International Journal of Special Education

2004, Vol 19, No.2.

ATTENTION DEFICIT HYPERACTIVITY DISORDER AND RATING SCALES WITH A
BRIEF REVIEW OF THE CONNORS TEACHER RATING SCALE (1998)
Matthew C!"e#
and
T$ F$ M%La&'h()*
Gonzaga Unier!it"
#$i! paper e%plore! t$e &iagno!tic and Stati!tical 'anual of 'ental
&i!order! (&S')IV* +,erican -!"c$iatric +!!ociation, 1994. definition of
+ttention &eficit /"peractiit" &i!order. (+&/&.. #$e u!e of rating !cale!
to diagno!e +&/& 0a! ealuated. 1ating !cale! $ae 2een u!ed !ince t$e
19304! and are $ig$l" influential in t$e detection of +&/& toda". 5e al!o
e%a,ined t$e adantage! and di!adantage! of u!ing rating !cale!. 1ating
!cale! !ee, to c$ange t$e percentage of indiidual! 0$o ,eet t$e criteria for
a diagno!i! of +&/& 2a!ed on different age group!, gender, and et$nicit".
6inall", t$e 7onner! #eac$er 1ating Scale (7#1S)1. (7onner!, Sitarenio!,
-ar8er, 9 Ep!tein, 199:. 0a! reie0ed. #$e i,portant c$ange! in t$e
rei!ion of t$e 7onner! #eac$er 1ating Scale)1ei!ed ( 7#1S)1. 0ere
detailed. #$e u!e of t$e 7#1S)1 i! reco,,ended a! part of a ,ulti)faceted
a!!e!!,ent to diagno!e and ealuate treat,ent procedure! for c$ildren and
adole!cent! 0it$ +&/&.
The original 7onner!4 #eac$er 1ating Scale (1968)was a 39-item rating scale used to determine
the teachers view of a childs behavior in the classroom (Conners 1969)! This scale was
recentl" revised (CT#$-#) in 1998 (Conners $itarenios %ar&er ' ()stein 1998) and resulted
in a *8-item scale! The revision of the original Conners Teacher #ating $cale was shortened to
accommodate the administrator of the test so that the information would be more easil" gathered!
+t has also changed from a 3 to , )oint -i&ert scale! This scale ranges from . not at all true to 3
ver" true (Conners et al! 1998)! 18 of the items on the CT#$-# were written to mirror closel"
the /$0-+1 criteria for 2/3/! The rest of the items came from various tests such as the
)revious Conners which have been shown to have clinical utilit" (4rown 19856 $atin 7insberg
0onetti $verd ' 8oss 19856 $tein ' 9:/onnell 1985) and reliabilit" (Conners 19696
(delbroc& ;reenbaum ' Conover 19856 ()stein ' <ieminen 19836 #oberts 0ilich -one" '
Ca)uto 19816 =entall ' 4arac& 19>9)! There are also shortened versions of the original CT#$
such as the I;5+ 7onner! (%elham 0ilich 0ur)h" ' 0ur)h" 1989) and +22reiated
S",pto, <ue!tionnaire ($)rague ' $leator 19>3)! These shorter versions are also ver" )o)ular
with teacher because of the brevit" of time needed to com)lete the scale!
+n recent "ears the one of the most common reasons for referral to mental health )ractitioners in
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the @nited $tates has been the )arents concern regarding their child and 2ttention /eficit
A3")eractivit" (2/3/)! 2/3/ is one of the most )revalent childhood )s"chiatric disorders
(4ar&le" 19986 3undhammer ' 0c-aughlin *..*)! 2round 19B of the 2merican school
children have some t")e of behavior )roblem! 3alf of these children have either a h")eractivit"
or inattention )roblem ($muc&er *..1)! Thus 2/3/ has a high incidence of occurring with
other )roblems (<ational +nstitute of 3ealth *..1)! 2ccording to the $urgeon ;eneral:s re)ort 3-
5B of 2merican school children have 2/3/ (2merican %s"chiatric 2ssociation *...)! (arlier
estimates have said that 1-*.B of the )o)ulation has 2/3/ (4ar&le" 1998)! This disorder is
diagnosed in bo"s more then girls in ratios ranging from ,C1 to 9C1! This difference is based on
where sam)le is ta&en whether clinical or communit" based (#eid *..1)! 2 formal definition of
2/3/ followsC
+&/& refer! to a fa,il" of related c$ronic neuro2iological di!order! t$at interfere 0it$
an indiidual=! capacit" to regulate actiit" leel ($"peractiit"., in$i2it 2e$aior
(i,pul!iit"., and attend to ta!8! (inattention. in deelop,entall" appropriate 0a"!
