Item Response Theory Analysis Research Articles

Mitigation of Effect Modification by Psychological Status in Patients with Hearing Loss

Although patient-reported outcomes provide valuable insights, these subjective data may not align with objective test results. Hearing loss is a pervasive problem, such that concordance between subjective perceptions of hearing ability and objective audiogram assessments would be beneficial. To determine (1) whether psychological status is an effect modifier of the association between subjective patient reports of hearing ability and objective audiometry results, and (2) whether any effect modification observed in standard static questionnaires would be either mitigated or exacerbated by adaptive testing based on Item Response Theory analyses. This diagnostic study at a tertiary care center and community-based practice included consecutive adults who presented with queries related to hearing loss. Participants were recruited and enrolled and data analyses occurred from 2022 to 2024. Participants prospectively reported their hearing-specific abilities through either a standard static or adaptive version of the Inner Effectiveness of Auditory Rehabilitation (EAR) scale, alongside validated measures of their mental health and audiometry. Word recognition scores (WRS) and pure tone averages (PTA) were used to analyze audiometric testing. The association between subjective Inner EAR results and audiometry was evaluated. Stratified analyses were used to assess for effect modification by psychological status. The results of standard static and adaptive testing were compared. In this study of 395 patients (mean [range] age, 55.9 [18-89] years; 210 [53.2%] female), standard static Inner EAR mean scores were appropriately higher in patients with higher (better) WRS (50.7, 95% CI, 46.4-54.9), compared with patients with lower (worse) WRS (34.7, 95% CI, 24.3-45.1). However, among patients with worse mental health, there was no association between standard static Inner EAR scores and WRS. In contrast, adaptive Inner EAR mean scores were significantly higher for those with better WRS, regardless of mental health status. Thus, effect modification was observed in standard static assessments, whereas adaptive testing remained durably associated with audiometry, regardless of mental health. Psychological status was an effect modifier of the association between standard Inner EAR scale scores and audiometry, with a positive association observed only in those with better mental health. Adaptive testing scores, however, remained significantly associated with audiometry, even when mental status was worse. Adaptive testing may stabilize the association between subjective and objective hearing outcomes.

Exploring the Link Between Sensory Processing and Psychopathology in a Community Sample of Young Adults: Bayesian Network Analyses

AbstractSensory processing is a fundamental aspect of human experience, and varies significantly between individuals, potentially affecting individual functioning, behaviour, and mental health. This study investigated the associations between sensory processing and psychopathology in a sample of the general population. Participants responded to a general psychiatric screening tool (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult) and to the Adolescent/Adult Sensory Profile (AASP) questionnaire. The sample comprised 1108 young adults (77.25% females, mean age 22.6). Data were analysed using item response theory and Bayesian network analyses, revealing specific associations between sensory profiles and psychopathological dimensions. Specifically, we detected associations between the low registration sensory profile and the dimensions of psychosis, substance use, and mania. Sensation seeking was associated with mania. Sensory sensitivity was related to depression and mania, while sensation avoiding was inversely correlated with mania. These findings suggest that reduced external sensory awareness may be linked to a predisposition to psychosis, while a multifaceted sensory processing pattern may indicate vulnerability to mood disorders. Assessing sensory processing could yield crucial insights into individual susceptibilities to mental disorders and help identify targeted preventive and therapeutic strategies

Validation of the Barthel Index in Chinese nursing home residents: an item response theory analysis.

The Barthel Index (BI) is used to standardize the grading of assessments for clinical needs, insurance support, and long-term care resource allocation in China. However, its psychometric properties among nursing home residents remain unclear. Therefore, this study aims to assess and modify the psychometric properties of BI in nursing home residents. A total of 1,402 individuals undergoing evaluation in a nursing home facility in China were included in this study from November 2021 to November 2022. Correlations between items were examined to identify the potential multicollinearity concerns. The unidimensional item response theory (IRT) was used to validate and modify the single structure of BI. Furthermore, the logistic regression/IRT hybrid DIF detection method was conducted to assess differential item functioning (DIF) between the dementia group and the normal group. The pairing of items 5 ("bowl control") and 6 ("bladder control") revealed a local dependence issue, leading to their consolidation. Items 56 (bowel and bladder control) and 9 (mobility) both displayed poor fit indices and underwent category collapsing. Through the application of the generalized partial credit model, the adjusted scale displayed better fit indices, demonstrating a robust discriminative power (DC >1.5) and orderly thresholds. Furthermore, non-uniform DIF was identified in item 2 (bathing) between the dementia group and the normal group. The modified BI demonstrated favorable psychometric properties and proved to be suitable for evaluating nursing home residents experiencing moderate functional impairment, which may provide a precise evaluation for long-term care resource allocation. Future studies could explore integrating supplementary measurements, such as objective indices, to assess a broader spectrum of functional statuses to potentially enhance the limited precision width observed in BI.

