Description of ADHD Reference Samples

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• Demographic Characteristics of the ADHD Reference Samples
• Treatment Status of the ADHD Reference Samples
• Medication Status of the ADHD Reference Samples
• Non-Medication Treatment Status of the ADHD Reference Samples
• Demographic Characteristics of the ADHD Reference Sample Raters

Demographic Characteristics of the ADHD Reference Samples

A total of 1,110 youth were included in the ADHD Combined Gender Reference Samples (N = 560 for Parent, N = 321 for Teacher, and N = 229 for Self-Report). Where the purpose of a normative sample is to establish norms for the broader population, the purpose of an ADHD reference sample is to aid in clinical decision making using standardized scores that reflect only youth diagnosed with ADHD, given that these youth present with a distinct profile of scores (see Clinical Group Differences in chapter 9, Validity, for more details on these score profiles). The ADHD Reference Samples consist of youth from a clinical population who had been previously diagnosed with one of the three ADHD presentations (i.e., Predominantly Inattentive, Predominantly Hyperactive/Impulsive, or Combined). Many youth also had at least one additional clinical diagnosis (42.6% for Parent, 43.2% for Teacher, 51.1% for Self-Report), which is reflective of a typical youth with ADHD (i.e., ADHD often co-occurs with other disorders). The most common co-occurring diagnoses were Generalized Anxiety Disorder and Specific Learning Disabilities. Table 7.30 displays the distribution of gender by age group within the Combined Gender ADHD Reference Samples. Table 7.31 summarizes the key demographic characteristics of the Combined Gender ADHD Reference Samples. This information on gender by age group and key demographic characteristics can also be found for the Gender Specific ADHD Reference Samples in Tables 7.32 and 7.33, respectively. Note that the Gender Specific ADHD Reference Samples include one fewer case than the Combined Gender sample, as one case indicated a gender other than male or female and therefore could not be classified in the Gender Specific samples. While the sample sizes are small by age group, continuous norming methodology was applied to allow for the conversion of raw scores to T-scores for all ages (see Standardization Procedures and Continuous Norming in this chapter).

Youth in the ADHD Reference Samples came from various school types (approximately 84.7% were enrolled in public schools, and the remaining students were enrolled in private schools or those labelled“other school type”), urbanicities (a large portion of the youth attended school in an urbanized area with a population of 50,000 people or more—47.9% Parent, 38.9% Teacher, 54.1% Self-Report; the remaining youth lived in urban clusters or rural areas), and the majority of the youth spoke only English (91.9% Parent, 96.2% Teacher, 91.6% Self-Report; the remaining youth were bilingual).

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Table 7.28. Gender x Age Group: Conners 4 ADHD Reference Samples–Combined Gender

Age (in years)	Parent				Teacher				Self-Report
	Male	Female	Other	Total	Male	Female	Other	Total	Male	Female	Other	Total
6/7	38	19	0	57	27	6	0	33	—	—	—	—
8	39	23	0	62	18	7	0	25	11	9	0	20
9	29	21	0	50	15	12	0	27	7	9	0	16
10	47	16	0	63	21	11	0	32	11	6	0	17
11	47	23	0	70	25	9	0	34	24	10	0	34
12	35	21	0	56	28	9	0	37	19	11	0	30
13	29	20	0	49	28	9	0	37	17	7	0	24
14	33	16	0	49	14	9	0	23	17	9	0	26
15	30	14	0	44	20	6	0	26	12	7	0	19
16	15	13	0	28	18	8	0	26	13	8	1	22
17/18	25	7	0	32	13	8	0	21	12	9	0	21
Total	367	193	0	560	227	94	0	321	143	85	1	229

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Table 7.29. Demographic Characteristics: Conners 4 ADHD Reference Samples–Combined Gender

