Evaluating the Hierarchical Structure of ADHD Symptoms and Invariance Across Age and Gender

The bifactor model of attention-deficit/hyperactivity disorder (ADHD) has been extensively explored, yet the tendency of the bifactor model to overfit data necessitates investigation of alternative, more parsimonious models, such as a modified bifactor structure. The present study used item response theory to compare unidimensional, correlated factors, bifactor, and modified bifactor models of ADHD symptoms in a clinical sample of youth ( N = 1,612) and examined differential item functioning (DIF) by age (<11 and ≥11 years) and gender. Results suggested that two restricted bifactor models showed superior fit compared with alternative models, and support strong general and inattention dimensions, with unreliable hyperactivity and impulsivity dimensions. No DIF was found across gender or age. The present study confirms that the general dimension (i.e., inhibition) and one specific dimension (i.e., sustained attention) represent distinct variability in ADHD symptoms that may improve prediction of symptom persistence, treatment response, or functional outcomes.