DSM-5 UPDATE

™

C. Keith Conners, Ph.D.

DSM-5 UPDATE

Contact MHS 1-800-456-3003 (U.S.) 1-800-268-6011 (Canada) +1-416-492-2627 (International) [email protected] www.mhs.com

This update was edited and typeset by David Wiechorek using InDesign CS6 and Microsoft Word 2010, using the Times New Roman, Arial, Verdana, and Myriad Pro fonts. The cover was designed by Dyan Buerano using Adobe InDesign CS6 and Adobe Illustrator CS6. Conners 3rd Edition, Conners 3, CRS–R, and QuikScore are trademarks of Multi-Health Systems Inc. DSM, DSM-IV, DSM-IV-TR, and DSM-5 are trademarks of the American Psychiatric Association. Copyright © 2014 Multi-Health Systems Inc. All rights reserved. No part of this technical report, or any related materials protected by copyrights are to be printed or otherwise reproduced by any means, including electronic storage within a computer program or database, without the permission of the publisher. These materials may not be translated into a natural or computer language without permission. This copyright is protected through the laws of the United States, Canada, and other countries. Persons who violate the copyrights on these materials may be liable to prosecution. Ethical codes of various professional associations to which users are likely to belong specifically prohibit both illegal behaviors and actions that would deny other parties fair compensation for their work. Persons who violate professional ethical codes related to inappropriate and unfair use of these materials may be brought before the relevant professional associations to which they belong. The information included in this technical report does not constitute, and shall not be considered, the advice, recommendation, assessment, or endorsement of MHS. To the extent permitted by law, any statutory or implied warranty of merchantability or fitness for a particular purpose is completely denied and disclaimed. MHS shall not be liable for any third party claims, lost profits, lost savings, loss of information, or any other incidental damages or other economic consequential damages resulting from the use of the technical report. Published in Canada by Multi-Health Systems Inc. Printed in Canada. January, 2014

Conners 3rd Edition™ (Conners 3™) DSM-5 Update C. Keith Conners

Overview The Conners 3rd Edition™ (Conners 3™), a revision of the Conners’ Rating Scales–Revised (CRS–R; Conners, 1997), included a number of new features. One of these new features was direct links between scale content on the full-length forms (i.e., Conners 3–Parent [Conners 3–P], Conners 3 –Teacher [Conners 3–T], and Conners 3–Self-Report [Conners 3–SR]) and symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association [APA], 2000), for Attention-Deficit/Hyperactivity Disorder (ADHD), and its most common comorbid disorders, Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). A new edition of the DSM was released in May, 2013: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; APA, 2013). Accordingly, a review of the Conners 3 Manual and associated materials, including the fulllength QuikScore™ forms, the Conners 3 Software Program, and online components (e.g., the Assessment, Progress, and Comparative Reports) was undertaken in order to determine the changes required to scoring and interpretation. This update outlines the revisions to symptom criteria for ADHD, CD, and ODD made in the DSM-5, as well as any changes made to forms, scoring, and interpretative considerations in the Conners 3. Much of what is required for administration, scoring, and interpretation of this assessment is still found in the Conners 3 Manual. The main computerized scoring update to the Conners 3 assessment is a report option featuring DSM-5 scoring. Correspondingly, for hand-scoring, DSM Symptom Scales on the Conners 3 QuikScore forms are updated with DSM-5 criteria. The DSM-5 scoring option incorporates the following: i.

An update to the ADHD Symptom Count for 17- to 18-year-olds;

ii. An amendment to the order of ODD Criterion A symptoms; and iii. A change to the symptom count requirements on the self-report form for ODD Criterion A8 (Note: symptom count requirements on the parent and teacher forms were not impacted by the modification to Criterion A8).

Any revisions or additions to interpretative considerations in the Conners 3 Manual and Assessment Reports (see Appendix E, Scoring DSM-IV-TR Symptom Scales in the Conners 3 Manual) are outlined in this update and printed in bold below Tables 1a through 3 (Note: The original interpretative considerations are included in this update to facilitate scoring and interpretation of the DSM-5 Symptom Scales). Further, interpretative considerations appear where relevant as notes in the Assessment Reports.

Changes to the Conners 3 Corresponding to DSM Criteria Updates Conners 3 DSM Scales are comprised of items that approximate symptom-level criteria from the DSM; full diagnostic criteria (e.g., course, age of onset, differential diagnosis, level of impairment, and pervasiveness) are not represented. (See the DSM-5 for full diagnostic criteria.) The itemized list of changes provided in this update details only those changes in the DSM-5 to ADHD, CD, and ODD symptom criteria that are measured, scored, and interpreted on the Conners 3. (Note: None of the changes to diagnostic criteria for CD impact scoring or interpretation of the Conners 3.) Only the Conners 3 full-length forms include the DSM-IV-TR Symptom Scales. As a result, any changes to scoring involve only the Conners 3 full-length forms (i.e., Conners 3–Parent [Conners 3–P], Conners 3–Teacher [Conners 3–T], and Conners 3–Self-Report [Conners 3–SR]). These can be scored by hand, software, or online (see the Conners 3 Manual for further information about scoring). For handscoring, the DSM Symptom Scales on the Conners 3 QuikScore forms are updated with DSM-5 criteria. With respect to computerized scoring, a DSM scoring option is now included that allows the assessor to choose either DSM-IV-TR scoring or DSM-5 scoring: • Reports produced using the DSM-IV-TR scoring option are identical to the original Conners 3 reports.

