Psychometric Properties of the Conners’ 3 Parent Rating Scale in a Clinical Sample of Iranian Children

Psychometric Properties of the Conners’ 3 Parent Rating Scale in a Clinical Sample of Iranian Children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric Properties of the Conners’ 3 Parent Rating Scale in a Clinical Sample of Iranian Children Fatemeh Mehrzad, Mehdi Tehrani-Doost, Niloofar Fallahinia, Zahra Shahrivar, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6850810/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Apr, 2026 Read the published version in BMC Psychiatry → Version 1 posted 10 You are reading this latest preprint version Abstract Background Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder among children that significantly affects academic, social, and emotional functioning. Early diagnosis is essential, highlighting the need for reliable and valid screening tools. The Conners’ Rating Scales (CRS) are frequently used for ADHD assessment; however, the psychometric properties of the latest version, the Conners' Parent Rating Scale-3 (Conners 3-P), have not yet been examined in Iranian clinical populations. Methods This study aims to evaluate the reliability and validity of the Conners 3-P Short Form in a clinical sample of Iranian children aged 6 to 12 years. The study involved 135 children, including 55 diagnosed with ADHD and 80 typically developing children. ADHD diagnoses were confirmed using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL_5). Parents completed the Conners 3-P and the ADHD Rating Scale-IV. Reliability was evaluated through Cronbach’s alpha and test-retest analysis, while validity was assessed using exploratory factor analysis (EFA), convergent validity testing, and Receiver Operating Characteristic (ROC) analysis. Results The EFA identified six factors: inattention, hyperactivity, learning problems, parents' negative attitude, aggression, and parents' positive attitude, accounting for 52.22% of the variance. The Conners 3-P demonstrated strong internal consistency (Cronbach’s alpha = 0.93) and excellent test-retest reliability (ICC = 0.86). Convergent validity analysis showed significant correlations between the Conners 3-P subscales and ADHD-RS-IV scores, particularly in hyperactivity (r = 0.638, p < 0.01). The ROC curve indicated high diagnostic accuracy (AUC = 0.92), with a cutoff score of 38.50 achieving 80% sensitivity and 89% specificity. Conclusions The Conners 3-P Short Form is a reliable and valid tool for assessing ADHD symptoms in Iranian children. Its strong psychometric properties support its clinical utility in diagnosing and monitoring ADHD. Future research should investigate its applicability in broader populations. ADHD Conners 3-P Psychometric Evaluation Figures Figure 1 Introduction Attention-Deficit/Hyperactivity Disorder (ADHD) is the most prevalent mental disorder among children. The global prevalence of ADHD in children and adolescents is 8.0% ( 1 ). It is reported to be 7.6% in children aged 3 to 12 years and 5.6% in adolescents aged 12 to 18 years ( 2 ). According to the findings of the most recent meta-analysis, the prevalence rate in Iran shows considerable variability, ranging from 11–25.8% ( 3 ). ADHD core symptoms are inattention, hyperactivity, and impulsivity ( 4 ). Children diagnosed with ADHD may experience considerable performance-related difficulties, including academic challenges, complications in interpersonal relationships with family members and peers, and diminished self-esteem ( 5 – 7 ). Social and emotional dysfunction are challenging aspects of ADHD, which markedly influence the prognosis for individuals affected by this condition ( 8 ). The parent-child relationship in families with a child diagnosed with ADHD is characterized by more conflict and substantially greater stress compared to families without such a member ( 9 ). Moreover, children and adolescents with ADHD often exhibit intrusive and disruptive behaviors during social interactions ( 10 ). Emotional impairments associated with ADHD may encompass difficulties in self-regulating emotions, excessive emotional expression, marked challenges in coping with frustration, and diminished empathy ( 11 – 13 ). Overall, this disorder is associated with psychosocial, academic, and neuropsychological impairments, an increased risk of suicidal ideation, and reduced levels of academic achievement and employment in adulthood ( 14 – 16 ). Therefore, early diagnosis and intervention for ADHD can significantly improve the educational and psychosocial development of children ( 17 ). Given the significance of early diagnosis and intervention in mitigating the negative effects associated with ADHD symptoms and their related complications, several diagnostic and screening tools have been developed and are currently accessible for the assessment of this disorder. These measures are based on self, parent, and teacher reports according to the age of the participants ( 18 ). Several reference assessment scales are currently utilized, such as the Conners’ Rating Scales (CRS), ADHD Rating Scale IV (ADHD-RS-IV) ( 19 ), and the Iowa Conners’ Rating Scale ( 20 ). The Conners’ Rating Scales (CRS) are among the most commonly used tools in clinical and research settings for diagnosing and screening ADHD in both children and adults. This tool evaluates the core symptoms of ADHD based on the criteria outlined in the DSM ( 21 , 22 ). The initial version of this instrument, a comprehensive checklist for evaluating a broad spectrum of problems identified by parents and teachers of school-aged children, was published in 1970 by Dr. Keith Conners ( 23 ). The second revised version, titled Conners' Rating Scales–Revised (CRS-R), was introduced in 1997 ( 24 ). This version specifically assesses ADHD and associated concerns, including cognitive difficulties related to learning disabilities, aggressive behaviors, social challenges, and emotional disturbances. Additionally, this revision includes the ADHD index and symptoms outlined in DSM-IV as notable enhancements ( 25 , 26 ). In the third version of the CRS questionnaire, presented in 2008, the self-report age range was extended to 8–18 years. This amendment not only allows for the collection of information from individuals familiar with the patient's behavior and problems but also enables direct input from the patient ( 27 ). The version includes three forms: parent report (Conners 3-P), teacher report (Conners 3-T), and self-report (Conners 3-SR). The short version of the Conners’ 3-P measures inattention with five questions, hyperactivity/impulsivity with six ,learning problems with five, executive functioning with five, aggression with five, and interpersonal relationships with five questions ( 28 ). In a study conducted in Iran by Shahaian et al. (2007), the 48-item form developed by Conners in 1978 for parent assessment was validated ( 29 ). The test-retest reliability coefficient was found to be 0.58, while Cronbach's alpha coefficient for the total score was determined to be 0.73 ( 30 ). This study concerns the older version of the Conners questionnaire. A recent study conducted in Iran by Amiri et al. (2023) assessed the psychometric properties of the Persian version of the Conners’ Early Childhood ADHD Questionnaire-Parents’ Form for Iranian children aged 3 to 6 years ( 31 ). This study demonstrated strong reliability and validity for screening the Iranian pediatric population, with an overall Cronbach’s alpha coefficient of 0.88. With the advancements in the latest version, it is essential to assess the psychometric properties of this tool prior to its application. Additionally, the current study focuses on a different age group, specifically children aged 6 to 12 years. Thus, the objective of this study is to evaluate the psychometric properties of the short version of the Conners’ Parent Questionnaire-3 (Conners 3-P) in a clinical sample of Iranian children aged 6 to 12 years. Methods and Materials Participants Participants consisted of children aged 6 to 12 years who presented for evaluation at the Child and Adolescent Clinic of psychiatry hospital, located in a major metropolitan area, and were diagnosed with ADHD by a child and adolescent psychiatrist. Following a comprehensive explanation of the study's objectives and methodologies to both parents and children, informed consent was obtained prior to enrollment. To verify the diagnosis and assess potential co-occurring disorders, a semi-structured interview—specifically, the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version for DSM-5 (K-SADS-PL-5)—was conducted by a child and adolescent psychiatry fellow. This interview included both the child and the parent. The inclusion criteria for participants in the ADHD group consisted of children aged 6 to 12 years who were diagnosed with attention deficit/hyperactivity disorder based on DSM-5 classification ( 32 ) and who had no major psychiatric or neurological disorders. Exclusion criteria included the concurrent presence of any other major psychiatric or neurological disorders. Ultimately, a total of 55 children from the affected participants were included in the study. The healthy group, was recruited from main stream elementary schools. Based on interviewing with parents, the students had no prior history of psychiatric disorders and expressed a willingness to participate in the study. Parents were requested to complete the Strengths and Difficulties Questionnaire (SDQ) for their children to make sure that they have no psychological problem. At the beginning of the study, 100 parents completed SDQ for their children. From this group, 20 children were excluded because of obtaining the scores above the cut-off point of the SDQ, indicating an abnormal range. Ultimately, 80 children with typical development were included in the healthy