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Descriptors:
Psychopathology; Risk; Public Health; Diagnostic Tests; Attention Deficit Hyperactivity Disorder; Genetics; Pervasive Developmental Disorders; Body Weight; Siblings; Prenatal Influences; Environmental Influences; Correlation; Attribution Theory; Molecular Structure; Autism; Hazardous Materials; Disadvantaged Environment; Intervention; Drug Therapy

Abstract:
Background: Attention deficit hyperactivity disorder (ADHD) and its possible causes still attract controversy. Genes, pre and perinatal risks, psychosocial factors and environmental toxins have all been considered as potential risk factors. Method: This review (focussing on literature published since 1997, selected from a search of PubMed) critically considers putative risk factors with a focus on genetics and selected environmental risks, examines their relationships with ADHD and discusses the likelihood that these risks are causal as well as some of the main implications. Results: No single risk factor explains ADHD. Both inherited and noninherited factors contribute and their effects are interdependent. ADHD is familial and heritable. Research into the inherited and molecular genetic contributions to ADHD suggest an important overlap with other neurodevelopmental problems, notably, autism spectrum disorders. Having a biological relative with ADHD, large, rare copy number variants, some small effect size candidate gene variants, extreme early adversity, pre and postnatal exposure to lead and low birth weight/prematurity have been most consistently found as risk factors, but none are yet known to be definitely causal. There is a large literature documenting associations between ADHD and a wide variety of putative environmental risks that can, at present, only be regarded as correlates. Findings from research designs that go beyond simply testing for association are beginning to contest the robustness of some environmental exposures previously thought to be ADHD risk factors. Conclusions: The genetic risks implicated in ADHD generally tend to have small effect sizes or be rare and often increase risk of many other types of psychopathology. Thus, they cannot be used for prediction, genetic testing or diagnostic purposes beyond what is predicted by a family history. There is a need to consider the possibility of parents and siblings being similarly affected and how this might impact on engagement with families, influence interventions and require integration with adult services. Genetic contributions to disorder do not necessarily mean that medications are the treatment of choice. We also consider how findings might influence the conceptualisation of ADHD, public health policy implications and why it is unhelpful and incorrect to dichotomise genetic/biological and environmental explanations. It is essential that practitioners can interpret genetic and aetiological research findings and impart informed explanations to families. (Contains 2 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Drug Addiction; Drug Therapy; Patients; Experience; Social Bias; Stereotypes; Social Discrimination

Abstract:
Experiences of stigma from others among people with a history of drug addiction are understudied in comparison to the strength of stigma associated with drug addiction. Work that has studied these experiences has primarily focused on stigma experienced from healthcare workers specifically even though stigma is often experienced from other sources as well. Because stigma has important implications for the mental health and recovery efforts of people in treatment, it is critical to better understand these experiences of stigma. Therefore, we characterize drug addiction stigma from multiple sources using qualitative methodology to advance understandings of how drug addiction stigma is experienced among methadone maintenance therapy patients and from whom. Results demonstrate that methadone maintenance therapy patients experience prejudice, stereotypes, and discrimination from friends and family, coworkers and employers, healthcare workers, and others. Discussion highlights similarities and differences in stigma experienced from these sources. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Mental Disorders; Mental Retardation; Drug Therapy; Evaluation Methods; Clinical Diagnosis; Comparative Analysis; Behavior Patterns; Patients; Outcomes of Treatment

