Maternal Ratings of Attention Problems in ADHD: Evidence for the Existence of a Continuum. Lubke, G. H, Hudziak, J. J, Derks, E. M, van Bijsterveldt, T. T. C E M, & Boomsma, D. I Journal of the American Academy of Child and Adolescent Psychiatry, 48(11):1085–1093, November, 2009. ISBN: 0890-8567
Maternal Ratings of Attention Problems in ADHD: Evidence for the Existence of a Continuum [link]Paper  doi  abstract   bibtex   
Objective: 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. Method: 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. Results: 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. Conclusions: 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. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(11):1085-1093.
@article{lubke_maternal_2009,
	title = {Maternal {Ratings} of {Attention} {Problems} in {ADHD}: {Evidence} for the {Existence} of a {Continuum}},
	volume = {48},
	issn = {1527-5418},
	url = {http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2782551&tool=pmcentrez&rendertype=abstract},
	doi = {10.1097/CHI.0b013e3181ba3dbb},
	abstract = {Objective: 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. Method: 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. Results: 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. Conclusions: 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. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(11):1085-1093.},
	language = {English},
	number = {11},
	urldate = {2015-05-11},
	journal = {Journal of the American Academy of Child and Adolescent Psychiatry},
	author = {Lubke, Gitta H and Hudziak, James J and Derks, Eske M and van Bijsterveldt, Tcem Toos C E M and Boomsma, Dorret I},
	month = nov,
	year = {2009},
	pmid = {19797980},
	note = {ISBN: 0890-8567},
	keywords = {ADOLESCENT, Attention Deficit Disorder with Hyperactivity, Attention Deficit Disorder with Hyperactivity: cla, Attention Deficit Disorder with Hyperactivity: dia, Attention Deficit Disorder with Hyperactivity: dru, Attention Deficit Disorder with Hyperactivity: gen, Attention Deficit Disorder with Hyperactivity: psy, CBCL, Central Nervous System Stimulants, Central Nervous System Stimulants: therapeutic use, Child, Cross-Sectional Studies, DEFICIT HYPERACTIVITY DISORDER, DEFICIT/HYPERACTIVITY DISORDER, DSM, DSM-IV, Diagnostic and Statistical Manual of Mental Disord, Diseases in Twins, Diseases in Twins: classification, Diseases in Twins: diagnosis, Diseases in Twins: genetics, Diseases in Twins: psychology, Drug Utilization, Drug Utilization: statistics \& numerical data, FACTOR MIXTURE-MODELS, FINITE MIXTURES, Humans, Longitudinal Studies, MAXIMUM-LIKELIHOOD, Male, Methylphenidate, Methylphenidate: therapeutic use, NETHERLANDS TWIN REGISTER, Netherlands, POPULATION-BASED SAMPLE, Personality Assessment, Personality Assessment: statistics \& numerical dat, Phenotype, Psychometrics, Psychometrics: statistics \& numerical data, Reproducibility of Results, TWINS, attention problems, factor mixture analysis, latent class analysis},
	pages = {1085--1093},
}
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