Measurement of risk for mental disorders and competence in a psychiatric epidemiologic community survey: the National Institute of Mental Health Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study

Dispositional factors in the explanation of symptoms of depression, anxiety, health anxiety and COVID-19 Phobia

Maladaptive personality, the motivational systems, and intolerance of uncertainty play important roles in the statistical explanation of depression and anxiety. Here, we notably examined for the first time whether symptoms of depression, anxiety, health anxiety, and fear of COVID-19 share similar associations (e.g., variance explained) with these important dispositional dimensions. For this cross-sectional study, data from 1001 participants recruited in Germany (50% women; mean age = 47.26) were collected. In separate models, we examined the cross-sectional associations of the symptoms of depression, anxiety, health anxiety, and fear of COVID-19 with the Personality Inventory for DSM Short Form Plus scales, the Behavioral Inhibition System / Flight-Fight-Freeze System / Behavioral Activation System scales, and Intolerance of Uncertainty scales. Relative weight analyses were used to determine the within-model importance of the different scales in the prediction of the symptoms. All in all, our study showed that maladaptive personality and intolerance of uncertainty dimensions are more important sets of predictors of the studied outcomes (with which depressive and anxious symptomatology feature very similar associations) than are the motivational system dimensions. Within predictor sets, the scales with the most important predictors were: Negative Affectivity, the Behavioral Inhibition System, and Burden due to Intolerance of Uncertainty. Our findings highlight the relevance of focusing behavioral targets of psychotherapy on these within-set traits and identify potential research priorities (maladaptive personality and intolerance of uncertainty) in relation to the symptoms of interest.

Adverse childhood experiences and perceived stress in early adulthood in the context of disadvantage

BACKGROUND

Adverse childhood experiences (ACEs) may sensitize individuals to view situations in adulthood as more stressful, which may contribute to poor health outcomes. In populations facing disadvantage, ACEs may lead to the accumulation of stressors (stress proliferation or mediation hypothesis) throughout the life course. ACEs could also heighten perceived stress later in life due to its enduring impact (stress sensitization or effect modification hypothesis).

OBJECTIVE

We examine the associations between ACEs and perceived stress in early adulthood, considering concurrent life stressors, in a longitudinal cohort of Puerto Rican youth exposed to a high degree of disadvantage.

PARTICIPANTS AND SETTING

A community-based sample of 1626 Puerto Rican children living in disadvantaged contexts was followed longitudinally in the Boricua Youth Study from 2000 to 2017.

METHODS

ACEs were measured prospectively during childhood (<18 yrs), and life stressors and past year perceived stress were measured in early adulthood (EA; mean age = 23.4, sd 2.22). Causal mediation analysis tested ACEs' effects on EA perceived stress indirectly through life stressors including potential effect modification.

RESULTS

ACEs influenced perceived stress in EA (standardized total effect = 0.13, p < .001) with 35% mediated by increased exposure to life stressors in EA due to ACEs. There was no evidence of increased sensitization to EA life stressors among those with higher ACEs exposure.

CONCLUSIONS

ACEs contribute to perceived stress in EA, albeit with small effect, partially through accumulating effects of ongoing stressors, supporting the stress proliferation hypothesis. Policies aimed at reducing exposure to adversity from childhood to EA are needed to reduce the experience of ACEs and negative sequelae.

Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5-11 Years

Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

How Ethnic Minority Context Alters the Risk for Developing Mental Health Disorders and Psychological Distress for Latinx Young Adults

Policy Points In low-income communities in the South Bronx and Puerto Rico, Puerto Rican youth are exposed to many of the same risk and protective factors for developing depression, anxiety, or psychological distress; yet it is unclear how the ethnic minority context of the South Bronx and ethnic majority context of Puerto Rico influence risk. Results from our quasi-experimental, longitudinal study demonstrate the importance of addressing social factors (parent-child relationships, youth peer relationships) for youth living in the majority context, and neighborhood and cultural factors (residential mobility, perceived discrimination, perceived social position in the neighborhood) for youth living in the minority context. Our findings support the need for tailoring programs specific to the needs of youth who reside in an ethnic majority or a minority context, since some of the risk factors might operate differently depending on context. Housing and neighborhood environment policies that address discrimination and eliminate structural inequities for ethnic minority groups may protect against the harm of minoritization on young people's mental health.

CONTEXT

Puerto Rican youth growing up in low-income communities in the South Bronx and Puerto Rico are exposed to many of the same risk factors for major depressive disorder, generalized anxiety disorder, and psychological distress. One potentially powerful factor differs: Puerto Ricans have been socially marginalized as an ethnic minority group in the South Bronx, but are the ethnic majority of the population in Puerto Rico. A growing body of literature demonstrates the influence of neighborhood, cultural, and social factors and parental psychopathology in the development of mental health problems. An important unanswered question is whether these risk and protective factors have the same impact for youth raised as members of an ethnic majority versus minority group.

METHODS

Using a population-based cohort study, with four waves of assessment from early childhood into young adulthood, we investigated whether ethnic minority context alters risk and protective factors for depression, anxiety, and psychological distress. Our longitudinal data set includes 2,491 young children at baseline (82.8% retained at wave 4). Using a quasi-experimental design, we examine how ethnic minority context can alter the development of mental health disorders as Latinx children transition to late adolescence and young adulthood.

FINDINGS

Some risk and protective factors operated differently across minority and majority contexts. Higher discrimination and social position were more powerful risk and protective factors, respectively, in the minority context, whereas positive peer relationships mattered more in the majority context. Children of mothers with depression were significantly more likely to develop anxiety in late adolescence and young adulthood in the majority context (60.0%) compared to the minority context (4.5%).

CONCLUSIONS

Preventing depression and anxiety disorders in Latinx young adults may require targeting different childhood factors depending on whether they reside within the ethnic majority or minority context. People in the ethnic minority context may benefit more from policies aimed at reducing discrimination and improving economic opportunity, while people in the majority context may benefit more from opportunities for strengthening family and peer relationships.

Childhood chronic condition and subsequent self-reported internalizing and externalizing problems in adolescence: a birth cohort study

Chronic conditions are common in childhood. We investigated the associations of childhood chronic conditions reported by parents with subsequent self-reported internalizing and externalizing problems in adolescence. A sample of 6290 children (3142 boys and 3148 girls) with data on chronic condition reported by parents both at 7 and at 16 years of age was obtained from the Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort (n = 9432) from an unselected, regionally defined population. Internalizing and externalizing problems were measured at 8 years of age with Rutter Children's Behavioral Questionnaire by teachers and at 16 years of age with Youth Self-Report by adolescents. When studying the effects of history of chronic conditions on these problems at 16 years of age, childhood internalizing and externalizing problems and social relations were adjusted. A history of chronic condition predicted subsequent somatic complaints among all adolescents. Early-onset chronic conditions were related to subsequent externalizing (OR 1.35; 1.02-1.79) and attention problems (OR 1.33; 1.01-1.75) and later onset of chronic conditions with internalizing (OR 1.49; 1.22-1.82) and thought problems (OR 1.50; 1.18-1.92). The effect was specific for sex and the type of chronic condition.

CONCLUSION

Childhood chronic conditions predicted internalizing and externalizing problems in adolescence. To prevent poor mental health trajectories, children with chronic conditions during their growth to adolescence need early support and long-term monitoring.

WHAT IS KNOWN

• Childhood adversities increase the risk of mental disorders. • Internalizing and externalizing problems have been suggested for measuring childhood and adolescent psychopathologies.

