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Strengths and Weaknesses of the ADHD Symptoms and Normal Behavior Scale (SWAN)

Screen for symptoms of attention deficit hyperactivity disorder (ADHD) in children and adolescents with comprehensive assessments in Creyos Health

 

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Benefits for Healthcare Providers

Administer the SWAN questionnaire in Creyos Health on its own or part of the Creyos ADHD Condition-Focused Protocol to better understand ADHD symptoms, strengths, and weaknesses.

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Simplify Administration

Administer the SWAN assessment in person or digitally with automated scoring and reporting for an efficient, patient-friendly experience.

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Adolescents With ADHD are 10 Times More Likely to Suffer From Depression

Early assessment together with cognitive function testing in Creyos can help guide long-term strategies to improve patient well-being. Administer the SWAN as part of the Creyos ADHD protocol to measure for 14 markers of ADHD.

Source: Chronis-Tuscano A., et al., 2010

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Depression Risk

Preview the Creyos SWAN Sample Report

Designed for parents, the SWAN assessment offered through Creyos is an 18-question checklist based on the ADHD diagnosis guidelines established in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

When administered alongside measures of cognitive performance, it allows clinicians to:

  • Efficiently measure and track attentional difficulties in children and adolescents (12–17 years old)
  • Administer in person or remotely with automated, real-time results
  • Gain comprehensive insight into overall patient wellbeing over time

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SWAN Report

How to Use the Creyos SWAN Assessment

Step 1: Explain the Questionnaire

Unlike many screening tools, the SWAN focuses on both strengths and weaknesses in attentional abilities, asking parents to compare symptoms both positively and negatively to other children to help minimize social-cultural and statistical biases.

Step 2: Administer Questionnaire

The SWAN assessment contains 18 questions related to symptoms consistent with ADHD. It can be administered in person through the Creyos Health platform on an in-clinic device or remotely through a provided link.

Step 3: Review Results

Creyos Health automatically scores SWAN results and provides reports. Higher scores indicate a greater possibility of ADHD diagnosis and suggest further mental health evaluation.

Step 4: Compare With Cognitive Results

When administered as part of the Creyos ADHD protocol, objective cognitive testing is bundled with self-reported symptoms from the SWAN. Comparing the results can help build a complete picture of a patient's health.

How to use SWAN

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Frequently asked questions

What is attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder is a neurodevelopmental disorder that affects a person's attention, hyperactivity, and impulsivity.

How is ADHD related to cognition?

Children diagnosed with ADHD often demonstrate differences not only on parent-reported scales, but on objective tests of cognition.

For example, one study (Crosbie et al., 2013) asked parents in a public setting to fill out the SWAN while their children completed a stop signal cognitive task (similar to the Creyos SART) meant to measure aspects of attention, such as response inhibition. Parent SWAN scores were correlated with objectively-measured ability to inhibit responses, speed of responses, and variability of responses.

The correlation between reported ADHD symptoms and behavioral measures was strong, and it did not depend on age or gender. There were even shared genetic contributors to reaction time and SWAN scores.

How does ADHD medication affect cognition?

For medication-based treatments such as methylphenidate, objective cognitive measures complement parent rating forms to help determine proper dosages and measure progress. In fact, cognition may mediate the effects of medication on behavioral outcomes—that is, medication improves cognition, which goes on to improve everyday symptoms of ADHD (see Hawk et al., 2018). Measuring cognition may also be beneficial for long-term follow up with ADHD patients, as maturation of cognitive function can predict ADHD remission (Halperin et al., 2008; Karalunas et al., 2017).

ADHD is a complex condition. Healthcare providers can benefit from administering both observer rating scales (like the SWAN) and objective cognitive testing (like the Creyos cognitive tasks) to fully measure and address a child’s symptoms.

Where did the SWAN assessment come from?

The SWAN was developed by Swanson et al. in 2001 as a comprehensive tool for assessing ADHD in children and adolescents.

Who uses the SWAN assessment?

Any healthcare provider who works with children may benefit from monitoring signs of ADHD. Even if ADHD is not a practice’s primary focus, attentional difficulties can be at least partially responsible for a variety of struggles that cause a parent to seek treatment, such as academic or social difficulties. A quick symptom inventory like the SWAN rating scale can help quantify, verify, or rule out attentional issues.

Clinical psychologists, psychiatrists, neurologists, and other healthcare providers working with young patients may find value in administering the SWAN rating scale alongside Creyos Health cognitive assessments to gain a fuller picture of a child’s mental and cognitive health.

How is the SWAN scored?

The SWAN assessment contains 18 questions and takes about five minutes for parents to complete. Questions 1-9 focus on symptoms related to inattention, while questions 10-18 focus on symptoms related to hyperactivity and impulsivity. The patient’s behavior is scored on a 7-point scale ranging from far above average to far below average, with 4 (average) representing normal behavior for the child’s age. Higher scores indicate a greater possibility of ADHD diagnosis and should be paired with additional questionnaires and cognitive tasks.

How does administration and scoring of the SWAN assessment work?

The SWAN can be administered on its own or as part of the ADHD Condition-Focused Protocol for a robust assessment that combines age-appropriate questionnaires and cognitive performance measures. The results are automatically assembled in a complete report to indicate 14 markers of ADHD.

When a patient completes the SWAN assessment, providers get immediate insights through easy-to-read reports that combine questionnaire data with cognitive test results for a full picture of patient brain health. Creyos can also use APIs to integrate with a variety of electronic health record (EHR) systems and has a built-in integration with Athenahealth. Our platform automatically collects, scores, and organizes results from each questionnaire and adds them to the patient’s EHR.

What behaviors does the SWAN evaluate?

The SWAN assessment evaluates behaviors related to ADHD, including inattention (difficulty focusing, staying organized, and following through on tasks), hyperactivity (excessive energy, restlessness, and fidgeting), and impulsivity (acting without thinking, interrupting others, and difficulty waiting). It addresses the full range of ADHD strengths and weaknesses rather than only categorical classifications and pathological symptoms.

How can the SWAN assessment support patients?

The SWAN assessment should be used as a screening tool to assist primary care providers or mental health professionals in understanding ADHD strengths and weaknesses and monitoring symptoms over time. Any conclusions drawn from the SWAN should be paired with further assessment, such as clinical interviews and observations, additional mental health examinations or assessments, and evaluations of the patient’s level of distress, functional impairment, and/or family history.

What can the SWAN assessment not do?

While higher scores are correlated with a diagnosis of ADHD, the SWAN assessment is not a diagnostic tool on its own. It is a multipurpose tool for screening, identifying, monitoring, and measuring the presence and severity of ADHD symptoms over time.

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