Gagandeep Singh, M.D., LLC – SNAP-IV Rating Scale

This questionare is a diagnostic tool used to measure the severity of attention-deficit/hyperactivity disorder (ADHD) symptoms. The SNAP-IV scale is an adaptation of the Swanson, Nolan, and Pelham-IV questionnaire. It is used with children between the ages of 6 and 18 years old.

Full Name *

Sex

Male

Female

For each item, check the column which best describes this child:

Often fails to give close attention to details or makes careless mistakes in work or tasks

Not at all

Just a little bit

Quite a bit

Very much

Often has difficulty sustaining attention in tasks or activities

Not at all

Just a little bit

Quite a bit

Very much

Often does not seem to listen when spoken to directly

Not at all

Just a little bit

Quite a bit

Very much

Often does not follow through on instructions and fails to finish work, chores, or duties

Not at all

Just a little bit

Quite a bit

Very much

Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort

Not at all

Just a little bit

Quite a bit

Very much

Often has difficulty organizing tasks and activities

Not at all

Just a little bit

Quite a bit

Very much

Often loses things necessary for activities (e.g., daytimer, books, equipment)

Not at all

Just a little bit

Quite a bit

Very much

Often is distracted by extraneous stimuli

Not at all

Just a little bit

Quite a bit

Very much

Often fidgets with hands or feet or squirms in seat

Not at all

Just a little bit

Quite a bit

Very much

Often is forgetful in daily activities

Not at all

Just a little bit

Quite a bit

Very much

Often runs about or climbs excessively in situations in which it is inappropriate

Not at all

Just a little bit

Quite a bit

Very much

Often leaves seat in situations in which remaining seated is expected

Not at all

Just a little bit

Quite a bit

Very much

Often has difficulty engaging in leisure activities quietly

Not at all

Just a little bit

Quite a bit

Very much

Often is “on the go” or often acts as if “driven by a motor”

Not at all

Just a little bit

Quite a bit

Very much

Often blurts out answers before questions have been completed

Not at all

Just a little bit

Quite a bit

Very much

Often talks excessively

Not at all

Just a little bit

Quite a bit

Very much

Often has difficulty awaiting turn

Not at all

Just a little bit

Quite a bit

Very much

Often interrupts or intrudes on others (e.g., butts into conversations/games)

Not at all

Just a little bit

Quite a bit

Very much

Often loses temper

Not at all

Just a little bit

Quite a bit

Very much

Often argues with family, friends, co-workers, supervisors

Not at all

Just a little bit

Quite a bit

Very much

Often deliberately does things that annoy other people

Not at all

Just a little bit

Quite a bit

Very much

Often blames others for his or her mistakes or misbehavior

Not at all

Just a little bit

Quite a bit

Very much

Often is spiteful or vindictive

Not at all

Just a little bit

Quite a bit

Very much

Often is angry and resentful

Not at all

Just a little bit

Quite a bit

Very much

Has difficulty staying on task

Not at all

Just a little bit

Quite a bit

Very much

Has difficulty getting started on work, tasks or assignment

Not at all

Just a little bit

Quite a bit

Very much

Has problems in accuracy or neatness of written work

Not at all

Just a little bit

Quite a bit

Very much

Has problems in completion of work in relation to tasks or assignments

Not at all

Just a little bit

Quite a bit

Very much

Has difficulty making transitions to the next topic or task

Not at all

Just a little bit

Quite a bit

Very much

Has difficulty attending to a group activity or discussion

Not at all

Just a little bit

Quite a bit

Very much

Has problems in interactions with supervisors

Not at all

Just a little bit

Quite a bit

Very much

Has problems in interactions with family, peers or co-workers

Not at all

Just a little bit

Quite a bit

Very much

Has difficulty staying seated according to office rules

Not at all

Just a little bit

Quite a bit

Very much

Has difficulty remaining quiet or behaving appropriately according to office rules

Not at all

Just a little bit

Quite a bit

Very much

Change on medication?

Yes

No

What are the child’s strengths?

What is your main concern?