Kimberley D. Lakes

CULTURAL COMPETENCE AND PSYCHOTHERAPY: APPLYING ANTHROPOLOGICALLY INFORMED CONCEPTIONS OF CULTURE

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinmans (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlors (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Functional adult outcomes 16 years after childhood diagnosis of Attention-Deficit/Hyperactivity Disorder:MTA results

OBJECTIVE To compare educational, occupational, legal, emotional, substance use disorder, and sexual behavior outcomes in young adults with persistent and desistent attention-deficit/hyperactivity disorder (ADHD) symptoms and a local normative comparison group (LNCG) in the Multimodal Treatment Study of Children with ADHD (MTA). METHOD Data were collected 12, 14, and 16 years postbaseline (mean age 24.7 years at 16 years postbaseline) from 476 participants with ADHD diagnosed at age 7 to 9 years, and 241 age- and sex-matched classmates. Probands were subgrouped on persistence versus desistence of DSM-5 symptom count. Orthogonal comparisons contrasted ADHD versus LNCG and symptom-persistent (50%) versus symptom-desistent (50%) subgroups. Functional outcomes were measured with standardized and demographic instruments. RESULTS Three patterns of functional outcomes emerged. Post-secondary education, times fired/quit a job, current income, receiving public assistance, and risky sexual behavior showed the most common pattern: the LNCG group fared best, symptom-persistent ADHD group worst, and symptom-desistent ADHD group between, with the largest effect sizes between LNCG and symptom-persistent ADHD. In the second pattern, seen with emotional outcomes (emotional lability, neuroticism, anxiety disorder, mood disorder) and substance use outcomes, the LNCG and symptom-desistent ADHD group did not differ, but both fared better than the symptom-persistent ADHD group. In the third pattern, noted with jail time (rare), alcohol use disorder (common), and number of jobs held, group differences were not significant. The ADHD group had 10 deaths compared to one death in the LNCG. CONCLUSION Adult functioning after childhood ADHD varies by domain and is generally worse when ADHD symptoms persist. It is important to identify factors and interventions that promote better functional outcomes.

The Reliability and Validity of the English and Spanish Strengths and Weaknesses of ADHD and Normal Behavior Rating Scales in a Preschool Sample: Continuum Measures of Hyperactivity and Inattention

Objective: To evaluate the reliability and validity of the English and Spanish versions of the Strengths and Weaknesses of ADHD-symptom and Normal-behavior (SWAN) rating scale. Method: Parents of preschoolers completed both a SWAN and the well-established Strengths and Difficulties Questionnaire (SDQ) on two separate occasions over a span of 3 months; instruments were in the primary language of the family (English or Spanish). Results: Psychometric properties for the English and Spanish versions of the SWAN were adequate, with high internal consistency and moderate test–retest reliability. Skewness and kurtosis statistics for the SWAN were within the range expected for a normally distributed population. The SWAN also demonstrated adequate convergent and discriminant validity in correlations with the various subscales of the SDQ. Conclusion: Psychometric properties of both the English and Spanish versions of the SWAN indicate that it is a reliable and valid instrument for measuring child attention and hyperactivity. The stability of ratings over time in this preschool sample was moderate, which may reflect the relative instability of these characteristics in preschool children.

More than one road leads to Rome: A narrative review and meta-analysis of physical activity intervention effects on cognition in youth

A growing body of research indicates that physical activity (PA) positively impacts cognitive function in youth. However, not all forms of PA benefit cognition equally. The purpose of this review was to determine the effect of different types of chronic PA interventions on cognition in children and adolescents. A systematic search of electronic databases and examination of the reference lists of relevant studies resulted in the identification of 28 studies. Seven categories of PA were identified, based on all possible combinations of three types of PA (aerobic, motor skill, cognitively engaging), and four comparison groups (no treatment, academic, traditional physical education (PE), aerobic). Effect sizes were calculated based on means and SDs at the post-test using Hedge’s g formula, which includes a correction for small sample bias. Each study was only entered once in each intervention-comparator category. Full data were provided from 21 studies (28 effect sizes; n = 2042 intervention; n = 2002 comparison group). Overall, chronic PA interventions had a significant small-to-moderate effect on cognition (0.46). Moderate significant positive effects were identified when PA interventions were compared to no treatment (0.86) or academic content (0.57). A non-significant effect was noted when PA interventions were compared to traditional PE (0.09) or aerobic group (0.80). However, high heterogeneity in pooled effect sizes suggests that important differences in the qualitative characteristics of the PA intervention and comparison interventions may exist. Effect sizes based on comparisons between different types of PA interventions and comparison groups are discussed in order to identify possible directions for future investigations. We conclude that chronic PA interventions have a positive impact on cognitive function in youth, but more systematic research is needed in this area.

Diverse Perceptions of the Informed Consent Process: Implications for the Recruitment and Participation of Diverse Communities in the National Children’s Study

We examined the experiences, perceptions, and values that are brought to bear when individuals from different ethnic and cultural backgrounds consider participating in health research. Fifty-three women from Latino, Asian American, Middle Eastern, or Non-Latino, White backgrounds participated in seven English or Spanish focus groups facilitated by trained investigators using a standard protocol. Investigators described the National Children’s Study (NCS) and then asked questions to elicit potential concerns, expectations, and informational needs. Group sessions were audio-recorded, transcribed verbatim, and analyzed using qualitative thematic methods. A major theme that emerged during focus groups was participant self-identification as a member of a cultural group or community when raising issues that would influence their decision to participate in research. A related theme was the belief by some that communities may differ in the ease of participation in the NCS. Identified themes related to the informed consent process included perceived risks, anticipated burden, perceived benefits, informational needs, and decision-making strategies. Although themes were shared across groups, there were cultural differences within themes. Findings indicated that individuals from diverse backgrounds may have different perspectives on and expectations for the research process. To effectively recruit representative samples, it will be important to address a range of issues relevant for informed consent and to consider the impact of participation on both individuals and communities.