1

Conners 3rd Edition™ (Conners 3™)

Interpretative Considerations:

• Reports produced using the DSM-5 scoring option include DSM-5 Symptom Counts and interpretative considerations.

• Inattentive, Hyperactive-Impulsive, and Combined subtypes were reclassified as presentations in the DSM‑5.

ADHD The following is a list of changes made in the DSM-5 to the diagnostic criteria for ADHD that required corresponding updates to the Conners 3 assessment. Tables 1a and 1b show the DSM-5 criteria for ADHD, the associated Conners 3 form items, and the response choices for when symptoms are Indicated, May be Indicated, or Not Indicated.

Response Style Analysis

™

CONNERS 3 –Teacher

Scoring and Reporting Adjustments: Inconsistency Index

• The names of the Conners 3 DSM Scales for ADHD were updated to reflect this reclassification.

• A statement was added in the DSM-5 to the pre-amble for both ADHD Predominantly Inattentive Presentation (Criterion A1) and ADHD Predominantly HyperactiveImpulsive Presentation (Criterion A2) that explicitly Student's Name/ID: ___________________________ requires the diagnostician to rule out “oppositional behavior, defiance, hostility, or failure to understand Gender: M F Teacher's Name/ID: ____________ (Circle One) tasks or instructions,” as the primary causes of ADHD symptoms.

• Instructions: In the DSM-5, the symptom count was reduced for 1. For each of the following items, transfer the circled scores from the Scoring Grid into the appropriate boxes, below. Conduct Disorder • Tobelow address 2.older For eachadolescents pair of items, subtract the lower value(17 from the higher and value and write the difference in the box directly each pair.the differential diagnosis consideration and adults years older), 3. Sum the Absolute Differences to get the Inconsistency Index Total (box A). Required Score Item Item added to Criterion A1 and Criterion A2, ifDSM-5 the 4.from Write the absolute differences that are equalof to 2Inattentive or 3 in box B. 6number to 5 ofsymptoms from each and/or May be Indic Criterion Number Score 5. Insert a checkmark in the box provided if a possible inconsistent response style is indicated. Indicated Symptom Count is probably met for any of the Hyperactive-Impulsive presentations. 1 2 A1 Item Item Item Item Item Item Item Item Item Item Item Item Item Item ADHD Item Itempresentations, Item Item Item the Item assessor must rule out 98 97 100 52 63 4 77 26 29 98 105 25 57 23 44 34 89 47 71 1 2 A2 105 • Item The change to the symptom count7 for13 older these behaviors as the primary cause of theA3 ADHD 14 Score 1 2 adolescents (17–18-year-olds) is incorporated into Absolute symptoms. considerationA4 1 2 35 + + + + + + + + This interpretative + = A Difference scoring algorithms for the Conners 3 reports, such that 1 2 automatically appears in the Conners 3 Assessment A5 21 Inconsistency Index Total (A) 5 symptoms are required for the Symptom Count to 1 2 A6 27 Reports when the Symptom Count is probably Possible inconsistent response style indicated Number of Absolute 1 2 be probably met for ADHD Predominantly Inattentive  A7 33 B met for any of the ADHD presentations (see the Differences = 2 or 3 (B) if A ≥ 6 and B ≥ 2 1 2 A8 61 Presentation and ADHD Predominantly HyperactiveInterpretative Considerations for Table 1a and 1b, 10 1 2 A9 Presentation. ADHD Combined Presentation PI Impulsive and NI Scale Guidelines DSM-5 Symptom Count and Criterion Status 1 2 A10 Score 90 Instructions: requires 5 symptoms each from inattentive and 2 Requirements for ADHD). A11 40 1. Transfer the Total Raw Scores for both the Positive Impression (PI) and Negative Impression (NI) Scales from the Scoring Grid into the Raw Score column of the table, below. hyperactive-impulsive symptom For hand2. Insert a checkmark in the Interpretive Guideline box if thecriteria. response style is indicated. 1 2 A12 31 • A lifespan-specific example was added to Criterion Score Interpretive Guideline 1 2 scoring, the QuikScore Raw forms are updated to note the A15 54 A1h in the DSM-5, Total Symptom C Positive Impression (PI) different symptom count requirements  forPossible individuals positive response style indicated if Raw Score ≥ 5. illustrating how the symptom of distraction may present in older adolescents. 16 years of age 17 years of response style Negative Impression (NI) and younger, versus those  Possible negative indicated if Raw Score ≥ 5.  Symptom criteria probably met if Total Sympt age and older (see Figure 1). • An interpretative consideration is includedNOTE: in The theConners 3–T does not assess Criterion A13 (staying out at n

(sum all chec

DSM-5 Symptom Counts

or Criterion A14 (running away from home). These criteria have been int

most teachers do not have the opportunity to observe these infractions. Conners 3 Assessment Report to account for this Instructions: change (see Interpretative Considerations for Table 1a). 1. For each item number listed below, transfer the circled score from the Scoring Grid into the Item Score column.

2. If the Item Score is equal to a number in either Required Score column, circle that number in the May be Indicated or Indicated column. NOTE: Do not circle anything if the Item Score does not match any number in either Required Score column or if the item has been omitted. 3. Insert a checkmark in the () column if a score has been circled in either Required Score column. a) For ADHD Inattentive Criterion A1d, insert a checkmark only if a Required Score has been circled for both items 73 and 57. b) For ADHD Hyperactive-Impulsive Criterion A2c, insert a checkmark if a Required Score has been circled for either (or both) items 24 or 7. c) For ADHD Hyperactive-Impulsive Criterion A2e, insert a checkmark if a Required Score has been circled for either (or both) items 17 or 78. 4. Count all checkmarks and write the sum in the Total Symptom Count box. 5. Insert a checkmark in the box at the bottom of the table if the symptom criteria is probably met.

