Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Processing time: 297 Days and 16.8 Hours
Core Tip

Core Tip: It is important to understand the factors that influence treatment outcomes for those with attention-deficit/hyperactivity disorder (ADHD). This generalized structural equation modeling pathway analysis studied heterogeneity in ADHD. We found that higher irritable oppositional defiant disorder (ODD) symptom levels mediated the treatment outcomes in children with ADHD. Treating children with ADHD is not only a matter of treating inattentive symptoms alone. 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.