Who completes the Conners 4 to assess Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents?

Who Completes the Conners 4 for ADHD Assessment

The Conners 4 must be completed by multiple informants—specifically parents/guardians, teachers, and the child/adolescent themselves (when age-appropriate)—to meet diagnostic requirements for ADHD. 1

Multi-Informant Requirement

The American Academy of Pediatrics explicitly requires that information be obtained from multiple sources to diagnose ADHD, with reports primarily from parents or guardians, teachers, and other school personnel involved in the child's care. 1 This multi-informant approach is non-negotiable because:

• Symptoms and impairment must be documented in at least two settings (e.g., home and school, home and work) for an ADHD diagnosis to be valid 2
• Single-setting symptoms may represent environmental factors, parent-child relationship difficulties, or other psychiatric conditions rather than ADHD, which is a pervasive neurodevelopmental disorder 2
• The Conners scales are specifically designed with three versions to capture this multi-informant perspective: parent version (Conners 3-P/4-P), teacher version (Conners 3-T/4-T), and self-report version (Conners 3-SR/4-SR) 3

Specific Informants by Age Group

Preschool-Aged Children (4-5 years)

• Parents/guardians complete the parent version 4
• Teachers or preschool staff complete the teacher version when the child is enrolled in a qualified preschool program (Head Start, public prekindergarten) 2
• For children lacking a separate observer outside the home, placement in a qualified preschool program is recommended to obtain observations from trained staff 2

Elementary School-Aged Children (6-11 years)

• Parents/guardians complete the parent version 1, 4
• At least one teacher (preferably multiple teachers) completes the teacher version 5
• The child may complete the self-report version if developmentally appropriate, though parent and teacher reports remain primary 3

Adolescents (12-18 years)

• Parents/guardians complete the parent version 1
• Multiple teachers complete the teacher version when adolescents have several instructors 4
• The adolescent completes the self-report version to provide their perspective on symptoms 3, 6

Evidence Supporting Non-Redundancy

Research demonstrates that parent, teacher, and youth reports on the Conners scales show low to moderate cross-informant agreement, confirming they are not redundant and each provides unique information about the child's functioning in different contexts. 3 This non-redundancy supports the clinical necessity of obtaining all three perspectives rather than relying on a single informant.

Common Pitfall to Avoid

Never diagnose ADHD based solely on parent-reported Conners scores, even if they are severely elevated. 2 Diagnosing from a single informant violates diagnostic criteria and may lead to misdiagnosis when symptoms reflect:

• More effective behavioral management at school versus home 2
• Adjustment disorders or family stressors 2
• Learning disabilities, anxiety, or depression that manifest differently across contexts 2
• Inconsistent parenting or parent-child relationship difficulties 2

When Teacher Reports Are Not Available

If school ratings cannot be obtained, the clinician should:

• Expand the observer pool to include coaches, school guidance counselors, or community activity supervisors 2
• For preschool children without outside observers, recommend parent training in behavior management (PTBM) before confirming the diagnosis, as this may reveal that symptoms improve with better management strategies 2, 4
• Consider placement in a qualified preschool program to obtain observations from trained staff 2

Integration with Comprehensive Evaluation

The Conners scales serve to systematically collect symptom information but do not diagnose ADHD by themselves. 4 They must be integrated with:

• Clinical interviews with parents and the child 4
• Direct examination and observation of the child 4
• Review of school records 5
• Screening for comorbid conditions (anxiety, depression, learning disabilities, sleep disorders) 4, 5
• Ruling out alternative medical causes through physical examination when indicated 5