Impairment

Instructions: For each item listed in the Impairment table below, refer to the

Figure 1. referConners 3–Teacher QuikScore Form -that Symptom Requirements NOTE: Please to the Conners 3 Manual and DSM-5 Update for exceptions may alter the Count Total Symptom Count.

ADHD Inattentive

C. Keith Conners, Ph.D.

DSM-5 Criterion

Item Number

Item Score

Required Score May be Indicated

()

Indicated

DSM-5 Criterion

Item Number

Item Score

113. The student’s problems seriously affect friendship

37

2

3

A2a

4

2

111

2

3

A2b

1

2

3

2

3

73

2

3

57

2

3

A1e

103

2

3

A1f

60

A1g

92

2

3

A1h

23

2

3

A1i

88

2

3

A1d

2

BOTH items circled

3

Total Symptom Count (sum all checkmarks)

 Age < 16; Symptom criteria probably met if Total Symptom Count > 6  Age > 17; Symptom criteria probably met if Total Symptom Count > 5 ADHD Combined



A2c A2d

3

24

1

2

3

7

1

2

3

2

3

32 17

1

2

3

78

1

2

3

50

2

3

A2g

9

2

3

A2h

76

2

3

A2i

29

2

3

A2e A2f

()

Indicated

A1b

69

112. The student’s problems seriously affect schoolwo

Required Score May be Indicated

A1a A1c

2

Item

ADHD Hyperactive-Impulsive

EITHER item circled

EITHER item circled

Total Symptom Count

Conners 3 ADHD Inde

Instructions: 1. For each item listed below, transfer the circled score from th 2. Transpose each score by following the Transposing Rule an 3. Sum the transposed scores to obtain the Total Transposed 4. Determine the probability of a classification of ADHD by circ Item 4

Item 7

Item 13

0, 1 2 3    0 1 2

0, 1 2 3    0 1 2

Statements for Item Score determining if 0,the 1 2 TotalTransposing Symptom   Rule 0 1 Count is probably Transposed met. Score

3  2

Total Transposed Score

0

1

2

3

4

5

Probability (%)

19

39

51

52

58

6

+

+

0

+

(sum all checkmarks)

 Age < 16; Symptom criteria probably met if Total Symptom Count > 6  Age > 17; Symptom criteria probably met if Total Symptom Count > 5

Symptom criteria probably met if symptom criteria probably met for ADHD Inattentive and ADHD Hyperactive-Impulsive

Conners 3

DSM-5 Update

CD

Scoring and Reporting Adjustments:

• Criterion A in the DSM-5 divides ODD symptom Revisions made in the DSM-5 to the diagnostic criteria for criteria into three types of behaviors, including Angry/ CD did not impact Criterion A symptoms (those symptoms Irritable Mood, Argumentative/Defiant Behavior, and assessed by the Conners 3); they are essentially identical to Vindictiveness. As a result of this change, diagnostic those printed in the DSM-IV-TR. Table 2 shows the DSM-5 Conners 3–T Assessment Report for Test Admin Date: 11/11/2013 criteria for ODD were reordered as follows: criteria for CD, the associated Conners 3 form items, and the response choices for when symptoms are Indicated, May be DSM-5 Conduct Disorder • Criterion A1 in the DSM-5 is in the same order it was Indicated, or Not Indicated. the DSM-IV-TR DSM-5 Symptoms: Criterion A Item Teacher's in Rating Criterion Status Aggression to People and Animals

Number 0

1

2

Scoring and Reporting Adjustments: A1.

98

A2.

105

A3.

14

None.

Interpretative Considerations:35 A4. A5.changes were made to the interpretative 21considerations No for CD. Table 2 includes interpretative considerations for CD A6. 27 that A7. apply to the DSM-5 Symptom Scales;33however, these notes are identical to the interpretative considerations for Destruction of Property the DSM-IV-TR Symptom Scales. The notes A8. 61are provided in this supplement to facilitate interpretation of the Symptom A9. 10 Count for DSM-5 scoring. Deceitfulness or Theft

3

?

• Criterion A2 in the DSM-5 was Criterion A6 in the DSM-IV-TR Indicated ü • Criterion A3 in the DSM-5 was Criterion A7 in the Indicated ü DSM-IV-TR Indicated ü • Criterion A4 in the DSM-5 was Criterion A2 in the Indicated ü DSM-IV-TR Indicated ü Indicated ü • Criterion A5 in the DSM-5 was Criterion A3 in the DSM-IV-TR Indicated ü • Criterion A6 in the DSM-5 was Criterion A4 in the Indicated¹ ü DSM-IV-TR Indicated¹

