[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"assessment-snap-iv":3,"all-assessments-nav":287,"related-assessments-query":967},{"id":4,"title":5,"body":6,"category":247,"categoryTitle":248,"clinicalCitations":249,"copyright":247,"description":258,"disclaimer":247,"downloadLink":247,"extension":259,"faqs":260,"featured":276,"i18nReady":276,"icon":247,"interpreter":247,"lastReviewed":277,"meta":278,"navigation":279,"path":280,"permissionsNote":247,"published":279,"recommendedFrequency":247,"relatedCodes":247,"relatedConditions":247,"reviewedBy":247,"seo":281,"slug":282,"stem":283,"summary":284,"takeaways":247,"timeline":247,"type":285,"usedToDiagnose":247,"__hash__":286},"assessments\u002Fassessments\u002Fsnap-iv.md","SNAP-IV Scoring · Swanson, Nolan and Pelham ADHD Rating Scale",{"type":7,"value":8,"toc":231},"minimark",[9,13,18,21,24,28,31,54,57,62,66,77,80,95,99,152,155,159,166,170,173,177,203,207,219,223],[10,11,12],"p",{},"The SNAP-IV is a free, widely used parent and teacher rating scale for evaluating ADHD symptoms in children, and the screening scale recommended in Canadian (CADDRA) ADHD guidelines.",[14,15,17],"h3",{"id":16},"about-the-snap-iv","About the SNAP-IV",[10,19,20],{},"The SNAP-IV was developed by James Swanson, William Nolan, and William Pelham as a rating scale for the symptoms of attention-deficit\u002Fhyperactivity disorder and oppositional defiant disorder in children. The most commonly used short version, the SNAP-IV-26, draws its items directly from the DSM symptom criteria, so a clinician can map ratings onto recognised diagnostic domains.",[10,22,23],{},"It is completed by an adult informant who knows the child well — typically a parent and a teacher — because ADHD requires evidence of symptoms across more than one setting. Like the NICHQ Vanderbilt, the SNAP-IV is designed for school-aged children and is freely available, which has made it a standard tool in primary care, paediatrics, and school-based assessment across North America.",[14,25,27],{"id":26},"what-the-snap-iv-measures","What the SNAP-IV Measures",[10,29,30],{},"The SNAP-IV-26 covers three symptom domains:",[32,33,34,42,48],"ul",{},[35,36,37,41],"li",{},[38,39,40],"strong",{},"Inattention"," (items 1–9) — the 9 DSM inattention symptoms.",[35,43,44,47],{},[38,45,46],{},"Hyperactivity\u002FImpulsivity"," (items 10–18) — the 9 DSM hyperactivity\u002Fimpulsivity symptoms.",[35,49,50,53],{},[38,51,52],{},"Oppositional Defiant Disorder"," (items 19–26) — 8 ODD symptoms, screening for the most common ADHD comorbidity.",[10,55,56],{},"Longer versions of the SNAP add further comorbidity screens, but the 26-item form is the one most often used in routine practice.",[58,59,61],"h2",{"id":60},"snap-iv-scoring-interpretation","SNAP-IV Scoring & Interpretation",[14,63,65],{"id":64},"how-to-score-the-snap-iv","How to Score the SNAP-IV",[10,67,68,69,72,73,76],{},"Each item is rated on a 4-point frequency scale: ",[38,70,71],{},"0 = Not at All, 1 = Just a Little, 2 = Quite a Bit, 3 = Very Much",", reflecting the past month. Rather than a single summed total, each subscale is scored as an ",[38,74,75],{},"average",": add the item ratings within a subscale and divide by the number of items in it.",[10,78,79],{},"There are two complementary ways to read the result:",[81,82,83,89],"ol",{},[35,84,85,88],{},[38,86,87],{},"Subscale average vs normative cut-point."," Compare each subscale average with the informant-specific cut-point (below). An average at or above the cut-point places the child in the clinically significant range for that domain.",[35,90,91,94],{},[38,92,93],{},"DSM symptom count."," Count the items rated 2 (Quite a Bit) or 3 (Very Much) within the inattention and hyperactivity\u002Fimpulsivity domains, mirroring the DSM threshold of six or more symptoms in a domain.",[14,96,98],{"id":97},"snap-iv-cut-points-at-a-glance","SNAP-IV Cut-Points at a Glance",[100,101,102,118],"table",{},[103,104,105],"thead",{},[106,107,108,112,115],"tr",{},[109,110,111],"th",{},"Subscale",[109,113,114],{},"Teacher cut-point (avg)",[109,116,117],{},"Parent cut-point (avg)",[119,120,121,132,141],"tbody",{},[106,122,123,126,129],{},[124,125,40],"td",{},[124,127,128],{},"≈ 2.56",[124,130,131],{},"≈ 