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. 2018 Aug;49(4):607-620.
doi: 10.1007/s10578-017-0777-1.

Should Clinicians Split or Lump Psychiatric Symptoms? The Structure of Psychopathology in Two Large Pediatric Clinical Samples from England and Norway

Lorena Fernández de la Cruz  1   2 , Pablo Vidal-Ribas  3   4 , Nada Zahreddine  3   5 , Børge Mathiassen  6 , Per Håkan Brøndbo  6 , Emily Simonoff  3 , Robert Goodman  3 , Argyris Stringaris  4
Affiliations

Should Clinicians Split or Lump Psychiatric Symptoms? The Structure of Psychopathology in Two Large Pediatric Clinical Samples from England and Norway

Lorena Fernández de la Cruz et al. Child Psychiatry Hum Dev. 2018 Aug.

Abstract

It has been suggested that the structure of psychiatric phenomena can be reduced to a few symptom dimensions. These proposals, mainly based on epidemiological samples, may not apply to clinical populations. We tested the structure of psychiatric symptoms across two pediatric clinical samples from England (N = 8434) and Norway (N = 5866). Confirmatory factor analyses of the parent-reported Strengths and Difficulties Questionnaire (SDQ) evaluated the relative fit of several models, including a first-order model, a second-order model with the widely-established broad symptom dimensions of internalizing-externalizing, and two bi-factor models capturing a general psychopathology factor. Predictive value of the SDQ subscales for psychiatric disorders was examined. A first-order five-factor solution better fit the data. The expected SDQ subscale(s) related best to the corresponding psychiatric diagnosis. In pediatric clinical samples, a granular approach to psychiatric symptoms where several dimensions are considered seems to fit the data better than models based on lumping symptoms into internalizing/externalizing dimensions.

Keywords: Construct validity; Factor structure; Nosology; Predictive value; Strengths and Difficulties Questionnaire.

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Conflict of interest statement

Dr. Fernández de la Cruz receives royalties for contributing articles to UpToDate, Wolters Kluwer Health. Prof. Goodman is the owner of Youthinmind Ltd, which provides no-cost and low-cost websites related to the Strengths and Difficulties Questionnaire and the Development and Well-Being Assessment. The authors have no other competing interests to declare.

Figures

Fig. 1
Fig. 1
Models to be tested in the confirmatory factor analyses. Solid lines represent factor loadings. Dashed lines represent correlations. Behav behavioral problems, Emo emotional problems, Ext externalizing, Gen general factor, Hyper hyperactivity problems, Int internalizing, Peer peer problems, Prosoc prosocial problems
Fig. 2
Fig. 2
Second-order factor models used in the confirmatory factor analyses. Solid lines represent factor loadings. Dashed lines represent correlations. Behav behavioral problems, Emo emotional problems, Ext externalizing, Hyper hyperactivity problems, Int internalizing, Peer peer problems, Prosoc prosocial problems
Fig. 3
Fig. 3
Standardized SDQ subscale scores across different comorbidities. Bars with bold border are those scores hypothesized to be higher for that group. ADHD attention-deficit/hyperactivity disorder, CD conduct disorder, EMO emotional disorders
See this image and copyright information in PMC

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