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The Conners' Parent Rating Scale

The Conners' Parent Rating Scale (CPRS) is a widely used research and clinical assessment tool designed to obtain parental reports of childhood behavior and mental issues, with a focus on symptoms related to Attention-Deficit/Hyperactivity Disorder (ADHD).

Originally developed in the 1970s by Dr. C. Keith Conners, the scale has evolved through four different versions to enhance its psychometric properties and to align with evolving clinical understandings of ADHD and various cultural contexts. Apart from its role in clinical context, it is also a popular tool in the research field for tracking changes and comparing behavioral phenotypes among children in treatment outcome and correlational studies.

The CPRS is a parent-report questionnaire that evaluates a range of behaviors, including hyperactivity, inattention, oppositionality, anxiety, and social problems. It is structured as a four-point Likert-type scale, offering degrees of agreement or disagreement, without a neutral option. The scale is available in both long (CPRS-R:L) and short (CPRS-R:S) formats to meet different clinical and research needs.

The CPRS is renowned for its high reliability, validity, and comprehensiveness. Despite its limitations in generalizability and potential for bias, the CPRS remains a competitive tool for assessing ADHD, standing out among other scales like the Vanderbilt Assessment Scale, the Behavior Assessment System for Children (BASC), and the Child Behavior Checklist/Teacher Report Form (CBCL/TRF). Compared with other scales, the CPRS offers detailed insights specifically into ADHD-related behaviors but does not extensively assess broader emotional or behavioral conditions. Additionally, the CPRS reveals significant gender and age differences in behavioral ratings.

History

CPRS-73

In 1970, Dr. Conners adapted a list of 73 symptoms from a 1960 study by Cytryn et al. to create a comprehensive checklist for parents assessing children referred to outpatient psychiatric services. He conducted a clinical study with 316 children classified as neurotic or hyperkinetic and 365 normal children, asking parents to rate their behavior. Through factor analysis, Conners identified three factors—conduct, personality, and antisocial behaviors—consistent with findings from other studies. He believed these insights could aid in the classification, diagnosis, and study of behavioral problems in children.

CPRS-93

Published in 1973, the CPRS-93 is the first Conners' Parent Rating Scale, featuring 93 items that assess problematic behaviors in children across 25 areas, including sleep, peers, and stealing. It was designed to identify "hyperkinetic children" and track the effects of drug treatments for behavioral issues. In addition to the form, there is also a Hyperactivity Index (HI), which acts as a measure of psychopathology. Despite lacking empirical support for its modifications from the previous 73-item version, the CPRS-93 gained popularity among clinicians as a diagnostic tool. This version established a correlation between test scores and clinical problems, with total scores converted to T-scores, indicating a positive relationship between higher T-scores and the likelihood of mental disorders.

CPRS-48

CPRS-48 was published in 1978 by Conners. Compared with CPRS-93, it deleted items that did not load in any previous factor analysis, and combined and reworded some other items, forming a questionnaire with 48 items. The HI is also included. To validate CPRS-48, the coefficients of congruence between the selected 40 corresponding items of CPRS-93 and CPRS-48 were calculated, which were reported to be high, demonstrating a strong similarity between the factors of CPRS-93 and CPRS-48.

CPRS-R:L & CPRS-R:S

After the publication of CPRS-48, controversies regarding the sample size and factor structure of CPRS arose. In 1997, Dr. Conners addressed these concerns by using a large normative sample of over 2,400 children to develop a revised version of CPRS, with an 80-item long form (CPRS-R:L) and a 27-item short form (CPRS-R:S). CPRS-R:L includes two additional scales: Conners' Global Index (CGI), similar to HI, and a DSM-IV Symptoms subscale for diagnosing ADHD.

Sample Questions of Conners Parent Rating Scale (Revised) Long Form

Factor Structures

CPRS-93:

1. Conduct Disorders
2. Anxious–Shy
3. Restless–Disorganized
4. Learning Problems
5. Psychosomatic
6. Obsessive–Compulsive
7. Antisocial
8. Hyperactive– Immature
9. Hyperactivity Index

CPRS-48:

1. Conduct Problems I, defiant or aggressive behavior
2. Learning Problems, attention and distraction problems
3. Psychosomatic, health problems
4. Impulsive–Hyperactive, Attention Deficit Disorder (ADD)/H-like symptoms without aggression
5. Conduct Problems II, defiant or aggressive behavior
6. Anxiety, withdrawal, isolation
7. Hyperactivity Index

CPRS-R:L:

 (1) Oppositional

(2) Cognitive Problems

(3) Hyperactivity

(4) Anxious–Shy

(5) Perfectionism

(6) Social Problems

(7) Psychosomatic

 Subscales:

• CGI

(1) Emotional Lability

(2) Restless–Impulsive

• DSM-IV Symptoms subscale

(1) DSM-IV Inattentive  

(2) DSM-IV Hyperactive–Impulsive

CPRS-R:S:

 (1) Oppositional

(2) Cognitive Problems

(3) Hyperactivity

Cultural Adaptation

Throughout the years, cross-cultural studies have been conducted by researchers internationally to adapt the Conners' Parent Rating Scale into different cultures. There have been trials for adaptations of the CPRS into cultural settings including France, India, Turkey, Germany, China, and others.

