C. Keith Conners, Ph.D.

PARENT | SINGLE-RATER REPORT

Name/ID: Amelie AA
CHILD

Birth Date: May 29, 2012

Age: 12
Grade:
Gender: Female

Parent’s/Guardian’s Name/ID:
RATER

Relationship to Child: Biological parent

Administration Date: July 3, 2024

OTHER

Examiner: González Cousido, Noelia

Data Entered By:
Assessment Language: Spanish
OPTIONS

Principal Reference Sample: Normative Sample Gender Specific–Females

NORM

Additional Reference
Sample(s):

This computerized report is an interpretive aid intended for use by qualified professionals only. It should not be used as th e sole criterion for clinical
diagnosis or intervention. Conners 4 results should be combined with information gathered from other psychometric measures, interviews, observations,
and review of available records. This report is based on algorithms that produce the most common interpretations for the scores that have been obtained.
The rater’s responses to specific items should be reviewed to ensure that these typical interpretations apply to the youth being described. This report is
intended for use by qualified individuals. Parts of this report contain copyrighted material, including test items. If it is necessary to provide a
copy of this report to anyone other than the examiner, sections containing copyrighted material must be removed.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

OVERVIEW ! Critical » Follow-Up ? Could Not Be Scored

Response Style Analysis
Negative
0 Impression Index
Raw Score
0 Inconsistency Index
Raw Score 0 Omitted Items

Critical & Indicator items

No endorsement of Severe Conduct Critical Items.

Severe Conduct
Critical Items

Self-Harm Critical
! Items
• Harming self deliberately

Sleep Problems Typical endorsement of Sleep Problems Indicator items.

Indicator

Conners 4 Scales

Note. 🗨 DSM Symptom Count. Inattention/Executive Dysfunction (INA/EDF), Hyperactivity (HYP), Impulsivity (IMP), Emotional Dysregulation (EM DYS), Depressed Mood (DEP), Anxious
Thoughts (ANX), Schoolwork (SCHOOL), Peer Interactions (PEER), Family Life (FAMILY), DSM ADHD Inattentive Symptoms (ADHD-I), DSM ADHD Hyperactive/Impulsive Symptoms
(ADHD-HI), DSM Total ADHD Symptoms (ADHD-TOT), DSM Oppositional Defiant Disorder Symptoms (ODD), DSM Conduct Disorder Symptoms (CD). Although not sufficient for a
diagnosis, the DSM requires a Symptom Count of at least 6/9 for both ADHD-I and ADHD-HI, a Symptom Count of at least 4/8 for ODD, and a Symptom Count of at least 3/15 for CD. For
ADHD Combined, a Symptom Count of at least 6/9 is required for both ADHD-I and ADHD-HI.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

RESPONSE STYLE ANALYSIS

Negative Impression
Index
Based on the Negative Impression Index score (raw score = 0), there was no indication of
exaggerated responding.
0 Raw Score

Inconsistency Index
Based on the Inconsistency Index (raw score = 0), there was no indication of inconsistent
responding.
0 Raw Score

Omitted Items
The parent responded to all Conners 4 items.
0

Critical & Indicator items

Severe Conduct Critical Items
Stealing while confronting someone – Not true at all (Never/Rarely)
None of the Severe Conduct Critical Setting fires to cause damage – Not true at all (Never/Rarely)
Items were endorsed by the parent. Breaking and entering – Not true at all (Never/Rarely)
Cruelty to animals – Not true at all (Never/Rarely)
Using a weapon – Not true at all (Never/Rarely)
Forcing sexual activity – Not true at all (Never/Rarely)

! Self-Harm Critical Items

One or more of the Self-Harm Critical
Items were endorsed by the parent. ! Harming self deliberately – Just a little true (Occasionally)
Immediate follow-up is strongly Talking about, planning, or attempting suicide – Not true at all (Never/Rarely)
recommended.

Sleep Problems Indicator

Compared to ratings of 12-year-old
females, the parent’s responses to the Having trouble sleeping – Not true at all (Never/Rarely)
Sleep Problems Indicator items were Appearing tired – Not true at all (Never/Rarely)
typical.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

CONNERS 4 SCALES
CONTENT SCALES

Within-Profile Comparisons
Raw
T-score 90% CI Percentile Guideline Difference from the youth’s Significant difference
Score
average (T = 47) (p < .05)
Inattention/Executive
Dysfunction 14 51 48–54 58th Average + 4.0 Higher

