Scale 267
usefulness and low item endorsement. However, this American Psychological Association. Standards for educational and
psychological testing (1985). Washington, DC: Author.
highlights the problem of scales based upon fre- Anderson, J. C., & Gerbing, D. W. (1984). The effect of sampling
quency of endorsement. Though some items rarely error on convergence, improper solutions, and goodness-of-fit
occur (e.g., items relating to psychosis), when they indices for maximum likelihood confirmatory factor analysis.
Psychometrika, 49, 155-173.
do occur they are important. The tradeoff of having Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987).
a shorter scale with better user-compliance and ac- DSM-III disorders in preadolescent children: Prevalence in a
ceptance, versus a longer scale covering many items large sample from the general population. Archives of General
Psychiatry, 44, 69-76.
that are important but rare, was decided in favor of Arnold, L. E., Barnebey, N. S., & Smeltzer, D. J. (1981). First
brevity and focus in the current revision. grade norms, factor analysis and cross correlation for Con-
In summary, the CPRS-R provides a reliable, ners, Davids, and Quay-Peterson behavior rating scales. Jour-
accurate, and relatively brief measure of parental nal of Learning Disabilities, 14, 269-275.
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