Gender and race measurement invariance of the Strengths and Difficulties Questionnaire in a U.S. base sample

IntroductionThe Strengths and Difficulties Questionnaire (SDQ) is one the most widely used behavior screening tools for public schools due to its strong psychometric properties, low cost, and brief (25-question) format. However, this screening tool has several limitations including being primarily developed for the purposes of identifying clinical diagnostic conditions and primarily in a European population. To date, there has been minimal comparative research on measurement invariance in relationship to important U.S. socio-demographic metrics such as race and gender.MethodThis study utilized both structural equation modeling (i.e., confirmatory factor analysis) and item response theory (IRT) methods to investigate the measurement invariance of the SDQ across gender (male, female) and race (Black, White). CFA analyses were first conducted for each of the SDQ subscales to identify potential misfit in loadings, thresholds, and residuals. IRT-graded response models were then conducted to identify and quantify the between-group differences at the item and factor levels in terms of Cohen's d styled metrics (d > 0.2 = small, d > 0.5 = medium, d > 8 = large).ResultsThere were 2,821 high school participants (52% Male, 48% Female; 88% Black, 12% White) included in these analyses. CFA analyses suggested that the item-factor relationship for most subscales were invariant, but the Conduct Problems and Hyperactivity subscales were non-invariant for strict measurement invariance. IRT analyses identified several invariant items ranging from small to large. Despite moderate to large effects for item scores on several scales, the test-level effects on scale scores were negligible.DiscussionThese analyses suggest that the SDQ subscale scores display reasonable comparable item-factor relationships across groups. Several subscale item scores displayed substantive item-level misfit, but the test level effects were minimal. Implications for the field are discussed.

Item Response Theory Analysis and Measurement Invariance Testing of the Cultural Humility and Enactment Scale

Objective This study aimed to validate the Cultural Humility and Enactment Scale (CHES) through (a) examining its factor structure with multiple samples; (b) employing item response theory (IRT) analysis to examine its item-level characteristics; (c) reducing potential redundancies among items; and (d) conducting measurement invariance (MI) testing. Method The sample included a total of 610 individuals with diverse demographic backgrounds recruited from Mturk. Analyses included exploratory factor analysis (EFA), IRT analysis, confirmatory factor analysis (CFA), and multi-group CFA. Results We replicated the three-factor structure and retained the 21-item CHES (CHES-21), which showed equivalent information coverage and superior model fit compared to the original 29-item version. We also obtained evidence for MI of the CHES-21 between White and nonwhite clients and between male and non-male clients. Conclusion Evidencing reliability and validity with a sample of adult clients, the CHES-21 can be effectively incorporated into counseling practice and counselor training.

Psychometric properties and item response theory analysis of the Persian version of the social pain questionnaire.

Social pain is an emotional reaction which is triggered by social exclusion and has been extensively investigated in the literature. The Social Pain Questionnaire (SPQ) is a self-report instrument which is the only scale for measuring social pain as a dispositional factor. The current study aimed at examining the psychometric properties of the SPQ in an Iranian sample. A sample of participants (N = 400) was recruited in a cross-sectional validation study. Exploratory Factor Analysis (EFA) as well as Confirmatory Factor Analysis (CFA) were conducted. The Item Response Theory (IRT) model parameters were evaluated and item response category curves were presented. Convergent and divergent validities as well as the reliability (by using Cronbach's alpha coefficient) were also assessed. The SPQ's unidimensionality was affirmed (RMSEA = 0.078; CFI = 0.915; TLI = 0.99) and its internal consistency was robust (Cronbach's α = 0.94). The correlation between the SPQ and the following measures endorsed its divergent and convergent validity: Self-esteem (r = -0.424), Perceived Social Support (r = -0.161), and Interpersonal Sensitivity (r = 0.636). Finally, Item Response Theory Analysis emphasized the effectiveness of the SPQ items in discerning various levels of social pain. The theta level ranged between -1 and + 1.2 and the IRT-based marginal reliability was 0.92 for the total score. The Persian SPQ stands as a reliable and valid measure for evaluating social pain. This scale has the potential to stimulate further research in the field for both clinical and non-clinical settings. By employing Item Response Theory (IRT) analysis, we have transcended the theoretical psychometric evaluation of the SPQ scale and demonstrated that SPQ is a unidimensional, valid and reliable measurement tool.

