Attention deficit hyperactivity disorder symptoms mediate early-onset smoking.

BACKGROUND/AIMS: Symptoms of attention deficit hyperactivity disorder (ADHD) have often been associated with early-onset smoking. We hypothesize that reductions in ADHD symptoms due to an intervention have a mediating effect on early-onset smoking. METHODS: In a universal, school-based, randomized controlled intervention trial, we examined whether intervention-induced reductions in ADHD symptoms at age 9 mediated the reduced risk of tobacco use onset among these children at age 10 or 11 years. A sample of 477 first-grade boys and girls were randomly assigned to the Good Behavior Game intervention (n = 263), a 2-year (grades 2 and 3) universal classroom-based intervention aimed at reducing disruptive behavior problems, or to a control condition (n = 214). ADHD symptoms were assessed through teacher ratings. Early onset of tobacco use was assessed through self-report. RESULTS: The intervention-induced reductions in ADHD symptoms fully mediated the distal effect of intervention on reductions in early-onset smoking. CONCLUSIONS: Our results showed that programs that target ADHD symptoms may protect children from early-onset smoking as well. Further research is needed to examine pathways from ADHD symptoms to tobacco use.

Determinants of self-reported emotional and behavioral problems in Turkish immigrant adolescents aged 11-18.

OBJECTIVE: The aim of this study was to determine how adolescent, parent, family and stress factors and parental psychopathology are associated with self-reported emotional and behavioral problems in Turkish immigrant adolescents. METHODS: Multiple logistic models were fitted to determine the associations between problems, assessed by the Youth Self-Report (n = 363), and determinants, derived from the Turkish Immigrant Assessment Questionnaire and the General Health Questionnaire-28 filled in by parents. RESULTS: Repeating a grade,not living with both parents, remarriage and death or serious health problems in the family were associated with higher YSR scores. Support from the mother's family was of major importance. The strongest predictive power was found for family-related factors in boys and for parent-related factors in girls. CONCLUSIONS: Cultural aspects and post-immigration issues play an important underlying role in explaining problem behavior in Turkish immigrant adolescents. Future research should include additional immigrant-specific factors, e. g., acculturation-related issues, preferably in a longitudinal study design to gain more insight into the complex relationship between immigrant status and psychopathology.

Factors associated with problem behaviors in Turkish immigrant children in The Netherlands.

BACKGROUND: The objective of this study was to examine the relationship between child, parent, family/support, and stress variables and problem behaviors in Turkish immigrant children in the Netherlands. METHODS: Parents of 833 children were interviewed and administered a Turkish version of the Child Behavior Checklist for ages 4 through 18 and a Turkish immigrant assessment questionnaire. RESULTS: Increased integration (i.e., children belonging to a second generation of immigrants, older children) generally reduced the risk for problem behaviors, while frequent arguments, divorce, psychological problems, and convictions/incarcerations increased the risk for problem behaviors. CONCLUSIONS: Results indicate that problem behaviors are associated with the high level of separation faced by Turkish immigrant families and that more integration leads to lower levels of problem behavior. Additionally, migration history alone does not contribute to problem behavior. Factors in the family (e.g., quarrels, divorce, conviction) associated with problem behaviors in Turkish immigrants are similar to those found in Dutch and American populations. Future studies could examine predictors of problem behaviors in other culturally separated immigrant groups in the Netherlands, and in Turkish immigrant groups in other countries.

Teacher-reported problem behaviour in Turkish immigrant and Dutch children: a cross-cultural comparison.