Hyperactivity 5 47 42–52 50th Average 0 Not Significant

Impulsivity 0 39 34–44 4th Low - 8.0 Lower

Emotional Dysregulation 5 51 47–55 74th Average + 4.0 Higher

Depressed Mood 2 51 46–56 76th Average n/a n/a

Anxious Thoughts 3 55 50–60 84th Average n/a n/a

IMPAIRMENT & FUNCTIONAL OUTCOME SCALES

Within-Profile Comparisons
Raw
T-score 90% CI Percentile Guideline Difference from the youth’s Significant difference
Score
average (T = 52.7) (p < .05)
Schoolwork 6 56 51–61 82nd Average + 3.3 Not Significant

Peer Interactions 4 56 51–61 82nd Average + 3.3 Not Significant

Family Life 1 46 42–50 52nd Average - 6.7 Lower

DSM SYMPTOM SCALES

Raw
T-score 90% CI Percentile Guideline Symptom Count
Score
ADHD Inattentive
Symptoms 7 49 45–53 55th Average 0/9 [DSM requires ≥ 6/9 symptoms]
ADHD Hyperactive/Impulsive
Symptoms 4 45 41–49 39th Average 1/9 [DSM requires ≥ 6/9 symptoms]

Total ADHD Symptoms 11 47 43–51 48th Average n/a

Oppositional Defiant
Disorder Symptoms 2 45 42–48 54th Average 1/8 [DSM requires ≥ 4/8 symptoms]
Conduct Disorder
Symptoms 1 48 44–52 66th Average 0/15 [DSM requires ≥ 3/15 symptoms]

CONNERS 4–ADHD INDEX

Raw Score Probability Score Guideline

ADHD Index 10 9% Very Low

Note(s).
CI = Confidence Interval
n/a = not applicable. The Depressed Mood and Anxious Thoughts scales are not included in the Within-Profile Comparisons. Additionally, Symptom
Counts are not applicable to DSM Total ADHD Symptoms. Please refer to the Conners 4 Manual for details.
A Symptom Count of at least 6/9 on both DSM ADHD Inattentive Symptoms and Hyperactive/Impulsive Symptoms is required to meet DSM Criteria for
ADHD Combined.
ⓘ Symptom Count scores for all DSM Symptom Scales contribute to diagnostic assessment but are not sufficient for determining a diagnosis. Please
refer to the Conners 4 Manual for interpretive considerations.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

INTERPRETIVE SUMMARY
Response Style Analysis

The Response Style Analysis (Negative Impression Index, Inconsistency Index, and Omitted Items) provides an
evaluation of how the parent approached completing the Conners 4.

▪ Negative Impression Index: Based on the Negative Impression Index score (raw score = 0), there was no
indication of exaggerated responding.

▪ Inconsistency Index: Based on the Inconsistency Index score (raw score = 0), there was no indication of
inconsistent responding.

▪ Omitted Items: The parent responded to all Conners 4 items.

Critical & Indicator Items

The Critical & Indicator Items provide a quick screening of harm to self or others, violent or destructive behaviors,
and problems with sleep. Information from these items should be examined in combination with responses from
other informants and a comprehensive assessment including interviews, observations, and a review of records.
Please see chapter 4 of the Conners 4 Manual for more information.

▪ Severe Conduct Critical Items: None of the Severe Conduct Critical Items were endorsed by the parent.
▪ Self-Harm Critical Items: The parent endorsed the following Self-Harm Critical Item for which immediate
follow-up is recommended: harming self deliberately.

▪ Sleep Problems Indicator: Compared to ratings of 12-year-old females, the parent’s responses to the Sleep
Problems Indicator items were typical.

Content Scales

This section summarizes Amelie’s Conners 4 Content Scale results, including: (a) a normative sample comparison
of their results to parent ratings of 12-year-old females, and (b) a within-profile comparison of Amelie’s results to
their own average score.

Normative Sample Comparisons:

Each of Amelie’s Content Scale raw scores was compared with what is typically reported by parents of 12 -year-old
females to obtain T-scores and percentiles. Higher T-scores and percentiles on the Conners 4 Content Scales
indicate more frequent or severe problems in the domain covered by that scale. The Items by Scale section of this
report displays the parent’s ratings to all Content Scale items and may inform further interpretation of the scale
scores; please see this section for a review of specific item-level elevations.

▪ Inattention/Executive Dysfunction (T-score = 51 [90% CI = 48–54]; Percentile = 58th): The

Inattention/Executive Dysfunction T-score is in the Average range. This scale includes items related to having
trouble paying attention and sustaining attention, as well as difficulty with other areas of executive functioning
such as planning, organizing, and time management. The parent reported that Amelie exhibits no more
difficulty in these areas than is typically reported by parents of 12-year-old females. None of the items on this
scale had elevated ratings.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

▪ Hyperactivity (T-score = 47 [90% CI = 42–52]; Percentile = 50th): The Hyperactivity T-score is in the Average
range. This scale includes items about restlessness, difficulty staying seated or sitting still, needing to move
around, getting overly excited, and talking too much. The parent reported that Amelie exhibits no more features
of hyperactivity than are typically reported by parents of 12-year-old females. Although the scale T-score was in
the Average range, it may be informative to review the 2/11 items that had elevated ratings.

