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Culturally Responsive Approaches for Addressing ADHD Within Multi-tiered Systems of Support

  • Child and Adolescent Disorders (TD Benton, Section Editor)
  • Published:
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Abstract

Purpose of Review

Limited work has emphasized cultural responsiveness when working with families and children with attention-deficit/hyperactivity disorder (ADHD) from diverse backgrounds. We present a primer for psychiatrists, psychologists, and other mental health professionals on the implementation of culturally responsive practices within a multi-tiered system of support (MTSS) framework when collaborating with schools.

Recent Findings

Individuals with ADHD demonstrate unique behavioral challenges that affect school and home functioning. As a framework to address the needs of all children with academic and behavioral issues, many public schools have adopted MTSS. Emerging findings on cultural adaptations of evidence-based interventions for ADHD within MTSS are promising.

Summary

Through a comprehensive tiered approach, this review focuses on (1) initial behavior screening and prevention, (2) implementation of evidence-based interventions tailored to the child’s development and family culture, and (3) collaboration between psychiatrists, psychologists, school personnel, and families regarding evaluation of outcomes for children with ADHD, particularly when pharmacological treatment is considered. Engaging in these approaches can promote culturally responsive practices and improve the quality of services provided to children with ADHD.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents. J Clin Child Adolesc Psychol. 2018;47:199–212.

    PubMed  PubMed Central  Google Scholar 

  2. Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents 1997-2016. JAMA Netw Open. 2018;1(4):e181471.

    PubMed  PubMed Central  Google Scholar 

  3. Dupaul GJ, Chronis-Tuscano A, Danielson ML, Visser SN. Predictors of receipt of school services in a national sample of youth with ADHD. J Atten Disord. 2019;23:1303–19. https://doi.org/10.1177/1087054718816169.

    Article  PubMed  Google Scholar 

  4. Coker TR, Elliott MN, Toomey SL, et al. Racial and ethnic disparities in ADHD diagnosis and treatment. Pediatrics. 2016;138(2):1–9.

    Google Scholar 

  5. Alvarado C, Modesto-Lowe V. Improving treatment in minority children with attention deficit/hyperactivity disorder. Clin Pediatr. 2017;56(2):171–6. https://doi.org/10.1177/0009922816645517.

    Article  Google Scholar 

  6. Stoiber KC. A comprehensive framework for multitiered systems of support in school psychology. In: Harrison PL, Thomas A, editors. Best practices in school psychology V. Bethesda: National Association of School Psychologists; 2014. p. 41–70.

    Google Scholar 

  7. Fallon LM, O’Keeffe BV, Sugai G. Consideration of culture and context in school-wide positive behavior support: a review of current literature. J Posit Behav Interv. 14(4):209–19. https://doi.org/10.1177/1098300712442242.

  8. Zong J, Batalova J. Frequently requested statistics on immigrants and immigration in the United States. 2015; Available at http://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states. Accessed 7 September 2019.

  9. Koball H, Jiang Y. Basic facts about low-income children: children under 18 years. 2016. 2018; Available at: http://www.nccp.org/publications/pdf/text_1194.pdf. Accessed 4 January 2020.

  10. Dettlaff AJ, Cardoso JB. Mental health need and service use among Latino children of immigrants in the child welfare system. Child Youth Serv Rev. 2010;32:1373–9.

    Google Scholar 

  11. Toppelberg CO, Hollinshead MO, Collins BA, Nieto-Castanon A. Cross-sectional study of unmet mental health need in 5-to-7-year old Latino children in the United States: do teachers and parents make a difference in service utilization? Sch Ment Heal. 2013;5(2):59–69.

    Google Scholar 

  12. Reardon T, Harvey K, Baranowska M, O’Brien D, Smith L, Creswell C. What do parents perceive are barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. Eur Child Adolesc Psychiatry. 2017;26(6):623–47.