OBJECTIVE: To compare problem behaviour in Turkish immigrant children living in the Netherlands versus problem behaviour in Dutch children from the general population as reported by teachers. METHOD: Teacher's Report Forms (TRF) were filled out by Dutch teachers, and for a subsample also by Turkish immigrant teachers, concerning 524 Turkish immigrant children selected randomly from the immigrant population in two large cities in the Netherlands. TRFs completed for Turkish immigrant children were compared with TRFs filled out for 1625 children selected randomly from the Dutch general population. RESULTS: No significant differences were revealed between children from both cultures on the TRF total problems, internalizing, externalizing and specific syndrome scales. Turkish immigrant teachers, however, reported higher total problems, internalizing and anxious/depressed scores for immigrant children than did Dutch teachers for the same immigrant children. CONCLUSION: No significant differences were found in the levels of behavioural and emotional problems reported by Dutch teachers for Turkish immigrant versus Dutch children. However, Turkish immigrant teachers reported high levels of anxiety and depression in immigrant children which go largely undetected by their Dutch teachers.

Problems reported by parents of children in multiple cultures: the Child Behavior Checklist syndrome constructs.

OBJECTIVE: The purpose of this study was to compare syndromes of parent-reported problems for children in 12 cultures. METHOD: Child Behavior Checklists were analyzed for 13,697 children and adolescents, ages 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand, and the United States. RESULTS: Comparisons of nine cultures for subjects ages 6 through 17 gave medium effect sizes for cross-cultural variations in withdrawn and social problems and small effect sizes for somatic complaints, anxious/depressed, thought problems, attention problems, delinquent behavior, and aggressive behavior. Scores of Puerto Rican subjects were the highest, whereas Swedish subjects had the lowest scores on almost all syndromes. With great cross-cultural consistency, girls obtained higher scores than boys on somatic complaints and anxious/depressed but lower scores on attention problems, delinquent behavior, and aggressive behavior. Although remarkably consistent across cultures, the developmental trends differed according to syndrome. Comparison of the 12 cultures across ages 6 through 11 supported these results. CONCLUSIONS: Empirically based assessment in terms of Child Behavior Checklist syndromes permits comparisons of problems reported for children from diverse cultures.

Comparisons of problems reported by parents of children in 12 cultures: total problems, externalizing, and internalizing.

OBJECTIVE: To compare parent-reported problems for children in 12 cultures. METHOD: Child Behavior Checklists were analyzed for 13,697 children and adolescents, aged 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand, and the United States. RESULTS: Comparisons of 12 cultures across ages 6 through 11 and 9 cultures across ages 6 through 17 yielded medium effect sizes for cross-cultural variations in Total Problem, Externalizing, and Internalizing scores. Puerto Rican scores were the highest, while Swedish scores were the lowest. With great cross-cultural consistency, Total and Externalizing scores declined with age, while Internalizing scores increased; boys obtained higher Total and Externalizing scores but lower Internalizing scores than girls. Cross-cultural correlations were high among the mean item scores. CONCLUSIONS: Empirically based assessment provides a robust methodology for assessing and comparing problems reported for children from diverse cultures. Age and gender variations are cross-culturally consistent. Although clinical cutoff points should not necessarily be uniform across all cultures, empirically based assessment offers a cost-effective way to identify problems for which children from diverse cultural backgrounds may need help.

To what extent are medical interviewing skills teachable?

Growth patterns of medical interviewing skills during a 6-year undergraduate curriculum are assessed by studying 563 medical students taken from five year-groups, interviewing simulated patients. In a cross-sectional, quasi-experimental design their skills are rated by means of the Maastricht History-taking and Advice Checklist (MAAS), an observation instrument which measures five categories of interviewing skills pertaining to initial medical consultations. The findings suggest that the skills for 'history-taking', 'presenting solutions' and 'structuring of the interview' are effectively learned. These learning effects result from a continuous small group teaching program with expert and peer review of videotaped encounters with simulated patients. The teaching effects of this program seem less for the skills pertinent to the phase of 'exploring the reasons for encounter' and to the 'basic interviewing skills', because the students' growing medical knowledge and the increasing ability to solve medical problems exert a counteracting influence on the acquisition of these easily deteriorating skills. The results might be helpful to curriculum planners in order to make their programs for medical interviewing skills more effective.