Demographic Factors Relate to Autism Diagnostic Certainty: Implications for Enhancing Equitable Diagnosis Among Youth.

OBJECTIVE: Autism diagnosis is fraught with inequities, including misdiagnosis and delayed identification that disproportionately affect minoritized youth. Aspects of clinician decision-making, particularly diagnostic certainty, may contribute to these inequities. Little is known about how closely clinician certainty corresponds with autistic traits, nor whether certainty relates to socio-demographic factors. METHOD: Autistic youth from the Simons Simplex Collection (N = 2,853) completed assessments after which clinicians rated how certain they were that the child met autism diagnostic criteria. Core clinical factors included clinician-observed (Autism Diagnostic Observation Schedule; ADOS) and parent-reported autistic traits (Social Communication Questionnaire), and an overall IQ score. RESULTS: Clinician certainty was moderately positively associated with parent-reported and observed autistic traits and was just as strongly negatively associated with IQ. Socio-demographic factors significantly associated with certainty, even accounting for clinical measures. Lower income and older child age related to less certainty. In contrast, clinicians rated higher certainty for youth identified as Hispanic, Black or African American, or Asian. Race and income also moderated the concordance between certainty with clinical factors. The agreement between higher ADOS scores and higher certainty was significantly weaker for lower-income families. The association between lower IQ and higher certainty was non-significant for Asian youth. CONCLUSIONS: Diagnostic certainty ratings do not necessarily correspond closely with the level of autistic traits, and clinician perception of autism diagnosis may be related to demographic factors. Caution is needed when relying on clinician certainty to inform diagnosis. Future research on diagnostic practices is urgently needed among diverse and minoritized communities.

Focusing Narrowly on Model Fit in Factor Analysis Can Mask Construct Heterogeneity and Model Misspecification: Applied Demonstrations across Sample and Assessment Types.

This study builds upon research indicating that focusing narrowly on model fit when evaluating factor analytic models can lead to problematic inferences regarding the nature of item sets, as well as how models should be applied to inform measure development and validation. To advance research in this area, we present concrete examples relevant to researchers in clinical, personality, and related subfields highlighting two specific scenarios when an overreliance on model fit may be problematic. Specifically, we present data analytic examples showing that focusing narrowly on model fit may lead to (a) incorrect conclusions that heterogeneous item sets reflect narrower homogeneous constructs and (b) the retention of potentially problematic items when developing assessment measures. We use both interview data from adult outpatients (N = 2,149) and self-report data from adults recruited online (N = 547) to demonstrate the importance of these issues across sample types and assessment methods. Following demonstrations with these data, we make recommendations focusing on how other model characteristics (e.g., factor loading patterns; carefully considering the content and nature of factor indicators) should be considered in addition to information provided by model fit indices when evaluating factor analytic models.

Observational measures of early irritability predict children's psychopathology risk.

Irritability is a transdiagnostic feature of diverse forms of psychopathology and a rapidly growing literature implicates the construct in child maladaptation. However, most irritability measures currently used are drawn from parent-report questionnaires not designed to measure irritability per se; furthermore, parent report methods have several important limitations. We therefore examined the utility of observational ratings of children's irritability in predicting later psychopathology symptoms. Four-hundred and nine 3-year-old children (208 girls) completed observational tasks tapping temperamental emotionality and parents completed questionnaires assessing child irritability and anger. Parent-reported child psychopathology symptoms were assessed concurrently to the irritability assessment and when children were 5 and 8 years old. Children's irritability observed during tasks that did not typically elicit anger predicted their later depressive and hyperactivity symptoms, above and beyond parent-reported irritability and context-appropriate observed anger. Our findings support the use of observational indices of irritability and have implications for the development of observational paradigms designed to assess this construct in childhood.

Validity of the DSM-5 anxious distress specifier for major depressive disorder.

