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

Objective: To address rising concerns about the possible overdiagnosis of attention-deficit hyperactivity disorder (ADHD) and overtreatment with stimulants.To date, almost no studies have examined ADHD in unbiased community-based studies, ascertaining both the prevalence of the diagnosis within nonreferred populations and the extent to which various treatments (i.e., stimulant medication, mental health treatments, and educational interventions) are used. Method: As a part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, the authors examined epidemiological survey data obtained from 1,285 children and their parents across 4 US. communities. Analyses examined the frequency of children's ADHD diagnosis, the extent to which medications were prescribed, as well as the provision of other services (e.g., psychosocial treatments, school-based educational interventions). Results: Findings indicated that 5.1% of children met full DSM-//I-RADHD criteria across the pooled sample. Only 12.5% of children meeting ADHD criteria had been treated with stimulants during the previous 12 months. Some children who had been prescribed stimulants did not meet full ADHD diagnostic criteria, but these children manifested high levels of ADHD symptoms, suggesting that the medication had been appropriately prescribed. Children with ADHD were generally more likely to receive mental health counseling and/or school-based interventions than medication. Conclusions: Medication treatments are often not used in treating ADHD children identified in the community, suggesting the need for better education of parents, physicians, and mental health professionals about the effectiveness of these treatments. On the basis of these data it cannot be concluded that substantial "overtreatment" with stimulants is occurring across communities in general. J. Am. Acad. Child Adolesc. Psychiatry: 1999, 38 (7):797-804. Key Words:attention-deficit hyperactivity disorder, attention deficit, hyperactivity, stimulants, misdiagnosis, services, treatment.Recent media reports indicate that the public has become increasingly concerned about the apparent dramatic rise in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and the prescription of psychostimulant

Because we used the DISC-IV to apply DSM-IV criteria, the study yielded prevalence rates that are generally comparable with those found in previous surveys. The inclusion of diagnosis-specific impairment criteria reduced rates slightly. When global impairment criteria were imposed, the rates were reduced by approximately half.

Our findings lend cross-cultural generalizability to recent reports that gender does not interact with correlates for ADHD overall, but that it may play a role in subtypes.

Findings supported the construct validity of ADHD in this culturally different sample and suggested that the CT and IT represent distinct disorders.

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

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N=1,896) and the treated samples (N=763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IVADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment. Keywords ADHD; Correlates; Prevalence; Comorbidity; Hispanic/LatinoThe clinical research literature has consistently shown that Attention-Deficit/Hyperactivity Disorder (ADHD) (American Psychiatric Association 1994) is a disabling disorder that affects individuals across the lifespan (Barkley et al. 1990;. However, it is not clear whether the patterns of correlates, comorbidity, and impairment of the disorder in treated samples are the same for persons identified with ADHD in probability community samples. Studying the differences in patterns is important because findings from treatment samples can be biased due to selection effects that Cohen and Cohen (1984) called, "the clinician's illusion." They argued that bias can arise because clinical studies tend to focus on persons with more chronic and severe manifestations of the disorder. Insofar as these selection effects are ignored when looking at patterns of correlates, comorbidity, and impairment, the estimates of the associations related to these patterns can be affected by statistical bias known as Berkson's bias (Angold et al. 1999;Berkson 1950). To estimate the extent of the bias, it is necessary to compare findings in treated samples and epidemiological samples, using similar study designs and measures.Treatment-referred samples are appropriate for studies that aim to generalize findings to children who receive services in clinics, and also for studies that provide initial descriptions of rare disorders when the concern is identification of potential risk factors, or when very little developmental epidemiological research has been done (Angold et al. 1999). However, when evaluating results from treated cases, researchers must keep in mind the likelihood that these cases have more symptomatology, are more impaired, and usually constitute a higher burden to caregivers than children not receiving services. Also, minority/ethnic groups and prepubertal girls may be underrepresented in clinical samples (Goodman et al. 1997). Epidemiological studies that obtain representative community samples are designed to provid...

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