ü

• Criterion A7 in the DSM-5 was Criterion A5 in the DSM-IV-TR A10. 90 Indicated ü • Criterion A8 in the DSM-5 is in the same order it was A11. 40 Indicated ü ODD in the DSM-IV-TR A12. 31 Indicated ü Table 3 shows the DSM-5 criteria for ODD, the associated • In the Conners 3, symptom criteria are reordered Serious Violations of Rules Conners 3 form items, and the response choices for and ü labeled as they are in the DSM-5 (i.e., Angry/ A15. 54 Indicated² when symptoms are Indicated, May be Indicated, or Not Irritable Mood, Argumentative/Defiant Behavior, and ¹Both Criterion (fire setting) andthat Criterion A9the (destruction were indicated. In order to meet Criterion A9, Indicated. ThereA8are two changes affected reportingof property) Vindictiveness; see Figure 2) in all of the ODD tables the assessor must confirm that property was destroyed other than by fire-setting (Criterion A8). and scoring of the Conners 3 scales, and some other in the reports. Similarly, the change to the order of interpretative considerations. symptom criteria for ODD is incorporated ²In order for Criterion A15 (truancy) to be indicated the assessor needs to ensure this criterion occurred before theinto agethe of 13 years. ODD table in the DSM-5 Symptom Counts section of the QuikScore forms (see Figure 3). Note: The Conners 3–T does not assess Criterion A13 (staying out at night without permission) or Criterion A14 (running away from home), as most teachers do not have the opportunity to observe these infractions. Figure 2. Conners 3–Teacher Assessment Report - DSM-5 Symptom Table

DSM-5 Oppositional Defiant Disorder DSM-5 Symptoms: Criterion A

Angry/Irritable Mood

Item Number 0

A1.

62

A2.

56

A3.

38

Teacher's Rating 1 2 3 ?

ü ü ü

Indicated

Indicated

Indicated

Argumentative/Defiant Behavior A4.

47

A5.

71

A6.

59

A7.

64

ü ü ü ü

51

ü

Vindictiveness A8.

Criterion Status

Indicated Indicated

Indicated Indicated Indicated

Symptom criteria reordered and labeled.

3

Conners 3rd Edition™ (Conners 3™) Age: ______ ______ ______/______/________ Name/ID: _______________________________________________ Birth Date: (Circle One) Month

Day

Year

Conduct Disorder Oppositional Defiant Disorder

Item 61

Item 25

Item Number

Item A1 38

A2 +

A3

A1

67

A2

24 =

A

1

nt response style A4 indicated 3 A5

62

A6

74

e Raw Score column of the table, below.

A7

87

A8

94

Score ≥ 4.

w Score ≥ 5.

t≥3

25

A3

59 2 86

2

13

A8

72

A9

82

A10

78

1 1

3 3

47

A6

() May be Indicated

3

38

A4 A5

Inconsistency Index Total (A)

2

Day

Year

Month

Day

Year

2

3

2

3 3

A11

16 2

A12

52

A13

91 2

A14

8

A15

33

2

Oppositional Defiant Disorder

Required Score Change

1

()

toIndicated order of criteria. 2 3[Note: There are 2 3 different item 1 2 3 numbers for 1 2 3 criteria A2 to 1 2 3 A7 in table (a) 1 2 3 vs. (b)]. 2 3 1

2

3

1

2

3

2 3 to Change 1 2 3 criterion 1 2 score 3 status 1 2 3 requirements for ODD 1 2 3 Criterion Total Symptom Count A8.

3 3

Total Symptom Count

Trim parts 2, 3, 4 & 5 to 17.125 in.

Item 43

Required Score Item Item Item DSM-5 May beNumber Indicated Score ScoreCriterion Indicated

Copyright © 2008 Multi-Health Systems Inc. All rights reserved. In the United States, P.O. Box 950, North Tonawanda, NY 14120-0950, 1-800-456-3003. In Canada, 3770 Victoria Park Ave., Toronto, ON M2H 3M6, 1-800-268-6011, 1-416-492-2627, Fax 1-416-492-3343.

DSM-IV-TR Criterion

()

Month

______/______/________

(b) DSM-5 Symptom Scale

(a) DSM-IV-TR Symptom Scale

air.

Birth Date: ______/______/________

Years Months MonthQuikScore Day Year Conners 3–Self-Report Form F Grade: ______and Criterion Status Score RequirementsAdministration Date: Administration Date: Change toGender: Order ofM______/______/________ Symptom Criteria

Required Score

DSM-5 Criterion

Item Number

Item Score

A1

67

A2

74

2

3

A3

87

2

3

A4

24

2

3

A5

1

A6

3

2

3

A7

62

2

3

A8

94

2

3

May be Indicated

2

 met Symptom probably  Symptom criteria probably if Totalcriteria Symptom Countmet ≥ 4if Total Symptom Count ≥ 3

3

2

3

1

Total Symptom Count (sum all checkmarks)



()

Indicated

 Symptom criteria probably met if Total Symptom Count ≥ 4

NOTE: The Conners 3–SR does not assess Criterion A7 (forced sexual activity). This criterion has been intentionally omitted due to the sensitive nature of this criterion.

