RESUMEN

This study examined the latent structure and validity of inattention, hyperactivity-impulsivity, and sluggish cognitive tempo (SCT) symptomatology. We evaluated mother and teacher ratings of ADHD and SCT symptoms in 140 Puerto Rican children (55.7% males), ages 6 to 11 years, via factor and regression analyses. A three-factor model (inattention, hyperactivity-impulsivity, and SCT) provided the best fit for both sets of ratings. Inattention was the strongest correlate of lower scores on neuropsychological, achievement, and psychosocial measures. Externalizing problems were most strongly associated with hyperactivity-impulsivity, and internalizing problems were most strongly associated with parent-rated SCT and teacher-rated Inattention. SCT was not associated with executive function but was negatively associated with math. Inattention accounted for a disproportionate amount of ADHD-related impairment, which may explain the restricted discriminant validity of DSM-IV types. The distinct factors of hyperactivity-impulsivity and SCT had unique associations with impairing comorbidities and are roughly equivalent in predicting external correlates of ADHD-related impairment.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/psicología , Atención , Trastornos del Conocimiento/psicología , Logro , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/etnología , Niño , Escolaridad , Femenino , Humanos , Hipercinesia/psicología , Conducta Impulsiva/psicología , Inteligencia , Relaciones Interpersonales , Masculino , Memoria a Corto Plazo , Madres , Pruebas Neuropsicológicas , Solución de Problemas , Escalas de Valoración Psiquiátrica , Desempeño Psicomotor , Puerto Rico , Enseñanza

RESUMEN

OBJECTIVE: Little is known about the effect of social context and gender on persistence of attention-deficit/hyperactivity disorder (ADHD) in children of early and middle school years. The study compared persistence of DSM-IV ADHD and ADHD not otherwise specified (NOS) over 2 years in two groups of Puerto Rican children. METHOD: A three-wave study obtained data on Puerto Rican children 5 through 13 years of age at baseline. Samples were drawn in the South Bronx in New York (n = 1,138) and two metropolitan areas in Puerto Rico (n = 1,353). The Diagnostic Interview Schedule for Children Version IV was used to diagnose ADHD and ADHD-NOS. RESULTS: ADHD or ADHD-NOS diagnosis at wave 1 strongly predicted disorder at waves 2 and 3. ADHD had a significantly stronger predictive effect than ADHD-NOS consistently across site and gender. There was a significant interaction with baseline age. For those younger at baseline, the strength of the prediction of ADHD-NOS was relatively weak; for older children, the presence of ADHD-NOS at baseline predicted risk of subsequent ADHD or ADHD-NOS. CONCLUSIONS: Persistence of ADHD in children of similar ethnicity does not manifest differently across context and gender. Results suggest that age-specific symptom criteria and modification of age-of-onset criteria should be considered for the diagnosis.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/etnología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Hispánicos o Latinos/psicología , Medio Social , Adolescente , Edad de Inicio , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Preescolar , Comparación Transcultural , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Ciudad de Nueva York , Determinación de la Personalidad , Puerto Rico , Factores Sexuales

RESUMEN

PURPOSE: The worldwide prevalence of conduct disorder (CD) and oppositional defiant disorder (ODD) is presented to examine the first of four criteria used in other studies to determine the validity of psychiatric disorders across cultures. METHODS: The authors searched Medline and PsycINFO from 1987 to 2008. Studies were included if they were representative of specific communities or countries and reported point prevalence of CD or ODD according to DSM-III-R or DSM-IV criteria for children 18 years or younger. RESULTS: Only methodological and not geographic factors were associated with variability of the prevalence estimates. CONCLUSIONS: The results are discussed in terms of their significance for the classification of disorders and the need for further research to establish the validity of these two disorders across cultures.

