Internal Validity of Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Overt Conduct Disorder Symptoms in Young Children: Implications from Teacher Ratings for a Dimensional Approach to Symptom Validity

Uses a dimensional approach to evaluate the internal validity of the attention deficit hyperactivity disorder (ADHD) inattention (I) and hyperactivity/impulsivity (H/I), oppositional defiant disorder (ODD), and overt conduct disorder (CD) symptoms (i.e., whether a symptom has a stronger correlation with its own dimension than the other three dimensions). In Study 1, teachers rated 1,445 children on the DSM-III-R I, H/I, ODD, and overt CD symptoms. In Study 2, teachers rated 1,711 children on the DSM-IV I, H/I, ODD, and overt CD symptoms. All the I symptoms showed internal validity in both studies. In contrast, the H/I symptoms and the ODD symptoms, especially the H/I symptoms, showed weaker internal validity. All the overt CD symptoms showed internal validity except the DSM-IV bullies others symptom, with this symptom being more strongly related to the ODD dimension. Confirmatory factor analysis provided support for a 4-factor model consisting of I, H/I, ODD, and overt CD factors. Finally, the importance of internal validity for the construct validation of the disruptive behavior symptoms is discussed.