Biomedical subjects

Regina Bussing

Publications and source records attributed to Regina Bussing.

11 recordsLinked to original sources

PubMed2006

What "Dr. Mom" ordered: a community-based exploratory study of parental self-care responses to children's ADHD symptoms.

Little is known about family initiated self-care interventions in response to symptoms of attention deficit/hyperactivity disorder (ADHD), and how self-care may co-exist with professional treatments. This paper explores parental self-care strategies for children with hyperactivity or attention problems, and examines factors and domains that influence their use from the mixed method perspective. As part of a longitudinal cohort study of ADHD detection and service use, caregivers of a representative US community sample of 266 children at high risk for ADHD completed a questionnaire that assessed five self-care strategies (behavior modification, coping, diet, over-the-counter medication use and religious practices), and made open-ended inquiry about discipline changes in response to behavioral concerns. Questionnaire responses were analyzed using logistic regression approaches. Open-ended answers were open coded; secondary analysis followed Spradley's model of domain analysis. Quantitative findings showed that behavior modification was the most commonly tried self-care strategy, followed by coping, diet, and religious practices. Over-the-counter trial was least common. The parents of professionally treated children were more likely to have employed behavior modification, coping strategies and over-the-counter medications than the parents of untreated children. Two-thirds of parents had changed their disciplinary action within three domains that were identified through qualitative analysis, including changes related to (a) the prevention of disciplinary problems (e.g., sustain eye contact, activation, consistency, clear instructions), (b) the solution of disciplinary problems (e.g., time-outs; privilege removal), and (c) parental coping associated with disciplinary problems (e.g., control own emotions, become less judgmental and more tolerant, and develop more appropriate expectations). These findings suggest that self-care strategies are commonly employed and appear to co-exist with professional treatment. Therefore, healthcare providers should actively explore parents' use of such strategies as some of them may interfere with prescribed treatments (e.g., over-the-counter) or absorb parental resources without likely benefit (e.g., diet).

Adaptation, Psychological↗

PubMed2005

Utility of a CPT in diagnosing ADHD among a representative sample of high-risk children: a cautionary study.

Continuous performance tests (CPTs) are widely used in the assessment and study of attention deficit hyperactivity disorder (ADHD). Although CPTs have reliably found differences between children with ADHD and normal controls, discriminating between children with ADHD and children with subclinical levels of behavioral or cognitive problems is a more clinically relevant and difficult endeavor. Additionally, most studies use convenience samples from clinical care settings that may not represent the ADHD population as a whole. The current study assessed the utility of a clinically used CPT, the Test of Variables of Attention (TOVA), in distinguishing between children with ADHD and children with subclinical levels of attention/behavior problems. Participants constituted a representative sample of elementary school students at high risk for ADHD, including 116 children with ADHD and 51 subclinical controls. Results found no significant differences between the ADHD and subclinical group on CPT variables, and CPT performance did not reliably predict group membership. Implications of the findings are discussed.

Attention↗

PubMed2005

Use and persistence of pharmacotherapy for elementary school students with attention-deficit/hyperactivity disorder.

OBJECTIVE: The aim of this study was to describe rates of attention-deficit/hyperactivity disorder (ADHD) medication treatment and relevant school services use during a 2-year period, and to examine independent predictors of these interventions. METHOD: Parent and child interviews (n = 266) and follow-up 12-month telephone surveys (n = 220) were conducted among a high-risk sample, selected from a districtwide, stratified, random sample of elementary-school students screened for ADHD risk. Medication treatment status and school services use were assessed from multiple sources, and their predictors were identified by logistic regression modeling, adjusting for sociodemographic and parental characteristics, as well as clinical-need variables. RESULTS: Approximately one third (35%) of the children received ADHD medications during a 2-year period, and of those treated at Time 2, approximately one third (36%) were no longer on medications at Time 3. Boys were more than twice as likely to receive ADHD medication as girls. Approximately one quarter (28%) of the children accessed school services and continued their use over 2 years. African-American youths were more likely to receive school services than were Caucasian children. CONCLUSIONS: In this elementary school-district high-risk sample, care for ADHD was remarkable for underuse and attrition of medication treatment, as well as poor linkage to relevant school services. Interventions to improve ADHD care should include supports to access and sustain medication treatment, as well as link with school services, especially for girls.

Attention Deficit Disorder with Hyperactivity↗

PubMed2003

Parental explanatory models of ADHD: gender and cultural variations.

