Chapter 1: Overview of Content

The following section provides an overview of the content included in the Conners 4 and highlights key content changes from the Conners 3. For moreinformation on the development of this content, see chapter 6 (Development), chapter 11 (Conners 4–Short), and chapter 12 (Conners 4–ADHD Index). For details on how to interpret scores from each content area,see chapter 4 (Interpretation).

Response Style Analysis

Concerns regarding individuals feigning ADHD, and the ease with which this can be achieved, have led to calls for the creation of symptom validityindicators in the assessment of ADHD (e.g., Harrison et al., 2019; Musso & Gouvier, 2014; Sollman et al., 2010; Suhr et al., 2017; Sullivan et al., 2007).To address this need, the Conners 4 includes the Negative Impression Index that measures potential symptom exaggeration. The Inconsistency Index isincluded to help detect possible random or careless responding, which can also affect the accuracy of results. Scores from these validity scales helpassessors ascertain the integrity of the information reported in the rating scale. Together with the validity scales, an analysis of Omitted Items and Pace (i.e., unusual administration speed) completes the picture of how a rater approached the Conners 4.

Critical & Indicator Items

The Conners 4 includes two sets of critical items—Severe Conduct and Self-Harm—as well as a Sleep Problems Indicator.

• Severe Conduct Critical Items ask about behaviors that may present danger or cause harm towards others (e.g., setting fires tocause damage, cruelty to animals, using a weapon). These behaviors are of signficant concern at any age. If any of these critical items are endorsed,they warrant immediate investigation and/or intervention.
• Self-Harm Critical Items ask about past thoughts and behaviors that intentionally cause injury or harm to one’s self. Thesebehaviors are of significant concern at any age. If any of these items are endorsed, immediate investigation and/or intervention is merited.
• The Sleep Problems Indicator consists of items that reflect behaviors or feelings that may suggest difficulties with sleep. Ifthis indicator is flagged, follow-up is recommended to obtain additional information. Given that sleep problems often co-occur with ADHD (e.g., Beckeret al., 2019; Becker et al., 2019; Gregory et al., 2017; Ruiz-Herrera et al., 2020; Virring et al., 2017) and can mirror symptoms of ADHD, exacerbateexisting symptoms, or be a side effect of medication treatment, it is critical that these problems are considered and explored further so thatappropriate differential diagnosis or intervention can be provided. When sleep problems are indicated, users may choose to follow up using the PROMIS®Sleep Related Disturbance–Short Form 8a and/or the PROMIS® Sleep Related Impairment–Short Form 8a (Yu et al., 2011), which are available for free toConners 4 users on the MHS Online Assessment Center+, in order to ensure thatsleep problems are fully assessed in this population (see Additional Sleep Problems Tools Available Free of Charge in this chapter).

Content Scales

The Content Scales include items that capture key clinical constructs related to ADHD, including Inattention/Executive Dysfunction, Hyperactivity,Impulsivity, and Emotional Dysregulation. Additionally, the Depressed Mood and Anxious Thoughts scales incorporate content associated with two commonco-occurring internalizing spectrum disorders of depression and anxiety, respectively.

Impairment & Functional Outcome Scales

Both the Diagnostic and Statistical Manual of Mental Disorders1 (DSM) diagnostic criteria and the determination ofeducational eligibility under Individuals with Disabilities Education Improvement Act (IDEA 2004) require that reported problems be associated withclinically significant impairment in the youth’s functioning. The Conners 4 includes three scales—Schoolwork, Peer Interactions, and Family Life—thatevaluate the level of impairment present in these key functional domains (note that the Family Life scale is not included on the Conners 4 Teacher).Moreover, an additional open-ended question was created to allow the raters to provide extra information on the pervasiveness of the problems reported andtheir impact on the youth’s functioning.

DSM Symptom Scales

The DSM Symptom Scales include items that map directly onto symptom criteria outlined in the DSM. The DSM Symptom Scales include the ADHDInattentive Symptoms, ADHD Hyperactive/Impulsive Symptoms,Oppositional Defiant Disorder Symptoms, and Conduct Disorder Symptoms scales. A DSM Total ADHDSymptoms scale is also available. It consists of all the DSM items from the ADHD Inattentive Symptoms and ADHD Hyperactive/Impulsive Symptom scales andprovides a dimensional representation of ADHD symptoms.

Conners 4–ADHD Index

Developed using advanced statistical techniques, the Conners 4–ADHD Index contains 12 items from the Conners 4 that best distinguish youth with aclinical diagnosis of ADHD from youth in the general population. See chapter 12, Conners 4–ADHD Index,for more information about the development and validation of this index.

Additional Questions

There are three additional questions at the end of the rating scale. These questions are open-ended and allow the rater an opportunity to provide extrainformation that may not have been captured by the Conners 4 items. The first question asks about the pervasiveness of the problems reported in thedifferent domains of functioning. The second question asks about any other current issues or problems. Finally, the third question asks the rater todescribe the youth’s strengths and skills.

Table 1.1.Structure and Content of Conners 4 Parent, Teacher, and Self-Report Forms

Note. Administration time is based on the average number of items completed per minute in both the Normative and ADHDReference Samples (see chapter 6, Development,for details).

1 Throughout this manual, DSM refers to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR, 2022).

ncG1vNJzZmilmKiwpbqNm6Ooml6YvLOxjbCgp5yfrMBvusStZqago2LEpq6Ohn%2BMZYekv6Wc0Z6qrGd8mq6zuo2Gf4xnfZa7tq3LrGacp56jsrO%2Fvm2Woaydoayurc2umKWXlqq5rXvPmqmtaV%2BYtXKrwqilrZ2eqXupwMyl

 Share!

• Share on Facebook
   
• Tweet
   
• Share on Google+
   
• Post to Tumblr
   
• Pin it
   
• Submit to Reddit