Racial Disparities in Autism Diagnosis, Assessment, and Intervention among Minoritized Youth: Sociocultural Issues, Factors, and Context.

PURPOSE OF REVIEW: Despite the increasing prevalence of autism spectrum disorder (ASD) among youth, disparities exist when it comes to access to diagnostic assessment and intervention of ASD in clinical and school settings. A review of the literature on sociocultural issues that contribute to these disparities would allow psychiatrists, clinicians, and researchers to better understand these challenges and aid in the development of culturally responsive approaches to support racially, ethnically, and linguistically diverse families of youth with ASD. RECENT FINDINGS: Disparities in ASD services are primarily due to system-level factors, including access to information or healthcare, stigma, and discrimination. Similarly, interactional factors, such as language/communication barriers, a lack of trust in professionals, and limited training in cultural responsiveness, can hinder support for diverse families of youth with ASD. This review focuses on several areas: (1) structural inequities that contribute to disparities in ASD services, (2) sociocultural issues in assessment and diagnosis, (3) sociocultural issues in interventions and service use, and (4) neurodiversity. This review underscores the importance of including diverse samples in ASD research to improve understanding of the strengths, challenges, perspectives, and preferences of underrepresented and underserved families of youth with ASD. These efforts can lead to culturally responsive service delivery.

A Validation Study of the BRIEF-2 Among Kindergarteners and First Graders At-Risk for Behavior Problems.

Early identification of executive dysfunction and timely school-based intervention efforts are critical for students at risk for problematic behaviors during early elementary school. The original Behavior Rating Inventory of Executive Functioning (BRIEF) was designed to measure real-world behavioral manifestations of executive functioning, neurocognitive processes critical for school success. With the updated BRIEF-2, independent validation is needed with kindergarten and first grade students at risk for emotional and behavioral disorders. Thus, using item level analyses, we examined the factor structure of the BRIEF-2 Teacher Rating form with 1,112 students. Results indicated little evidence for the original three-index model and supported a modified two-index model, with a Cognitive Regulation Index and an overall Behavior-Emotion Regulation Index. Criterion related validity indicated positive relationships with performance-based executive functioning (Head-Toes-Knees-Shoulders) and later internalizing and externalizing behaviors. We discuss implications of findings for early identification and school-based intervention efforts, as well as future research.

Culturally Responsive Approaches for Addressing ADHD Within Multi-tiered Systems of Support.

PURPOSE OF REVIEW: Limited work has emphasized cultural responsiveness when working with families and children with attention-deficit/hyperactivity disorder (ADHD) from diverse backgrounds. We present a primer for psychiatrists, psychologists, and other mental health professionals on the implementation of culturally responsive practices within a multi-tiered system of support (MTSS) framework when collaborating with schools. RECENT FINDINGS: Individuals with ADHD demonstrate unique behavioral challenges that affect school and home functioning. As a framework to address the needs of all children with academic and behavioral issues, many public schools have adopted MTSS. Emerging findings on cultural adaptations of evidence-based interventions for ADHD within MTSS are promising. Through a comprehensive tiered approach, this review focuses on (1) initial behavior screening and prevention, (2) implementation of evidence-based interventions tailored to the child's development and family culture, and (3) collaboration between psychiatrists, psychologists, school personnel, and families regarding evaluation of outcomes for children with ADHD, particularly when pharmacological treatment is considered. Engaging in these approaches can promote culturally responsive practices and improve the quality of services provided to children with ADHD.

Association of acculturative stress, Islamic practices, and internalizing symptoms among Arab American adolescents.

Although the numbers of Arab American immigrant youth in schools is increasing, there is little understanding of their mental health and the sociocultural factors that might influence it. This study examined the relationship between 2 sociocultural factors (i.e., acculturative stress and religious practices) and internalizing symptoms in first- and second-generation Muslim Arab American adolescents. Adolescents (n = 88) ages 11 to 18 completed measures related to acculturative stress, religious practices, internalizing symptoms, and general demographic information. Results of multiple regression analyses found that acculturative stress significantly predicted internalizing symptoms. Gender was found to moderate this association. No differences in the reported acculturative stress and internalizing symptoms were found between youth of different generational status (i.e., first- vs. second-generation). Finally, adolescents' organizational religious practices, but not their private religious practices, were found to be associated with lower acculturative stress. Implications are discussed related to how school psychologists can provide culturally responsive services to this population. (PsycINFO Database Record

Differentiating Behavioral Ratings of Inattention, Impulsivity, and Hyperactivity in Children: Effects on Reading Achievement.

