Connor’s Rating Scale for ADHD – 3

Psycho-diagnostic Report

Introduction

The Conners Rating Scale is a diagnostic tool used to assess ADHD and related

behavioral/emotional disorders in children aged 6–18 years. It includes three primary forms:

parent version, teacher version and self-report version. Domains assessed are inattention,

hyperactivity/impulsivity, learning problems, executive functioning, aggression and peer

relations.

Authors, History, and Test Development

The Conners Rating Scale was developed by Dr. C. Keith Conners in 1969 by Multi

Health Systems. It was first released in 1969 as the Conners Teacher rating scale to assess

hyperactivity. In 1970 the Conners Parent Rating Scale was developed to gather parental reports.

In 1997 a major revision occurred with the introduction of Conners' Parent and Teacher Rating

Scales–Revised (CPRS-R / CTRS-R), which covered ADHD symptoms and related behavioural

issues, including both long and short forms. Conners 3 (Conners Third Edition) was released in

2010, which incorporated DSM-IV-TR alignment, adding parent, teacher, and self-report forms,

along with an ADHD Index, Global Index, and executive functioning scales. Conners 4 (Latest

Version), which was released in 2022, provides a thorough evaluation of symptoms and

impairment associated with ADHD as well as prevalent co-occurring disorder and problems, and

also improves culture and linguistic adaptation, expands norms, improves scoring, and updates

for the DSM-5.

Brief introduction about the conditions/variables the test assesses

The Conners’ 3 rating scale of ADHD assesses the symptoms of ADHD across multiple

dimensions closely aligning it with the DSM-5 criteria. Firstly, inattention is related to

behaviours such as the inability to focus for a longer duration and hold sustained attention on

tasks requiring focus for long, being distracted easily and difficulty initiating or completing

tasks. (Conners & Multi-Health Systems Inc., 2008). Secondly, hyperactivity or impulsivity is

characterised by the frequent need to move around, fidget or squirm, and inability to remain

seated in one designated space. Similarly, impulsivity is noted in terms of difficulty being quiet,

interrupting others or blurting often etc. (Conners & Multi-Health Systems Inc., 2008). Across

the domain of learning problems, difficulties are observed in regard to arithmetic, spelling,

reading, writing, making meaning of what is written, often requiring extra explanations. (Wu et

al., 2023). Executive functioning is assessed across behaviours such as planning and organizing,

ability to meet deadlines and turning in completed work on time, as well as poor last-minute

work submissions. Since Conner’s test is also used to aid assessment of Oppositional Defiant

Disorder (ODD) and Conduct Disorder, the dimension of defiance or aggression, evaluates

behaviours such as threatening or bullying others, physical or verbal forms of aggression,

destructive tendencies of behaviour, displaying argumentative behaviours, initiating fights,

display poor control of anger and impulses and so on. The Conners rating scale also gauges peer

relations domain through items evaluating ability to form friendships, nature of social

relationships, feeling of being overlooked in a friend group etc. (Conners & Multi-Health

Systems Inc., 2008).

Apart from that, the self-report version of Conners 3 also computes behaviours related to

family relations such as difficulties in relationships with family members such as frequent
conflicts, hostility, emotional distancing and defiance. (Conners & Multi-Health Systems Inc.,

2008)

Psychometric properties of the test

Indian norms

​ ​ The Conners assessment is currently widely used in India. A cross-cultural study

conducted in Mumbai, suggested that the important dimensions to be tested for ADHD are

covered. Although, Indian teachers observed somewhat different patterns of issues compared to

American teachers (Rosenberg & Jani, 1995). Additionally, a translated version of the CPRS-48

was used among Rural West Bengali families. After the researchers removed any ambiguities

and rephrased certain questions there was ease of comprehension and the mean scores were

similar to the American population (Pal et al., 1999). It can be observed that the main dimensions

to be investigated are fulfilled in the Indian setting. While, translation to local language and

rephrasing certain questions in accordance to Indian context while conducting the tests in India

further increases the validity.

Reliability

​ ​ The test- retest reliability is very good. The coefficients are ranging from .71 to

.98 (Pearson’s r) in the 2-to-4-week test-retest measure. The internal consistency for the form is

very good as well, the coefficients are .77 to .97 (Cronbach’s alpha) for the total sample

examined. Also, the Inter-rater reliability is good showing coefficients ranging from .53 to .94

(Conners, 2015).

Validity
 The Conners 3, being a revision of the Conners Rating Scales – Revised (CRS-R™;

Conners, 1997), incorporates new Validity Scales: Positive Impression, Negative Impression,

Inconsistency Index. Besides, Screener items, Critical items, and Impairment items are newly

added. Additionally, items are updated according to DSM-5 as well. (Conners, 2015). The

validity of the structure of the form was gained using factor analytic techniques. The convergent

and divergent validity was obtained by assessing the association with other related assessments.