Asunto(s)

Déficit de la Atención y Trastornos de Conducta Disruptiva/epidemiología , Trastorno de la Conducta/epidemiología , Cultura , Adolescente , Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Niño , Trastorno de la Conducta/diagnóstico , Comparación Transcultural , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Salud Global , Humanos , Masculino , Prevalencia , Escalas de Valoración Psiquiátrica , Psicometría , Estados Unidos/epidemiología

RESUMEN

We examined the phenotypic expression of attention-deficit/hyperactivity disorder (ADHD) across cultures by assessing the factor/latent class structure of its core symptoms. We conducted a systematic review of the literature published from January 1987 to November 2008 using Medline and PsycINFO. We systematically reviewed 2,511 article abstracts, and 48 of these abstracts were included in this review. Research with school-age children from 15 countries including different samples, informants, and rating instruments supported a two-factor ADHD model consisting of inattention and combined hyperactivity and impulsivity. This model was not supported for preschool children. Cross-cultural equivalence for the two-factor model was suggested in some studies. Latent class analyses using parental data and more recent approaches like factor mixture modeling are generally consistent with factor analyses. These findings argue in favor of a cross-cultural validity of the syndrome. The implications of these findings for further research and classificatory systems in mental health like the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) are discussed.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/etnología , Atención , Comparación Transcultural , Características Culturales , Conducta Impulsiva/etnología , Agitación Psicomotora/etnología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Análisis Factorial , Humanos , Conducta Impulsiva/psicología , Agitación Psicomotora/psicología

RESUMEN

OBJECTIVE: This study examined the impact of inattention, hyperactivity, and oppositional defiant disorder (ODD) behaviors and gender on family life. METHOD: We created scales for the Family Experiences Inventory (FEI) in a nonclinical sample of Spaniard families with children ages 6 to 12 years (N = 369) and analyzed the perceived impact of these three behavior dimensions on family experiences. RESULTS: Multiple regression analyses indicated that ODD behaviors were uniquely correlated with Total FEI and its dimensions. Inattention was also uniquely related to higher negative Impact on School Relations and lower Positive Impact on Parents scales. Finally, gender-hyperactivity interactions indicated that boys with higher hyperactivity scores were more likely to score higher on the FEI Total, School Relations, and Siblings scales, and more likely to score lower on the Positive Impact on Parents scale than girls. CONCLUSIONS: These findings suggested that parents perceive greater child-related impact and place greater burden from having a male child with hyperactivity. Inattention, hyperactivity, and oppositional defiant behaviors are associated with global parent-child interactive stress but the pattern of associations will vary depending upon the behavior, child gender, and context of family life examined.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/psicología , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Familia/psicología , Hipercinesia/psicología , Niño , Conducta Infantil/psicología , Análisis Factorial , Femenino , Hispánicos o Latinos/psicología , Humanos , Modelos Lineales , Masculino , Percepción , Estrés Psicológico , Encuestas y Cuestionarios

RESUMEN

This study evaluates the initial efficacy of the Parent-Child Interaction Therapy (PCIT) for Puerto Rican preschool children aged 4-6 years with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), combined or predominantly hyperactive type, and significant behavior problems. Thirty-two families were randomly assigned to PCIT (n = 20) or a 3.5-month waiting-list condition (WL; n = 12). Participants from both groups completed pretreatment and posttreatment assessments. Outcome measures included child's ADHD symptoms and behavior problems, parent or family functioning, and parents' satisfaction with treatment. ANCOVAs with pretreatment measures entered as covariates were significant for all posttreatment outcomes, except mother's depression, and in the expected direction (p < .01). Mothers reported a highly significant reduction in pretreatment hyperactivity and inattention and less aggressive and oppositional-defiant behaviors, conduct problems assessed as problematic, parenting stress associated with their child's behavior, and an increase in the use of adequate parenting practices. For the WL group, there were no clinically significant changes in any measure. Treatment gains obtained after treatment were maintained at a 3.5-month follow-up assessment. PCIT seems to be an efficacious intervention for Puerto Rican families who have young children with significant behavior problems.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/etnología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Trastornos de la Conducta Infantil/etnología , Trastornos de la Conducta Infantil/terapia , Terapia Familiar/métodos , Relaciones Padres-Hijo/etnología , Adulto , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Conducta Infantil/etnología , Conducta Infantil/psicología , Trastornos de la Conducta Infantil/psicología , Preescolar , Femenino , Humanos , Masculino , Responsabilidad Parental/etnología , Responsabilidad Parental/psicología , Padres/psicología , Satisfacción del Paciente , Proyectos Piloto , Puerto Rico , Estrés Psicológico/etnología , Estrés Psicológico/terapia , Resultado del Tratamiento

