C. Keith Conners, Ph.D.

SELF-REPORT | SINGLE-RATER REPORT

Name/ID: Amelie AA
YOUTH

Birth Date: May 29, 2012

Age: 12
Grade:
Gender: Female

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 youth's responses to specific items should be reviewed to ensure that these typical interpretations apply to them. 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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 Self-Report 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
2 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 • Harming self deliberately

! Items

Sleep Problems
» Indicator
• Having trouble sleeping • Feeling tired

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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 Self-Report 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 = 2), there was no indication of
exaggerated responding.
2 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 youth 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 youth. 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 youth. ! Harming self deliberately – Just a little true (Occasionally)
Immediate follow-up is strongly Thinking about harming self – Not true at all (Never/Rarely)
Planning or attempting to harm self – Not true at all (Never/Rarely)
recommended.

» Sleep Problems Indicator

Based on the youth’s responses to the
Sleep Problems Indicator items, a more » Having trouble sleeping – Completely true (Very often/Always)
in-depth assessment of sleep problems » Feeling tired – Pretty much true (Often/Quite a bit)
is recommended.

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 Self-Report 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 = 61.3) (p < .05)
Inattention/Executive Slightly
Dysfunction 27 61 57–65 91st Elevated - 0.3 Not Significant
Slightly
Hyperactivity 14 61 55–67 95th Elevated - 0.3 Not Significant

Impulsivity 10 59 53–65 79th Average - 2.3 Not Significant

Slightly
Emotional Dysregulation 12 64 59–69 92nd Elevated + 2.7 Not Significant
Slightly
Depressed Mood 7 61 56–66 89th n/a n/a
Elevated
Slightly
Anxious Thoughts 8 61 57–65 90th n/a n/a
Elevated
IMPAIRMENT & FUNCTIONAL OUTCOME SCALES

Within-Profile Comparisons
Raw
T-score 90% CI Percentile Guideline Difference from the youth’s Significant difference
Score
average (T = 55.7) (p < .05)
Slightly
Schoolwork 8 60 54–66 84th Elevated + 4.3 Not Significant

Peer Interactions 5 55 48–62 80th Average - 0.7 Not Significant

Family Life 4 52 45–59 65th Average - 3.7 Not Significant

DSM SYMPTOM SCALES

Raw
T-score 90% CI Percentile Guideline Symptom Count
Score
ADHD Inattentive
Symptoms 15 59 54–64 90th Average 3/9 [DSM requires ≥ 6/9 symptoms]
ADHD Hyperactive/Impulsive Slightly
Symptoms 14 60 54–66 87th 3/9 [DSM requires ≥ 6/9 symptoms]
Elevated
Slightly
Total ADHD Symptoms 29 60 55–65 89th n/a
Elevated
Oppositional Defiant
Disorder Symptoms 9 58 53–63 77th Average 1/8 [DSM requires ≥ 4/8 symptoms]
Conduct Disorder
Symptoms 4 55 50–60 76th Average 1/15 [DSM requires ≥ 3/15 symptoms]

CONNERS 4–ADHD INDEX

Raw Score Probability Score Guideline

ADHD Index 20 83% High

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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 Self-Report 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 Amelie approached completing the Conners 4.

▪ Negative Impression Index: Based on the Negative Impression Index score (raw score = 2), 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: Amelie 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 Amelie.
▪ Self-Harm Critical Items: Amelie endorsed the following Self-Harm Critical Item(s) for which immediate
follow-up is recommended: harming self deliberately.

▪ Sleep Problems Indicator: Amelie’s endorsement of the having trouble sleeping and feeling tired items were
higher than typically reported by 12-year-old females. A more in-depth assessment of sleep difficulties is
recommended as such difficulties can mimic or aggravate other symptoms assessed on the Conners 4.

Content Scales

This section contains a summary of Amelie’s Conners 4 Content Scale results, including (a) a normative sample
comparison of their results to the self-report ratings of other 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 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
Amelie’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.