group. Furthermore, parents of both groups were asked to complete the Conners-3, while the parents of the ADHD group were additionally requested to complete the ADHD Rating Scale Questionnaire. Measures Conners’ Parent Questionnaire-3 Short Form This questionnaire includes six measuring subscales: inattention, hyperactivity/impulsivity, learning problems, executive function, aggression, and interpersonal relationships ( 27 , 33 ). A psychometric study of the Italian version of parent version on 631 youths showed the Cronbach’s alpha coefficients for the Executive Functioning, Learning Problems, Aggression, Peer Relations, Hyperactivity/Impulsivity, and Inattention subscales as 0.76, 0.72, 0.47, 0.72, 0.82, and 0.89, respectively. These findings indicate strong inter-item correlations across all the Conners’ 3 subscales except for the Aggression scale and suggest that the items within each scale are effectively measuring the same construct ( 28 ). Translation and back translation of the Conners’ Questionnaire The questionnaire was translated into Farsi by two child and adolescent psychiatrists from the Department of Child and Adolescent Psychiatry at a psychiatry hospital. The Farsi version was subsequently back-translated into English by a language expert. The compatibility of the two original versions and the English back translation was reviewed by consultants of the child and adolescent psychiatrist at the psychiatry hospital. The revised English version was then translated back into Farsi by the child and adolescent psychiatry team, along with necessary revisions. A checklist for evaluating the questionnaire's questions in terms of their compatibility with the social and cultural conditions of Iranian people was prepared and completed by five child and adolescent psychiatrists. Additionally, the content validity index (CVI) was calculated for the entire questionnaire as well as for each individual question. Experts' opinions and necessary corrections were incorporated through focus group discussions. The modified questionnaire was then presented to 17 individuals from the target group to assess their understanding and consistency in interpreting the questions. ADHD Rating Scale IV (ADHD-RS-IV)-Home Version This questionnaire consists of 18 items developed by Faries et al. (2001) to assess ADHD symptoms in children and adolescents aged 5 to 18 years ( 34 ). It includes separate versions for home and school, capturing the child's behavior over the past six months. Responses are made using a four-point Likert scale. The questionnaire has two subscales: attention deficit and hyperactivity/impulsivity, each consisting of 9 items. This tool demonstrates acceptable levels of reliability and validity ( 19 , 35 ). The Persian version of this instrument has been validated by Ghanizadeh and Jafari (2010) in Iran. The findings of this study identified two subscales of the questionnaire: inattentiveness (Cronbach's alpha = 0.81) and hyperactivity/impulsivity (Cronbach's alpha = 0.85). The total score of the questionnaire demonstrated a Cronbach's alpha of 0.83 ( 36 ). Kiddie Schedule for Affective Disorders and Schizophrenia- present and life time version for DSM-5 (K-SADS-PL_5) This semi-structured interview is designed to assess psychiatric disorders in children and adolescents according to the DSM diagnostic criteria. The DSM-IV version of this tool was translated into Farsi language and validated in Iran by Ghanizadeh et al. (2006) ( 37 ) and Shahrivar et al. (2009) ( 38 ), demonstrating good to excellent sensitivity, specificity, and both positive and negative predictive values across nearly all disorders. The test-retest reliability for ADHD was 0.81, and the inter-rater reliability was 0.69. The Strength and Difficulties Questionnaire (SDQ) This questionnaire, designed by Goodman (1997), is a behavioral screening tool for children and adolescents ( 39 ). It consists of 25 questions divided into 5 subscales. This questionnaire has been validated by Ghanizadeh et al. (2007) ( 40 ) and Shahrivar et al. (2008) ( 41 ) in Iran. The obtained Cronbach's alpha for the parent version is 0.73, indicating sufficient convergent and divergent validity. Statistical Analysis The Content Validity Index (CVI) was calculated to assess the content validity of the questionnaire. Exploratory Factor Analysis (EFA) with Varimax Rotation was employed to identify subscales, determine the questions associated with each subscale, and evaluate the percentage of explained variance, thereby assessing the validity of the structure. To evaluate the diagnostic power of the questionnaire and identify the cut-off point with the highest sensitivity and specificity for diagnosing ADHD symptoms in patients, the Receiver Operating Characteristic (ROC) curve and Area Under the Curve (AUC) were utilized. Convergent and divergent validity were examined using the Multi-Trait Multi-Method Matrix method. Additionally, Cronbach's alpha and the Intra-class Correlation Coefficient (ICC) were calculated to measure the reliability of the questionnaire. Finally, scores from different educational and age subgroups of teenagers were compared using an independent t-test. To evaluate the test-retest reliability, seventeen parents from the ADHD group were randomly selected to re answer the Conners’ 3-P questionnaire after a period of 2 to 3 weeks. Results Demographic Features This study involved 135 adolescents aged 6 to 12, consisting of 76 boys (56.3%) and 59 girls (43.7%). Among the participants, there were 55 children with ADHD (40.7%) and 80 healthy children (59.3%). The average age of the participants was 8.27 years, with a standard deviation of 1.70, within the age range of 6 to 12 years. Exploratory Factor Analysis The results of the Exploratory Factor Analysis (EFA) and the evaluation of items in each factor using the Varimax Rotation method revealed six factors: inattention, hyperactivity, learning problems, parents’ negative attitude, aggression, and parents’ positive attitude. These six factors collectively account for 52.22% of the total variance, which is considered an acceptable outcome. The Cronbach's alpha score for the entire questionnaire was 0.93, with all scales exceeding 0.70 and ranging from 0.69 to 0.93. (Table 1 ). Table 1 Characteristics and Reliability of the Primary Subscales of the Conners’ 3-P Subscales Percentage of explained variance Cronbach's alpha Mean (SD) Inattention 15.22 0.93 13.90 (9.51) Hyperactivity 11.07 0.92 7.02 (5.58) Learning Problems 7.10 0.82 2.62 (2.88) Parents Negative Attitude 6.80 0.75 3.48 (3.21) Aggression 6.62 0.86 2.41 (3.49) Parents Positive Attitude 5.39 0.69 8.97 (3.90) Total 52.22 0.93 38.41 (20.03) Group Comparison of Conners’ Score An independent t-test was conducted to distinguish between the two groups, and the mean scores for all six subscales were calculated. The total score of the Conners’ also revealed a significant difference between the groups, with the ADHD group scoring higher (Table 2 ). Table 2 Group Comparison of Conners’ Score Subscales ADHD Group Mean (SD) Healthy Group Mean (SD) P-value Inattention 21.85 (8.63) 8.43 (5.30) p < 0.001 Hyperactivity 12.10 (4.46) 3.52 (2.96) p < 0.001 Learning Problems 4.21 (3.56) 1.52 (1.57) p < 0.001 Parents Negative Attitude 5.56 (3.67) 2.05 (1.77) p < 0.001 Aggression 4.87 (4.31) 0.72 (0.92) p < 0.001 Parents Positive Attitude 7.14 (2.98) 10.22 (3.99) p < 0.001 Total 55.76 (18.64) 26.48 (9.45) p < 0.001 Convergent validity of Conners’ 3-P The correlation between the subscales identified by the Conners’ 3-P and the hyperactivity and inattention subscales of the ADHD-RS-IV was investigated through the simultaneous use of both assessments. This analysis utilized the Multi-Trait Multi-Method Matrix method (Table 3 ). The correlation between hyperactivity factors on the two questionnaires was high and significant (r = 0.638, p < 0.01). The correlation between the inattention subscale of the ADHD-RS-IV and the Conners' subscales was significant but moderate, (r = 0.342, p < 0.05). A strong correlation was also found between hyperactivity on the ADHD-RS-IV and aggression on the Conners' scale (r = 0.633, p < 0.01). Additionally, there was an inverse but non-significant correlation between the parents’ positive attitude subscale and both ADHD subscales. Table 3 Correlation Matrix of Conners’ Variables with Hyperactivity and Inattention Subscales from the ADHD Rating Scale Inattention (Con) Hyperactivity (Con) Learning Problem (Con) Parents Negative Attitude (Con) Aggression (Con) Parent Positive Attitude (Con) Hyperactivity (ADHD-RS) R .426 ** .638 ** .321 * .305 * .633 ** − .020 P-value .001 .000 .017 .023 .000 .885 Inattention (ADHD-RS) R .342 * .273 * .255 .039 .192 − .265 P-value .011 .044 .060 .779 .159 .050 *. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed). Sensitivity and Specificity At this stage, the total score from six factors was used as a continuous variable, while the presence or absence of ADHD was classified as a binary variable in the Relative Operating Characteristic (ROC) chart. The ROC chart was used to evaluate the diagnostic power of the Conners’ questionnaire in distinguishing children with ADHD from healthy children (Fig. 1 ). According to the graph, the Area Under the Curve (AUC) was 0.92, indicating a high diagnostic power for the questionnaire. The total score that achieved the highest sensitivity and specificity was used to determine the cutoff point. The results showed that the cut point for the total score of 38.50, represented the highest sensitivity (80%) and specificity (89%). Thus, a score above 38.50 classifies a child as having ADHD, while a score below this threshold categorizes them as healthy. Test-retest Reliability The results of retesting the questionnaire with 17 parents after 2–3 weeks, along with the reliability measured using the intraclass correlation coefficient (ICC), are presented in Table 4 . These findings indicate that the tool has good test-retest reliability. Table 4 The Result of Test-retest Reliability Subscales ICC P-value Inattention 0.81 (0.56–0.92) p < 0.001 Hyperactivity 0.85 (0.64–0.94) p < 0.001 Learning Problems 0.83 (0.59–0.93) p < 0.001 Parents Negative Attitude 0.69 (0.33–0.87) p < 0.001 Aggression 0.79 (0.52–0.92) p < 0.001 Parents Positive Attitude 0.78 (0.49–0.91) p < 0.001 Total 0.86 (0.67–0.95) p < 0.001 Discussion Early diagnosis and treatment can prevent adverse consequences of ADHD in the future. One tool used for diagnosing and screening the disorder is the Conners' Rating Scales (CRS) questionnaire, available in its third version, which is completed by parents, teachers, and the patients themselves. Before applying this latest version, it is essential to evaluate the psychometric characteristics of the tool. Therefore, the purpose of this study was to assess the psychometric properties of the short form of the Conners-3 Parent Questionnaire in a clinical sample of Iranian children aged 6 to 12 years, in comparison to typically developing children. The number of factors identified in this study was six, including inattention, hyperactivity, learning problems, parents’ negative attitude, aggression, and parents’ positive attitude. In study done by Gallant involving healthy children and patients aged 6 to 18 years, five factors were identified: Executive Functioning, Learning Problems, Aggression, Peer Relations, and Hyperactivity/Impulsivity ( 42 ). Similarly, Christiansen et al. (2016) identified five factors: Inattention/Learning Problems, Hyperactivity/Impulsivity, Aggression, Peer/Family Relations, and Defiance ( 43 ). Gomez et al. (2020) also identified five factors: Inattention, Hyperactivity, Learning Problems, Aggression, and Peer Relation ( 44 ). A key distinction in this study is the inclusion of "positive and negative parents' attitudes," which other studies often classify under executive function. This difference may be attributed to cultural variations among different countries and the differing sensitivities of parents in Iran compared to those in other countries. Additionally, the differences in the average age and gender distribution of the study participants compared to those in other studies may influence the findings. For example, participants in the study by Gomes et al. (2020) had an average age of 11.7 ± 2.9 years, with 75% being boys. In contrast, the children in this research had an average age of 8.2 ± 1.7 years, with 56.3% being boys. The Cronbach's alpha score for the entire questionnaire was 0.93, with all its scales above 0.7, ranging from 0.69 to 0.93. This indicates an acceptable level of reliability for the questionnaire. In contrast, the Cronbach's alpha for the Gallant’s validation study of the questionnaire ranged from 0.85 to 0.94 ( 42 ). In a study conducted in 2023, in preschool children, the internal consistency of the Persian version of the Conners’ Early Childhood – Parents’ Form in Iran was calculated with an overall Cronbach’s alpha coefficient of 0.88 ( 31 ). Another aspect of this study was to determine the cutoff point for the questionnaire to differentiate between healthy individuals and those with ADHD. The ROC diagram revealed an AUC value of 0.92, indicating a significant difference from 0.5, which would suggest random differentiation between patients and healthy individuals. This finding further supports the validity of the questionnaire for Iranian children. The cut point of raw score identified in this study was 38.50. In one study aimed at determining the prevalence of ADHD among students in Mexico, a T-score above the 65th percentile was used as a cutoff point ( 45 ). In a study conducted in 2021, ROC curve analysis was utilized to assess and compare the diagnostic accuracy of the inattention, hyperactivity/impulsivity, and aggression scales from C 3-P(S), C 3-T(S), and the Child Behavior Checklist to distinguish between children with and without ADHD. The AUC values for the combined inattention and hyperactivity/impulsivity scales and aggression for C 3-P(S) were 0.85 and 0.83, respectively. Furthermore, the sensitivity and specificity for these scales were 79.3% and 79.4%, respectively. The optimal cutoff points were determined to be 17 and 3, respectively ( 46 ). In another study conducted by Deb et al. (2008), the ROC chart was employed to establish the cutoff point for the parental version, resulting in a sensitivity of 90% and a specificity of 67%. The AUC was calculated to be 0.84 ( 47 ). In contrast, this study reported a higher AUC of 0.92, suggesting improved diagnostic power in differentiating between healthy individuals and those with ADHD. Furthermore, utilizing this cutoff point, this study achieved a sensitivity of 80% and a specificity of 89%, which are generally regarded as favorable outcomes. The convergent validity of the questionnaire was assessed by analyzing its correlation with the ADHD-RS-IV. The strongest correlation was found between the hyperactivity factors of both questionnaires, as well as between the hyperactivity scores of the ADHD-RS-IV and the aggression scores from the Conners’ Questionnaire. Conversely, the weakest correlation was observed between the parents' positive attitude on the Conners’ 3-P Questionnaire and the hyperactivity score of ADHD-RS-IV, and this correlation was inverse. This suggests that as parents' positive attitude scores increase, hyperactivity scores decrease, which aligns with theoretical expectations; specifically, poorer child behavior is associated with lower parental positivity. Nevertheless, this correlation was not statistically significant. Consistent with our findings, a study conducted in 2021 evaluated the validity of the French Lausanne version (FLV) of the CPRS-R short form in children diagnosed with ADHD. The study demonstrated the convergent validity of the CPRS-R:S evidenced by a very strong correlation between the FLV Hyperactivity score and the Impulsivity/Hyperactivity score of the ADHD Symptoms Rating Scale (ADHD-SRS) ( 48 ). In conclusion, this study's findings suggest that the short version of Conners’ 3-P shows acceptable reliability and validity in assessing children's ADHD symptoms through parental reports. One of the notable strengths of this study is the concurrent use of two questionnaires and the subsequent evaluation of the correlation between their subscales. Furthermore, the percentage of explained variance by the identified factors was significant, and the cut-off point for the questionnaire was determined utilizing the ROC curve. However, a limitation of the study is its reliance on a clinical sample, which may result in a lack of generalizability to the broader patient population. Therefore, it is recommended that future research be conducted among the general population to enhance the validity of the findings. Declarations Ethics Approval and Consent to Participate This study was approved by the Research Ethics Committee of Tehran University of Medical Sciences (code: IR.TUMS.MEDICINE.REC.1398.113) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from the legal guardians of all participants. Consent for publication All authors agree to submit for consideration for publication in the Journal of Child and Adolescent Psychiatry and Mental Health. Clinical trial registration Not applicable. Data Availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding Statement This work was supported by the Tehran University of Medical Sciences [grant number 1400-2-210-53504]. Author Contributions FM: Investigation, Writing – Review & Editing MT: Conceptualization, Supervision, Writing – Review & Editing NF: Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing ZS: Methodology, Supervision, Writing – Review & Editing JMG: Formal Analysis, Writing – Review & Editing Acknowledgements We extend our sincere appreciation to all children and their parents for contributing to this study. References Ayano G, Demelash S, Gizachew Y, Tsegay L, Alati R. The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. Journal of Affective Disorders. 2023;339:860-6. Salari N, Ghasemi H, Abdoli N, Rahmani A, Shiri MH, Hashemian AH, et al. The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis. Italian Journal of Pediatrics. 2023;49(1):48. Hakim Shooshtari M, Shariati B, Kamalzadeh L, Naserbakht M, Tayefi B, Taban M. 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Validation of the ADHD Rating Scale as a clirlician administered and scored instrument. Journal of Attention Disorders. 2001;5(2):107-15. DuPaul G. ADHD Rating Scale-IV: checklists, norms, and clinical interpretation. Akashi Shuppan. (No Title). 2008. Ghanizadeh A, Jafari P. Cultural structures of the Persian parents' ratings of ADHD. J Atten Disord. 2010;13(4):369-73. Ghanizadeh A, Mohammadi MR, Yazdanshenas A. Psychometric properties of the Farsi translation of the kiddie schedule for affective disorders and schizophrenia-present and lifetime version. BMC psychiatry. 2006;6:1-5. Shahrivar Z, Kousha M, Moallemi S, Tehrani‐Doost M, Alaghband‐Rad J. The reliability and validity of kiddie‐schedule for affective disorders and schizophrenia‐present and life‐time version‐Persian version. Child and Adolescent Mental Health. 2010;15(2):97-102. Goodman R. The Strengths and Difficulties Questionnaire: a research note. Journal of child psychology and psychiatry. 1997;38(5):581-6. Ghanizadeh A, Izadpanah A. Scale validation of the strengths and difficulties questionnaire in Iranian children. 2007. Tehranidoust M, Shahrivar Z, Pakbaz B, Rezaei A, Ahmadi F. Validity of farsi version of strengths and difficulties questionnaire (SDQ). Advances in cognitive science. 