Alyson C. Gerdes

Peer-assessed outcomes in the multimodal treatment study of children with attention deficit hyperactivity disorder

Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285 children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were participants in the Multimodal Treatment Study of Children with ADHD (MTA). Treatment groups were compared using the orthogonal treatment contrasts that accounted for the largest amount of variance in prior MTA outcome analyses: Medication Management + Combined Treatment versus Behavior Therapy + Community Care; Medication Management versus Combined Treatment; Behavior Therapy versus Community Care. There was little evidence of superiority of any of the treatments for the peer-assessed outcomes studied, although the limited evidence that emerged favored treatments involving medication management. Post hoc analyses were used to examine whether any of the four treatment groups yielded normalized peer relationships relative to randomly selected-classmates. Results indicated that children from all groups remained significantly impaired in their peer relationships.

Maternal Attributions, Affect, and Parenting in Attention Deficit Hyperactivity Disorder and Comparison Families.

The goal of this study was to simultaneously examine maternal attributions, affect, and parenting in mothers of children with and without attention deficit hyperactivity disorder (ADHD) using a multimethod approach (vignettes, confederate child video clips, and video clips of mothers own child). Of the participants, 23 were 7- to 12-year-old children (19 boys, 4 girls) with ADHD and their mothers, and 29 were 7- to 12-year-old comparison children (21 boys, 8 girls) and their mothers. Results indicated that mothers of children with ADHD attributed inattentive-impulsive behavior to less controllable and intentional factors and reported more negative affect and power assertive parenting in response to it than comparison mothers. They also attributed this behavior to more internal factors than comparison mothers but only when viewing their own children and to more global/stable factors but only when viewing their own children or a confederate child. Interestingly, mothers of children with ADHD reported more positive parenting in response to prosocial behavior while attributing this behavior to less controllable and global/stable factors than comparison mothers; compliance also was seen as less controllable, global/stable, and intentional by mothers of children with ADHD.

Discriminating between Children with ADHD and Classmates Using Peer Variables.

Objective: Impaired peer relationships have long been recognized as one of the major functional problems of children with ADHD, but no specific guidelines on clinical levels of impairment in this domain exist. Method: This study used Receiver Operating Characteristics methodology to determine what aspects of peer functioning best discriminate between children with ADHD and their classmates. Optimal cutoffs indicative of clinical levels of impairment associated with ADHD diagnosis were determined for all variables. The participants were 165 children with AD/HD who were part of the Multimodal Treatment Study of Children With ADHD and their 1,298 classmates. Results: Variables that best discriminated between children with ADHD and their classmates included peer rejection and negative imbalance between given and received liking ratings (i.e., children with ADHD liked others more than they were liked). Conclusion: Peer rejection and negative imbalance show most promise for identifying clinically significant levels of peer relationship impairment in children with ADHD. (J. of Att. Dis. 2009; 12(4) 372-380)

A Review of Peer Relationships and Friendships in Youth With ADHD.

Objective: The purpose of this essay is to examine peer relationships in youth with ADHD and to review current peer functioning interventions. Method: The studies included in this review were identified using the following search terms: “attention-deficit/hyperactivity disorder,” “ADHD,” “peer relationships,” “friendships,” “social skills,” “intervention,” and “treatment.” Other than a few seminal studies published prior to 2000, studies included were published between 2000 and 2012. Results/Discussion: Background information regarding peer relationship difficulties and specific social skills deficits of youth with ADHD is reviewed and current social skills and friendship intervention programs are examined. Future directions also are provided.

Parental Functioning in Families of Children With ADHD Evidence for Behavioral Parent Training and Importance of Clinically Meaningful Change

Objective/Method: Statistically significant and clinically meaningful effects of behavioral parent training on parental functioning were examined for 20 children with ADHD and their parents who had successfully completed a psychosocial treatment for ADHD. Results/Conclusion: Findings suggest that behavioral parent training resulted in statistically significant improvements in some domains of parenting behavior for both mothers and fathers and in reductions in most domains of parenting stress for mothers. Importantly, clinically meaningful change also was noted for these parental functioning areas, as well as for other domains of parental functioning that did not result in statistically significant findings. Clinical implications are discussed.

Child and Parent Predictors of Perceptions of Parent—Child Relationship Quality

Objective/Method: Predictors of perceptions of parent—child relationship quality were examined for 175 children with ADHD, 119 comparison children, and parents of these children, drawn from the follow-up phase of the Multimodal Treatment Study of Children with ADHD. Results/Conclusion: Children with ADHD perceived their mothers and fathers as more power assertive than comparison children. Children higher on depressive symptomatology also perceived their mothers and fathers as less warm and more power assertive. Mothers perceived themselves as more power assertive and fathers perceived themselves as less warm if they were higher on depressive symptomatology themselves or had children with ADHD or higher levels of depressive symptomatology. Several interactions indicated that the association between child factors and parental perceptions of warmth and power assertion often depended on parental depressive symptomatology. The findings resolve a previous contradiction in the literature regarding the relationship between child depressive symptoms and parental perceptions of parent—child relationship quality. (J. of Att. Dis. 2007;11(1) 37-48)

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.

Latino Parental Help Seeking for Childhood ADHD

To better understand the help seeking process that occurs within Latino families when a child is exhibiting behaviors consistent with attention-deficit/hyperactivity disorder (ADHD), qualitative and quantitative data from 73 Latino parents were examined. Findings suggest that most Latino parents in the current sample recognized ADHD symptoms as concerning and in need of professional help and reported being motivated to seek help. Unfortunately, they also appeared to lack knowledge about the etiology of and effective treatment for ADHD, and many identified barriers to seeking help. Future research must involve community collaborations aimed at increasing awareness and knowledge of ADHD and decreasing barriers to seeking help in targeted Latino communities.

Acculturation and Latino adolescent mental health: integration of individual, environmental, and family influences.

Abstract In order to address the mental health disparities that exist for Latino adolescents in the United States, psychologists must understand specific factors that contribute to the high risk of mental health problems in Latino youth. Given the significant percentage of Latino youth who are immigrants or the children of immigrants, acculturation is a key factor in understanding mental health among this population. However, limitations in the conceptualization and measurement of acculturation have led to conflicting findings in the literature. Thus, the goal of the current review is to examine and critique research linking acculturation and mental health outcomes for Latino youth, as well as to integrate individual, environmental, and family influences of this relationship. An integrated theoretical model is presented and implications for clinical practice and future directions are discussed.