Racial differences on the Conners Teacher Rating Scale

Sex Differences in Early Childhood Education Intervention Impacts on Cognitive Outcomes

Several influential studies reported sex differences in early care and education (ECE) treatment on young adult IQ and academic outcomes. This paper extends that work by asking whether sex differences in impacts of the Carolina Abecedarian Project emerged during the treatment period or subsequently and whether sex differences were maintained into middle adulthood. The randomized clinical trial (98% Black, 51% female) followed 104 infants 5 to 45 years of age. Longitudinal analyses estimated treatment and sex-by-treatment differences at 5 years, from 5 to 21 years, and at 21 and 45 years. Results revealed treated children entered school with higher IQ and reading skills than control children. Treatment impacts on IQ and math increased over time for females and decreased for males yielding sex differences in treatment impacts at 21 and 45 years. These findings suggest that, while the ECE treatment similarly benefited boys and girls in the short term, the long-term impacts likely depended on subsequent experiences.

What's race got to do with it? Informant rating discrepancies in neuropsychological evaluations for children with ADHD

OBJECTIVE

To evaluate race-based discrepancies in informant ratings and in rates of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis among a clinically referred sample of Black and White children.

METHOD

Demographic information and ratings of inattention, hyperactivity/impulsivity, and conduct were collected from caregivers and teachers as part of neuropsychological evaluations at an outpatient clinic. The final sample included 3,943 children (6-18 years), of which 70% were White and 30% were Black.

RESULTS

Teachers, but not caregivers, endorsed more inattentive symptoms and conduct problems for Black than for White children, irrespective of ADHD diagnostic status and socioeconomic status (SES), and after controlling for child sex, child age, and learning difficulties. Teachers endorsed more hyperactive/impulsive symptoms for Black children with ADHD of lower SES than for White children with these characteristics. Caregivers of Black children of higher SES reported fewer hyperactive/impulsive symptoms than caregivers of White children of higher SES. Despite differences in teachers' ratings by race, diagnostic rates of ADHD in the context of neuropsychological evaluations were comparable for Black and White children.

CONCLUSIONS

Consistent with previous literature, teachers endorsed more ADHD and conduct problems in Black children. Within our clinically referred sample, this may reflect teacher bias rather than actual prevalence differences by rafce, given that Black caregivers endorsed fewer or similar numbers of symptoms relative to White caregivers. This lack of racial disparities in rates of ADHD diagnosis is inconsistent with findings in community- and population-based samples, and reflectspossible benefit of the use of neuropsychological evaluations in diagnostic decision-making for ADHD.

Challenges in ADHD care for ethnic minority children: A review of the current literature

While attention deficit hyperactivity disorder (ADHD) has been extensively studied in the past decades, the role of social and cultural practices in its assessment, diagnosis, and treatment has been often overlooked. This selective review provides an overview of research that explores social and cultural influences on help-seeking behavior in ethnic minority children with ADHD. Studies were selected that address cultural diversity in three areas of ADHD help-seeking: problem recognition, access to mental health services, and treatment. Special attention was given to studies of treatment selection and adherence in minority groups. Findings suggested that cultural disparities in ADHD care among ethnic minority children occur in the early stages of problem recognition, through service selection, and in the quality of treatment. Ethnic minority children were less likely than their nonminority counterparts to be diagnosed with ADHD and its comorbid conditions and less likely to be prescribed and adhere to stimulant drug treatment. These differences reflect cultural diversity in norms and attitudes towards mental health issues (e.g., fear of social stigma) as well as limited access to qualified health care. Paradoxically, cultural, racial, and language bias may also lead to the overidentification of ethnic minority children as disabled and to higher ratings of ADHD symptoms. This review highlights the importance of sociocultural factors in understanding developmental psychopathology and help-seeking behavior. In addition, it further supports calls for increasing cultural competence in communications during clinical assessment, diagnosis, and treatment in minority communities. Clinical, theoretical, and methodological considerations for future research are discussed.

Investigating school children’s behavioral and emotional problems using pediatric symptoms checklist-17 in a structural equation modeling framework

The Pediatric Symptom Checklist-17 was originally used in primary care settings with parents to identify their children’s behavioral and emotional problems, but there has been some research supporting use of this scale in school settings. This study examined: (a) the factor structure and measurement invariance of the teacher-rated Pediatric Symptom Checklist-17 and (b) complex relationships among demographic characteristics, behavioral and emotional problems, and learning outcomes using structural equation modeling in elementary schools. A sample of 508 children in grades one and two were rated by their teachers with the Pediatric Symptom Checklist-17. Measures of Academic Progress test was utilized to measure participants’ learning outcomes in reading and math. The results confirmed a three-factor structure of the Pediatric Symptom Checklist-17 (internalizing problems, externalizing problems, and attention problems) and attested the measurement invariance across different demographic groups (i.e. gender, ethnicity, and grade levels). Boys were more likely to have severe attention problems which were associated with lower learning outcomes as seen by Measures of Academic Progress reading and math scores. Attention problems mediated the relationship between gender and learning outcomes. This study has implications for the use of the Pediatric Symptom Checklist-17 in school-based settings. Additionally, it highlights the potential relationships among gender, attention problems, and learning outcomes.

Evaluating Parental Disagreement in ADHD Diagnosis: Can We Rely on a Single Report From Home?

OBJECTIVE

Few studies assessed factors associated with the agreement/disagreement between fathers and mothers when rating ADHD symptoms of their offspring.

