Conners· Adult ADHD Rating

Scales (CAARS TM)

Technical Manual

C. Keith Conners, Ph.D.,

Drew Erhardt, Ph.D., &
Elizabeth P. Sparrow, Ph.D.

I MHSBeyon d /~ssP.ssmen ts
Copyright © 1999, Multi-Health Systems Inc. All Rights Reserve
No part of this manual may be reproduced by any means without

MHS in the U.S.: P.O. Box 950, North Tonawanda, NY 14120-0

d.
permission from the publisher.

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 Conners' Adult ADHD Rating Scales (CAARS)

Contents
About the Authors .......................................................................... ......................................................................... ............. ix
Author·s Preface .................................................................................................................................................... ................ x
Publisher·sPreface ................................................................................................................................................................ xii

Qapter 1--lntroduction .............................................................................................................................................................. 1

Main Features of the CAARS ............................................................................................................... ............................ 1
CAARS Components ....................................................................................................................................................... 2
CAARS Long Forms .......................................................................... ........................................................................ 3
CAARS Short Forms ................................................................................................................................................. 3
CAARS Screening Forms ..................................... ..................................................................................................... 4
Uses of the CAARS .......................................................................... ..................................... ........................................... 4
Principles of Use ..................................... .......................................................................................................................... 4
User Qualifications ............................................................................................................... ..................................... ........ 4
Contents of this Manual ..................................... ..................................... ........................................................................ 4
Cllapter 2--Administration and Scoring of the CAARS ................................................................................................................ 5
Choosing a CAARS Form ..................................... ............................................................................................................ 5
Long Versus Short Forms .......................................................................... ................................................................ 5
Short or Screening Forms ... .. .... .... .. .......... ... .. .. .. ... .... ... ......... .... ...... ... .. .. .. .... ....... .. .. .. .... ..... ....... .... .. .... .... .. .. ........ ... .. . 5
Remote Administration .................................................................................................................................................... 6
Materials Needed ...................................................................................................... ...................................................... 6
Administration nme .......................................................................... ............................................................................... 6
Readability of the CAARS ..................................... ........................................................................................................... 6
Administration Procedure ............................................................................................................... .................................. 7
Scoring the CAARS ..................................... ..................................................................................................................... 8
Profiling the CAARS Scores .......................................................................... .................................................................... 9
Scoring and Profiling Examples ............................................................................................................... .......................... 9
Long Forms ............................................................................................................... ............................................... 9
Short Forms .......................................................................... ......................................................................... ........ 10
Screening Forms .......................................................................... ..................................... ..................................... 10
Chapter 3---4nterprelation and Use ............................................................................................................................................ 21
Interpretation of the CAARS ..................................... .......................................................................... ........................... 21
Interpreting Item Responses .................................................................................................................................. 21
Interpreting Subscale Scores ..................................... ............................................................................................ 22
Interpreting Profile Patterns ..................................... ..................................... .......................................................... 22
A Step-by-Step Guide for Interpreting the CAARS ......................................................................................................... 22
Step 1: Does the CAARS provide valid information about ADHD symptoms? ......................................................... 23
Step 2: Which item responses are elevated? ............................... ......................................................................... 23
Step 3: Examine subscale scores and the overall level of symptomatology? .......................................................... 23
Step 4: Integrate information from the self-report and observer forms. ................................................................. 23
Step 5: Integrate information from the CAARS and other sources of information. ................................................. 24
Step 6: Consider a diagnosis and define a set of recommendations. ..................................................................... 24
Case Studies .............................................................................................................. .................................... ............... 24
Case 1 (JenniferM., a 19-Year-Old Female) ..................................... ...................................................................... 24
Case 2 (Calvin D., an 18-Year-Old Male) .......................... :...................................................................................... 28
Case 3 (Scott P., a 53-Year-Old Male) .......................................................... .......................................................... 31
Case 4 (Thomas S., a 44-Year-Old Male) ................................... ............................................................................ 33
Case 5 (Meredith W., a 26-Year-Old Female) ......................................................................... ..................... ............ 34
Case 6 (James G., a 49-Year-Old Male) .................................... ............................................................................. 40
Conclusion ..................................................................................................................................................................... 43

V
 Conners· Adult AOHO Rating Scales !CAARS)
-----
Cllapter 4--Computar Admlnillrltlon and Scorfng .................. ••............. ••••... ••... ••••.. ·... ··.... ····....... ·····.. ·····....... ··... ·.. ··................ 45
General Information ..................••••••••••············.. ········.. ····.... ··············.. ···.. ·····.. ·······················.... ·····················.. ····.. ······· 45
Modes of Administration ....................................••••••••••••.. ••••••.. ••••••··················.. ············.. ····...... ····.. ······...... ··... ·.. ·•.. •..... 45
The CAARS and PsychManager ............................................................................ ........................... .............................. 45
Features of the CAARS Computer Program for Windows ................................................. •............. •............................... 45
Hardware. Software. and Documentation Requirements ........................... ................................. •.................................. 46
Using the CAARS Computer Program for Windows ............................ ............................... •........................... ................. 46
Advantages of Computerization ........................... ............................ .............................................................................. 47
Software Support ........................................................ .................................................................................................. 47
Furtherlnformation ............................ ........................................................ ........................... ......................................... 47
C111pt11r 5-MIISUl"NIN t of Adult ADHD and the Development of the CAARS ......................................................................... 49
Development of the CAARS ........................................................................................................................................... 50
Creation of the ADHD Index ............ ....................................................................................................................... 51
Creation of the Inconsistency Index ............................................................................................................. .......... 51
Creation of DSM-IV Symptom Scales ..................................................................................................................... 52
Creation of Short Forms ............................ ........................... .................................................................................. 52
Creation of Observer Scales ................................................................................................................................... 53
Concluding Remarks ............................ ...................................................... ........................... ......................................... 54
Chapter 6--Nonnl1ive Samples and Psychometric Properties of the CAARS ............................................................................ 55
Normative Data ........................... .................................................................................................................................. 55
Age and Gender Effects ............................ ............................................................................................................. ........ 55
Self-Report Forms ....................................................... ........................................................................................... 58
Observer Forms ............................ ........................... ............................................................................................... 58
Reliability ........................... ............................ ..... .................................................................................... ...................... 59
Internal Reliability ............................ ....................................................................................................................... 59
Mean Inter-Item Correlations ........................... ...................................................................................................... SO--
Test-Retest Reliability ....................................................... ............................ ......................................................... 60
Standard Error of Measurement ................................................................................... .......................................... 62
Reliability Summary ............ ........................................................ ....................................................... ..................... 63
Chapter 7-Vaidityofthe CAARS ............................................................................................................................................. fu
Factorial Validity ........................................................................................................................................ ..................... 67
Confirmatory Factor Analysis ...................................................... ........................... ............................ ............................. 67
CAAAS-S:L ....................................................................................................................................... .................... 67
CAARS-S:S...................................................... ............ ........................... .............................................................. 68
CAARS-0:L ........................... ............................................................................................................. ................... 68
CAARS-0:S....................................................................................................................................... .................... 68
lntercorrelations of the CAARS Scales ........................... ......................... ........................... ..... ....................................... 68
DiscriminantValidity ....................................................................................................................................................... 70
ADHD Index ........................................................................................................................................................... 70
Construct Validity ........................... ............................................................... ...................................................... ........... 71
Relationship between Childhood and Current Symptoms ........................... ........................... ................................. 71
Relationship between Self-Report and Observer Ratings ...................................................... ................................. 71
Validity Summary ................................................................ ........................... ................................................................ 71
Chaptlr ~ Comments ............................................................................................................................................ 73
RlfSIIICm ................................................................................................................................................................................ 75
11--dix A-E . . IPercenti·1es .......................................................................................................................................... . 11
,,,.,,..., mplflCI
Appendix B--ltems by Subscale ............................................................................................................................................ 135
Index.................................................................... .......................... ........................ ································································ 139

vi
 Chapter 1
Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) was • The CAARS were developed to employ Dr. Conners'
originally thought to be a condition specific to childhood 30 years of experience and research in the field of
or early adolescence. In recent years, however, research ADHD.
has consistently demonstrated that ADHD is often a chronic • The CAARS have parallel structure with the Conners'
condition that persists into adulthood. In addition to the Rating Scales-Revised (CRS-R; Conners, 1997),
core symptoms of ADHD, which involve problems in which improves the transition when used across the
attention, hyperactivity, and impulsivity, adults with this lifespan. Table 1.1 (overleaf) presents an overview of
disorder have been found to be at risk for a variety of other basic features shared by the CRS- R and the CAARS.
problems and conditions. For example, ADHD adults have
been found to be at risk for lower levels of educational
and occupational attainment, employment instability,
Main Features of the CAARS
substance abuse, and antisocial behavior (Barkley, The CAARS are a unique integration of theoretical
Murphy, & Kwasnik, 1996; Weiss & Hechtman, 1993). knowledge, clinical experience, empirical sophistication,
and state-of-the-art psychometric techniques. They are
A serious limitation in the assessment of adult ADHD has reliable and valid measures of adult ADHD-related
been the lack of reliable and valid measures of ADHD symptoms and behaviors. The CAARS offer many
symptoms for use with adult populations. The release of advantages to the practitioner:
the Conners' Adult ADHD Rating Scales (CAARS)
represents a major development in the assessment of the • A large normative database (N = 2,000)
psychopathology and problem behaviors associated \\i th Multidimensional scales that assess ADHD and
adult ADHD. The CAARS are a set of easily administered related symptoms and behaviors
self-report and observer-rated instruments designed to
assess symptoms and behaviors related to ADHD in adults. Matching forms for self-report and observer (e.g.,
friends, coworkers, family members) ratings
These instruments were developed with the follo\\ing Clinical and diagnostic relevance
issues and concerns in mind:
Long and short versions
The new instruments provide reliable and valid as-
ADHD Index, which contains the items that best dis-
sessment of ADHD-related symptoms across clinically
tinguish individuals with ADHD from non-clinical
important domains (e.g., home, work, and interper- individuals
sonal functioning).
Inconsistency Index, which is useful for detecting an
The new instruments discriminate between clinical and
inconsistent response style
nonclinical groups. This is an essential quality of a
useful instrument. Scales match the DSM-IV criteria for ADHD
The new instruments allow for multi.modal ac;sessmP-nt Easy administration, scoring, and profiling of results
(e.g., self-report and observer ratings), since multiple
sources of information are essential for an accurate Graphs to monitor progress
clinical picture. Excellent reliability and validity
Short forms have been developed for use in research Applicable in managed care situations
settings, where a quick screen for ADHD symptoms
is required, or where repeated testing is needed (e.g., The CAARS are suitable instruments for reporting on
treatment monitoring). adults ages 18 and up. Both self-report and observer forms
The instruments address ADHD symptoms directly utilize a 4-point (0 = Not at all, never; I =Justa little, once
linked to the criteria for the disorder in the Diagnostic in a while; 2 = Pretty much, often; 3 = Very much, very
and Statistical Manual of Mental Disorders, Fourth frequently), Likert-style format in which respondents are
Edition (DSM-IV) (APA, 1994). asked to rate items pertaining to their behavior/problems.
 l\llmflts' Adult AIJHD Hnting Scnlos (CAAl1S)

For the self-report fonns. the respondents nre nsked lo rnle

their own c:-..-pcrienccs. while for the obsetver forms. the
( I K to 2 9 years old, 30 to 39 years old, 40 to 49 years old
and 50 years old and older). '
•
respondents arc asked to rate n particular person (e.g.,
friend. coworker. or family member). The CAARS were Interpretation of the CAARS should be based on individual
designed with the higher scores indicating increasing item responses, T-scores for the various scales, the ADHD
symptom levels. Index, the Inconsistency Index, and an integration of the
assessment information with other clinical material. The
Normative data for the CAARS come from large integration of CAARS scores with other sources of data
conmmnity-based samples (N= 2,000) ofnonclinical adults (e.g., interviews, observations, formal testing) gives the
collected throughout the United States and Canada from administrator ofthe instrument a more comprehensive and
1996 until 1998. Each of the short scales (self-report and systematic view of the individual being assessed than might
observer) take about 10 minutes to administer, and each be obtained from a single information source.
of the long scales takes less than 30 minutes. Scoring each
scale will rarely require more than 10 minutes with the
handscorable QuikScore forms, or a few seconds with the CAARS Components
computer program. The CAARS consists of two types of forms: 1) c~s
for self report (or client) ratings, and 2) CAARS--0 for
The CAARS QuikScore forms include a Profile form that observer (family/peer/supervisor) ratings. The self-report
allows for the visual display of the individual's assessment and observer forms were created to provide multimodal
scores and comparisons with an appropriate normative assessments of the same behaviors and problems and
group. Raw scores are converted automatically to T-scores contain an identical set of scales, subscales, and indexes.
when the Profile form is completed. No special scoring Multiple sources of information are essential for an accurate
templates are needed, since all of the scoring information clinical assessment. Whenever practical, it is best to collect
is provided on the QuikScore form. Separate norms are both self-report and observer information.
provided for men and women in different age intervals
Table 1.2 (overleaf) presents the names of the various
CAARS forms and their abbreviations.

Table 1.1
Basic Features Shared by the CRS-R and CAARS

Featmea CR~R CAARS

Assess key AOHD Inattention Inattention

symptoms Hyperactivity Hyperactivity
lmpulsivity lmpulsivity

Assess other crinically Oppositional Emotional !ability

relevant syl'J1)toms Conduct problems Problems with self-concept
Interpersonal problems

Contain scales linked to the Separate subscales for the Separate subscales fur the
DSM criteria for AOHD inattentive and hyperactive- inattentive and h~peractwe-
impulsive subtypes impulsive subtypes

Age-specmc norms 3 to 17 years of age 18 years of age and older

Gender-specific norms Yes Yes

Long and short forms Yes Yes

Short forms designed for Yes Yes

treatment monitoring

Forms for nutimodal Self-report forms Self-report forms

assessment Parent forms Observer forms
Teacher forms

ADHD lnde)( distingiishes clincal and Yes Yes

non-cfinical subjects, using ADHD sy111>toms

2
 Introduction

Tabla 11 Index is also included on the long forms. This index

Scalaa of the CAARS and Their Abbreviations contains the best set of items for distinguishing ADHD
adults from nonclinical adults. The last measure on the
Self.fleport Scale Abbreviations No. of Items
long forms is the Inconsistency Index, which is useful in
CAARS Sett-Report: Long Version CAARS-S:L 66 identifying random or careless responding. Table 1.3 lists
CAARS Sett-Report: Short Version CAARS-S:S 26 the measures that appear on the self-report (CAARS-S:L)
CAARS Sett-Report: Screening Version CAARS-S:SV 30
and observer (CAARS-0:L) long forms.
Obaetver Scale Abbreviations No. of Items
Tabla 1.3
CAARS Observer: Long Version CAARS--0:L 66 Measures Contained in the Long Forms
CAARS Observer: Short Version CAARS-0:S 26 (Salt-Report and Observer)
CAARS Observer: Screening Version CAARS-0:SV 30
Factor-Derived Subscales

Within the two types of forms (self-report and observer) • Inattention/Memory Problems
• Hyperactivity/Restlessness
there are long, short, and screening versions of the CAARS:
• lmpulsivity/Emotional Lability
• Problems with Sett-Concept
The long versions (CAARS-S:L and CAARS--0:L)
contain a group of scales that were empirically de- DSM-IV ADHD Symptom Subacales
rived to assess a broad range of problem behaviors,
such as inattention or memory problems, hyperactiv- • Inattentive Symptoms
• Hyperactive-Impulsive Symptoms
ity, impulsivity, and poor self-concept. The long forms • Total ADHD Symptoms
take more time to administer and score, but they con-
vey more detailed information, including the Incon- ADHD Index
sistency and ADHD Indexes.
• The short versions of the CAARS are used when ad- lnconsistllncy Index
ministration time is limited or where multiple admin-
istrations over time are needed. Two different types
of short forms are available: the CAARS-S:S and the CAARS Short Forms
CAARS-0:S. They contain fewer items of the identi- The self-report (CAARS-S:S) and observer (CAARS-0:S)
cal factor-derived subscales that appear on the long short forms have 26 items and 6 subscales. Four
forms, plus the full ADHD and Inconsistency Indexes. abbreviated, factor-derived scales assess a cross-section
• The screening versions of the CAARS (CAARS- of ADHD-related symptoms and behaviors: a 5-item
S:SV and the CAARS-0:SV) contain the DSM-IV Inattention/Memory Problems subscale, a 5-item
ADHD Symptom measures and the ADHD Index, Hyperactivity/Restlessness subscale, a 5-item lmpulsivity/
which may be useful when a quick screen is needed Emotional Lability subscale, and a 5-item Problems with
for DSM-IV symptoms for ADHD. Self-Concept subscale. These scales use subsets of items
from the long form. See chapter 5 for a description of the
Information on which form is appropriate in specific
procedure used to develop the short forms. The 12-item
instances is provided in chapter 2.
ADHD Index is also included on the fom1S, as well as the
Inconsistency Index. Table 1.4 lists the measures that
CAARS Long Forms appear on the self-report (CAARS-S:S) and observer
The self-report (CAARS-S:L) and observer (CAARS- (CAARS-0:S) short forms.
O:L) long forms have 66 items and 9 subscales. There are
four factor-derived scales that assess a cross-section of Tabla 1.4
ADHD-related symptoms and behaviors: a 12-item Measures Contained in the Short Forms
Inattention/Memory Problems subscale, a 12-item (Self-Report and Observer)
Hyperac;tivity/Restlessness subscale, a 12-item
Factor-Derived Subscales
lmpulsivity/Emotional Lability subscale, and a 6-item
Problems with Self-Concept subscale. There are also three • Inattention/Memory Problems
• Hyperactivity/Restlessness
DSM-IV ADHD symptom measures that assess ADHD • lmpulsivity/Emotional Lability
symptoms according to the criteria set listed in the DSM- • Problems with Self-Concept
IV (APA, 1994): a 9-item Inattentive Symptoms subscalc,
ADHD Index
a 9-item Hyperactive-Impulsive Symptoms subscale, plus
a Total ADHD Symptoms subscale. A 12-item ADHD Inconsistency Index

