Often does not follow through on instructions and fails to finish schoolwork, chores, or duties5. Often has difficulty organizing tasks and activities

6. Often avoids, dislikes, or reluctantly engages in tasks requiring sustained mental effort

7. Often loses things necessary for activities (e.g., toys, school assignments, pencils, or books)

8. Often is distracted by extraneous stimuli

9. Often is forgetful in daily activities

10. Often has difficulty maintaining alertness, orienting to requests, or executing directions

11. Often fidgets with hands or feet or squirms in seat

12. Often leaves seat in classroom or in other situations in which remaining seated is expected

13. Often runs about or climbs excessively in situations in which it is inappropriate

14. Often has difficulty playing or engaging in leisure activities quietly

15. Often is "on the go" or often acts as if "driven by a motor"

16. Often talks excessively

17. Often blurts out answers before questions have been completed

18. Often has difficulty awaiting turn

19. Often interrupts or intrudes on others (e.g., butts into conversations/games)

20. Often has difficulty sitting still, being quiet,... inhibiting impulses in...classroom or at home

21. Often loses temper

22. Often argues with adults

23. Often actively defies or refuses adult requests or rules

24. Often deliberately does things that annoy other people

25. Often blames others for his or her mistakes or misbehavior

26. Often touchy or easily annoyed by others

27 Often is angry and resentful

28. Often is spiteful or vindictive

29. Often is quarrelsome

30. Often is negative, defiant, disobedient, or hostile toward authority figures

31. Often makes noises (e.g., humming or odd sounds)

32. Often is excitable, impulsive

33. Often cries easily

34. Often is uncooperative

35. Often acts "smart"

36. Often is restless or overactive

37. Often disturbs other children

38. Often changes mood quickly and drastically

39. Often easily frustrated if demand are not met immediately

40. Often teases other children and interferes with their activities

Check the column which best describes this child: Not at Just a Quite Very

Bit Much

41. Often is aggressive to other children (e.g., picks fights or bullies)

42. Often is destructive with property of others (e.g., vandalism)

43. Often is deceitful (e.g., steals, lies, forges, copies the work of others, or "cons" others)

44. Often and seriously violates rules (e.g....truant, runs away, or completely ignores class rules)

45. Has persistent pattern of violating the basic rights of others or major societal norms

46. Has episodes of failure to resist aggressive impulses (to assault others or to destroy property)

47. Has motor or verbal tics (sudden, rapid, recurrent, nonrhythmic motor or verbal activity)

48. Has repetitive motor behavior (e.g., hand waving, body rocking, or picking at skin)

49. Has obsessions (persistent and intrusive inappropriate ideas, thoughts, or impulses)

50. Has compulsions (repetitive behaviors or mental acts to reduce anxiety or distress)

51. Often is restless or seems keyed up or on edge

52. Often is easily fatigued

53. Often has difficulty concentrating (mind goes blank)

54. Often is irritable

55. Often has muscle tension

56. Often has excessive anxiety and worry (e.g., apprehensive expectation)

57. Often has daytime sleepiness (unintended sleeping in inappropriate situations)

58. Often has excessive emotionality and attention-seeking behavior

59. Often has need for undue admiration, grandiose behavior, or lack of empathy

60. Often has instability in relationships with others, reactive mood, and impulsivity

61 Sometimes for at least a week has inflated self-esteem or grandiosity

62. Sometimes for at least a week is more talkative than usual or seems pressured to keep talking

63. Sometimes for at least a week has flight of ideas or says that thoughts are racing

64. Sometimes for at least a week has elevated, expansive or euphoric mood

65. Sometimes for at least a week is excessively involved in pleasurable but risky activities

66. Sometimes for at least 2 weeks has depressed mood (sad, hopeless, discouraged)

67. Sometimes for at least 2 weeks has irritable or cranky mood (not just when frustrated)

68. Sometimes for at least 2 weeks has markedly diminished interest or pleasure in most activities

69....