METHOD

Teachers and both parents assessed a referred sample of 98 children and adolescents aged 6 to 16 years ( M age = 9.79, SD = 2.59) using the Swanson, Nolan, and Pelham (SNAP-IV) rating scale. The agreement was assessed for each of the items of the scale and correlated with variables measuring children's features, socioeconomic adversity, family functioning, and parental psychopathology.

RESULTS

Mean agreement between parents was moderate for the inattentive and good for the hyperactive-impulsive construct. Mothers tended to report more symptoms than fathers. The agreement was lower in those families where parents had discrepant educational levels.

CONCLUSION

Our findings suggest a significant cross-informant disagreement between parents on symptoms of ADHD. Discrepant parental education has a relevant role in explaining parental disagreement in reporting ADHD symptoms.

Factor Structure of the Conners' Teacher Rating Scale-Short Form in a Low-Income Preschool Sample

The Conners' Teacher Rating Scale (CTRS) is among the most commonly used rating scales for the evaluation of childhood behavior disorders. This study examined the structural characteristics of the CTRS in a sample of 235 low-income, primarily African American, preschool children. Children were rated on the CTRS by an assessment research assistant, an intervention research assistant, and a classroom teacher. Multiple exploratory factor analyses converged on the same basic three-factor solution. The three factors could be labeled Hyperactivity/Impulsivity, Inattention, and Oppositional Behavior. This three-factor solution did not correspond to the published factor structure of the CTRS. Instead, it more closely paralleled consensus ratings of experts in the field of child psychology and the criteria for behavior disorders according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV; American Psychiatric Association, 1994).

`Real' Boys? Manufacturing Masculinity and Erasing Privilege in Popular Books on Raising Boys

In recent years an analysis of gender that includes understanding the condition of men and boys in society has garnered considerable attention. We examine four highly promoted pop-psychology books about raising boys. Although such an endeavor could help critically inspect false universalities about gender and examine the ways in which boys and men both benefit from and are constrained by gender polarization and male privilege, we find that these books suffer from three limitations. First, they subscribe to essentializing and universalizing assumptions about gender and parenting that make for a faulty foundation from which to examine gender. Next, these books build their arguments on the unsubstantiated assertion that boys are disadvantaged. Finally, these arguments rest on a fundamental failure to address the institutions and social arenas in which gender is acquired and expressed. These authors fail to examine the forces of privilege and power informing gender identity.

Long-chainn-3 PUFA supplementation decreases physical activity during class time in iron-deficient South African school children

Both Fe deficiency and poorn-3 fatty acid status have been associated with behavioural changes in children. In the present study, we investigated the effects of Fe and DHA+EPA supplementation, alone or in combination, on physical activity during school days and on teacher-rated behaviour in healthy Fe-deficient school children. In a 2 × 2 factorial design, children (n98, 6–11 years) were randomly assigned to receive (1) Fe (50 mg) plus DHA (420 mg)+EPA (80 mg), (2) Fe plus placebo, (3) placebo plus DHA+EPA or (4) placebo plus placebo as oral supplements (4 d/week) for 8·5 months. Physical activity was measured during four school days at baseline and endpoint using accelerometers, and data were stratified into morning class time (08.00–10.29 hours), break time (10.30–11.00 hours) and after-break class time (11.01–12.00 hours) for analysis. Classroom behaviour was assessed at endpoint using Conners’ Teacher Rating Scales. DHA+EPA supplementation decreased physical activity counts during morning class time, increased sedentary physical activity, and decreased light- and moderate-intensity physical activities. Consistently, DHA+EPA supplementation increased sedentary physical activity and decreased light-intensity physical activity during after-break class time. Even though there were no treatment effects found on teacher-rated behaviour, lower physical activity during morning class time was associated with lower levels of teacher-rated hyperactivity and oppositional behaviour at endpoint. Despite a positive association between Fe status and physical activity during break time at baseline, Fe supplementation did not affect physical activity during break time and class time. Our findings suggest that DHA+EPA supplementation may decrease physical activity levels during class time, and further indicate that accelerometry might be a useful tool to assess classroom behaviour in healthy children.

Attention deficits and hyperactivity-impulsivity: what have we learned, what next?

The domains of self-regulation, self-control, executive function, inattention, and impulsivity cut across broad swathes of normal and abnormal development. Attention-deficit/hyperactivity disorder is a common syndrome that encompasses a portion of these domains. In the past 25 years research on attention-deficit/hyperactivity disorder has been characterized by dramatic advances in genetic, neural, and neuropsychological description of the syndrome as well as clarification of its multidimensional phenotypic structure. The limited clinical applicability of these research findings poses the primary challenge for the next generation. It is likely that clinical breakthroughs will require further refinement in describing heterogeneity or clinical/biological subgroups, renewed focus on the environment in the form of etiological events as well as psychosocial contexts of development, and integration of both with biological understanding.

Sociocultural issues in african american and Hispanic minorities seeking care for attention-deficit/hyperactivity disorder

OBJECTIVE

To review the sociocultural factors that may affect the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) in African American and Hispanic minorities seen in the primary care setting in the United States.

DATA SOURCES

Searches on MEDLINE and PubMed were conducted in April and September 2012 on ADHD and its related problems and disabilities. A general search was conducted using the terms (attention deficit hyperactivity disorder OR attention deficit/hyperactivity disorder OR ADHD OR AD/HD) AND (ethnicity OR cultural OR culture). Issues of particular relevance to racial and ethnic minorities utilizing health care services were researched using the string (black OR African OR Hispanic OR Latino OR minority OR racial) combined with terms relating to access, insurance, comorbidity, high-risk behavior, treatment compliance, and nonpharmacologic modalities. Searches were limited to English-language citations, and no date parameters were used. References identified as pertinent to this review were selected for citation.