WHAT IS NEW

• Having a chronic condition (CC) before the age of 7 or later but before the age of 16 had different outcomes in adolescence. The early onset predicted externalizing problems, whereas the late onset predicted internalizing problems and thought problems in adolescence. The risk of somatic complaints was increased regardless of CC onset time. These findings can reflect more restricted ability to mental processing in the younger children.

Parental incarceration during childhood and later delinquent outcomes among Puerto Rican adolescents and young adults in two contexts

OBJECTIVE

Childhood parental incarceration has been linked to increased rates of delinquency and arrest during adolescence and young adulthood; however, previous research has focused on White and/or Black samples rather than Latinx youth. We examined relationships between childhood parental incarceration and later delinquency and arrest among Puerto Rican youth living in Puerto Rico (majority context) and the mainland United States (minority context).

HYPOTHESES

We expected that childhood parental incarceration would be significantly linked to delinquent behavior and arrest. In line with acculturation theory, we hypothesized that residence (proxy for minority status) would be significantly related to delinquent outcomes and that an interaction effect would emerge between parental incarceration and residence.

METHOD

Longitudinal data from the Boricua Youth Study were examined for 1,294 Puerto Rican youth from the South Bronx, NY (minority context) and greater San Juan, PR (majority context). We conducted a series of negative binomial and logistic regressions to determine the effects of parental incarceration and residence in childhood on self-reported delinquent behavior and arrest in adolescence and young adulthood, while also examining factors previously linked to delinquency in Puerto Rican youth.

RESULTS

Childhood parental incarceration and South Bronx residence were both linked to delinquent behavior but not arrest, even when simultaneously examining several individual, diagnostic, environment/social, and family factors reported in childhood. However, we did not observe an interaction effect between parental incarceration and residence for either outcome.

CONCLUSIONS

Findings suggest that Puerto Rican youth with histories of parental incarceration could benefit from targeted programs aimed at preventing future delinquency. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Evidence of concurrent and prospective associations between early maltreatment and ADHD through childhood and adolescence

PURPOSE

An emerging body of work suggests a link between childhood maltreatment and attention-deficit hyperactivity disorder (ADHD). However, research examining the role of maltreatment in the early course of the disorder lacks robust evidence from longitudinal studies. Our aim was to examine concurrent and prospective associations between maltreatment experiences and ADHD diagnosis and sex differences, and to estimate the association between repetitive maltreatment exposure and ADHD through childhood and adolescence.

METHODS

Data were obtained from the Boricua Youth Study, a longitudinal study of 2480 children and adolescents of Puerto Rican background. Neglect, physical, emotional and sexual abuse, and foster placement were regressed on ADHD diagnosis measured at each of three waves using the Diagnostic Interview Schedule for Children-IV. Multilevel regressions estimated the effects of exposure on ADHD, adjusted by age, sex, income, household education, parental psychopathology, comorbidity and ADHD medication status.

RESULTS

Emotional abuse and foster placement had robust associations with ADHD diagnosis. For girls, physical abuse had a threefold increase in the odds of having ADHD diagnosis; for boys, associations were observed only for emotional abuse. Prospective models examining the risk of ADHD following maltreatment provided initial evidence for the effects of physical abuse on ADHD, and a linear trend for repetitive exposure suggested increased probability for disorder persistence.

CONCLUSIONS

Associations between early maltreatment and ADHD were robust. Different categories of maltreatment increase the likelihood of ADHD for girls and boys. Increased exposure to maltreatment may predict symptom persistence. Interventions addressing ADHD must consider the effects of both sex and family environment.

The linkage between mental health, delinquency, and trajectories of delinquency: Results from the Boricua Youth Study

PURPOSE

To examine the longitudinal relationship between depression, delinquency, and trajectories of delinquency among Hispanic children and adolescents.

METHODS

Propensity score matching is used to match depressed and non-depressed youth and a combination of group-based trajectory and multinomial logistic regression techniques are used.

RESULTS

After adjusting for pre-existing differences between depressed and non-depressed youth, the causal relationship between depression and delinquency and the association between depression and trajectories of delinquency appears to be largely spurious. However, the effect of depression on predicting a high rate and increasing trajectory of delinquency is robust.

CONCLUSIONS

Depression and high-rate offending are linked in a sample of Hispanic children and adolescents.

Do parenting behaviors modify the way sensation seeking influences antisocial behaviors?

BACKGROUND

Parenting behaviors have been shown to moderate the association between sensation seeking and antisocial behaviors.

METHODS

Data were obtained from the Boricua Youth Study, a longitudinal study of 2,491 Puerto Rican youth living in the South Bronx, New York, and the metropolitan area of San Juan, Puerto Rico. First, we examined the prospective relationship between sensation seeking and antisocial behaviors across 3 yearly waves and whether this relationship varied by sociodemographic factors. Second, we examined the moderating role of parenting behaviors-including parental monitoring, warmth, and coercive discipline-on the prospective relationship between sensation seeking and antisocial behaviors.

RESULTS

Sensation seeking was a strong predictor of antisocial behaviors for youth across two different sociocultural contexts. High parental monitoring buffered the association between sensation seeking and antisocial behaviors, protecting individuals with this trait. Low parental warmth was associated with high levels of antisocial behaviors, regardless of the sensation seeking level. Among those with high parental warmth, sensation seeking predicted antisocial behaviors, but the levels of antisocial behaviors were never as high as those of youth with low parental warmth.

CONCLUSIONS

Study findings underscore the relevance of person-family context interactions in the development of antisocial behaviors. Future interventions should focus on the interplay between individual vulnerabilities and family context to prevent the unhealthy expression of a trait that is present in many individuals.

Developmental Psychopathology in a Racial/Ethnic Minority Group: Are Cultural Risks Relevant?

OBJECTIVE

The current study examined (a) the mediating role of parenting behaviors in the relationship between parental risks and youth antisocial behaviors (YASB), and (b) the role of youth cultural stress in a racial/ethnic minority group (i.e., Puerto Rican [PR] youth).

METHOD

This longitudinal study consisted of 3 annual interviews of PR youth (N = 1,150; aged 10-14 years at wave 1) and their caretakers from the South Bronx (SB) in New York City and from San Juan, Puerto Rico. Parents reported on parental risks, parenting behaviors, and YASB. Youth also self-reported on YASB and youth cultural stress. A lagged structural equation model examined the relationship between these variables across 3 yearly waves, with youth cultural stress as a moderator of the association between effective parenting behaviors and YASB.

RESULTS

Findings supported the positive influence of effective parenting on YASB, independently of past parental risks and past YASB: higher effective parenting significantly predicted lower YASB at the following wave. Parenting also accounted for (mediated) the association between the composite of parental risks and YASB. Youth cultural stress at wave 1 was cross-sectionally associated with higher YASB and moderated the prospective associations between effective parenting and YASB, such that for youth who perceived higher cultural stress, the positive effect of effective parenting on YASB was weakened compared to those with lower/average cultural stress.

CONCLUSION

Among PR families, both parental and cultural risk factors influence YASB. Such findings should be considered when treating racial/ethnic minority youth for whom cultural factors may be a relevant influence on determining behaviors.

One-year trajectory analysis for ADHD symptoms and its associated factors in community-based children and adolescents in Taiwan

BACKGROUND

Several longitudinal studies have shown the partial symptomatic persistence of attention-deficit hyperactivity disorder (ADHD) in clinic-based samples. However, little is known about the patterns and trajectories of ADHD symptoms in community-based populations.

