Nov 17, 2020  |   2 minute read

Child ADHD | SNAP IV 26

Child ADHD SNAP IV 26

Recommended frequency: Every 4 weeks

Summary

The SNAP-IV 26-item scale is an abbreviated version of the Swanson, Nolan, and Pelham (SNAP) Questionnaire (Swanson, 1992; Swanson et al., 1983). Items from the DSM-IV criteria for attention-deficit/hyperactivity disorder (ADHD) are included for the two subsets of symptoms: Inattention (items 1–9) and Hyperactivity/Impulsivity (items 10–18). Also, items from the DSM-IV criteria for oppositional defiant disorder (ODD) are included (items 19–26) because ODD is often present in children with ADHD. The scale can be used by the parents and teacher of children and adolescents between the ages of 8 to 18.

Psychometric Properties

To examine Swanson, Nolan, and Pelham-IV (SNAP-IV) psychometric properties, parent (N = 1,613) and teacher (N = 1,205) data were collected from a random elementary school student sample in a longitudinal attention deficit hyperactivity disorder (ADHD) detection study. SNAP-IV reliability was acceptable. Factor structure indicated two ADHD factors and an oppositional defiant disorder (ODD) factor. Parent and teacher scores varied by gender and poverty status (d = .49-.56) but not age; only teacher scores varied by race (d = .25-.55). Screening and diagnostic utility was evaluated with likelihood ratios (LRs) and posttest probabilities. Parent SNAP-IV scores above 1.2 increased probability of concern (LR > 10) and above 1.8, of ADHD diagnosis (LR > 3). Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only (LR = 4.2 and >5, respectively). Higher teacher scores for African American children and race differences in measurement models require future study.

Sources:

1. https://pubmed.ncbi.nlm.nih.gov/18310593/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623293/
3. http://www.shared-care.ca/files/Scoring_for_SNAP_IV_Guide_26-item.pdf

The Scale

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Scoring

Symptom severity is rated on a 4-point scale. Responses are scored as follows:
Not at all = 0
Just a little = 1
Quite a bit = 2
Very much = 3
The scores in each of the three subsets (inattention, hyperactivity/impulsivity, and opposition/defiance) are totalled. A suggested scoring guideline is below:
Questions 1 – 9: Inattention Subset
< 13/26 = Symptoms not clinically significant
13 – 17 = Mild symptoms
18 – 22 = Moderate symptoms
23 – 26 = Severe symptoms
Questions 10 – 18: Hyperactivity/Impulsivity Subset
<13/26 = Symptoms not clinically significant
13 – 17 = Mild symptoms
18 – 22 = Moderate symptoms
23 – 26 = Severe symptoms
Questions 19 – 26: Opposition/Defiance Subset
< 8/24 = Symptoms not clinically significant
8 – 13 = Mild symptoms
14 – 18 = Moderate symptoms
19 – 24 = Severe symptoms
Suggested Targets:
<13/26 for inattention
<13/26 for hyperactivity/impulsivity
<8/24 for oppositional defiant disorder
If desired, the average rating for each subset can be calculated by totaling the scores for the items in the subset and dividing by the number of items. The average can be compared with cut-off scores suggestive of ADHD reported in the literature.

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