SNAP&Conners-3 Questionnaire: PARENT FORM

The SNAP (Swanson, Nolan, and Pelham) Rating Scale is a commonly used assessment tool for identifying symptoms of ADHD, Oppositional Defiant Disorder (ODD), and other behavioral challenges. The Conners-3 (Long Version) provides a comprehensive evaluation of ADHD, ODD, Conduct Disorder (CD), Anxiety, Learning Difficulties, and Social Struggles. This questionnaire is completed by parents and teachers based on their direct observations of the child's behavior across different settings.

General Details

First Name (parent/guardian)

Last Name (parent/guardian)

Name of Client (person being assessed)

Inlude first and last name

Section A: Inattention (ADHD – Inattentive Symptoms)

This section evaluates difficulties with attention, focus, and task completion, which are core symptoms of ADHD-Inattentive Type. Individuals with inattention often struggle with staying focused, following instructions, and completing tasks without becoming distracted

Guidance for Completing the SNAP Questionnaire.Each question should be rated based on the individual’s behavior over the past six months, using the following scale:

0 – Not at all (The behavior is never or rarely observed)

1 – Just a little (The behavior is occasionally observed)

2 – Quite a bit (The behavior is frequently observed)

3 – Very much (The behavior is always observed or is a significant problem)

1. Attention - Fails to give close attention to details or makes careless mistakes in schoolwork or other activities.

2. Has difficulty sustaining attention in tasks or play activities.

3. Does not seem to listen when spoken to directly.

4. Does not follow through on instructions and fails to finish schoolwork or chores (not due to defiance)

5. Has difficulty organising tasks and activities.

6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.

7. Loses things necessary for tasks or activities (e.g., school materials, books, pencils, toys).

8. Is easily distracted by extraneous stimuli.

9. Is forgetful in daily activities.

Please provide any example's to support your score

Guidance for Completing: "Please provide any examples to support your score" – Inattention (ADHD – Inattentive Symptoms)When filling out this section, provide real-life examples that illustrate the individual's inattention-related difficulties in daily life, school, or work settings. Below are examples based on each inattentive symptom:

Section B: Hyperactivity/Impulsivity (ADHD-Hyperactive-Impulsive Symptoms)

This section assesses excessive activity levels, impulsive actions, and difficulties with self-control, which are core symptoms of ADHD – Hyperactive/Impulsive Type. Individuals with these symptoms may struggle to remain seated, talk excessively, or act without thinking about the consequences.

10. Fidgets with hands or feet or squirms in seat.

11. Leaves seat in classroom or other situations where remaining seated is expected.

12. Runs about or climbs excessively in inappropriate situations.

13. Has difficulty playing or engaging in activities quietly.

14. Is often "on the go" or acts as if "driven by a motor."

15. Talks excessively

16. Shouts and/or blurts out answers before questions have been completed.

17. Has struggles with waiting for their turn.

18. Interrupts or/or intrudes on others (e.g., butts into conversations or games).

Examples/Illustrations

When filling out this section, provide specific examples that demonstrate how the individual's hyperactive or impulsive behaviors impact daily life, school, or work. Below are real-life examples for each symptom:

Section C: Oppositional Defiant Disorder (ODD) Symptoms

This section evaluates patterns of persistent rule-breaking, aggression, or behaviors that violate social norms. Conduct Disorder (CD) symptoms are typically more severe than Oppositional Defiant Disorder (ODD) and may involve aggression, deceitfulness, or disregard for rules and authority.

19. Loses temper frequently

20. Argues with adults

21. Actively defies or refuses to comply with adults’ requests or rules.

22.Deliberately annoys people

23.Blames others for their mistakes or misbehavior

24. Is easily annoyed by others

25. Is often angry or resentful

26. Is often spiteful or vindictive

Please provide more information

When filling out this section, provide real-life examples that illustrate how the individual displays oppositional, defiant, or argumentative behaviors in daily life, school, or social situations. Below are examples for each symptom:

Section D: Conduct Disorder (CD) Symptoms

27 Bullies, threatens, or intimidates others.

28. Has initiated or encouraged physical fights

29. Has used weapons that could cause serious harm (e.g., bat, knife, gun).

30. Has been physically unkind/cruel to people

31. Has been physically unkind/cruel to animals

32.Has stolen while confronting a victim (e.g., mugging, extortion, armed robbery).

33. Has forced someone into sexual activity.

34. Deliberately engages in fire-setting with intent to cause damage.

35. Deliberately destroys others’ property.

36.Breaks into cars and/or buildings

37. Obtains goods, favors and avoids obligations through lying.

38. Has stolen items of value without confrontation (e.g., shoplifting, forgery).

39. Stays out at night despite parental rules (before age 13).

40. Has run away from home overnight at least twice.

41. Often truant from school (before age 13).

Additional Information

Please provide examples of any of the above to help support your assessment

Section E: Anxiety Symptoms

This section assesses the individual's levels of anxiety, nervousness, and worry in various situations. Anxiety can affect daily functioning, school/work performance, social interactions, and overall emotional well-being.

42. Worries excessively about different things.

43. Is often fearful or anxious.

44. Is afraid of making mistakes or being embarrassed.

45. Has frequent stomach aches or headaches with no medical cause.

46. Becomes nervous in new situations.

47. Avoids social situations due to anxiety.

48. Is easily startled.

49. Has frequent nightmares.

50. Complains about feeling tense or on edge.

Please provide supporting examples

Section F: Learning Problems & Executive Functioning

This section assesses the individual's academic challenges, cognitive processing abilities, and executive functioning skills, which are essential for planning, organizing, and completing tasks efficiently.

51. Has difficulty completing assignments.

52. Struggles with understanding and following instructions.

53. Takes longer than others to complete schoolwork.

54. Difficulty with reading or written expression.

55. Often forgets what was just taught.

56. Frequently needs help staying on task.

57. Has difficulty planning and organising work.

58. Struggles with problem-solving skills.

Anything you can tell us to support the assessment process

Section G: Peer & Social Problems

This section evaluates the individual's social interactions, relationships with peers, and ability to navigate social situations. Difficulties in this area can impact friendships, school/work environments, and emotional well-being.

59. Has trouble making and keeping friends

60. Is often isolated or withdrawn from peers.

61. Struggles to understand social cues.

62. Gets into conflicts with other children.

63. Is often rejected or ignored by peers

64. Has difficulty managing emotions in social settings.

More information - examples would be helpful

Section H: Emotional Dysregulation & Mood Symptoms

This section assesses how well the individual regulates their emotions and their general mood stability. Emotional dysregulation refers to difficulty managing emotions, leading to intense reactions, mood swings, frustration, or difficulty calming down after distressing events.

65. Has frequent mood swings.

67. Frequently feels sad or hopeless.

68. Lacks motivation or energy.

69. Is overly sensitive to criticism.

70. Often feels overwhelmed.

Please provide some examples

Declaration

I confirm that the information provided in this form is accurate and truthful to the best of my knowledge. I understand that this information will be used as part of the assessment process and may contribute to recommendations for support or intervention. If there are any changes or updates to this information, I will notify the relevant professional.

Please sign here - this confirms that you have read and agreed to the declaration

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