▪ Impulsivity (T-score = 39 [90% CI = 34–44]; Percentile = 4th): The Impulsivity T-score is in the Low range. This
scale includes items about interrupting others, blurting out answers, acting before thinking, and having trouble
waiting for one’s turn. The parent reported that Amelie displays less impulsivity than is typically reported by
parents of 12-year-old females. None of the items on this scale had elevated ratings.

▪ Emotional Dysregulation (T-score = 51 [90% CI = 47–55]; Percentile = 74th): The Emotional Dysregulation T-
score is in the Average range. This scale includes items about overreacting, losing temper, and having trouble
calming down. The parent reported that Amelie exhibits no more difficulty controlling and managing emotions
than is typically reported by parents of 12-year-old females. Although the scale T-score was in the Average
range, it may be informative to review the 1/8 items that had elevated ratings.

▪ Depressed Mood (T-score = 51 [90% CI = 46–56]; Percentile = 76th): The Depressed Mood T-score is in the
Average range. This scale includes items related to feeling sad, lacking enjoyment in things that used to be
enjoyed, and feeling hopeless about the future. The parent reported that Amelie seems to experience no more
features of depressed mood than are typically reported by parents of 12-year-old females. Although the scale T-
score was in the Average range, it may be informative to review the 1/6 items that had elevated ratings.

▪ Anxious Thoughts (T-score = 55 [90% CI = 50–60]; Percentile = 84th): The Anxious Thoughts T-score is in the
Average range. This scale includes items about youths' experience of—or difficulty with—regulating fears or
worries, including appearing tense or nervous, and worrying too much about different things. The parent reported
that Amelie appears to experience no more anxiety than is typically reported by parents of 12-year-old females.
None of the items on this scale had elevated ratings.

Within-Profile Comparisons:
Within-profile comparisons were conducted on the following scales: Inattention/Executive Dysfunction,
Hyperactivity, Impulsivity, and Emotional Dysregulation. Each scale’s T-score was compared to Amelie’s average
T-score of 47.0 on these scales. Based on the parent’s ratings, Amelie’s Inattention/Executive Dysfunction and
Emotional Dysregulation T-scores were significantly higher than their average T-score, suggesting relatively more
difficulties in these areas. Their Hyperactivity T-score was consistent with their average T-score. Their Impulsivity T-
score was significantly lower than their average T-score, suggesting relatively fewer difficulties in this area.

Impairment & Functional Outcome Scales

This section summarizes Amelie’s Conners 4 Impairment & Functional Outcome Scale results, including: (a) a
normative sample comparison of their results to parent ratings of 12-year-old females, and (b) a within-profile
comparison of Amelie’s results to their own average score.
Normative Sample Comparisons:
Each of Amelie's Impairment & Functional Outcome Scale raw scores was compared with what is typically
reported by parents of 12-year-old females to obtain T-scores and percentiles. Higher T-scores and percentiles on
the Conners 4 Impairment & Functional Outcome Scales indicate more frequent or severe impairment in the domain
covered by that scale. The Items by Scale section of this report displays the parent’s ratings to all Impairment &
Functional Outcome Scale items and may inform further interpretation of the scale scores; please see this section
for a review of specific item-level elevations.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

▪ Schoolwork (T-score = 56 [90% CI = 51–61]; Percentile = 82nd): The Schoolwork T-score is in the Average
range. This scale includes items related to turning in late or incomplete work, losing homework, and not checking
their work for mistakes. The parent reported that Amelie exhibits no more impairment in schoolwork than is
typically reported by parents of 12-year-old females. None of the items on this scale had elevated ratings.

▪ Peer Interactions (T-score = 56 [90% CI = 51–61]; Percentile = 82nd): The Peer Interactions T-score is in the
Average range. This scale includes items related to the youth annoying their peers, not being invited by others to
play or go out, and others not wanting to be friends with them. The parent reported that Amelie exhibits no
more impairment when interacting with peers than is typically reported by parents of 12-year-old females.
Although the scale T-score was in the Average range, it may be informative to review the 3/6 items that had
elevated ratings.

