Validity of the SNAP-IV For ADHD Assessment in South African Children With Neurodevelopmental Disorders.
Michal R Zieff, Michelle Hoogenhout, Emma Eastman and 7 others
PMID 35451673WHAT IT FOUND
The SNAP-IV ADHD scale shows mixed validity in South African children with neurodevelopmental disorders.
It correlates well with other behavioral measures, but specific items like 'talks excessively' fail in non-verbal children, and 'does not listen' is often misinterpreted as autism symptoms rather than inattention.
Key findings
01The scale demonstrated good internal consistency and correlated moderately with the Child Behavior Checklist (CBCL) for ADHD-related subscales, supporting its concurrent validity.
02Item 15 ('Talks excessively') performed poorly in the factor analysis and was excluded, as it likely measured verbal ability rather than hyperactivity in children with limited speech.
03Items measuring inattention, specifically 'does not listen' and 'distracted by extraneous stimuli', cross-loaded onto other factors, suggesting parents of children with ASD may endorse them due to social communication impairments rather than ADHD.
STILL TO COME
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What it does not show
The sample was restricted to children aged 6 and older with neurodevelopmental disorders, excluding those with primary neuromotor disabilities like cerebral palsy. A significant proportion of the sample had limited speech or no spoken language, which affected the applicability of certain items. The study relied on parent report, which may be influenced by the child's developmental level and the parent's interpretation of behaviors. The sample was drawn from tertiary hospitals in Cape Town, which may not represent all children with NDDs in South Africa.
Declared interests
The study was funded by the Stanley Center for Psychiatric Research, the National Institute of Mental Health, the Simons Foundation Autism Research Initiative, and the Harry Crossley Foundation.
The easy way to misread this
Do not assume a high SNAP-IV score confirms ADHD in children with ASD or intellectual disabilities. The scale's items, particularly those about listening and distraction, may capture social communication impairments or language delays rather than true attention deficits. Clinical judgment and further assessment are required to distinguish between ADHD symptoms and behaviors explained by other neurodevelopmental conditions.