2007;8(4):33-9. Gallant S, editor Psychometric Properties of the Conners 3rd Edition. Poster presented at the annual meeting of the American Psychological Association; 2007. Christiansen H, Hirsch O, Drechsler R, Wanderer S, Knospe E-L, Günther T, et al. German validation of the conners 3u+ 00ae rating scales for parents, teachers, and children. Zeitschrift für Kinder-und Jugendpsychiatrie und Psychotherapie. 2016. Gomez R, Vance A, Stavropoulos V. Correlated trait–correlated method minus one analysis of the convergent and discriminant validity of the Conners 3 Short Forms. Assessment. 2020;27(7):1463-75. Gallardo-Saavedra GA, del Consuelo Martínez-Wbaldo M, Padrón-García AL. Prevalence of ADHD in Mexican schoolchildren through screening with Conners scales 3. Actas Españolas de Psiquiatría. 2019;47(2):45-53. Gomez R, Vance A, Watson S, Stavropoulos V. ROC Analyses of Relevant Conners 3–Short Forms, CBCL, and TRF Scales for Screening ADHD and ODD. Assessment. 2021;28(1):73-85. Deb S, Dhaliwal AJ, Roy M. The usefulness of Conners' Rating Scales-Revised in screening for attention deficit hyperactivity disorder in children with intellectual disabilities and borderline intelligence. Journal of intellectual disability research : JIDR. 2008;52(11):950-65. Fumeaux P, Mercier C, Roche S, Iwaz J, Stéphan P, Revol O. Validation of the French Version of Conners’ Parent Rating Scale–Revised, Short Form in ADHD-Diagnosed Children and Comparison With Control Children. Journal of Attention Disorders. 2021;25(1):124-33. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6850810","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":487098785,"identity":"9ce4394d-11b9-4112-8631-43c694baffeb","order_by":0,"name":"Fatemeh Mehrzad","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Mehrzad","suffix":""},{"id":487098786,"identity":"b4db8308-4700-47a0-b270-ae8fb0b9d1bf","order_by":1,"name":"Mehdi Tehrani-Doost","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYFACHhAhwdjPwNiALCyBRwNUy8wGsBYDorUwMG44AKYNcKqEA3v23mMffu6wkN18/nDbgx8MfxLX9h9g/PCDwSIfpy0855Jn9p6RMN52I7HdsIfBIHHbjQRmyR4GCcsGXFokcowZeNskgCoZ2yR4wFoYGKSBfsHpRB75N8aMf4FaNvcfbJP8A9Jy/gDzb7xaJHiMmUG2bGBIbJMG23IggQ2/LWdyjJll2ySMZ9wAapExMAZ5qs2yxwC3Fvb2M8aMb9vqZPv7jz+TfFMhJ7vt/OHDN35U1BER3GAAVgeKU2I1jIJRMApGwSjACgASJ06wjpyvdAAAAABJRU5ErkJggg==","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mehdi","middleName":"","lastName":"Tehrani-Doost","suffix":""},{"id":487098787,"identity":"8d769a5e-4a97-4ed7-acea-b255e13ba4f7","order_by":2,"name":"Niloofar Fallahinia","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Niloofar","middleName":"","lastName":"Fallahinia","suffix":""},{"id":487098788,"identity":"c4490e47-1821-4bc4-a912-eacfc6fda6d5","order_by":3,"name":"Zahra Shahrivar","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Shahrivar","suffix":""},{"id":487098789,"identity":"651ce148-b2f4-484a-9a63-cc563c1fd105","order_by":4,"name":"Javad Mahmoudi Gharaei","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Javad","middleName":"Mahmoudi","lastName":"Gharaei","suffix":""}],"badges":[],"createdAt":"2025-06-09 05:23:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6850810/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6850810/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-026-07928-y","type":"published","date":"2026-04-27T15:57:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87380574,"identity":"5f0509f1-03d2-4516-b7b0-3c7855593e75","added_by":"auto","created_at":"2025-07-23 08:35:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38413,"visible":true,"origin":"","legend":"\u003cp\u003eROC Curve Showing Diagnostic Accuracy of Conners’ Questionnaire for Identifying ADHD in Children and Controls\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6850810/v1/48928c097a9065b6cc6f5771.png"},{"id":108439280,"identity":"33d8c303-d8b2-48f7-a334-ae30c9cac6ef","added_by":"auto","created_at":"2026-05-04 16:19:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":317262,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6850810/v1/fd9a2e4c-0243-46aa-844f-9644fbebd8c3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric Properties of the Conners’ 3 Parent Rating Scale in a Clinical Sample of Iranian Children","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAttention-Deficit/Hyperactivity Disorder (ADHD) is the most prevalent mental disorder among children. The global prevalence of ADHD in children and adolescents is 8.0% (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is reported to be 7.6% in children aged 3 to 12 years and 5.6% in adolescents aged 12 to 18 years (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). According to the findings of the most recent meta-analysis, the prevalence rate in Iran shows considerable variability, ranging from 11\u0026ndash;25.8% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). ADHD core symptoms are inattention, hyperactivity, and impulsivity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Children diagnosed with ADHD may experience considerable performance-related difficulties, including academic challenges, complications in interpersonal relationships with family members and peers, and diminished self-esteem (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Social and emotional dysfunction are challenging aspects of ADHD, which markedly influence the prognosis for individuals affected by this condition (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The parent-child relationship in families with a child diagnosed with ADHD is characterized by more conflict and substantially greater stress compared to families without such a member (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Moreover, children and adolescents with ADHD often exhibit intrusive and disruptive behaviors during social interactions (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Emotional impairments associated with ADHD may encompass difficulties in self-regulating emotions, excessive emotional expression, marked challenges in coping with frustration, and diminished empathy (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Overall, this disorder is associated with psychosocial, academic, and neuropsychological impairments, an increased risk of suicidal ideation, and reduced levels of academic achievement and employment in adulthood (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Therefore, early diagnosis and intervention for ADHD can significantly improve the educational and psychosocial development of children (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven the significance of early diagnosis and intervention in mitigating the negative effects associated with ADHD symptoms and their related complications, several diagnostic and screening tools have been developed and are currently accessible for the assessment of this disorder. These measures are based on self, parent, and teacher reports according to the age of the participants (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Several reference assessment scales are currently utilized, such as the Conners\u0026rsquo; Rating Scales (CRS), ADHD Rating Scale IV (ADHD-RS-IV) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and the Iowa Conners\u0026rsquo; Rating Scale (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Conners\u0026rsquo; Rating Scales (CRS) are among the most commonly used tools in clinical and research settings for diagnosing and screening ADHD in both children and adults. This tool evaluates the core symptoms of ADHD based on the criteria outlined in the DSM (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The initial version of this instrument, a comprehensive checklist for evaluating a broad spectrum of problems identified by parents and teachers of school-aged children, was published in 1970 by Dr. Keith Conners (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The second revised version, titled Conners' Rating Scales\u0026ndash;Revised (CRS-R), was introduced in 1997 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This version specifically assesses ADHD and associated concerns, including cognitive difficulties related to learning disabilities, aggressive behaviors, social challenges, and emotional disturbances. Additionally, this revision includes the ADHD index and symptoms outlined in DSM-IV as notable enhancements (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In the third version of the CRS questionnaire, presented in 2008, the self-report age range was extended to 8\u0026ndash;18 years. This amendment not only allows for the collection of information from individuals familiar with the patient's behavior and problems but also enables direct input from the patient (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The version includes three forms: parent report (Conners 3-P), teacher report (Conners 3-T), and self-report (Conners 3-SR). The short version of the Conners\u0026rsquo; 3-P measures inattention with five questions, hyperactivity/impulsivity with six ,learning problems with five, executive functioning with five, aggression with five, and interpersonal relationships with five questions (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a study conducted in Iran by Shahaian et al. (2007), the 48-item form developed by Conners in 1978 for parent assessment was validated (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The test-retest reliability coefficient was found to be 0.58, while Cronbach's alpha coefficient for the total score was determined to be 0.73 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). This study concerns the older version of the Conners questionnaire. A recent study conducted in Iran by Amiri et al. (2023) assessed the psychometric properties of the Persian version of the Conners\u0026rsquo; Early Childhood ADHD Questionnaire-Parents\u0026rsquo; Form for Iranian children aged 3 to 6 years (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). This study demonstrated strong reliability and validity for screening the Iranian pediatric population, with an overall Cronbach\u0026rsquo;s alpha coefficient of 0.88. With the advancements in the latest version, it is essential to assess the psychometric properties of this tool prior to its application. Additionally, the current study focuses on a different age group, specifically children aged 6 to 12 years. Thus, the objective of this study is to evaluate the psychometric properties of the short version of the Conners\u0026rsquo; Parent Questionnaire-3 (Conners 3-P) in a clinical sample of Iranian children aged 6 to 12 years.