The Main and Interactive Associations between Demographic Factors and Psychopathology and Treatment Utilization in Youth: A Test of Intersectionality in the ABCD Study

Prevalence of ADHD among Black Youth Compared to White, Latino and Asian Youth: A Meta-Analysis

OBJECTIVE

To systematically review the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Black children and adolescents compared to White, Latino and Asian children and adolescents.

METHOD

Peer-reviewed articles were identified in seven databases and included if they reported prevalence of ADHD among Black children and adolescents living in a minority context and compared rates to at least one of White, Latino or Asian samples. A total of 7050 articles were retrieved and 155 articles were subjected to full evaluation. Twenty-three studies representing 26 independent samples were included.

RESULTS

The pooled sample size was n = 218,445 (k = 26), n = 835,505 (k = 25), n = 493,417 (k = 24), and n = 66,413 (k = 7) of Black, White, Latino, and Asian participants, respectively. Pooled prevalence rate of ADHD was 15.9% (95%CI 11.6% - 20.7%) among Black children and adolescents, 16.6% (95%CI 11.6% - 22.2%) among Whites, 10.1% (95%CI 6.9% - 13.8%) among Latinos and 12.4% (95%CI 1.4% - 31.8%) among Asians. There was no significant difference in prevalence between ethnic groups, whereas both Black and White children and adolescents had marginally statistically significant higher prevalence than Asians. The results of a meta-regression analysis showed no moderating effects of the type of sample and the year of publication of studies. A significant publication bias was observed, suggesting that other moderators were not identified in the present systematic review.

CONCLUSION

In contrast to the assertion in the DSM-5 that clinical identification among Black children and adolescents is lower than among White children and adolescents, the present meta-analysis suggests similar rates of ADHD among these two groups. The importance of considering cultural appropriateness of assessment tools and processes is emphasized.

Longitudinal study of peer victimization, social support, and mental health during early adolescence

BACKGROUND

Peer victimization predicts the development of mental health symptoms in the transition to adolescence, but it is unclear whether and how parents and school environments can buffer this link.

METHODS

We analyzed two-year longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, involving a diverse sample of 11 844 children across the United States (average at baseline = 9.91 years; standard deviation = 0.63; range = 8.92-11.08; complete case sample = 8385). Longitudinal associations between peer victimization and two-year changes in mental health symptoms of major depression disorder (MDD), separation anxiety (SA), prodromal psychosis (PP), and attention-deficit/hyperactivity disorder (ADHD) were examined including a wide range of covariates. Mixed linear models were used to test for the moderating effects of parental warmth and prosocial school environment.

RESULTS

20% of children experienced peer victimization. Higher exposure to peer victimization was associated with increases in MDD, SA, and ADHD symptoms. Parental warmth was associated with decreases in MDD symptoms but did not robustly buffer the link between peer victimization and mental health symptoms. Prosocial school environment predicted decreases in PP symptoms and buffered the link between peer victimization and MDD symptoms but amplified the link between peer victimization and SA and ADHD symptoms.

CONCLUSIONS

Peer victimization is associated with increases in mental health symptoms during the transition to adolescence. Parental warmth and prosocial school environments might not be enough to counter the negative consequences of peer victimization on all mental health outcomes.

Motor abnormalities, depression risk, and clinical course in adolescence

Background

Motor abnormalities, such as psychomotor agitation and retardation, are widely recognized as core features of depression. However, it is not currently known if motor abnormalities connote risk for depression.

Methods

Using data from the Adolescent Brain Cognitive Development (ABCD) Study, a nationally representative sample of youth (n=10,835, 9-11 years old), the present paper examines whether motor abnormalities are associated with (a) depression symptoms in early adolescence, (b) familial risk for depression (familial risk loading), and (c) future depression symptoms. Motor abnormalities measures included traditional (DSM) motor signs such as psychomotor agitation and retardation as well as other motor domains such as developmental motor delays and dyscoordination.

Results

Traditional motor abnormalities were less prevalent (agitation=3.2%, retardation=0.3%) than non-traditional domains (delays=13.79%, coordination=35.5%) among adolescents. Motor dysfunction was associated with depression symptoms (Cohen's ds=0.02 to 0.12). Familial risk for depression was related to motor abnormalities (Cohen's ds=0.08 to 0.27), with the exception of motor retardation. Family vulnerability varied in sensitivity to depression risk (e.g., retardation: .53%; dyscoordination: 32.05%). Baseline endorsement of motor abnormalities predicted future depression symptoms at one-year follow-up.

Conclusions

These findings suggest that motor signs reflect a novel, promising future direction for examining vulnerability to depression risk in early adolescence.

Person-Centered Cultural Assessment Can Improve Child Mental Health Service Engagement and Outcomes

OBJECTIVE

Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children's mental health care.

METHODS

Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child's problems and family help-seeking.

RESULTS

Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families' values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response.

CONCLUSIONS

The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).

Considerations to Youth's Psychopathology and Mental Healthcare Disparities Research through the Intersections of Dominant and Non-dominant Identities

This article presents a commentary on the interactive associations of demographic factors on youth's psychopathology and mental health service utilization. Intersectionality allows for a more comprehensive understanding of how intersecting non-dominant identities play a role in health outcomes and mental health treatment use. However, these studies can consider conceptualizing intersectionality beyond the methods/statistics, as well as attend to the broader context around what the scientific data is informing. Further, it is imperative that researchers conducting this type of work consider multiple possible interpretations and acknowledge the researcher(s) positionality. Research implications that incorporate intersecting non-dominant demographic identities and its role with other broader systems of position, privilege, and power are therefore discussed. In doing so, these implications may further contribute to the discussion of youth's mental health- and mental healthcare-disparities.