Abstract
Using data based on self-, parent, and teacher reports, we assessed various aspects of psychopathology in a large sample of control children and those with ADHD. Confirmatory factor analysis was employed to extract response bias from latent constructs of aggression, anxiety, attention problems, depression, conduct disorder, and hyperactivity. These latent constructs were then entered into logistic regression equations to predict membership in control versus ADHD groups, and to discriminate between ADHD subtypes. Results of the regression equations showed that higher levels of attention problems and aggression were the best predictors of membership in the ADHD group relative to controls. Logistic regression also indicated that a higher degree of aggression was the only significant predictor of membership in the ADHD-Combined group compared to the ADHD-Inattentive group. However, when comorbid diagnoses of Oppositional Defiant Disorder and Conduct Disorder were controlled for in the logistic regression, greater hyperactivity rather than aggression was the sole variable with which to distinguish the ADHD-Combined from the ADHD-Inattentive subtype. Results are discussed in the context of the DSM-IV ADHD nosology and the role of instrument and source bias in the diagnosis of ADHD.
Similar content being viewed by others
REFERENCES
Achenbach, T. M. (1991a). Manual for the Teacher's Report Form and 1991 profile. Burlington, VT: Department of Psychiatry, University of Vermont.
Achenbach, T. M. (1991b). Manual for the Child Behavior Checklist/ 4–18 and 1991 profile. Burlington: Department of Psychiatry, University of Vermont.
American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
August, G. J., Realmuto, G. M., Crosby, R. D., & MacDonald III, A. W., (1995). Community-based multiple-gating screening of children at risk for conduct disorder. Journal of Abnormal Child Psychology, 23, 521–544.
Barkley, R. A. (1982). Guidelines for defining hyperactivity in children (attention-deficit disorder with hyperactivity). In B. Lahey & A. Kazdin (Eds.), Advances in clinical child psychology (Vol. 5, pp. 137–180). New York: Plenum.
Barkley, R. A. (1990). Attention-deficit/hyperactivity disorder: A handbook for diagnosis and treatment. New York: The Guilford Press.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.
Barkley, R. A. (1998). Attention-deficit/hyperactivity disorder: A handbook for diagnosis and treatment. New York: The Guilford Press.
Bauermeister, J. J. (1992). Factor analyses of teacher rating of attentiondeficit hyperactivity and oppositional defiant symptoms in children four through thirteen years. Journal of Clinical Child Psychology, 21, 27–34.
Benson, J. (1998). Developing a strong program of construct validation: Atest anxiety example. Educational Measurement: Issues and Practices, 17, 10–17.
Bentler, P. M. (1995). EQS: Structural Equation Program Manual. Encino, CA: Multivariate Software, Inc.
Biederman, J., Faraone, S. V., & Lapey, K. (1992). Comorbidity of diagnosis in attention-deficit hyperactivity disorders. In G. Weiss (Ed.), Child and adolescent psychiatric clinics of North America: Attention-deficit hyperactivity disorder (pp. 335–360). Philadelphia: Saunders.
Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.
Bryant, F., & Yarnold, P. R. (1995). Reading and understanding multivariate statistics (L. Grimm & P. R. Yarnold, Eds., pp. 99–136). Washington, DC: American Psychological Association.
Callahen, S. A., Panichelli-Mindel, S. M., & Kendall, P. C. (1996). DSM-IV and Internalizing Disorders: Modifications, Limitations and Utility. School Psychology Review, 25, 297–307.
Cole, D. A. (1987). Utility of confirmatory factor analysis in test validation research. Journal of Consulting and Clinical Psychology, 55, 584–594.
Cole, D. A. (1990). Relation of social and academic competence to depressive symptoms in childhood. Journal of Abnormal Psychology, 99, 423–429.
Conners, C. K. (1989). Conners' Teacher Rating Scales. North Tonawanda, NY: Multi-Health Systems.
DuPaul, G. J. (1991). Parent and teacher ratings of ADHD symptoms: Psychiatric properties in a community-based sample. Journal of Clinical Child Psychology, 20, 245–253.
DuPaul, G. J., Anastopoulos, A. D., Power, T. J., Reid, R., Ikeda, M. J., & McGoey, K. E. (1998). Parent ratings of attentiondeficit/ hyperactivity disorder symptoms: Factor structure and normative data. Journal of Psychopathology and Behavioral Assessment, 20, 83–102.
Eiraldi, R. B., Power, T. J., & Neru, C. M. (1997). Patterns of comorbidity associated with subtypes of attention deficit hyperactivity among 6–to 12–year-old children. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 325–333.
Faraone, S. V., Biederman, J., & Milberger, S. (1995). How reliable are maternal reports of their children's psychopathology? One-year recall of psychiatric diagnoses of ADHD children. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1001–1008.
Faraone, S. V., Biederman, J., Weber, W., & Russell, R. L. (1998). Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: Results from a clinically referred sample. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 185–193.
Fergusson, D. M. & Horwood J. (1995). Predictive validity of categorically and dimensionally scored measures of disruptive childhood behaviors. Journal of the American Academy of Child Adolescent Psychiatry, 34, 477–485.
