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Multisource Network and Latent Variable Models of Sluggish Cognitive

Tempo, ADHD-Inattentive, and Depressive Symptoms with Spanish Children:
Equivalent Findings and Recommendations

Article  in  Journal of Abnormal Child Psychology · January 2022

DOI: 10.1007/s10802-021-00890-1

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Research on Child and Adolescent Psychopathology
https://doi.org/10.1007/s10802-021-00890-1

Multisource Network and Latent Variable Models of Sluggish Cognitive

Tempo, ADHD‑Inattentive, and Depressive Symptoms with Spanish
Children: Equivalent Findings and Recommendations
G. Leonard Burns1   · Jonathan Preszler1 · Amina Ahnach1 · Mateu Servera3 · Stephen P. Becker2

Accepted: 15 December 2021

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

Abstract
Multisource network and latent variable models were used to examine the construct validity of sluggish cognitive tempo
(SCT) symptoms relative to attention-deficit/hyperactivity disorder-inattentive (ADHD-IN) and depressive symptoms. The
five objectives were to determine the (1) distinctiveness of SCT, ADHD-IN, and depressive symptom communities, (2)
similarity of the three symptom communities across mother, father, and teacher ratings, (3) individual symptoms with the
strongest influence on other symptoms, (4) individual symptoms with the strongest relations to academic and social impair-
ment, and (5) similarity between network and latent variable model results. Mothers, fathers, and teachers rated SCT,
ADHD-IN, and depressive symptoms for 2,142 Spanish children (49.49% girls, ages 8–13 years, third to sixth grade).
Walktrap community analysis resulted in SCT, ADHD-IN, and depressive symptom communities with three SCT symptom
communities within the overall SCT symptom community (daydreams, mental confusion, and hypoactive communities).
The symptom networks were also similar across mothers, fathers, and teachers, especially mothers and fathers. Finally, for
all three sources, the same two SCT and two ADHD-IN symptoms showed unique relations with academic impairment and
the same depressive symptom showed unique relations with social impairment. A latent variable model yielded equivalent
results. Both models thus supported the validity of SCT symptoms relative to ADHD-IN and depressive symptoms. Com-
plexities are noted in the selection of network and latent variable models to study child and adolescent psychopathology with
recommendations for their selection.

Keywords  Sluggish cognitive tempo · ADHD · Depression · Impairment · Children · Network analysis · Network model ·
Latent variable model

Latent variable and network models are the two most common
frameworks for the study of psychopathology (Bringmann
& Eronen, 2018). Latent variable models first focus on the
identification of syndromes (sets of highly related symptoms).
One version of a latent variable model (LVM) then focuses
on the identification of the correlates of the latent variable or
syndrome (risk factors, associated features, prognosis, and
treatment response). Correlates of the latent variable can be
internal and external to individuals. Within this version of
* G. Leonard Burns
glburns@wsu.edu
1 The version described in the first paragraph is the one most often
Washington State University, Pullman, WA 99164‑4820, USA
2 used for research on psychopathology. In addition, although the iden-
Cincinnati Children’s Hospital Medical Center, University
of Cincinnati College of Medicine, Cincinnati, USA
3
University of the Balearic Islands, Palma, Spain
the LVM, the latent variable is not considered the cause of
symptom covariation. The latent variable instead represents
the common variance in the symptom set with its explana-
tion sought through the identification of its unique and dif-
ferent correlates, especially relative to other syndromes. The
symptoms, however, remain the focus for assessment and
interventions (i.e., the symptoms in the syndrome as a sample
from a much larger class of behaviors). Much of our current
understanding of psychopathology stems from this version
of a LVM model.1
1
 Bringmann and Eronen (2018) describe different versions of a
latent variable model (i.e., there is no single latent variable model).
tification of internal and external correlates of the common variance
in the syndrome constitutes a type of explanation, the identification of
causal processes is much more complex.

