Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

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).

References

  • Adams, C. D., Kelley, M. L., & McCarthy, M. (1997). The adolescent behavior checklist: development and initial psychometric properties of a self-report measure for adolescents with ADHD. Journal of Clinical Child Psychology, 26, 77–86.

    Article  PubMed  Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms &Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual for mental disorders (4th ed. rev.). Washington, DC: Author.

  • American Psychiatric Association. (1980). Diagnostic and statistical manual for mental disorders (3rd ed.). Washington, DC: Author.

  • Baeyens, D., Roeyers, H., & Walle, J. V. (2006). Subtypes of attention-deficit/hyperactivity disorder (ADHD): Distinct or related disorders across measurement levels? Child Psychiatry and Human Development, 36, 403–417.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (ed). (2006). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford.

    Google Scholar 

  • Barkley, R. A. (2001). The Inattentive type of ADHD as a distinct disorder: What remains to be done. Clinical Psychology: Science and Practice, 8, 489–493.

    Article  Google Scholar 

  • Chhabildas, N., Pennington, B. F., & Willcutt, E. G. (2001). A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD. Journal of Abnormal Child Psychology, 29, 529–540.

    Article  PubMed  Google Scholar 

  • Chen, F. F., West, S. G., & Sousa, K. H. (2006). A comparison of bifactor and second-order models of quality of life. Multivariate Behavioral Research, 41, 189–225.

    Article  Google Scholar 

  • Collett, B.R., Crowley, S.L., Gimpel, G.A., & Greenson, J.N. (2000). The factor structure of DSM-IV attention deficit-hyperactivity symptoms: A confirmatory factor analysis of the ADHD-SRS. Journal of Psychoeducational Assessment, 361–373.

  • Conners, C.K. (1997). Conners’ Rating Scales-Revised Technical Manual New York: Multi-Health Systems Inc.

  • Conners, C. K. (2008). Conners 3 rd Edition: Manual. Multi-Health Systems Inc.: Toronto.

    Google Scholar 

  • Diamond, A. (2005). Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity). Development and Psychopathology, 17, 807–825.

    Article  PubMed  Google Scholar 

  • Dumenci, L., McConaughy, S. H., & Achenbach, T. M. (2004). A hierarchical three-factor model of inattention-hyperactivity-impulsivity derived from the attention problems syndrome of the teacher’s report form. School Psychology Review, 33, 287–301.

    Google Scholar 

  • DuPaul, G. J. (1991). Parent and teacher ratings of ADHD symptoms: Psychometric properties in a community-based sample. Journal of Clinical Child Psychology, 20, 245–253.

    Article  Google Scholar 

  • Finney, S. J., & DiStefano, C. (2006). Nonnormal and categorical data in structural equation modeling. In G. R. Hancock & R. O. Mueller (Eds.), Structural equation modeling: A second course. Charlotte, NC: Information Age Publishing.

    Google Scholar 

  • Flora, D. B., & Curran, P. J. (2004). An evaluation of alternative methods for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491.

    Article  PubMed  Google Scholar 

  • Glutting, J. J., Youngstrom, E. A., & Watkins, M. W. (2005). ADHD and college students: Exploratory and confirmatory factor structures with student and parent data. Psychological Assessment, 17, 44–55.

    Article  PubMed  Google Scholar 

  • Gomez, R., Harvey, J., Quick, C., Scharer, I., & Harris, G. (1999). DSM-IV AD/HD: Confirmatory factor models, prevalence, and gender and age differences based on parent and teacher ratings of Australian primary school children. Journal of Child Psychology and Psychiatry, 40, 265–274.

    Article  PubMed  Google Scholar 

  • Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. Journal of Child Psychology and Psychiatry, 38, 581–586.

    Article  PubMed  Google Scholar 

  • Hart, E. L., Lahey, B. B., Loeber, R., Applegate, B., & Frick, P. J. (1995). Developmental change in attention deficit hyperactivity disorder in boys: A four-year longitudinal study. Journal of Abnormal Child Psychology, 23, 729–749.

    Article  PubMed  Google Scholar 

  • Hinshaw, S. P. (2001). Is the inattentive type of ADHD a separate disorder? Clinical Psychology: Science and Practice, 8, 498–501.

    Article  Google Scholar 

  • Holzinger, K. J., & Swineford, F. (1937). The bifactor method. Psychometrika, 2, 41–54.

    Article  Google Scholar 

  • Hudziak, J. J., Heath, A. C., Madden, P. F., Reich, W., Bucholz, K. K., Slutske, W., et al. (1998). Latent class and factor analysis of DSM-IV ADHD: A twin study of female adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 848–837.

    Article  PubMed  Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children—present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.