RESUMEN

OBJECTIVE: The study describes prevalence and rates of services and medication use and associated factors over time among Puerto Rican youths with attention-deficit/hyperactivity disorder (ADHD). METHOD: Longitudinal data are obtained on Puerto Rican children ages 5 through 13 years in the south Bronx in New York (n = 1,138) and two metropolitan areas in Puerto Rico (n = 1,353). The Diagnostic Interview Schedule for Children-IV is the diagnostic tool. Five composite measures of risk factors: negative family influences, ineffective structuring, environmental risks, child risks, and maternal acceptance are constructed to relate services and medication use to risk variables. RESULTS: ADHD prevalence is similar in Puerto Rico and the south Bronx. Overall mental health services, medication, and psychostimulant use is lower in Puerto Rico across three time points. Most participants never received treatment at any time point. More environmental risks, negative child traits, and low maternal warmth are associated with more services, even after adjusting for comorbidity. When risk variables are controlled, the effects of ADHD on services use decrease. Previous treatment is a strong predictor of subsequent treatment. CONCLUSIONS: Rates of services and medication use are lower in Puerto Rico. Context seems to be more important than ethnicity in predicting mental health services and medication use among Puerto Rican children with ADHD. Other psychiatric diagnoses and general risk variables are important correlates of services and medication use.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Quimioterapia/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Adolescente , Áreas de Influencia de Salud , Niño , Preescolar , Femenino , Humanos , Masculino , Ciudad de Nueva York/epidemiología , Puerto Rico/etnología , Encuestas y Cuestionarios , Factores de Tiempo

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Comparación Transcultural , Países en Desarrollo , Metilfenidato/uso terapéutico , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Región del Caribe , Niño , Preescolar , Femenino , Humanos , América Latina , Masculino , Evaluación de Necesidades , Derivación y Consulta

RESUMEN

BACKGROUND: Research comparing treatment-referred boys and girls with attention-deficit/hyperactivity disorder (ADHD) has yielded equivocal results. Contradictory findings may be associated with differential referral practices or unexplored interactions of gender with ADHD subtypes. METHOD: We examined possible gender differences in ADHD and its subtypes among children aged 4 to 17 in a representative community sample (N = 1896) in Puerto Rico. Caretakers provided information through the Diagnostic Interview Schedule for Children (version IV) and a battery of impairment, family relations, child problems, comorbidity and treatment measures. RESULTS: ADHD was 2.3 times more common in boys than girls, but with one exception there was little evidence that the patterns of associations of ADHD with correlates were different for boys and girls. The exception was school suspension, which was more common among ADHD boys than girls. Additional gender interactions were found when ADHD subtypes were considered. Among those with combined type (n = 50), boys were more likely to be comorbid with mood disorders than girls. For those with the inattentive type (n = 47), girls were more likely to be comorbid with anxiety disorders than boys. CONCLUSIONS: Our findings lend cross-cultural generalizability to recent reports that gender does not interact with correlates for ADHD overall, but that it may play a role in subtypes.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/psicología , Adolescente , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Niño , Preescolar , Comorbilidad , Familia/psicología , Femenino , Humanos , Masculino , Trastornos del Humor/epidemiología , Trastornos del Humor/psicología , Relaciones Padres-Hijo , Escalas de Valoración Psiquiátrica , Puerto Rico/epidemiología , Factores de Riesgo , Factores Sexuales

RESUMEN

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastornos Mentales/epidemiología , Características de la Residencia/estadística & datos numéricos , Adolescente , Conducta del Adolescente/psicología , Factores de Edad , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno por Déficit de Atención con Hiperactividad/terapia , Déficit de la Atención y Trastornos de Conducta Disruptiva/epidemiología , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Niño , Conducta Infantil/psicología , Preescolar , Comorbilidad , Femenino , Humanos , Entrevista Psicológica , Masculino , Trastornos Mentales/psicología , Oportunidad Relativa , Padres/psicología , Prevalencia , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Puerto Rico/epidemiología , Factores Sexuales , Factores Socioeconómicos

RESUMEN

BACKGROUND: Differences in service utilization indicating that boys use more mental health services than girls were analyzed to see if they could be explained by known correlates of service use. These correlates were arranged into individual (severe emotional disturbance, level of impairment and externalizing disorders), family (parental education, psychopathology and parental concern) and school factors (difficulties with school work). The objectives were to understand and identify the factors accounting for gender differences in mental health service utilization in order to develop alternatives to promote equity in service delivery. METHODS: A representative sample of 1,896 children 4 to 17 years of age and their primary caretakers were interviewed for this study. Reports of service use were obtained using the Service Assessment for Children and Adolescents. Logistic regression was used to assess the relationship between gender and service use, adjusting for known correlates. RESULTS: Our results showed that, except for impairment, other individual, family and school factors did not explain gender differences in service utilization. Males with impairment were 2.87 times more likely to receive services than impaired females (p

