SNAP-IV-26 RATINGS

Date reviewed: [Date]
Child: [Name or ID, age, school grade]
Why rated: [New attention or behavior concern, ADHD assessment, or treatment check]
Rating window: [The period raters were asked to describe, such as the past month]

RATERS
Parent or caregiver: [Name, relationship to the child, date completed]
Teacher: [Name, class or subject, how long they have taught the child]
Treatment during the window: [Medicine and dose for each rater's window, or none]

SUBSCALE AVERAGES
Inattention, items 1 to 9: [Parent average and teacher average, 0 to 3; band for each]
Hyperactivity-impulsivity, items 10 to 18: [Parent and teacher averages; band for each]
Combined ADHD, items 1 to 18: [Parent and teacher averages]
Oppositional, items 19 to 26: [Parent and teacher averages; band for each]
Rater cutoffs reached: [Which averages reach the parent or teacher cutoff for that subscale, or none]

ITEMS RATED 2 OR 3
Inattention: [Parent count out of 9, teacher count out of 9]
Hyperactivity-impulsivity: [Parent count out of 9, teacher count out of 9]
Oppositional: [Parent count out of 8, teacher count out of 8]
Blank items: [Item numbers left blank and whether they were asked, or none]

HOME AND SCHOOL COMPARED
Where the raters match: [Subscales and behaviors both describe]
Where they split: [Subscales that differ by half a point or more, and the likely reason]

CHANGE SINCE LAST RATING
Earlier averages: [Date, rater, and each subscale average, or first rating]
Change: [Rise or fall in each subscale, each rater against their own earlier form]

IMPRESSION
Rating pattern: [Inattentive, hyperactive-impulsive, combined, oppositional, or below threshold]
Clinical summary: [Onset, settings, impairment, and other explanations weighed]

PLAN
Next step: [Full ADHD assessment, start or adjust treatment, school supports, or rate again]
Next ratings due: [Which raters, and when]

Clinician: [Name, credentials]