Usage

Diagnosis

The diagnosis of mental disorders using the CPRS involves comparing the resulting T-scores with those of a representative sample. The T-score for each subscale is determined through three steps: calculating the raw score, determining the subscale prorated score, and converting the score into a T-score using a T-score table.

Raw Score

The raw score is calculated by adding up the scores of each item in a subscale. Each item carries a score from 0–3.

Subscale Prorated Score

The subscale prorated score adjusts the raw score for unanswered items.

$Prorated\ Score=(Raw\ Score\times Number\ of\ Items\ Relating\ to\ the\ Subscale)\div Number\ of\ Answered\ Items\ Relating\ to\ the\ Subscale$

T-score

T-scores are obtained from the prorated scores by referencing an appropriate table. The tables are sorted by the subject’s prorated score, the subject’s sex, and the type of the Conners' rating scale (teacher or parent).

Generally, a T-score > 60 indicates potential ADHD, and a T-score > 70 indicates serious ADHD symptoms.

Treatment Outcome Studies

Treatment outcome studies utilize the CPRS in the way it was originally designed: to track behavioral changes in children in response to external factors. In the CPRS-93 and CPRS-48, the Hyperactivity Index (HI) is regarded as the most sensitive to treatment effects.

Conners, Taylor, Meo, Kurtz, and Fournier (1972) used the CPRS-93 and abbreviated symptom questionnaire (ASQ-P/T) to measure behavioral changes in children with minimal brain dysfunction undergoing pharmacological treatment. Eighty-one children were divided into three groups receiving Cylert, Dexedrine, and a placebo, with behavior assessed at baseline and every two weeks for eight weeks. Treatment effects were observed in four factors: conduct disturbance, impulsivity, immaturity, and antisocial behavior. Conners noted a significant treatment effect with the abbreviated parent rating.

Caresia et al. (1984) studied the behavioral impact of pemoline treatment on children with hyperactivity using the CPRS-48 in an eight-week clinical trial involving nine children with ADHD. A CPRS-48 form was completed weekly, and significant score changes were observed in the Conduct Problems I, Learning Disabilities, and Impulsivity-Hyperactivity factors starting from week six.

Correlational Studies

Correlational studies are conducted to examine the relationship between factors such as the occurrence of natural hazards, sleep patterns, or parental body language and children's behavior. In these studies, the CPRS is employed for the quantitative measurement of children's behavior.

In Jefferson and Johnson's (1991) study, behavioral differences among juvenile delinquent subtypes were assessed using the CPRS-48. A sample of 28 males was categorized as neurotic, socialized-subcultural, or psychopathic delinquents based on the Personal Opinion Survey. The mothers of these individuals completed CPRS-48 forms to evaluate their behavior before the age of 10. Significant correlations were found between psychopathic delinquents and the Learning Problem factor (p < .05), and the Hyperkinesis Index (p < .01).

Shepard (1992) investigated the link between spousal abuse and maternal ratings of children's behavior using the CPRS-48. The study involved 26 children, 22 fathers, and 25 abused mothers, who completed the CPRS-48 and the Abusive Behavior Inventory. Significant correlations were observed between ABI-reported psychological abuse and CPRS-48 factors: Conduct Disorder (r = .41), Anxiety (r = .55), and HI (r = .49). Additionally, all CPRS-48 factor T-scores (except Learning Problem) exhibited a positive correlation with psychological abuse.

Reliability, Validity, and Limitations of the Conners’ Parent Rating Scale – Revised (CPRS-R)

Reliability

The CPRS-R demonstrates high internal consistency, with Cronbach’s alpha coefficients ranging from .75 to .94 for males and .75 to .93 for females. Test-retest reliability over a six-week period showed strong correlations, especially for the Cognitive Problems (r = .78) and Hyperactivity-Impulsivity (r = .71) factors. These findings indicate that the scale is both consistent and stable over time.

Validity

The CPRS-R has strong criterion and construct validity. In a comparison between children diagnosed with ADHD and non-ADHD peers, the ADHD group scored significantly higher on multiple scales including Oppositional, Cognitive Problems, Hyperactivity-Impulsivity, Anxious/Shy, Social Problems, and Psychosomatic, with no significant difference on the Perfectionism scale. Discriminant analysis showed a 93.4% overall classification accuracy, with sensitivity at 92.3% and specificity at 94.5%.

