Latent Structure of Sluggish Cognitive Tempo and ADHD Symptoms

描述(由申请人提供)：我们建议评估一种新的评估迟缓认知节奏(SCT)的方法，并描述其潜在结构与ADHD的DSM-IV症状的关系。SCT是一种不同于多动-冲动和注意力不集中的综合征。它与注意力不集中的ADHD类型有关。SCT最初的特征是白日做梦，看起来行动迟缓或昏昏欲睡。该结构被描述性地扩展为信息处理缓慢、工作记忆不一致、难以保持警觉和觉醒、难以保持方向感、倾向于缓慢运动和被动(低主动性)。SCT的研究一直受到尚未解决的测量问题的制约。没有基于经验的评估SCT的方法可用。大多数研究只使用了2-3个SCT条目，远远少于可靠测量潜在结构的推荐数量(Devellis，2003)。另一个限制是SCT项目是非特定的，可能与一系列短暂状态(疲劳、睡眠剥夺等)有关。以及其他精神病态疾病。如果不加以纠正，SCT项目的这一方面将虚假地增加SCT的观察患病率以及SCT和内化障碍之间的明显共病。这项拟议的研究试图通过评估以面试者为基础的诊断性访谈--儿童迟滞认知节奏访谈(K-SCT)来弥补文献中的这一空白。K-SCT包含一个扩展的项目库(16个项目)。它提示面试官将批注的项目分类为主要项目、次要项目或临时项目。我们将使用心理测量学标准、因素分析和潜在类别分析来评估条目，并探索将SCT引入ADHD症状库可能产生的病因学影响。ADHD-I一直被批评为异质性，并被错误地嵌套在外化障碍中。这类问题是仅仅依靠多动-冲动症状的数量作为区分类型的标准的结果。SCT项目可能会根据一系列典型症状来定义ADHD-I，而不是指表现出与ADHD-C相同的注意力不集中症状，但不包括6种多动-冲动症状的儿童。如果SCT确实表征了无多动的注意力缺陷障碍的典型病例，那么ADHD症状扩展池(ADHD+SCT)的潜在建模可能会将病例聚合为具有比使用当前系统更多的组内相似性和更少组间相似性的组。这将有助于确定不同类型之间的遗传和治疗反应差异。公共卫生相关性：拟议的研究将评估一种新的认知节奏迟缓(SCT)诊断程序，该程序克服了目前的几个限制。它还将检查SCT如何与DSM-IV中现有的ADHD症状相适应。这一结果可能为更新ADHD的诊断标准提供指导，以加强努力识别不同类型之间的遗传和治疗反应差异。

DESCRIPTION (provided by applicant): We propose to evaluate a new method of assessing Sluggish Cognitive Tempo (SCT), and to characterize its latent structure in relation to DSM-IV symptoms of ADHD. SCT is a syndrome that is distinct from Hyperactivity-Impulsivity and Inattention. It is associated with inattenttive types of ADHD. The original features of SCT were daydreams and seems sluggish or drowsy. The construct has been broadened descriptively refer to slow information processing, inconsistent working memory, difficulty maintaining alertness and arousal, difficulty maintaining orientation, and tendency toward slow movement and passivity (low initiative). Research into SCT has been constrained by unresolved measurement issues. No empirically-based method of assessing SCT is available. Most studies have used only 2-3 SCT items, a number far fewer than recommended for reliable measurement of a latent construct (Devellis, 2003). Another limitation is that SCT items are non-specific and may be related to a range of transitory states (fatigue, sleep deprivation, etc.) and other psychopathological conditions. Left uncorrected, this aspect of SCT items would spuriously increase the observed prevalence of SCT and the apparent comorbidity between SCT and internalizing disorders. The proposed study seeks to remedy this gap in the literature by evaluating an interviewer- based diagnostic interview, the Kiddie Sluggish Cognitive Tempo Interview (K-SCT). The K- SCT contains an expanded item pool (16 items). It prompts the interviewer to classify endorsed items as being either primary, or as secondary to another condition or to a transient state. We will use psychometric criteria, factor analysis, and latent class analysis to evaluate items and to explore what the nosological effects may be of introducing SCT into the ADHD symptom pool. ADHD-I has been criticized for being heterogeneous and for being incorrectly nested within the externalizing disorders. Such problems are the consequences of relying solely on the number of hyperactivity-impulsivity symptoms as the criterion for differentiating types. SCT items may make it possible to define ADHD-I in terms of a set of characteristic symptoms, rather than as children who display the same symptoms of inattention as ADHD-C, but fall short of 6 symptoms of hyperactivity-impulsivity. If SCT indeed characterizes the prototypical case of attention deficit disorder without hyperactivity, then latent modeling of an expanded pool of ADHD symptoms (ADHD+SCT) may aggregate cases into groups with more within-group similarities and fewer between-group similarities than is seen using the current system. This would facilitate the identification of genetic and treatment response differences among types. PUBLIC HEALTH RELEVANCE: The proposed study will evaluate a novel diagnostic procedure for Sluggish Cognitive Tempo (SCT) that overcomes several current limitations. It will also examine how SCT fits in with the existing ADHD symptoms in DSM-IV. The results may provide a guide for updating the diagnostic criteria for ADHD in a way that would enhance efforts to identify genetic and treatment response differences among the types.