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

▪ Inattention/Executive Dysfunction (T-score = 61 [90% CI = 57–65]; Percentile = 91st): The

Inattention/Executive Dysfunction T-score is in the Slightly Elevated 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. Amelie reported slightly more difficulty in
these areas than is typically reported by 12-year-old females. A total of 6/20 items on this scale had elevated
ratings.

▪ Hyperactivity (T-score = 61 [90% CI = 55–67]; Percentile = 95th): The Hyperactivity T-score is in the Slightly
Elevated range. This scale includes items about restlessness, difficulty staying seated or sitting still, needing to
move around, getting overly excited, and talking too much. Amelie reported slightly more features of
hyperactivity than are typically reported by 12-year-old females. A total of 3/11 items on this scale had elevated
ratings.

▪ Impulsivity (T-score = 59 [90% CI = 53–65]; Percentile = 79th): The Impulsivity T-score is in the Average range.
This scale includes items about interrupting others, blurting out answers, acting before thinking, and having
trouble waiting for one’s turn. Amelie reported no more impulsivity than is typically reported by 12-year-old
females. Although the scale T-score was in the Average range, it may be informative to review the 1/9 items that
had elevated ratings.

▪ Emotional Dysregulation (T-score = 64 [90% CI = 59–69]; Percentile = 92nd): The Emotional Dysregulation T-
score is in the Slightly Elevated range. This scale includes items about overreacting, losing temper, and having
trouble calming down. Amelie reported slightly more difficulty controlling and managing emotions than is
typically reported by 12-year-old females. A total of 4/8 items on this scale had elevated ratings.

▪ Depressed Mood (T-score = 61 [90% CI = 56–66]; Percentile = 89th): The Depressed Mood T-score is in the
Slightly Elevated range. This scale includes items related to feeling sad, not doing things they used to enjoy, and
feeling hopeless about the future. Amelie reported slightly more features of depressed mood than are typically
reported by 12-year-old females. A total of 3/6 items on this scale had elevated ratings.

▪ Anxious Thoughts (T-score = 61 [90% CI = 57–65]; Percentile = 90th): The Anxious Thoughts T-score is in the
Slightly Elevated 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. Amelie
reported slightly more anxiety than is typically reported by 12-year-old females. A total of 2/6 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 61.3 on these scales. None of these comparisons were statistically significant, meaning that Amelie’s T-
scores on these scales were consistent with their average T-score.

Impairment & Functional Outcome Scales

This section contains a summary of Amelie’s Conners 4 Impairment & Functional Outcome Scale results, including
(a) a normative sample comparison of their results to the self-report ratings of other 12-year-old females, and (b) a
within-profile comparison of Amelie’s results to their own average score.

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

Normative Sample Comparisons:

Each of Amelie's Impairment & Functional Outcome Scale raw scores was compared with what is typically
reported by 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 Amelie’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.

▪ Schoolwork (T-score = 60 [90% CI = 54–66]; Percentile = 84th): The Schoolwork T-score is in the Slightly
Elevated range. This scale includes items related to turning in late or incomplete work, losing homework, and not
checking their work for mistakes. Amelie reported slightly more impairment in schoolwork than is typically
reported by 12-year-old females. A total of 1/7 items on this scale had elevated ratings.

▪ Peer Interactions (T-score = 55 [90% CI = 48–62]; Percentile = 80th): 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. Amelie reported no more impairment when
interacting with peers than is typically reported by 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.

▪ Family Life (T-score = 52 [90% CI = 45–59]; Percentile = 65th): The Family Life T-score is in the Average range.
The items on this scale reflect family disruptions caused by the youth, such as arguing with family members,
creating problems for the family, as well as causing the family to be late for appointments. Amelie reported no
more impairment when interacting and getting along with family members than is typically reported by 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.

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 55.7 on these scales. None of these comparisons
were statistically significant, meaning that Amelie’s T-scores on all Impairment & Functional Outcome Scales were
consistent with their average T-score on these scales.