STUDY SELECTION/DATA EXTRACTION

Information revealing contrasts between minorities and the US non-Hispanic white population was organized in distinct categories, such as access to medical care and insurance, cultural attitudes, and the effects of stigmatization. The authors also provide perspectives for the primary care physician from their own clinical experience.

DATA SYNTHESIS

Rates of diagnosis of in the United States are higher for non-Hispanic whites than for minorities, yet true prevalence is probably similar across racial-ethnic groups. When the stigma of mental illness is added to the challenges faced by racial/ethnic minorities or immigrant status, patients may be especially sensitive. Underuse of clinical services may reflect economic limitations on access to care, cultural attitudes toward mental illness, and the effects of real or perceived prejudice and stigmatization.

CONCLUSIONS

Primary care clinicians in the United States should seek to become more aware of cultural factors that could interfere with the recognition and management of ADHD.

Instruments measuring externalizing mental health problems in immigrant ethnic minority youths: a systematic review of measurement properties

BACKGROUND

Little is known about reliability and validity of instruments measuring externalizing mental health problems in immigrant ethnic minority youths.

AIMS

To provide an overview of studies on measurement properties of instruments measuring these problems in immigrant ethnic minority youths, their methodological quality and results.

METHODS

A systematic review of the literature in MEDLINE, EMbase, PsycINFO and Cochrane Library was performed. Evaluation of methodological quality of studies found was done by using the 'COSMIN-checklist'. Full text, original articles, published in English after 1990 were included. Articles had to concern the development or evaluation of the measurement properties of self-reported, parent-reported and/or teacher- or clinician-reported questionnaires assessing or screening externalizing mental health problems in immigrant ethnic minority youths. Specific results of analyses on (an) immigrant ethnic minority group had to be given.

RESULTS

Twenty-nine studies evaluating 18 instruments met our criteria. Most studies concerned instruments with known validity in Western populations, tested mainly in African Americans. Considering methodological quality, inequivalences between ethnicities were found, self-reports seemed to perform better, and administration of an instrument influenced reliability and validity.

CONCLUSION

It seems that the majority of instruments for assessing externalizing problems in immigrant ethnic minority youths is currently not sufficiently validated. Further evaluating existing instruments is crucial to accurately assess and interpreted externalizing problems in immigrant ethnic minority youths.

Individual differences in attention deficit hyperactivity disorder symptoms and associated executive dysfunction and traits: sex, ethnicity, and family income

The goal of the present investigation was to investigate sex, ethnic, and socioeconomic status (SES) influences on attention deficit hyperactivity disorder (ADHD) symptoms and risk markers, including executive dysfunction and temperament traits. Participants were 109 children who were 3 to 6 years old (64% male; 36% ethnic minority) and their primary caregivers and teachers who completed a multistage, multi-informant screening, and diagnostic procedure. Parents completed a diagnostic interview and diagnostic and temperament questionnaires, teachers completed questionnaires, and children completed cognitive control tasks. Because of targeted overrecruitment of clinical cases, 56% of children in the sample were diagnosed with ADHD. Results suggested minimal sex differences, but prominent ethnic differences, in ADHD symptoms and temperament and executive function risk markers. Further, low family income was associated with increased ADHD symptoms and more temperament and executive function risk markers, and low family income explained many ethnic differences in ADHD symptoms and these risk markers. There were prominent interactions among child sex, ethnicity, and family income. Thus, study results suggest that children with multiple individual difference demographic risk factors (e.g., such as being male and ethnic minority) are at highly increased risk of ADHD symptoms and associated risk markers in the temperament and executive function domains.

Conners' continuous performance test (CCPT-II) in children with ADHD, ODD, or a combined ADHD/ODD diagnosis

The current study investigated if results on the Conners' Continuous Performance Test (CCPT-II) could discriminate between children with ADHD (n = 59), ODD (n = 10), ADHD+ODD (n = 15), and normal controls (n =160), and how the results are associated with and explained by the intellectual function of the child. The sample was derived from the Bergen Child Study (BCS), a longitudinal, ongoing, population-based study of children's development and mental health. CCPT-II performance did not differentiate between the three diagnostic groups (i.e., ADHD, ODD, and ADHD+ODD). Children with ODD (with or without comorbid ADHD) did not differ from children in the control group on any CCPT-II parameters. Children with ADHD made statistically significant more errors of omissions and showed a more variable response time to targets than the control group. The correlations between CCPT-II measures and IQ were mild to moderate, and there was a statistically significant group difference in IQ: Children with ADHD, and children with ADHD+ODD, obtained lower IQ scores than normal controls. A hierarchical multiple regression analysis showed that IQ, but not diagnostic group status, was significant predictors of CCPT-II performance. CCPT-II performance should be interpreted with caution when assessing ADHD and/or ODD in children.

Ethnic differences in problem perception and perceived need for care for young children with problem behaviour

BACKGROUND

 Problem perception and perceived need for professional care are important determinants that can contribute to ethnic differences in the use of mental health care. Therefore, we studied ethnic differences in problem perception and perceived need for professional care in the parents and teachers of 5- to 6-year-old children from the general population who were selected for having emotional and behavioural problems.

