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Cited by 2Attention Deficit Hyperactivity DisorderChildren's Physical and Motor DevelopmentBehavioral and Psychological Studies

Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD

Open access
Kofler, Michael J., Soto, Elia F., Rapport, Mark D., Whitehead, Samuel·2025·Journal of Psychopathology and Behavioral Assessment
DOI 10.1007/s10862-025-10218-8PMC PMC12380012
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Abstract

Though often conflated with face validity, ecological validity refers to the degree that a test or measure predicts real-world behavior/functioning. The current study leveraged two independent samples to provide a critical evaluation of the extent to which clinic-based actigraphy demonstrates ecological validity evidence relative to parent- and teacher-reported hyperactivity ratings. Further, across both samples we evaluated the extent to which the ecological validity evidence for these mechanical measures of hyperactivity varies as a function of the task children are completing while their movement is assessed objectively (low vs. high cognitive demands). Across two independent samples comprising clinically-evaluated children with and without ADHD (Ns = 88, 184; Mages = 9.2, 10.4; 6%, 33% girls; 68%, 70% White Non-Hispanic), latent path models indicated that clinic-based actigraphy during visuospatial working memory testing (high cognitive demands) demonstrated significant associations with both parent- and teacher-rated hyperactivity that were indistinguishable (p > .05) from parent and teacher ratings’s associations with each other in both sample 1 (r = .57) and sample 2 (r = .35; all p < .001). Actigraphy during baseline (low cognitive demand) conditions also uniquely predicted hyperactivity at home and school in both samples (all p < .001), albeit with a less consistent yet robust pattern relative to parent/teacher associations. In both samples, actigraphy showed strong test–retest reliability over 2–4 weeks across clinic-based tasks with high cognitive demands (r = .61-.93) and high concurrent validity across tasks with high vs. low cognitive demands (r = .35-.61; all p < .007). This pattern supports the ecological validity of clinic-based actigraphy during working memory testing, which predicts real-world behavior at home and school just as well as parent perceptions of hyperactivity at home predict teacher perceptions of hyperactivity at school (and vice versa).

Integrity signals

Registry

Crossref · 10.1007/s10862-025-10218-8

Cites

76 of 76 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

16 of 48 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The visual hyperactivity factor in that study showed strong convergent validity with actigraph data.

    “In that study, a bifactor model emerged for both informants consisting of two uncorrelated factors – visual hyperactivity and verbal intrusiveness – and showed superior fit relative to a correlated factors model, as well as strong convergent validity between the visual hyperactivity factor and collected actigraph data (Kofler et al., 2020).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kofler et al., 2020 source

      The Results (Tier 3: Structural Models; page not provided) report significant associations between parent- and teacher-rated visual hyperactivity and actigraph-measured baseline activity. The correlations were modest (r=.25–.27), however, and associations with task-specific activity were not consistent, so describing the convergent validity as strong overstates the findings. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    The mixing of hyperactivity and impulsivity items is well documented.

    “The conflation of hyperactivity and impulsivity items is well documented (DuPaul et al., 2015), and elucidated recently using structural modeling based on parent and teacher ratings of DSM-5 hyperactivity/impulsivity symptoms (Kofler et al., 2020).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites DuPaul et al., 2015 source
    • cites Kofler et al., 2020 source
  • Premisecitation

    Under conditions requiring little cognitive effort, children with ADHD and children without ADHD cannot be reliably distinguished from each other.

    “In contrast, children with and without ADHD are largely indistinguishable from one another under low cognitive demand task conditions (Hudec et al., 2015; Kofler et al., 2016; Patros et al., 2017; Rapport et al., 2008; Sarver et al., 2015; cf. Soto et al., 2024)”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Hudec et al., 2015 source
    • cites Kofler et al., 2016 source

      The Discussion reports approximately 70% overlap between ADHD and non-ADHD activity levels under high-stimulation, low-cognitive-load conditions, supporting 'largely indistinguishable.' But the Results (Worst case estimation) find a statistically significant difference (d = 0.44), so the source does not support saying the groups cannot be reliably distinguished at all. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Patros et al., 2017 source
  • Premisecitation

    Children with ADHD and typically developing children both move significantly more during tasks with high cognitive demands than during tasks with low cognitive demands.

