2

Chapter
andScoringof the 0AARS
Adllministratilon
CAARS forms are easy to administer and score. The
administration prrocess for the two longestforms (CAARS-
a CATARS
Ghoosing Form
With the availability of six CAARS forms, practitionerswill
S:L and CAARIS-O:L) can take lessthan 30 minutes:the
wonder rvhich form is most appropriate in a particulaLr
shorterforms (CAARS-S :S, CAARS-S :SV CAARS-O :S,
assessmentsituation. Whenever possible or practical,
and CAARS{I:S\D take about 10 rninutes. The various
responsesshould be obtained fiom the individual being
forms are setat a North American fourth-grade reading lwel
(Dale & Chall, 1948)and are designedto be adrninisteredto assessed,as well as obsen er riatings from at least one
urdividual who is familiar with the individual being asessetl.
adults aged 18 and up. Responsesare enteredon one of the
six QuikScore firrms. The QuikScore forms can be used to
qurckly scoretherCAARSandtransfer the resultsto aProfile LongVersusShortForms
form (containedwithin eachof the six CAARS forms). The There are several relevant considerationsfor deciding
Profile form allor.vsfor the visual display of the respondent's whether to usea long or short CAARS form. The long fonn
assessment scor'esand drarvscomparisonsto an appropriate collectsmore information and is more comprehensivefor
normative age and gendergroup. clinical or researchpurposes,so it should be administered
whenever possible. The long form encompassescore
As notedin chapter l, the CAARS consistof two typesof symptoills of ADHD, DSM-IV crileria for ADHD and related
forms: one seto.fforms for self-report ratings and the other problem areas,as rvell as an inclex to detectinconsistent
set for observ'erratings. The scalesand scoring for the responding.
self-reportand rcbserverforms are identical, although the
nornN are different. The long forms (CAARS-S.L and The short fonn is ideally suted to thoseclinical and research
CAARS-O:L) are comprised of 66 items and contain 9 situations r.vhereit is impor[ant to reduce administration
subscales.The short forms (CAARS-S:S and CAARS- time. The long form generally takrosaboutthree times longer
O:S) are comprisedof 26 items and contain 6 subscales. to complete than the short form. Consequently,rvhen the
The screeningforms (CAARS-S:SV and CAARS-O:SD scalesare going to be readminir;teredfrequently (e.g., in
are comprisedof 30 items and contain four subscales. managedcaresettings),the short form is usrnlly preferable.

Since some of the behaviorsand symptomsmeasuredby On occasion,it might be helpfu.lto useboth versions,for
the CAARS changeover time, the administration of a form example, long form at baselineand follow-up, and short
should be completed in one sitting in the presenceof a form for intermittent evaluation.
trained examiner. If necessary however, the CAARS can
be administereri over the phone, or the respondent can Shortor Screening
Forms
complete the jinstrument at home. If either of these
When practitioners or researchersare deciding which short
proceduresis followed, special care strould be taken that
form to use, they should consider the sinntion and their
the respondentclearly understands the instmctions for
own preferences"Both the short and the screening forms
completingthe lbrm. The CAARS can alsobe completedin
are about the same length. The CAARS-S:S and the
a group format. The shorter CAARS forms (CAARS-S.S,
CAARS-O:S assessthe core qyrnptomsof ADF{D, aswell
CAARS-S:SV CAARS-O:S, and CAARS-O:SV) are
as related problem areas. In ad.dition, these short fonns
particularly suiited for those group testing situations in
include the Inconsistency Index: this may provide usefirl
which respondentshavea limited amornt of time to cornplete
information rvhen there is conce:rnaboutthe validity of the
the form.
respondent'sor observer'sratinrgs.

When using the observerforms front the CAARS, it is

The CAARS-S:SV and the CA.ARS-O:SV screenfor the
es s ent ial t h a t th e o b s e rv e r h a s a c l o se, persoual
core symptomsof ADHD, inclucling symptomsof all three
relationshipwirththe personbeing assessed. The observer
DSM-IV subtypes of ADHD" ,OnIy the subscalesmost
should also have seen the client's behavior recently. An
directly relevant to ADFID diagnosis are represented--
appropriatepersonto complete the observerform mightbe
the ADHD Index and the DSM-IV subscales"
a spouse,parenLt,adult child, close friend, or coworker.
 Scales(CAARS)
ADHDRiating
Conners'Adult

The test materials neededate as follo'ws:

RemoteAdministration respondent
presenceof a . an intact CAARS QuikScore form for each'
The cAARS should be administered in the eras-
trainedmentalhezrlthprofessionaloradministrator
. a soft-lead pencil (preferablywithout attached
rv henev er pos s i b l e .H o w e v e r,th e re w i l l b e si tuati onsi n ers),or
rvlrichitisonlypossibletoobtaininformationbysending . aball-Point Pen
forms to the respondent's horne. If necessary,
the Quikscore
itemi tnay also be read aloud over the phone'
the
In these
respondent to
Time
Administration
cases,the administlator should remind (CAARS-S:L
input from Most adults can complete the long forms
complete the items independently, without
others.Inaddition,therespond'entshouldnotdisassemble' andCAARS_O:L)inlesstlran30nrtLnutesandtheshorter and
would make it forms (CAARS-S:S, CAARS-S:Sr4 CAARS-O:S'
damage,or defacetlheforms, since doing so
The respondent CAARS-O:SV)inaboutl0minutes'Respondentswith
diffrcult or impossible to score them'
at a readingdifficultiesorwhosenativelarrguageisnotEnglish
should also be remiLndedto complete the assessment who take less
complete dtfferent parts of the may take slightly longer' Those resp'ondents
single sitting rather than
should thanl0minutesonthelongerCAAI|'Sformsorlessthan5
urr.rrro.rrt at different times' The administrator responding
minutes on the shorter forms may be
alwaysobtaininforrmedconsentfromrespondentsbefore 30 minutes
haphazardly.Respondentswho take longer than
anadministrationanddebriefthema-ftenvards'Wlren on tl-reshorter
performing a remrlte administration, the administrator onthe longer forn1sor longer than 15 minutes
rvith cotnprehensiou'
rea.ding,
procedures forms ma-vhavediftrculties
should adhere as closely as possible to the
or decision making.
explainedintlrischiryter.Itisalsoimportanttosetadeadline
it is highly
for the return of the forms' In addition'
reconmendedthafthepractitionerSetupaface-to-face of the CAARS
ReadabilitY
rneetingorintervii:wwiththeresporrdentbeforeoraftera CAARS using
Readability analysesrvereconductedon the
CAARS administrlttion. Harrison
1948). (1980)
tlreDale-chall forrnula@ale & clull,
foundtheDale-Challfonnulato'betlrenostvalidand
Theresultsobtairredfronraremoteadminisuationnrustbe
such CAARS accurateofthenirrenostcomnornlyutilizedreadability
interpretedwith carution.For example, on all
"The data obtained formulas.TheDale-Clrallformulaisbasedonsemantlc
reports, add the following phrase:
non-standard (word) diffrculty and syntactic (serrtence)diffrculty'
requires additionralvalidation because a
adm inis t r at i o n p ro c e d u re w a s u s e d .' ' In th eabsenceof
advisable to C omputati onstodetermi nesentrencel engt handr vor d
external validating information, it is highly The number of
the standard length were performed for all CAAITS items'
perform a follow-up administration' using
completeSentencesarecountedanddividedintotlre
onsite protocol. length
number of rvords to determine average sentence
$D S /S E N )' N ext,thenunrberof..unfami liar ', t vor ds
MilterialsNeeded GIFIr/IWDS)are counted'
A word is consideredunfamiliar

Tb€ CA*ARSca& be administeredin paper-and-pencil

ifitdoesnotappealonalistof3,000..familiar''words
CAARS
format using tritHS QuikScore forms' The conrpiledbyEdgarDale(revisedin1983)...Familiar''rvords

dmiaisrrator shrnrldrote that eachof the six QuikScore areknorvnuvgopercentofclrildreninthefourthgrade'

CAARS-
forilxs(CAARS{,:I* CAAR}S' S,CAARS-S:SY Considerationoftheamountoffamiliarandunfamiliar
wordsincludedincreasestlreaccurracyofthereadinglevel
O:L,CAARS-{):S,andCAARS-O:SV)includesall
necessary inforrnationfor administering'scoring'and assessment.Thegradereadinglevelisdeterminedusing
scoring the follorving formula :
profiling the particularmeasure'No special
templatesare required.The CAARS QuikScoreforms + (0'0496xWDSi
variousscales Grade= (0.1579xPERCENTUFNIWDS)
.oniuin specialaidsthat makescoringthe
sEl9 + 3.6365
quick and accurate. Since these forms contain
transfonnationtablesfromralvscorestostandatdtzedT- Use of the Dale-Chall procedurefor the CAARS items
hand
scores,there :is no need to perform tedious producesa North Americanfourthgradereading
level'As
normative
usitlg conventional tables'
conversions Such,theCAARSscalescancortfidentlybeadministered
tomostadults.Theresultsofthereadabilityanalysisare
shownin Table2.1'
 oftheCAARS
andScoring
Administration

Table2.1 ventory is a list of questionsthat ask aboutproblems

Levels
CAARSReadability and behaviorsthat peoplesomtltimesexperience.On
the observerfonns (CAARS-CI:L, CAARS-O:S, and
Form Words
% of Unfamiliar GradeEquivalent CAARS-O:S'V), the instructions ask the respondent
A to make his or her rating rvith respectto a particular
CAARS_S:L 14.31 a

CAABS_S:S 10.11 A
a
person's recent behavior. To htdp avoid bias and fak-
CAARS_S:SV 1520 .i
ing, verbally emphasizethat threscalehas no right or
CAARS-0:L 15.66 A
wrong answers.You should also emphasizethat all
CAARS-0:S 18.48 A
a

r+ answersare confidential.
CAARS-0:SV 15.69

It is essential at this early stiagein the assessment

processthat the respondenthas read the instructions
Procedure
Administration and understandsthe procedure.For respondentsrvho
Although it is bestto administer the CAARS to respondents have reading diffrculties, it mily be necessaryfor you
one at a time, group administration is possible(especially to read the instructions aloud rvhile the respondent
rvith the sh.orterfcrrms).In either case,the administration readsalong on his or her or.vn.[orm.
should be conductedin a quiet setting that is free from
Make sure that the respondentunderstandsthat he or
distractions or diisturbances.An administrator should
she must read each item carefuily and then make a
alm os t alwa y s b e p re s e n t rv h e n th e re s p ondent i s
rating by circling the appropriatenun'rber:"0" for "Not
completing a CA",\RSform. Group administration of any
at all, or never," " 1" for "Just a little, oncein a while,"
CAARS fonn is not recomnlendedfor respondentsrvith "2" for "Preffy ntuch, often," and "3" for "Very nuch,
r eading dif f i c u tti e s . T tre b a s i c s te p s i n the test very frequently."
administratiouprocessof any CAARS form are asfollows:
. Instruct the respondentto sek:ctthe "best" ansrverif
1. Ensure that the respondenthas a rvriting instrument. he or she is not sure horv to answer a particular iten.
No item should go unanswered.Sornetimesrespoll-
2. feel comfortableand relaxed.
Hetp the resprondent dents will ask how to respond to, or horv to under-
stand,particular items. Somerrespondentinquiries re-
Exllain to threrespondentthat the purposeof the ad- quire a clarification of instructionsand will be straight-
ministration sessionis to learn lnore about his or her forward to ansrver.Other inquiries maybe lessstraiglit-
feelingsand behaviors.Explain that thereare no tinre fonvard, and care must be ttal<ento respond to the
that the respondentflrlly under-
lirnits. It is erssential inquiry iu a rvaythat rvill nottrias the response.Often,
standsthe naLfure of the CAARS admrnistrationpro- it will be sufFrcientto sa;',"T'hat's fine' but for norv,
cess,so that you obtain tmly informed consent. please answer as best you can, and rve can discuss
that item after you have finislted."
Give the reqrondenta copy of the CAARS form. For
the self-repontforms (CAARS-S:L, CAARS-S:S, and 7. If the respondentlvants to cheurgeall ans\ver.iustruct
CAARS-S:Si,$, ask the respondentto cornpletethe him or her to drarv an ")C' through the original re-
nane and demographicsectionson the form. For tl're sponseand circle the correct response.Attempts to
observerforrns (CAARS-O:L, CAARS-O.S, and erasean answer will make the scoring page smudged
CAARS-O:Ii$, the respondentwill be askedto com- and diffrcult to read. For this reason,the original re-
plete the dennographicsection for him or herself as
sponseshould not be erased,
well as for the person being described.The respon-
dent should also indicate his or her relationship with 8. When the respondenthas conLpletedthe fonn, quickl-v
the personb{Pingevaluatedby placing a checkrnark in check it to ensurethat all items havebeencompleted.
the appropriatebox near the top of the QuikScorefonn. Obtain answersfor all unaddlesseditems,and ask tl-re
respondent whether he or she had diffrculty under-
For the obs'erverforrns, the age and gender of the standing Particular items.
observerare;not used in scoring and as a result, if it
facilitatesaclministration,cornpletionof this infonla- 9. After ttre CAARS is completed,initiate a bnef disctts-
tion rnay be presentedto the respondentas optional. sion with the respondent. llhis 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;about thetnselves.Re-
information is alrvaysrequired. spondentscan elaborate on certain iterns and their
answers,and ask questions.In this sort of discus-
The first palgeof the CAARS form also provides in- sion, you may also be able to gaugethe respondents'
structionsand explains to the respondenttirat tl-rein- degree of candor and learn a little rnore about their
 'Adult (CAARS)
Scales
Rating
ADHD

personalitiesand backgrounds. Although you ilray 2. For all CAARSforms,makesu(ethat the responses
be scheduling a formal feedback session,it is impor- havetransferredclearlyto the s<]oringsheet.
tant to explain the next steps and reiterate what the
resultsrvill be usedfor. Finally, thank the respondents
and reassurettrem that the responsesgiven will re-
nain confidentiialand will be usedtoward positive and
helpful ends. Postadministration debriefing can be
fairty brief and does not need to become a lengthy
discussionwittr the respondent. Respondentsoften
will be eager to find out what their responsesmean,
and may ask you to make interpretive comments dur-
ing or after an administration. It is very important not
to make any interpretive commentsduring or immedi-
ately after an administration. Interpretation of the
CAARS should only be completedby qualified pro- or index and then dividing by the total numberof items
fessionaisand orily after carefully revierving all avail- that had responses.For exampl{, if a respondentob-
taineda raw scoreof 6, but ansvgpred only 3 of 5 items
ableinfonnation. Properinterpretationis not possible
on a particular subscale,the scofe may be adjustedby
rvithoutample reflectionon the responsesand results,
(6)
rnultiplying the obtainedrarv sc$re by the number
and this generally cannot be done within a ferv sec-
(6 x 5 = 30).Theresult
of iterns(5)on thefi.rllsubscale
onds."Offthe cuf interpretive remarks only serveto
detract from the assessmentprocess. Instead, you shouldbe divided bv the nu of items that had
score(30 + 3) of
responses(3) to get the adjustect]rarv
should say that the responsesneed to be processed
and examined.If applicable,you should be prepared
10.You shouldtalieinto accoudtthe numberof sub-
stiflrtionsfor rnissirrgitenu rvhe{ interpretingCAARS
to tell the respondentsrvhen and where the feedback
results.As a general rule, if than hvo items are
sessionwill occur,and who rvill be providing this de-
missingfor a particular le. the scorefor that
tailed feedback.[f necessary make an appointtnent
rvith the respondentto discussthe CAARS results. subscaleshoultl be considered iilvalitl. Overall, if five
or more items are missing fr{m the long form or
You rnay now scorethe respondent's CAARS form. three or more are missingfroftr the shortversions,
thenthe entireprotocolshoultll$econsideredinvalid.

