The CUIDAR Early Intervention Parent Training Program for Preschoolers at Risk for Behavioral Disorders: An Innovative Practice for Reducing Disparities in Access to Service.

Researchers report mental health disparities that indicate that children and families with the highest need for services often are less likely to use them. Only a few investigators have focused on service delivery models to address underuse of services. This study examines the Children's Hospital of Orange County (CHOC)/University of California, Irvine (UC Irvine) Initiative for the Development of Attention and Readiness (CUIDAR) model of service delivery in reducing disparities in access to and use of services and in decreasing child behavior problems in a community-based study with 169 self-referred, low-income, and predominantly minority families. The findings indicate that among minority families, CUIDAR is both more accessible and more equitably used than local, publicly funded mental health services. Among Latinos, attendance rates are higher when services are provided in Spanish. Parents report significant improvements in overall child difficulty and conduct problems. In addition, parents report high levels of satisfaction with the program.

A clinical review of outcomes of the multimodal treatment study of children with attention-deficit/hyperactivity disorder (MTA).

Over the past decade, the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder has provided a bewildering wealth of data (more than 70 peer-reviewed articles) addressing treatment-related questions for children with attention-deficit/hyperactivity disorder. However, the take-home messages for clinicians may not always be clear. Therefore, this article reviews key findings, including relative benefits of medication and behavioral treatments, long-term effects at 2 and 3 years, treatment mediators and moderators, preliminary delinquency and substance use outcomes, and growth suppression related to stimulant use. Appropriate interpretations of the findings and their limitations are discussed, and recommendations for clinical practice are derived.

Characterizing the ADHD phenotype for genetic studies.

The genetic study of ADHD has made considerable progress. Further developments in the field will be reliant in part on identifying the most appropriate phenotypes for genetic analysis. The use of both categorical and dimensional measures of symptoms related to ADHD has been productive. The use of multiple reporters is a valuable feature of the characterization of psychopathology in children. It is argued that the use of aggregated measures to characterize the ADHD phenotype, particularly to establish its pervasiveness, is desirable. The recognition of the multiple comorbidities of ADHD can help to isolate more specific genetic influences. In relation to both reading disability and conduct disorder there is evidence that genes may be involved in the comorbid condition that are different from pure ADHD. To date, progress with the investigation of endophenotypes for ADHD has been disappointing. It is suggested that extending such studies beyond cognitive underpinnings to include physiological and metabolic markers might facilitate progress.

Preschool ADHD: exploring uncertainties in diagnostic validity and utility, and treatment efficacy and safety.

The current scientific and clinical status of preschool attention deficit hyperactivity disorder and its management is reviewed. Recent clinical and neuropsychological research supporting the utility of the construct will be presented along with a critical analysis of diagnostic issues. The published literature on treatment efficacy (both pharmacological and nonpharmacological) will be reviewed with a special focus on the issue of the safety and side effects of psycho-stimulants. The need for early identification and preventative intervention is indicated but caution should be employed in the use of psychostimulants with this age group.