Conners 4 Manual Chapter 7: Description of ADHD Reference Samples

Description of ADHD Reference Samples

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• Demographic Characteristics of the ADHD Reference Samples
• Treatment Status of the ADHD Reference Samples
• Medication Status of the ADHD Reference Samples
• Non-Medication Treatment Status of the ADHD Reference Samples
• Demographic Characteristics of the ADHD Reference Sample Raters

Demographic Characteristics of the ADHD Reference Samples

A total of 1,110 youth were included in the ADHD Combined Gender Reference Samples (N = 560 for Parent, N = 321 for Teacher, and N = 229 for Self-Report). Where the purpose of a normative sample is to establish norms for the broader population, the purpose of an ADHD reference sample is to aid in clinical decision making using standardized scores that reflect only youth diagnosed with ADHD, given that these youth present with a distinct profile of scores (see Clinical Group Differences in chapter 9, Validity, for more details on these score profiles). The ADHD Reference Samples consist of youth from a clinical population who had been previously diagnosed with one of the three ADHD presentations (i.e., Predominantly Inattentive, Predominantly Hyperactive/Impulsive, or Combined). Many youth also had at least one additional clinical diagnosis (42.6% for Parent, 43.2% for Teacher, 51.1% for Self-Report), which is reflective of a typical youth with ADHD (i.e., ADHD often co-occurs with other disorders). The most common co-occurring diagnoses were Generalized Anxiety Disorder and Specific Learning Disabilities. Table 7.30 displays the distribution of gender by age group within the Combined Gender ADHD Reference Samples. Table 7.31 summarizes the key demographic characteristics of the Combined Gender ADHD Reference Samples. This information on gender by age group and key demographic characteristics can also be found for the Gender Specific ADHD Reference Samples in Tables 7.32 and 7.33, respectively. Note that the Gender Specific ADHD Reference Samples include one fewer case than the Combined Gender sample, as one case indicated a gender other than male or female and therefore could not be classified in the Gender Specific samples. While the sample sizes are small by age group, continuous norming methodology was applied to allow for the conversion of raw scores to T-scores for all ages (see Standardization Procedures and Continuous Norming in this chapter).

Youth in the ADHD Reference Samples came from various school types (approximately 84.7% were enrolled in public schools, and the remaining students were enrolled in private schools or those labelled“other school type”), urbanicities (a large portion of the youth attended school in an urbanized area with a population of 50,000 people or more—47.9% Parent, 38.9% Teacher, 54.1% Self-Report; the remaining youth lived in urban clusters or rural areas), and the majority of the youth spoke only English (91.9% Parent, 96.2% Teacher, 91.6% Self-Report; the remaining youth were bilingual).

Treatment Status of the ADHD Reference Samples

Clinicians and raters in the ADHD Reference Samples were asked about the treatment status (both medication treatments as well as psychosocial treatments) of the youth being rated. The vast majority of the youth were receiving at least one form of treatment (99.1% for Parent, 96.0% for Teacher, 85.2% for Self-Report).

Medication Treatment Status of the ADHD Reference Samples

Raters in the ADHD Reference Samples were asked whether the youth being rated takes medication to treat psychological or psychiatric conditions. This information was confirmed by the youth’s clinician. Reported medication use varied from 59.5% to 68.6% across forms (see Table 7.36). Scale- and item-level differences in medication use were examined using effect sizes (as measured by Cliff’s d; Cliff, 1993) to assess whether medication use impacted item- or scale-level ratings. No meaningful differences were observed across all forms when comparing ratings of youth who were taking medication to those who were not. Scale-level differences ranged from trivial to small effect sizes across Parent, Teacher, and Self-Report ratings (see Table 7.37). At the item level, all items showed trivial to small effect sizes across all forms (Cliff’s d = -0.24 to 0.14). Considering the absence of meaningful differences between groups, further analyses in this manual were conducted on the full ADHD Reference Samples, collapsing across medication status.

Non-Medication Treatment Status of the ADHD Reference Samples

Of the youth in the ADHD Reference Samples receiving non-medication treatments, the most frequently reported treatments were Special Education and Psychological Therapy. The other forms of treatment that were most commonly listed included family therapy, private tutoring or private schooling, school-based intervention such as Scientific Research Based Intervention, or social work. See Table 7.38 and Table 7.39 for a summary of the forms of treatments that were reported in the Combined Gender and Gender Specific ADHD Reference Samples, respectively.

Demographic Characteristics of the ADHD Reference Sample Raters

Table 7.40 contains a summary of the demographic characteristics that describe the parent/guardians who rated their child using the Conners 4 Parent and of the teachers who rated their students using the Conners 4 Teacher in the ADHD Combined Gender Reference Samples. Details of the demographic characteristics of the raters in the Conners 4 Gender Specific ADHD Reference Samples can be found in Table 7.41.

In examining the Combined Gender samples, the majority of the Parent raters were female (92.1%) and were White (85.2% in the U.S.) or not a visible minority (91.2% in Canada). There are a variety of relationships between the parent/guardian rater and the youth being rated, with biological mother as the most common relationship at 84.3%, followed by biological father at 6.8%. Parent raters who indicated that they were an “Other relative,” a “Non-relative,” or an “Other guardian” (1.4%) were asked to specify how they were related to the child being rated. The most frequent response was grandmother.

Teacher raters were predominantly female (81.9%) and were White (89.5% in the U.S.) or not a visible minority (100.0% in Canada). Half of the teachers reported that they taught at the elementary school level (50.8%), followed by middle school/junior high schools (24.0%), and district K–12 schools (24.0%). Teachers were asked to report the class(es) taught to the student being rated. A qualitative analysis revealed that all core subject areas from Kindergarten to Grade 12 were represented, including, but not limited to, social science, languages, mathematics, science and technology, arts, health and physical education, and special education. Teachers reported that they either knew the student being rated very well (52.6%) or moderately well (47.4%). A large portion reported having known the student for 6 months or longer (77.6%) prior to rating them, and a large portion of teachers indicated that they interacted with the student being rated on a daily or almost daily basis (82.9%).

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