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First published online April 16, 2019

The Validity of the SNAP-IV in Children Displaying ADHD Symptoms

Abstract

The Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) is a widely used scale that measures the core symptoms of attention deficit hyperactivity disorder (ADHD). However, there are contradictory findings regarding factor structure. Factor structure and measurement equivalence/invariance analysis on parent and teacher SNAP-IV for children referred for an ADHD assessment (N = 250; 6-17 years), revealed a two-factor structure provided the best fit. SNAP-IV scores were also compared with clinician diagnosis of ADHD and research diagnoses of ADHD and hyperkinetic disorder. Parent ratings of inattention and hyperactivity/impulsivity were good predictors of research but not clinician diagnosis. For teacher ratings, only hyperactivity/impulsivity scores were associated with research and clinician diagnosis. SNAP-IV scores showed high sensitivity but low specificity to clinician diagnosis. The SNAP-IV is a valid outcome measure for use in randomized controlled trials and clinical settings, and is best used as a screening rather than a diagnostic tool for ADHD.

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References

Abikoff H., McGough J., Vitiello B., McCracken J., Davies M., Walkup J., . . . Ritz L. (2005). Sequential pharmacotherapy for children with comorbid attention-deficit/hyperactivity and anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 418-427.
Adams Z. W., Derefinko K. J., Milich R., Fillmore M. T. (2008). Inhibitory functioning across ADHD subtypes: Recent findings, clinical implications, and future directions. Developmental Disabilities Research Reviews, 14, 268-275.
Alda J. A., Serrano-Troncoso E. (2013). Attention-deficit hyperactivity disorder: Agreement between clinical impression and the SNAP-IV screening tool. Actas Espanolas de Psiquiatria, 41, 76-83.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Buitelaar J. K., Barton J., Danckaerts M., Friedrichs E., Gillberg C., Hazell P. L., . . . Michelson D. (2006). A comparison of North American versus non-North American ADHD study populations. European Child & Adolescent Psychiatry, 15, 177-181.
Bussing R., Fernandez M., Harwood M., Hou W., Garvan C. W., Eyberg S. M., Swanson J. M. (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: Psychometric properties and normative ratings from a school district sample. Assessment, 15, 317-328.
Cheung G. W., Rensvold R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9, 233-255.
Collett B. R., Ohan J. L., Myers K. M. (2003). Ten-year review of rating scales. V: Scales assessing attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 1015-1037.
Correia Filho A. G., Bodanese R., Silva T. L., Alvares J. P., Aman M., Rohde L. A. (2005). Comparison of risperidone and methylphenidate for reducing ADHD symptoms in children and adolescents with moderate mental retardation. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 748-755.
Dickey W. C., Blumberg S. J. (2004). Revisiting the factor structure of the Strengths and Difficulties Questionnaire: United States, 2001. Journal of American Academy Child & Adolescent Psychiatry, 43, 1159-1167.
DuPaul G. J., Weyandt L. L., Janusis G. M. (2011). ADHD in the classroom: Effective intervention strategies. Theory Into Practice, 50, 35-42.
Enders C. K., Bandalos D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8, 430-457.
Fabiano G. A., Pelham W. E. Jr., Coles E. K., Gnagy E. M., Chronis-Tuscano A., O’Connor B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129-140.
Gaub M., Carlson C. L. (1997). Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. Journal of Abnormal Child Psychology, 25, 103-111.
Goodman A., Heiervang E., Collishaw S., Goodman R. (2011). The “DAWBA bands” as an ordered-categorical measure of child mental health: Description and validation in British and Norwegian samples. Social Psychiatry and Psychiatric Epidemiology, 46, 521-532.
Goodman R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of American Academy Child & Adolescent Psychiatry, 40, 1337-1345.
Goodman R., Ford T., Richards H., Gatward R., Meltzer H. (2000). The Development and Well-Being Assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry, 41, 645-655.
Graham J. W. (2003). Adding missing-data relevant variables to FIML-based structural equation models. Structural Equation Modeling, 10, 80-100.
Guo B., Kaylor-Hughes C., Garland A., Nixon N., Sweeney T., Simpson S., . . . Morriss R. (2017). Factor structure and longitudinal measurement invariance of PHQ-9 for specialist mental health care patients with persistent major depressive disorder: Exploratory Structural Equation Modelling. Journal of Affective Disorders, 219, 1-8.
Gustafsson J.-E., Åberg-Bengtsson L. (2010). Unidimensionality and interpretability of psychological instruments. In Embretson S. E. (Ed.), Measuring psychological constructs: Advances in model-based approaches (pp. 97-121). Washington, DC: American Psychological Association.
