SWANSON, NOLAN, AND PELHAM RATING SCALE (SNAP)

Transcription

1 Page 1 of 8 DSM-5 criteria for the diagnosis of ADHD emphasize the importance of gathering information about an individual's behavior in multiple settings and from multiple informants. To accomplish this, standardized ADHD rating scales are recommended as Best Practice by the American Psychiatric Association and the American Academy of Pediatrics. DefiniPoint provides a variety of standardized ADHD rating scales to gather this behavioral information. Additionally, DefiniPoint allows the results from multiple informants (including disparate rating scales) to be compared and integrated into a single probability score. DefiniPoint facilitates Best Practice ADHD assessments consistent with DSM-5 diagnostic criteria which include the evaluation of other emotional/behavioral, developmental, and physical conditions. As such, the information provided by DefiniPoint is not intended to be the sole source of information but rather is part of a comprehensive evaluation. SWANSON, NOLAN, AND PELHAM RATING SCALE (SNAP) The SNAP Rating Scale is a 90-item scale used to evaluate children and adolescents for ADHD. The SNAP includes all DSM-5 inattentive and hyperactive-impulsive symptoms. The SNAP was the ADHD rating scale used in the Multimodal Treatment Study of Children with ADHD (MTA Study), the largest and most comprehensive ADHD treatment study ever conducted. In addition to ADHD symptoms, the SNAP includes 8 symptoms of oppositional-defiance/conduct disorder, 5 symptoms of inattention/overactivity, 5 symptoms of aggression/defiance and 10 items of the Swanson, Kotkin, Agler, Mylnn, and Pelham (SKAMP) Rating Scale to gauge impairment in the classroom. The SNAP includes 10 items as a general index of childhood problems (Conners/Iowa Index). Lastly, the SNAP includes screening items for several other disorders which may overlap with or masquerade as symptoms of ADHD. The SNAP is not designed to be used in the formal process of diagnosing these non-adhd disorders, but if symptoms receive a high ('Quite A Bit' or 'Very Much') rating, then an assessment of the implicated disorders may be warranted. The table below shows the areas covered and the number of items for each area. Conduct Disorder (4 items) Intermittent Explosive Disorder (1 item) Stereotypic Movement Disorder (1 item) Obsessive-Compulsive Disorder (2 items) Generalized Anxiety Disorder (6 items) Narcolepsy (1 item) Adjustment Disorder (2 items) Histrionic Personality Disorder (1 item) Narcissistic Personality Disorder (1 item) Borderline Personality Disorder (1 item) Manic Episode (5 items) Dysthymic Disorder (3 items) Posttraumatic Stress Disorder (2 items) To complete the SNAP, informants rate each symptom on a 0 'Not at all' to 3 'Very much' scale. Clinical thresholds for Inattention, Hyperactivity/Impulsivity, Combined Inattention/HI, and Oppositional Defiance provide for interpretation of symptom severity. Because information from multiple sources is recommended when evaluating individuals for ADHD, DefiniPoint allows rating scale results from different informants to be compared and integrated into a single probability score. DefiniPoint generates a summary score for each ADHD subtype by utilizing the clinical threshold scores to convert the symptom score for each subtype into a score of This score increases with higher probability scores reflecting a greater likelihood that ADHD is an appropriate diagnosis. As noted above, this probability score is only one component of a comprehensive evaluation and should not be used in isolation to diagnose any individual. Downloaded: 04/14/ :11:23

2 Page 2 of 8 RESULTS The graph above summarizes the Teacher's observations of Nancy Smith's ADHD symptoms. The score for the inattentive, hyperactive-impulsive, and combined presentations increases as the average response score increases for each presentation (e.g. scale = 0 'Not at all' to 3 'Very much'). For each subtype (presentation specifier), a score >= 50 exceeds the clinical threshold and represents a positive screen for ADHD. A score < 50 indicates the clinical threshold was not reached. Tabular results for Nancy Smith are shown below and organized by subscale. Entries indicate the average score on items comprising the scale. Normative data were used to establish the Clinical Thresholds. Average scores at or above the clinical threshold represent a positive screen for difficulties in the given domain BUT should not be used in isolation to establish a diagnosis. Instead, the findings should be considered in conjunction with ratings provided by other sources, e.g., other teachers, parents, along with other data obtained on the individual. If ratings have been collected from other sources, you can use DefiniPoint's patented statistical algorithm to integrate these ratings and compute an overall ADHD probability score for this individual. Subscale Clinical Threshold (average) Average Score Impairment Inattentive >= Not present Hyperactivity/Impulsivity >= Present Combined >= Not present ODD >= Not present Inattention/Overactivity Aggression/Defiance Conners Academic Deportment Downloaded: 04/14/ :11:23

3 Page 3 of 8 ITEM RESPONSES Ratings on individual items and additional information on the SNAP Ratings Scales is provided below. Scoring uses the scale: 0 'Not at all', 1 'Just a little', 2 'Quite a bit' to 3 'Very much' and responses are organized by subscales. Reviewing the individual item ratings will highlight specific areas of difficulty reported by the parent. If symptoms receive a high ('Quite A Bit' or 'Very Much') rating, then further assessment of the implicated disorders may be warranted. Inattentive 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 Hyperactivity/Impulsivity Response Score 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" Very Much 3 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) ODD Response Score 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 Downloaded: 04/14/ :11:24