theCAARS
Scoring 4. The scoringsheetbeneatl-r thei m/responseportlons
of theCAARSQuikScore forms formattedlike a grid,
Raw scoresand l-scores for the six CAARS forms can be
and all the scoringis doneon hat grid. The scales,
calculatedby non-practitionersbecauseof the sirnplicitv horizontallyacross
zubscales.and indexes are identi
of the calculation. However, interpretation of this thetop of thegrid. For eachite follorv the horizontal
information must be undertakenby an experiencedrnental line acrossto anywhiteboxes appearin the row.
health professional.The instructions for handscoringthe In eachwhitebox. write theci response number
QuikScoreforms appearbelow. (e.g.,ifthe nurnber"l"is circledthenrwite"l"ineach
rvhiteboxthatappears on thatI ne).For the CAARS
Handscoringthe CAARS long forms (CAARS-S:L ald long forms only (CAARS-S: and CAARS-O:L),
CAARS-O:L) takes under I0 minutes: handscoring the numbers from the right side o the scoringgrid are
shorterforms (CAARS-S :S, CAARS-S :SY CAARS-O. S, r.vrittenin thewhiteboxesthat thearrow(s)point-
and CAARS-O:SD take lessthan 5 minutes.The numbers ing to the left. Numbersfrom left sideof the scor-
on the forms may be added easily rvithout the use of a ing grid arewritten in the whi boxes that have the
calculator,but the use of such a device, particularly on the
arrorv(s)pointingto the right.
long forms, may expedite the scoring processslightly and
) Add the nunrbersin the white for each column.
ensure greater accuracy. and write the sum in the a box at the bottont
of the columns.
1. To usethe self-scoring feature of a particular CAAITS
form, separatethe QuikScore form at the perforation. Forthe CAARS longforms ly (CAARS-S:Land
The scoring sheet is found between the response CAARS-O:L),Box G is obtai by addingthe totals
sheetsfor the two long forms (CAARS-S:L and for columnsE andF.
CAARS-O:L) and underneaththe responsesheetfor
the four shorterforms (CAARS-S:S, CAARS-S:SV 7. For thoseCAARS forms that includethe Inconsis-
CAARS-O:S, and CAARS-O:Sp. No conversion tencyIndex(CAARS-S:L,C :S.CAARS-O:L,
tables or scoring stencils are required. and CAARS-O:S), write the c rcled responsefor the
 Administration oftheCAARS
andScorino

16items listed at the bottom of the particular QuikScore t. Locate the correct age category column for the re-
form. For eachof the 8 pairs of numbers,calculatethe spondent.The age range colutnns are displayed on
absolutedifferencebetrveenthe hvo uuntbers(i.e., theProfileform (18-29yearolds,30-39yearolds,40-
subtractthe smaller item responsescorefroni the larger 49 year olds.or 50 year olds or older).
one).For e;<ample,if the responsesfor a pair of items
On the Profile fonn. circle the conespondingra\v score
was "1" and "3," the absolutedifferencervould be
"2." Add tllre8 absolute-differencescoresto get the numbers frorn the scoring r;heet.The raw score for
subscaleA is circled in one of the four columnsnnder
InconsisterrcyIndex raw score.
the letter A, the raw scorefor subscaleB goesin one
8. Using the InconsistencyIndex raw score,complete of the four columns urder the letter B, and so on. You
the relevantInconsistencyIndex Criteria information must circle the rarv score n,umberin the correct age
in the box llabelled"InconsistencyIndex Guide" that rangecolumn to obtain accurateresults.If a raw score
appearsnear the bottom of the QuikScoreform. If the exceedesthe highest value prrnted on the Profile fonn,
answeris "'yes"to the criterion question,theremay be circle the top score and print the rarv number at the
some inconsistenc,vto the respclnses.The results top.
shouldbe interpretedrvith cautior:1. Note: For the obsen er fonns, it is the genderand age
of the tr)ersonbeing describ,edthat deternunestireage
You may norvprofile the CAAtr{.Sscores. column and genderthat are usedon the Profiie fonn.
(Do not use the age and genderof the observer).
Profiling
the CAARIS
Scores -t. Using a ruler. connectthe cirrcledscoreson the Prohle
Each of the three Vpes of CAARS forms (long, short and form rvith solid lines to obtainthe profile shape.
screening)gene:rate a different number of rarv scores.The 4. Detenninethe l-scoresby follorvingan imaginaryhori-
ralv scoresare converted into standard l-scores on the zontal line from the circled raw scoreacrossto either
appropriateCAARS Profile form. A Z-scoreis a standard outsidecolumn of the Profilerfonn. You (or a qualified
scoreu'ith a nedn of 50 ard a standarddeviationof l0 in all rnentalhealth professional)ma},norvinterpretthe re-
samplesand acrossall scales.Z-scoresallor.vpractitioners sultsas explainedin chapter'3.
to comparesubrscale resultsrvithin a single CAARS form
and to compare subscaleresults acrossvarious CAARS
forms. The CAARS Profile forms for the long versions andProfilinrg
Scoring
(CAARS-S:L and CAARS-O.L) arenvo-sided,rvith l-score
infonnationfor malespresentedon one side and Z-score
Examples
infomrationfor fernaleson the other.For the shortversions As descnbedin this chapter,it is a relativelysimple taskto
(CAARS_S:S,CAARS_O:S, CAARS_S:SV: CAARS_ scoreand profrle any of the CAARS forms. Erarnples of
O:S\|, the prol.rlesheetis one-sidedrvith the profile area cornpieted CAARS QuikScore forms are shorvn in this
for maleson the left side,and the profile areafor femaleson sectl0n.
the right side. For both males and females, Z-score
information is ervailablefor four drfferentage groups(18- LongForms
29yearolds,30-39 yearolds.40-49 irearolds,and 50 year The respondentin this example is a 35-year-oldfernale,
oldsor older). N.K. Figure2.I shorvsa completedresponsesheetfor the
CAARS-S:L. Notethat N.K. circledtheappropriatenurnbr
Before filling out a CAARS Profile form, check the ("0," "1," "2," ar "3") for each item. The administrator
headingat the top of the form to ascertainrvhetherit is the shouldcarefully checkto make suretirat all itemsare rated
form for males or females. It would be a major error to at the end of the testing siftiatioir. If the respondentdid
convert and plot the scoresusing the rvrong set of gender not press heavily enough, the markings on the middle
norrns.When profiling an observerfonn (CAARS-O.L, scoring sheetrvill not be clear. Consequently,be sure to
CAARS-O:S, IIAARS-O:S9, be sure to plot the scores retain the front and back responsesheetsof tlheforur.
according to the age and gender of the person being
Figrrre 2.2 shows the cornpletr:dscoring sheet for the
described(not the observer).Transfer ttherar,vscoresfrorn
CAARS-S:L, using the ansp'ers; presentedin Figure 2.1.
the totalboxesa,tthe bottomof a particu.larCAARS scoring
Scores have been transferred .into the boxes and then
sheetto the appropriateProfile form r"rsingthe follorving 'fhe
sununed within eacl-rcolurnn. total scoresfor each
procedure:
subscal ew ere then cai cul ated and rec ondedin t he
appropri ate boxes. The admi ni strator f ollor ved t he
 (CAARS)
AdultADHDRatingScales
Conners'
a cornpletedCAARS--S:S Profllefonnfor
to Figrue2.6sh.orvs
form' uslng selecteditems Notr:thattherawscores
instructions on the sr;oring R.P.'sscoreson ilrevariousscales'
Index'
caiculate the lnconsistency fromthescoringsl.reetlravebeentransferredtoilreProfile
Thescoreshavebeenplotted
Figue 2 .3 shorvsa conrpletedCAARS-S:L
Profile form for fonn,rvheretheyareplotted'
in the columnlabeled
scales' Note that the ralv on the "Mal'e" sideoi the forrn and
N.K.'s scoreson the various for arespondent
have been transferredto the M2 (30-39yearolds),rvhichis appropriate
scoresfrom the scoring sheet
Profile fornt, rvherethey are
plotted" The scoreshave been of this genderandage'
plotted on the..FemzLle,l side of the fornr andiin the column
labeledF2 (30-39 )i€arsold)'
rvhich is appropnate for a Forms
Version
Screening
age" Note also that for the is a 55i-yearoldmale' D'S''
,.uponO.nt of this gendt' and The respondentin this example
scale'N'K' had a raw score P'S'Figure2'7 shorvs
Inattention/MemoqtProblerns n'ho is describinga 28-yearoldfernale'
(35) that rvasaboveittt ttigtttst f-score
shorvnon the fornr' for the CAARS-O:SV' Note
a cornpletedrespon" 'httt ("0"'
theappropriatenunrber
Wl1enthisoccurs'tlrepractitionershouldcircletlrelriglrest thatD.S. (theobserver)circled
at the top ir-rorder to .,1,,'.'2," or "3") for eacl'ritem. The administratorcareftlll'v
number and rvnte tl're rarv ntunber
an extreme score that rvas iterns ornthe sheetrvererated
shorvthat the respondeuthad checkedto rnake sure that all
printed on the form' sheetin casethe nriddle sconng
beyondtlle range of scores and then retarnedthe front
sheetwas t'tot clear'
ShortForms scoring sheetfor the
is a 35-year-oldrnale'R'P' Figure 2.8 shorvsthe cornpleted
Tlr.erespondentin this example presentedin Figute2''7'
responsesheet for the CAARS-O:SV using the a'srvers
Figure 2.4 shorvsa completed into the boxes and lvere then
circled the appropriatenunrber Scoreswere t'ut'"fJt"d
CAARS-S:S' Note that R'P
..1,,,,,2,,, ot"3") for each item. (The administrator summedwithin eachcolurnn'
C.0,,,
make.sure that all items were CAIRS-O:SV Profile form
snoUa carefirlly c;heckto Figure 2.9 shorvsa completed
Note
on thevariousscales' that
r at edat t lr een d o fth e te s ti n g s i trra ti o n a n dretai nedthe forD.S.'s,ail;;p'i'
the middle scoring sheet were to
transferred
ftont sheet of the form in case therarvscores fro'r thescori'gstreet
plotted
rvasnol clear') rvereplotted' They were
the Profile form rvherethey
scoring sheet for tl're ontlre..Fenlale,,sideoftlreforrrr,rrndirrtlte..Ftr',coluntn,
Figure 2.5 show'sthe completed
rvl ri chi sappropri ateforaferrral esrrbj ect , ls- 2gyear sof
CA A RS - S : S u s i :n g th e a n s rv e rs p re s e n te di n-Fithen
gure2' 4'
into the boxes and rvere age.Tiris,.,..''],.gforn.rrvotrldtleincorrectlyprofiledif
Scoreswere tralniferred gender and age (55-
The administrator then ptotted accordingio ttte observer's
sumrned rvithin each column'
sconng form to use selected Year-oldmale)'
follorved instnrctionson the
lndex'
itenrsto caiculatethe Inconsistency

10
 of theCAARS
andScoring
Administration

Fgure2.l
Respon
Sample fordreCAARS-S:L
seSheet

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

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

Birthdate,lS-i€l-1-h5 ase:35 Dzte:I I Ul-J 3-L

Today's

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€
=
Usc the following scale: 0 = Not al atl, never; I Justa littlc, oncc in a whilel
2: Pretty much, oftcn; and 3 = Very mucil. very frequently'

lfems continued on back Page""-

,';'*KI'rm#;*I-i:jffi*'!*i*il*"*
#MHSffi.i,1"+.T"tlfL.lH*lilffi ,ffi,#,'X*Hf
11
 AdultADHDRatingScales(CAARS)
Conners'

Figure2.l(Continued)
SheetfortheCAARS-S:L
Response
Sample

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':ffi'd? ifilt*"

# MHSffi ,:,r,dsffi"ffi
12
 of theCAARS
Administra andScoring

2.2
Figure
Scorin
Sample fortheGAARS-S:L
gSheet

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

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

(lender:
'x-P
BirthdaterasJa)lL3 nge:35 Today's[rate:l I l]-lJ-g$ Name:
Mcntb DaY Ys
Mcnlh bY Ycr

indicatedon either sifte of the scoringgrid'

Instructions: Translercircled numbersinto unshadedboxesacrosseachmw, as
Eachcirctednumberwill be copiedonre or t\t'tce'
Transfer each circled number below
inb boxesthat lmk like this
A B C D E F G H
It€m t
x 3 G \ O
"'
,t"'i" ' d i " ' bb
"..o..:
1 7 3
"'
i " '
1 0 0
0"'
'
o"'S"
"' Q
( ) 9q ' 00 ""' ' '
,r"'i"
...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"
.r"'3"'-' O g ' 0 '
' o... 1 0
\,
i o 3 O1 q0 "0
"0 ""
"s .2. H
3
2.... "0" "
' 0 '
' 0 " '
' o '

0
a : '
"'0"
" 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

thc sum in thc box et lhc bottom of thc colunros'

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

i*"%;,"
t <
 ADHD
Conners'Adult Rating (CAARS)
Scates

2'3
Figure
ProfileFormfortheCMRS-S:L
Sample

Ctient ID:
Date:-j-l-l+#
Today's Name:
Birthdate,#*y#

F1 = Femates18 to 29 Yearsof age i

F2 = Females3Oto 39 Yearsof age i
F3 = Females 40 to 49 Years of age
F4 = Females 5O Years of age or older

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

14
 oftheCAARS
Administra andScoring

2.4
Figure
Sample Sheet
Response fortheCAARS-S:S

ShortVersion(CAARIS-S:
CAARS-Self-Report: S)
by C.K. Conners,Ph.D.,D. Erhardt,Ph-D.,& E.P. Sparrow'Ph.D.