Demographic		Parent		Teacher		Self-Report
		N	%	N	%	N	%
Gender	Male	368	65.7	227	70.7	143	62.4
	Female	192	34.3	94	29.3	85	37.1
	Other	0	0.0	0	0.0	1	0.4
U.S. Race/Ethnicity	Hispanic	46	9.5	19	6.2	16	7.5
	Asian	5	1.0	1	0.3	1	0.5
	Black	17	3.5	36	11.8	15	7.0
	White	387	79.6	233	76.4	166	77.6
	Other	31	6.4	16	5.2	16	7.5
Canadian Race/Ethnicity	Not visible minority	69	93.2	13	86.7	15	100.0
	Visible minority	5	6.8	2	13.3	0	0.0
U.S. Region	Northeast	82	16.9	110	36.1	42	19.6
	Midwest	138	28.4	65	21.3	59	27.6
	South	201	41.4	110	36.1	99	46.3
	West	65	13.4	20	6.6	14	6.5
Canadian Region	East	9	12.2	0	0.0	1	6.7
	Central	42	56.8	12	75.0	9	60.0
	West	23	31.1	4	25.0	5	33.3
Parental Education Level	No high school diploma	7	1.3	—	—	5	2.2
	High school diploma/GED	49	8.9	—	—	41	17.9
	Some college or associate’s degree	135	24.5	—	—	47	20.5
	Bachelor’s degree	178	32.3	—	—	72	31.4
	Graduate or professional degree	182	33.0	—	—	64	27.9
ADHD Presentation	Inattentive	172	30.7	97	30.2	85	37.1
	Hyperactive/Impulsive	88	15.7	65	20.2	36	15.7
	Combined	300	53.6	159	49.5	108	47.2
Age in years M (SD)		11.4 (3.0)		11.8 (3.1)		12.6 (2.8)
Total		560	100.0	321	100.0	229	100.0

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Table 7.30. Gender x Age Group: Conners 4 ADHD Reference Samples–Gender Specific

Age (in years)	Parent		Teacher		Self-Report
	Male	Female	Male	Female	Male	Female
6/7	38	19	27	6	—	—
8	39	23	18	7	11	9
9	29	21	15	12	7	9
10	47	16	21	11	11	6
11	47	23	25	9	24	10
12	35	21	28	9	19	11
13	29	20	28	9	17	7
14	33	16	14	9	17	9
15	30	14	20	6	12	7
16	15	13	18	8	13	8
17/18	25	7	13	8	12	9
Total	367	193	227	94	143	85

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Table 7.31. Demographic Characteristics: Conners 4 ADHD Reference Samples–Gender Specific

Demographic		Parent				Teacher				Self-Report
		Male		Female		Male		Female		Male		Female
		N	%	N	%	N	%	N	%	N	%	N	%
U.S. Race/ Ethnicity	Hispanic	31	9.8	15	8.8	15	6.9	4	4.6	9	6.8	7	8.6
	Asian	3	0.9	2	1.2	0	0.0	1	1.1	1	0.8	0	0.0
	Black	11	3.5	6	3.5	29	13.3	7	8.0	12	9.1	3	3.7
	White	249	78.8	138	81.2	163	74.8	70	80.5	100	75.8	65	80.2
	Other	22	7.0	9	5.3	11	5.0	5	5.7	10	7.6	6	7.4
Canadian Race/Ethnicity	Not visible minority	47	92.2	22	95.7	7	87.5	6	85.7	11	100.0	4	100.0
	Visible minority	4	7.8	1	4.3	1	12.5	1	14.3	0	0	0	0.0
U.S. Region	Northeast	49	15.5	33	19.4	77	35.3	33	37.9	27	20.5	15	18.5
	Midwest	90	28.5	48	28.2	45	20.6	20	23.0	38	28.8	21	25.9
	South	136	43.0	65	38.2	85	39	25	28.7	58	43.9	40	49.4
	West	41	13.0	24	14.1	11	5.0	9	10.3	9	6.8	5	6.2
Canadian Region	East	7	13.7	2	8.7	0	0	0	0	0	0	1	25.0
	Central	29	56.9	13	56.5	5	55.6	7	100.0	6	54.5	3	75.0
	West	15	29.4	8	34.8	4	44.4	0	0.0	5	45.5	0	0.0
Parental Education Level	No high school diploma	4	1.1	3	1.6	—	—	—	—	4	2.8	1	1.2
	High school diploma/GED	37	10.2	12	6.3	—	—	—	—	31	21.7	10	11.8
	Some college or associate’s degree	81	22.4	54	28.6	—	—	—	—	25	17.5	22	25.9
	Bachelor’s degree	120	33.1	58	30.7	—	—	—	—	43	30.1	29	34.1
	Graduate or professional degree	120	33.1	62	32.8	—	—	—	—	40	28.0	23	27.1
ADHD Presentation	Inattentive	100	27.2	72	37.3	57	25.1	40	42.6	46	32.2	38	44.7
	Hyperactive/Impulsive	67	18.3	21	10.9	53	23.3	12	12.8	29	20.3	7	8.2
	Combined	200	54.5	100	51.8	117	51.5	42	44.7	68	47.6	40	47.1
Age in years M (SD)		11.4 (3.1)		11.4 (2.9)		11.7 (3.1)		11.9 (3.1)		12.6 (2.6)		12.5 (2.9)
Total		367	100.0	193	100.0	227	100.0	94	100.0	143	100.0	85	100.0