13
Vol.:(0123456789)

Network models (NM) suggest that psychopathology
research should focus on the relations between individual
symptoms rather than focus on the latent variable (e.g.,
McNally, 2016). More specifically, this model suggests that
interactions among individual symptoms (as well as pos-
sible correlates of individual symptoms) across time result
in causally connected symptoms with the mental disorder
emerging from such interactions. This model has provided
useful analyses of a wide range of mental disorders (e.g.,
Bansal et al., 2020; Eadeh et al., 2021; Fried et al., 2017;
Goh et al., 2021; Martel et al. in press; Mullarkey et al.,
2019).
Although latent variable and network models are often
presented as competing models, it is increasingly recognized
that both models yield statistically equivalent results under
certain conditions (Bringmann & Eronen, 2018). More spe-
cifically, if the data-generating model (i.e., the model that
generates the pattern of covariances among the symptoms) is
a factor model as opposed to a small-world network model,
then latent variable and network models yield statistically
equivalent results (Christensen & Golino, 2021; Christensen
et al., 2020; van Bork et al., 2019). Equivalent results mean
that factor loadings will be equivalent to node strength (net-
work loadings). Equivalent results also mean that the num-
ber of factors from a LVM will be the same as the number
of symptom clusters from a NM.
If the NM and the LVM yield divergent results (e.g., three
symptom clusters versus one factor), then there are many
possible reasons for the divergence (e.g., collider variables
in networks, the data generating mechanism is a small world
network rather than a factor mechanism, violations of the
assumptions of the factor model, see Christensen & Golion,
2021; van Bork et al., 2019). A careful inspection of the data
and model fit may help with the determination of the model
most consistent data generating mechanism. In addition, the
development of procedures to identify the mechanism is an
active research area (Christensen & Golion, 2021; van Bork
et al., 2019).
Purpose of Current Study
This study first applied a network and then a latent vari-
able model to mother, father, and teacher ratings of slug-
gish cognitive tempo (SCT), attention-deficit/hyperactivity
disorder (ADHD) inattentive (IN), and depressive symp-
toms with Spanish children.2 Given our assumption that the
2
  The Spanish data has been used in a series of studies to investigate
the reliability and construct validity of scores from the scales of the
Child and Adolescent Behavior Inventory (Burns et  al., 2020, 2021,
2021; Sáez et  al., 2019; Servera et  al., 2018). These earlier studies
used the latent variable model. Aspects of the findings from these ear-
13
Research on Child and Adolescent Psychopathology
data-generating model for symptom covariation was a factor
model, network and latent variable models were expected to
yield equivalent findings. Although the same findings do not
prove the data-generating model was a factor model, equiva-
lent findings would be consistent with this assumption and
have implications for the most useful way to conceptualize
the covariation among the SCT, ADHD-IN, and depressive
symptoms.
We first briefly summarize the findings from the applica-
tion of a LVM to SCT symptoms and then review the one
study that used a NM with SCT symptoms. These findings
are then used to provide the objectives and hypotheses for
the study.
Sluggish Cognitive Tempo Symptoms and a Latent
Variable Model
SCT involves three highly-related sets of symptoms—
daydreams (e.g., lost in a fog, stares blankly into space), men-
tal confusion (e.g., loses train of thought, difficulty expressing
thoughts) and hypoactivity (e.g., low level of activity, easily
tired or fatigued). A LVM was used to identify the SCT symp-
toms (symptoms with substantial loading on an SCT factor
and much higher loadings on SCT than an ADHD-IN factor;
Barkley, 2013; Becker et al., 2020; Burns & Becker, 2021;
Sáez et al., 2019; see Becker et al., 2016, for a meta-analytic
review). These studies yielded 13 and 15 item SCT scales
(Barkley, 2013; Burns & Becker, 2021), the two most widely
used measures of SCT (Becker, 2021).
Table  1 shows the 15 item SCT scale. Studies with
mother, father, and teacher ratings of South Korean, Spanish,
Turkish, and United States children and adolescents support
the reliability and validlity of scores from this scale (Başay
et al., 2021; Becker et al., 2020; Burns & Becker, 2021;
Burns, Preszler et al. 2021a; Burns, Servera et al., 2021;
Jung et al., 2020; Sáez et al., 2019; Servera et al., 2018).
SCT scores, for example, demonstrated different and unique
relations with other symptom and impairment dimensions
relative to ADHD-IN scores. The framework for these stud-
ies was a LVM, with this model providing nearly all of our
current understanding of SCT. We now turn to the under-
standing of SCT from a NM perspective.
Sluggish Cognitive Tempo Symptoms and a Network
Model
Only one study has applied a NM to SCT symptoms (Goh
et al., 2020). With parent ratings of United States children
and adolescents, Goh et al. (2020) found SCT, inattentive,
Footnote 2 (continued)
lier studies provide the framework for the comparison of the network
and latent variable models in the current study.
Research on Child and Adolescent Psychopathology
Table 1  Sluggish Cognitive Tempo Items
Daydreams Subfactor
2. Lost in a fog (fog)
3. Stares blankly into space (stares)
5. Daydreams (daydreams)
8. Gets lost in own thought (lost in thoughts)
12. Spaces or zones out (spaces out)
Mental Confusion Subfactor
6. Loses train of thought (train of thought)
10. Forgets what was going to say (forgets)
11. Easily confused (confused)
13. Gets mixed up (mixed up)
14. Thinking is slow (slow thinking)
15. Difficulty expressing thoughts (tongue-tied)
Hypoactive Behaviors Subfactor
1. Behavior is slow (sluggish)
4. Drowsy or sleepy (yawns) during the day (drowsy)
7. Low level of activity (underactive)
9. Easily tired or fatigued (easily tired)
Originally an SCT item that studies have shown to more strongly
relate to ADHD-inattention factor than the SCT factor:
16. Lacks motivation to complete tasks (apathetic)
Earlier studies identified the three SCT subfactors (Becker et  al.,
2020; Burns & Becker, 2021; Sáez et al., 2019). The drowsy or sleepy
(yawns) during the day sometimes has a slightly higher loading on
the daydreams subfactor than the hypoactive subfactor. The loses
train of thought item also sometimes loads slightly higher on the day-
dreams than mental confusion subfactor. The italicized phrase in the
parenthses is the label for the symptom in Figs. 1, 2, 3
hyperactive, impulsive, and impairment item symptom
communities. SCT symptoms thus represented a distinct
symptom community from the other symptom communi-
ties. The study also found that eight of 36 symptoms (one
inattentive, one hyperactive, three impulsive, one SCT, and
two mixed inattentive/SCT items) demonstrated unique rela-
tions with different types of impairment. The authors noted,
however, an issue of wording overlap between symptom and
impairment items, thus creating a tautological question for
the interpretation of symptom-impairment relations (Goh
et al., 2020). There is also a question if the application of
a LVM to these symptoms would have yielded equivalent
results (i.e., if the data-generation model was a factor model,
then a network and latent variable model would have yielded
equivalent results).
This study builds on Goh and colleagues’ (2020) NM in
several ways. First, symptoms of depression were included
to determine if SCT and depressive symptoms represent
distinct symptom communities. This comparison is impor-
tant given questions that SCT may partly reflect depression
(Garner et al., 2013). Second, ADHD-IN symptoms were
included to determine if these symptoms form a distinct
symptom community from the SCT symptoms, an attempt
to replicate aspects of Goh et al. (2020).3 Third, measures
of academic and social impairment were included to deter-
mine if individual SCT, ADHD-IN, and depressive symp-
toms have unique relations with impairment. These meas-
ures of impairment did not involve a tautological issue with
the symptom ratings. Fourth, while Goh et al. (2020) used
a single source for the symptom ratings, the current study
used three different sources (mothers, fathers, and teachers),
thus making it possible to determine the similarity of the
networks across informants. Fifth, the participants for the
current study were from Spain, thus allowing an attempt
to replicate aspects of Goh et al. (2020) with participants
from another country. Sixth, although Goh et al. (2020) did
not apply a LVM to their symptoms, the current study also
applied a latent variable model to the symptom ratings. If
network and latent variable models yield equivalent results
in this study, then such would question the usefulness of the
application of a NM to these symptoms. We now note the
objectives and hypotheses for the study.
Objectives and Hypotheses
If the data-generating model for the covariation among SCT,
ADHD-IN, and depressive symptoms is a factor model, then
the application of network and latent variable models to
these symptoms will yield equivalent results (Bringmann
& Eronen, 2018; Christensen & Golino, 2021; Christensen
et al., 2020; von Bork et al., 2019). Equivalent results would
raise questions about the usefulness of applying a NM to
these symptoms. More specifically, is it useful to apply a
NM if a factor model is the data-generating model? This
is an important matter to investigate given the increasing
number of studies that apply a NM to child and adolescent
psychopathology and then interpret the results as if the
data-generating model was a small-world network model.
A systematic consideration of this question has the poten-
tial to improve the use of these models to study child and
adolescent psychopathology. Accordingly, we examined the
covariation among SCT, ADHD-IN, and depressive symp-
toms with the assumption that a factor model is the data-
generating model rather than a small-world network model.
Objectives and hypotheses were based on this assumption.
The first objective was to determine the symptom commu-
nities with a NM. The prediction was that SCT, ADHD-IN,
and depressive symptoms would represent separate symptom
3
  Given our focus on the SCT, ADHD-IN, and depression symptoms,
the complexity of this NM, especially across the three sources, and
the clear separation of the ADHD-hyperactive/impulsive, and inatten-
tive symptoms in earlier NM studies (Goh et al., 2020; Martel et al.
in press; Preszler & Burns, 2019; Preszler et al., 2020), this study did
not include the hyperactive/impulsive symptoms.
13

