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Hoffmann MS, Moore TM, Axelrud LK, Tottenham N, Rohde LA, Milham MP, Satterthwaite TD, Salum GA. Harmonizing bifactor models of psychopathology between distinct assessment instruments: Reliability, measurement invariance, and authenticity. Int J Methods Psychiatr Res 2023; 32:e1959. [PMID: 36655616 PMCID: PMC10485343 DOI: 10.1002/mpr.1959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Model configuration is important for mental health data harmonization. We provide a method to investigate the performance of different bifactor model configurations to harmonize different instruments. METHODS We used data from six samples from the Reproducible Brain Charts initiative (N = 8,606, ages 5-22 years, 41.0% females). We harmonized items from two psychopathology instruments, Child Behavior Checklist (CBCL) and GOASSESS, based on semantic content. We estimated bifactor models using confirmatory factor analysis, and calculated their model fit, factor reliability, between-instrument invariance, and authenticity (i.e., the correlation and factor score difference between the harmonized and original models). RESULTS Five out of 12 model configurations presented acceptable fit and were instrument-invariant. Correlations between the harmonized factor scores and the original full-item models were high for the p-factor (>0.89) and small to moderate (0.12-0.81) for the specific factors. 6.3%-50.9% of participants presented factor score differences between harmonized and original models higher than 0.5 z-score. CONCLUSIONS The CBCL-GOASSESS harmonization indicates that few models provide reliable specific factors and are instrument-invariant. Moreover, authenticity was high for the p-factor and moderate for specific factors. Future studies can use this framework to examine the impact of harmonizing instruments in psychiatric research.
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Affiliation(s)
- Maurício Scopel Hoffmann
- Department of NeuropsychiatryUniversidade Federal de Santa MariaSanta MariaBrazil
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Section on Negative Affect and Social ProcessesHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Tyler Maxwell Moore
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Luiza Kvitko Axelrud
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Section on Negative Affect and Social ProcessesHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Nim Tottenham
- Department of PsychologyColumbia UniversityNew YorkNew YorkUSA
| | - Luis Augusto Rohde
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT‐CNPq)São PauloBrazil
- Department of Psychiatry and Legal MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Michael Peter Milham
- Nathan S. Kline Institute for Psychiatric ResearchOrangeburgNew YorkUSA
- Center for the Developing BrainChild Mind InstituteNew YorkNew YorkUSA
| | - Theodore Daniel Satterthwaite
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Informatics and Neuroimaging CenterPhiladelphiaPennsylvaniaUSA
| | - Giovanni Abrahão Salum
- Graduate Program in Psychiatry and Behavioral SciencesUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Section on Negative Affect and Social ProcessesHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT‐CNPq)São PauloBrazil
- Department of Psychiatry and Legal MedicineUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Center for the Developing BrainChild Mind InstituteNew YorkNew YorkUSA
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Gomez R, Chen W, Houghton S. Differences between DSM-5-TR and ICD-11 revisions of attention deficit/hyperactivity disorder: A commentary on implications and opportunities. World J Psychiatry 2023; 13:138-143. [PMID: 37303925 PMCID: PMC10251354 DOI: 10.5498/wjp.v13.i5.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/02/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
Current ICD-11 descriptions for attention deficit hyperactivity disorder (ADHD) were recently published online, in the same year as the DSM-5-TR (text revised edition) was released. In this commentary, we compare and contrast the DSM-5/DSM-5-TR and ICD-11 diagnostic criteria, summarize important differences, and underscore their clinical and research implications. Overall, three major differences emerge: (1) The number of diagnostic criteria for inattention (IA), hyperactivity (HY) and impulsivity (IM) symptoms (i.e., DSM-5-TR has nine IA and nine HY/IM symptoms, whereas ICD-11 has 11 IA and 11 HY/IM sym-ptoms); (2) the clarity and standardization of diagnostic thresholds (i.e., the diagnostic thresholds for symptom count in IA and HY/IM domains are explicitly specified in DSM-5-TR, whereas in ICD-11 they are not); and (3) the partitioning of HY and IM symptoms into sub-dimensions (i.e., difference in partitioning HY and IM symptom domains relates to the differences between the current and previous editions of DSM and ICD, and this has important research implications). Currently, no ICD-11 based ADHD rating scales exist and while this absence represents an obstacle for respective research and clinical practice, it also presents opportunities for research development. This article highlights these challenges, possible remedies and novel research opportunities.