    “Children with ADHD, as well as same age typically developing (TD) children, move significantly more when engaged in high relative to low cognitive demand tasks (for review see Kofler et al., 2016).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kofler et al., 2016 source

      The Results section (Activity Level: ADHD vs. Typically Developing Group Comparisons; page unavailable) reports a significantly larger ADHD–TD activity difference during high- than low-cognitive-demand conditions. That supports a demand-related difference in relative activity, but it does not establish that movement increased significantly within each group; in particular, it does not show the claimed increase among TD children. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Interpretationcitation

    The perception that clinic-based actigraphy has poor ecological validity likely partly reflects the common practice of measuring movement mainly during low cognitive demand tasks.

    “(c) the common practice of measuring children’s motor movement via actigraphy primarily during repetitive/monotonous activities or tasks with low cognitive demands that evoke comparatively lower levels of movement than those observed in educational settings (for review, see Kofler et al., 2016).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kofler et al., 2016 source

      The Methods section (Coding of Moderators; page unavailable) distinguishes low-demand activities from classroom schoolwork, and the Results show that cognitive demands affect measured ADHD–control differences in activity. But those results do not establish that clinic-based actigraphy is commonly conducted mainly during low-demand tasks or that such tasks produce less movement than educational settings; the reported low-demand and classroom effect sizes did not differ significantly. The paper therefore supports the relevance of task demands, not the full explanation attributed to it. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 12
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    Parent and teacher ratings are the accepted benchmark for measuring excessive motor movement in children with ADHD in clinical and diagnostic work and for tracking treatment outcomes.

    “Despite the sophistication and improved reliability of these latter measures, parent/teacher ratings remain the gold standard of quantifying excessive motor movement in children with ADHD for clinical/diagnostic purposes and monitoring treatment related outcomes (Barkley, 2019; DuPaul & Stoner, 2014; Kofler et al., 2020).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Barkley, 2019 source
    • cites DuPaul & Stoner, 2014

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Kofler et al., 2020 source

      The Method sections on Participants and Parent and Teacher-rated Hyperactivity show that parent and teacher ratings assessed hyperactivity symptoms and contributed to ADHD diagnosis (page numbers unavailable). The paper does not call those ratings the gold standard for quantifying motor movement or establish their use for monitoring treatment outcomes; its Limitations section instead notes that ratings may reflect factors beyond how much a child moves. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The working memory tests have high internal consistency (alpha .81-.97), one- to three-week test-retest reliability (.76-.90), and expected correlations with complex span (r=.69) and updating tasks (r=.61).

    “Reliability and validity evidence includes high internal consistency (α = .81-.97) and 1–3-week test-retest reliability (.76-.90; Kofler et al., 2019; Sarver et al., 2015), and expected relations with criterion working memory complex span (r = .69) and updating tasks (r = .61) (Wells et al., 2018).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Kofler et al., 2019 source

      The Method section (High Working Memory Conditions; page unavailable) reports reliability evidence for complex-span tasks, but gives internal consistency of α=.77–.81 and three-month test–retest reliability of .70–.80, not the quoted ranges or one-to-three-week interval. The citing sentence attributes the r=.69 and r=.61 correlations to Wells et al. (2018), not to Kofler et al. (2019). (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Sarver et al., 2015 source
    • cites Wells et al., 2018 source

  • May combine two claims.

    Premisecitation

    In Kofler et al. (2020), a bifactor model with two uncorrelated factors, visual hyperactivity and verbal intrusiveness, fit better than a correlated factors model for both parent and teacher informants.

    “In that study, a bifactor model emerged for both informants consisting of two uncorrelated factors – visual hyperactivity and verbal intrusiveness – and showed superior fit relative to a correlated factors model, as well as strong convergent validity between the visual hyperactivity factor and collected actigraph data (Kofler et al., 2020).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kofler et al., 2020 source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Parent and teacher ratings are favored because they are inexpensive and are argued to have better ecological validity than objective mechanical measures like actigraphs.

    “The preference for and popularity of using parent/teacher ratings to assess hyperactivity reflects the economic utility of obtaining, administering, and scoring the instruments, and their oft argued superior ecological validity relative to objective mechanical measures such as actigraphs (Barkley, 1991; Dane, Schachar, & Tannock, 2000; Halperin et al., 1993).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Barkley, 1991 source
    • cites Dane, Schachar, & Tannock, 2000 source
    • cites Halperin et al., 1993 source

      The Measures section describes using parent and teacher ratings alongside an actigraph, but does not explain why ratings might be preferred. A search of our copy for cost, ease of administration, and ecological validity found no passage comparing ratings with actigraphs on those grounds. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    The four DSM-5-TR hyperactivity items identified in Kofler et al. (2020) uniquely reflect excess motor movement rather than verbal intrusion/impulsivity.

