Journal of Abnormal Child Psychology, Vol. 26, No. 4, 1998, pp.

279-291

Revision and Restandardization of the Conners Teacher

Rating Scale (CTRS-R): Factor Structure, Reliability, and
Criterion Validity
C. Keith Conners,1,4 Gill Sitarenios,2 James D. A. Parker,3 and Jeffery N. Epstein1

Received May 9, 1997; revision received October 23, 1997; accepted September 9, 1997
The Conners Teacher Rating Scale (CTRS) is a commonly used research and clinical tool
for assessing children's behavior in the classroom. The present study introduces the revised
CTRS (CTRS-R) which improves on the original CTRS by (1) establishing normative data
from a large, representative North American sample, (2) deriving a factor structure using
advanced statistical techniques, and (3) updating the item content to reflect current concep-
tualizations of childhood disorders. Using confirmatory factor analysis, a six-factor structure
was found which includes Hyperactivity-Impulsivity, Perfectionism, Inattention/Cognitive
Problems, Social Problems, Oppositionality, and Anxious/Shy factors. The reliability of the
scale, as measured by test-retest correlations and internal consistency, is generally satisfac-
tory. Using all of the scale factors to discriminate between attention deficit hyperactivity
disordered and normal children, 85 percent of children were correctly classified, supporting
the validity of the scale and indicating excellent clinical utility. Similarities and differences
between the original CTRS factor structure and the CTRS-R factor structure are discussed.
KEY WORDS: ADHD; CTRS-R; rating scale; classroom behavior; children.

For over 30 years, the Conners' Teacher Rating
Scale (CTRS) has been used by clinicians and re-
searchers to assess teachers' perceptions of children's
behavior in the classroom. This scale was first intro-
duced in a series of research reports demonstrating
the efficacy of psychostimulant medication as an in-
tervention for behaviorally disordered children (Con-
ners & Eisenberg, 1963; Conners, Eisenberg, & Bar-
cai, 1967). Since the introduction of the original
39-item CTRS (CTRS-39), abbreviated versions of
this scale have been offered. These include the 28-
item CTRS (Goyette, Conners, & Ulrich, 1978), Ab-
breviated Symptom Questionnaire (Sprague & Slea-
tor, 1973), and IOWA Conners (Pelham, Milich,
Murphy, & Murphy, 1989). All of the CTRS scales
have well-established reliability (Conners, 1969;
1Duke University Medical Center, Durham, North Carolina 27710.
2York University, Toronto, Ontario, Canada M3J-1P3.
3Trent University, Peterborough, Ontario, Canada K9J-7B8.
4 Address all correspondence concerning this article to C. Keith
Conners, Box 3431, Duke University Medical Center, Durham,
North Carolina 27710.
Edelbrock, Greenbaum, & Conover, 1985; Epstein &
Nieminen, 1983; Roberts, Milich, Loney, & Caputo,
1981; Zentall & Barack, 1979), validity (Camp &
Zimet, 1974; Kendall & Brophy, 1981; Klee & Gar-
finkel, 1983; Roberts et al., 1981), and clinical utility
(Brown, 1985; Satin, Winsberg, Monetti, Sverd, &
Foss, 1985; Stein & O'Donnell, 1985). Indeed, it is
because of its excellent psychometric properties that
the CTRS has received widespread use and has ap-
peared in hundreds of research studies.5
The major purpose of the CTRS is to provide
information at a screening level to assist clinicians
and researchers in understanding several important
domains of child behavior. Such information is con-
sidered a necessary part of the process of assess-
ment, diagnosis, and treatment monitoring. Such
screening information is helpful in directing more
detailed observations in the classroom, guiding fur-
ther inquiry in clinical situations, or in charac-
5An annotated bibliography of research utilizing the CTRS is
available from Multi-Health Systems, 908 Niagra Falls Blvd.,
North Tonawanda, NY 14120-2060.

