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The World Federation of ADHD Guide 97 enagers). Parents then draw conclusions about tolerability and likely effect. If this is favourable the trial can be extended to mornings during the school week with the teacher measuring effect with a standardized rating scale (e.g. the SKAMP). Where effectiveness is established, it is still necessary to try to optimize dose and again one should aim for maximum response, with minimal adverse effects at the minimum dose. It is important to remember that some adverse common effects such as loss of appetite or sleep problems can be managed by adjusting routines or the timing of doses. Titration on to dexamfetamine A titration on to dexamfetamine can follow the same procedures described for methylphenidate but with reduced doses (5 mg methylphenidate ≈ 2.5 mg de- xamfetamine). As the half-life of dexamfetamine is somewhat longer than that of Table 5.1 CLINICAL INTERPRETATION OF SCORES FROM THE SNAP-IV RATING SCALE SNAP-IV Rating Scale score Post-treatment monitoring Total score (range 0–54) Mean item total score a Subscale b score (range 0–27) Mean item subscale score a Clinical interpretation 0–18 ≤1 0–9 ≤1 Very good/optimal response: symptoms well within normal range 19–26 <1.5 10–13 <1.5 Good response: symptoms within normal range but may be improved 27–36 1.5–2 14–18 1.5–2 Response still clinically significant: symptoms just outside normal range and response probably inadequate. Need to assess other factors 37–54 >2 19–27 >2 Inadequate response: many symptoms still observed. Need to assess other factors a Calculated by dividing the total/subscale score by the number of items (18 for the total; 9 for each subscale); b Inattention or Hyperactivity/Impulsivity subscales. SNAP-IV, Swanson, Nolan and Pelham-IV Rating Scale.