Will the Real Conners 3® please stand up?Hofmeyr
ADHD awareness month is celebrated every October and awareness has grown worldwide. ADHD and the measures used to aid in the diagnosis thereof have also received much attention over the last few years.
Theories about the disorder and treatment thereof are diverse and often contradicting, some make more sense than others and some defy logic. Some suggest a change in diet or medication, and others work directly with the brain waves in the form of neurofeedback; some believe the affliction does not even exist and it is a ploy from the pharmaceutical companies to make money, some believe that the DSM-5 classification of ADHD is incorrect.
The truth is probably somewhere in-between.
Add to this already confusing mix of information, unreliable and invalid assessments and you have a good chance of making an inaccurate diagnosis that may affect someone for the rest of their life.
As professionals we need to wade through all the available information and use a model/theory that makes most sense and creates the least harm. Paramount to this is using a psychometrically sound assessment that aids in the diagnosis of not only ADHD, but of its co-morbid disorders too. The Conners 3 is one such assessment. Unfortunately, many free online versions of the Conners “Connors“ are available on the internet. Below we will look at some of the unique features of the Conners 3 and point out why the Conners 3 is the leading assessment used to aid in the diagnosis of ADHD.
The Real Conners 3
The Conners 3 is the product of more than 40 years research in the field of ADHD. The Conners 3 with DSM-5 update, was released in 2015. It aligns with the classification of ADHD in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is described as a thorough and focussed assessment of ADHD and its most common comorbid problems and disorders in children and adolescents. Sadly, the author of the invaluable Conners series of assessments, Dr C. Keith Conners passed away earlier this year.
The Conners 3 is unique in that it assesses not only for symptoms of ADHD, but also for features of its comorbid disorders such as Conduct Disorder and Oppositional Defiance Disorder. The Conners 3 features Severe Conduct Critical items as well as Screener items for Anxiety and Depression. Furthermore, the Conners 3 results are used to develop individualised treatment plans, and to monitor individuals’ responses to treatment.
The assessment is completed by the youth themselves, their parent/s and/or their teacher to provide information regarding the youth’s behaviour in different settings. It takes about 20 minutes to complete each of the full-length forms. In addition to the full-length forms the Conners 3 also has Short forms, an ADHD Index, which contains the 10 items that best differentiate youth with ADHD from youth in the general population, and a Global Index, which consists of the 10 highest loading items. The Conners 3 forms can be hand-scored, scored online, or by a software programme. The software and online formats provide the professional with an option to generate three different comprehensive electronic reports.
The Conners 3 has excellent psychometric properties and can be used with confidence as part of the assessment process. The normative sample consisted of 3400 youth from the general U.S. and Canadian population, evenly distributed by age and gender, and racial distribution closely match that of the U.S. population (U.S. Bureau of the Census, 2000). Having a South African norm group for an assessment is always beneficial, however, the Conners 3 is based on DSM-5 criteria which are standard across the world. South African norms would not change the diagnosis but it will be helpful for development and treatment. JvR Psychometrics will embark on a data gathering project starting early in 2018.
According to the Conners 3 Manual potential users of the Conners 3 include psychologists, clinical social workers, physicians, counsellors, psychiatric workers, and paediatric/psychiatric nurses. The manual further sets out the stringent conditions of who may use this assessment. In South Africa, the Health Professions Council of South Africa (HPCSA) restricts the use of diagnostic assessments like the Conners 3 to psychologists. In the rest of Africa, international criteria will apply. If using psychometric assessments is not within your scope of practice as set out by the HPCSA, refer to a duly qualified practitioner to aid in the diagnosis.
The Conners 3 Manual further elaborates that ADHD is a diagnosis that is familiar to most people, even to those not involved in mental health assessment and treatment. Because of the prevalence and widespread media coverage of ADHD many people feel that they know what the manifestations are. Professionals in the field, realise that accurate identification of ADHD is not obvious or straightforward. It is critical to have appropriate assessment tools based on both clinical work and research findings that contribute toward accurate diagnosis and treatment planning.
The Conners 3 fit the above description and therefore helps clinicians determine if a child is having more difficulty in a given area than other youth of the same age. This developmentally-referenced guideline helps reduce over-diagnosis by allowing for a direct comparison of an individual’s behaviour with characteristic behaviour found in a normative sample (Conners, 2008).
Many online derivatives and previous versions of the Conners exist on the internet. Using an unofficial version of the “Connors” is not only a copyright infringement, which is a criminal offense, but it is unethical to use a questionnaire that does not have sound psychometric properties. These properties are only ascertained through extensive empirical research and as mentioned, the Conners 3 has 40 years of research and three revisions of the assessment behind it. Ongoing research ensures that an assessment stays up-to-date and relevant. If a behavioural checklist is not proven to be valid and reliable, the risk of misdiagnosing ADHD increases. These derivative questionnaires seldom assess for the co-morbid disorders which often accompany ADHD and do not provide suggestions for a treatment plan. These questionnaires are often the only questionnaires used to diagnose ADHD. The Conners 3 reports and the Conners 3 manual clearly state that the results obtained from the Conners 3 cannot be used by itself to diagnose ADHD. It is part of a much larger process to ensure the diagnosis is correct. This should be true for all diagnoses.
Taking the above information into consideration, it is clear that the benefits of using the authentic Conners 3 with DSM-5 update, far outweighs using a discontinued or free online or unofficial version. Older versions of the Conners do not align with the DSM-5 and have therefore been discontinued by the publisher and copyright holder, Multi-Health Systems Inc. (MHS). The Conners 3 is a copyrighted assessment and can therefore not be copied without the explicit written permission from the publisher, Multi-Health Systems Inc.
Below are some pictures to help you determine whether you are using, or have been asked to complete, the correct Conners 3.
The Conners 3 Manual
The Conners 3 QuikScore™ Forms
The Online Conners 3 Questionnaire
The Conners 3 Electronic Report
Ensure that all the components are in colour and that the MHS and Conners logos are present. The DSM-5 endorsement can be located on the top right corner of the QuikScore forms. When completing the online Conners 3 you will receive an email invitation asking you to follow a link to the MHS online portal. You will be guided through the answering process. Once a client has completed the Conners 3, an electronic report will be sent to the professional’s email address.
With all the different views, theories and treatment options available for ADHD, it is good to know that at least one of the measures used to assist in the accurate diagnosis is constantly kept up to date and relevant.
Conners, C.K. (2009). Conners 3rd Edition™ Manual. Toronto, Canada: Multi-Health Systems Inc.
Conners 3rd Edition™ (Conners 3®). (2015). Brochure retrieved from https://www.mhs.com/MHS-Assessment?prodname=conners3