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The Unity and Diversity of Inattention and Hyperactivity/Impulsivity in ADHD: Evidence for a General Factor with Separable Dimensions

Journal of Abnormal Child Psychology volume 37, pages 1137–1150 (2009)Cite this article

Abstract

To examine the unity and diversity of inattention and hyperactivity/impulsivity symptom domains of Attention-Deficit/Hyperactivity Disorder (ADHD) in a clinical sample of adolescents with ADHD. Parents and adolescents were administered a semi-structured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia for School-Age Children — Present and Lifetime Version (K-SADS-PL), to assess adolescent ADHD. Data from 201 parent interviews and 189 adolescent interviews were examined. Four potential factor structures for the 18 ADHD symptoms were tested using confirmatory factor analysis: two models with correlated factors and two bifactor models. A bifactor model with two specific factors best accounted for adolescent symptoms, according to both parent and adolescents’ reports. Replication of these findings from behavioral rating scales completed for this sample by parents and teachers indicates that the findings are not method– or informant-specific. The results suggest that there is an important unitary component to ADHD symptoms and separable dimensional traits of Inattention and Hyperactivity/Impulsivity.

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Notes

  1. The clinician’s summary on the K-SADS-PL integrated parent, adolescent, and teacher reported symptoms. Each symptom was scored when the informant provided evidence of an observed behavior for each symptom. In the case of any discrepancies between informants, evidence of observed behavior by one informant was scored as a symptom over a lack of symptom endorsement. In general, when discrepancies occurred, parents tended to endorse symptoms over adolescent report, which is consistent with others who have reported that adolescents tend to underreport symptoms of ADHD (Barkley, 2006).

  2. We also conducted these analyses without the psychiatric control group, and found that the bifactor model still fit well without these cases (parent-report KSADS: df = 46, chi-square = 54, CFI = 0.98, TLI = 0.98, RMSEA = 0.03; adolescent-report KSADS: df = 48, chi-square = 60, CFI = 0.98, TLI = 0.98, RMSEA = 0.04).

  3. Yet another model structure is a second-order factor model, where the correlations among the specific, lower-order factors imply a general, second-order factor that leads to the lower-order factors. However, in the current context, there would be only two lower-order factors (inattention and hyperactivity/impulsivity), and so a second-order model is statistically under-identified (i.e., the model’s parameters cannot be uniquely estimated; Rindskopf and Rose 1988). However, the bifactor model and second-order models are mathematically related, which suggests that similar conceptual interpretations of the factors can be made (see Yung et al. 1999).

  4. It is not possible to test whether these differences in fit across models are statistically significant because the models are not formally nested (that is, it is not possible to specify a correlated factor model by placing constraints on the parameters of the bifactor model, or vice versa).

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Acknowledgements

This research was supported by a research grants from the Canadian Institutes of Health Research (CIHR) to R. Tannock. We thank Marisa Catapang and Min-Na Hockenberry at the Hospital for Sick Children for assisting with coordinating the study, Heidi Bernhardt and Denise Difede for assisting families at the Centre for Addiction and Mental Health (CAMH), and Richard F. West for comments on this manuscript.

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Affiliations

  1. York University, Toronto, Canada

    Maggie E. Toplak, Ashley Pitch, David B. Flora & Linda Iwenofu

  2. Neurosciences and Mental Health Research Program, The Hospital for Sick Children, Toronto, Canada

    Karen Ghelani

  3. Centre for Addiction and Mental Health, Toronto, Canada

    Umesh Jain

  4. Neurosciences and Mental Health Research Program, The Hospital for Sick Children, Ontario Institute for Studies in Education of the University of Toronto, Toronto, Canada

    Rosemary Tannock

  5. 126 BSB, Department of Psychology, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada

    Maggie E. Toplak

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  1. Maggie E. Toplak
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Toplak, M.E., Pitch, A., Flora, D.B. et al. The Unity and Diversity of Inattention and Hyperactivity/Impulsivity in ADHD: Evidence for a General Factor with Separable Dimensions. J Abnorm Child Psychol 37, 1137–1150 (2009). https://doi.org/10.1007/s10802-009-9336-y

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Keywords

  • ADHD
  • Symptom domains
  • Inattention
  • Hyperactivity/impulsivity
  • Factor analysis
  • Adolescents
  • Bifactor model