    Article  PubMed  Google Scholar 

  • Kuntsi, J., Oosterlaan, J., & Stevenson, J. (2001). Psychological mechanisms in hyperactivity. I. Response inhibition deficit, working memory impairment, delay aversion, or something else? Journal of Child Psychology and Psychiatry, 42, 199–210.

    Article  PubMed  Google Scholar 

  • Lahey, B. B. (2001). Should the combined and predominantly inattentive types of ADHD be considered distinct and unrelated disorders? Not now, at least. Clinical Psychology:Science and Practice, 8, 494–497.

    Article  Google Scholar 

  • Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Willcutt, E. (2005). Instability of the DSM-IV subtypes of ADHD from preschool through elementary school. Archives of General Psychiatry, 62, 896–902.

    Article  PubMed  Google Scholar 

  • Lahey, B. B., Pelham, W. E., Schaughency, E. A., Atkins, M. S., Murphy, H. A., Hynd, G. W., et al. (1988). Dimensions and types of attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 330–335.

    Article  PubMed  Google Scholar 

  • Martel, M., Nikolas, M., & Nigg, J. T. (2007). Executive function in adolescents with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1437–44.

    Article  PubMed  Google Scholar 

  • Milich, R., Balentine, A. C., & Lynam, D. R. (2001). ADHD combined type and ADHD predominantly Inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488.

    Article  Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (2002). Mplus User’s Guide (5th ed.). Los Angeles, CA: Muthén and Muthén.

    Google Scholar 

  • Nigg, J. T. (2006). What causes ADHD? Understanding what goes wrong and why. Guilford Press: New York.

    Google Scholar 

  • Nigg, J. T., & Casey, B. J. (2005). An integrative theory of attention-deficit/hyperactivity disorder based on the cognitive and affective neurosciences. Development and Psychopathology, 17, 785–806.

    PubMed  Google Scholar 

  • Nigg, J. T., Stavro, G., Ettenhofer, M., Hambrick, D. Z., Miller, T., & Henderson, J. M. (2005). Executive functions and ADHD in adults: Evidence for selective effects on ADHD symptom domains. Journal of Abnormal Psychology, 114(3), 706–717.

    Article  PubMed  Google Scholar 

  • Nigg, J. T., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, E. J. S. (2004). Causal heterogeneity in ADHD: Do we need neuropsychologically impaired subtypes? Biological Psychiatry, 57, 1224–1230.

    Article  Google Scholar 

  • Pillow, D. R., Pelham, W. E., Hoza, B., Molina, B. 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, 293–310.

    Article  PubMed  Google Scholar 

  • Proctor, B. E., & Prevatt, F. (2009). Confirming the factor structure of attention-deficit/hyperactivity disorder symptoms in college students using student and parent data. Journal of Learning Disabilities, 42, 250–259.

    Article  PubMed  Google Scholar 

  • Rasmussen, E. R., Todd, R. D., Neuman, R. J., Heath, A. C., Reich, W., & Rohde, L. A. (2002). Comparison of male-adolescent report of attention-deficit/hyperactivity disorder symptoms across two cultures using latent class and principle components analysis. Journal of Child Psychology and Psychiatry, 43, 797–805.

    Article  PubMed  Google Scholar 

  • Rindskopf, D., & Rose, T. (1988). Some theory and applications of confirmatory second-order factor analysis. Multivariate Behavioral Research, 23, 51–67.

    Article  PubMed  Google Scholar 

  • Rohde, L. A., Barbosa, G., Polanczyk, G., Eizirik, M., Rasmussen, E. R., Neuman, R. J., et al. (2001). Factor and latent class analysis of DSM-IV ADHD symptoms in a school sample of Brazilian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 711–718.

    Article  PubMed  Google Scholar 

  • Rowland, A. S., et al. (2008). The shifting subtypes of ADHD: classification depends on how symptom reports are combined. Journal of Abnormal Child Psychology, 36, 731–43.

    Article  PubMed  Google Scholar 

  • Rubia, K. (2005). RED: ADHD under the “micro-scope”of the rat model. Behavioral Brain Sciences, 28, 439–440.

    Google Scholar 

  • Sagvolden, T., Aase, H., Johansen, E. B., & Russell, V. A. (2005). A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behav and Brain Sciences, 28, 397–420.

    Google Scholar 

  • Sattler, J. M. (2008). Assessment of children (5th ed.). San Diego, USA: Jerome M. Sattler, Publisher, Inc.

    Google Scholar 

  • Schmid, J., & Leiman, J. M. (1957). The development of hierarchical factor solutions. Psychometrika, 5, 141–152.

    Google Scholar 

  • Solanto, M. V., Gilbert, S. N., Raj, A., Zhu, J., Pope-Boyd, S., Stepak, B., et al. (2007). Neurocognitive functioning in AD/HD, Predominantly Inattentive and Combined Subtypes. Journal of Abnormal Child Psychology, 35, 729–744.