communities. The SCT symptom community was, however,
expected to contain three subcommunities—daydreams,
mental confusion, and hypoactive behaviors. Table 1 shows
the SCT symptoms expected in the three SCT symptom
communities. The basis for the prediction of three SCT
communities was the prior identification of three SCT fac-
tors (Becker et al., 2020; Burns & Becker, 2021; Sáez et al.,
2019). SCT symptoms in each SCT symptom community
were expected to match the symptoms on the three SCT
factors.4
The second objective was to evaluate the similarity
of symptom networks across mother, father, and teacher
ratings. Similarity was expected, especially for mothers
with fathers, given an earlier study with this sample found
invariance of like-item loadings and thresholds for SCT,
ADHD-IN, and depression symptoms across mothers and
fathers (Burns, Preszler et al., 2021; Burns, Servera et al.,
2021).
The third objective was to determine the central symp-
toms. Central symptoms are considered to maintain the
structure of the network because of their strong associa-
tions with other symptoms (such symptoms have a higher
likelihood of co-occurring with other symptoms in the net-
work). ADHD-IN symptoms reluctant to engage in tasks
that require concentration and effort, difficulty sustaining
attention, and easily distracted were expected to be cen-
tral ADHD-IN symptoms (Martel et al. in press; Preszler
& Burns, 2019; Preszler et al., 2020). It was an exploratory
question if any SCT or depressive symptoms would emerge
as central symptoms.
There are complexities with interpretation of central
symptoms (Bringmann et al., 2019). For example, if the
data-generating model is a factor model, then a measure of
symptom centrality, expected influence (sum of a symptom’s
absolute edge weights), is equivalent to the sum of factor
loadings (Christensen & Golino, 2021). In addition, if a
subset of symptoms within a syndrome have highly simi-
lar content (wording), then such symptoms can emerge as
central symptoms and symptoms with strong factor load-
ings (Christensen et al., 2020). Symptom centrality and high
factor loadings can thus be a reflection of redundancy in
content/wording of such symptoms. We return to these com-
plexities in the Discussion.
The fourth objective determined if any individual symp-
toms had unique relations with academic and social impair-
ment. Although SCT and ADHD-IN factors demonstrated
unique associations with academic and social impairment
4
  The item lacks motivation to complete tasks, originally considered
an SCT item, was expected to be part of the ADHD-IN symptom
community due to its stronger relation with the ADHD-IN than SCT
factor (Sáez et al., 2019).
13
Research on Child and Adolescent Psychopathology
factors (Becker et al., 2020; Burns & Becker, 2021; Sáez
et al., 2019), these analyses did not evaluate the unique
effects of individual symptoms. However, given findings
from a NM (Preszler & Burns, 2019), ADHD-IN symptoms
close attention to details, difficulty sustaining attention, and
reluctance to engage in tasks that require sustained mental
effort were expected to be uniquely associated with aca-
demic impairment. It was an exploratory question which
individual SCT symptoms would have unique associations
with academic impairment. Individual depressive symptoms,
however, were not expected to have unique associations with
academic impairment with any unique associations being
with social impairment. It was unknown if any individual
ADHD-IN and SCT symptoms would have unique associa-
tions with social impairment with the depressive symptoms
in the network.
The fifth objective involved the application of a LVM to
the SCT, ADHD-IN, and depressive symptom ratings. If a
NM identified daydreams, mental confusion, hypoactive,
ADHD-IN, and depressive symptom communities, then a
factor analysis was expected to yield five factors correspond-
ing to the five symptom communities. Academic and social
impairment factors were also regressed on SCT, ADHD-IN,
and depression factors to allow a comparison with individual
symptom-impairment relations from a NM. The regression
results were expected to yield similar conclusions to the
results with individual symptoms (e.g., the ADHD-IN fac-
tor and individual ADHD-IN symptoms would have unique
assocations with academic impairment).
Methods
Participants and Procedures
The participants were mothers, fathers, and teachers
of 2,142 children (50.51% boys) in third through sixth
grades (ages 8–13 years; M = 10.30, SD = 1.21) from 32
randomly selected schools on the Balearic Islands, Spain.
A total of 3,855 families were contacted by the research-
ers. Mothers and fathers provided ratings on 1,648 and
1,358 children, respectively (1,777 unique children were
rated by parents). A total of 196 teachers provided ratings
on 1,773 children with each teacher rating an average of
10.93 (SD = 6.05) children. Approximately 85% of the
children lived with both parents and approximately 13%
with a single parent (approximately 2% missing). Parents
indicated that 5.13% of the children had an ADHD diag-
nosis and 4.86% learning problems. Additional details on
the characteristics of the parents (education and family
income) and children can be found elsewhere (Sáez et al.,
2019). Mothers, fathers, and teachers provided written
informed consent.
Research on Child and Adolescent Psychopathology

