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Conners-4 Reference
Rating Scales for ADHD & Related Concerns · OHI Documentation
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OHI — ADHD

Conners-4 Reference

Score interpretation, composite and subscale profiles, T-score classification guide, rater form overview, and clinical guidance for OHI eligibility documentation.

About the Conners-4

What It Measures

The Conners, 4th Edition (Conners-4; Conners, 2023) is a multi-informant rating scale assessing ADHD and related concerns in individuals ages 6–18. It collects ratings from parents/caregivers, teachers, and the student (self-report, ages 8–18). Scores reflect the frequency of observed behaviors over the past month. The Conners-4 aligns with DSM-5-TR diagnostic criteria and is structured to support documentation of ADHD-related concerns across settings.

Rater Forms
Parent/Caregiver (P) — Ages 6–18
Teacher (T) — Ages 6–18
Self-Report (SR) — Ages 8–18
FormItemsRespondentKey Considerations
Parent/Caregiver (P)
 110 Parent, guardian, or primary caregiver Captures home and community behavior. Most comprehensive form. Includes impairment items covering home, social, and academic settings.
Teacher (T)
 97 Classroom teacher or school staff Essential for school eligibility decisions. Captures academic setting behavior. Impairment items focus on classroom and peer functioning. Required for OHI documentation alongside parent data.
Self-Report (SR)
 99 Student, ages 8–18 Provides student perspective on inattention, hyperactivity, emotional dysregulation, and impairment. Useful for capturing internalized symptoms. Cross-informant discrepancies are clinically meaningful.
Score Types

How Scores Are Reported

All Conners-4 scores are reported as T-scores (mean = 50, SD = 10), normed by age and gender. Higher T-scores indicate more frequent or severe symptoms. The Conners-4 does not report standard scores (SS) or scaled scores — all interpretation is T-score based. Percentile ranks are also provided.

  • T ≥ 70 — Very Elevated (≥98th percentile) — clinically significant; strong support for concern
  • T 65–69 — Elevated (93rd–97th percentile) — clinically significant
  • T 60–64 — High Average (84th–92nd percentile) — borderline; monitor closely
  • T 40–59 — Average — within normal limits
  • T ≤ 39 — Low — below average symptom frequency

⚠️ Important: Rating Scales Alone Do Not Diagnose ADHD

The Conners-4 is one piece of a comprehensive evaluation. Elevated scores support the presence of ADHD-related concerns but must be interpreted alongside developmental history, medical history, classroom observations, academic performance, cognitive data, and rule-out of other explanations (anxiety, trauma, learning disability, sleep disorders, etc.).

ADHD Index & Content Scales
ScaleFormsWhat It MeasuresClinical Note
ADHD Index
Global severity indicator
 P T SR Overall ADHD symptom severity. Best single indicator of ADHD-consistent profile. Reflects overall symptom severity drawn from items that most reliably distinguish ADHD-consistent profiles. Primary score for OHI documentation. T ≥ 65 on two or more rater forms is strongly clinically significant.
Inattention/Executive Dysfunction
 P T SR Difficulty sustaining attention, organizing tasks, following through on instructions, losing materials, and forgetting daily tasks. Reflects both inattention and executive function deficits. Closely linked to academic impact. Elevated scores here, especially on teacher form, are critical for classroom impact documentation.
Hyperactivity
 P T SR Restlessness, fidgeting, difficulty staying seated, excessive motor activity, and appearing to be in constant motion (DSM-5-TR criterion language). Most observable in structured settings. Teacher ratings often lower than parent if the student has learned to manage behavior at school.
Impulsivity
 P T SR Acting without thinking, interrupting others, difficulty waiting, blurting out answers, emotional reactivity. Overlaps with emotional dysregulation. Elevated impulsivity with low hyperactivity may suggest predominantly inattentive presentation with poor inhibition.
Emotional Dysregulation
 P T SR Difficulty managing emotional responses — frustration intolerance, mood lability, overreaction to minor events, difficulty calming down. Not a DSM-5 ADHD criterion but highly associated with ADHD, especially combined presentation. Elevated scores here do not indicate Emotional Disturbance eligibility independently.
Depressed Mood
 P SR Sadness, hopelessness, low energy, social withdrawal, diminished interest. Not present on teacher form. Screen for co-occurring depression. Elevated scores warrant referral for mental health evaluation. Not sufficient for ED eligibility determination.
Anxious Thoughts
 P SR Worry, nervousness, fearfulness, tension, somatic complaints. Not present on teacher form. Important rule-out — anxiety can mimic inattention. If Anxious Thoughts is elevated and ADHD Index is borderline, consider anxiety as primary concern.
Schoolwork
 P T Academic impairment — difficulty completing assignments, poor academic performance, organization problems in school. Direct measure of educational impact. Essential for OHI eligibility documentation. Elevated scores here support "adversely affects educational performance" criterion.
Peer Interactions
 P T SR Social difficulties, conflict with peers, difficulty making or keeping friends, social immaturity. Supports functional impact documentation. Peer difficulties in ADHD are often related to impulsivity and emotional dysregulation rather than social skills deficits per se.
Family Life
 P SR Conflict and strain in the home environment related to the student's behavior. Contextual information for the FIE. Not directly used for eligibility criteria but supports the overall picture of functional impairment.
DSM-5-TR Symptom Scales

