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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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对立违抗障碍儿童家庭影响因素和家庭相关干预方案

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心理学 2014年第3期 1983-1995页

作者：蔺秀云李文琳黎燕斌赵悦彤申军华方晓义

对立违抗障碍(oppositional defiant disorder,ODD)是一组以对权威人物的抗拒、挑衅、公然违抗、敌对等行为为典型特征的破坏性行为障碍。以往众多研究表明，家庭因素是影响ODD及其症状表现的至关重要因素。总结以往文献，将家庭中影响... 详细信息

对立违抗障碍(oppositional defiant disorder,ODD)是一组以对权威人物的抗拒、挑衅、公然违抗、敌对等行为为典型特征的破坏性行为障碍。以往众多研究表明，家庭因素是影响ODD及其症状表现的至关重要因素。总结以往文献，将家庭中影响ODD及其症状表现的因素划分为整体水平、互动水平和个体水平三个层面。整体水平主要包括家庭社会经济地位、家庭氛围：互动水平主要是不同子系统的互动状况，包括教养方式、夫妻关系：个体水平主要包括父母的精神健康状况、文化水平、压力、心理控制源和儿童的智力水平、气质特质、其它行为和情绪问题。与之相应的，对ODD及其症状的家庭相关的干预措施中也会涉及到三个层面。干预措施中，父母行为训练模式及其变式都已经被实践和研究证明效果显著。这些变式主要有：不服从儿童帮助项目、亲子互动治疗、顽劣年纪系列以及积极教养计划等。今后研究应该对家庭影响因素进一步整合，并考虑到中国家庭独生子女、隔代抚养、多人管理孩子等的中国文化特点。

关键词：对立违抗障碍家庭影响因素家庭干预方案 oppositional defiant disorder family factors family intervention program

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Longitudinal Dyadic Analyses of Mothers' Emotion Dysregulation and Children's Emotion Dysregulation and oppositional defiant Symptoms among Chinese Children:Mediation by Mother-Child Relationship Quality

Longitudinal Dyadic Analyses of Mothers' Emotion Dysregulati...

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第二十一届全国心理学学术会议

作者： Yongqiang Jiang Xiuyun Lin Institute of Developmental Psychology School of Psychology Beijing Normal University

This study examined whether and how mothers’ and children’s perceptions of the mother-child relationship quality mediate the longitudinal associations between mothers’ and children’s initial emotion dysregulation and children’s later emotion dysregulation and oppositional defiant disorder(ODD) symptoms. Participants were 123 Chinese children with ODD and their mothers from a three-wave(2 years apart) longitudinal study. We used the multiple informant approach and dyadic analysis approach. Results revealed that(1) mothers’ emotion dysregulation significantly related to their own concurrent perceptions of relationship quality, whereas children’s wave 1 emotion dysregulation significantly related to their own and mothers’ perceptions of relationship quality at wave 1;(2) mothers and children perceptions of relationship quality from wave 1 to wave 2 were stable but also interdependent such that ones’ wave 1 perception of relationship quality significantly influenced the other’s wave 2 perception;more importantly,(3) relationship quality mediated the longitudinal associations between mothers’ and children’s wave 1 emotion dysregulation and children’s wave 3 emotion dysregulation and ODD symptoms in an interdependent pattern. These findings have implications for family intervention targeting maternal emotion dysregulation and strengthening mothers’ and children’s subjective perceptions of the mother-child relationship quality for children with ODD.

关键词： oppositional defiant disorder Emotion Dysregulation Mother-Child Relationship Quality Dyadic Analysis

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