Client ID: R P Gepder:@ F

(Circlc Orc)

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

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

UL"
t"I'IJ#-T#T}ffi
#MHSmS:;#i.Hllfl i*;r*"11'ffiffi*i'# .i;1^,*LH",lTiHIff

4 a
t'1
 ADHD
Conners'Adult Rating (CAARS)
Scales

2.5
Figure
g SheetfortheGAARSJ:S
Scorin
Sample

Scale:Short Version (cAr\RS-S:S)

cAuARS-self-Report Ph.Q.
by c' K. conners,Ph.D.,D. Erhardt,Ph.D.,& E. P"Sparrow,

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

-?; Ya
-; Month DaY
ffi

row'
Instructions: Transfercircled numbersinto the unshadedboxesacrosseach
as indicatedbelow. Eachcircled numberwill be copiedonce or trrice.

:1
22
7

t1

z1
21
tt
25
26
26

& Td obtrin rr\Y scfrrcs, sdd thc oumbcrs

wbitc boxcs for clch column (A to E) and
tbc surn in thc borl .t the botlof, o f t h c c o
io thc

l
enter
umns'

.:ltr*xlH[ffi #lf,ff*T,:Hffi I*;ffi H;",

5,1i3#;.!Tiffi
#MHSffi
16
 andScoringof the CAARS
Administration

Figure2.6
ProfileFormfor the GAARS-S:S
Sample

Short Version(CAARS-S:S)P'rofileForm
CAARS-Self-Report:
Gender€)oT
ClientID: 1?.P

b3 ,Age:35 Today'sDatezLL lLSJ]g Name:

Eirthdatez O2l LA DaY Ycar
Month

A. I n a t t e n t i o n / M e m oPr rYo b l e m s
M1 = Males
'lB 29 yearsof age
to F 1 = F e m a l e s1 B t o 2 9 Y e a r so f a g e B. Hvoeractivitv/Restlessness
M2 = Males30 to 39 yearsof age F 2 = F e m a l e s3 0 t o 3 9 Y e a r so f a g e C. t m r i u t s i v i t y / E h o t i o nLaal b i l i t y
F 3 = F e m a l e s4 0 t o 4 9 Y e a r so f a g e D. P r o b l e m sv v i t hS e l f - C o n c e P t
M3 = M a l e s4 0 t o 4 9 y e a r s o f a g e E. A D H Dl n d e x
M4 = Males50 years of age or older F 4 = F e m a l e s5 0 Y e a r so f a g e o r o l d e r

)I
I
A B c D E I B c D 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 M1M2M3M4 MlM2M3M4

i)

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 ; , . 1 r . : . 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
78 1s - - 15 14 - - 13 - 12 - 15 15'12 - 27 - 25 - - 1 2 1 3 '
- ' 1 3 1 3 1 2 - t 1 - 1 5 ' 1 5 n 1 6 E 7 7
- 1 4 - 3 0 - 27 1 3 1 2
77 1312 - 1 1 - 2 4 X 7 6
76 -'tz - - 1 4 ' 1 t ?-. 1 5 ' - : ' 2926 ' 24
- - 1 1 ' , 1, 2 -
t + t l - 1 5 - 1 5 - 6 E ' B 7 5
75 14 1 3 ' 14 ' 114?3' 71
- ]3 '',t2 - 11 28 2523 1 2 - 14 - : 12 12 14
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 ' 1 3 - ' , ! 3 - v 7 1
71 - 12 - 11 - 10 13 10 ?623'21 10 11
-
- 11 n - : - rr - D 4 tl
- 11 10 12 - ''1212 " 2?23 - ll 10
70- - 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 - - - 11 - 20 - - 6€
g - - - ' - 9 - fl 10 - I 8 1:l
- 13 - - 232020'
66 11 9 10
. 11 - 22 - ' '18 f f i 8 - - 1 1 2 0 1 9 1 8 1 8 6 s
- - 9 - 11 - 11 - 64
- - 10 10 - 19 19 17 I - 8 9
64 10 - 8 8 - 10
- - 10 9 - 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 - - 7 ' 1rl ' - ' - 17 16 - 61
- - '- 8 - I I
9 7 I 201717
61 :-----7 - ffi- - I 17 15 60
60 9 - I 7 11 - I 9 - - 16 15 - 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 - 18 15 ' l
- - 8 7 - - 8 1515 57
8 - 10 - 6 I 6 17 - 151 7
-
57 \ 'lL A a - R I I 1313 56
-\ . c 1 1L
6 6 B - - 7 1414 55
55 - 6 --:\- ? 6 - 7 ' 16 - ' 12 - 6
- 131212 54
- 1 3 ' 1 3- - - 7 6 6 5 5
s4 7 - 9 - - \ - s 7 5 6

6 s - 7 u \ - s rs(frz rr 5 - 7 - ' 7 7 ' 1 t- - 1 3 - 5 3

s3 - - 5
- 6 1?12 11 11 52
- s -\ o s s - 6 5
52 - a < ( 6 q 6 " 1 0 5 1
- 8 - ' - a 6 5' -,/- 1 11 1 f 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
- 'Y;.-z'-' 11 4 - 5
47 - 5 ? - 4 " 9 _ 4 6
- - 4 - 4f3T- ' 4 3 - I I 1
46 4 6
- - Y g - - 3 - - 1 0 - - ' - 3 3 - - 4 3 3 3 - - - 4 ' 8 '
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 3 2 - 2 - 2 2 2 1 5 J 41
J J - 1

- 3 - 1 - 1 2 ' - 5 5 42 - 2 - 3 - ' 2
4 1 - 1 1 - 1 2 1 1 2 - 5 40
2 - t ' z - - 1 7 - 4 :
4 0 - 1 2 1 4 - z t
z 2 - - 1 - s - 3 9
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
0 0 0 - 1 - - o - 1 0 0 3 -
J O - V 1 - - 0 - 0 - 4 2 2 1 - 2 3 1 3 5
?( n - 0 - o 1 1 34
0 0 0
3 4 2
0 0
33
2
J I

0
30 29
29 0 t6
28
rmawan&' NY I'1120'0950' (800){56-1003'
(-r copvnghtcr lgg8,\,rurri-Hcarrh systcr^ rnc. Arr rightsresryed- ln theu.s.A'. P.o Box 950,Norrh
E nif lf F a x ' + l - ' 1 1 6 4 9 2 - 3 t3r 4( 818 8 ) 5 4 0 4 4 8 4
:IvlrrLrrnLanada. l T T 0 V i * . r i a p a r k A v c . . T o r u n t o . uo -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 - 2 6 2 ?

11
 ADHDRatingScalesTCAARS)
Conners'Adult

2.7
Figure
Response
Sample :SV
SheetfortheCAARS-0

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

N a m c : P .S . YourName: D, S
Gender: Ilf fF) Cenrler: age:5 5 .-
(circh hEf Q*_l
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
desgibgthispcrsonrcerrtly.lrdicateyourrespons€foreac}rit.rrrbycirclingthenumtlertlratcorrcsgnndst,oyourchoice'Uscthefo||owing|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
The person being described... Eetr :hilc
sfteo frtque$Y

I. losesthings necessaryfor tasks or activities

(e.g., to-do lists, pencils, books, or tooXs).
2. talkstoo much- '
0
0
o 1 G}
,',
t- J

3
3. is alwayson the go as if drivenby a nrotor. 0 1 a) 3
4, getsrowdy or boisterousduringleisuneactivities. @, 1 ia, 3
5. hasa shortfuse/hottemper. 0 o it 3
6. leavesscatrvhennot suppqsedto.
7. throwstantrums.
o 0 o
1 it
it
3
3
8. hastroublewaiting in line or takingturnswith others. 0 1 Q\ 3
9- hasrroublekeepingattentionfocurcdwhenworkingor at leisure. 0 o1 .',
a- 3
10. avoidsnewchallengesbeqauseof lack,offaitlr in his/herabilities. 0 CE 3
1l. appeam restless insideevenwhensittingstill.
12,:isdiitracied'b1isiglts.or.s<iunds whentryingto concentrate. . ',
0
' 0
c 1
aa

al
3
S/{

13. is forgetfulin dailyactivitiss. 0 CD 3

o e
I

, 14..fi65 fprlble tist6ningtg*hat otherpeople619saying.:' ,,, 0 ?. 3

'.2 3
15. is anunderachiever. 1
' ' 0 '12 3 :
16. is alwajs on the go.
17. can'tgetthingsdoneunlessthere'san absolutedeadline. - 0 i2 3
18. fidgek (*ift handsor feet)or squirmsin seat @ I 1t 3
19. rnakescarelessmislakmor hastouble payingcloseattentionto detail.
20. intrudeson othersl,acti''sities,,,
0
0
e 1 CD
12
J .

2 I . doesn't like eademic *udieJwqk pojects wtrere effort u drinking a lo is required n t t l 12 J

22. isrestless or overactive. i 0 i2 3

23. sometimesoverfocuseson details, at other times appearsdistractedby
everlthing going on around him4rer. 0 ( 1\ 3
.24'can1t:ki#p.'tiifieimind.onsbm.e,"thingunlessitrsrea!yinterestiiiLg:'' ,0 J

25. givesanswersto qucstionsbeforethe questionshavebcencompleted. @ 1

'26.,hasfoubtefinishingjobt sl<sorschoolwij*.
27. intemrptsotherswhenthey are workiingor busy.
,. l o U o
1 3
J

28. expresseslack of confidencein self becarrs€of pastfailures. 0 Ia 3

29. appeansdistractedwhenthingsare.goingon aroundhim/her.
.30. has'iroblemsoreanizinetasksandactivities.
e 1
3
3

# r ,yrd Copt{igh O 1993,iAdri-Hrdtr Sy*m lrr, Atl rigtu nrved. to rhc U.S.A.,PO- Bor 950. f{tnb Tsnad+ NY l{l2O{PJO, (tm} {5+'1m3.
tn Curd+ tno V!dd. pst.tn. Trrwro, ON )€H .ttM6.(soo) 26t{oll. ltr'anrtiut .11161t2-267'l Fs. +l{lg -l}al F (8tt) J4G-l4t{
# IVIl1D

1B
 of theCAARS
andScoring
Administration

Fgarre2.8
SampteScoringSheetfor the GAARS-O:SV

CAARS-Observer:ScreeningVersion (CAAIRS-O:SV)
by c. K. connrers,Ph.D.,D. Erhardf Ph.D.,& E. P.Spanow,Ph.D.

Instructions: Transfercircled numbersinto the unshadedboxesacr'osseachrow, as indicatedbelow'

Eachcirclednumberwill be corpiedonce.

,+

t0

|l
ra

l]

t4

t5

l6

l7

ll

l9

?0

2.1

!l

!{

t{

25

l7 0
2A 0
TI 0

'lo
lo
6
obtarn rlw scorcs. edd lhc nuEbcrs !n the
wbitc boxcs for crcb column (A lo D) and 'cntcr
tha sum in thc hor rt lhe bottom of lhc columns

iHtr#,X".Iljffi;'lH i*;T;.*-.
*?.H.lfl;
# MHSffi :j*# ;H::*5 AlH,ffi-*,'I-H,t'

19
 ADHD
Conners'Adult Rating (CAABS)
Scales

' ', '

, Figurel.9
:SV
ftqfile FormfortheGAARS-0
Sample

:SV)Prrofi|e Fonn
CAARS4 bserver: Screening :Version (CAA:RS:O
PS
Gender: M J$
(Circle

I ern this person:s:D spousep parent t sibling E

M1 = Males 18 to 29 years of age F.l = Females18 to 29 yearsof age A, DSM-IVInattbntiveSymptoms

M2 = Males 30 to 39 years of 6ge F2 = Females30 to 39 yearsof age B. DSM-lVHyperactive/lmpulsive
Symptoms
M3 = Males4Oto 49 years o-fage F3 = Females40 to 49 yearsof bge C. DSM-IVADHDSymptorns Total
M4 = Males 5Oyears of age or older F4 = Females50 years of age or older D. ADHDIndex

Cornisfr O 199( Muh!.tlahi Syrm lrc. AH rigilr rFKd- lo rlc U S A. PO- Bc gJO. ]rfil Trrrqqdr HY l{l2oo1o. (!fl} {56J0ol
+I -'t t 6-'19?-;6z7 Ftr + | r l5-ael-l }11 cr (r3x) 5'o{4E{
# M HS r. ii.i* l??o vrdo.i. puk An.. Troaro. oN M2tt lM( (sog) 26s$ I I trsunon{

?0
 Chapter3
andUse
Interpretation

This chapterdescribesthe interpreLivestrategl'for using clinical settingsrvith respondentslrvhorvish to elicit special

consideration.Extremely high sc:alescoreson the CAARS
t he G A A R S . T h i s i n te rp re ti v e s tl a te g y begi ns rvi th
should alwaysbe suspect,especirallyT'scoresthat exceed
considerationof the r,'alidity of the responses'then
80. Note that such extrerneSgofgsusually indicate severe
proceedsrvith a sun/ey of the responsesat the item level,
symptomatology,but may on occasion be the result of
shifts to interpreting individual scales,exarnineswhether
symptom exaggerationor malingering. Interpretationof
Scoreson the various scalesrepresenta pattern that has
extemescorescanbe clarifiedby i:omparingthe infonnation
diagnosticimplications, and interpretstheseresultsin the
provided by the respondentto o,therindepeldent sottrces
context of other information about the individual's
of i nformati on that have been obtair - r ed.I f lar ge
symptonlsand behaviors.
discrepanciesexist bet*:eenthe respondentand the other
sources,then the possibility of rnalingerilg is mag1ified.
of the CAARS
Interpretation Faking good (also called social {esirabilitv) is a persistent
Beforethe GAARS scalescanbe interpreted,it is crucial to problem in psychometric testing. Respondentshigh in
considerthreatsto the validity of the measures.Although social desirability are more likeltyto presentthernselvesin
self-reportmeasureslike the CAARS assessa variety of a positive mannerand, asa resullt,may biastheir responses
ADHD-related symptoms, CAARS scoresare subject to to test items in what they consider to be a favorable
severalpossiblebiases.For example.sorneindividuals tend direction. To reduce the potenttial for social desirabilitl',
to underestimateor underreport symptomsin the sen'ice respondentsshould be reassuredabout the confidentialitv
of presenting a favorable evalmtion of themselvesor a of their responses.Co-administrationof the CAARS rvitft
the PaulhusDeception Scales(PDS) is recommer-rded for
family member. Gender and cultural differencesalso may
influencereporting. While the CAARS shorvexcellenttest- more formal assessmentof socially desirablerespondi'rg.
retestreliability and validity, theseand other factorsmay
lead to poor test-retestreliability atld suspectvalidity in ltemRes;Ponses
lnterpreting
the individual's responses.Thus, it is important to ask The first stepin interpreting the resultsfrom any GAARS
about the circumstancesunder rvhich the respondent form is to examine individual item responses. By pemsing
cornpletedthe questionnaireand also to ask directly about the "Verv much, very frequentlly"or "Pret$'much. often"
rvhether the individual had diffrculty in interpreting or responsecategories,it is often apparent rvhich tlpes of
understandingparticular items. symptomsare problematicfor the individual. For example,
an individual may endorse many inattention/memory
It is important to assessr.vhetherthe results afe a valid
probl ems, but few hyperacti vi ty/r est lessnessor
representationof the individual's true feelings and
impulsivity/emotional labitity symptoms.When perusing
experiences.An important validity q)ncern is the possibility
individual items, it is important to look for consistencyin
of random responses.R.andomresponding can result frorn
the pattern of responsesandl not to overinterpret any
a gloup testing siruation rvhere there are poorly rnotivated to predictive porver for a
individual responservith respre:ct
individuals, or rvherndisoriented clinical respondents 11 this conterit, the CAARS
particular clinical disorder.
completethe scalesin a randorn manner. In addition, in
contain no "critical items," tha,tis, items tirat are rveighted
unusualtesting situationsrvherethere is a fixed time limit
as more irnportantthan other items'
(e.g.,researchsettings),respondentstnay answerparts of
the GAARS at random to finish the assessmentin the Symptomsat the item level merybe important ildicators of
allottedtime. idiographic treatment targets (i.e., targets defined at tl-re
point at rvhich treatmentis tail.oredfor the individlal). For
Two basic lypes of faking responsebiases have been
example,an individual with prirnarily atteltional problems
identified in the test developrnelt literafgre: "faking bad"
might be treated differently from anotherindividual rvith
and,,faking good." Faking bad occursrvhenthe indiyidual
primarily hyperactivity probleurs.All of the cAARs forms
attemptsto presenthimself or herself in a negativelight.
make it easy to pinpoint several of the more important
This type of deliberatemalingenng may be encounteredin
ADHD-related syrnptoms,lvhi,chin hrn allorvsthe clinician

