Family Caregiver Acceptability of Assessing Caregiver Adverse Childhood Experiences (ACEs) and Distress in Pediatric Specialty Care.

INTRODUCTION: Providing quality healthcare for children includes assessing and responding to needs of their family caregivers. Three salient domains to consider are caregivers' early adverse childhood experiences (ACEs), their current levels of distress, and their resilience in coping with both prior and current stressors. OBJECTIVE: Determine acceptability of assessing caregiver ACEs, current distress, and resilience in pediatric subspecialty care settings. METHODS: Caregivers of patients in two pediatric specialty care clinics completed questionnaires about their ACEs, recent emotional distress, and resilience. Importantly, caregivers also rated the acceptability of being asked these questions. Participants included 100 caregivers of youth ages 3-17 across Sickle Cell Disease and Pain clinic settings. The majority of participants were mothers (91.0%) who identified as non-Hispanic (86.0%). Caregiver race was primarily African American/Black (53.0%) and White (41.0%). The Area Deprivation Index (ADI) was used to assess socioeconomic disadvantage. RESULTS: High levels of caregiver acceptability or neutrality with assessing ACEs and distress, as well as high ACEs, distress, and resilience. Associations were found between caregiver ratings of acceptability with caregiver resilience and socioeconomic disadvantage. Caregivers reported openness to being asked about their experiences during childhood and recent emotional distress, although ratings of acceptability varied according to other contextual variables, such as level of socioeconomic disadvantage and caregiver resilience. In general, caregivers perceived themselves to be resilient in the face of adversity. CONCLUSIONS: Assessing caregiver ACEs and distress in a trauma-informed way may provide opportunities for better understanding the needs of caregivers and families in order to support them more effectively in the pediatric setting.

Feasibility, Acceptability, and Preliminary Outcomes of a Culturally Adapted Evidence-Based Treatment for Latino Youth With ADHD.

Objective: To advance our knowledge about the most effective way to treat Latino youth with ADHD, the current feasibility and pilot study compared a culturally adapted evidence-based treatment (CAT) for ADHD to standard evidence-based treatment (EBT). Method: Following a comprehensive ADHD assessment, 61 Latino families of school-aged children (mean age of 8 years) were randomly assigned to either CAT or standard EBT (i.e., parent management training). Results: CAT outperformed standard EBT when examining homework completion and mother-reported treatment satisfaction. Apart from two trends favoring CAT, CAT and EBT both resulted in significant improvements in parent- and teacher-reported ADHD symptoms and functional impairment, as well as mother- and father-reported parental functioning. Conclusion: CAT outperformed standard EBT when examining several engagement and acceptability outcomes. CAT and EBT were equally effective when examining traditional treatment outcomes, which is impressive considering the robustness of standard EBT, especially when delivered by culturally competent staff.

Parental ADHD Knowledge in Latinx Families: Gender Differences and Treatment Effects.

OBJECTIVE: The current study aimed to extend findings of a study comparing two psychosocial treatments for ADHD in Latinx youth by examining if parental ADHD knowledge improves following treatment and if parental gender differences in ADHD knowledge exist. METHOD: Following a comprehensive ADHD assessment, 58 Latinx families of school-aged children (mean age of 8 years) were randomly assigned to either culturally-adapted treatment (CAT) or standard evidence-based treatment (EBT). Parents completed an ADHD Knowledge measure both pre- and post-treatment. RESULTS/CONCLUSION: Latinx mothers demonstrated greater knowledge of ADHD symptomatology than fathers at pre-treatment. CAT resulted in improvements in parental knowledge of ADHD for both mothers and fathers, whereas standard EBT resulted in no change in maternal knowledge and reduced paternal knowledge of ADHD symptomatology. Clinical implications will be discussed.

Family Functioning in Latinx Families of Children with ADHD: The Role of Parental Gender and Acculturation.

OBJECTIVES: It has been well-established that parents of children with ADHD report significantly higher levels of parenting stress and home chaos, and lower levels of parental efficacy than parents of children without ADHD. Unfortunately, most of the extant ADHD literature has focused on European American children and families, resulting in a paucity of research focusing on ethnic minority families of children with ADHD. The current study aimed to expand what is known about Latinx parents of children with ADHD by exploring contextual and cultural factors, such as parental gender and acculturation, which may account for variations in parenting experiences within this population. METHODS: The present study utilized secondary data analysis to analyze ratings of parenting stress, home chaos, and parental efficacy among a sample of Latinx mothers and fathers of children with ADHD (n = 46 dyads). RESULTS: Results indicated that Latinx mothers of children with ADHD reported higher levels of parenting stress than Latinx fathers of children with ADHD; however, no significant parental gender differences were found in ratings of parental efficacy or home chaos. Additionally, several significant relationships were found between parental acculturation and family functioning variables. CONCLUSIONS: Latinx families of children with ADHD are an understudied and underserved population within the field of clinical psychology. The current study provides critical information on Latinx family functioning within the context of ADHD treatment, specifically pertaining to the complex interplay of parenting and acculturation variables.

