Informant-Based Determinants of Symptom Attenuation in Structured Child Psychiatric Interviews

Informant-related determinants of item attenuation, that is, the drop-off in symptom endorsement rates at retest, were examined in an enriched community subsample of 245 parent–child pairs drawn from the National Institute of Mental Health Methods for Epidemiology of Child and Adolescent Mental Disorders Study. Youngsters and their parents were interviewed with the Diagnostic Interview Schedule for Children (Version 2.3; DISC-2.3) on two occasions with a mean test–retest interval of 12 days. Item attenuation rates were high for both informants, with adults failing to confirm 42% and children 58% of baseline responses at retest. Stepwise regressions revealed that item attenuation at DISC-P retest was higher for adult informants who were younger, and who reported on older and less impaired children. On the DISC-C, attenuation was higher for children who were less impaired, rated as doing worse in school, and who had a longer test–retest interval. These results are broadly consistent with past studies examining the determinants of attenuation and test–retest reliability and have implications for the design and use of structured diagnostic instruments.     

Diagnostic judgments as a function of client and therapist race

The purpose of the present investigation was to examine the process of differential evaluation of clients as a function of client and therapist race. It was hypothesized that race of client and therapist would interact, influencing the judgments of client psychopathology, appropriateness for therapy, verbal facility, and likelihood of treatment success despite standardization of the clinical stimuli. Graduate students in clinical psychology and with varying levels of training (i.e., 1 to 5 years) were asked to rate videotaped interviews of clients in which race of the client and level of psychopathology (i.e., normal, neurotic, and psychotic) were systematically varied. There were significant differences in ratings as a function of race of client, race of therapist, and level of psychopathology observed. Black clients were not rated differently on degree of psychopathology but were rated as less verbally skilled and less appropriate for treatment but more likely to benefit from treatment than white clients. Contrary to expectations, white therapists tended to underrate the pathology of black clients. On the other hand, black therapists tended to overrate the pathology of white clients and made mixed judgments of black clients. The implications of these findings are discussed.This study was supported in part by NIMH Research Centers in Minority Institutions (RCMI) Grant G12RR03206-2.     

Parental and family risk factors for substance use in inner-city African-American children and adolescents

The purpose of this study was to develop and test a multidimensional model of parental and family influences on risk for substance use in inner-city African-American primary grade children and their adolescent siblings. The risk factors investigated were conceptually grouped into three broad domains of family influences and the respective indices computed: parental risk attributes, family risk attributes, and parenting styles. Parenting styles were captured as indicators of a latent construct, poor parenting. In study 1, we hypothesized that the parental and family risk variables would be mediated through parenting styles to predict intentions to use drugs, actual drug use, positive drug attitudes, and negative drug attitudes in a sample of 455 inner-city African-American families and their primary-grade children. In study 2, the substance use risk model was tested on a sample of 59 adolescent sibilings to determine whether the pattern of parental and family factors that contributed to early high-risk attitudes and behaviors in children would predict drug attitudes and behaviors in teen siblings. The results confirmed our expectations that parental and family risks were important predictors of childrens' negative drug attitudes and intentions to use drugs in the future and that positive parental and family characteristics would protect against future risk by enhancing negative drug attitudes. Also, substance use attitudes and behaviors in the teen siblings were predicted primarily by family risk characteristics. The family risk index also predicted frequency of use of hard drugs, but only when mediated through poor parenting. The implications of these results for future research are discussed.     

The comorbidity of ADHD in a community sample of children aged 6 through 16 years

Secondary analyses of the data from the Puerto Rico Child Psychiatry Epidemiologic Study were undertaken to provide information on the comorbidity patterns of ADHD. A high level of comorbidity was found among ADHD and other diagnostic categories, particularly the conduct/oppositional group. Comorbidity was associated with level of impairment and with service utilization.     

Indexical Reference and bodily causal diagrams in intentional action

In this paper, completed only months before his death, the author studies a number of concepts of importance for the analysis of intentional action. Four themes in particular are discussed: the intentionality of action, the practical syllogism, what the author terms the practical causality of practical thinking, and the proximate cause of action. (K. S.)     

Marital discord and psychiatric disorder in children and adolescents

The relationship between marital discord and any DISC-2.1/DSM-III-R child psychiatric diagnosis was explored. Interview data from a community sample of 90 parent/child pairs and a clinic sample of 37 parent/child pairs were analysed. The data were collected at Columbia University/the New York State Psychiatric Institute as part of the pilot project of a multi-site methodological study. Rates of marital discord and DISC diagnoses were found higher in the clinic sample than in the community sample. The association between marital discord and any diagnosis remained significant when other risk and protective factors were controlled. Policy implications and recommendations for future research strategies suggested by the current exploratory study were discussed.     

Acculturation and mental health: Current findings and recommendations for future research

Results of existing literature suggest that the relationship between acculturation and mental health is complex. Some studies have found a beneficial association between increased acculturation and mental health, whereas others have found a detrimental association or no relationship at all. We reviewed literature on acculturation and mental health in Hispanics/Latino Americans, Asians/Asian Americans, and other ethnic groups. Results indicate that greater acculturation is associated with increased substance use and abuse. Findings for other disorders and symptoms demonstrate considerable heterogeneity and potential reasons for this variation are provided. Acculturation involves a complex set of processes that appear to have differential impact on mental health outcomes. Critical issues in the measurement of acculturation are discussed, and recommendations for future research are offered.     

Adherence to antiretroviral medications in HIV: differences in data collected via self-report and electronic monitoring.

Controversy remains regarding the reliability of methods used to determine adherence to antiretroviral medication in HIV. In this study the authors compared adherence rates of 119 HIV-positive participants during a 6-month study, as estimated via electronic monitoring (EM) and self-report (SR). Adherence for both short (4-day) and long (4-week, or intervisit) periods was examined, as well as factors that underlie discrepancies between EM and SR. Results showed that intervisit EM estimates were consistently lower than those of SR. SR estimates based on shorter periods (4 days) were closer to those of EM. Higher discrepancies between EM and SR estimates were associated with lower cognitive functioning and externalized locus of control. These findings lend support for using both EM and SR methods; however, study design (e.g., length) and other factors (e.g., cognitive status, cost) should be considered.     

Radical hope in revolting times: Proposing a culturally relevant psychological framework

Growing research supports the link between individual expressions of hope and psychological well‐being. In this paper, we draw on psychological theories of hope, racial and ethnic studies, and the literature on radical healing to propose a framework of radical hope. Although the proposed multidimensional framework integrates cultural practices of People of Color in the United States, it is flexible enough to be adapted to other contexts. The paper begins by providing a brief review of the literature that conceptualizes the concept of hope in the field of psychology as a prelude to comparing the concept to the interdisciplinary notion of radical hope. Based on this body of work, we then introduce a culturally relevant psychological framework of radical hope, which includes the components of collective memory as well as faith and agency. Both components require an orientation to one of four directions including individual orientation, collective orientation, past orientation, and future orientation. The framework also consists of pathways individuals can follow to experience radical hope including (a) understanding the history of oppression along with the actions of resistance taken to transform these conditions, (b) embracing ancestral pride, (c) envisioning equitable possibilities, and (d) creating meaning and purpose in life by adopting an orientation to social justice. We conclude with a proposed research agenda for radical hope.