淡江大學機構典藏:Item 987654321/122775
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    Title: Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy
    Authors: Tzang, Ruu-Fen;Chang, Yue-Cune
    Keywords: Attention-deficit/hyperactivity disorder;Oppositional defiant disorder;Aggression;Remission;Generalized structural equation modeling
    Date: 2022-06-19
    Issue Date: 2022-06-15 12:10:59 (UTC+8)
    Publisher: Baishideng Publishing Group Inc
    Abstract: 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.
    Relation: World Journal of Psychiatry 12(6), p.787-800
    DOI: 10.5498/wjp.v12.i6.787
    Appears in Collections:[Graduate Institute & Department of Mathematics] Journal Article

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