Psychometric Properties of the Conners-3 Parent Short Form and Self-Report in Farsi-Speaking Adolescents with ADHD

Imagine a world where understanding a child's mind requires more than just a conversation; it requires a map. For decades, scientists and doctors have relied on standardized questionnaires to navigate the complex landscape of Attention-Deficit/Hyperactivity Disorder, or ADHD. This condition, characterized by persistent patterns of inattention, hyperactivity, and impulsivity, affects millions of children and teenagers globally. To diagnose it accurately, clinicians need tools that are not only reliable but also culturally sensitive, as the way symptoms are reported can shift dramatically depending on language and background. One such tool is the Conners-3, a widely used assessment system designed to gather insights from both parents and the young people themselves. While this tool has been tested extensively in English-speaking and other Western populations, a significant gap remained for Persian-speaking families in Iran, particularly for teenagers. Without a validated version of these questionnaires in their native language, doctors in Iran faced the challenge of assessing a complex disorder with instruments that had never been proven to work correctly in their specific cultural context.

In 2024, a team of researchers at Tehran University of Medical Sciences set out to fill this gap. They focused on a critical developmental window: adolescence. Unlike younger children, teenagers with ADHD often present differently; the physical restlessness of hyperactivity tends to fade, while struggles with focus and organization often persist or even intensify. The researchers recruited 152 adolescents, ranging from 12 to 18 years old. The group included 60 teenagers who had already been clinically diagnosed with ADHD and 92 peers who were developing typically, with no history of major psychiatric disorders. To ensure the diagnosis of the clinical group was accurate, the team used a rigorous, semi-structured interview known as the K-SADS-PL-5, which is considered a gold standard for confirming psychiatric conditions. The goal was simple yet vital: to see if the Persian versions of the Conners-3 Parent Short Form and the Self-Report form could accurately distinguish between these two groups and provide trustworthy scores for clinical use.

The study began by having parents and teenagers fill out the questionnaires, which ask about behaviors over the past month on a scale from "never" to "always." The researchers then compared these answers against another established measure, the ADHD Rating Scale-IV, to see if the new Persian versions were measuring the same things. The results were encouraging for the parent version of the test. When parents filled out the form, the scores showed strong consistency, meaning the questions reliably measured the same traits every time. More importantly, the parent form was excellent at telling the difference between teenagers with ADHD and those without. The data showed that the parent report could correctly distinguish between the groups with an AUC of 0.90, catching about 87 percent of the true cases while correctly ruling out about 90 percent of the non-cases. The questions about inattention were particularly powerful, performing almost as well as the entire test combined. This suggests that for Persian-speaking families, a parent's observation of their teenager's focus issues is a highly reliable indicator of the disorder.

The story was slightly more nuanced when looking at the teenagers' own reports. The self-report form, where the adolescents answered the questions themselves, also showed promise in distinguishing between the two groups, with an AUC of 0.80. However, the internal consistency of this version was lower, especially among the teenagers who did not have ADHD. In this group, the answers were less uniform, likely because typically developing teenagers rarely endorse symptoms, leading to a "floor effect" where there is very little variation in their responses to analyze. This does not mean the self-report is useless; rather, it suggests that while it captures a valuable perspective that parents cannot see, it should be used as a supporting tool alongside the parent report rather than as the sole basis for a diagnosis. The study also found that the two forms did not always agree perfectly, with parents often rating symptoms higher than the teenagers did. This discrepancy is a well-known phenomenon in ADHD research and was observed here as well, reinforcing the idea that gathering information from multiple sources provides the clearest picture.

To ensure the results were not just a one-time fluke, the researchers asked a smaller group of 21 families to complete the questionnaires again three to four weeks later. The scores remained reasonably stable over this short period, indicating that the tools are measuring enduring traits rather than temporary moods. However, the small size of this retest group meant that some specific areas, like the inattention scale for parents, did not reach statistical significance in this second round, a limitation the authors noted with caution. Despite this, the overall picture is one of validation. The study confirms that the Persian Conners-3 Parent Short Form is a robust, reliable instrument for assessing ADHD in Iranian adolescents. It provides doctors with a scientifically sound way to evaluate the severity of symptoms and track progress. The self-report form, while showing some weaknesses in consistency, remains a valuable addition to the clinical toolkit, offering the unique voice of the teenager themselves.

This work represents a significant step forward for mental health care in Iran, moving beyond the limitations of using tools designed for different cultures and languages. By proving that these questionnaires work effectively in a Persian-speaking context, the researchers have provided clinicians with the confidence to use them for screening and diagnosis. The findings highlight that while the core symptoms of ADHD are universal, the way they are measured must be adapted to fit the people being assessed. For the families involved, this means access to more accurate evaluations and, ultimately, better-tailored support. The study concludes that while the parent report stands ready as a primary diagnostic aid, the self-report is best used to complement it, ensuring that the assessment captures both the observable behaviors seen by parents and the internal experiences felt by the teenagers.