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Cited by 39Autism Spectrum Disorder ResearchAttention Deficit Hyperactivity DisorderDevelopmental and Educational Neuropsychology

A transdiagnostic approach to neurodiversity in a representative population sample: The N+ 4 model

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Apperly, Ian A., Lee, Robert, van der Kleij, Sanne W., Devine, Rory T.·2024·JCPP Advances
DOI 10.1002/jcv2.12219PMC PMC11143952
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Abstract

Background: The concept of neurodiversity draws upon scientific research, and lessons from practice and lived experience to suggest new ways of thinking about neurodevelopmental conditions. Among the formative observations are that characteristics associated with neurodevelopmental conditions are part of a “broader phenotype” of variation across the whole population, and that there appear to be “transdiagnostic” similarities as well as differences in these characteristics. These observations raise important questions that have implications for understanding diversity in neurodevelopmental conditions and in neurocognitive phenotypes across the whole population. Method: The present work examines broader phenotypes using seven widely used self‐report assessments of traits associated with autism, ADHD, dyslexia, Developmental Coordination Disorder/dyspraxia, tic disorders/Tourette's, cortical hyperexcitability associated with subclinical epilepsy, and sensory sensitivities. A representative sample of 995 adults (aged 17–77) in the UK completed self‐report measures of neurodiversity, wellbeing, generalized anxiety, and depression, and cognitive abilities (nonverbal intelligence and executive functioning). Results: We used confirmatory factor analysis to test whether variation and covariation was better characterized (1) by traditional diagnostic labels, or (2) transdiagnostically according to similarities in functions, behaviours, or phenomena. Results indicated that neurodiversity characteristics were best explained using a bifactor model with one general “N” factor and four condition‐specific factors. Conclusion: This was the largest examination to date of the factor structure of broader phenotypes relevant to neurodevelopmental conditions. It provides critical benchmark data, and a framework approach for asking systematic questions about the structure of neurocognitive diversities seen in the whole population and in people with one or more diagnoses.

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  • Many diagnostic frameworks lack consensus or explanatory validity.

    “many diagnositic frameworks lack consensus or explanatory validity [7, 9, 14, 196, 280].”

    From Cripping AI: Reimagining AI Through Lived Disability Experiences (2026) · cites this paper as [7]

    The Introduction (‘Neurodevelopmental conditions as complex phenotypes’; page unavailable) says traditional diagnostic categories have prompted questions about their validity and may not capture important complexity. The Discussion (‘Assumptions, limitations, and further work’; page unavailable) describes contested boundaries between neurodevelopmental and psychiatric conditions. These passages support concerns about some diagnostic categories, but do not establish that many diagnostic frameworks lack explanatory validity as a matter of fact. (LLM, conf=0.82)

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  • These standards have limitations and have been repeatedly challenged by clinical professionals.

    “these standards have their limitations and have been repeatedly challenged by clinical professionals.”

    From Cripping AI: Reimagining AI Through Lived Disability Experiences (2026) · cites this paper as [7]

    The Introduction (‘Neurodevelopmental conditions as complex phenotypes’; page unavailable) says categorical diagnoses have limitations and that some have questioned their validity. The Introduction (‘Transdiagnostic approaches to psychiatry and neurodevelopmental conditions’; page unavailable) also says researchers have questioned psychiatric diagnostic categories. Neither passage establishes that clinical professionals, specifically, have repeatedly challenged these standards. (LLM, conf=0.84)

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  • Recent clinical work increasingly advocates for transdiagnostic approaches that shift focus from diagnostic categories to individuals' needs and experiences.

    “Recent clinical work increasingly advocates for transdiagnostic approaches that shift the focus from diagnostic categories to individuals' needs and experiences [7, 9].”

    From Cripping AI: Reimagining AI Through Lived Disability Experiences (2026) · cites this paper as [7]

    The Introduction (“Neurodevelopmental conditions as complex phenotypes”; page unavailable) says that features outside diagnostic categories can be more important to people's experiences and needs, and describes arguments for approaches that better capture this complexity. It does not establish that clinical work increasingly advocates such a shift; it describes a research approach and says some authors favor combining new approaches with, rather than replacing, diagnostic categories. (LLM, conf=0.79)

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Research works printed but not linked: 2

  1. Muthèn, L. K., & Muthèn, B. O. (2017). Mplus: Statistical analysis with latent variables. User’s Guide (8th ed.). Muthèn & Muthèn.
  2. Singer, J. (1999). ‘Why can’t you be normal for once in your life?’ From a ‘problem with no name’ to the emergence of a new category of difference. In M. Corker & S. French (Eds.), Disability discourse. Open University Press.

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Authors
Apperly, I. A., Lee, R., van der Kleij, S. W., & Devine, R. T.
Affiliations
  • University of Birmingham (GB)
  • Centre for Developmental Science School of Psychology University of Birmingham Birmingham UK
Corresponding author
Apperly, Ian A.
ORCID
Venue
JCPP Advances
Publisher
Wiley
Published
2024-02
Volume
4
Issue
2
Pages
e12219-e12219
ISSN
2692-9384 (ISSN-L)
DOI
10.1002/jcv2.12219
PMC
PMC11143952
OpenAlex
W4391430359
Cited by
37
References
67
Citations by year
2026: 21 · 2025: 11 · 2024: 5
FWCI
8.99
Type
journal article
Language
en
Open access
Licence
Locations
  • JCPP Advances (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Medical Research Council (MR/X002896/1)
  • University of Birmingham (College of Life and Environmental Sciences ‐ small)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Keywords
neurodiversity, transdiagnostic approach, neurodevelopmental disorders, autism spectrum disorder, attention deficit hyperactivity disorder, dyslexia, developmental coordination disorder, tic disorders, Tourette syndrome, cortical hyperexcitability, sensory sensitivity, bifactor model, factor structure, generalized anxiety disorder, depression, well-being, nonverbal intelligence, executive function

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