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

Table 1 Sample characteristics and means and standard deviations of study measures

Characteristics	N	Mean, n (%)	SD
Age	231	10.17	2.59
Male (%)	231	175 (75.8)
Comorbidity
Yes	230	168 (73.0)
No	230	62 (27.0)
Subtype
Combined	230	158 (68.7)
Inattentive	230	72 (31.3)
Education
Elementary school	228	171 (75.0)
Junior high school	228	54 (23.7)
Senior high school	228	3 (1.3)
ADHD
Inattention	231	17.19	4.50
Hyperactivity	231	12.43	6.46
Disruptive child symptom
Oppositional defiant disorder	231	12.25	5.82
Aggression	231	13.32	7.23
Remission
Inattention	231	71 (30.7)
Hyperactivity	231	124 (53.7)
Disruptive child symptom
Oppositional defiant disorder	231	114 (49.4)
SCL
Somatization	231	4.53	6.19
Obsessive compulsive	231	5.68	5.53
Interpersonal sensitivity	231	3.31	4.10
Depression	231	5.11	6.08
Anxiety	231	2.54	3.43

SCL: Symptom check list; ADHD: Attention-deficit/hyperactivity disorder; SD: Standard deviation.

Table 2 Results of the multiple logistic regression model in pathway to the remission of inattention of attention-deficit/hyperactivity disorder

	Coef	SE	z	P value	95%CI
Remission I
ADHD-I B	-0.258	0.047	-5.53	< 0.001	(-0.350)-(-0.167)
Aggression_B	-0.112	0.038	-2.96	0.003	(-0.186)-(-0.038)
Delinquent B	0.112	0.038	2.96	0.003	0.038-0.186
Satisfaction	0.402	0.147	2.74	0.006	0.114-0.689
_cons	3.065	0.834	3.68	< 0.001	1.431-4.699

Pseudo-R² statistics assessed the predictive strength of the logistic regression model. The deviance and McFadden’s pseudo R² were D (226) = 214.144 (P = 0.704), pseudo R² = 0.2487, respectively. Remission I: Remission status of inattention; ADHD-I B: Attention-deficit/hyperactivity disorder baseline inattention; Aggression_B: Baseline aggressive behaviors; Delinquent B: Baseline delinquent behaviors; CI: Confidence interval; Coef: Coefficient; SE: Standard error.

Table 3 Results of the multiple logistic regression model in pathway to the remission of hyperactivity/impulsivity of attention-deficit/hyperactivity disorder

	Coef	SE	z	P value	95%CI
Remission H/I
ADHD-H/I B	-0.132	0.030	-4.39	< 0.001	(-0.191)-(-0.073)
Aggression_B	-0.102	0.035	-2.92	0.004	(-0.170)-(-0.033)
Anx/dep B	0.075	0.046	1.64	0.101	(-0.015)-0.164
Social pro. B	-0.177	0.076	-2.34	0.019	(-0.325)-(-0.029)
Thought pro. B	0.204	0.070	2.92	0.004	0.067-0.340
Satisfaction	0.579	0.133	4.34	< 0.001	0.317-0.840
_cons	1.743	0.518	3.36	0.001	0.727-2.759

Pseudo-R² statistics assessed the predictive strength of the logistic regression model. The deviance and McFadden’s pseudo R² were D (224) = 242.862 (P = 0.184), pseudo R² = 0.2386, respectively, which indicated that the model fit was good. Remission H/I: Remission status of hyperactivity/impulsivity of attention-deficit/hyperactivity disorder; ADHD-H/I B: Attention-deficit/hyperactivity disorder baseline hyperactivity/impulsivity of attention-deficit/hyperactivity disorder; Aggression_B: Baseline aggressive behaviors; Anx/dep B: Baseline anxiety/depression; Social pro. B: Baseline social problems; Thought pro. B: Baseline thought problem; CI: Confidence interval; Coef: Coefficient; SE: Standard error.

Table 4 Results of the multiple logistic regression model in pathway to the remission of oppositional defiant disorder

	Coef	SE	z	P value	95%CI
Remission ODD
ODD B	-0.130	0.033	-3.97	< 0.001	(-0.195)-(-0.066)
Aggression B	-0.117	0.037	-3.15	0.002	(-0.190)-(-0.044)
Delinquent B	0.117	0.037	3.15	0.002	0.044-0.190
Satisfaction	0.505	0.127	3.98	< 0.001	0.256-0.754
_cons	1.453	0.516	2.82	0.005	0.442-2.464

Pseudo-R² statistics assessed the predictive strength of the logistic regression model. The deviance and McFadden’s pseudo R² were D (226) = 255.740 (P = 0.085) and pseudo R² = 0.2013, respectively, which indicated that the model fit was good. Remission ODD: Remission status of oppositional defiant disorder; ODD B: Baseline oppositional defiant disorder; Aggression_B: Baseline aggressive behaviors; Delinquent B: Baseline delinquent behaviors; CI: Confidence interval; Coef: Coefficient; SE: Standard error.

Table 5 Results of the combined (mediation) model presented by the generalized structural equation modeling

	Coef	SE	z	P value	95%CI
Remission I
Remission H/I	3.394	0.782	4.340	0.000	1.862-4.927
Remission ODD	1.628	0.524	3.100	0.002	0.600-2.656
ADHD-I B	-0.234	0.058	-4.050	0.000	(-0.348)-(-0.121)
Aggression_B	-0.019	0.043	-0.440	0.661	(-0.104)-0.066
Delinquent_B	0.019	0.043	0.440	0.660	-0.066-0.104
Satisfaction	0.216	0.173	1.250	0.212	(-0.124)-0.556
_cons	-1.433	1.196	-1.200	0.231	(-3.777)-0.910
Remission H/I
Remission ODD	2.602	0.393	6.620	0.000	1.832-3.373
ADHD-H/I B	-0.148	0.036	-4.150	0.000	(-0.218)-(-0.078)
Aggression_B	-0.050	0.039	-1.270	0.205	(-0.127)-0.027
Anx/dep B	0.093	0.054	1.710	0.087	(-0.014)-0.200
Social pro. B	-0.203	0.086	-2.380	0.017	(-0.371)-(-0.036)
Thought pro. B	0.160	0.078	2.050	0.040	0.007-0.313
Satisfaction	0.431	0.153	2.810	0.005	0.130-0.731
_cons	0.567	0.607	0.930	0.350	(-0.622)-1.756
Remission ODD
ODD B	-0.130	0.033	-3.970	0.000	(-0.195)-(-0.066)
Aggression_B	-0.117	0.037	-3.150	0.002	(-0.190)-(-0.044)
Delinquent B	0.117	0.037	3.150	0.002	0.044-0.190
Satisfaction	0.505	0.127	3.980	0.000	0.256-0.754
_cons	1.453	0.516	2.820	0.005	0.442-2.464

Remission I: Remission status of inattention; ADHD-I B: Baseline inattention; Aggression_B: Baseline aggressive behaviors; Delinquent B: Baseline delinquent behaviors; Remission H/I: Remission status of hyperactivity/impulsivity of attention-deficit/hyperactivity disorder; ADHD-H/I B: Baseline hyperactivity/impulsivity of attention-deficit/hyperactivity disorder; Anx/dep B: Baseline anxiety/depression; Social pro. B: Baseline social problems; Thought pro. B: Baseline thought problem; Remission ODD: Remission status of oppositional defiant disorder; ODD B: Baseline oppositional defiant disorder; CI: Confidence interval; Coef: Coefficient; SE: Standard error.