Asunto(s)

Síntomas Afectivos/epidemiología , Alcoholismo/epidemiología , Trastornos de la Conducta Infantil/epidemiología , Hispánicos o Latinos/estadística & datos numéricos , Control Interno-Externo , Servicios de Salud Mental/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Síntomas Afectivos/diagnóstico , Síntomas Afectivos/etnología , Factores de Edad , Alcoholismo/diagnóstico , Alcoholismo/etnología , Niño , Trastornos de la Conducta Infantil/diagnóstico , Trastornos de la Conducta Infantil/etnología , Preescolar , Femenino , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Entrevista Psicológica , Masculino , Determinación de la Personalidad/estadística & datos numéricos , Psicometría/estadística & datos numéricos , Puerto Rico , Derivación y Consulta/estadística & datos numéricos , Reproducibilidad de los Resultados , Factores Sexuales , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/etnología , Revisión de Utilización de Recursos/estadística & datos numéricos

RESUMEN

In this paper we describe the process used to develop treatment manuals for internalizing and externalizing disorders in children and adolescents. These manuals were developed to offer health care providers and others working in child mental health a flexible intervention that could be adapted to different countries and localities based on: 1) the amount of health care and school resources that are available; 2) the nature and severity of the types of problems children have; and 3) the preferences and cultural factors that are important within these communities. We also discuss the experiences and cultural issues faced by sites in Egypt, Lebanon, Israel, and Brazil who volunteered to implement the manualized treatment programs. The feedback received from these sites indicates that the manuals can be implemented to help children with internalizing and externalizing problems.

Asunto(s)

Déficit de la Atención y Trastornos de Conducta Disruptiva/terapia , Medicina Basada en la Evidencia , Control Interno-Externo , Manuales como Asunto , Servicios de Salud Mental/organización & administración , Adolescente , Brasil , Niño , Trastornos de la Conducta Infantil/terapia , Diversidad Cultural , Egipto , Humanos , Israel , Líbano

RESUMEN

Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon.

Asunto(s)

Comparación Transcultural , Educación a Distancia , Medicina Basada en la Evidencia/educación , Evaluación de Procesos, Atención de Salud/normas , Adolescente , Brasil , Niño , Egipto , Humanos , Israel , Líbano , Trastornos Mentales/terapia

RESUMEN

In this paper we describe the process used to develop treatment manuals for internalizing and externalizing disorders in children and adolescents. These manuals were developed to offer health care providers and others working in child mental health a flexible intervention that could be adapted to different countries and localities based on: 1) the amount of health care and school resources that are available; 2) the nature and severity of the types of problems children have; and 3) the preferences and cultural factors that are important within these communities. We also discuss the experiences and cultural issues faced by sites in Egypt, Lebanon, Israel, and Brazil who volunteered to implement the manualized treatment programs. The feedback received from these sites indicates that the manuals can be implemented to help children with internalizing and externalizing problems.

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Neste artigo, descrevemos o processo utilizado para elaborar manuais de tratamento para transtornos de externalização e intrnalização em crianças e adolescentes. Esses manuais foram elaborados para oferecer uma intervenção flexível para provedores de atenção à saúde e demais profissionais que trabalham com a saúde mental da criança, podendo ser adaptados a diferentes países e localidades, com base: 1) no nível de atenção médica e de recursos educacionais disponíveis; 2) na natureza e na gravidade dos tipos de problemas que as crianças apresentam; e 3) nas preferências e fatores culturais que são importantes nessas comunidades. Discutimos, também, as experiências e os problemas culturais enfrentados pelas localidades no Egito, Líbano, Israel e Brasil que foram voluntárias em implementar os programas de tratamento especificados nos manuais. O retorno recebido dessas localidades indica que os manuais podem ser implementados para auxiliar as crianças com problemas de externalização e internalização.

