"God Did Not Create Us This Way": An Investigation into the Experiences of School Counselors Working with Arab-Muslim LGBTQ Youth.

Schools play a key role in supporting, protecting, and advocating for LGBTQ students. However, educational programs worldwide tend to exclude and marginalize LGBTQ issues, especially when it comes to ethnic and racial minorities. In the current study, we examined Arab school counselors' experiences of working with Arab-Muslim LGBTQ youth. After 100 counselors declined to participate, the study included semi-structured interviews with 60 female counselors in Arab-Muslim schools in Israel. Data were analyzed using interpretive phenomenological analysis. Four main themes emerged: religious considerations, causal explanations of LGBTQ orientation, working practices, and supportive resources. Our findings point to the unique challenges facing Arab school counselors who are torn between their professional values and traditional norms. Among the strategies counselors used for managing this tension were separating LGBTQ orientation from LGBTQ adolescents, passive listening while avoiding proactive inquiry, and referring to LBGTQ orientation as a transient phase. Our findings emphasize the need to develop culturally relevant programs that address LGBTQ orientation for students, teachers, and families.

Selective mutism in immigrant families: An ecocultural perspective.

Although the diagnosis of selective mutism (SM) is more prevalent among immigrant children, the link between the disorder and an immigration background has been elusive. Guided by ecocultural models of development, the current study aimed to construct a theory-based description of SM while considering individual, family, and contextual risk factors. Participants were 78 children with SM (38.4% with an immigration background), and 247 typically developed children (18.2% with an immigration background). Consistent with previous studies, our results suggest that anxiety was the most important predictor of SM symptoms, above and beyond immigration background. Immigration, especially if coupled with bilingual status and low family income, predicted increased levels of SM symptoms. Identifying multi-level predictors of SM may help researchers and clinicians to improve early identification and treatment of SM in culturally and linguistically diverse children.

Infant screen media and child development: A prospective community study.

The current study examined longitudinal associations between early screen media exposure (assessed at 6, 12, and 24 months) and the child's motor and language/communication development at the ages of 24 and 36 months. We also aimed to study whether these associations varied by socioeconomic status (SES). Participants were 179 parent-infant dyads, recruited from well-baby clinic services during routine visits. Child development measures included standardized measures of developmental milestones as assessed by professionals and referral data to child developmental centers. Both measures were retrieved from the official health maintenance organization records by an expert in child development. Results indicated that screen exposure at 6 and 12 months was associated with a higher risk for language/communication deficits at 36 months in children with moderate or high SES but not in children with low SES. Our findings are consistent with existing literature demonstrating cross-sectional and longitudinal associations between early screen exposure and language development deficits. Given that media use practices and motivations vary among families from different backgrounds, further investigation of the interaction between SES and screen exposure is needed.

Beyond the language barrier: A systematic review of selective mutism in culturally and linguistically diverse children.

Selective mutism is a childhood psychiatric disorder that has been associated with adverse psychological, social and educational outcomes. Although evidence suggests that culturally and linguistically diverse children might be overrepresented among children with selective mutism, a direct examination of how migration or minority status are associated with the development and persistence of the disorder is still scarce. Guided by eco-cultural perspectives of development, the current review aims to provide an overview of selective mutism in culturally and linguistically diverse children. A systematic literature review of selective mutism studies that included a group of culturally and linguistically diverse children yielded eight studies that met our inclusion criteria. Although these studies support the view that bilingualism and minority status might be associated with selective mutism, the role of sociocultural factors in the development and persistence of the disorder remained mostly unexamined. The review concludes with a discussion of potential directions for future research, including examination of the cultural and psychological meanings of silence and talk, socialization goals, gender inequality, and parental acculturation strategies.

An Authentic Inner Compass and Need Satisfaction as Wellbeing Resources in Bedouin Teaching Students During the COVID-19.