Treatment Status of the ADHD Reference Samples

Clinicians and raters in the ADHD Reference Samples were asked about the treatment status (both medication treatments as well as psychosocial treatments) of the youth being rated. The vast majority of the youth were receiving at least one form of treatment (99.1% for Parent, 96.0% for Teacher, 85.2% for Self-Report).

Medication Treatment Status of the ADHD Reference Samples

Raters in the ADHD Reference Samples were asked whether the youth being rated takes medication to treat psychological or psychiatric conditions. This information was confirmed by the youth’s clinician. Reported medication use varied from 59.5% to 68.6% across forms (see Table 7.36). Scale- and item-level differences in medication use were examined using effect sizes (as measured by Cliff’s d; Cliff, 1993) to assess whether medication use impacted item- or scale-level ratings. No meaningful differences were observed across all forms when comparing ratings of youth who were taking medication to those who were not. Scale-level differences ranged from trivial to small effect sizes across Parent, Teacher, and Self-Report ratings (see Table 7.37). At the item level, all items showed trivial to small effect sizes across all forms (Cliff’s d = -0.24 to 0.14). Considering the absence of meaningful differences between groups, further analyses in this manual were conducted on the full ADHD Reference Samples, collapsing across medication status.

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Table 7.32. Medication Use Status at Time of Rating: Conners 4 ADHD Reference Samples–Combined Gender 

Medication Use Status	Parent		Teacher		Self-Report
	N	%	N	%	N	%
Does not take medication	169	31.4	123	38.8	87	40.5
Takes medication	370	68.6	194	61.2	128	59.5
Total	539	100.0	317	100.0	215	100.0

Note. Responses were not provided for N = 21 in the Parent sample, N = 4 in the Teacher sample, and N = 14 in the Self-Report sample.

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Table 7.33. Scale Level Differences Comparing No Medication Use to Medication Use at Time of Rating: Conners 4 ADHD Reference Samples 

Scale		Parent	Teacher	Self-Report
Content Scales	Inattention/Executive Dysfunction	−.10	.06	−.04
	Hyperactivity	−.12	.01	−.14
	Impulsivity	−.18	−.02	−.10
	Emotional Dysregulation	−.17	−.10	−.19
	Depressed Mood	−.11	−.04	−.16
	Anxious Thoughts	−.09	−.05	.00
Impairment & Functional Outcome Scales	Schoolwork	−.04	.10	−.02
	Peer Interactions	−.18	−.09	−.12
	Family Life	−.21	—	−.13
DSM Symptom Scales	ADHD Inattentive Symptoms	−.13	.01	−.14
	ADHD Hyperactive/Impulsive Symptoms	−.08	.07	−.04
	Total ADHD Symptoms	−.13	.04	−.09
	Oppositional Defiant Disorder Symptoms	−.18	−.02	−.16
	Conduct Disorder Symptoms	−.18	−.05	−.06

Note. Values presented are Cliff's d. Guidelines for interpreting Cliff's |d|: negligible effect size < .15; small effect size = .15 to .32; medium effect size = .33 to .46; large effect size ≥ .47.