(<ational +nstitute of 3ealth *..3)!
The three main characteristics of 2/3/ are h")eractivit" im)ulsivit" and inattention! Children
with 2/3/ have shown to score an average of > to 15 )oints below the control grou)s on
standardiDed intelligence tests (8araone et al! 19936 8ischer 4ar&le" 8letcher ' $mallish 199.6
0c;ee 7illiams 0offitt ' 2nderson19896 %rior -eonard '7ood 19836 Tarver-4ehring
4ar&le" ' Earlsson 19856 7err" (l&ind ' #eeves 198>)! The reason for this difference is not
clear and it has been s)eculated that this ma" be the result of the test ta&ing behaviors found in
children with 2/3/! The inattentive res)onse of children with 2/3/ could lead to answers
which were given in haste and therefore wrong (4ar&le" 1998)! $ome studies have shown that
the relationshi) between low test scores and 2/3/ comes from learning disabilities (-/) found
in the children with 2/3/ (4ohline 1985)! 3owever in a stud" carried out b" 4ar&le" et
al!found that children with 2/3/A-/ had higher test scores then children diagnosed with onl"
-/ (4ar&le" 199.)!
Children with 2/3/ have shown intelligence Fuotients from mildl" mentall" intellectuall"
retarded to gifted! 4esides scoring lower on intelligence testing children with 2/3/ have
shown some difficult" in the classroom! Children with 2/3/ normall" have trouble in two
areasC academic )erformance and achievement! 0ost children referred to clinics are )erforming
well below their &nown levels of abilities (4ar&le"1998)! (vidence su))orts that medication will
hel) some school children with academic )roductivit" and accurac" (4ar&le" 19>>6 %elham
4ender Caddell 4ooth ' 0oorer 19856 #a))ort /u%aul $toner ' ?ones 1986)! (ven with
medication students are still showing below average )erformances on standardiDed tests
com)ared to their )eers b" as much as 1. to 3. )oints in a multitude of various subGect areas6
reading s)elling math and reading com)rehension (4ar&le" /u%aul ' 0c0urra" 199.6 4roo&
' Ena)) 19966 Cantwell ' $atterfield 19>86 Case" #our&e ' /el /otto 19966 /"&man '
2c&erman 199*6 8ischer et al! 199.6 $emrud-Cli&eman et al! 199*)!
56B of children with 2/3/ reFuire tutoring 3.B are forced to re)eat a grade and 3.-,.B must
be )laced in s)ecial education )rogram (4ar&le"1998)! 2s man" as ,6B of 2/3/ children ma"
be sus)ended from school and 1. to 35B ma" dro) out of high school (4ar&le" 8ischer et al!
199.6 4ar&le" /u%aul ' 0c0urra" 199.6 4rown ' 4orden 19866 8araone et al! 19936 0unir
4iedermen ' Enee 198>6 $tewart et al! 19666 $Datmari 9fford ' 4o"le 19896 7eiss '
3echtmen 1993)! $ome children with 2/3/ show social deficits! 2s adolescents the" are more
li&el" for motor vehicle accidents tobacco use and teenage )regnanc" (<ational +nstitute of
3ealth *..3)! 2/3/ is a serious disorder and a reliable wa" to diagnose needs to be develo)ed!
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&S')IV and +&/&
The most commonl" used diagnostic criteria used in the @nited $tate are the &iagno!tic and
Stati!tical 'anual of 'ental &i!order! (/$0-+16 2merican %s"chiatric 2ssociation 199,) and
the International 7la!!ification of &i!ea!e!! This test is ver" similar to the /$0-+1 and is used
internationall" (+C/-1.6 7orld 3ealth 9rganiDation 199,)! 2ccording to 4ar&le" (1998) the
/$0-+1 are some of the most rigorous and em)iricall" derived criteria ever created in the histor"
of clinical diagnosis for this disorder! This version of the /$0 was based on items used in rating
scales that have a high intercorrelation to each other and are valid in distinguishing 2/3/ from
other grou)s of children ($)itDer et al! 199.)! The /$0-+1 criterion has different s"m)toms for
inattention and h")eractivit"! /ividing the criteria into these categories allows diagnoses of
2/3/ and 2// in one set of criteria (4ar&le" 1998)! 2ll of the s"m)toms must be )resent for
at least 6 months and must reach at least siH of the nine criteria in the categor" (2merican
%s"chiatric 2ssociation 199,)! The other conditions which must be )resent for diagnosis of
2/3/ is that must a))ear before age seven must be )resent in two or more settings there must
be clear evidence of clinicall" significant im)airment in social academic or occu)ational
function and s"m)toms do not occur during the course of another )s"chotic disorder and lastl"
are not better accounted for b" another mental disorder (2merican %s"chiatric 2ssociation 199,)!

