Nuanced Approaches in ADHD, Eating Disorders, and Psychometrics
Profiles Within ADHD and Hidden Internalizing Challenges
This week, psychological assessment research shed light on the complex interplay between attention-deficit/hyperactivity disorder (ADHD) and co-occurring internalizing psychopathologies among adults. A recent study using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) examined clinical profiles across groups, including ADHD alone, ADHD combined with internalizing disorders like anxiety or depression, internalizing disorders alone, and subjective attention complaints without diagnosis.
Key findings revealed that while cognitive complaints were elevated across all ADHD and attention complaint groups, it was the presence of internalizing psychopathology that produced marked elevations in emotional dysfunction scales. This suggests that the MMPI-3 may be particularly useful in differentiating pure attentional concerns from those complicated by internal distress. Furthermore, distinctions between ADHD subtypes—primarily inattentive versus combined presentations—were also supported by differences on behavioral problem scales.
For school psychologists and clinicians, these findings emphasize the need for a comprehensive assessment that captures not only attention symptoms but also emotional and behavioral functioning. When internalizing symptoms co-occur with ADHD, intervention planning must be tailored to address this multifaceted clinical picture rather than focusing narrowly on attentional issues alone.
Unpacking Eating Disorder Measures in Type 1 Diabetes
In another domain of school and clinical psychology intersecting with health, the assessment of eating disorders in adults with Type 1 diabetes (T1D) remains a challenge. The Diabetes Eating Problems Survey-Revised (DEPS-R) is widely used, but, as highlighted in recent item response theory (IRT) research, some items may conflate diabetes management behaviors with disordered eating symptoms. The study analyzed item difficulty and discrimination properties, revealing that several items commonly endorsed even by individuals with low pathology contribute little information for detecting disordered eating behavior (DEB). Conversely, items indicative of severe symptoms, such as inducing vomiting, were so rarely endorsed that their utility in screening was modest. The most informative items were those capturing high-severity symptoms, with moderate discrimination.
This nuanced analysis suggests the DEPS-R requires refinement to improve its precision and reduce false positives tied to diabetes management struggles rather than true psychopathology. For practitioners in school and medical psychology, the takeaway is clear: screening tools must be sensitive to the specific context of chronic illness to accurately identify behavioral risks and avoid overpathologizing normative self-care behaviors.
Toward Continuums in Measurement: Beyond Binary Classifications
A third piece of research addressed a foundational psychometric issue relevant across psychological measurement: how we categorize response scales. Traditional classification treats polytomous item responses as either nominal (unordered categories) or ordinal (ordered categories), but this binary view oversimplifies what may instead be a spectrum of “orderedness.” The authors proposed six indices to quantify the degree to which item categories exhibit order, rather than assuming all are strictly ordinal or nominal. Their tests applying these indices across numerous datasets demonstrated that parametric indices reliably capture gradations in category ordering, even when some categories have few responses.
This conceptual advance encourages researchers and practitioners to reconsider how measurement tools are constructed and interpreted. Recognizing ordering as a continuum rather than a yes/no property can improve model fit, the validity of inferences drawn from scales, and ultimately the precision of psychological assessment.
Looking Ahead: Embracing Complexity for Better Practice
Together, these studies echo a broader movement toward greater sophistication in psychological assessment and measurement. Whether parsing the nuanced profiles of ADHD and co-occurring disorders, refining instruments for eating disorders in specialized populations, or rethinking fundamental assumptions in psychometrics, the message is clear: embracing complexity and evidence-based refinement enhances our ability to support student and adult mental health.
As always, continuing to monitor cutting-edge, empirically grounded research will keep practitioners equipped to meet evolving challenges. We encourage you to stay tuned to this newsletter for more insights into advances shaping the field of school psychology.