279
0091-0627/98/0800-0279$15.00/0 C 1998 Plenum Publishing Corporation
280
terizing the broad outlines of behavior in group or
epidemiological investigations. In addition to its fre-
quent usage as a screening instrument, the CTRS
has also been utilized as an adjunctive measure to
a comprehensive assessment battery (Barkley, 1990)
and as a measure of treatment effectiveness (Con-
ners, 1994). Many clinicians and researchers com-
plement parental clinical interviews with CTRS rat-
ings in order to obtain an accurate measure of
children's classroom behavior. Teacher ratings have
become even more essential to the diagnostic proc-
ess given recent changes in Diagnostic and Statistical
Manual of Mental Disorders (DSM) nosology which
require evidence of cross-situational (home and
school) behavioral problems for an attention deficit
hyperactivity disorder (ADHD) diagnosis.
Consistent with its origins, the CTRS has also
been utilized to measure the effects of medication
treatment on classroom behavior (Fischer & Newby,
1991; Rapport, DuPaul, Stoner, & Jones, 1986). Re-
search studies have shown that the CTRS is a sen-
sitive measure of titration effects and treatment out-
come in drug studies using psychostimulants (e.g.,
Abikoff & Gittelman, 1985b) and antidepressants
(e.g., Gualtieri, Keenan, & Chandler, 1991). Last, the
CTRS has been used for measuring the effects of
nondrug interventions in the classroom (Abikoff &
Gittleman, 1984, 1985a; Horn, lalongo, Popovich, &
Peradotto, 1987; Kendall & Braswell, 1982).
Despite its continued and widespread use, sev-
eral factors indicate the need to update the CTRS
in terms of its form and test construction properties.
First, original standardization of the CTRS was non-
systematic. Several research reports on normative
data were published using geographically specific and
modest-sized samples (Conners, 1969; Goyette et al.,
1978; Trites, Blouin, & Laprade, 1982). Since Trites
et al.'s sample was the largest of those published, the
normative results from their sample of 9,583 Cana-
dian schoolchildren have been those most often util-
ized for scoring of the CTRS (Conners, 1989). Chil-
dren from varying backgrounds, cultures, and
geographic regions are scored according to these
norms. Though the Trites et al. sample is impressive
in size, the geographic and cultural representation of
a single province in Canada (Ottawa) probably does
not generalize to all North American children. There
is a clear need for updated norms based upon a na-
tionally representative sample of North American
schoolchildren.
A second reason for revising the CTRS is that
a definitive, empirically derived factor structure has
Conners, Sitarcnios, Parker, and Epstein
not been agreed upon. The original factor analysis
of the 39-item scale (Conners, 1969) demonstrated
that the CTRS items clustered into easily identifiable
factors, including Conduct Problems, Daydreaming-
Inattention, Anxious-Fearful, and Hyperactive Be-
havior, that corresponded well with teacher reports
of student behavior. Subsequent studies have found
somewhat different factor structures (Leung, Luk, &
Lee, 1989; Luk, Leung, & Lee, 1988; O'Leary,
Vivian, & Nisi, 1985; Taylor & Sandberg, 1984; Trites
et al., 1982; Werry & Hawthorne, 1976). Though fac-
tor similarities across these studies far outweigh the
differences (Epstein, March, Conners, & Jackson,
1997; Reid, 1995; Trites et al., 1982), uncertainties
exist regarding specific item loadings, number of fac-
tors, and the importance of factors that are inconsis-
tent across studies. As with the normative data, scor-
ing of the factors has relied on the factor analytic
results of Trites et al. However, this factor structure
has never been replicated, cross-validated, or sub-
jected to confirmatory factor analysis. Therefore, the
stability of the original CTRS factor structure/scoring
system remains unsettled. A more systematic ap-
proach to constructing a definitive factor structure
for the revised CTRS using empirical validation is
required.
Third, the content of the scale needs to be up-
dated to fit current conceptualizations of childhood
disorders. The items on the original 39-item CTRS
were derived to capture a wide variety of misbehav-
iors that could occur in a classroom environment.
Since the development of the CTRS in the 1960s, a
large body of empirical studies concerning child-
hood disorders has been accomplished. Advances in-
clude the development of a clinical nosology for dis-
orders such as ADHD, as well as reports on the
comorbidities with other childhood disorders, such
as cognitive problems and other externalizing disor-
ders (Hinshaw, 1991). The original CTRS contained
few items that related specifically to cognitive prob-
lems or learning disabilities in the classroom. Includ-
ing behaviors that are related to ADHD is necessary
in order to accurately portray the full range of prob-
lems that these children may be experiencing in the
classroom.
In sum, the major purpose of the present study
was to revise the CTRS in order to (1) provide new
norms using a large, representative North American
sample of schoolchildren; (2) provide a definitive,
stable, and reliable factor structure for the CTRS;
and (3) update items on the CTRS to incorporate
current conceptualizations of childhood disorders.
Conners Teacher Rating Scale Restandardized
The reliability and validity of this revised scale was
also examined.
STUDY 1: SCALE DEVELOPMENT6
Method
Participants
Participants consisted of 1,702 students (832
males and 870 females) ranging in age from 3 to 17
years. Females had a mean age of 10.51 years (SD =
3.34) and males a mean age of 10.34 years (SD =
3.35). The median combined annual household in-
come of the students who were rated by their teacher
was between $40,001 and $50,000. This compares
with 1993 U.S. census data of $43,005 median com-
bined household income (U.S. Department of Com-
merce, 1996.) The 200 data collection sites covered
49 U.S. states as well as all 10 provinces in Canada.
The number of cases in each state was roughly pro-
portional to the population density, with the most
cases coming from the East and West Coasts. Eighty-
three percent (83%) of the students were European
American, 7% African American, 5% Hispanic, and
5% other. The U.S. census figures from 1990 pro-
jected to 1993 (U.S. Office of Commerce, 1996) in-
dicated that 83% of the population were European
American, 12% African-American, 10% Hispanic,
and 4% other. Thus, the children in this study were
slightly underrepresentative of African-American and
Hispanic children.
Measure
An item pool was developed stemming from
various sources including the original CTRS scale.
Other items were adapted from other versions of the
Conners' Rating Scales (e.g., lOWA-Conners). Eight-
een items were closely worded to conform with cur-
rent Diagnostic and Statistical Manual of Mental Dis-
orders (4th ed.) (DSM-IV; American Psychiatric
Association, 1994) criteria for ADHD (these items
have been analyzed separately and will be reported
independently). Some items were created to reflect
6Considerably more detail on sample characteristics, including age,
gender, geographic distribution, and statistical analyses, is avail-
able in separate users' manual and technical manual, Multi-
Health Systems, Toronto, Canada.
281
changes in clinical practice and obtain clinically rele-
vant pieces of information. The large project called