3
Gonnms' Adtrlt AOHD Ratin g Scales (CAARS)

obs erve r mea sure s that are best used by clin·icians as part
CAARS Screening forms . . .
test users need to tak
of an ove rall chru cal eval uati on. All
obse rver (CA AR S- a responden:
T he self -rep ort (CA AR S-S :SV ) and into acco unt any factors that may influence
s and 3 DSM -IV ADHD s, or factors that
O:S V) scre enin g fom ts hav e 30 item to inac cura tely repo rt his or her symptom
symptom measures that ~ ADH
D symptoms acco rdin g tely report symptoms
may infl uen ce an obse rver to inac cura
-IV (APA, 1994): a 9-
to tl1e criteria set outlined in the DSM of the indi vidu al bein g asse ssed .
, a 9-it em Hyperactive-
item Inattentive Symptoms subscaJe
Total ADHD Symptoms
lmpulsi\le Symptoms subscale, and a
subscale. The 12-item ADHD Inde x
is also included on the User Qualifications
RS shou ld have an
fomlS. Tab le 1.5 lists the measures
that app ear on the self- All user s of inst rum ents like the CAA
r (CA AR S-0 :SV ) es and limitations of
repo rt (CA AR S-S :SV ) and obs erve und erst and ing of the basi c prin cipl
psy cho logi cal test
screening fomlS. The screening forms are usef
ul whe n a quick psy cho logi cal test ing, esp ecia lly
bilit y and validity,
screen for DSM -IV ADHD sym ptom
s is required. inte rpre tatio n. Spe cific issu es of relia
disc usse d in chap ters 6
as they pert ain to the CAA RS, are
CAA RS are easy to
Table 1.5 and 7 of this man ual. Alth oug h the
s
Me uur n Contained in the Screening Form adm inis ter and scor e, enc oura ging
thei r use by rese arch
(Self-Report and Obaerver) ultim ate responsibility
assi stan ts and othe r sup port staff, the
inte rpre tatio n mus t be
for adm inis trat ion, sco ring, and
OSM-N AONO Syap taa S..c alea gniz es the limi tatio ns
assu med by an indi vidu al who reco
• lnattantMI SVn1,toms of psyc holo gica l test ing.
• tfyperactMH"1)tllsive SVn1,toms
• i>tal AOHD SVn1,toms be fam ilia r with the
All user s of the CA AR S sho uld
ing dev elop ed by the
stan dard s for psy cho logi cal test
tion (AP A, 198 5).
Am eric an Psy cho logi cal Ass ocia
uld also be mem bers
Qua lifie d user s of this type of test sho
Uses of the CAARS ofprof essi ona l asso ciat ions that end
orse a set ofstan dard s
cal test s, or lice nse d
The CAA RS mea sure a cros s-se ctio
n of AD IID- rela ted for the ethi cal use of psy cho logi
cho logy , edu cati on,
~-m ptom s and beh mio rs in adu
lts. The y can be used as prof essi ona ls in the area s of psy
field .
part of a routine scre enin g in a num
ber of settings, such as med icin e, social wor k, or an allie d
~ clin ics, resi dent
ial trea tme nt centers, prisons,
psycbiatric hospitals, and priv ate
prac tice offices. The
of mon itori ng ADI ID Contents of this Manual
CAA RS are also useful in the con text ual prov ide deta iled
oftrea tme nt Pote ntia l test users The rem aini ng chap ters of this man
~ ~ \l\"C r the com se of the CA AR S, the
, soc ial wor kers , info rma tion abo ut the adm inis trat ion
incl ude psy cho logi sts, phy sici ans tatio n and use of the
selo rs. The CAARS are scor ing proc edu res, and the inte rpre
JISJchiab.ists, researchers, and coun ual des crib es the
md ul tool s for pro vidi ng the prac titio
ner or AD IID test resu lts . In add itio n, the man
of the CA AR S, the
ed info rma tion abo ut bac kgr oun d and dev elop men t
1c:s ca.d ltt ..ith stru ctur ed and norm and the psyc hom etric
an indn idua l
com pute rize d vers ion of the CAA RS,
2 desc ribe s the bas ic
prop erti es of the scal es. Cha pter
CA AR S are not sco ring the var iou s
The self -rep ort ver sion s of the proc edu res for adm inis teri ng and
unw illin g or una ble to xes. Cha pter 3 pres ents
rec --1111c:oied for persons who are CAA RS form s, subs cale s, and inde
to a questionnaire. The inte rpre tati on of the
ulO p"Q le to resp ond ing hon estly a disc ussi on of the app rop riat e
vidu als who are clin ical and rese arch
CAARS are not reco mm end ed for indi CAA RS, and thei r pote ntia l uses in
ondents who hav e be help ful dur ing the
diiforiallcdoueverdy impaired. For resp sett ings. Six case stud ies that may
r can read alou d the d in cha pter 3. Cha pter
poor reading abilities, the adm inis trato inte rpre tatio n pha se are also incl ude
re.co rd the answ ers on com pute rize d vers ion
CAA RS ilam to the individual and 4 outl ines the ben efits of usin g the
info rma tion desc ribi ng
the QuikScore form. of the CAA RS. Cha pter 5 prov ides
men t of the CA AR S.
the theo retic al rati ona le and dev elop
ples for the CA AR S
Principles of Use Cha pter 6 desc ribe s the norm ativ e sam
cho met ric pro pert ies
RS are not inte nde d and pres ents info rma tion on the psy
The lat mer lbouJd know that the CAA of the vari ous scal es, sub scal es, and
inde xes. Cha pter 7
tion in a clin ical
to be lhe only JOurces of info rma dity of the CA AR S .
titute for a com plet e pres ents info rma tion on the vali
~ The CAARS are not a subs Cha pter 8 prov ides con clud ing com
men ts.
tipl e sou rces of
clin ical assessment that util izes mul
f self -rep ort and
information. lbe inst rum ents are brie
4
 Chapter
Adllministratilon Scoring f the
ndScoring
nd the0AARS
0AARS
CAARS forms are easy to administer and score. The
GhoosingCATARS
GhoosingCATARS
orm
administration prrocessor the two longest orms (CAARS-
administrationprrocess forms,practitionerswill
the availability of six CAARS forms,practitioners
With theavailability
S:L and CAARIS-O:L) can take ess han 30 minutes: he
wonder rvhich form is most appropriate in a particulaLr
shorter orms (CAARS-S :S, CAARS-S
CAARS-S :SV CAARS-O :S,
Whenever possible or practical,
assessment ituation. Wheneverpossible
and CAARS{I:S\D take about 10 rninutes.The
rninutes.The various
responses hould be obtained fiom the individual being
obtainedfiom
are set at a North American
forms areset A merican fourth-grade reading wel
(Dale & Chall, 1948)
1948)and assessed, s well as obsener
obsener riatings rom at least one
and are
aredesigned
designed o be adrninis tered o
urdividual who is familiar with the ndividual being asessetl.
adults aged 18 and up. Responses re enteredon
adultsaged enteredon oneof
one of the
six QuikScore irrms. The QuikScore orms can be used o
qurcklyscore
qurckly score herCAARSandtransfer he results o aProfile
herCAARSandtransfer heresults LongVersus hort
hortForms
Forms
form (contained
(containedwithin
within each
eachofof the six CAARS forms). The There are several relevant consideration
considerations s or deciding
Profile orm allor.vs
allor.vsor
or the visual display
thevisual displayof the respondent's
of therespondent's whether o use a ong or short CAARS form. The long fonn
usea
cor'es nd drarvscomparisons
assessmentcor'es
assessment drarvscomparisons o an appropriate collectsmore nformation and is more comprehensive
comprehensiveor or
normativeage
normative and gender
ageand gendergroup.
group. clinical or researchpurposes,
researchpurposes,so t should be administered
possible.
As noted n chapter , the CAARS consist
consistof
of two types of
typesof whenever ADHD, DSM-IV The long form encompasses or e
of
symptoillsof
symptoills crileria for ADHD and related
seto.fforms or self-report ratings andthe
forms: one seto.fforms and the other problem areas, as rvell as an inclex o detect nconsistent
areas,as
set for observ'er atings. The
The scalesand
scalesand scoring for the responding.
and rcbserverorms are identical,
self-reportand
self-report identical,although
although he
nornN are different. The long forms (CAARS-S.L and The short onn is ideally suted to those
thoseclinical and research
clinical andresearch
comprised of 66 items and contain 9
CAARS-O:L) are comprisedof situations r.vhere t is impor[ant to reduce
reduceadministration
administration
subscales. he short forms (CAARS-S:S and CAARS- time. The long form generally takros bout hree imes longer
comprisedof 26 items and contain 6 subscales.
O:S) are comprisedof complete than the short form. Consequently, vhenthe
to completethan vhen the
The screening orms (CAARS-S:SV and CAARS-O:SD are going to be readminir;tered
scalesare
scales readminir;teredrequently (e.g., n
requently(e.g.,
of 30 items
comprisedof
arecomprised
are itemsand contain four subscales.
and containfour managed are
aresettings), he short orm is usrnlly preferable.
settings), heshort

someof the behavio

Sincesomeof behaviorsrsand symptomsmeasured y
and symptomsmeasured On occasion, t might be helpfu.l o useboth
useboth versions, or
the CAARS change
changeover
over time, the administrationof
administration of a form example, ong form at baselineand
baselineand follow-up, and short
should be completed in one sitting in the presence
presenceofof a form for intermittent evaluation.
examiner. If necessary however, the CAARS can
trained examiner.If
be administereri over the phone, or the respondent can Short r Screening
Screeningorms
orms
complete the jinstrument at home. If either of these
When practitioners
practitionersor
or researchers re deciding which short
procedures s followed, special care strould be taken that
form to use, they should consider the sinntion and their
the respondent clearly understands he instmctions for
respondentclearly
own preferences"
preferences"Both
Both the short and the screening orms
completing he brm. The CAARS can alsobealsobe completed n
are about the same length. The CAARS-S:S and th e
a group ormat. The shorter CAARS forms (CAARS-S.S,
shorterCAARS
CAARS-O:S assess he core qyrnptoms f ADF{D, as
assesshe aswell
well
CAARS-S:SV CAARS-O:S, and CAARS-O:SV) ar e
as related problem areas. In ad.dition, theseshort
these short fonns
particularly suiited or those group testing situations in
include the Inconsistency Index: this may provide usefirl
which respondents ave
aveaa limited amornt of time to cornplete
information rvhen here s conce:rn bout he validity of the
the orm.
respondent'sor observer's atinrgs.

When using the observer orms front the CAARS, it is

essentialthat the observer has a close, persoual The CAARS-S:SV and the CA.ARS-O:SV
CA.ARS-O:SVscreen
screen or the
th e
core symptoms
symptomsofof ADHD, inclucling symptoms
symptomsofof all three
wirth he person
relationshipwirth
relationship personbeing
being assessed. he observer
DSM-IV subtypes of ADHD" ,OnIy the subscalesmost
subtypesof
should also have seen the client's behavior recently. An
directly relevant to ADFID diagnosis are represented -
appropriateperson o complete he observer orm mightbe
the ADHD Index and the DSM-IV subscales"
a spouse, arenLt, dult child, close riend, or coworker.
 DHD iating calesCAARS)
Conners'AdultDHD

The test materials neededate as ollo'ws:

Remote dministration espondent
the presenceof a . an ntact CAARS QuikScore orm for each'
The cAARS should be administered in eras-
trainedmentalhezrlthprofessionaloradministrator
. a soft-leadpencil (preferablywithout attached
r v h e n e v e r p o s s ib
ib l e . H o w e v e r , t h e r e
eww i l l b e s i t u a t io
io n s i n ers),or
rvlrichitisonlypossibletoobtaininformationbysending . aball-Point Pen
f necessary,
the Quikscore forms to the respondent'shorne.
itemi tnay also be read aloud over the
cases, he administlator should remind the
phone' In these
respondent o Administrationi m e
complete the items independently, without input from Most adults can complete
completethe
the long forms (CAARS-S:L
andCAARS_O:L)inlesstlran30nrtLnutesandtheshorter
others.Inaddition,therespond'entshouldnotdisassemble' and
would make t forms (CAARS-S:S, CAARS-S:Sr4 CAARS-O:S'
damage,or deface lhe orms, since doing so
The respondent CAARS-O:SV)inaboutl0minutes'Respondentswith
diffrcult or impossible to score them'
t a readingdifficultiesorwhosenative
readingdifficul tiesorwhosenativelarrguageisnotEn
larrguageisnotEnglish
glish
should also be remiLndedo complete the assessment ho take ess
parts of the may take slightly longer' Those resp'ondents
single sitting rather than complete dtfferent
should thanl0minutesonthelongerCAAI|'Sformsorlessthan5
urr.rrro.rrt at different times' The administrator responding
minutes on the shorter forms may be
alwaysobtaininforrmedconsentfromrespondentsbefore han 30 minutes
haphazardly.Respondents ho take onger
anadministrationanddebriefthema-ftenvards'Wlren
15 minuteson tl-re horter
onthe longer orn1sor longer than 15minutes
performing a remrlte administration, the administrator otnprehensiou'
the procedures forms ma-v avediftrcultiesrvith rea.ding,
should adhere as closely as possible to
or decision making.
explainedintlrischiryter.Itisals
explainedin tlrischiryter.Itisalsoimportanttosetad
oimportanttosetadeadline
eadline
it is highly
for the return of the forms' In addition'
reconmendedthafthepractitionerSetupaface-to-face
rneetingorintervii:wwiththeresporrdentbeforeoraftera
ReadabilitY
f h eCAARSconductedon the CAARS using
Readability analyses vere
vereconducted
CAARS administrlttion. Harrison 1980)
tlreDale-chall forrnula@ale & clull, 1948).
foundtheDale-Challfonnulato'betlrenostvalidand
Theresultsobtairredfronraremoteadminisuationnrustbe
CAARS
suchCAARS
such accurateofthenirrenostcomnornlyutilizedreadability
interpretedwith carution. or example, on all
"The data obtained formulas.TheDale-Clrallformulaisbasedonsemantlc
reports, add the following phrase:
a non-standard (word) diffrculty and syntactic (serrtence) iffrculty'
requires additionralvalidation because
a d m i n i s t r a t i on
on p r o c e d u r e w a s u
ussed.''Intheabsen ncceof
it is highly advisable to C o m p u t a t i o n s t o de
de t e r m i n e s e n t r en
en c e l e n g t h a n d r v o
orr d
external validating information, performed for all CAAITS items' The number of
the standard length were
perform a follow-up administration' using
completeSentencesarecountedanddividedintotlre
onsite protocol. sentence ength
number of rvords to determine average
$ D S/ SEN ) ' N e x t , t h e n u n r b e r o f . . u n f a m i l i a r ' , t v o r d s

MilterialsNeeded
Milterials Needed
administered n paper-and-pencil
GIFIr/IWDS)are arecounted'
counted' A word is considered nfamiliar
ifitdoesnotappealonalistof3,000..familiar''words
Tb€ CA*ARS a& be
CAARS
format using tritHS QuikScore forms' The
conrpiledbyEdgarDale(revised
conrpiledbyEdgarDale(revisedin1983)...Fami
in1983)...Familiar''rvords
liar''rvords

dmiaisrrator shrnrld ote that eachof the six QuikScore areknorvnuvgopercentofclrildreninthefourthgrade'

S,CAARS-SSY CAARS-
forilxs CAARS{,:I* CAAR}S' S,CAARS-S Considerationoftheamountoffamiliarandunfamiliar
wordsincludedincreasestlreaccurracyofthereadinglevel
O:L,CAARS-{):S,andCAARS-O:SV)includesall
coring'and
an d assessment.Thegradereadinglevelisdeterminedusing
necessarynforrnation or administering'
o specialscoring the ollorving formula :
profiling the particular measure'NNo
orms
templates re required.The CAARS QuikScore + (0'0496 WDSi
scoring he variousscales Grade (0.1579 PERCENTUFNIWDS)
.oniuin special ids hat make
makescoring
sEl9 + 3.6365
quick and accurate. Since these forms contain
transfonnationtablesfromralvscorestostandatdtzedT- Use of the Dale-Chall procedureor the CAARS items
scores, here :is no need o perform tedious hand
:isno ourth grade eadingevel'As
conversions sitlg conventional ormative ables' produces North
NorthAmerican
American
Such,theCAARSscalescancortfidentlybeadministered
tomostadults.Theresultsofthereadabilityanalysisare
shownn Table .1 '
 heCAARS
ndScoringff heCAARS
AdministrationndScoring

Table . 1 ventory is a list of questions hat ask aboutproblems

CAARS eadabilityevels
eadabilityevels and behaviors hat people somtltimesexperience.On
peoplesomtltimes On
the observer onns (CAARS-CI:L, CAARS-O:S, and
Form % of Unfamiliar ords Grade quivalent CAARS-O:S'V), the instructions ask the respondent
instructionsask
to make his or her rating rvith respect o a particular
C A A R S _S : L 14.31 A
a

10.11 A person's recent behavior. To htdp avoid bias and fak-

recentbehavior.
C A A B S _S : S a

C A A R S _S : S V 1520
1520 .i has no right or
threscalehas
ing, verbally emphasize hat threscale
C A A R S - 0: L 15.66 A
wrong answers.You should also emphasize hat all
C A A R S - 0: S 18.48 A
a
answersare confidential.
CAARS-0:SV 15.69 r+

It is essentialat this early stiage

stiagenn the assessment

r ocedure
rocedure
Administration process hat the respondent
respondenthas
and understandshe procedure.For
has read the instructions
respondentsvho
F or respondentsvho
best o administer he CAARS to respondents
Although it is best diffrculties, t mily be necessary
readingdiffrculties,
havereading
have necessaryor or you
oneat
one at a time, group administration s possible especially
groupadministration to read the instructions aloud rvhile the respondent
instructionsaloud
rvith the sh.ortercrrms). n either case, he administrati
administration
on along on his or
readsalong
reads her or.vn [orm.
or.vn[orm.
should be conducted n a quiet setting that is free from
Make sure that the respondent
surethat understands hat he or
respondentunderstands
distractionsor diisturbances. n administrator should
she must read each item carefuily and then make a
almost always be present rvhen the respondent s
rating by circling the appropriate nun'rber: 0" for "Not
appropriatenun'rber:
completinga CA",\RS orm. Group administration of any
administrationof
at all, or never,"" 1" for "Justa little, once n a while,"
respondents vith
recomnlended or respondentsvith
CAARS fonn is not recomnlended "2" for "Preffy
"Preffyntuch,
ntuch,often," and "3" for "Very nuch,
often,"and
reading difficutties. Ttre basic steps in the test very frequently."
administratiouprocess f any CAARS form are as ollows:
. Instruct the respondent
respondento o sek:ct he "best" ansrver f
1. Ensure that the respondent has a rvriting instrument. he or she s not sure horv to answer a particular iten.
No item should go unanswered. espoll-
Sornetimesespoll-
unanswered.Sornetimes
2. e el comfortableand relaxed.
Hetp he resprondenteel dents will ask how to respond o, or horv to under-
stand,particular items. Some respondentnquiriesnquiries re-
Exllain to thre espondent
espondenthat hat the purpose
purposeof
of the ad- will be straight-
quire a clarification of instructions
instructionsand
andwill
ministration about his or her
sessions to learn lnore abouthis
ministrationsession Other nquiries maybe ess essstraiglit-
straiglit-
forward to ansrver.
ansrver.Other
feelingsand
feelings E xplain that there
and behaviors.Explain are no tinre
thereare o respond o the th e
fonvard, and care must be ttal<enttal<eno
erssentiahat
h
l at
lirnits. It is erssential the lrlly
respondentlrlly
respondent under- he response. ften,
inquiry iu a rvay hat rvill nottrias heresponse.
stands he naLfure f the CAARS admrnistrationpro- it will be sufFrcient
sufFrciento o sa;', T'hat's fine' but for norv,
cess,so
cess, so that you obtain tmly informed consent. pleaseanswer as best you can, and rve can discuss
that item after you have finislted."
Give the reqrondent
reqrondenta a copy of the CAARS form. For
CAARS-S:S, and
theself-repontorms (CAARS-S:L, CAARS-S:S,an d
7. If the respondent vants to cheurge ll ans\ver. ustruct
ask the respondent o cornplete he
CAARS-S:Si,$,
nane and demographicsectionson the form. For tl're him or her to drarv an ")C' through the original re-
sponseand circle the correct response.Attempts
A ttempts to
observer orrns (CAARS-O:L, CAARS-O.S, an d an answer will make the scoring page smudged
erasean
erase
CAARS-O:Ii$, the therespondent w ill be asked o com-
respondentwill For this reason, he original re-
and diffrcult to read. For
plete the dennographic ection or him or herself as
herselfas
sponseshould not be erased,
well as for the person being described.The respon-
personbeing
dent should also indicate his or her relationship with 8. When the respondent
respondenthas conLpletedhe onn, quickl-v
has conLpletedhe
the person b{Ping valuatedby placing a checkrnark n
personb{Ping check t to ensure hat all items havebeen
itemshave completed.
beencompleted.
the
theappropriate box near he top of the QuikScore onn.
appropriatebox Obtain answers or all unaddlessedtems,
tems,and ask l-re
andask
respondent whether he or she had diffrculty under-
For the obs'erver orrns, the age and gender of th thee
standing Particular items.
observerare;
observer not used n scoring and as a
are;not result, f it
facilitatesaclministration, ornpletionof this infonla-
ornpletionof 9. After ttreCAARS is completed,nitiate a bnef disctts-
ttreCAARS
tion rnay be presented o the respondentas a s optional. sion with the respondent. lhis postadmir-ristration
The age and gender of the person being described debriefing provides a good oppoffunity for resporl-
does, holer,,er, affect the scoring and therefore this dents to reveal other details;
details;about
about thetnselves.Re-
Re-
information is alrvays equired. spondentscan elaborate on certain iterns and their
elaborateon
answers,and ask questions. n this sort of discus-
The first palge f the CAARS form also provides n- sion, you may also be able o gauge he respondents'
structionsand explains o the respondent
respondentirat tl-ren-
irat tl-ren-
degree of candor and learn a little rnore about their
 'Adult
ADHD ating calesCAARS)

personalitiesand backgrounds. Although you ilray

personalitiesand 2. For all CAARS orms,
orms,make su(e hat he responses
makesu(e
be scheduling a formal feedback session, t is impor- s<]oringheet.
have ransferred learly o the s<]oringheet.
steps and reiterate what the
tant to explain the next stepsand
results vill be used or. Finally, thank the respondents
and reassure trem that the responsesgiven will re-
nain confidentiialand be used oward positive
and will beused positiveand
and
helpful ends. Postadministration debriefing can be
Postadministrationdebriefing
fairty brief and does not need to become a lengthy
discussionwittr the respondent. Respondentsoften
respondent.Respondents
will be eager to find out what their responses mean,
responsesmean,
ask you to make interpretive comments
and may askyou commentsdur-dur-
ing or after an administration. It is very important not
commentsduring or immedi-
to make any nterpretive commentsduring
ately after an administratio
administration.n. Interpretation of ththee
the total number
then dividing by thetotal
or index and thendividing numberof of items
completedby qualified pro-
CAARS should only be completedby
fessionaisand
fessionais and orily after carefully revierving all avail- that had responses. or exampl{, if a respondent b-
Proper nterpretation s not possible taineda
tained scoreof 6, but ansvgpred
a raw scoreof ansvgprednly nly 3 of 5 items
able nfonnation.
nfonnation.Proper
subscale,he scofe
on a particular subscale,he may be adjusted y
scofemay beadjusted
amplereflection
rvithoutample
rvithout on the responses nd results,
reflectionon
rnultiplying the obtained arv sc$re 6) by the number
arvsc$re
and this generally cannot be done within a ferv sec-
onds. Offthe cuf interpretive remarks only serve o of terns 5) on he i.rll ubscale6 x 5 = 30).The esult
detract from the assessment rocess. Instead, you
rocess.Instead, be divided
shouldbe
should bv the nu
dividedbv of items that had
need to be processed responses3) to get the adjustect]rarvcore 30 + 3) of
should say that the responses
responsesneed
be prepared 10.Youshould alie nto accoudthe
10.You number f sub-
accoudthenumber
and examined. f applicable,you should shouldbe
stiflrtions or rnissirrg tenu rvhe{ nterpreting
rnissirrgtenu CAARS
nterpretingCAARS
to tell the respondents
respondentsvhen and where the feedback
vhenand
A s a general rule, i f
results.As t h a n hvo ar e
temsar
tems
sessionwill occur,and
occur,and who rvill be providing this de- missing or a particular le. he score or that
tailed feedback. f necessary make an appointtnent
necessarymake
rvith the respondent o discuss he CAARS results. subscale shoultl be considered ilvalitl. Overall, if five
subscaleshoultl
or more items are missing r{m the long form or
now score he respondent's CAARS form. threeor more
threeor are missing
moreare roftr he shortversions,
missingroftr
You rnay
rnaynow
he entireprotocol
then heentire protocolshoultl $e onsiderednvalid.
shoultl$e