Non-Medication Treatment Status of the ADHD Reference Samples

Of the youth in the ADHD Reference Samples receiving non-medication treatments, the most frequently reported treatments were Special Education and Psychological Therapy. The other forms of treatment that were most commonly listed included family therapy, private tutoring or private schooling, school-based intervention such as Scientific Research Based Intervention, or social work. See Table 7.38 and Table 7.39 for a summary of the forms of treatments that were reported in the Combined Gender and Gender Specific ADHD Reference Samples, respectively.

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Table 7.34. Non-Medication Treatment Status: Conners 4 ADHD Reference Samples–Combined Gender 

Treatment Type	Parent		Teacher		Self-Report
	N	%	N	%	N	%
Group Therapy	22	3.9	14	4.4	12	5.2
Psychological Therapy	212	37.9	90	28.0	97	42.4
Occupational Therapy	17	3.0	16	5.0	4	1.7
Speech Therapy	28	5.0	26	8.1	15	6.6
Special Education	276	49.3	247	76.9	134	58.5
Other Treatment	60	10.7	38	11.8	30	13.1
No Treatment (other than medication)	152	27.1	40	12.5	47	20.5
Total	560	100.0	321	100.0	229	100.0

Note. Raters were instructed to select all applicable treatments. Selections were not mutually exclusive as youth could be receiving multiple forms of treatment concurrently; therefore, the sum of treatment types is greater than the total N.

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Table 7.35. Non-Medication Treatment Status: Conners 4 ADHD Reference Samples–Gender Specific 

Treatment Type	Parent				Teacher				Self-Report
	Male		Female		Male		Female		Male		Female
	N	%	N	%	N	%	N	%	N	%	N	%
Group Therapy	17	4.6	5	2.6	12	5.3	2	2.1	10	7.0	2	2.4
Psychological Therapy	130	35.4	82	42.5	59	26.0	31	33.0	59	41.3	37	43.5
Occupational Therapy	13	3.5	4	2.1	14	6.2	2	2.1	4	2.8	0	0.0
Speech Therapy	22	6.0	6	3.1	17	7.5	9	9.6	11	7.7	4	4.7
Special Education	191	52.0	85	44.0	175	77.1	72	76.6	85	59.4	49	57.6
Other Treatment	32	8.7	28	14.5	26	11.5	12	12.8	14	9.8	15	17.6
No Treatment (other than medication)	106	28.9	46	23.8	32	14.1	8	8.5	32	22.4	15	17.6
Total	367	100.0	193	100.0	227	100.0	94	100.0	143	100.0	85	100.0

Note. Raters were instructed to select all applicable treatments. Selections were not mutually exclusive as youth could be receiving multiple forms of treatment concurrently; therefore, the sum of treatment types is greater than the total N.

Demographic Characteristics of the ADHD Reference Sample Raters

Table 7.40 contains a summary of the demographic characteristics that describe the parent/guardians who rated their child using the Conners 4 Parent and of the teachers who rated their students using the Conners 4 Teacher in the ADHD Combined Gender Reference Samples. Details of the demographic characteristics of the raters in the Conners 4 Gender Specific ADHD Reference Samples can be found in Table 7.41.

In examining the Combined Gender samples, the majority of the Parent raters were female (92.1%) and were White (85.2% in the U.S.) or not a visible minority (91.2% in Canada). There are a variety of relationships between the parent/guardian rater and the youth being rated, with biological mother as the most common relationship at 84.3%, followed by biological father at 6.8%. Parent raters who indicated that they were an “Other relative,” a “Non-relative,” or an “Other guardian” (1.4%) were asked to specify how they were related to the child being rated. The most frequent response was grandmother.