71
 ADHD
Conners'Adult Rating (CAARS)
Scales

to efficiently andempatheticallydirect the clinical inten'ieu: Table3.1

Itern revierv permits a similar approach to rnany other Interpretive for I-ScoresandPercentiles
Guidelines
irnportant signs and symptornsthat may be present and
FScore Percentile
allorvsthe cliniciau to spend less time on qymptomsthat Range Range Guidgline
have not been endorsed.The constituent items for each
CAAR.Ssubscaleare given in appendix B to facilitate the Above70 UHr
Verymuchaboveaverage
66to 70 Muchaboveaverage
interpretationof itern responses.
61to 65 B6-94 h ^ , , ^
AUUVE
^ . , ^ . . . ^ ^
dviil dgU

56 to 60 74-85 S l i gh t l y a b o v ea v e r a g e
45to 55 1'7 1?
Subscale
lnterpreting Scores 40 to 44
Average
S l i g h t l yb e l o wa v e r a g e
In te r pr et at ion of th e C A AR S re q u i re s a g e n eral 35to 39 6-15 B e l o wa v e r a g e
understanding of the nature of ADHD syrnptoms across 30 to 34 Much belovuaverage
Below30 <2 Verymuch below 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 scorescompare to those of adults of
particular individual's scoresfalls rvith respect to the
the sameage range and genderfrom the normative sarnp,le.
CAARS populationnorrns.For exarnple,an indMdrnl witlt Horvever,theseare rnerel-v approximateguidelines.There
a l-score above70 on the ADHD Index is likeJlyto have is no reasonto believethat thereis a nteaningfuldifference.
significant levels of ryrnptoms that may neet cliagnostic for example,betrveena Z-scoreof 55 and ar?-scoreof 56.
criteria,suchasin the DSM-IV (AIA, 1994). Do not use theseguidelines as absolutenrles.

Wren using this strategy(i.e., using Z-score norms to Somepractitionersnraybe more fainiliar rvith percentiles.
conpare the individual's responsesto population norms) Guidelinesfor percentileassessrnent arealsogiven in Thlble
that population nonrs
it is irnportantto note at the or"rtset 3. 1. A percentileexpressesthe percentageof individualsin
in tliis casen-mstrepresentan alppropriatecor-nparison the uonnativegroup u'ho scoredlou'ertlian the respondent.
group. For the CAARS, normative comparisonsare So,for example,if "Steven" scoredat the 90u'percentileon
presentedbygenderand agefor a large nonnative sample. the Hyperactivity/Restlessness subscale,then Steven's
High Z-scoresrepresenta problem:,lorver l-scores suggest score on the Hyperactivity/Restlessnesssubscalervas
that the individual doesnot preserLrt particular sytnptoms higher than 90 percentof other men his age,The percentile
or setsof syrnptoms.The l-score is a standard.izedscore suggeststhat Stevenhasmore hlperactiviry'problemsthan
rvith the useful feafure that each subscalervill have the a large percentageof otirer rnen his age, rvhich indicates
sarnelrean and standarddeviation. Such a featureallor.l,s the possibilityof a clinically significantprobllem.Percentrles
the testuserto directly comparethe scoreson one subscale derivedempirically from the uormative data are shorvnitt
to the scoresou another.Sucha comparisonis not possible appendix A, by age and gender.
if the rarv scalescoresare not transformedbecausethere is
a different number of items comprising many of the
subscales.Thus, the range of possible raw scoresfor the ProfilePatterns
Interpreting
various subscales,before l-score trausfornnation.is When interpreting the CAARS, the clinician will rvanttto
difrerent. examinethe pattem of elevatedscalescoresin addition to
consideringindividual l-scores (or percentiles).Where no
T-scoreshavea meanof 50 and a standarddeviationof 10. Z-score is above 65, the CAARS is not indicative of
The I-scores used rvith the CAARS are linear l-scores. clinically elevatedsymptoms.When oue 7'-scoreis abrlve
Linear I-scores do not transforrn the actual dis;tributions 65, then the pattern is marginal. In tum, the greater the
of the variablesin any rvay: hence,rvhile eachvariable has number of scalesthat shorv clinically relevant elevations
been transfonled to have a mean of 50 and a standard (I-scores above 65), the greater the likelihood that the
deviation of 10, the distributions of the subscalescoresdo CAARS scoresindicate a moderateto severeproblem.
not change.Variables that are not normally distributed in
the rarv data rvill continue to be non-nonnally distributed
after the transformation.
A Step-hy-Step for
Guidle
As a generalguide, I-scores can lbeinterpretedlusing the
theCAARS
lnterpreting
guide for
Tlle follon'ing sectiondescribesa step-b)'-step
grudelinesprovidedin Thble3. l, Theseguidelinesdescribe
interpretingthe CAARS.

aa
 andUse
lnterpretation

pnovide
valid 65 representclinically sigmficant symptons in a "highbase
Step1: DoestheCAARS
rate" group, such as among thoslepresentingto a mental
aboutADHDsymptoms?
inforrnation health clinic. Conversel)',you may wish to use a higher
Given an understandingof the individual's tnotivation to cntenon score(e.g., Z-scoreof 70 or even75) for inferring
cornpletethe scale,the irnpactof other problernson hiVher clinically significant problemsin a "lolvbase rate" group,
ability to completethe scaleaccurately,the settingin n'hiclt such as a population of adults without identified problems.
the scalewas adrninistered,and the purposefor rvhich the
resultswill be use{ make a judgnrent regarding the validiry The DSM-IV ADI{D scaleson the long and scrceningforms
of the CAARS data. As a first step, rinspectthe CAARS can al so be used to i denti fy adul ts who m ay be
InconsistenryIndex to estimatervhetherthe pattemof item experiencing clinically signillicant levels of ADHD
responses is both internally consistentand consistentwith symptoms,as well as to gain anrinitial understandingof
the responsepatterns shor.vnby other indiuduals of the the patterning of such symptoms.In addition to examidng
sameage and gender.If not, then the results nay or may the overall I-scores for the DSM-IV scales,you are
not be valid, dependingon other infonnation available. encouragedto revierv individual,itetn responsesfor these
scalesgiven that each itern is itirectly associatedrvith a
Motivational issuesthat also needto be consideredinclude DSM-IV criterion. The items tl'ratconstinrtethe DSM-IV
the respondent'sdesire to avoid treatrnentby inflating subscales are shownin appendixB. If anitem from a DSM-
symptomsor mininizing syrnptoms.Concernsregarding IV scaleis rated as "2" ("Pret!y much or often") or "3"
self-presentation(the needto look good) may'alsointroduce ("Very much or very frequentl-v"),then the conesponding
a systematicresponsebias.It is alsoimportantto consider DSM-IV criterion may be rnet.TlheCAARS fiinding should
r v h e t h e r r e s p o n s et e n d e n c i e sa s s o c i a t e dr , v i t h t h e be combined rvith other information to judge if the
respondent'sculhrral background rnight irfluence his or symptomsshould be consideredas present.
her report of symptoms.
Examinethe I-scores on the four:factor-derivedsubscales.
are
Step2: Whichitemresponses Descriptions of these subscales,along rvith the other
subscalesproducedby the CAARS, are provided in Thble
elevated?
3.2 (overleafl. These subscalerlescriptionsshould be of
Once the validity of the responseshas been considered,
assistancein explaining and intr:rpretingscoreson all the
the next step is to revierv the individual items. Specific
CAARS long, short, obsen'er,and self-reportscales.
items are very useful in helping you tarrgetquestionsduring
the clinical interview',and in selectingtargetsfor treatment
(e.9., inattention problems vs. only hyperactivity or Step4: lntegrate fromthe
inforrmation
impulsiviry problen-rs).The cottstituentiterus for each andobserver
self-report forms.
subscaleare shorvnin appendixB. When practical or possible,collect a self-reportand at least
one set of observerratings (from an individual very fatniliar
Step3: Examine scoresand
subscale wrth the respondent).The differ,entCA'r{I{S versionshave
beenconstructedwith sinrilar sulxcalestructureto facilitate
the overalllevelof symptomatology.
comparison.When ratings frorn informants agee that thereis
To deterrnineboth the overall level of ADHD-related
either a definite clinical problemor a lack of a problenl theuse
synlptoms and the pattenring of those symptoms, revierv
of multiple raterssewesto give validity to the results.When
the respondent'sscoreson the following CAARS measures:
there is a disagrcementbenveenraters,you tntst carefully
l) theADI{D Index, 2) the threeDSM-IV ADFID symptom
evaluate the reason for the discrepanry. Have the raters
subscales(vtz., Inattentive Symptorns,Hyperactive-
correctly completedthe ratings?Is there a reasonto suspect
Impulsive Symptoms,Tbtal ADI{D Symptoms),and 3) the
that one set of ratings has lessvalidiry*than the other sets?
four factor-derived subscales(vrz., Inattention/lvlernory
Inconsistenciesin responsesfrorn different infornants ma1,
Problems, Hyperactivity -Restlessness, impul sivity/
indicatea problemthat is being dr:niedor not recogtrizedbya
EmotionalLabiliqv,and Problernswith Self-Concept). Keep
significant party (e.g., self or one or more observers).
in rmnd that the DSM-IV ADHD symptornssubscalesare
Alternately, inconsistenciesrnay eilsoreflectactualdifli'erences
tu'ravailableon the short forms rvhereasthe factor-derived
in the client's fi.urctioningacrosssettingsand/or p€rsons,or
subscales are unavailableon the screeningforms.
dtfferent thresholds for rating a given behavior highly. In
surnnury, it is important to recognizetlut discrepancies among
The ADHD Index respresentsa measureof the overall level
ratersfrequently occur.You must useclinicaljudgment about
of ADHD-related qymptoms.This index is the best screen
the relative quality of the data sourcesand potential reasons
for identi$,ingthose"at-risk" for ADHD. Nomrs are given
for any reporteddiscrepalcies.
for populationsamplesby ageand gender.I-scoresabove
 ADHD
Conners'Adult Rating (CMRS)
Scales

lfromthe
information
Step5: lntegrate GaseStudires
CAARS andfromothersources. To provide concrete examples of potendal uses of the
Usilg datafrornotherratingscales,structuredinterviervs, CAARS in various applications. six case stridies are
tests,andothermentalhealthprofessionals, interpretthe presented.To protect confidentiality, r1oneof the examples
validiry-andclinical significanceof the CAARSscores. depict real patients. Horvever,the case Studiesare based
on information synthesizedfrorn nu|tiple individuals from
Table3.2 actual clinicai practice and, theroby, the case studies
SubscaleDescriPtions
CAARS realisticall,v portray how the CAARS is used' They
representhorv one might best make useof the CAARS to
Subscale of High.Scorers
Tendencies
establishthe prior probability of c;linically significant
Problems
Inattention/Memory Learnmore slowly,haveProblems ADFID-relatedsymptor-ns.In clinical practice,of course,
o r g a n i z i nagn d c o m p l e t i ntga s k s ,a n d the treati ng mental heal th provtLderw ould include
havetroubleconcentrating
infonnation from other Sources.Thq casesrverecl1osento
representstereotlpicalproblemsthat are colnmon inclinical
estlessness
Hyperactivity/B Havedifficultyworkingat the same
task for very long,and feel more practice. The information presented in these cases
restlessand "on the go" than others comprisesthe "bare bones" of rvhat is availablefrom the
LabilitY E n g a g ei n m o r ei m p u l s i v ae c t st h a n
CAARS. Although all the casesnext representadultsrvho
lmpulsivitY/Emotional
o t h e r s ,m o o d sc h a n g eq u i c k l Y
and were deterrnir-red to suffer from ADF{D, the user should
o f t e n ,a n d a r e m o r ee a s i l Ya n g e r e d bear in rnind that the CAARS c?r br3useful in differential
and irritatedby PeoPle
diagnosisand will often assistthe cli.nicianin determiling
withSelf-ConcePt
Problems low
Havepoor socialrelationships, that a diagrrosisof ADHD is not rvarranted'
and low self-confidence
self-esteem,

Index
ADHD Haveclinicallysigniticant levelsof M.,il 1$l'Year'Old
Case1 (Jennifer
A D H Ds y m p t o m cs o m p a r e d to adults
with a low score.Highscoresare
Female)
c lgr n r c aAl D H D
u s e f u fl o r d i f f e r e n t i a t i n Ms. M., a l9-year-old single,African-Arnericanrvotnan,is
i n d i v i d u a fl sr o m n o n - c l r n i cianld i v i d u a l s .
a sophomoreat college. She currenrtlylives at hornervith
with the her father and stepmother. She rvasreferred by her family
SYmPtoms Havetendenciesassociated
lnattentive
DSM-lV
inattentivesubtYpeof ADHD, doctor for an evaluation (at the suggestionof one of her
describedin the DSM-IV professorsat coilege) to determine rvhether she suffers
from ADHD.
H a v et e n d e n c i eass s o c i a t ewdi t h t h e
Hyperactive-lmPulsive
DSM-lV
hyperactive-impulsive subtypeof
ADHDa , s d e s c i b eidn t h e D S M - I V lnformation
Background
Ms. M. has hvo siblings: a Z}'yeu:l.oldbrother and a 15-
DSM-IVTotalADHDSYmPtoms Meet the criteriafor ADHD,as
describedin the DSM-IV year-old sister.Her father (age 41) irsa family therapistrvho
lrasalso worked as a pastor.Her stepmother(also age 47)
works as a teacher.
anddefine
a diagnosis
Step6:Gonsider Ms. M.'s biological parents divorced rvhen she rvas lI
a setof recommendations. yearsold. Sherecallsa history of conflict rvith her mother'
Taking all sources of information into consideration, noting tl-ratshe never felt very close to her. Sheapparently
including the CAARS, consider an appropriate diagnosis' alternatedliving with her mother and father for a ferv years
a1d,whereildicated, decidea treatmentplan that is tailored following their divorce. Horvever,followilg her mother's
to the needsof the individual. You will need to decide horv rernarriage,shedecidedto live witltrher fatherand his nerv
best to make use of the cAARS data with respect to rvife. Ms. M. reportsthat shehasnot spokento her mother
discussingthe individual's problems rvith the individual' in several nronths. Altl-roughshe perceivesher father as
Additionally, the CAARS fonlat lendsitself nicely to report loving a1d as rvalting rvhat is best for [er, she believes
generation,but the decisiol of when and rvho should have hin to be somervhatauthoritariarLrand overprotective in
accessto a report are decisions for the clinician and the his dealings rvith her.
individual being assesseil.

