Exploratory Factor Analysis of DISC-IV Impairment for ADHD Diagnosis Open Access

Deubler, Emily Louise (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/r494vk655?locale=en


Introduction:Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects an estimated 6.4 million school-aged youth. Many clinicians rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM) for an ADHD diagnosis. As the diagnosis of ADHD relies on a set of subjective responses to assess objective criteria, ADHD remains complicated to diagnose. As a result, DSM has undergone numerous revisions, the most recent which maintains the symptom and impairment criteria, but drops the multi-axial system which previously suggested a global assessment of functioning for a diagnosis. The goal of this paper is to perform an exploratory factor analysis to investigate the factors of impairment associated with ADHD and the four most common co-occurring mental disorders (generalized anxiety, major depression, CD and ODD) and determine whether a composite scale of impairment would be more valid when assessing the impairment criteria for a diagnosis of ADHD.

Methods: An exploratory factor analysis was performed on the Diagnostic Interview Schedule for Children Version IV (DISC-IV) impairment questions related to ADHD-I, ADHD-H, generalized anxiety, major depression, CD and ODD. Subsequently, a sensitivity analysis was performed to determine the validity of the results by adding a random uniform deviate to create 10 new datasets, and performing ten additional exploratory factor analyses. Empirical 95% confidence intervals of the Cronbach's alpha values for all of the datasets were computed to determine the reliability of the initial results.

Results: The results of the factor analysis illustrated that the factors generally grouped together by condition as there were two ADHD factors, one CD factor, one GA factor, one MD factor and one ODD factor. The results of the sensitivity analysis yielded a mean Cronbach alpha greater than 0.70 for each of the factors, illustrating a reliable scale.

Discussion: The results of this analysis demonstrate the validity of relying on condition-specific criteria for the diagnosis of ADHD, as the factors grouped by condition. These results also support the revision of the DSM criteria from the multi-axial system, suggesting that the multi-axial system may not increase the validity of the diagnosis of certain conditions.

Table of Contents

1. Introduction...1

1.1 Problem Statement...1

1.2 Purpose Statement...2

1.3 Significance Statement...2

2. Background...3

Study Topic: ADHD...3

2.1 ADHD Overview...3

2.2 ADHD Diagnosis and DSM...4

2.3 Impairment and DISC...6

Statistical Method: Factor Analysis...7

2.4 Overview...7

2.5 Methodological Decisions...7

2.6 Confirmatory Factor Analysis...12

3. Methodology...13

3.1 Study Design...13

3.2 Measurements...14

3.2.1 Phase 1: ADHD Screening...14

3.2.2 Phase II: Diagnostic Interview for Mental Disorders...15

3.3 DISC-IV...16

3.4 Statistical Analysis...17

4. Results...19

4.1 Original PLAY Data Results...19

4.2 Sensitivity Analysis Results...20

5. Discussion...22

5.1 Implications...24

5.2 Strengths and limitations...25

5.3 Recommendations...26


Appendix: Tables and Figures...30

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