Canine-Assisted Therapy for Children With ADHD: Preliminary Findings From The Positive Assertive Cooperative Kids Study

Objective: The objective of this study was to provide preliminary findings from an ongoing randomized clinical trial using a canine-assisted intervention (CAI) for 24 children with ADHD. Method: Project Positive Assertive Cooperative Kids (P.A.C.K.) was designed to study a 12-week cognitive-behavioral intervention delivered with or without CAI. Children were randomly assigned to group therapy with or without CAI. Parents of children in both groups simultaneously participated in weekly parent group therapy sessions. Results: Across both treatment groups, parents reported improvements in children’s social skills, prosocial behaviors, and problematic behaviors. In both groups, the severity of ADHD symptoms declined during the course of treatment; however, children who received the CAI model exhibited greater reductions in the severity of ADHD symptoms than did children who received cognitive-behavioral therapy without CAI. Conclusion: Results suggest that CAI offers a novel therapeutic strategy that may enhance cognitive-behavioral interventions for children with ADHD.

Applications of Generalizability Theory to Clinical Child and Adolescent Psychology Research

Using generalizability theory to evaluate the reliability of child and adolescent measures enables researchers to enhance precision of measurement and consequently increase confidence in research findings. With an observer-rated measure of child self-regulation, we illustrate how multiple sources of error variance (e.g., raters, items) affect the dependability (replicability) of scores and demonstrate methods for enhancing dependability of observer ratings. Using ratings of 181 children, we illustrate the use of two-facet (i.e., raters and items as sources of error) and three-facet (i.e., raters, items and occasions) analyses to optimize design features of future studies using this measure. In addition, we show how generalizability theory provides a useful conceptual framework for thinking about determinants of scores on acquaintance (e.g., teacher or parent) ratings, as well as observer ratings, and sheds light on the strengths and limitations of both types of data for child and adolescent clinical research.

The CUIDAR Early Intervention Parent Training Program for Preschoolers at Risk for Behavioral Disorders: An Innovative Practice for Reducing Disparities in Access to Service.

Researchers report mental health disparities that indicate that children and families with the highest need for services often are less likely to use them. Only a few investigators have focused on service delivery models to address underuse of services. This study examines the Childrens Hospital of Orange County (CHOC)/University of California, Irvine (UC Irvine) Initiative for the Development of Attention and Readiness (CUIDAR) model of service delivery in reducing disparities in access to and use of services and in decreasing child behavior problems in a community-based study with 169 self-referred, low-income, and predominantly minority families. The findings indicate that among minority families, CUIDAR is both more accessible and more equitably used than local, publicly funded mental health services. Among Latinos, attendance rates are higher when services are provided in Spanish. Parents report significant improvements in overall child difficulty and conduct problems. In addition, parents report high levels of satisfaction with the program.

Maternal Perspectives on the Return of Genetic Results: Context Matters

The objectives of this study were to study maternal preferences for the return of their childs genetic results and to describe the experiences, perceptions, attitudes, and values that are brought to bear when individuals from different racial and cultural backgrounds consider participating in genetic research. We recruited women with diverse sociodemographic profiles to participate in seven focus groups. Twenty‐eight percent of participants self‐identified as Hispanic; 49% as White, non‐Hispanic; and 21% as Asian or Asian American. Focus groups were conducted in English or Spanish and were audio‐recorded and transcribed verbatim. Transcripts were analyzed using qualitative thematic methods. Results indicated that preferences and decisions regarding the return of results may depend on both research and individual contextual factors. Participants understood the return of results as a complex issue, where individual and cultural differences in preferences are certain to arise. Another key finding was that participants desired an interpersonal, dynamic, flexible process that accommodated individual preferences and contextual differences for returning results. Our findings indicate a need to have well‐developed systems for allowing participants to make and change over time their choices regarding the return of their childs genetic results.

Reading Performance as a Function of Treatment With Lisdexamfetamine Dimesylate in Elementary School Children Diagnosed With ADHD

Background: Medication treatment studies of ADHD have typically not assessed effects on reading performance, although reading difficulties frequently co-occur in children with ADHD. The current study characterizes the effects of lisdexamfetamine dimesylate (LDX; Vyvanse®, Shire US Inc.), at peak efficacy, on reading performance in children with ADHD. Method: Children (ages 6-12; N = 26) with ADHD enrolled in a modified laboratory school study with an open-label, dose-optimization phase of LDX (30-70 mg/d). The Gray Oral Reading Test-4 (GORT-4) with measures of rate, accuracy, and comprehension was administered at baseline and 3-4 hr postdose, following 4 to 5 weeks of optimal dose titration. Results: Treatment reduced ADHD symptoms. Reading rate was improved, especially among children with higher verbal fluid reasoning without additional symptoms of neurodevelopmental delay. No differences were observed for reading accuracy or comprehension. Conclusion: Endophenotypical profiles may predict drug effects in specific skill areas, such as reading rate.