Table 2  ADHD-Inattentive,
Depressive, Social Impairment,
and Academic Impairment
Items
ADHD-Inattention Items
Fails to give close attention to details or makes careless mistakes (close attention)
Has difficulty keeping attention focused during tasks (sustain attention)
Does not seem to listen when spoken to directly (listen)
Does not follow through on instructions and fails to finish tasks (follow through)
Shows poor organization skills (organizational skills)
Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (concentration)
Loses things (loses things)
Easily distracted by irrelevant (minor or little) things (easily distracted)
Forgetful in daily activities (forgetful)
Depressive Items
Seems sad, unhappy, or depressed (sad)
Seems to feel worthless (feels worthless)
Seems lonely (lonely)
Seems not to enjoy activities that he or she previously thought were fun (anhedonia)
Seems to feel hopeless about things (hopeless)
Seems not to have enough energy to complete tasks or participate in activities that he or she used to have
the energy to do (lacks energy)
Academic Impairment Items
Completion of homework assignments
Reading skills
Arithmetic skills
Writing skills
Overall academic skills
Social Impairment Items for Parent Scale
Interactions with father, guardian, or partner
Interactions with mother, guardian, or partner
Interactions with adults other than parents (grandparents, babysitters, adult family friends)
Interactions with brothers and sisters
Interactions with peers
Social Impairment Items for Teacher Scale
Interactions with teachers
Interactions with peers

The italicized phrase in the parenthses is the label for the symptom in Figs. 1, 2, 3

Measure interactions] for grade level). Social and academic impair-

Child and Adolescent Behavior Inventory (CABI)
Mothers, fathers, and teachers completed the CABI (Sáez
et al., 2019). SCT, ADHD-IN, depression, academic impair-
ment, and social impairment scales were used in the study.
Symptoms were rated with 6-point anchors (0 = almost never
[never or about once per month], 1 = seldom [about once
per week], 2 = sometimes [several times per week], 3 = often
[about once per day], 4 = very often [several times per day],
and 5 = almost always [many times per day]). Social and
academic impairment items were rated with 7-point anchors
(0 = severe difficulty, 1 = moderate difficulty, 2 = slight dif-
ficulty, 3 = average performance [average interactions]
for grade level, 4 = slightly above average, 5 = moderately
above average, and 6 = excellent performance [excellent
ment items were reverse keyed, so higher scores represent
impairment. Tables 1 and 2 show the wording of the items.
Earler studies support the reliability and validity these
scale scores (Becker et al., 2020; Burns, Preszler et al., 2021;
Burns, Servera et al., 2021). Reliability (alpha) values for
mothers (fathers, teachers) for SCT, ADHD-IN, depres-
sion, social impairment, and academic impairment scores
were 0.93 (0.92, 0.97), 0.95 (0.95, 0.97), 0.87 (0.84, 0.92),
0.90 (0.91, 0.87), and 0.94 (0.95, 0.97), respectively. Inter-
rater factor correlations for SCT, ADHD-IN, depression,
social impairment, and academic impairment for moth-
ers with fathers were 0.81 (SE = 0.02), 0.83 (SE = 0.01),
0.73 (SE = 0.03), 0.70 (SE = 02), and 0.87 (SE = 0.01)
respectively, mothers with teachers 0.43 (SE = 0.02),
0.55 (SE = 0.02), 0.43 (SE = 0.03), 0.18 (SE = 0.03), and
0.72 (SE = 0.02) respectively, and fathers with teachers

13

0.42 (SE = 0.03), 0.54 (SE = 0.03), 0.37 (SE = 0.04), 0.14
(SE = 0.03), and 0.69 (SE = 0.02), respectively. Low social
impairment corrrelations for parents with teachers was
probably due to different items on parent and teacher social
impairment scales along with setting influences.
Missing Data
For mother and father ratings, only three cases left any
symptom ratings blank. There were no missing ratings
for teachers. The calculation of the polychoric correlation
matrix among the symptom ratings within each source used
a pairwise procedure to maximize the information for each
correlation for network and latent variable model analyses.
Analytic Strategy for Network Model
Network Estimation
Given the symptom ratings were treated as categorical indi-
cators, networks were estimated using the R mixed graphi-
cal model package (mgm; Haslbeck & Waldorp, 2015). The
EBIC fit index penalty was used to regularize the network.
This procedure yields a network that shrinks small bivariate
partial coefficients to 0 under the assumption that empirical
data has ambient noise correlations. The goal of regulariza-
tion is to estimate a network that better approximates the
underlying generative network and thus generalizes well to
the population (Epskamp & Fried, 2018). This procedure
was applied to each source separately.
Communities of Symptoms
The walktrap algorithm was used to identify symptom com-
munities (Golino & Epskamp, 2017). One hundred iterations
of each algorithm were completed to ensure reliability of the
findings. The R package igraph (version 1.4.2.1; Csardi &
Nepusz, 2006) was used for the community analyses.
Network Comparisons Across Sources
Three procedures were used to evaluate the similarity of
symptom networks across sources. First, edge weights were
correlated across each pair of sources to quantify their simi-
larity. Second, the same edge weights were subtracted across
sources to determine edge differences. Given there are cur-
rently no significant tests for such differences from the mgm
method, these comparisons are descriptive. Third, total abso-
lute value of all edge weights in each network (called “global
strength”) were summed to evaluate differences of global
strength across sources.
13
Research on Child and Adolescent Psychopathology
Centrality
The Expected Influence (EI) centrality measure was used
to identify symptoms that were relatively central to the
network (Bringmann et al., 2019). The EI measure is the
sum of the absolute value of edge weights associated with a
symptom. A symptom high in EI has a higher likelihood of
co-occurring with other symptoms in the network (McNally,
2016). Bootstrapped stability analysis was conducted using
the R package bootnet (Epskamp et al., 2018) to test the
stability of the EI values.
Impairment
The networks were again estimated to determine the unique
relations of individual symptoms with social and academic
impairment measures.These networks were estimated with
the same procedures as the primary networks.
Analytic Strategy for Latent Variable Model
The Mplus statistical software (version 8.3) with the items
treated as categorical indicators (WLSMV estimator) was
used for the LVM analyses (i.e., exploratory confirmatory
factor analysis and exploratory structural regression analysis,
see Asparouhov & Muthén, 2009). The Mplus type = com-
plex option was used to take into account children nested
within teachers.
Results
Network Model Results
Community Analyses
Figures 1, 2, 3 show the symptom networks for mother,
father, and teacher ratings, respectively. ADHD-IN and
depressive symptoms were in their respective communities
with the 15 SCT symptoms represented by three communi-
ties. One community reflected mental confusion (loses train
of thought, forgets what was going to say, gets mixed up,
easily confused, thinking is slow, and difficulty expressing
thoughts). Daydreams was the second community (lost in
a fog, stares blankly into space, spaces or zones out, gets
lost in own thoughts, and daydreams) with the third com-
munity representing hypoactive behaviors (drowsy or sleepy
[yawns] during the day, behavior is slow, easily tired or
fatigued, and low level of activity (underactive). It was espe-
cially noteworthy that the hypoactive SCT symptom commu-
nity was distinct from the depressive symptom community.
Research on Child and Adolescent Psychopathology

