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

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World Journal of Psychiatry 2022年第6期12卷 787-800页

作者： Ruu-Fen Tzang Yue-Cune Chang Department of Child and Adolescent Psychiatry Mackay Memorial HospitalTaipei 104Taiwan Department of Childhood Care and Education Mackay Junior College of MedicineNursingand ManagementNew Taipei City 112Taiwan Department of Mathematics Tamkang UniversityNew Taipei City 251Taiwan

BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD *** is known about poor treatment efficacy owing to ADHD *** 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 *** A total of 231 children and adolescents completed ADHD inattention and H/I *** scores from the Swanson,Nolan,and Pelham,version IV scale were *** child behavior checklist(CBCL)and parent’s satisfaction questionnaire were *** relationships were analyzed by *** 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 *** directly mediated ADHD symptom *** 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 *** aggression mediated ODD symptom *** 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 *** 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

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