Additionally, the discriminative validity was proven statistically (Conners, 2015).

Administration of Conners 3

​ ​ The Conners 3 rating booklet is a simple paper-pencil test which is administered

on individuals between the ages 6-18. The test evaluates symptoms of ADHD based on the

DSM-IV diagnostic criteria of ADHD. Selection of which form to be used is decided by purpose

of the administration- Full Length forms for comprehensive evaluation especially at the initial

assessment, Short forms for follow-up and progress monitoring, and Index forms in case of time

constraint and rater’s availability (Conners, 2008).

​ ​ Conners 3 can be administered either in a group or individual setting. The

administration should be ideally completed in one setting and is to be done individually. It is

important for the rater to consider behaviour that has occurred within the past month when

completing the form. It is recommended that the appropriate rater (parent or teacher) must know

the child/adolescent) for at least 1 month before completing the form (Conners, 2008).

​ ​ The Full length Conners3 forms have 99-115 items and take about 15-20 minutes

to complete. The Short forms have between 41-45 items completed within 10 minutes. The Index

forms with 10 items can be completed within 5 minutes (Conners, 2008).

 ​ ​ The items in Conners3 are rated on a four-point Likert scale:

In the past month, this was…

●​ 0=Not true at all (Never, Seldom)

●​ 1=Just a little true (Occasionally)

●​ 2= Pretty much true (Often, Quite a bit)

●​ 3= Very much true (Very Often, Very Frequently)

Instructions and Scoring of the CONNERS3

​ ​ Scoring of the Conners3 ratings can be done by hand. A scoring grid is provided

in the form along with corresponding score numbers for each item rating. Each rating is

transferred onto the appropriate score value. The circled number is then entered into the

unshaded box across each row. The values in each column are summed up to obtain the total raw

scores for each scale of the test.

​ ​ The Conners3 forms also include a score profile for both Gender and age-groups

(6-11 & 12-18 for Parent and Teacher forms, and 8-12 & 13-18 for Self-Report forms). Using the

Raw Scores from the Scoring Grid, circle the raw score for each scale under the appropriate scale

and age column. Follow the row across to either outside column to find the T-score for each

scale. Connect the circled scores with a straight line to obtain the profile (Conners, 2008).

Additionally, Response Style Analysis is performed by transferring the Raw Scores for

both Positive Impression (PI) and Negative Impression (NI) scales from the Scoring Grid into the

appropriate box below the profile table. Insert a checkmark in the Interpretative Guideline box if

the response style is indicated.

 Interpretations are made using the T-scores obtained for each scale:

●​ T-scores <60 indicate typical functioning.

●​ T-scores between 61-70 indicate slightly atypical behaviour to moderately severe

symptoms.

●​ T-scores >70 indicate very atypical or severe symptoms.

Current Relevance of the Test

The Conners-3 continues to be a widely supported instrument in the diagnosis of

attention deficit disorder/hyperactivity (ADHD) and other behavioural issues in a child and

adolescent. Its reliability, validity, or cross-cultural generalizability is consistently confirmed in

recent studies, both in empirical studies of parent, teacher, and self-report formats and on the

meta-analytic evidence (Izzo et al., 2019; Morales-Hidalgo et al., 2016; Gomez & Vance, 2019).

The brevity and clarity of the short forms make them especially useful in an initial

screening and applicable to various locations due to its high rate of precision in the diagnostic.

Research reports have good psychometric qualities, with significant symptoms that have

measurement invariance by gender or strong discriminant validity of dimensions of core

symptoms along with comorbid conditions like oppositional defiant disorder (ODD) (Gomez et

al., 2019).

When it comes to these strengths, research indicates that there is fairly low

inter-informant concordance, especially in inattention and hyperactivity/impulsivity, which

highlights the need to focus on multi-informant assessment to achieve a comprehensive

behavioural phenotype (Gomez et al., 2018; Izzo et al., 2018).

Applications of the test

The Conners-3 is a multifaceted clinical and research tool having a number of major

applications. As a measure used in individual assessment, it can provide multi-rater data-based

whereas parent, teacher, and self-report-based data provide the opportunity to evaluate the

symptomatology of attention-deficit/hyperactivity disorder (ADHD) and other behavioral

problems in a systematic manner. The given measure reduces the impact of the informant bias

and improves the overall scope of clinical judgment due to its proven reliability and validity

(Izzo et al., 2018; Izzo et al., 2019; Haidar, 2021).

