Norms for parental ratings on Conners' abbreviated parent-teacher questionnaire: implications for the design of behavioral rating inventories and analyses of data derived from them

Journal of Abnormal Child Psychology,  Dec, 1997  by Katherine S. Rowe,  Kenneth J. Rowe

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As definitions and correlates of attention deficits and hyperactivity are refined in diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., 3rd ed. rev., and 4th ed.) (DSM-III, -III-R, and -IV; American Psychiatric Association, 1980, 1987, and 1994, respectively) and the International Classifications of Diseases (9th ed.) (ICD-9; World Health Organization, 1978) and ICD-10 (WHO, 1992, 1996) (See Appendix, Note 1), behavioral rating scales using nomenclatures contributing to and derived from these sources continue to be used widely as assessment instruments for the evaluation of children and adolescents (Barkley, 1990; Cantwell, 1996; Hinshaw & Nigg, 1994; Rubio-Stipec et al., 1996). Such instruments are also used routinely in epidemiological studies to obtain prevalence estimates of children with behavior problems (Anderson, Williams, McGee, & Silva, 1987; Bird et al., 1988; Holborow & Berry, 1986a; Schachar, 1991; Trites, Dugas, Lynch, & Ferguson, 1979; Wang, Chong, Chou, & Yang, 1993; Yao, Solanto, & Wender, 1988). Despite the limited utility of rating inventories for diagnosis (Hinshaw, 1994; Hodges, 1993), as well as methodological problems endemic to their design and related data analyses (Rowe & Rowe, 1992a), advantages entailed in their use include ease of administration and the convenience of obtaining impressions of child normative behaviors in home and school settings from large numbers of adult informants.

An early, influential and widely used instrument for assessing hyperactive/inattentive behavior is Conners' (1973) Abbreviated Parent-Teacher Questionnaire (hereafter referred to as APTQ) - various versions of which have been referred to as the Abbreviated Symptom Questionnaire (Conners, 1972; Sprague & Sleator, 1973; Conners, 1990a), the Hyperkinesis Index (Goyette, Conners, & Ulrich, 1978), or the Hyperactivity Index (Conners, 1990b, 1994) (see Appendix, Note 2). The durability of the APTQ and its hybrids is evidenced not only by its wide usage, but more particularly because its item format and response categories have since been adopted by numerous other designers of behavioral rating inventories for clinical and research applications. Such instruments include the Stony Brook Scale (O'Leary & Steen, 1982), the ADD-H Comprehensive Teachers' Rating Scale (ACTeRS; Ullmann, Slater, & Sprague, 1985a), the SNAP Rating Scale (Swanson, Nolan, & Pelham, 1981), the Yale Children's Inventory (Shaywitz, Schnell, Shaywitz, & Towle, 1986), the Children's Attention and Adjustment Survey (Lambert, Hartsough, & Sandoval, 1990), and the Disruptive Behavior Disorders Rating Scale (Pelham, Gnagy, Greenslade, & Milich, 1992) among others.

The APTQ consists of 10 overlapping items drawn from the 39-item Teacher Rating Scale (Conners, 1969) and the 93-item Parent Questionnaire (Conners, 1970) that were most frequently rated by both teachers and parents, and sensitive to drug challenge (Conners, 1972, 1973). With some rewording from their host instruments (as noted by Sandoval, 1977; Ullmann, Sleator, & Sprague, 1985b; Werry, Sprague, & Cohen, 1975), the items elicit observations of hyperactive-inattentive behaviors and those associated with mood or emotional lability (see Table III). Each item is made up of behavioral description(s) expressed in negative nomenclature, which requires a rating response in one of four ordinal categories labeled and scored as not at all (0), just a little (1), pretty much (2), and very much(3). Typical of its use is that a simple, additive, item total or "scale score" is computed on the assumption that the items "represent" a single latent construct or scale (i.e. Hyperactive Index). From a total possible score of 30, an observed score of greater than or equal to 15 (or a mean item score of 1.5) has been reported as representing 2 standard deviations above the overall mean for the scale, and often used in a quasidiagnostic way to identify children with clinically significant hyperactivity (Sprague, Cohen & Werry, 1974) (See Appendix, Note 3).

Historically, the APTQ has been used for three main purposes: (1) To measure the severity of hyperactivity and/or attention deficit behaviors in children (Conners, 1970; Dykman & Akerman, 1991; Holborow & Berry, 1986b; Kupietz, Bialer & Winsberg, 1972; Taylor, et al., 1986; Zelko, 1991); (2) for assessing the effects of medication on behavioral change (Conners & Werry, 1979; Eisenberg & Conners, 1971; Jaselskis, Cook, Fletcher & Leventhal, 1992; Sprague & Sleator 1973; Vitiello, et al., 1991), and (3) as inclusion criteria in clinical trials (Carter et al., 1993; Conners, Goyette, Southwick, Lees, & Andrulonis, 1976; Harley, Mathews & Eichman, 1978; Williams, Cram, Tausig & Webster, 1978).

Surveys obtaining teacher and/or parent ratings on various forms of Conners' behavioral rating inventories (Conners, 1969, 1970, 1972, 1973, 1978, 1980) have been conducted in several countries including the United States and Canada, (Parker, Sitarenios, & Conners, 1996; Sprague et al., 1974; Werry et al., 1975), New Zealand (Werry & Hawthorne, 1976), Germany (Sprague, Cohen, & Eichsleder, 1977), Spain (Arias & O'Leary, 1983), and Queensland, Australia (Holborow, Berry, & Elkins, 1984) and Brazil (Brito, 1987). However, as shown in Table I, marked variations in score distributions from country to country are evident. Other studies from South Australia (Glow, 1978, 1981; Glow, Glow, & Rump, 1982) and Canada (Trites et al., 1979) have reported prevalence estimates for the Hyperkinesis Index subscale from administration of the full Teacher Rating Scale (Conners, 1969) or Parent Questionnaire (Conners, 1970), or have used the revised versions (Goyette et al., 1978) for studies in Hong Kong (Luk, Leung, & Lee, 1988), Taiwan (Wang et al., 1993), and with Chinese children in the U.S. (Yao et al., 1988). The key features of these studies are summarized in Table I.