Mission Psychological Consultants


The Attention
LEARNING
Center

Orange County: San Juan Capistrano & Irvine
San Diego County: Encinitas
(800) 233-9117

  
   

First in Orange and San Diego Counties
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ADD Parent & Teacher Behavior Rating Scales
Submit Online

Prefer to print out and fax the form? Click Here

Please submit this form and we will contact you regarding the results and making an appointment. Unfortunately, we only are able score these rating scales and contact individuals from the Southern California area.

If you do not live in Southern California please click here
 
 
SNAP Questionnaire
From Swanson, Sandman, Deutsch and Baron (1993), Pediatrics, Vol. 72, p.51
INATTENTION Not At All Just A Little Pretty Much Very Much
11. Often fails to finish things he or she starts
12. Often doesn’t seem to listen
13. Easily distracted

14. Has difficulty concentrating on school work or other tasks requiring sustained attention
15. Has difficulty sticking to a play activity
IMPULSIVITY Not At All Just A Little Pretty Much Very Much
16. Often acts before thinking
17. Shifts excessively from one activity to another

18. Has difficulty organizing work (not due to cognitive impairment)
19. Needs a lot of supervision
20. Frequently calls out in class

21. Has difficulty awaiting turn in games or group situations

HYPERACTIVITY Not At All Just A Little Pretty Much Very Much
22. Excessively runs about or climbs on things
23. Has difficulty sitting still or fidgets excessively
24. Has difficulty staying seated
25. Moves about excessively during sleep

26. Is always “on the go” or acts as if “driven by a motor”
PEER INTERACTIONS Not At All Just A Little Pretty Much Very Much
27. Fights, hits, punches, etc.
28. Is disliked by other children
29. Frequently interrupts other children’s activities
30. Bossy, always tells other children what to do
31. Teases or calls other children names
32. Refuses to participate in group activities
33. Loses temper often and easily

Child’s Name:

  

 Age:

 

Grade:

Gender:  

Your Name:
  Mother Father Teacher   Other:

E-Mail:

  

Phone:

  
Address:

Concerns, Questions, Comments:

                      
 

 

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32122 Camino Capistrano, Suite 200

San Juan Capistrano, CA 92675
Toll Free: (800) 233-9117
Phone:     (949) 248-7411
Fax:         (949) 248-7511
E-Mail:      info@mpccares.com
Web          www.mpccares.com