criterion

Summary

• In the DSM-5, a frequency qualifier was added to Criterion A8 of “atImpairment least twice within the past 6 Instructions: With the of the DSM-5, it was necessary to review months,” for spiteful or item vindictive behavior. items 31 or For each listed in the Impairment table below, refer to the Scoring Grid and circle the release score. dh)and circle the39. score. 1 and 17. the Conners 3 Manual and associated materials (i.e., the (or both) items 20 or 7. • 55.Criterion status score requirements are updated on the Impairment (or both) items 66 or Impairment QuikScore forms, Conners 3 Software Program, and Not true at all/ Just a little true/ Pretty much true/ Very much true/ Conners 3–SR accommodate frequency Not true at all/ Just a littleto true/ Pretty much true/the Very much true/ qualifier Item never occasionally veryneed often to online components, including reports)often to assess the never occasionally often very often added to Criterion A8 (see Figure 3). Specifically, for 0 1 Scales. This 2 review led 3to the 95. I have problems that make school really hard for me. update the DSM Symptom 0 1 2 3 or vindictive behavior to be tive-Impulsive the symptom of spiteful 1 2 3 96. I have problems that make friendships really hard for me. determination0that with some 0 1 2 3 small modifications scoring classified as May be Indicated on the Conners 3–SR, Required Score 0 1 2 Scales could 3 97. I have problems that make things really hard for me at home. 0 1 2 3 me. and interpretation of the DSM Symptom be () May be Indicateda response of 1 [Just a little true (Occasionally)] is ndicated aligned with the diagnostic criteria in the DSM-5. The required. Previously, a response of 1 was classified as 2 3 Conners 3 ADHD Index Conners 3 Manual contains most of the material required to 2 3 Not Indicated. However, it was determined that the Instructions: administer, score, 1. For itemtrue listed below, transfer the circled score from the Scoring Grid into the Item Score row. and interpret the assessment. This update 3 row. frequency of “Just a each little (Occasionally)” applies Grid into the Item2Score 2. Transpose each score by following the Transposing Rule and enter the score into each Transposed Score box. score into each 2 Transposed Score box. 3 better reporting and scoring changes, and interpretative 3. Sum the transposed to obtain the Total Transposed circle this score in the Probability Score table. to atable. behavior that meets scores symptom criteria if Score, thendetails circle this score in the Probability Score 4. Determine the probability of a classification of ADHD by circling the corresponding Probability score. 2 3 score. esponding Probability considerations that need to be taken into account when using it occurs at least twice within the past 6 months. 1 Item 2 3Item Item Item Item Item Item Item Item Item Item Item Item Item Item Item 6 63 not change 9 21 34 35 43 50 61 interpret 63 DSM-5 symptom criteria to score and the DSM Symptom did on15the 43 count50requirements 61 3 35 2 34 Item Score Symptom Scales on the Conners 3. 2 3 Conners 3–P and Conners 3–T; existing criterion 2 1 32 30, 1 2 3 0, 1 2 3 0, 1 2 3 0, 1 2, 3 0, 1 2, 3 0, 1 2 3 0, 1 2, 3 0, 1 2, 3 0, 1 2 3 0, 1 2, 3 0, 1 2, 3 0, 1 2 3 0, 1 2, 3 0, 1 2, 0, 3 1 0, 2 3 status score requirements for this frequency Transposing Ruleaccount    of                                   0 1 2 0 1 2 0 1 0 2 0 1 2 0 1 0 2 0 1 2 0 1 2 03 spiteful 2 0 or 1 2vindictive 0 1 0 2 0 10 21 2 0 1 2 behavior. Transposed Score + + + + + + + + + =

d column. s been omitted.

EITHER item circled

EITHER item circled

+

+2

3

+

+

otal Symptom Count

+

+

=

Total Transposed Score

Total

Interpretative Considerations:Transposed Score


et if Total Symptom Count > 6

• Criterion A now states that the symptoms that define Conners 3 ADHD Index Probability Score Total Transposed Score interaction must be “exhibited during with3 at least 016 117 218 4 5 6 7 8 9 10 11 6 7 8 ODD 9 10 11 12 13 14 15 Probability (%) 59 66 73 78 83 87 91 94 DHD 78 Inattentive and 73 83 one 87 individual 91 94 who 96 97 not98a sibling.” 98 26 99 35 99 44 99 52 is

et if TotalIndex SymptomProbability Count > 5 DHD Score

• To address this change, the following interpretative consideration should be taken into account when the Symptom Count is probably met for ODD: “ODD Criterion A states that symptoms must be exhibited during interaction with at least one individual who is not a sibling. If the Symptom Count is probably met for ODD, follow-up is recommended to ensure this requirement is satisfied” (see Interpretative Considerations for Table 3). This interpretative consideration automatically appears in the Conners 3 Assessment Reports when the Symptom Count is probably met. 4

12

13

14

15

16

17

18

96

97

98

98

99

99

99

Trim parts 2, 3, 4 & 5 to 17.125 in.

FigureMonths 3.

Years

Copyright © 2008, 2014 Multi-Health Systems Inc. All rights reserved. In the United States, P.O. Box 950, North Tonawanda, NY 14120-0950, 1-800-456-3003. In Canada, 3770 Victoria Park Ave., Toronto, ON M2H 3M6, 1-800-268-6011, 1-416-492-2627, Fax 1-416-492-3343.

_____ Age: ______ ______

1a

1b

1c

1d

1e

1f

1g

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized, work; has poor time management; fails to meet deadlines).

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

DSM-5 Criterion A

I have trouble keeping myself organized. Avoids or dislikes things that take a lot of effort and are not fun. Avoids or dislikes things that take a lot of effort and are not fun. I don’t like doing things that make me think hard.

SR P T SR

T SR

P

Has difficulty organizing tasks or activities.

T

Loses things (for example, schoolwork, pencils, books, tools, or toys). Loses things (e.g., schoolwork, pencils, books, tools, or toys). I lose stuff that I need.

Has trouble organizing tasks or activities.

I have trouble finishing things.

I have trouble following instructions.