BACKGROUND: This study describes parents' explanatory models of Attention Deficit Hyperactivity Disorder (ADHD) and examines model variation by child characteristics. METHOD: Children with ADHD (N = 182) were identified from a school district population of elementary school students. A reliable coding system was developed for parental responses obtained in ethnographic interviews in order to convert qualitative into numerical data for quantitative analysis. RESULTS: African-American parents were less likely to connect the school system to ADHD problem identification, expressed fewer worries about ADHD-related school problems, and voiced fewer preferences for school interventions than Caucasian parents, pointing to a potential disconnect with the school system. CONCLUSIONS: More African-American than Caucasian parents were unsure about potential causes of and treatments for ADHD, indicating a need for culturally appropriate parent education approaches.

Adult↗

PubMed2003

Child temperament, ADHD, and caregiver strain: exploring relationships in an epidemiological sample.

OBJECTIVE: To investigate the relationship between child-reported dimensions of temperament and attention-deficit/ hyperactivity disorder (ADHD), as well as other indicators of child psychopathology, including disruptive disorders, depression, and anxiety. It also examined whether difficult child temperament scores independently predicted caregiver strain. METHOD: A school-district-wide, two-phase screening design (response rate 70% for phase 2) identified elementary school children at high risk for ADHD. Two hundred high-risk children and their parents completed standardized instruments to assess child temperament, diagnoses of disruptive disorders, children's symptoms of anxiety and depression, and caregiver strain. Relationships were examined using analysis of variance, correlations, and multivariate prediction models, adjusting for child sociodemographic characteristics and psychopathology. All estimates were weighted for sampling design and differential participation. RESULTS: Combined subtype ADHD was associated with lower scores on task orientation and higher scores on general activity level. Depressive symptoms correlated significantly with all but one difficult temperament dimension, in a pattern consistent with clinical symptoms of depression. Child temperament did not vary by ADHD treatment status. Among these high-risk children, maternal caregiver strain experiences were increased by male gender, inattention symptoms, and oppositional defiant disorder, but not by difficult temperament scores. CONCLUSION: This study provides support for Graham and Stevenson's hypothesis of continuity between specific temperament traits and certain child psychiatric disorders, namely ADHD and depressive disorders.

Adult↗

PubMed2003

Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD.

OBJECTIVE: This study explores whether parental support networks vary by sociodemographic factors among children at high risk for attention-deficit/hyperactivity disorder (ADHD) and whether network characteristics influence the receipt of mental health treatment for the child. METHOD: A school district-wide, two-phase screening study design was used to identify 266 children at high risk for ADHD. Parents completed standardized instruments assessing network structure and function, DSM-IV diagnoses of disruptive disorders, caregiver strain, and treatment receipt, and children self-reported internalizing symptoms. Relationships were examined with analysis of variance and multivariate prediction, adjusting for sociodemographic characteristics, psychopathology, and parental strain. RESULTS: Network characteristics varied by race and socioeconomic status (SES), but not by child gender. African-American and disadvantaged parents reported smaller network sizes, but more frequent contact and higher levels of support than their white and high-SES counterparts. High levels of instrumental support lowered the odds of ADHD treatment during the 12 months before (OR =.7, p <.001) and after (OR =.7, p <.001) the network assessment interview. In contrast, parental strain increased the likelihood of ADHD treatment during both periods. CONCLUSIONS: Clinicians should anticipate high levels of caregiver strain and low levels of instrumental support among their patients' parents and address the potential high need for respite care in treatment plans.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

Use of complementary and alternative medicine for symptoms of attention-deficit hyperactivity disorder.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is a common childhood psychiatric condition for which evidence-based treatments have been established. This study describes use of complementary and alternative medicine among children with ADHD or at risk of having ADHD and explores possible predictors of use of such treatments. METHODS: A sample of 1,615 parents of elementary school students in a public school district were interviewed in a telephone screening survey of ADHD symptoms and use of traditional and nontraditional ADHD treatment. A total of 822 parents had a child with a diagnosis of ADHD, had a child in whom ADHD was suspected, or had a child about whose emotions or behavior the parents or school staff had general concerns. RESULTS: Use of complementary and alternative medicine was significantly higher among children who had received a diagnosis of ADHD (12 percent) or in whom ADHD was suspected (7 percent) than among those about whom parents or school staff had general concerns (3 percent). Faith healing had been used for 4 percent of the 822 children. Nontraditional treatments were more likely to have been used among children with a diagnosis or a suspected diagnosis of ADHD and those whose parents used the Internet as a source of information than among other children. CONCLUSIONS: Providers should inquire about nontraditional interventions and educate families about evidence-based approaches when treating children with ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2002

ADHD and conduct disorder: an MRI study in a community sample.