Scoringh eCAARS 4. Thescoring heet eneatl-rhe m/response ortlons

heCAARSQuikScoreorms formatted ike a grid,
of heCAARS
scoresand l-scores for the six CAARS forms can be
Raw scoresand
all the
andall
and thescoring s doneon
scorings doneon hat grid. The scales,
by non-practitioners
calculatedby
calculated non-practitionersbecause of the sirnplicitv
becauseof
zubscales. nd ndexes are denti horizontally across
horizontallyacross
of the calculation. However, interpretation of this opof thegrid.For
the opof grid. Foreach te follorv the horizontal
eachte
undertakenby an experienced nental
information must be undertakenby acrosso any
line acrosso whiteboxes
anywhite the row.
boxes appearn therow.
health professional. he instructions or handscoring he In eachwhite
whitebox. write heci
box.write heci responseumber
QuikScore orms appear
appearbelow.
below. (e.g.,fthe nurnber"l" s circledthenrwite"l" neach
fthenurnber"l"
rvhite ox hat
hatappears
appearsn n hat ne).For
ne).For the CAARS
Handscoring he CAARS long forms (CAARS-S:L ald long forms only (CAARS-S: and CAARS-O:L),
andCAARS-O:L),
CAARS-O:L) takes under I0 minutes: handscoring he numbers rom the right side o the scoringgrid are
shorter orms (CAARS-S :S, CAARS-S :SY CAARS-O. S, thewhiteboxes
r.vrittenn thewhiteboxeshathat the arrow(s) oint-
thearrow(s)
minutes.The numbers
and CAARS-O:SD take ess han 5 minutes.The Numbers rom
ing to the eft. Numbersrom sideof the scor-
left sideof
on the forms may be added easily rvithout the use of a ing grid are written in the
arewritten whi boxes hat have the
thewhi
useof such a device, particularly on the
the right.
arrorv(s) ointing o theright.
calculator, but the useof
long forms, may expedite he scoring process
processslightly
slightly and
) the nunrbersn
Add thenunrbers the white
n thewhite for each column.
eachcolumn.
ensure greater
greateraccuracy.
accuracy.
the sum in the a
nd write thesum the bottont
box at thebottont
of the columns.
1. To use he self-scoring eature of a particular CAAITS
form, separatehe QuikScore form at the perforation. Forthe CAARS longforms ly (CAARS-S:L
(CAARS-S:Land
and
The scoring sheet is found between the response CAARS-O:L),Box G s obtai by addingthe totals
sheets or the two long forms (CAARS-S:L and andF.
E andF.
CAARS-O:L) and underneath he response heet or for columns
the our shorter orms (CAARS-S:S, CAARS-S:SV thoseCAARS orms hat include he Inconsis-
7. For thoseCAARS
CAARS-O:S, and CAARS-O:Sp. No conversion ndex CAARS-S:L,C
tencyndex
tency :S.CAARS-O:L,
:S.CAARS-O:L,
tables or scoring stencils are required.
tablesor and CAARS-O:S), write the c rcled response or the
 Administration
n
ndScorino
dScorinoff heCAARS
heCAARS

16 tems isted
istedat thebottomof
at thebottom of theparticular QuikScore t. Locate the correct age category column for the re-re -
form. For each
form.For of the 8 pairs
eachof pairsof
of numbers, alculate he spondent.The age range colutnns are
colutnnsare displayed
displayedon
on
betrveen he hvo uuntbers i.e.,
differencebetrveen
absolutedifference
absolute Profile orm (18-29year
theProfile
the (18-29yearolds, 30-39year
olds,30-39 olds,40 -
yearolds,
subtract he smaller tem response core roni the arger
subtracthe 49 year
yearolds. or 50 year olds or older).
olds.or
For e;<ample,f the responses
one).For
one). responsesoror a pair of items
"1" "3," the Profile fonn. circle theconesponding
On theProfile the conesponding a\vscore
a\v score
was and the absolutedifference
absolutedifference vouldbe
vould be
"2." Add tllre numbers rorn the scoring r;heet.The T he raw score or
8 absolute-difference cores o get the
tllre8
subscale is circled n one of the our columns
columnsnnder
nnder
Inconsisterrcyndex
Inconsisterrcy ndex raw score.
the letter A, the raw score or subscale goes n one
letterA,

8. Using the Inconsistency

Inconsistencyndex
ndex raw score,
score,complete
complete of the our columns urder the etter B, and so on. You
the relevant nconsistencyndex Criteria information must circle the rarv score n,umber n the correct age
scoren,umber
in the box llabelled Inconsistency ndex Guide" that rangecolumn
range columntoto obtainaccurate
obtainaccurate esults. f a raw score
appears ear he bottom of theQuikScore orm. If the exceedeshe
exceedes he value prrnted on the Profile fonn,
highestvalue
highest
answer s "'yes" o the criterion question, here
heremay
maybe
be circle the top scoreand print the rarv number at theth e
some nconsistenc,v
nconsistenc,vo o the respclnses. he results top.
shouldbe
should be nterpreted vith cautior:1. obsener fonns, it is the genderand age
Note: For the obsener
of the tr)erson eing describ,ed
describ,edhat
hat deternunesireage
ireage
You may norvprofile the CAAtr{.S cores.
norvprofile column and gender hat are usedon
usedon the Profiie fonn.
(Do not use he ageand
age and genderof the observer).
Profilingh e CAARIS
CAARIScores
cores -t. Using a ruler. connect he cirrcled cores n the Prohle
Each of the threeVpes of CAARS forms (long, short and form rvith solid ines o obtain heprofile
he profile shape.
screening) ene:rate different number
numberof
of rarvscores.
rarv scores. he 4. Detennine he l-scoresby follorvingan imaginary hori-
ralv scores
scoresare
are converted nto standard l-scores on the zontal line from the circled raw score
scoreacross
across o either
appropriateCAARS Profile form.
appropriateCAARS form. A Z-score s a standard outsidecolumn of the Profileronn.
outsidecolumn You (or a qualified
Profileronn. You(or
score 'ith a nedn of 50 ard a standard eviationof l0 in all rnentalhealth
rnental professional)ma},
healthprofessional) ma},norv
norv nterpret he re-
samples nd across ll scales. -scores llor.v ractitioners as explained n chapter' .
sultsas
sults
comparesubrscaleesults vithin a single
to comparesubrscale singleCAARS
CAARS form
and to compare subscale esults across
acrossvarious
various CAARS
forms. The CAARS Profile forms for the long versions
versions Scoring n dProfilinrg
Scoringn
(CAARS-S:L and
andCAARS-O.L)
CAARS-O.L) are
infonnation or malespresented
nvo-sided, vith l-score
arenvo-sided,
malespresented n one side and Z-score
sideand
Examples
infomration or fernales n the other.For
other.For the
theshort versions
shortversions descnbedn this chapter, t is a relativelysimple
As descnbedn relativelysimple ask o
(CAARS_S:S,CAARS_O:S, CAARS_S:SV:CAARS_
CAARS_S:SV:CAARS_ scoreand profrle any of the CAARS forms. Erarnples
scoreand Erarnplesof
of
O:S\|, the prol.rle heet s one-sided
theprol.rle vith the profile area
one-sidedvith cornpietedCAARS QuikScore forms are shorvn n this
cornpietedCAARS
for maleson
maleson the eft
eftside, and he profile area or females n
side,and sectl0n.

the right side. For both males and f emales, Z-score

information s ervailableor four drfferentage groups 18-
drfferentage Long orms
29yearolds,
29year 30-39 yearolds.
olds,30-39 yearolds.40-49
40-49 rearolds,
olds,and 50 year
and50 The respondent n this example s a 35-year-old ernale,
or older).
oldsor
olds N.K. Figure2.I shorvs completed esponse esponseheet
heet or th e
CAARS-S:L. Note hat N.K. circled heappropriate
heappropriate urnbr
Before filling out a CAARS Profile form, check th e ("0," "1," "2," ar "3") for each t em. The administrator
at the top of he form to ascertain vhether t is he
headingat
heading shouldcarefully
should check o makesure
carefullycheck makesure irat al alll items
itemsare rated
arerated
form for males or females. It would be a major error to at the end of the f
testing siftiatioir. the respondentdid did
and plot the scoresusing
convertand
convert scoresusing the rvrong set of gender not press heavily enough, the markings on the middle
When
norrns.When
norrns. profiling an observer onn (CAARS-O.L, scoring sheet vill not be clear. Consequ
Consequently,
ently, e sureto
sure to
CAARS-O:S, IIAARS-O:S9, be sure o plot the scores retain the front and b
back
ack response heets f tlhe orur.
according to the age and gender of the person being
Figrrre 2.2 shows the cornpletr:d coring sheet or th e
described not the observer).Transfer
T ransfer the ar,v cores rorn
coresrorn
ansp'ers;resentedn
CAARS-S:L, using the ansp'ers;resented n Figure 2.1.
otalboxesa,t
the otalboxes bottomof a particu.larCAARS
a,t he bottomof C AARS scoring
Scoreshave
Scores have been transferred into he boxes and then
sheet o t he appropriate
appropriateProfile
Profile form r"rsing
r"rsinghe
he follorving sununed within eacl-r olurnn. 'fhe total scores or each
procedure:
s u b s c a l ew e r e t h e n c a i c u l a t e dand
d and r e c o n d e d n t h e
eb o x e s . The a d m i n i s t r a t o r o l l o r v e d h e
a p p r o p r i a t eb
 calesCAARS)
Conners'dultADHD ating
roflle onnfor
to Figrue2.6 sh.orvscornpleted AARS--S:S
2.6sh.orvs
form' uslng selected tems otr: hat he awscores
instructions on the sr;oring R.P.'s cores n lrevarious cales'
Index'
caiculate the lnconsistency fromthescoringsl.reetlravebeentransferredtoilreProfile
T hescores ave een lotted
The
Figue 2 3 shorvs conrpleted
CAARS-S:L Profile form for fonn, vhereheyareplotted' abeled
scales' Note that the ralv on he "Mal'e" sideoi the forrn and n the column
"Mal'e"side
N.K.'s scoreson the various or a espondent
scores rom the scoring sheet
havebeen ransferred o the M2 (30-39 ear lds), vhichsappropriate
Profile fornt, rvhere hey are
plotted" The scoreshave been of this gender ndage'
the fornr andi n the column
plotted on the..FemzLle,lide of
F2 (30-39 )i€arsold)' rvhich
is appropnate or a ersion orms
labeled
,.uponO.nt of this gendt' and
Note also that for the
age"Note
age" Screening
The respondentn this example
s a 55i-yearoldmale'
male'D'S''
D'S''
N 'K' had a raw score
cale'N'K' 2'7 shorvs
P'S' Figure
Inattention/MemoqtProblerns n'ho s describinga 28-yearoldfernale'
(35) that rvasaboveittt ttigtttst f-score
shorvnon the fornr' for the CAARS-O:SV' Note
a cornpleted espon" 'httt
unrber "0"'
Wl1enthisoccurs'tlrepractitionershouldcircletlrelriglrest thatD.S. (the observer) ircled he appropriate
(theobserver)
ntunber at the top ir-r order to
ir-rorder .,1,,' '2," or "3") for eacl'rtem. The administrator areftlll'v
number and rvnte tl're rarv rvas
ad an extremescore hat iterns orn he sheet vere ated
shorv hat the respondeut checked o rnake sure hat all
rinted on the form' sheet n case he nriddle sconng
beyond lle range of scores and hen retarned he front
sheetwas t'tot clear'
Short orms scoring sheet or th e
s a 35-year-old nale' R'P' Figure 2.8 shorvs he cornpleted
Tlr.e espondentn this example a'srverspresentedn Figute2''7
responsesheet or th e CAARS-O:SV using he
Figure 2.4 shorvsa completed into the boxes and lvere
then
circled he appropriate unrber Scoreswere t'ut'"fJt"d
CAARS-S:S'Note hat R'P
..1,,, ,2,,, ot"3") for each tem. (The administrator summedwithin eachcolurnn'
C.0,,, carefirlly c;heck o make.sure that all items were CAIRS-O:SV Profile orm
snoUa Figure 2.9 shorvs completed hat
r a t e d a t t l r e e n d o f t he
he t e s t i n g s i t r r a t i o na
na n d r e t a i n e d t h e forD.S.'s ail;;p'i' on hevarious cales' ote
form in case the middle scoring sheet street ere ransferredo
the arvscoresro'r thescori'g
ftont sheet of the
were plotted
rvereplotted' They
rvasnol clear') the Profile form rvhere hey
scoring sheet or tl're ontlre..Fenlale,,sideoftlreforrrr,rrndirrtlte..Ftr',coluntn,
Figure 2.5 show's he completed
r v l r i c h i s a p p r op
op r i a t e f o r a f e r r r a lle
esrrbject,ls-2gyeaarr s o f
C AAR S- S: Su s i : n g t h e an
an s r v e r s p r e s e n t e d in
in - F i he
g unr e 2 ' 4'
4'
nto the boxes and rvere age.Tiris,.,..''],.gforn.rrvotrldtleincorrectlyprofiledif
and age (55-
Scoreswere tralniferred then according o ttte observer'sgender
The administrator ptotted
sumrned rvithin each column'
sconng form to use selected Year-oldmale)'
follorved nstnrctionson the
ndex'
itenrs o caiculate he Inconsistency

10
 ndScoringff he
AdministrationndScoring CAARS
heCAARS

Fgur e2.l
esponeSheeto rdre
Sampleespon
Sample CAARS-S:L
dreCAARS-S:L

CAARS-Self-Fleport: ong Version (GAAR.S-S:L)

P.Sparrow,M./\.
D. Erhardt" h.D.,& E. P.Sparrow,
by c. K. conners,Ph.D.,D. M ./\.

Birthdate,lS-i€l-1-h5 ase:35 Today's zte: I Ul-J 3-L

dccide how
sometimes cxpcricnced by adults' Read each item <xrefully and
Instructions: l-istcd bcto*, arc items conccrning behaviors or prohlems
for cach itcm b,v circling thc number thal corresponds to your choicc'
much or how frt{ucntly each item describcs you receotly. Indicatc your rtspons€
= Just
Usc he ollowing scale: 0 = Not al atl, never; a ittlc, oncc n a whilel
Justa
=
2: Pretty much, oftcn; and 3 Very mucil. very frequently'

lf em s c ont inued o n bac k P a g e " " -

#MHSffi.i,1"+.T"tlfL.lH*lilffi ,ffi,#,'X*Hf';'*KI'rm#;*I-i:jffi*'
';'*KI'rm#;*I-i:jffi*' *i*il*"*

11
 CAARS)
Conners'dultADHD ating cales

Figure2.lContinued)
Sample esponseheetor heCAARS-S:L

cAARS-self-Report: Long version (CAARSTS:L)

byC"K-GonnersnPh'D'nD"Erhardt'Ph'D''&E'P"Sparrow'M'A"l

* H'ffi'J't.5,t XIH if ^H- I': fi'd? ifilt*"

I':fi'd?
# MHS fi ,:,r,dsffi"ffi
12
 andScoringff he
Administra andScoring CAARS
heCAARS

Figure.2
Samplecorin
Sample orr heGAARS-S:L
corinSheeto

CAARS-Self-Report: ong Version (CAARS-S:L)

by c. K. conners,
conners,Ph.D., P h.D.,& E. P.
D. Erhardt,Ph.D.,
Ph.D.,D. Sparrow, lh.D.
P.Sparrow,

(lender:

BirthdaterasJa)lL3 nge:35 Today'srate: I l]-lJ-g$ Name: 'x-P

Mcntb DaY Ys
Mcnlh bY Ycr

numbers nto unshaded oxesacross achmw, as ndicated on eithersifte

ndicatedon of the scoringgrid'
either sifteof
Instructions: Transler circlednumbers
Translercircled
circtednumberwill be copiedonre or t\t'tce'
Eachcircted
Each
circled number below
Transfer eachcircled
Transfereach
inb boxes hat lmk like this
A B C D E F G H
It€m t
x 3 G \ O
"'
,t"'i" d i " ' bb
"..o..:
7 3
"'
i " '
1 0 0
0"'
'
o"'S"
"' Q q ' 00 ""' ' '
,r"'i" ( ) 9
...H,/.... ' f i1l "o
0 "o' ' "
r t 3 " ' '.)4...
0
n"'3" . .{\1{ ). . 0 ' "
"' 6'
.r"'i" f 1 l ) e0
" 0o ' '"
";+." "'
...L9.....
r s 3
.o"'i"
"' 1
1 0
o ' o "
' 0 '
"' j o ' o "
.r"'i"
O g ' 0 '
' o...
.r"'3"'-'
1 0
\,
i o 3 O1 q0 "0
"0 ""
"s .2. H
3
2.... "0" "
' 0 '
' 0 " '
' o '
a :
" ' 00" '
" o "
' 0

0 '
" "
0"
' ' 0 " " '
" 0 "
' 0

To obtaio raw scorcs" edd thc numbcrs io thc

whitc borcr for cach column (A to tl) and enlcr A

t h c s u m i n t h c b o x et l h c b o t t o m of t h c c o l u n r o s '

aEMHSffi g,tfr#Hn:ffi *"ffi ffi ,t,"ifr,:ffi ;lH"H#.T.I,1ffi-";'1fl

*"%;,"
t <
 DHD atingcatesCAARS)
Conners'Adult

Figure'3
Sample rofile ormortheCMRS-S:L

Ctient ID :

Birthdate,#*y# Today'sate:-j-l-l+#
Today's ate:-j-l-l+# Name:

F1 = Femates18 to 29 Yearsof age i

F2 = Females3O o 39 Yearsof age i
F3 = Females 40 to 49 Years of age
F4 = Females 5O Years of age or older

lz5 r'1/. ru t*
r':?"ffiif;#X.;:;;;;;d(r$)5{++rs/
- r .n i$- ---*l ln rlG LJ S-4. rrrt - {tttl <ro-arlta

#MIrS **.:;

14
 heCAARS
andScoringf heCAARS
Administra andScoring

Figure.4
Figure.4
esponseheetor
Sampleesponse
Sample heCAARS-S:S
or heCAARS-S:S

V ersion CAARIS-S:
hortVersion
CAARS-Self-Report: )
P h- D., E.P. Spar r ow'Ph.D.
s,Ph.D.,D . Er har dt,Ph-
by C.K. Conner s,Ph.D., P h.D.

Client D: R P Gepder :@ F
(Circlc Orc)

Birthdate,**/-Ll{"3 age:35
age:35 Today's "t.,lL*.* JS_dB

Instructions: Listed betow are itcms conccrning behaviors or problcms sr-'rmetimcs xpericnced by adulr+. Regd each inn carcfutly and decide how
sr-'rmetimcsxpericnced
much or how frcquently each item tiescribes you recentlv. Indicate your response or each tem by circting the number that corrcsponds o ytrur choicc.
tiescribesyou
Use hc follou'ing scale: 0: Not at all, neveq I : Just a little, once n a while;
Justa I - i-
? = Prctty much, oftcn; and 3 = Vcry much, very frequently.