DSM Symptom Scales

Results from the Conners 4 DSM Symptom Scales describe the youth's ratings 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.

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

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 Amelie’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.

▪ DSM ADHD Inattentive Symptoms (T-score = 59 [90% CI = 54–64]; Percentile = 90th; Symptom Count = 3/9):
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. Amelie reported no more features of
inattentiveness than are typically reported by 12-year-old females. The DSM ADHD Inattentive Symptom Count
was 3 (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 prominent.

▪ DSM ADHD Hyperactive/Impulsive Symptoms (T-score = 60 [90% CI = 54–66]; Percentile = 87th; Symptom
Count = 3/9): 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 Slightly
Elevated range. Amelie reported slightly more features of hyperactivity/impulsivity than are typically reported by
12-year-old females. The DSM ADHD Hyperactive/Impulsive Symptom Count was 3 (the DSM threshold for
children is 6 out of 9 symptoms). Given that Amelie's ratings slightly exceeded what is typically reported by
similarly-aged females, further investigation of possible symptoms of ADHD Predominantly
Hyperactive/Impulsive Presentation is warranted despite the low symptom count.

▪ DSM Total ADHD Symptoms (T-score = 60 [90 CI = 55–65]; Percentile = 89th): 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 Slightly Elevated range. Amelie reported slightly more ADHD symptoms than what
is typically reported by 12-year-old females.

▪ DSM Oppositional Defiant Disorder Symptoms (T-score = 58 [90% CI = 53–63]; Percentile = 77th; 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. Amelie reported no more
features of opposition and defiance than are typically reported by 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 = 55 [90% CI = 50–60]; Percentile = 76th; Symptom Count =
1/15): 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 1 (the
DSM threshold is 3 out of 15 symptoms), including a symptom related to destruction of property. These results
suggest that symptoms of Conduct Disorder are not prominent.

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 = 83%): Amelie’s probability score is in the High range, indicating
high similarity with 12-year-olds who have ADHD. This ADHD Index score is dissimilar to scores from the
general population.

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 Self-Report 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 Amelie shared about their problems, strengths, and skills.

Describe how these behaviors cause serious problems for you at home, in school, at work, or with your friends.

No response provided.

Do you have any other problems?

No response provided.

What are your main strengths or skills?

No response provided.

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 Conners 4 Self-Report 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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 Self-Report 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. 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 = 2)

NII Item
Item # Item Text Rating
Score
16 I get a headache when I have to pay attention for a long time. Pretty much true (Often/Quite a bit) 2
34 It's impossible for me to pay attention to things. Just a little true (Occasionally) 0
51 I have no control over my behavior. Just a little true (Occasionally) 0
54 I complain even when I'm having fun. Just a little true (Occasionally) 0
72 There's no way I can think unless I'm moving around. Just a little true (Occasionally) 0
78 There is nothing I can focus on for a long time. Not true at all (Never/Rarely) 0
It's impossible for me to get my work done because I can't
91 Just a little true (Occasionally) 0
remember how to do it.
99 Nothing makes me happy. Not true at all (Never/Rarely) 0

Inconsistency Index (Raw Score = 0)

Item
Pair Item # Item Text Rating Pair
Score
104 It's hard for me to pay attention for a long time. Just a little true (Occasionally)
1 0
108 I have trouble focusing for a long time. Pretty much true (Often/Quite a bit)
46 I get tired because I worry so much. Just a little true (Occasionally)
2 0
75 I worry too much about a lot of things. Just a little true (Occasionally)
8 I have too much energy to stay still. Just a little true (Occasionally)
3 0
88 It's hard for me to sit still. Just a little true (Occasionally)
12 I feel sad, gloomy, or irritable for many days at a time. Just a little true (Occasionally)
4 I feel like things are not going well in my life, and I can't 0
111 Just a little true (Occasionally)
do anything about it.
68 I get really angry all of a sudden. Pretty much true (Often/Quite a bit)
5 0
114 It's hard for me to control how angry I get. Just a little true (Occasionally)

