• Content Updates
• Norm Updates
• Increased Flexibility

The Conners 4 builds on the strong foundation established by the Conners 3. Both provide a comprehensive, reliable, and psychometrically sound tool to gather data about ADHD symptoms, impairment, and other problems associated with ADHD. The Conners 4 features several refinements and enhancements to the structure, content, and format of the Conners 3.

Content Updates

Content updates, at the item and scale level, are described below (for more information, see New and Modified Scales in chapter 6, Development). See Table 1.2 for an outline of similarities and differences in the content and structure of the Conners 3 and Conners 4.

Response Style Analysis Updates

The Response Style Analysis presents metrics that provide a more comprehensive set of indicators to better understand a rater’s response style. If any of these metrics are flagged on the report, further exploration is needed to consider any possible concerns and to use this information to guide the interpretation of the results. In addition to updating the validity scales, additional metrics were also created for the Response Style Analysis (Omitted Items and Pace; for detailed information on each of these metrics, see Step 1: Examine the Response Style Analysis in chapter 4, Interpretation).

• The Negative Impression Index was updated to include items that capture two ways a rater may provide an unrealistic or exaggerated presentation of the youth’s problems (or in the case of the Self-Report, the youth providing unrealistic or exaggerated presentation of their own problems). First, and similar to the Conners 3 Negative Impression Scale, there are items that capture a negative response bias, or a possible “faking bad.” Second, and new to the Conners 4, are items that capture the potential exaggeration of ADHD symptoms (similar to an embedded Symptom Validity Test; e.g., “It’s impossible for them to pay attention to things”).

• The Inconsistency Index has been updated with Conners 4 items that are likely to be endorsed similarly by raters. These pairs of items are both conceptually (i.e., the items contain similar content) and empirically (i.e., the items are highly correlated) similar to each other. Raters with discrepancies between their ratings of these pairs of items will be flagged for possible inattentive or careless responding.

• The Positive Impression scale from the Conners 3 is no longer included in the Conners 4. Although originally developed for inclusion in the Conners 4, the Positive Impression scale was excised as it was not found to be sensitive enough to capture “faking good” responding (i.e., responding in a socially desirable manner to make a more favorable impression; see Positive Impression Index in chapter 6, Development, for details on this decision). Instead, more common concerns regarding feigning (e.g., exaggerated symptoms) were prioritized.

• Omitted Items provides the total number of items that the rater omitted when completing the Conners 4. There is a maximum number of items that can be omitted for each of the Conners 4 scales. If the maximum allowable number of omitted responses has been exceeded for a given scale, the scale cannot be scored and this metric is flagged on the report. If the maximum allowable number is not exceeded, the scale score is automatically prorated when scored online. The scales that have been prorated are noted in the report.

• Pace (available for online administrations only), a new metric on the Conners 4, provides the average number of items completed per minute. This metric is flagged when an unusually fast or unusually slow response rate is indicated.

Updated Item-Level Content

Items were updated to increase fairness and to add new content (see appendix C, Items by Scale, for all item content).

• Items have been updated for cultural sensitivity. Multi-cultural experts provided feedback on item content prior to data collection to ensure that fairness was a cornerstone of item development. Language experts also reviewed and modified items that could be easily misinterpreted by non-English speakers (e.g., idiomatic language was reduced, compound items were split into separate items wherever possible), or items that did not translate well.

• Gender-inclusive language (e.g., singular “they”) is now used in all Conners 4 items to be inclusive for all genders.

• Items were updated based on a comprehensive and systematic review of advances in the ADHD literature.

• New item-level indicators measuring self-harm and sleep problems were added, which help screen for difficulties that the youth may be experiencing.

Updated Scales and Scale Structure

Some scales were reconceptualized or expanded, and new scales were developed to cover other important content areas (see chapter 6, Development).

• New scales have been added for the evaluation of Emotional Dysregulation, Depressed Mood, and Anxious Thoughts.

• The following Conners 3 Content Scales—Learning Problems, Peer Relations, and Family Relations—have been updated to focus on impairments due to ADHD symptoms in the school, social, and family domains in the new Impairment & Functional Outcome Scales.