"I'IJ#-T#T}ffiL"
#MHSmS:;#i.Hllfl *;r*"11'ffifi*i'# .i;1^,*LH",lTiHIff

4 a
t'1
 DHD atingcalesCAARS)
Conners'Adult

Figure.5
Sample corinSheet
Sheetor he GAARSJS
or heGAARSJ

cAuARS-self-Report cale:Short Version (cAr\RS-S S)

h.Q. P h.D.,& E. P"
D.. Erhardt,Ph.D.,
by c' K. conners, Ph.D.,D P"Sparrow,
Sparrow,

Birrhdare,Oa/-ll &3 age:35 Today'sD.t",ll-[5i3$ I{ame:

-?; Ya
-; Month DaY
ffi

Instructions: Transfercircled numbers nto the unshaded oxesacrosseach ow'

Transfercircled
as ndicated below. Each
ndicatedbelow. Eachcircled numberwill be copiedonce
circlednumber or trrice.
onceor

:1
22
7

t1

z1
21
tt
25
26
26

& Td obtrin rr\Y s c frrc s , sdd thc oumbcrs

wbitc boxcs f o r c l c h c o l u m n (A t o E)
tb c s u rn in th c b o rl .t th e b o tl o f, o f th c
a n d
io thc
enter
columns'

#MHSffi .:ltr*xlH[ffi #lf,ff*T,:Hffi I*;ffi 5,1i3#;. Tiffi;",

16
 ndScoringff he CAARS
AdministrationndScoring

Figur e . 6
Sample rofile ormor he GAARS-S:S

CAARS-Self-Report: hort Version CAARS-S:S) 'rofile o r m

Gender €) oT
Client D : 1?.P

b3 ,Age: 5 Today'sDatez L lLSJ]g Name:

Eirthdate O2l L A
M o n th DaY Ycar

A. Inattention/Mem mo o r rYo b l e m s
M1 = Ma le s
l B 29 y e a rs o f a g e
to F1 = Females B o 29 Years f age B. H v o e r a c t i v i t v / R es t l e s s n e s s
M2 = Ma le s 30 to 3 9 y e a rs of ag e F 2 = Fe ma le s30 to 3 9 Ye a rsof ag e C. t m r i u t s i v i t y / E h o t i o n aal b i l i t y
F 3 = Fe ma le s40 to 49 Ye a rso f a g e D. P r o b l e m s v i t hS hS e l f - C o n c e P t
M3 = s 40 t o 49 y e a rs of ag e
Ma le s40 E. ADHD ndex
M4 = Ma le s 50 y e a rs o f a g e o r o ld e r s50 Ye a rs f a g e or o ld e r
F 4 = Fe ma le s50

)I
I
E I E
F'I F2 F 3 F 4 F 1 F 2 F 3 F 4 F 1 F 2 F 3 F 4 F 1 F 2 F 3 F 4 F 1 F 2 F 3 F 4 T
r M1M2M3M4M1M2M3M4 M1M2M3M4 M1M2M3M4MlM2M3M4

t;

85
8 4 ' 1 4
8 3 - 1 4 1 5 - -
8 2 - : - i
er - 1q -.-
14 13 - 14 14 lr lz -
s 0 [ . : - ] : i . , . 1 ; , . 1r . : . t . ' . . . . , : ' . . : j | 8 . ; 2 9 . . . : 2 - 6' . -' .. . t+"- - - ''- - -r '' iv 6 - 79
i s - 1 3 - - 1 5 - ' 3 1 - 2 8 : - 1515 -
- B E 78
- 15 14 - - 13 - 12 - 15 15'12 - 27 - 25 - - 1 2 1 3
78 1s - - ' 1 3 1 3 1 2 t 1 - 1 5 ' 1 5 n 1 6 E ' 7 7
- 14 - 30 - 2 7 1 3 1 2
77 1312 - 1 1 - 2 4 X 7 6
76 -'tz - - 14 ' 1t?. 15 ' -:' 2926 ' 24 - 7 5
- - 1 1 ' ,, 2 - t + t l 1 5 1 5 6 E ' B
5 14 1 3 14 ' 14 ' 114?3' 71
- ]3 '',t2 - 11 28 2523 1 2 - 14 - : 12 12
74 -'r1
- 11 - : - f l - 1 0
- 1112 - 13 11 - 1413 2724 ' 22 -
13 13 12 - 10 - 14 - 14 - 24"42 12
72 1 3 - 1 5 1 3 12 - 1 3 - " 2 4 '
71 - 12 - 11 - 10 13 10 ?623'21
- ll 10
10 11
-
- 11 n - : -
1 3 - '
rr -
, 3 - v
D 4 tl
7 1

- 11 12 - ' ' 1 2 1 2 " 2?23

70- 10 - 1 2 1 1 1 0 9 9 1 3 - - n 6 9
14 - 11 - 10 - 25 '2220
69 12 10 - -
- 12 - - 12 - 12 ?2Z]'?0 ' 68
- 12 - 11 - 10 - - 12' 2421 10
68
- 11 9 - 11 11 9 ' :2119 1 0 - 9 - - 1 0 1 0 - 1 2 - r . - 1 9 1 9 6 7
67 9 - 10 - - I - 8 1:l - 11 - 20 - - 6€
- g - - - ' 232020' - 9 fl
66 11 9 10 - 13 -
. 11 - 22 - ' '18 f f i 8 - - 1 1 2 0 1 9 1 8 1 8 6 s
- - 11 - 11 - 64
10 - - 8 - 10 10 8 - 19 19 17 I - 8 - 9 9
64 - 10 9 - - 10 19181717 63
- I
6 3 1 0 - 9 8 1 2 ' 8 - 2 1 1 8 " - 8 1 0 8 - 7 - 1 0 1 0 - 1 8 1 6 6 2
- - 10 I 9 I - - 10 I 18 16
62 8 - I - 7 ' 1 rl ' - ' - 17 16 - 61
- - 201717 '- 8 - I
61 9 7 I - 15 60
:-----7 - ffi- I 17
60 9 - I 7 11 - I 9 - - 1615 - 59
- - 8 '16 16 - 7 9
-@-{)a a 7
5e - 7 - 7 7 7 6 6 €r - 16 - 1414 58
sB -Y - -a - - 8 7 - I - 1 815 ' l -
- 7 - 8 1515 57
17 - 151 7 - 8
57 8 - 10 - \ 6 I 6 -
-\ . c 1 1L 'l L
A a - R I- I- 1313 5
556
B 7 1414
55 - 6 --:\- ? 6 - 7 ' 16 - ' 12 - 6 6 6
- 131212
- - 7 6 6 5 5 54
- 9 - - \ - s 7 5 - 13'13 6
s4 7
6 s - 7 u \ - s rs(frz rr 5 - 7 - ' 7 7 ' 1 t- - 1 3 - 5 3
s3 - - - 6 1?12 11 11 52
- -\ o s s - 6 5 5
52 s - a < ( 6 q 6 " 1 0 5 1
- 8 - ' - a 6 5' -,/- 11 1 r
51 6 :\-
6 - s \- - 5/ 13
- 4 4 4 - 3 9 4 9
s " ' / 1 0 l o g - 4 8
- 5 4 4 4 - 5 - 10.10
- - 4 -\- - 12 I 9 8
48 5 --(a )- - - - 4 3 3 5 5 9 - 8 4 7
47 - 5 - ' Y;.-z ' -' 11 4 5
_ 4 6
- 1 ? - 4 " 9
4 - 6 - 4 - 4f3T- ' 4 3 I I
46 - 3 3 - - 4 3 3 3 - - - 4 ' 8 '
- - - Y g - - 3 - - 1 0 - - '
4 5 4 3 3 3 - 3 4 4
3 4 -
2 2 3 3 7 6 6 43
- 3 - 3 2 - 2 - 6 6 '
4 3 3 ' 5 ' 3 2 - 6 42
- - 8 - - 5 - 2 - 2 - 3 2 '
4 2 2 - 2 2 2 2 1 5 J 41
42 - 2 - 3 - ' 2 J J - 1

- 3 - 1 - 1 2 ' - 5 5
4 1 - 1 1 - 1 2 1 1 2 - 5 40
1 2 1 4 - z t 2 - t ' z - - 1 7 - 4 : - - - - 3 9
4 0 z 2 1 s
0 - - t - o
t t T -
3 9 2 - - 0 2 - - 1 - ' , l - 2 1 - 4 ' 3 3 8
38 2 1 - 1 0 - - 1 0 - 3 3 - i 0 - 0 - 0 0 1 - ' 4
0 3 0 - - o - 0 0 5 2 2 3 6
1 - - 0 - 0 - 4 2 2 1 0 0 0 - 1 - - o - 1 0 0 3 -
J O - V - 2 3 1 3 5
?( n - 0 - o 1 1 34
0 0
3 4 2
0 0
33
2
J I

0
30 29
9 t6
28
(-r copvnght r lgg8, ,rurri-Hcarrh y stcr^ rnc. Arr ights esryed- n the
ystcr^ u.s.A'. P.o Box 950,
theu.s.A'. Norrh mawan&' NY I'1120'0950'800) 56-1003'
950,Norrh
r(888)5404484
E nif lf
l T T 0 V i * . r i a p a r k A v c . . T o r u n t o . o -Nu n r v e . ( 8 0 0 ) 2 6 8 - 6 0 l t . l n t m a t i m a l , + l - 4 1 6 4 9 2 - 2a6x2' ?+ l - ' 1 1 6 4 9 2 - 3 3 4 1
:IvlrrLrrnLanada.
 11

DHD ating cales CAARS)

Conners'AdultDHD

Figure.7
Figure.7
Sample esponseheet
heetor SV
SV
or heCAARS-0
heCAARS-0

CAARS-Ob$elver:ScreeningVersion (CAARS--O:SV)
CAARS-Ob$elver:Screening
by C. K. Conners, Ph.D.,
Ph.D.,D.
D. Erhardt,Ph.D., P. Sparrow, Ph"D.
& E" P.Sparrow,
Erhardt, Ph.D.,&
OssER\TR

N a m c : P .S . YourName: D, S
YourName:
Gender: Ilf fF)
(circh hEf Cenrler:
Q*_l age:5
age:5 5 .-
Today's Date: f J /JU_1-19-I arn this p€rson's: 1 spousefi parcnt O sibling D other:

tartruc1iros:Usedbelowarcitcrrseorrcerningbchavionorprofrlerrrssomctimcscxpcrierrcedhyadutts.Reedeachitcmca'efllyarddocidchowmuc}rorhr:wfrequ
d e s g i b g th i s p c rs on
on rc e rrtl y .l rd i c a te y o u rre s p o
on
n s € fo re a c }ri t.rrrb y c i rc l i n g th e n u
um
m tl e rtl ra tc o rrc s g n n d s t,o y o u
urc
rc h o i c e ' U s c th e fo | |o
|o w i n g | c :
| = Just a littlc. oncc in a while; 2 = Prc*ty muc\ ofte4 srd 3 "' Very mw[ very freqrrntly.
Jusl r lidt
Not rt ell, PrEfy ar{tL VcrI larr\ vtry
orcc in r
he person being described... Eetr :hilc sfteo frtque$Y

I.

2.
loses hings necessary or tasks or activities
(e.g., o-do lists, pencils, books, or tooXs).
talks oo much- '
0
0
o 1 G}
,',
t- J

3
3. alwayson he goas
is alwayson go as f driven
drivenby
by a nrotor. 0 1 a) 3
@, 1 ia, 3
o
4, gets owdy
owdyoror boisterous uring eisune ctivities.
boisterousuring
5. hasa
has a short use/hot
use/hotemper.
emper. 0 it 3

6. leaves cat vhen vhennot

not suppqsed
suppqsedo. o.
o o itit 3
1 3
7. throws antrums. 0
8. has roublewaiting n lineor line or taking urns
urnswith
with others. 0 1 Q\ 3
9- has rouble eeping ttention ocurcdwhen workingor
ocurcdwhenworking or at eisure. 0 o1 .',
a- 3
CE
c
10. avoids ewchallenges
ew challenges eqause lack,of aitlr n his/her bilities.
eqause f lack,ofaitlr 0 3
1 . appeam
appeamestless venwhen itting till.
estlessnside venwhen 0 aa 3
' 0
diitracied'b1i iglts.or.s<iunds hen ryingto concentrate. . ',
12,:isdiitracied'b1i
12,:is 1
CD
al
S/{

e
13. s forgetful
forgetfuln n dailyactivitiss.
dailyactivitiss. 0 I 3

o
, 14..fi65 prlble tist6ningtg hat otherpeople 19 aying.: ,, , 0 ?. 3
'.2 3
15. s anunderachiever.
an underachiever. 1
' 0 '12 3 :
16. s alwajs
alwajson the go.
on thego.
17. can't get hings oneunless
can'tget here's nabsolute
oneunlesshere's n absolute eadline. - 0 i2 3
@ 1t 3
e
18. fidgek (*ift hands r feet)or
feet) or squirms n seat I

19. rnakes areless islakm

islakmoror has ouble paying loseattention
loseattentionoo detail. 0 12
20. intrudes n othersl,acti''sit ies,,, 0
n
1 CD
12
J .

2 I . doesn't like eademic *udieJwqk pojects wtrere effort u drinking a lo is required t t l J

22. isrestless or overactive. i 0 i2 3

23. sometimes verfocuses
verfocuseson details, at other imes appears istracted
on details,at istractedby by
everlthing going on around him4rer. 0 ( 1\ 3
.24'can1t:ki#p.'tiifieimind.onsbm.e,"thingunl
.24'can1t:ki#p.'tiifieimind.ons bm.e,"thingunlessitrsrea
essitrsrea yinterestiiiLg:'
yinterestiiiLg:''' ,0 J

25. gives
givesanswers hequestionsave
o qucstions efore hequestions bcen ompleted.
avebcen @ 1
o
answerso
'26.,hasfoubtefinishin j*. , . l 3
o
hasfoubtefinishingjobt
gjobt sl<sorschoolwi
sl<sorschoolwij*. 1
areworkiing r busy.
27. intemrpts therswhen hey areworkiing U J

e
28. expresses ack of confidence n self becarrs€ f past ailures.
expressesack 0 Ia 3
29. appeans istracted hen hings
appeansistracted are.going n around im/her.
hingsare.going 3
has'iroblems
.30.has'iroblem
.30. reanizineasks ndactivities.
s reanizineasks ndactivities. 1 3

# r ,yrd U.S.A.,PO- Bor 950. {tnb Tsnad+

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heCAARS

Fgarre2.8
Sampte coring heet or he GAARS-O:SV

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CAARS-Observer:Screening
P.Spanow,Ph.D.
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19
 atingcalesCAABS)
DHD atingcales
Conners'Adult

' ',
, Figurel.9
Sampletqfi eForm SV
SV
heGAARS-0
or heGAARS-0
Formor

bse ve : Screen ng :Ve

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Males18 yearsof
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yearsof
of age A, DSM-IV nattbntive ymptoms
DSM-IVnattbntive
M2 = Males 30 to 39 years of 6ge F2 = Females 0 to 39 years
yearsof
of age B. DSM-lVHyperactive/lmpulsiveymptoms
DSM-lVHyperactive/lmpulsive ymptoms
M3 = Males 4O o 49 years
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o-f ge F3 = Females 0 to 49 years
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of bge C. DSM-IVADHD ymptorns otal
ymptornsotal
M4 = Males 5Oyears
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Females50 D. ADHD ndex

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 ?0

Chapter
n dU s e
Interpretation

This chapterdescribeshe interpreLive trategl'for using clinical settings vith respondentslrvhovish o elicit special
consideration. xtremelyhigh sc:ale cores n the CAARS
sc:alecores
i n t e r p r e t i v es t l a t e g y b e g i n s r v i t h
t h e G AAR S. T h i s shouldalwaysbe suspect, specirally 'scores hat exceed
consideration of the r,'alidity of the responses' he n
80. Note that such extrerne Sgofgs sually ndicate
extrerneSgofgs ndicateseveresevere
proceeds vith a sun/eyof the responses t the item level,
symptomatology,but may on occasionbe the result of
shifts o interpreting ndividual scales, xarnineswhether
symptom exaggerationor malingering. Interpretation Interpretationof of
Scores n the various scales epresent
epresentaa pattern hat has
extemescores anbe clarifiedby i:omparing he nfonnation
diagnostic mplications,and interprets hese esults n th
the
e
providedby
provided by the respondent o o,ther ndepeldent sottrces
context of other information about the individual's
o f i n f o r m a t i o n t h a t h a v e b e e n o b t a i r - r e d .f l a r g e
symptonlsand behaviors.
discrepancies xist bet*:een he respondent nd the other
sources, hen the possibility of rnalingerilg is mag1ified.
possibilityof
f h e CAARS
Interpretation Faking good (also
(alsocalled social esirabilitv) is a persistent
calledsocial
Before he GAARS scales anbe nterpreted,t is crucial o problem in psychometric testing. Respondentshigh in
consider hreats o the validity of the measures. lthough social desirabilityare more ikelty o present hernselvesn
aremore
m ay bias heir responses
a resullt,maybias
self-reportmeasures ike the CAARS assess variety of a positivemannerand,
positivemanner asa
and,as
ADHD-related symptoms,
symptoms,CAARS
CAARS scores
scoresare
are subject o to test items in what they consider to be a favorable
severalpossible
possiblebiases.For
biases. example. sorne ndividuals tend direction. To reduce the potenttial for social desirabilitl',
to underestimate r underreportsymptoms n the sen'ice respondents hould be reassured bout he confidentialitv
of presenting
presentinga a favorable evalmtion of themselvesor a of their responses. o-administrationof the CAARS rvitft
Gender and cultural differences also may the PaulhusDeception Scales PDS) s recomme
recommer-rded
r-rdedor
or
family member.
member.Gender
influence eporting. While the CAARS shorvexcellent est- more formal assessment f sociallydesirable espondi'rg.
retest eliability and validity, these and other factorsmay
theseand
lead to poor test-retest eliability atld suspect alidity in t emRes;Ponses
temRes;Ponses
lnterpreting
the individual's responses. hus, it is important to ask as k
The first step n interpretingthe results rom any GAARS
about the circumstancesunder rvhich the respondent form is to examine ndividual item responses. y pemsing
cornpletedhe questionnaire nd also o ask directly about the "Verv much, very frequentlly"or "Pret$'much. often"
rvhether he individual had diffrculty in interpreting or responsecategories, t is often apparent vhich tlpes of
understanding articular tems. symptomsare problematic or the ndividual.For example,
afe a valid an individual may endorse many inattention/memory
It is important to assess .vhether he results
.vhetherhe resultsafe
p r o b l e m s , b u t f e w h y p e r a c t i v i t y / r e s t l e s s n e s so r
representationof the individual's true feelings an d
impulsivity/emotional labitity symptoms.When perusing
experiences. n important validity q)ncern s thepossibility to look for consistencyn
individual items, t is important
importantto
R.andom esponding can result frorn
of random responses.R.andom
the pattern of responses ndl not to overinterpret an y
a gloup testing siruation rvhere here are poorly rnotivated
individual response vith respre:cto predictive porver or a
individuals, or rvhern isoriented clinical respondents
particular clinical disorder. 11 this conterit, the CAARS
complete he scales n a randorn manner. n addition, n irat are veighted
s, tems iratare
contain no "critical items," tha,ts,
items,"tha,t
unusual esting situations vhere here s a fixed time limit
estingsituations
as more rnportant han other tems'
(e.g., esearch ettings), espondentsnay answerparts of
the GAARS at random to finish the assessmentn the Symptomsat the tem level mery e mportant ldicators of
levelmery
allotted ime. idiographic treatment targets (i.e., targets defined at tl-re
point at rvhich reatment s tail.oredor the ndividlal). For
Two basic lypes of faking responsebiases have been prirnarily atteltional problems
identified n the test
testdeveloprnelt
developrnelt iterafgre:
iterafgre:"faking
"faking bad" example,an
example, an individual with from another ndividual rvith
might be treateddifferently
and,,fakinggood."Faking bad occurs vhen he ndiyidual
badoccurs
primarily hyperactivity probleurs.All of the cAARs forms
probleurs.All
attempts o present himself or herself n a negative ight.
presenthimself
several of the more important
make it easy o pinpoint severalof
This type
typeof be encounteredn
of deliberatemalingenng may beencountered
ADHD-related syrnptoms, vhi,ch n hrn allorvs he clinician
heclinician

71
 DHDating
DHD
Conner s'Adult calesCAARS)
atingcalesC AARS)

the clinical inten'ieu:

direct theclinical
efficientlyandempatheticallydirect
to efficientlyandempathetically Table . 1
Itern revierv permits a similar approach to rnany other o r I-Scores nd
Interpretive uidelinesor ndPercentiles
Percentiles
irnportant signs and symptorns hat may be present
presentandand
FScore Percentile
allorvs he cliniciau to spend ess ime on qymptoms hat Range Range Guidgline
have not been endorse
endorsed. T he constituent tems for each
d.The
subscale re given in appendix
CAAR.Ssubscale
CAAR.S appendixBB to facilitate
facilitatethe
the Above 0 UHr
Verymuch bove verage
66 o 70 Much bove verage
interpretationof itern
interpretationof responses.
iternresponses.
61 o 65 B6-94 h ^ , , ^
AUUVE
^ . , ^ . . . ^ ^
dviil dgU

56 o 60 74-85 S l i g tly
tlyaa b o v e v e ra g e
45 o 55 1'7 1? Av e ra g e

Ilnt
n t e rerpret
p r e t a t i o ning
o f ubs
t h e CcAAR
aleSc ores
alec 40 o 44 Slig h tly e lo wa
wa v e ra g e
requires a general 35 o 39 6-15 Be lo w v e ra g e
understanding of the nature of ADHD syrnptoms across 30 o 34 Much belovu verage
Below 0 <2 Verymuch
Very muchbelowbelowaverage
average
the life span. Given such an understanding, the CAARS
are easy to interpret based on an analysis of where a horv al individual's
individual's scores compare o thoseof
scorescompare thoseof adultsof
adults of
particular individual's scores alls rvith respect o the and gender rom the normative sarnp,le.
the same age ange andgender
sameage
CAARS population
populationnorrns.norrns.For exarnple,an ndMdrnl witlt
For exarnple,an Horvever, hese re nerel-v pproximate uidelines. here
nerel-vpproximate
above70 on the ADHD Index is likeJly
a l-score above70 likeJlyo
o have no reason o believe hat there s a nteaningfuldifference.
is noreason d ifference.
significantlevels
significant levelsof of ryrnptoms hat may neet cliagnostic ar?-score f 56 .
for example, etrveen Z-score f 55 and ar?-score
criteria,such
criteria, suchas the DSM-IV (AIA, 1994).
as n theDSM-IV heseguidelinesas
Do not use heseguidelines absolutenrles.
as absolutenrles.