74
 9Z
'sulBluop
qlr.r esB3arli sorulloruossI sv IBlIosJOfuoluI ,buepualB pue's8un1]Strtculdsttu,(11rerrbe4'ssaqqpaS.t0;
prrBcruepBcBur lueuurBdrul qllid I)elBlsossepue s8urues 'uorJuzrrre8rosrq'srorJe sseleJec8ut>1eupuB 'llelop
Jo []euEA E ssoJOBaATSBAJOd uaeq enpq sruo]du/ft esorll 'sJorlio ol uelsll ol '$lseJ
ol trorluolle rood lorr Sunuaas
'renoa:olA1
'pooqlFpB ,(1ruoolur puB osuosselopBqSnoJql
pelelduocuu uoo.{rteqSurgrqs luenbe-g',t11rqucer1srp
uorqseJelqels e ur patsrs-rede,reql)uB pooqpyrlc .{pee ur '(3u4yp 'suorlesJoluoc 'somlool
IBIcos ut Sutledrcrued
po8JorueuorlBzrrra8Josrp pue '{lrarspdurl 1eror eqeq pue
Srnpueue'Surpeer''3'e)
serlrnll3eJo .&euene Surmplueserd
IBqro^'ssoussop ser'rrorluelleulqtl.{4soupclnTp1uecg1u315
tnqqspt Sur8u8ueuou ,i1:epcrUud
SuFnp]uerrcs srtuqt
ed{l per4quroJ'CHCIVJo,{ro8e1ec AI-IAISCeq}roJElrellrc uorluope pernplsnsrood apnlour surolqordleuoquelle.Jo
sleerueqs '61q-yJoJ eualuc cr}souSerp s}eoru
'sW seJlueec'spuEnrop clluopPce]uermc loeruo] puBr.rrooJSSEIs
{ireelc 'hl "{lpcgrcedS
leqt etecrpursecmoseldqpru tuor3retup erLL oql ur uorlslrnJo1,Qr[qe :er1Suuredurreq 0] pue sseJlsrp
s u o r s s a r d ;uel c r u l 1 3 olqeJoprsuoc Jo oollos e aq 01papoda: ore suortuzrleqro^
enrsprdurrpue'norlerluocuoc'8urle8pgqlrl\ serllnc1glq
'(g se.treJoos 'fi r,,rrs
pdru r pue'sseussollsoJcuoloru toque peurSunlonur
arp)ureuedesuodserplie^ B palecrpurxopq ,bualsrsuocul sorlplcgJrp Surpuuls-8uo1qtr,!\ stueserd aqg 'ntr 'shtr
srH 's8urler s.reqlpJreq roJ uuoJ oluord palelduroc erp ot porotsruIupB SB.r\'ctt{gy Jo ssrlueeJpotBrsosseprrB
sluese;d1'g arn8rg '1sr8o1oqc,ftdgets oql r11r.l..{\oh]elur {reurud qtoq Suualoc ',\\el'uelul [BcruIIOpeJn]orulsruesV
ue oi :oud'I:O-SUyyJ orp uenriSse^\ roqteJ s.'IAI 's1,\l sualqoJd0urluasar6
'(3 sernorooserll) ureDedasuodserprIE^ B paleolpul
'3u11p9,{puerrrc eq o1
xopul icuatsrsuo3ul s.'ntr 's6r.uJoJ pode:-;1es eql JoJ
so^orlaqoqsqcnl.t 'sselc,{8o1orq
JIOSJOTI roq qlr^r ,tlpclglp
rluoJ olgor4 palelduroooqt stuase:rJ1'g em31g 'orurlcaql 'relsotuos
tsoru eqt Surneqsl eqs Juounc oqt roJ 0'Z pue
1e1sr3o1or1c,ftdgetsB qlr.{\ /rlor,ue}urecBJ'o}-oceJ
B eJoJoq
ralsoruoslsrg eql roJ g'T,JoVdC e Suru:ea dgecnuepece
,{lelurpaururl'J:S-SUyVJ orl} porotsrururpese.tt 'hl 'st\l
pe18Eru1s seq 'y{ 'sW 't66I Jo IIBJetlt uI a:ouroqdose sB
sllnsau
suvvS peroluoerlsaJorl.{le3e11oc ,Qrunruruoslecol ? ol pexeJsuPJl
'ntr 'sIAI'looqcs qEnl Surlertpe-r8
eqg 'a8alloc papuo]tp
'looqcsJo euoq Jeqlrosurelqo:d
le reUV 'ecrJucBsprre uo.ge Jo lpep tee:8 e loot le^el leql
Ierornerloqluecgru8ts esod tou pry pue Ieuollrsoddo 'S'
1eSurnenloeterlt solou aqs t Jo VdC B qtr^r (97 go sselc
Jo lupgep.{1re,rolou sBAtorls 'pllqa)..ululuoool pJeq,.puB '1oot1cs rl8rq
e ur o"Z)srotrorl rlll^\ polunperSaqs srerl^r
',frrusprdurr
elrlce ,{:ene uooQoAerlol pps sr orlsq8noqtlg ur pe,roldurrmuuuuoJiadcrruapecy
'(sroua sseloJeo e{Btu
pnB'ssauoArle{lel'ssoulnJloS.roy'uotlezrueS:osrp 'reunuer8'i1sr13ug
ol.dcuepue]rorl ol enpued ur) qleru pue
'., (lr lr qr lc erls lp 'uor lueJ leur 'pel zes S utut eruer
qtl,tr .{lltcrrIJlp }soru eq} petl oqs .,'CL,oJBJB puB ..V,,
rllrA\sortlrcrJgp'sseussepser ruog iiu uagns,{1pcruorqcse 'lootlos
Fuorse3coue qlrr\ seper8,.J., uJeeol popuel eqs
ralq8nepsTqsequcsep'W 'rIAl'o^oqepolou uopelluoJul tpt \ q8rq ot JorJd ',frnrsprduuleqro^ pue 'ssBI3ur tno 3ut41u1
'sIAI,{q peprnord eluq
]uotsrsuoo{tq8q ore roq}eJs.'tN 's{se} Surleldruoosluolqord'Sutualsrl rood'uotlueDsut
'llls
trs o1 ,firpqeul Jatl lnoqe otuorl solou Euqu,t pue
'seposrdeoi\rssoJdeproieur asudruocol fluenas Jo JOquruI
SurlueumroJsJeqoeol sllecoJ'IAtr'sntr'uo uegeS:opuqUIoJC
r4luonrJns oro.{{suro}dru,{sJotl}oq{\Jealcunsr 1rq8noqlp
'crtoqledupue pes {lluetstsuoc fuo1s1g
toorlcs
IooJ ol teq pol sesseJ}s
IeJuauuolrluo oJorl,{\sporredJnoJJo oonlt sequosepoqs 's8rup Jerllo
'polou sBA{ sopostde ctueutod.,(qr,r cluetu;o ,ftotsq o51
'sre88ut ol asuodse.lu1f,epred seutq,{usul Jo IoqocpJo osnsnonard Jo ]ueJJnoluecgru8rsou suoclsJ
IeluouruoJrrrue 'W 'st{ 'suol}mlpaul anrlceoqcAsd
pue e{orus }ou seop
sseusnorxuB pue,tmqetrr:t'sseurpes'enufillne uee,{'\leq
'ntr 'slnl ,{ue qllu }ueulleeJl yo ,{:o1stqou sBI{ pue suorleclperu
Suqrqs 'ollqul ,{1rpgSuteqse poolu rerl sequcsop 'soqcepeeqcrpor:ad
.,{ue3ur-1e},{l}uar:nc tou sl oqs
'uorlelnrurlsJo ;o uorldacxeeqt tlll,'\\ suelqord qtpaq luo.Irnoou suoda:
le^ol q8q e tno loes;ol poeue seq.{lpreue8 'htr slntr'srrreruop 'qceadsssor3e
pue ';edrual qcrnb e seq 'uorleogller8 8ur,(elep,qlrcgttP 11qsdlaq-gospue'tolottt
sBqoqs lErll so^elleqosp
'w 'sN ,{lalqeurard s}uaunrtoc trrerudola,rep req rlll.\\ sonllerulouqei(uu uodar JeqlEJJaq
'sN 'ssoJls eull B ]e
Jo srol\sue ]no Surgnlq ut pue tq8noqlero; elenbepe rou 'Inl JsrllION IBluBtuOlqBJeplsuocJo
',{cueu8erd{qlpaq ,fiJereue8e
lnorllrA{ sluotuuos Jo slueruelels a{BuI o} ,{cuepuel rnmo prp uoFetse8q8noqtp
'lotlocle 'ooceqolesn
e ur polcegor sI finrspdrul
'JouuBIu,(1eup e uI sISEI
Jo Suunp s8ruprorllo ro lou plp reqlou
'suotlectldutoc pur8e.r
,iJeue,re Suqelduoc ,tpcrgrp 8ur'req se pue ,(1tseepeloq raq ]ErqrsetouoH tnorllll\ ,ftonr1op
'W 'sW 'poiou osle aJett 'q{
Sururoceqse JIOSJoIIseqlJcsop Isr.ruou,rquua] le ruoq sBA\oqstetll pouodeJJotllBJs,'hl
uoJO leluotu poulelsns8uJ:tnberIDISBI o{llsp ro plo^u o} fuolsrH
leorpaW
uorlelardialul
asn pLre
 ADHD
Conners'Adult Rating (CAARS)
lScales

3.1
Figure
Profile
Female
CAARS-S:L Study1)
Formfor Ms.M' (Gase

o
(Circlc&rc)

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

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

Ftyp€radivitY/Restlessness F. Symptoms
DSM-IV Hyperactive-lmpulsive
F2= B.
G. lmpulsivity/Emotionat Lability G. DSM-IVADHD SYnrPtoms Total
F3=
F4= D. Problems with Self-ConcePt H. ADHDIndex
I

dgMrilsrffil:,ffi.H#n:*f*g;m*,Y*'iilffi ffi *-.

;1H.1'H*l''llffi;'!3ifi

LO
 andUse
lnteroretation

Fgure32
ProfileFormfor Ms.M. (Case
CAARS-0:L Female Study1)

PpnsoxBurxcDrxcrusnn Onsunrzn

Name:f4s lil YourName:tl t t-1

Gender:M @ Ag.tJ9- Age:$.J
(Circlc Onc) (qxioaul)

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

Msrth Day Yar

F1 A Problems
lnattention/lrJemory E DSM-IVInattentiveSymptoms
F2 B. Hyperactivity/Restlessness E DSM-IVHyperactive-lmpulsive
Symptoms
F3 C. Lability
lmpulsivity/Emotional G DSM-IVADHD SymptonrsTotal
F4 D Problemswith Setf-Concept R ADHDIndex

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
 ADHD
Conners'Adutt Rating (CMRS)
Scales

individlals rvith ADHD, l[s. M. also presentsrvith mood will begin his first year at technical r:ollegein the next school
lability, a short temper,antl a propensitytowards impulsive, year.He hopesto ultimately transl'erfron this collegeto a
angry outburststhat conlribute to some problems in her four-year university. Mr. D.'s palents dil,orced rvhen he
interpersonalrelationshipr;.Primary'and associatedfeatures rvas l2 years old. He and his younger brother lived r,vith
of A,DFID,including poor t;ustainedattention,disffactibility, their mother rvhile having frequenfcontactwith their father'
disorganization, a hasli and careless responsesfy"le,
r e s t l e s s u e s s l. 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 , MedicalHistory
forgetfulness,and dfficullies completing tasksare all likely Mr. D. appearsto be in generallygoodphysicalhealth' He
to have contributedto Ms. M.'s difficulties at school' reports no history of physical o:r sexlal abuse or other
forns of trauma. Screening cluestiouspertaining to
Recomrnendations subStanceablse andprirnary sy-lrptomsof mood or an-xietv
A number of recommerrdations,spanning educational, disord.ersrverealso negative.Other th.anmeetingfor a ferv
pharmacologic,and theralreutic interventions, are indicated. sessionsrvith his mother's mentialhealth professionalat
Ms. M. may beneflt from a trial of a medication with age 12 (following his parents' diivorce),Mr' D' does not
establishedefficacy iu treating primary and associated have a1y history ofpsychiatric trqatment,and he has never
been on any psychoactivemedioations.
$,mptomsof ADF{D. Researchon the efficacyof stimulant
me,dicationsin samples ,rf children rvith ADFID suggests
that approximately 70--80 percent or higher respond SchoolHistory
positiyely. Less research has been conducted on the Althoggh Mr. D. reportsthat he performedin the average
responseof adults rvith ADF{D to the psychostimulant rangein elementaryschool,he receivedC and D gtadesin
medicatiors.Horvever,a lnunber of placebo+ontrolledtrials junior high and barely graduatedfrom high school due to
have been conducted over recent years and generally acadernicdifficulties. Mr. D. reports that his teachers
suggesta favorable restr)onse. A trial of psychostirnulant thought he achievedbelorvhis cerpacity,listenedpoorly in
rnedications might be indicated, given their proven class, and exerted insuffrcient e ort' Horvever, Mr' D'
effectivenessin improving attention Span,organizatiotl, believesthat he did put forth considerableeffort btrt that
and t as k c o mp l e ti o n rv h i l e re d u c i n g i mpul si vi ty, hi s perfornance w as cornprromi sedby his poor
distractibilify, restlessness,and emotional labilify in concentration,forgelfi.rlness,alrd organizatiolal deficits.
resporuiveadults rvith ADHD. If a stirnulant trial is pursud He describestirned testsas partir:ularlyproblenatic as his
Ms. M. should keep a careftil diary of side effectsand daily tendencyto daydreama1d becoruedistractedwould leave
behavior,particularly i1 social, acadenric,and occupational ftim rvith insu-ffrcie1ttime to completeexalrs. He reports
contexts requirilg sustained attentiol and other self- that teachersthroughout his sohooling regardedhim as
regulatedbehaviors. capableof leaming, and none rraisedthe possibiliry of a
specific learning disabilitY.
Although pharmacotogictreatmentmay improveMs' M''s
capacity to meet acadenricdemands,she should also make Problems
Presenting
use of the academic srpport servicesavailable through A semistmctured clinical inteniiervcoveringbothprimary
her college.She rnight consider obtaining an educational andassociated feanrres of ADFil) rvasadministered to Mr.
assesstnentconsisting of IQ and achievelnenttesting to D. His responses sr.rggestedlo,ng-stand-ingproblens itt
clarifi, her current level of acadenric furrctiorung and to sustainilgatteltiot1to a varie5yof tasks(e.g.,lectures,
ictentifyareas of strenl;th and rveakness'Many colleges readilg,driying,conversations, hotnework), distractibiliry,
curreltly offer educatiolal assistancei1the form of futorilg forgefulless,disorganization, inattention details,and
to
programs, study skill enhancement'and environmental avoidingor dislikingtasksrequitingsustained mentaleffort.
acconrmodationsto help,optirni ze theacademicperformalce Additionalll,,he positively enclorseditems pertaining to
of studentsrvith specizrlneeds. fidgeryandrestlessbehaviors,havingdiffrcultyremaining
seated,a generallyhigh level of activity,intolerancefor
Male)
[1.,an 18-Year-0ld
Gase2 (Galvin sedentary seekingouta highlevelof stimulatiou,
actir.ities,
rnalewho rvas and pursuilg potentiallydanLgerous activities.Mr. D.
Mr. D. is an l8-year-old,Asian-Arnericau
referredfor an assesstnentto determinewhetherhe has describes thesesymptorns ascluonica1dstablein rnhue,
with an initial onset in early childhood('as far back as I
ADHD.
canremember"). Thefeatures arealsoSaidtobepervasive
lnfornnation
Background acrossa varie$"of settings.
Mr. D. currently lives with roonunates:until recently,lre
residedrvith his mother. Mr. D. graduatedhigh school and
28
 andUse
lnterpretation

