Nichols J Quyen V A, Shoulberg Erin K, Garner Annie A, Hoza Betsy, Burt Keith B, Murray-Close Dianna, Arnold L Eugene
Department of Psychological Sciences, University of Vermont, Burlington, VT, USA.
Department of Psychology, St. Louis University, St. Louis, MO, USA.
J Abnorm Child Psychol. 2017 Apr;45(3):625-641. doi: 10.1007/s10802-016-0183-3.
Factor analytic studies of attention-deficit/hyperactivity disorder (ADHD) in children and adults have shown that second-order and bifactor models better represent ADHD symptoms than two- or three-factor models, yet there is far less evidence for a bestfitting model of ADHD in adolescence. Thus, the current study examined the factor structure of ADHD in adolescence and further evaluated the external validity of the best fitting model. Participants were 588 adolescents (22 % female; 366 with a childhood ADHD diagnosis; mean age 15.9 years) from the 8-year assessment of the Multimodal Treatment Study of Children with ADHD (MTA). ADHD symptoms were assessed via adolescent self-report, parent report, and teacher report on the SNAP-IV scale. Potential factor structures for the 18 symptoms of ADHD were tested for each informant, which included traditional one-factor, two-factor, and three-factor models of ADHD, as well as second-order factor (specific factors loading onto general factor) and bifactor (items loading onto both specific and general factors) models. Unique associations between external criteria and the identified factors of each informant's best fitting model were examined. Although several of the proposed models exhibited good fit, the second-order two-factor model best accounted for ADHD in adolescence according to self-report and parent report, and the second-order three-factor model was optimal according to teacher report. Several key measurement issues emerged for the hierarchical bifactor models, such as numerous Heywood cases and out-of-bound parameter estimates, which rendered them unfit as optimal representations of ADHD in adolescence. These findings and the implications of the best fitting model of ADHD in adolescence suggest that a possible reorganization of this disorder may eventually aid clinicians in the accurate diagnosis of ADHD in adolescents.
针对儿童和成人注意力缺陷多动障碍（ADHD）的因素分析研究表明，二阶模型和双因素模型比两因素或三因素模型能更好地体现ADHD症状，但关于青少年ADHD最佳拟合模型的证据要少得多。因此，本研究考察了青少年ADHD的因素结构，并进一步评估了最佳拟合模型的外部效度。研究参与者为来自儿童ADHD多模式治疗研究（MTA）8年评估的588名青少年（22%为女性；366名有儿童期ADHD诊断；平均年龄15.9岁）。通过青少年自评、家长报告和教师报告，采用SNAP-IV量表对ADHD症状进行评估。针对每位信息提供者，对ADHD的18种症状的潜在因素结构进行了测试，其中包括ADHD的传统单因素、双因素和三因素模型，以及二阶因素模型（特定因素加载到一般因素上）和双因素模型（项目同时加载到特定因素和一般因素上）。研究考察了外部标准与每位信息提供者最佳拟合模型的已识别因素之间的独特关联。尽管提出的几种模型拟合度良好，但根据青少年自评和家长报告，二阶双因素模型最能解释青少年的ADHD，而根据教师报告，二阶三因素模型是最优的。分层双因素模型出现了几个关键的测量问题，如大量的海伍德情况和超出范围的参数估计，这使得它们不适于作为青少年ADHD的最佳表征。这些发现以及青少年ADHD最佳拟合模型的意义表明，这种疾病可能的重新组织最终可能有助于临床医生准确诊断青少年ADHD。
