title: An Alternative Approach to Scoring the MTA-SNAP-IV to Guide Attention-Deficit/Hyperactivity Disorder Medication Treatment Titration towards Symptom Remission: A Preliminary Consideration.
abstract: OBJECTIVE
  The Multimodal Treatment Study for Attention-Deficit/Hyperactivity Disorder Swanson, Nolan, and Pelham, Version IV (MTA-SNAP-IV) is a common rating scale to measure attention-deficit/hyperactivity disorder (ADHD) symptoms during medication treatment. Relying on the traditional scoring approach for this instrument to identify symptom remission, however, may leave a child with significant residual symptoms. The objective of this study was to examine an alternative scoring approach for this instrument to identify the extent of residual symptoms for children completing ADHD medication treatment.
  
  
  METHODS
  Parent and teacher ratings on the ADHD symptom component of the MTA-SNAP-IV were extracted from medical records of 80 children completing medication treatment at a specialty clinic in Canada. Data were scored in two ways. 1) Traditional scoring based on assigning a value ranging from 0 to 3 for response options: "Not at all," "Just a little," "Pretty much," or "Very much," for each symptom and then determining a mean across items, and 2) alternative scoring based on assigning values of 0, 0, 0.5, and 1 across the same response options and summing the total across items. Symptom remission based on the former is defined as a mean value ≤ 1, and for the latter it is defined as a summed value equal to 0.
  
  
  RESULTS
  Children were significantly less likely to be classified as symptom remitted under the alternative scoring method based on parent, teacher, and combined parent-teacher ratings. Using the alternative scoring approach, residual symptoms were identified for 25%, 39%, and 70% of children classified as symptom remitted (under traditional scoring rules) by parents, teachers, and parents/teachers combined, respectively.
  
  
  CONCLUSIONS
  Potential "residual" ADHD symptoms were identified in many children attaining symptom remission using the traditional scoring approach; however, further scrutiny of this alternative scoring approach is required. Although it may improve the ability to detect residual symptoms that could signal the need for further intervention to achieve symptom remission, it may increase the risk of over treatment.
authors.affiliation: 1 Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wagner
authors.affiliation: 2 Department of Pediatrics, Psychiatry and Community Health Sciences, Cumming School of Medicine. University of Calgary , Calgary, Alberta, Canada .
authors.forename: John D
authors.initials: JD
authors.lastname: McLennan
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification / Q000188:drug therapy*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents; D011594:Psychometrics; D012074:Remission Induction; D012720:Severity of Illness Index; D063189:Symptom Assessment