CONNERS RATING SCALE - SUMMARY SHEET (1978 NORMS)

Name: Age : Date Assessed :

A total score of at least 36 points is needed which is determined from both the parent and the teacher checklists .
The teacher checklist must score at least 18 ofthese points.

PARENT SCALE TEACHER SCALE

Item Score Item Score

4 1
10 ~ 3
11 7
13 8
19 14
25 15
30 21
31 22
33 26
37 28

PARENT TOTAL: TEACHER TOTAL :

COMBINED TOTAL SCORE FROM BOTH SCALES : /60

PARENT SCALE: (Factor Analysis)

Conduct Problem Learning Problems Psychosomatic Impulsive/Hyper Anxiety

Item Score Item Score Item Score Item Score Item Score

2 10 32 4 12
8 25 41 5 16
14 31 43 11
19 37 44 13
20
27
35
39

TOTALS : /24 /12 /12 /12 /6

TEACHERS SCALE: (Factor Analysis)

Conduct Problems Hyperactivity Inattention-Passive

Item Score Item Score Item Score

4 1 7
5 2 9
6 3 18
10 8 20
11 14 21
12 15 22
23 16 26
27 28

TOTALS /24 /21 /24

SLPS\856\Conners Rating Scale Summary Sheet 10/08/2002

 CONNERS QUESTIONNAIRE
TEACHERS VERSION

Name of child : Today's Date:

Please read each question carefully in relation to the

child and tick the most suitable answer .

Not at Just a Pretty Very

All Little Much Much
1 Restless in the 's uirm ' sense.
2 Makes ina ro riate noises when the shouldn't.
Demands must be met immediate) .
Acts 'smart' im udent or sass
5 Tem er outbursts and un redictable behaviour.
6 Overl sensitive to criticism .
Distractible or attention s an a roblem .
8 Disturbs other children .
s Da dreams.
1o Puts and sulks .
11 Mood chan es uickl and drasticall .
12 Quarrelsome .
13 Submissive attitude towards authorit .
14 Restless . Alwa s u and on the o.
15 Excitable, im ulsive.
16 Excessive demands for teacher's attention .
17 A ears to be unacce ted b rou .
18 A ears to be Basil led b other children .
19 No sense of 'fair la '
2o A ears to lack leadershi .
21 Fails to finish thin s that the start.
22 Childish and immature.
23 Denies mistakes or blames others .
24 Does not et alon well with other children .
25 Uncoo erative with classmates .
26 Easil frustrated in their efforts .
27 Uncoo erative with teacher.
28 Difficulty in learning . 1

THANK YOU FOR COMPLETING THE CHECKLIST

South Lake\XL\850\856\Conners Questionnaire 10- 08-02

 CONNER'S QUESTIONNAIRE (PARENT RESPONSE)

Name of child : Date :

Please answer all questions : Beside each item indicate the degree
of the problem by a check mark ( ) Not at Just a Pretty Very
all little much much
1 Picks things (nails, fingers, hair, clothing)
2 Sassy to grown-ups
3 Problem with making or keeping friends
4 Excitable, impulsive
5 Wants to run things
6 Sucks or chews (thumbs, clothing, blankets)
7 Cries easily or often
8 Carries a chip on his shoulder
9 Daydreams
10 Difficulty in learning
11 Restless in the "squirmy" sense
12 Fearful of new situations (people, places, going to school)
'~3 Restless, always up and on the go
14 Destructive
15 Telis lies or stories that aren't true
16 Shy
17 Gets into more trouble than others same age
18 Speaks differently from others same age (baby talk hard to understand)
19 Denies mistakes or blames others
20 Quarrelsome
21 Pouts and sulks
22 Steals
23 Disobedient or obeys but resentfully
24 Worries more than others (about being alone, illness, death)
25 Fails to finish things
26 Feelings easily hurt
27 Bullies others
28 Unable to stop a repetitive activity
29 Cruel
30 Childish or immature (wants help he shouldn't need, needs constant
reassurance)

SLPS/850/856 Conner's Questionnaire (Parent Response) 1 0-08-02

 Not at Just a Pretty Very
all little much much
31 Distractibility or attention span a problem
32 Headaches
33 Mood changes quickly and drastically
34 Doesn't like or doesn't follow rules or restrictions
35 Fights constantly
36 Doesn't get along with brothers or sisters
37 Easily frustrated in efforts
38 Disturbs other children
39 Basically an unhappy child
40 Problems with eating (poor appetite, up between bites)
41 Stomach aches
42 Problems with sleep (can't fall asleep, up early, up in the night)
43 Other aches and pains
44 Vomiting or nausea
45 Feels cheated in family circle
46 Boasts and brags
47 Lets self be pushed around
48 Bowel problems (frequently loose, irregular habits, constipation

SLPS/850/856 Conner's Questionnaire (Parent Response) 1 0-08-02