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The SNAP IV Rating Scale - School

James M. Swanson, Ph.D., University of California, Irvine, CA 92715

 

Child's Name
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Gender
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Age
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Date of Birth
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Health Card #
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Psychiatrist
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Grade
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Type of Class
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Class Size
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Completed By
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Relationship to Patient
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Date
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Dear Parent/Guardian: Please complete this form based on your observation of your child in the home setting.

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


1. Often fails to give close attention to details or makes careless mistakes in school work
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2. Often has difficulty sustaining attention in tasks or play activities
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3. Often does not seem to listen when spoken to directly
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4. Often does not follow through on instructions and fails to finish schoolwork
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5. Often has difficulty organizing tasks and activities
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6. Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort
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7. Often loses things necessary for activities (e.g. school assignments, pencils, or books)
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8. Often is distracted by extraneous stimuli
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9. Often is forgetful in daily activities
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10. Often has difficulty maintaining alertness, orienting to requests or executing assignments
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11. Often fidgets with hands or feet or squirms in seat
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12. Often leaves seat in classroom when remaining seated is expected
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13. Often runs about or climbs excessively in situations where it is inappropriate
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14. Often has difficulty playing or engaging in leisure activities quietly
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15. Often is “on the go” or often acts as if “driven by a motor”
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16. Often talks excessively
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17. Often blurts out answers to questions before the questions have been completed
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18. Often has difficulty awaiting turn
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19. Often interrupts or intrudes on others (e.g., butts into conversations/games)
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20. Often has difficulty sitting still, being quiet, or inhibiting impulses in the classroom
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21. Often loses temper
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22. Often argues with adults
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23. Often actively defies or refuses adult requests or rules
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24. Often deliberately does things that annoy other people
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25. Often blames others for his or her mistakes or misbehavior
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26. Often touchy or easily annoyed by others
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27. Often is angry and resentful
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28. Often is spiteful or vindictive
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29. Often is quarrelsome
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30. Often is negative, defiant, disobedient, or hostile toward authority figures
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31. Often makes noises (e.g., humming or odd sounds)
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32. Often is excitable, impulsive
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33. Often cries easily
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34. Often is uncooperative
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35. Often acts “smart”
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36. Often is restless or overactive
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37. Often disturbs other children
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38. Often changes mood quickly and drastically
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39. Often easily frustrated if demands are not met
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40. Often teases other children and interferes with their activities
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41. Often is aggressive towards other children (e.g. picks fights or bullies)
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42. Often is destructive with property of others (e.g. vandalism)
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43. Often is deceitful (e.g. steals, lies, forges, copies of the work of others, or “cons” others)
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44. Often and seriously violates rules (e.g. is truant, runs away, or completely ignores rules)
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45. Has persistent pattern of violating the basic rights of others or major societal norms
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46. Has episodes of failure to resist aggressive impulses (assaulting others, destroying property)
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47. Has motor or verbal tics (sudden, rapid, recurrent, non-rhythmic motor or verbal activity)
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48. Has repetitive motor behavior (body rocking, hand waving, or picking at skin)
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49. Has obsessions (persistent and intrusive inappropriate ideas, thoughts or impulses)
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50. Has compulsions (repetitive behaviors or mental acts to reduce anxiety or distress)
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51. Often is restless or seems keyed up or on edge
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52. Often is easily fatigued
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53. Often has difficulty concentrating (mind goes blank)
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54. Often is irritable
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55. Often has muscle tension
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56. Often has excessive anxiety and worry (e.g. apprehensive expectation)
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57. Often has daytime sleepiness (unintended sleeping in inappropriate situations)
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58. Often has excessive emotionality and attention-seeking behavior
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59. Often has need for undue admiration, grandiose behavior, or lack of empathy
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60. Often has instability in relationships with others, reactive mood, and impulsivity
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61. Sometimes for at least a week has inflated self-esteem or grandiosity
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62. Sometimes for at least a wk is more talkative than usual or seems pressured to keep talking
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63. Sometimes for at least a week has flight of ideas or says that thoughts are racing
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64. Sometimes for at least a week has elevated, expansive, or euphoric mood
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65. Sometimes for at least a week is excessively involved in pleasurable but risky activities
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66. Sometimes for at least 2 weeks has depressed mood (sad, hopeless, discouraged)
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67. Sometimes for at least 2 weeks has irritable or cranky mood (not just when frustrated)
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68. Sometimes for at least 2 wks has marked diminished interest or pleasure in most activities
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69. Sometimes for at least 2 wks has psychomotor agitation (is even more active than usual)
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70. Sometimes for at least 2 wks has psychomotor retardation (slowed down in most activities)
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71. Sometimes for at least 2 weeks is fatigued or has loss of energy
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72. Sometimes for at least 2 wks has feelings of worthlessness/excessive or inappropriate guilt
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73. Sometimes for at least 2 weeks has diminished ability to think or concentrate
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74. Chronic low self-esteem most of the time for at least a year
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75. Chronic poor concentration or difficulty making decisions most of the time for at least a year
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76. Chronic feelings of hopelessness most of the time for at least a year
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77. Currently is hypervigilant (overly watchful/overly alert) or exaggerated startle response
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78. Currently is irritable, has anger outbursts, or has difficulty concentrating
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79. Currently has an emotional (nervous, worried, hopeless, tearful) response to stress
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80. Currently has a behavioral (fighting, vandalism, truancy) response to stress
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81. Has difficulty getting started on classroom assignments
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82. Has difficulty staying on task for an entire classroom period
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83. Has problems in completion of work on classroom assignments
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84. Has problems in accuracy or neatness of written work in the classroom
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85. Has difficulty attending to a group classroom activity or discussion
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86. Has difficulty making transitions to the next topic or classroom period
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87. Has problems in interactions with peers in the classroom
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88. Has problems in interactions with staff (teacher or aide)
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89. Has difficulty remaining quiet according to classroom rules
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90. Has difficulty staying seated according to classroom rules
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