A. Mothers MGM

Loses things

Close Forgetful
attention

Sluggish
Easily
Organization
distracted Underactive
skills

Sustain
attention

Easily Drowsy
Tired

Follow
through

Concentration

Listen
Fog
Stares

Apathetic

Spaces out
Lost
in
Thoughts
Daydreams

Sad

Lacks energy

Train
of
Lonely Thought
Feels Worthless
Confused

Hopeless Mixed up
Anhedonia

Forgets

Slow Thinking

Tongue−Tied

Fig. 1  Mixed graphical model network graph of mother ratings. The Orange = ADHD—Inattention symptoms + symptom Apathetic
nodes represent symptoms of SCT, ADHD-IN and Depression and (lacks motivation to complete tasks symptom, outlined in a thick
the edges represent the statistical association between the symp- black border); green = depression symptoms. Light green, pink, and
toms after statistically controlling for the other symptoms. Thicker blue = SCT symptom communities. For ease of interpretation, edges
edges represent stronger associations, with green edges representing lower than .05 are not displayed in the network. For context, the larg-
positive associations. A Fruchterman-Reingold layout was speci- est edge weight is Forgets – Train of Thought (.39). Tables  1 and 2
fied for mothers. The colored groups represent the walktrap results. show the complete wording of the symptoms

Network Comparisons Across Sources thus differences were small. In contrast, edge weight dif-
ferences between parents and teachers had over twenty dif-
Although none of the networks shared the same strongest ferences above 0.10 (i.e., -0.22 was the largest for mother
edge weight, the three networks shared many similarities. with teacher comparisons and -0.29 the largest for father
For example, the networks correlated 0.94 for mothers with with teacher comparisons). The negative sign means the
fathers, 0.86 for mothers with teachers, and 0.84 for fathers edge weights were stronger for teacher ratings. The global
with teachers. These analyses were repeated after removing strength results also indicated that teacher ratings had more
all edges that equaled 0 to quantify the agreement without highly connected symptoms than mother and father rating.
the high number of shared 0 s inflating the correlations (i.e., Global strength values were 13.59, 12.69, and 11.81 for
0.89 for mothers with fathers, 0.75 for mothers with teach- teachers, mothers, and fathers, respectively.5
ers, and 0.72 for fathers with teachers).
5
Comparison of edge weight differences between mother   Higher partial correlations (and thus global strength) for teachers
and higher loadings for teachers were probably because each teacher
and father symptom networks revealed only three pairs with rated multiple children relative to mothers and fathers. Supplemental
an absolute value greater than 0.10 (range = 0.12 to 0.13), Tables S1 to S3 show the symptom-factor loadings.

13
 Research on Child and Adolescent Psychopathology

B. Fathers MGM

Loses things

Close Forgetful
attention

Sluggish
Easily
Organization
distracted Underactive
skills

Sustain
attention

Easily Drowsy
Tired

Follow
through

Concentration

Listen
Fog
Stares

Apathetic

Spaces out
Lost
in
Thoughts
Daydreams

Sad

Lacks energy

Train
of
Lonely Thought
Feels Worthless
Confused

Hopeless Mixed up
Anhedonia

Forgets

Slow Thinking

Tongue−Tied

Fig. 2  Mixed graphical model network graph of father ratings. The Inattention symptoms + symptom Apathetic (lacks motivation to com-
nodes represent symptoms of SCT, ADHD-IN and Depression and plete tasks symptom, outlined in a thick black border); green = depres-
the edges represent the statistical association between the symptoms sion symptoms. Light green, pink, and blue = SCT symptom com-
after statistically controlling for the other symptoms. Thicker edges munities. For ease of interpretation, edges lower than .05 are not
represent stronger associations, with green edges representing posi- displayed in the network. For context, the largest edge weight is Easily
tive associations and red edges. This network is on the same layout as Tired – Underactive (.31). Tables 1 and 2 show the complete wording
mother ratings, given the similarities between their network results. of the symptoms
The colored groups represent the walktrap results. Orange = ADHD—

Average within-domain (e.g., IN symptom with IN symp- had the strongest EI for the three sources (mothers = 2.36;
tom) edge weights were 0.06-0.07, whereas the average fathers = 1.69; teachers = 3.02). For fathers, the SCT symp-
between-domain edge weight was 0.005 or less. This indi- toms lost in a fog (1.59) and easily confused (1.18) along
cates connections were within symptom sets. Edge weights, with the ADHD-IN symptoms forgetful in daily activities
edge weight comparisons, and global strength values are (1.49) and easily distracted (1.42) also had EI values above
available in the supplemental materials. one standard deviation. For mothers, the SCT symptom eas-
ily confused (1.50) and the ADHD-IN symptom easily dis-
Centrality tracted (1.63) had EI values above one standard deviation.
The other SCT symptom with an elevated EI was gets lost
Supplemental Fig. S1 shows expected influence (EI) z-scores in own thoughts (1.79) for teachers. None of the depressive
for the symptom networks for mothers and fathers with symptoms had elevated EI values. ADHD-IN symptoms has
Fig. S2 showing EI z-scores for teachers. ADHD-IN symp- difficulty keeping attention focused during tasks and easily
tom has difficulty keeping attention focused during tasks distracted are consistently emerging as central symptoms

