SNAP Form (Ramona)
Community Outreach of Pediatrics and Psychiatry in Education
Welcome to the SNAP form.
Date Filled Out
Submitted By
Student
Student Name
Preferred Name
Date of Birth
Gender
Grade
The MTA SNAP-IV Rating Scale
(c) James M. Swanson, PhD., University of California, Irvine, CA 92715
1. Fails to give close attention to details or makes careless mistakes in schoolwork or tasks
Not at all
Just a little
Quite a bit
Very much
2. Has difficulty sustaining attention in tasks or play activities
Not at all
Just a little
Quite a bit
Very much
3. Does not seem to listen when spoken to directly
Not at all
Just a little
Quite a bit
Very much
4. Does not follow through on instructions and fails to finish schoolwork, chores or duties
Not at all
Just a little
Quite a bit
Very much
5. Has difficulty organizing tasks and activities
Not at all
Just a little
Quite a bit
Very much
6. Avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort
Not at all
Just a little
Quite a bit
Very much
7. Loses things necessary for activities (e.g., toys, school assignments, pencils, or books]
Not at all
Just a little
Quite a bit
Very much
8. Is distracted by extraneous stimuli
Not at all
Just a little
Quite a bit
Very much
9. Is forgetful in daily activities
Not at all
Just a little
Quite a bit
Very much
10. Has difficulty maintaining alertness, orienting to requests, or executing directions
Not at all
Just a little
Quite a bit
Very much
11. Fidgets with hands or feet or squirms in seat
Not at all
Just a little
Quite a bit
Very much
12. Leaves seat in classroom or in other situations where remaining seated is expected
Not at all
Just a little
Quite a bit
Very much
13. Runs about or climbs excessively in situations in which it is inappropriate
Not at all
Just a little
Quite a bit
Very much
14. Has difficulty playing or engaging in leisure activities quietly
Not at all
Just a little
Quite a bit
Very much
15. Is "on the go" or often acts as if "driven by a motor"
Not at all
Just a little
Quite a bit
Very much
16. Talks excessively
Not at all
Just a little
Quite a bit
Very much
17. Blurts out answers before questions have been completed
Not at all
Just a little
Quite a bit
Very much
18. Has difficulty awaiting turn
Not at all
Just a little
Quite a bit
Very much
19. Interrupts or intrudes on others (e.g., butts into conversations or games]
Not at all
Just a little
Quite a bit
Very much
20. Has difficulty sitting still, being quiet, or inhibiting impulses in the classroom or at home
Not at all
Just a little
Quite a bit
Very much
21. Loses temper
Not at all
Just a little
Quite a bit
Very much
22. Argues with adults
Not at all
Just a little
Quite a bit
Very much
23. Actively defies or refuses adult requests or rules
Not at all
Just a little
Quite a bit
Very much
24. Deliberately does things that annoy other people
Not at all
Just a little
Quite a bit
Very much
25. Blames others for his or her mistakes or misbehaviour
Not at all
Just a little
Quite a bit
Very much
26. Is touchy or easily annoyed by others
Not at all
Just a little
Quite a bit
Very much
27. Is angry and resentful
Not at all
Just a little
Quite a bit
Very much
28. Is spiteful or vindictive
Not at all
Just a little
Quite a bit
Very much
29. Is quarrelsome
Not at all
Just a little
Quite a bit
Very much
30. Is negative, defiant, disobedient, or hostile toward authority figures
Not at all
Just a little
Quite a bit
Very much
Additional Comments
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