METHODS

A cross-sectional study with data of 10,951 children from grade two of the elementary schools in the Rotterdam-Rijnmond area, The Netherlands. Parents and teachers completed the strengths and difficulties questionnaire (SDQ) as well as questions on problem perception and perceived need for care. The SDQ was used to identify children with emotional and behavioural problems. We included Dutch, Surinamese, Antillean, Moroccan and Turkish children in our sample with high (>P90) SDQ scores (N = 1,215), who were not currently receiving professional care for their problems.

RESULTS

Amongst children with high SDQ scores, problem perception was lower in non-Dutch parents than in Dutch parents (49% vs. 81%, p < 0.01). These lower rates of problem perception could not be explained by differences in socioeconomic position or severity of the problems. No ethnic differences were found in parental perceived need and in problem perception and perceived need reported by teachers. Higher levels of problem perception and perceived need were reported by teachers than by parents in all ethnic groups (PP: 87% vs. 63% and PN: 48% vs. 23%).

CONCLUSIONS

Child health professionals should be aware of ethnic variations in problem perception as low problem perception in parents of non-Dutch children may lead to miscommunication and unmet need for professional care for the child.

Under diagnosis of adult ADHD: cultural influences and societal burden

OBJECTIVE

To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden.

METHOD

A review of the literature over the past 10 years was performed using OVID.

RESULTS

Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse.

CONCLUSION

The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.

Future directions in ADHD etiology research

Reviews salient emerging themes in the scientific literature related to identifying etiology and pathophysiology of ADHD. While bypassing the need for new treatment research, the review highlights three themes. First, recognition of the epigenetic effects is expected to revitalize the search for and mapping of early environmental influences on the development of ADHD. Second, neurobiological findings will have limited impact if not examined in the context of significant race and cultural variation in ADHD-related developmental processes, and in the context of rapidly changing social and technological contexts of children's development worldwide. Third, further examination of the phenotype and characterization of its dimensional and categorical structure remains a major need. Overall, the coming decades of etiology research on ADHD will be expected to capitalize on new scientific tools. The hope in the field is that new insights into fundamental prevention can emerge.

The relationship between race and challenging behaviours in infants and toddlers with autistic disorder and pervasive developmental disorder-not otherwise specified

OBJECTIVE

To examine the contributions of race and diagnostic category to endorsement rates of challenging behaviours in infants and toddlers with autism, PDD-NOS and atypical development without ASD, using the Baby and Infant Screen for Children with aUtIsm Traits, Part-3 (BISCUIT Part-3).

DESIGN

Multivariate analyses of variance (MANOVAs) on each sub-scale of the BISCUIT Part-3. Follow-up univariate analyses and post-hoc tests as needed.

METHODS

Scores on the BISCUIT Part-3 were compared for 453 Caucasian and 409 African-American infants and toddlers, grouped by race and diagnosis.

RESULTS

Significant differences between races were found on five out of 10 aggressive behaviours, while no significant differences were found on self-injurious or stereotypic behaviours. Significant differences between diagnostic groups were found on all behaviours.

CONCLUSION

Cultural factors should be taken into account when examining challenging behaviours in infants and toddlers with ASD.

A comparison of autism spectrum disorder DSM-IV criteria and associated features among African American and white children in Philadelphia County

BACKGROUND

Racial differences are documented in the timing and type of autism spectrum disorder (ASD) diagnosis among white and African American children. Differences in clinical presentation by race may contribute to these disparities. This study explores documented differences in core ASD symptoms and associated behavioral features among African American and white children.

METHODS

This project is a secondary data analysis from the Pennsylvania Autism and Developmental Disabilities Surveillance Program and utilized methodology that evaluates existing records, reviews, and codes for DSM-IV criteria for ASD and 12 associated behavioral features. The sample comprised 343 children meeting surveillance case definition for ASD, from 3 population-based cohorts of children in Philadelphia County.

RESULTS

A higher frequency of white children compared to African American children with ASD have documented DSM-IV criteria of inflexible adherence to nonfunctional routines/rituals (92% vs 81%; p = .005) and persistent preoccupation with parts of objects (67% vs 50%; p = .002). A higher frequency of white children with ASD compared to African American children with ASD have documented abnormal motor development (74% vs 60%; p = .008) and odd responses to sensory stimuli (76% vs 51%; p < .001). There were no significant differences in externalizing behaviors or reciprocal social interaction.

CONCLUSIONS

This study suggests differences in the types of ASD symptoms and associated behavioral features exhibited by African American as compared to white children with ASD. Further research is needed to determine if these differences contribute to disparities in the timing or type of ASD diagnosis.

Teacher Ratings of Children’s Behavior Problems and Functional Impairment Across Gender and Ethnicity: Construct Equivalence of the Strengths and Difficulties Questionnaire

The present study examined construct equivalence of the teacher Strengths and Difficulties Questionnaire and compared mean scores in an ethnically diverse sample of children living in the Netherlands. Elementary schoolteachers completed the Strengths and Difficulties Questionnaire for 2,185 children aged 6 to 10 years of the four largest ethnic groups in the Netherlands, namely native Dutch ( n = 684) and Moroccan ( n = 702), Turkish ( n = 434), and Surinamese ( n = 365) immigrant children. Multigroup confirmatory factor analysis suggested the factor structure of the Strengths and Difficulties Questionnaire to be invariant across children’s ethnicity and gender. Additionally, the factor structure appeared to be similar for Dutch and Surinamese teachers. However, mean scores on emotional problems, hyperactivity, conduct problems, prosocial behavior, and impairment varied significantly according to ethnicity and gender. Mean scores on peer problems differed significantly for boys and girls, but not across ethnicity. Whether mean differences reflect a method bias or actual differences in classroom behaviors is discussed and needs further research.

