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Using factor analytic models to examine the association between attention-deficit/hyperactivity disorder symptoms and health-related outcomes in a representative population survey

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ADHD Attention Deficit and Hyperactivity Disorders

Abstract

The objective of the study was to examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in a representative population survey of adults and the association of these factors with health outcomes. Hierarchical and correlated factor analysis models were compared, and regression analyses with these models were used to determine the associations with psychological distress and substance use problems. A total of 1449 adults 18–65 years of age participated in a cross-sectional survey over the phone. ADHD symptom data came from an ADHD screener (10 items), and health outcomes were assessed using a questionnaire measuring psychological distress and two measures of substance use problems. The hierarchical general factor models with specific factors best represented the structure of ADHD in this representative population survey. The general factor and residual inattention factor were significantly associated with psychological distress, and the general factor was associated with substance use problems. From the correlated factor models, the inattention factor was associated with psychological distress and the hyperactivity factor was related to substance use problems. The hierarchical and correlated factor models explained similar levels of variance in outcomes. The results replicate previous studies indicating that a model of ADHD symptoms with a unitary dimension and separable dimensions of residual inattention and hyperactivity/impulsivity demonstrates a better fit than correlated factor models. The ADHD general factor was consistently significantly related to outcomes.

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Notes

  1. In these bifactor models, it is important to recognize that the specific factors represent residual covariation among items, which is the relationships between items that remain with covariation due to the general factor removed. Therefore, the specific factor for the inattention items, for example, does not necessarily represent the construct of inattention itself or an inattention subscale; instead, it represents the relationships between these items that remains while accounting for a broader ADHD construct.

  2. Consistent results were obtained when the items were treated as categorical, and the CFA models were estimated using a robust weighted least-squares method (i.e., the WLSMV estimator in Mplus).

  3. Due to technical estimation issues, it was not possible to regress the binary problem score outcome on all four factors from the bifactor model with three specific factors simultaneously. Therefore, this outcome was first regressed on the general factor and the residual inattention and hyperactivity factors in one model, and then a separate model was used to regress the binary outcome on the general factor and the residual inattention and impulsivity factors.

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Authors and Affiliations

  1. Department of Psychology, York University, Toronto, ON, Canada

    Geoff B. Sorge & David B. Flora

  2. Department of Sociology, Collaborative Program in Addiction Studies, University of Toronto, Toronto, ON, Canada

    Mark van der Maas

  3. Population and Community Health Unit, Department of Family Medicine, Western University, London, ON, Canada

    Evelyn Vingilis & Jane Seeley

  4. Department of Sociology, Centre for Criminology and Sociological Studies, University of Toronto, Toronto, ON, Canada

    Patricia Erickson

  5. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Nathan J. Kolla

  6. Centre for Addiction and Mental Health, Complex Mental Illness, Forensic Service, Toronto, ON, Canada

    Nathan J. Kolla

  7. Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Robert E. Mann

  8. Department of Psychology, LaMarsh Centre for Child and Youth Research, York University, 126 Behavioural Science Bld., 4700 Keele St., Toronto, ON, M3J 1P3, Canada

    Maggie E. Toplak

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  1. Geoff B. Sorge
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  2. David B. Flora
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  8. Jane Seeley
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  9. Maggie E. Toplak
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Correspondence to Maggie E. Toplak.

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Sorge, G.B., Flora, D.B., van der Maas, M. et al. Using factor analytic models to examine the association between attention-deficit/hyperactivity disorder symptoms and health-related outcomes in a representative population survey. ADHD Atten Def Hyp Disord 7, 225–235 (2015). https://doi.org/10.1007/s12402-015-0167-0

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