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Chapter 1: Introduction
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Chapter 2: Administration
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Chapter 3: Scoring and Reports
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Chapter 4: Interpretation
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Chapter 5: Case Studies
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Chapter 6: Development
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Chapter 7: Standardization
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Chapter 8: Reliability
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Chapter 9: Validity
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Chapter 10: Fairness
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Chapter 11: Conners 4–Short
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Chapter 12: Conners 4–ADHD Index
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Appendices
Conners 4 ManualAppendix A: Omitted Responses |
Appendix A: Omitted Responses |
- Omitted Responses for the Negative Impression Index
- Omitted Responses for the Inconsistency Index
- Omitted Responses for the DSM Symptom Counts
The Conners 4th Edition (Conners 4®) results will be less valuable and less accurate if responses are missing. If the allowable number of omitted responses has been exceeded for a given scale (see Table A.1), the scale cannot be scored and is marked as “?” in the digital reports. This question mark indicates that the scale cannot be scored due to too many omitted responses. However, if the maximum number of allowable omissions has not been exceeded, then scores will be prorated for the following scales: Content Scales, Impairment & Functional Outcome Scales, and DSM Symptom Scales (for the purposes of calculating T-scores), and the Conners 4®–ADHD Index. Raw scores for these scales are prorated with the following formula:
For example, a rater obtained a raw score of 10, but answered only 5 out of 6 items on a particular scale. The score may be prorated by multiplying the obtained raw score of 10 by the number of items (6) on the full scale (10 × 6 = 60). The obtained result is then divided by the number of completed items on the scale (5) to get the prorated raw score of 12 (60 ÷ 5). The prorated raw score takes into account the missing items and adjusts the total raw score based on how the rater answered the other items on the scale. Prorating is automatically implemented where applicable when using digital scoring.
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Table A.1. Maximum Number of Allowable Item Omissions for Conners 4 Scales
Scale |
Conners 4 |
Conners 4–Short |
|||||
Parent |
Teacher |
Self-Report |
Parent |
Teacher |
Self-Report |
||
Content Scales |
Inattention/Executive Dysfunction |
2 |
2 |
2 |
1 |
1 |
1 |
Hyperactivity |
1 |
1 |
1 |
1 |
1 |
1 |
|
Impulsivity |
1 |
1 |
1 |
1 |
1 |
1 |
|
Emotional Dysregulation |
1 |
1 |
1 |
1 |
1 |
1 |
|
Depressed Mood |
1 |
1 |
1 |
– |
– |
– |
|
Anxious Thoughts |
1 |
1 |
1 |
– |
– |
– |
|
Impairment & Functional Outcome Scales |
Schoolwork |
1 |
1 |
1 |
1 |
1 |
1 |
Peer Interactions |
1 |
1 |
1 |
1 |
1 |
1 |
|
Family Life |
1 |
– |
1 |
1 |
– |
1 |
|
DSM Symptom Scales* |
ADHD Inattentive Symptoms |
1 |
1 |
1 |
– |
– |
– |
ADHD Hyperactive/Impulsive Symptoms |
1 |
1 |
1 |
– |
– |
– |
|
Total ADHD Symptoms |
2 |
2 |
2 |
– |
– |
– |
|
Oppositional Defiant Disorder Symptoms |
1 |
1 |
1 |
– |
– |
– |
|
Conduct Disorder Symptoms |
1 |
1 |
1 |
– |
– |
– |
|
Conners 4–ADHD Index |
1 |
1** |
1** |
1 |
1** |
1** |
*The maximum number of allowable omissions are for the DSM Symptom
Scales and does not apply to Symptom Counts.
** For the Conners 4 Teacher ADHD Index and Self-Report ADHD Index, the scale cannot be
scored if the omitted item is one of the weighted items
(see chapter 12 for a discussion of the Conners
4–ADHD Index scoring).
Omissions are handled differently for the Negative Impression Index, the Inconsistency Index, and the DSM Symptom Counts. These are discussed in detail in the following sections.
Omitted Responses for the Negative Impression Index
The Negative Impression Index cannot be prorated. When Negative Impression Index item responses are missing, the following rules are applied in order:
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If the raw score (based on the items that were rated) is equal to, or higher than the cut-off (for values, see Table 4.2 in chapter 4, Interpretation), then the status of “An unrealistic or exaggerated presentation” is provided regardless of how many items have been omitted (see Example 1 in Table A.2).
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If the raw score (based on the items that were rated) plus the number of missing items multiplied by three is lower than the minimum cut-off, then the status of “No indication of exaggerated responding” is provided (see Example 2 in Table A.2). Note: The number of missing items is multiplied by three as this is the highest possible score for a Negative Impression Item.
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If neither of the above two conditions are met, then the status of the Negative Impression Index is “Cannot be determined” (see Example 3 in Table A.2).