▪ Family Life (T-score = 46 [90% CI = 42–50]; Percentile = 52nd): The Family Life T-score is in the Average
range. The items on this scale reflect family disruptions caused by the youth, such as creating stress and chaos
among family members, as well as causing the family to be late for appointments. The parent reported that
Amelie exhibits no more impairment when interacting and getting along with family members than is typically
reported by parents of 12-year-old females. None of the items on this scale had elevated ratings.

Within-Profile Comparisons:
Within-profile comparisons were conducted on the Conners 4 Impairment & Functional Outcome Scales. Each
scale’s T-score was compared to Amelie’s average T-score of 52.7 on these scales. Based on the parent’s ratings,
Amelie’s Schoolwork and Peer Interactions T-scores were consistent with their average T-score. Their Family Life
T-score was significantly lower than their average T-score, suggesting relatively less impairment in this area.

DSM Symptom Scales

Results from the Conners 4 DSM Symptom Scales describe the parent's ratings of the youth on items that
correspond with DSM Criterion A for ADHD, Oppositional Defiant Disorder, and Conduct Disorder.
Conners 4 DSM T-scores and percentiles provide a relative comparison with the Principal Reference Sample (12-
year-old females). Higher T-scores and percentiles on the Conners 4 DSM Symptom Scales indicate more frequent
or severe problems in the domain covered by that scale. Note that the DSM T-scores are not sufficient for
confirming or rejecting the presence of the disorder; however, they can inform diagnostic decisions by illuminating
the presence and severity of the symptoms. Conners 4 DSM Symptom Counts are absolute counts, rather than
norm-referenced values. Symptom Counts can help identify features of DSM ADHD, Oppositional Defiant Disorder,
or Conduct Disorder for diagnostic consideration, but cannot definitively establish the persistent pattern of behavior
that is required by Criterion A in the DSM. The DSM necessitates an investigation of the following considerations to
arrive at a diagnosis:

▪ ADHD: Symptoms cannot be solely due to oppositional behavior, defiance, hostility, or failure to understand
tasks or instructions.

▪ Oppositional Defiant Disorder: Behaviors must occur during interactions with at least one individual who is not a
sibling.
Additional symptom-specific requirements for Criterion A as well as other DSM criteria (e.g., age of onset,
inconsistency with developmental expectations, pervasiveness across settings, impairment) must also be
considered before assigning a diagnosis. Please refer to the DSM for full diagnostic criteria.
The Items by Scale section of this report displays the parent’s ratings to all DSM Symptom Scale items and may
inform further interpretation of the scale scores. Please see this section to review items that contribute to the
Symptom Count of each scale and to review item-level elevations.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

▪ DSM ADHD Inattentive Symptoms (T-score = 49 [90% CI = 45–53]; Percentile = 55th; Symptom Count = 0/9):
This scale includes items representing the DSM symptoms of ADHD Predominantly Inattentive Presentation.
The DSM ADHD Inattentive Symptoms T-score is in the Average range. The parent reported that Amelie
exhibits no more features of inattentiveness than are typically reported by parents of 12-year-old females. The
DSM ADHD Inattentive Symptom Count was 0 (the DSM threshold for children is 6 out of 9 symptoms). This
pattern of results suggests that symptoms of ADHD Predominantly Inattentive Presentation are not present.

▪ DSM ADHD Hyperactive/Impulsive Symptoms (T-score = 45 [90% CI = 41–49]; Percentile = 39th; Symptom
Count = 1/9): This scale includes items representing the DSM symptoms of ADHD Predominantly
Hyperactive/Impulsive Presentation. The DSM ADHD Hyperactive/Impulsive Symptoms T-score is in the
Average range. The parent reported that Amelie exhibits no more features of hyperactivity/impulsivity than are
typically reported by parents of 12-year-old females. The DSM ADHD Hyperactive/Impulsive Symptom Count
was 1 (the DSM threshold for children is 6 out of 9 symptoms). This pattern of results suggests that symptoms of
ADHD Predominantly Hyperactive/Impulsive Presentation are not prominent.

▪ DSM Total ADHD Symptoms (T-score = 47 [90 CI = 43–51]; Percentile = 48th): This scale includes all items
from the Conners 4 DSM ADHD Inattentive and Hyperactive/Impulsive Symptom scales. The DSM Total ADHD
Symptoms T-score is in the Average range. The parent reported that Amelie exhibits no more ADHD
symptoms than what is typically reported by parents of 12-year-old females.