Abstract:
This article describes a psychotropic PRN Evaluative Tool developed by interprofessional clinicians to address inconsistent reporting and assessment of the effectiveness of PRN medications used for people who are developmentally disabled. Fifty-nine participants (37 males, 22 females), ages 16 to 60 years, were included in the review, all diagnosed with an intellectual disability and a serious mental illness. Participants' range of intellectual disability varied from severe to mild. The review was conducted over a 2-year period. Data was evaluated by comparing differences in a number of patient pre and post behaviors after having received PRN medication. Results indicated a statistically significant decrease in the total number of post-PRN behavior variables observed compared with the pre-PRN behavior variables. This tool has improved patient outcomes through the reduction of unnecessary and/or ineffective PRNs by providing a more thorough assessment of the effectiveness of PRN medications and thereby reducing subjective and ambiguous language. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Community Support; Sexual Identity; Gender Issues; Transitional Programs; Family Involvement; Case Studies; Resilience (Psychology); Mental Health; Drug Therapy; Counseling Techniques; Identification (Psychology); Teamwork; Interdisciplinary Approach; Mothers; Parent Role

Abstract:
Interventions with a school-aged youth are presented to demonstrate a child's gender transition from female to male with the support of a single mother, grandmother, therapist, pediatric endocrinologist, gender education and advocacy group, and gender-affirming school. This single case study illustrates both the positive psychological effects of resilience-building therapy and family/community supports in facilitating a transition to an affirmed gender and the dilemmas confronted when introducing hormone blockers to a child, removing a child from a familiar environment to allow a fresh gender start, and respecting a child's wishes to stay private about the child's gender past. (Contains 1 note.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Evidence; Risk; Smoking; Intervention; Behavior Modification; Depression (Psychology); Low Income Groups; Socioeconomic Status; Counseling; Counseling Effectiveness; Drug Therapy; Health Promotion; Prevention; Health Behavior; Behavior Change; Health Education; Public Health; Community Health Services; Health Personnel; Program Implementation; Program Effectiveness; Outcomes of Treatment; Correlation

Abstract:
Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for greater than 7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P = 0.026) or have attempted quitting (85.0 versus 47.4%, P = 0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Attention Deficit Hyperactivity Disorder; Incidence; Stimulants; Elementary School Students; Middle School Students; School Surveys; Elementary School Teachers; Middle School Teachers; Teacher Attitudes; Drug Therapy; Identification

Abstract:
Background: Estimates of ADHD diagnosis and stimulant medication use vary across studies. Few studies ascertain the teacher perspective on these rates. Objective: To ascertain teachers' perceptions of ADHD prevalence and medication treatment within their classrooms. Method: The present school survey collected teacher report of identified children with ADHD as well as unidentified but suspected children with ADHD in an effort to determine the occurrence of ADHD and related behaviors in elementary and middle school classrooms. The number of children treated with stimulant medication was also collected. Results are grouped by elementary/middle school level. Results: Results indicated 5.58 % of elementary and 3.53 % of middle school students were identified to the teacher as diagnosed with ADHD. A comparable number were suspected to have ADHD, but were not formally identified. Three-quarters of identified elementary school, and two-thirds of middle school students, received medication treatment. Few moderators of prevalence rates were identified. Conclusion: Teacher perceptions suggest an under-identification of children with ADHD in elementary and middle school classrooms. Stimulant medication treatment wanes as children progress to middle school, per teachers' reports. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Outcome Measures; Substance Abuse; Depression (Psychology); Suicide; Drug Therapy; Comorbidity; Therapy; Caseworkers; Social Work; Measures (Individuals); Symptoms (Individual Disorders); Scores; Mental Health

Abstract:
This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to enhanced case management (ECM) (n = 64) or treatment as usual (TAU) (n = 56). Both groups were followed up at six and 12 months. Participants' current clinical status across a broad range of domains in the past 90 days was assessed using the Global Appraisal of Individual Needs and included their Depressive Symptom Scale, Homicidal-Suicidal Thought Index, and Mental Health Treatment Index scores. The findings did not reveal any statistically significant effects of ECM on outcome measures. However, in view of the high rates of adverse treatment outcomes among comorbid groups, including suicide, the finding of a clinically significant reduction in homicidal and suicidal thoughts warrants further research; the comprehensive approach to treatment tested may be especially helpful to depressed substance abusers with such ideations. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Autism; Play; Child Rearing; Parenting Styles; Fathers; Drug Therapy; Parent Child Relationship; Pervasive Developmental Disorders; Toddlers; Comparative Analysis