    Article  PubMed  Google Scholar 

  • Sonuga- Barke, E. J. S. (2005). Causal models of Attention-Deficit/Hyperactivity Disorder: From common simple deficits to multiple developmental pathways. Biological Psychiatry, 57, 1231–1238.

    Article  PubMed  Google Scholar 

  • Sonuga- Barke, E. J. S. (2003). The dual pathway model of AD/HD: An elaboration of neurodevelopmental characteristics. Neuroscience &Biobehavioral Reviews, 27, 593–604.

    Article  Google Scholar 

  • Sonuga-Barke, E. J. S. (2002). Psychological heterogeneity in AD/HD-a dual pathway model of behaviour and cognition. Behavioral Brain Research, 130, 29–36.

    Article  Google Scholar 

  • Sonuga-Barke, E. J. S., Sergeant, J. A., Nigg, J., & Willcutt, E. (2008). Executive dysfunction and delay aversion in Attention Deficit Hyperactivity Disorder: Nosologic and diagnostic implications. Child and Adolescent Psychiatric Clinics of North America, 17, 367–384.

    Article  PubMed  Google Scholar 

  • Span, S. A., Earleywine, M., & Strybel, T. J. (2002). Confirming the factor structure of attention deficit hyperactivity disorder symptoms in adult, nonclinical samples. Journal of Psychopathology and Behavioral Assessment, 24, 129–136.

    Article  Google Scholar 

  • Spearman, C. (1904). “General intelligence,” objectively determined and measured. American Journal of Psychology, 15, 201–293.

    Article  Google Scholar 

  • Suskauer, S. J., Simmonds, D. J., Caffo, B. S., Denckla, M. B., Pekar, J. J., & Mostofsky, S. H. (2008). fMRI of instrasubject variability in ADHD: Anomalous premotor activity with prefrontal compensation. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1141–1150.

    Article  PubMed  Google Scholar 

  • Swanson, J., Schuck, S., Mann, M., Carlson, C., Hartman, K., Sergeant, J. et al. (2005). Categorical and dimensional definitions and evaluations of symptoms of ADHD: The SNAP and the SWAN Ratings Scales [Draft]. Available at: www.adhd.net/SNAP_SWAN.pdf. Accessed April 2, 2009.

  • Toplak, M. E., Jain, U., & Tannock, R. (2005). Decision-making and cognitive abilities in adolescents with Attention-Deficit-Hyperactivity Disorder (ADHD). Behavioral and Brain Functions. 1:8, http://www.behavioralandbrainfunctions.com/content/1/1/8.

  • Toplak, M. E., & Tannock, R. (2005). Time perception: modality and duration effects in attention-deficit-hyperactivity disorder (ADHD). Journal of Abnormal Child Psychology, 33, 639–654.

    Article  PubMed  Google Scholar 

  • Van den Bergh, F., Spronk, M., Ferreira, L., Bloemarts, E., Groenink, L., Olivier, B., et al. (2006). Relationship of delay aversion and response inhibition to extinction learning, aggression, and sexual behaviour. Behavioural Brain Research, 175, 75–81.

    Article  PubMed  Google Scholar 

  • Wechsler, D. (1997). Wechsler Adult Intelligence Scale–Third Edition. San Antonio: The Psychological Corporation.

    Google Scholar 

  • Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence (WASI). The Psychological Corporation: USA.

    Google Scholar 

  • Wechsler, D. (2003). Wechsler Intelligence Scale for Children–Fourth Edition. The Psychological Corporation: USA.

    Google Scholar 

  • West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation models with non-normal variables: Problems and remedies. In R. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 56–75). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of executive function theory of ADHD: A meta-analytic review. Biological Psychiatry, 57, 1336–1346.

    Article  PubMed  Google Scholar 

  • Wolraich, M. L., Hanna, J. N., Pinnock, T. Y., 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 Children and Adolescent Psychiatry, 35, 319–324.

    Article  Google Scholar 

  • Young, D. J., & Hay, D. A. (2009). The diagnosis and measurement of ADHD: A comparative analysis. Journal of the American Academy of Child and Adolescent Psychiatry.

  • Yu, C.-Y., & Muthén, B. (2002, April). Evaluation of model fit indices for latent variable models with categorical and continuous outcomes. Paper presented at the annual meeting of the American Educational Research Association, New Orleans,

  • Yung, Y. F., Thissen, D., & McLeod, L. D. (1999). On the relationship between the higher-order factor model and the hierarchical factor model. Psychometrika, 24, 45–51.

    Google Scholar 

Download references

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.

Author information

Authors and 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

Authors
  1. Maggie E. Toplak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley Pitch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David B. Flora
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda Iwenofu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karen Ghelani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Umesh Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rosemary Tannock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maggie E. Toplak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-009-9336-y

Keywords

Search

Navigation