Conners' Teacher Rating Scale For Preschool Children: A Revised, Brief, Age-Specific Measure

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Conners' Teacher Rating Scale for Preschool Children: A Revised, Brief, Age-
Speciﬁc Measure
Article in Journal of Clinical Child & Adolescent Psychology · April 2009

DOI: 10.1080/15374410802698446 · Source: PubMed
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Conners’ Teacher Rating Scale for Preschool Children: A

Revised, Brief, Age-Specific Measure
David J. Purpura and Christopher J. Lonigan
Department of Psychology, Florida State University.
Abstract
The Conners’ Teacher Rating Scale--Revised is one of the most commonly used measures of child
behavior problems; however, the scale length and the appropriateness of some of the items on the
scale may reduce the usefulness of the CTRS for use with preschoolers. In this study, a Graded
Response Model analysis based on Item Response Theory was applied to the CTRS data from 669
preschool children. Children in this data sample ranged in age from 25 to 74 months, 44.4% were
identified as African American, 45.4% Caucasian, 10.2% other. The sample was 53.7% boys and
46.3% girls. A revised version of the scale was developed specifically for use with preschool
children. Five items each for the Inattention, Hyperactivity/Impulsivity, and Opposition scale were
included in the revised scale. The revised scales significantly reduce the time needed for teachers
to complete the measures while retaining the scales’ ability to discriminate children with different
levels of behavioral problems.
Keywords
CTRS; ADHD; IRT; assessment; behavior
Item Response Theory Analysis of the Conners’ Teacher Rating Scale for
Preschool Children
Early behavioral intervention may be crucial when it comes to reducing the negative impact
of behavioral problems. To treat behavioral problems successfully, it is necessary to assess
such problems effectively. Accurately measuring behavioral problems allows researchers to
target treatment development to the specific behavioral problem, and allows clinicians to
have a clear picture of any relevant behavioral problems. Additionally, effective assessment
of behavioral problems enables researchers to include strong measures of behavioral
problems in their research. Current methods of measuring behavioral problems are often
time-consuming because of the length of the measures. It is important that these assessment
tools not only accurately measure the spectrum of behavioral problems, but that they are also
easy to use by both researchers and individuals such as teachers and classroom observers,
who must complete the forms. Further, these measures should be age appropriate as
behavioral problems may manifest differently across time (Willoughby, 2003).
Behavioral Problems
Attention Deficit/Hyperactivity Disorder (ADHD) is one behavioral problem that has
received significant attention in both classroom and research settings because of its
potentially adverse effects on academic outcomes and classroom functioning (American
Correspondence concerning this article should be addressed to David J. Purpura ([email protected]) or Christopher J. Lonigan,
Ph.D. ([email protected]), Department of Psychology, Florida State University, Tallahassee, FL 32306-1270..
Purpura and Lonigan Page 2
Psychiatric Association, 2000). The two primary domains of behavior that define ADHD are
inattention and hyperactivity/impulsivity. Approximately 1.5% of girls and 3% of boys in
preschool display clinically significant ADHD symptoms (Cuffe, Moore, and McKeown,
2005). Although the diagnostic stability of an ADHD in preschool children is high after
three years (Lahey, Pelham, Loney, Kipp, Ehrhardt, Lee, et al., 2004), the specific subtype
diagnosis is unstable over the same time period, indicating that it may be best to examine
these domains on a continuum, rather than in diagnostic categories (Lahey, Pelham, Loney,
Steve, & Wilcutt, 2005)
Other behaviors associated with ADHD, such as oppositional behaviors, often pose a
challenge in the classroom because of their adverse effects on classroom functioning.
Disruptive and defiant attitudes and actions can hinder class activities and make learning
difficult for both the child with disruptive behaviors and other children in the classroom. The
time teachers spend focusing on correcting disruptive and oppositional behaviors takes away
from time that could be spent achieving academic goals.
Conners’ Teacher Rating Scale

The Conners’ Teacher Rating Scale (CTRS; Conners, 1969, 1997a, 1997b) is a commonly
used measure of behavioral problems associated with ADHD, which originally was
developed as a measure of behavioral change for pharmacological studies (Conners, 1969).
The primary version of the CTRS is a 59-item form (CTRS-R:L; Conners, 1997a) that is
comprised of six scales (Oppositional, Cognitive Problems/Inattention, Hyperactivity,

Anxious-Shy, Perfectionism, and Social Problems) as well as an ‘ADHD Index’ score, a
‘DSM-IV: Inattention’ score, and a ‘DSM-IV: Hyperactivity’ score. Several abbreviated
forms exist including a 28-item short form (Goyette, Conners, & Ulrich, 1978) and a revised
short-form (CTRS-R:S; Conners, 1997b), which is also 28 items (sixteen overlap with the
original short-form). The CTRS-R:S has three scales (Oppositional, Cognitive Problems/
Inattention, and Hyperactivity) and an ‘ADHD Index’ scale. Two other measures are the
IOWA Conners (Pelham, Milich, Murphy, & Murphy, 1989), which is 10 items long and has
two scales (Inattention/Overactivity and Aggression) and the Abbreviated Symptom
Questionnaire (Sprague & Sleator, 1973), which also has two scales (Restless/Impulsive and
Emotional Lability; Parker, Sitarenios, and Conners, 1996).
Measurement Concerns
As the use of the CTRS has become more common in classroom and research settings,
structural and logistical problems in the effective use of the measure have become more
salient. The three major areas of concern are the factor structure of the measure, the item
composition within each factor, and the length of the CTRS. In utilizing a measure of
behavioral problems for research, it is important that the factor structure is clearly defined
and appropriate for measuring the targeted constructs. Inattention, Hyperactivity/
Impulsivity, and Oppositional behaviors are the three factors that are the most logical and
necessary factors to measure because they directly map onto the ADHD and oppositional
spectrum of behaviors in the Diagnostic and Statistical Manual of Mental Disorders 4th
Edition--Text Revision (DSM-IV-TR; APA, 2000). The CTRS-R:L and the CTRS-R:S both
contain scales that are intended to measure Inattention, Hyperactivity, and Oppositional
behavior. However, the other two brief measures (ASQ and IOWA-Conners) contain scales
that are not clear measures of DSM-IV-TR disorders and thus, limit their use in research.
The item composition of each of these three primary scales, specifically regarding the
Inattention scale, is a key concern when using these measures for assessing behavioral
problems in preschool children. Several of the items on the inattention scales of the CTRS-
R:L and CTRS-R:S, are measures of academic competence that may be related to inattention
in children at older ages. Specifically, three of these items (“poor in spelling,” “not reading
up to par,” and “poor in arithmetic”) are not appropriate measures of any behavioral
problems in a preschool population (Gerhardstein, et al., 2003) and lack face validity as
measures of inattention. Thus, the CTRS-R:L and the CTRS-R:S inattention scales lack
validity for use with preschool children.
The third major concern with the current versions of the CTRS is the length. With the
significant increase in early education research over the last 15-20 years (Administration on
Children, Youth and Families, 1997; NICHD, 2000) and the accumulation of research
indicating that behavioral problems are negatively associated with academic functioning
(Hinshaw, 1992; Spira & Fischel, 2005), it is necessary to measure behavioral problems in
this type of research. However, the addition of behavioral measures to assessment batteries
can be difficult due to teacher time-shortages and cost. The long version of the CTRS
typically takes 15 to 20 minutes to complete and the short form typically takes 5 to 10
minutes to complete. In a preschool classroom of 10 children, it would take a preschool
teacher approximately between 2.5 hours and 3.5 hours to complete the long-form of the
CTRS and approximately 1 hour and 1.5 hours to complete the short-form. Due to teacher
shortages and extensive teaching requirements, the workday for teachers is limited in non-
scheduled time (Darling-Hammond, 2000). Having a small amount non-scheduled time
leaves little room for teachers to spend time formally evaluating children’s behavior by
completing lengthy forms for screening or research purposes. When teachers do have the
time to complete these measures for research purposes, they must be compensated for their
time. The already high costs of conducting large-scale early education research often limit
the additional funding that can be spent on behavioral measures. These concerns often result
in many researchers opting not to include the behavioral assessment in their study. Not
collecting this type of data may leave significant gaps in the empirical knowledge of
children’s behavior and its relation to their academic development.
To conduct high quality research, it is necessary not only to collect complete data sets, but
also to ensure that measurement of the constructs are valid in all populations being assessed.
These item content and length concerns can be resolved through the application of Item
Response Theory (IRT) to the CTRS, both ensuring that items provide the maximum
amount of information concerning the three behavioral domains and reducing the length of
the scale without a the loss of construct relevant information.
Item Response Theory

An empirical analysis of the structure and content of the CTRS is needed to arrive at a
revised version of the scale that maximizes discriminating power in each behavioral domain.
IRT, introduced by Lord and Novick (1968a), is a tool that is well-suited to such research.
IRT is a model-based method of latent trait measurement that relates the amount of
individual’s latent ability or attribute to the probability of endorsing an item (Hambleton,
Swaminathan, & Rogers, 1981). IRT allows researchers to select items based on item-level
characteristics (difficulty of the item and the items ability to discriminate between
individuals with latent trait scores above and below the item difficulty). Specifically,
multidimensional item response theory, which is used to model the relationships between
two or more unobservable variables within one measure, is necessary to examine the
structure of the CTRS.
In Classical Test Theory (CTT), the true score of the entire test is used to define ability;
however, with IRT, the individual responses and item functioning are used to define ability.
The term “ability” is typically used to refer to the “latent traits” being studied, largely
because of the extensive use and development of IRT within the educational field.
Development of assessment measures using CTT has limited effectiveness because it is
population dependent, and the standard error of measurement is averaged across the
spectrum of ability levels (Hambleton, Swaminathan, & Rogers, 1981). IRT not only
eliminates these limitations, but also informs the test constructor as to the most optimal way
to maximize the discriminating power of a measure across the full range of behavior.
Parameters within an IRT analysis allow selection of items with high discriminating power
across a range of the latent trait that is measured. When guessing is not factored into
response patterns, IRT models have parameters for both individual person ability and item
functioning. The parameters that describe item functioning (assuming no guessing) are
referred to as the “a” parameter and the “b” parameter. The “b” parameter is also called the
“difficulty parameter” because it measures the difficulty of an item along the ability
continuum. In a four option Likert scale, such as the CTRS, there are three “b” parameters;
b1, b2, and b3. These are the points along the ability spectrum at which a specific response
option would be endorsed fifty percent of the time for an individual with a given ability. The
“a” parameter is also called the “discrimination parameter” because it is a measure of how
well an item differentiates between individuals above and below that point on the ability
continuum. Elevated “a” values suggest items have strong discriminating abilities at a given
point along the behavioral spectrum.
Through the use of these parameters, Item Information Functions (IIF), which show the
amount of information obtained from an individual item at all points across the spectrum of
behavior, can be developed. IIFs show the ability of an item to provide information across
the behavioral spectrum. The sum of the IIFs from a test is the Test Information Function
(TIF). Two different types of tests can be developed using IIFs and TIFs. The first type of
test is one in which categorizing individuals is desired, such as for screening measures.
Items with a narrow range of difficulty scores, surrounding the point at which group
discrimination is desired, are selected for this type of measure. Items with a range of
difficulty parameters can be selected to develop a broad abilities test, one with which it is
possible to measure comprehensively a specific latent trait over a large range of ability. This
type of test is predominantly used when the ability of interest is dimensional in nature such
as measuring children’s behavior.
Current Study
Current versions of the CTRS are inappropriate for use with preschool-age children in
classrooms because of the factor structure of the measure, the item composition of one or
more scales, or the length of the measure. Changes in the use of the CTRS have dictated that
changes be made in its structure to facilitate ease of use as well as to increase its
effectiveness. Therefore, the goal of this study was to construct a measure of behavioral
problems (Inattention, Hyperactivity/Impulsivity, and Oppositional behaviors) most closely
associated with DSM-IV-TR behavioral problems that was brief, psychometrically sound,
and appropriate for use with preschool children. This study was designed to achieve this
goal through the following three-step process: First, to estimate the information each item
provided to its respective scale. Second, to remove any items that did not provide adequate
information about their respective behavioral scales. Third, to select five items per
behavioral domain that maximized the discriminating power of each of the scales across the
full range of behavior.
Method
Participants
Data were collected in public and private preschools serving children from low- to upper
middle-socioeconomic statuses as part of two larger studies. Children ranged in age from 25
months to 74 months, with a mean age of 51.35 months (SD = 8.52 months). Of the 669
participants, 44.4% were identified as African American, 45.4% Caucasian, 10.2% other.
The sample was 53.7% boys and 46.3% girls. Parental consent was obtained for each child
prior to the start of the assessment.
Measures
Conners’ Teacher Rating Scale—Classroom teachers reported their observations of
children’s behavior, using a 44-item hybrid version of the Conners’ Teacher Rating Scale
(CTRS). The hybrid version was constructed by combining the 28 items from the CTRS-R:S
with the non-overlapping items from the original CTRS short-form (for a more detailed
description of the formation of this version, see Gerhardstein, et al., 2003). For preschool
children, the hybrid CTRS yields a three-factor model of behavior: Inattention,
Hyperactivity/Impulsivity, and Opposition. Teachers rated how often a child exhibited the
behavior indexed by each item on a scale of 0 (not at all) to 3 (frequently). Three items on
this measure (Items 29, 34, and 41) are related to academic performance (“poor in spelling”,
“not reading up to par”, and “poor in arithmetic”) and do not load on any of the three factors
(Gerhardstein et al., 2003). These three items were not included in any data analysis.
ADHD Rating Scale-IV: School Checklist—The ADHD Rating Scale-IV: School

Checklist was completed by an intervention instructor for a sample of 268 children from one
of the larger projects. These instructors were individuals who were either working towards
or had completed an undergraduate degree in psychology, communication disorders, special

education, or a related field. These instructors spent 20 minutes per day, five days per week,
for a period of three months, with each child in small group settings. This measure assesses
each of the 18 DSM-IV-TR criteria for ADHD (9 inattention items, 6 hyperactivity items,
and 3 impulsivity items). Intervention instructors rated how often a child exhibited the
behavior indexed by each item on a scale of 0 (never or rarely) to 3 (very often).
Data Analysis Procedure

A multidimensional IRT model was constructed to assess the item functioning within the
context of the three correlated scales. Other dimensions of model fit were not assessed
because much of the data used in this study also were used in Gerhardstein et al. (2003) in
which the three-factor model was found to be the best-fitting model. Item parameters for the
41 CTRS items were calculated using Mplus version 4.1 (Muthen, & Muthen, 2005).
Five items from each scale were targeted for inclusion in the revised CTRS. Item selection
was conducted based on a four-step procedure set forth by Lord (1977). These steps were,
(1) select the shape of the desired TIF, (2) select items that contribute unique information to
the TIF, (3) calculate the TIF, and (4) compare the actual TIF to the target TIF and if they
are not comparable, repeat steps 2 and 3. To accomplish the first step, a broad abilities test
was selected. In classroom settings, children’s behavioral problem levels may span the entire
spectrum of behavioral problem functioning. In the second step, items for each scale were
organized into five groups based on their b parameters, and the item that was best able to
discriminate between individuals of different ability levels was selected. The third step was
accomplished by utilizing Samejima’s graded response model (Samejima, 1969), an IRT
model specifically designed for Likert type scales, using MODFIT (Stark, 2001). In the
fourth step, if the actual TIF did not compare adequately to the target TIF then one or more
items were replaced with other items that had not been selected during the second step. Item
replacement and TIF comparison was repeated until the actual and target TIF were
maximally comparable.
After test construction was complete, it was necessary to compare the revised measure to
other, more established measures of behavioral problems. The three behavioral scales were
compared to their respective scales on the hybrid CTRS. Because the hybrid version of the
CTRS included all the items from the CTRS-R:S, scores for that measure were also
compared to the revised CTRS. Additionally, a sample of the children in this study had also
been rated on the inattention and hyperactivity/impulsivity factors of the ADHD Rating
Scale. These scores were also compared to the revised CTRS. Missing data for these
comparisons were accounted for through multiple imputation using NORM Version 2.03
(Schafer, 2000).
Results
Item parameters for each of the 41 items are shown in Table 1. Four Inattention items (Items
9, 16, 17, 21), one Hyperactivity/Impulsivity item (Item 20), and one Opposition item (Item
6) marginally fit their respective scales (i.e., had a parameters below .750) and were not
used in item selection. TIFs for the hybrid CTRS are shown in panel 1 of Figure 1. The
hyperactivity/impulsivity scale provided almost twice as much information at its peak than
the other two scales, because it is comprised of more items. All three scales had Standard
Error (SE) values below .5, which suggests that the hybrid CTRS provided adequate
information across the ability continuum (Hambleton et al., 1981).
As can be seen in Table 1, several items within each scale had comparable a and b
parameters. These results suggested that more items could be removed from the scales
without reducing the ability of the scale to discriminate across the behavioral spectrum.
Using the previously mentioned four steps of test construction, a short version of the CTRS
for preschool children was constructed. Five items were selected for each scale based on the
unique information they provided to the scale as well as their ability to discriminate
individuals at a variety of levels of behavior. The TIFs formed by each of the three 5-item
scales equated to the target TIF (see panel 2 of Table 1). The standard error of all three
revised scales was less than .5, which is in the acceptably low range, across the spectrum of
behavior (Hambleton, et al., 1981).
The Inattention scale was comprised of 11 items from the hybrid CTRS. Of the 7 well-fitting
items, five items that provided unique discrimination abilities were selected for the final
behavioral scale. Three items (Items 23, 26, and 39) each had comparable b parameters
however; item 26 was the best fit to the revised scale, and it provided more unique
information at the upper end of the behavioral spectrum than did the other two items. The
other four items selected provided adequate information in the lower and middle ranges of
the behavioral spectrum. The final inattention scale was comprised of Items 18, 24, 26, 35,
and 44.
Nineteen items from the hybrid CTRS formed the Hyperactivity/Impulsivity scale. The 18
well-fitting items were separated into five groups based on their b parameters. The first
group, lowest b parameters, consisted of only Item 1. This item was well suited for inclusion
in the final item scale. The second group (Items 3, 7, 8, 19, 30, 33, 38, and 42) was
equivalent in terms of a parameters. However, Item 30 provided the most unique
information for the overall needs of the five item scale. In group three (Items 2, 13, 14, and
37), Item 13 provided the most unique information to the scale. In the fourth group (Items
15, 28, and 43), and Item 43 was the best fitting item for the scale. The fifth group was
composed of Items 32 and 40. Both items had comparable b parameters, but Item 40 had a
higher a parameter and was the better overall item for the scale. The revised Hyperactivity/
Impulsivity scale was comprised of Items 1, 13, 30, 40, and 43.
Eleven items from the hybrid CTRS formed the Opposition scale. The 10 well-fitting items
were separated into five groups based on their b parameters. The first group, the one with
the lowest b parameters, consisted of only Item 10. This item was well suited for inclusion
in the final item scale. In the second group (Items 4 and 11), Item 11 provided the most
unique information for the overall needs of the five item scale. In group three (Items 12 and
25), item 25 provided the most unique information to the scale and also had greater potential
for discrimination than Item 12. In the fourth group (Items 5, 22, 27, and 36), Item 22 was
the best fitting item for the scale. Item 31 was the only item in the fifth group, and it
provided sufficient unique information to be included in the scale. The revised Oppositional
scale was comprised of Items 10, 11, 22, 25, and 31.
The revised 15-item CTRS is shown in Appendix A. Items 1-5 represent Hyperactivity/
Impulsivity; Items 6-10 represent Inattention; and Items 11-15 represent Opposition. The
revised CTRS scales were compared to the CTRS-R:S scales, the original hybrid CTRS
scale, and the ADHD Rating Scale-IV. Factor correlations between the scales are presented
in Table 2. The 5-item scale for Hyperactivity/Impulsivity was significantly correlated with
the other two Hyperactivity/Impulsivity scales (CTRS-R:S, r = .94, p < .001; Hybrid CTRS,
r = .94, p < .001). The 5-item scale for Inattention was significantly correlated to the other
two Inattention scales (CTRS-R:S, r = .32, p < .001; Hybrid CTRS, r = .92, p < .001). The
5-item scale for Oppositional behavior was significantly correlated to the other two
Oppositional scales (CTRS-R:S, r = .91, p < .001; Hybrid CTRS, r = .96, p < .001).
Due to the significant difference between correlations on the Inattention measures, it was
necessary to compare them both to an independent measure of inattention (ADHD Rating
Scale-IV: School Checklist). The 15-item CTRS inattention scores were significantly
correlated to the ADHD inattention criteria (r = .18, p < .001) but, the CTRS-R:S inattention
scores were not significantly correlated to the ADHD inattention scale (r = .06, p = .310 for
the CTRS-R:S). The Hyperactivity/Impulsivity scales were also compared to the ADHD
Rating Scale-IV: School Checklist Hyperactivity/Impulsivity scale. Both the 15-item CTRS
scale (r = .22, p < .001) and the CTRS-R:S scale (r = .24, p < .001) were significantly
correlated with the ADHD Rating Scale. Tests for differences in correlated correlations were
examined, and they indicated no significant differences between the scales, indicating that
both the revised scale and the CTRS-R:S scale comparably correlate with the DSM-IV-TR
hyperactivity/impulsivity criteria.
Lastly, because the sample population was not racially representative of a national sample, a
differential item functioning (DIF) analysis was necessary to ensure that the items did not
have variable difficulty parameters as a function of ethnicity. The items on the hybrid CTRS
were used for this analysis. A DIF model using the mean DIF as a reference was utilized in
this analysis. No significant DIF was found for any items on any of the scales.
Discussion
The primary goal of this study was to develop a revised CTRS (CTRS-15) for preschool
children that would enhance research and screening capabilities. Utilizing IRT, five items
for each of the three behavioral subscales were selected based on each item’s unique
contribution to its respective TIF. The revised hyperactivity/impulsivity and oppositional
behavior scales performed comparable to other well established scales. The revised
inattention scale was more highly correlated to the DSM-IV-TR inattention criteria for than
was the CTRS-R:S inattention scale. The revisions made to the CTRS have resulted in a
brief, psychometrically sound, measure of behavioral problems that is appropriate to use
with preschool children.
Past attempts to develop a brief measure of behavioral problems (CTRS-R:S; Conners,

1997b; Goyette, Conners, Ulrich, 1978; Pelham, Milich, Murphy, & Murphy, 1989; Sprague
& Sleator, 1973), have lacked either appropriate scale structures or item content for young
children. In this study, the three behavioral scales on the CTRS-15 mapped directly on to
behavioral domains found in the DSM-IV-TR and the specific items selected for inclusion
reflected those scales appropriately for preschool children. The direct relation between the
CTRS-15 and the DSM-IV-TR domains enables researchers to integrate their research more
efficiently to the existing literature than could be done with other measures.
Implications for Research, Policy, and Practice

The efficient nature of the CTRS-15 makes inclusion of this measure in large-scale
classroom studies more practical. The shorter amount of time necessary to complete this
measure, compared to other comparable measures, may reduce teachers’ apprehension
towards participating in studies that include behavioral measures. Further, the brevity of this
measure, coupled with the removal of minimally informative questions from the scale, may
help to reduce the amount of missing or incomplete data. These scales enable researchers to
examine the effects of each behavioral domain on other variables, such as academic
performance, as well as the effects of other variables on each behavioral domain in an
efficient manner. Additionally, due to this measure’s direct relation to DSM-IV-TR
behaviors, teachers could use the CTRS-15 as a screening tool to refer children with
potential behavior problems for further evaluation.
Limitations
Prior to formal implementation of the CTRS-15, a few concerns may need to be addressed.
Although the purpose of this study was to develop a psychometrically sound behavioral
assessment measure for preschool children, it may be wise to examine whether items on the
CTRS vary in both difficulty and discrimination properties as a function of age. It may
become evident that one item that is a good measure of inattention in preschool children
may not be as informative at older ages. The same is also true in the reverse direction, where
an item which was a very poor measure of inattention in preschool, such as one related to
academic performance, may be much more informative as high academic performance
becomes more expected of children. Whereas inattention may negatively impact academic
performance, such items are indirect indicators of the construct of interest. Moreover, there
are many possible reasons for poor academic performance, only one of which may be
problems of attention. It is necessary to examine the developmental continuum of behavioral
problems, as it is evident behavioral problems are malleable (Anastopoulos, Shelton,
DuPaul, & Guevremont, 1993) and change with age (Lahey et al. 2004). Research that
specifically investigates the CTRS item properties for older children would be a valuable
asset to the area of behavioral measurement after the preschool period.
A second area that must be addressed is the potential for items to function differently
without the presence of other items from the original scale. That is, the CTRS-15 should be
validated on another sample of preschool children to ensure that the items function in the
same manner as demonstrated in this study. Based on IRT theories of local item
independence, it is understood that the items on rating scales are generally independent from
influence by other items (Lord & Novick, 1968b); however, it would be prudent to validate
the supposed independence of the selected items. Future research can minimize the impact
of both areas of limitation through conducting further use of IRT models on the CTRS for
other age groups, as well as validating the CTRS-15 on another sample of preschool children
and cross-validating this measure with other types of inattention measures.
A final area of interest raised by this study is the stability of the relation between inattention
and academic problems in children. A substantial body of research has indicated that high
levels of inattention are related to lower academic performance (Frick, et al., 1991; Lonigan,
et al., 1999; Willcutt & Pennington, 2000). However, the overlap between items that directly
measure inattention and academic performance on behavioral rating scales may have created
an artificial relation due to lack of discriminant validity of these measures. The relation
between these two domains should be reexamined utilizing multiple measures of inattention,
including the CTRS-15, to delineate between the direct effects, if any, of inattention on
academic performance and the artificial effects resulting from inefficient measurement.
Conclusion
In conclusion, the results of this study indicate that the CTRS can be reduced in length with
an enhanced ability to discriminate effectively across the behavioral spectrum. The
CTRS-15 may, in fact, be more accurate than other versions of the CTRS because items that
were only marginally informative or inappropriate for use with preschool children were
removed, reducing potential measurement error. Further, the practical benefits derived from
the CTRS-15, such as the reduced length of the measure, may increase the use of the
measure in research conducted in classrooms as well as potentially increase teacher
compliance in such research. Therefore, the use of the CTRS-15 as a behavioral measure in
research studies within classrooms may add valuable knowledge to the fields of behavioral
and education research, as well as contribute to the investigation of the relation between
these two areas.
Acknowledgments
This work was supported by grants from the National Institute of Child Health and Human Development
(HD38880, HD30988) and the Institute of Education Science, U.S. Department of Education (R305B04074). Views
expressed herein are solely those of the authors and have not been reviewed or cleared by the grantors. We thank
Christopher Schatschneider for his helpful comments and guidance.
Appendix
Conners Teacher Rating Scale - 15
Not True Just a Little Pretty Very Much

at All True Much True
Never, Occasionally True Very Often,
Seldom Often, Quite Very Frequent
a Bit
1. Restless in the “squirmy” sense 0 1 2 3

2. Restless, always up and on the go 0 1 2 3
3. Cannot remain still 0 1 2 3
4. Runs about or climbs excessively in situations 0 1 2 3

where
it is inappropriate
5. Has difficulty playing or engaging in leisure 0 1 2 3

activities quietly
6. Fails to finish things that s/he starts 0 1 2 3
7. Inattentive, easily distracted 0 1 2 3
8. Forgets things she/he has already learned 0 1 2 3
9. Short attention span 0 1 2 3
10. Does not follow through on instructions and 0 1 2 3

fails to
Not True Just a Little Pretty Very Much

at All True Much True
Never, Occasionally True Very Often,

Seldom Often, Quite Very Frequent
a Bit
finish schoolwork (not due to oppositional
behavior or
failure to understand instructions)
11. Pouts and sulks 0 1 2 3
12. Mood changes quickly 0 1 2 3
13. Uncooperative 0 1 2 3
14. Defiant 0 1 2 3
15. Spiteful or vindictive 0 1 2 3
References
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Performance Measures. U.S. DHHS; Washington, D.C.: 1997. Head Start Bureau.
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Figure 1.
In panel 1, the Test Information Functions for full behavior scales show the amount of
information provided by each behavior scale across the behavioral spectrum. Each behavior
scale, prior to removal of poor fitting and extraneous items, appears to be close to a normal
curve except each scale provides a varying amount of total information. In panel 2, the
Target Information Function and Test Information Functions of Revised Scales are
presented. Each behavior scale, after being reduced to five items each, appears to
approximate the normal curve and provides comparable information to the other two scales
as well as the Target Test Information Function.
Table 1
Discrimination parameters (“a” parameters) and Difficulty parameters (“b” parameters) for each item within
each behavior factor.
Item a SE b1
Inattention
Item 9 – Daydreams 0.634 0.031 0.423
Item 16 - Appears to be easily led by other children 0.682 0.025 −0.314
Item 17 - Appears to lack leadership 0.705 0.025 0.060
Item 18* - Fails to finish things that s/he starts 0.849 0.015 0.261
Item 21 - Easily frustrated in efforts 0.705 0.026 0.233

Item 23 - Difficulty in learning 0.846 0.018 0.649
Item 24* - Inattentive, easily distracted 0.905 0.012 −0.109
Item 26* - Forgets things she/he has already learned 0.803 0.022 0.672
Item 35* - Short attention span 0.890 0.013 0.002
Item 39 - Lacks interest in schoolwork 0.773 0.024 0.766
Item 44* - Has difficulty engaging in leisure activities quietly 0.858 0.018 0.528
Hyperactivity/Impulsivity
Item 1* - Restless in the “squirmy” sense 0.888 0.010 −0.356
Item 2 - Makes inappropriate noises when s/he shouldn’t 0.864 0.011 0.228
Item 3 - Demands must be met immediately 0.786 0.013 −0.028
Item 7 - Distractibility or attention span a problem 0.847 0.014 −0.138
Item 8 - Disturbs other children 0.870 0.026 0.030
Item 13* - Restless, always up and on the go 0.924 0.019 0.122
Item 14 - Excitable, impulsive 0.875 0.011 0.074

Item 15 - Excessive demands for attention 0.812 0.021 0.339
Item 19 - Childish and immature 0.758 0.020 0.008
Item 20 - Denies mistakes or blames others 0.685 0.022 0.032
Item 28 - Is always “on the go” or acts as if driven by a motor 0.903 0.013 0.350
Item 30* - Cannot remain still 0.929 0.019 −0.057
Item 32 - Leaves seat when remaining seated is expected 0.812 0.016 0.536
Item 33 - Fidgets with hands or feet or squirms in seat 0.886 0.009 −0.038
Item 37 - Only pays attention to things he/she is really interested in 0.782 0.008 0.119
Item 38 - Has difficulty waiting his/her turn 0.814 0.015 −0.065
Item 40* - Runs about or climbs excessively 0.889 0.017 0.504
Item 42 - Interrupts or intrudes on others 0.821 0.013 −0.061
Item 43* - Difficulty playing or engaging in leisure activities quietly 0.827 0.018 0.342
Oppositional Defiant Behaviors

Item 4 - Acts “smart” (impudent or sassy) 0.833 0.034 0.335
Item 5 - Temper outbursts and unpredictable behavior 0.882 0.008 0.542
Item 6 - Overly sensitive to criticism 0.536 0.018 −0.082
Item 10* - Pouts and sulks 0.822 0.015 0.045
Item a SE b1
Item 11* - Mood changes quickly 0.873 0.018 0.408

Item 12 – Quarrelsome 0.898 0.015 0.447
Item 22* - Uncooperative 0.928 0.008 0.487
Item 25* - Defiant 0.946 0.013 0.433
Item 27 - Actively defies or refuses to comply with adults’ requests 0.942 0.009 0.476
Item 31* - Spiteful or vindictive 0.841 0.015 0.864
Item 36 - Argues with adults 0.870 0.021 0.564
*
Note. Indicates item was selected for the CTRS-15.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Table 2
Correlations between between rating scales within each behavioral domain.
View publication stats

Behavioral Domain/Scale
Behavioral Domain/Scale 1 2 3 4 5 6 7 8 9 10
Inattention
Purpura and Lonigan
1. CTRS-15 − − − −
2. CTRS-R:S .32* − − −
3. Hybrid CTRS .92* .34* − −
4. ADHD-IV Rating Scale .18* .06 .20* −

Hyperactivity/Impulsivity
5. CTRS-15 −
6. CTRS-R:S .94* −
7. Hybrid CTRS .94* .96* −
8. ADHD-IV Rating Scale .20* .22* .24* −

Opposition
9. CTRS-15 −
10. CTRS-R:S .91* −
11. Hybrid CTRS .96* .94*
*
Indicates correlation is significant at p < .001.
Page 15

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Article in Journal of Clinical Child & Adolescent Psychology · April 2009

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J Clin Child Adolesc Psychol. 2009 March ; 38(2): 263–272. doi:10.1080/15374410802698446.

Conners’ Teacher Rating Scale for Preschool Children: A

Conners’ Teacher Rating Scale

comprised of six scales (Oppositional, Cognitive Problems/Inattention, Hyperactivity,

Item Response Theory

prior to the start of the assessment.

ADHD Rating Scale-IV: School Checklist—The ADHD Rating Scale-IV: School

or had completed an undergraduate degree in psychology, communication disorders, special

Data Analysis Procedure

Past attempts to develop a brief measure of behavioral problems (CTRS-R:S; Conners,

Implications for Research, Policy, and Practice

asset to the area of behavioral measurement after the preschool period.

these two areas.

Conners Teacher Rating Scale - 15

Not True Just a Little Pretty Very Much

1. Restless in the “squirmy” sense 0 1 2 3

2. Restless, always up and on the go 0 1 2 3

3. Cannot remain still 0 1 2 3

4. Runs about or climbs excessively in situations 0 1 2 3

5. Has difficulty playing or engaging in leisure 0 1 2 3

6. Fails to finish things that s/he starts 0 1 2 3

7. Inattentive, easily distracted 0 1 2 3

8. Forgets things she/he has already learned 0 1 2 3

9. Short attention span 0 1 2 3

10. Does not follow through on instructions and 0 1 2 3

Not True Just a Little Pretty Very Much

Never, Occasionally True Very Often,

11. Pouts and sulks 0 1 2 3

12. Mood changes quickly 0 1 2 3

15. Spiteful or vindictive 0 1 2 3

Rating Scale – Short Form in a low-income preschool sample. Journal of Psychoeducational

2003; 44:88–106. [PubMed: 12553414]

each behavior factor.

Item 21 - Easily frustrated in efforts 0.705 0.026 0.233

Item 24* - Inattentive, easily distracted 0.905 0.012 −0.109

Item 35* - Short attention span 0.890 0.013 0.002

Item 39 - Lacks interest in schoolwork 0.773 0.024 0.766

Item 1* - Restless in the “squirmy” sense 0.888 0.010 −0.356

Item 13* - Restless, always up and on the go 0.924 0.019 0.122

Item 14 - Excitable, impulsive 0.875 0.011 0.074

Item 30* - Cannot remain still 0.929 0.019 −0.057

Item 40* - Runs about or climbs excessively 0.889 0.017 0.504

Item 42 - Interrupts or intrudes on others 0.821 0.013 −0.061

Oppositional Defiant Behaviors

Item 10* - Pouts and sulks 0.822 0.015 0.045

Item 11* - Mood changes quickly 0.873 0.018 0.408

Item 12 – Quarrelsome 0.898 0.015 0.447

Item 22* - Uncooperative 0.928 0.008 0.487

Item 25* - Defiant 0.946 0.013 0.433

Item 31* - Spiteful or vindictive 0.841 0.015 0.864

Item 36 - Argues with adults 0.870 0.021 0.564

View publication stats

3. Hybrid CTRS .92* .34* − −

4. ADHD-IV Rating Scale .18* .06 .20* −

7. Hybrid CTRS .94* .96* −