Dr. Lubke is with the University of Notre Dame; Dr. Hudziak is with the University of Vermont; Dr. Derks is with the University of Utrecht; Drs. Boomsma and van Bijsterveldt are with the VU University Amsterdam.
Dr. Lubke is with the University of Notre Dame; Dr. Hudziak is with the University of Vermont; Dr. Derks is with the University of Utrecht; Drs. Boomsma and van Bijsterveldt are with the VU University Amsterdam.
J Am Acad Child Adolesc Psychiatry. 2009 Nov;48(11):1085-1093. doi: 10.1097/CHI.0b013e3181ba3dbb.
To investigate whether items assessing attention problems provide evidence of quantitative differences or categorically distinct subtypes of attention problems (APs) and to investigate the relation of empirically derived latent classes to DSM-IV diagnoses of subtypes of attention-deficit/hyperactivity disorder (ADHD), for example, combined subtype, predominantly inattentive type, and predominantly hyperactive/impulsive type.
Data on attention problems were obtained from maternal ratings on the Child Behavior Check List (CBCL). Latent class models, which assume categorically different subtypes, and factor mixture models, which permit severity differences, are fitted to data obtained from Dutch boys at age 7 (N = 8,079), 10 (N = 5,278), and 12 years (N = 3,139). The fit of the different models to the data is compared to decide which model, and hence, which corresponding interpretation of AP, is most appropriate. Next, ADHD diagnoses are regressed on latent class membership in a subsample of children.
At all the three ages, models that distinguish between three mainly quantitatively different classes (e.g., mild, moderate, and severe attention problems) provide the best fit to the data. Within each class, the CBCL items measure three correlated continuous factors that can be interpreted in terms of hyperactivity/impulsivity, inattentiveness/dreaminess, and nervous behavior. The AP severe class contains all of the subjects diagnosed with ADHD-combined subtype. Some subjects diagnosed with ADHD-predominantly inattentive type are in the moderate AP class.
Factor mixture analyses provide evidence that the CBCL AP syndrome varies along a severity continuum of mild to moderate to severe attention problems. Children affected with ADHD are at the extreme of the continuum. These data are important for clinicians, research scholars, and the framers of the DSM-V as they provide evidence that ADHD diagnoses exist on a continuum rather than as discrete categories.
研究评估注意力问题的项目是否提供了定量差异或注意力问题（AP）的类别上明显不同的亚类的证据，并研究经验上得出的潜在类别与 DSM-IV 注意力缺陷/多动障碍（ADHD）亚型的诊断之间的关系，例如，合并亚型、主要注意力不集中型和主要多动/冲动型。
使用儿童行为检查表（CBCL）中的母亲评分来获取注意力问题的数据。潜在类别模型假设存在类别上不同的亚类，而因子混合模型则允许存在严重程度的差异，适用于从荷兰 7 岁（N=8079）、10 岁（N=5278）和 12 岁（N=3139）男孩的数据。比较不同模型对数据的拟合程度，以确定哪个模型，以及相应的 AP 解释，最合适。接下来，在儿童的子样本中，将 ADHD 诊断回归到潜在类别成员。
在所有三个年龄段，区分三种主要定量不同类别的模型（例如，轻度、中度和重度注意力问题）最能拟合数据。在每个类别中，CBCL 项目测量三个相关的连续因子，可以根据多动/冲动、注意力不集中/梦幻和神经质行为进行解释。AP 严重类包含所有被诊断为 ADHD-合并亚型的受试者。一些被诊断为 ADHD-主要注意力不集中型的受试者在中度 AP 类中。
因子混合分析提供了证据，表明 CBCL AP 综合征沿着从轻度到中度到重度注意力问题的严重程度连续体变化。受 ADHD 影响的儿童处于连续体的极端。这些数据对于临床医生、研究学者和 DSM-V 的制定者都很重要，因为它们提供了 ADHD 诊断存在于连续体而不是离散类别的证据。