    “the four DSM-5-TR hyperactivity items identified in the Kofler et al. (2020) bifactor study as uniquely reflecting excess motor movement (as opposed to verbal intrusion/impulsivity).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Kofler et al. (2020) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent clinical trials suggest that clinic-based actigraphy may be useful for assessing the comparative efficacy of psychosocial treatments for ADHD.

    “recent clinical trials suggest that clinic-based actigraphy maybe useful for assessing the comparative efficacy of psychosocial treatments for ADHD (Kofler et al., 2018; cf. Kofler et al., 2020).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Kofler et al., 2018 source

      The Method > Activity Level passage describes using actigraphs to measure children’s movement during cognitive tasks, and Method > Procedure describes neurocognitive testing sessions. Our copy does not address clinical trials or the use of clinic-based actigraphy to compare psychosocial treatment efficacy; searches for those terms found no supporting passage. Page numbers were not available. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites Kofler et al., 2020 source

      The Method (Objectively-measured Hyperactivity; page unavailable) describes laboratory-based actigraphy used to measure children's movement, and the Discussion (Clinical and Research Implications; page unavailable) suggests its potential utility in ADHD assessment. This paper does not report a clinical trial or assess actigraphy's usefulness for comparing the efficacy of psychosocial treatments; the sentence cites Kofler et al. (2018) for that trial-based point and offers this paper only as a comparison. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    In Sample 2, clinic-based actigraphy during visuospatial working memory testing with high cognitive demands was significantly associated with parent-rated hyperactivity, and this association was statistically indistinguishable from the parent-teacher association (r=.35).

    “latent path models indicated that clinic-based actigraphy during visuospatial working memory testing (high cognitive demands) demonstrated significant associations with both parent- and teacher-rated hyperactivity that were indistinguishable (p>.05) from parent and teacher ratings’s associations with each other in both sample 1 (r=.57) and sample 2 (r=.35; all p<.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In Sample 2, clinic-based actigraphy during visuospatial working memory testing with high cognitive demands was significantly associated with teacher-rated hyperactivity, and this association was statistically indistinguishable from the parent-teacher association (r=.35).

    “latent path models indicated that clinic-based actigraphy during visuospatial working memory testing (high cognitive demands) demonstrated significant associations with both parent- and teacher-rated hyperactivity that were indistinguishable (p>.05) from parent and teacher ratings’s associations with each other in both sample 1 (r=.57) and sample 2 (r=.35; all p<.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In Sample 1, clinic-based actigraphy during visuospatial working memory testing with high cognitive demands was significantly associated with parent-rated hyperactivity, and this association was statistically indistinguishable from the parent-teacher association (r=.57).

    “latent path models indicated that clinic-based actigraphy during visuospatial working memory testing (high cognitive demands) demonstrated significant associations with both parent- and teacher-rated hyperactivity that were indistinguishable (p>.05) from parent and teacher ratings’s associations with each other in both sample 1 (r=.57) and sample 2 (r=.35; all p<.001).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In both samples, actigraphy during baseline conditions with low cognitive demands uniquely predicted parent-rated hyperactivity at home.

    “Actigraphy during baseline (low cognitive demand) conditions also uniquely predicted hyperactivity at home and school in both samples (all p<.001), albeit with a less consistent yet robust pattern relative to parent/teacher associations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In Sample 1, clinic-based actigraphy during visuospatial working memory testing with high cognitive demands was significantly associated with teacher-rated hyperactivity, and this association was statistically indistinguishable from the parent-teacher association (r=.57).

    “latent path models indicated that clinic-based actigraphy during visuospatial working memory testing (high cognitive demands) demonstrated significant associations with both parent- and teacher-rated hyperactivity that were indistinguishable (p>.05) from parent and teacher ratings’s associations with each other in both sample 1 (r=.57) and sample 2 (r=.35; all p<.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The primary Tier 2 structural model including parent ratings, teacher ratings, baseline actigraphy, phonological WM actigraphy, and visuospatial WM actigraphy latents showed adequate fit in Sample 1, with all indicators loading significantly.

