Parent SNAP-IV rating of attention-deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD, validity, and reliability in a Brazilian sample

Costa, Danielle S.; Paula, Jonas Jardim de; Malloy-Diniz, Leandro F.; Romano-Silva, Marco A.; Miranda, Débora M.

doi:10.1016/j.jped.2018.06.014

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Original articles • J. Pediatr. (Rio J.) 95 (6) • Nov-Dec 2019 • https://doi.org/10.1016/j.jped.2018.06.014 copy

Parent SNAP-IV rating of attention-deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD, validity, and reliability in a Brazilian sample^☆ ☆ Please cite this article as: Costa DS, de Paula JJ, Malloy-Diniz LF, Romano-Silva MA, Miranda DM. Parent SNAP-IV rating of attention-deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD, validity, and reliability in a Brazilian sample. J Pediatr (Rio J). 2019;95:736-43. , ^☆☆ ☆☆ Study conducted at Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To investigate the psychometric properties of the short or multimodal treatment study version of the Swanson, Nolan, and Pelham, Version IV (SNAP-IV) scale, which measures attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms.

Methods:

Participants were 765 parents of children from 4 to 16 years old (641 non-attention-deficit/hyperactivity disorder and 124 attention-deficit/hyperactivity disorder children) from Belo Horizonte, Brazil, who reported sociodemographic characteristics and answered the SNAP-IV. Parents of the clinical sample also underwent the K-SADS-PL interview.

Results:

Age was significantly associated with SNAP-IV hyperactivity-impulsivity problems (r = −0.14), but not with inattention or oppositional defiant disorder. Sex was a significant influence on attention-deficit/hyperactivity disorder and oppositional defiant disorder severity (all p < 0.001), with boys showing higher scores in the full sample, but not within the attention-deficit/hyperactivity disorder group. Exploratory and confirmatory factor analysis supports a three-factor structure of the SNAP-IV scale. Moderate-to-strong correlations were found between SNAP-IV and K-SADS-PL measures. All SNAP-IV scales showed very high internal consistency coefficients (all above 0.91). SNAP-IV inattention scores were the most predictive of attention-deficit/hyperactivity disorder diagnosis (AUC: 0.877 for the averaging rating method and the raw sum method, and 0.874 for the symptom presence/absence method).

Conclusion:

The parent SNAP-IV showed good psychometric properties in a Brazilian school and clinical sample.

Keywords
Attention-deficit/hyperactivity disorder; Oppositional defiant disorder; Psychological assessment; Clinical psychiatry; Psychometrics

	All (n = 765)	School sample (n = 641)	ADHD sample (n = 124)
Age (years), mean (SD)	9.30 (2.51)	9.40 (2.56)	8.74 (2.14)
Male, n (%)	428 (56)	331 (52)	97 (78)
SES, mean (SD)	23.72 (7.44)	22.79 (6.93)	28.52 (8.10)
ADHD presentation
Inattentive, n (%)	47 (6.1)	-	47 (38)
Hyperactive-impulsive, n (%)	10 (1.3)	-	10 (8)
Combined, n (%)	67 (8.8)	-	67 (54)
Psychiatric comorbidity
Oppositional defiant disorder	34 (4.4)	-	34 (27)
Mood/anxiety disorder	42 (5.5)	-	42 (34)

	School sample (n = 641)			ADHD sample (n = 124)
	Mean score^a a Score of each dimension is averaged by the number of items (sum/9 for inattention and hyperactivity-impulsivity, and sum/8 for ODD symptoms).	Raw score^b b Sum of items in each dimension.	Symptoms score^c c Categorization of each SNAP-IV item as present/absent. The items scored as 0 ('not at all') and 1 ('just a little') were computed as absent (0 points), and scores equivalent to 2 ('quite a bit') and 3 ('very much') were computed as present (1 point).	Mean score^a a Score of each dimension is averaged by the number of items (sum/9 for inattention and hyperactivity-impulsivity, and sum/8 for ODD symptoms).	Raw score^b b Sum of items in each dimension.	Symptoms score^c c Categorization of each SNAP-IV item as present/absent. The items scored as 0 ('not at all') and 1 ('just a little') were computed as absent (0 points), and scores equivalent to 2 ('quite a bit') and 3 ('very much') were computed as present (1 point).
Inattention
Male	1.14 ± 0.77 [2.56]	10 ± 7 [23]	3 ± 3 [9]	2.11 ± 0.60 [2.89]	19 ± 5 [26]	7 ± 2 [9]
Female	0.78 ± 0.68 [2.22]	7 ± 6 [20]	2 ± 3 [8]	2.25 ± 0.53 [3.00]	20 ± 5 [27]	8 ± 2 [9]
Total	0.97 ± 0.75 [2.44]	9 ± 7 [22]	2 ± 3 [8]	2.14 ± 0.58 [2.89]	19 ± 5 [26]	7 ± 2 [9]
Hyperactivity/impulsivity
Male	1.00 ± 0.78 [2.56]	9 ± 7 [23]	3 ± 3 [9]	1.78 ± 0.85 [3.00]	16 ± 8 [27]	5 ± 3 [9]
Female	0.75 ± 0.65 [2.11]	7 ± 6 [19]	2 ± 2 [7]	1.70 ± 0.82 [2.78]	15 ± 7 [25]	5 ± 3 [9]
Total	0.88 ± 0.73 [2.44]	8 ± 7 [22]	2 ± 3 [8]	1.76 ± 0.84 [3.00]	16 ± 8 [27]	5 ± 3 [9]
Oppositional
Male	0.82 ± 0.75 [2.38]	7 ± 6 [19]	2 ± 2 [7]	1.28 ± 0.83 [2.75]	10 ± 7 [22]	3 ± 3 [8]
Female	0.62 ± 0.70 [2.00]	5 ± 6 [16]	1 ± 2 [6]	1.03 ± 0.74 [2.13]	9 ± 6 [17]	3 ± 2 [6]
Total	0.72 ± 0.73 [2.25]	6 ± 6 [19]	1 ± 2 [7]	1.23 ± 0.81 [2.63]	10 ± 6 [22]	3 ± 3 [8]

