Does actigraphy validate DSM-IV criteria and methods for diagnosing pervasive hyperactivity?
Attention deficit hyperactivity disorder is the current label for one of the most prevalent and intensively studied syndromes in child psychiatry, and possibly the most controversial. The DSM-IV specifies hyperactivity as a core component of ADHD-Combined Type, along with impulsivity and inattention. This study highlighted the relevant issues in the diagnosis of ADHD, including the reliability and validity of assessment, measurement, source of information, and situationality versus pervasiveness of symptoms. Diagnosis is central to medical practice and research. If, in fact, not all children diagnosed with ADHD-Combined Type are pervasively hyperactive, this challenges the validity of our current assessment methods, the criteria set forth by the DSM-IV, and all research based on these incorrect assumptions. The primary purpose of this research was to determine whether hyperactivity was pervasive or situational. A two-group by 14-day repeated measures (1,440 data points per 24 hours per child) experimental design was used to compare the measured activity levels of nine children diagnosed with the combined type of ADHD with nine group age-matched controls. A collateral purpose was to determine the extent to which standard parent and teacher reports of motor excess and inattention correlated with measured activity. Actigraphy data were explored statistically at the group level and graphically at the individual level. The lack of any significant evidence of pervasive hyperactivity unequivocally challenged the validity of the DSM-IV conceptualization of ADHD-Combined Type that stipulated that children must display pervasive hyperactivity. Results of situational analyses demonstrated both evidence of person stability (pervasiveness) and instability (situationality) depending on the methodology used to analyze the data. A significant group by period of day quadratic effect provided clear evidence of situational hyperactivity capable of differentiating the control group from the ADHD group. These findings were not sustained at the individual level of analysis. Rated and measured activity level data were not significantly correlated, but overwhelming differences emerged between parent and teacher ratings and measured activity level data. Actigraphy provides an accurate, reliable and valid measure of activity, and is an independent and objective standard against which to test the validity of diagnostic classifications derived from traditional assessment methods.
Licht, Carolyn Ann, "Does actigraphy validate DSM-IV criteria and methods for diagnosing pervasive hyperactivity?" (2006). ETD Collection for Fordham University. AAI3201132.