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

基于诊所的活动记录仪评估临床评估的患有和未患有注意力缺陷多动障碍(ADHD)儿童多动症的生态效度

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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; M (ages) =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).

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