METHODS

To differentiate developmental trajectories of ADHD symptoms over 1 year, with a four-wave quarterly follow-up in children and adolescents in the community of Taiwan, we conducted this prospective study in 1281 students in grade 3, 5, and 8. All the students in the regular classes rather than special educational classes were eligible and recruited to the study. Inattention, hyperactivity-impulsivity, and opposition-defiance were rated by parent reports on the Chinese version of the Swanson, Nolan, and Pelham Version IV Scale (SNAP-IV). Group-based trajectory modeling and multivariable regression analyses were used to explore the individual, family and social factors associated with differential trajectories.

RESULTS

Trajectories were classified as Low (29.9-40.6%), Intermediate (52.5-58.5%) and High (6.9-12.5%) based on the symptom severity of ADHD symptoms assessed by the SNAP-IV. The proportion of children in the high ADHD trajectory might approximately reflect the prevalence of ADHD in Taiwan. The following factors differentiated High from Low trajectories: male gender, more externalizing problems, fewer prosocial behaviors, school dysfunction, more home behavioral problems, and less perceived family support.

CONCLUSIONS

Our findings that the concurrent conditions of emotional or externalizing problems, as well as impaired school and home function at baseline, might differentiate the high ADHD symptoms trajectory from others could help developing the specific measures for managing high ADHD symptoms over time in a school setting.

Parental warmth and psychiatric disorders among Puerto Rican children in two different socio-cultural contexts

BACKGROUND

Parental warmth (PW) has a strong influence on child development and may precede the onset of psychiatric disorders in children. PW is interconnected with other family processes (e.g., coercive discipline) that may also influence the development of psychiatric disorders in children. We prospectively examined the association between PW and child psychiatric disorders (anxiety, major depression disorder, ADHD, disruptive behavior disorders) over the course of three years among Puerto Rican youth, above and beyond the influence of other family factors.

METHODS

Boricua Youth Study participants, Puerto Rican children 5 to 13 years of age at Wave 1 living in the South Bronx (New York) (SB) and San Juan and Canguas (PR) (n = 2,491), were followed for three consecutive years. Youth psychiatric disorders were measured by the Diagnostic Interview Schedule for Children-IV (DISC-IV). Generalized Linear Mixed models tested the association between PW (Wave 1) and psychiatric disorders in the next two years adjusting for demographic characteristics and family processes.

RESULTS

Higher levels of PW were related to lower odds of child anxiety and major depressive disorder over time (OR = 0.69[0.60; 0.79]; 0.49[0.41; 0.58], respectively). The strength of the association between PW and ADHD and disruptive behavior disorder declined over time, although it was still significant in the last assessment (OR = 0.44[0.37; 0.52]; 0.46[0.39; 0.54], respectively). PW had a unique influence on psychiatric disorders beyond the influence of other parenting and family processes. Stronger associations were observed among girls for depression and ADHD.

CONCLUSIONS

Incorporating PW behaviors such as acceptance, support, and comforting into interventions focused on parenting skills may help prevent child psychiatric disorders.

Childhood Adversity and Early Initiation of Alcohol Use in Two Representative Samples of Puerto Rican Youth

Early alcohol use is associated with multiple negative outcomes later in life, including substance use disorders. Identification of factors related to this very early risk indicator can help inform early prevention efforts. This study prospectively examined the relationship between childhood adversities and early initiation of alcohol use (by age 14) among Puerto Rican youth, the Latino subgroup at highest risk for alcohol use disorders in adulthood. The data come from the Boricua Youth Study, a longitudinal study of Puerto Rican youth in two sites (South Bronx, New York, and the standard metropolitan area of San Juan, Puerto Rico). We focus on youth who were ages 10 and older at Wave 1 [M age at Wave 1 (SE) = 11.64(0.05), N = 1259, 48.85 % females]. Twelve childhood adversities were measured at Wave 1 and include 10 adverse childhood experiences commonly studied and two additional ones (exposure to violence and discrimination) that were deemed relevant for this study's population. Early initiation of alcohol use was determined based on youth report at Waves 1 through 3 (each wave 1 year apart). Cox proportional hazards models showed that, when considered individually, adversities reflecting child maltreatment, parental maladjustment, and sociocultural stressors were related to early initiation of alcohol use. Significant gender interactions were identified for parental emotional problems and exposure to violence, with associations found among girls only. Adversities often co-occurred, and when they were considered jointly, physical and emotional abuse, parental antisocial personality, and exposure to violence had independent associations with early alcohol use, with a stronger influence of exposure to violence in girls compared to boys. The accumulation of adversities, regardless of the specific type of exposure, increased the risk for starting to drink at a young age in a linear way. The associations between childhood adversities and early alcohol use were generally consistent across sociocultural contexts, in spite of differences in the prevalence of exposure to adversity. Our findings highlight the importance of targeting multiple adversities and expanding the notion of adversity to capture the experiences of specific groups more adequately.

[Prevalence and Associated Factors of Mental Disorders in Colombian Child Population, the 2015 National Mental Health Survey]

INTRODUCTION

The 2015 National Mental Health Survey aimed to expand our knowledge about the real mental state of children in Colombia, taking into account the fact that most mental disorders in adults begin during childhood or adolescence. It is essential to have an improved knowledge of the magnitude of this issue and to design timely interventions that reduce long term complications.

OBJECTIVE

The aim of the study was to determine the prevalence of the disorders in the last 12 months and 30 days according to the DSM-IV, as well as to collect data about social and demographic variables.

METHODS

The structured Diagnostic Interview Schedule for Children (DISC-P), which provides DSM-IV diagnoses, was applied to carers of non-institutionalised children between 7 and 11 years old. The disorders evaluated included: major depressive disorder, dysthymia, generalised anxiety disorder, separation anxiety disorder, attention deficit hyperactivity disorder in its three kinds (mixed, inattentive, and hyperactive), oppositional defiant disorder, and conduct disorder. The instrumentation was computer-assisted.

RESULTS

Prevalences of the disorders are present both in the last 30 days and in the last 12 months. In general, there is a prevalence of any of the disorders of 3% (95% CI, 2.2-4.0) in the last 30 days, and 4.7% (95% CI, 3.6-6.2) in the last 12 months. When evaluated individually, attention deficit hyperactivity disorder is the most frequent disorder, with a prevalence of 2.3% and 3.0% in the last 30 days and the last 12 months, respectively. In addition, the disorders that are known to frequently begin during childhood are the most common disorders in the age group studied, with a prevalence of 2.5% in the last 30 days and 3.2% in the last year.

CONCLUSIONS

The 2015 National Mental Health Survey provides precise information about the real mental situation in children between the ages of 7 and 11 years in Colombia, compared with past epidemiological studies in the country, which were restricted to specific populations. By improving the reliability on knowledge about mental disorders in children, it will be possible to design more appropriate and precise strategies for prevention, diagnosis, and treatment.

