Swanson, Nolan and Pelham Questionnaire (SNAP)

Overview
The SNAP Rating Scale, based on DSM-5 criteria for ADHD, is  DSM-5 Criteria for Inattention and
psychometrically sound, easily accessible and simple to interpret. This
Hyperactivity/Impulsivity Symptoms
comprehensive (90 item) ADHD rating scale effectively discriminates
between children with and without ADHD, and accurately predicts  DSM-5 Criteria for ODD
presentation specifiers (inattention, hyperactivity/impulsivity and combined).
The SNAP is particularly helpful in making a differential diagnosis and  90 Items Including DSM Screen for
includes items to gauge other DSM-5 disorders. Numerous Disorders

The psychometric properties and clinical utility of the SNAP have been  Normative Data used to Provide a
demonstrated in multiple studies since its introduction in 2001. Response to Single Score for Each Informant
treatment and direct classroom observations has established the validity of
SNAP, and it was used as the primary outcome measure in the  DefiniPoint Integrates Multi-informant
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Multimodality Treatment Study of ADHD. The SNAP has been found to be Scores to Provide Single Result
reliable and well validated with normative data available from parents (N =
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1,613) and teachers (N = 1,205).

Classroom Impairment
The SNAP includes the 10 items of the Swanson, Kotkin, Agler, Mylnn, and Pelham (SKAMP) Rating Scale to gauge
severity of impairment in the classroom. These items are classroom manifestations of inattention, hyperactivity, and
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impulsivity (i.e., getting started, staying on task, interactions with others, completing work, and shifting activities).

Differential Diagnosis
Since Oppositional Defiant Disorder is often present in children with ADHD, the SNAP includes DSM-5 criteria for ODD.
Because it measures inattention/overactivity separately from aggression/defiance, the SNAP is able to distinguish these
two related behaviors. The SNAP also measures the general index of childhood problems.

Several other DSM-5 disorders may overlap with or masquerade as symptoms of ADHD. These may be comorbid
disorders, but the presence of one or more of these disorders may exclude a diagnosis of ADHD. The SNAP is not
designed to be used in the formal process of diagnosing these non-ADHD disorders, but if symptoms of the SNAP receive
a high (“Quite A Bit” or “Very Much”) rating, then an assessment of the implicated disorders may be warranted.

 Conduct Disorder (4 items)  Histrionic Personality Disorder (1 item)

 Intermittent Explosive Disorder (1 item)  Narcissistic Personality Disorder (1 item)
 Stereotypic Movement Disorder (1 item)  Borderline Personality Disorder (1 item)
 Obsessive-Compulsive Disorder (2 items)  Manic Episode (5 items)
 Generalized Anxiety Disorder (6 items)  Dysthymic Disorder (3 items)
 Narcolepsy (1 item)  Posttraumatic Stress Disorder (2 items)
 Adjustment Disorder (2 items)

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Swanson JM, Kraemer HC, Hinshaw SP, Arnold LE, Conners CK, Abikoff HB, Clevenger W, Davies M, Elliott GR, Greenhill LL, Hechtman L, Hoza B, Jensen PS, March JS,
Newcorn JH, Owens EB, Pelham WE, Schiller E, Severe JB, Simpson S, Vitiello B, Wells K, Wigal T, Wu M. Clinical relevance of the primary findings of the MTA: success
rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry. 2001 Feb;40(2):168-79.
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Bussing R, Fernandez M, Harwood M, Wei Hou, Garvan CW, Eyberg SM, Swanson JM. Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder
symptoms: psychometric properties and normative ratings from a school district sample. Assessment. 2008 Sep;15(3):317-28. Epub 2008 Feb 29.
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Wigal SB, Gupta S, Guinta D, Swanson JM. Reliability and validity of the SKAMP rating scale in a laboratory school setting. Psychopharmacol Bull. 1998;34(1):47-53.
 The SNAP Teacher and Parent Rating Scale
James M. Swanson, Ph.D.
0 to 3 rating scale: Not at All = 0, Just A Little = 1, Quite A Bit = 2, and Very Much = 3

