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

The SWAN was developed as a screening instrument for ADHD in children and adolescents under the age of 18. It can be administered alongside measures of cognitive function in Creyos Health, allowing practitioners to efficiently measure ADHD, cognition, and comorbid disorders in one integrated protocol.

How to Take the SWAN Questionnaire

The SWAN includes a set of 18 questions that stem from the definition of ADD/ADHD outlined in the DSM-IV. A child’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.

For parents, completing the SWAN takes about five minutes. Items 1 to 9 are associated with inattentive ADHD and items 10 to 18 are associated with hyperactive/impulsive ADHD. Scores are established by averaging scores in each subscale, then comparing the scores to research-based cutoff scores.


History of the SWAN Questionnaire

Unlike many screening tools, the SWAN focuses on both strengths and weaknesses in attentional abilities. This approach—comparing both positively and negatively to average children—helps minimize social-cultural and statistical biases. It also addresses the full range of strengths and weaknesses in attention-related behaviors, rather than only categorical classifications and pathological symptoms.

Swanson’s team had previously created the SNAP-IV scale, but iterated on it to measure nuances in the severity of symptoms, resulting in the SWAN as an improved ADHD assessment tool. In studies establishing cutoff scores, the SWAN generally demonstrates high sensitivity for ADHD (+82%), but specificity varies depending on the study and population.

SWAN Report

The SWAN ADHD Questionnaire in the real world

Almost 1 in 10 children will be diagnosed with attention-deficit/hyperactivity disorder, according to the CDC, resulting in challenges for many children and their families. Healthcare providers who work with children often encounter ADHD, whether it is the main focus of treatment or not, so a simple instrument for measuring attentional problems is invaluable in nearly any practice.

Speak to us about using the SWAN in your practice or study