48 I have trouble concentrating. Pretty much true (Often/Quite a bit)

6 0
58 I get so distracted that I can't get things done. Just a little true (Occasionally)
7 I have trouble sleeping because I worry about things. Just a little true (Occasionally)
7 0
26 I have trouble controlling my worries. Just a little true (Occasionally)
31 My family gets frustrated with me. Just a little true (Occasionally)
8 0
89 I cause problems for my family. Not true at all (Never/Rarely)

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 Self-Report 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 = 61)

Also on DSM Item
Item # Item Text
ADHD-I Score
2 X I forget to do things. 1
6 X I don't like doing things that make me think hard for a long time. 1
11 I have trouble getting started on things I'm supposed to do. 1
14 X I am easily distracted. 2
18 X People don't think I'm listening to them. 1
22 X I don’t finish things I start, like schoolwork, work, or other tasks. 1
29 It's hard for me to get back to work after I've been interrupted. 2
35 X I have trouble following instructions. 1
43 It's hard for me to manage my time. 2
48 I have trouble concentrating. 2
60 X I have trouble keeping my things organized. 1
66 X It's hard for me to pay attention to details. 1
69 X I make careless mistakes. 2
74 I have trouble planning ahead. 1
81 X I lose things that I need. 1
92 X I avoid doing things that make me think hard for a long time. 1
96 It's hard for me to figure out what to do first. 2
104 It's hard for me to pay attention for a long time. 1
106 I have trouble changing from one task to another. 1
108 X I have trouble focusing for a long time. 2
DSM ADHD-I = DSM ADHD Inattentive Symptoms

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 Self-Report 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 = 61)

Also on DSM Item
Item # Item Text
ADHD-HI Score
3 X I get out of my seat when I am not supposed to. 1
8 I have too much energy to stay still. 1
17 X I feel like I need to be moving around. 1
21 I don't know that I'm being loud until someone tells me. 2
47 X I talk too much. 2
52 X I run or climb even when I am not supposed to. 0
64 X I can't play or do things quietly. 1
88 X It's hard for me to sit still. 1
98 X I feel like I am driven by a motor. 1
109 X I fidget or squirm in my seat. 2
112 X I feel restless. 2
DSM ADHD-HI = DSM ADHD Hyperactive/Impulsive Symptoms

Impulsivity (T-score = 59)

Also on DSM Item
Item # Item Text
ADHD-HI Score
13 I say the first thing that I think of. 1
28 I forget to ask before using other people's things. 1
37 I decide quickly without really thinking things through. 2
50 X I have trouble waiting for my turn. 1
57 X I interrupt people when they are talking or playing games. 1
90 I do things before thinking about them. 1
100 I talk when it's not my turn. 1
107 X I blurt out the answer before the question is finished. 1
110 I'm impulsive. 1
DSM ADHD-HI = DSM ADHD Hyperactive/Impulsive Symptoms

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 Self-Report 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 = 64)

Item
Item # Item Text
Score
4 I lose my temper. 1
33 It's hard for me to control my feelings. 2
41 I have trouble calming down when I get upset. 1
53 I say or do things I don't mean because I'm angry. 2
68 I get really angry all of a sudden. 2
82 I overreact when I get upset. 1
95 My mood changes quickly. 2
114 It's hard for me to control how angry I get. 1

Depressed Mood (T-score = 61)

Item
Item # Item Text
Score
12 I feel sad, gloomy, or irritable for many days at a time. 1
38 The future seems hopeless to me. 0
56 I feel worthless. 1
84 I am tired. 2
97 I don’t feel like doing things that I used to enjoy. 2
111 I feel like things are not going well in my life, and I can't do anything about it. 1

Anxious Thoughts (T-score = 61)