Incremental Clinical Utility of ADHD Assessment Measures With Latino Families.

Objective: This study examined the incremental clinical utility of parent and teacher reports of ADHD symptomatology and functional impairment in Latino youth, as well as parent and teacher agreement with the final clinical judgment on a diagnostic structured interview. Method: Participants included 70 Latino youth (47 males, 23 females; M age = 8.13 years, SD = 2.51 years) and their parents and teachers; 60 participants were diagnosed with ADHD. Correlations, percent agreement, kappas, and regressions were utilized. Results: Results demonstrated that teachers agreed with the final clinical judgment more often than did parents. Results additionally demonstrated that functional impairment did not statistically significantly improve diagnostic models already including ADHD symptoms; follow-up analyses were run and are discussed. Finally, results demonstrated that teacher reports statistically significantly improved diagnostic models already including parent reports. Conclusion: The current findings suggest the importance of including both parent and teacher reports of both ADHD symptomatology and functional impairment when assessing ADHD in Latino youth.

Group Treatment of Fecal Incontinence: A Description of an Interdisciplinary Intervention.

INTRODUCTION: Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness. METHOD: Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed. RESULTS: Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (P ≤ 0.01), and soiling was reduced (P ≤ 0.00). Medication adherence was also improved (P ≤ 0.04). Treatment results were maintained at 1-month follow-up. DISCUSSION: A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes. CONCLUSION: Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.

Latino Family Participation in Youth Mental Health Services: Treatment Retention, Engagement, and Response.

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.

Rates, Associations, and Predictors of Psychopathology in a Convenience Sample of School-Aged Latino Youth: Identifying Areas for Mental Health Outreach.

The Latino youth population is rapidly growing and expected to comprise nearly 40% of the total youth population by 2060. Unfortunate disparities exist in the United States (U.S.), such that young Latinos are less likely than non-Hispanic Whites to receive and benefit from mental health services. In order to identify and prioritize specific areas of mental health outreach, the current study examined preliminary rates, associations, and predictors of child psychopathology in a convenience sample of Latino youth. 123 Spanish and English speaking Latino parents of school-aged children completed a series of questionnaires regarding child and family functioning. Latino youth in the current sample demonstrated comparable rates of psychopathology to non-referred, normative samples. Parental acculturation (particularly Separated parental acculturation status: high orientation to Latino culture and low orientation to U.S. mainstream culture) was associated with an increased prevalence of clinically significant psychopathology across several domains, and socioeconomic status was associated with an increased prevalence of thought problems. Additionally, Separated parental acculturation status significantly predicted the prevalence of clinically significant anxious/depressed problems, such that youth of parents displaying Separated acculturation status were significantly more represented in the clinically-elevated groups than the functional groups. These preliminary results suggest that prioritizing outreach to Latino youth of parents maintaining orientation to Latino culture but not U.S. mainstream culture may be necessary in order to begin addressing existing mental health disparities in the U.S.

Understanding parental locus of control in Latino parents: Examination of cultural influences and help-seeking intentions for childhood ADHD.

OBJECTIVE: To address the disparities that exist in utilization of mental health services for ADHD among Latino families and to further our understanding of factors that influence parents' decisions to seek treatment for ADHD, the goal of the current study was to examine parental locus of control (PLOC) in a community sample of Latino parents. Specifically, the current study investigated cultural influences on PLOC, as well as the influence of PLOC on help-seeking. METHOD: Seventy-four primarily Spanish-speaking, Latino parents of school-age children completed measures to assess their help-seeking intentions, PLOC, and cultural orientation. RESULTS: Results indicated that U.S. mainstream orientation was associated with increased feelings of parental control and decreased beliefs in fate/chance and several Latino cultural values were associated with increased beliefs in fate/chance, and decreased feelings of parental efficacy and parental control. In addition, 2 PLOC domains (e.g., parental efficacy and fate/chance) were associated with beliefs that the behaviors of a child with ADHD would go away on their own. CONCLUSIONS: Results highlight the need for interventions aimed at modifying parenting behavior to take parents' cultural beliefs and values into account in order to accommodate and engage Latino families more effectively.