Unraveling the Optimum Latent Structure of Attention-Deficit/Hyperactivity Disorder: Evidence Supporting ICD and HiTOP Frameworks

Rapson Gomez, Lu Liu, Robert Krueger, Vasileios Stavropoulos, Jenny Downs, David Preece, Stephen Houghton, Wai Chen

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Attention Deficit/hyperactivity disorder (ADHD) is conceptualized differently in the Diagnostic and Statistical Manual (DSM-5), the International Classification of Diseases-10 (ICD-10), and the Hierarchical Taxonomy of Psychopathology (HiTOP) frameworks. This study applied independent cluster confirmatory factor analysis (ICM-CFA), exploratory structure equation model with target rotation (ESEM), and the S-1 bi-factor CFA approaches to evaluate seven ADHD models yielded by different combinations of these taxonomic frameworks. Parents and teachers of a community sample of children (between 6 and 12 years of age) completed the Disruptive Behavior Rating Scale (for ADHD symptoms) and the Strengths and Difficulties Questionnaire (for validation). Our findings for both parent and teacher ratings provided the most support for the S-1 bi-factor CFA model comprised of (i) a g-factor based on ICD-10 impulsivity symptoms as the reference indicators and (ii) inattention and hyperactivity as specific factors. However, the hyperactivity-specific factor lacked clarity and reliability. Thus, our findings indicate that ADHD is best viewed as a disorder primarily reflecting impulsivity, though with a separable inattention (but no hyperactivity) component, i.e., “ADID (attention deficit/impulsivity disorder).” This model aligns with the HiTOP proposals.

Original languageEnglish (US)
Article number666326
JournalFrontiers in Psychiatry
StatePublished - May 14 2021

Bibliographical note

Funding Information:
The work contributed by LL was supported by the National Science Foundation of China (81873802). The work contributed by JD was supported by a Department of Health Western Australia Merit Award. The work contributed by WC was supported by Mental Health Service, Fiona Stanley Hospital.

Publisher Copyright:
© Copyright © 2021 Gomez, Liu, Krueger, Stavropoulos, Downs, Preece, Houghton and Chen.


  • ADHD
  • CFA models
  • DSM- 4
  • ESEM model
  • HiTOP
  • ICD-10
  • S-1 bi-factor CFA models
  • children

PubMed: MeSH publication types

  • Journal Article


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