Psychometric properties of the Swedish version of the SNAP-IV rating scale parent form in a birth cohort of 11-year-old children

Abstract

Objective: The primary aim of this study was to confirm the internal consistency and factor structure of the Swedish version of the Swanson-Nolan-Pelham scale fourth edition (SNAP-IV) for parents and to examine its clinical utility for identifying children diagnosed with attention deficit/hyperactivity disorder (ADHD). Materials and Methods: Parents of 11-year-old children from a birth cohort in the Halland region of Sweden (N = 981) completed the SNAP-IV assessment. Background data on ADHD diagnoses and medical treatment with stimulants were obtained from the Swedish National Patient Registry. We assessed the factor structure of the SNAP-IV using confirmatory factor analysis with diagonally weighted least squares estimation, and its clinical utility using logistic regression and receiver operating characteristic curve analysis. Results: A three-factor bifactor S-1 model of the Swedish SNAP-IV where all items load onto a general hyperactivity/impulsiveness factor and items specific to inattentiveness and Oppositional Defiant Disorder (ODD) load onto independent factors fit best and exhibited high internal consistency. Excluding ODD items, a similar two-factor bifactor S-1 model fit well. The SNAP-IV demonstrated robust clinical utility for identifying children diagnosed with ADHD as evidenced by significant associations between clinical diagnoses and the SNAP-IV subscales, as well as excellent classification accuracy for both the inattention and hyperactivity/impulsivity subscales when using continuous values. Taken together, the Swedish version of the SNAP-IV parent form was found to be a useful instrument with good criterion validity for assessing ADHD symptoms in 11-year-old children. The clinical application of cutoffs is discussed.