    PubMed  PubMed Central  Google Scholar 

  13. Lawton KE, Kapke TL, Gerdes AC. Understanding parental locus of control in Latino parents: examination of cultural influences and help-seeking intentions for childhood ADHD. Cult Divers Ethn Minor Psychol. 2016;22(2):288–98. https://doi.org/10.1037/cdp0000022.

    Article  Google Scholar 

  14. Mah JWT, Johnston C. Cultural variations in mothers’ attributions: influence of child attention-deficit/hyperactivity disorder. Child Psychiatry Hum Dev. 2007;38:135–53.

    PubMed  Google Scholar 

  15. Yeh M, McCabe K, Ahmed S, Trang D, Ganger W. Sociocultural factors and parent-therapist agreement on explanatory etiologies for youth mental health problems. Admin Pol Ment Health. 2016;43(5):693–702.

    Google Scholar 

  16. Li K. Religion and medicalization: the case of ADHD. J Sci Study Relig. 2013;52(2):309–27.

    Google Scholar 

  17. Villatoro AP, Morales ES, Mays VM. Family culture in mental health help-seeking and utilization in a nationally representative sample of Latinos in the United States: the NLAAS. Am J Orthop. 2014;84(4):353–63.

    Google Scholar 

  18. Kapke TL, Grace MA, Castro A, Gerdes AC. Examining Latino family participation in treatment for childhood ADHD: the role of parental cultural factors and perceptions. Child Fam Behav Ther. 2019;41:84–109.

    Google Scholar 

  19. Eiraldi R, Diaz Y. Use of treatment services for attention-deficit/hyperactivity disorder in Latino children. Curr Psychiatry Rep. 2010;12(5):403–8.

    PubMed  PubMed Central  Google Scholar 

  20. Godoy L, Mian ND, Eisenhower AS, Carter AS. Pathways to service receipt: modeling parent help-seeking for childhood mental health problems. Admin Pol Ment Health. 2014;41:469–79. https://doi.org/10.1007/s10488-013-0484-6.

    Article  Google Scholar 

  21. Pham AV, Carlson JS, Kosciulek JF. Ethnic differences in parental beliefs of attention-deficit/hyperactivity disorder and treatment. J Atten Disord. 2010;13(6):584–91.

    PubMed  Google Scholar 

  22. Measham T, Heidenreich-Dutray F, Rousseau C, Nadeau L. Cultural consultation in child psychiatry. In: Kirmayer LJ, Guzdar J, Rousseau C, editors. Cultural consultation. New York: Springer; 2014. p. 71–87.

    Google Scholar 

  23. Sirin SR, Sin E, Clingain C, Rogers-Sirin L. Acculturative stress and mental health: implications for immigrant-origin youth. Pediatr Clin. 2019;66(3):641–53.

    Google Scholar 

  24. Halgunseth LC, Ispa JM, Rudy D. Parental control in Latino families: an integrated review of the literature. Child Dev Perspect. 2006;77(5):1282–97.

    Google Scholar 

  25. Lorenzo-Blanco EI, Meca A, Unger JB, Romero A, Szapocznik J, Piña-Watson B, et al. Longitudinal effects of Latino parent cultural stress, depressive symptoms, and family functioning on youth emotional well-being and health risk behaviors. Fam Process. 2017;56(4):981–96.

    PubMed  Google Scholar 

  26. White RM, Roosa MW, Weaver SR, Nair RL. Cultural and contextual influences on parenting in Mexican American families. J Marriage Fam. 2009;71(1):61–79.

    PubMed  PubMed Central  Google Scholar 

  27. Nafees B, Setyawan J, Lloyd A, Ali S, Hearn S, Sasane R, et al. Parent preferences regarding stimulant therapies for ADHD: a comparison across six European countries. Eur Child Adolesc Psychiatry. 2014;23:1189–200. https://doi.org/10.1007/s00787-013-0515-6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Brinkman WB, Sucharew H, Majcher JH, Epstein JN. Predictors of medication continuity in children with ADHD. Pediatrics. 2018;141(6):e20172580.