9ne of the )roblems with the /$0-+1 is its treatment of 2/3/- )redominantl" inattentive (%+)!
The main difference between 2/3/-%+ and 2/3/-combined (C) is that 2/3/-%+s main
)roblems come with focusedAselective attention and sluggish information )rocessing whereas the
2/3/-C focuses on the )roblem of )ersistent effort and distractibilit" (4ar&le" 1998)! This
would mean that 2// and 2/3/ will be classified as different disorders and the rating scales
accom)an" each will have to change! 3owever there has not been enough research on this to)ic
to ma&e a definite se)aration of the two (4ar&le" 1998)!

2 second im)ortant concern is the a))ro)riateness of the items for different develo)mental
)eriods (4ar&le" 1998)! This was not the case for inattention! 3arts recent research showed that
inattention remained stable from middle childhood to adolescence (3art et al! 1995)! Thereafter
h")eractivit" has been shown to decline as 2/3/ children reach adolescence (4ar&le" 1998)!
2lthough the h")eractivit" level of those with 2/3/ statisticall" declines as the" get older
4ar&le"s findings show that man" 2/3/ children still show signs of h")eractivit" even though
the" dont Fualif" for the diagnosis! Therefore this a))arent decline in the )ercent of those
diagnosed is not in correlation with the decline in the severit" of s"m)toms used in the criteria
(4ar&le" 8ischer (delbroc& ' $mallish 199.6 8ischer 4ar&le" (delbroc& ' $mallish 1993)!
+n 8ischers stud" little difference was found in the measure of the im)airment between those no
longer meeting diagnostic criteria for 2/3/ and those still doing so (8isher et al! 199.)!
2ll reliable ratings in the @nited $tates are based on the /$0-+1! 3owever this is not the case
with other nations! +n ;erman" researchers using the /$0-+1 found that 1>!8B of the children
had 2/3/ (4aumgaertel et al! 1995)! This is not Gust the case with ;erman" man" countries
have an inflated rate of 2/3/ using the /$0-+1 criteria (#ohde *..*)! This is a ver" im)ortant
statistic when over 1A3 of the 2merican school )o)ulation is from another culture with 3is)anics
being the largest (#eid 1995)! This research is something that rating scales need to consider
when tr"ing to meet the criteria for /$0-+1!
1ating Scale!
The use of rating scales has alwa"s been one of the maGor wa"s of diagnosing a )erson with
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2/3/ (4ar&el" 19986 /u%aul ' $toner 199,)! #ating scales have become one of the
essential elements in the evaluation and diagnosis of children with behavior )roblems (4ar&le"
1998)!
7linician! and re!earc$er! con!ider t$e u!e of relia2le and alid teac$er)co,pleted rating
!cale! a! !tandard practice for t$e diagno!i! and treat,ent of attention
deficit>$"peractiit" di!order (2/3/. (2merican 2cadem" of Child and 2dolescent
%s"chiatr" 199>6 2merican 2cadem" of %ediatrics *...) (0attison ;adow $)raf&in
<olan $chneider *..3)!
The rating scale first began to affect the diagnosis of 2/3/ with the Conners Teacher #ating
$cale (CT#$) in 1969 (Conners 196919>3)!(;um)el 7ilson $halev 1998)! 8rom the earl"
19>.s on there has been a )rofessional )reference for the rating scale (;um)el 7ilson $halev
1998)! 4efore the last decade it has been acce)ted that the eH)ression course and outcome of
)s"chological disorders were largel" universal and inde)endent of each other (0arsella '
Eameo&a 1989)! This is another reason that rating scales were so heavil" de)ended on without
Fuestion (#eid Casat <orton 2nasto)oulos ' Tem)le *..1)!