13
Research on Child and Adolescent Psychopathology

C. Teachers MGM

Stares

Daydreams
Fog

Lost Sluggish
in
Thoughts
Drowsy
Spaces out

Easily Underactive
distracted
Easily
Tired

Train
of
Thought
Sustain
attention
Forgetful

Apathetic
Close
attention Forgets Confused
Slow Thinking
Loses things

Mixed up

Organization
skills Tongue−Tied
Concentration
Follow
through

Lacks energy

Lonely

Listen
Anhedonia

Hopeless

Sad

Feels Worthless

Fig. 3  Mixed graphical model network graph of teacher ratings. The
nodes represent symptoms of SCT, ADHD-IN and Depression and
the edges represent the statistical association between the symptoms
after statistically controlling for the other symptoms. Thicker edges
represent stronger associations, with green edges representing posi-
tive associations. This network is on the same layout as mother rat-
ings, given the similarities between their network results. The colored
groups represent the walktrap results. Orange = ADHD—Inattention
symptoms + symptom Apathetic (lacks motivation to complete tasks
symptom, outlined in a thick black border); green = depression symp-
toms. Light green, pink, and blue = SCT symptom communities. For
ease of interpretation, edges lower than .05 are not displayed in the
network. For context, the largest edge weight is Mixed Up – Confused
(.46). Tables 1 and 2 show the complete wording of the symptoms

(Martel et al. in press; Preszler & Burns, 2019; Preszler and social impairment. For mother and father ratings, SCT
et al., 2020). symptoms easily confused, spaces or zones out, and diffi-
The case-dropping bootstrapped results (using 5000 boot- culty expressing thoughts had nonzero edge weights with
straps) indicated that the correlation stability (CS) coefficient academic impairment, while ADHD-IN symptoms difficulty
for EI was above 0.50 (range: 0.59—0.67) for all three raters. keeping attention focused during tasks and avoids, dislikes
Epskamp et al. (2018) recommend that the CS-coefficient or is reluctant to engage in tasks that require sustained
should not be below 0.25, and ideally above 0.50 to provide mental efforts had nonzero edge weights with academic
evidence for stability of the EI values. impairment. For mother ratings only, ADHD-IN symptom
easily distracted had a nonzero edgeweight with academic
impairment. For ratings by teachers, SCT symptoms easily
Impairment confused and difficulty expressing thoughts and ADHD-IN
symptoms fails to give close attention to details or makes
Table 3 shows the SCT, ADHD-IN, and depressive symp- careless mistakes, has difficulty keeping attention focused
toms with nonzero edge weights with academic impairment during tasks, shows poor organization skills, and avoids,

13
 Research on Child and Adolescent Psychopathology

Table 3  SCT, ADHD-IN, Symptoms Academic Impairment Social Impairment

and Depressive Symptoms
with Nonzero Edgeweights Mothers Fathers Teachers Mothers Fathers Teachers
with Academic and Social
Impairment SCT symptoms
Easily confused 0.07 0.08 0.11
Spaces or zones out 0.05 0.06
Difficulty expressing thoughts 0.05 0.05 0.09
ADHD-inattention symptoms
Close attention 0.10
Sustaining attention 0.12 0.13 0.05
Does not listen 0.06
Poor organization skills 0.08
Sustained mental effort tasks 0.15 0.13 0.10
Easily distracted 0.05
Depressive symptoms
Seems sad, unhappy, or depressed 0.05 0.04 0.08
Seems lonely 0.05 0.11

All values are regularized edge weights. Blank spaces indicate no relationship. SCT sluggish cognitive
tempo, ADHD attention-deficit/hyperactivity disorder

dislikes or is reluctant to engage in tasks that require sus-
tained mental effort had nonzero edge weights with aca-
demic impairment (i.e., four of nine ADHD-IN symptoms
had non-zero edgeweights with academic impairment). In
addition, the item lacks motivation to complete tasks (see
footnote 4) had a nonzero edge weight with academic
impairment for teachers. No depressive symptoms had a
non-zero edge weight with academic impairment.
For social impairment, the depressive symptom sad,
unhappy, or depressed had a nonzero edge weight with
social impairment for mothers, fathers, and teachers, while
the depressive symptom lonely had a nonzero edge weight
for fathers and teachers. In contrast, no SCT symptoms had a
nonzero edge weight with and only one ADHD-IN symptom
for fathers (does not seem to listen when spoken to directly)
had a nonzero edge weight.
Latent Variable Model Results
A daydreams, mental confusion, hypoactive, ADHD-IN, and
depressive five-factor model resulted in a close fit with no
localized ill-fit for each source (mothers: χ2 (320) = 1123,
p < 0.001, CFI = 0.99, RMSEA = 0.039 (0.037, 0.042), and
SRMR = 0.02; fathers: χ2 (320) = 842, p < 0.001, CFI = 0.99,
RMSEA = 0.035 (0.032, 0.038), and SRMR = 0.02;
and teachers: χ 2 (320) = 1545, p < 0.001, CFI = 0.99,
RMSEA = 0.046 (0.044, 0.049), and SRMR = 0.01). Pri-
mary loadings were moderate to substantial with only 12 of
348 cross-loadings greater than 0.30 (nearly all of the cross-
loadings were less than an absolute 0.10). Supplemental
Tables S1 to S3 show the primary and secondary standard-
ized loadings for the three sources.
Higher scores on ADHD-IN and SCT factors were
uniquely associated with significantly (ps < 0.01) higher
scores on the academic impairment factor (all three sources
for ADHD-IN and mothers and teachers for SCT).6 ADHD-
IN’s unique association with academic impairment was
stronger than SCT’s unique association with academic
impairment (partial standardized regression coefficients of
0.60 to 0.62 vs. 0.09 to 0.25, respectively). Although the
depressive factor did not have a significant unique associa-
tion with the academic impairment factor, its unique asso-
ciation with the social impairment factor was significant
(ps < 0.001) for each source (partial standardized regression
coefficients from 0.30 to 0.43). In contrast, the SCT factor
did not have a significant unique association with the social
impairment factor while the ADHD-IN factor did have a sig-
nificant (ps < 0.001) unique association with social impair-
ment for fathers and teachers (partial standardized regression
coefficients of 0.16 and 0.18, respectively). The depression
factor thus had a stronger unique relation with social impair-
ment than the ADHD-IN factor. Table S4 shows the regres-
sion results and Table S5 shows the correlations of SCT,
ADHD-IN, and depressive factors with academic and social
impairment factors.
6
  The SCT factor was not separated into the three SCT subfactors for
the exploratory structural regression analyses Additional research is
required to determine the best SCT items to represent each subfactor
and if the three SCT subfactors have unique and different associations
with impairment relative to ADHD-IN and depression.