Association of child maltreatment and depressive symptoms among Puerto Rican youth

This article compares multiple types of child maltreatment among Puerto Rican youth. We seek to expand the limited knowledge of the effects of multiple types of maltreatment on depressive symptoms in a specific Latino population as emerging studies indicate that children who are exposed to one type of maltreatment are often exposed to other types. This study examines the predictive strength of different and multiple types of lifetime child maltreatment (i.e., physical, sexual, and emotional abuse; and neglect), and the effect of youth support from parents, youth coping, youth self-esteem, and place of residence on depressive symptoms among Puerto Rican youth. Secondary data analyses were performed using three annual waves (2000-2004) of data from the Boricua Youth Study. The analytic sample consists of 1041 10-13 year old Puerto Rican youth living in New York and Puerto Rico. Results indicate that: (1) youth who experienced 'sexual abuse only', 'multiple maltreatment' (2 or more types of maltreatment), 'physical abuse only' have a significant increase in depressive symptoms (75.1%, 61.6%, and 40.5% respectively) compared to those without maltreatment; and (2) place of residence, exposure to violence, and mental disorders were significant risk factors. When developing psychosocial interventions, professionals should particularly focus on youth who report past lifetime experience with child maltreatment. Particular attention should be given to children living in the Bronx, New York and similar urban low-income areas who report past lifetime experience with multiple types of child maltreatment and who present symptoms or a diagnosis of co-occurring mental health problems.

Association of Mental Disorders and Consultation with Family Members and Friends in Children and Adolescents: The CASPIAN-IV Study

Background:

Behavioral disorders are common in the pediatric age group. This study aims to assess the relationship between the frequency of behavioral and mental disorders and counseling with family members and friends in a representative sample of Iranian children and adolescents.

Methods:

In this nationwide study, 14880 school students, aged 6–18 years, were selected by cluster and stratified multi-stage sampling method from 30 provinces in Iran. The World Health Organization Global School-based Health Survey questionnaire was used.

Results:

Overall, 13486 students (49.2% girls) with the mean (standard deviation) age of 12.47 (3.36) years completed the study. According to the students’ self-report, 56.1% of boys and 42.2% of girls shared their problems with their fathers. All behavioral disorders were less prevalent in children and adolescents who consulted with their father compared with those who did not (P < 0.001). In addition, 84.6% of boys and 84.0% of girls shared their problem with their mother. All behavioral disorders were less prevalent in children and adolescents who consulted with their mother compared with those who did not (P < 0.001). 45.6% of boys and 44.8% of girls shared their problem with their brother or sister. Some behavioral disorders were less prevalent in children and adolescents who consulted with their brother or sister (P < 0.01); however, the prevalence was not statistically different for most disorders (P > 0.05). Moreover, 60.4% of boys and 66.0% of girls shared their problems with their friends. The prevalence of most behavioral disorders was lower in those who consulted with their friends (P < 0.001).

Conclusions:

Children and adolescents should be encouraged to consult with their parents and friends about their problems. Parents should offer their children an opportunity to express their views and wishes about their problems.

Persistence of Parent-Reported ADHD Symptoms From Childhood Through Adolescence in a Community Sample

OBJECTIVE

To examine ADHD symptom persistence and factors associated with elevated symptom counts in a diverse, longitudinal community-based sample.

METHOD

Parents reported demographics and completed a diagnostic interview repeatedly over a 6-year period. At Time 1, 481 interviews were completed about children (5-13 years); all participants were invited to four annual follow-up interviews, and 379 (79%) completed at least one. Inattentive (IA) and hyperactive-impulsive (HI) symptom counts were modeled with logistic quantile regression, while accounting for study design complexities.

RESULTS

The prevalence of seven IA symptoms remained stable from early childhood through late adolescence. The prevalence of eight HI symptoms decreased by more than half over time. After demographic adjustment, the upper quartile of HI symptom counts decreased with age (p < .01). High HI symptom counts persisted more among those with high IA symptom counts (p = .05).

CONCLUSION

This study further characterizes and provides insights into ADHD symptom trajectory through adolescence.

Socio-Cultural Context and Bulling Others in Childhood

The objective of this epidemiological study was to examine, using an ecological perspective, which individual and distal contextual factors (familial, social and cultural) are associated with bullying other children across two different sites. Our sample included 1,271 Puerto Rican children 10 and older years of age at baseline residing in the South Bronx in New York and in the Standard Metropolitan Area in San Juan and Caguas, Puerto Rico. Bullying others was assessed through parents' and children's response to one item in the conduct disorder section of the Diagnostic Interview Schedule for Children Version IV (DISC IV). Child, family, social and cultural factors were examined as independent variables with bullying others as dependent variable in hierarchical models adjusting for gender, maternal education, poverty, single parent household and site. Prevalence of bullying others was 15.2% in South Bronx versus 4.6% in Puerto Rico (p<0.0001). Poor social adjustment and academic achievement, parental harsh discipline, negative school environment, exposure to violence, peer delinquency and level of acculturation in the child were all risk factors for bullying others. Child acculturation accounted for site differences in rates of bullying others. We conclude that, besides the school context, specific aspects of the community, family, and culture influence the development of bullying perpetration and should be targets for interventions and prevention programs. Minority youth living in at-risk contexts may benefit from contextually sensitive preventive interventions that address how assimilation into a high-risk context may increase involvement in bullying perpetration.

Family Influences on the Relationship Between Hurricane Exposure and Ataques de Nervios

This study focused on characteristics of the family environment that may influence the relationship between hurricane exposure and ataques de nervios in Puerto Rican children and youth. Approximately 18 months after Hurricane Georges hit Puerto Rico in 1998, participants were randomly selected based on a probability household sample using 1990 US Census block groups. Caregivers and children were interviewed about past year and lifetime experience of ataques de nervios, hurricane exposure, and the family environment in Spanish. Areas of the family environment assessed include parent-child relationship quality, parent-child involvement, parental monitoring, discipline, and parents' relationship quality. Structural equation models were estimated for parents and children, and by age group. For children (4-10 years old, N = 582), hurricane exposure was directly related to lifetime experience of ataques, but not for past year experience of ataques. However, for children, none of the family variables had a significant mediating role in the relation between hurricane exposure and either past year or lifetime experience of ataques; rather, parent-child involvement decreased risk for lifetime and past year ataques. For youth (11-17 years old, N = 569), per youth report, positive discipline mediated the hurricane exposure to lifetime experience of ataques relationship, whereas parents' relationship quality mediated the relationship between exposure and past year experience of ataques. Hurricane exposure decreased positive discipline and parents' relationship quality, and positive discipline and parents' relationship quality decreased risk for ataques. Per parent report, parent-child involvement decreased risk for past year or lifetime experience of ataques. Implications for post-disaster mental health recovery efforts are discussed.

Parent-Child Relationship Quality and Gender as Moderators of the Influence of Hurricane Exposure on Physical Health Among Children and Youth

OBJECTIVE

To investigate the long-term influence of disaster exposure, parent-child relationship quality (PCRQ), and gender on child and youth physical health.

METHODS

Parent-child dyads (N = 1,886) were randomly selected and interviewed approximately 18 months after Hurricane Georges hit Puerto Rico (1998), and reinterviewed 12 months later. The outcome variables were parent report of a global rating of children's physical health, and frequency of medical problems and medical visits in the past year.

RESULTS

Conservative analyses that accounted for a host of postdisaster health-relevant factors showed that hurricane exposure exerted detrimental influence on physical health at both 18 and 30 months after the event. The moderating role of PCRQ in the relation between hurricane exposure and physical health varied by gender.

CONCLUSION

Disasters have long-term potential to influence the physical health of children and adolescents. PCRQ serves as resource but its role in the context of disasters is complex.