%arental ratings have also been shown to be reliable and full of good information (;lascoe '
/wor&in 1995)! ;lascoe ' /wor&in state that the accurac" of information from )arent ratings
hel)s clinical diagnosis of 2/3/! #ecent studies have shown that correctl" inter)reted )arental
concern eH)ressed on rating scales can be Gust as accurate as develo)mental-behavioral screening
tests when tr"ing to detect children with disabilities (e!g! /iamond 198>6 ;lascoe 199>a199>b
*...6 ;lascoe 2ltemeier ' 0ac-ean 19896 0ulhern /wor&in '4ernstein 199,6 Thom)son
' Thom)son 19916 Ioung /avis $choen ' %ar&er1998)! +n another stud" b" ;lascoe and
colleagues it was found that using the %arents: (valuation of /evelo)mental $tatus (%(/$)
eH)resses a high sensitivit" with certain )arents concerns (e!g! motor language global cognitive
academic) when identif"ing disabilities with children four "ears and older (;lascoe 1991
199,199>a 199>b *...6 ;lascoe et al! 19896 ;lascoe ' 0ac-ean 199.6 ;lascoe 0ac-ean '
$tone 1991)! The o))osite was found to be true the rating scale shows that )arents of children
without disabilities do not have the )reviousl" eH)ressed concerns (/ewe" Crawford ' Ea)lan
*..3)! 9bviousl" rating scales are a useful wa" of )resenting Fuestions to )arents to receive
information! +n a stud" done b" 0ash and Terdal it was re)orted that )arents are an im)ortant
source of information! The" are familiar with the childs histor" and current situation and have
the cognitive s&ills that enable them to recogniDe and describe their childs )s"cho)atholog" and
learning difficulties (0ash ' Terdal 199>)! %arents can identif" the strengths and wea&nesses of
the child that ma" not be assessed b" standard )s"chometric testing (/ewe" et al! *...)!
Teacher rating scales are also an im)ortant )art of the evaluation and diagnosis of 2/3/ (0iller
Eo)lewicD, ' Elein199>.. Teacher rating scales )rovide necessar" information about the child
in the school setting! The teacher also becomes a secondar" informant who can Gudge the
behavior of the child in the conteHt of his )eers (0atson 1993)! Teacher rating scales on average
are more reliable then )arent rating scales and tend to be more sensitive to h")eractive behaviors
(4ar&le" 1981)! 2ll ratings scales have some )roblem with reliabilit" and validit"6 however
when combining multi)le as)ects of evaluation ratings scales are )roven to be a useful tool in
establishing the )resence of s"m)toms their onset and duration )ervasiveness and their
statistical deviance com)ared to a normal child of the same age (4ar&le" 1981)!
#ating scales are a valuable tool in the assessment of 2/3/6 however there are man" factors
that can affect the reliabilit" and Fualit" of a rating scale (%ar&er 199*)! 0an" of the most
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commonl" used rating scales have similar factors that ma&e them effective! 8or eHam)le the"
offer a Fuic& and eas" format standardiDed sets of behaviors to insure that s)ecific behaviors are
being assessed are economical in terms of cost and time and reduce rater bias and subGectivit"
b" using standardiDed )resentation of Fuestions! The" also )rovide a means of evaluating
freFuenc" and severit" of behaviors with age and gender s)ecific norms to com)are to and can be
given to both )arents and teachers (showing the )roblem in multi)le settings reFuired b" /$0-
+1)! <ormative sam)les include children form different socioeconomic and racial and ethnic
)o)ulations and are multifactorial (-erner ?! -owenthal ' -erner $!1995)!
2 maGor concern with rating scales is that the" are thought to be gender biased! There have been
numerous studies com)leted which show that girls differ from bo"s in the rate of 2/3/ (2rnold
19966 ;aub ' Carlson 199>b)! 3owever the /$0-+1 does not ta&e gender into account when
)utting out its criteria (Collett 9han 0"ers *..3)! @nfortunatel" this ma" mean that the /$0-
+1 ma" not be demonstrated as accuratel" in females as it is in males (9han ' ?ohnston 19996
Juinn ' <adeau *..*)! This issue leads to the subseFuent misdiagnosis of females!