Fischer, M., Barkley, R. A., Fletcher, K. E., & Smallish, L. (1993). The stability of dimensions of behavior in ADHD and normal children over an 8–year follow-up. Journal of Abnormal Child Psychology, 21, 315–337.
Gaub, M., & Carlson, C. L. (1997). Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. Journal of Abnormal Child Psychology, 25, 103–111.
Goodyear, P., & Hynd, G. W. (1992). Attention-deficit disorder with (ADD/H) and without (ADD/WO) hyperactivity: Behavioral and neurophysiological differentiation. Journal of Clinical Child Psychology, 21, 273–305.
Goyette, C. H., Conners, C. K., & Ulrich, R. F. (1978). Normative data on the Revised Conners Parent and Teacher Rating Scales. Journal of Abnormal Child Psychology, 6, 221–236.
Healey, J. M., Newcorn, J. H., Halperin, J. M., Wolf, L. E., Pascualvaca, D. M., Schmeider, J., & O'Brien, J. D. (1993). The factor structure of ADHD items in DSM-III-R: Internal consistency and external validation. Journal of Abnormal Child Psychology, 21, 441–453.
Henik, A., & Tzelgoy, J. (1985). Control of halo error: A multiple regression approach. Journal of Applied Psychology, 70, 577–580.
Hinshaw, S. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychological Bulletin, 101, 443–463.
Hollingshead, A. B. (1975). Four-Factor Index of Social Status. Unpublished manuscript, Yale University, Department of Sociology.
Hynd, G.W., Alison, R. L., Semrud-Clikeman, M., Nieves, N. Huettner, M. I., & Lahey, B. B. (1991). Attention deficit disorder without hyperactivity: A distinct behavioral and neurocognitive syndrome. Journal of Child Neurology, 6, S37–S43.
Jensen, P. S., Watanabe, H. K., Richter, J. E., Roper, M., Hibbs, E. D., Salzberg, A. D., & Lie, S. (1996). Scales, diagnoses, and child psychopathology: II. Comparing the CBCL and the DISC against external validators. Journal of Abnormal Child Psychology, 24, 151–168.
Kovacs, M. (1982). The Children's Depression Inventory: A selfrating depression scale for school-aged youngsters. Unpublished manuscript, University of Pittsburgh.
Lahey, B. B., Applegate, B., McBurnett, K., Biederman, J., Greenhill, L., Hynd, G., Barkley, R. A., Newcorn, J., Jensen, P., Richters, J., Garfinkel, B., Kerdyk, L., Frick, P. J., Ollendick, T., Perez, D., Hart, E. L., Waldman, I., & Shaffer, D. (1994). DSM-IV field trial for attention-deficit/hyperactivity disorder in children and adolescents. American Journal of Psychiatry, 151, 1673–1685.
Lahey, B. B., Pelham, W. E., Schaughency, E. A., Atkins, M. S., Murphy, H. A., Hynd, G., Russo, M., & Hartdagen, S. (1988). Dimensions and types of attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 330–335.
Levy, F., Hay, D. A., McStephen, M., Wood, C., & Waldman I. (1997). Attention-deficit hyperactivity disorder: a category or a continuum? Genetic analysis of a large-scale twin study. Journal of the American Academy of Child Adolescent Psychiatry, 36, 737–744.
Loeber, R., Brinthaupt, V. P., & Green, S. M. (1990). Attention deficits, impulsivity, and hyperactivity with or without conduct problems: Relationships to delinquency and unique contextual factors. In R. J. McMahon & R. DeV. Peters (Eds.), Behavior Disorders of Adolescence (pp. 39–61). New York: Plenum Press.
Loeber, R., Green, S. M., & Lahey, B. B. (1990). Mental health professionals' perception of the utility of children, mothers, and teachers as informants on childhood psychopathology. Journal of Clinical Child Psychology, 19, 136–143.
Loney, J., & Milich, R. (1982). Hyperactivity, inattention, and aggression in clinical practice. In M. Wolraich & D. Routh (Eds.), Advances in developmental and behavioral pediatrics (Vol. 3, pp. 113–147). Greenwich, CT: JAI Press.
Morgan, A., Hynd, G., Riccio, C., & Hall, J. (1996). Validity of DSM-IV ADHD predominantly inattentive and combined types: Relationship to previous DSM diagnoses/subtype differences. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 325–333.
Neter, J., Wasserman, W., & Kutner, M. (1985). Applied linear statistical models. Homewood, IL: Irwin.
O'Donnell, D., Biederman, J., Jones, J., Wilens, T. E., Millberger, S., Mick, E., & Faraone, S. V. (1998). Informativeness of child and parent reports on substance use disorders in a sample of ADHD probands, control probands, and their siblings. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 752–758.
Ostrander, R., Weinfurt, K. P., Yarnold, P. R., & August, G. J. (1998). Diagnosing attention deficit disorders with the Behavioral Assessment for Children and the Child Behavior Checklist: Test and construct validity analyses using optimal discriminant classification trees. Journal of Consulting and Clinical Psychology, 66, 660–672.