▪ DSM Oppositional Defiant Disorder Symptoms (T-score = 45 [90% CI = 42–48]; Percentile = 54th; Symptom
Count = 1/8): This scale includes items representing the DSM symptoms of Oppositional Defiant Disorder. The
DSM Oppositional Defiant Disorder Symptoms T-score is in the Average range. The parent reported that
Amelie exhibits no more features of opposition and defiance than are typically reported by parents of 12-year-
old females. The DSM Oppositional Defiant Disorder Symptom Count was 1 (the DSM threshold is 4 out of 8
symptoms), including symptom(s) related to vindictiveness. This pattern of results suggests that symptoms of
Oppositional Defiant Disorder are not prominent.

▪ DSM Conduct Disorder Symptoms (T-score = 48 [90% CI = 44–52]; Percentile = 66th; Symptom Count =
0/15): This scale includes items representing the DSM symptoms of Conduct Disorder. The DSM Conduct
Disorder Symptoms T-score is in the Average range. The DSM Conduct Disorder Symptom Count was 0 (the
DSM threshold is 3 out of 15 symptoms). These results suggest that symptoms of Conduct Disorder are not
present.

Conners 4–ADHD Index

The Conners 4–ADHD Index is composed of the 12 items that best differentiate youth with ADHD from those in the
general population. The ADHD Index Probability score denotes the probability that a given score came from a youth
with ADHD.

▪ Conners 4–ADHD Index (Probability Score = 9%): The parent’s ratings of Amelie produced a probability score
in the Very Low range, indicating very low similarity with 12-year-olds who have ADHD. This ADHD Index score
is much more similar to scores from the general population.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

ADDITIONAL QUESTIONS
The following section displays additional comments that the parent shared about Amelie’s problems, strengths, and
skills.
Describe how these behaviors cause serious problems for your child at home, in school, at work, or with their friends.

No response provided.

Do you have any other concerns about your child?

No response provided.

What strengths or skills does your child have?

No response provided.

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 Conners 4 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative)
Admin Date: July 3, 2024
ITEMS BY SCALE
Test users are responsible for ensuring the confidentiality and security of test
materials, including test items and scales, in accordance with professional
standards and applicable legislation. MHS test materials are protected by various
intellectual property laws, including copyright and trademark laws.
The following section of the report, entitled Items by Scale, contains test
items and scales that are copyrighted/trade secret material. Disclosure of
these materials is prohibited by law. In the event that disclosure of the
report becomes necessary or is required by law, the section entitled Items
by Scale must be removed before any such disclosure.

For more information on the release of test materials in the legal context,
please refer to the MHS Test Disclosure Policy.

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.

Response Style Analysis

The ratings provided are the original responses. These ratings are reverse scored (when applicable) and scores of 2 or 3
are used to calculate the Negative Impression Index (NII) raw score. Item pairs with a difference score (Item Pair Score) of
2 or 3 are used to calculate the Inconsistency Index raw score. Please see the Conners 4 Manual for details.

Negative Impression Index (Raw Score = 0)

NII Item
Item # Item Text Rating
Score
12 Gets a headache when they have to pay attention for a long time. Not true at all (Never/Rarely) 0
31 It's impossible for them to pay attention to things. Not true at all (Never/Rarely) 0
35 Wants good things to happen to them. (R) Pretty much true (Often/Quite a bit) 0
43 Enjoys doing their favorite activity. (R) Completely true (Very often/Always) 0
77 There is nothing they can pay attention to for a long time. Not true at all (Never/Rarely) 0
85 Has at least one happy memory. (R) Completely true (Very often/Always) 0
96 Is impossible to please. Not true at all (Never/Rarely) 0
103 Writes reminders that they don't remember writing. Not true at all (Never/Rarely) 0
(R) = Item was reverse scored.

Inconsistency Index (Raw Score = 0)

Item
Pair Item # Item Text Rating Pair
Score
34 Makes impulsive decisions. Not true at all (Never/Rarely)
1 0
109 Is impulsive. Not true at all (Never/Rarely)
14 Needs to be moving around. Not true at all (Never/Rarely)
2 0
86 Has trouble sitting still. Just a little true (Occasionally)
28 Creates stress for the family. Not true at all (Never/Rarely)
3 0
88 Creates a chaotic family life. Not true at all (Never/Rarely)
16 Actively refuses to follow the rules. Not true at all (Never/Rarely)
4 0
83 Actively refuses to do what adults tell them to do. Not true at all (Never/Rarely)
40 Forgets to turn in completed work. Not true at all (Never/Rarely)
5 0
64 Hands things in late. Just a little true (Occasionally)

55 Interrupts other people's conversations, games, or activities. Not true at all (Never/Rarely)
6 0
97 Talks out of turn. Not true at all (Never/Rarely)
73 People don't want to be friends with them. Not true at all (Never/Rarely)
7 0
100 Has trouble making or keeping friends. Just a little true (Occasionally)

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.

