Implementation of a culturally adapted treatment to reduce barriers for Latino parents.

Literature to date has not yet included a comprehensive examination of barriers to participation in treatment for Latino populations, incorporating the role of acculturation. This study reports on the process of developing and implementing a culturally adapted treatment for promoting parent involvement by Latino parents in Head Start preschool programs and examines engagement factors affecting participation in the treatment. Results show that Latino parents with higher native cultural competence perceived more benefits to the treatment and reported fewer barriers than parents with lower native cultural competence. Also, the total number of barriers to participation that parents perceived before treatment was negatively associated with treatment participation, above and beyond the influence of acculturation factors, parent perceptions of economic stress, and perceived program benefits. Results are discussed in terms of how to establish effective community-based mental health and educational outreach programs to promote engagement with Latino families. The importance of using bidimensional models of acculturation within research designs with Latino populations and ideas for future research are discussed.

A controlled study of a simulated workplace laboratory for adults with attention deficit hyperactivity disorder.

Despite an extant literature documenting that adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for significant difficulties in the workplace, there is little documentation of the underlying factors associated with these impairments. The main aim of this study was to examine specific deficiencies associated with ADHD on workplace performance in a simulated workplace laboratory relative to controls. Participants were 56 non-medicated young adults with DSM-IV ADHD and 63 age- and sex-matched controls without ADHD. Participants spent 10h in a workplace simulation laboratory. Areas assessed included: (1) simulated tasks documented in a government report (SCANS) often required in workplace settings (taxing vigilance; planning; cooperation; attention to detail), (2) observer ratings, and (3) self-reports. Robust findings were found in the statistically significant differences on self-report of ADHD symptoms found between participants with ADHD and controls during all workplace tasks and periods of the workday. Task performance was found to be deficient in a small number of areas, and there were a few statistically significant differences identified by observer ratings. Symptoms reported by participants with ADHD in the simulation including internal restlessness, intolerance of boredom and difficulty maintaining vigilance were significant and could adversely impact workplace performance over the long-term.

Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD.

OBJECTIVE: Despite the increasing presentation of attention-deficit/hyperactivity disorder (ADHD) in adults, many practitioners remain reluctant to assess individuals for ADHD, in part related to the relative lack of data on the presenting symptoms of ADHD in adulthood. Comorbidity among adults with ADHD is also of great interest due to the high rates of psychiatric comorbidity, which can lead to a more persistent ADHD among adults. METHOD: We assessed 107 adults with ADHD of both sexes (51% female; mean +/- SD of 37 +/- 10.4 years) using structured diagnostic interviews. Using DSM-IV symptoms, we determined DSM-IV subtypes. The study was conducted from 1998 to 2003. RESULTS: Inattentive symptoms were most frequently endorsed (> 90%) in adults with ADHD. Using current symptoms, 62% of adults had the combined subtype, 31% the inattentive only subtype, and 7% the hyperactive/impulsive only subtype. Adults with the combined subtype had relatively more psychiatric comorbidity compared to those with the predominately inattentive subtype. Women were similar to men in the presentation of ADHD. CONCLUSION: Adults with ADHD have prominent inattentive symptoms of ADHD, necessitating careful questioning of these symptoms when evaluating these individuals.

Does conduct disorder mediate the development of substance use disorders in adolescents with bipolar disorder? A case-control family study.

BACKGROUND: Recent work has highlighted important relationships among conduct disorder (CD), substance use disorders (SUD), and bipolar disorder in youth. However, because bipolar disorder and CD are frequently comorbid in the young, the impact of CD in mediating SUD in bipolar disorder youth remains unclear. METHOD: 105 adolescents with DSM-IV bipolar disorder (mean +/- SD age = 13.6 +/- 2.50 years) and 98 controls (mean +/- SD age = 13.7 +/- 2.10 years) were comprehensively assessed with a structured psychiatric diagnostic interview for psychopathology and SUD. The study was conducted from January 2000 through December 2004. RESULTS: Among bipolar disorder youth, those with CD were more likely to report cigarette smoking and/or SUD than youth without CD. However, CD preceding SUD or cigarette smoking did not significantly increase the subsequent risk of SUD or cigarette smoking. Adolescents with bipolar disorder and CD were significantly more likely to manifest a combined alcohol plus drug use disorder compared to subjects with bipolar disorder without CD (chi(2) = 11.99, p < .001). CONCLUSIONS: While bipolar disorder is a risk factor for SUD and cigarette smoking in a sample of adolescents, comorbidity with preexisting CD does not increase the risk for SUD. Further follow-up of this sample through the full risk of SUD into adulthood is necessary to confirm these findings.