The School Children Mental Health in Europe (SCMHE) Project: Design and First Results

Background : The School Children Mental Health in Europe (SCMHE) project aims to build up a set of indicators to collect and monitor children's mental health in an efficient and comparable methodology across the EU countries. It concerns primary schools children aged 6 to 11 years a range where few data are available whereas school interventions are promising. Methods : Three informants were used: parents, teachers and children. In selecting instruments language, instruments were selected according to the easiness to translate them: SDQ (Strengths and Difficulties Questionnaire) for parents and teachers and DI (Dominic Interactive). A two-step procedure was used: schools randomization then six children by class in each grade. Results : 9084 children from seven countries (Italy, Netherlands, Germany, Romania, Bulgaria, Lithuania, and Turkey) completed the Dominic Interactive in their own language. 6563 teachers and 6031 parents completed their questionnaire, and a total of 5574 interviews have been completed by the 3 informants. The participation rate of the children with parents in the participating schools was about 66.4%. As expected teachers report more externalised problems and less internalised problems than parents. Children report more internalised problems than parents and teachers. Boys have consistently more externalised problems than girls and this is the reverse for internalised problems. Combining the diverse informants and impairment levels children with problems requiring some sort of mental health care were about 9.9%: 76% did not see any mental health professional: 78.7% In Eastern countries 63.1% in Western Europe.

Sluggish cognitive tempo and its neurocognitive, social and emotive correlates: a systematic review of the current literature

OBJECTIVES

Since the elimination of items associated with Sluggish Cognitive Tempo (SCT) during the transition from DSM-III to DSM-IV from the diagnostic criteria of Attention-deficit Hyperactivity Disorder (ADHD), interest in SCT and its associated cognitive as well as emotional and social consequences is on the increase. The current review discusses recent findings on SCT in clinical as well as community based ADHD populations. The focus is further on clinical correlates of SCT in populations different from ADHD, SCT's genetic background, SCT's association with internalizing and other behavioral comorbidities, as well as SCT's association with social functioning and its treatment efficacy.

METHOD

A systematic review of empirical studies on SCT in ADHD and other pathologies in PsycInfo, SocIndex, Web of Science and PubMed using the key terms "Sluggish Cognitive Tempo", "Cognitive Tempo", "Sluggish Tempo" was performed. Thirty-two out of 63 studies met inclusion criteria and are discussed in the current review.

RESULTS/CONCLUSION

From the current literature, it can be concluded that SCT is a psychometrically valid construct with additive value in the clinical field of ADHD, oppositional defiant disorder (ODD), internalizing disorders and neuro-rehabilitation. The taxonomy of SCT has been shown to be far from consistent across studies; however, the impact of SCT on individuals' functioning (e.g., academic achievement, social interactions) seems remarkable. SCT has been shown to share some of the genes with ADHD, however, related most strongly to non-shared environmental factors. Future research should focus on the identification of adequate SCT measurement to promote symptom tailored treatment and increase studies on SCT in populations different from ADHD.

How to Understand Divergent Views on Bipolar Disorder in Youth

There are two divergent viewpoints on the phenomenology and outcome of bipolar I (BP I) disorder in youth. Disparities evolved as unintended consequences from investigators' inconsistencies both in translating the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R, and DSM-IV criteria and in operationalizing them differently in their standardized assessments. Rates of conservatively diagnosed BP I are lower both in community studies of youths than in adults and from liberally defined BP I in youths. Rates of co-occurring attention-deficit hyperactivity disorder (ADHD) are lower in conservatively than liberally defined children and adolescents with BP I. Rates of both BP I and of ADHD are lower in offspring of BP I probands, and outcome more closely approximates that of adults with BP I in conservatively versus liberally defined children and teens with BP I. Both perspectives can claim evidence for reliability and validity that support their positions. However, the samples are so different that it is difficult to compare studies conducted from these different perspectives.

Asthma and mental health among youth in high-risk service settings

OBJECTIVE

To investigate the prevalence of asthma and mental health problems among representative samples of youth in high-risk service settings and the community, and to examine the relationship between asthma and mental health in these groups.

METHODS

Data were drawn from the Alternative Service Use Patterns of Youth with Serious Emotional Disturbance Study (SED) (n = 1181), a combined representative, cross-sectional sample of youth in various clinical settings and the community. Multiple logistic regression analyses were used to examine the association between asthma and mental disorders. Demographic characteristics were investigated as potential confounders.

RESULTS

Asthma was common among 15.2% of youth in service settings and 18.8% of youth in the community. The prevalence of mental disorders was extremely high among youth with and without asthma in all service settings, and asthma was associated with increased prevalence of mental disorders among youth in the community, but not among youth in service settings. The relationship between asthma and internalizing disorders among youth in the community does not appear entirely attributable to confounding by demographics.

CONCLUSIONS

Findings are consistent with and extend previous data by showing that both asthma and mental disorders are disproportionately common among youth in high-risk service settings. Almost half of youth with asthma in service settings meet diagnostic criteria for a mental disorder. Clinicians and policy makers who are responsible for the health care of youth in these high-risk groups should be aware that asthma is common, and that the prevalence of internalizing disorders are especially common among those with asthma.

The promotion of mental health and the prevention of mental health problems in child and adolescent

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.

Measurement properties of the Adolescent Quality of Life Mental Health Scale (AQOL-MHS)

BACKGROUND

This article presents data on the psychometric properties of a new measure, the Adolescent Quality of Life Mental Health Scale (AQOL-MHS), designed to measure quality of life in clinical samples of Latino adolescents aged 12-18 years. Participants were recruited in Puerto Rico to have one of five prevalent mental health disorders. The initial instrument development was achieved through a grounded theory approach with the use of focus groups and in-depth interviews.

METHODS

We conducted two stages of exploratory factor analyses (EFA) on 60 candidate items. The first stage was to establish the number of factors to extract, and the second was to improve the model by selecting the best items. A final EFA model retained 31 items and 3 factors labeled Emotional Regulation (11 items), Self-Concept (10 items) and Social Context (10 items).

RESULTS

The instrument showed good internal consistency, test-retest reliability, and construct validity. The hypotheses-driven validity tests were all supportive of the AQOL-MHS. There was evidence for convergent validity and discriminant validity, and results for known-groups' validity were overwhelmingly supportive of the ability of the instrument to identify differences between groups.

CONCLUSIONS

These preliminary findings support our conceptual model and the use of the AQOL-MHS domain and overall scores. We believe that this instrument will provide clinicians additional insight into the different aspects of quality of life that are important to adolescents with mental health problems. Therefore, we consider the AQOL-MHS a vital patient-centered outcome measure for assessment strategies in the prevention and treatment of this population.

Multiple mediators of the relationships among maternal childhood abuse, intimate partner violence, and offspring psychopathology

The aim of the study was to examine whether maternal depression, mothers' and fathers' parenting, child physical punishment and negative life events (NLE) mediate the effect of maternal childhood abuse (CA), intimate partner violence (IPV) and cumulative violence (both CA and IPV) on Spanish children's and adolescents' psychopathology. Furthermore, multiple mediator models examine whether IPV mediates the effect of CA on the contextual and family factors mentioned above. Three hundred and eighteen Spanish outpatients aged 7 to 18 and their parents were assessed using a structured interview and other instruments for measuring the study variables. Structural equation models (SEMs) showed multiple pathways explaining psychopathological problems among offspring of mothers who suffered CA, IPV and both of these violent experiences. In particular, mothers' depression mediated the link between maternal CA, IPV, cumulative violence and children's externalizing, and total behavior problems. Child NLE was an important pathway between maternal CA and total behavior problems, as well as between cumulative violence and both externalizing and total problems. IPV contributed to explaining the link between maternal CA and contextual and family factors, such as child physical punishment and NLE, which were in turn, associated with children's behavior problems. Findings show the complex interconnections between different types of violence and their harmful effects on the mental health of women and their offspring, as well as the need to extend our knowledge on this subject.