The role of the teacher in identifying learning disabilities: a study using the McCarney Learning Disability Evaluation Scale (LDES)

The purpose of the study was to examine whether the Greek translation of the Learning Disability Evaluation Scale (LDES) can be used in the identification of learning disabilities. The LDES was completed by 165 teachers for one of their students, aged 5 to 14 years. The LDES was significantly correlated to students' grades in Math and Greek Language and to the Reading Ability Test. Scores on LDES from the above randomly selected sample were significantly different from scores on LDES for another sample of 47 students, who were manifesting learning disabilities, indicating that the LDES can distinguish between the two samples. The exploratory factor analysis revealed that the LDES maintains the original factor structure and the reliability values supported its internal consistency. Results and limitations are discussed.

Psychometric properties of teacher SKAMP ratings from a community sample

This study examines the basic psychometric properties of the Swanson, Kotkin, Agler, M-Flynn, and Pelham Scale (SKAMP), a measure intended to assess functional impairment related to attention deficit hyperactivity disorder, in a sample of 1,205 elementary students. Reliability, factor structure, and convergent, discriminant and predictive validity are evaluated. Results provide support for two separate but related subscales, Attention and Deportment, and provide evidence that the SKAMP predicts school functioning above and beyond symptoms alone. Boys, African American children, and children living in poverty are rated as having higher impairment scores than girls, Caucasian children, and more advantaged peers. Norm-referenced data are provided by gender, race, and parental concern level. This study supports the reliability and validity of the SKAMP in a large, diverse community sample and broadens its clinical utility.

Cross-informant correlations on social competence and behavioral problems in Sami and Norwegian preadolescents

In a community-based birth cohort from Arctic Norway, correlations between parents and teachers on child competence and behavioral problems were determined for Sami and Norwegian 11-12 year-olds, using as instruments the child behavior checklist (CBCL), teacher report form (TRF), and the impact supplement of the extended strength and difficulties questionnaire (SDQ). Parent-teacher correlations on child behavioral problems were generally high in the Norwegian group, but low in the Sami group. Cross-cultural differences in cross-informant correlations were highest regarding externalizing and attention problems. Parent-teacher correlations on total impact of child difficulties also differed between the ethnic groups. Once again, a lower correlation was found for the Sami children. The discrepancy between parents' and teachers' perception of problems that needed attention was highest for the Sami, and lowest for the Norwegians. The Sami parents reported fewer perceived difficulties and less impact of problems than did the Norwegian parents. In contrast, no ethnic differences emerged for teachers' ratings. The paper discusses how cultural norms might influence the reports of child problems. It demonstrates the importance of combining parent and teacher reports of child behavior problems in minority and indigenous children, who often live under different cultural norms in home and school contexts.

Children, ADHD, and citizenship

The diagnosis of attention-deficit hyperactivity disorder is a subject of controversy, for a host of reasons. This paper seeks to explore the manner in which children's interests may be subsumed to those of parents, teachers, and society as a whole in the course of diagnosis, treatment, and labeling, utilizing a framework for children's citizenship proposed by Elizabeth Cohen. Additionally, the paper explores aspects of discipline associated with the diagnosis, as well as distributional pathologies resulting from the application of the diagnosis in potentially biased ways.

Social competence and emotional/behavioral problems in a birth cohort of Sami and Norwegian preadolescents in Arctic Norway as reported by mothers and teachers

In a 7-year follow-up birth cohort from the general population in the Sami core area in Finnmark, Arctic Norway, we examined mothers' and teachers' reports of social competence and emotional/behavioral problems among 71 indigenous Sami and 77 Norwegian 11-12-year-olds. The instruments used were the Child Behavior Checklist (CBCL) for parents and the Teacher Report Form (TRF). No ethnic differences were found on competence scales. Total Problems reported by Sami and Norwegian mothers were low in comparison with the overall mean found in multicultural meta-studies. Sami mothers reported lower Total Problems and Attention Problems than did Norwegian mothers. There were no ethnic differences on the TRF measures. Consistent with other international studies, mothers and teachers rated girls higher than boys on social competence and boys higher than girls on Externalizing and Attention Problems. Gender differences were larger on the TRF than on the CBCL. The very low problem ratings made by the Sami mothers indicate that there is a need for specific clinical cut-off points to distinguish between clinically referred and non-referred children in this indigenous Arctic population.

Attention deficit hyperactivity disorder in African American children: what can be concluded from the past ten years?

Samuel et al. [Samuel, V. J., Curtis, S., Thornell, A., George, P., Taylor, A., Brome, D. R., et al. (1997). The unexplored void of ADHD and African-American research: A review of the literature. Journal of Attention Disorders, 1(4), 197-207.] reviewed the literature on Attention Deficit Hyperactivity Disorder (ADHD) in African Americans, and found a paucity of research. The present review of 73 articles updates this assessment of available research and presents the current understanding of ADHD symptoms, assessment, diagnosis, and treatment in African American children ages 3-18. The authors conducted a qualitative review, as well as a mini meta-analysis of 5 studies of ADHD symptoms and 5 studies of ADHD diagnosis to clarify the question of racial differences in prevalence. African American youth had more ADHD symptoms (Cohen's d=0.45, p<.001), yet were diagnosed with ADHD only two-thirds as often as Caucasian youth (OR=.66, p<.001). This pattern was not explained by teacher rating bias or by SES, but may be influenced by parent beliefs about ADHD, higher rates of risk, and lack of treatment access and utilization. Lower treatment rates may be related to high rates of classroom behavior problems among African American youth. Findings also suggest that existing assessment tools may not adequately capture ADHD manifestation in African Americans. Findings highlight the need for more investigation and awareness of relevant cultural issues to inform a culturally competent approach to assessment, diagnosis, and treatment of ADHD in African Americans.

Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample

To examine Swanson, Nolan, and Pelham-IV (SNAP-IV) psychometric properties, parent (N = 1,613) and teacher (N = 1,205) data were collected from a random elementary school student sample in a longitudinal attention deficit hyperactivity disorder (ADHD) detection study. SNAP-IV reliability was acceptable. Factor structure indicated two ADHD factors and an oppositional defiant disorder (ODD) factor. Parent and teacher scores varied by gender and poverty status (d = .49-.56) but not age; only teacher scores varied by race (d = .25-.55). Screening and diagnostic utility was evaluated with likelihood ratios (LRs) and posttest probabilities. Parent SNAP-IV scores above 1.2 increased probability of concern (LR > 10) and above 1.8, of ADHD diagnosis (LR > 3). Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only (LR = 4.2 and >5, respectively). Higher teacher scores for African American children and race differences in measurement models require future study.

Modifying the response labels of an ADHD teacher rating scale: psychometric and epidemiologic implications

OBJECTIVE

To evaluate the impact of changing the response labels of a teacher rating scale in a population-based study of ADHD.

METHOD

For parents, the Diagnostic Interview Schedule for Children, which asks whether each of 18 symptoms occurred "often" in the past year, was used. For teachers, most scales use a 4-point scale, with often and very often as the two highest categories. To make the two instruments more compatible, the authors created a teacher rating scale with often as the highest category. Teachers rated more than 6,000 elementary school students using this instrument. Some teachers completed ratings using both questionnaire formats.

RESULTS

The scale's internal consistency, convergent validity, and test-retest reliability are excellent. The factor structure is consistent with established DSM-IV-based instruments. Response category choices influence the proportion of children exceeding symptom and impairment thresholds.

CONCLUSION

Altering the response scale does not degrade the psychometric properties of the instrument but makes important differences in the sample.

Factor structure of parent- and teacher-rated attention-deficit/hyperactivity disorder symptoms in the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS)

OBJECTIVE

This study examines one-, two-, and three-factor models of attention-deficit/hyperactivity disorder (ADHD) using the existing 18 Diagnostic and Statistical Manual of Mental Disorder, 4th edition (DSM-IV) symptoms in a sample of symptomatic preschoolers.

METHODS

Parent and/or teacher ratings of DSM-IV symptoms were obtained for 532 children (aged 3-5.5) who were screened for the Preschool ADHD Treatment Study (PATS). Confirmatory factor analysis (CFA) using symptoms identified on the Conners' Parent and Teacher Rating Scales was conducted to assess a two-factor model representing the DSM-IV dimensions of inattention (IN) and hyperactivity/impulsivity (H/I), a three-factor model reflecting inattention, hyperactivity, and impulsivity, and a single-factor model of all ADHD symptoms. Exploratory factor analysis (EFA) was subsequently used to examine the latent structure of the data.

RESULTS

For parent ratings, the two-factor and three-factor models were marginally acceptable according to several widely used fit indices, whereas the one-factor model failed to meet minimum thresholds for goodness-of-fit. For teachers, none of the models was a solid fit for the data. Maximum likelihood EFAs resulted in satisfactory two and three-factor models for both parents and teachers, although all models contained several moderate cross loadings. Factor loadings were generally concordant with those published for older children and community-based samples.

CONCLUSION

ADHD subtypes according to current DSM-IV specifications may not be the best descriptors of the disorder in the preschool age group.

Variations in prevalence of attention deficit hyperactivity disorder worldwide

Attention deficit hyperactivity disorder (ADHD) is among the most common, intensely investigated, and yet diagnostically controversial neurobehavioral conditions of childhood. The prevalence of ADHD has been reported with great variations among different studies, ranging from 2.2% to 17.8%. The aim of this review was to investigate the variables that influence the prevalence of ADHD and to derive a best estimate for the prevalence of the disorder. We reviewed all the 39 studies on ADHD prevalence appearing in the Pubmed and published since 1992. These studies indicate that ADHD is more common in boys than girls, in younger than older children and adolescents, in one-setting rather than two-setting screening studies, in studies based on DSM-IV rather than DSM-III-R criteria. Additional factors that may well influence prevalence rates include source of information and assessment of clinical impairment. In conclusion, our findings suggest that population characteristics, methodology features, ethnic and cultural differences and diagnostic criteria involved in studies affect the prevalence of ADHD. Standardized designs may lead to firm conclusions on the true prevalence of ADHD, the estimation of which seems impossible to be achieved by reviewing the already existing literature.

Ethnic variation of self-reported psychopathology among incarcerated youth

Research on ethnic minority populations has shown them to be undertreated, underdiagnosed and perceived as more psychopathological in comparison to the Caucasian population. This study aimed to assess ethnic variation of self-perceived psychopathology in a population of incarcerated youths. The Youth Self-Report (YSR) was completed by 5964 incarcerated adolescents (95% male; mean age = 16.5) in the California Youth Authority (CYA) system. Overall, ethnic minorities (African-Americans and Hispanics) self-report lower levels of psychiatric problems than Caucasians. These differences were more pronounced in males than females. Further research is needed to better ascertain the reasons for these differences.

