Objective Children with ADHD often exhibit psychiatric comorbidities, which may impact illness presentation, diagnosis, and treatment outcomes. Guidelines exist for dealing with these complex cases but little is known about how comorbidities are being handled in community pediatric settings. The purpose of this study was to evaluate how mental health comorbidities affect community physicians’ ADHD care practices and patients’ symptom trajectories. Methods Medical charts of 319 children presenting at primary care clinics for ADHD-related concerns were reviewed. Physician assessment and treatment behaviors were extracted and parents rated ADHD symptoms at the time of diagnosis and at 3, 6, and 12 months. Baseline ratings were used to group children as no comorbid mental health condition, internalizing, or externalizing comorbid condition. Multilevel analyses compared community physician care behaviors and ADHD symptom trajectories across groups. Results Approximately 50 percent of the sample met screening criteria for a comorbid mental health condition. For children diagnosed with ADHD and treated with medication, community physician care largely did not differ across groups, but children with internalizing comorbidities made significantly smaller improvements in inattentive and hyperactive/impulsive symptoms compared to children with no comorbidities. Conclusion Children with ADHD and mental health comorbidities, particularly internalizing disorders, exhibit less robust response to ADHD medication and may require additional testing prior to starting medication and/or alternative treatment approaches. Potential barriers to conducting comprehensive assessments and to providing multi-modal treatment are discussed.

Discrepancies often exist between self-reported and parent-reported symptoms when assessing youth psychosocial functioning. Parent-child discrepancies in ratings may be important for understanding psychopathology and patterns of family functioning, particularly during adolescence and for youth with chronic illness. This study examined patterns of multirater reporting discrepancies in a pediatric asthma population. Adolescents ( = 707; 11-17 years old) and their primary caregivers completed ratings of adolescents' psychological symptoms. Latent profile analysis identified five profiles of parent-adolescent discrepancies, including one group with highly discordant ratings, two groups in agreement, and two groups with slightly discordant ratings. Adolescents who agreed with their parents on the presence of elevated symptoms and those who had significant discrepancies in ratings, such that parents reported elevated symptoms compared to youth self-report, had poor pulmonary functioning and elevated reports of parent-rated family conflict. Results suggest the need to assess internalizing and externalizing symptoms in adolescents with asthma using a multirater approach while also highlighting the complexity in interpreting patterns of discrepancies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Introduction Family factors are directly associated with the psychosocial adjustment of children with chronic illnesses such as asthma (Kaugars et al., 2004). Research indicates that negative family factors may also contribute to child disease severity via bio-behavioral mechanisms of effect. For instance, children from more conflicted families often experience greater internalizing symptoms that subsequently impact their asthma severity (Wood et al., 2006). These pathways have yet to be examined with a comprehensive focus on strength-based family factors. This study examined whether factors such as family cohesion, problem-solving abilities, and communication influence asthma severity via their effects on child depression and anxiety symptoms. Methods Participants were 215 children (136 males and 79 females), ages five to twelve years old, and their families. Primary caregiver, child, and teacher ratings of child and family functioning in addition to objective measures of parent-child interactions and asthma severity were collected. Results Using structural equation modeling, we identified significant indirect associations between family factors and child asthma severity via child depressive symptoms; however, these associations were not present in models with child anxiety symptoms. Discussion Results suggest an indirect effect of family functioning on children’s lung function, with differential roles of anxiety and depression in these pathways. This paper also highlights the importance of incorporating multi-rater multi-method measures to understand children’s experiences in pediatric asthma.

No abstract

Compared to their peers, Latina/o youth are at high risk of being overweight and obese and experiencing related health problems. Because of this, it is important to identify factors that may contribute to obesity among Latina/o youth. We explored the relationships among internal health locus of control (IHLOC), cultural factors (cultural orientation, ethnic identity), and Latina/o adolescents' body mass index (BMI; an index of obesity and overweight). One hundred twenty-eight Latina/o adolescents (ages 13-18 years) completed a series of questionnaires to assess ethnic identity (i.e., affirmation-belonging and participation), cultural orientation (i.e., Latina/o cultural orientation and Anglo cultural orientation), and IHLOC. We also obtained participants' reports of weight and height, which were used to calculate BMI. Results indicated that there was an inverse association between IHLOC and BMI; specifically, the greater internal control the adolescents perceived they had over their health, the lower their BMI. As expected, Latina/o cultural orientation moderated this relation, such that at moderate and high levels of Latina/o cultural orientation, IHLOC was associated with lower BMI. Contrary to expectations, ethnic identity affirmation-belonging moderated this relation in the opposite direction, such that at low and moderate levels of ethnic identity affirmation-belonging, IHLOC was associated with lower BMI. The importance of IHLOC, cultural factors, and context in obesity among Latina/o youth and the implications of these results for obesity intervention programming are discussed.