Symptom Count Scores

In addition to T-scores, the Conners-4 provides DSM-5-TR Symptom Scales that count the number of symptoms rated as "pretty much" or "very much" present. These map directly to DSM-5-TR diagnostic criteria:

  • Inattention Symptoms — 9 items (threshold: ≥6 for ages 6–16; ≥5 for ages 17+)
  • Hyperactive-Impulsive Symptoms — 9 items (same thresholds)

Meeting symptom count thresholds on two or more rater forms, combined with age of onset, cross-setting impairment, and rule-out of other causes, supports the DSM-5-TR criteria for ADHD diagnosis. Symptom counts alone are not diagnostic.

Validity Indicators
IndicatorWhat It FlagsAction
Positive Impression
 Rater may be presenting the student in an unusually favorable light — underreporting concerns. Interpret scores with caution; consider motivation for underreporting (custody, denial). Cross-reference with other rater forms.
Negative Impression
 Rater may be over-reporting concerns — scores may reflect rater distress or exaggeration. Do not dismiss ratings outright; explore rater context. Compare with teacher and self-report. Note in FIE interpretation section.
Inconsistency Index
 Rater responded inconsistently to similar items — may indicate careless responding, confusion, or reading difficulty. If flagged, results may be invalid. Consider re-administration with clarification or use alternate informant data.
T-Score Classification
T ≥ 70
Very Elevated
≥ 98th percentile. Clinically significant. Strongly consistent with ADHD concern. Supports eligibility documentation.
T 65–69
Elevated
93rd–97th percentile. Clinically significant. Supports ADHD concern when present across raters.
T 60–64
High Average
84th–92nd percentile. Borderline elevated. Clinically meaningful when combined with history and other data.
T 40–59
Average
16th–84th percentile. Within normal limits. Does not support ADHD concern in isolation.
T ≤ 39
Low
≤ 15th percentile. Below average symptom frequency. Consider positive impression validity indicator.
FIE Report Language Examples
T-Score RangeSample FIE Language
T ≥ 70 On the Conners-4, [Student]'s parent rated the [Scale] scale in the Very Elevated range (T = XX, ≥98th percentile), indicating that symptoms of [inattention/hyperactivity/impulsivity] are occurring at a frequency that is highly atypical for [his/her/their] age and gender and significantly interferes with daily functioning.
T 65–69 The teacher-rated [Scale] scale fell in the Elevated range (T = XX), reflecting concerns about [student's] [inattention/behavior] that occur at a rate significantly above age expectations in the classroom setting.
T 60–64 The [Scale] scale was rated in the High Average range (T = XX), suggesting borderline elevated concerns that, in the context of the broader evaluation data, are clinically meaningful.
T 40–59 Ratings on the [Scale] scale fell in the Average range (T = XX), indicating that concerns in this area are within normal limits based on this rater's observations.
Cross-Informant Interpretation

Making Sense of Rater Discrepancies

Discrepancies across raters are common and clinically informative — they do not invalidate the data. Consider these patterns:

  • Parent elevated, teacher average: Symptoms may be more pronounced in unstructured home settings, or the student has learned compensatory strategies at school. Consider homework and transition demands.
  • Teacher elevated, parent average: Academic setting demands may be particularly challenging. Parent may not observe academic behavior. Consider whether home structure is masking symptoms.
  • Self-report lower than parent/teacher: Common — students often have limited insight into their own attention and behavior. Not a sign of deception.
  • Self-report higher than raters: May reflect internalized distress, anxiety, or depression co-occurring with ADHD. Clinically important.
  • All raters elevated: Strongest support for pervasive ADHD concern across settings — important for cross-setting impairment criterion.
OHI Eligibility — Texas IDEA Criteria