the ACQ study, headed by Thomas Achenbach, pro-
vided crucial information from a large national study
of parent-related items and factor structure that also
helped shape thinking regarding the item pool
(Achenbach, Howell, Quay, & Conners, 1991). Once
the item pool was established, a number of psycholo-
gists with clinical and/or research experience re-
viewed the proposed items and commented on item
clarity and clinical significance. Through this review,
some of the items were discarded, and others were
revised. A preliminary pool of 131 items covering the
following seven content areas remained: conduct
problems, activity problems, attention problems,
emotionality, learning problems, social problems, and
perfectionism. The 131 items were rated using a 4-
point Likert scale (ranging from 0 for not at all true
to 3 for very much true). The revised 4-point Likert
scale also included temporal descriptions (e.g., very
often) for each point on the Likert scale in order to
simplify both responding and interpretation. The fi-
nal version of the scale included a subset of items
which comprised the old Hyperactivity Index score,
as well as a new ADHD Index derived from empiri-
cal discrimination between clinical and matched con-
trol cases. The psychometric properties of the Hy-
peractivity Index and DSM-IV scales are reported
elsewhere (Conners, Parker, & Sitarenios, 1997)
(Parker, Sitarenios, & Conners, 1997).
Procedure
Officials and school psychologists from 200
schools throughout Canada and 49 of the United
States functioned as site coordinators for the present
study. Site coordinators were provided with consent
forms, questionnaires, and forms which outlined the
background of the study to students, parents, and
teachers in their school. Teachers who agreed to par-
ticipate were asked to rate as many children in their
classes as possible, but no more than 10 children for
any one teacher. The median number of children
rated by a teacher was three students. Teachers did
not receive incentives for completing forms. Children
and adolescents in special education classes were not
included in this study. Completed forms were re-
turned to the site coordinators who forwarded them
to the authors.
282
Statistical Analyses
The sample was randomly separated into a deri-
vation sample (n = 1,200) and a replication sample
(n = 502). The 131 items from the derivation sample
were intercorrelated and the resulting matrix sub-
jected to principal-axis factoring. A series of factor
analyses were conducted to determine what items
should be retained. Items were included on the final
version of the scale if the following criteria were met:
(1) Items had to load significantly (greater than .30)
on a given factor and lower than .30 on the other
factors, and (2) following the rational approach to
scale construction, an item was eliminated if it lacked
conceptual coherence with its factor. Scree test and
eigenvalues (> 1.0) were used to select the number
of factors for rotation (Cattell, 1978). In addition, we
employed the split-half factor comparabilities
method (Everett, 1983) to determine the most reli-
able factor solution.
The factor structure for the revised CTRS
(CTRS-R) was tested in the replication sample (n =
502) using confirmatory factor analysis with EQS for
Windows (version 5.1; Bentler, 1995). As recom-
mended by Cole (1987) and Marsh, Balla, and
McDonald (1988), multiple criteria were used to as-
sess the goodness-of-fit of the six-factor model: the
goodness-of-fit index (GFI; Joreskog & Sorbom,
1986), the adjusted GFI (AGFI; Joreskog & Sorbom,
1986), and the root-mean-square residual (RMS).
Based on the recommendations of Anderson and
Gerbing (1984), Cole (1987) , and Marsh, et al.
(1988), the following criteria were used to indicate
the goodness-of-fit of the model to the data: GFI >
.85; AGFI > .80; RMS < .01.
Results
Scale Development
The correlation matrix of the 131 item-pool was
subjected to principal-axis factoring and scree test
and eigenvalue greater than 1.0 criteria (Cattell,
1978), and indicated the relative suitability of four,
five, six, and seven factors for rotation. In order to
determine the most reliable number of factors to re-
tain for rotation, the split-half factor comparabilities
method was applied (Everett, 1983). To this end, the
derivation sample was randomly split into two sub-
samples (n = 600 and 600). For each sample four-,
Conners, Sitarenios, Parker, and Epstein
five-, six-, and seven-factor solutions were rotated to
solution (varimax rotation). Results indicated that
the six-factor solution produced the highest factor
comparability coefficients. Based on these results, the
entire derivation sample was factor-analyzed and six
factors were rotated to a varimax solution. Items
were eliminated from further analyses because they
failed to load (above .30) on any one factor, or be-
cause they loaded above .30 on more than one factor
(in several cases items were retained that double-
loaded above .30 because there was a high loading
for the target factor and the loading for the second
factor was just above .30). The remaining items were
factor-analyzed and six factors rotated to a varimax
solution. This procedure was repeated until 38 items
remained.
Table I presents the factor loadings, eigenvalues,
and percentage of variance for each factor for this
analysis. The six rotated factors accounted for 63.1%
of the total variance. The first factor accounted for
14.3% of the total variance and the seven items that
loaded on this factor appeared to tap a "hyperactiv-
ity-impulsivity" dimension. The second factor ac-
counted for 12.0% of the total variance and the six
items that loaded on this factor appeared to tap a
"perfectionism" dimension. The third factor ac-
counted for 11.2% of the total variance and the eight
items that loaded on this factor appeared to tap an
"inattention/cognitive problems" dimension. The
fourth factor accounted for 9.2% of the total vari-
ance and the five items that loaded on this factor
appeared to tap a "social problems" dimension. The
fifth factor accounted for 9.2% of the total variance
and the six items that loaded on this factor appeared
to tap an "oppositional" dimension. The sixth factor
accounted for 7.2% of the total variance and the six
items that loaded on this factor appeared to tap an
"anxious/shy" dimension.
Factor Replication
The six-factor model for the CTRS-R was tested
using an oblique and an orthogonal solution using
confirmatory factor analysis (n = 502). Since the
oblique model was more consistent with the signifi-
cant correlations between factors and subsequently
provided a better model fit, only results from the
oblique confirmatory factor analysis are presented.
All three goodness-of-fit indicators suggested that
the model had good fit to the data (GFI = .852,
Conners Teacher Rating Scale Restandardized 283
Table I. Rotated Factor Loadings from a Principal Axis Factor Analysis of Items from the Conners' Teacher
Rating Scale— Revised (Derivation Sample, N = 1..200)
Factors
Items 1 2 3 4 5 6
Factor 1: Hyperactivity-Impulsivity
31 Restless .775 .063 .221 .073 .101 .094
35 Always on the go .818 -.032 .139 .077 .199 .030
33 Leaves seat .727 .064 .219 .144 .249 .042
28 Difficulty waiting .757 .031 .171 .139 .288 .112
30 Runs about .739 .044 .156 .181 .264 .030
34 Difficulty playing .714 -.004 .210 .147 .242 .061
26 Excitable .758 -.026 .148 .088 .271 .115