A growing body of literature suggests that students from underserved backgrounds are more vulnerable to the adverse economic, emotional, and academic effects of the current COVID-19 pandemic. While this vulnerability was attributed to multiple structural and socio-cultural barriers, little attention has been paid to the role of psychological resources in preserving wellbeing in times of crisis and change. Guided by the Self-Determination Theory (SDT), the current study examined the role of the authentic inner compass (AIC) and need-satisfaction in predicting the wellbeing of Bedouin students attending teachers' higher education institutes in the south of Israel during the COVID-19. Participants were 84 Bedouin teaching students (84.1% female) who completed online questionnaires addressing the sense of AIC, need-based experiences, psychological distress, and positive affect. Consistent with the propositions of the SDT, we found that a strong and clear sense of AIC, as well as high need satisfaction and low need frustration, were associated with lower distress and higher positive effect in Bedouin teaching students. We have also found that need satisfaction moderated the effect of the AIC on students' wellbeing so that AIC better predicted lower distress and higher positive effect when students' levels of need satisfaction were higher. Our findings lend further support to the importance of the AIC and need satisfaction to optimal functioning even in collectivist cultural contexts that do not prioritize values of autonomy. The current study provides insight into the interplay between AIC and need-based experience by describing the conditions under which AIC may be beneficial for wellbeing in times of crisis.

Global and Local Trends Affecting the Experience of US and UK Healthcare Professionals during COVID-19: Twitter Text Analysis.

BACKGROUND: Healthcare professionals (HCPs) are on the frontline of fighting the COVID-19 pandemic. Recent reports have indicated that, in addition to facing an increased risk of being infected by the virus, HCPs face an increased risk of suffering from emotional difficulties associated with the pandemic. Therefore, understanding HCPs' experiences and emotional displays during emergencies is a critical aspect of increasing the surge capacity of communities and nations. METHODS: In this study, we analyzed posts published by HCPs on Twitter to infer the content of discourse and emotions of the HCPs in the United States (US) and United Kingdom (UK), before and during the COVID-19 pandemic. The tweets of 25,207 users were analyzed using natural language processing (NLP). RESULTS: Our results indicate that HCPs in the two countries experienced common health, social, and political issues related to the pandemic, reflected in their discussion topics, sentiments, and emotional display. However, the experiences of HCPs in the two countries are also subject to local socio-political trends, as well as cultural norms regarding emotional display. CONCLUSIONS: Our results support the potential of utilizing Twitter discourse to monitor and predict public health responses in emergencies.

Primary School Children's Self-Reports of Attention Deficit Hyperactivity Disorder-Related Symptoms and Their Associations With Subjective and Objective Measures of Attention Deficit Hyperactivity Disorder.

BACKGROUND: The diagnosis of Attention deficit hyperactivity disorder (ADHD) is primarily dependent on parents' and teachers' reports, while children's own perspectives on their difficulties and strengths are often overlooked. GOAL: To further increase our insight into children's ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children's self-reports, parents' and teachers' reports, and standardized continuous performance test (CPT) data. We also examined whether the addition of children's perceptions of ADHD-symptoms to parents' and teachers' reports would be reflected by objective and standardized data. METHODS: The study included 190 children with ADHD, aged 7-10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children's self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and CPT scores. RESULTS: Children's self-evaluations of their functioning were globally associated with their teachers' and parents' evaluations, but not uniquely. Children's self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not. CONCLUSION: Primary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children's perspectives into account during ADHD diagnosis and treatment is highlighted.

Identity-based hate and violence as trauma: Current research, clinical implications, and advocacy in a globally connected world.

Hate-based violence is increasingly recognized as an urgent social justice and human rights issue that is pervasive across geographical and socioeconomic boundaries. There is a growing body of research that demonstrates the traumatic impact of hate-based violence on the victim's mental and physical health. This review focuses on examining scientific knowledge and prevalence data on identity-based hate and violence exposure. A framework for conceptualizing hate-based violence as a traumatic event or series of traumatic events is offered as a means to understand research findings and intervention approaches. The importance of research, advocacy, and human rights training is highlighted in the efforts to address the traumatic impact of identity-based hate and violence.

Educating nursing students for cultural competence in emergencies: a randomized controlled trial.