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eParticipants consisted of children aged 6 to 12 years who presented for evaluation at the Child and Adolescent Clinic of psychiatry hospital, located in a major metropolitan area, and were diagnosed with ADHD by a child and adolescent psychiatrist. Following a comprehensive explanation of the study's objectives and methodologies to both parents and children, informed consent was obtained prior to enrollment. To verify the diagnosis and assess potential co-occurring disorders, a semi-structured interview\u0026mdash;specifically, the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version for DSM-5 (K-SADS-PL-5)\u0026mdash;was conducted by a child and adolescent psychiatry fellow. This interview included both the child and the parent. The inclusion criteria for participants in the ADHD group consisted of children aged 6 to 12 years who were diagnosed with attention deficit/hyperactivity disorder based on DSM-5 classification (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) and who had no major psychiatric or neurological disorders. Exclusion criteria included the concurrent presence of any other major psychiatric or neurological disorders. Ultimately, a total of 55 children from the affected participants were included in the study.\u003c/p\u003e\u003cp\u003eThe healthy group, was recruited from main stream elementary schools. Based on interviewing with parents, the students had no prior history of psychiatric disorders and expressed a willingness to participate in the study. Parents were requested to complete the Strengths and Difficulties Questionnaire (SDQ) for their children to make sure that they have no psychological problem. At the beginning of the study, 100 parents completed SDQ for their children. From this group, 20 children were excluded because of obtaining the scores above the cut-off point of the SDQ, indicating an abnormal range. Ultimately, 80 children with typical development were included in the healthy group. Furthermore, parents of both groups were asked to complete the Conners-3, while the parents of the ADHD group were additionally requested to complete the ADHD Rating Scale Questionnaire.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eConners\u0026rsquo; Parent Questionnaire-3 Short Form\u003c/h2\u003e\u003cp\u003eThis questionnaire includes six measuring subscales: inattention, hyperactivity/impulsivity, learning problems, executive function, aggression, and interpersonal relationships (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). A psychometric study of the Italian version of parent version on 631 youths showed the Cronbach\u0026rsquo;s alpha coefficients for the Executive Functioning, Learning Problems, Aggression, Peer Relations, Hyperactivity/Impulsivity, and Inattention subscales as 0.76, 0.72, 0.47, 0.72, 0.82, and 0.89, respectively. These findings indicate strong inter-item correlations across all the Conners\u0026rsquo; 3 subscales except for the Aggression scale and suggest that the items within each scale are effectively measuring the same construct (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTranslation and back translation of the Conners’ Questionnaire\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was translated into Farsi by two child and adolescent psychiatrists from the Department of Child and Adolescent Psychiatry at a psychiatry hospital. The Farsi version was subsequently back-translated into English by a language expert. The compatibility of the two original versions and the English back translation was reviewed by consultants of the child and adolescent psychiatrist at the psychiatry hospital. The revised English version was then translated back into Farsi by the child and adolescent psychiatry team, along with necessary revisions. A checklist for evaluating the questionnaire's questions in terms of their compatibility with the social and cultural conditions of Iranian people was prepared and completed by five child and adolescent psychiatrists. Additionally, the content validity index (CVI) was calculated for the entire questionnaire as well as for each individual question. Experts' opinions and necessary corrections were incorporated through focus group discussions. The modified questionnaire was then presented to 17 individuals from the target group to assess their understanding and consistency in interpreting the questions.\u003c/p\u003e\n\u003ch3\u003eADHD Rating Scale IV (ADHD-RS-IV)-Home Version\u003c/h3\u003e\n\u003cp\u003eThis questionnaire consists of 18 items developed by Faries et al. (2001) to assess ADHD symptoms in children and adolescents aged 5 to 18 years (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). It includes separate versions for home and school, capturing the child's behavior over the past six months. Responses are made using a four-point Likert scale. The questionnaire has two subscales: attention deficit and hyperactivity/impulsivity, each consisting of 9 items. This tool demonstrates acceptable levels of reliability and validity (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The Persian version of this instrument has been validated by Ghanizadeh and Jafari (2010) in Iran. The findings of this study identified two subscales of the questionnaire: inattentiveness (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.81) and hyperactivity/impulsivity (Cronbach's alpha\u0026thinsp;=\u0026thinsp;0.85). The total score of the questionnaire demonstrated a Cronbach's alpha of 0.83 (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eKiddie Schedule for Affective Disorders and Schizophrenia- present and life time version for DSM-5 (K-SADS-PL_5)\u003c/h2\u003e\u003cp\u003eThis semi-structured interview is designed to assess psychiatric disorders in children and adolescents according to the DSM diagnostic criteria. The DSM-IV version of this tool was translated into Farsi language and validated in Iran by Ghanizadeh et al. (2006) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and Shahrivar et al. (2009) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), demonstrating good to excellent sensitivity, specificity, and both positive and negative predictive values across nearly all disorders. The test-retest reliability for ADHD was 0.81, and the inter-rater reliability was 0.69.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eThe Strength and Difficulties Questionnaire (SDQ)\u003c/h3\u003e\n\u003cp\u003eThis questionnaire, designed by Goodman (1997), is a behavioral screening tool for children and adolescents (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). It consists of 25 questions divided into 5 subscales. This questionnaire has been validated by Ghanizadeh et al. (2007) (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) and Shahrivar et al. (2008) (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) in Iran. The obtained Cronbach's alpha for the parent version is 0.73, indicating sufficient convergent and divergent validity.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe Content Validity Index (CVI) was calculated to assess the content validity of the questionnaire. Exploratory Factor Analysis (EFA) with Varimax Rotation was employed to identify subscales, determine the questions associated with each subscale, and evaluate the percentage of explained variance, thereby assessing the validity of the structure. To evaluate the diagnostic power of the questionnaire and identify the cut-off point with the highest sensitivity and specificity for diagnosing ADHD symptoms in patients, the Receiver Operating Characteristic (ROC) curve and Area Under the Curve (AUC) were utilized. Convergent and divergent validity were examined using the Multi-Trait Multi-Method Matrix method. Additionally, Cronbach's alpha and the Intra-class Correlation Coefficient (ICC) were calculated to measure the reliability of the questionnaire. Finally, scores from different educational and age subgroups of teenagers were compared using an independent t-test. To evaluate the test-retest reliability, seventeen parents from the ADHD group were randomly selected to re answer the Conners\u0026rsquo; 3-P questionnaire after a period of 2 to 3 weeks.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Features\u003c/h2\u003e\u003cp\u003eThis study involved 135 adolescents aged 6 to 12, consisting of 76 boys (56.3%) and 59 girls (43.7%). Among the participants, there were 55 children with ADHD (40.7%) and 80 healthy children (59.3%). The average age of the participants was 8.27 years, with a standard deviation of 1.70, within the age range of 6 to 12 years.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eExploratory Factor Analysis\u003c/h2\u003e\u003cp\u003eThe results of the Exploratory Factor Analysis (EFA) and the evaluation of items in each factor using the Varimax Rotation method revealed six factors: inattention, hyperactivity, learning problems, parents\u0026rsquo; negative attitude, aggression, and parents\u0026rsquo; positive attitude. These six factors collectively account for 52.22% of the total variance, which is considered an acceptable outcome. The Cronbach's alpha score for the entire questionnaire was 0.93, with all scales exceeding 0.70 and ranging from 0.69 to 0.93. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics and Reliability of the Primary Subscales of the Conners\u0026rsquo; 3-P\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscales\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePercentage of explained variance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCronbach's alpha\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInattention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.90 (9.51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHyperactivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.02 (5.58)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLearning Problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.62 (2.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents Negative Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.48 (3.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAggression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.41 (3.49)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents Positive Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.97 (3.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.41 (20.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eGroup Comparison of Conners\u0026rsquo; Score\u003c/h2\u003e\u003cp\u003eAn independent t-test was conducted to distinguish between the two groups, and the mean scores for all six subscales were calculated. The total score of the Conners\u0026rsquo; also revealed a significant difference between the groups, with the ADHD group scoring higher (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGroup Comparison of Conners\u0026rsquo; Score\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscales\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eADHD Group\u003c/p\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHealthy Group\u003c/p\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInattention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21.85 (8.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.43 (5.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHyperactivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12.10 (4.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.52 (2.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLearning Problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.21 (3.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.52 (1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents Negative Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.56 (3.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.05 (1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAggression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.87 (4.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.72 (0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents Positive Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.14 (2.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.22 (3.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55.76 (18.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.48 (9.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eConvergent validity of Conners\u0026rsquo; 3-P\u003c/h2\u003e\u003cp\u003eThe correlation between the subscales identified by the Conners\u0026rsquo; 3-P and the hyperactivity and inattention subscales of the ADHD-RS-IV was investigated through the simultaneous use of both assessments. This analysis utilized the Multi-Trait Multi-Method Matrix method (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The correlation between hyperactivity factors on the two questionnaires was high and significant (r\u0026thinsp;=\u0026thinsp;0.638, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The correlation between the inattention subscale of the ADHD-RS-IV and the Conners' subscales was significant but moderate, (r\u0026thinsp;=\u0026thinsp;0.342, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). A strong correlation was also found between hyperactivity on the ADHD-RS-IV and aggression on the Conners' scale (r\u0026thinsp;=\u0026thinsp;0.633, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Additionally, there was an inverse but non-significant correlation between the parents\u0026rsquo; positive attitude subscale and both ADHD subscales.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation Matrix of Conners\u0026rsquo; Variables with Hyperactivity and Inattention Subscales from the ADHD Rating Scale\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eInattention (Con)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eHyperactivity (Con)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eLearning Problem (Con)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eParents Negative Attitude (Con)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003eAggression (Con)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eParent Positive Attitude (Con)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHyperactivity (ADHD-RS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.426\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e.638\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.321\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e.305\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.633\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.020\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.885\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInattention (ADHD-RS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.342\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e.273\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e.044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e.779\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e.159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003e*. Correlation is significant at the 0.05 level (2-tailed).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSensitivity and Specificity\u003c/h2\u003e\u003cp\u003eAt this stage, the total score from six factors was used as a continuous variable, while the presence or absence of ADHD was classified as a binary variable in the Relative Operating Characteristic (ROC) chart. The ROC chart was used to evaluate the diagnostic power of the Conners\u0026rsquo; questionnaire in distinguishing children with ADHD from healthy children (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). According to the graph, the Area Under the Curve (AUC) was 0.92, indicating a high diagnostic power for the questionnaire. The total score that achieved the highest sensitivity and specificity was used to determine the cutoff point. The results showed that the cut point for the total score of 38.50, represented the highest sensitivity (80%) and specificity (89%). Thus, a score above 38.50 classifies a child as having ADHD, while a score below this threshold categorizes them as healthy.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eTest-retest Reliability\u003c/h2\u003e\u003cp\u003eThe results of retesting the questionnaire with 17 parents after 2\u0026ndash;3 weeks, along with the reliability measured using the intraclass correlation coefficient (ICC), are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. These findings indicate that the tool has good test-retest reliability.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe Result of Test-retest Reliability\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubscales\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eICC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInattention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.81 (0.56\u0026ndash;0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHyperactivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.85 (0.64\u0026ndash;0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLearning Problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.83 (0.59\u0026ndash;0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents Negative Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.69 (0.33\u0026ndash;0.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAggression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.79 (0.52\u0026ndash;0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParents Positive Attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.78 (0.49\u0026ndash;0.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.86 (0.67\u0026ndash;0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEarly diagnosis and treatment can prevent adverse consequences of ADHD in the future. One tool used for diagnosing and screening the disorder is the Conners' Rating Scales (CRS) questionnaire, available in its third version, which is completed by parents, teachers, and the patients themselves. Before applying this latest version, it is essential to evaluate the psychometric characteristics of the tool. Therefore, the purpose of this study was to assess the psychometric properties of the short form of the Conners-3 Parent Questionnaire in a clinical sample of Iranian children aged 6 to 12 years, in comparison to typically developing children.