Generalized structural equation modeling:Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy  

作　　者：Ruu-Fen Tzang Yue-Cune Chang 

机构地区：[1]Department of Child and Adolescent Psychiatry,Mackay Memorial Hospital,Taipei 104,Taiwan [2]Department of Childhood Care and Education,Mackay Junior College of Medicine,Nursing,and Management,New Taipei City 112,Taiwan [3]Department of Mathematics,Tamkang University,New Taipei City 251,Taiwan

出　　处：《World Journal of Psychiatry》2022年第6期787-800,共14页世界精神病学杂志

摘　　要：BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD symptoms.Little is known about poor treatment efficacy owing to ADHD heterogeneity.AIM To use generalized structural equation modeling(GSEM)to show how the heterogeneous nature of hyperactivity/impulsivity(H/I)symptoms in ADHD,irritable oppositional defiant disorder(ODD),and the presentation of aggression in children interferes with treatment responses in ADHD.METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests.ODD scores from the Swanson,Nolan,and Pelham,version IV scale were obtained.The child behavior checklist(CBCL)and parent’s satisfaction questionnaire were completed.The relationships were analyzed by GSEM.RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD,ODD symptoms,and childhood aggressive behavior.ODD directly mediated ADHD symptom severity.The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494%[=exp(2.602)]in children with comorbid ADHD and ODD[odds ratio(OR)=2.602,95%confidence interval(CI):1.832-3.373,P=0.000]after adjusting for the effects of other factors.Childhood aggression mediated ODD symptom severity.The chance of reaching remission based on ODD symptoms was lowered by 11.000%[=1-exp(-0.117)]in children with more severe baseline symptoms of aggression based on the CBCL score at study entry[OR=-0.117,95%CI:(-0.190)-(-0.044),P=0.002].CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity.More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment,e.g.,symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.

关 键 词：Attention-deficit/hyperactivity disorder Oppositional defiant disorder AGGRESSION REMISSION Generalized structural equation modeling 

分 类 号：R749.94[医药卫生—神经病学与精神病学]