Asunto(s)

Humanos , Niño , Adolescente , Control Interno-Externo , Manual de Referencia , Medicina Basada en la Evidencia , Servicios de Salud Mental/organización & administración , Déficit de la Atención y Trastornos de Conducta Disruptiva/terapia , Brasil , Diversidad Cultural , Egipto , Israel , Líbano , Trastornos de la Conducta Infantil/terapia

RESUMEN

Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon.

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A disseminação de estratégias de intervenção e avaliação baseadas em evidências para crianças e adolescentes com problemas comportamentais e/ou emocionais é hoje uma prioridade mundial. No entanto, o desenvolvimento de equipes capacitadas para implementação de estratégias de intervenção e avaliação baseadas em evidências nos diferentes países é limitado por restrições ambientais e econômicas. Neste artigo, discute-se um modelo de treinamento/supervisão à distância. Em seguida, são descritos sete desafios específicos encontrados e as soluções utilizadas para superar os obstáculos para implementação de estratégias de intervenção e avaliação baseadas em evidências em diferentes localidades no Brasil, Egito, Israel e Líbano.

Asunto(s)

Humanos , Niño , Adolescente , Evaluación de Procesos, Atención de Salud/normas , Comparación Transcultural , Educación a Distancia , Medicina Basada en la Evidencia/educación , Brasil , Egipto , Israel , Líbano , Trastornos Mentales/terapia

RESUMEN

BACKGROUND: The aim of this investigation was to examine the construct validity and distinctiveness of the inattentive type (IT) and combined type (CT) of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Latino/Hispanic sample. METHOD: A comprehensive assessment was conducted with a clinically diagnosed school-based sample of 98 children aged 6 to 11 (CT=44; IT=25; control group=29). RESULTS: Both ADHD groups were impaired on academic achievement measures, presented more ADHD-type behaviors during math and vigilance tasks, and exhibited greater internalizing symptoms. The IT group had a later onset of inattention symptoms, presented more sluggish cognitive tempo symptoms, was less prone to initiate social interactions or to be assertive and more self-controlled in social interchanges, was less likely to have externalizing behaviors, had mothers who reported less child-related family stress, and was less impaired in their adaptive functioning. CONCLUSIONS: Findings supported the construct validity of ADHD in this culturally different sample and suggested that the CT and IT represent distinct disorders.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/clasificación , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Niño , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Pruebas Psicológicas , Puerto Rico/epidemiología , Reproducibilidad de los Resultados , Ajuste Social

RESUMEN

This study compared Hispanic children (ages 7 to 11) with combined type (CT, n=33) and inattentive type (IT, n=21) attention deficit hyperactivity disorder (ADHD) and a control group (n=25) on time-estimation and time-reproduction tasks. The ADHD groups showed larger errors in time reproduction but not in time estimation than the control group, and the groups did not differ from each other on their performance on this task. Individual differences could not be accounted for by oppositional-defiance ratings and low math or reading scores. Although various measures of executive functioning did not make significant unique contributions to time estimation performance, those of interference control and nonverbal working memory did so to the time-reproduction task. Findings suggest that ADHD is associated with a specific impairment in the capacity to reproduce rather than estimate time durations and that this may be related to the children's deficits in inhibition and working memory.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Hispánicos o Latinos/psicología , Memoria , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Trastornos de la Memoria/etiología , Trastornos de la Memoria/psicología , Procesos Mentales , Análisis y Desempeño de Tareas , Factores de Tiempo

RESUMEN

BACKGROUND: Few prevalence studies in which DSM-IV criteria were used in children in representative community samples have been reported. We present prevalence data for the child and adolescent population of Puerto Rico and examine the relation of DSM-IV diagnoses to global impairment, demographic correlates, and service use in an island-wide representative sample. METHODS: We sampled 1886 child-caretaker dyads in Puerto Rico by using a multistage sampling design. Children were aged 4 to 17 years. Response rate was 90.1%. Face-to-face interviews of children and their primary caretakers were performed by trained laypersons who administered the Diagnostic Interview Schedule for Children, version IV (DISC-IV) in Spanish. Global impairment was measured by using the Children's Global Assessment Scale scored by the interviewer of the parent. Reports of service use were obtained by using the Service Assessment for Children and Adolescents. RESULTS: Although 19.8% of the sample met DSM-IV criteria without considering impairment, 16.4% of the population had 1 or more of the DSM-IV disorders when a measure of impairment specific to each diagnosis was considered. The overall prevalence was further reduced to 6.9% when a measure of global impairment was added to that definition. The most prevalent disorders were attention-deficit/hyperactivity disorder (8.0%) and oppositional defiant disorder (5.5%). Children in urban settings had higher rates than those in rural regions. Older age was related to higher rates of major depression and social phobia, and younger age was related to higher rates of attention-deficit/hyperactivity disorder. Both overall rates and rates of specific DSM-IV/DISC-IV disorders were related to service use. Children with impairment without diagnosis were more likely to use school services, whereas children with impairment with diagnosis were more likely to use the specialty mental health sector. Of those with both a diagnosis and global impairment, only half received services from any source. CONCLUSIONS: Because we used the DISC-IV to apply DSM-IV criteria, the study yielded prevalence rates that are generally comparable with those found in previous surveys. The inclusion of diagnosis-specific impairment criteria reduced rates slightly. When global impairment criteria were imposed, the rates were reduced by approximately half.