2nother valid concern with rating scales is that the" were created for elementar" age school
children and did not account for children under age four or adults (Collett 9han 0"ers *..36
3undhammer ' 0c-aughlin *..*)! 4ar&le" s)ecificall" ma&es note of this b" sa"ingC t$e
appropriatene!! of t$e ite, !et for deelop,ental period (4ar&le" 1998)! This concern is
s)ecificall" addressed in terms of adults who dis)la" im)ulsivit" and some as)ects of
h")eractivit" but dont Fuite meet the criteria for h")eractivit" (4ar&le" 1998)! There has been
ver" little research done in the area of adulthood 2/3/ and how the /$0-+1 criterion conforms
to college students in the @nited $tates (/u%aul $chaughenc" 7e"andt Tri)) Eiesner 9ta '
$tanish *..1)! 2dults rel" heavil" on self-re)orted scales diagnosis with 2/3/ (/ulcan 199>6
?ac&son ' 8arrugia 199>)! 3eiligenstein et al! (1998) )erformed a stud" using ,,8 universit"
students that showed ,B of the )artici)ants had 2/3/6 this was found b" using /$0-+1
criteria! 3owever when 3eiligenstein et al! )erformed a similar stud" with self-rating scales the
)ercent of )eo)le who Fualified for 2/3/ rose u) to 11B (3eiligenstein et al! 1998)!
Therefore 3eiligenstein et al! (1998) decided that rating scale criteria brought forth b" the /$0-
+1 is too high when a))lied to universities! 1arious researchers believe that students will
underscore themselves on the tests6 as a result of academic underachievement associated with
2/3/ will not be re)resented on the test (?avors&" ' ;ussin 199,6 #ichard 1995)! 2 few
studies regarding 2/3/ children into adulthood have been com)leted6 however this is an area
that needs more eHtensive research (4ar&le" 1998)!

The final maGor concern with rating scales is its corres)ondence to different ethnic grou)s! +n the
)ast it was believed that eH)ression course and outcome of )s"chological disorders were largel"
universal and was not effected b" ethnicit" (0arsella ' Eameo&a 1989)! <ow researchers sa"
that cultural bias is an issue with 2/3/ testing (#eid 1988)! Thus the creditabilit" of behavior
rating scales to culturall" or ethnicall" diverse )eo)le has been Fuestioned (#eid Casat <orton
2nasto)oulos ' Tem)le *..1)! 7ith the increase of minorit" grou)s which in some states eFual
half of the student )o)ulation the need of a scale that has stabilit" through ethnicit" is becoming
more a )revalent issue (2merican Council on (ducation 19886 Jualit" (ducation for 0inorities
%roGect 199.)! These are the main concerns regarding 2/3/ rating scales! 0ore )roblems are
being discovered facing rating scales but ethnic inclusion gender bias and earl" childhood and
adult ratings are three legitimate concerns!
4ar&le" (1981) stated the following criteria for rating scalesC the scales should be worded so that
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The maGorit" of adults can understand them the scale should have enough items to assess
constructs under the stud" but not so man" that it is overl" time consuming and the answer
format should have the degree of )roblem being endorsed instead of onl" "e! or no answers!
8urthermore the test should focus more on the construct being tested it should have construct
validit" which tries to correlate the s"m)toms of 2/3/ with the Fuestions being as&ed and it
should also be similar to other useful measures in the field in the manner of criteria and
outcomes! The rating scale should also be reliable for all individuals tested and two different
raters should be )rovided for each child and the scale norms should include a large age range!
2lthough it is not s)ecificall" mentioned the normative grou) should include )eo)le from
different )arts of the countr" several of those with various socioeconomic bac&grounds a range
of ethnicit" and a number of individuals from both ruralA cit" surroundings (#eid Casat <orton
2nasto)oulos ' Tem)le *..1)! 8inall" the" should )rovide some information on )lanning
interventions after the com)letion of the test the maGorit" of the scales do not include this as)ect!
(4ar&le" 1981)!
#$e 7onner!4 #eac$er 1ating Scale (7#1S and 7#1S)1.
The Conners Teacher #ating $cale (CT#$) is one of the three most )o)ular rating scales used b"
)rofessionals toda" for teacher rating scales to diagnose 2/3/ (4ar&le" *..3! The CT#$
consists of either 39 or *8 Fuestions and addresses four factorsC conduct )roblem h")eractivit"
inattentive-)assive and h")eractivit" indeH (%ar&er 199*)! 2lthough the scale has been used for
over thirt" "ears it retains its )rofessional a))eal and has remained stable (;um)el 7ilson '
$halev 1998)! This scale covers children from ages 3 to 1>! The CT#$-# has been shown to be
an adeFuate scale for )reschoolers both in middle to u))er classes and in both )redominantl"
white schools and in lower socioeconomic mainl" 2frican 2merican schools (0iller Eo)lewicD
'Elein 199>6 8antuDDo ;rim 0ordell 0c/ermott et al! *..1)!