Wren using this strategy i.e., using Z-score

Z-scorenorms
norms to Somepractitionersnray be more ainiliar rvith percentiles.
nraybe
conpare the individual's responses
responseso o population
populationnorms)
norms) or percentile ssessrnent
Guidelinesor
Guidelines ssessrnentre alsogiven n Thlble
realso
it is irnportant o note
noteat h at population
at the or"rtsethat populationnonrs
nonrs
casen-mst epresentan
in tliis casen-mst epresentan alppropriate or-nparison 3 1.A
1. A percentile
percentileexpresses
expresseshe percentage f individuals n
groupu'ho
uonnativegroup
theuonnative
the u'hoscored ou'er lian therespondent.
scoredou'er the respondent.
group. For the CAARS, normative comparisonsar
comparisonsar e So, or example, f "Steven"scored at the 90u'percentile n
scoredat
presentedby ender
enderand
and age or a large nonnative sample. the Hyperactivity/Restlessnessubscale, hen Steven's
Z-scores epresent problem:,
High Z-scoresepresent problem:,orver
orver -scoressuggest
-scores suggest score on the Hyperactivity/Restlessness ubscale va s
Hyperactivity/Restlessnessubscale
doesnot preserLrtarticular
that the individual doesnot a rticular sytnptoms han 90 percentof other
higher han90 age,The percentile
men his age,The
othermen
setsof syrnptoms. he l-score is a standard.ized core
or setsof suggestshat Steven as
suggestshat morehlperactiviry'problemshan
asmore
rvith the useful feafure that each subscale vill have the a large percentage f otirer rnen his age, rvhich indicates
age,rvhich
sarne standarddeviation. Such a feature
rean and standarddeviation.
sarnerean featureallor.l,s
allor.l,s
thepossibility f a clinicallysignificantprobllem. ercentrles
estuser o directl
the estuser ycompare he scores n one subscale
directly derivedempirically
derived shorvn tt
empirically from the uormative data are shorvntt
another.Sucha comparison s not possible
to the scores u another.Sucha age and gender.
appendix A, by ageand
if the rarv scale cores re not transformedbecause
therarv here s
becausehere
a different number of items comprising many of th e
subscales. hus, the range
rangeofof possible aw scores or the Interpretingrofile atterns
Interpretingrofile
various subscales, efore l-score trausfornnation.s
trausfornnation.s When interpreting he CAARS, the clinician will rvantt o
difrerent. examine he pattem of elevated
elevated cale scoresn
calescores n addition o
consideringndividual l-scores (or percentiles).Whereno
W here no
T-scores ave a mean
avea meanof standarddeviationof
of 50 and a standarddeviation of 10. Z-score s above 65, the CAARS is not indicative of
The I-scores used vith the CAARS are linear l-scores. clinically elevated ymptoms.When
W hen oue 7'-score s abrlve
7'-scores
Linear I-scores do not transforrn he actual dis;tributions 65, then the pattern s marginal. In tum, the greater he
of thevariables n any
the variablesn anyrvay: hence, vhile each
rvay:hence, eachvariable has
variablehas numberof
number of scales hat shorv clinically relevant
shorvclinically relevantelevations
elevations
been transfonled to have a mean of 50 and a standard (I-scores above 65), the greater he likelihood that the
above65),
of 10, he di
deviationof
deviation distributions
stributionsof coresdo
of the subscale coresdo CAARS scores ndicate a moderate o severe roblem.
scoresndicate
change.Variables hat are not normally distributed in
not change.Variables
the rarv data vill continue o be non-nonnally distributed
after the transformation.
after
A Step-hy-Stepu idleo r
uidle
h eCAARS
lnterpreting
As a general
generalguide,
guide,I-scores
I-scores can lbe nterpretedl sing th
thee sectiondescribes step-b)'-step uide or
Tlle follon'ing sectiondescribes
Thble3. , These
grudelines rovided n Thble3. guidelinesdescribe
Theseguidelines describe
he CAARS.
interpretinghe
interpreting

aa
 n dUs e
lnterpretation

65 represent linically sigmficant symptons n a "highbase

Step : Doesh eCAARSnovidealid
Doesh
rate" group, such as among thosle resenting o a mental
bout DHD ymptoms?
inforrnation health clinic. Conversel)', ou may wish to use a higher
understandingof the individual's tnotivation o
Given an understandingof cntenon score e.g.,
e.g.,Z-score even75) for inferring
Z-score f 70 or even75)
cornpletehe
cornplete he scale, he rnpactof otherproblerns n hiVher
rnpactof
clinically significant problems n a "lolvbase rate" group,
rate"group,
ability o complete he scaleaccurately, he setting n n'hiclt
scaleaccurately,he adultswithout identified problems.
suchas
such a population of adultswithout
asa
wasadrninistered, nd the purpose or rvhich he
the scalewas
thescale
will be use{ make a udgnrent regarding hevalidiry
resultswill
results he validiry The DSM-IV ADI{D scales n the ong andscrcening
TheDSM-IV orms
scrceningorms
of the CAARS data. As a first step,
data.As rinspecthe
step,rinspect he CAARS can also be used to identify adults who may be
Inconsistenryndex to estimate
Inconsistenryndex estimatevhether
vhether hepattem
he pattemof
of item experiencing clinically signillicant evels of ADHD
a nd consistentwith
responsess both internally consistentand w ith symptoms,as well as to gain anr nitial understandingof
the response atterns shor.vn y other indiuduals of th
atternsshor.vn the
e the patterning of such symptoms. n addition to examidng
sameageand
sameage and gender. f not, then the results
resultsnay
nay or may the overall I-scores for the DSM-IV scales,you ar e
be valid, depending
not bevalid, on other nfonnation available.
dependingon encouragedo revierv ndividual, tetn responses
responsesor
or these
associatedvith a
scalesgiven that each itern is itirectly associatedvith
alsoneed o beconsidered
Motivational ssues hat alsoneed nclude
be considerednclude he DSM-IV
DSM-IV criterion. The items l'rat
l'ratconstinrte
constinrtehe
treatrnentby inflating
the respondent's esire o avoid treatrnentby re shown n appendix B. If anitem from a DSM-
appendixB.
subscalesreshown
symptomsor
symptoms C oncerns egarding
or mininizing syrnptoms.Concerns "2" ("Pret ymuch or often") or "3 "
IV scale s rated as
self-presentationthe need o look good)
theneed good)may'also
may'also ntroduce
("Very much or very frequentl-v"),
frequentl-v"),hen
hen he conesponding
a systematicesponse ias. t is also mportant o consider DSM-IV criterion may
maybebe rnet.
rnet.Tlhe CAARS fiinding
TlheCAARS fiindingshould
should
sa s s o c i a t e d , v i t h h e
r v h e t h e r e s p o n s e e n d e n c i e sa be combined rvith other information t o judge if t he
respondent's ulhrral background
backgroundrnight rnight irfluence his or consideredas present.
symptomsshould be consideredas
her report of symptoms.
on the our: actor-derived ubscales.
Examine he I-scores on
Step : Which tem esponsesr e Descriptions of these subscales, long rvith the other
subscales roduced by the CAARS, areprovided n Thble
roducedby
elevated?
3.2 (overleafl. These subscale lescriptionsshould be of
Once the validity of the responses as been considered,
assistancen explaining and ntr:rpreting
ntr:rpretingscores
scores n all the
the next step s to revierv the individual items. Specific
short, obsen'er,and
CAARS long, short,obsen'er, self-reportscales.
and self-reportscales.
arevery useful n helping you tarrget uestions
items arevery uestionsduring
during
clinical nterview', nd n selecting argets or treatment
theclinical
the
(e.9., nattention problems vs. only hyperactivity or Step : ntegratenforrmationrom he
impulsiviry problen-rs). he cott stituent terus for each self-reportn dobserverorms.
o rms.
subscale re shorvnn appendixB.
shorvn n appendixB. When practical or possible,
possible,collect
collect a self-report and at least
self-reportand
set of observer atings (from an ndividual very atniliar
one setof
wrth the respondent).
respondent).The The differ,entCA'r{I{S versionshave
differ,entCA'r{I{Sversions have
S t ep
the : Examineubs
Examine
evel fubs
overallevel
theoverall c alec
alec ores nd
symptomatology. constructedwith sinrilar sulxcale
beenconstructed
been structure o facilitate
sulxcalestructure
comparison.When ratings rorn informants agee that here s
To deterrnine both the overall level of ADHD-related
deterrnineboth
eithera
either a definite clinical problem
definiteclinical problemor of a problenl theuse
or a ack ofa theuse
synlptoms and the pattenring of those symptoms, revierv
symptoms,revierv
of multiple raters sewes o give validity to theresults.
raterssewes theresults.When
When
therespondent's
the cores n the ollowing CAARS measures:
respondent'scores
there s a disagrcement benveen aters,
disagrcementbenveen you tntst carefully
aters,you
theADI{D Index,
l) theADI{D Index,2) hreeDSM-IV ADFID symptom
2) the hreeDSM-IV
evaluate the reason for the discrepanry. Have the raters
subscales vtz., Inattentive Symptorns, Hyperactive-
Symptorns,Hyperactive-
correctly completed he ratings? s there thereaa reason o suspect
Impulsive Symptoms, Tbtal ADI{D Symptoms),
Symptoms,Tbtal Symptoms),andand 3) the
set of ratings has ess
that one setof essvalidiry*
validiry* han the other sets?
four factor-derivedsubscales vrz., Inattention/lvlernory
Inconsistenciesn responses rorn different nfornants ma1,
responsesrorn
Problems, Hyperactivity R estlessne s, impul s vity/
indicatea
indicate a problem hat s being dr:niedor not recogtrizedby
EmotionalLabiliqv, ndProblernswith Self-Concept). eep
L abiliqv, ndProblerns
significant party (e.g., self or one or more observers).
in rmnd that the DSM-IV ADHD symptorns ubscalesubscalesre re
Alternately, nconsistencies
nconsistenciesnay eilso eflect
nayeilso eflectactual difli'erences
actualdifli'erences
tu'ravailable n the short forms rvher eas he factor-derived p€rsons, r
in the client's fi.urctioning
fi.urctioningacross settingsand/or
acrosssettings and/orp€rsons,
orms.
subscalesre
subscales reunavailableon
unavailableon the screening dtfferent thresholds for rating a given behavior highly. In
torecognize lut discrepancies
surnnury, t is important torecognize mong
discrepanciesmong
The ADHD Index respresents measure of the overall evel
measureof
occur.You mustuse
raters requently occur.You clinicaljudgment about
must useclinicaljudgment
of ADHD-related qymptoms.This T his index is thebest
thebestscreen
screen
the relative quality of the datasources ndpotentialreasons
datasources ndpotential reasons
for identi$,ing hose at-risk" for ADHD. Nomrs are given
Nomrsare
for any reported
reporteddiscrepalcies.
discrepalcies.
ageand gender. -scores
for population amples y ageand -scoresabove
above
 DHD ating
Conner s'Adult calesCMRS)
atingcales

f romh e
from
Step : ntegratenformation GaseStudires
CAARS n d romother ources. To provide concrete examplesof potendal uses
concreteexamples of th e
usesof

Usilg data rorn other ating

rornother scales, tructurednterviervs,
atingscales, CAARS in various applications. six case stridies ar e
ndothermental
tests, ndother nterpret he
healthprofessionals,nterpret
mentalhealth To protect confidentiality, r1one f the examples
presented.To
presented.
significance f the
ndclinicalsignificance theCAARS scores.
CAARSscores. depict real patients.
patients.Horvever, caseStudies re based
Horvever, he caseStudies
validiry- ndclinical
on nformation synthesized rorn nu|tiple individuals from
Table .2 actual clinicai practice and, theroby, the case studies
CAARSu
CAARS u scale escriPtions realisticall,v portray how the CAARS is used' They
represent orv one might best
orvone bestmake of the CAARS to
useof
makeuse
Subscale Tendenciesf H gh.Scorers
establish he prior probability of c;linically significant
ADFID-relatedsymptor-ns.n clinical practice, of course,
practice,of
roblems
Inattention/Memory Learnmore slowly, aveProblems
moreslowly,
gnd c o mp le tin ga s k s , nd
o rg a n iz in gnd the treating mental health provtLder ould include
roubleconcentrating
have roubleconcentrating
infonnation from other Sources. hq cases vere cl1oseno
verecl1osen

at the same represent tereotlpicalproblems hat are colnmon nclinical

stlessness
Hyperactivity/B Havedifficulty orking
Havedifficulty orkingat
ong,and eel more
task or very ong, and practice. The information presented n these cases
comprises he "bare bones" of rvhat s available rom theth e
restless nd "on the go" than others
thanothers

En g a g en mo re mp u ls iv e c ts h a n
CAARS. Although all the cases ext represent dults vho
abilitY
lmpulsivitY/Emotional
m o o d s h a n g e u i c k l Ynd
o th e rs ,mo Y nd were deterrnir-redo suffer from ADF{D, the user should
bear n rnind that the CAARS c?r br3 seful n differential
o fte n , nd a re mo re
reee a s ilY n g e re d
and rritated y PeoPle
diagnosis nd will often assist he cli.nician n determiling
oftenassist
Problemsith ow
Self-ConcePt Havepoor social elationships,
ithSelf-ConcePt that a diagrrosisof ADHD is not rvarranted'
self-esteem,nd
self-esteem, nd ow self-confidence

ADHDndex Haveclinically igniticantevels

Haveclinically e vels f Case (Jennifer ., l 1$l'Year'Old
o mp a re do a d u lts
ADHD
with a
y
low
mp to ms
score. H scores
Highscores
igh re Female)
u s e fu l or d iffe re n tia tin gl
lrn
rn rc a l D HD Ms. M., a l9-year-oldsingle,African-Arnerican votnan, s
n d iv id u a ls .
ro
in d iv id u a ls m
mn n o n -c lrn ic a l
a sophomoreat college. She currenrtlyives at horne vith
Shecurrenrtly
her father and stepmother. She rvas eferred by her family
DSM-lVnattentiveYmPtoms Have endencies ssociated ith th e
inattentive ubtYpe f ADHD, doctor for an evaluation (at the suggestionof one of her
describedn the DSM-IV professorsat coilege) to determine rvhethershe suffers
from ADHD.
Ha v e e n d e n c ie ss s o c ia te d ith he
DSM-lV yperactive-lmPulsive
hyperactive-impulsive ubtype f
A D H D , s d e s c ib e dn th e DSM-IV nformation
Background
ADHDSYmPtoms Meet he criteria or ADHD, s
Ms. M. has hvo siblings: a Z}'yeu:l.oldbrother and a 15-
DSM-IV otalADHD
describedn the DSM-IV year-old sister.
sister.Her
Her father (age 41) rs
rsa
a family therapist vho
also worked as a pastor.
lrasalso
lras Her stepmother also age 47)
pastor.Her
works as a teacher.
d iagnosisn d efine
Step :Gonsiderdiagnosis lI
Ms. M.'s biological parents divorced rvhen she rvas
a seto f recommendations. old. She ecalls
yearsold.
years a history
ecallsa of conflict rvith
historyof her mother'
rvithher
Taking all sources of information into consideration, he never felt very close o her. She
noting tl-rat henever apparently
Sheapparently
including the CAARS, consider an appropriate diagnosis' alternated iving with her mother and father or a ferv
years
a1d,where ldicated, decide a treatmentplan that s tailored
decidea following their divorce. Horvever, ollowilg her mother's
to the needs of the individual. You will need o decide horv
needsof hedecided o live witltr
rernarriage, hedecided her father
witltrher and his nerv
fatherand
best to make use of the cAARS data with respect to Ms. M. reports hat shehas
rvife.Ms.
rvife. not spoken o her mother
hasnot
discussing he individual's problems vith the individual' in several nronths. Altl-roughshe perceivesher father as
Additionally, the CAARS fonlat lends tself nicely to report loving a1d as rvalting rvhat is best or [er, she believes
shebelieves
generation, ut the decisiol of when and rvho shouldhave authoritariarLr nd overprotective n
access o a report are decisions for the clinician and the hin to be somervhat
his dealingsrvith her.
individual being assesseil.
 74

u p a

l f o o D 8 p u
I o s OJ s S
h sB J p o s e u , p s W
'
q
t o s r p p s Se ,
p
r s S J e , s e
e o J
r l
e p { q u
e O I O J r J
s' s
u r t s , o s E o s
JE J s w
s p d 1 s , 8 u e q p
q s' h' l
o s e ; se p o q u'

c , 3 . p s S , S
p o y q , s n' o
e m p s
a p
m s s W s r u a o I
s o l J s o I J s'
r c s s p'
o J s' o o J J s o I
o I
t f p '
q1s J J s r
U u u' s s S
s' ' J J o a r o
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'
u S s S ]
l
' e p , s N s {
3 u p o q u u o p s s q r
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e o u , q u F
s u r s s r
. B o C. e q S '
o p q u u e o r p
e s p u c m q o p o o ue e
r a s o e
p o . o l J
1 p
s g q V t a s t S1 I l I
S e
l e J u p r
e s e J '
S q p e
n a
p o? e
l Q, e a e u p s s
e u e J s p
s y s p o ,
d S V Tg l r s h J'
eB o e qB 1 1
pZ0 o J s S e t
OJ a o eg1 o o r
q r , q o s
s e p n s x
o e s
3' pB p a u e o s '

0 s s s sS u O u
V pO [ S { o ag1 s
u 1
p p J S o e u r s s
c' s
n a q S s x pB p e u a
S c s s p p r ' e s '
q 8 n p e
s o p 0 ae o J o ; s
0 e S Q o u o s el
e e de e s" h {
r p o m ] c s s
s e 6' e s
l s r p u
E r e S A A , e
V C
s 1, ] S S q t 1 s q o s ss qI
m Se J se 3 S S
p e 1 p B u p
u I
s s ' u p l e e qe u
S p
o q o o p , F p' A '
S o s u E J
$ s e a
p 8 s ' u' p B I d q u u c p
s S s pB , I a q
B s

9
 Scales
DHD ating
Conner s'Adult CAARS)
S cales

Figure.1
CAARS-S:Lemale rofile orm
emalerofile or Ms.
ormor M ' (Gase tudy )
Ms.M

o
Circlc&rc)

Birthdare,#/*,# nge: 11 roday'sDate:-[-/]*rJ*

roday'sDate:-[-/]*rJ* Name:

F 1= A Inaftention/MemorY Problems E. DSM-IV nattentiw SYmPtoms

B. Ftyp€radivitY/Restlessness F. DSM-IV Hyperactive-lmpulsiveymptoms
F2=
G. lmpulsivity/Emotionat Lability G. DSM-IVADHD SYnrPtomsotal
ADHDSYnrPtoms
F3=
D. Problems with Self-ConcePt H. ADHD ndex
F4=
I

dgMrilsrffi:,ffi.H#n:*f*g;m*,Y*'iilffi
dgMrilsrffi :,ffi.H#n:*f*g;m*,Y*'iilffi fi *-.
;1H.1'H*l''llffi;' 3ififi
 LO

ndU se
lnteroretation
ndU

Fgure32
Female rofile orm
L Femalerofile
CAARS-0:L
CAARS-0: ormor Ms.M. (Case tudy )
or Ms.M.