The longitudinal course of comorbid oppositional defiant disorder in girls with attention-deficit/hyperactivity disorder: findings from a controlled 5-year prospective longitudinal follow-up study.

OBJECTIVE: A better understanding of the long-term scope and impact of the comorbidity with oppositional defiant disorder (ODD) in girls with attention-deficit/hyperactivity disorder (ADHD) has important clinical and public health implications. However, most of the available information on the subject derives from predominantly male samples. This study evaluated the longitudinal course and impact of comorbid ODD in a large sample of girls with ADHD. METHODS: Subjects were pediatrically and psychiatrically referred girls with and without ADHD assessed blindly at baseline (mean age = 11.6 years), and 5 years later (mean age = 16.6 years) by mid to late adolescence. The subjects' diagnostic status of ADHD with and without comorbid ODD at baseline was used to define three groups (controls [N = 107], ADHD [N = 77], ADHD + ODD [N = 37]). Outcomes were examined using logistic regression (for binary outcomes) and linear regression (for continuous outcomes). RESULTS: Compared with girls who had ADHD only, those with ADHD + ODD at baseline had a significantly increased risk for ODD and major depression at follow-up. Both groups of girls with ADHD had an increased risk for conduct disorder and bipolar disorder at follow-up. CONCLUSIONS: These longitudinal findings in girls with ADHD support and extend previously reported findings in boys indicating that ODD heralds a compromised outcome for girls with ADHD in adolescence.

Concordance between cigarette smoking and the modified Fagerström Tolerance Questionnaire in controlled studies of ADHD.

Our objective was to compare scores on a smoking questionnaire to a diagnosis of cigarette smoking. As part of follow-ups in studies of ADHD, we assessed for cigarette smoking using structured interviews and the modified Fagerstrom Tolerance Questionnaire (mFTQ). Data were obtained from 162 subjects (mean = 19.2 yrs). ROC analysis and kappa coefficients revealed that a cutoff score of 3 on the mFTQ showed the strongest agreement with a full diagnosis of cigarette smoking (kappa = 0.68). Clinicians and researchers using the mFTQ in adolescents and young adults should consider a cutoff score of 3 to be indicative of cigarette smoking.

Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents.

OBJECTIVE: To examine the effects of early stimulant treatment on subsequent risk for cigarette smoking and substance use disorders (SUDs) in adolescents with attention-deficit/hyperactivity disorder (ADHD). DESIGN: Case-controlled, prospective, 5-year follow-up study. SETTING: Massachusetts General Hospital, Boston. PARTICIPANTS: Adolescents with and without ADHD from psychiatric and pediatric sources. Blinded interviewers determined all diagnoses using structured interviews. Intervention Naturalistic treatment exposure with psychostimulants for ADHD. MAIN OUTCOME MEASURES: We modeled time to onset of SUDs and smoking as a function of stimulant treatment. RESULTS: We ascertained 114 subjects with ADHD (mean age at follow-up, 16.2 years) having complete medication and SUD data; 94 of the subjects were treated with stimulants. There were no differences in SUD risk factors between naturalistically treated and untreated groups other than family history of ADHD. We found no increased risks for cigarette smoking or SUDs associated with stimulant therapy. We found significant protective effects of stimulant treatment on the development of any SUD (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.13-0.60; chi(2)(113) = 10.57, P = .001) and cigarette smoking (HR, 0.28; 95% CI, 0.14-0.60; chi(2)(111) = 10.05, P = .001) that were maintained when controlling for conduct disorder. We found no effects of time to onset or duration of stimulant therapy on subsequent SUDs or cigarette smoking in subjects with ADHD. CONCLUSION: Stimulant therapy does not increase but rather reduces the risk for cigarette smoking and SUDs in adolescents with ADHD.