Factor 2: Perfectionism
108 Perfectionist -.038 .808 -.125 -.03 -.014 .052
100 Things just so -.013 .819 -.090 .000 .010 .135
103 Checking -.053 .791 -.089 -.007 -.035 .033
104 Over-focused -.036 .743 -.014 .052 -.010 .104
106 Neat -.093 .629 -.138 -.066 -.030 -.016
101 Same way every time .122 .654 .079 .082 .032 .180

Factor 3: Inattention/Cognitive Problems

70 Forgets things .177 .060 .810 .112 .108 .121
47 Avoids mental effort .382 .105 .695 .212 .167 .071
67 Poor spelling .130 .060 .756 .102 .096 .124
66 Poor reading .159 .036 .793 .141 .070 .151
72 Lacks interest .238 .139 .603 .253 .285 .044
69 Poor arithmetic .104 .065 .760 .119 .103 .151
38 Fails to finish .336 .130 .565 .267 .172 .051
118 Loses things .282 .137 .439 .298 .186 .014

Factor 4: Social Problems

79 Unaccepted .195 -.011 .146 .755 .193 .172
95 Last to be picked .185 -.010 .240 .733 .137 .208
77 No friends .119 .000 .188 .764 .204 .205
89 Doesn't make friends .247 -.016 .218 .760 .272 .225
96 Poor social skills .257 .010 .300 .643 .338 .239

Factor 5: Oppositional
11 Defiant .267 .015 .154 .164 .808 .088
10 Sassy .228 .020 .137 .110 .798 .072
21 Defies .322 .018 .169 .173 .763 .078
22 Spiteful .135 .001 .102 .188 .657 .115
20 Argues .371 .021 .125 .126 .733 .079
7 Explosive .313 -.011 .133 .138 .589 .197

Factor 6: Anxious/Shy
76 Feelings hurt .074 -.138 .127 .168 .086 .754
57 Emotional .219 -.083 .084 .117 .280 .688
55 Timid -.086 -.086 .169 .255 -.104 .515
58 Sensitive .175 -.158 .103 .060 .174 .688
52 Cries .075 -.042 .041 .138 .154 .587
75 Shy -.179 -.092 .211 .295 -.130 .467