The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study

Cognitive impairment is common in people with schizophrenia (PWS). To detect the presence and its consequences, cognitive measures with sound psychometric properties are needed. However, these are lacking especially in low-income countries. Hence, we developed the Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS). In this study, we evaluated the psychometric properties of the ECAS in a cross-sectional study involving 350 PWS. Confirmatory factor analysis demonstrated a one-factor solution. ECAS score correlated significantly but weakly with a disability measure (r = −0.13, p = 0.02) and symptom dimensions of PANSS (r between −0.12 and −0.29, p < 0.05), except for positive symptoms (r = −0.10, p > 0.05). Years of education (β = 0.12, 95% CI (0.09, 0.14), p < 0.001), male sex (β = 0.22, 95% CI (0.05, 0.39)), age β = −0.02, 95% CI (−0.03, −0.01), and medication side effects (β = −0.03, 95% CI (−0.06, −0.01), p = 0.021) were significantly associated with the composite score of ECAS. The Item Response Theory analysis showed that the tool best functions among participants with moderate cognitive impairment (difficulty coefficient between −1.12 and 0.27). The Differential Item Functioning analyses showed that education had a positive contribution on Digit Symbol Substitution Test (MH OR = 2.64, 95% CI (1.34, 5.20)). The results showed that ECAS is valid in assessing cognition in PWS in low-resource settings.

Measuring risky loot box use: An item response theory analysis of the Risky Loot Box Index among adolescents.

Loot boxes (LBs) are virtual items embedded within video games that contain randomly generated in-game prizes. LB use can become risky, so it is important to have good measurement instruments, especially among adolescents, who are particularly involved in video gaming and LB purchasing. The present study analyses the adequacy of the Risky Loot Box Index (RLI; Brooks & Clark, 2019) by applying item response theory (IRT). Participants were 2,443 (59% males, mean age = 16.48, SD = 1.22) Italian high school students. The 2PL logistic model was applied. Item properties (i.e., severity and discrimination) were consistent with the aim of efficiently measuring risky LB use. The test information function indicated that the instrument was adequately informative. The RLI appeared to be invariant across gender, with male adolescents more at-risk than female adolescents. LB engagement was also found to explain latent trait of risky LB use over and beyond video gaming and gambling frequency and severity when controlling for gender. The RLI is an efficient screening tool that can specifically measure risky LB use among youth. It can profitably be used for research and intervention purposes. The promising usefulness of the IRT score for clinical purposes is also discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development of a rapid tool for screening financial toxicity based on the comprehensive score for financial toxicity

ObjectiveThis study aimed to use item response theory (IRT) to develop and validate a short version of the Chinese COmprehensive Score for financial Toxicity (COST-S-C) in patients with cancer. MethodsA total of 500 patients with cancer participated in the survey. Confirmatory factor analysis (CFA) was used to assess the factor structure of the COST-S-C. A two-parameter IRT model was used to examine the item fit of the COST-S-C. Item discrimination, item characteristic curves (ICCs), item information curves (IICs), and item fit were estimated. Differential item functioning (DIF) was assessed for participants’ gender and age. Reliability, convergent and discriminant validity was examined as well as estimating the optimal cut-off points of the COST-S-C. ResultsThe CFA results supported the bi-factor structure of the COST-S-C. The IRT analysis findings revealed that several items showed problems with the ICCs, providing little information in terms of IICs as well as poor discrimination. Item 5 showed a negligible DIF problem with age. A valid 3-item COST-S-C scale and its optimal cut-off point was developed. ConclusionsThe COST-S-C is a valid and quick screening tool used to distinguish patients with cancer who report significant financial toxicity in various medical settings.

Supplemental Material for Measuring Risky Loot Box Use: An Item Response Theory Analysis of the Risky Loot Box Index Among Adolescents

Supplemental Material for Measuring Risky Loot Box Use: An Item Response Theory Analysis of the Risky Loot Box Index Among Adolescents

The Vaccination Fear Scale (VFS-6): Adaptation, Cross-Cultural Validation, and Invariance among Genders and Six Different Cultures, Applying Classical Test Theory (CTT) and Item Response Theory (IRT).