MRI studies of children with Attention-Deficit Hyperactivity Disorder (ADHD) have consistently attributed core deficits of inattention and impulsivity to frontal-striatal-cerebellar abnormalities; however, no study has investigated the neuroanatomical characteristics of children with ADHD and Conduct Disorder (CD). This study examined a community sample of 12 children with combined subtype ADHD (aged 8-12, 7 with CD) and 19 healthy controls matched for age, gender, handedness and poverty. Volume measurements, including left/right asymmetries, were quantified from MRI of the total brain, caudate and cerebellar vermis. No significant differences in total brain volume, caudate volume, asymmetry of the hemispheres or asymmetry of the caudate were found between the groups. Measurements of the left and total posterior superior and inferior lobes of the vermis, however, indicated smaller volumes for both pure ADHD and co-morbid children compared to the controls. Analysis of variance demonstrated no significant volumetric differences between the pure ADHD and co-morbid types. Prolonged exposure to methylphenidate was associated with caudate volumes. These results suggest ADHD and ADHD co-morbid with CD have similar deviant cerebellar morphology and replicate previous studies with an epidemiologically derived sample.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

Agreement between CASA parent reports and provider records of children's ADHD services.

This study examines agreement between parental reports of children's ADHD outpatient services ascertained with the Child and Adolescents Services Assessment (CASA) and provider records among a sample of elementary school students who participated in an epidemiologically based health services study. Parental reports of any outpatient mental health treatment, services intensity, and medication regimens were compared to records of the specified mental health and primary care providers using intraclass correlations and kappa estimates. Results indicated that parental reports using the CASA produced valid data on whether any outpatient ADHD services had been received in the past 12 months (83% agreement), and on details of the child's medication regimens (kappas above 0.90), but that agreement was poor on how many times the child had been seen (intraclass correlation 0.29), without agreement differences by provider type. These findings support the validity of using parental report for ADHD services in primary care settings and for study of medication regimens.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

Barriers to detection, help-seeking, and service use for children with ADHD symptoms.

This study describes 4 help-seeking steps among children at high risk for attention deficit hyperactivity disorder (ADHD), and identifies barriers to ADHD symptom detection and treatment. Using a district-wide stratified random sample of 1615 elementary school students screened for ADHD risk, predictors of 4 help-seeking steps among a high-risk group (n = 389) and parent-identified barriers to care among children with unmet need for ADHD care (n = 91) were assessed. Study findings indicate that although 88% of children were recognized as having a problem, only 39% had been evaluated, 32% received an ADHD diagnosis, and 23% received current treatment. Older children and those with more severe behavior problems were more likely to be perceived by their parents as having a problem. Additionally, gender and ethnic disparities in the subsequent help-seeking process emerged. Boys had over 5 times the odds than girls of receiving an evaluation, an ADHD diagnosis, and treatment. Compared to African American youth, Caucasian children had twice the odds of taking these help-seeking steps. For those children with unmet need for ADHD care, poverty predicted lower treatment rates and was associated with the most pervasive barriers. The gap between parental problem recognition and seeking services suggests that thresholds for parental recognition of a child behavior problem and for seeking ADHD services may be different. Future research examining the help-seeking process for ADHD should include a qualitative component to explore the potential mechanisms for gender and ethnic differences.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

Exploring help-seeking for ADHD symptoms: a mixed-methods approach.

OBJECTIVE: Gender and race differences in treatment rates for attention-deficit/hyperactivity disorder (ADHD) are well documented but poorly understood. Using a mixed-methods approach, this study examines parental help-seeking steps for elementary school students at high risk for ADHD. METHODS: Parents of 259 students (male/female, African American/Caucasian) identified as being at high risk for ADHD completed diagnostic interviews and provided detailed accounts of help-seeking activities since they first became concerned about their child. Help-seeking steps (n=1,590) were analyzed using two methods: inductive analysis based on grounded theory, and deductive quantitative analysis of coded data derived from application of the network-episode model, merged subsequently with demographic and other characteristics. RESULTS: The inductive analysis revealed unique parental perceptions of their children's sick role and of the agents of identification and intervention for each of the four groups. Deductive analysis showed significant variations by race and gender in consultation experiences, in the person or entity being consulted and in the transactions occurring in the consultation, and in illness careers. CONCLUSION: ADHD symptoms are interpreted as having different implications for the sick role and the intervention, dependent on a child's gender and race. Educational interventions need to address cultural stereotypes contributing to inequitable access to treatment.

Attention Deficit Disorder with Hyperactivity↗