BACKGROUND: DSM-5 introduced the anxious distress specifier in recognition of the clinical significance of anxiety in depressed patients. Recent studies that supported the validity of the specifier did not use measures that were designed to assess the criteria of the specifier but instead approximated the DSM-5 criteria from scales that were part of an existing data base. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the validity of the specifier diagnosed with a semistructured interview. METHODS: Two hundred sixty patients with a principal diagnosis of major depressive disorder were evaluated with semistructured diagnostic interviews. The patients were rated on clinician rating scales of depression, anxiety and irritability, and completed self-report measures. RESULTS: Approximately three-quarters of the depressed patients met the criteria for the anxious distress specifier. Patients with anxious distress had a higher frequency of anxiety disorders, particularly panic disorder and generalized anxiety disorder, as well as higher scores on measures of anxiety, depression, and anger. The patients meeting the anxious distress subtype reported higher rates of drug use disorders, poorer functioning during the week before the evaluation, and poorer coping ability compared to the patients who did not meet the anxious distress specifier. Moreover, anxious distress was associated with poorer functioning and coping after controlling for the presence of an anxiety disorder. CONCLUSIONS: The results of the present study indicate that anxious distress is common in depressed patients and support the validity of the DSM-5 anxious distress specifier.

Unique and shared features of narcissistic and antisocial personality disorders: Implications for assessing and modeling externalizing traits.

OBJECTIVES: We aimed to determine which, if any, features distinguish antisocial and narcissistic personality disorders (ASPD and NPD), two overlapping externalizing disorders. METHODS: A large sample of outpatients (N = 2,149) completed interview measures assessing personality pathology, other psychopathology, and impairment. The structure of antisocial and narcissistic traits was examined using both exploratory bifactor and traditional exploratory factor analytic approaches, and we examined relations for our emergent factors. RESULTS: Factor analytic results indicated that most narcissistic and antisocial traits were strongly overlapping, although some features emerged as relatively distinct (e.g., arrogance defining NPD). Factors modeling our specific bifactor dimensions showed very weak psychopathology and impairment relations. CONCLUSIONS: The structure of ASPD and NPD traits does not align neatly with Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Section II conceptualizations, Regardless of the factor analytic approach used. Our findings also indicate that specific dimensions defining these PDs show modest predictive power after accounting for a general externalizing dimension.

An Examination of the Structure and Construct Validity of the Wender Utah Rating Scale.

The Wender Utah Rating Scale (Ward, Wender, & Reimherr, 1993 ) has been widely used in adult attention-deficit/hyperactivity disorder (ADHD) research to assess childhood symptoms retrospectively, but little research has examined its factor structure and specificity in predicting ADHD versus other psychopathology. Consequently, this study had 2 goals: (a) to examine the Wender Utah Rating Scale's structure, and (b) to explicate the construct validity of this measure by relating factors from our structural analyses to other ADHD, psychopathology, and personality measures. Structural analyses in an adult community sample (N = 294) yielded a 3-factor structure of aggression (e.g., angry), internalizing distress (e.g., depressed), and academic difficulties (e.g., underachiever). Correlational and regression analyses indicated that these factors failed to display specificity in their associations with ADHD versus other psychopathology. Aggression and internalizing distress associated most strongly with indicators of externalizing (e.g., ill temper, manipulativeness) and internalizing psychopathology (e.g., depression, anxiety), respectively. Academic difficulties associated most strongly with ADHD symptoms, but these relations were relatively weak. Taken together, these findings raise concerns about the Wender Utah Rating Scale's construct validity, although additional longitudinal research is needed to clarify to what extent the Wender Utah Rating Scale validly assesses childhood ADHD symptoms.

Negative Mood Dysregulation Loads Strongly Onto Common Factors With Many Forms of Psychopathology: Considerations for Assessing Nonspecific Symptoms.

There have been proposals to expand definitions for categorical disorders and dimensionally conceptualized syndromes (e.g., psychopathy) to include negative mood lability and dysregulation (NMD). Factor analytic results are often presented in support of these proposals, and we provide factor analytic demonstrations across clinically oriented samples showing that NMD indicators load strongly onto factors with a range of psychopathology. This is unsurprising from a transdiagnostic perspective but shows that factor analysis could potentially be used to justify expanding definitions for specific constructs even though NMD indicators show strong, nonspecific loadings on psychopathology factors ranging widely in nature. Expanding construct definitions and assessment approaches to emphasize NMD also may negatively impact discriminant validity. We agree that targeting NMD is essential for comprehensive assessment, but our demonstrative analyses highlight a need for using factor analysis and other statistical methods in a careful, theoretically driven manner when evaluating psychopathology structure and developing measures.