Prevalence and correlates of ADHD symptoms in the national health interview survey

OBJECTIVE

Study the prevalence and correlates of ADHD symptoms in the National Health Interview Survey (NHIS).

METHODS

NHIS includes 10,367 children ages 4 to 17. Parents report lifetime diagnosis of ADHD and complete the Strengths and Difficulties Questionnaire (SDQ). Prevalences of clinically significant ADHD and comorbid symptoms by race and ethnicity, gender, and age are presented.

RESULTS

Prevalence of clinically significant SDQ ADHD symptoms is 4.19% (males) and 1.77% (females). Male prevalence by race is 3.06% for Hispanics, 4.33% for Whites, and 5.65% for Blacks. Significant differences in prevalence occur across gender (p < .01) and among males across race (p < .01), age (p < .01), and income (p < .02). In the full sample, 6.80% of males and 2.50% of females have a parent-reported lifetime ADHD diagnosis but are negative for SDQ ADHD. Likewise, 1.59% of males and 0.81% of females are positive for SDQ ADHD but negative for parent report of ADHD diagnosis. SDQ ADHD positive children have substantially higher proportions of elevated scores on other SDQ subscales.

CONCLUSION

ADHD symptoms vary by race and ethnicity, gender, and age and are associated with other emotional and behavioral difficulties. Both overdiagnosis and underdiagnosis of ADHD may be issues in the U.S. population of 4- to 17-year-olds.

Racial and ethnic differences in ADHD and LD in young school-age children: parental reports in the National Health Interview Survey

OBJECTIVES

Racial and ethnic disparities have been documented for many physical health outcomes in children. Less is known, however, about disparities in behavioral and learning disorders in children. This study uses data from a national health survey to examine racial and ethnic differences in identified attention deficit hyperactivity disorder (ADHD) and learning disability (LD).

METHODS

The 1997-2001 National Health Interview Surveys obtained information from parents about the health and sociodemographic characteristics of children. Using these data, prevalence rates of identified ADHD and/or LD were estimated for Hispanic, African American, and white children 6-11 years of age. Racial and ethnic differences in health conditions, income, and insurance coverage were examined as possible explanations for disparities in parental reports of ADHD and LD, as well as the use of any prescription medication among children with ADHD.

RESULTS

Hispanic and African American children, compared to white children, had parental reports of identified ADHD without LD less often, and adjustments for the confounding variables-birthweight, income, and insurance coverage-did not eliminate these differences. Hispanic and African American children, compared to white children, also had parental reports of ADHD with LD less often after adjustments for the effects of confounding variables. By contrast, after adjustments for confounding variables, Hispanic and African American children were as likely as white children to have LD without ADHD. Among children with ADHD, use of any prescription medication was reported less often for Hispanic and African American children than white children. These disparities in medication use persisted after adjustments for confounding variables.

CONCLUSIONS

The prevalence of ADHD and the use of any prescription medication among children with ADHD differed among Hispanic, African American, and white children. These disparities could not be explained by racial and ethnic differences in other health conditions and sociodemographic variables.

Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents

This article examines evidence-based assessment practices for attention deficit hyperactivity disorder (ADHD). The nature, symptoms, associated features, and comorbidity of ADHD are briefly described, followed by a selective review of the literature on the reliability and validity of ADHD assessment methods. It is concluded that symptom rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994), empirically and rationally derived ADHD rating scales, structured interviews, global impairment measures, and behavioral observations are evidence-based ADHD assessment methods. The most efficient assessment method is obtaining information through parent and teacher rating scales; both parent and teacher ratings are needed for clinical purposes. Brief, non-DSM based rating scales are highly correlated with DSM scales but are much more efficient and just as effective at diagnosing ADHD. No incremental validity or utility is conferred by structured interviews when parent and teacher ratings are utilized. Observational procedures are empirically valid but not practical for clinical use. However, individualized assessments of specific target behaviors approximate observations and have both validity and treatment utility. Measures of impairment that report functioning in key domains (peer, family, school) as well as globally have more treatment utility than nonspecific global measures of impairment. DSM diagnosis per se has not been demonstrated to have treatment utility, so the diagnostic phase of assessment should be completed with minimal time and expense so that resources can be focused on other aspects of assessment, particularly treatment planning. We argue that the main focus of assessment should be on target behavior selection, contextual factors, functional analyses, treatment planning, and outcome monitoring.

The role of children's ethnicity in the relationship between teacher ratings of attention-deficit/hyperactivity disorder and observed classroom behavior

Significant ethnic differences have been consistently documented on attention-deficit/hyperactivity disorder (ADHD) teacher rating scales. Whether these ethnic differences result from a teacher rating bias or reflect actual classroom behavior patterns is unknown. Ethnic differences between Caucasian and African American (AA) elementary schoolchildren on teacher ratings and codings of observed classroom behavior were examined with latent variables. In structural equation models, correlations between teacher ratings and observed classroom behavior suggested nonbiased teacher ratings of AA schoolchildren with diagnosed ADHD. Ethnic differences were documented for both teacher ratings of ADHD and classroom behavior. Differences in classroom behavior were attenuated when the behavior of an average child in the classroom was taken into account. Multiple explanations for this pattern of results are discussed.