urxcDrxcrusnn
Ppnsox urxcDrxcrusnn Onsunrzn

Name: 4s lil
li l Your ame: l t t-1
Gender:M
Gender: M @ Ag.tJ9- Age:$.J
(Circlc Onc) (qxioaul)

T o d a y ' s a t e :I l - / l J / q A f a m this person's:D spouseflP-*nt

person's:D CI sibling D other:
Msrth Day Yar

F1 A lnattention/lrJemoryroblems E DSM-IV nattentive ymptoms

F2 B. Hyperactivity/Restlessness E Hyperactive-lmpulsiveymptoms
DSM-IVHyperactive-lmpulsive
DSM-IV ymptoms
F3 C. lmpulsivity/Emotionalability G ADHDSymptonrs
DSM-IVADHD
DSM-IV Symptonrs otal
F4 D with Setf-Concept
Problemswith
Problems R ADHD ndex

Cogyrigh O t99S, Multi-lfqfti Syic lE- Af riddr ffiecd. ln rlrc U S-A-, PO Box 950, Nrth Tmurda NY l4l2o49Jo, (8e) 456-l@3
s ' rr^
+l{16-.192-2627 Fq +l-.1992-l}.1 q (ttr) 5:l(}-r.raH
=El lYItlD Ia Crrdr lTtO \6dryb Prt An. Tauro, ON rjltH 3N16, (too) 25s-60rl lxqutinl
 ?1

DHD ating
Conners'Adutt calesCMRS)
atingcales

individlals rvith ADHD, l[s. M. alsopresents vith mood will begin his first year at technical r:ollege n the next school
lability, a short emper, antl a propensity owards mpulsive,
emper,antl He hopes o ultimately transl'er ron this college o a
year.He
year.
angry outbursts hat conlribute to some problems n her four-year university. Mr. D.'s palents dil,orced rvhen he
Primary' and associatedeatures rvas l2 years old. He and his younger
yearsold. brother lived r,vith
youngerbrother
interpersonal elationshipr;.Primary'and
actibility, their mother rvhile having frequenf contactwith their father'
frequenfcontact
of A,DFID, ncluding poo t;ustained ttention,disff disffactibility,
disorganization, a hasli and careless esponse esponsesfy"le,sfy"le,
r e s t l e s s u e s s .o w t o l t : r a n c e f o r q u i e t a c t i v i t i e s , Medical istory
forgetfulness, nd dfficullies completing asks asksareare all likely Mr. D. appears o be n generallygood
goodphysicalhealth' He
physicalhealth'

to havecontributed o Ms. M.'s difficulties at school' reports no history of physical o:r sexlal abuse
abuseoror other
forns of trauma. Screening cluestious ertaining t o
Recomrnendat ions subStance blse andprirnary sy-lrptomsof mood or an-xietv
disord.ersvere negative.Other
alsonegative.
verealso th.anmeeting or a ferv
Otherth.an
A number of recommerrdations, panning educational,
sessions vith his mother's mential health professionalat
mentialhealth at
and theralreutic nterventions, are ndicated.
pharmacologic,and
pharmacologic,
12 (following his parents'
age12
age diivorce),M
parents'diivorce), r' D' does not
Mr'
Ms. M. may beneflt from a trial of a medication with
have a1y history ofpsychiatric trqatment,and he has
havea1y never
hasnever
establishedefficacy iu treating primary and associated
Research n the efficacyof stimulant
theefficacy been on any psychoactivemedioations.
$,mptomsof ADF{D.
ADF{D.Research
me,dications n samples rf children rvith ADFID suggests
that approximately 70--80 percent or higher respond School istory
positiyely. Less research has been conducted on th e Althoggh Mr. D. reports hat he performed n the average
response of adults rvith ADF{D to the psychostimulant range n elementary chool,he received receivedC C and D gtades n
medicatiors.Horvever,
Horvever,aa nunber of placebo+ontrolled rials
nunberof junior high and barely graduated rom high school due to
hat his teachers
have been conducted
conductedover over recent years and generally acadernicdifficulties.
acadernic difficulties. Mr. D. reports istened
suggesta favorablerestr)onse. trial of psychostirnulant thought he achievedbelorvhis cerpacity,i stenedpoorly n
rnedications might be indicated, given their proven class, and exerted insuffrcient e ort' Horvever,Mr' D'
effectivenessn improving attention Span, organizatiotl,
Span,organizatiotl, believes hat he did put forth considerable ffort btrt that
and t a s k c o m p l e t i o n r v h i l e r e d u c i n g impulsivity, h i s p e r f o r n a n c e was c o r n p r r o m i s e d y h i s p o o r
concentration, orgelfi.rlness, lrd organizatiolal defi cits.
deficits.
distractibilify, restlessness, nd emotional labilify in
resporuiveadultsrvith ADHD. If a stirnulant trial is pursud He describes irned tests as partir:ularlyproblenatic as his
testsas
Ms. M. should keep
keepa a careftil diary of side and daily
effectsand
sideeffects tendency o daydreama1d becoruedistractedwould leave
a1dbecorue
behavior,particul arly i1 social, acadenric, nd occupational
particularly ftim rvith insu-ffrcie1time to completeexalrs. He reports
contexts equirilg sustained attentiol and other self- that teachers hroughout his sohooling regardedhim as
capableof leaming, and none rraised he possibiliry of a
rraisedhe
regulatedbehaviors.
specific earning disabi itY.
Although pharmacotogic reatmentmay mproveMs' M''s
pharmacotogicreatment
o meet acadenricdemands,she should also make
sheshould
capacity
use of the academic srpport servicesavailable through Presentingroblems
Presenting roblems
A semistmcturedlinical nteniierv overing othprimary
her college.She rnight considerobtaining an educational
Shernight associated
andassociated
and e anrres f ADFil) rvas dministeredo Mr.
eanrresf
assesstnentonsisting of IQ and achievelnent esting to D. His responsesr.rggested o,ng-stand-ing roblens tt
clarifi, her current level of acadenric urrctiorung and to sustainilgatteltiot1 o a varie5y f tasks e.g., ectures,
ictentifyareas
areasof M any colleges
of strenl;th and rveakness'Many otnework),istractibiliry,
readilg,driying, onversations,
curreltly offer educatiolal assistance1the form of futorilg forgefulless,disorganization, nattentiono details, nd
programs, study skill enhancement'and environmental avoiding r disliking asks equiting ustained ental ffort.
acconrmodationso help, optirni ze theacademicperformalce
help,optirni Additionalll,, e positively nclorsedtemspertaining
pertainingoo
of students vith specizrl eeds. fidgeryandrestlessbehaviors,havingdiffrcultyremainin
seated, generally igh levelof activity, ntoleranceor
Gase (Galvin1., n 18-Year-0ldale) uta high evel f stimulatiou,
sedentaryctir.ities,eeking uta
who rvas and pursuilg potentially anLgerousctivities. M r. D.
c tivities.Mr.
Mr. D. is an l8-year-old, sian-Arnericaunale
nalewho
he has scluonica1d stablen rnhue,
a1dstable
referred or an assesstnento determine
determinewhether
whether describes hese ymptorns
with an initial onset n earlychildhood 'as far back
backasas
ADHD.
can emember").he eatures realso
eaturesre obepervasive
Saidobe
alsoSaid
nfornnation across varie$"of settings.
varie$"of
Background
Mr. D. currently ives with roonunates:until recently, re
resided vith his mothe . Mr. D. graduated high school and
graduatedhigh
 28

ndU
ndU se
lnterpretation

Figure.3
CAARS-S:SVde Rofile ormo rMr.
ormo D . Gase
Mr.D Gasetudy2)
tudy2)

.rsio"nCnnngS:SV)- rofile Form

.rsio"n
_crcening
CITARS-.gettReport
l{ame:1r.
l{ame:1r. I fr
Gender: F
(Circlc Onc)

Ilirthdate:O3 /OL/-$O age: I S T o d a y ' s D a t e :l / l 5 / ? 8

Mcnth Dar' Ycr
Md{h Dry Ya

= of ag e i A- OSttt-lV nattentivrr ymptoms

i-M1 = lvt"l"- 18 o 21) ears
earsof
of age i F1 Females 18 to 29 Years Hyperac*ive/lmpulsiveymptoms
o 3l) yearsof
years of age = Females 30 to 39 Years of age i e. DSM-IV
DSM-IVHyperac*ive/lmpulsive
I t'rtZ Males
Males3O
3O i F2
DSM-IV ADHOSY'mPtoms
DSM-IVADHO otal
SY'mPtomsotal
= to 4ll yearsof
years of age = 40 to zl9 Years of age 1 C.
i ttlig Males40
Males 40 i F3 Females D. ADHD ndex
=
i F4 Females 50 years of age or dder
il - _ _ . - . . - J or older
t',,tt+ Males 50 yeats of age

# MHS ."ffi,:#;}H Hl"Ttr* * "*;',ffi,J,'hH't'

O Bor 950, Nrth Tmwradl f{Y t'll20-@50, (m} 45elm3'
ldr<idion l. r111619?-2627 Frr. ll{16-49?'llal a (ett) 5'{$4{[4'
 1A

DHD ating
Conners'Adult calesCAARS)
atingcales

.4
Figure.4
Figure
CAARS-0:SValeProfile ormor
orm D' Case tudy )
Mr.D'
orMr.

A DSM-IV nattentive YmPtoms

-lVHyperadive/lmpulsive ymptoms
B. DSi. -lVHyperadive/lmpulsive
C, DSM-IVADHDSymPtoms otal
D. ADHD ndex

HM:HS fi ,.:,1zuffi ffi * H,ffi*J,T-5f li-ffi lH.ffi X. ffi;,H I rl%.**

H,ffi*J,T-5f
 30

ndU
ndU se
lnteroretation

apparentacademic
tn addition to contributing to his apparentacademic n formation
nformation
Background
nrderachievetnent,Mr. D.'s presenting s-vntptoms lso Mr. P. is currently rnarried. He is also the father of three
interferedlrvith is ftutctioning as a dellvery person or lus
ftutctioningas (ages2,25,26)rom
(ages2,25,26) rom he irstofhis luee revious
irstofhis reviousarriages,
arriages,
&ther's business.H e rvould beconte natteutive vhen
He all of vhich ndedn divorce.
allof
deliveriesor forget the location
driring, fbrget deliveriesor locationof
of streets,
repeatedlyask for directions to the same
and neeil to repeatedlyask Mr. P. s a high school graduate
graduatevvho
vvhocurrently
currently rvorks as a
destinations. hese qymplolllsappear
heseqymplollls appear o beassociated vith
be associatedvith generalontractor
general ontractornd v orkedsa plumber
ndprerriously
vorkeds
distressand are a particular source of
sonle sutljectivedistressand and carpenter.Mr. P. suspected hat he might have ADF{D
afterrecognizing
after symptomsof ADF{D are
recognizing hat many of the symptomsof
concern given hat Mr. D. is about to start college.
college.He
He characteristic f his long-terrn urrctioning.
pr€:gsn15s motivated to do well but rvorried about the
potential adverse mpacl of his presenting
presentingslmptoms
slmptoms on
his abilit'f to manage
managehis
his acadernic emands. Medical istory
There appear o be no medicalconditions associated 'ith
medical conditionsassociated
CAARS esults the onsetor maintenanceof Mr. P.'s
onsetor presenting roblems.
P.'spresenting
\ft. D. rvas
rvasadministered'
administered'he h e CAARS-S:SV inunediately His reportedmedical status
statusss positive or herpes, nd some
beforea
before a ace-to-face
ace-to-facentervier.v vith the ps,vchiatrist t the
ntervier.vvith allergies. neurological alge 7 edto
examatalge
neurologicalexamat edtoapresunptire
apresunptire
clinic. Figure 3.3 shorvs he completed
Figure3.3 Screening ersiott
completedScreening diagnosisof
diagnosis of petit mal seizures, not confirmed b-vother
seizures,not
Profi e onn. IvIr.D.'s motlher vasadnrinistered
IvIr.D.'s motlhervas he CAARS-
adnrinisteredhe There s no history o1l rand
physicians.There
physicians. randmal
mal seiaues and
O:SVprior to her nten'ie:rv vith hepsychiatrist. igure
nten'ie:rvvith igure3.3.4
4 no recent ndications of milder seizure Despitea
activiry.Despite
seizureactiviry. a
Profile forrn for theobsen'er
h,e omtleted Profileforrn
shorvsh,e
shorvs the obsen'er atings. history of alcohol and recreation.al rug use, Mr. P. does
use,Mr.
not report patterns
patternsof
of use suggelstive f substance buse
suggelstive
or dependence.
Clinicalmpressions
m pressions
Mr. D. reports
reportssolne hllperactiveand impr.rlsive
solnehllperactive impr.rlsiveeafures
eafures
attentional an d
but his presentation s marked by the attentionalan School istory
i.urctioning elhcits
executivei.urctioning
executive l'ratare
elhcitsl'rataremost consistent'vith
mostconsistent overactiveor highly fidgety votulgster.
Although not an overactiveor
diagnosisof ADHD, Pr:edominantly
a diagnosisof nattentiveType.
Pr:edominantlynattentive Type. Mr. P. reports that he has had symptoms
symptomsof of attention
problemssince his elementary school years.
elementaryschool years.Teachers
Teachersat
that time commented
commentedon on his frequent daydreaming
daydreamingand and
Becom m endat i ons
focusedattention and generally regarded
poorly focusedattention regardedhimhim as
Mr. D. may benefit from a trial of psychostimulant
coreand achieving ar belorv ris potential.
potential.Although
Although not a rvillftrlll'
rnedication iven ts proven efficary n improving coreand
provenefficary
noncompliant or defiant youth, Mr. P. recails that hi s
1,'mptomsf ,A.DHD
associated1,'mptoms
associated ,A.DHDn n responsive hildrenaud
difficulties achieving academically
academicallyat at expected evels.
adults. 1'a timulant rial is ptusued,N4r. D . should eep
N 4r.D. a
eepa
following tlrrough on instructiorLs, nd completing asks.
daily diary of his side-effbcts nd self-regulated ehaviors,
and conflict rvith his parents.Tllese
caused amilial discord andconflict parents.Tllese
particulaLrlyn those so<;ial, cademic, and occupationai
cademic,and
are also described as having been pen asive
describedas
contexts equiring sustainedattention.
sustainedattention. syrnptoms school,and social s;ettings nd as associated
acrosshome, school,and
Nthougtr pharmacologi,;
pharmacologi,;reatmentreatmentmay improveMr. D.'s
may improveMr. rvith both subjective distress ;and mpairment across
capacityto
capacity acadetnicdeurauds,he
to meet acadetnicdeurauds, he sl-rould lso use multiple dornains. Although hr: did fairly rvell during
so f h i s c o l l e g e . A n
cs u p p o r t s e r v i c e so
t h e a c a d e m i cs elernentaryschool (earning
(earningprimzrily
primzrily As and )B's), eachers
and)B's),
o nsisting rlIQ and achievement
assessnlentonsisting achievementesting estingma ma y did note attentional problelilS. zllld his subsequent
clarify his current level of intellectual and academic performancedeclined
performance receivedC's in junior
such hat he receivedC's
declinedsuch
functioning, identi$ arc)as f strenEh and rveakness, nd schooland predominan
high schooland tly )'s andF's irLhigh
predominantly irLhigh school.

rule out the possibility

possibilityof
of a leaming disorder. Poorperfonnance ed him to drop out of higlt lschool uring
his senior year, although he comlpleted he courser,vork
year,although courser,vorkhe
he
follorving year o earn his high sr;hooldiploma.
diploma.
Case3 Scott . , 53-Year-Oldale)
Mr. P. s a 53-year-old,Craucasiannale rvho vas eferred or
53-year-old,Craucasian
Presentingroblems
an asses;smenty his filmily physician, lvho tvantedan
tvanted an
A semistrucnlredlinical ntervierv overing othpriniary
nterviervovering
evaluation o detennile tvhether his ndir.idual nrffers rom andassociated
and e afiues fADHD rvas drninistered
eafiues
associated o Mr.
an attention-defi it disorder.
attention-defiit
difficulties vith
symptoms ncludeddifficulties
P . His primary symptomsncluded
cornpleting variety of tasks and projects, ifficulty
tasksand
concentrating,ecoming ored orgef,rlness,nd
easily,orgef,rlness,
oredeasily, nd
 31

Conners'dultADHD ating calesCAARS)

dultADHD

Figure.5
CAARS-S:Lale
CAARS-S:L Mr.P(Case tudy )
aleProfile ormor Mr.P

^,. irh Mr . ?I G
"-' e n c l e r t @
F
Client ll): \ tr (c'crcorci

irthdate:gt li'b 135- nge: 3 Today'sDate: I L/j -ile Name:

Monttr DaY Ya
Mdh [)sl' Ycr

M1 = Males
Males1818 o 2t) years of age A. Inattentionrt'lemory roblems E. DSM-IV lnattentive SYnnPtoms
M2 = hlales 30 to 3() years of age B. Hyperactivi$/Restlessness F. DSM-IV Hyperactive'lnrpulsive Symptoms
lmpulsivity/Emotionalability G. DSM-IVADHD SYmPtoms otal
DSM-IVADHDSYmPtoms
3 = Males
Males4O4O o 4 ) years
yearsof
of age i C.
M4 = Males 5Oyears of age or older I D. Problemswith Self-ConcePt H. ADHD ndex

E*e'e '.er*Tcsea HY l{r2o{95o, (tm) {s&}ml'

f;.- a.ar* r,tutri_Hqtsh ygsx Ic; Ax rish5 ,o-wd rn lc u: +.?o
# Iy t-l 1 D h c s ' d r. ";r9s.
l .,.,0 \6 c .o .i l p rrtA rc .T o ..o n ,o N i l z rrru o .(r@ )2 6 rs n b :i r{rt{l tr* ? -:i J l F g -c l -rl 6 -' ' s 2 -l x 3 m (ttl )t{+ 4 {t' f
 n

ndUs e
ndUs
lnterpretation

disorganization. onseque,ntly e colld not cornmulicate in social and occnpational contex:ts equiring sustailed
attention. The forgetfrrlnessand self- management
forgetfrrlnessand deficits
managementdeficits
effectively r iurction at a level
iurctionat consistentvith his abilities.
levelconsistent
He had diftrcul.ty sustainiil,gattention to reading material, of adults with ADHD often respond vell to the provision
and r'vork-related of external structuring techniques, such as the frequelt
techniques,such
lectures, onversations, rLdhousehold-
household-and
C olor oding,
Of ists, notes o oneself,Color
useOf
use consistentituais
oding,consistent
msks.other problerns vere
msks.other distractibility, shifting benveen
veredistractibility,
and ong-tenn), and routines, eminders, iling, priontizing of tasks, and
tasks,and
mtir.ities, not completing lrsks both short-
short-and
osing things,
geffirlne s, osing breaking dou,n
dou,nof nnnageableuruts.
of large task into snraller,nnnageableuruts.
disorgaLiz,ation, ot I sten:Lg, for
Liz,ation,ot forgeffirlne
errors' and Mr. P. may benefit from many of these strategies, long
thesestrategies,
being inattentive o details, making careless
carelesserrors'
of computer software progralns
progralnsthat
that assist
avoiding tasks requiring sustained mental effort (b y with the use Further
procrastination).He also asbeingbored
clescribed imself asbeing
alsoclescribed hrm in rnanaginghis time, priorities, and calendar.
calendar.Further
self-helpbooksor
gains may be realized hrough reading self-helpbooks or
and prone to daYdreaming'
easilyand
easily
affending seminarsairned at promoting time-mLanagement
In his current work, Mr. P. believes hat fiis presentilg and organizationalskills. Horveyer, ecause elf-irutiated
s1'mptoms i g n i f i c a n t l y i r n p a i r h i s e f f i c i e n c y a n d methodshaveproven
proventoto be nsuffr,oient, onslltation rvith
nsuffr,oient,onslltation
ivith
and have undermined his level of success.
productivtityand
productivtity a behaviorally oriented mental health professional
Although he tends o acc:omplish .vorh-related .vorh-relatedasks, asks, he experience eaching hese
heseskills be considered.
skills might beconsidered.
estimates hat they genel'alty ake trvice as long as they
should, and he rvorks in fear of others discovering his Case (Thomas . ,€ l ll'Year-Oldale)
inefficiency.Functioning,n previous.jobss reported o S., a44-year'old aucasian ;ale,
Mr. S.,a44-year'old eferredirnself
;ale,eferred oa
irnselfo
havebeenr disorganization, orgeffirlness.
havebeenrmpaired by his disorganization, o deterrnine hether e suffers
clinic for an assessment
inattentio:n, nd proneness;o becomirlg uored uickly. With fromADHD.
respect 6 his interpersolral tilctioning, Mr. P. believes
*nt his presenting symptoms, n conjunction rvith other
presentingsymptoms,
n formation
nformation
Background
factors, <lntributedo prior marital diffrcultiesand o stress
maritaldiffrculties
Mr. S, currently ives r,vithhis rvife of 10 years
r,vithhis yearsandand his 4-
in his relartionship ith his current vife.
year-old daughter.Mr.
M r. S..r.vho earnedhis colllege egree
S.. r.vhoearned
from a stateuniversity, r.vorks s a graphic desigler a1d
CAARS esults co-ownsand operates businLess
alsoco-owns
also vith rvife. Mr. s.
v ith his rvife.Mr.
vas; dministeredire CAARS-S:1,urunediately efore
tvk.P. vas;dministered
tvk.P. came to suspect hat he may sulfer from ADI{D on the
a face-to-face nten'ier.v vith a staff psychologist at the
psychologistat
basis of chronic problems with hyperactivity and
clinic. Figrrre3.5 presenrtshe completedProfile forrn for
Figrrre3.5 w ith an onset n earll'child
earll'childhood.
hood.
impatience,with
the self-reporttonn. Mr. I,.'s Inconsistency ldex suggested
I,.'sInconsistency
a valid response attern (his score vas 1)''
vas1) Mr. S. notes hat
S.notes his presenting yrnptorns ave
hathis beengoing
avebeen
and does not have
rvas adoptedand
on most of his life. He rvasadopted
C l i ni calm pr essi ons infonnation pertaining to his biologicalrelatives.