Figure3.3
Mde Rofile
CAARS-S:SV FormforMr.D.(Gase
Study2)

S_crcening
CITARS-.gettReport (CnnngS:SV);- lrofile Form
V.rsio"n
l{ame:f1r. I (fr F
Gender:
(Circlc Onc)

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

Mcnth Dar' Ycr
Md{h Dry Ya

= of age i A- OSttt-lVInattentivrrSymptoms
i-M1 = lvt"l"- 18 to 21)yearsof age i F1 Females 18 to 29 Years Symptoms
= Females 30 to 39 Years of age i e. DSM-IVHyperac*ive/lmpulsive
I t'rtZ= Males3Oto 3l) years of age i F2
Total
F3 = Females 40 to zl9 Years of age 1 C. DSM-IVADHO SY'mPtoms
i ttlig= Males40 to 4ll years of age i D. ADHD Index
= Males 50 yeats of age or older
i t',,tt+ i F4 = Females 50 years of age or dder
l - _ _ . - . . - J

PO Bor 950, Nrth Tmwradl f{Y t'll20-@50, (m} 45elm3'

# MHS:."ffi,:#;}H iHl"Ttr* * "*;',ffi,J,'hH't' ldr<idion l. r111619?-2627 Frr. ll{16-49?'llal a (ett) 5'{$4{[4'

1A
 ADHD
Conners'Adult Rating (CAARS)
Scales

Figure3.4
Study2)
MaleProfileFormfor Mr.D'(Case
CAARS-0:SV

A DSM-IVlnattentiveSYmPtoms
Symptoms
B. DSi.!-lVHyperadive/lmpulsive
C, DSM-IVADHDSymPtomsTotal
D. ADHD lndex

Hffiiffi
HM:HSffi ,.:,1zu * H,ffi*J,T-5f.li-ffi lH.ffi X.ii ffi;,H Ifrl%.**

30
 andUse
lnteroretation

tn addition to contributing to his apparent academic Information

Background
nrderachievetnent,Mr. D.'s presenting s-vntptomsalso Mr. P. is currently rnarried. He is also the father of three
interferedlrvithhis ftutctioning as a dellvery personfor lus (ages 22,25,26)fromthefirstofhistlueeprevious
marriages,
&ther's business.He rvould beconteinatteutivervhen all of rvhichendedin divorce.
driring, fbrget deliveries or forget the location of streets,
and neeil to repeatedlyask for directions to the same Mr. P. is a high school graduatevvhocurrently rvorks as a
destinations.Theseqymplolllsappearto be associatedrvith general andprerriously
contractor asa plumber
rvorked
sonle sutljective distress and are a particular source of and carpenter.Mr. P. suspectedthat he might have ADF{D
concern ;given that Mr. D. is about to start college. He after recognizing that many of the symptomsof ADF{D are
pr€:gsn15 as motivated to do well but rvorried about the characteristicof his long-terrnfurrctioning.
potential adverseimpacl of his presenting slmptoms on
his abilit'f to managehis acadernicdemands. MedicalHistory
There appearto be no medical conditionsassociatedu'ith
Results
CAARS the onsetor maintenanceof Mr. P.'s presentingproblems.
\ft. D. rvasadministered' the CAARS-S:SV inunediately His reportedmedical statusis positivefor herpes,and some
beforea lace-to-faceintervier.vrvith the ps,vchiatristat the allergies.Aneurologicalexamatalge17ledto apresunptire
clinic. Figure 3.3 shorvsthe completedScreeningVersiott diagnosis of petit mal seizures,not confirmed b-v other
Profile fonn. IvIr.D.'s motlherrvasadnrinisteredthe CAARS- physicians.There is no history o1lgrand mal seiaues and
O:SVprior to her inten'ie:rvrvith the psychiatrist.Figure3.4 no recent indications of milder seizureactiviry.Despite a
shorvsth,esomtleted Profile forrn for the obsen'erratings. history of alcohol and recreation.aldrug use, Mr. P. does
not report patterns of use suggelstiveof substanceabuse
lmpressions
Clinical or dependence.

Mr. D. reports solne hllperactive and impr.rlsivefeafures

but his presentationis marked by the attentional and SchoolHistory
executivefi.urctioningdelhcitstl'ratare most consistentr'vith Although not an overactive or highly fidgety votulgster.
a diagnosisof ADHD, Pr:edominantlyInattentiveType. Mr. P. reports that he has had symptoms of attention
problems since his elementary school years.Teachersat
that time commented on his frequent daydreamingand
Becommendations
poorly focused attention and generally regardedhim as
Mr. D. may benefit from a trial of psychostimulant
achievingfar belorvlris potential.Although not a rvillftrlll'
rnedicationgiven its provenefficary in improving coreand
noncompliant or defiant youth, Mr. P. recails that his
associateds1,'mptoms of ,A.DHDin responsivechildren aud
difficulties achieving academicallyat expectedlevels.
adults.I1'astimulanttrial is ptusued,N4r.D. shouldkeepa
following tlrrough on instructiorLs,and completing tasks.
daily diary of his side-effbctsand self-regulatedbehaviors,
causedfamilial discord and conflict rvith his parents.Tllese
particulaLrlyin those so<;ial,academic,and occupationai
syrnptoms are also described as having been pen asive
contextsrequiring sustainedattention.
acrosshome, school,and social s;ettingsand as associated
Nthougtr pharmacologi,;treatmentmay improve Mr. D.'s rvith both subjective distress ;and impairment across
capacity to meet acadetnicdeurauds,he sl-rouldalso use multiple dornains. Although hr: did fairly rvell during
t h e a c a d e m i cs u p p o r t s e r v i c e s o f h i s c o l l e g e . A n elernentaryschool (earning primzrily As and )B's),teachers
assessnlent consistingorlIQ and achievementtestingmay did note attentional problelilS. zllld his subsequent
clarify his current level of intellectual and academic performancedeclined such that he receivedC's in junior
functioning, identi$ arc)asof strenEh and rveakness,and high schooland predominantlyt)'s andF's irLhigh school.
rule out the possibility of a leaming disorder. Poor perfonnanceled him to drop out of higlt lschoolduring
his senior year, although he comlpletedthe courser,vorkthe
follorving year to earn his high sr;hooldiploma.
Case;3(ScottF.,a 53-Year-Old
Male)
Mr. P.is a 53-year-old,Craucasiantnale rvho rvasreferredfor
Problems
Presenting
an asses;sment by his filmily physician, lvho tvanted an
clinicalinterviervcoveringbothpriniary
A semistrucnlred
evaluationto detennile tvhetherthis indir.idual nrffersfrom
andassociatedfeafiuesofADHD rvasadrninistered to Mr.
an attention-deficit disorder.
P. His primary symptomsincludeddifficultiesrvith
cornpletinga variety of tasksand projects,difficulty
becomingboredeasily,forgef,rlness,
concentrating, and

31
 AdultADHDRatingScales(CAARS)
Conners'

Figure3.5
MaleProfileFormfor Mr.P (Case
CAARS-S:L Study3)

^,. irh M rtr . ?I G

"-' e n c l e r t @
F
Client ll): \ (c'crcorci

Birthdate:gt li'b 135- nge:53 Today'sDate: I L/j!-ile Name:

Monttr DaY Ya
Mdh [)sl' Ycr

M1 = Males 18 to 2t) years of age A. Problems

Inattentionrt'lemory E. DSM-IV lnattentive SYnnPtoms
M2 = hlales 30 to 3() years of age B. Hyperactivi$/Restlessness F. DSM-IV Hyperactive'lnrpulsive Symptoms
lmpulsivity/EmotionalLability Total
G. DSM-IVADHD SYmPtoms
M3 = Males4Oto 4!) years of age i C.
M4 = Males 5Oyears of age or older I D. Problemswith Self-ConcePt H. ADHD Index

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

f;.- a.ar* r,tutri_Hqtshsygsx Ic; Ax rish5 ,o-wd rn ilc u:!+.?o
#Iyt-l1D h c s ' d r . ";r9s.
l.,.,0\6c.o.ilprrtArc.To..on,oNilzrrruo.(r@)26rsnb:ir{rt{ltr*?-:iJlFg-cl-rl6-''s2-lx3m(ttl)t{+4{t'f

n
 andUse
lnterpretation

disorganization.conseque,ntlyhe colld not cornmulicate in social and occnpational contex:tsrequiring sustailed

effectivelyor fiurctionat a level consistentrvith his abilities. attention. The forgetfrrlnessand self- managementdeficits
He had diftrcul.ty sustainiil,gattention to reading material, of adults with ADHD often respondrvell to the provision
lectures,conversations,arLdhousehold-and r'vork-related of external structuring techniques,such as the frequelt
msks.other problernsrveredistractibility, shifting benveen useOflists, notesto oneself,Colorcoding,consistentrituais
mtir.ities, not completing tlrsks(both short- and long-tenn), and routines, reminders,filing, priontizing of tasks,and
ng, for geffirlness,losing things,
not I isten:L
disorgarLiz,ation, breaking dou,nof large task into snraller,nnnageableuruts.
being inattentive to details, making carelesserrors' and Mr. P. may benefit from many of these strategies,along
avoiding tasks requiring sustained mental effort (by with the use of computer software progralns that assist
procrastination).He alsoclescribedhimself asbeing bored hrm in rnanaginghis time, priorities, and calendar.Further
easilyand prone to daYdreaming' gains may be realized through reading self-helpbooks or
affending seminarsairned at promoting time-mLanagement
In his current work, Mr. P. believes that fiis presentilg and organizational skills. Horveyer,becauseself-irutiated
s 1' m pt om ss i g n i fi c a n tl y i rn p a i r h i s e ffi ci ency and methodshave proven to be insuffr,oient,conslltation rvith
'ivith
productivtityand have undermined his level of success. a behaviorally oriented mental health professional
Although he tends to acc:omplishr.vorh-relatedtasks, he experienceteachingtheseskills might be considered.
estimatesthat they genel'altytake trvice as long as they
should, and he rvorks in fear of others discovering his S.,€l ll'Year-Old
Casea (Thomas Male)
inefficiency.Functioning,in previous.jobsis reportedto Caucasian
Mr. S., a44-year'old referredhirnselfto a
m;ale,
havebeenrimpaired by his disorganization,forgeffirlness. to whetherhe suffers
deterrnine
clinic for an assessment
inattentio:n,and proneness;to becomirlgfuoredquickly. With
fromADHD.
respectt6 his interpersolralftilctioning, Mr. P. believes
*nt his presenting symptoms,in conjunction rvith other
Information
Background
factors,c<lntributedto prior marital diffrcultiesand to stress
Mr. S, currently lives r,vithhis rvife of 10 yearsand his 4-
with his current rvife.
in his relartionship
year-old daughter.Mr. S.. r.vhoearnedhis colllegedegree
from a state university, r.vorksas a graphic desigler a1d
Results
CAARS also co-ownsand operatesa businLess rvith his rvife. Mr. s.
tvk.P.rvas;administeredtire CAARS-S:1,urunediatelybefore came to suspect that he may sulfer from ADI{D on the
a face-to-faceinten'ier.vrvith a staff psychologist at the basi s of chroni c probl ems w i th hyperact ivit y and
the completedProfile forrn for
clinic. Figrrre 3.5 presenrts impatience,with an onsetin earll'childhood.
the self-reporttfonn. Mr. I,.'s InconsistencyIldex suggested
a valid responsepattern (his scorervas 1)' Mr. S. notesthat his presentingsyrnptornshavebeengoing
on most of his life. He rvas adopted and does not have
C l i n i c al m
l pressions infonnation pertaining to his biological relatives.
Tlie datafrom mrtltiple sourcesindicatethat Mr. P. clearl-v
meetsdiagnosticcriteria for ADHD. Specificalll',5. tneets MedicalHistorY
criteriafor the DSM-IV categoryof ADHD, Predorninantly Information on prenataland birth history is lacking due to
InattentiveType.Mr. P. t:ndorsedinattentive syrnptomsof Mr. S.'s adopted stams. He reports no seriouschildhood
suffrcientnumber (9 of 9 behavioralcriteria), severity,and illnesses.His current health is reportedto be good,and he
durationto neet DSM-iV criteria for tlie disorder.A ferv is not taking a1y medicatiols. There is no reportedhistory
feafltreswere reportedbut theseare
h-vperactiveiirnpulsive of heart problems,liver disease,seianres,tics, high blood
not suffrr;ientin number or severitVto rvarranta diagnosis pressure,serioushead injury, or thyroid problems.Mr. S.
of ADHD, cornbinedryPe. enjoysalcohol and drinks in modr:rationmultiple timesper
rveekbut indicatesno currelt or prior tlsagesuggestiveof
Recommendations abuse.Sirnilarly, he indicatesno clrrent or prior abuseof
Mr. P. rrnaybenefit from a trial of psychostimulant a pack or lessof cigarettes
illicit drugs.He smokesone-|-ralf
medicat jions.In responsive adults,stimulantmedications per day.
have been found to improve attentionspan, task
completion,and self-organization rvhile reducing SchoolHistory
irnpulsivity, andrestlessness.
distractibililv, If a rnedication He reports that diffrculties wittr sitting stilli and staying
triai involvingstimulantsis pt-usued, Mr. P.shouldkeepa focused on ongoing activities were noteclas early as
careful diary of sideeffectsa1ddaily behayior, particularly kindergarten.He also notesthat his adoptiveparentsha'n'e
 ADHD
Conners'Adult Rating (CAARS)
iicales

frequently' cornlnented on his seeming not to listen. Results

CAARS
Symptomsof ADHD have been pervasive acrosshonte, Mr. S. was administered the CAARIS:S immediately
school, and occupational seffings and appear to have been before a preliminary intervierv rvith a prychometrist at the
associated'withsomeimpairment in thosea-reas. Difficulties clinic. Figure 3.6 presentsthe coruLpleted Profile form for
r.lith remaining seatd sustaining attention and motivation, lhe short forrn. Mr. S's Inconsistenry Index indicated a
and courpletingtasksin an efficient manner all contributed valid resporlsepattern (his scoreu'as 4).
to acaderniicunderachievetnentthrough elementaryschool
(rvherehe rreceivedB and C grades),higlrrschool(3.2 GPA), Mr. S.'srvife u'asadministeredthe CAARS-O:S at the time
and colleg;e(2.4 GPA). E'oth formal testing and teacher of theprelirninaryintervier.vin thecl.inic.FiEue 3.7presents
irnpressionsindicated that these levels of academic the completedProfile fornt for thr: obsen'erratings. Her
perfonnanLco lvere below'what was expectedon the basis InconsistencyIndex indicateda valid responsepattern(her
of Mr. S.'scognitiveabilitLes. scorewas 2).