Hall C. L., Walker G. M., Valentine A. Z., Guo B., Kaylor-Hughes C., James M., . . . Hollis C. (2014). Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD—“Assessing QbTest Utility in ADHD” (AQUA): A randomised controlled trial. BMJ Open, 4, e006838.
Hollis C., Hall C. L., Guo B., James M., Boadu J., Groom M. J., . . . Morris R. (2018). The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: Single-blind randomised controlled trial. Journal of Child Psychology and Psychiatry, 59, 1298-1308.
Jensen P. S. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086.
Kaplan D. (2008). Structural equation modeling: Foundations and extensions (Vol. 10). Thousand Oaks, CA: Sage.
Marsh H. W., Morin A. J., Parker P. D., Kaur G. (2014). Exploratory structural equation modeling: An integration of the best features of exploratory and confirmatory factor analysis. Annual Review of Clinical Psychology, 10, 85-110.
Muthén L. K., Muthén B. O. (1998-2017). Mplus user’s guide. Retrieved from https://www.statmodel.com/download/usersguide/MplusUserGuideVer_8.pdf
National Institute for Health and Clinical Excellence. (2008). Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults (Clinical guideline 72). London, England: Author.
Niclasen J., Teasdale T. W., Andersen A.-M. N., Skovgaard A. M., Elberling H., Obel C. (2012). Psychometric properties of the Danish Strength and Difficulties Questionnaire: The SDQ assessed for more than 70,000 raters in four different cohorts. PLoS ONE, 7, e32025.
Pappas D. (2006). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation. Journal of Psychoeducational Assessment, 24, 172-178.
Pillow D. R., Pelham W. E., Hoza B., Molina B. S., Stultz C. H. (1998). Confirmatory factor analyses examining attention deficit hyperactivity disorder symptoms and other childhood disruptive behaviors. Journal of Abnormal Child Psychology, 26, 293-309.
Stevens J., Quittner A. L. (1998). Factors influencing elementary school teachers’ ratings of ADHD and ODD behaviors. Journal of Clinical Child Psychology, 27, 406-414.
Swanson J. M., Kraemer H. C., Hinshaw S. P., Arnold L. E., Conners C. K., Abikoff H. B., . . . Wu M. (2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 168-179.
Swanson J. M., Lerner M., March J., Gresham F. M. (1999). Assessment and intervention for attention-deficit/hyperactivity disorder in the schools: Lessons from the MTA study. Pediatric Clinics of North America, 46, 993-1009.
Swanson J. M., Schuck S., Porter M. M., Carlson C., Hartman C. A., Sergeant J. A., Lakes K. (2012). Categorical and dimensional definitions and evaluations of symptoms of ADHD: History of the SNAP and the SWAN Rating Scales. International Journal of Educational and Psychological Assessment, 10(1), 51-70.
Tabachnick B. G., Fidell L. S. (2007). Using multivariate statistics. Boston, MA: Allyn & Bacon.
Ullebø A. K., Breivik K., Gillberg C., Lundervold A. J., Posserud M. B. (2012). The factor structure of ADHD in a general population of primary school children. Journal of Child Psychology and Psychiatry, 53, 927-936.
Vandenberg R. J., Lance C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3, 4-70.
Wigal S., Swanson J. M., Feifel D., Sangal R. B., Elia J., Casat C. D., . . . Conners C. K. (2004). A double-blind, placebo-controlled trial of dexmethylphenidate hydrochloride and d, l-threo-methylphenidate hydrochloride in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 1406-1414.
Wolraich M. L., Hannah J. N., Baumgaertel A., Feurer I. D. (1998). Examination of DSM-IV criteria for attention deficit hyperactivity disorder in a county-wide sample. Journal of Developmental and Behavioral Pediatrics, 19, 162-168.
Wolraich M. L., Lambert W., Doffing M. A., Bickman L., Simmons T., Worley K. (2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28, 559-568.

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Published In

Article first published online: April 16, 2019
Issue published: September 2020

Keywords

  1. exploratory structural equation modeling
  2. factor analysis
  3. criterion validity
  4. measurement equivalence/invariance
  5. SNAP-IV

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© The Author(s) 2019.
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PubMed: 30991820

Authors

Affiliations

Charlotte L. Hall
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
Boliang Guo
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
Althea Z. Valentine
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
Madeline J. Groom
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
David Daley
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
Kapil Sayal
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
Chris Hollis
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK

Notes

Charlotte L. Hall, Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK. Email: [email protected]

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