Principles and procedures for revising the hierarchical taxonomy of psychopathology.

Quantitative, empirical approaches to establishing the structure of psychopathology hold promise to improve on traditional psychiatric classification systems. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a framework that summarizes the substantial and growing body of quantitative evidence on the structure of psychopathology. To achieve its aims, HiTOP must incorporate emerging research in a systematic, ongoing fashion. In this article, we describe the historical context and grounding of the principles and procedures for revising the HiTOP framework. Informed by strengths and shortcomings of previous classification systems, the proposed revisions protocol is a formalized system focused around three pillars: (a) prioritizing systematic evaluation of quantitative evidence by a set of transparent criteria and processes, (b) balancing stability with flexibility, and (c) promoting inclusion over gatekeeping in all aspects of the process. We detail how the revisions protocol will be applied in practice, including the scientific and administrative aspects of the process. Additionally, we describe areas of the HiTOP structure that will be a focus of early revisions and outline challenges for the revisions protocol moving forward. The proposed revisions protocol is designed to ensure that the HiTOP framework reflects the current state of scientific knowledge on the structure of psychopathology and fulfils its potential to advance clinical research and practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The folk psychiatry model: Developing a measure of lay perceptions of PTSD.

Whereas existing data verify the importance of support networks in facilitating resilience following trauma, the sociocultural perceptions of posttrauma difficulties that provide context for these interactions remain largely unexplored. Folk psychiatry models propose that lay explanations of mental illness can be quantified along distinct moralizing, medicalizing, and psychologizing dimensions. The current project aimed to develop a trauma-specific measure capturing lay explanations of posttraumatic stress disorder (PTSD) based on this framework. Data were collected from three samples of Mechanical Turk respondents (N1 = 367; N2 = 365; N3 = 401) as well as an independent sample of university students (N4 = 311). Factor analysis of the final, 13-item Folk Psychiatry Measure-PTSD (FPM-P) indicated close fit of a correlated three-factor model in MTurk and student respondents. Across samples, moralizing beliefs about PTSD (e.g., people with PTSD lack a moral compass) evidenced moderate-to-strong correlations with general attitudes toward those with mental illness, including positive associations with authoritarianism, social restrictiveness, blame, anger, and perceived dangerousness. Negative associations with benevolence and support for community-based care were also noted. Medicalizing beliefs (e.g., PTSD is caused by a chemical imbalance) demonstrated more modest associations with negative attitudes, as noted through weak correlations with increased authoritarianism, anger, and lower benevolence toward those experiencing psychological difficulties. Finally, psychologizing explanations (e.g., people with poor relationships and low social support are at greater risk of developing PTSD) evidenced weak but positive associations with benevolence and pity for those with mental health concerns. Implications and cultural-based nuances of the scale are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Bridge Between DSM-5 Section II Personality Disorder Criteria and ICD-11 Personality Disorder Trait Domains.

The organization of personality pathology into trait domains (vs. specific disorders) in ICD-11 represents an important shift in personality disorder (PD) nosology. However, to facilitate clinical implementation, a bridge is needed between this system and the DSM-5 Section II system familiar to many researchers and clinicians. In this study, individual DSM-5 PD criteria were assigned to ICD-11 trait domains based on the published Clinical Descriptions and Diagnostic Requirements. This scoring scheme was examined empirically alongside DSM-5 PD dimensions (using SIDP ratings from the MIDAS project; N = 2,147 outpatients) in terms of descriptive properties and relations with psychosocial morbidity and functioning. Most PD criteria could be matched to at least one ICD-11 trait domain, indicating considerable cross-system continuity. However, points of incongruity are noteworthy for research and clinical applications. Results provide key information for bridging categorical and dimensional frameworks, indicating that the shift toward trait-based PD models need not be as disruptive as feared.

