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

doi:10.5498/wjp.v12.i6.787

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World Journal of Psychiatry

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World J Psychiatry. Jun 19, 2022; 12(6): 787-800
Published online Jun 19, 2022. doi: 10.5498/wjp.v12.i6.787

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

Ruu-Fen Tzang, Yue-Cune Chang

Ruu-Fen Tzang, Department of Child and Adolescent Psychiatry, Mackay Memorial Hospital, Taipei 104, Taiwan

Ruu-Fen Tzang, Department of Childhood Care and Education, Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 112, Taiwan

Yue-Cune Chang, Department of Mathematics, Tamkang University, New Taipei City 251, Taiwan

Author contributions: Tzang RF and Chang YC designed the study and wrote the protocol; Chang YC undertook the statistical analysis; and all authors contributed to and approved the final manuscript.

Institutional review board statement: The study was reviewed and approved by the Mackay Memorial Hospital, Institutional Review Board (Approval No. MMH-I-S-489).

Informed consent statement: Patient were not required to give informed consent to the study because the analysis used the data of Institutional Review Board No: MMH-I-S-489; name of project: Exploring the symptomatology on children with internet addiction and attention deficit hyperactivity disorder and their parent that were obtained after each patient agreed the study by written consent.

Conflict-of-interest statement: All the authors have no potential conflicts of interest to disclose.

Data sharing statement: Participants gave informed consent for data sharing.

Corresponding author: Ruu-Fen Tzang, MD, Associate Professor, Department of Child and Adolescent Psychiatry, Mackay Memorial Hospital, No 92, sec 2, Zhong Shan N Rd, Taipei 104, Taiwan. rf.tzang@gmail.com

Received: August 20, 2021
Peer-review started: August 20, 2021
First decision: October 4, 2021
Revised: October 15, 2021
Accepted: May 5, 2022
Article in press: May 5, 2022
Published online: June 19, 2022
Processing time: 297 Days and 16.8 Hours

ARTICLE HIGHLIGHTS

Research background

Many parents seek help from mental health experts due to irritability in children with attention-deficit/hyperactivity disorder (ADHD). But treatment efficacy for irritable and aggressive ADHD in children remains ineffective. Therefore, the heterogeneity to ADHD treatment should be proposed by a specific mathematical method.

Research motivation

Treating children with ADHD is not only a matter of treating inattentive symptoms alone. It is important to understand the factors that influence treatment outcomes for those with ADHD.

Research objectives

This study used the generalized structural equation modeling (GSEM) pathway analysis to analyze heterogeneity in ADHD.

Research methods

We used the GSEM to test the hypothesis that ODD is essentially an intermediate mediator of treatment effectiveness for ADHD (in terms of odds of reaching remission or the chance of remission) by direct and indirect pathway analysis.

Research results

Higher irritable oppositional defiant disorder (ODD) symptom levels mediated the treatment outcomes in children with ADHD. Earlier recognition of risky hyperactivity/impulsivity ADHD symptoms + irritable ODD + childhood aggression as a particular subgroup and earlier provision of a more intensive combination of pharmacotherapy and cognitive behavior therapy modalities are essential.

Research conclusions

Treating children with ADHD is not only a matter of treating inattentive symptoms alone, but there is also a need to recognize and manage symptoms of ODD and the presented aggressive behavior, delinquent behavior, and thought problems in children with ADHD to improve ADHD treatment outcomes.

Research perspectives

Poor treatment outcomes in ADHD can be predicted as irritable ODD subtype of ADHD with aggressive behavior. An early and more intensive combined biopsychosocial model approach for ADHD should be warranted for these children. This study revealed additional insights into devising more efficacious pharmacotherapies and cognitive behavior therapies.