1.78",[106,133,134,136,138],{},[124,135,46],{},[124,137,131],{},[124,139,140],{},"≈ 1.44",[106,142,143,146,149],{},[124,144,145],{},"Oppositional Defiant",[124,147,148],{},"≈ 1.38",[124,150,151],{},"≈ 1.88",[10,153,154],{},"These are Swanson's normative 95th-percentile cut-points; they are informant-specific because teachers and parents rate differently. A subscale average at or above the relevant value indicates symptoms in the clinically significant range and supports referral for a full evaluation — it is a screening result, not a standalone clinical conclusion.",[14,156,158],{"id":157},"administration","Administration",[10,160,161,162,165],{},"The SNAP-IV is completed independently by the informant and takes about 10 minutes. Because DSM-5-TR requires symptoms in two or more settings, a valid ADHD screen uses ",[38,163,164],{},"both"," a parent and a teacher form. Non-clinical staff can administer the forms, but a licensed clinician must interpret them in the context of history, functional impairment, and other information.",[14,167,169],{"id":168},"psychometric-properties","Psychometric Properties",[10,171,172],{},"The SNAP-IV's three-factor structure (inattention, hyperactivity\u002Fimpulsivity, ODD) has been confirmed across language versions, with high internal consistency and good criterion validity for identifying children with a clinical ADHD diagnosis (Bussing et al., 2008; Tallberg et al., 2025). Receiver-operating-characteristic analyses support strong classification accuracy for the inattention and hyperactivity\u002Fimpulsivity subscales.",[14,174,176],{"id":175},"limitations","Limitations",[32,178,179,185,191],{},[35,180,181,184],{},[38,182,183],{},"Screening, not diagnosis."," A positive SNAP-IV supports, but does not replace, a full clinical evaluation.",[35,186,187,190],{},[38,188,189],{},"Informant differences."," Parent and teacher ratings often diverge; cut-points are informant-specific for this reason, and both perspectives are needed.",[35,192,193,196,197,202],{},[38,194,195],{},"Age range."," The SNAP-IV is designed for school-aged children; for adults, use the ASRS, and for retrospective childhood symptoms in adults, the ",[198,199,201],"a",{"href":200},"\u002Fassessments\u002Fwurs-61\u002F","WURS-61",".",[58,204,206],{"id":205},"snap-iv-vs-nichq-vanderbilt","SNAP-IV vs NICHQ Vanderbilt",[10,208,209,210,214,215,202],{},"The SNAP-IV and the ",[198,211,213],{"href":212},"\u002Fassessments\u002Fnichq-vanderbilt\u002F","NICHQ Vanderbilt"," are the two dominant free, DSM-aligned paediatric ADHD rating scales, both requiring parent and teacher informants. The Vanderbilt adds a 1–5 performance\u002Fimpairment subscale used directly in its positive-screen rule; the SNAP-IV is scored by subscale averages against normative cut-points. Many Canadian clinics standardise on the SNAP-IV because it is the scale embedded in CADDRA guidance. For adult ADHD, pair with the ",[198,216,218],{"href":217},"\u002Fassessments\u002Fasrs\u002F","ASRS",[58,220,222],{"id":221},"billing-the-snap-iv-cpt-96127","Billing the SNAP-IV (CPT 96127)",[10,224,225,226,230],{},"SNAP-IV administration qualifies for reimbursement under ",[198,227,229],{"href":228},"\u002Fcpt-codes\u002F96127-brief-emotional-behavioural-assessment\u002F","CPT code 96127"," (brief emotional\u002Fbehavioural assessment) when scored and documented with clinical interpretation. The AMA allows up to 4 units per encounter; Medicare limits this to 3. When parent and teacher forms are both completed in the same encounter, each may be billed as a separate unit.",{"title":232,"searchDepth":233,"depth":233,"links":234},"",3,[235,236,237,245,246],{"id":16,"depth":233,"text":17},{"id":26,"depth":233,"text":27},{"id":60,"depth":238,"text":61,"children":239},2,[240,241,242,243,244],{"id":64,"depth":233,"text":65},{"id":97,"depth":233,"text":98},{"id":157,"depth":233,"text":158},{"id":168,"depth":233,"text":169},{"id":175,"depth":233,"text":176},{"id":205,"depth":238,"text":206},{"id":221,"depth":238,"text":222},null,"ADHD & Behavioural Assessment",[250,252,255],{"text":251},"Swanson JM. School-Based Assessments and Interventions for ADD Students. Irvine, CA: KC Publishing; 1992.",{"text":253,"link":254},"Bussing R, Fernandez M, Harwood M, et al. Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment. 2008;15(3):317-328.","https:\u002F\u002Fdoi.org\u002F10.1177\u002F1073191107313888",{"text":256,"link":257},"Tallberg P, Vahlström R, Martí Valls C, et al. Psychometric properties of the Swedish version of the SNAP-IV rating scale parent form in a birth cohort of 11-year-old children. Nord J Psychiatry. 2025;79(7):503-514.","https:\u002F\u002Fdoi.org\u002F10.1080\u002F08039488.2025.2531230","SNAP-IV scoring guide — Swanson, Nolan and Pelham ADHD rating scale (26-item). Inattention, hyperactivity\u002Fimpulsivity, and ODD subscales, 0–3 averaged. Free clinical use.","md",[261,264,267,270,273],{"question":262,"answer":263},"What is the SNAP-IV?","The SNAP-IV is a parent- and teacher-rated scale for assessing attention-deficit\u002Fhyperactivity disorder (ADHD) symptoms in children, developed by James Swanson, William Nolan, and William Pelham. The widely used SNAP-IV-26 has 26 items: 9 DSM inattention symptoms, 9 hyperactivity\u002Fimpulsivity symptoms, and 8 oppositional defiant disorder (ODD) symptoms. It is free for clinical and research use and is the screening scale recommended in Canadian (CADDRA) ADHD practice guidelines.",{"question":265,"answer":266},"How is the SNAP-IV scored?","Each item is rated 0 (Not at All), 1 (Just a Little), 2 (Quite a Bit), or 3 (Very Much) over the past month. Items are grouped into the inattention, hyperactivity\u002Fimpulsivity, and ODD subscales, and each subscale is scored as an average (sum of items divided by the number of items). The subscale average is compared with normative cut-points rather than producing a single total score.",{"question":268,"answer":269},"What is a positive SNAP-IV cut-off?","Swanson's normative 95th-percentile cut-points are informant-specific. For the teacher form they are approximately 2.56 (inattention), 1.78 (hyperactivity\u002Fimpulsivity), and 1.38 (ODD); for the parent form they are 1.78 (inattention), 1.44 (hyperactivity\u002Fimpulsivity), and 1.88 (ODD). A subscale average at or above the relevant cut-point indicates symptoms in the clinically significant range and warrants a full evaluation. The SNAP-IV is a screening aid, not a diagnosis.",{"question":271,"answer":272},"Is the SNAP-IV free to use?","Yes. The SNAP-IV and the abbreviated SNAP-IV-26 are freely available for clinical and educational use at no cost and require no licensing fees, which is part of why they are widely used in primary care and school settings.",{"question":274,"answer":275},"Can I bill CPT 96127 for the SNAP-IV?","Yes. CPT 96127 (brief emotional\u002Fbehavioural assessment) covers administration of the SNAP-IV when it is scored and documented with clinical interpretation. The AMA allows up to 4 units per encounter; Medicare limits this to 3. Parent and teacher forms can each be billed as a separate unit when both are completed in the same encounter. See the [CPT 96127 billing guide](\u002Fcpt-codes\u002F96127-brief-emotional-behavioural-assessment\u002F).",false,"2026-06-07",{},true,"\u002Fassessments\u002Fsnap-iv",{"title":5,"description":258},"snap-iv","assessments\u002Fsnap-iv","SNAP-IV scoring guide — the Swanson, Nolan and Pelham ADHD rating scale (SNAP-IV-26). Inattention, hyperactivity\u002Fimpulsivity, and ODD subscales rated 0–3 and averaged, with informant-specific cut-points for parent and teacher forms.","assessment","ELVLVd6ds5hLPQ2DB_3czkDf3dbLOzvsvCePz7KpQig",[288,293,298,302,306,311,316,320,325,330,335,340,345,350,354,358,363,368,373,377,381,386,391,396,400,404,408,413,417,422,427,432,437,442,446,450,455,459,463,467,471,475,480,485,489,494,499,504,509,513,517,521,526,530,534,539,543,548,552,557,561,565,569,574,579,583,588,593,597,601,605,609,614,618,622,626,630,634,639,644,648,652,656,660,664,669,673,677,681,686,690,695,700,704,708,712,716,720,725,730,734,738,742,746,750,754,758,762,766,771,775,779,783,787,791,796,800,805,809,813,818,822,826,830,834,838,843,847,851,856,857,861,865,869,873,877,881,886,891,896,901,905,909,913,917,921,925,929,933,938,942,946,950,954,958,963],{"title":289,"slug":290,"path":291,"categoryTitle":292},"ACE Score","aces","\u002Fassessments\u002Faces","Trauma & 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