Childhood chronic physical condition, self-reported health, and life satisfaction in adolescence

The present study investigates the prevalence and type of chronic conditions at 7 years of age-with special reference to atopic conditions-and their longitudinal associations with self-reported health and life satisfaction in adolescence. The data were obtained from Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort from an unselected, regionally defined population (n = 9,432). The present study investigated a sample of 8,036 children with data of chronic conditions at 7 years of age and a sample of 6,680 children with data of chronic conditions at 16 years of age. According to parents' report the prevalence of CC at 7 years of age was 14.8 % among boys and 13.2 % among girls, these figures being at 16 years of age 20.7 and 19.4 %, respectively. Atopic conditions were the most common chronic conditions at 7 years of age (12.7 % vs. other chronic conditions 4.7 %). Childhood chronic condition was associated with subsequent self-reported health in adolescence, but not with subsequent self-reported life satisfaction. Chronic condition at 7 years of age increased the risk of reporting health as "poor" even if the chronic condition was no longer prevalent at 16 years of age. Atopic conditions seemed to be linked with self-reported poor/moderate health more often than other chronic conditions among girls. Conclusion Childhood chronic conditions seem to affect adolescent's subjective health, but fortunately, they do not affect adolescents' subjective well-being to such an extent that it could lower their life satisfaction.

Cross-Sectional Study of Unmet Mental Health Need in 5- to 7-Year Old Latino Children in the United States: Do Teachers and Parents Make a Difference in Service Utilization?

The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher's Report Form]) were examined in a community sample of young Latino children of immigrants (n = 228; mean age = 6) and compared across mothers' and teachers' responses. Mother-teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers (p = .03). Teachers' reports were not associated with service utilization. Mother-teacher agreement was low for externalizing (r = .23; p ≤ 0.01) and total problems (r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother-teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need-both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.

Family influences on the long term post-disaster recovery of Puerto Rican youth

This study focused on characteristics of the family environment that may mediate the relationship between disaster exposure and the presence of symptoms that met DSM-IV diagnostic criteria for symptom count and duration for an internalizing disorder in children and youth. We also explored how parental history of mental health problems may moderate this mediational model. Approximately 18 months after Hurricane Georges hit Puerto Rico in 1998, participants were randomly selected based on a probability household sample using 1990 US Census block groups. Caregivers and children (N = 1,886 dyads) were interviewed with the Diagnostic Interview Schedule for Children and other questionnaires in Spanish. Areas of the family environment assessed include parent-child relationship quality, parent-child involvement, parental monitoring, discipline, parents' relationship quality and parental mental health. SEM models were estimated for parents and children, and by age group. For children (4-10 years old), parenting variables were related to internalizing psychopathology, but did not mediate the exposure-psychopathology relationship. Exposure had a direct relationship to internalizing psychopathology. For youth (11-17 years old), some parenting variables attenuated the relation between exposure and internalizing psychopathology. Family environment factors may play a mediational role in psychopathology post-disaster among youth, compared to an additive role for children. Hurricane exposure had a significant relation to family environment for families without parental history of mental health problems, but no influence for families with a parental history of mental health problems.

Maternal childhood abuse, intimate partner violence, and child psychopathology: the mediator role of mothers' mental health

This study examined the mediator role of mothers' mental health in the relationship among maternal childhood abuse (CA), intimate partner violence (IPV), and offspring's psychopathology, and explored whether mediational pathways were moderated by children's sex. Participants were 327 Spanish outpatient children, 8 to 17 years old, and their mothers. Mothers' global psychological distress and depressive symptoms mediated the associations between mothers' violence history and children's externalizing problems. However, only depressive symptoms fully mediated these relationships. Children's sex did not have a moderating role in adjusted paths. Mothers' depressive symptoms are an important mechanism by which maternal violence experiences could affect externalizing problems in Spanish children.

Adolescent nonsuicidal self-injury: the effects of personality traits, family relationships and maltreatment on the presence and severity of behaviours

Personality traits, family environment and maltreatment episodes are often associated with nonsuicidal self-injury (NSSI); however, research on these associations has shown mixed results. The aim of the present study was to clarify the effects of these factors on the presence and the severity of NSSI among a sample of Italian students who attended secondary schools (N = 267, mean age = 17.03 SD = 0.866). The results showed that personality traits, family environment and maltreatment differently predicted the presence and the severity of NSSI. Self-injurers were more impulsive and aggressive than non-self-injurers and reported poorer relationship quality with their mothers and more sexual and physical abuse episodes than non-self-injurers. Conversely, the frequency of NSSI behaviours was predicted by the presence of less impulsiveness, more anxiety and aggressiveness, poorer relationship quality with both parents and a lower degree of identification with the father. Finally, more frequent self-injurers also reported more sexual abuses and neglect episodes than less frequent self-injurers.

Social inequalities in mental health and health-related quality of life in children in Spain

OBJECTIVES

To assess mental health and health-related quality of life (HRQoL) of children and adolescents in Spain and to investigate the existence of a social gradient in mental health and HRQoL.

METHODS

Within the Spanish National Health Survey (2006), the parents' version of the Strengths and Difficulties Questionnaire was administered to a population aged 4 to 15 years, and the parents' version of the modified KIDSCREEN-10 Index was given to a population aged 8 to 15 years. Sociodemographic data and information on family structure, socioeconomic status, health status, and discrimination were collected. Regression models were developed to analyze associations of socioeconomic status with mental health and HRQoL.

RESULTS

A total of 6414 children and adolescents aged 4 to 15 years participated. Mean Strengths and Difficulties Questionnaire score was 9.38 (SD, 5.84) and mean KIDSCREEN-10 Index score (n = 4446) was 85.21 (SD, 10.73). Children whose mothers had a primary school education (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 1.29-1.46) or a secondary education (OR: 1.21; 95% CI: 1.14-1.29) presented poorer mental health than those whose mothers had a university degree. Children from disadvantaged social classes (IV-V) showed slightly poorer HRQoL scores (OR: 0.98; CI: 0.97-0.99) than the remaining children.

CONCLUSIONS

There is a social gradient in the mental health of children and young adolescents in Spain. No social gradient was found for HRQoL, although children from families of disadvantaged social classes had slightly worse HRQoL scores than their counterparts from more advantaged classes.

Adolescents' perceptions of parental behavior: psychometric properties of the short Egna Minnen Beträffande Uppfostran-Adolescent version (S-EMBU-A) in a clinical sample

OBJECTIVES

The aim of this study was to evaluate the psychometric properties of the Spanish version of the short Egna Minnen Beträffande Uppfostran-Adolescent version (S-EMBU-A) in a clinical context.

METHODS

The S-EMBU-A is a 22-item self-report questionnaire, based on the original 64-item EMBU-A, that assesses perceived parental rearing style in adolescents, comprising 3 subscales (Rejection, Emotional Warmth, and Overprotection). The questionnaire was administered to a clinical sample of 281 Spanish psychiatric outpatients aged 13 to 18 years. Confirmatory factor analysis was performed, analyzing the adolescents' reports about their parents' rearing style.

