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Child & Youth Mental Health Algorithm - GPSC

Child & Youth Mental Health Algorithm - GPSC

Patient Name:Date of

Patient Name:Date of Birth:Physician Name:MRN/File No:Date:SNAP-IV 26 – Teacher and Parent Rating ScaleName: ________________________________________________________ Gender: ___________ Age: ____________Grade: _______ Ethnicity: African-American Asian Caucasian Hispanic Other: ________________Completed by: _________________________________________ Type of Class: __________ Class size: _____________For each item, check the column which best describes this child: Not At All Just A Little Quite A Bit Very Much1. Often fails to give close attention to details or makescareless mistakes in schoolwork or tasks2. Often has difficulty sustaining attention in tasks or play activities3. Often does not seem to listen when spoken to directly4. Often does not follow through on instructions and fails to finishschoolwork, chores, or duties5. Often has difficulty organizing tasks and activities6. Often avoids, dislikes, or reluctantly engages in tasks requiringsustained mental effort7. Often loses things necessary for activities (e.g., toys,school assignments, pencils, or books)8. Often is distracted by extraneous stimuli9. Often is forgetful in daily activities10. Often has difficulty maintaining alertness, orienting to requests,or executing directions11. Often fidgets with hands or feet or squirms in seat12. Often leaves seat in classroom or in other situations in whichremaining seated is expected13. Often runs about or climbs excessively in situations in whichit is inappropriate14. Often has difficulty playing or engaging in leisure activities quietly15. Often is “on the go” or often acts as if “driven by a motor”16. Often talks excessively17. Often blurts out answers before questions have been completed18. Often has difficulty awaiting turn19. Often loses temper20. Often argues with adults21. Often actively defies or refuses adult requests or rules22. Often deliberately does things that annoy other people23. Often blames others for his or her mistakes or misbehavior24. Often touchy or easily annoyed by others25. Often is angry and resentful26. Often is spiteful or vindictive108 Version: January 2011. Refer to www.caddra.ca for latest updates.

SNAP-IV 26 RATING SCALE: SCORING INSTRUCTIONSThe SNAP-IV is a revision of the Swanson, Nolan and Pelham (SNAP) questionnaire (Swanson et al. 1983).The items from the DSM-IV criteria for Attention Deficit Hyperactivity Disorder (ADHD) are included for thetwo following subsets of symptoms: inattention (items 1 to 0) and hyperactivity/impulsivity (items 10 to18). The scale also includes the DMS-IV criteria for Oppositional Defiant Disorder (items 19 to 26) sincethis is often present in children with ADHD.The SNAP-IV is based on a 0 to 3 rating scale: Not at all = 0, Just a little = 1, Often = 2, andVery often = 3. Sub scale scores on the SNAP-IV are calculated by summing the scores on the subsetand dividing by the number of items in the subset. The score for any subset is expressed as the AverageRating-Per-Item, as shown for ratings on the ADHD-Inattentive (ADHD-I) subset:Total ADHD-Inattention = 18 Average = 18/9 = 2.0Not at all Just a little Often Very often(0) (1) (2) (3) Score1. Makes careless mistakes* 22. Difficulty sustaining attention* 33. Does not listen* 34. Fails to finish work* 25. Disorganized* 16. Can’t concentrate* 37. Loses things* 18. Easily distracted* 39. Forgetful* 0ADHD-Inattention ADHD-Hyperactivty/Impusivity Oppositional Defiant Disorder#1 #10 #19#2 #11 #20#3 #12 #21#4 #13 #22#5 #14 #23#6 #15 #24#7 #16 #25#8 #17 #26#9 #18Total Total TotalAverage Average Average107

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