OBJECTIVE: The purpose of the study is to differentiate between behaviors of ADHD: inattention, hyperactivity, and impulsivity and how each domain contributes to reading achievement in elementary school-aged children. METHOD: Data from 131 children were collected, which include performance from reading fluency and comprehension measures as well as parent and teacher ratings of ADHD behaviors based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. RESULTS: Correlation and regression analyses revealed that inattentive behaviors were strongly linked to reading fluency and comprehension. Hyperactivity and impulsive behaviors did not predict reading achievement. A significant two-way interaction was found only for gender and inattention with reading comprehension as the outcome. CONCLUSION: Many of the behaviors related to inattention strongly predicted reading fluency, reading comprehension, and overall reading ability. Boys who exhibited inattentive behaviors performed more poorly on reading comprehension measures than girls with inattentive behaviors.

Specific Learning Disorders and ADHD: Current Issues in Diagnosis Across Clinical and Educational Settings.

With the recent changes in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), this article provides a comprehensive review of two high-incidence disorders most commonly seen in childhood and adolescence: specific learning disorder (SLD) and attention-deficit/hyperactivity disorder (ADHD). Updates regarding comorbidity, shared neuropsychological factors, and reasons for the changes in diagnostic criteria are addressed. Although the revisions in the DSM-5 may allow for better diagnostic sensitivity based on the symptomology, specifiers, and the clinical features outlined, there continues to be challenges in operationalizing SLD and implementing consistent assessment practices among mental health professionals particularly when considering the Individuals with Disabilities Education Act (IDEA), which provides guidelines in the evaluation of SLD in school settings. Clinical and educational assessment implications are discussed with special attention to develop a collaborative approach between psychiatrists, psychologists, and educators when providing service delivery for children and adolescents with neurodevelopmental disabilities.

Verbal and visuospatial working memory as predictors of children's reading ability.

Children with reading difficulties often demonstrate weaknesses in working memory (WM). This research study explored the relation between two WM systems (verbal and visuospatial WM) and reading ability in a sample of school-aged children with a wide range of reading skills. Children (N = 157), ages 9-12, were administered measures of short-term memory, verbal WM, visuospatial WM, and reading measures (e.g., reading fluency and comprehension). Although results indicated that verbal WM was a stronger predictor in reading fluency and comprehension, visuospatial WM also significantly predicted reading skills, but provided more unique variance in reading comprehension than reading fluency. These findings suggest that visuospatial WM may play a significant role in higher level reading processes, particularly in reading comprehension, than previously thought.

The influence of inattention and rapid automatized naming on reading performance.

The current study examined the relation between attention, rapid automatized naming (RAN), and reading fluency among typically developing children. A total of 104 third- and fourth-grade children (8-11 years of age) completed RAN measures consisting of four stimuli (letter, digit, color, and object) and an oral reading fluency measure from the Gray Oral Reading Test-Fourth Edition. Correlational and hierarchical regression analyses revealed that all four RAN stimuli, particularly letter RAN, were significant predictors of reading fluency. Additionally, parent and teacher ratings of inattention from the Swanson, Nolan and Pelham-Version Four rating scale predicted RAN after controlling for gender, working memory, and estimated IQ. Further analyses indicated that RAN performance mediated the relation between inattention and reading fluency. Results support the need to consider attentional variables when assessing reading performance, even among typically developing children.

Ethnic differences in parental beliefs of attention-deficit/hyperactivity disorder and treatment.

OBJECTIVE: A survey study was conducted to explore ethnic differences in parental beliefs about the causes and treatments of ADHD and whether these beliefs predicted treatment preference. METHOD: Ethnically diverse parents of 5- to 12-year-old children with ADHD (n = 58) and without ADHD (n = 61) completed a questionnaire developed by the authors that asked them to rate statements about biological and psychological causes of ADHD and their beliefs about medication and behavioral treatment. RESULTS: There were no significant ethnic differences in how parents viewed causes of ADHD. Beliefs about behavioral treatment revealed significant group differences, as ethnic minority (e.g., African American, Latino) parents rated behavioral treatments more positively than did Caucasian parents. Beliefs about biological causes predicted medication treatment and combined treatment use. CONCLUSION: Dissemination of information regarding evidence-based treatments should be given special attention as it may influence parents' decisions to pursue specific treatments based on their beliefs.