BACKGROUND: Racial and ethnic minorities suffer significantly more than others in the wake of disasters. Despite the growing recognition of the importance of culturally competent health services, systematic cultural competence training in the medical education system is still scarce, especially in the field of emergency. The current study aimed to examine the effectiveness of an online culturally informed intervention for increasing cultural competence in emergencies among nursing students. METHODS: A randomized controlled trial was used to test the intervention effectiveness in increasing nursing students' cultural competence in four domains: attitudes, knowledge, skills, and encounters. The study included 72 undergraduate nursing students recruited from two academic institutes. Participants were randomized (1:1 ratio) to an intervention (n = 34) and control group (n = 38). The study adheres to the Consolidated Standards of Reporting Trials (CONSORT). Data analysis was based on multivariate analysis of variance with repeated measures, followed by post hoc analyses with Bonferroni correction for multiple comparisons. RESULTS: Results showed that the intervention was effective in increasing the participants' culturally competent knowledge. The effect of the intervention on the skills domain approached significance. No group differences were identified in the attitudes and the encounters domains. CONCLUSIONS: An online culturally informed intervention, incorporated in the curriculum, was effective in enhancing the cognitive aspect of cultural competence (especially at the basic knowledge and understanding levels), but not other domains. Our results encourage the development of future intervention programs that are based on a deep understanding of local values, needs, and preferences.

[International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder]. / Internationale Konsenserklärung zu Screening, Diagnostik und Behandlung von Jugendlichen und Heranwachsenden mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und gleichzeitigen Störungen durch Substanzgebrauch.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Building capacity in times of crisis: Increasing cultural competence of healthcare professionals in the context of the COVID-19.

BACKGROUND: Nurses are the frontline healthcare professionals fighting the medical and social effects of the current COVID-19 pandemic. Although they work with diverse populations, there is a lack of literature on culturally competent education during an emergency such as a pandemic. AIMS AND OBJECTIVES: To examine the effectiveness of an online education programme aimed at increasing cultural competence among rescue teams and healthcare professionals facing the challenges of the COVID-19 pandemic. DESIGN: Pre-post-web-based intervention study. METHODS: Pre-post-intervention surveys were administered to a matched sample of Israeli healthcare and rescue organisation professionals. The initial sample included 303 participants (52% women) who completed the pre-intervention survey. More than half of the sample (56%, n = 170) were paid workers or volunteers in health organisations. Of the initial sample, 154 participants completed the post-intervention survey following the online cultural competence education programme. Descriptive statistics and multivariate analysis were used to evaluate participants' gains in culturally competent attitudes, knowledge, skills and encounters. This study followed the STROBE guidelines. RESULTS: Participants found the online programme useful in improving their cultural competence during the COVID-19 pandemic. The highest gains were found in the attitudes domains, whereas the lowest in the knowledge domain. Pre-intervention cultural competence scores and incorporating the programme in the educational curricula predicted increased gains in cultural competence. CONCLUSIONS: Online educational interventions showed potential for increasing professionals' awareness of cultural biases, differences and attitudes, leading to more open and accepting attitudes towards patients of different backgrounds. RELEVANCE TO CLINICAL PRACTICE: Recognising the need for real-time, low-cost and available training, the World Health Organization recommended using online courses for healthcare professionals struggling in the pandemic frontline. Online education programmes provide a useful platform for training health professionals in times of emergency.

Perceived Discrimination and Motivation to Pursue Higher Education in Ethiopian-Origin Students: The Moderating Role of Ethnic Identity.

Research has increasingly recognized the adverse effects of perceived discrimination on the academic outcomes of children and adolescents from ethnic and racial minority backgrounds. However, little is known about the association between perceived discrimination and the motivation of ethnic minority students to pursue higher education. Guided by an academic resilience framework, the current study examined the relationship between perceived discrimination and two types of motivation to pursue higher education (personal/career-driven and expectation-driven) among Ethiopian undergraduate students in Israel. In addition, we examined the role of ethnic identity as a potential moderator of this relationship. Participants were 183 undergraduate students of Ethiopian origin (77% females) who studied in 18 different higher-education institutes. Participants completed self-report questionnaires concerning their experiences of perceived discrimination, affiliation with their Ethiopian identity, and their reasons for pursuing higher education. Results showed that frequent discrimination experiences were positively related to a stronger ethnic identity and to higher levels of personal/career motivation to pursue higher education. Ethnic identity moderated the relationship between perceived discrimination and personal/career motivation so that the association was significant under low and moderate levels of ethnic identity but not under high levels. Our findings suggest that the awareness of discrimination may motivate students to pursue higher education and succeed in academia. However, the motivating force of perceived discrimination diminishes under high levels of ethnic identification. Further investigation is needed to explore how discrimination and ethnic identity work together to impact academic motivation in different developmental stages and socio-cultural contexts.