SNAP-IV item/dimension	Inattention	Hyperactivity/impulsivity	ODD symptoms
SNAP.1	0.90	0.10	0.00
SNAP.2	0.74	-0.04	0.01
SNAP.3	0.57	-0.12	0.12
SNAP.4	0.79	-0.08	0.00
SNAP.5	0.87	0.03	0.00
SNAP.6	0.77	0.04	0.10
SNAP.7	0.68	-0.09	-0.01
SNAP.8	0.71	-0.08	0.02
SNAP.9	0.78	0.01	0.03
SNAP.10	0.40	-0.37	0.04
SNAP.11	0.36	-0.59	-0.10
SNAP.12	0.23	-0.63	0.01
SNAP.13	0.24	-0.49	0.13
SNAP.14	0.12	-0.77	-0.03
SNAP.15	-0.11	-0.66	0.19
SNAP.16	0.09	-0.49	0.26
SNAP.17	0.15	-0.47	0.31
SNAP.18	0.00	-0.45	0.40
SNAP.19	0.09	-0.09	0.69
SNAP.20	-0.12	-0.13	0.78
SNAP.21	0.06	-0.16	0.65
SNAP.22	-0.03	-0.22	0.67
SNAP.23	0.10	-0.02	0.68
SNAP.24	0.10	0.03	0.77
SNAP.25	0.07	0.16	0.83
SNAP.26	0.00	0.04	0.59
Cronbach's α	0.94	0.92	0.93
Gutmann's λ	0.94	0.92	0.93
McDonalds' ω	0.94	0.92	0.93
K-SADS-PL inattention^a a Spearman correlation coefficient.	0.59^b b Significant at p ≤ 0.001.	0.25^b b Significant at p ≤ 0.001.	0.11
K-SADS-PL hyp-imp^a a Spearman correlation coefficient.	0.47^b b Significant at p ≤ 0.001.	0.74^b b Significant at p ≤ 0.001.	0.50^b b Significant at p ≤ 0.001.
SNAP-IV inattention^a a Spearman correlation coefficient.	-	0.73^b b Significant at p ≤ 0.001.	0.60^b b Significant at p ≤ 0.001.
SNAP-IV hyperactivity/impulsivity^a a Spearman correlation coefficient.	0.73^b b Significant at p ≤ 0.001.	-	0.74^b b Significant at p ≤ 0.001.
SNAP-IV ODD symptoms^a a Spearman correlation coefficient.	0.60^b b Significant at p ≤ 0.001.	0.74^b b Significant at p ≤ 0.001.	-

	Area	SE	p	Cutoff	Sensitivity	Specificity
Mean^a a Score of each dimension is averaged by the number of items (sum/9 for inattention and hyperactivity-impulsivity and sum/8 for ODD symptoms). /Raw score^b b Sum of items in each dimension.
Inattention	0.877	0.015	<0.001	≥1.72/≥16	0.792	0.811
Hyperactivity-impulsivity	0.788	0.023	<0.001	≥1.17/≥11	0.700	0.728
ODD symptoms	0.704	0.025	<0.001	≥0.81/≥7	0.708	0.657
Symptoms score ^c c Categorization of each SNAP-IV item as present/absent. The items scored as 0 ('not at all') and 1 ('just a little') were computed as absent (0 points), and scores equivalent to 2 ('quite a bit') and 3 ('very much') were computed as present (1 point).
Inattention	0.874	0.016	<0.001	≥6	0.817	0.805
Hyperactivity-impulsivity	0.784	0.024	<0.001	≥4	0.700	0.761
ODD symptoms	0.703	0.026	<0.001	≥2	0.675	0.684

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[1] * Corresponding author. E-mail:jonasjardim@gmail.com (J.J. de Paula).