What is the SWAN?

The Strengths and Weaknesses of Attention-Deficit/Hyperactivity Symptoms and Normal Behavior (SWAN) questionnaire was developed by Swanson and colleagues (2015) to assess ADHD symptoms in both clinical and non-clinical populations. It builds on the team’s earlier work with the SNAP-IV scale, but introduces a more balanced and dimensional approach—capturing not only deficits, but also strengths in attention-related behaviors.

What It Measures

The SWAN contains 18 items, each based on the core ADHD criteria described in the DSM-IV, and structured to evaluate a child’s behavior relative to same-age peers. Respondents rate each item on a 7-point scale, ranging from far below average to far above average, with a score of 4 representing age-typical behavior.

This dimensional scoring helps:

• Capture the full spectrum of attention and impulse-control traits

• Reduce cultural and statistical biases

• Support more nuanced and personalized evaluation

Subtypes and Scoring

• Items 1–9 correspond to inattentive-type ADHD

• Items 10–18 correspond to hyperactive/impulsive-type ADHD

Scores are averaged within each subscale and compared to validated cutoff thresholds from multiple large-scale studies (Robaey et al., 2007; Chan et al., 2014; Alhaji, 2022). For parent-reported scores, an average above 0.745 on either subscale indicates potential clinical concern. (Note: this is a statistical coincidence that the cutoff is the same for both subtypes.)

Caution should be used when interpreting teacher-reported scores, as they may vary depending on context and population norms.

Psychometric Properties

The SWAN has demonstrated strong sensitivity for detecting ADHD—typically above 82%—making it a valuable screening tool. Specificity can vary based on study design and population. As with all behavioral questionnaires, there is a risk of false positives, particularly in individuals with complex presentations or comorbid conditions.

How It Relates to Cognition

ADHD symptoms are closely tied to cognitive functions such as working memory, response inhibition, and sustained attention. By pairing the SWAN with Creyos Health’s cognitive tasks, clinicians can gather objective data to validate or clarify behavioral observations. This dual-pronged approach—subjective ratings and cognitive performance—enhances confidence in diagnostic impressions and supports tailored intervention planning.

Clinical Considerations

The SWAN is a screening instrument, not a standalone diagnostic tool. Clinicians should interpret results in the context of comprehensive clinical assessment, including structured interviews, cognitive testing, and functional history.

The SWAN can be added to any Creyos Health protocol, providing seamless integration alongside ADHD-related tools such as the ASRS (for adults) and VADPRS (for parents of younger children), and complementing performance-based cognitive assessments.

To explore all behavioral and cognitive health tools available in the Creyos platform, refer to the Creyos Standardized Questionnaires Guide.