A Machine-Based Prediction Model of ADHD Using CPT Data.

Despite the popularity of the continuous performance test (CPT) in the diagnosis of attention-deficit/hyperactivity disorder (ADHD), its specificity, sensitivity, and ecological validity are still debated. To address some of the known shortcomings of traditional analysis and interpretation of CPT data, the present study applied a machine learning-based model (ML) using CPT indices for the Prediction of ADHD.Using a retrospective factorial fitting, followed by a bootstrap technique, we trained, cross-validated, and tested learning models on CPT performance data of 458 children aged 6-12 years (213 children with ADHD and 245 typically developed children). We used the MOXO-CPT version that included visual and auditory stimuli distractors. Results showed that the ML proposed model performed better and had a higher accuracy than the benchmark approach that used clinical data only. Using the CPT total score (that included all four indices: Attention, Timeliness, Hyperactivity, and Impulsiveness), as well as four control variables [age, gender, day of the week (DoW), time of day (ToD)], provided the most salient information for discriminating children with ADHD from their typically developed peers. This model had an accuracy rate of 87%, a sensitivity rate of 89%, and a specificity rate of 84%. This performance was 34% higher than the best-achieved accuracy of the benchmark model. The ML detection model could classify children with ADHD with high accuracy based on CPT performance. ML model of ADHD holds the promise of enhancing, perhaps complementing, behavioral assessment and may be used as a supportive measure in the evaluation of ADHD.

Health-Care Services as a Platform for Building Community Resilience among Minority Communities: An Israeli Pilot Study during the COVID-19 Outbreak.

BACKGROUND: Previous studies of minority groups in times of emergency have tended to focus on risk reduction or on individual resilience, overlooking the community factors that could be bolstered to promote better health and safety outcomes. The current study aimed to examine the role of health-care services in the perceived community resilience of urban and suburban Arab communities in Israel during the COVID-19 outbreak. METHOD: The study included 196 adults age 17-76 years, who filled out on-line questionnaires in May 2020; 112 participants lived in an urban community and 84 lived in a suburban community. Community resilience was evaluated using the Conjoint Community Resiliency Assessment Measure (CCRAM), a validated five-factor multidimensional instrument. RESULTS: Residents of the suburban community reported higher community resilience than residents of the urban community. This difference was related to increased preparedness levels and strength of place attachment in the suburban community. Residents of suburban communities were also more satisfied and confident in health-care services than those of urban communities. Regression analysis showed that the satisfaction with primary health-care services, and not community type, significantly predicted community resilience. CONCLUSIONS: Our results support the pivotal role of primary health care in building community resilience of minority communities in times of emergency and routine.

Age-Specific Time Trends in Incidence Rates of Autism Spectrum Disorder Following Adaptation of DSM-5 and Other ASD-Related Regulatory Changes in Israel.

We analyzed data on 879,029 children born in 1999-2017 from a large Israeli health fund to evaluate time-trends in incidence of autism spectrum disorder (ASD). This included examining possible effects associated with the adaptation of the DSM-5 criteria for ASD, and the implementation of regulatory changes affecting eligibility for ASD-related stipends and services. ASD cases were ascertained based on electronic medical records review, with complete verification of ASD case status. Results indicated a substantial increase in ASD incidence rate (IR) over time that was overall not appreciably affected by the above changes. Cumulative incidence through age 8 rose from 0.46% (boys: 0.73; girls: 0.18) in 2007 to 1.30% (boys: 2.12; girls: 0.45) in 2018. Age-specific analyzes indicated that the largest increase in IR occurred in toddlers and preschool children, with a more modest increase at older age groups. Results suggest that the rise in early diagnosed ASD does not stem from a downward shift in the distribution of ages at first diagnosis, but rather from early detection of cases not previously diagnosed. Findings highlight the need to expand research aimed at identifying exogenous factors that may underlie the rise in incidence, and to evaluate factors that may contribute to late diagnosis of some cases. Autism Res 2020, 13: 1893-1901. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: In an analysis of nearly 900,000 Israeli children born in 1999-2017, we found that the incidence of autism spectrum disorder (ASD) increased significantly over time, especially among toddlers and preschool children but also at older age groups. We additionally observed that changes affecting diagnostic criteria for ASD and eligibility for ASD-related services did not appreciably affect these trends. Results highlight the need to continue research aimed at identifying factors causing this increase and reasons contributing to late diagnosis of some cases.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder.

