Rethinking hyperactivity in pediatric ADHD: Preliminary evidence for a reconceptualization of hyperactivity/impulsivity from the perspective of informant perceptual processes.
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= 1.51; 47 girls; 67% White/non-Hispanic). The current DSM hyperactivity/impulsivity item pool can be reliably reclassified by knowledgeable judges into items reflecting excess physical movement (visual hyperactivity) and auditory interruptions (verbal intrusion). This bifactor structure showed evidence for multidimensionality and superior model fit relative to traditional hyperactivity/impulsivity models. The resultant visual hyperactivity factor was reliable, replicable, and showed strong convergent validity evidence via associations with objectively assessed hyperactivity. The verbal intrusion factor also showed evidence for reliability and explained a substantive portion of reliable variance, but demonstrated lower estimated replicability. These findings provide preliminary support for conceptualizing ADHD symptoms from the perspective of their cognitive-perceptual impact on others, as well as differentiating excess physical movement (hyperactivity) from other behaviors assessed under the hyperactivity/impulsivity umbrella. "Verbal intrusion" appears to provide a better explanation than "impulsivity" for the reliable, non-hyperactivity variance assessed by these items, but the current item set appears insufficient for replicable measurement of this construct. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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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).”
From Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD (2025) · cites this paper as Kofler et al., 2020
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 measuredKofler et al. (2020) provided strong empirical support for estimating children's hyperactivity from DSM-5 visual hyperactivity symptoms alone rather than from a combination of hyperactivity and impulsivity items.
“Beyond the definitional issue, the Kofler et al. (2020) study addressed the second of these concerns, and provided robust empirical support for using DSM-5 visual hyperactivity symptoms alone, rather than a combination of hyperactivity and impulsivity (verbal intrusiveness) items, to estimate hyperactivity in children.”
From Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD (2025) · cites this paper as Kofler et al., 2020
The Results (Tier 2a) report strong support for a visual-hyperactivity factor and better fit than traditional combined hyperactivity/impulsivity models. But the Method (Bifactor-(s-1) Models) says the preferred factor was estimated using all items, with verbal-intrusion items also loading on a separate factor; the study did not establish that visual-hyperactivity items alone should be used to estimate hyperactivity. The Discussion describes the findings as a proof-of-concept first step. (LLM, conf=0.84)
Experimental — accuracy not yet measuredParent 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).”
From Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD (2025) · cites this paper as Kofler et al., 2020
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 measuredRecent 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).”
From Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD (2025) · cites this paper as Kofler et al., 2020
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 measuredThe 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).”
From Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD (2025) · cites this paper as Kofler et al., 2020
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).”
From Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD (2025) · cites this paper as Kofler et al., 2020
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).”
From Ecological Validity of Clinic-Based Actigraphy for Assessing Hyperactivity in Clinically Evaluated Children with and without ADHD (2025) · cites this paper as Kofler et al. (2020)
It is tenuous-if not scientifically indefensible-to reify any single test as measuring any single executive function.
“Stated bluntly, it is tenuous — if not scientifically indefensible — to reify any single test as measuring any single executive function.53,150”
From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [150]
The Method (Objectively-measured Hyperactivity; page unavailable) mentions working-memory tasks and executive processes, while the Method (Data Analysis Overview; page unavailable) concerns the validity of ADHD symptom-rating factors. Neither addresses whether a single test can measure a single executive function. Searches for single-test measurement, executive functions, and task impurity found no passage making the attributed point. (LLM, conf=0.76)
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Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder
Kofler, M. J., Soto, E. F., Singh, L. J., Harmon, S. L., Jaisle, E. M., Smith, J. N., Feeney, K. E., & Musser, E. D. (2024) · Nature Reviews Psychology · doi:10.1038/s44159-024-00350-9 · Cited by 51 · see citing works
“By contrast, the same overall test scores in children with ADHD might be related to action-cancellation processes (stopping an in-progress behaviour) that, in turn, predict impulsive or verbally intrusive behaviours 150 .”
Self-citationKofler, M. J., Soto, E. F., Rapport, M. D., & Whitehead, S. (2025) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-025-10218-8 · Cited by 2 · see citing works
Self-citation
- Authors
- Kofler, M. J., Groves, N. B., Singh, L. J., Soto, E. F., Chan, E. S. M., Irwin, L. N., & Miller, C. E.
- Affiliations
- Florida State University (US)
- ORCID
- Venue
- Psychological Assessment
- Published
- 2020-08
- Volume
- 32
- Issue
- 8
- Pages
- 752-767
- ISSN
- 1040-3590 (ISSN-L)
- 1939-134X
- PMC
- PMC7394731
- OpenAlex
- W3031894906
- Cited by
- 13
- References
- 56
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 2 · 2021: 2
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Assessment (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R34 MH102499-01; R01 MH115048)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- attention deficit hyperactivity disorder, hyperactivity/impulsivity, hyperactivity, impulsivity, bifactor model, convergent validity, measurement reliability
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Cognition, Factor Analysis, Statistical, Female, Humans, Hyperkinesis, Impulsive Behavior, Male, Perception, Psychiatric Status Rating Scales, Psychomotor Agitation, Reproducibility of Results, Actigraphy
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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