Eigenvalue 5.437 4.562 4.253 3.5 3.486 2.752

% of Variance 14.3 12 11.2 9.2 9.2 7.2
284
AGFI = .825, and RMS = 0.025).7 All of the pa-
rameter estimates between items and factors were
significant: for the Oppositional factor, the six-pa-
rameter estimates ranged from .732 to .903 (mean =
.823); for the Hyperactivity-Impulsivity factor, the
seven-parameter estimates ranged from .806 to .863
(mean = .840); for the Inattention/Cognitive Prob-
lems factor, the eight-parameter estimates ranged
from .609 to .868 (mean = .728); for the Social Prob-
lems factor, the five-parameter estimates ranged
from .776 to .927 (mean = .836); for the Anxious/Shy
factor, the six-parameter estimates ranged from .474
to .834 (mean = .644); for the Perfectionism factor,
the six-parameter estimates ranged from .632 to .859
(mean = .753).
STUDY 2: RELIABILITY, INTERNAL
CONSISTENCY, AND AGE AND SEX
DIFFERENCES
Method
Participants
The sample consisted of the 1,702 students used
in Study 1 (832 males and 870 females). A subset of
50 children (25 males and 25 females) were rated by
their teachers on the CTRS-R on two occasions ap-
proximately 6 weeks apart.
Results
Table II presents the internal reliability coeffi-
cients for the CTRS-R scales, separately for 3- to 7-
year-olds, 8- to 12-year-olds, and 13- to 17-year-olds.8
Coefficient alphas for the six scales ranged from .73
to .95 for males and .76 to .94 for females, suggesting
that the scales on the CTRS-R have excellent inter-
nal reliability.
Using Pearson product-moment correlations
(n = 50), the CTRS-R scales had the following 6-
week test-retest correlations: .86 (p < .05) for Op-
7
The model had to be slightly modified with the addition of se-
lected correlated errors (2.6% of possible correlated errors). See
Tanaka and Huba (1984) for a discussion of this procedure. The
mean for these error correlation was .345 (range = .177 to .661).
8
These age ranges are used for ease of presentation. For a more
detailed presentation and analysis of age effects, see Conners
(1997).
Conners, Sitarenios, Parker, and Epstein
positional, .72 (p < .05) for Hyperactivity-Impulsiv-
ity, .47 (p < .05) for Inattention/Cognitive Problems,
.61 (p < .05) for Social Problems, .88 (p < .05) for
Anxious/Shy, and .77 (p < .05) for Perfectionism.
Several investigators have demonstrated significant
drops in CTRS scores from the first to the second
administration (Milich, Roberts, Loney, & Caputo,
1980; Werry & Sprague, 1974). This effect was as-
sessed in this sample (n = 50) using all six factors.
A statistically significant increase in Oppositional
scores was observed between Time 1 (mean = .68,
SD = 1.70) and Time 2 (mean = 1.10, SD = 2.51;
f(49) = 2.19, p = .033). Also, a decrease in Hyper-
active scores was documented between Time 1
(mean = 4.66, SD = 5.26) and Time 2 (mean =
3.18, SD = 4.13; t(49) = 2.85, p = .006). No other
factors displayed significant trends across administra-
tions (all ps > .2).
Means and standard deviations for the various
CTRS-R scales (separately by sex and age group) are
presented in Table III. A series of (Sex x Age
Group) analyses of variance analyses were conducted
with each of the CTRS-R scales as the dependent
variable. For the Oppositional scale, males were
rated significantly higher than females, F(l, 1,696) =
25.91, p < .001, but the main effect for age group
and the interaction were not significant.
For the Hyperactivity-Impulsivity scale, males
were rated significantly higher than females, F(l,
1,696) = 83.46, p < .001, and a significant main ef-
fect was found for age group, F(2, 1,696) = 9.91, p <
.001; the interaction was not significant. Using uni-
variate analysis of variance for age group, the 3- to
7-year-olds were rated significantly higher than the
8- to 12-year-olds, F(1, 1,696) = 6.18, p < .05, and
the 13- to 17-year-olds, F(1, 1,696) = 19.76, p <
.001, and the 8- to 12-year-olds were rated signifi-
cantly higher than the 13- to 17-year-olds, F(l,
1,696) = 6.67, p < .001.
For the Inattention/Cognitive Problems scale,
males were rated significantly higher than females,
F(l, 1,696) = 45.25, p < .001, and a significant main
effect was found for age group, F(2, 1,696) = 6.57,
p < .001; the interaction was not significant. Using
univariate analysis of variance for age group, the 3- to
7-year-olds were rated significantly higher than the 13-
to 17-year-olds, F(l, 1,696) = 3.77, p < .05, and the
8- to 12-year-olds were rated significantly higher than
the 13- to 17-year-olds, F(l, 1,696) = 13.14, p < .001.
For the Social Problems scale, males were rated
significantly higher than females, F(1, 1,696) =
Conners Teacher Rating Scale Restandardi/ed 285

Table II. Internal Reliability Coefficients for Scales on the Conners' Teacher Rating Scale— Revised (CTRS-R)
3 to 7 years 8 to 12 years 13 to 17 years
CTRS-R Scale Males Females Males Females Males Females
Oppositional .91 .88 .92 .93 .91 .92
Hyperactivity-Impulsivity .95 .92 .94 .88 .93 .91
Inattentive/Cognitive Problems .87 .94 .93 .92 .92 .89
Social Problems .93 .91 .93 .93 .91 .9
Anxious/Shy .83 .84 .82 .8 .73 .76
Perfectionism .91 .88 .86 .9 .85 .86
n 203 202 399 416 230 252

20.95, p < .001, but the main effect for age group
and the interaction were not significant.
For the Anxious/Shy scale, a significant main ef-
fect was found for age group, F(2, 1,696) = 5.28, p <
.001, but the main effect for sex and the interaction
were not significant. Using univariate analysis of vari-
ance for age group, the 3- to 7-year-olds were rated
significantly higher than the 13- to 17-year-olds, F(l,
1,696) = 10.51, p < .001, and the 8- to 12-year-olds
were rated significantly higher than the 13- to 17-
year-olds, F(l, 1,696) = 3.77, p < .05.
For the Perfectionism scale, females were rated
significantly higher than males, F(l, 1,696) = 21.43,
p < .001, and a significant main effect was found for
age group, F(2, 1,696) = 7.42, p < .001; the inter-
action was not significant. Using univariate analysis
of variance for age group, the 3- to 7-year-olds were
rated significantly lower than the 8- to 12-year-olds,
F(l, 1,696) = 7.94, p < .001, and the 13- to 17-year-
olds, F(l, 1,696) = 14.40, p < .001.
The intercorrelations of the CTRS-R scales are
presented in Table IV (separately for males and fe-
males). To examine for possible gender differences
in the pattern of intercorrelations, the equality of the
correlation matrices was tested using EQS for Win-
dows (version 5.1; Bentler, 1995). The criteria for de-
termining the equality of the correlation matrices was
a nonnormed fit index (NNFI; Bentler & Bonett,
1980) greater than .900 and a comparative fit index
(CFI; Bentler, 1990) greater than .900. Results indi-
cated that the pattern of intercorrelations for the
CTRS-R scales was virtually identical across the
sexes (NNFI = .972 and CFI = .986). A similar pat-
tern of results was found when the equality of the
correlation matrices among the three age groups was
tested using EQS (NNFI = .966 and CFI = .977).
STUDY 3: CRITERION VALIDITY
Method
Participants
Two groups of children were used in the present
study. The first group consisted of 160 children (127
males and 33 females) who met the following criteria:
(a) parent and/or teacher referral to an outpatient
ADHD clinic due to reported problems with inatten-
tion, hyperactivity, and/or impulsivity; (b) independent
diagnosis of ADHD by psychologist and/or psychiatrist
using DSM-IV criteria for ADHD. Diagnosis was