• The DSM Symptom Scales now include a DSM Total ADHD Symptoms scale which aids in a dimensional approach to ADHD assessment.

• The Conners 3 Defiance/Aggression scale has been removed, although content related to defiant and aggressive behavior can be found in the DSM Oppositional Defiant Disorder Symptoms and DSM Conduct Disorder Symptoms scales.

• The Conners 3 Global Index no longer appears on the Conners 4. To monitor treatment effectiveness and/or change over time, use the Conners 4–Short or the Conners 4–ADHD Index.

• The Conners 4–ADHD Index has been revised to feature new items and scoring methodology. Items were selected from the full-length Conners 4 based on modern statistical techniques to optimize the Index’s ability to classify between youth with and without ADHD.

• There is now greater alignment in scales between the Conners 4 Parent, Teacher, and Self-Report. All scales appear across all rater types, with the exception of the Family Life scale, which the teacher may not have insight into (see Greater Alignment of Item Content Across Rater Forms in chapter 6, Development, and Internal Structure in chapter 9, Validity).

• The updated structure has greater alignment with the upcoming Conners Adult ADHD Rating Scales 2nd Edition (CAARS 2™; Conners et al., 2022) that facilitates a lifespan approach to ADHD assessment and monitoring.

Norm Updates

New Normative Samples

Updated normative data was derived from a large sample designed to be representative of the North American population based on the 2018 U.S. and 2016 Canadian census figures. Please see Description of Normative Samples in chapter 7, Standardization, for additional information about the Normative Sample, which is stratified based on age, gender, race/ethnicity, parental education level, and geographic region.

ADHD Reference Sample

An ADHD Reference Sample has been added to allow assessors to compare a youth’s scores to others already diagnosed with ADHD. This reference group is useful when a youth’s scores are extreme in comparison with the Normative Sample and provides a helpful comparison in evaluating the severity of the reported problems (see Description of ADHD Reference Samples in chapter 7, Standardization, for more information).

Increased Flexibility

User-Friendly, Customizable Reports

The Conners 4 Single-Rater reports now open with a user friendly, single-page Overview that captures a high-level view of all information, followed by more detailed data and interpretive guidelines, as well as a modified parent feedback handout. With the exception of the Cover Page and Overview, users have the option to disable all main sections of the report. This flexibility allows the user to view and print only the sections that are needed.

Compare across Multiple Reference Samples

Examiners can now select up to three reference samples to include in the Single-Rater report. For example:

• Compare the results from Combined Gender norms, as well as Gender-Specific Male and Female norms (for information on which reference sample to select for transgender youth, non-binary youth, and those who do not identify as either male or female, see Understanding Reference Samples in chapter 3, Scoring and Reports).

• Compare the youth’s results to a Normative Sample and an ADHD Reference Sample to examine not only how the client compares to a typical population, but also how they compare to other youth already diagnosed with ADHD. The ADHD Reference Sample is available for the Conners 4 Single-Rater reports only.

Ability to Exclude Sensitive Content

Some users may want to exclude sensitive items regarding harm to self and/or violent or destructive behavior for certain assessment contexts (e.g., for younger raters). Although it is recommended that these items are always asked, it is now possible to exclude these items by removing the Self-Harm Critical Items and the DSM Conduct Disorder Symptoms scale (which houses all of the Severe Conduct Critical Items) from the assessment. If removed, the rater will not see the items and they will not appear on the report. Please see chapter 2, Administration, for details.

Use Purchase & Consumption

On the MHS Online Assessment Center+, instead of purchasing specific form types of the Conners 4 based on length (i.e., full-length vs. Short vs. ADHD Index), rater (Parent vs. Teacher vs. Self-Report) or language (i.e., English vs. Spanish vs. French), users can now purchase a general Conners 4 use and apply it across any form on the Conners 4. A use is consumed when a Conners 4 report is generated in the MHS Online Assessment Center+. This increases flexibility as users do not need to manage multiple balances of forms, and instead can manage one total use balance.