Number Question
1 Often fails to give close attention to details or makes careless mistakes in schoolwork or tasks
2 Often has difficulty sustaining attention in tasks or play activities
3 Often does not seem to listen when spoken to directly
4 Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
5 Often has difficulty organizing tasks and activities
6 Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort
7 Often loses things necessary for activities (e.g., toys, school assignments, pencils, or books)
8 Often is distracted by extraneous stimuli
9 Often is forgetful in daily activities
10 Often has difficulty maintaining alertness, orienting to requests, or executing directions
11 Often fidgets with hands or feet or squirms in seat
12 Often leaves seat in classroom or in other situations in which remaining seated is expected
13 Often runs about or climbs excessively in situations in which it is inappropriate
14 Often has difficulty playing or engaging in leisure activities quietly
15 Often is “on the go” or often acts as if “driven by a motor”
16 Often talks excessively
17 Often blurts out answers before questions have been completed
18 Often has difficulty awaiting turn
19 Often interrupts or intrudes on others (e.g., butts into conversations/games)
20 Often has difficulty sitting still, being quiet, or inhibiting impulses in the classroom or at home
21 Often loses temper
22 Often argues with adults
23 Often actively defies or refuses adult requests or rules
24 Often deliberately does things that annoy other people
25 Often blames others for his or her mistakes or misbehavior
26 Often touchy or easily annoyed by others
27 Often is angry and resentful
28 Often is spiteful or vindictive
29 Often is quarrelsome
30 Often is negative, defiant, disobedient, or hostile toward authority figures
31 Often makes noises (e.g., humming or odd sounds)
32 Often is excitable, impulsive
33 Often cries easily
34 Often is uncooperative
35 Often acts “smart”
36 Often is restless or overactive
37 Often disturbs other children
38 Often changes mood quickly and drastically
39 Often easily frustrated if demand are not met immediately
40 Often teases other children and interferes with their activities
41 Often is aggressive to other children (e.g., picks fights or bullies)
42 Often is destructive with property of others (e.g., vandalism)
43 Often is deceitful (e.g., steals, lies, forges, copies the work of others, or “cons” others)
44 Often and seriously violates rules (e.g., is truant, runs away, or completely ignores class rules)
45 Has persistent pattern of violating the basic rights of others or major societal norms
46 Has episodes of failure to resist aggressive impulses (to assault others or to destroy property)
47 Has motor or verbal tics (sudden, rapid, recurrent, nonrhythmic motor or verbal activity)
48 Has repetitive motor behavior (e.g., hand waving, body rocking, or picking at skin)
49 Has obsessions (persistent and intrusive inappropriate ideas, thoughts, or impulses)
50 Has compulsions (repetitive behaviors or mental acts to reduce anxiety or distress)
51 Often is restless or seems keyed up or on edge
52 Often is easily fatigued
53 Often has difficulty concentrating (mind goes blank)
54 Often is irritable
55 Often has muscle tension
56 Often has excessive anxiety and worry (e.g., apprehensive expectation)
57 Often has daytime sleepiness (unintended sleeping in inappropriate situations)
58 Often has excessive emotionality and attention-seeking behavior
59 Often has need for undue admiration, grandiose behavior, or lack of empathy
60 Often has instability in relationships with others, reactive mood, and impulsivity
61 Sometimes for at least a week has inflated self esteem or grandiosity
62 Sometimes for at least a week is more talkative than usual or seems pressured to keep talking
63 Sometimes for at least a week has flight of ideas or says that thoughts are racing
64 Sometimes for at least a week has elevated, expansive or euphoric mood
65 Sometimes for at least a week is excessively involved in pleasurable but risky activities
66 Sometimes for at least 2 weeks has depressed mood (sad, hopeless, discouraged)
67 Sometimes for at least 2 weeks has irritable or cranky mood (not just when frustrated)
68 Sometimes for at least 2 weeks has markedly diminished interest or pleasure in most activities
69 Sometimes for at least 2 weeks has psychomotor agitation (even more active than usual)
70 Sometimes for at least 2 weeks has psychomotor retardation (slowed down in most activities)
71 Sometimes for at least 2 weeks is fatigued or has loss of energy
72 Sometimes for at least 2 weeks has feelings of worthlessness or excessive, inappropriate guilt
73 Sometimes for at least 2 weeks has diminished ability to think or concentrate
74 Chronic low self-esteem most of the time for at least a year
75 Chronic poor concentration or difficulty making decisions most of the time for at least a year
76 Chronic feelings of hopelessness most of the time for at least a year
77 Currently is hypervigilant (overly watchful or alert) or has exaggerated startle response
78 Currently is irritable, has anger outbursts, or has difficulty concentrating
79 Currently has an emotional (e.g., nervous, worried, hopeless, tearful) response to stress
80 Currently has a behavioral (e.g., fighting, vandalism, truancy) response to stress
81 Has difficulty getting started on classroom assignments
82 Has difficulty staying on task for an entire classroom period
83 Has problems in completion of work on classroom assignments
84 Has problems in accuracy or neatness of written work in the classroom
85 Has difficulty attending to a group classroom activity or discussion
86 Has difficulty making transitions to the next topic or classroom period
87 Has problems in interactions with peers in the classroom
88 Has problems in interactions with staff (teacher or aide)
89 Has difficulty remaining quiet according to classroom rules
90 Has difficulty staying seated according to classroom rules