Unraveling the Optimum Latent Structure of Attention-Deficit/Hyperactivity Disorder: Evidence Supporting ICD and HiTOP Frameworks.

Rapson Gomez,Stephen Houghton,David Preece,Jenny Downs,Robert Krueger,Lu Liu,Wai Chen,Vasileios Stavropoulos

doi:10.3389/fpsyt.2021.666326

Abstract

Attention Deficit/hyperactivity disorder (ADHD) is conceptualized differently in the Diagnostic and Statistical Manual (DSM-5), the International Classification of Diseases-10 (ICD-10), and the Hierarchical Taxonomy of Psychopathology (HiTOP) frameworks. This study applied independent cluster confirmatory factor analysis (ICM-CFA), exploratory structure equation model with target rotation (ESEM), and the S-1 bi-factor CFA approaches to evaluate seven ADHD models yielded by different combinations of these taxonomic frameworks. Parents and teachers of a community sample of children (between 6 and 12 years of age) completed the Disruptive Behavior Rating Scale (for ADHD symptoms) and the Strengths and Difficulties Questionnaire (for validation). Our findings for both parent and teacher ratings provided the most support for the S-1 bi-factor CFA model comprised of (i) a g-factor based on ICD-10 impulsivity symptoms as the reference indicators and (ii) inattention and hyperactivity as specific factors. However, the hyperactivity-specific factor lacked clarity and reliability. Thus, our findings indicate that ADHD is best viewed as a disorder primarily reflecting impulsivity, though with a separable inattention (but no hyperactivity) component, i.e., “ADID (attention deficit/impulsivity disorder).” This model aligns with the HiTOP proposals.

Highlights

For Attention Deficit/Hyperactivity Disorder (ADHD), the latest fifth edition of the Diagnostic and Statistical Manual [DSM-5; [1]] has retained the same comparable nine inattention (IA), six hyperactivity (HY), and three impulsivity (IM) symptoms as in previous editions [DSM-IV; [2, 3]]
The major findings and interpretations made here raise the possibility that the core symptoms for ADHD are impulsivity and inattention—and not hyperactivity
Is consistent of only two and not three separate symptom groups, as proposed in both the major clinical classification systems (DSM-5 and ICD-10). The constituents in this dimension are in line with ICD-10 configuration—and not DSM-5

Summary

Introduction

For Attention Deficit/Hyperactivity Disorder (ADHD), the latest fifth edition of the Diagnostic and Statistical Manual [DSM-5; [1]] has retained the same comparable nine inattention (IA), six hyperactivity (HY), and three impulsivity (IM) symptoms as in previous editions [DSM-IV; [2, 3]]. In the International Classification of Diseases-10 [ICD10; [4]], ADHD is referred to as Hyperkinetic Disorder (HD). DSM-5 and ICD-10 have the same sets of symptoms for ADHD/HD, they are grouped differently. Unlike DSM-5, the HY and IM symptoms in ICD-10 are considered as distinct groups. The “talkative” symptom (classified as a HY symptom in the DSM-5) is designated as an IM symptom in ICD-10; these HY and IM symptom groups in ICD-10 have been referred to as “motoric HY/IM” and “verbal HY/IM,” respectively [5]

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Conclusion