Tlie data rom mrtltiple

mrtltiplesources
sourcesndicate
ndicate hat Mr. P. clearl-v
meets iagnostic riteria or ADHD. Specificalll', . tneets Medical istorY
the DSM-IV category f ADHD, Predorninantly
criteria or theDSM-IV Information on prenatal
prenataland birth history s lacking due o
andbirth
InattentiveType. Mr. P. :ndorsednattentive
Type.Mr. syrnptoms f
nattentivesyrnptoms Mr. S.'s adoptedstams.He reports
reportsno seriouschildhood
no seriouschildhood
suffrcientnumber 9 of 9 behavioralcriteria), severity, nd
criteria),severity, illnesses.HisHis current health s reported o be good,
good,and
and he
duration o neet DSM-iV criteria or tlie disorder. ferv is not taking a1y medicatiols. There s no reported history
reportedhistory
eafltres
h-vperactiveiirnpulsive afltreswere reported ut these re
werereported of heart problems, iver disease, eianres,
eianres,ics, high blood
ics,high
not suffrr;ientn number or severitV
numberor severitVoo rvarranta diagnosis
rvarranta pressure, erioushead njury, or thyroid problems.Mr.
problems. Mr. S.
of ADHD, cornbined yPe. alcoholand drinks n modr:rationmultiple timesper
enjoysalcohol
enjoys
rveekbut
rveek but indicatesno currelt or prior tlsage uggestive f
Recommendations abuse.Sirnilarly, he indicates
indicatesnono clrrent or prior abuse
abuseofof
Mr. P. rrnay enefit rom a trial of psychostimulant illicit drugs.He smokes ne-|-ralf pack
packoror less
lessof
of cigarettes
medications.n responsivedults, timulantmedications
m edications per day.
ove attentionspan, a s k
impr oveattention
havebeen
have been ound t o
completion, n d self- or ganizationvhilevhilerr educing School istory
irnpulsivity,istractibililv,nd estlessness. arnedication
f arnedication He reports that diffrculties wittr sitting stilli and staying
triai nvolving timulantss pt-usued,
pt-usued,r. P. should eep
r. P.should focused on ongoing activities were noteclnoteclas as early as
careful iary
iaryof sideeffects 1ddaily
of sideeffects behayior, articularly
1ddailybehayior, H e also notes hat his adoptiveparents
kindergarten.He ha'n'e
parentsha'n'e
 i calesCAARS)
icales
DHD ating
Conner s'Adult

frequently'cornlnented on his seeming not to listen.

frequently'cornlnented CAARS esults
CAARSesults
Symptomsof
Symptoms of ADHD have been pervasive
pervasiveacross honte,
acrosshonte, Mr. S. was administered the CAARIS:S immediately
administeredthe
and occupational seffings and appear o have been
school,and
school, before a preliminary intervierv rvith a prychometrist at the
associated'with ome mpairment in those a-reas. ifficulties
thosea-reas. coruLpletedrofile form for
clinic. Figure 3.6 presents he coruLpletedrofile fo r
r.lith remaining seatd sustaining
sustainingattention and motivation,
attentionand lhe short forrn. Mr. S's Inconsistenry Index indicated a
and courpletingtasks n an efficient manner all co ntributed valid resporlse attern (his scoreu'as 4).
scoreu'as
to acaderniic nderachievetnent hrough elementary
elementaryschool
school
(rvherehe
(rvhere rreceived and C grades),
herreceived grades),higlrr school 3.2 GPA),
higlrrschool vifeu'asadministered
Mr. S.'s vifeu'as he CAARS-O:S at the ime
administeredhe

and colleg;e 2.4 GPA). E'oth formal

formal testing
testingand
and teacher of theprelirninary
theprelirninaryntervier.v
ntervier.vn the
thecl.inic.
cl.inic. iEue 3.7
3.7presents
presents
irnpressions ndicated that these evels of academic the completed Profile fornt for thr: obsen'er atings.
completedProfile Her
atings.Her
expectedon the basis
v ere below'what was expectedon
perfonnanLcoverebelow'what ndicateda valid response attern her
Inconsistencyndex ndicateda
of Mr. S.'scognitiveabilitLes.
S.'scognitiveabilitLes. scorewas 2) .
scorewas

Presentingroblems C l i ni calm pr essi ons

A sernistmctured linical intervierv
interviervcovering both priniary
coveringboth Theprirnary diagnosiss ADHD, Combined ype.Mr.
prirnarydiagnosis M r. S.
and associatedeatures administered o Mr.
of ADHD was administeredo
eaturesof ,n d m p u l s i v e
d e s c r i b e sn a t t e n t i v e , y p e r a c t i v e ,n
S. His responses ndicate the presence
presenceofof significant symptomsf suffrcienteverity lddurationo
suffrcient everityldduration o meetDSM-
D SM-
features of inattention, overactivity, and impulsivity. IV diagnostic riteria or the
diagnosticriteria disorder. bservationsade
thedisorder.
Pos endorsed naff e'ntive eatue s nclude diffrculties
Pos tively endorsednaff by Mr. S.'s wife appear o support his diagnosis. he
S.'swife
sustaininll attention to tasks, distractibiliry", difficulfy symptoms renoted renoted o beof beof early onset, hronic
earlyonset, hronicand stable
andstable
following through with tasks o completion, often shifting in naftrre, ervasive cross effings, ndassociated nd associatedith it h

betweenunfinished activities, becoming bored easily,

betweenunfinished bothsubjective
both subjectiveistress
istress ndsone
ndsone mpairment.
seerning ot to listen to ottLers, nd avoiding tasks equiring
sustained nental effort. Ivtr. attention span
S. describeshis attentionspan
Ivtr.S. R ecom m endat i ons
as imited, even or tasks hat engage his nterest, but he
nterest,but Mr. S . may benefit from a triill o f ps.vchostimulattt
notes hat his concentration s extremely poor for medications. n responsiveadults, stimulant rnedications
adults,stimulant
nonengaging asks such ttrat it makes them quite diffrcult h a v e b e e n f o u n d t o improve a t t e n t i o n s p a n , t a s k
for him to complete. Althqugh chronic messiness nd sotne
complete.Althqugh c o m p l e t i o n , a n d s e l f - o r g a n i z a t i o n , vhile r e d u c i n g
difficulties rvith organization vere alluded to, he notes hat di stractibi ity, and restles ness.
impul sivity, distractibi
he profits rom writing things doln, listing prionties, and
re$ing or his wetl-organi:ledwife to handle
handlevarious payroll,
variouspayroll, Glinical ollow-Up
bookkeepi g, and pape w o k tasks. Hyperactive symp oms
tasks.Hyperactive Six months fter hepreliminarymeetingn the
Sixmonths and
clinican
theclinic d
include generally higher than averageactivity levels, monthsafter the start
5% monthsafter of phannacologicalreatment,
startof reatment,
diffrculties emaining sutted, feeling a need o be always o the clinic or a follow-up ntervierv. t
S. returnedo
Mr. S.returned
on the go, fidgeting, and restlessness'A nun'rber
nun'rberof of this ime,lvlr.S
S.. vas lso eadnrinisteredheCAARS-S:S.
heCAARS-S:S.
impulsive features are also reported.Mr. S. emphasized
featuresare hecompleted rofile
Figrue .8presentshecompleted rofileonn heshort
onn or heshort
irnpatienr;eand difficulty rvaiting his turn, but he also fonn. The CAARS resultswere consistentvith
wereconsistent clinical
vithclinical
describedhimself as seekingout a high level of stinrulation impressionsrom the follorv-up hat ndicated
nterviervhat
follorv-upntervierv
(e.
(e.g.,
g., motor
motorboating, moto cycling, occasionallyslqydiving).
boating,moto S.was espondingavorably
Mr. S.was
thatMr.
that o treatment.
avorablyo

Dfficulties on the ob related o presenting ymptoms ave

generally nvolved managing papenvorkand completing
Gase (Meredith . ,a 26-Year-0ld
tasks nan efficient manner. ML S. describes is irnpatience
manner.ML Female)
as sufftcientlysevere s o constrainSome f his activities Ms. W. is a 26-year-old, marri.ed, Caucasian 'voman,
marri.ed,Caucasian
(e.g.,avoiding
(e.g., any waiting-lines,not driving during tines
avoidingany currently rvorkilg as a dental hygienist.
hygienist.She carne o the
Shecarne
rvhen raffrc rnay S. reports hat, over irne,
be heary). Mr. S.reports
rnaybe clinic for an evaluation or ADHD.
he has become more a\\'are of his diffrculties and better
able to conpensate or them or to avoid sifuations vhere
they are likely to have an adverse mpact' Indeed' his Backgroun
W Information
W.. currently
IvIs. er husband, r. W. (age
ives ,vith erhusband, (age29),
29),
occupational functioning suggests an adaptive h eir6-
s. W describesheir6-
sa inancial dvisor. s.W
u,ho vorks sa
accommodationo some of his presenting
someof presentingdiffrculties'
diffrculties' happy, nd healthy despite ome
healthydespite
1,earmarriage sstable,happy,
difficulties reated y her restlesslless, nterrupting,
 34

Interpretation
ndUs
ndUs e

e. 6
Figur e.
nitial rofile orm
CAARS-S:S ormo o r Mr.
Mr.SS . Case tudy )

hortVersion CAARS-S:S
CAATRS-Self,-Report: ProfileForm
CAARS-S:SProfile Form
Clienr tD : Mr ' S Gende,r:
@ f
(Circlc One)

BirthrdareQ4__/L9J
+ Age: 4 4 T o d a y ' sDate:05 lg-l9g-
Date:05 Name:
-Dtl
Month Ycar M o n th Dav Year

A. I n a t t e n t i o n / M e m o r yr yr o b l e m s
I Ut = lr4ales
lr4ales88 o 29 years f age F1 = s 1B o 2 9 y e a rso
Fe ma le s1B rs o f a g e
B. H y p e r a c t i v i t y / F l es t l e s s n e s s
UZ = Males 0 o 39 years f ag e F2 = s3 0 to 3 9 y e a rso
Fe ma le s3 rs o f a g e
C. l m p u l s i v i t y / E m o , t i o n aa lb i l i t y
I
0 to 49 years
yearsof F3 = s4 0 to 49 y e a rs of ag e
I tutg lr4ales
lr4ales0 of age Fe ma le s4 D. Problems ith Self-Conceot
F4 = E. ADHD ndex
i M+ = lirlales 0 years of age or older s50 y e a rs of a g e or o ld e r
Fe ma le s50

#M 1998.4ulri-Hcahh ysrms nc All rights eswed ln rhcU

Copyrighr 1998.4ulri-Hcahh Box 950,Nonh
S.A.,P.O Box950,
rhc U S.A.,P.O Tonawan&, Y 14120'0950.8
NonhTonawan&, 800)
00) 56-1001'
2 HN3 M 6 .(8 m )2 6 8 -6 0 1 1n rc m a ti m a l .+ l -1 1 6 .,1 ,9 2 -2a6x2.+
In C a n a d a .3 T T 0 V i c ro ri a p a rk A v c ..T o rc n ro .O 1 1 4 1 6 -4 9 2 ' 3 3 4 3 o r(8 8 8 )5 4 0 -4 4 8 4
 ?q

ADHD ating calesCAARS)

Conners'dultADHD
Conners'dult

Figure.7
Figure.7
nitialProfileorm
CAARS-0:S or Mr'
ormor S. Case tudy )
Mr'S.

Ctu\Rs-Obsierver: hort Version CAARS-O:S) Profile Form I

l-tr. S l l YourName:ljas-S i
; JA
Gende:r, .
rF. Ag",lL{-
^ -^. ii
; L_._
(}'nd*r:
Gender:M M F
F' Age:
Ase: dtA
ltg- I
i
Urclc (J
Gfrcb FJ
Orrc) "tj - _
L_._ -,_, _ _.
__.
_.-______ _.-_--_.19 .lS----" -i
===--:...===a
spouseE parent O sibling O other:
iI Today's Date:MonI
O5 ljg-/jf
D*y Ycx I em this person's: i
M1 = Males 18 o 29 years
Males18 yearsof
of age F1 = Females 18 to 29 years of ag e A. l n a t t e n l i o n / M e m o r Yl o b l e m s
= 8. Hyperactivity/Restlessness
M2 = Males 3O o 39 yeilrs of age
Males3O F2 Females 30 to 39 years of age
C. l m p u l s i v i t y / E r n o t i o n aal b i l i t y
M3 = Males 40 to 49 yerars f age
Males40 F3 = Females 40 to 49 years of age D. P r o b l e m sw s w i t l hS
hS e l f - C o n c e P t
M4 = Males 50 years of age or older F4 = Females 50 years of age or older E. ADHD lndex

GNrrISffi ..:iffi*f 'fl.i1ffi:SH,ffi#,T-Hf*-ffi ltrffi

..:iffi*f'fl.i1ffi:SH,ffi#,T-Hf X.ilffi',|fl *i?*"
 Jb

Interpretation
n dU se

Figure . 8
rofileForm or Mr. S. (Gase tudy
CAARS-S:S ollow-Up rofileForm tudy4)
4)

€fiAR$-Self-Re ort: Short Ve

Vers
rs on CAAR
CA ARS-
S-S:
S:S)
S)Profile
ProfileForm
Form
'. Csent D; Mr. S
CsentD; Gender:
@ r
(Circle Onc)

Birthrlate:O+J9 lQt_ Age: + 4 Date:05l Lj 1.9&

Today'sDate:
Today's Name:
Month 6^y Ycar Month Day Ycar

4 W = Ma le s 1 B o 29 y e a rs o f a g e F1 = s 1 B o 2 9 y e a rso
Fe ma le s1 rs o f a g e A. Inattention/Memorv Problems
= Miales = B. H y p e r a c t i v i ty / R e s i l e s s n es s
fi l*Z Miales3030 to 39 years of ag e F2 Females 30 to 39 years of age
C. l m p u l s i v i t-yw/ E
= Miales = i tm
h otionalLability
l3 Miales40
40 to 49 years of age F3 Females40
Females 40 to 49 years of age D. Problems Self-Conceot'
".r: = Ma le s 50 y e a rs o f a g e o r o ld e r =
,i t*+ F4 Females 50 years of age or older E. ADHD Index

CopyrightOI998.Multi-HetthSystcmtnc AII righrsrexrued InrhcUSA..PO BoxgJO.NonhTona*'an&.NYl'1120-0950,(800)45C30o3.

I n C a n a d a . S TT
TT 0 V i c t o r i l P a r k
kA
Avc.Toronto,ON M2 H l M6 ,(8 m)2 5 8 -5 0 1 1 l n r m a r i o n a l,l, + 1 4 1 6 4 9 2 - 2 62
62 7 . F a x , + t J I r i { 9 2-
2- 3 l 4 3 o r ( 8 8 8 )5
)5 4 0 - 4 t 8 . 1
 37

Conners'dultADHD ating calesCAARS)

$'as not
an d effectively. she notes hat comptaing lp$iE,n-ork
anxiousness,ailure to comrplete ousehold asks,
bom particularly problernatic, n large pqrt due to the strict
tendency o "nag" and "give orders'" Ms' W' rvas rvasbom
by
she recalls
recallsa a generally happy routine, corrtingencies,and high erpgcmriom iurposed
and raised n the midrvest.
midrvest.she
her parents. wlren Ms. W attendedorllege, hotreser, her
parents.wlren
childhood but notes that shr: was frequently concerned
abiliry to study and to meet acadgmic demands rvas
rvith meetilg her parents' ftigh expectations, saying the
wrong thittgs," and arousirrgher mother's anger' Sh e compromised by a combination of lrer rtifficulties rvith
describes he family atmosphereduring h.er early yeals as
h.erearly sitting still, distractibility, boredonl and balancing her
desire to present he "perfect
being shapedby her parelts' desireto newly acquired reedom ald social acti\"itiesgith the need
fui1ily" rvith a heavy empha.sis n religious values, high to focus
focusher
her energieson
energieson school.
school.Alttrrlugh
Alttrrlughthese
theseprobiems
probiems
standards,and highly stmctured, rigid routiles, rules, and led her to drop out of school, she rehrrned the follorvittg
M s. W. describesher mother as her "best year with increased levels of matuitl" :motiyation and
contingencies.Ms.
friend' and they remain fairly close. She reports that she effort. She earned "mostly B's along rvith a ferv A's and
has always gotten along rvell rvith her father, who worked C's" on her rvaY o graduating.
as
asaa firefighter.
Presentingroblems
Ms. W. left hLorneo attendcollege at age 18 and moved o
collegeat A semistmcturedlinical ntervierv over:ingothprirnary
nterviervover:ing
a different city durilg her rnarriage. She notes hat part of
Shenotes associated
andassociated
and e aruresf ADF{Dwas
earures adlninisteredo Ms.
wasadlninistered
the reason or the latter move was to achieve a greater w. Her symptomsnclude oor
chiefsymptoms
Herchief sustainedttention,
oorsustained
degreeof independence roru her parents' i fflrculties ompletinlgas;ks, nd anxiety
restlessness.ifflrculties
symptoms. eatures f attentional roblems ncludepoor
roblemsnclude
sustained ttention hat is particurlarly alientduring
particurlarlyalient
Medical istorY
Ms. W. reports hat she shevras
vrasborn
born at term by vaginal nonengagingasks e-g., eading, tudying, ousehold
delivery vitfta
vitft a breech res;entation. he s said o have
he chor es) , istr actibility, r equentshifting betr veen
did not ndavoiding r strongly
ndavoiding
asks,orgeffi.rlness,
beenhealthV t birth and reports hat rer mother
motherdid turcornpleted
during a generally disliking asks equiring sustainednental ffort.She
equiringsustained also
Shealso
use obacco, lcohol,or other drugs drugsduring
trealthy regnancy. he eports o abnormalities r delays diffrculties n completing asks trat are necessary
notesdiffrculties
notes
self-help
motor,andself-help
peech,motor,and but not nherently nteresting o her- Ms. W's impulsivity
her-Ms.
with her development crosls
herdevelopment croslspeech,
hewasa
skill domains. hewas a generally ealthy hildbut suffered is reflectedn her endencyo make tatementsr comments
isreflected
allergies. t age20,
fromallergies.
from Mts.W.
20,Mts. oresomemusclesn her
W . oresome rvithoutadequateorethought, lurting out answers r
necklvhile kiingand has ince x:periencedome
andhas ome ecuning comments rematurely,nterruptirng r intrudingupon
headachesndneckpain. Clrrent medical roblen'rs
pain.Clrrent onsist
roblen'rsonsist others, mpatience, ifficultiesdelayinggratification,
of allergies. urrent medica.tions nclude irth controlpills
nclude pills nuking hasty ecisions,nd actingwithout hinking'"
and PRN Motrin, Tylenol,and ryclobenzaprineor neck
PRNMotrin,
no history of treatment Ms.W alsodescribeserseras eing xlgetyand estless,
Ms.W
pain and headaches. s. \V. has hasno
"always n he go," andhaving hronic iffrculties itting
ivith any
anypsychoactive
psychoactiveerlications.
erlications. hedoes
hedoesnot
not srnoke still for extended eriods f time.
time.E,xcessive
E,xcessive a lkativeness
alkativeness
rbuseff alcoholor other
and eports o significant rbuse drugs.
otherdrugs.
anda
and a orv oleranceor solitary nd, o a lesser xtent, utet
lesserxtent,
shenotes onsuming mallquantities f alcohol e.g., n
onceper veek r ess'
beer)once activitiesverealso noted.Difficultiescornpletingasks
ounce fliquor,one
onebeer) asMs''
said o be preselt,asMs
relatedo her currentob are
hercurrent notsaid
arenot
..loves"her lvork and finds th.e equired asks o be
w.
School istory H orvever, he does eel that her need o be
engaging.Horvever,
Academically, s. W tendedo performbetterhan
s.W average,
hanaverage,
constantly oing something, iffrculties ittingstill, andan d
attainingB grades r bette:rhroughout lementary chool
bette:rhroughout
verbal mpulsivifyoccasionally ause er diffrculties t
andA
and A s an,d ,s n unior trigh and high school.Early on' alsoattributes omeriction with her
Shealso husbando
herhusband
rvork.She
rvork.
teachersabeledher as "hyperactive" nd frequently her restlesslless,oor o or task completion t home' an d
cornplarnedf herdiffrculties ittingstill, poor
poorsustained
sustained
tendencytointerruptlr.imwhenheisothenviseengaged.
atteution, atking out of turn, impatience, nd seeking
attention n negative r/ays. Although ment'ories f
r/ays.Although
attentional roblems re not as salient
salientduring
during her unior CAARS
Ms. W. rvasesults
adrninisteredhe GAARIi-S:L rnmediately
rvasadrninistered
highandhighschoolyears,shedoesrecallpersistent a staffpqychologistt
before face-to-face n terviervvith
ntervierv vitha
pr oblems ith r estlessnessn d ver bal mpulsivity.
distractibility theclinic.
the he colnpleted rofile onr-t
clinic.Figure3.9 presentshecolnpleted
Furthermore, he eports hat nattentiou nd
o rm.Her nconr;istenry
heself-reportorm.
for heself-report ndex ndicated
consistentlympairedher ability to read and stgdy
haveconsistently
have
a valid reqponseher
validreqponse scorewas
herscore 5)'
was5)'
 3B

n dU se
lnt,grpretation

Figure.9
CAARS-S:Lemale rofile orm
ormor Ms.W. Case tudy )
or Ms.W.