An Initial Investigation of the Joint Classification of Hypomania- and Neurodevelopmental Disorder-Relevant Dimensions Within the Hierarchical Taxonomy of Psychopathology.

We examined hierarchical structural models of psychopathology in samples of (a) adults recruited online and screened based on psychopathology history (N = 429) and (b) undergraduates (N = 529) to inform classification of neurodevelopmental disorder (NDD)- and hypomania-relevant dimensions within the Hierarchical Taxonomy of Psychopathology (HiTOP). Results differed across samples in some ways, but converged to indicate that some NDD- and hypomania-relevant dimensions aligned closely with different HiTOP spectra. For example, some hypomania-relevant dimensions (e.g., affective lability) overlapped strongly with the internalizing spectrum, whereas others (e.g., self-perceived charisma) were reverse-indicators of detachment. Examination of cross-sectional and prospective correlates for emergent factors also was informative in some ways. This included NDD-relevant and disinhibited externalizing dimensions associating robustly with treatment seeking history and recent experiences of distress. These results provide initial insights into classifying NDD- and hypomania-relevant dimensions within the HiTOP and indicate a need for future research in this area.

Discrete emotions and global affect: Applying empirically driven approaches to experience sampling data to model state and trait affective structure and affect-alcohol use associations in a heavy drinking young-adult sample.

Affective functioning is central to most contemporary models of alcohol use. However, the affective structure at the within- and between-person levels is rarely investigated nor is the differential predictive value of specific affect dimensions assessed across state and trait formats. We examined a) the structure of state and trait affect using experience sampling methodology (ESM) and b) predictive associations between the empirically derived affect facets and alcohol use. Participants were 92 heavy drinking college students aged 18-25 who completed 8 momentary assessments of their affect and drinking a day for 28-days. We found evidence for a single positive affect factor at both the within- (i.e., state) and between-person (i.e., trait) levels. We found a hierarchical factor structure for negative affect, represented by a general, superordinate dimension as well as facet-level sadness, anxiety, and anger dimensions. Associations between affect and alcohol use differed across trait and state levels and across specific types of negative affect. Lagged state positive affect and sadness as well as trait positive affect and sadness were inversely associated with drinking. Lagged state anxiety and trait general negative affect were positively associated with drinking. Thus, our study demonstrates how associations between drinking and affect can be studied in relation to general (e.g., general negative affect) and more specific aspects of affective experiences (e.g., sadness versus anxiety) concurrently within the same study and across trait and state levels of assessment.

The Predictive Validity of Consensual and Unique Facets of Neuroticism, Conscientiousness, and Agreeableness in Five Personality Inventories.

Consensual facet structures help to unify a highly fractured personality literature, but mask information obtained from unique personality facets assessed by individual personality inventories. The current study identifies the consensual and unique facets of neuroticism, conscientiousness, and agreeableness based on analyses of five widely used personality inventories (Disinhibition Inventory-I [DIS-I], Faceted Inventory for the Five-Factor model [FI-FFM], HEXACO Personality Inventory-Revised [HEXACO-PI-R], NEO Personality Inventory-3 [NEO-PI-3], and Temperament and Affectivity Inventory [TAI]) in a community sample (N = 440). Factor analyses revealed that neuroticism consisted of three consensual facets (distress/depression, anger, and sentimental anxiety) and four unique facets (shyness, regret/self-doubt, lassitude, and distractibility); conscientiousness consisted solely of four consensual facets (achievement striving, order, attentiveness, and responsibility); and agreeableness consisted solely of four consensual facets (prosociality, anger, venturesomeness, and trust). Regression analyses indicated that unique neuroticism facets predicted significant incremental variance across a range of psychological disorders. These results have significant implications for how neuroticism, conscientiousness, and agreeableness should be modeled at the lower order level in psychopathology research.

Total cortisol output during an acute stressor predicts youths' internalizing symptoms during the COVID-19 pandemic.