The Conners-3 enables teachers to classify students with ADHD and other disorders in

educational settings, which helps in decision making on whether the students qualify to be put in

special education or the kind of accommodation that suits the student by providing data that

conforms to educational requirements. In addition to that, evidence-based decisions on

interventions and service delivery rely on the standardized scores based on the instrument

(Morales-Hidalgo et al., 2016; Gomez et al., 2019; Haidar, 2021).

At group or population levels, the full-length and short forms of the Conners-3 provide

psychometrically sound screening and triaging processes of identifying children at risk of ADHD

and comorbid disorders in clinical or school-based settings. In this regard, the instrument

promotes early intervention by quick screening of those who should be intervened on either

further assessment or intervention (Izzo et al., 2019; Gomez et al., 2019; Morales-Hidalgo et al.,

2016; 2023).

In checking the efficacy of treatment, repeated administrations of the Conners-3 would

allow the clinician to see an improvement or decrement of symptoms as time progresses, and
therefore allow them to gauge the rate at which treatment is achieving desired efficacy, and to

adjust the treatment approach where needed. The collection of such longitudinal data has been

one of the most useful, particularly in the study of pharmacological and psychosocial

interventions (Haidar, 2021; Izzo et al., 2018).

 Proforma of the Client

Name: SS

Age: 17 years 10 Months

Gender: Female

Education: 12th Grade

Languages Spoken: English, Kannada, Hindi & Tulu

Informant: KS, Mother

Presenting Complaints

1.​ Client reports feeling overwhelmed and being “burnt out” due to the stress of balancing

dance classes and school.

Purpose of Administration:

To assess if the client shows signs and symptoms of ADHD primarily in the domains of

Inattention, Executive Functioning, Hyperactivity/Impulsivity, Learning Problems,

Defiance/Aggression, Peer Relations, and Family Relations using Conner’s Rating Scale for

ADHD 3 – Self-Report Short and Conner’s Rating Scale for ADHD 3 – Parent Short.

Observation:

The client, SS, was observed to be well groomed, polite and in a distressed mood. Client reported

being overwhelmed with balancing her roles as a student and a classical dancer. The client

displayed signs of stress as she described her stressors regarding her upcoming dance

performance and exams.

Tests Administered:

1.​ Conner’s Rating Scale for ADHD 3 – Self-Report Short

 2.​ Conner’s Rating Scale for ADHD 3 – Parent Short

Results

Table 7.1: Results for Connor’s Rating Scale for ADHD – Parent Report Form

Dimensions Raw Score T Score Interpretation

Inattention 7 66 Moderately Elevated

Hyperactivity/Impulsivity 10 86 Very Elevated

Executive Function 4 52 Average

Learning Problems 3 54 Average

Aggression 1 52 Average

Peer Issues 3 64 Moderately Elevated

Response Style Analysis

Raw Score Interpretation

Positive Impression 1 No Possible Positive Response Style

Negative Impression 3 No Possible Negative Response Style

Table 7.1 presents the raw score, T score (as reported by the client) and the interpretation of the

same in the following dimensions: Inattention, Hyperactivity/Impulsivity, Learning Problems,

Defiance/Aggression and Family Relations.

Table 7.2: Results for Connor’s Rating Scale for ADHD- Self Report Form

Dimensions Raw Score T Score Interpretation

Inattention 8 60 Average

Hyperactivity/Impulsivity 9 68 Moderately Elevated

Learning Problems 4 52 Average

Aggression 5 70 Very Elevated

Family Relations 0 42 Average

Response Style Analysis

Raw Score Interpretation

Positive Impression 0 No Possible Positive Response Style

Negative Impression 3 No Possible Negative Response Style

Table 7.2 presents the raw score, T score (as reported by the parent of the client) and the

interpretation of the same in the following dimensions: Inattention, Hyperactivity/Impulsivity,

Learning Problems, Executive functioning, Defiance/Aggression and Peer Relations.

 Interpretation

Inattention:

Inattention is related to behaviours such as the inability to focus for a longer duration and hold

sustained attention on tasks requiring focus for long, being distracted easily and difficulty

initiating or completing tasks (Conners & Multi-Health Systems Inc., 2008).

The client shows moderately elevated atypical inattention patterns as indicated by the T-score.

The client reports no trouble in paying attention to details, keeping track of tasks, seeing tasks to

completion and concentrating on certain things. She reports no trouble in sustaining attention for

long periods and ignoring distractions. The parent of the client conflicts with the client’s

self-observation and reports moderate problems with sustained attention, making careless

mistakes, attention span, distractibility, concentration, turning in work on time, etc.

Thus, the client subjectively does not suffer from inattention, whereas the parent reports

moderate inattention patterns in the client.

