Gagandeep Singh, M.D., LLC – SNAP-IV Rating Scale
Full Name
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Phone
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Email
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Sex
Male
Female
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For each item, check the column which best describes this child:
Often fails to give close attention to details or makes careless mistakes in work or tasks
Not at all
Just a little bit
Quite a bit
Very Much
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Often has difficulty sustaining attention in tasks or activities
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often does not seem to listen when spoken to directly
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often does not follow through on instructions and fails to finish work, chores, or duties
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often has difficulty organizing tasks and activities
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often loses things necessary for activities (e.g., daytimer, books, equipment)
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often is distracted by extraneous stimuli
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often fidgets with hands or feet or squirms in seat
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often is forgetful in daily activities
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often runs about or climbs excessively in situations in which it is inappropriate
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often leaves seat in situations in which remaining seated is expected
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often has difficulty engaging in leisure activities quietly
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often is “on the go” or often acts as if “driven by a motor”
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often blurts out answers before questions have been completed
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often talks excessively
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often has difficulty awaiting turn
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often interrupts or intrudes on others (e.g., butts into conversations/games)
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often loses temper
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often argues with family, friends, co-workers, supervisors
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often deliberately does things that annoy other people
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often blames others for his or her mistakes or misbehavior
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often is spiteful or vindictive
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Often is angry and resentful
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has difficulty staying on task
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has difficulty getting started on work, tasks or assignment
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has problems in accuracy or neatness of written work
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has problems in completion of work in relation to tasks or assignments
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has difficulty making transitions to the next topic or task
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has difficulty attending to a group activity or discussion
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has problems in interactions with supervisors
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has problems in interactions with family, peers or co-workers
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has difficulty staying seated according to office rules
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Has difficulty remaining quiet or behaving appropriately according to office rules
Not At All
Just A Little
Quite A Bit
Very Much
This field is required.
Change on medication?
Yes
No
This field is required.
What are the child’s strengths?
undefined
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What is your main concern?
undefined
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