Teacher raters were predominantly female (81.9%) and were White (89.5% in the U.S.) or not a visible minority (100.0% in Canada). Half of the teachers reported that they taught at the elementary school level (50.8%), followed by middle school/junior high schools (24.0%), and district K–12 schools (24.0%). Teachers were asked to report the class(es) taught to the student being rated. A qualitative analysis revealed that all core subject areas from Kindergarten to Grade 12 were represented, including, but not limited to, social science, languages, mathematics, science and technology, arts, health and physical education, and special education. Teachers reported that they either knew the student being rated very well (52.6%) or moderately well (47.4%). A large portion reported having known the student for 6 months or longer (77.6%) prior to rating them, and a large portion of teachers indicated that they interacted with the student being rated on a daily or almost daily basis (82.9%).

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Table 7.36. Demographic Characteristics of Parent Raters: Conners 4 Parent ADHD Reference Samples 

Rater Demographic		Combined		Males		Females
		N	%	N	%	N	%
Gender	Male	44	7.9	29	7.9	15	7.8
	Female	516	92.1	338	92.1	178	92.2
	Other	0	0.0	0	0.0	0	0.0
U.S. Race/Ethnicity	Hispanic	39	8.0	24	7.6	15	8.8
	Asian	6	1.2	4	1.3	2	1.2
	Black	21	4.3	15	4.7	6	3.5
	White	414	85.2	268	84.8	146	85.9
	Other	6	1.2	5	1.6	1	0.6
Canadian Race/Ethnicity	Not visible minority	68	91.9	45	88.2	23	100.0
	Visible minority	6	8.1	6	11.8	0	0.0
Relation to Youth Being Rated	Biological mother	472	84.3	311	84.7	161	83.4
	Biological father	38	6.8	23	6.3	15	7.8
	Non-biological mother	37	6.6	21	5.7	16	8.3
	Non-biological father	5	0.9	5	1.4	0	0.0
	Other relative	7	1.2	6	1.6	0	0.0
	Non-relative	0	0.0	0	0.0	0	0.0
	Other guardian	1	0.2	1	0.3	1	0.5
Age in years M (SD)		42.2 (6.7)		41.9 (6.6)		42.8 (6.8)
Total		560	100.0	367	100.0	193	100.0

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Table 7.37. Demographic Characteristics of Teacher Raters: Conners 4 Teacher ADHD Reference Samples 

Rater Demographic		Combined		Males		Females
		N	%	N	%	N	%
Gender	Male	58	18.1	38	16.7	20	21.3
	Female	263	81.9	189	83.3	74	78.7
	Other	0	0.0	0	0.0	0	0.0
U.S. Race/Ethnicity	Hispanic	10	3.3	8	3.7	2	2.3
	Asian	1	0.3	0	0.0	1	1.1
	Black	15	4.9	9	4.1	6	6.9
	White	273	89.5	195	89.4	78	89.7
	Other	6	2.0	6	2.8	0	0.0
Canadian Race/Ethnicity	Not visible minority	16	100.0	9	100.0	7	100.0
	Visible minority	0	0.0	0	0.0	0	0.0
Length of Relationship	1 to 5 months	72	22.4	60	26.4	12	12.8
	6 to 11 months	128	39.9	86	37.9	42	44.7
	12 months or more	121	37.7	81	35.7	40	42.6
How well does the teacher know the student being rated?	Moderately well	152	47.4	115	50.7	37	39.4
	Very well	169	52.6	112	49.3	57	60.6
How often does the teacher interact with the student being rated?	Less than weekly	4	1.2	3	1.3	1	1.1
	Weekly	51	15.9	41	18.1	10	10.6
	Daily or almost daily	266	82.9	183	80.6	83	88.3
Age in years M (SD)		39.7 (10.6)		39.8 (11.0)		39.7 (9.5)
Total		321	100.0	227	100.0	94	100.0

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