The following response key applies to all remaining tables in this section.
Item Score: 0 = Not true at all (Never/Rarely); 1 = Just a little true (Occasionally); 2 = Pretty much true (Often/Quite a bit);
3 = Completely true (Very often/Always)
(R) = Item was reverse scored: 3 = Not true at all (Never/Rarely); 2 = Just a little true (Occasionally); 1 = Pretty much true
(Often/Quite a bit); 0 = Completely true (Very often/Always)

Content Scales
Note. Elevated item scores are indicated by a shaded cell.

Inattention/Executive Dysfunction (T-score = 51)

Also on DSM Item
Item # Item Text
ADHD-I Score
2 X Is forgetful in daily activities. 1
5 X Avoids or dislikes things that take a lot of effort and are not fun. 1
7 Has trouble getting started on tasks or projects. 1
10 X Is easily distracted. 1
15 X Doesn’t seem to listen to what people are saying to them. 0
19 X Doesn't finish schoolwork, work, or other tasks. 1
26 Has trouble getting back on task after being interrupted. 1
32 X Fails to follow through on instructions. 1
42 Has difficulty managing their time. 1
48 Has trouble concentrating. 1
57 X Has trouble organizing tasks or activities. 1
62 X Fails to pay close attention to details. 0
66 X Makes careless mistakes in schoolwork or other activities. 0
71 Has trouble planning ahead. 0
79 X Loses or misplaces things that they need. 0
87 Gets so focused on something that they lose track of what is going on around them. 1
93 Has a hard time prioritizing tasks. 1
102 Has a short attention span. 1
105 Has trouble changing from one task to another. 0
107 X Has trouble staying focused on work or play for a long time. 1
DSM ADHD-I = DSM ADHD Inattentive Symptoms

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.

Hyperactivity (T-score = 47)

Also on DSM Item
Item # Item Text
ADHD-HI Score
3 X Leaves their seat when they should stay seated. 0
14 X Needs to be moving around. 0
18 Isn't aware that they are being loud. 1
47 X Talks too much. 2
51 X Runs or climbs when they are not supposed to. 1
60 X Is unable to be quiet when playing or using free time. 0
69 Gets overly excited. 0
86 X Has trouble sitting still. 1
95 X Acts as if driven by a motor. 0
108 X Fidgets or squirms in their seat. 0
111 X Is restless. 0
DSM ADHD-HI = DSM ADHD Hyperactive/Impulsive Symptoms

Impulsivity (T-score = 39)

Also on DSM Item
Item # ADHD-HI
Item Text
Score
9 Blurts out the first thing that comes to mind. 0
25 Uses other people's things without asking permission. 0
50 X Has difficulty waiting for their turn. 0
55 X Interrupts other people's conversations, games, or activities. 0
75 X Intrudes on or takes over what others are doing. 0
89 Acts before thinking. 0
97 Talks out of turn. 0
106 X Blurts out answers before the question has been completed. 0
109 Is impulsive. 0
DSM ADHD-HI = DSM ADHD Hyperactive/Impulsive Symptoms

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.

Emotional Dysregulation (T-score = 51)

Item
Item # Item Text
Score
4 Loses temper. 1
30 Has trouble controlling their emotions. 1
39 Has trouble calming down when upset. 1
52 Says or does things they don't mean to because they are angry. 1
65 Gets really angry all of a sudden. 1
80 Overreacts when they get upset. 0
92 Mood changes quickly and drastically. 0
113 Has trouble controlling their anger. 0

Depressed Mood (T-score = 51)

Item
Item # Item Text
Score
8 Is sad, gloomy, or irritable. 1
36 Seems hopeless about the future. 0
54 Feels worthless. 1
82 Seems tired. 0
94 Doesn’t enjoy things like they used to. 0
110 Feels helpless. 0

Anxious Thoughts (T-score = 55)

Item
Item # Item Text
Score
22 Has trouble controlling their worries. 1
46 Gets tired or worn out from worrying. 0
72 Worries too much about many different things. 1
99 Appears tense, nervous, or jumpy. 0
112 Fears they will act in a way that could lead to embarrassment or rejection. 1

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.

Impairment & Functional Outcome Scales

Note. Elevated item scores are indicated by a shaded cell.

