Abstract
As research examining sluggish cognitive tempo (SCT) advances, it is important to examine the structure and validity of SCT in a variety of samples, including samples of children who are clinically-distressed but not referred specifically for attention-deficit/hyperactivity disorder (ADHD). The present study used a large sample of psychiatrically hospitalized children (N = 680; 73 % male; 66 % African American) between the ages of 6 and 12 to examine the latent structure of SCT, ADHD, oppositional defiant disorder (ODD), depression, and anxiety using confirmatory factor analysis (CFA). Results of the CFA analyses demonstrated that SCT is distinct from these other dimensions of child psychopathology, including ADHD inattention, depression, and anxiety. Regression analyses indicated that SCT symptoms were positively associated with depression and, to a lesser degree, anxiety. SCT symptoms were also positively associated with children’s general social problems, whereas SCT symptoms were negatively associated with an observational measure of behavioral dysregulation (i.e., frequency of time-outs received as a part of a manualized behavior modification program). These associations were significant above and beyond relevant child demographic variables (i.e., age, sex, race), children’s other mental health symptoms (i.e., ADHD, ODD, depression, anxiety symptoms), and, for all relations except child anxiety, parents’ own anxiety and depression symptoms.
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Notes
Measurement invariance was tested to investigate if CFA results were consistent between boys and girls. At the outset, our model demonstrated adequate configural invariance (χ 2 = 1426.41, p < 0.001, χ 2/df = 1.75; CFI = 0.89; TLI = 0.88; RMSEA = 0.04, 90%CI 0.04, 0.05), suggesting that the pattern of free and fixed loadings was invariant across genders. Using the configural model as a baseline, we tested weak invariance of factor loadings across participant gender. Given our focus on SCT, we first tested whether constraining the factor loadings of the three SCT items to be equal across gender significantly worsened fit compared to a model in which these loadings were allowed to freely vary (i.e., partial invariance: Bryne et al. 1989). The constrained model was not significantly different from the unconstrained model (Δχ2(3) = 0.12, n.s.; ΔCFI = 0.00; RMSEA = 0.04), suggesting invariance for the SCT items. We next tested weak invariance across all factor loadings. Although the chi-square difference test was significant (Δχ2(30) = 45.27, p = 0.03), such tests may be too strict for testing full invariance given the large sample size and other indices suggesting invariance (ΔCFI = 0.00; RMSEA = 0.05 falls within the 95 % CI of the configural model). Examination of specific items indicated that item 24 (“Doesn’t eat well”) loaded on the DEP factor for boys (λ = 0.27) but not for girls (λ = 0.12). As a check, allowing this item to freely vary while constraining all others to be equal did, in fact, indicate weak invariance (Δχ2(29) = 41.37, n.s.; ΔCFI = 0.00; RMSEA = 0.05). Finally, tests of strong factorial invariance were conducted, with results suggesting invariant factor intercepts across gender (Δχ2(6) = 7.05, n.s.; ΔCFI = 0.00; RMSEA = 0.05). Given these results, the full model collapsed across gender is presented.
References
Achenbach, T. M. (2001). Child behavior checklist for ages 6 to 18. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.
Adams, Z. W., Milich, R., & Fillmore, M. T. (2010). A case for the return of attention-deficit disorder in DSM-5. The ADHD Report, 18, 1–6.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
Barkley, R. A. (2012). Distinguishing sluggish cognitive tempo from ADHD in children and adolescents: executive functioning, impairment, and comorbidity. Journal of Clinical Child and Adolescent Psychology. doi:10.1080/15374416.2012.734259. Advance online publication.
Bauermeister, J. J., Barkley, R. A., Bauermeister, J. A., Martínez, J. V., & McBurnett, K. (2012). Validity of the sluggish cognitive tempo, inattention, and hyperactivity symptom dimensions: neuropsychological and psychosocial correlates. Journal of Abnormal Child Psychology, 40, 683–697.
Becker, S. P., & Langberg, J. M. (2012). Sluggish cognitive tempo among young adolescents with ADHD: relations to mental health, academic, and social functioning. Journal of Attention Disorders. doi:10.1177/1087054711435411. Advance online publication.
Becker, S. P., Langberg, J. M., Vaughn, A. J., & Epstein, J. N. (2012a). Clinical utility of the vanderbilt ADHD diagnostic parent rating scale comorbidity screening scales. Journal of Developmental and Behavioral Pediatrics, 33, 221–228.
Becker, S. P., Luebbe, A. M., Greening, L., Fite, P. J., & Stoppelbein, L. (2012b). A preliminary investigation of the relation between thyroid functioning and sluggish cognitive tempo in children. Journal of Attention Disorders. doi:10.1177/1087054712466917. Advance online publication.
Becker, S. P., Luebbe, A. M., & Langberg, J. M. (2012c). Co-occurring mental health problems and peer functioning among youth with attention-deficit/hyperactivity disorder: a review and recommendations for future research. Clinical Child and Family Psychology Review, 15, 279–302.
Becker, S. P., Luebbe, A. M., Stoppelbein, L., Greening, L., & Fite, P. J. (2012d). Aggression among children with ADHD, anxiety, or co-occurring symptoms: competing exacerbation and attenuation hypotheses. Journal of Abnormal Child Psychology, 40, 527–542.
Brady, E. U., & Kendall, P. C. (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111, 244–255.
Briggs-Gowan, M. J., Carter, A. S., & Schwab-Stone, M. (1996). Discrepancies among mother, child, and teacher reports: examining the contributions of maternal depression and anxiety. Journal of Abnormal Child Psychology, 24, 749–765.