Texas OHI Eligibility Requires ALL of the Following

  • The student has a chronic or acute health problem — ADHD qualifies as a chronic health condition under OHI
  • The health problem results in limited alertness with respect to the educational environment — including heightened alertness to environmental stimuli that results in limited alertness to the academic task
  • The limited alertness adversely affects educational performance
  • The student requires specially designed instruction as a result
  • The condition is not better explained by another disability category
Using Conners-4 Data for OHI Documentation

✅ What Supports the Eligibility

  • ADHD Index T ≥ 65 on two or more rater forms
  • Elevated Inattention/Executive Dysfunction on teacher form
  • Elevated Schoolwork scale (direct academic impact measure)
  • DSM-5-TR symptom counts at or above threshold on two rater forms
  • Cross-setting impairment (home and school both elevated)
  • Consistency with teacher observations and academic history
  • Medical diagnosis of ADHD from licensed physician or psychologist (not required by IDEA but supports documentation)

⚠️ What to Rule Out

  • Learning disability (SLD) as primary cause of academic difficulties — conduct cognitive and achievement testing
  • Anxiety — elevated Anxious Thoughts with borderline ADHD Index warrants further exploration
  • Depression — elevated Depressed Mood may better explain inattention
  • Trauma response — may present identically to ADHD on rating scales
  • Sleep disorders — chronic sleep deprivation mimics inattention symptoms
  • Vision/hearing concerns — rule out sensory causes of inattention
  • Language processing difficulties — can look like inattention in a classroom
ADHD Presentation Types (DSM-5-TR)
PresentationCriteriaConners-4 Profile Typically Shows
Predominantly Inattentive
ADHD-PH (314.00)
 ≥ 6 inattention symptoms (≥ 5 if age 17+); fewer than 6 hyperactive-impulsive symptoms Elevated Inattention/Executive Dysfunction; Average or mildly elevated Hyperactivity and Impulsivity; often elevated Schoolwork scale
Predominantly Hyperactive-Impulsive
ADHD-PHI (314.01)
 ≥ 6 hyperactive-impulsive symptoms (≥ 5 if age 17+); fewer than 6 inattention symptoms Elevated Hyperactivity and Impulsivity; Average or mildly elevated Inattention; often elevated Emotional Dysregulation
Combined Presentation
ADHD-C (314.01)
 ≥ 6 symptoms in both domains (≥ 5 if age 17+) Elevated across Inattention/Executive Dysfunction, Hyperactivity, and Impulsivity; often highest ADHD Index scores; frequently elevated Emotional Dysregulation
Diagnostician's Role — Important Scope Note

What the Diagnostician Documents vs. What the ARD Committee Decides

The diagnostician's role is to document the presence and educational impact of ADHD-related concerns through the FIE. The ARD committee — not the diagnostician — determines OHI eligibility and recommends accommodations or specially designed instruction. Do not recommend specific interventions or treatments in the FIE; frame findings in terms of educational impact and areas of need.

Common FIE Documentation Phrases

Connecting Conners-4 Scores to Educational Impact

  • "Rating scale data across settings indicate that [Student]'s inattentive symptoms occur at a frequency significantly above age expectations and are directly impacting [his/her/their] ability to sustain focus during independent work, complete multi-step assignments, and manage organizational demands in the classroom."
  • "The Schoolwork scale was rated in the Elevated range by [Student]'s teacher (T = XX), directly measuring the adverse impact of ADHD-related concerns on academic functioning."
  • "Cross-informant data on the Conners-4 indicate that ADHD-related concerns are pervasive across home and school settings, consistent with the DSM-5-TR requirement that symptoms be present in two or more settings."
  • "Validity indicators were within acceptable limits across all three rater forms, suggesting the data are a reliable representation of [Student]'s behavioral profile."
Reference Note: Scale descriptions and clinical guidance on this page are paraphrased for professional reference from the Conners-4 manual (Conners, 2023, MHS). Practitioners should consult the official Conners-4 manual for standardized administration, scoring, and normative interpretation. Eligibility determinations must be made by a qualified multidisciplinary ARD team. Barber Sped Hub is an independent diagnostic reference and is not affiliated with or endorsed by MHS (Multi-Health Systems) or any test publisher.