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Conners4 Parent ADHDIndex

conners adhd

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446 views3 pages

Conners4 Parent ADHDIndex

conners adhd

Uploaded by

foram
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Multi-Health Systems, Inc.

This assessment is copyrighted by Multi-Health Systems, Inc. (MHS, Inc.) and is protected by
various intellectual property laws including copyright and trademark laws. Any unauthorized
reproduction (e.g., distributed by email detachment, posted on the internet, photocopied, etc.) of
this assessment is not permitted.

If you believe that you have received an unauthorized copy of this assessment, or if you have any
questions, please contact MHS at [email protected]

Multi-Health Systems, Inc.


CONNERS 4™–AI PARENT
RESPONSE BOOKLET C. Keith Conners, PhD

Instructions:
Here are some things parents might say about their children. Please read each item carefully. Indicate how true
it is of your child or how often it happened in the past month. Think about whether:

0 = In the past month, this was not true at all about my child. It never or rarely happened.
1 = In the past month, this was just a little true about my child. It happened occasionally.
2 = In the past month, this was pretty much true about my child. It happened often or quite a bit.
3 = In the past month, this was completely true about my child. It happened very often or always.

Please circle only one answer for each item. If you want to change your answer, put an X through it and circle your
new choice. Be sure to answer every item. For items that you find difficult to answer, please give your best guess.

*Required field

CHILD BEING DESCRIBED YOUR INFORMATION


First Name:* First Name:
Last Name:* Last Name:
ID:* (or First and Last Name) ID:
Birth Date:* (MMM) / (DD) / (YYYY) Relationship to Child:
Age:* Biological parent
Gender: Non-biological parent (Please specify)
Male Other relative/guardian (Please specify)
Female

Other (Please specify)

Grade:

Today’s Date:* (MMM) / (DD) / (YYYY)

Copyright © 2022 Multi-Health Systems, Inc. (MHS, Inc.). All rights reserved.
In the United States, P.O. Box 950, North Tonawanda, NY 14120-0950, 1-800-456-3003.
In Canada, 3770 Victoria Park Ave., Toronto, ON M2H 3M6, 1-800-268-6011, 1-416-492-2627,
Fax 1-416-492-3343. International, +1-416-492-2627. Fax, +1-416-492-3343 or (888)540-4484.
CONNERS 4™–AI PARENT · C. Keith Conners, PhD
Child’s Name/ID: Today’s Date: (MMM) / (DD) / (YYYY)
Think about your child in the past month.
0 = Not true at all 1 = Just a little true 2 = Pretty much true 3 = Completely true
(Never/Rarely) (Occasionally) (Often/Quite a bit) (Very often/Always)

1. Is easily distracted. 0 1 2 3

2. Has trouble getting back on task after being interrupted. 0 1 2 3

3. Fails to follow through on instructions. 0 1 2 3

Copyright © 2022 Multi-Health Systems, Inc. (MHS, Inc.). All rights reserved. In the United States, P.O. Box 950, North Tonawanda, NY 14120-0950, 1-800-456-
4. Has trouble concentrating. 0 1 2 3

5. Is impulsive. 0 1 2 3

3003. In Canada, 3770 Victoria Park Ave., Toronto, ON M2H 3M6, 1-800-268-6011, 1-416-492-2627, Fax 1-416-492-3343.
6. Has trouble organizing tasks or activities. 0 1 2 3

7. Has a short attention span. 0 1 2 3

8. Has a hard time prioritizing tasks. 0 1 2 3

9. Has trouble changing from one task to another. 0 1 2 3

10. Is restless. 0 1 2 3

11. Has trouble staying focused on work or play for a long time. 0 1 2 3

12. Checks their work for mistakes. 0 1 2 3

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