4 Page 4 of 8 27 Often is angry and resentful 28 Often is spiteful or vindictive Inattention/Overactivity Response Score 4 Often does not follow through on instructions and fails to finish schoolwork, chores, or duties 8 Often is distracted by extraneous stimuli 11 Often fidgets with hands or feet or squirms in seat 31 Often makes noises (e.g., humming or odd sounds) 32 Often is excitable, impulsive Aggression/Defiance Response Score 21 Often loses temper 23 Often actively defies or refuses adult requests or rules 29 Often is quarrelsome 34 Often is uncooperative 35 Often acts "smart" Conners Response Score 4 Often does not follow through on instructions and fails to finish schoolwork, chores, or duties 8 Often is distracted by extraneous stimuli 11 Often fidgets with hands or feet or squirms in seat 21 Often loses temper 32 Often is excitable, impulsive 33 Often cries easily 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 Academic Response Score 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 Very Much 3 84 Has problems in accuracy or neatness of written work in the classroom 85 Has difficulty attending to a group classroom activity or discussion Very Much 3 86 Has difficulty making transitions to the next topic or classroom period Deportment Response Score 87 Has problems in interactions with peers in the classroom 88 Has problems in interactions with staff (teacher or aide) Downloaded: 04/14/ :11:24

5 Page 5 of 8 89 Has difficulty remaining quiet according to classroom rules 90 Has difficulty staying seated according to classroom rules Conduct Disorder Response Score 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 Intermittent Explosive Disorder Response Score 46 Has episodes of failure to resist aggressive impulses (to assault others or to destroy property) Tourette's Disorder Response Score 47 Has motor or verbal tics (sudden, rapid, recurrent, nonrhythmic motor or verbal activity) Stereoscopic Movement Disorder Response Score 48 Has repetitive motor behavior (e.g., hand waving, body rocking, or picking at skin) Obsessive-Compulsive Disorder Response Score 49 Has obsessions (persistent and intrusive inappropriate ideas, thoughts, or impulses) 50 Has compulsions (repetitive behaviors or mental acts to reduce anxiety or distress) Generalized Anxiety Disorder Response Score 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) Narcolepsy Response Score 57 Often has daytime sleepiness (unintended sleeping in inappropriate situations) Histrionic Personality Disorder Response Score 58 Often has excessive emotionality and attention-seeking behavior Narcissistic Personality Disorder Response Score 59 Often has need for undue admiration, grandiose behavior, or lack of empathy Borderline Personality Disorder Response Score 60 Often has instability in relationships with others, reactive mood, and impulsivity Downloaded: 04/14/ :11:24

6 Page 6 of 8 Manic Episode Response Score 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 Very Much 3 64 Sometimes for at least a week has elevated, expansive or euphoric mood Very Much 3 65 Sometimes for at least a week is excessively involved in pleasurable but risky activities Major Depressive Episode Response Score 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 Dysthymic Disorder Response Score 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 Posttraumatic Stress Disorder Response Score 77 Currently is hypervigilant (overly watchful or alert) or has exaggerated startle response 78 Currently is irritable, has anger outbursts, or has difficulty concentrating Adjustment Disorder Response Score 79 Currently has an emotional (e.g., nervous, worried, hopeless, tearful) response to stress Very Much 3 80 Currently has a behavioral (e.g., fighting, vandalism, truancy) response to stress Very Much 3 Additional Items Response Score 10 Often has difficulty maintaining alertness, orienting to requests, or executing directions 20 Often has difficulty sitting still, being quiet, or inhibiting impulses in the classroom Downloaded: 04/14/ :11:25

7 Page 7 of 8 or at home 30 Often is negative, defiant, disobedient, or hostile toward authority figures 40 Often teases other children and interferes with their activities 91 Downloaded: 04/14/ :11:25

8 Powered by TCPDF ( Nancy Smith Page 8 of 8 The psychometric properties and clinical utility of the SNAP have been demonstrated in multiple studies since its introduction in Response to treatment and direct classroom observations has established the validity of SNAP, and it was used as the primary outcome measure in the Multimodality Treatment Study of ADHD. The SNAP has been found to be reliable and well validated with normative data available from parents (N = 1,613) and teachers (N = 1,205). References for the SNAP Rating Scales: 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 Feb;40(2): 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 Sep;15(3): Epub 2008 Feb 29. 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): References for the DefiniPoint probability score: Robeva R, Penberthy JK, Loboschefski T, Cox D, Kovatchev B. Sequential Psychophysiological Assessment of ADHD: A Pilot Study of Bayesian Probability Approach Illustrated by Appraisal of ADHD in Female College Students. Applied Psychophysiology and Biofeedback, 29 (1), 1-18, 2004 Kovatchev BP, Penberthy JK, Robeva RS, Breton M, Cox DJ. Computational Strategies in the Evaluation of Attention Deficit/Hyperactivity Disorder (ADHD). In: Attention Deficit/Hyperactivity Disorder Research, Michelle P. Larimer (Ed.). Nova Science Publishers, Inc., NY Penberthy JK, Cox, DJ, Breton M, Robeva R, Loboschefski T, Kovatchev BP. Calibrated Bio-Behavioral Assessment of ADHD: A Prospective Study of a Meta-Analysis Method. Applied Psychophysiology and Biofeedback, 30 (1): Robeva R, Penberthy JK. Bayesian probability approach to ADHD appraisal. Methods Enzymol. 2009;467: Downloaded: 04/14/ :11:25