Sometimes for at least 2 weeks has psychomotor agitation (even more active than usual)
70. Sometimes for at least 2 weeks has psychomotor retardation (slowed down in most activities)

71. Sometimes for at least 2 weeks is fatigued or has loss of energy

72. Sometimes for at least 2 weeks has feelings of worthlessness or excessive, inappropriate guilt

73. Sometimes for at least 2 weeks has diminished ability to think or concentrate

74. Chronic low self-esteem most of the time for at least a year

75. Chronic poor concentration or difficulty making decisions most of the time for at least a year

76. Chronic feelings of hopelessness most of the time for at least a year

77. Currently is hypervigilant (overly watchful or alert) or has exaggerated startle response

78. Currently is irritable, has anger outbursts, or has difficulty concentrating

79. Currently has an emotional (e.g., nervous, worried, hopeless, tearful) response to stress

80. Currently has a behavioral (e.g., fighting, vandalism, truancy) response to stress

81. Has difficulty getting started on classroom assignments

82. Has difficulty staying on task for an entire classroom period

83. Has problems in completion of work on classroom assignments

84. Has problems in accuracy or neatness of written work in the classroom

85. Has difficulty attending to a group classroom activity or discussion

86. Has difficulty making transitions to the next topic or classroom period

87. Has problems in interactions with peers in the classroom

88. Has problems in interactions with staff (teacher or aide)

89. Has difficulty remaining quiet according to classroom rules ____ ____ ____ ____ 90. Has difficulty staying seated according to classroom rules

Swanson, N.d.; see Appendix B for "Scoring Instructions for the SNAP-IV-C Rating Scale")

Treatment Tactics

Antipsychotic Medicines the following excerpts from 2006 University Wire release relate critical concerns regarding treatment of ADHD with drugs.

The Daily Universe) (U-WIRE) PROVO, Utah -- Risks of serious injury and even death associated with stimulants to treat attention-deficit (hyperactivity) disorder merit stricter warning labels for those drugs, a federal panel said

The panel advised the Food and Drug Administration to add a "black box" warning to methylphenidates like Ritalin to emphasize potential cardiovascular problems the drugs could cause. Although the FDA doesn't need to heed the panel's advice, it often does.

The panel's announcement came after an FDA database search found 25 deaths -- including 19 children -- linked to the stimulants in the past five years.

Utah has the 10th lowest rate of ADHD diagnosis in the nation, but local pharmacists and psychiatrists still see plenty of cases in both children and adults.

According to the Utah Health Data Committee Web site, psychiatrists in Utah prescribed more than 1.7 million doses of methylphenidates in 2003. Ritalin, Concerta, Methylin and Metadate -- all candidates for the label change -- were prescribed most frequently.

Marianne Hawkins, a nurse at Utah Valley Regional Medical Center's outpatient psychology office, said the psychiatrists she works with try to avoid prescribing medication if at all possible.

ADHD occurs in people of all ages, but until 2001, only children were diagnosed. Hawkins said adults are rarely diagnosed and treated for ADHD in her office. She estimated about 97% of ADHD patients she worked with were children.

When a child is diagnosed with ADHD, psychiatrists meet with the child's parents to map out a behavior modification plan. This includes setting goals and counseling with the parents and child to reach those goals. Teachers are often involved, too.

If behavior therapy doesn't work, a psychiatrist will prescribe methylphenidates. Usually mixing behavior therapy with a low dose of the drugs is the best cure. Dosage tapers off as the child grows up until the drugs are no longer needed.

Ritalin, the most well-known methylphenidate, has been on the market since 1955. Laurie Ostroff-Landau, spokesperson for Ritalin's producer, Novaris, said extensive clinical trials were run before Ritalin hit the market 50 years ago. Research on its safety has continued since.

There are always going to be risks involved with medication," [Jim Averett, a pharmacist at the BYU Student Health Center,] said."You as the patient need to decide if the benefits outweigh the risks." (Cloward, 2006)

William Cooper, M.D., M.P.H., associate professor of Pediatrics in the Child and Adolescent…