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 heterog...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.展开更多
To the editor:Adverse home environments(AHE),characterised by family conflict,parental separation or dysfunctional parenting,are linked to negative mental health outcomes in children and adults.12 AHE disproportionate...To the editor:Adverse home environments(AHE),characterised by family conflict,parental separation or dysfunctional parenting,are linked to negative mental health outcomes in children and adults.12 AHE disproportionately affect children with neurodevelopmental disorders such as attention-deficit/hyperactivity disorder(ADHD),which is characterised by inattention,hyperactivity/impulsivity and functional impairments.3 Apart from core symptoms,including inattention and hyperactivity,disruptive behaviour disorders(DBD),such as oppositional defiant disorder(ODD)and conduct disorder(CD),may be associated with AHE.Conduct problems are risk factors for ODD.And CD has become a main concern for childhood mental health.展开更多
文摘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.
基金supported by National Natural Science Foundation Youth Project (81901386)the Fundamental Research Funds for the Central Universities (YG2025ZD07)+5 种基金the National Science and Technology Innovation 2030 Major Project of China (2021ZD0203900)National Natural Science Foundation of China (NSFC) grant (82422029)the Science and Technology Commission of Shanghai Municipality (24Y22800200, 22QA1407900)NSFC grant (82271530)Innovation teams of high-level universities in Shanghaithe Scientific Research and Innovation Team of Liaoning Normal University (24TD004).
文摘To the editor:Adverse home environments(AHE),characterised by family conflict,parental separation or dysfunctional parenting,are linked to negative mental health outcomes in children and adults.12 AHE disproportionately affect children with neurodevelopmental disorders such as attention-deficit/hyperactivity disorder(ADHD),which is characterised by inattention,hyperactivity/impulsivity and functional impairments.3 Apart from core symptoms,including inattention and hyperactivity,disruptive behaviour disorders(DBD),such as oppositional defiant disorder(ODD)and conduct disorder(CD),may be associated with AHE.Conduct problems are risk factors for ODD.And CD has become a main concern for childhood mental health.