The coronavirus disease 2019 (COVID-19) pandemic had a meaningful impact on several areas of human activity. With respect to psychological assessment, the requirements to study the fear of vaccination as a means to diminish negative behaviour towards vaccination had been reported. This study aimed to evaluate the factorial invariance of the six-item Vaccination Fear Scale (VFS-6) across individuals and cultures. To achieve this goal, a sample of university students was recruited (n = 2535; mean age = 20.59, SD = 2.04; males: 26.75%, females: 73.25%) from Spain (n = 388; 15.3%), Italy (n = 376; 14.83%), Lebanon (n = 487; 19.21%), Nigeria (n = 561; 22.13%), Turkey (n = 410; 16.17%), and Ukraine (n = 313; 12.34%). The results showed that the most appropriate factorial structure, exhibiting excellent fit indices, was a model with two correlated factors (cognitive symptoms: items 1, 2, and 4; somatic symptoms: items 3, 5, and 6) for both the total sample and individual samples from each country and language (Spanish, Italian, Arabic, English, Turkish, and Ukrainian). Notably, the VFS-6 demonstrated configural, metric, scalar, and strict invariance across sex. Regarding countries and languages, configural invariance was observed between them. Also, metric invariance was observed between Spain, Italy, and Ukraine and between Lebanon, Nigeria, and Turkey, which indicates the presence of two well-differentiated groups of countries and the possibility of inferential analysis between them. Item Response Theory analysis suggested an appropriate level of discrimination and difficulty of the test. These significant findings lay the groundwork for future investigations into vaccination fear across diverse cultural backgrounds, providing valuable insights for addressing vaccination-related concerns worldwide.

Item response theory and computer adaptive testing of the sexual knowledge scale of the sexual knowledge and attitude test in a college sample

ABSTRACT Our study addresses the limited availability of well-validated scales for assessing general sexual knowledge among college populations. To fill this gap, we examined the psychometric properties of a 41-item sexual knowledge scale derived from the Sexual Knowledge and Attitudes Test – Adolescents (SKAT-A) in a sample of young adults aged 18–25 (N = 1,291). We employed classical test theory (CTT) procedures, followed by item response theory (IRT) and computerized adaptive testing (CAT), to refine the SKAT-A knowledge scale. Both CTT and IRT analyses identified six items for removal due to poor discrimination and difficulty parameters. A confirmatory factor analysis supported a well-defined unidimensional latent trait of sexual knowledge. The results of CAT simulations using dynamic item administration demonstrated the scale’s measurement precision, with moderate test reliability and relatively low standard errors. On average, there was a 54.3% reduction in the number of items administered without compromising scale reliability. This study concludes that the SKAT-A efficiently assesses a unidimensional trait of sexual knowledge in college-attending young adults. It highlights that only a subset of items from the full test bank is necessary to achieve this, providing a practical and reliable tool for assessing sexual knowledge in this population.

Turkish adaptation of Oxford positive self scale: Association with psychological distress, subjective vitality and psychological well-being

Positive cognitions contribute directly to psychological well-being, whilst negative cognitions are associated with many mental disorders including depression and anxiety. Psychometric properties of the Oxford Positive Self-Scale were analyzed in a Turkish sample group to assess positive beliefs about the self. In this context, two studies were conducted with two different sample groups. Study I included 403 participants (57 % female, mean age: 25.66) and Study II included 375 participants (56 % female, mean age: 26). Confirmatory factor analyses conducted within the scope of Study I confirmed the 8-item short form of the scale with a 4-factor structure. Configural, metric and scalar analyses also confirmed the measurement invariance. Reliability analyses showed that the scale was in the acceptable reliability range. Item Response Theory analysis provided discrimination. Furthermore, positive self was positively correlated with openness, conscientiousness, extraversion, agreeableness, subjective happiness, self-esteem and negatively correlated with neuroticism. Structural equation modeling in Study II revealed that psychological distress and subjective wellbeing mediate the relationship between positive self-regard and psychological well-being, highlighting their roles in predictive validity analysis. The results suggest that the Oxford Positive Self-Scale short form is valid and reliable for assessing individuals' positive self-cognitions.

