Bifactor latent structure of attention-deficit/hyperactivity disorder (ADHD)/oppositional defiant disorder (ODD) symptoms and first-order latent structure of sluggish cognitive tempo symptoms.

Abstract

The objective was to determine if the latent structure of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms is best explained by a general disruptive behavior factor along with specific inattention (IN), hyperactivity/impulsivity (HI), and ODD factors (a bifactor model) whereas the latent structure of sluggish cognitive tempo (SCT) symptoms is best explained by a first-order factor independent of the bifactor model of ADHD/ODD. Parents' (n = 703) and teachers' (n = 366) ratings of SCT, ADHD-IN, ADHD-HI, and ODD symptoms on the Child and Adolescent Disruptive Behavior Inventory (CADBI) in a community sample of children (ages 5-13; 55% girls) were used to evaluate 4 models of symptom organization. Results indicated that a bifactor model of ADHD/ODD symptoms, in conjunction with a separate first-order SCT factor, was the best model for both parent and teacher ratings. The first-order SCT factor showed discriminant validity with the general disruptive behavior and specific IN factors in the bifactor model. In addition, higher scores on the SCT factor predicted greater academic and social impairment, even after controlling for the general disruptive behavior and 3 specific factors. Consistent with predictions from the trait-impulsivity etiological model of externalizing liability, a single, general disruptive behavior factor accounted for nearly all common variance in ADHD/ODD symptoms, whereas SCT symptoms represented a factor different from the general disruptive behavior and specific IN factor. These results provide additional support for distinguishing between SCT and ADHD-IN. The study also demonstrates how etiological models can be used to predict specific latent structures of symptom organization. (PsycINFO Database Record

The Internal, External, and Diagnostic Validity of Sluggish Cognitive Tempo: A Meta-Analysis and Critical Review

“…Factor analytic studies clearly suggest that SCT is a distinct symptom dimension that is separable from ADHD 12–14,16–35 and other dimensions of psychopathology 20,30,34,37 , and there is initial evidence that SCT is also distinct from daytime sleepiness 36 . Further research is needed to clarify (1) whether the 13 SCT items identified in this review as consistently loading on an SCT factor are the optimal symptom set for assessing SCT, (2) whether SCT is invariant across different raters, and (3) whether SCT is best conceptualized as unidimensional or multidimensional in nature.…”

“…Results from our review clearly indicate that SCT is distinct from ADHD and other psychopathology symptom dimensions. In particular, studies using both exploratory and confirmatory factor analytic techniques have found a set of SCT symptoms to be distinct from ADHD inattentive symptoms, and recent bifactor modeling further demonstrates that ADHD or a general disruptive behavior factor does not underlie SCT symptoms 27,37 . However, in contrast to the established symptom set for the ADHD dimensions, an agreed-upon symptom set for SCT does not exist.…”

Sluggish cognitive tempo in children referred to a pediatric Sleep Disorders Center: Examining possible overlap with sleep problems and associations with impairment

“…Daytime sleepiness specifically has been hypothesized to be redundant with SCT (Willoughby et al, 2008), and empirical research with adults indicates that SCT is more strongly associated with daytime sleepiness as compared to other domains of sleep (Becker et al, 2014b). There is a clear need for studies that examine the relation between SCT and daytime sleepiness in pediatric samples, particularly since separate lines of research have shown both SCT (Becker et al, 2016, Bernad et al, 2015, Langberg et al, 2014a, Lee et al, 2015, Willcutt et al, 2014) and daytime sleepiness (Bruni et al, 2006, Dewald et al, 2010, Langberg et al, 2014c, Langberg et al, 2013, Meijer, 2008) to be associated with poorer academic functioning. Finally, the Becker et al (2015c) study included only children with ADHD, and examining SCT in non-ADHD clinical samples has been identified as a research priority (Barkley, 2014, Becker, 2013, Becker et al, 2016).…”

Impulsivity Symptoms as Core to the Developmental Externalizing Spectrum

“…It is theorized that oppositional-defiance and hyperactivity-impulsivity may form such an externalizing spectrum during childhood (Burt, McGue, Krueger, & Iacono, 2005; Lahey et al, 2004). However, this theory has only been minimally tested at present, with two latent variable studies finding support for a bifactor structure of a general externalizing factor with co-existing specific factors of Oppositional Defiant Disorder (ODD) and Attention-Deficit/Hyperactivity Disorder (ADHD; e.g., Burns, Moura, Beauchaine, & McBurnett, 2014; Lee, Burns, Beauchaine, & Becker, 2015). …”

“…Recent empirical work using a latent variable approach is consistent with such theory, suggesting that a single general latent factor underlies ADHD and ODD, with such a factor accounting for all of the variance in hyperactivity-impulsivity scores, and over half of the variance in oppositional-defiance and inattention scores (Burns et al, 2014). Furthermore, the sluggish cognitive tempo factor, related to ADHD inattention, exhibited discriminant validity by loading onto its own factor and predicting academic impairment (Lee et al, 2015). …”