A client-level session-by-session evaluation of behavioral activation's mechanism of action.

BACKGROUND AND OBJECTIVES: Our understanding of how Behavioral Activation (BA) for depression works is limited. BA is theorized to lead to changes in depression through changes in activation. While distal support for activation as a mechanism has been obtained, more research is needed before definitive conclusions can be drawn. Research on mechanism should consider the appropriate time-frame for examining changes in the theorized mechanism variable and whether the proposed mechanism is expected to exert causal influence in all BA cases. These issues were considered in the current study in which a post-hoc analysis was conducted to explore BA's mechanism using single-subject data obtained at each session during the course of treatment. METHODS: Activation and depression data were obtained from a randomized-controlled trial of BA for Latinos (BAL) compared to treatment-as-usual (TAU). Cross-lagged correlations were computed to test whether activation changes preceded, co-occurred with, or lagged behind changes in depression in a sample of 21 clients (BAL n = 14; TAU n = 7). Differences among participants based on activation-depression patterns were examined. RESULTS: For 79% of the BAL sample, changes in activation preceded or co-occurred with changes in depression, while no clients in the TAU sample evidenced this pattern. LIMITATIONS: Use of more proximal and objective measures of the constructs of interest and a higher dosage of BA may have served as a stronger test of the treatment's mechanism. CONCLUSIONS: More time-sensitive measurement of changes in variables of interest is needed.

A randomized hybrid efficacy and effectiveness trial of behavioral activation for Latinos with depression.

Depression presents a significant public health burden for Latinos, the largest and fastest-growing minority group in the United States. The current study performed a randomized controlled trial of Behavioral Activation (BA) for Latinos (BAL, n=21), with relatively minor modifications, compared to treatment as usual (TAU, n=22) in a community mental health clinic setting with a sample of depressed, Spanish-speaking Latinos. TAU was a strong comparison condition, taking place at the same clinic, under the same guidelines and clinic protocols, with similar levels of ongoing consultation, and using the same pool of therapists as BAL. Results indicated that BAL performed well with respect to treatment engagement and retention. Regarding acute treatment outcomes, an interaction emerged between number of sessions attended and condition. Specifically, only BAL clients who were engaged in treatment and attended more sessions demonstrated significant reductions in depression and improvements in quality of life and mental health functioning. Results are discussed in terms of the balance of efficacy and effectiveness issues addressed in this trial.

Assessing ADHD in Latino families: evidence for moving beyond symptomatology.

OBJECTIVE: In an effort to combat the mental health disparities that exist among Latinos, the current study aimed to add to our knowledge related to culturally appropriate assessments for Latino children presenting with ADHD. METHOD: As part of a larger study, a community sample of 68 Spanish-speaking, Latino parents completed the Spanish translation of the Disruptive Behavior Disorders Rating Scale (DBD-S), a commonly used, parent-report measure of ADHD. RESULTS: Results suggest that although both the Inattentive and Hyperactive/Impulsive subscales of the DBD-S are psychometrically sound, the Hyperactive/Impulsive subscale may not be culturally appropriate with some Latino families, particularly those who are less acculturated. This was further supported by preliminary evidence suggesting that this subscale also was not diagnostically useful with the current, community sample. CONCLUSION: The potential problems associated with the overemphasis on symptomatology when working with Latino families, the importance of examining functional impairment as part of a culturally appropriate assessment, and the need to replicate the current findings with a clinical sample are discussed.

Advancing our knowledge of ADHD in Latino children: psychometric and cultural properties of Spanish-versions of parental/family functioning measures.

The lack of available Spanish versions of assessment measures contributes to insufficient research and underutilization of mental health services for Latino children with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the goal of the current study was to examine the psychometric and cultural properties of several Spanish versions of parental/family functioning measures commonly used in comprehensive ADHD assessments (i.e., the Parenting Sense of Competence Scale, Alabama Parenting Questionnaire, and Confusion, Hubbub, and Order Scale). Participants included 68 Spanish-speaking, Latino parents in Southeast Wisconsin. In general, the Spanish translations of the measures demonstrated good reliability and validity. Furthermore, the psychometrically-sound measures were significantly related to acculturation as predicted, suggesting that the scales are not only psychometrically valid, but also culturally valid for use with Spanish-speaking, Latino families.