Individual differences in cortisol output may influence adolescents' adjustment to the COVID-19 pandemic; however, boys and girls may differ in terms of associations between cortisol output and internalizing symptoms in the context of COVID-19-related stress. We examined whether pre-pandemic cortisol output during an acute stressor, assessed approximately three years prior to the pandemic, predicted change in adolescents' internalizing symptoms early during the COVID-19 pandemic. Consistent with previous work on other life stressors, girls' cortisol output was positively associated with anxious and somatic symptoms early in the pandemic. Conversely, cortisol output and depressive symptoms were negatively associated for boys; boys with higher cortisol had depressive symptoms which significantly decreased over time. Findings suggest that hypothalamic-pituitary-adrenal axis stress functioning plays a role in shaping differences between adolescent boys' and girls' adjustment during the experience of a ubiquitous chronic stressor.

Assessing the dominance behavioral system in early childhood using observational methods.

BACKGROUND: The dominance behavioral system (DBS) is a biologically based system that underpins individual differences in motivation for dominance and power. However, little is known about the DBS in childhood. In order to make strong claims about the DBS's trait-like properties and predictive validity, a clearer understanding of its early development is required. PARTICIPANTS AND PROCEDURE: In a pilot study aimed at developing a behavioral coding system for dominance, a key facet of the DBS, we collected and coded observational data from 58 children, assessed at ages 3 and 5-6. These data were examined in conjunction with measures of child temperament via observational measures, and symptoms of psychopathology. RESULTS: Dominance was moderately stable in early childhood to a degree comparable to other early child temperament traits. Consistent with the study hypotheses, boys were more dominant than girls, and dominance was negatively associated with children's behavioral inhibition, effortful control, and internalizing symptoms. CONCLUSIONS: These results provide initial support for the validity and developmental sensitivity of an objective coding system for assessing facets of the DBS in early childhood. Ultimately, the use of this coding system will facilitate future studies of how early DBS predicts psychological adjustment later in life.

A multisample demonstration of using the prolific platform for repeated assessment and psychometric substance use research.

The Prolific platform offers a potentially useful and efficient crowdsourcing option for repeated assessment substance use research, including for psychometric research requiring large samples. We present both (a) a series of practical recommendations for using Prolific and (b) data from multiple samples demonstrating Prolific's potential for efficiently collected repeated measures data. First, we present data from a 5-day daily diary protocol. We recruited a large sample (N = 321 at Day 1) screened for a history of self-identified mental health issues and weekly alcohol use. Participant adherence was good (82%) even without in-person contact. Alcohol use patterns conformed to theoretical expectations: Participants were more likely to drink on Fridays and Saturdays than other days, men drank more than women, and higher Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) scores were associated with an increased likelihood of use and more overall drinking on a given day. Second, we present data from 429 Prolific participants screened for a history of mental health issues who completed assessments 2 weeks apart with strong retention (N = 377; 88%). We compare these data with the data from undergraduates (N = 529) to demonstrate Prolific's utility for conducting psychometrically oriented substance use research. Internal consistency estimates for measures from the Prolific data matched or exceeded those from the undergraduate data. Furthermore, measure scores showed strong temporal stability, and factor structures (e.g., AUDIT item-level structures) conformed to theoretical expectations. Collectively, these findings indicate that Prolific can be used successfully for repeated measures data collection. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Development and Preliminary Validation of the Pandemic Avoidance and Concern Scales (PACS).

The COVID-19 pandemic has led to radical disruptions to the routines of individuals and families, but there are few psychometrically assessed measures for indexing behavioural responses associated with a modern pandemic. Given the likelihood of future pandemics, valid tools for assessing pandemic-related behavioral responses relevant to mental health are needed. This need may be especially salient for studies involving families, as they may experience higher levels of stress and maladjustment related to school and business closures. We therefore created the Pandemic Avoidance and Concern Scales (PACS) to assess caregivers' and youths' adjustment to COVID-19 and future pandemics. Concern and Avoidance factors derived from exploratory factor analyses were associated with measures of internalizing symptoms, as well as other indices of pandemic-related disruption. Findings suggest that the PACS is a valid tool for assessing pandemic-related beliefs and behaviors in adults and adolescents. Preliminary findings related to differential adjustment between caregivers and youths are discussed.