P

SR

T

Has trouble keeping his/her mind on work or on play for long. Has trouble keeping his/her mind on work or play for long. I have trouble keeping my mind on what I am doing. Does not seem to listen to what is being said to him/her. Does not seem to listen to what is being said to him/her. I have trouble keeping my mind on what people are saying to me. Does not follow through on instructions (even when he/she understands and is trying to cooperate). Fails to complete schoolwork, chores, or tasks (even when he/she understands and is trying to cooperate). Does not follow through on instructions (even when he/she understands and is trying to cooperate). Fails to complete schoolwork or tasks (even when he/she understands and is trying to cooperate).

92 5

97

51

60

28

21

103

– –

–

2

2

2

2

–

–

–

–

–

–

–

1, 0 1, 0

1, 0

1, 0

1, 0

1, 0

1, 0

1, 0

1, 0

1, 0 -or1,0

1, 0 -or1,0

1, 0 -or1,0

–

2 – – – – – –

1, 0 -and1, 0 1, 0 1, 0 1, 0 1, 0 1, 0 1, 0

1, 0

1, 0 –

–

–

Not Indicated

Table continued next page...

3, 2 3, 2

3, 2

3

3

3

3

3, 2

3, 2

3, 2 -and3. 2

61 -and17 84

3, 2 -and3. 2

73 -and57

3, 2 -and3. 2

68 -and79

P

P T SR P T SR

I make mistakes by accident.

3, 2 -or3 3, 2 3, 2 3, 2 3, 2 3, 2 3, 2

31 -or39 95 111 63 35 69 42

It is hard for me to pay attention to details.

SR

3, 2

3, 2 37

Doesn’t pay attention to details; makes careless mistakes.

47

Doesn’t pay attention to details; makes careless mistakes.

Item #

T

Item

Indicated

P

Form

May be Indicated

Table 1a. DSM-5 Symptom Count and Criterion Status Score Requirements for ADHD DSM-5 Symptom Count Requirements: • ADHD Predominantly Inattentive Presentation: At least 6 of the 9 symptoms for individuals ≤ 16 years of age; at least 5 of the 9 symptoms for individuals ≥ 17 years of age. • ADHD Combined Presentation: Meets criteria for both Inattentive and Hyperactive-Impulsive presentations.

DSM-5 Update

5

6 1ha

Form

Item

101 23 77 2 88 32

Item #

Indicated

3, 2 3, 2 3 3, 2 3, 2 3

May be Indicated

– – 2 – – 2

1, 0 1, 0 1, 0 1, 0 1, 0 1, 0

Not Indicated

a

Criterion A1h states that in older adolescents, the tendency to be easily distracted by extraneous stimuli may include unrelated thoughts as the source of distraction. Follow-up is recommended to check if Criterion A1h has been met for older adolescents.

ADHD Criterion A states that symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. If the Symptom Count is probably met for ADHD Predominantly Inattentive, Hyperactive-Impulsive, or Combined Presentation, follow-up is recommended to ensure this requirement is satisfied.


The following response key applies to the criterion status score requirements noted in the Indicated, May be Indicated, and Not Indicated columns: 0 = Not true at all (Never, Seldom); 1 = Just a little true (Occasionally); 2 = Pretty much true (Often, Quite a bit); 3 = Very much true (Very often, Very frequently).

P = parent; T = teacher; SR = self-report.

Notes:

Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

P Is easily distracted by sights or sounds. T Is easily distracted by sights or sounds. SR I get distracted by things that are going on around me. P Is forgetful in daily activities. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying 1i T Is forgetful in daily activities. bills, and keeping appointments). SR I forget stuff. DSM-5 Symptom Criteria reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Copyright, 2013. American Psychiatric Association.

DSM-5 Criterion A

Table 1a. (Continued) DSM-5 Symptom Count and Criterion Status Score Requirements for ADHD


2a

2b

2ca

2d

2e

2f

Often fidgets with or taps hands or feet or squirms in seat.

Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)

Often unable to play or engage in leisure activities quietly.

Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

Often talks excessively.

DSM-5 Criterion A

3

Talks too much. Talks too much. I talk too much.

T SR

I like to be on the go rather than being in one place.

I feel like I am driven by a motor.

Is constantly moving.

Acts as if driven by a motor.

P

SR

T

Is constantly moving

34

50

3

–

–

–

1 -or1 1 -or1 1 -or2

–

–

–

–

–

1 -or1 1 -or1

–

–

–

2

–

–

1, 0

1, 0

1, 0

0 -and0 0 -and0 0 -and1,0

1, 0

1, 0

1, 0

0 -and0 0 -and0 1, 0 -and1,0

1, 0

1, 0

1, 0

1, 0

1, 0

1, 0

Not Indicated


3, 2

3, 2

3, 2

3, 2 -or3, 2 3, 2 -or3, 2 3, 2 -or3

54 -or45 17 -or78 66 -or55 Acts as if driven by a motor.

P

3, 2

3, 2 84

32

I have trouble playing or doing things quietly.

3, 2

Is noisy and loud when playing or using free time.

71

SR

Is noisy and loud when playing or using free time.

I am restless.

I run or climb even when I am not supposed to.

Restless or overactive.

Runs or climbs when he/she is not supposed to.

T

P

SR

T

Restless or overactive.

3, 2 -or3, 2 3, 2 -or3, 2 3, 2 -or3, 2

69 -or99 24 -or7 20 -or7

P

3, 2

64

Runs or climbs when he/she is not supposed to.

3, 2

3, 2

I get out of my seat when I am not supposed to.

1

93

60

SR

Leaves seat when he/she should stay seated.

P

3, 2

3, 2

Leaves seat when he/she should stay seated.