13
Research on Child and Adolescent Psychopathology
Discussion
Network and latent variable models were applied to mother,
father, and teacher ratings of SCT, ADHD-IN, and depres-
sive symptoms in a large sample of Spanish children. Given
our assumption that a factor rather than a network model
generated the covariances among the symptom ratings,
the expectation was for the two models to yield equivalent
results (Christensen & Golino, 2021; Christensen et al.,
2020; van Bork et al., 2019). Support was found for this
prediction. We now summarize these similarities and then
discuss the implications for the selection of network and
latent variable models to evaluate the construct validity of
SCT, ADHD, and depressive symptom ratings as well as
the study of child and adolescent psychopathology more
broadly.
Network Model Symptom Communities and Latent
Variable Model Factors
Walktrap community analyses yielded SCT, ADHD-IN, and
depressive symptom communities. Within the overall SCT
symptom community, there were also three distinct subcom-
munities (daydreams, mental confusion, and hypoactive
behaviors). Factor analyses found support for daydreams,
mental confusion, hypoactive, ADHD-IN, and depressive
factors. The symptoms within each symptom community
were also the same symptoms on the matching factor with
only a few exceptions. These five symptom communities and
their respective symptoms from a NM thus closely matched
the five factors and their respective symptoms from a LVM.
The symptom communities from a NM were similar
across mother, father, and teacher ratings, especially moth-
ers and fathers. Teacher symptom ratings had stronger edge
weights and higher factor loadings than parents. Invariance
analyses on the same data also found invariance of like-item
loadings and thresholds for SCT, ADHD-IN, and depressive
symptoms across mother and father symptom ratings in an
earlier study (Burns, Preszler et al., 2021; Burns, Servera
et al., 2021). Network and latent variable model analyses
again yielded similar results.
Network Model Central Symptoms and Latent
Variable Model Strong Symptoms
For this discussion, a symptom is considered a central symp-
tom if such occurred for at least two of the three sources.
The ADHD-IN symptom difficulty keeping attention focused
during tasks had high EI values for all three sources. For
mother and father ratings, the ADHD-IN symptom easily
distracted and the SCT symptom easily confused were also
central symptoms. Factor loadings for these symptoms were
substantial (if not the highest loadings on their factor). As
expected, under the assumption of a factor data-generating
model, there is correspondence between NM central symp-
toms and LVM strongest symptoms and this occurred in this
study.
To summarize, the interpretation of central symptoms
should consider these issues. Researchers should be cau-
tious when interpretating central symptoms if (1) symptoms
within a syndrome have consistently high inter-symptom
correlations, (2) symptoms have highly similar content/
wording, and (3) the data-generating model is a factor
model, especially the third point. (Christensen & Golino,
2021; Christensen et al., 2020). In this study, centrality val-
ues are not providing useful information from a network
perspective (one symptom directly related to others), but
instead indentifying symptoms with the highest communal-
ity, findings redundant with LVM results.
Network Symptom‑Impairment and Latent
Variable‑Impairment Relations
Earlier studies with this sample and others found that SCT
and ADHD-IN factors had significant unique associations
with academic and social impairment factors (Becker et al.,
2020; Burns & Becker, 2021; Sáez et al., 2019). In this study,
a depressive factor was added to this regression analysis to
expand on these earlier results (e.g., Would SCT predict
academic impairment even after controlling for ADHD-IN
and depression?). The ADHD-IN factor continued to have a
significant unique association with the academic impairment
factor for three sources and the SCT factor for two sources.
As expected, the depression factor did not have a significant
unique association with the academic impairment factor
while it did have a significant unique association with the
social impairment factor for three sources. SCT did not have
a unique association with social impairment while ADHD-
IN did show such a unique association for two of three
sources. These LVM results also indicated that ADHD-IN
had a stronger unique association than SCT with academic
impairment with depression having a stronger unique asso-
ciation than ADHD-IN and SCT with social impairment.
Do individual symptom-impairment relations from a NM
offer unique insights relative to latent variable-impairment
relations from a LVM? We first review the individual symp-
toms with unique relations with impairment and then com-
pare the relative usefulness of network and latent variable
model results on impairment. We mostly focus on the indi-
vidual symptom-impairment relations that occurred for all
three sources for this discussion.
Two ADHD-IN symptoms (difficulty keeping attention
focused during tasks and avoids, dislikes, or is reluctant to
engage in tasks that require sustained mental efforts) and
13