Table III. Means and Standard Deviations for Scales on the Conners' Teacher Rating Scale— Revised (CTRS-R)a
3 to 7 years 8 to 12 years 13 to 17 years
CTRS-R Scale Females Males Females Males Females Males

Oppositional 0.57 (1.66) 1.23 (2.85) 0.75 (2.24) 1.38 (2.92) 0.88 (2.22) 1.57 (3.09)
Hyperactivity-Imp. 1.55 (3.28) 3.49 (5.25) 0.99 (2.42) 2.92 (4.76) 0.74 (2.17) 2.06 (3.79)
Inatten./Cognitive 3.07 (5.27) 4.26 (5.15) 2.94 (4.8) 5.19 (6.14) 2.09 (3.59) 3.9 (5.09)
Social Problems 0.88 (2.29) 1.42 (2.86) 0.99 (2.54) 1.61 (3.12) 0.66 (1.81) 1.32 (2.61)
Anxious/Shy 2.36 (3.05) 2.26 (2.87) 2.05 (2.64) 2 (2.82) 1.86 (2.36) 1.59 (2.14)
Perfectionism 2.42 (3.38) 1.62 (3.17) 3.13 (3.89) 2.07 (3.08) 3.17 (3.55) 2.62 (3.2)
n 202 203 416 399 252 230
a
Hyperactivity-Imp. = Hyperactivity-Impulsivity; Inatten./Cognitive = Inattention/Cognitive Problems.
286 Conners, Sitarenios, Parker, and Epstein

Table IV. Correlations Among Scales on the Conners' Teacher Rating Scale— Revised
(CTRS-R)a
CTRS-R scale 1 2 3 4 5 6
1. Oppositional .62* .46* .53* .37* .05
2. Hyperactivity-Impulsivity .52b .56* .48* .30* -.02
3. Inattentive/Cognitive Problems .34b .46* .54* .39* -.11*
4. Social Problems .47b .38* .49* .53* .08*
5. Anxious/Shy .26b .19* .27* .43* .21*
6. Perfectionism -.03 -.04 -.18* .00 .23*
a
Males (n = 832) above the diagonal and females (n = 870) below.
b
p < .01.

based upon a structured clinical interview by James
Swanson and Eric Taylor (personal communication),
modified to include current DSM-IV criteria, and cov-
ering ADHD as well as DSM-IV criteria for opposi-
tional-defiant and conduct disorder. Additional infor-
mation included a developmental history (Conners &
March, 1994) and review of school records. Eighty-six
percent of the participants were European American,
8.8% were African American, 1.9% were Hispanic,
and 3.0% were other; the mean age was 10.36 years
(SD = 3.57).
The second group (non-ADHD) consisted of
160 children (33 males and 127 females) from studies
1 and 2 who were randomly selected and matched
with the ADHD sample on the basis of age, sex, and
ethnicity.
Procedure
For participants in the ADHD sample, the
CTRS-R information was obtained as part of routine
clinical assessment.
ADHD groups. The ADHD group scored signifi-
cantly higher (using t-tests) than the non-ADHD
group on the Oppositional scale, the Hyperactivity-
Impulsivity scale, the Inattention/Cognitive Problems
scale, the Social Problems scale, and the Anxious/Shy
scale; the non-ADHD group scored significantly
higher than the ADHD group on the Perfectionism
scale.
A direct discriminant function analysis was per-
formed using CTRS-R scales as predictors of mem-
bership in the two groups (ADHD vs. non-ADHD).
Discriminant function scores were subsequently used
to classify the 320 children into ADHD and non-
ADHD groups. The results of this classification are
presented in Table VI. Following the definitions and
procedures outlined by Kessel and Zimmerman
(1993), a variety of diagnostic efficiency statistics
were calculated for the CTRS-R from these classifi-
cation results: Sensitivity was 78.1%, specificity was
91.3%, positive predictive power was 89.9%, negative
predictive power was 80.7%, false positive rate was
8.8%, false negative rate was 21.9%, kappa was .694,
and the overall correct classification rate was 84.7%.

RESULTS GENERAL DISCUSSION

Table V presents means and standard deviations The revision of the CTRS presented herein is a
for the CTRS-R scales for the ADHD and non- substantial upgrade from the widely used, previous