Research on concurrent validity has yielded mixed results. Earlier versions (e.g., CPRS-93, CPRS-48) showed variable correlations with other validated instruments. Some studies found significant relationships with other behavior rating scales, while others—particularly those using direct observation—reported limited agreement.

Strengths and Limitations

The CPRS-R offers several advantages: it is brief, easy to administer, empirically derived, and aligned with DSM criteria. It allows parents—key informants in a child’s life—to report on behaviors in everyday settings. Its compatibility with the Conners’ Teacher Rating Scale–Revised further strengthens its utility for comprehensive behavioral assessment.

However, the scale is not without limitations. Like all behavioral rating tools, it is based on subjective reports, which may introduce bias. Although the CPRS-R demonstrates strong reliability and validity, some inconsistencies in concurrent validity—especially in early studies—limit generalizability. Additionally, no rating scale should be used in isolation for diagnosis; multi-informant, multi-method approaches are essential.

Despite these challenges, the CPRS-R remains a robust, evidence-based instrument for screening, diagnosis, and treatment monitoring of children with ADHD and related behavioral concerns.

Comparison of the Conners' Parent Rating Scale–Revised (CPRS-R) with Other ADHD Rating Scales

The CPRS-R is specifically designed to evaluate ADHD symptoms in children and adolescents. It aligns with DSM criteria and includes separate scales for inattention and hyperactivity/impulsivity. The CPRS-R is widely used in clinical settings for diagnosis, tracking symptom severity, and monitoring treatment outcomes. While it offers detailed insight into ADHD-related behaviors, it does not extensively assess broader emotional or behavioral conditions.

Comparison with the Vanderbilt Assessment Scale

The Vanderbilt Assessment Scale is commonly used in primary care settings due to its comprehensive scope. It evaluates core ADHD symptoms as well as co-occurring disorders such as oppositional defiant disorder, conduct disorder, anxiety, and depression. In addition to symptom assessment, the Vanderbilt includes a functional performance section that examines how symptoms impact academic and social functioning. It also tracks potential medication side effects (e.g., sleep issues, headaches). Both parent and teacher versions provide a well-rounded view of behavior across different environments. While broader in scope than the CPRS-R, the Vanderbilt is typically better suited for initial screening rather than in-depth clinical evaluation.

Comparison with the Behavior Assessment System for Children (BASC)

The Behavior Assessment System for Children is a multidimensional assessment system that gathers behavioral data from three perspectives: parent, teacher, and self-report. It evaluates a wide range of emotional and behavioral conditions, including hyperactivity, aggression, anxiety, depression, and learning difficulties. A unique feature of the BASC is the Parenting Relationship Questionnaire (PRQ), which assesses aspects of the parent-child relationship, such as involvement, attachment, and stress levels—areas not addressed by the CPRS-R. While the CPRS-R focuses specifically on ADHD, the BASC is more appropriate for broader psychological evaluations, particularly in educational and clinical settings.

Comparison with the Child Behavior Checklist / Teacher Report Form (CBCL / TRF)

The Child Behavior Checklist / Teacher Report Form (CBCL/TRF) is widely used to identify emotional and behavioral problems in children. It includes eight syndrome scales, such as anxious/depressed, withdrawn/depressed, attention problems, and aggressive behavior. Although the CBCL contains an Attention Problems scale, it does not distinguish between inattention and hyperactivity/impulsivity as clearly as the CPRS-R. Furthermore, the CBCL includes additional factors not assessed by the CPRS-R, including Immature, Sexual, and Uncommunicative behaviours. It is commonly used in research settings and for long-term behavioral monitoring.

Gender and Age Differences in CPRS-R Ratings

Research using the Conners' Parent Rating Scale–Revised (CPRS-R) has revealed significant variations in behavioral ratings based on gender and age. Although earlier studies indicate that gender differences in behavioral ratings are generally minor in general populations, these differences become more significant in children with behavioral difficulties. Boys generally receive higher scores on measures related to cognitive difficulties, hyperactivity-impulsivity, and oppositional behavior while girls tend to score higher on scales measuring anxiety, psychosomatic symptoms, and perfectionism. These trends align with broader psychological findings indicating that males are more commonly associated with externalizing behaviors (e.g., aggression, impulsivity), while females are more often linked to internalizing behaviors (e.g., anxiety, depression).

Age-related patterns have also been observed in CPRS-R data. As children grow older, ratings on cognitive problems, hyperactivity/impulsivity, anxiety, shyness, and psychosomatic complaints typically decrease. This likely reflects normal developmental changes, as certain behaviors become less common with age. In contrast, ratings for perfectionism tend to rise as children get older. This increase may relate to shifts in how ritualistic and perfectionistic behaviors are perceived—while such behaviors are considered normal in younger children, they may be seen as problematic in older age groups.