Ethnic and regional differences in primary care visits for attention-deficit hyperactivity disorder

The ethnic and regional differences in primary care visits for children regarding the frequency of attention-deficit hyperactivity disorder (ADHD) diagnoses, stimulant prescriptions, and other mental health diagnoses were examined. The authors analyzed 6 years (1995-2000) of data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey and found that an ADHD diagnosis and/or a stimulant prescription were less likely to be recorded during visits by Hispanic-American youths relative to visits by white-American youths. The authors also found that stimulant prescriptions were given more frequently for visits of children with ADHD in the south and west than in the northeast. Finally, no ethnic differences were found in the likelihood of receiving a psychotropic medication once an ADHD diagnosis was given or receiving a mental health diagnosis other than ADHD. Ethnic disparities in primary mental health care appear to exist for ADHD and not for other mental disorders pooled together.

Cross-cultural Similarities in ADHD-Like Behaviour Amongst South African Primary School Children

This study investigates whether the Disruptive Behaviour Disorders (DBDs) rating scale measures the same constructs in South African as in Western cultures, and explores the differences in scale scores as a function of language, gender and age. Teacher ratings between 1997 and 1999 of the 18 DSM-IV symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in 6 094 primary school children of six language groups in the Limpopo Province of South Africa were collected and analysed. For all language groups, the results were consistent with a two-factor model of ADHD with correlated factors. There were gender and age effects on both scales. The prevalence rates for ADHD sub-types were in line with rates in the United States of America (US) and Europe. Similarities across language groups, as well as to results reported in the US and Europe, were striking. Despite the limitations discussed, teacher ratings of ADHD symptoms on the DBD scale can be used as a screening instrument in South Africa. Separate norms for different language groups are not indicated.

The effects of race and problem type on teachers' assessments of student behavior

The authors tested the hypothesis that race bias in teacher evaluations may be problem specific by examining the extent to which ratings of child behavior were influenced by the interaction between the race of the child and the type of presenting behavior. Teachers (N = 197) were presented with three vignettes (overcontrolled, undercontrolled, and "normal"), systematically paired with a photograph of a male child (African American, Asian American, or Caucasian). Respondents rated the seriousness, referability, and typicality of the behavior; the child's family life; academic ability and performance; and causal dimensions. Although results did not reveal a bias in the ratings of African American students, data suggest that stereotypes remain embedded in teachers' interpretive framework for Asian Americans, particularly regarding expectations of overcontrolled traits.

Patterns and correlates of agreement between parent, teacher, and male adolescent ratings of externalizing and internalizing problems

The authors examined how well 394 triads of male youths, caregivers, and teachers agreed about youth problems reported on the Achenbach checklists. Dyadic agreement was measured through difference scores (subtracting the raw score of youth self-report from the caregiver's or teacher's score for shared items), q correlations between pairs of raters across items, and D2 (generalized distance between item profiles) for both externalizing and internalizing items. Teachers reported fewer internalizing and externalizing problems than did caregivers or youths. Teacher-youth disagreement was higher for African American than European American males about externalizing criteria. Caregiver depression and stress (but not paternal antisocial behavior or maternal substance abuse) correlated with higher disagreement with other informants about all criteria. These factors appear to increase disagreement about the level of problems but not about specific symptom patterns.

Stimulant treatment in Maryland public schools

OBJECTIVE

A statewide school survey was performed to provide naturalistic data on the prevalence of medication administered to Maryland public school students for the treatment of attention deficit hyperactivity disorder (ADHD) to clarify the concern of some state legislators about stimulant treatment for youths.

METHODS

In April 1998, school nurses supervised a survey of all Maryland public school students medicated during school hours for ADHD. The data collected on these students included: type of medication administered, gender, school level, race/ethnicity, special education and Section 504 status, and the specialist of the prescriber.

RESULTS

Of the 816 465 students surveyed, 20 050 (2. 46%) received methylphenidate and 3721 (0.46%) received other medications for ADHD. Other major findings were: 1) methylphenidate constituted 84% of all the medication administered for ADHD; 2) the male:female ratio of the medication's recipients was 3.5:1 and 4.3:1 in elementary and secondary school, respectively; 3) black and Hispanic students received methylphenidate at approximately half the rate of their white counterparts; 4) 45% of all students receiving methylphenidate had special education status and an additional 8% had Section 504 status; and 5) nurse practitioners were the prescribers of 3% of the methylphenidate prescribed to Maryland students.

CONCLUSIONS

This large, population-based, point prevalence study of medication administered to students for ADHD adds new and updated findings on prevalence variations, rates for minority and special education/Section 504 students, and specialty prescriber rates.

Revision and restandardization of the Conners Teacher Rating Scale (CTRS-R): factor structure, reliability, and criterion validity

The Conners Teacher Rating Scale (CTRS) is a commonly used research and clinical tool for assessing children's behavior in the classroom. The present study introduces the revised CTRS (CTRS-R) which improves on the original CTRS by (1) establishing normative data from a large, representative North American sample, (2) deriving a factor structure using advanced statistical techniques, and (3) updating the item content to reflect current conceptualizations of childhood disorders. Using confirmatory factor analysis, a six-factor structure was found which includes Hyperactivity-Impulsivity, Perfectionism, Inattention/Cognitive Problems, Social Problems, Oppositionality, and Anxious/Shy factors. The reliability of the scale, as measured by test-retest correlations and internal consistency, is generally satisfactory. Using all of the scale factors to discriminate between attention deficit hyperactivity disordered and normal children, 85 percent of children were correctly classified, supporting the validity of the scale and indicating excellent clinical utility. Similarities and differences between the original CTRS factor structure and the CTRS-R factor structure are discussed.