Development and validation of an 8-item version of the Real Relationship Inventory–Client form

Objective: To develop and validate a very brief version of the 24-item Real Relationship Inventory–Client (RRI-C) form. Method: Two independent samples of individual psychotherapy patients (Nsample 1 = 700, Nsample 2 = 434) completed the RRI-C along with other measures. Psychometric scale shortening involved exploratory factor analysis, item response theory analysis, confirmatory factor analysis (CFA), and multigroup CFA. Reliability and convergent and discriminant validity of the scale and subscales were also assessed. Results: The 8-item RRI-C (RRI-C-SF) preserves the two-factor structure: Genuineness (k = 4, α = .86) and Realism (k = 4, α = .87), which were correlated at r = .74. CFA provided the following fit indices for the bifactor model: X 2/df = 2.16, CFI = .99, TLI = .96, RMSEA = .07, and SRMR = .03. Multigroup CFA showed that the RRI-C-SF was invariant across in-person and remote session formats. The RRI-C-SF demonstrated high reliability (α = .91); high correlation with the full-length scale (r = .96); and excellent convergent and discriminant validity with measures of other elements of the therapeutic relationship, personality characteristics, current mental health state, and demographic-clinical variables. Clinical change benchmarks were calculated to serve as valuable tools for both research and clinical practice. Conclusion: The RRI-C-SF is a reliable measure that can be used for both research and clinical purposes. It enables a nuanced assessment of the genuineness and the realism dimensions of the real relationship.

Intersectional Stigma, Fear of Negative Evaluation, Depression, and ART Adherence Among Women Living with HIV Who Engage in Substance Use: A Latent Class Serial Mediation Analysis.

Women Living with HIV (WLHIV) who use substances face stigma related to HIV and substance use (SU). The relationship between the intersection of these stigmas and adherence to antiretroviral therapy (ART), as well as the underlying mechanisms, remains poorly understood. This study aimed to examine the association between intersectional HIV and SU stigma and ART adherence, while also exploring the potential role of depression and fear of negative evaluation (FNE) by other people in explaining this association. We analyzed data from 409 WLHIV collected between April 2016 and April 2017, Using Multidimensional Latent Class Item Response Theory analysis. We identified five subgroups (i.e., latent classes [C]) of WLHIV with different combinations of experienced SU and HIV stigma levels: (C1) low HIV and SU stigma; (C2) moderate SU stigma; (C3) higher HIV and lower SU stigma; (C4) moderate HIV and high SU stigma; and (C5) high HIV and moderate SU stigma. Medication adherence differed significantly among these classes. Women in the class with moderate HIV and high SU stigma had lower adherence than other classes. A serial mediation analysis suggested that FNEand depression symptoms are mechanisms that contribute to explaining the differences in ART adherence among WLHIV who experience different combinations of intersectional HIV and SU stigma. We suggest that FNE is a key intervention target to attenuate the effect of intersectional stigma on depression symptoms and ART adherence, and ultimately improve health outcomes among WLHIV.

Item response theory analysis of daytime sleepiness as a symptom of obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a sleep disorder which is linked to many health risks. The gold standard to evaluate OSA in clinical trials is the Apnea-Hypopnea Index (AHI). However, it is time-consuming, costly, and disregards aspects such as quality of life. Therefore, it is of interest to use patient-reported outcomes like the Epworth Sleepiness Scale (ESS), which measures daytime sleepiness, as surrogate end points. We investigate the link between AHI and ESS, via item response theory (IRT) modeling. Through the developed IRT model it was identified that AHI and ESS are not correlated to any high degree and probably not measuring the same sleepiness construct. No covariate relationships of clinical relevance were found. This suggests that ESS is a poor choice as an end point for clinical development if treatment is targeted at improving AHI, and especially so in a mild OSA patient group.

Psychometric Properties of the Iranian Version of the Invalidating Childhood Environment Scale.