Asunto(s)

Manual Diagnóstico y Estadístico de los Trastornos Mentales , Hispánicos o Latinos/psicología , Trastornos Mentales/epidemiología , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Déficit de la Atención y Trastornos de Conducta Disruptiva/diagnóstico , Déficit de la Atención y Trastornos de Conducta Disruptiva/epidemiología , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Niño , Preescolar , Estudios Transversales , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Incidencia , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Servicios de Salud Mental/estadística & datos numéricos , Determinación de la Personalidad , Trastornos Fóbicos/diagnóstico , Trastornos Fóbicos/epidemiología , Trastornos Fóbicos/psicología , Puerto Rico/etnología , Muestreo

RESUMEN

OBJECTIVE: To examine to what extent Latino/Hispanic children with and without attention-deficit/hyperactivity disorder (ADHD) are receiving treatment and to identify variables that predict treatment with stimulant medication. METHOD: Primary caretakers of a probability household sample (N = 1,897) of Puerto Rican children aged 4-17 years were administered structured interviews (response rate: 90.1%) from 1999-2000 to ascertain psychiatric disorders and types of services received. RESULTS: Only 7.0% of children with ADHD received stimulant medication during the last year; moreover, only 3.6% had actually continued this treatment at the time of the interview. One fourth or less of those with ADHD received school-based services or psychosocial treatment. The male-female ratio in stimulant medication use was 10 to 1. In addition, only 0.2% of those with no psychiatric diagnosis received this treatment. ADHD and ADHD-not otherwise specified, impairment, and being male significantly predicted stimulant treatment. CONCLUSIONS: Children with ADHD in this Latino/Hispanic population are not receiving the most efficacious treatments based on scientific findings and relevant clinical consensus. This population is undertreated rather than overtreated.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Hispánicos o Latinos/estadística & datos numéricos , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/psicología , Niño , Preescolar , Femenino , Humanos , Masculino , Muestreo

RESUMEN

This paper describes the reliability and validity of the service assessment for children and adolescents (SACA) for use among Spanish-speaking respondents. The test-retest reliability of the instrument was assessed in a randomly selected clinical sample of 146 Puerto Rican children and adolescents aged 4-17. Both parents and children were administered the SACA twice by independent interviewers over an average 12-day follow-up period. The accuracy of parental and youth self-reports was assessed by comparing these reports to information obtained from medical records. The results showed that parents and children (aged 11-17) were able to report with fair to moderate reliability any last year use of mental health services, any outpatient mental health services, and school services. Residential and hospitalization services were reported by both informants with substantial test-retest reliability. Slight or no test-retest reliability was obtained for parent and child on the use of the specific type of mental health professionals, as well as parental reports of several treatment modalities. Substantial sensitivity of the SACA was obtained when comparing medical records to parental and child reports to lifetime use of any service and outpatient mental health service. Moderate sensitivity was obtained for last year use of mental health services for both parent and child informants.

Asunto(s)

Servicios de Salud del Adolescente/estadística & datos numéricos , Servicios de Salud del Niño/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Entrevista Psicológica/métodos , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Revisión de Utilización de Recursos/métodos , Adolescente , Adulto , Niño , Preescolar , Recolección de Datos , Femenino , Hispánicos o Latinos/psicología , Hospitales Psiquiátricos/estadística & datos numéricos , Humanos , Modelos Logísticos , Padres/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Puerto Rico , Tratamiento Domiciliario/estadística & datos numéricos , Autorrevelación