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.