\u003c/p\u003e\u003cp\u003eThe number of factors identified in this study was six, including inattention, hyperactivity, learning problems, parents\u0026rsquo; negative attitude, aggression, and parents\u0026rsquo; positive attitude. In study done by Gallant involving healthy children and patients aged 6 to 18 years, five factors were identified: Executive Functioning, Learning Problems, Aggression, Peer Relations, and Hyperactivity/Impulsivity (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Similarly, Christiansen et al. (2016) identified five factors: Inattention/Learning Problems, Hyperactivity/Impulsivity, Aggression, Peer/Family Relations, and Defiance (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Gomez et al. (2020) also identified five factors: Inattention, Hyperactivity, Learning Problems, Aggression, and Peer Relation (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). A key distinction in this study is the inclusion of \"positive and negative parents' attitudes,\" which other studies often classify under executive function. This difference may be attributed to cultural variations among different countries and the differing sensitivities of parents in Iran compared to those in other countries. Additionally, the differences in the average age and gender distribution of the study participants compared to those in other studies may influence the findings. For example, participants in the study by Gomes et al. (2020) had an average age of 11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 years, with 75% being boys. In contrast, the children in this research had an average age of 8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 years, with 56.3% being boys.\u003c/p\u003e\u003cp\u003eThe Cronbach's alpha score for the entire questionnaire was 0.93, with all its scales above 0.7, ranging from 0.69 to 0.93. This indicates an acceptable level of reliability for the questionnaire. In contrast, the Cronbach's alpha for the Gallant\u0026rsquo;s validation study of the questionnaire ranged from 0.85 to 0.94 (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). In a study conducted in 2023, in preschool children, the internal consistency of the Persian version of the Conners\u0026rsquo; Early Childhood \u0026ndash; Parents\u0026rsquo; Form in Iran was calculated with an overall Cronbach\u0026rsquo;s alpha coefficient of 0.88 (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother aspect of this study was to determine the cutoff point for the questionnaire to differentiate between healthy individuals and those with ADHD. The ROC diagram revealed an AUC value of 0.92, indicating a significant difference from 0.5, which would suggest random differentiation between patients and healthy individuals. This finding further supports the validity of the questionnaire for Iranian children. The cut point of raw score identified in this study was 38.50. In one study aimed at determining the prevalence of ADHD among students in Mexico, a T-score above the 65th percentile was used as a cutoff point (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a study conducted in 2021, ROC curve analysis was utilized to assess and compare the diagnostic accuracy of the inattention, hyperactivity/impulsivity, and aggression scales from C 3-P(S), C 3-T(S), and the Child Behavior Checklist to distinguish between children with and without ADHD. The AUC values for the combined inattention and hyperactivity/impulsivity scales and aggression for C 3-P(S) were 0.85 and 0.83, respectively. Furthermore, the sensitivity and specificity for these scales were 79.3% and 79.4%, respectively. The optimal cutoff points were determined to be 17 and 3, respectively (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In another study conducted by Deb et al. (2008), the ROC chart was employed to establish the cutoff point for the parental version, resulting in a sensitivity of 90% and a specificity of 67%. The AUC was calculated to be 0.84 (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). In contrast, this study reported a higher AUC of 0.92, suggesting improved diagnostic power in differentiating between healthy individuals and those with ADHD. Furthermore, utilizing this cutoff point, this study achieved a sensitivity of 80% and a specificity of 89%, which are generally regarded as favorable outcomes.\u003c/p\u003e\u003cp\u003eThe convergent validity of the questionnaire was assessed by analyzing its correlation with the ADHD-RS-IV. The strongest correlation was found between the hyperactivity factors of both questionnaires, as well as between the hyperactivity scores of the ADHD-RS-IV and the aggression scores from the Conners\u0026rsquo; Questionnaire. Conversely, the weakest correlation was observed between the parents' positive attitude on the Conners\u0026rsquo; 3-P Questionnaire and the hyperactivity score of ADHD-RS-IV, and this correlation was inverse. This suggests that as parents' positive attitude scores increase, hyperactivity scores decrease, which aligns with theoretical expectations; specifically, poorer child behavior is associated with lower parental positivity. Nevertheless, this correlation was not statistically significant. Consistent with our findings, a study conducted in 2021 evaluated the validity of the French Lausanne version (FLV) of the CPRS-R short form in children diagnosed with ADHD. The study demonstrated the convergent validity of the CPRS-R:S evidenced by a very strong correlation between the FLV Hyperactivity score and the Impulsivity/Hyperactivity score of the ADHD Symptoms Rating Scale (ADHD-SRS) (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn conclusion, this study's findings suggest that the short version of Conners\u0026rsquo; 3-P shows acceptable reliability and validity in assessing children's ADHD symptoms through parental reports. One of the notable strengths of this study is the concurrent use of two questionnaires and the subsequent evaluation of the correlation between their subscales. Furthermore, the percentage of explained variance by the identified factors was significant, and the cut-off point for the questionnaire was determined utilizing the ROC curve. However, a limitation of the study is its reliance on a clinical sample, which may result in a lack of generalizability to the broader patient population. Therefore, it is recommended that future research be conducted among the general population to enhance the validity of the findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of Tehran University of Medical Sciences (code: IR.TUMS.MEDICINE.REC.1398.113) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from the legal guardians of all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors agree to submit for consideration for publication in the Journal of Child and Adolescent Psychiatry and Mental Health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Tehran University of Medical Sciences [grant number 1400-2-210-53504].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFM: Investigation, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eMT: Conceptualization, Supervision, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eNF: Formal Analysis, Writing \u0026ndash; Original Draft Preparation, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eZS: Methodology, Supervision, Writing \u0026ndash; Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eJMG: Formal Analysis, Writing \u0026ndash; Review \u0026amp; Editing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincere appreciation to all children and their parents for contributing to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAyano G, Demelash S, Gizachew Y, Tsegay L, Alati R. 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An evaluation of the quality of life of children with ADHD and their families. Anatolian Journal of Psychiatry/Anadolu Psikiyatri Dergisi. 2014;15(3).\u003c/li\u003e\n\u003cli\u003eWehmeier PM, Schacht A, Barkley RA. Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. J Adolesc Health. 2010;46(3):209-17.\u003c/li\u003e\n\u003cli\u003eGroves NB, Wells EL, Soto EF, Marsh CL, Jaisle EM, Harvey TK, et al. Executive Functioning and Emotion Regulation in Children with and without ADHD. Research on Child and Adolescent Psychopathology. 2022;50(6):721-35.\u003c/li\u003e\n\u003cli\u003eStrine TW, Lesesne CA, Okoro CA, McGuire LC, Chapman DP, Balluz LS, et al. Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Prev Chronic Dis. 2006;3(2):A52.\u003c/li\u003e\n\u003cli\u003eBraaten EB, Ros\u0026eacute;n LA. Self-regulation of affect in attention deficit-hyperactivity disorder (ADHD) and non-ADHD boys: differences in empathic responding. J Consult Clin Psychol. 2000;68(2):313-21.\u003c/li\u003e\n\u003cli\u003eHinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, et al. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012;80(6):1041-51.\u003c/li\u003e\n\u003cli\u003eBiederman J, Petty CR, Woodworth KY, Lomedico A, Hyder LL, Faraone SV. Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. J Clin Psychiatry. 2012;73(7):941-50.\u003c/li\u003e\n\u003cli\u003eBalazs J, Kereszteny A. Attention-deficit/hyperactivity disorder and suicide: A systematic review. World J Psychiatry. 2017;7(1):44-59.\u003c/li\u003e\n\u003cli\u003eHamed AM, Kauer AJ, Stevens HE. Why the diagnosis of attention deficit hyperactivity disorder matters. Frontiers in psychiatry. 2015;6:168.\u003c/li\u003e\n\u003cli\u003ePeterson BS, Trampush J, Brown M, Maglione M, Bolshakova M, Rozelle M, et al. Tools for the diagnosis of ADHD in children and adolescents: a systematic review. Pediatrics. 2024;153(4):e2024065854.\u003c/li\u003e\n\u003cli\u003eDuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale--IV (for Children and Adolescents): Checklists, Norms, and Clinical Interpretation: Guilford Publications; 1998.\u003c/li\u003e\n\u003cli\u003ePelham WE, Milich R, Murphy DA, Murphy HA. Normative data on the IOWA Conners Teacher Rating Scale. Journal of Clinical Child Psychology. 1989;18(3):259-62.\u003c/li\u003e\n\u003cli\u003eConners CK. Rating scales in attention-deficit/hyperactivity disorder: use in assessment and treatment monitoring. Journal of Clinical Psychiatry. 1998;59(7):24-30.\u003c/li\u003e\n\u003cli\u003eConners CK. Clinical use of rating scales in diagnosis and treatment of attention-deficit/hyperactivity disorder. Pediatric Clinics of North America. 1999;46(5):857-70.\u003c/li\u003e\n\u003cli\u003eCK C. Rating scales for use in drug studies with children. Psychopharmacol Bull. 1973;9:24-42.