What to Know About the Conners 4 ADHD Assessment

The Conners 4 is a reporting measure used for evaluating children and adolescents for attention-deficit/hyperactivity disorder (ADHD).

The Conners 4 has forms for parents and teachers that show how a child presents in the home and the classroom.

Children ages eight and up can also complete a self-report form that provides information about their experience of their symptoms.

What Is the Conners 4 Used For?

The Conners rating scales for ADHD were introduced by Multi-Health Systems, Inc (MHS) in 1970. It undergoes regular updates to ensure accuracy and validity. The Conners 4 is the most recent update and was released in 2022 and replaced the Conners 3.

The Conners 4 Test Measures

• When scored, the Conners 4 will measure:
• Attention issues
• Impulsivity
• Executive dysfunction
• Hyperactivity
• Anxiety
• Depression

Since it is not unusual for children and teens to have some difficulty with things like focusing throughout the school day, arguing with authority figures, or occasionally forgetting assignments, these scales help providers determine when a child’s difficulties go beyond what is developmentally appropriate.

Determining If an ADHD Diagnosis May Be Appropriate

In addition to these scales, the Conners 4 measures how closely the client’s presentation matches the diagnostic criteria for ADHD, oppositional defiant disorder (ODD), and conduct disorder. The Conners 4–ADHD Index then indicates how likely a client has ADHD based on these scores. This helps the evaluator determine whether a diagnosis of ADHD can explain symptoms the client is experiencing or if another diagnosis is a better fit.

Validity Scales

Finally, the Conners 4 has validity scales that screen for consistency (making sure that the person completing the form did not answer randomly) as well as for possible over or under-reporting of symptoms.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, states that:

• A child or adolescent must have six symptoms of either inattentive or hyperactive-type ADHD in order to meet criteria and be diagnosed
• Older adolescents must have five or more symptoms.
• If a client meets criteria based on both the inattentive and hyperactive/impulsive symptoms, they can be diagnosed with ADHD Combined Type.

How Is the Conners 4 Different From Other Conners Tests?

According to MHS, the Conners 4 provides several useful updates from the previous edition:

• Improved Cultural Competency: First, developers incorporated new research about ADHD presentation across cultures and ethnicities to improve cultural competency and diagnostic accuracy for BIPOC children who, historically, have been misdiagnosed.
• Allowed for greater gender expression: Clients have the option to choose “other” as a gender instead of just “male” and “female” as well.
• Better rating scales: Instead of just screening for possible anxiety and depression, the Conners 4 has norm-referenced rating scales for these symptoms to provide more information about a child’s symptoms. Similarly, instead of simply asking if a child has difficulty in different areas, it calculates how severely a child is impaired at home, school, and in social settings. It provides additional questions about safety concerns and sleep issues as well.
• Updated Language: The Conners 4 uses updated language to be more inclusive and easier for respondents to understand.

Potential Limitations of the Conners 4

The Conners 4 does not independently determine whether or not someone has ADHD. An evaluator may administer a cognitive assessment to get more information about learning, functioning, and abilities.

They may use a test of sustained attention to observe a child or teen’s ability to focus in real-time. Depending on the child’s age, the evaluator may use a personality test to see if they meet criteria for another diagnosis in addition to or instead of ADHD.

As with previous versions of this measure, the Conners 4 measures observable behaviors. Since ADHD is a neurodevelopmental difference, it can impact behavior. However, some people with ADHD may mask or hide their symptoms and may get a false negative (test results might not be consistent with ADHD). In other words, someone who has ADHD might not be diagnosed with ADHD, and test results might not accurately reflect their diagnosis.

For those whose symptoms do not present in a way that is easily measured by the Conners 4, they may still identify with symptoms of ADHD. This is valid, and if they find that resources by and for the ADHD community benefit them, they can still use these resources.

Additionally, many do not have access to formal assessment for ADHD, particularly those with low income. If you notice symptoms but cannot get evaluated, the ADHD community and resources can still help you manage your or your child's symptoms.

How to Complete the Conners 4

The Conners 4 can be completed on paper or online. Evaluators may send an encrypted link via email, allow you to complete the Conners 4 on a computer in their office, or provide a printed form.

Like the Conners 3, the Conners 4 utilizes a series of Likert scale questions with the options:

• Not true at all/Never
• Just a little true/Occasionally
• Pretty much true/Often
• Very much true/Very often

The Conners 4 Parent Form

If you complete the Conners 4 parent form (answering questions about your child), answer the questions honestly regarding your child’s behavior and what they shared with you.

The Conners 4 Self-Report Form

If you are completing the self-report form (if you are the child or teen being evaluated), answer honestly and know that there are no right or wrong responses about your own experience.

How Is the Conners 4 Scored?

The Conners 4 uses online scoring and yields T-scores, a type of norm-referenced rating. If you complete the Conners 4 online, the software scores your completed test and sends scores to the evaluator automatically. If you complete a paper form, the evaluator will input your responses into the scoring program.

"Over-reporting" means that an individual reported more symptoms than are actually present, and "under-reporting" means that they held back and did not disclose symptoms that might be present. The intent of validity scales is to determine when someone's answers might not be honest, though sometimes validity scales might elevate even if the individual is trying to be honest in their report.

For instance, a child with low self-esteem might elevate for over-reporting, or a child who is worried about pleasing adults may elevate for under-reporting. A parent or teacher who is overwhelmed by a child’s behaviors might unintentionally over-report symptoms as well.

An evaluator must consider validity scales in interpreting the test data. If validity scales indicate that the scores cannot accurately determine whether or not an individual meets criteria for ADHD, the evaluator might use other self-report measures, tests of sustained attention, and information from the intake interview to determine whether or not criteria are present.

Understanding Your Child's Conners 4 Scores

After completing an evaluation, a provider should meet with the parent and child to go over the scores and answer any questions you have about the results. 

Remember that inattention, restlessness, executive dysfunction, and other symptoms that occur with ADHD are not unique to one diagnosis. Even if a client does not meet the diagnostic criteria for ADHD, this does not mean they do not have these symptoms.

For more information on how to support your ADHD child, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is an organization run by and for the ADHD community. Additionally, Neurodivergent Practitioners and ND Therapists are both online directories that can connect you with mental health providers who offer neurodiversity-affirming care and support.