María C. Fernández

Bilingual Receptive Vocabulary in Hispanic Preschool Children

Hispanic preschoolers in Miami, who are economically and culturally similar to the generalpopulation, were tested on receptive vocabulary in English and Spanish. English scores, even for children from homes where some English is spoken, were more than one and a haif standard deviations below the mean. The Spanish mean, by contrast was 95, a small, though significant difference from the Spanish norm. Factors other than vocabulary knowledge that might account for the lower scores are exploredL These include a different order of item difficulty, the potentially inappropriate norming sample, and the underestimation of bilingual knowledge inherent in single-language measures.

From awareness to acknowledgment: The development of concern among Latina mothers of children with disruptive behaviors

The purpose of this study was to describe the process by which Latina mothers become concerned about their children’s disruptive behaviors and deem professional help to be a necessary measure. A sample fo 62 Latina first-time help seekers were asked to narrate their stories of their children’s behavior, the process by which they became concerned, and their decision to seek professional services. Both qualitative and quantitative measures and procedures were used. Key findings include the following. Most mothers described onset after age 3.75. Earlier recognition of disruptive behaviors and earlier concern over these were associated with greater perceptions of functional impairment and with a greater degree of maternal distress at the time of the interview. Increases in awareness and in concern were associated with life events such as moving, migration, and changes in family composition. Mothers often assumed these life events to be causally linked to children’s difficulties. Earlier concern did not speed the awareness process. A “saturation point” was a better descriptor of the culmination of maternal concern than “problem recognition” or “problem labeling” School report of negative behavior was the strongest catalyst to problem acknowledgement. Mothers who recognized onset after their children entered school progressed through the concern process significantly faster than mothers who became concerned at younger child ages.

Cuban Mothers' Schemas of ADHD: Development, Characteristics, and Help Seeking Behavior

Parents play a crucial role in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD), one of the most prevalent developmental disorders of young children We report the findings of a qualitative study of Cuban-American mothers of 7 to 10 year old children with ADHD. Results suggest that mothers lacked a cultural model for ADHD and held a cultural model of normal child development which hampered their development of a schema of ADHD. Development of ADHD schemas were motivated by perplexity at their childrens behavior and by the high value mothers ascribed to academic achievement. Although the schemas developed by the mothers were labeled as ADHD, their behavioral characterizations of their children, their attributions for the condition and for its causes, and their management strategies were not always in agreement with those of the biomedical model for the condition. However, once mothers classified their childrens behavior as atypical, they actively sought assistance from the professional sector.

Disruptive Behaviors and Maternal Responsibility: A Complex Portrait of Stigma, Self-Blame, and Other Reactions.

Feelings of stigma and self-blame were studied among 62 Cuban, Dominican, and Puerto Rican mothers of 4- to 10-year-old children with disruptive behaviors. Data were collected and analyzed both qualitatively and quantitatively. Results indicated that 42% blamed themselves for their children’s behaviors, and 39% felt stigmatized by others. Feelings of stigma and self-blame were not significantly associated. Mothers who blamed themselves had a lower level of education and gave their children significantly more impaired functional ratings than mothers who did not blame themselves. Mothers who felt stigmatized became concerned about their children and sought help earlier, rated their children’s behavior at home more poorly, felt more socially restricted by their children’s behavior, and were less likely to feel competent in managing their children than mothers who did not feel stigmatized. Sources of stigma were family, the social network, schools, and the mother’s own schemas. Responses to stigma included isolation, self-blame, blaming others, and rejection of the stigma.

Presymptomatic ALS genetic counseling and testing : Experience and recommendations

Remarkable advances in our understanding of the genetic contributions to amyotrophic lateral sclerosis (ALS) have sparked discussion and debate about whether clinical genetic testing should routinely be offered to patients with ALS. A related, but distinct, question is whether presymptomatic genetic testing should be offered to family members who may be at risk for developing ALS. Existing guidelines for presymptomatic counseling and testing are mostly based on small number of individuals, clinical judgment, and experience from other neurodegenerative disorders. Over the course of the last 8 years, we have provided testing and 317 genetic counseling sessions (including predecision, pretest, posttest, and ad hoc counseling) to 161 first-degree family members participating in the Pre-Symptomatic Familial ALS Study (Pre-fALS), as well as testing and 75 posttest counseling sessions to 63 individuals with familial ALS. Based on this experience, and the real-world challenges we have had to overcome in the process, we recommend an updated set of guidelines for providing presymptomatic genetic counseling and testing to people at high genetic risk for developing ALS. These recommendations are especially timely and relevant given the growing interest in studying presymptomatic ALS.

Modes of Entry Into Services for Young Children With Disruptive Behaviors

The authors undertook this study to describe Latina mothers’ professional help seeking for their young children’s disruptive behaviors. They interviewed 62 Cuban, Puerto Rican, and Dominican first-time help seekers and found four modes of entry: (a) coercion, (b) acceptance of offered referral, (c) responsive and resourceful help seeking subsequent to school reports of behavior problems, and (d) a laborious and convoluted path that was characteristic of 52% of the sample. Schools, maternal and child characteristics, and social network forces played significant roles for all mothers, but the final determinants of service entry varied by the mode of entry followed. Findings suggest that problem labeling is not a necessary precursor to service entry and that direct referrals might effectively shortcut the help-seeking process. Finally, the process that underlies service entry would be described more aptly as a Theory of Affective Action than a Theory of Reasoned Action.