Examining the Item-Level Structure of the Triarchic Psychopathy Measure: Sharpening Assessment of Psychopathy Constructs.

The Triarchic Psychopathy Measure (TriPM) has emerged as a widely used measure for assessing a three-trait model of disinhibition, meanness, and boldness. Building on recent psychometric work, we examined the TriPM's item-level factor structure and correlates in both a clinically oriented community sample (n = 700) and in undergraduates (n = 527). Our results indicated a replicable three-factor structure generally corresponding with disinhibition, meanness, and boldness, although many items were not clear indicators of their assigned TriPM domain scales. Consequently, these dimensions may be better represented by Alternate Disinhibition (14 items), Boldness (13 items), and Meanness (8 items) domain scales. Additionally, we identified sets of items defining distinct Self-Assurance and Fearlessness dimensions within Boldness and Irresponsibility and Impulsivity dimensions within Disinhibition. We discuss these findings in the context of other recent studies examining the TriPM's item-level structure, highlighting key future directions for sharpening measurement of the externalizing spectrum.

Examining the Criterion Validity and Diagnostic Specificity of Self-Report Measures of Narcissism and Mania.

We examined the validity of self-report measures of narcissism and mania by relating them to interview-based ratings of psychopathology. Narcissism scales were taken from the Narcissistic Personality Inventory (NPI), the Personality Diagnostic Questionnaire-4+, and the Short Dark Triad. Mania measures included the Altman Self-Rated Mania Scale (ASRM) and scales taken from the Hypomanic Personality Scale (HPS) and Expanded Version of the Inventory of Depression and Anxiety Symptoms. Our analyses addressed two key issues. The first issue was whether these scales demonstrated significant criterion validity (e.g., whether the HPS scales correlated significantly with interview ratings of mania). The second issue was whether they displayed specificity to their target constructs (e.g., whether the NPI scales correlated more strongly with ratings of narcissistic personality disorder than with other forms of psychopathology). All of the narcissism scales-including all three NPI subscales-correlated significantly with interview ratings of narcissistic personality disorder and showed considerable evidence of diagnostic specificity. Most of the mania scales also displayed good criterion validity and diagnostic specificity. However, two measures-the ASRM and the HPS Social Vitality subscale-had weak, nonsignificant associations with interview ratings of manic episodes; these findings raise concerns regarding their validity as specific indicators of mania.

Informing the classification and assessment of positive emotional experiences: A multisample examination of hierarchical positive emotionality models.

Despite being multifaceted in nature, positive emotional (PE) experiences often are studied using only global PE ratings, and measures assessing more specific PE facets do not converge in their assessment approaches. To address these issues, we examined hierarchical factor structures of ratings of positive emotionality, which reflect propensities toward experiencing PE, in both online community adult (N = 375) and undergraduate (N = 447) samples. Preregistered analyses indicated (a) a broad distinction between tendencies to experience social affection and other PE types, and that (b) PE ratings can be differentiated by as many as four replicable factors of Joviality, Social Affection, Serenity, and Attentiveness. These PE dimensions were associated with distinct personality and psychopathology profiles. Examples of these distinctive associations included Joviality displaying robust positive associations with grandiosity and exhibitionism; conversely, although Social Affection and Joviality were strongly correlated, Social Affection showed associations in the opposite direction with grandiosity and exhibitionism. Other notable results include Serenity (e.g., feeling relaxed) showing negative associations with negative emotionality at a magnitude indicating that Serenity may reflect low levels of negative emotionality to a considerable degree. Collectively, these results highlight the need to consider distinct PE facets in addition to global PE ratings when assessing PE, as important nuance may be lost otherwise. Furthermore, our results indicate the need for additional research clarifying PE structure at different levels of abstraction to inform future measure development efforts and assessment approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).