two SCT symptoms (easily confused and difficulty express-
ing thoughts) showed unique relations with academic
impairment whereas one depressive symptoms (seems sad,
unhappy, or depressed) showed a unique relation with social
impairment. Given these individual symptom-impairment
unique effects replicated across all three sources, these
results were robust. Two more ADHD-IN symptoms, fails
to give close attention to details or makes careless mistakes
and shows poor organization skills, had unique associations
with academic impairment for teachers (thus four of nine
ADHD-IN symptoms showed unique associations with aca-
demic impairment for teachers).
How would a NM interpret these results? A NM would
argue for the importance of specific individual symptoms
as bridge symptoms to impairment. This focus would
therefore argue for the importance of the individual symp-
toms for screening, assessment, and treatment (e.g., Goh
et al., 2020; Martel et al. in press). In other words, rather
than a focus on the summary score on the nine ADHD-IN
symptoms for assessment and treatment, the specific indi-
vidual symptoms would be the focus. This interpretation of
the individual symptom-impairment depends on the data-
generating model being a small-world network model rather
than a factor model. This interpretation also perhaps reflects
a failure to consider that the strong individual symptoms
represent a much larger response class of behavior relevant
to impairment and, with highly correlated symptoms with a
high level of redundancy in content and wording, it is prob-
ably the communality in the larger response class responsi-
ble for the symptom/syndrome to impairment association.
To summarize, if a factor model was the data-generating
model, then a LMV interpretation of the individual symptom-
impairment relations would be more appropriate. A LVM
interpretation would argue that such individual symptoms
best reflect the latent variable (strongest loadings) and thus
probably the aspect of the latent variable most strongly asso-
ciated with the latent impairment variable. The LVM would
also view the symptoms with the strongest loadings as rep-
resentative of a sample of behavior reflecting a much larger
class of behavior relevant to impairment with treatment plans
based on this assumption (treatment with a focus on the larger
response class).
Selection of Network or Latent Variable Models
for Study of SCT and ADHD Symptoms
This section offers tentative guidelines for the decision to
select a network or latent variable model to seek an under-
standing of SCT and ADHD symptoms. It is important to
take into consideration more the data-generating model (i.e.,
the model responsible for the covariation among the symp-
toms). If the data generating model is a factor model, then
the use of a LVM is more appropriate than a NM. If the
13
Research on Child and Adolescent Psychopathology
data generating model is a small-world network model, then
the use of a NM is more appropriate than a LVM. Statisti-
cal tests are currently available to provide guidance on the
nature of the data-generating model (Christensen & Golino,
2021; Christensen et al., 2020). A failure to consider the
data-generating model can result in problematic interpreta-
tions, especially if a NM is applied to symptom ratings when
the data-generating model is a factor model. In this situa-
tion, as demonstrated in the current study, the two models
yield equivalent results.
It would also be useful to have hybrid latent variable and
network models where this single model could be applied to
the data simultaneously (e.g., Bringmann, 2021). The ability
to apply such a hybrid model simultaneously to the same data
would allow for the exploration of more complex questions.
Such developments, however, imply increasing complexity
and it is always important to remember the reason for the use
of such models (e.g., understanding psychopathology and
the development of more specific individualized treatments).
More specifically, by embracing complexity and thereby sac-
rificing parsimony in such models, researchers risk reducing
clinical applicability or comprehension.
Limitations and Future Directions
It is important to note several limitations. First, and probably
the most important, the study involved cross-sectional data.
Intensive longitudinal data, that is, daily measurement of
SCT, ADHD-IN, and depressive symptoms along with daily
measures of impairment, would allow a more informative
comparison of a NM with its greater focus on individual
symptoms and a LVM with its greater focus on latent vari-
ables. Equivalent results across the two longitudinal models
would yield additional support for a factor data-generation
model. Second, this study included school-aged children in
­3rd-6th grades and it is unknown if similar results would occur
with adolescents. Third, although a key strength of this study
was the use of three sources (mothers, fathers, and teachers),
future research should include self-report assessment of SCT
(Becker, 2021) and depression. Fourth, the depression measure
did not assess complete range of depressive symptoms (e.g.,
the factor data-generating model might only apply to these
depressive symptoms while a small-world network model
might apply to the complete range of depressive symptoms).
Fifth, the social impairment measure was a global measure of
the quality of interactions with others. Previous research has
consistently found SCT symptoms to be uniquely associated
with shyness, social withdrawal and isolation (Becker, Garner
et al., 2019; Burns & Becker, 2021; Servera et al., 2018). We
did not include such measures, and it will be important for
future research to include them. And, finally, it is important to
remember the findings so far are specific to the CABI scales.
Research on Child and Adolescent Psychopathology
Recommendations
Network and latent variable models were applied to mother,
father, and teacher ratings of SCT, ADHD-IN, and depres-
sive symptoms in a large sample of Spanish children. Given
the assumption that the data-generating model for symptom
covariation was a factor model, the two different models of
psychopathology were expected to yield equivalent results.
Both models yielded equivalent results, thus providing support
for the data-generating assumption, along with support for the
construct validity of SCT symptoms relative to ADHD-IN and
depressive symptoms. Prior to the application of a NM to child
and adolescent symptom ratings, researchers should consider
and, if possible, determine the data-generating model. If the
data-generating model is a factor model, then it is probably
best to use a LVM rather than a NM.
Supplementary Information  The online version contains supplemen-
tary material available at https://d​ oi.o​ rg/1​ 0.1​ 007/s​ 10802-0​ 21-0​ 0890-1.
Acknowledgements  The authors would like to acknowledge the dis-
cussions with Alexander P. Christensen on network and latent variable
models. These discussions were helpful in the revisions of this paper.
Funding  This research was supported by two grants from the Ministry
of Economy and Competitiveness of Spanish Government under award
numbers PSI2014-52605-R and PSI2017-82550-R (AEI/FEDER, UE),
and a predoctoral fellowship co-financed by MINECO (Spanish Gov-
ernment) and the European Social Fund (BES-2015–075142). The
content is solely the responsibility of the authors and does not neces-
sarily represent the official views of the Spanish Government. We thank
Cristina Trias for assistance with the study.
Ministerio de Economía y Competitividad,PSI2014-52605-R
PSI2017-82550-R, Mateu Servera, National Institutes of Health,
K23MH108603, Stephen Becker.
Compliance with Ethical Standards  Burns, G. L., Geiser, C., Servera, M., Becker, S. P., & Beauchaine, T.
Ethical Approval  The research protocol was approved by the Research
Ethics Committee (Institutional Review Board [IRB]) of the University
of the Balearic Islands.
Informed Consent  Mothers, fathers, and teachers provided written
informed consent.
Conflict of Interest  The authors of the current study declare that they
have no conflicts of interest.
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