Bifactor Models of Attention-Deficit/Hyperactivity Disorder (ADHD): An Evaluation of Three Necessary but Underused Psychometric Indexes

Abstract

Background: In the past decade, the bifactor model of attention-deficit/hyperactivity disorder (ADHD) has been extensively researched. This model consists of an ADHD general dimension and two specific factors: inattention and hyperactivity/impulsivity. All studies conclude that the bifactor is superior to the traditional two-correlated factors model, according to the fit obtained by factor analysis. However, the proper interpretation of a bifactor not only depends on the fit but also on the quality of the measurement model. Objective: To evaluate the model-based reliability, distribution of common variance and construct replicability of general and specific ADHD factors. Method: We estimated expected common variance, omega hierarchical/subscale and H-index from standardized factor loadings of 31 ADHD bifactor models previously published. Results and Conclusion: The ADHD general factor explained most of the common variance. Given the low reliable variance ratios, the specific factors were difficult to interpret. However, in clinical samples, inattention acquired sufficient specificity and stability for interpretation beyond the general factor. Implications for research and clinical practice are discussed.