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Shorter sleep duration can negatively impact children's daytime functioning and health. Latino children living near urban areas in the Mainland U.S. and Island Puerto Rico (PR) can be exposed to urban poverty and sociocultural stressors that challenge optimal sleep outcomes. Interventions to improve urban Latino children's sleep health should consider families' cultural background and environmental context to enhance acceptability and feasibility. This work describes our stepwise, multimethod approach to adapting a culturally and contextually tailored "School Intervention to Enhance Latino Students' Time Asleep (SIESTA)" for sixth- to eighth-grade Latino children residing in Greater Providence and San Juan and findings from a pilot randomized control trial (RCT) demonstrating SIESTA's efficacy. Results indicated high acceptability and greater improvement of sleep duration and behaviors in SIESTA versus control participants. The SIESTA shows potential to improve sleep outcomes in urban Latino middle schoolers. Results will inform a large-scale RCT to evaluate SIESTA's effectiveness and barriers to implementation. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the effect of social context and gender on persistence of "attention-deficit/hyperactivity disorder" (ADHD) in children of early and middle school years. The study compared persistence of "DSM-IV" ADHD and ADHD not otherwise specified (NOS) over 2 years in two groups of Puerto Rican children. Method: A three-wave study obtained data on Puerto Rican children 5 through 13 years of age at baseline. Samples were drawn in the South Bronx in New York (n = 1,138) and two metropolitan areas in Puerto Rico (n = 1,353). The Diagnostic Interview Schedule for Children Version IV was used to diagnose ADHD and ADHD-NOS. Results: ADHD or ADHD-NOS diagnosis at wave 1 strongly predicted disorder at waves 2 and 3. ADHD had a significantly stronger predictive effect than ADHD-NOS consistently across site and gender. There was a significant interaction with baseline age. For those younger at baseline, the strength of the prediction of ADHD-NOS was relatively weak; for older children, the presence of ADHD-NOS at baseline predicted risk of subsequent ADHD or ADHD-NOS. Conclusions: Persistence of ADHD in children of similar ethnicity does not manifest differently across context and gender. Results suggest that age-specific symptom criteria and modification of age-of-onset criteria should be considered for the diagnosis. (Contains 1 figure and 2 tables.)

Latino children in the U.S. have high rates of unmet need for mental health services, perhaps due to biased perceptions of impairment and need for care by parents and providers. We tested this argument using an experimental vignette design. Vignettes described children with problems that varied on "severity" (mild vs. serious), "nature" of the problem (internalizing vs. externalizing), as well as "gender" and "ethnicity" (Latino vs. Anglo). Raters were Latino and Anglo parents (N = 185) and providers (N = 189). Vignettes with Latino names were viewed as more impaired by both parents and providers, and this effect was significantly stronger in Latino vignettes with less severe problems. Severity and Latino features of vignettes also interacted with judgments of need for service. At higher severity, vignettes with Anglo names were judged to need service more than vignettes with Latino names, despite the same judged levels of impairment. Results are discussed in the light of the unmet need for Latinos. (Contains 4 tables and 1 figure.)

Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.

Background: Research comparing treatment-referred boys and girls with attention-deficit/hyperactivity disorder (ADHD) has yielded equivocal results. Contradictory findings may be associated with differential referral practices or unexplored interactions of gender with ADHD subtypes. Method: We examined possible gender differences in ADHD and its subtypes among children aged 4 to 17 in a representative community sample (N = 1896) in Puerto Rico. Caretakers provided information through the Diagnostic Interview Schedule for Children (version IV) and a battery of impairment, family relations, child problems, comorbidity and treatment measures. Results: ADHD was 2.3 times more common in boys than girls, but with one exception there was little evidence that the patterns of associations of ADHD with correlates were different for boys and girls. The exception was school suspension, which was more common among ADHD boys than girls. Additional gender interactions were found when ADHD subtypes were considered. Among those with combined type (n = 50), boys were more likely to be comorbid with mood disorders than girls. For those with the inattentive type (n = 47), girls were more likely to be comorbid with anxiety disorders than boys. Conclusions: Our findings lend cross-cultural generalizability to recent reports that gender does not interact with correlates for ADHD overall, but that it may play a role in subtypes.

We reviewed the Spanish translation of the Youth Quality of Life Instrument-Research Version (YQOL-R) and culturally adapted the measure with Puerto Rican and Mexican American children and adolescents. The YQOL-R is a self-reported measure that includes four domains: Sense of Self, Social Relationships, Environment, and General Quality of Life. A total of 10 focus groups were conducted with children aged 9 to 11, adolescents aged 12 to 17, their parents, and mental health providers. Five focus groups were conducted in San Diego, California and five in San Juan, Puerto Rico. Eligible participants were recruited from children's outpatient psychiatry clinics. We followed an iterative and recursive process in reviewing changes and modifications to the instrument using a bilingual committee and a Multi National Bilingual Committee. Greater semantic, content, and technical equivalence of the Spanish and English versions for the YQOL-R was achieved for the two largest U.S. Latino subgroups: Mexican Americans and Puerto Ricans. The cultural adaptation process revealed several important issues regarding the measurement of quality of life in different age groups. Additional items for school, relationships (both family and friends) and spare time suggested the need for a future children's version of the instrument. For the adolescents, additional items were suggested in the areas of sexuality, intergenerational conflict and acculturative stress.