It is hard for me to sit still.

SR

4

98

Item #

Indicated

T

Fidgets or squirms in seat.

Fidgets or squirms in seat.

Item

T

P

Form

May be Indicated

Table 1b. DSM-5 Symptom Count and Criterion Status Score Requirements for ADHD DSM-5 Symptom Count Requirements: • ADHD Predominantly Hyperactive-Impulsive Presentation: At least 6 of the 9 symptoms for individuals ≤ 16 years of age; at least 5 of the 9 symptoms for those ≥ 17 years of age. • ADHD Combined Presentation: Meets criteria for both Inattentive and Hyperactive-Impulsive presentations.

DSM-5 Update

7

8 2h

2i

Often has difficulty waiting his or her turn (e.g., while waiting in line).

Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Blurts out answers before the question has been completed. Blurts out answers before the question has been completed. I blurt out the answer before the question is finished. Has difficulty waiting for his/her turn. Has difficulty waiting for his/her turn. I have trouble waiting for my turn. Interrupts others (for example, butts into conversations or games). Interrupts others (e.g., butts into conversations or games). I interrupt other people.

P T SR

Item

P T SR P T SR

Form

6

29

104

43 9 9 61 76 27

Item #

Indicated

3, 2

3, 2

3, 2

3, 2 3, 2 3, 2 3, 2 3, 2 3, 2

May be Indicated

–

–

–

– – – – – –

1, 0

1, 0

1, 0

1, 0 1, 0 1, 0 1, 0 1, 0 1, 0

Not Indicated

a

Criterion A2c states that in adolescents, overactivity may be experienced as subjective feelings of restlessness. Follow-up is recommended to ensure criterion A2c has been met for the self-report of younger children.

ADHD Criterion A states that symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. If the Symptom Count is probably met for ADHD Predominantly Inattentive, Hyperactive-Impulsive, or Combined Presentation, follow-up is recommended to ensure this requirement is satisfied.




Notes:

DSM-5 Symptom Criteria reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Copyright, 2013. American Psychiatric Association.

2g

Often blurts out an answer before a question has been completed (e.g., completes people's sentences; cannot wait for turn in conversation).

DSM-5 Criterion A

Table 1b. (Continued) DSM-5 Symptom Count and Criterion Status Score Requirements for ADHD


4

5

6

7a

Has been physically cruel to people.

Has been physically cruel to animals.

Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).

Has forced someone into sexual activity.

Has deliberately engaged in fire setting with the intention of causing serious damage.

8

3

Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).

b

2

Often initiates physical fights.

Destruction of Property

1

Often bullies, threatens, or intimidates others.

Aggression to People and Animals

DSM-5 Criterion A

Has intentionally set fires for the purpose of causing damage. I like to set things on fire.

T SR

Has intentionally set fires for the purpose of causing damage.

–

SR P

Has forced someone into sexual activity.

Has forced someone into sexual activity. T

P

SR

T

Steals while confronting a person (for example, mugging, purse snatching or armed robbery). Steals while confronting a person (e.g., mugging, purse snatching, or armed robbery). I steal from other people (by mugging, purse snatching, or armed robbery).

I am mean to animals.

P

Is cruel to animals.

Is cruel to animals.

P SR

I do things to hurt people.

SR T

Physically hurts people.

Physically hurts people.

P T

59

SR

72

61

78

–

33

11

13

27

96

47

21

41

86

35

39

14

I use a weapon (like a bat, brick, broken glass, knife, or gun) to scare or hurt people.

P

Uses a weapon (e.g., a bat, brick, broken bottle, knife, or gun).

27

Uses a weapon (for example, a bat, brick, broken bottle, knife, or gun).

T

38

I start fights with other people.

30 105

SR

Starts fights with others on purpose.

P

25

Intentionally starts fights with others.

I bully or threaten other people.

SR

98

16

Item #

T

Bullies, threatens, or scares others.

Bullies, threatens, or scares others.

Item

T

P

Form

Table 2. DSM-5 Symptom Count and Criterion Status Score Requirements for CD DSM-5 Symptom Count Requirements: At least 3 of the 15 symptoms. Indicated

May be Indicated

1

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

1

1

1

1

1

1

0

0

0

–

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

Not Indicated


3, 2

3, 2, 1

3, 2, 1

–

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

DSM-5 Update

9

10

DSM-5 Criterion A

12

Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

14

15

Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.

Is often truant from school, beginning before age 13 years.

– I go out at night even when I am supposed to be at home. Runs away from home for at least one night. – I run away from home. Skips classes. Skips classes. I skip classes.

T SR P T SR P T SR

Goes out at night even though it breaks the rules.

I steal important things when no one is watching.

P

Steals secretly (e.g., shoplifting or forgery).

Steals secretly (for example, shoplifting or forgery).

P SR

I tell lies to get out of doing things or to get stuff.

T

Lies to avoid having to do something or to get things.

Lies to avoid having to do something or to get things.

P SR

I break into houses, buildings, or cars.

SR T

Has broken into someone else's house, building, or car.

T


I destroy stuff that belongs to other people.

P

Intentionally damages or destroys things that belong to others.

SR

Intentionally damages or destroys things that belong to others.