Froblems
Presenting C l i n i c al m
l pressions
A sernistmcturedclinical interviervcoveringboth priniary The prirnarydiagnosisis ADHD, Combined Type.Mr. S.
and associatedfeaturesof ADHD was administeredto Mr. d e s c r i b e si n a t t e n t i v e h, y p e r a c t i v ea, n d i m p u l s i v e
S. His responsesindicate the presenceof significant symptoms of suffrcientseverity alddurationto meetDSM-
features of inattention, overactivity, and impulsivity. IV diagnostic criteriafor thedisorder.Observations made
by Mr. S.'s wife appearto support this diagnosis. The
Positively endorsedinaff e'ntivefeatue s include diffrculties
sustaininll attention to tasks, distractibiliry", difficulfy symptomsarenotedto beof earlyonset,chronicandstable
following through with tasks to completion, often shifting in naftrre,pervasiveacrossseffings,and associated with
between unfinished activities, becoming bored easily, bothsubjective distressandsone impairment.
seerningnot to listen to ottLers,and avoiding tasksrequiring
sustainedrnental effort. Ivtr. S. describeshis attention span Recommendations
as limited, even for tasks that engagelhisinterest,but he Mr. S. may benefit from a triill of ps.vchostimulattt
not es t hat h i s c o n c e n tra ti o n i s e x tre mel y poor for medications.In responsiveadults, stimulant rnedications
nonengagingtasks such ttrat it makes them quite diffrcult have been found to i mprove attenti on span, t ask
for him to complete.Althqugh chronic messinessand sotne compl eti on, and sel f-organi zati on,rvh ile r educing
difficulties rvith organization lvere alluded to, he notesthat impul sivity, di stractibility, and restlessness.
he profits from writing things doln, listing prionties, and
re$ing or his wetl-organi:ledwife to handlevariouspayroll, Follow-Up
Glinical
bookkeeping, and paperw ork tasks.Hyperactive symptoms Six monthsafterthepreliminarymeetingin theclinicand
include generally higher than average activity levels, 5% monthsafter the start of phannacological treatment,
diffrculties remaining sutted, feeling a need to be always Mr. S. returnedto the clinic for a follow-upintervierv. At
on the go, fidgeting, and restlessness'A nun'rberof thistime,lvlr.S.rvasalso readnrinistered theCAARS-S:S.
impulsive featuresare also reported. Mr. S. emphasized Figrue3.8presents thecompleted Profilefonnfor theshort
irnpatienr;eand difficulty rvaiting his turn, but he also fonn. The CAARS resultswereconsistent rvith clinical
describedhimself as seekingout a high level of stinrulation impressions from the follorv-up interviervthat indicated
(e.g., motor boating, motorcycling, occasionallyslqydiving). thatMr. S.wasresponding favorablyto treatment.

Dfficulties on thejob relatedto presentingsymptomshave

generallyinvolved managing papenvork and completing
W.,a 26-Year-0ld
Gase5 (Meredith
tasksinan efficient manner.ML S. describeshis irnpatience Female)
as sufftciently severeas to constrain Someof his activities Ms. W. is a 26-year-old, marri.ed,Caucasian\'voman,
(e.g.,avoiding any waiting-lines, not driving during tines currently rvorkilg as a dental hygienist. She carneto the
rvhentraffrc rnaybe heary). Mr. S. reportsthat, over tirne, clinic for an evaluationfor ADHD.
he has become more a\\'are of his diffrculties and better
able to conpensatefor them or to avoid sifuationsrvhere d Information
Backgroun
they are likely to have an adverse impact' Indeed' his Mr. W. (age29),
IvIs.W. currentlylivesr,vithherhusband,
oc c upat io n a l fu n c ti o n i n g s u g g e s ts a n adapti ve u,hotvorksasa financialadvisor.Ms.W describestheir6-
accommodationto someof his presentingdiffrculties'
1,earmarriageas stable,happy,and healthydespitesome
difficultiescreatedby her restlesslless,interrupting,

34
 Interpretation
andUse

Figure 3.6
InitialProfileFormfor Mr.S. (CaseStudy4)
CAARS-S:S

ShortVersion(CAARS-S:SProfileForm
CAATRS-Self,-Report:
ID: Mr' S
Clienrt Gende,r:
@ f
(Circlc One)

BirthrdareQ4__/L9J
5+ Age: 44 Today'sDate:05 lg-l9g- Name:
-Dtl
Month Ycar Month Dav Year

F1 = A. I n a t t e n t i o n / M e m o rPyr o b l e m s
I Ut = lr4ales
18 to 29 yearsof age F e m a l e s1 B t o 2 9 y e a r s o f a g e
B. Hyperactivity/Flestlessness
UZ = Males30 to 39 yearsof age F2 = F e m a l e s3 0 t o 3 9 y e a r s o f a g e C. lmpulsivity/Emo,tioL nab l ility
I
= 40 to 49 yearsof age F3 = F e m a l e s4 0 t o 4 9 y e a r s o f a g e
I tutg lr4ales D.
E.
P r o b l e m sw i t h S e l f - C o n c e o t
ADHD Index
i M+ = lirlales50 years of age or older F4 = F e m a l e s5 0 y e a r s o f a g e o r o l d e r

CopyrighrI 1998.l4ulri-HcahhSysrmsInc All rightsreswed ln rhcU S.A.,P.O Box 950,NonhTonawan&,NY 14120'0950. (800)456-1001'

#M InCanada.3TT0VicroriaparkAvc..Torcnro M.2OHN3 M 6 . ( 8 m ) 2 6 8 - 6 0 1l1n r c m a t i m a l . + l - 1 1 6 . , 1 , 9 2 -F2a6x2.1+ 1 4 1 6 - 4 9 2 ' 3 3 4 3 o r ( 8 8 8 ) 5 4 0 - 4 4 8 4

?q
 AdultADHDRatingScales(CAARS)
Conners'

Figure3.7
Formfor Mr'S.(Case
lnitialProfile
CAARS-0:S Study4)

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

l-tr. S ll YourName:ljas-S i
JA rF. ^ -^. ii (}'nd*r:
Gender:M M F
F' Ase: dtA
Age: I
;i Gende:r,
@. Ag",lL{-
"tj ; iL_._ ltg- i
(Urclc (J!FJ
GfrcbOrrc) L_._ -,_, _.
- _ __ _.-______ _.-_--_.19 .lS----" -i
===--:...===a

iI Today's Date: O5 ljg-/jf I em this person's:{ spouseE parent O sibling O other:- i

MonI! D*y Ycx

M1 = Males 18 to 29 years of age F1 = Females 18 to 29 years of age A. l n a t t e n l i o n / M e m o rPYl o b l e m s

8. Hyperactivity/Restlessness
M2 = Males 3Oto 39 yeilrs of age 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 nLaal b i l i t y
M3 = Males40 to 49 yerarsof age F3 = Females 40 to 49 years of age D. P r o b l e m sw i t l 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

'*-ffi ltrffi X.ilffi',|fl i*i?*"

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

Jb
 Interpretation
andUse

Fi gure3.8
CAARS-S:SFollow-UpProfileFormfor Mr. S. (GaseStudy4)

€fiAR$-Self-Report: Short Version CAARS-S:S)ProfileForm

'. CsentID; Mr. S
Gender:
@ r
(Circle Onc)

Birthrlate:O+J9 lQt_ Age: + 4 Today'sDate:05l Lj 1.9& Name:

Month 6^y Ycar Month Day Ycar

4 W = Males 1Bto 29 years of age F1 = F e m a l e s1 B t o 2 9 y e a r s o f a g e A. Inattention/Memorv Problems

= Miales30 to 39 years of age F2 = B. Hyperactivity/Resilessness
fi l*Z Females 30 to 39 years of age
C. l m p u l s i v i t-yw/ E
= Miales40 to 49 years of age i tm
h otionalLability
il3 F3 = Females 40 to 49 years of age D. Problems Self-Conceot'
".r: = Males50 yearsof age or older
,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.

InCanada.STT0VictorilParkAvc.Toronto,ON M2HlM6,(8m)258-5011 lnrmarional,+1416492-2627.Fax,+tJIri{92-3l43or(888)540-4t8.1

37
 AdultADHDRatingScales(CAARS)
Conners'
$'as not
effectively. she notes that comptaing lp$iE,n-ork
anxiousness,failure to comrpletehousehold tasks, and pqrt due to the strict
particularly problernatic, in large
tendencyto "nag" and "give orders'" Ms' W' rvas bom by
routine, corrtingencies,and high erpgcmriom iurposed
and raisedin the midrvest.she recalls a generally happy
her parents. wlren Ms. W attendedorllege, hotreser, her
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 arousirrg her mother's anger' She compromised by a combination of lrer rtifficulties rvith
describesthe family atmosphereduring h.erearly yeals as sitting still, distractibility, boredonl and balancing her
being shapedby her parelts' desire to presentthe "perfect newly acquired freedom ald social acti\"itiesgith the need
fui1ily" rvith a heavy empha.sison religious values, high to focus her energieson school. Alttrrlugh theseprobiems
standards,and highly stmctured, rigid routiles, rules, and led her to drop out of school, she rehrrned the follorvittg
year with increased levels of matuitl" :motiyation and
contingencies.Ms. W. describesher mother as her "best
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 rvaYto graduating.
as a firefighter.
Problems
Presenting
Ms. W. left hLorne to attendcollege at age 18 and movedto A semistmctured bothprirnary
clinicalinterviervcover:ing
a different city durilg her rnarriage. She notes that part of andassociated fearures of ADF{Dwasadlninistered to Ms.
the reason for the latter move was to achieve a greater w. Her chief symptomsinclude poor sustainedattention,
degreeof independencefroru her parents' restlessness. difflrcultiescompletinlgtas;ks,and anxiety
symptoms.Featuresof attentionalproblemsincludepoor
sustainedattentionthat is particurlarly salientduring
MedicalHistorY
Ms. W. reportsthat she vrasborn at term by vaginal nonengaging tasks(e-g.,reading,studying,household
deliveryrvitft a breechpres;entation. Sheis saidto have chores),distractibility,frequentshifting betrveen
andavoidingor strongly
tasks,forgeffi.rlness,
beenhealthVat birth and reportsthat lrer motherdid not turcornpleted
use tobacco,alcohol,or other drugs during a generally dislikingtasksrequiringsustainedrnentaleffort.Shealso
trealthypregnancy. Shereportsno abnormalitiesor delays notesdiffrcultiesin completingtasksttrat are necessary
with her development acroslsspeech,motor,and self-help but not inherentlyinterestingto her-Ms. W's impulsivity
is reflectedin hertendencyto makestatements or comments
skill domains.Shewasa generallyhealthychildbut suffered
fromallergies. At age20,Mts.W. toresomemusclesin her rvithoutadequateforethought,blurting out answersor
necklvhileskiingandhassinceex:perienced somerecuning commentsprematurely,interruptirngor intrudingupon
headaches andneckpain.Clrrent medical problen'rs consist others,impatience,difficultiesdelayinggratification,
includebirth controlpills nuking hastydecisions, and"actingwithoutthinking'"
of allergies.current medica.tions
andPRNMotrin, Tylenol,and ryclobenzaprinefor neck
Ms.W alsodescribes herserasbeingfxlgetyandrestless,
pain and headaches. Ms. \V. has no history of treatment
merlications. Shedoesnot srnoke "alwayson thego," andhavingchronicdiffrcultiessitting
ivith any psychoactive talkativeness
still for extendedperiodsof time.E,xcessive
andreportsno significantzrbuse of alcoholor otherdrugs.
anda lorvtolerance extent,qutet
for solitaryand,to a llesser
shenotesconsumingsmallquantitiesof alcohol(e.g.,an cornpleting tasks
activitieslverealso noted.Difficulties
ounceofliquor, onebeer)onceperrveekor less'
relatedto hercurrentjob arenot saidto bepreselt, Ms'as
..loves"her lvork and finds th.erequiredtasksto be
w.
History
School engaging.Horvever,she doesfeel that her needto be
Academically,Ms.W tendedto performbetterthanaverage,
constantlydoing something,diffrcultiessittingstill, and
attainingB gradesor bette:rthroughoutelementaryschool verbalimpulsivifyoccasionallycauseher diffrcultiesat
andA s an,dB,s in junior trigh and high school.Early on' rvork.Shealsoattributessomefriction with herhusband
to
teacherslabeledher as "hyperactive"and frequently her restlesslless, poor task completionat home' and
cornplarned of her diffrcultiessittingstill, poorsustained
tendencytointerruptlr.imwhenheisothenviseengaged.
atteution,tatking out of turn, impatience,and seeking
attention in negative\r/ays.Although ment'oriesof
junior Results
CAARS
attentionalproblemsare not as salientduring her the GAARIi-S:Lirnmediately
Ms. W. rvasadrninistered
highandhighschoolyears,shedoesrecallpersistent at
beforea face-to-faceinterviervrvitha staffpqychologist
problemswith restlessness and verbal impulsivity.
theclinic.Figure3.9 presents the colnpleted Profilefonr-t
shereportsthat inattentiouanddistractibility
Furthermore, indicated
form.
for theself-report Her Inconr;istenryIndex
haveconsistentlyimpairedher ability to read and stgdy
a valid reqponse(herscorewas5)'

3B
 andUse
lnt,grpretation

Figure3.9
ProfileFormfor Ms.W. (Case
Female
CAARS-S:L Study5)

cli,entm:f11_\l_ Gender:,np
Birthdate:Al-/lb-/-la Age:3.b Today'sDate: { | /ia/3-h Name:
Mdrth fay Ya Matnh Df Ycr

F 1= Females18 to 29 yearsof age i A. lnattention/l'lemoryProt*ems E. DSM-ru InattentiveSynptoms

F'.?= Females30 to 39 yeansof age B. Hyperactivity/Restlessness Symptoms
F. DSM-IV Hyperactiv+.lmpulsiv'e
F 3 =Females40 to 49 years of age C. lmpulsivityrEmotional Lahlility G. DSMJV ADHD SymptomsTcrtal
F,4= Females50 yerarsof age or older D. Problemswifr Setf-ConcePt H- ADHD lndex

-r -?v^ C^wyridlOl99f, l,{uld-flcdrhs5'arlm-Anrighslwcd. lnrhcU.SA.,PO.Bdg50,trlsrhTmndlNYl412(}{99).{rm){56-1m3.