Item
Item # Item Text
Score
7 I have trouble sleeping because I worry about things. 1
26 I have trouble controlling my worries. 1
46 I get tired because I worry so much. 1
75 I worry too much about a lot of things. 1
102 I feel nervous or jumpy. 2
113 I'm scared that people won't like me if they see how nervous I am. 2

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 Self-Report 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 = 60)

Item
Item # Item Text
Score
5 I have trouble knowing what to do even when it was just explained to me. 2
27 I don't know what my homework is or where I've put it. 1
42 I forget to turn in completed work. 0
58 I get so distracted that I can't get things done. 1
67 I hand things in late. 1
77 I accidentally skip questions in work or tests. 1
115 I check my work for mistakes. (R) 2

Peer Interactions (T-score = 55)

Item
Item # Item Text
Score
1 I get invited to play or go out with others. (R) 1
23 Other kids say I'm annoying. 0
40 Other kids complain about the way I act. 1
59 Making friends is hard for me. 2
76 People don't want to be friends with me. 0
86 I feel like I don't fit in. 1

Family Life (T-score = 52)

Item
Item # Item Text
Score
9 I feel rejected by my family. 0
31 My family gets frustrated with me. 1
55 I make my family late for things. 0
62 I argue with family members. 2
80 I get along well with my family. (R) 1
89 I cause problems for my family. 0

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 Self-Report 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 = 59, Symptom Count = 3/9 [DSM requires ≥ 6/9 symptoms])

DSM Symptom Item Criterion

Item # Item Text
Criterion A Score Status

1a 66 OR It's hard for me to pay attention to details. 1 ✓

69 I make careless mistakes. 2
1b 108 I have trouble focusing for a long time. 2 ✓
1c 18 People don't think I'm listening to them. 1
1d 22 AND I don’t finish things I start, like schoolwork, work, or other tasks. 1
35 I have trouble following instructions. 1
1e 60 I have trouble keeping my things organized. 1
1f 6 OR I don't like doing things that make me think hard for a long time. 1
92 I avoid doing things that make me think hard for a long time. 1
1g 81 I lose things that I need. 1
1h 14 I am easily distracted. 2 ✓
1i 2 I forget to do things. 1

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 Self-Report 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 = 60, Symptom Count = 3/9 [DSM requires ≥ 6/9 symptoms])
DSM Symptom Item Criterion
Item # Item Text
Criterion A Score Status
2a 88 OR It's hard for me to sit still. 1 ✓
109 I fidget or squirm in my seat. 2
2b 3 I get out of my seat when I am not supposed to. 1
2c 52 OR I run or climb even when I am not supposed to. 0 ✓
112 I feel restless. 2
2d 64 I can't play or do things quietly. 1
2e 17 OR I feel like I need to be moving around. 1
98 I feel like I am driven by a motor. 1
2f 47 I talk too much. 2 ✓
2g 107 I blurt out the answer before the question is finished. 1
2h 50 I have trouble waiting for my turn. 1
2i 57 I interrupt people when they are talking or playing games. 1

DSM Oppositional Defiant Disorder Symptoms

(T-score = 58, 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 I lose my temper. 1
2 49 I am easily annoyed. 1
3 39 People make me angry. 1

Argumentative/Defiant Behavior

4 101 I argue with adults. 1

5 19 OR I refuse to follow the rules. 0
85 I refuse to do what adults ask me to do. 1
6 63 I annoy people on purpose. 1
7 94 I blame others for my mistakes or bad behavior. 1
Vindictiveness
8 45 OR When I get mad at someone, I get even with them. 1 ✓
70 I upset or offend others on purpose. 1