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Affiliation(s)
- Rapson Gomez
- School of Science, Psychology, and Sport, Federation University, Melbourne 3806, Australia
| | - Wai Chen
- Curtin Medical School, Curtin University, Perth 6102, Australia
| | - Stephen Houghton
- Graduate School of Education, The University of Western Australia, Perth 6009, Australia
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Arildskov TW, Virring A, Lambek R, Carlsen AH, Sonuga-Barke EJS, Østergaard SD, Thomsen PH. The factor structure of attention-deficit/hyperactivity disorder in schoolchildren. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 125:104220. [PMID: 35462238 DOI: 10.1016/j.ridd.2022.104220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/21/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Most studies support a bifactor model of childhood ADHD with two specific factors. However, several studies have not compared this model with a bifactor model with three specific factors, few have tested the actual strength of the factors, and none have examined whether "talks excessively" should be treated as a hyperactivity versus impulsivity symptom in children with ADHD. AIMS To examine the factor structure of ADHD symptoms and evaluate the relative strength of potential factors. METHODS Parent-reports on the ADHD-Rating Scale (ADHD-RS-IV) were collected for 2044 schoolchildren from the general population and 147 children with ADHD from a clinical sample. Single-, two- and three-(correlated and bi-)factor models were tested using confirmatory factor analysis. RESULTS Most models had a satisfactory fit. However, a correlated three-factor model where "talks excessively" was included as an indicator of impulsivity, and especially a bifactor model with one strong, well-defined general and two/three (ICD-10 defined) weak specific factors fit the data slightly better than the remaining models. CONCLUSIONS The factor structure is best characterized by a bifactor model with a strong general factor and two/three weaker specific factors. Therefore, we suggest emphasizing the ADHD-RS-IV total score rather than the subscale scores in clinical practice.
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Affiliation(s)
- Trine Wigh Arildskov
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Anne Virring
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
| | - Rikke Lambek
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | | | - Edmund J S Sonuga-Barke
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Søren D Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Affective Disorders, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Liu L, Wang Y, Chen W, Gao Y, Li H, Wang Y, Chan RCK, Qian Q. Network analysis of 18 attention-deficit/hyperactivity disorder symptoms suggests the importance of " Distracted" and " Fidget" as central symptoms: Invariance across age, gender, and subtype presentations. Front Psychiatry 2022; 13:974283. [PMID: 36339870 PMCID: PMC9633674 DOI: 10.3389/fpsyt.2022.974283] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
The network theory of mental disorders conceptualizes psychiatric symptoms as networks of symptoms that causally interact with each other. Our present study aimed to explore the symptomatic structure in children with attention-deficit/hyperactivity disorder (ADHD) using network analyses. Symptom network based on 18 items of ADHD Rating Scale-IV was evaluated in 4,033 children and adolescents with ADHD. The importance of nodes was evaluated quantitatively by examining centrality indices, including Strength, Betweenness and Closeness, as well as Predictability and Expected Influence (EI). In addition, we compared the network structure across different subgroups, as characterized by ADHD subtypes, gender and age groups to evaluate its invariance. A three-factor-community structure was identified including inattentive, hyperactive and impulsive clusters. For the centrality indices, the nodes of "Distracted" and "Fidget" showed high closeness and betweenness, and represented a bridge linking the inattentive and hyperactive/impulsive domains. "Details" and "Fidget" were the most common endorsed symptoms in inattentive and hyperactive/impulsive domains respectively. On the contrary, the "Listen" item formed a peripheral node showing weak links with all other items within the inattentive cluster, and the "Loss" item as the least central node by all measures of centrality and with low predictability value. The network structure was relatively invariant across gender, age and ADHD subtypes/presentations. The 18 items of ADHD core symptoms appear not equivalent and interchangeable. "Distracted" and "Fidget" should be considered as central, or core, symptoms for further evaluation and intervention. The network-informed differentiation of these symptoms has the potentials to refine the phenotype and reduce heterogeneity.
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Affiliation(s)
- Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Perth, WA, Australia.,Curtin Medical School, Curtin University, Perth, WA, Australia.,Curtin enAble Institute, Curtin University, Bentley, WA, Australia.,Graduate School of Education, University of Western Australia, Perth, WA, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia.,School of Psychology, Murdoch University, Perth, WA, Australia
| | - Yuan Gao
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Haimei Li
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China.,National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
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