= fi{l tl$ la CurA+ lrt6 vi€rqir PEt.{8, T6odo, ura N,f2I{ 3M6, (to6) ?6&{0l I lnarulimrt, +1116J.u2-?5,27. FE, }l'll6-rl9?-llai r (ttt) s'l0-4'rt'

< (.{
 (CAARS)
ADHDRatingSicales
Conners'AdrLlt

Clinicallmpressions Background Inforrnatk'€

Ms.W.'sresultson theCAARSsuggest
thatshemeets Dr. G is a 49-year-old C".xre;es €sheranvo sons(aged
current cril.eriafor ADHD, Combined Rpe. Ms. W. also 24 utd 16). He earnedhis lvtD- frosr anlC}&plil medical
presentsrvilth significant anxious features suggestiveof a school and currently rvorhs as n hryital physician.
generalizectanxiety disorder.Specifically, shedescribesher Previously l'rehas worked as a fand!- p-atice doctor, an
mood asbeing generallytelnseand anxiousand notesthat emergencyroom director, ald as a 'nriter rl ho published a
she feels unable to relax, and frequently "lvound up" novel in the early 1970s.Dr. G's irqr rnaniageshaveended
rvithout knowing why. Ms. W. feels prone to frequent, in divorce (the rnost recent rr'as in l99j). Dr. G became
excessive,and unrealistic worry about a variety of issues aware of ADHD through his colleagm who recognizedin
(e.g., anticipating future events, not accomplishing him the long-terrn qymptomsof the disorder.Dr. G came to
necessaylvork- and home-basedtasks, saying or doing suspect that he may have the dirnrder on the basis of
thewrong thing). Shealsorlescribesherselfasbeing overly chronic diffi culties rvith inattention- distractibiliry-,poor
concemed,withher competence,feeling olenvhelm.edrvl'ren planning, and disorganization. The latter [$'o areas
facedrvith rnultiple tasksto cornplete,tending to evaluate representchief presentingconcennsa:; Dr. G describes
herselfin a negativervay;ard demonstratingaboveaverage lumself as highly drsorganized,prone to procrastination,
levels of self-consciousnr:ss and need for reassurance. and hamperedby h.isfailure to plan adequatelyin both his
Frequentlyexperiencedsomatic anxious feaftrresinclude personaland professionallife.
srveating,headaches,nausea,stonach distress,dizziness,
needingto usethe bathroorn,and being easilyrvokenfrom MedicalHistory
sleep.I\4s.'W.describesan early-adult onsetfor the rnajority Dr. G. reports no history of physical abuse,sexualabuse,
of the arxiLousqymptornsnoted above. Screensfor panic or other forms of trauma. There is, however,a history of
attacks,agoraphobia,socieilphobia, and childhood history abusing both alcohol (rvith apparent dependency)and
anxiety disorderwere all negative.
of separatircn cocaine.Dr. G participated in a 30-day substanceabuse
treatmentprogram. The failure to mLake adequatetreatment
Recommendations gains led to Dr. G.'s participation in a second30-day
Treatmentrecomnendatio:ns comprisebothpharmacologic program several months later. Ttris p.rogramreportedly
and psyctrosocial interventions.Medicatioumay be resultedin a cessationof substanceuse,althougha relapse
beneficialin improvingcoreandassociated symptorns of involving cocaineuseled to anotherrequiredparticipation
ADF{D(includinginattenti,cn, andimpulsivity)
restlessness, ilr a 28day program. Sincethat time, Dr. G reportsno narcotic
andmayalsobe directedtorvardthe reductionof an-xious or other substanceuse rvith the exceptiono.[ over-the-
features.A.nurnberofpossiblemedicationstrategies exist. countermedicationfor headaches. Dr. G: reportsno alcohol
includingpsychostimulants, antidepressants, or anti- use in the past five years. He has been involved in
anxietyagentseitheraloneor in combination. Ms. W.might Alcoholics Anonymous since ttrat time and reported
alsobenefit from involvenrent in an organizationdesigned regrrlarly attending ftvo or tluee meetj,ngsa r'veekat the
to supportand provideinformationto individualsrvith time of the curreut evaluation.
ADF{Dandrelateddisorders. Eitheraloneor in cornbination
rvith rnedication,cognitive-behavioral interventionsare School
History
likely to be useful in helping Ms. W. to reduceher Although he was not grosslyoveractiveor impulsive as a
overanxious qymptoms. Suchtreatmentis likely to include youth, Dr. G.'s childhood memoriesare significant because
the teachingof specificbehavioraltechniques(e.g., of hi s di ffi cul ti es rvi th i nattenti on, di s t r act ibilit y,
relaxationL and/or deepbreathingtraining) along rvith disorganizationand with rvaiting hir;ftrnrLinlines,remaining
cognitive r;opingskillsto reducegenerallevelsof tension, seated,ard completing his chores,homervork,and other
build morerealisticexpeclations andthoughtpatterns,and tasks.Despiteevidenceof well-abo've-a\/erage intelligence,
prornotethe capacityto recognizeand cornbatanxious Dr. G.'s early schooling rvas marked by'his coasting by on
symptoms. his abilitr,'and achieving averagegradesdespitefailing to
completeor tum in mucll of his assignedwork, being highly
Case6 (JamesG.,a 49-Year-0ld
Male) distractedin class.ard shorvinglittle molivationwith respect
to
Dr. G refbrredhimselftrr a clinic for an assessnent to acadenus. His gradesirnproveds;otnelhatin high school,
determinewhetherhesuff'ersfrom ADI{D. although difficulties rvith completing assignments,and
latepersisted.
orprojects
turningin papers Procrastination,
poorstudl'habits,and continuing and
attentional
orgaruzationaldifficulties made lr.isfirst year of college a

40
 andUse
Interpretation

he notesproblemsrvith forgetfulness (e.g.,writing dorvn

rvhich resultedin nearlyall F gradesand a decision
d,isaster,
prescriptions),papenvork, and ke,eping up rvith reading.
to drop ottt.
The el,idenceof distressandimpaLirmelt is perhapstnost
Subsequernt contact rvith a psychologist,horvever,was notableinDr. G's personaldomain:chronicnrisn'nnagernent
higtrly influential in inducing Dr. G to imposea n[tch higher of his finances: a history of unstableromantic
level of structurein his til'e (e.g.,devising and adheringto relationships:guilt regardinghis iailureto realizehis full
a strict schedule:frequentlyusittg lists and notes).These potential:and over-reliance on ollers to contpensate for
changeSrrssultedin rnuch improved perfomrancervhenhe his disorganization and causing
forgeffi.rlness, stress in
resruneds;choolat a nervr;ollegein Colorado.Difficulties Dr.G's relationshiPs.
sustaining this level of effort and structure, along rvith
continuin;gp roblemsrvith i nattention,and task-conrpletion' Results
CAARS
and becorningdivertedby more appealing,non-academic Dr. G wasadministeredthe CAARITS:L immediatelybefore
pursuits,rnademedical sr:hoolmore challenging.Despite a face-to-faceinterview rvith a staff psychologistat the
believing himself capableof perfonning at the lughestlevel, clinic. Figure 3. l0 presentsthe completedProfile forrn for
he graduarted in the lorverthird of his nredicalschoolclass. the self-reportform. His Inconsis;tencyIndex indicated a
F{rsproblems appear to have adverselya-ffectedDr. G's valid responsepaffern (his scorervas2).
ability to meet academicdemandsat school and, despite
his obtairringan M.D. degree,contributedto his ach.ieving lmpressions
Clinical
at a level belorvhis capacitY.
Dr. G.'s results on the CAARS suggestthat he meets
current criteria for AD HD, PredonrinantlyInattentirreTlpe.
Problem:;
Presenting Dr. G. positivety endorsed iniltterrtive symptoms of
A semistrmcturedclinical interviervcoveringboth primar-v su-ffrcientnunber (8 of 9), duration, zutdseverityto rneet
and asscciatedfeaturesof ADHD lvas administeredto Dr. D SM-IV criteria for ADF{D, PredonrinantlyInattentire}pe.
indicat,enumerous,ADF{Dsymptomsin
G. His rerSpollS€s Although not sufficient in nurnberto meetcriteria for tlie
the attentionaldornainanJ a smaller number of lrl'peractive/ conbined type of ADHD. he did indicatesomediffrculties
impulsive syinptoms.Sp'ecifically'he describesdifficulfy in the hyperactive/impulsivedomain.
rvitl'rthefollorving:sustainingattentiouto a vanetyof tasks
and activities(e.g., lechrres,instmctions,con\/ersations, mendations
Recom
television,and p?p€rwork):becorningeasily bored or
Dr. G may benefitfrom a trial of medicationr.lith established
distracted: shifting frecluently betrveen llfilished
efficacy in treating primary and associateds-vmptomsof
activities;:seemingnot ttl listen to others: and completing
A D H D . C onsi derati on must be gi ven t o st im ulant
both shorrt-termtasks(e.g.,readingarticles,rvriting letters,
rnedicationswhich, in responsiveadults,havebeenfound
doing daily chores)and longer-termprojects(e.g.,learning
to irnprove attention span, tasjkcompletion, and self-
to speak Spanish). In rlddition. Dr. G. has difficulties
organization,rvhile reducing impulsivi t"v,di stractibiI iti', ard
attendingto details,preventingcarelesserrors,and finding
restlessness.Research on the: efficacy of stimulant
things, aLndexperiencesdisorganization,procrastination,
medicationsin samplesof childr:enrvith ADI{D suggests
at rvork and in personalnatters.
and forgetfi,rlness
that approximately 70-80 percent or higher respond
positively. Less researchhas been conductedon the
Dr. G reportsthat lr.isattt:ution problemsrveretnostnotable
responseof adults with ADFID to the psychostimulant
during arctivitiesthat rvere not inherently engaging and
medications.Hor,vever,a numberrlf plaLcebo-controlled
tnals
rvhenhe tvasr,vorkingrvithout the pressrueof an itnminent
have been conducted over recent years and generally
deadline.His featuresin tl'rehlperactive/impulsivedotnaiu
suggesta favorable response.In,divirlualsrvith substance
includedproblernsremai.ningseatedfcrrprolongedperiods,
abusehistories, like Dr. G. canLpose a dilernma for the
diffrculry rvaiting his htm, enjoyrnent of fast-pacedand
clinician rvith respect to pharr-naLcologic treatnlent.
somervltatriska activities, receipt of numerous speeding
Prescribingstimulant medicationsto such personseutails
tickets,and some propensity for verbal impulsivity (e.g.'
a risk due to the drug's abusepotential.Although euphoria
intemrpting others,or blurting out answersor comments
doesnot occurwith orally administerred stimulantdmgs in
without adequateforetlLought).
the dose ranges rypically employed, may appearif the
it
Although he functions;adequatelyin his rvork and is drug is taken in large doses,intravenously,or "snorted."
respectedby his colleaguesand patients,Dr. G reports Horvever,rvithholding a potentially effrcacioustreatrnent
that his occupationalp,:rforlnance is negatively affected to individuals rvith impairing ADFD is also uudesirable,
by his attention problernsand disorganiz,ation.Specificalll', particularly if they appearto havegailed coltrol oyer tireir
substanceabuse.
41
 (CAARS)
AdultADHDRatingSca'les
Conners'
3.10
Figure
lnitialProfile for Dr'G'(CaseStudy6)
CAARS-S:L Form

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

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

Birthdate,kt*-t# Da.v Ycd

A. lnattention/MemorYProblems E. DSi,l-lV InattentiveSymprtorns

Ml = Males 18 to 29 !'ears of age F. DSiI-lV Hyperaclive-lmgulsiveSymptoms
M2 = Males 30 to 39 !'ears of age B. HyPeractivitY/Restlessness
Lability
G. lmpulsivity/Emotional G. DSM-IVADHD SYmPtomsTotal
M3 = Males4Oto 49 Yearsof age H. ADHDIndex
M4 = Males5OYearsof age or older D. Problemswith Self-ConcePt

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

47
 andUse
Interpretation

i,*ical Follow-Up Conclusion

,r;SeG rvastreatedfor ADHD usinga commondrugtreatment Potentialusersof the CAARI] are remindedthat
At thebegirningof thefirst rveekof treafinent,
i:futhis disorder. assessments and diagnosticrepprtsrequirea detailed
,,.*. G was asked to complete the CAARS-S:SV. Consistent
j-,*ffi the clinical impressionsthat Dr. G exhibited substantial
justificationof conclusionsbasetrlon measureslike the
CAARSandotherdata.The levq:lof detailprovidedin
$D*ID q,mptoms, his lscoreswereabove70for all theCAARS
thesecasestudiesrvill not, in gepreral,
besuffrcientfor
=eks Two monthsafter ttre start of the dmg treatment(8
: rcks later),Dr. G completed assessment anddiagnosticreporilis.Thetrueuseftilness
a secondCAARS-S:SV. Onthis
of the CAARSis a functionof tfe measure's abilityto
msion, consistent rvithclinicalimpressions thatDr. G was
:xe*ondingpositivelyto thedmg treatment, provideinsightsthatwill behelpfulfor diagnosingand
all of theI-scores
,. *re belorv'70.Figrue3.11isDr. G's Profileform,shor.ving treatingadultswith ADHD. Di1'erse casestudieswere
his
providedto demonstratethe uqeof the CAJ{{S in a
C{ARS-S:SV results on the first occasion,
before treatment
numberof sinr,ations and contqxts,and to clarif,, the
d on the secondoccasion,after8 rveeksof drugtreatment.
useof the CAARSin actualpral;tice.
Ikhen usedin this way,theProfileform providesa visualrecord
dthe changein scoresoverrtime.

43