Latent Structure of Sluggish Cognitive Tempo and ADHD Symptoms

描述（由申请人提供）：我们建议评估一种评估迟缓认知克里思速度（SCT）的新方法，并表征其与ADHD的DSM-IV症状相关的潜在结构。SCT是一种与多动-冲动和注意力不集中不同的综合征。它与注意力不集中型ADHD有关。SCT的最初特征是白日梦，似乎迟缓或昏昏欲睡。该结构已经被扩展到缓慢的信息处理，不一致的工作记忆，难以保持警觉和唤醒，难以保持方向感，以及倾向于缓慢运动和被动（低主动性）。SCT的研究一直受到未解决的测量问题的限制。没有基于外科学的SCT评估方法可用。大多数研究只使用了2-3个SCT项目，远远少于推荐的潜在结构的可靠测量（Devellis，2003）。另一个局限性是SCT项目是非特异性的，可能与一系列短暂状态（疲劳、睡眠剥夺等）有关。和其他精神病理状况如果不加以纠正，SCT项目的这一方面将虚假地增加观察到的SCT患病率和SCT与内化障碍之间的明显共病。拟议的研究旨在弥补这一差距，在文献中评估的访谈为基础的诊断性访谈，儿童Sludge认知克里思访谈（K-SCT）。K-SCT包含一个扩展的项目池（16个项目）。它提示面试官将认可的项目分类为主要的，或次要的另一种条件或暂时状态。我们将使用心理测量标准，因素分析和潜在类别分析来评估项目，并探讨将SCT引入ADHD症状库的疾病学影响。ADHD-I一直被批评为异质性，并被错误地嵌套在外化障碍中。这些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后果。SCT项目可以根据一组特征性症状来定义ADHD-I，而不是像ADHD-C一样表现出注意力不集中的症状，但缺乏6种多动-冲动症状的儿童。如果SCT确实描述了注意力缺陷障碍的典型病例而没有多动，那么扩展的ADHD症状池（ADHD+SCT）的潜在建模可能会将病例聚集成组，组内相似性更高，组间相似性更低，而不是使用当前系统。这将有助于识别不同类型之间的遗传和治疗反应差异。公共卫生相关性：这项拟议的研究将评估一种新的诊断程序，克服了目前的几个局限性，为迟缓认知克里思（SCT）。它还将研究SCT如何适应DSM-IV中现有的ADHD症状。这些结果可能为更新ADHD的诊断标准提供指导，以加强识别不同类型之间遗传和治疗反应差异的努力。

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.