The factor structure of attention-deficit/hyperactivity disorder in schoolchildren.
Trust the ADHD-RS-IV total score in school kids; the sub-scales mostly measure the same thing.
01Research in Context
What this study did
Arildskov et al. (2022) looked at how ADHD symptoms hang together in school kids.
They ran a confirmatory factor analysis on the ADHD-RS-IV forms filled out by parents and teachers.
The goal was to see if the usual two sub-scales (inattention and hyperactivity/impulsivity) really stand apart.
What they found
The data fit a bifactor model best: one big general ADHD factor plus two small specific factors.
In plain words, the total score tells you most of what you need to know; the sub-scale scores add little new info.
So, when you interpret the ADHD-RS-IV, trust the total score more than the hyperactivity or inattention slices.
How this fits with other research
Alexandre et al. (2018) used the same rating scale with Danish preschoolers and found three linked factors instead of a bifactor.
The difference is age: little kids may truly show three clumps of symptoms, while school-age kids fold into one main trait.
Gomez et al. (2021) tested adults with a different scale and also saw weak hyperactivity factors, matching the "ignore the sub-scales" advice.
Together, the picture is clear: total scores are safest once kids hit elementary years.
Why it matters
Stop splitting hairs between inattention and hyperactivity items on the ADHD-RS-IV after about age six.
Use the total score to screen, track progress, and write goals.
If you need finer grain, add other tools like executive-function checklists or direct observation instead of over-interpreting sub-scales.
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02At a glance
03Original 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.
Research in developmental disabilities, 2022 · doi:10.1016/j.ridd.2022.104220