Paternite, C. E., Loney, J., & Roberts, M. A. (1996). A preliminary validation of subtypes of DSM-IV attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 1, 70–86.
Pelham, W. E., Evans, S., Gnagy, E., & Greenslade, K. E. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive disorders: Prevalence, factor analyses, and conditional probabilities in a special education sample. School Psychology Review, 21, 285–299.
Pelham, W. E., Gnagy, E., Greenslade, K. E., & Milich, R. (1992). Teacher rating of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210–218.
Pillow, D. R., Pelham, W. E., Jr., Hoza, D., Molina-Brooke, S. G., & Stultz, C. H. (1998). Confirmatory factor analyses examining attention deficit hyperactivity disorder symptoms and other childhood disruptive behaviors. Journal of Abnormal Child Psychology, 26, 293–309.
Power, T. J., Doherty, R. B., Panichelli-Mindel, S. M., Karustis, J. L., Eiraldi, R. B., Anastopoulos, A. D., & DuPaul, G. J. (1998). The predictive validity of parent and teacher reports of ADHD symptoms. Journal of Psychopathology and Behavioral Assessment, 20, 57–81.
Quay, H. C. (1996, January). Gray's behavioral inhibition in ADHD: An update. Paper presented at the annual meeting of the International Society for Research in Child and Adolescent Psychopathology, Santa Monica, CA.
Quay, H. C.,& Peterson, D. R. (1983). Revised Behavior Problem Checklist. Coral Gables, FL: University of Miami, Department of Psychiatry.
Reich,W., Shayla, J. J., & Taibelson, C. (1992). The Diagnostic Interview for Children and Adolescents-Revised (DICA-R). St. Louis, MO: Washington University Press.
Reich, W., & Welner, Z. (1990). Diagnostic Interview for Children and Adolescents-DSM-III-R-Parent Version. St. Louis, MO: Washington University Press.
Reynolds, C. R. (1982). Convergent and divergent validity of the Revised Children's Manifest Anxiety Scale. Educational Psychological Measurement, 42, 1205–1212.
Reynolds, C. R., & Kamphaus, R. W. (1992). Behavioral Assessment System for Children manual. Circle Pines, MN: American Guidance Service.
Reynolds, C. R., & Richmond, B. O. (1985). Revised Children's Manifest Anxiety Scale (RCMAS). Los Angeles: Western Psychological Services.
Routh, D. K. (1990). Taxonomy in developmental psychopathology: Consider the source. In M. Lewis & S.M. Miller (Eds.), Handbook of developmental psychopathology: Perspectives in developmental psychology (pp. 53–62). New York: Plenum Press.
Rutter,M. (1982). Syndromes attributed to "minimal brain dysfunction" in childhood. American Journal of Psychiatry, 15, 601–616.
Rutter, M. (1988). DSM-III-R: A postscript. In M. Rutter, A. H., Tuma, I. S. Lann (Eds.), Assessment and diagnosis in child psychopathology, pp. 453–464. New York: Guilford Press.
Saylor, C. F., Finch, A. J., Jr., Spirito, A., & Bennet, B. (1984). The Children's Depression Inventory: A systematic evaluation of psychometric properties. Journal of Consulting and Clinical Psychology, 52, 955–967.
Schmitt, N., & Stults, D. M. (1986). Methodological review: Analysis of multitrait-multimethod matrices. Applied Psychological Measurement, 10, 1–22.
Skansgaard, E. P., & Burns, G. L. (1998). Comparison of DSM-IV ADHD combined and predominantly inattention types: Correspondence between teacher ratings and direct observations of inattentive, hyperactivity/impulsivity, slow cognitive tempo, oppositional defiant, and overt conduct disorder symptoms. Child and Family Behavior Therapy, 29, 1–14.
Smith, R. L. (1992). Suppressor variables in multiple regression/ correlation. Educational and Psychologiocal Measurement, 52, 17–29.
Vaughn, M. L., Riccio, C. A., Hynd, G. W., & Hall, J. (1997). Diagnosing ADHD (Predominantly Inattentive and Combined Type subtypes): Discriminant validity of the Behavior Assessment System for Children and the Achenbach Parent and Teacher Rating Scales. Journal of Clinical Child Psychology, 26, 349–357.
Willcutt, E. G., Pennington, B. F., Chabildas, N. A., Friedman, M. C., & Alexander, J. (1999). Psychiatric comorbidity associated with DSM-IV ADHD in a nonreferred sample of twins. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1355–1362.
Wolraich, M., Hannah, J., Pinnock, T., Baumgaertel, A., & Brown, J. (1996). Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a country-wide sample. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 319–324.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Crystal, D.S., Ostrander, R., Chen, R.S. et al. Multimethod Assessment of Psychopathology Among DSM-IV Subtypes of Children With Attention-Deficit/Hyperactivity Disorder: Self-, Parent, and Teacher Reports. J Abnorm Child Psychol 29, 189–205 (2001). https://doi.org/10.1023/A:1010325513911
Issue Date:
DOI: https://doi.org/10.1023/A:1010325513911