Schoolwork (T-score = 56)

Item
Item # Item Text
Score
24 Doesn't know what their homework is or where they put it. 1
40 Forgets to turn in completed work. 0
56 Has trouble completing schoolwork or work because of distractions. 1
64 Hands things in late. 1
74 Hands in incomplete work or tests. 1
114 Checks their work for mistakes. (R) 2

Peer Interactions (T-score = 56)

Item
Item # Item Text
Score
1 Gets invited to play or go out with others. (R) 2
20 Is annoying to peers. 1
38 Peers complain about their behavior. 0
63 Interacts well with peers. (R) 0
73 People don't want to be friends with them. 0
100 Has trouble making or keeping friends. 1

Family Life (T-score = 46)

Item
Item # Item Text
Score
13 Disrupts family activities. 0
28 Creates stress for the family. 0
41 Makes it hard for the family to have fun together. 0
53 Causes the family to be late for appointments or activities. 0
58 Argues with family members. 1
78 Doesn't get along well with family members. 0
88 Creates a chaotic family life. 0

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.

DSM Symptom Scales

Note. Elevated item scores are indicated by a shaded cell. Checkmarks in the Criterion Status column contribute to the
Symptom Count for the scale. Please see the Conners 4 Manual for more details.

DSM ADHD Inattentive Symptoms

(T-score = 49, Symptom Count = 0/9 [DSM requires ≥ 6/9 symptoms])
DSM Symptom Item Criterion
Item # Item Text
Criterion A Score Status

1a 62 OR Fails to pay close attention to details. 0

66 Makes careless mistakes in schoolwork or other activities. 0

1b 107 Has trouble staying focused on work or play for a long time. 1

1c 15 Doesn’t seem to listen to what people are saying to them. 0

1d 19 AND Doesn’t finish schoolwork, work, or other tasks. 1

32 Fails to follow through on instructions. 1

1e 57 Has trouble organizing tasks or activities. 1

1f 5 Avoids or dislikes things that take a lot of effort and are not fun. 1

1g 79 Loses or misplaces things that they need. 0

1h 10 Is easily distracted. 1

1i 2 Is forgetful in daily activities. 1

16 Copyright © 2022 Multi-Health Systems Inc. (MHS, Inc.). All rights reserved.
 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.

DSM ADHD Hyperactive/Impulsive Symptoms

(T-score = 45, Symptom Count = 1/9 [DSM requires ≥ 6/9 symptoms])
DSM Symptom Item Criterion
Item # Item Text
Criterion A Score Status
2a 86 OR Has trouble sitting still. 1
108 Fidgets or squirms in their seat. 0
2b 3 Leaves their seat when they should stay seated. 0
2c 51 OR Runs or climbs when they are not supposed to. 1
111 Is restless. 0
2d 60 Is unable to be quiet when playing or using free time. 0
2e 14 OR Needs to be moving around. 0
95 Acts as if driven by a motor. 0
2f 47 Talks too much. 2 ✓
2g 106 Blurts out answers before the question has been completed. 0
2h 50 Has difficulty waiting for their turn. 0
2i 55 OR Interrupts other people’s conversations, games, or activities. 0
75 Intrudes on or takes over what others are doing. 0

DSM Oppositional Defiant Disorder Symptoms

(T-score = 45, Symptom Count = 1/8 [DSM requires ≥ 4/8 symptoms])
DSM Symptom Item Criterion
Item # Item Text
Criterion A Score Status
Angry/Irritable Mood
1 4 Loses temper. 1
2 49 Is irritable or easily annoyed by others. 0
3 37 Is angry and resentful. 0
Argumentative/Defiant Behavior
4 98 Argues with adults. 0
5 16 OR Actively refuses to follow the rules. 0
83 Actively refuses to do what adults tell them to do. 0
6 59 Annoys other people on purpose. 0
7 91 Blames their mistakes or misbehaviors on others. 0
Vindictiveness
8 45 OR Tries to get even with people. 0 ✓
67 Upsets or offends others on purpose. 1

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 Parent Single-Rater Report for Amelie AA
Principal Reference Sample: 12-year-old females (Normative) | Admin Date: July 3, 2024

This section of the report contains copyrighted items and information that are not intended for public
disclosure. If it is necessary to provide a copy of the report to anyone other than the examiner, this section
must be removed.
DSM Conduct Disorder Symptoms
(T-score = 48, Symptom Count = 0/15 [DSM requires ≥ 3/15 symptoms])
DSM Symptom Item Criterion
Item # Item Text
Criterion A Score Status
Aggression to People and Animals
1 33 Bullies, threatens, or scares others. 0
2 21 Starts fights with people. 0
3 84 Uses a weapon to scare or hurt people. 0
4 6 Physically hurts people. 0
5 70 Is cruel to animals. 0
Steals while confronting a person (for example, mugging, purse
6 17 0
snatching, or armed robbery).
7 101 Has forced someone into sexual activity. 0
Destruction of Property
8 29 Has intentionally set fires for the purpose of causing damage. 0
9 81 Intentionally damages or destroys things that belong to others. 0
Deceitfulness or Theft
10 44 Has broken into someone else's house, building, or car. 0
11 68 Lies to avoid having to do something or to get things. 1
Steals valuable things secretly (for example, through shoplifting or
12 27 0
forgery).
Serious Violations of Rules
13 61 Stays out at night, even though it breaks the rules. 0
14 104 Has run away from home for at least one night. 0
15 90 Skips classes. 0