    “As shown in Table 3, the model showed adequate fit in Sample 1, with all indicators loading significantly onto their respective latent constructs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The initial two-factor model separating lower and higher working memory demands produced inadmissible results (e.g., intercorrelations >1.0) and was abandoned.

    “However, these models produced inadmissible results (e.g., intercorrelations greater than 1.0) and were therefore abandoned.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The primary 3-factor actigraph model (phonological WM, visuospatial WM, baseline) showed adequate fit in Sample 1, with all indicators loading significantly.

    “The primary actigraph model therefore included 3 factors for actigraphy during (a) phonological working memory testing, (b) visuospatial working memory testing, and (c) the baseline painting conditions. As shown in Table 2, this model showed adequate fit in Sample 1, with all indicators loading significantly onto their respective latent constructs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants who identified as White or reported higher maternal education were disproportionately represented relative to other racial identities and education levels.

    “participants that identified as White or reported higher maternal education (i.e., bachelor’s degree or higher) were disproportionally represented relative to other racial identities and education levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Actigraphy showed strong evidence of ecological validity, with the parent-teacher association statistically indistinguishable from both informants' associations with both actigraph latents across both samples, except for a smaller teacher ratings/phonological actigraphy association in Sample 1.

    “Similarly, actigraphy showed strong evidence of ecological validity, with the association between parent and teacher ratings being statistically indistinguishable from both informants’ associations with both actigraph latents across both samples, with the exception of a smaller teacher ratings/phonological actigraphy association in Sample 1.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The primary Tier 2 structural model findings were replicated in Sample 2 (all CFI/TLI ≥ .90, RMSEA < .10).

    “These findings were replicated in Sample 2 (all CFI/TLI ≥ .90, RMSEA < .10).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The model with separate parent and teacher hyperactivity ratings showed adequate fit in Sample 1, with all indicators loading significantly.

    “As shown in Table 2, the model with separate parent and teacher hyperactivity ratings showed adequate fit in Sample 1, with all indicators loading significantly onto their respective latent constructs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The pattern and interpretation of all findings remained unchanged in both samples with age and sex covaried, with correlation coefficients differing by no more than |r| = .01 (Sample 1) to .05 (Sample 2).

    “the pattern and interpretation of all findings remained unchanged in both samples with age and sex covaried, such that the correlation coefficients did not differ between the primary and exploratory analyses by more than |r| = .01 (Sample 1) to .05 (Sample 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In Sample 2, the association between parent and teacher ratings was statistically indistinguishable from their associations with actigraphy during all 3 clinic-based conditions (all r=.35), except for smaller associations between teacher ratings and actigraphy during phonological working memory testing (r=.21).

    “the association between parent and teacher ratings was statistically indistinguishable (Δχ2 [5] = −7.41, p=.99) from their associations with actigraphy during all 3 clinic-based conditions (all r=.35), with the exception of smaller associations between teacher ratings and actigraphy during phonological working memory testing (r=.21).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Task order was counterbalanced across testing sessions to reduce order effects.

    “All tasks were counterbalanced across testing sessions to minimize order effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Children received brief breaks after each task and longer preset breaks every two to three tasks to reduce fatigue.

    “Children received brief breaks after each task and preset longer breaks every 2–3 tasks to minimize fatigue.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Clinic-based actigraphy during working memory testing predicts real-world behavior at home and school as well as parent perceptions at home predict teacher perceptions at school, and vice versa.

    “This pattern supports the ecological validity of clinic-based actigraphy during working memory testing, which predicts real-world behavior at home and school just as well as parent perceptions of hyperactivity at home predict teacher perceptions of hyperactivity at school (and vice versa).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: No prior study has used latent modeling to compare clinic-based actigraphy and parent/teacher ratings head-to-head within the same sample, or replicated these estimates across independent samples.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Actigraphs placed at the same body site on the same person have estimated reliability from .90 to .99.

    “The estimated reliability for actigraphs placed at the same site on the same person ranges from .90 to .99 (Tryon et al., 1991).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Tryon et al., 1991 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study was not preregistered, but all decisions about measure inclusion and exclusion and the analytic plans were made before data access, except where noted.