Bryne, B. M., Shavelson, R. J., & Muthén, B. (1989). Testing for the equivalence of factor covariance and mean structures: the issue of partial measurement invariance. Psychological Bulletin, 105, 456–466.
Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, predominantly inattentive type. Journal of Clinical Child and Adolescent Psychology, 31, 123–129.
Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behavioral Science, 19, 1–15.
Diamond, A. (2005). Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): a neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity). Development and Psychopathology, 17, 807–825.
Fergusson, D. M., Lynskey, M. T., & Horwood, L. J. (1993). The effect of maternal depression on maternal ratings of child behavior. Journal of Abnormal Child Psychology, 21, 245–269.
Frick, P. J., Lahey, B. B., Applegate, B., Kerdyck, L., Ollendick, T., Hynd, G. W., et al. (1994). DSM-IV field trials for the disruptive behavior disorders: symptom utility estimates. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 529–539.
Garber, J., & Weersing, V. R. (2010). Comorbidity of anxiety and depression in youth: implications for treatment and prevention. Clinical Psychology: Science and Practice, 17, 293–306.
Garner, A. A., Marceaux, J. C., Mrug, S., Patterson, C., & Hodgens, B. (2010). Dimensions and correlates of attention-deficit/hyperactivity disorder and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 38, 1097–1107.
Garner, A. A., Mrug, S., Hodgens, B., & Patterson, C. (2011). Do symptoms of sluggish cognitive tempo in children with ADHD symptoms represent comorbid internalizing difficulties? Journal of Attention Disorders. doi:10.1177/1087054711431456. Advance online publication.
Hartman, C. A., Willcutt, E. G., Rhee, S. H., & Pennington, B. F. (2004). The relation between sluggish cognitive tempo and DSM-IV ADHD. Journal of Abnormal Child Psychology, 32, 491–503.
Jacobson, L. A., Murphy-Bowman, S. C., Pritchard, A. E., Tart-Zelvin, A., Zabel, T. A., & Mahone, E. M. (2012). Factor structure of a sluggish cognitive tempo scale in clinically-referred children. Journal of Abnormal Child Psychology, 40, 1327–1337.
Kline, R. B. (1998). Principles and practice of structural equation modeling. New York: Guilford.
Lahey, B. B., Schaughency, E. A., Hynd, G. W., Carlson, C. L., & Nieves, N. (1987). Attention deficit disorder with and without hyperactivity: comparison of behavioral characteristics of clinic-referred children. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 718–723.
Lahey, B. B., Carlson, C. L., & Frick, P. J. (1997). Attention-deficit disorder without hyperactivity. In T. A. Widiger, A. J. Frances, H. A. Pincus, R. Ross, M. B. First, & W. Davis (Eds.), DSM-IV sourcebook, Vol. 3 (pp. 163–188). Washington, DC: American Psychiatric Association.
Lahey, B. B., Applegate, B., Waldman, I. D., Loft, J. D., Hankin, B. L., & Rick, J. (2004). The structure of child and adolescent psychopathology: generating new hypotheses. Journal of Abnormal Psychology, 113, 358–385.
McBurnett, K., Pfiffner, L. J., & Frick, P. J. (2001). Symptom properties as a function of ADHD type: an argument for continued study of sluggish cognitive tempo. Journal of Abnormal Child Psychology, 29, 207–213.
Mikami, A. Y., Huang-Pollock, C. L., Pfiffner, L. J., McBurnett, K., & Hangai, D. (2007). Social skills differences among attention-deficit/hyperactivity disorder types in a chat room assessment task. Journal of Abnormal Child Psychology, 35, 509–521.
Muris, P., Roelofs, J., Rassin, E., Franken, I., & Mayer, B. (2005). Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression. Personality and Individual Differences, 39, 1105–1111.
Muthén, L. K., & Muthén, B. O. (1998–2007). Mplus user’s guide (5th ed). Los Angeles, CA: Muthén & Muthén.
Nakamura, B. J., Ebesutani, C., Bernstein, A., & Chorpita, B. F. (2009). A psychometric analysis of the child behavior checklist DSM-oriented scales. Journal of Psychopathology and Behavioral Assessment, 31, 178–189.
Penny, A. M., Waschbusch, D. A., Klein, R. M., Corkum, P., & Eskes, G. (2009). Developing a measure of sluggish cognitive tempo for children: content validity, factor structure, and reliability. Psychological Assessment, 21, 380–389.
Pillow, D. R., Pelham, W. E., Hoza, B., Molina, B. S. G., & Stultz, C. H. (1998). Confirmatory factor analyses examining attention deficit hyperactivity disorder and other childhood disruptive behaviors. Journal of Abnormal Child Psychology, 26, 293–309.
Skirbekk, B., Hansen, B. H., Oerbeck, B., & Kristensen, H. (2011). The relationship between sluggish cognitive tempo, subtypes of attention-deficit/hyperactivity disorder, and anxiety disorders. Journal of Abnormal Child Psychology, 39, 513–525.
Willcutt, E. G., Nigg, J. T., Pennington, B. F., Solanto, M. V., Rohde, L. A., Tannock, R.,… Lahey, B. B. (2012). Validity of DSM-IV attention-deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121, 991–1010
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Becker, S.P., Luebbe, A.M., Fite, P.J. et al. Sluggish Cognitive Tempo in Psychiatrically Hospitalized Children: Factor Structure and Relations to Internalizing Symptoms, Social Problems, and Observed Behavioral Dysregulation. J Abnorm Child Psychol 42, 49–62 (2014). https://doi.org/10.1007/s10802-013-9719-y
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DOI: https://doi.org/10.1007/s10802-013-9719-y