BACKGROUND: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. OBJECTIVE: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. METHOD: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. RESULTS: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. CONCLUSION: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

A culturally-competent approach to emergency management: What lessons can we learn from the COVID-19?

The COVID-19 pandemic, like other disasters, is exposing and exacerbating social, economic, and health care inequalities. Although the ethical and clinical imperative of providing culturally-competent health care has long been recognized, the influence of culturally-competent interventions within emergency management has not been systematically examined. This paper discusses several culturally-competent strategies that were taken by the Israeli national and local authorities in high-risk areas and communities during the COVID-19 outbreak. In addition to controlling the pandemic outbreak, such an approach has the potential to reduce social disparities in health care, promote community resilience, and facilitate social cohesion. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Attention Deficit/Hyperactivity Disorder and Global Severity Profiles in Treatment-Seeking Patients with Substance Use Disorders.

INTRODUCTION: Comorbid attention deficit/hyperactivity disorder (ADHD) is present in 15-25% of all patients seeking treatment for substance use disorders (SUDs). Some studies suggest that comorbid ADHD increases clinical severity related to SUDs, other psychiatric comorbidities, and social impairment, but could not disentangle their respective influences. OBJECTIVES: To investigate whether comorbid adult ADHD in treatment-seeking SUD patients is associated with more severe clinical profiles in these domains assessed altogether. METHODS: Treatment-seeking SUD patients from 8 countries (N = 1,294: 26% females, mean age 40 years [SD = 11 years]) were assessed for their history of DSM-IV ADHD, SUDs, and other psychiatric conditions and sociodemographic data. SUD patients with and without comorbid ADHD were compared on indicators of severity across 3 domains: addiction (number of SUD criteria and diagnoses), psychopathological complexity (mood disorders, borderline personality disorder, lifetime suicidal thoughts, or behavior), and social status (education level, occupational and marital status, and living arrangements). Regression models were built to account for confounders for each severity indicator. RESULTS: Adult ADHD was present in 19% of the SUD patients. It was significantly associated with higher SUD severity, more frequent comorbid mood or borderline personality disorder, and less frequent "married" or "divorced" status, as compared with the absence of comorbid ADHD. ADHD comorbidity was independently associated with a higher number of dependence diagnoses (OR = 1.97) and more psychopathology (OR = 1.5), but not marital status. CONCLUSIONS: In treatment-seeking SUD patients, comorbid ADHD is associated with polysubstance dependence, psychopathological complexity, and social risks, which substantiates the clinical relevance of screening, diagnosing, and treating ADHD in patients with SUDs.

The Utility of the CPT in the Diagnosis of ADHD in Individuals with Substance Abuse: A Systematic Review.

BACKGROUND: Early identification of attention-deficit/hyperactivity disorder (ADHD) in individuals with substance use disorders (SUD) is important because ADHD has an adverse effect on the development and course of SUD. Given the limited validity of self-report measures of ADHD in individuals with SUD, it is important to investigate the utility of the continuous performance test (CPT) in classifying ADHD in adults with SUD. OBJECTIVE: This review aims to examine the quantitative similarities and differences in CPT performance of adults with ADHD, SUD, and their comorbidity to determine if a distinct neurocognitive profile exists for each. METHOD: A systematic review of CPT studies that included patients with the comorbidity of ADHD and SUD and a comparison group of one of the disorders alone was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. RESULTS: Eight studies were identified with sample sizes ranging from n = 17 to n = 386. The comorbidity of ADHD and SUD was, mostly, not associated with higher rates of commission and omission errors than either disorder alone. However, the comorbidity of ADHD and SUD was more likely to be associated with increased deficits in response time variability compared with individuals with ADHD alone. CONCLUSIONS: This review highlights the shortage of large-scale CPT research involving patients with ADHD and SUD. The CPT might be sensitive to attentional deficits, but it lacks specificity for the classification of adult ADHD, SUD, or their comorbidity, and the CPT is thus not useful in discriminating comorbid ADHD and SUD from either disorder alone. Future CPT research should explore whether specific attentional deficits account for the development and persistence of SUD. Such research should also reach beyond traditional CPT measures and include other cognitive and behavioral deficits that were associated with ADHD, such as distractibility and hyperactivity.

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.