    “The study was not pre-registered; however, all measure inclusion/exclusion decisions and analytic plans were made a priori, prior to accessing the data except as clearly noted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    Summing activity across three actigraph sites to create Total Hyperactivity Scores increases statistical power and broadly samples children's activity level.

    “This approach has the advantage of increasing power while providing a broad sampling of children’s activity level (Rapport et al. 2009; Soto et al., 2024).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Rapport et al. 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Soto et al., 2024 source

  • May combine two claims.

    Premisecitation

    Unstructured qualitative clinic assessment of a child's activity level corresponds weakly with naturalistic behavior, correctly identifying about 20% of children who meet full diagnostic criteria.

    “Further, prior evidence suggests that unstructured, qualitative assessment of a child’s activity level in a clinic setting such as a physician’s office corresponds weakly (correctly identifies approximately 20% of children meeting full diagnostic criteria) with their behavior in more naturalistic settings such as the home or at school (Sleator & Ullmann, 1981).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Sleator & Ullmann, 1981 source

  • May combine two claims.

    Premisecitation

    The K-SADS has well-established psychometric properties, including inter-rater agreement from .93 to 1.00, test-retest reliability from .63 to 1.00, and concurrent criterion validity with established parent rating scales.

    “Its psychometric properties are well established, including inter-rater agreement of .93 to 1.00, test-retest reliability of .63 to 1.00, and concurrent (criterion) validity between the K-SADS and psychometrically established parent rating scales (Kaufman et al., 1997).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kaufman et al., 1997 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Ratings from informants and objective actigraphy show low to moderate correlations, around .32 to .58.

    “Proponents embracing arguments concerning the enhanced ecological validity of rating scales over clinic-based options often cite evidence regarding the low to moderate correlations between informant ratings and objective actigraphy (r=.32-.58; Rapport, Kofler, & Himmerich, 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Rapport, Kofler, & Himmerich, 2006 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    An examiner stationed out of the child's view monitored performance to provide structure and reduce examiner demand characteristics.

    “Performance was monitored at all times by the examiner, who was stationed just out of the child’s view to provide a structured environment while minimizing improvements related to examiner demand characteristics (Gomez & Sanson, 1994).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gomez & Sanson, 1994 source

  • May combine two claims.

    Interpretationown data

    Clinic-based actigraphy provides robust test-retest reliability (r=.61-.93 across different working memory tests administered on different testing days) and concurrent validity (r=.35-.61 across tasks with high vs. low cognitive demands).

    “Thus, the most parsimonious conclusion is that clinic-based actigraphy provides robust test-retest reliability (r=.61-.93 across different working memory tests administered on different testing days) and concurrent validity (r=.35-.61 across tasks with high vs. low cognitive demands).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Actigraphy during clinic-based visuospatial working memory testing predicts real-world behavior at home and school just as well as parent perceptions of hyperactivity at home predict teacher perceptions of hyperactivity at school (and vice versa).

    “Stated differently, actigraphy during clinic-based visuospatial working memory testing predicts real-world behavior at home and school just as well as parent perceptions of hyperactivity at home predict teacher perceptions of hyperactivity at school (and vice versa).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Parent and teacher ratings reflect children's behavior in real-world settings.

  • May combine two claims.

    Study design and conductown data

    The two independent samples differed in inclusion criteria, demographics, and the extent to which demographics predicted hyperactivity.

    “First, the independent samples differed in several ways, including inclusion criteria, certain demographics, and the extent to which those demographics predicted hyperactivity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The smaller associations in Sample 2 likely reflect increased clinical heterogeneity of Sample 2 and increased quantity of indicators for each actigraph latent in Sample 1.

    “which likely reflects the increased clinical heterogeneity of Sample 2 as well as the increased quantity of indicators for each actigraph latent in Sample 1.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Actigraphy during phonological working memory and baseline conditions also showed ecological validity evidence, though sometimes with smaller associations than the parent/teacher benchmark.

    “Actigraphy during phonological working memory testing and our baseline conditions also showed ecological validity evidence; however, in some cases, the magnitude of these associations was somewhat smaller than our criterion parent/teacher benchmark.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The DSM-5-TR explicitly notes that traditional neuropsychological tests are not useful for ADHD diagnosis.

    “the DSM-5-TR explicitly notes are not useful for ADHD diagnosis (APA, 2022; Rapport et al., 2001).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites APA, 2022

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Rapport et al., 2001 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Face validity likely does not enhance ecological validity.