Conners 4–ADHD Index

Conners 4–ADHD Index (Probability Score = 9%)
Item
Item # Item Text
Score
10 Is easily distracted. 1
26 Has trouble getting back on task after being interrupted. 1
32 Fails to follow through on instructions. 1
48 Has trouble concentrating. 1
57 Has trouble organizing tasks or activities. 1
93 Has a hard time prioritizing tasks. 1
102 Has a short attention span. 1
105 Has trouble changing from one task to another. 0
107 Has trouble staying focused on work or play for a long time. 1
109 Is impulsive. 0
111 Is restless. 0
114 Checks their work for mistakes. (R) 2

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 Parent Single-Rater Report for Amelie AA
Admin Date: July 3, 2024

CONNERS 4TH EDITION

FEEDBACK HANDOUT FOR PARENT RATINGS

Child’s Name/ID: Amelie AA

Child’s Age: 12
Parent’s Name:

Assessment Date: July 3, 2024

Examiner’s Name: González Cousido, Noelia

This feedback handout provides an overview of the scores from the parent’s (or guardian’s) ratings of Amelie’s
behaviors and feelings as assessed by the Conners 4th Edition (Conners 4) Parent form. Throughout this report,
“parent or guardian” will be referred to as “parent.”

What is the Conners 4 and why do parents complete it?

The Conners 4 is a set of rating scales that are used to gather information about symptoms of Attention-
Deficit/Hyperactivity Disorder (ADHD) and other related conditions, as well as difficulties experienced by the youth
in several domains. The Conners 4 forms are used all over the world and have been through extensive research,
development, and validation processes. Results from the Conners 4 can help to better understand a youth who is
having difficulty, and to determine how to help. Information from parents about their child’s behavior and feelings is
extremely important, as the parents generally know their child better than anyone else and can provide information
about their child’s behavior in a number of settings.

Results from the Conners 4 Parent form

The professional who asked for this form to be completed will help explain these results and answer any questions.
These scores were calculated based on a comparison of Amelie to youth of the same age and gender. The
results from parent ratings on the Conners 4 should be combined with other important information, such as
interviews with Amelie and their parent(s), other test results, school records, and observations. All of the
combined information is used to determine if Amelie needs help in a certain area and what kind of help is
needed. Please keep in mind that not all areas assessed on the Conners 4 are reflected in this handout. The
professional who is working with you may wish to communicate with you regarding other areas of concern, and in
some cases may recommend further evaluation or follow-up. As you review the results, it may be helpful for you to
share any additional insights that you might have, make notes, and freely discuss the results with the professional.
If you have difficulty understanding this information, you should seek clarity from the professional.

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 Parent Single-Rater Report for Amelie AA
Admin Date: July 3, 2024

DOES THE YOUTH EXHIBIT ANY SYMPTOMS OF ADHD?

The following results are based on the parent’s report of Amelie’s behavior related to ADHD symptoms, compared to
what is typically reported by parents of 12-year-old females.

Does not display more Does not engage in more Does not display more Does not exhibit more
difficulty with attention and hyperactive behavior than impulsivity than typically difficulty regulating
executive functioning than typically reported. reported. emotions than typically
typically reported. reported.

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 Parent Single-Rater Report for Amelie AA
Admin Date: July 3, 2024

DOES THE YOUTH EXHIBIT ANY OTHER SYMPTOMS MEASURED BY THE

CONNERS 4?

The following results are based on the parent’s report of Amelie’s behavior related to other symptoms measured by the
Conners 4, compared to what is typically reported by parents of 12-year-old females.

Does not seem to experience Does not appear to experience Does not display more anger,
more features of depressed mood more anxiety than typically defiance, and/or vindictiveness
than typically reported. reported. than typically reported.

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 Parent Single-Rater Report for Amelie AA
Admin Date: July 3, 2024

IN WHAT SETTINGS DOES THE YOUTH EXPERIENCE DIFFICULTIES?

The following results are based on the parent’s report of Amelie’s difficulties with schoolwork, when interacting with
peers, and when interacting with family, compared to what is typically reported by parents of 12-year-old females.

Does not exhibit more difficulty with Does not display more difficulty Does not display more difficulty
schoolwork than typically reported. interacting with peers than typically interacting with family than typically
reported. reported.

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