cli,entm: 11_\l_ Gender:,np

Birthdate:Al-/lb-/-la
Mdrth fay Ya
Age:3.b
Age:3.b Today's ate:Matnh
{ | /ia/3-h
Df Ycr Name:

F 1= Females18 to 29 years
Females18 yearsof
of age i A. lnattention/l'lemory rot*ems E. DSM-ru InattentiveSynptoms
DSM-ruInattentive Synptoms
F'.? Females30 to 39 yeans f age
Females30 B. Hyperactivity/R stlessne s F. DSM-IV
DSM-IVHyperactiv+.lmpulsiv'e ymptoms
Hyperactiv+.lmpulsiv'eymptoms
F 3 =Females40 to 49 years
Females40 yearsof
of age C. lmpulsivityrEmotional ahlility G. DSMJV ADHD Symptoms
DSMJVADHD Tcrtal
SymptomsTcrtal
F,4= Females50 yerars f age or older
Females50 D. Problems wifr Setf-ConcePt
Problemswifr H- ADHD ndex

-r -?v^ C^wyridlOl99f, l,{uld-flcdrhs5'arlm-Anrighslwcd. l n r h c U . S A . , P O . B dg

dg 5 0 , t r l s r h T m n d
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 < .{

DHD ating icalesCAARS)

Conners'AdrLlt

Clinicalmpressions
Clinicalmpressions Backgro nd Inforrnatk'€
I nforrnatk'€
Ms.W.'s
Ms. W.'s esults n theCAARS
theCAARS uggesthatshemeets
hatshemeets Dr. G is a 49-year-old C".xre;es €sheranvo sons aged
current cril.eria or ADHD, Combined Rpe. Ms. W. also 24 utd 16). He earned
earnedhis
his lvtD- frosr anlC}&plil medical
presents vilthsignificant
vilth significant anxious featuressuggestive
features suggestiveof
of a school and currently rvorhs as n hryital physician.
generalizect nxiety
nxietydisorder.
disorder.Specifically,
Specifically, shedescribes
shedescribes er Previously l'rehas
l'rehas worked as a fand - p-atice doctor, an
moodas
mood being generally elnse nd anxiousand
asbeing anxiousand notes hat as a nriter rl ho published a
emergency oom director, ald asa
she feels unable to relax, and frequently "lvound up"
up " novel n the early 1970s.Dr.
1970s.Dr. G's irqr rnaniageshave
rnaniageshaveended
ended
rvithout knowing why. Ms. W. feels prone to frequent, in divorce (the rnost recent rr'as n l99j). Dr. G became

excessive, nd unrealisticworry about a variety of issues aware of ADHD through his colleagm who recognized n
awareof
(e.g., anticipating future events, not accomplishing him the ong-terrn qymptomsof the disorder.D Dr.
r. G came o
necessaylvork- and home-based asks, saying or doing suspect hat he may have the dirnrder on the basis of
thewrong hing). She
thewrong also lescribes erselfas
Shealso erselfasbeing
being overly chronic diffi culties rvith inattention-distractibi
culties inattention-distractibiiry-,poor
iry-,poor
concemed,with er competence,
competence,eeling
eeling olenvhelm.ed vl'ren planning, and disorganization.The
disorganization. The latter [$'o areas
faced vith rnultip
rnultiple
letasks
tasks o cornplete, ending to evaluate represent hief presentingconcenns :; Dr. G describes
herself n a negative vay;
vay;ard
ard demonstratingabove
demonstratingaboveaverage
average lumself as highly drsorganized, rone to procrastination,
levels of self-consciousnr:ssnd
self-consciousnr:ssnd need for reassurance. and hampered
hamperedby by h.is ailure to plan adequately n both his
Frequentlyexperienced omatic
Frequentlyexperienced anxious eaftrres nclude
omaticanxious personaland professional ife.
srveating, eadaches, ausea, tonach distress,dizziness,
d izziness,
needing o use he ba
bathroorn,and being easily voken rom
throorn,and Medical story
W. early-adult onset or the rnajority
sleep. \4s. describes n early-adultonset Dr. G. reports no history of physical
reportsno physicalabuse,
abuse,sexual abuse,
sexualabuse,
of the arxiLous ymptornsnoted above.Screens or panic
notedabove. or other forms of trauma. There s, however,
however,a a history of
attacks, goraphobia, ocieil hobia,
hobia,and
and childhood history (rvith nd
disorderwere all negative.
separatircnnxiety disorderwere
of separatircnnxiety abusing both alcohol apparent dependency)
Dr. G participated n a 30-day substance buse
cocaine.Dr.
cocaine.
treatmentprogram. The failure to mLake
mLakedequate reatment
dequatereatment
Recommendations gains led to Dr. G.'s participation n a second30-day
second30-day
omprise othpharmacologic
Treatmentecomnendatio:nsomprise
Treatmentecomnendatio:ns program several months later. Ttris p.rogram eportedly
severalmonths
M edicatioumay be
and psyctrosocialnterventions.Medicatioumay resultedn
resulted n a cessation f substance se,although
se,althougha a relapse
beneficialn improving oreoreand ymptornsff
associatedymptorns
andassociated involving cocaine use ed to another equiredparticipation
cocaineuse
ADF{D including
includingnattenti,cn,
nattenti,cn,estlessness, nd mpulsivity) ilr a 28day program.
program.Since time, Dr. G reports
Since hat time,Dr. no narcotic
reportsno
mayalso
andmay
and bedirected
alsobe directedorvard he reduction f an-xious
orvardhereduction exceptiono.[ over-the-
or other substance se rvith the exceptiono.[
.nurnber fpossiblemedication
features. .nurnber medicationtrategies xist.
trategiesxist. medicationor
countermedication
counter or headaches. r. G: eportsno alcohol
including sychostimulants,ntidepressants,
n tidepressants, r anti- use in the past five years. He has been involved in
anxiety gents ither alone r n combination. s.W.might
itheralone W.might Alcoholics Anonymous since ttrat time and reported
also enefit rom nvolvenrentn anorganization
enefitrom esigned
an organizationesigned regrrlarlyattending ftvo or tluee meetj,ngs r'veek t the
to support nd provide nformation o individuals vith evaluation.
the curreutevaluation.
time of thecurreut
ADF{D nd elated isorders.
isorders.ither alone r n cornbination
itheralone
rvith rnedication,ognitive-behavioral
rnedication, ognitive-behavioral nterventions re School istory
likely to be useful n helping Ms. W. to reduce reducehehe r Although he was not grossly
grosslyoveractive
overactiveor or impulsive as a
overanxious ymptoms. uch reatment
reatments ikely to nclude
s ikelyto youth,Dr.
youth, G.'schildhood memories
Dr. G.'schildhood memoriesare significant because
are significantbecause
the teaching f specific ehavioral echniquese.g., of his difficulties rvith inattention, distractibility,
relaxationL deepbreathing raining) along
nd/or deepbreathing
relaxationLnd/or rvith
alongrvith nd with rv aiting hir; t rnrLin
disorganization ndwith ines, emaining
rnrLinines,
cognitive;oping kills o reduce eneralevelse vels f tension, a rd completing
seated,ard chores,homervork,and
his chores,homervork,
completinghis a nd other
more ealisticexpeclations
buildmore
build expeclationsnd nd hought atterns,
atterns,nd
nd D espiteevidence f well-abo've-a\/erage
tasks.Despiteevidence ntelligence,
prornotehe
prornote he capacity o recognize nd cornbat nxious Dr. G.'s schooling vas
earlyschooling
G.'searly vasmarked
markedby'his coasting y on
by'hiscoasting
symptoms. and achieving
his abilitr,'and averagegrades
achievingaverage gradesdespite
despite ailing to
completeor
complete or tum in mucll of his assignedwork, being highly
Case (James . , 49-Year-0ldale)
49-Year-0ldale) ard shorving ittle molivationwith respect
distracted n class.ard
rnproveds;otnelhat n high school,
His grades rnproveds;otnelhat
Dr. G refbrred imself rr a clinic for an assessnento to acadenus.
although difficulties rvith completing assignments,and and
determine hether esuff'ers rom ADI{D.
esuff'ersrom
a te e sisted.
ate
papersrrprojects
turningn papers rocrastination,
sisted.rocrastination,
studl'habits,
poorstudl'
poor h abits, ndcontinuing ttentionaln d
nd continuingttentional
d ifficulties made r.is irst year of collegea
orgaruzationaldifficulties collegea
 40

ndU se
ndU
Interpretation

vhich resulted n nearly

d,isaster,vhich all F grades
nearlyall gradesand
andaa decision he notes roblems vith orgetfulnesse.g.,writingdorvn
roblemsvith w riting dorvn
nd ke,epingp
prescriptions),apenvork, ndke,eping p rvith reading.
rvithreading.
to drop ottt.
el,idence f distress nd mpaLirmelts perhaps
Theel,idence
The perhapsnost
nost
o ntact rvith a psychologist,
Subsequerntontactrvith psychologist,horvever, wa s
horvever,wa nDr. G's personal
notablenDr.
notable omain: hronic risn'nnagernent
personalomain:
higtrly nfluential n inducing Dr. G to mpose
mposeaa n[tch higher o f his finances: a histor y of unstable omantic
level of structure n his til'e(e.g.,devising and adhering o
devisingand relationships:uilt regarding is ailure o realize is ull
a strict schedule:requently
strictschedule: usittg ists and notes).These
requentlyusittg T hese nd over-reliancen ollers to contpensate
potential: ndover-reliance or
or
changeSrssulted n rnuch mproved perfomrance vhenhe
rssultedn his disorganizationnd forgeffi.rlness,ausing tressn
t a nerv ;ollege n Colorado.Difficulties G's relationshiPs.
Dr.G's
Dr.
resruned ;choollevel along rvith
sustaining his of effort and structure,
structure,along
continuin;g nattention,and task-conrpletion'
p roblems vith i nattention,and
n;gp CAARS esults
becorningdiverted
andbecorning
and divertedbyby more appealing,non-academic Dr. G was administered he CAARITS:L immediately efore
wasadministered
pursuits, nade
nademedical m ore challenging.Despite
medical sr:hoolmore a face-to-face nterview rvith a staff psychologist
psychologistat
at the
believing himself capableof perfonning at the ughest evel, clinic. Figure 3. 0 presents he completedProfile orrn for
presentshe fo r
he graduartedn the orver hird of his nredicalschool class.
nredicalschoolclass. the self-report orm. His Inconsis;tencyndex indicated a
F{rsproblems
problemsappear adverselya-ffected r. G's
appear o have adverselya-ffected valid response affern (his score vas 2).
vas2).
ability to meet academicdemands
demandsat at school and, despite
schooland,
his obtairringan M.D. degree, ontributed o his ach.ieving Clinicalmpressions
m pressions
at a level
levelbelorv his capacitY.
belorvhis
Dr. G.'s results on the CAARS suggest hat he meets
current criteria for AD HD, Predonrinantly nattentirre lpe.
Presentingroblem:; Dr. G. positivety endorsed niltterrtive symptoms of
primar-v
bothprimar-v
both
A semistrmcturedlinical intervierv
interviervcovering
covering o Dr. su-ffrcient unber (8 of 9), duration,zutd
duration, zutdseverity
severity o rneet
and asscciatedeatures of ADHD lvas administered
eaturesof administeredo D SM-IV criteria or ADF{D, Predonrinantly nattentire pe.
ADF{D,Predonrinantly
G. His rerSpollS€s ndicat,e umerous,ADF{Dsymptoms n Although not sufficient in nurnber o meet criteria for tlie
meetcriteria
the attentionaldornain
theattentional anJ a smallernumber of lrl'peractive/
dornainanJ conbined type of ADHD. he did indicate
typeof diffrculties
somediffrculties
indicatesome
impulsive syinptoms. Sp'ecifically'h
syinptoms.Sp'ecifically' hee describes ifficulfy in the hyperactive/impulsive omain.
he ollorving: ustaining ttentiou o a vanety
rvitl'rhe
rvitl'r vanetyofof tasks
and activities e.g., echrres, con\/ersations,
nstmctions,con\/ersations,
echrres,nstmctions,
Recom e n ations
television,and p?p€rwork):
p?p€rwork):becorning easily bored or
becorningeasily
maybenefit rom a trial of medication .lith established
Dr. G maybenefit
distracted: shifting frecluently betrveen lfilished
efficacy n treating primary and associated -vmptoms f
activities;: eeming
eemingnot others:and completing
not ttl listen to others:and
AD H D . C o n s i d e r a t i o n m u s t b e g i v e n t o s t i m u l a n t
shorrt-termasks e.g., eading
bothshorrt-term
both articles, vriting etters,
eadingarticles,
rnedicationswhich, in responsive dults,have been ound
havebeen
daily chores)
doingdaily
doing and onger-termprojects e.g., earning
chores)and
to irnprove attention span, tasjk completion, and self-
tasjkcompletion,
to speak Spanish). n rlddition. Dr. G. has difficulties
organization, vhile reducing mpulsivi t"v, i stractibi ti', ard
attending o details, careless rrors,
preventingcareless
details,preventing and inding
rrors,and
things, aLnd xperiences isorganization,procrastination, restlessness. esearch on the: the:efficacy
efficacy of stimulant
medications n samples
samplesofof childr:en vith ADI{D suggests
forgetfi,rlnesstt rvork and in personalnatters.
and forgetfi,rlness n atters.
that approximately 70-80 percent
percento o r higher respond
positively. Less research has been conducted
researchhas conductedon on the
Dr. G reports hat lr.is attt:utionproblems vere nost
lr.isattt:ution nostnotable
notable
responseof
response of adults with ADFID to the psychostimulant
during arctivities
arctivitieshat engaging and
hat rvere not inherently engagingand
Hor,vever, number lf plaLcebo-controlled
medications.Hor,vever, nals
rvhenhe
rvhen ,vorking vithout he pressrue f an tnminent
he vas ,vorkingvithout
have been conducted over recent years and generally
H is features
deadline.His featuresn tl'rehlperactive/impulsive otnaiu
n tl'rehlperactive/impulsive
periods,
prolongedperiods,
crrprolonged suggesta favorable response.n,divirluals vith substance
includedproblerns
problernsemai.ning
emai.ning eated
eatedcrr
abusehistories, ike Dr. G. canL ose osea a dilernma or the
th e
diffrculry rvaiting his htm, enjoyrnent
enjoyrnentofof fast-paced and
fast-pacedand
clinician rvith respect to pharr-naLcologic r eatnlent.
reatnlent.
somervltat iska activities, receipt of numerous
activities,receipt numerousspeeding
speeding
Prescribingstimulant medications o suchpersons
personseutails
eutails
someprope sity for verbal impulsivity (e.g.'
tickets,and someprope
or comments a risk due o the drug's abuse otential.
otential.Although euphoria
Althougheuphoria
intemrpting others,
others,or or blurting out answers
answersor
occurwith orally administerred
not occurwith
doesnot
does administerredtimulant dmgs n
timulantdmgs
without adequate oretlLought).
the dose ranges employed, t may appear f the
ypically
drug is taken n large doses, ntravenously,or or "snorted."
Although he functions;adequately n his rvork and is
functions;adequately
Horvever, vithholding
vithholdinga effrcaciousreatrnent
a potentially effrcaciousreatrnent
respected y his colleagues nd patients,
patients,Dr.
Dr. G reports
that his occupationalp,:rforlnance s negatively affected to individuals rvith impairing ADFD is also uudes
uudesirable,
irable,
and disorganiz,ation.Specificalll',
Specificalll', particularly f they appear o have
theyappear gailed coltrol oyer ireir
havegailed
by his attention problerns
problernsand
substanceabuse.
 41

ADHD ating ca'lesCAARS)

Conners'dultADHD

Figure. 10
nitialProfile
CAARS-S:L G'' Case tudy )
n itialProfileormor Dr'G

-A\
GendenlM ) F
clieut tD: {-"rr. Gr H*o.r

nge: Qt TodaY'sDate: j /13-/ g A

Birthdate,kt*-t# Da.v Ycd

lnattention/MemorY roblems E. DSi,l-lV InattentiveSymprtorns

Ml = Males 18 o 29 'ears of age A.
B. HyPeractivitY/Restlessness F. DSiI-lV Hyperaclive-lmgulsive ymptoms
M2 = Males 30 to 39 'ears of age
Males30 G. DSM-IVADHD SYmPtoms otal
= Males4O o 49 Yearsof age
M3 Males 4O G. lmpulsivity/Emotionalability
D. Problemswith Self-ConcePt H. ADHD ndex
=
M4 Males 5OYearsof age or older
Males5O

t--- -
*MHsffi ,",#"+JslH[:#,t*ffi ffi #r.Ilffi;,i?i:r'ilL*
 47

ndU
ndU se
Interpretation

i,*ical Follow-Up Conclusion

,r;SeG rvas
rvasreated
reatedoror ADHD usinga
usinga common rug reatment
Potentialusersof
Potentialusers of the CAARI] are reminded ha t
i:futhis disorder. t the
thebegirning of the irst rveek f reafinent,
begirningof
assessmentsnddiagnostic epprts equirea equirea detailed
,,.*. G was asked o complete he CAARS-S:SV. Consistent
j-,*ffi the clinical impressions
justificationof conclusionsbaset
conclusionsbasetrl rl
n measuresike the
impressionshat
hat Dr. G exhibited
exhibitedsubstantial
substantial
CAARSand
CAARS otherdata.
andother The evq:l f detailprovidedn
data.The providedn
$D*ID q,mptoms,
q,mptoms,is is scoreswere above 0 or all the
scoreswereabove theCAARS
CAARS
these ase tudies vill not, n gepreral,esuffrcient
tudiesvill suffrcientor or
=eks Two months after ttre start of the dmg treatment 8
monthsafter
: rcks later),Dr.G assessmentnddiagnostic
nddiagnosticeporilis.
eporilis.he
he rueuseftilness
rueuseftilness
D r. G completedsecond
completedsecond AARS-S:SV. n hi his
s
of theCAARS s a functionof
functionof tfe measure's
measure'sbility
bility o
msion, consistentvithclinical
v ithclinical mpressionshat
hatDr.
Dr. G was provide nsights hatwill
hatwill behelpful
behelpful or diagnosing nd
:xe*ondingpositivelyo hedmg
hedmg reatment,ll
reatment,ll of the -scores
,. *re belorv70.Figrue .11 treating dultswith ADHD. Di1'ersease
Di1'ersease tudies ere
.11 sDr.
Dr.G's orm,shor.vingis
G's Profile orm,shor.ving
provided o demonstrate
demonstratehe he uqeof
uqeof the CAJ{{S in a
C{ARS-S:SV results n the irst occasion,
C{ARS-S:SVresults occasion,efore
eforereatment
numberof
number of sinr,ationsnd contqxts
contqxts,, nd to clarif,, the
d on the
thesecond fter8 rveeks f drug reatment.
second ccasion, fter8
useof
use the CAARS n actualpral;tice.
of theCAARS
Ikhenused
Ikhen n this
usedn way, heProfile
thisway, orm provides visual ecord
heProfile ormprovides
dthe change
changenn scores
scoresverr ime.
verrime.