RESULTS

Confirmatory factor analysis yielded an acceptable fit to data of the 3-factor model (comparative fit index = 0.90; root mean squared error of approximation = 0.054) and parameters were equivalent for the ratings assigned to fathers and mothers. Satisfactory internal consistency reliability was obtained for the 3 scales (Cronbach α ≥ .74). The influence of gender (of adolescents and parents) and age on scale scores was inappreciable. High scores for Rejection and low scores for Emotional Warmth were related to bad relationships with parents, absence of family support, presence of rejection, harsh discipline, and lack of parental supervision.

CONCLUSIONS

The Spanish version of S-EMBU-A can be used with psychometric guarantees to identify rearing style in psychiatric outpatients, because evidence of quality in clinical setting matches that obtained in community samples.

Association between infection early in life and mental disorders among youth in the community: a cross-sectional study

BACKGROUND

The objective of this study was to examine the association between infection early in life and mental disorders among youth in the community.

METHODS

Data were drawn from the MECA (Methods in Epidemiology of Child and Adolescent psychopathology), a community-based study of 1,285 youth in the United States conducted in 1992. Multiple logistic regression analyses were used to investigate the association between parent/caregiver-reported infection early in life and DSM/DISC diagnoses of mental disorders at ages 9-17.

RESULTS

Infection early in life was associated with a significantly increased odds of major depression (OR = 3.9), social phobia (OR = 5.8), overanxious disorder (OR = 6.1), panic disorder (OR = 12.1), and oppositional defiant disorder (OR = 3.7).

CONCLUSIONS

These findings are consistent with and extend previous results by providing new evidence suggesting a link between infection early in life and increased risk of depression and anxiety disorders among youth. These results should be considered preliminary. Replication of these findings with longitudinal epidemiologic data is needed. Possible mechanisms are discussed.

Overlooked and underserved: "action signs" for identifying children with unmet mental health needs

OBJECTIVE

The US Surgeon General has called for new approaches to close the mental health services gap for the large proportion of US children with significant mental health needs who have not received evaluation or services within the previous 6 to 12 months. In response, investigators sought to develop brief, easily understood, scientifically derived "warning signs" to help parents, teachers, and the lay public to more easily recognize children with unmet mental health needs and bring these children to health care providers' attention for evaluation and possible services.

METHOD

Analyses of epidemiologic data sets from >6000 children and parents were conducted to (1) determine the frequency of common but severely impairing symptom profiles, (2) examine symptom profile frequencies according to age and gender, (3) evaluate positive predictive values of symptom profiles relative to Diagnostic and Statistical Manual of Mental Disorders diagnoses, and (4) examine whether children with 1 or more symptom profiles receive mental health services.

RESULTS

Symptom-profile frequencies ranged from 0.5% to 2.0%, and 8% of the children had 1 or more symptom profile. Profiles generated moderate-to-high positive predictive values (52.7%-75.4%) for impairing psychiatric diagnoses, but fewer than 25% of children with 1 or more profiles had received services in the previous 6 months.

CONCLUSIONS

Scientifically robust symptom profiles that reflect severe but largely untreated mental health problems were identified. Used as "action signs," these profiles might help increase public awareness about children's mental health needs, facilitate communication and referral for specific children in need of evaluation, and narrow the child mental health services gap.

Maternal experiences of childhood abuse and intimate partner violence: Psychopathology and functional impairment in clinical children and adolescents

OBJECTIVES

The current study examined the independent effects of mothers' childhood abuse (CA) and intimate partner violence (IPV) on psychopathology and functional impairment in children; and the potential moderating and mediating role of individual and family factors in these relationships. Additionally, this study explored the potential cumulative effects of both maternal CA and IPV on children's outcomes.

METHOD

The sample included 547 Spanish children and adolescents aged between 8 and 17 years, and their parents, who had accessed mental health services. The assessment was based on structured interviews with the children and their parents. Statistical analyses were carried out through hierarchical multiple, negative-binomial and logistic regressions, and Structural Equation Models.

RESULTS

Children whose mothers experienced CA and those whose mothers suffered physical IPV showed increased DSM-IV disruptive disorders and externalizing behavior problems, respectively. Children who directly observed physical IPV and also suffered physical punishment by parents showed increased internalizing problems. IPV had effects, either direct or indirect by physical punishment, on children's externalizing problems. Cumulative effect analyses indicated that the prevalence of disruptive disorders was highest in children whose mothers had suffered both CA and IPV.

CONCLUSION

Spanish children whose mothers have suffered CA, IPV or both, are at high risk of serious conduct problems, whereas children exposed to IPV and who were also physically abused are at greater risk of internalizing problems. Physical punishment of children contributes in part to explain externalizing problems of IPV-exposed children. These findings indicate potential targets of assessment and intervention for families seeking help in mental health services.

Perceived discrimination and antisocial behaviors in Puerto Rican children

This study examined whether perceived discrimination was related to antisocial behaviors (ASB) in a probability sample of Puerto Rican children living in the South Bronx, New York and the San Juan Metropolitan area of Puerto Rico (N = 1,271). After adjusting for a host of well-known factors associated with ASB, such as sociodemographic variables (i.e., age, gender, household composition), psychosocial stressors (i.e., stressful life events, exposure to violence), and various forms of violence and abuse (i.e., coercive parental discipline, verbal, psychological, physical and sexual abuse), perceived discrimination remained a robust correlate of ASB among both samples. Findings are discussed with reference to the detrimental associations of perceived discrimination.

Investigating the Role of Gender and Delinquency in Exposure to Violence Among Puerto Rican Youth

Using a longitudinal sample of Puerto Rican adolescents living in the Bronx, New York, this study examines the predictors of exposure to violence within gender. Results from a series of negative binomial regressions suggested (a) sensation seeking, peer delinquency, coercive discipline, and initial delinquency increased the likelihood of exposure to violence for both males and females at multiple time points and (b) initial delinquency was the only consistent predictor of exposure to violence at all time points. Regarding the role of gender, the results indicated that some risk factors were similar across genders (e.g., sensation seeking, coercive discipline, peer delinquency, and delinquent behavior), whereas other risk factors differed across gender (e.g., age and welfare among males and school environment for females). Study limitations and implications are discussed.

Short-term persistence of DSM-IV ADHD diagnoses: influence of context, age, and gender

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.

Parental familism and antisocial behaviors: development, gender, and potential mechanisms

OBJECTIVE

To examine the relation between parental familism (strong values of attachment to nuclear and extended family members) and youth antisocial behaviors over time.

METHOD

Puerto Rican children 5 to 13 years of age at baseline residing in the South Bronx in New York (n = 1,138) and in the Standard Metropolitan Area in San Juan and Caguas, Puerto Rico (n = 1,353) were followed over two waves 1 year apart from 2000 to 2004. Parental familism was assessed using an adaptation of the Sabogal Familism Scale. Level of youth past-year antisocial behaviors was measured by the Antisocial Behavior Index. The association between familism and Antisocial Behavior Index over three waves was examined through mixed models stratified by age and gender, adjusted by site (South Bronx or San Juan), propensity scores reflecting site differences in family income, maternal age and education, plus environmental and child risk factors. Specific family processes were examined as potential mediators.