Objective: To understand the consequences of an invalidating environment, it is essential to have a measurement tool with appropriate statistical properties. Thus, the primary aim of this study was to render the ICES (Invalidating Childhood Environment Scale) into Persian and subsequently evaluate the psychometric attributes of this translated version. Method : Data were collected from 1221 nonclinical participants, including 1053 females and 168 males, who were students at medical universities in Tehran, Iran. Several questionnaires, such as the ICES, CTQ (Childhood Trauma Questionnaire), DTS (Distress Tolerance Scale), BIS-11 (Barratt Impulsiveness Scale), Self-Compassion Questionnaire, Dutch Eating Behavior Questionnaire, and EAT-26 (Eating AttitudesTest) were used in the study. The data sets were investigated through SPSS and R language to evaluate the ICES' reliability and construct validity. Additionally, Item Response Theory (IRT) was employed with the Graded Response Model (GRM) to measure the psychometric properties of each item in terms of difficulty and discrimination parameters. Results: Confirmatory factor analysis indicated that both single-factor and two-factor models fit well for both maternal and paternal versions of the ICES. The internal consistency, as assessed by Cronbach's alpha, was high and satisfactory for both maternal (0.87) and paternal (0.87) versions. Notably, the IRT analysis revealed that item 9 performed poorly in both maternal and paternal versions. Compared to the one-factor model, the two-factor model demonstrated a superior fit. Additionally, the test-retest reliability of the ICES over two months demonstrated good reliability for both maternal and paternal versions (0.98). Divergent and convergent validity analysis revealed a significant negative relationship between childhood invalidation environment and distress tolerance (r = 0.175, P < 0.01) as well as self-compassion (r = 0.142, P < 0.01), which were inversely related to the ICES. Furthermore, there was a considerably positive correlation between the invalidating environment experienced during childhood and impulsivity, as evidenced by r = 0.196 and P < 0.01. Conclusion: This study established the favorable psychometric properties of the Persian version of the ICES, indicating that this version is reliable and valid to assess the Invalidating Childhood Environment in the Iranian population. However, further investigations are warranted to reevaluate its validity and reliability.

When better is the enemy of good: two cautionary tales of conceptual validity versus parsimony in clinical psychometric research.

This paper presents an empirical challenge to the assumption that an item-response theory analysis always yields a better measure of a clinical construct. We summarize results from two measurement development studies that showed that such an analysis lost important content reflecting the conceptual model ("conceptual validity"). The cost of parsimony may thus be too high. Conceptual models that form the foundation of QOL measurement reflect the patient's experience. This experience may include concepts and items that are psychometrically "redundant" but capture distinct features of the concept. Good measurement is likely a balance between relying on IRT's quantitative metrics and recognizing the importance of conceptual validity and clinical utility.

Are In-the-Moment Resilience Processes Predicted by Questionnaire-Based Measures of Resilience?

Research on resilience is a growing field, and resilience has been conceptualized and operationalized in multiple ways. The aim of this study was to compare the Brief Resilient Coping Scale (BRCS), a conventional measure of resilience, with within-person process indicators derived from experience sampling method (ESM). A sample of 177 teachers from southern Finland participated in the study, commencing with a startup session followed by an 8-day ESM period. Through twice-daily prompts, participants reported their immediate positive and negative affect as well as recent stressors encountered, such as workload and challenging social interactions. As expected, within-person variation in affect was predicted by stressors. However, contrary to expectations, individual differences in affective reactivity to stressors were not predicted by BRCS (βpositive affect [95% CI] = -.20, [-.51, .11]; βnegative affect = .33, [-.07, .69]). Item response theory analyses of the BRCS revealed problems with precision. The results call into question the validity of measuring resilience using single administrations of retrospective self-report questionnaires such as the BRCS.

How well do DSM-5 criteria measure alcohol use disorder in the general population of older Swedish adolescents? An item response theory analysis

BackgroundThis study assesses the psychometric properties of DSM-5 criteria of AUD in older Swedish adolescents using item response theory models, focusing specifically on the precision of the scale at the cut-offs for mild, moderate, and severe AUD. MethodsData from the second wave of Futura01 was used. Futura01 is a nationally representative cohort study of Swedish people born 2001 and data for the second wave was collected when participants were 17/18 years old. This study included only participants who had consumed alcohol during the past 12 months (n = 2648). AUD was measured with 11 binary items. A 2-parameter logistic item response theory model (2PL) estimated the items’ difficulty and discrimination parameters. Results31.8% of the participants met criteria for AUD. Among these, 75.6% had mild AUD, 18.3% had moderate, and 6.1% had severe AUD. A unidimensional AUD model had a good fit and 2PL models showed that the scale measured AUD over all three cut-offs for AUD severity. Although discrimination parameters ranged from moderate (1.24) to very high (2.38), the more commonly endorsed items discriminated less well than the more difficult items, as also reflected in less precision of the estimates at lower levels of AUD severity. The diagnostic uncertainty was pronounced at the cut-off for mild AUD. ConclusionDSM-5 criteria measure AUD with better precision at higher levels of AUD severity than at lower levels. As most older adolescents who fulfil an AUD diagnosis are in the mild category, notable uncertainties are involved when an AUD diagnosis is set in this group.