Table V. Means and Standard Deviations (in Parenthesis) for the Non-ADHD (n = 160)
and ADHD (n = 160) Groups on the Conners' Teacher Rating Scale— Revised (CTRS-R)"
CTRS-R Scale Non-ADHD ADHD T P
Oppositional 0.65 (1.62) 4.48 (4.95) 9.31 <.001
Hyperactivity-Impulsivity 1.46 (2.94) 7.92 (6.28) 11.77 <.001
Inattentive/Cognitive Problems 2.46 (3.58) 11.18 (5.79) 16.21 <.001
Social Problems 0.93 (1.91) 5.01 (4.70) 10.19 <.001
Anxious/Shy 1.80 (2.50) 4.01 (3.54) 6.45 <.001
Perfectionism 2.70 (3.77) 1.90 (3.28) 2.03 .043
a
ADHD = attention deficitftyperactivity disorder.
Conners Teacher Rating Scale Restandardized
Table VI. Classification Results (ADHD vs. Non-ADHD)
for the Conners' Teacher Rating Scale— Reviseda
Diagnosis
Test ADHD Non-ADHD Total
Present 125 14 139
Absent 35 146 181
Total 160 160 320
a
ADHD = attention deficit/hyperactivity disorder.
version of this scale. The major improvements lie in
the revision's psychometric development and repre-
sentativeness of the standardization sample. First,
the derived norms from this large North American
sample should provide a more accurate account of
normative classroom behavioral patterns than pre-
viously used norms developed on a less-repre-
sentative sample. Second, the revised CTRS has a
stable factor structure that was developed with a
large representative sample and confirmed using ad-
vanced statistical techniques.
In terms of test construction statistics, the re-
vised CTRS conforms with American Psychological
Association guidelines (APA, 1985). As with the
original CTRS, high levels of reported reliability sug-
gest that an accurate, reliable assessment of teacher
perceptions of child misbehavior are obtained
through the use of this scale. However, there is one
anomalous finding in that the Inattention factor,
though internally consistent (alpha = .87 to .94), has
a moderate test-retest reliability (r = .47). Previous
studies have generally found high test-retest reliabili-
ties for the comparable factor of the earlier version
of the teacher scale. For example, Luk et al. (1988)
found that r = .80; Brito (1987) reported r = .74,
Milich et al. (1980) found r = .91, and Roberts et
al. (1981) reported r = .84. In addition, Edelbrock
et al. (1985) found that all scales had test-retest re-
liabilities between .88 and .96. Further work will be
needed to assess whether the test-retest finding with
the current version of this factor is idiosyncratic for
the particular sample studied, or constitutes a weak-
ness in the item content.
Consistent with Milich et al. (1980), a significant
decrease in Hyperactivity scores was seen between
subsequent administrations of the CTRS-R. Milich
et al. concluded that regression to the mean was re-
sponsible for this effect. Given that the 50 cases used
to replicate this effect in this study were clinic-re-
ferred children who were likely presenting with ex-
treme behavioral difficulties at the time of the initial
287
rating, it seems likely that decreases in their Hyper-
activity scores over time may be explained by regres-
sion to the mean as well. This result suggests the
need to obtain multiple baseline ratings of children,
especially if the CTRS-R is to be used to assess treat-
ment efficacy. The observed increase in Oppositional
scores across administration is a less robust finding
that needs to be replicated.
The sensitivity (78%) and specificity (91%) of
the CTRS-R in identifying ADHD children appear
to be much improved from examinations of the di-
agnostic sensitivity and specificity of the original
CTRS (Klee, 1983; Luk & Leung, 1989). The most
likely reason for this increase in diagnostic utility is
because of better coverage of ADHD diagnostic cri-
teria and more overlap between DSM criteria and
scale items.
Despite a number of important changes, efforts
were made to keep the key features of the previous
versions intact. The scale remains relatively brief,
which is crucial for increasing teachers willingness to
complete these questionnaires. Also, the 4-point Lik-
ert style format which provides a simple format for
teachers to report on the severity of children's class-
room misbehavior has been retained.
The factor structure of the CTRS-R has changed
from the original CTRS because of the inclusion of
a new and broader item pool, more representative
sampling, and more stringent methodological devel-
opment. Most previous studies agreed in finding fac-
tors representing conduct problems, hyperactivity, so-
cial problems, and emotional problems. But a variety
of other factors had been proposed, with little agree-
ment across investigators (Leung et al., 1989; Luk et
al., 1988; O'Leary et al., 1985; Taylor & Sandberg,
1984; Trites et al., 1982; Werry & Hawthorne, 1976).
Many of these extraneous factors had few items and
accounted for little variance on the CTRS. An exam-
ple of one of these factors is the Daydreaming-Atten-
dance Problem factor found by Trites et al. (Trites et
al., 1982) which accounted for only 2.8% of CTRS
variance (eigenvalue = 1.1). An improvement in the
CTRS-R factor analysis is that (1) factors were con-
firmed through confirmatory statistical techniques so
that smaller, less stable factors would be unlikely to
be retained, and (2) all of the factors retained con-
tribute significantly to the amount of variance ex-
plained on the CTRS-R items (minimum eigen-
value = 2.8). Though further factor-analytic studies
that evaluate the CTRS factor structure across differ-
ent cultures both outside and within North America
288
are needed, the reported factor structure should re-
main the definitive standard for scoring of this scale.
A few of the original CTRS factors have congru-
ent factors on the revised scale. The original CTRS
had two factors which measured externalizing prob-
lems labeled Hyperactivity and Conduct Problems.
The CTRS-R has similar factors labeled Hyperactiv-
ity-Impulsivity and Oppositional. The original Hyper-
activity factor included a wide variety of externalizing
behaviors including oppositional (e.g., quarrelsome),
hyperactive (e.g., fidgeting), inattentive (e.g., short at-
tention span), and socially inappropriate (e.g., hums
and makes odd noises) behaviors. The Hyperactivity-
Impulsivity factor on the revised CTRS is a much
more hyperactivity-specific factor. All of the items on
CTRS-R Hyperactivity-Impulsivity factor ask specifi-
cally about hyperactive and impulsive symptoms.
Thus, this factor now provides a much purer and spe-
cific measure of hyperactive/impulsive behaviors in
the classroom and is consequently more consistent
with its "Hyperactivity" label.
The original CTRS had a Conduct Problems
factor that covered a multitude of behaviors clearly
related to current conceptualizations of oppositional-