RESULTS

Parental familism was protective against antisocial behaviors in girls (estimate = -0.11, standard error = 0.03, p < .001 for 5- to 9-year-olds; estimate = -0.15, standard error = 0.03, p < .0001 for those ≥ 10 years old). For boys, parental familism was only protective in 5- to 9-year-olds (estimate = -0.09, standard error = 0.03, p = .0008). The protective effect of parental familism on antisocial behaviors operated mostly through parent-child relationships for 5- to 9-year-old children and parental attitudes/behaviors toward youth high-risk behaviors for both age groups.

CONCLUSIONS

Familism may protect youth against increasing levels of antisocial behaviors (except for boys who are ≥ 10 years old). Incorporating familism as part of therapeutic approaches addressing antisocial behaviors for youth may be helpful.

Distinguishing features of cuban children referred for professional help because of ADHD: looking beyond the symptoms

OBJECTIVE

To distinguish Cuban children clinically referred because of ADHD from an at-risk community sample and a community control group in terms of symptoms, associated difficulties and impairment of family and peer relations.

METHOD

Parents and teachers of 1,036 children (6-8 years old) completed an established ADHD rating scale and a behavioral screening measure, including peer functioning.We also administered a structured clinical interview and measures of family impairment to the clinical sample and to an at-risk community-based subsample.

RESULTS

Although both clinical and at-risk groups displayed more externalizing and internalizing symptoms than controls, referred children were not only characterized by higher levels of ADHD symptoms, but also by greater impairment of family and peer relations than at-risk community children or community controls.

CONCLUSION

The findings suggest that ADHD has major consequences on the family and peer functioning of Cuban children, which may lead to their referral for treatment.

Use of mental health services and unmet needs for socially-at-risk. Spanish children and adolescents

Reported one-year prevalence of service use due to mental disorders in children and adolescents from the general population varies according to country, organization of services, and services considered. Among factors associated with use of services, the literature lists parental and school personnel's perception of problems, having a psychiatric diagnosis (especially externalizing), symptom severity, comorbid disorders, functional impairment, family burden, family environment or being a boy (Cabiya et al., 2006; Farmer et al., 2003; Sayal, 2004). A better understanding of these factors may help to optimize access to services of children needing help.

Central American mothers report family history of depression and alcohol abuse as a predictor of teenage health risk behaviors

PURPOSE

The purpose of this study was to explore the relationships of family history of depression and alcohol abuse as a predictor of health risk behaviors among Central American teenagers.

DATA SOURCES

Demographic data were collected from a convenience sample of 101 Central American mothers with a teenage daughter ages 12-17 years who were living in Northern Virginia. The research questions assessed the family history of depression, alcohol abuse, and maternal depression. Scores were calculated to predict risk of teenage health risk behaviors.

CONCLUSIONS

The Hispanic mothers in this study reported that their teenagers had significant health risk behaviors, including school dropout and expulsion, alcohol and substance use, pregnancy, and gang membership. Family history of depression and alcohol abuse in a first degree relative predicted teenage risk behavior 71% of the time.

CLINICAL IMPLICATIONS

There is no consensus on a standard screening approach for depression in teenagers. Developing a standardized approach to gathering information from teenagers that includes genetic family traits may have significant effects on interventions for teenage health risk behavior and ways to provide the best services for vulnerable teenagers. The results of this study have implications for nurse practitioners caring for teenagers.

Trauma, posttraumatic stress symptoms, and alcohol-use initiation in children

OBJECTIVE

This study examined initiation of alcohol use among adolescents, in relation to their earlier traumatic experiences and symptoms of posttraumatic stress disorder (PTSD).

METHOD

Data were from a longitudinal study of children of Puerto Rican background living in New York City's South Bronx and in San Juan, Puerto Rico. The subsample (n = 1,119; 51.7% male) of those who were 10-13 years old and alcohol naive at baseline was used in the analyses.

RESULTS

Alcohol-use initiation within 2 years after baseline was significantly more common among children reporting both trauma exposure and 5 or more of a maximum of 17 PTSD symptoms at baseline (adjusted odds ratio = 1.84, p < .05) than among those without trauma exposure, even when potentially shared correlates were controlled for. Children with trauma exposure but with fewer than five PTSD symptoms, however, did not differ significantly from those without trauma exposure, with regard to later alcohol use.

CONCLUSIONS

PTSD symptoms in children 10-13 years old may be associated with early onset of alcohol use. It is important to identify and treat PTSD-related symptoms in pre-adolescent children.

Sex Differences in Trajectories of Offending Among Puerto Rican Youth

Although sex is one of the strongest correlates of crime, contentions remain regarding the necessity of sex-specific theories of crime. The current study examines delinquent trajectories across sex among Puerto Rican youth socialized in two different cultural contexts (Bronx, United States and San Juan, Puerto Rico). Results indicate: similar substantive offending trajectories across males and females within each cultural context; that males exhibit a higher frequency of offending and higher levels of risk factors for delinquency; and there more similarities than differences in how risk/protective factors relate to patterns of offending across male versus female youth. Study limitations and implications for sex-specific criminological theories are also discussed.

Perceived parental rearing style in childhood: internal structure and concurrent validity on the Egna Minnen Beträffande Uppfostran--Child Version in clinical settings

BACKGROUND

We provide the first validation data of the Spanish version of the Egna Minnen Beträffande Uppfostran--Child Version (EMBU-C) in a clinical context. The EMBU-C is a 41-item self-report questionnaire that assesses perceived parental rearing style in children, comprising 4 subscales (rejection, emotional warmth, control attempts/overprotection, and favoring subjects).

METHODS

The test was administered to a clinical sample of 174 Spanish psychiatric outpatients aged 8 to 12. Confirmatory factor analyses were performed, analyzing the children's reports about their parents' rearing style.

RESULTS

The results were almost equivalent for father's and mother's ratings. Confirmatory factor analysis yielded an acceptable fit to data of the 3-factor model when removing the items of the favoring subjects scale (root mean squared error of approximation <0.07). Satisfactory internal consistency reliability was obtained for 2 of the 3 scales, rejection and emotional warmth (Cronbach alpha >.73), whereas control attempts scale showed lower values, as in previous studies. The influence of sex (of children and parents) on scale scores was inappreciable and children tended to perceive their parents as progressively less warm as they grew older. As predicted, the scores for rejection and emotional warmth were related to bad relationships with parents, absence of family support, harsh discipline, and lack of parental supervision.

CONCLUSIONS

The Spanish version of EMBU-C can be used with psychometric guarantees to identify rearing style in psychiatric outpatients because evidences of quality in this setting match those obtained in community samples.

Child and family psychiatric and psychological factors associated with child physical health problems: results from the Boricua youth study

To examine associations among Puerto Rican children's physical health problems and children's internalizing disorders, parental psychopathology and acculturative stress, and family factors. A population-based probability sample of 2491 Puerto Rican children, aged between 5 and 13 years, and caregivers from the South Bronx and the U.S. Commonwealth of Puerto Rico participated in this study. The parent version of the Diagnostic Interview Schedule for Children-IV was used to assess children's internalizing disorders. Children's anxiety disorders, parental psychopathology, and acculturative stress were associated with childhood asthma, abdominal pain, and headaches. Children's depressive disorders, maternal acceptance, and family functioning were associated with abdominal pain and headaches. Parents of children living in Puerto Rico were more likely to report physical health problems in their children than in the Bronx. Children's internalizing disorders, parental psychopathology, and acculturative stress may be important areas to target among Puerto Rican children with physical health problems.