    “despite evidence that face validity likely does not enhance ecological validity (Ziemnik & Suchy, 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ziemnik & Suchy, 2019 source

  • May combine two claims.

    Interpretationown data

    Actigraphy during clinic-based testing is superior to, or equivalent with, parent and teacher hyperactivity ratings in terms of consistency across sessions and types of activities.

    “Taken together, these findings indicate that actigraphy during clinic-based testing is superior to, or equivalent with, parent and teacher hyperactivity ratings in terms of consistency across sessions and types of activities.”
    Quote in the paperSubstantial claim
38 of 38

  • The paper relies on this without support.

    No prior study has used latent modeling to compare clinic-based actigraphy and parent/teacher ratings head-to-head within the same sample, or replicated these estimates across independent samples.

    “However, to our knowledge, no study to date has used latent modeling to compare these estimates head-to-head within the same sample – let alone replicated these estimates across independent samples.”

  • The paper relies on this without support.

    Nationally representative norms for actigraphy during criterion tests are not currently available.

    “nationally representative norms (during criterion tests) are not currently available”

  • The paper relies on this without support.

    Parent and teacher ratings reflect children's behavior in real-world settings.

    “informant ratings were the apt comparison given that they are considered to reflect behavior in real-world settings”

  • The paper relies on this without support.

    Actigraphy during working memory tasks measures hyperactivity.

    “objective measurement of hyperactivity in the clinic (i.e., via actigraphy)”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Discussion gives different mean ages for both samples

    Minor

    The discussion reports mean ages of 9.4 and 10.2 years, but the participant descriptions report 9.63 and 10.40 years. Neither pair agrees at the stated precision.

  • Age associations are described as having opposite directions

    Minor

    The limitations section says the age associations differed in direction across samples. The sensitivity results instead give negative age coefficients in both samples: older children had lower, not higher, measured hyperactivity where associations were significant.

  • Sample 1 mean age differs between the abstract and Methods

    Minor

    The abstract gives Sample 1's mean age as 9.2 years, whereas the participant description gives 9.63 years. These cannot be the same mean rounded to one decimal place.

  • Reported cross-method correlation range excludes a reported result

    Minor

    The discussion summarizes cross-method correlations as .35-.57, but the Sample 2 results report a teacher-rating/phonological-actigraphy correlation of .21.

  • Discussion understates Sample 2's age range

    Minor

    The limitations section says both samples were aged 8-12, but the participant description gives an 8-13 range for Sample 2.

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Cibrian, E., Padron, C., Bruce, A., Cho, S., Tatsuki, Patron, B., Geren, M. M. O., Irwin Harper, L. N., & Kofler, M.J. (2025, January). Examining objectively-measured motor activity among children with and without ADHD and GAD. [Poster presentation]. The American Professional Society of ADHD and Related Disorders (APSARD), Annual Conference, San Diego, CA, United States.
  2. Faust, D., Arkes, H. R., & Gaudet, C. E. (2024). Applying decision research to improve clinical outcomes, psychological assessment, and clinical prediction. Oxford University Press.
  3. Kaufman, A. S., & Kaufman, N. L. (2014). Technical & interpretive manual: Kaufman Test of Educational Achievement (3rd ed.). NCS Pearson.

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Related

Authors
Kofler, M. J., Soto, E. F., Rapport, M. D., & Whitehead, S.
Affiliations
  • Florida State University (US)
  • Louisiana State University (US)
  • University of Central Florida (US)
Corresponding author
Kofler, Michael J.
ORCID
Venue
Journal of Psychopathology and Behavioral Assessment
Publisher
Springer Science and Business Media LLC
Published
2025-05-31
Volume
47
Issue
2
ISSN
  • 0164-0305 (ISSN-L)
  • 0882-2689
  • 1573-3505
DOI
10.1007/s10862-025-10218-8
PMC
PMC12380012
OpenAlex
W4410918047
Semantic Scholar
85ce9859a1f7c9d0c3552f47f7898ca0a2e62f75
Cited by
2
References
76
Citations by year
2026: 2
FWCI
1.30
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Psychopathology and Behavioral Assessment (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institute of Mental Health (R01MH125893)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
  • Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
Keywords
actigraphy, ecological validity, hyperactivity, attention deficit hyperactivity disorder, children, visuospatial working memory, cognitive demand, parent ratings

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