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 Self-Report 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 = 55, Symptom Count = 1/15 [DSM requires ≥ 3/15 symptoms])
DSM Symptom Item Criterion
Item # Item Text
Criterion A Score Status
Aggression to People and Animals
1 36 I bully, threaten, or scare others. 1
2 24 I start fights with other people. 1
3 87 I use a weapon to scare or hurt people. 0
4 10 I hurt people by doing things like punching, kicking, or scratching. 0
5 73 I do things to hurt animals. 0
6 20 I steal from people by robbing them. 0
7 103 I made someone do something sexual against their will. 0
Destruction of Property
8 32 I set things on fire to cause damage. 0
9 83 I destroy things on purpose that belong to others. 1 ✓
Deceitfulness or Theft
10 44 I've broken into houses, buildings, or cars. 0
11 71 I tell lies to get out of doing things or to get stuff. 1
12 30 I steal valuable things when no one is watching. 0
Serious Violations of Rules
13 65 I stay out at night, even though it breaks the rules. 0
14 105 I have run away from home for at least one night. 0
15 93 I skip classes. 0

Conners 4–ADHD Index

Conners 4–ADHD Index (Probability Score = 83%)
Item
Item # Item Text
Score
5 I have trouble knowing what to do even when it was just explained to me. 2
14 I am easily distracted. 4
21 I don't know that I'm being loud until someone tells me. 2
31 My family gets frustrated with me. 1
37 I decide quickly without really thinking things through. 2
48 I have trouble concentrating. 2
60 I have trouble keeping my things organized. 1
66 It's hard for me to pay attention to details. 1
76 People don't want to be friends with me. 0
86 I feel like I don't fit in. 1
104 It's hard for me to pay attention for a long time. 2
112 I feel restless. 2
Item scores for items 14 and 104 have been doubled (see the Conners 4 Manual for details about weighted scoring for the ADHD Index).

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

CONNERS 4TH EDITION

FEEDBACK HANDOUT FOR SELF-REPORT RATINGS

Child’s Name/ID: Amelie AA

Child’s Age: 12
Assessment Date: July 3, 2024
Examiner’s Name: González Cousido, Noelia

This feedback handout provides an overview of the scores from Amelie's ratings of their behaviors and feelings
as assessed by the Conners 4th Edition (Conners 4) Self-Report form.

What is the Conners 4 and why do youth 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 the youth about their own behavior and feelings is
extremely important, as the youth knows how they feel better than anyone else. Self-reports provide valuable
information about the youth’s own perceptions, feelings, and attitudes that parents and teachers may not be aware
of. Unlike parent and teacher ratings, which provide information about either home or school settings, youth are
able to give information about their feelings and behaviors across settings and situations.

Results from the Conners 4 Self-Report 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 self-report ratings on the Conners 4 should be combined with other important information, such as
interviews with Amelie and their parent(s) or guardian(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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 Self-Report Single-Rater Report for Amelie AA
Admin Date: July 3, 2024

DID THE YOUTH REPORT ANY SYMPTOMS OF ADHD?

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

Reported slightly more Reported slightly more Did not report more Reported slightly more
difficulty with attention and hyperactive behavior than impulsivity than typically difficulty regulating
executive functioning than typically reported, such reported. emotions than typically
typically reported, such as: as: reported, such as:

• having trouble getting back • being loud without • having trouble controlling
on task knowing their emotions
• having difficulty managing • fidgeting • saying or doing things they
time don’t mean when angry
• having trouble concentrating • feeling restless • getting really angry

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

DID THE YOUTH REPORT ANY OTHER SYMPTOMS MEASURED BY THE

CONNERS 4?

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

Reported slightly more features of Reported slightly more anxiety Did not report more anger,
depressed mood than typically than typically reported, such as: defiance, and/or vindictiveness
reported, such as: than typically reported.

• not doing things they used to • feeling nervous or jumpy

enjoy
• feeling worthless • fearing they'll be embarrassed

• feeling helpless • having trouble sleeping because

of worry

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

IN WHAT SETTINGS DID THE YOUTH REPORT DIFFICULTIES?

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

Reported slightly more difficulty with Did not report more difficulty Did not report more difficulty
schoolwork than typically reported, interacting with peers than typically interacting with family than typically
such as: reported. reported.

• having trouble knowing what to do

• checking work for mistakes

• not knowing where or what their

homework is

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