$ome studies have shown that age had an effect on the )ercent of )eo)le diagnosed with 2/3/6
stating that children are diagnosed more then adolescence (#owe ' #owe 199>)! $ome also
argue that the CT#$ focuses onl" on the negative as)ects of the child (2chenbach 19916
2chenbach ' (delbroc& 19836 2t&ins et al! 19856 -ambert et al! 199.6 9:-ear" ' $teen 198*6
%elham et al! 199*6 Jua" ' %eterson 19836 #utter 196>6 $ha"witD et al! 19866 @llmann et al!
1985a)! This can create a bias with the tester and increase the searching for a )atholog" instead of
accuratel" recording the given information regarding true diagnosis (#owe ' #owe 199*)!
9riginall" the CT#$ was develo)ed as wa" to screen and test behavior )roblems when children
too& medication this means that the scale is sensitive to medication! The CT#$ is useful with a
dual function for assessing )s"chosocial and drug treatment )roblems with children that have
behavior )roblems (3orn +alongo %o)ovich ' %eradotto 198>6 8ischer ' <ewb" 1991)!
CT#$ does show some test-retest reliabilit" (i!e! test a child twice to see if the same conclusions
come from the data)! This was shown b" coming u) with similar findings when retesting children
(;low ;low ' #um) 198*)! 9ne of the maGor )roblems with the CT#$ is that the norming
grou) is Fuite small and from one section of the countr" and a new larger grou) needs be tested
from all over the countr" so that the scale can be &e)t u) to date ( Conners $itarenios, %ar&er, 9
()stein, 1998)!

The newest version of the CT#$ has a greater focus on 2/3/-related behavior and relevance
regarding the Fuestions as&ed! The CT#$-# (1998) has more discriminator" status toward
detecting 2/3/ then the )revious version (Conners et al! 1998)! 2n additional finding from the
Conners at al! (1998) was the scale should not be used alone but instead other diagnostic tests
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should be em)lo"ed! The CT#$ however seems to detect 2/3/ in more 2frican 2merican
children then in white children (Conners et al! 19986 -angsdorf et al! 19>96 7aechter et al!
+<T(#<2T+9<2- ?9@#<2- 98 $%(C+2- (/@C2T+9< 1ol 19 <o!*!
19>9)! 0ore in-de)th research regarding race found that an antisocial factor is found more in
2frican 2merican males and a sociall" inferior factor is found more in white females! The one
stud" on the difference between teacher bias and the theor" of a races acting showed differentl"
the )resence of teacher bias when eHamining white and 2sian children ($onuga 4ur&e 0inocha
Ta"lor ' $andberg 1993!)! The final consideration was that when using the CT#$ the rater
should ta&e racial factors into account and to not onl" use the CT#$ as the onl" diagnostic tool
for detecting 2/3/ ( ()stein, 0arch Conners, ?ac&son, 1998)! +n conclusion the CT#$ is a ver"
reliable and )restigious scale but the tester must be aware of some of the shortcomings of the
scale! #ating scales are and will continue to be used as maGor diagnostic tool for the detection of
2/3/ school children for the foreseeable future! The rating scale is a device that most )eo)le
can easil" use and generaliDe to various subGects! The rating sale is a ver" Fuic& wa" to gather
information from the most im)ortant sources! 8urthermore rating scales show that the behaviors
are occurring in more then one setting! +n addition the scales allow for )arents to )rovide
information about their child in a clear and succinct wa"! The rating scale does have it )roblems
such as gender race and age bias6 however these are things that will eventuall" im)rove and
change with further revisions! 9ne also has to consider that a trul" universal and inclusive scale is
nearl" im)ossible to create! 0ost im)ortantl" the rating scale has become one of the most useful
diagnostic tools for detecting 2/3/!
Re+e!e*%e#
2chenbach T!0! (1991)! 7$ild 2e$aior c$ec8li!t for age! 4)1:! 4urlingtonC @niversit" of
1ermont!
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/"&man #!2! ' 2c&erman %! T! (199*)! 2ttention deficit disorder and s)ecific reading
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