T

P

Item

33

54

6

8

–

76

91

–

91

52

31

58

16

40

56

78

90

89

82

10

65

Item #

Indicated

3, 2

3, 2

3, 2

3, 2, 1

–

3, 2, 1

3, 2

–

3, 2

3, 2, 1

3, 2, 1

3, 2, 1

3, 2

3, 2

3, 2

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

3, 2, 1

1

1

1

–

–

–

1

–

1

–

–

–

–

–

–

–

–

–

–

–

–

May be Indicated

DSM-5 Symptom Criteria reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Copyright, 2013. American Psychiatric Association. Notes: P = parent; T = teacher; SR = self-report. The following response key applies to the criterion status score requirements noted in the Indicated, May be Indicated, and Not Indicated columns: 0 = Not true at all (Never, Seldom); 1 = Just a little true (Occasionally); 2 = Pretty much true (Often, Quite a bit); 3 = Very much true (Very often, Very frequently). Interpretative Considerations: a The Conners 3–SR does not assess Criterion A7 (forced sexual activity) due to the sensitive nature of this criterion. b If both Criterion A8 (fire setting) and A9 (destruction of property) are indicated, in order to meet Criterion A9, the assessor must confirm that property was destroyed other than by fire-setting. c The Conners 3–T does not assess Criterion A13 (staying out at night without permission) or Criterion A14 (running away from home), as teachers generally would not be directly aware of these infractions. d In order for DSM-5 Criterion A13 (staying out at night) to be indicated, the assessor needs to ensure this criterion occurred before the age of 13 years. e In order for DSM-5 Criterion A15 (truancy) to be indicated, the assessor must ensure that the truancy occurred before the age of 13 years.

e

c

13

Often stays out at night despite parental prohibitions, beginning before age 13 years. c,d

11

Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others).

Serious Violations of Rules

10


Deceitfulness or Theft

9 b

Form

(Continued) DSM-5 Symptom Count and Criterion Status Score Requirements for CD

Has deliberately destroyed others' property (other than by fire setting).

Table 2. Not Indicated

0

0

0

0

–

0

0

–

0

0

0

0

1, 0

1, 0

1, 0

0

0

0

0

0

0


2

3

Is often touchy or easily annoyed.

Is often angry and resentful.

4

5

6

7

Often argues with authority figures or, for children and adolescents, with adults.

Often actively defies or refuses to comply with requests from authority figures or with rules.

Often deliberately annoys others.

Often blames others for his or her mistakes or misbehavior.

Argumentative/Defiant Behavior

1

Often loses temper.

Angry/Irritable Mood

DSM-5 Criterion A

Blames others for his/her mistakes or misbehavior. I blame others for things I do wrong.

Blames others for his/her mistakes or misbehavior.

P SR

I try to annoy other people.

SR T

Annoys other people on purpose.

Annoys other people on purpose.

P T

I do what my parents or other adults ask me to do. (R)

SR

Actively refuses to do what adults tell him/her to do.

P

Actively refuses to do what adults tell him/her to do.

I argue with adults.

SR T

Argues with adults.

T

Argues with adults.

People make me angry.

SR P

Is angry and resentful.

Is angry and resentful.

P T

I am easily annoyed by others.

SR

Is irritable and easily annoyed by others.

P Is irritable and easily annoyed by others.

I lose my temper.

SR T

Loses temper.

Loses temper.

Item

T

P

Form

Table 3. DSM-5 Symptom Count and Criterion Status Score Requirements for ODD DSM-5 Symptom Count Requirements: At least 4 of the 8 symptoms.

62

64

21

3

59

59

1 (R)

71

94

24

47

102

87

38

48

74

56

73

67

62

14

Item #

Indicated

May be Indicated

–

1

–

–

–

–

2

1

–

–

–

–

–

1

1

–

1

–

2

1

–

1, 0

0

1, 0

1, 0

1, 0

1, 0

1, 0

0

1, 0

1, 0

1, 0

1, 0

1, 0

0

0

1, 0

0

1, 0

1, 0

0

1, 0

Not Indicated


3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

3

3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

3, 2

3

3, 2

3, 2

DSM-5 Update

11

12 8

Tries to get even with people. When I get mad at someone, I get even with them.

SR

Tries to get even with people.

Item

T

P

Form

3, 2 3, 2

94

May be Indicated

1

1

1

0

0

0

Not Indicated

ODD Criterion A states that symptoms must be exhibited during interaction with at least one individual who is not a sibling. If the Symptom Count is probably met for ODD, follow-up is recommended to ensure this requirement is satisfied.


3, 2

Indicated

51

57

Item #



(R) = Item is reverse scored.

Notes:

DSM-5 Symptom Criteria reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Copyright, 2013. American Psychiatric Association.

Has been spiteful or vindictive at least twice within the past 6 months.

DSM-5 Criterion A

(Continued) DSM-5 Symptom Count and Criterion Status Score Requirements for ODD

Vindictiveness

Table 3.


References American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: American Psychiatric Publishing. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Conners, C. K. (1997). Conners’ Rating Scales–Revised Technical Manual. Toronto, Ontario, Canada: Multi-Health Systems. Conners, C. K. (2008, 2010). Conners 3rd Edition Manual. Toronto, Ontario, Canada: Multi-Health Systems.

USA P.O. Box 950 North Tonawanda, NY 14120-0950 Phone: 1.800.456.3003 Fax: 1.888.540.4484 C ANADA 3770 Victoria Park Ave. Toronto, ON M2H 3M6 Phone: 1.800.268.6011 Fax: 1.888.540.4484 INTERNATIONAL Phone: +1.416.492.2627 Fax: +1.416.492.3343 WEBSITE www.mhs.com/conners EMAIL [email protected]

DSM-5 UPDATE

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