\u003c/li\u003e\n\u003cli\u003eC. C. Conners\u0026rsquo; Rating Scales\u0026ndash;Revised. Technical Manual Toronto, Ontario: Multi-Health Systems Inc. ; 1997.\u003c/li\u003e\n\u003cli\u003eConners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners\u0026apos; Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of abnormal child psychology. 1998;26:257-68.\u003c/li\u003e\n\u003cli\u003eConners CK, Sitarenios G, Parker JD, Epstein JN. Revision and restandardization of the Conners Teacher Rating Scale (CTRS-R): factor structure, reliability, and criterion validity. Journal of abnormal child psychology. 1998;26:279-91.\u003c/li\u003e\n\u003cli\u003eConners CK. Conners third edition (Conners 3). Los Angeles, CA: Western Psychological Services. 2008.\u003c/li\u003e\n\u003cli\u003eIzzo VA, Donati MA, Novello F, Maschietto D, Primi C. The Conners 3-short forms: Evaluating the adequacy of brief versions to assess ADHD symptoms and related problems. Clin Child Psychol Psychiatry. 2019;24(4):791-808.\u003c/li\u003e\n\u003cli\u003eGoyette CH, Conners CK, Ulrich RF. Normative data on revised Conners Parent and Teacher Rating Scales. J Abnorm Child Psychol. 1978;6(2):221-36.\u003c/li\u003e\n\u003cli\u003eShahyaian AS, S.; Beshash, L.; Yousefi, F. Normative Data, Factor Analysis, and Reliability of the Parent-Short Form of the Conners\u0026apos; Rating Scale for Children Aged 6-11 in Shiraz. Journal of Psychological Studies. 2007;3(3):97-120.\u003c/li\u003e\n\u003cli\u003eAmiri S, Ahsani M, Malek A, Sadeghi-Bazargani H, Ghorashizadeh A, Abdi S, et al. Psychometric properties of the Persian version of Conners Early Childhood ADHD Questionnaire-Parents\u0026rsquo; Form in Iranian children aged 3-6 years. Medical Journal of Tabriz University of Medical Sciences. 2023;45:505-15.\u003c/li\u003e\n\u003cli\u003eDiagnostic and statistical manual of mental disorders : DSM-5. 5th ed. ed. Arlington, VA :: American Psychiatric Association; 2013.\u003c/li\u003e\n\u003cli\u003eKao GS, Thomas HM. Test Review: C. Keith Conners Conners 3rd Edition Toronto, Ontario, Canada: Multi-Health Systems, 2008. Journal of Psychoeducational Assessment. 2010;28(6):598-602.\u003c/li\u003e\n\u003cli\u003eFaries DE, Yalcin I, Harder D, Heiligenstein JH. Validation of the ADHD Rating Scale as a clirlician administered and scored instrument. Journal of Attention Disorders. 2001;5(2):107-15.\u003c/li\u003e\n\u003cli\u003eDuPaul G. ADHD Rating Scale-IV: checklists, norms, and clinical interpretation. Akashi Shuppan. (No Title). 2008.\u003c/li\u003e\n\u003cli\u003eGhanizadeh A, Jafari P. Cultural structures of the Persian parents\u0026apos; ratings of ADHD. J Atten Disord. 2010;13(4):369-73.\u003c/li\u003e\n\u003cli\u003eGhanizadeh A, Mohammadi MR, Yazdanshenas A. Psychometric properties of the Farsi translation of the kiddie schedule for affective disorders and schizophrenia-present and lifetime version. BMC psychiatry. 2006;6:1-5.\u003c/li\u003e\n\u003cli\u003eShahrivar Z, Kousha M, Moallemi S, Tehrani‐Doost M, Alaghband‐Rad J. The reliability and validity of kiddie‐schedule for affective disorders and schizophrenia‐present and life‐time version‐Persian version. Child and Adolescent Mental Health. 2010;15(2):97-102.\u003c/li\u003e\n\u003cli\u003eGoodman R. The Strengths and Difficulties Questionnaire: a research note. Journal of child psychology and psychiatry. 1997;38(5):581-6.\u003c/li\u003e\n\u003cli\u003eGhanizadeh A, Izadpanah A. Scale validation of the strengths and difficulties questionnaire in Iranian children. 2007.\u003c/li\u003e\n\u003cli\u003eTehranidoust M, Shahrivar Z, Pakbaz B, Rezaei A, Ahmadi F. Validity of farsi version of strengths and difficulties questionnaire (SDQ). Advances in cognitive science. 2007;8(4):33-9.\u003c/li\u003e\n\u003cli\u003eGallant S, editor Psychometric Properties of the Conners 3rd Edition. Poster presented at the annual meeting of the American Psychological Association; 2007.\u003c/li\u003e\n\u003cli\u003eChristiansen H, Hirsch O, Drechsler R, Wanderer S, Knospe E-L, G\u0026uuml;nther T, et al. German validation of the conners 3u+ 00ae rating scales for parents, teachers, and children. Zeitschrift f\u0026uuml;r Kinder-und Jugendpsychiatrie und Psychotherapie. 2016.\u003c/li\u003e\n\u003cli\u003eGomez R, Vance A, Stavropoulos V. Correlated trait\u0026ndash;correlated method minus one analysis of the convergent and discriminant validity of the Conners 3 Short Forms. Assessment. 2020;27(7):1463-75.\u003c/li\u003e\n\u003cli\u003eGallardo-Saavedra GA, del Consuelo Mart\u0026iacute;nez-Wbaldo M, Padr\u0026oacute;n-Garc\u0026iacute;a AL. Prevalence of ADHD in Mexican schoolchildren through screening with Conners scales 3. Actas Espa\u0026ntilde;olas de Psiquiatr\u0026iacute;a. 2019;47(2):45-53.\u003c/li\u003e\n\u003cli\u003eGomez R, Vance A, Watson S, Stavropoulos V. ROC Analyses of Relevant Conners 3\u0026ndash;Short Forms, CBCL, and TRF Scales for Screening ADHD and ODD. Assessment. 2021;28(1):73-85.\u003c/li\u003e\n\u003cli\u003eDeb S, Dhaliwal AJ, Roy M. The usefulness of Conners\u0026apos; Rating Scales-Revised in screening for attention deficit hyperactivity disorder in children with intellectual disabilities and borderline intelligence. Journal of intellectual disability research : JIDR. 2008;52(11):950-65.\u003c/li\u003e\n\u003cli\u003eFumeaux P, Mercier C, Roche S, Iwaz J, St\u0026eacute;phan P, Revol O. Validation of the French Version of Conners\u0026rsquo; Parent Rating Scale\u0026ndash;Revised, Short Form in ADHD-Diagnosed Children and Comparison With Control Children. Journal of Attention Disorders. 2021;25(1):124-33.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ADHD, Conners 3-P, Psychometric Evaluation","lastPublishedDoi":"10.21203/rs.3.rs-6850810/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6850810/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAttention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder among children that significantly affects academic, social, and emotional functioning. Early diagnosis is essential, highlighting the need for reliable and valid screening tools. The Conners\u0026rsquo; Rating Scales (CRS) are frequently used for ADHD assessment; however, the psychometric properties of the latest version, the Conners' Parent Rating Scale-3 (Conners 3-P), have not yet been examined in Iranian clinical populations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study aims to evaluate the reliability and validity of the Conners 3-P Short Form in a clinical sample of Iranian children aged 6 to 12 years. The study involved 135 children, including 55 diagnosed with ADHD and 80 typically developing children. ADHD diagnoses were confirmed using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL_5). Parents completed the Conners 3-P and the ADHD Rating Scale-IV. Reliability was evaluated through Cronbach\u0026rsquo;s alpha and test-retest analysis, while validity was assessed using exploratory factor analysis (EFA), convergent validity testing, and Receiver Operating Characteristic (ROC) analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe EFA identified six factors: inattention, hyperactivity, learning problems, parents' negative attitude, aggression, and parents' positive attitude, accounting for 52.22% of the variance. The Conners 3-P demonstrated strong internal consistency (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.93) and excellent test-retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.86). Convergent validity analysis showed significant correlations between the Conners 3-P subscales and ADHD-RS-IV scores, particularly in hyperactivity (r\u0026thinsp;=\u0026thinsp;0.638, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The ROC curve indicated high diagnostic accuracy (AUC\u0026thinsp;=\u0026thinsp;0.92), with a cutoff score of 38.50 achieving 80% sensitivity and 89% specificity.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe Conners 3-P Short Form is a reliable and valid tool for assessing ADHD symptoms in Iranian children. Its strong psychometric properties support its clinical utility in diagnosing and monitoring ADHD. Future research should investigate its applicability in broader populations.\u003c/p\u003e","manuscriptTitle":"Psychometric Properties of the Conners’ 3 Parent Rating Scale in a Clinical Sample of Iranian Children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 08:35:02","doi":"10.21203/rs.3.rs-6850810/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-08T19:39:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-08T20:30:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241392816011927155458643539286035899358","date":"2025-07-30T20:57:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-29T13:31:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334544414215285052351586512053618781977","date":"2025-07-23T10:08:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-16T16:07:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-16T17:34:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-12T13:34:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-12T13:32:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-06-09T05:07:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"36b47f81-835b-4440-adda-edc0415104f8","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:19:23+00:00","versionOfRecord":{"articleIdentity":"rs-6850810","link":"https://doi.org/10.1186/s12888-026-07928-y","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2026-04-27 15:57:30","publishedOnDateReadable":"April 27th, 2026"},"versionCreatedAt":"2025-07-23 08:35:02","video":"","vorDoi":"10.1186/s12888-026-07928-y","vorDoiUrl":"https://doi.org/10.1186/s12888-026-07928-y","workflowStages":[]},"version":"v1","identity":"rs-6850810","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6850810","identity":"rs-6850810","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}