Abstract:
Oxytocin seems associated with parenting style, and experimental work showed positive effects of intranasally administered oxytocin on parenting style of fathers. Here, the first double-blind, placebo-controlled, within-subject experiment with intranasal oxytocin administration to fathers of children with autism spectrum disorder (ASD) is presented. Fathers with their typically developing toddler (n = 18), and fathers of toddlers diagnosed with ASD (n = 14), were observed in two play sessions of 15 min each with an intervening period of 1 week. In all fathers oxytocin elevated the quality of paternal sensitive play: fathers stimulated their child in a more optimal way, and they showed less hostility which suggests the positive effects of oxytocin on paternal sensitive play irrespective of clinical status of their child. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Identification; Mental Health; Older Adults; Depression (Psychology); Incidence; Schizophrenia; Medical Services; Expenditures; Mental Disorders; Correlation; Health Services; Drug Therapy; Clinical Diagnosis; Health Insurance; Anxiety; Classification; Eligibility

Abstract:
Purpose: Little is known about mental health disorders (MHDs) and their associated health care expenditures for the dual eligible elders across long-term care (LTC) settings. We estimated the 12-month diagnosed prevalence of MHDs among dual eligible older adults in LTC and non-LTC settings and calculated the average incremental effect of MHDs on medical care, LTC, and prescription drug expenditures across LTC settings. Methods: Participants were fee-for-service dual eligible elderly beneficiaries from 7 states. We obtained their 2005 Medicare and Medicaid claims data and LTC program participation data from federal and state governments. We grouped beneficiaries into non-LTC, community LTC, and institutional LTC groups and identified enrollees with any of 5 MHDs (anxiety, bipolar, major depression, mild depression, and schizophrenia) using the International Classification of Diseases Ninth Revision codes associated with Medicare and Medicaid claims. We obtained medical care, LTC, and prescription drug expenditures from related claims. Results: Thirteen percent of all dual eligible elderly beneficiaries had at least 1 MHD diagnosis in 2005. Beneficiaries in non-LTC group had the lowest 12-month prevalence rates but highest percentage increase in health care expenditures associated with MHDs. Institutional LTC residents had the highest prevalence rates but lowest percentage increase in expenditures. LTC expenditures were less affected by MHDs than medical and prescription drug expenditures. Implications: MHDs are prevalent among dual eligible older persons and are costly to the health care system. Policy makers need to focus on better MHD diagnosis among community-living elders and better understanding in treatment of MHDs in LTC settings. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Parent Attitudes; Researchers; Attention Deficit Hyperactivity Disorder; Clinical Diagnosis; Definitions; Ethnocentrism; Drug Therapy; Decision Making; Intervention; Research Methodology; Biomedicine

Abstract:
An enduring controversy over the nature of ADHD complicates parents' decisions regarding children likely to be diagnosed with the condition. Using a fallibilist perspective, this review examines how researchers construe ADHD and acknowledge the controversy. From a systematic literature search of empirical reports using parents of ADHD-diagnosed children as primary informants, 36 reports published between 1996 and 2008 (corresponding to 30 studies) were selected. Data on the studies' characteristics and methodologies, definitions of ADHD, and extent of the acknowledgment of the ADHD controversy were extracted, as were data on a wide range of parental concerns and experiences. Researchers in 27 of 30 studies define ADHD as a valid disorder, in 22 studies they tend to recommend parental adherence to the biomedical view, and in eight studies they specifically acknowledge an ADHD controversy. This body of studies reports varied and poignant observations on parents' situations and dilemmas. Still, it largely reflects a Western-ethnocentric view and appears greatly preoccupied with parents who do not medicate their children, ignoring parents' rationales for using medications. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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