This month’s research update focuses on the development of symptoms and treatment of ADHD in Latinx youth.

A longitudinal study of Mexican-origin youth

The first study associated factors like gender, nativity, and cultural values with the symptomatic expression of ADHD and other behavioral disorders in a community sample of 674 Mexican-origin youth. This longitudinal study examined responses from the NIMH Diagnostic Interview Schedule for Children-IV (DISC-IV) administered to youth every year for 7 years. At ages 10 (beginning age for all involved in the study), 12, 14, and 16, youth also completed the Mexican American Cultural Values Scale (MACVS), which asks about topics including gender roles, family values, and religion. In addition, from the age of 10 until 15, youth completed the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) to assess Spanish and English use.

Results suggest that Mexican-American youth exhibit similar (but not completely replicable) externalizing disorder trajectories as documented in previous studies of non-Latinx, white youth. Specifically, ADHD symptoms appeared to decline as Mexican-American youth age, whereas symptoms of oppositional defiant disorder and conduct disorder increase in early adolescence and then decline or level off.

Contrary to previous research with non-Latinx youth supporting heightened ADHD trajectories among boys versus girls, Mexican-American girls in the study displayed higher levels of externalizing factors over time compared to Mexican-American boys. This gender discrepancy may suggest unique socialization pressures for boys versus girls particularly evident in Mexican-origin families.

Interestingly, current study results supported a phenomenon called the immigrant paradox, which suggests that recent immigrants report more positive health outcomes compared to second+ generation individuals despite the substantial stressors associated with immigration. Specifically, youth in the current study demonstrated a higher risk for ADHD and other behavior disorders if they were second+ generation, reported less orientation to Mexican cultural values, and spoke less Spanish/more English.

Finding support for the immigrant paradox related to ADHD risk extends an important discussion regarding the role Latinx culture may play protecting against externalizing symptoms in Latinx communities. Given results implicating factors such as gender and acculturation as influential to developmental pathways for externalizing disorder trajectories, authors suggest that researchers critically establish theories and interventions considering diverse ethnic minority populations and their sources of resilience.

Atherton OE, Ferrer E, & Robins RW. (2018). The development of externalizing symptoms from late childhood through adolescence: A longitudinal study of Mexican-origin youth. Developmental Psychology, 54(6), 1135-1147. http://dx.doi.org/10.1037/dev0000489

Evaluating a culturally adapted prevention intervention

Given that the first paper implicated culturally informed ADHD interventions, the second study examined a culturally adapted prevention intervention.

Researchers took a qualitative approach to evaluate the cultural relevance and acceptability of GenerationPMTOâ, a behavioral parenting prevention intervention adapted for low-income and immigrant Latinx families. A total of 97 Spanish-speaking parents of youth ages 12-14 with behavior problems completed GenerationPMTOâ and subsequently participated in a focus group about their experiences. Researchers audio-recorded and transcribed focus-group responses for qualitative coding using a thematic analysis approach, which is when current study responses are used to derive meaningful themes about a topic of interest (in this case, the parenting program components and their cultural relevance).

Overall, parents in the study reported satisfaction with the intervention components; they identified positive involvement, skills encouragement, effective limit-setting, and emotion regulation as the most relevant to their parenting practices. Most parents described that role-playing throughout the program was beneficial and helped them feel more comfortable with the strategies; however, two parents expressed dissatisfaction with the role-plays, stating that they did not match what really happens at home. Parents in all focus-groups expressed appreciating discussion of immigration-related challenges and benefits, such as experiencing discrimination and parent-child “cultural gaps.”

When asked how the intervention could be improved, parents suggested adding content regarding adolescent drug use and sexuality. Promising qualitative findings from the current study suggest GenerationPMTO is a culturally appropriate and relevant program for Mexican-American parents of youth with behavioral problems. Dissemination of culturally attended prevention programs emphasizing evidence-based strategies and discussion of culturally specific topics (such as experiences with discrimination) may help reduce mental health disparities for at-risk populations, such as immigrant families.

Parra‐Cardona R, López‐Zerón G, Leija SG, Maas MK, Villa M, Zamudio E, ... & Domenech Rodríguez MM. (2018). A Culturally Adapted Intervention for Mexican‐Origin Parents of Adolescents: The Need to Overtly Address Culture and Discrimination in Evidence‐Based Practice. Family Process (epub ahead of print). doi: 10.1111/famp.12381

Lauren Haack, PhD, is an assistant professor and attending psychologist in the department of psychiatry at the University of California, San Francisco. Her research program and clinical practice focus on accessible and culturally attuned evidence-based services for vulnerable youth and families, with a particular specialty in ADHD services for children in Spanish-speaking, Latinx families.

Jocelyn Caballero, BA, is currently a research coordinator for a neuropsychology lab in the department of psychiatry at the University of California, San Francisco. Her goal is to become a leading psychologist and researcher of mental health within the Latinx community. She will apply to clinical psychology graduate programs in hopes to research the etiology of neurodevelopmental disorders in Latinx immigrant families and therefore help restore developmental trajectories.