Tzang RF, Chang YC. Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy. World J Psychiatry 2022; 12(6): 787-800 [PMID: 35978969 DOI: 10.5498/wjp.v12.i6.787]
Corresponding Author of This Article
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
Research Domain of This Article
Psychiatry
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
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
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.