Objective: This article provides the results of the psychometric testing of the Brief Impairment Scale (BIS). The BIS is a 23-item instrument that evaluates three domains of functioning: interpersonal relations, school/work functioning, and self-care/self-fulfilment. It capitalizes on the strengths of existing global measures while addressing some of their limitations. Method: Cross-sectional parent respondent data from one clinical (N = 757) and two community samples (N = 1,888 and 1,132) of children ranging in age from 4 to 17 years is employed to test the reliability and validity of the BIS. Receiver operating characteristic analyses are employed to assess useful cutoff scores on the scale. Results: The total scale's internal consistency ranged from 0.81 to 0.88 and from 0.56 to 0.81 on the three subscales. Test-retest reliability for individual items ranged from fair to substantial in all but six items. The BIS has high convergent and concurrent validity. Receiver operator characteristic analyses suggest possible thresholds for different uses. Conclusions: The BIS is psychometrically sound, useful in assessments and as an outcome measure in clinical practice and research. Its advantages over other global impairment instruments are that it is respondent based, short in administration time, and multidimensional. J. Am. Acad. Child Adolesc. Psychiatry, 2005;44(7):699-707. Key Words: impairment, assessment instruments, multidimensional scales.

This article investigates geographic variation in stimulant medication use by youth with attention-deficit/hyperactivity disorder (ADHD) served by public mental health and/or drug and alcohol programs in San Diego (n = 790) during 1997-1998 and in Puerto Rico (n = 726) during 1998. Youth were stratified into four groups: (a) ADHD, (b) ADHD--not otherwise specified (ADHD-NOS), (c) other "DSM-IV" diagnoses, (d) no diagnosis. Reported rates of stimulant use were as follows: ADHD, 32.9% (Puerto Rico) and 38.8% (San Diego), and ADHD-NOS, 20.2% (Puerto Rico) and 17.8% (San Diego). Youth in San Diego were more likely to use other psychotropics and to have experienced residential or inpatient care compared with youth in Puerto Rico. A regression model indicated that predictors of stimulant use at both sites included ADHD, ADHD-NOS, male gender, and younger age. Despite sociodemographic and cultural differences, both settings demonstrated similar patterns of stimulant use, suggesting these medications are not overused in public sectors.

Objective: To assess changes in the availability of mental health crisis services in Puerto Rico relative to US states before and after Hurricanes Maria and Irma. Data Sources/Study Setting: National Mental Health Services Surveys conducted in 2016 and 2020. Study design: Repeated cross‐sectional design. The independent variable was mental health facility location in Puerto Rico or a US state. Dependent variables were the availability of three mental health crisis services (psychiatric emergency walk‐in services, suicide prevention services, and crisis intervention team services). Data Collection/Extraction Methods: The proportion and per 100,000 population rate of facilities offering crisis services were calculated. Principal Findings: The availability of crisis services at mental health facilities in Puerto Rico remained stable between 2016 and 2020. These services were offered less at indigent care facilities in Puerto Rico than US states (e.g., 38.2% vs. 49.5% for suicide prevention, p = 0.06) and the magnitude of difference increased following Hurricane Maria. Conclusions: There are disparities between Puerto Rico and US states in the availability of mental health crisis services for indigent patients. [ABSTRACT FROM AUTHOR]

The results of performance test batteries implemented on different hardware and software are comparable if the results are corrected for reliability attenuation. The Automated Performance Test System, written in N82-BASIC, is performed on a NEC laptop and its DELTA version written in TurboC is performed on a Compaq laptop. Although the performance of the Compaq is better, the tests show a correlation of 0.92 to 1.00. The tests measure similar variables and the results of one system can be normalized for another by bias adjustment.

A number of risk factors, functional impairment, comorbidity and service utilization patterns associated with depression in community adolescents who met the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria for minor depression (mDEP) is examined and their profile are compared to adolescents who met the criteria for MDD. Youngsters with mDEP had significant impairment and used more mental health services than those with major depression.

This article investigates geographic variation in stimulant medication use by youth with attention-deficit/hyperactivity disorder (ADHD) served by public mental health and/or drug and alcohol programs in San Diego (n = 790) during 1997-1998 and in Puerto Rico (n = 726) during 1998. Youth were stratified into four groups: (a) ADHD, (b) ADHD-not otherwise specified (ADHD-NOS), (c) other DSM-IV diagnoses, (d) no diagnosis. Reported rates of stimulant use were as follows: ADHD, 32.9% (Puerto Rico) and 38.8% (San Diego), and ADHD-NOS,20.2% (Puerto Rico) and 17.8% (San Diego).Youth in San Diego were more likely to use other psychotropics and to have experienced residential or inpatient care compared with youth in Puerto Rico. A regression model indicated that predictors of stimulant use at both sites included ADHD, ADHD-NOS, male gender, and younger age. Despite sociodemographic and cultural differences, both settings demonstrated similar patterns of stimulant use, suggesting these medications are not overused in public sectors. [ABSTRACT FROM AUTHOR]

Studies the psychometric properties of a shortened of the Spanish adolescent dissociative experiences scale. Eight items selected to assess pathological forms of dissociative experiences; Internal consistency and test-retest reliability.

Background: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why.Objective: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users.Subjects: Data were collected from a random Puerto Rican community sample of caregiver-child dyads.Measures: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems.Statistical Methods: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care.Results: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis.Conclusion: : Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need. [ABSTRACT FROM AUTHOR]

Latino/as in the U.S. and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as - both first generation immigrants and those of Latino/a descent - in the U.S. (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites.