Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD.

Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4-18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.

Self-concept in children and adolescents with attention deficit hyperactivity disorder.

Children with attention deficit hyperactivity disorder (ADHD) struggle with behavioral symptoms, yet little research has provided information about how behavioral symptoms impact their self-concept, especially in terms of gender, age, and ethnicity. Data were collected from 145 children and adolescents with ADHD and their mothers. African Americans, Hispanic Americans, and Caucasians were nearly equally represented in the sample, with approximately one third each. The Child Behavior Checklist was used to assess ADHD symptom severity, and Piers--Harris Children's Self-Concept Scale was used to measure self-concept. Older ages and more internalizing behavior problems predicted lower self-concept. There were no significant differences between ethnic groups on behavior problem and self-concept scores, although post hoc analyses revealed a trend for Caucasian children with ADHD to have lower self-concept scores than those of African American or Hispanic children. The findings indicate that there is a need to assess self-concept in children and adolescents with ADHD, especially those who are older and have comorbid conditions of anxiety and depression.

Mammography decision making in older women with a breast cancer family history.

PURPOSE: This study's purpose is to describe and explain how women 55 years of age and older with a family history of breast cancer make screening mammography decisions. DESIGN: A qualitative design based on grounded theory. This purposeful sample consisted of 23 women 55 years of age or older with one more first-degree relatives diagnosed with breast cancer. METHOD: Open-ended interviews were conducted with 23 women 55 years of age and older with a family history of breast cancer using a semistructured interview guide. Transcribed interview data were analyzed using constant comparative analysis to identify the conditions, actions, and consequences associated with participant's screening mammography decision making. FINDINGS: Women reported becoming aware of their breast cancer risk usually due to a triggering event such as having a family member diagnosed with breast cancer, resulting in women "guarding against cancer." Women's actions included having mammograms, getting health check-ups, having healthy behaviors, and being optimistic. Most women reported extraordinary faith in mammography, often ignoring negative mammogram information. A negative mammogram gave women peace of mind and assurance that breast cancer was not present. Being called back for additional mammograms caused worry, especially with delayed results. CONCLUSIONS: The "guarding against cancer" theory needs to be tested in other at-risk populations and ultimately used to test strategies that promote cancer screening decision making and the adoption of screening behaviors in those at increased risk for developing cancer. CLINICAL RELEVANCE: Women 55 years of age and older with a breast cancer family history need timely mammogram results, mammography reminders, and psychosocial support when undergoing a mammography recall or other follow-up tests.

Prevalence of vitamin D deficiency among immigrants to South Dakota.

INTRODUCTION: Vitamin D deficiency is gaining increased attention nationally. Recent clinical cases suggest that this condition is a significant problem in local refugee populations. The Sioux Falls Health Department recently implemented a policy of screening and treating all new refugees as part of the new refugee examinations at Falls Community Health Center. METHODS: Data from this screening during the first nine months of 2009 were reviewed and analyzed for prevalence of hypovitaminosis D in this population. Results from a total of 157 individuals were included in this study. RESULTS: Two percent of this population had initial calcidiol levels below the detection threshold. Six percent were severely deficient, defined as <15 ng/mL, and 58 percent were mildly deficient (15-32 ng/mL). Only 36 percent had levels above 32 ng/mL, considered adequate for bone health, with a mere 1 percent showing optimal levels of > 50 ng/mL. CONCLUSIONS: Hypovitaminosis D represents a significant public health issue among recent immigrants in Minnehaha County, S.D., and warrants aggressive attention by both primary care and public health professionals.

Patterns of parenting in Korean mothers of children with ADHD: A Q-methodology study.

The purpose of this study was to investigate patterns of parenting in Korean mothers of children with attention-deficit/hyperactivity disorder (ADHD) and identify major threads that structured various patterns of parenting. Q-methodology, a technique for extracting subjective attitudes, was used for data collection and analysis. Participants were asked to sort statements on issues associated with parenting. Factor analysis was applied to identify patterns in the ranking of statements. Participants were 45 Korean mothers of children with ADHD. As a result, three patterns of parenting emerged: Praise-Fairness, Strict-Control, and Sensitive Response-Balanced. These patterns differed on two axes: external and internal control and positive and negative reinforcement. This study provides an opportunity to enhance our understanding of the parenting patterns of mothers of children with ADHD in Korea. The findings can function as a cornerstone for developing future models of parenting children with ADHD and parent-child interactions.

Service needs of families with children with ADHD.

This article describes service use, perceived helpfulness of services, and the services requested of 157 families living with a child or adolescent with attention-deficit/hyperactivity disorder (ADHD) and specifically asks if service use and service need is a function of certain social demographic factors. Whereas these data suggest that ADHD is a fairly universal experience, as indicated by the high rate of service use across ethnic groups, income status, sex, and family composition, single-mother families used the most services, Hispanic families used the fewest, and families with boys with ADHD used more services than families with girls with ADHD. Income was not a significant factor in any services used or services requested. This study lends strength to the argument that more specialized services for certain groups are needed in venues with local community services, such as schools, where the majority of these children and families are already seeking help.

Latino parents' accounts of attention deficit hyperactivity disorder.

UNLABELLED: Although researchers have conducted a vast amount of research about attention deficit hyperactivity disorder (ADHD), few have addressed how Latino families experience ADHD. THE PURPOSE: (a) finding out about ADHD, (b) taking on a biomedical meaning, (c) living between two cultures, (d) caring for a child with ADHD, and (e) looking toward the future with ADHD. Although some of the circumstances encountered by Latino parents resemble those typically found in the literature about ADHD and families, their experience is rendered inordinately complex by multiple overlapping sociocultural, linguistic, and parental circumstances.

Modeling ADHD child and family relationships.

Little information is available on how to help families manage common negative sequelae of attention deficit/hyperactivity disorder (ADHD). This article is a report of the extent to which a theoretical formulation of child behavior, maternal distress, and family conflict was explained by data obtained from a community sample of families with children and adolescents with ADHD. Structural equation modeling was used to test the theoretical model. The primary variables of interest were (a) child behavior problems, (b) maternal distress, and (c) family conflict. The results suggest that maternal distress may mediate the relationship between child behavior problems and family conflict, indicating the critical importance of mothers in ADHD families and the need to provide them with additional support.

Children's accounts of attention-deficit/hyperactivity disorder.

As a postmodern illness, attention-deficit/hyperactivity disorder (ADHD) is embedded in controversy, reflective of the cultural times in which we live. Within this debate, 2 perspectives, ADHD as myth and ADHD as behavioral disorder, are most frequently voiced. This article describes these 2 differing perspectives and reports qualitative data from 39 children and adolescents with a diagnosis of ADHD regarding their perceptions, meanings,and experiences of living with this disorder. None of the participants in this study denied that they had difficulties and many of the difficulties they described corresponded to DSM-IV-R criteria and the scientific literature. Given these discoveries, the continual debate about the authenticity of ADHD only further victimizes families who are in desperate need of services.

Racism as a source of health disparity in families with children with attention deficit hyperactivity disorder.

Although poverty and health are inextricably linked, one cannot assume that simple poverty and low socioeconomic status are the primary causes of health disparity among racial groups. Examining the roles of racism and discrimination in access to health care and in the health experiences of people of color is fundamental to the goal of eliminating health disparities by 2010. Data from ethnic minority groups on how race influences health and health care services are absent from much of the nursing research literature. This article explores racism as a source of health disparity and discusses methodological implications for research, using attention deficit hyperactivity disorder (ADHD) research as an example.