Hyperactivity/Impulsivity:

Hyperactivity and impulsivity are characterised by the frequent need to move around, fidget or

squirm, and inability to remain seated in one designated space, difficulty being quiet, interrupting

others or blurting often, etc. (Conners & Multi-Health Systems Inc., 2008). The parent reports

very elevated problems with fidgeting, restlessness, acting as if driven by a motor, constant

movement, excitability and impulsivity. The client reports moderately elevated impulsivity

patterns, blurting out answers and talking too much occasionally, if particularly excited. The

client reports problems with restlessness and overthinking. She reports that she has trouble sitting
still quite often. Thus, the client shows moderately elevated problems with Hyperactivity and

Impulsivity.

Learning Problems:

Learning problems include difficulties with regard to arithmetic, spelling, reading, writing, and

making meaning of what is written, often requiring extra explanations (Wu et al., 2023). The

client reports no problems with reading, spelling and understanding written material. The parent

corroborates with the client and reports absolutely no learning problems. The parent notes that

the client needs no extra instruction or explanations and is gifted academically. Thus client is

concluded to show no learning difficulties.

Aggression:

The dimension of aggression is evaluated through behaviours threatening or bullying others,

physical or verbal forms of aggression, destructive tendencies of behaviour, displaying

argumentative behaviours, initiating fights, displaying poor control of anger and impulses etc.

(Conners & Multi-Health Systems Inc., 2008). The client reports that she starts fights with other

people when her standards for work aren't met by her peers when working in group settings. The

client does not report any destructive behaviour like breaking things when angry or destroying

others’ property. The parent reports no bullying or threatening behaviour, lying or excessive

resentment and anger.

Thus, it can be concluded that the client displays aggression when her perfectionist ideals aren't

met by her peers.

Executive Functioning:

Executive functioning is assessed across behaviours such as planning and organising, ability to

meet deadlines and turning in completed work on time, as well as poor last-minute work

submissions (Conners & Multi-Health Systems Inc., 2008). The client reports having no

problems with memory w.r.t keeping track of school work. The parent reports that the client has

no problems with planning and organising, ability to meet deadlines and turning in completed

work on time, as well as poor last-minute work submissions. Thus, keeping in mind the

interpretation of t-score, it can be inferred that the client has optimal executive functioning.

Family Relations:

This particular dimension includes behaviours such as difficulties in relationships with family

members, such as frequent conflicts, hostility, emotional distancing and defiance (Conners &

Multi-Health Systems Inc., 2008). The client reports no harshness w.r.t punishments, heightened

expectations and criticism from parents. Thus, keeping in mind the interpretation of t-score, it

can be inferred that the client has no difficulties in her family relationships.

Peer Relations:

The domain is assessed through items evaluating ability to form friendships, nature of social

relationships, feeling of being overlooked in a friend group etc. (Conners & Multi-Health

Systems Inc., 2008). The parent of the client reports that she has a lot of problems making and

keeping friends. She is reported to have had very few friends during her school days with

examples of how she walked out alone from school every day.

Thus, keeping in mind the interpretation of t-score, it can be inferred that the client has moderate

difficulties in her peer relationships.

 Impression

The client shows signs of hyperactivity and some aggression; otherwise, no signs of ADHD,

ODD and Conduct Disorder.

Recommendations

Since the client shows signs of hyperactivity and some aggression, interventions and therapy

related to impulse control is recommended. The client shows signs of rigidity and perfectionism.

Assessing for traits of ASD is recommended. The client might benefit from time management

strategies.

Summary

The Conners Rating Scales (Parent and Self-Report Forms) were administered on SS, a

17-year-old female undergoing secondary education. Hyperactivity and impulsivity are more

consistently reported, with the parent indicating very elevated levels and the client reporting

moderately elevated patterns, both forms describing restlessness, impulsive behaviour, and

trouble remaining still. Executive functioning and learning problems fall within the average

range across both reports, suggesting the client demonstrates age-appropriate planning,

organization, and academic functioning. Notably, aggression is rated as very elevated in the

self-report, contextualized by the client’s interpersonal frustration and perfectionism during

group work, while the parent observes no such behaviours, pointing to possible context-specific

irritability or frustration-driven outbursts.

Peer relationship difficulties are noted as moderately elevated by the parent, referencing a history

of social withdrawal or challenges in maintaining friendships, whereas the client does not raise

such concerns in the self-report. Family relations, executive functioning, and response style

indices are within normal limits, indicating the absence of distortion in self-presentation. Taken

together, the findings suggest the client does not meet the full criteria for ADHD, ODD, or

Conduct Disorder at this stage. However, signs of elevated hyperactivity and aggression,

possibly linked to rigid perfectionistic tendencies, warrant clinical attention. Considering the

rigidity and interpersonal frustration, a further assessment for autism spectrum traits may be

beneficial to clarify underlying factors contributing to the behavioural profile.

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