Practical consequences of model misfit when using rating scales to assess the severity of attention problems in children

Abstract

Objectives In this study, we examined the consequences of ignoring violations of assumptions underlying the use of sum scores in assessing attention problems (AP) and if psychometrically more refined models improve predictions of relevant outcomes in adulthood. Methods Tracking Adolescents' Individual Lives data were used. AP symptom properties were examined using the AP scale of the Child Behavior Checklist at age 11. Consequences of model violations were evaluated in relation to psychopathology, educational attainment, financial status, and ability to form relationships in adulthood. Results Results showed that symptoms differed with respect to information and difficulty. Moreover, evidence of multidimensionality was found, with two groups of items measuring sluggish cognitive tempo and attention deficit hyperactivity disorder symptoms. Item response theory analyses indicated that a bifactor model fitted these data better than other competing models. In terms of accuracy of predicting functional outcomes, sum scores were robust against violations of assumptions in some situations. Nevertheless, AP scores derived from the bifactor model showed some superiority over sum scores. Conclusion These findings show that more accurate predictions of later‐life difficulties can be made if one uses a more suitable psychometric model to assess AP severity in children. This has important implications for research and clinical practice.

Sluggish Cognitive Tempo among Iranian Children and Adolescents: A Validation Study of the Farsi Child and Adolescent Behavior Inventory (CABI)–Parent Version

“…For practitioners, the concept of SCT is important to further distinguishing attention problems such as daytime sleepiness and internalizing problems from typical ADHD [ 14 , 15 , 16 ]. Importantly, children and adolescents with ADHD and co-occurring symptoms of SCT may be less likely to respond to the first-line treatment with methylphenidate [ 17 , 18 ]; rather, they may be more likely to respond to atomoxetine [ 19 , 20 ], and they may be somewhat less likely to respond to evidence-based behavioral treatment [ 21 ].…”