defiant disorder (e.g., uncooperative) and conduct
disorder (e.g., steals). A problem with this factor was
that many of the items on the Conduct Problems fac-
tor had dual loadings on the Hyperactivity factor;
thus similar items were used in deriving scores for
both of these factors. As a result, these two factors
were highly correlated (r = .70; Lahey, Green, &
Forehand, 1980), bringing into question whether dif-
fering constructs were being measured. Another
problem with this factor was that some of this scales'
items had very low base rates of endorsement since
they assessed more deviant behaviors (e.g., "destruc-
tive"). Thus, some items had minimal clinical utility
for the majority of children being rated. The compa-
rable factor on the CTRS-R is the Oppositional fac-
tor, which includes only items that are consistent with
an Oppositional-Defiant Disorder diagnosis. Since
factor construction techniques for the CTRS-R ex-
cluded items with dual loadings (see Methods), cor-
relations between the Hyperactivity factor and Op-
positional factor (average r across sexes = .57) are
smaller than comparable correlations on the original
CTRS. The smaller correlations among the external-
izing factors and the behavior-specific domains en-
compassed by each factor allow for a finer analysis
of the domains of externalizing problem behavior
than was possible with the broad Conduct Problems
and Hyperactivity factors of the original CTRS.
Conners, Sitarenios, Parker, and Epstein
The other domain of ADHD symptoms, inat-
tention, is also somewhat different between the
original and revised CTRS. On the original CTRS,
inattention symptoms clustered on the Hyperactivity
factor and were measured by three items measuring
specifically inattentiveness (daydreams, short atten-
tion span, and inattentive). The revised scale has an
Inattentive/Cognitive Problems factor which has
items related to forgetfulness, difficulty engaging in
sustained mental effort, failing to finish things, and
losing things, all DSM-IV Inattention symptoms.
These items provide a much wider range of symp-
toms associated with the inattentive domain of
ADHD. Also loading on this factor are items related
to academic achievement and motivation for school-
work. The clustering of inattentive symptoms on the
same factor as academic achievement may be a re-
sult of the high correlation between these two vari-
ables in elementary school children (Hinshaw,
1991), and is in agreement with the factor structure
derived from a national sample of parent ratings
(Achenbach et al., 1991).
Two of the CTRS-R factors are almost identical
to factors on the original CTRS: Anxious/Shy and
Social Problems. The corresponding factors on the
CTRS were Anxious/Passive and Asocial. In addition
to being similarly named, the item content and do-
mains that are measured appear to be similar across
the scales.
The remaining CTRS-R factor is a measure of
Perfectionism and includes items that appear related
to obsessive-compulsive personality traits or diagno-
sis of obsessive compulsive disorder (OCD). Whether
such an interpretation can be sustained will await
empirical tests, because the factor by itself does not
fully encompass current diagnostic criteria for OCD.
Though between-group differences on this factor
were opposite in direction from the other factor
scores—all of which showed higher symptomatology
in ADHD than normal children, scores on the Per-
fectionism factor added discriminatory power to the
discriminant function analysis in identifying ADHD
children. This discriminatory power may be a result
of ADHD children being rated low on this factor be-
cause perfectionism is often antithetical to disorgani-
zation, even though comorbidity between OCD and
ADHD has been reported in the literature (Curry &
Murphy, 1995). The identification of perfectionistic
behaviors is important since OCD children often
share similar symptomatology with ADHD children,
particularly inattentiveness, even though the neuro-
cognitive processes that cause inattention in ADHD
Conners Teacher Rating Scale Restandardized
(inability to engage and sustain attention) and OCD
(difficulty disengaging attention) may be entirely dif-
ferent (March, Leonard, & Swedo, 1995).
In summary, the CTRS-R factor structure and
scoring system provides an effective structure for
measuring specific symptom patterns related to
ADHD. In addition, corollary factors are present
which measure many of the symptoms and disorders
that are often comorbid with ADHD. Among these
comorbid symptom clusters are oppositionality
(Barkley, Fischer, Edelbrock, & Smallish, 1990) ,
cognitive and learning problems (Hinshaw, 1991),
anxiety disorders (Munir, Biederman, & Knee, 1987),
social problems (Milich & Landau, 1982), and obses-
sive/compulsive behaviors (Curry & Murphy, 1995).
Thus, a CTRS-R scoring profile can provide the re-
searcher or clinician information with information re-
garding the severity of ADHD as well as valuable
information about comorbid conditions which may be
interacting with ADHD symptomatology.
A limitation of the present study concerns the
manner in which data were collected. Teachers often
filled out forms on several children at once, whereas
typical clinical use is for the teacher to rate one child
of interest at a time. Whether this procedure adds
noise to the resulting data is unknown. But the large
sample size and discriminative power of the scales
suggests that there is sufficient precision to allow
useful decisions in individual cases.
We expect the CTRS-R to replace the original
version and receive the same widespread use as was
afforded the original version. With widespread use
can come abuse of an instrument. Therefore, a word
of caution must be issued regarding its clinical usage.
As reported, the CTRS-R has excellent clinical utility
and provides a reliable, valid, and convenient means
of measuring teacher perceptions of classroom mis-
behavior. However, a comprehensive assessment
should usually include other data, such as the clinical
interview, a medical examination, and objective data
regarding school functioning such as test scores,
grades, and longitudinal school progress. (Barkley,
1990). Thus, a rating scale such as the CTRS-R
should be only one component of the evaluative
process and should not be solely relied upon for
making clinical decisions.
ACKNOWLEDGMENTS
Preparation of this manuscript was partially sup-
ported by National Institute of Mental Health
289
(NIMH) Grant No. MH01229 (C. Keith Conners,
principal investigator).
The authors wish to thank Drew Erhardt, John
March, Steve Stein, members of the NIMH MTA
Steering Committee, and a number of unnamed col-
leagues who contributed their expertise over several
years.
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