Presenting problems and assigned diagnoses among young Latino children with disruptive behavior

It is unclear whether the behaviors that alert families to the need for services are those that classify children for the diagnoses they receive. This study describes the behaviors that Latina mothers from Cuba, Puerto Rico, and the Dominican Republic report to have induced them to seek services for their young children. Both qualitative and quantitative analyses were used. Results indicated that mothers most frequently cited behaviors that fell in the categories of Hyperactivity, Aggression/Temper Tantrums, and School Complaints as reasons for help seeking. Whereas aggression and self-injurious acts were most alarming to mothers, School Complaints appeared to be a strong motivator for help seeking. Children whose mothers cited school behavior as a reason for help seeking had significantly poorer global functioning and presented significantly higher care giving demands than peers. In addition, their mothers reported significantly more disciplinary laxity than the mothers of peers without School Complaints. Maternal narratives of children’s behaviors moderately concurred with assigned diagnoses. Mothers overlooked inattentive behaviors in children with ADHD and reported much more aggression and oppositionality than might be expected from the number of diagnoses of ODD that were assigned.

Maternal Cognitions about Distress and Anxiety in Young Latino Children with Disruptive Behaviors

This study was undertaken to describe how Caribbean Latina mothers understand distress in children, the behaviors that they attribute to it, and the labels that they use to express their cognitions. Findings from 62 mothers of young children with disruptive behaviors indicated that mothers made attributions about anxiety in 40% of the children with a high likeli-hood of clinical anxiety. Hyperactive and restless behavior, but not children’s fears, was understood by mothers to reflect anxiety. References to ‘nervios’ could be categorized into: an illness condition, a crisis condition, and a temperament type. Only temperament usage was applied to children.

ALBA Screening Instrument (ASI): A brief screening tool for Lewy Body Dementia

BACKGROUND Early detection of neurodegenerative diseases is essential for treatment and proper care of these patients. Screening tools available today are effective for several types of dementia. However, there is no one specific for Lewy Body Dementia (LBD). OBJECTIVES The aim of this paper is to present a tool for early detection of LBD, accessible even for non-medical staff. METHODS We stratified subjects (MMSE>20) into four groups: health controls (HC), Mild Cognitive Impairment (MCI), LBD and other dementias (Alzheimer and vascular). All subjects (age range 50-90) were examined with a comprehensive neuropsychological and neuropsychiatric evaluation, as well as neuroimaging to differentiate diagnosis between groups, fulfilling corresponding criteria. Both neurologists and neuropsychologists were blind to the performance on clinical evaluations and ASI, respectively. The sensitivity and specificity of the instrument were determined to differentiate LBD from other groups. RESULTS We evaluated 427 subjects, 91 HC, 140 with MCI and 196 with dementia. In the dementia group, 75 were diagnosed with LBD and 121 with other dementias. ASI total score was 12.7±0.4 for LBD, 2.9±0.2 for HC, 5±0.7 for MCI, and 5.4±2.6 for other causes of dementia. ROC curve analysis showed a sensitivity of 90.7% and a specificity of 93.6% stands, with 9 as the cutoff with better test performance compared against other groups. CONCLUSION ASI is a brief screening tool for LBD with high sensitivity and specificity and useful even for non-medical staff.

Thalamus volume change and cognitive impairment in early relapsing–remitting multiple sclerosis patients

Aims The objective of the study was to assess whether changes in the volume of the thalamus during the onset of multiple sclerosis predict cognitive impairment after accounting for the effects of brain volume loss. Methods A prospective study included patients with relapsing–remitting multiple sclerosis less than 3 years after disease onset (defined as the first demyelinating symptom), Expanded Disability Status Scale of 3 or less, no history of cognitive impairment and at least 2 years of follow-up. Patients were clinically followed up with annual brain magnetic resonance imaging and neuropsychological evaluations for 2 years. Measures of memory, information processing speed and executive function were evaluated at baseline and follow-up with a comprehensive neuropsychological test battery. After 2 years, the patients were classified into two groups, one with and the other without cognitive impairment. Brain dual-echo, high-resolution three-dimensional T1-weighted magnetic resonance imaging scans were acquired at baseline and every 12 months for 2 years. Between-group differences in thalamus volume, total and neocortical grey matter and white matter volumes were assessed using FIRST, SIENA, SIENAXr, FIRST software (logistic regression analysis P < 0.05 significant). Results Sixty-one patients, mean age 38.4 years, 35 (57%) women were included. At 2 years of follow-up, 17 (28%) had cognitive impairment. Cognitive impairment patients exhibited significantly slower information processing speed and attentional deficits compared with patients without cognitive impairment (P < 0.001 and P = 0.02, respectively). In the cognitive impairment group a significant reduction in the percentage of thalamus volume (P < 0.001) was observed compared with the group without cognitive impairment. Conclusion We observed a significant decrease in thalamus volume in multiple sclerosis-related cognitive impairment.