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Table A.2. Negative Impression Index Interpreted with Omitted Items: Conners 4 Parent Examples
Example |
NII Raw Score |
Number of |
NII Cut-Off |
NII Status |
Explanation |
1 |
9 |
1 |
≥ 8 |
An unrealistic or exaggerated presentation |
The NII cut-off (8) has been exceeded by the NII raw score (9), regardless of the omitted items. This NII score may be an underestimate. |
2 |
0 |
2 |
≥ 8 |
No indication of exaggerated responding |
The cut-off (8) cannot be met or exceeded. That is, even if both of the omitted items were rated as 3, the score (2 × 3 = 6) does not meet the cut-off. |
3 |
5 |
1 |
≥ 8 |
Cannot be determined |
Depending on the value for the omitted item, the cut-off could either be met (e.g., if the omitted item score = 3, the Raw Score = 5 + 3 = 8), or not met (e.g., if the omitted item score = 2, the Raw Score = 5 + 2 = 7). Because of this ambiguity, the NII cannot be interpreted. |
Note. NII = Negative Impression Index. NII Raw Score is based on the sum of the items that were rated.
Omitted Responses for the Inconsistency Index
When Inconsistency Index item responses are missing, the following rules are applied, in order:
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If the raw score (based on the item pairs that were rated) is equal to, or higher than the cut-off (for values, see Table 4.3 in chapter 4, Interpretation), then the status of “A high level of inconsistency” is provided, regardless of how many item pairs have been omitted (see Example 1 in Table A.3).
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If the raw score (based on the item pairs that were rated) plus the number of missing item pairs multiplied by three is lower than the minimum cut-off, then the status of “No indication of inconsistent responding” is provided (see Example 2 in Table A.3). Note: The number of missing item pairs is multiplied by three as this is the highest possible difference score for an Inconsistency Index item pair.
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If neither of the above two conditions are met, then the status of the Inconsistency index is “Cannot be determined” (see Example 3 in Table A.3).
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Table A.3. Inconsistency Index Interpreted with Omitted Items: Conners 4 Parent Examples
Example |
IncX Raw Score |
Number of |
IncX Cut-Off |
IncX Status |
Explanation |
1 |
5 |
1 |
≥ 4 |
A high level of Inconsistency |
The IncX cut-off (4) has been exceeded by the IncX raw score (5), regardless of the omitted items. This IncX score may be an underestimate. |
2 |
0 |
1 |
≥ 4 |
No indication of inconsistent responding |
The cut-off (4) cannot be met or exceeded. That is, even if the difference between the omitted pair was 3, the score does not meet the cut-off. |
3 |
1 |
1 |
≥ 4 |
Cannot be determined |
Depending on the value for the omitted item, the cut-off could either be met (e.g., if the omitted pair difference score = 3, the Raw Score = 1 + 3 = 4), or not met (e.g., if the omitted pair difference score = 0, the Raw Score = 1 + 0 = 1). Because of this ambiguity, the IncX cannot be interpreted. |
Note. IncX = Inconsistency Index. IncX Raw Score is based on the item pairs that were rated.
Omitted Responses for the DSM Symptom Counts
The DSM Symptom Counts cannot be prorated in the same manner as raw scores. When item responses are omitted, one needs to determine if the symptom criteria outlined by the DSM1 is affected. If it is affected, then the symptom is omitted. It should be noted that in both “OR” criteria (i.e., endorsement of either item is required to count toward a criterion) and “AND” criteria (i.e., both items count toward a criterion), the symptom is considered omitted if both items are omitted or if one item is omitted and the other item is not endorsed (see appendix D for details about how Conners 4 items map onto DSM symptom criteria). The following rules are applied for DSM Symptom Counts:
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If the omitted item(s) impacts one of the DSM symptom criteria, the Symptom Count will be provided, with a note that the Symptom Count may be an underestimation because the rater did not respond to all of the symptom criteria (see Example 1 in Table A.4).
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If the omitted items impact more than one of the DSM symptom criteria, there are two possible scenarios:
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If the Symptom Count is below the DSM symptom count requirement, then the Symptom Count cannot be provided for the scale and is marked as “?” on digital reports to indicate that it cannot be scored due to too many omitted responses (see Example 2 in Table A.4).
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If the Symptom Count is at or above the DSM symptom count requirement, then the Symptom Count will be provided; however, a note will indicate that the obtained Symptom Count may be an underestimation of the actual Symptom Count because the rater did not respond to all the symptom criteria (see Example 3 in Table A.4).
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Table A.4. DSM ADHD Inattentive Symptoms Scale Interpreted with Omitted Items: Conners 4 Parent Examples
Example |
DSM ADHD Inattentive Symptoms Obtained Score |
Number of Omitted Items |
Symptom Count Reported |
Meaning of Notation |
1 |
1 |
1 |
1*/9 |
*Symptom Count(s) may be underestimated due to omitted item(s). |
2 |
1 |
2 |
? |
? = could not be scored due to omitted item(s). |
3 |
8 |
2 |
8*/9 |
*Symptom Count(s) may be underestimated due to omitted item(s). |
Note. The DSM requires at least 6/9 symptoms to be endorsed to meet Criterion A of the diagnostic criteria for ADHD for youth ≤ 16 years of age, and at least 5/9 symptoms for youth ≥ 17 years of age.
1 Throughout this manual, DSM refers to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR, 2022).
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