    PubMed  PubMed Central  Google Scholar 

  29. Smith TB, Rodriguez MD, Bernal G. Culture. J Clin Psychol. 2011;67(2):166–75. https://doi.org/10.1002/jclp.20757.

    Article  PubMed  Google Scholar 

  30. Every Student Succeeds Act of 2015, Pub. L. No. 114–95, 129 Stat. 1802. 2015.

  31. Fuchs D, Fuchs LS. Introduction to response to intervention: what, why, and how valid is it? Read Res Q. 2006;41(1):92–9. https://doi.org/10.1598/rrq.41.1.4.

    Article  Google Scholar 

  32. Horner RH, Sugai G, Anderson CM. Examining the evidence base for school-wide positive behavior support. Focus Except Child. 2010;42(8):1–14.

    Google Scholar 

  33. Fabiano GA, Pyle K. Best practices in school mental health for attention-deficit/ hyperactivity disorder: a framework for intervention. Sch Ment Heal. 2019;11(1):72–91.

    Google Scholar 

  34. DuPaul GJ, Weyandt LL. School-based intervention for children with attention deficit hyperactivity disorder: effects on academic, social, and behavioral functioning. Int J Disabil Dev Educ. 2006;53(2):161–76.

    Google Scholar 

  35. Barish HH, Saunders M, Wolf MM. Good behavior game: effects of individual contingencies for group consequences on disruptive behavior in a classroom. J Appl Behav Anal. 1969;2(2):119–24.

    Google Scholar 

  36. Nolan JD, Houlihan D, Wanzek M, Jenson WR. The good behavior game: a classroom-behavior intervention effective across cultures. Sch Psychol Int. 2014;35(2):191–205.

    Google Scholar 

  37. Ortiz J, Bray MA, Bilias-Lolis E, Kehle TJ. The good behavior game for Latino English language learners in a small-group setting. Int J Sch Educ Psychol. 2017;5(1):26–38.

    Google Scholar 

  38. Webster-Stratton C, Reinke WM, Herman KC, Newcomer LL. The incredible years teacher classroom management training: the methods and principles that support fidelity of training delivery. School Psych Rev. 2011;40:509–29.

    Google Scholar 

  39. McIntosh K, Chard DJ, Boland JB, Horner RH. Demonstration of combined efforts in school-wide academic and behavioral systems and incidence in reading and behavior challenges in early elementary grades. J Posit Behav Interv. 2006;8:146–54. https://doi.org/10.1177/10983007060080030301.

    Article  Google Scholar 

  40. Bal A. Culturally responsive positive behavioral interventions and supports: a process–oriented framework for systemic transformation. Rev Educ Pedagogy Cultural Stud. 2018;40(2):144–74.

    Google Scholar 

  41. Malik TA, Rooney M, Chronis-Tuscano A, Tariq N. Preliminary efficacy of a behavioral parent training program for children with ADHD in Pakistan. J Atten Disord. 2017;21(5):390–404. This article provides recommendations for culturally adapting an evidence-based parent-training intervention for children with ADHD.

    PubMed  Google Scholar 

  42. Eiraldi RB, Mautone JA, Power TJ. Strategies for implementing evidence-based psychosocial interventions for children with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am. 2012;21(1):145–59.

    PubMed  PubMed Central  Google Scholar 

  43. Volpe RJ, Fabiano GA. Daily behavior report cards: an evidence-based system of assessment and intervention. New York: Guilford Press; 2013.

    Google Scholar 

  44. Gerdes AC, Kapke TL, Grace M, Castro A. Feasibility, acceptability, and preliminary outcomes of a culturally adapted evidence-based treatment for Latino youth with ADHD. J Atten Disord. 2019. https://doi.org/10.1177/10870544718821729. This article provides evidence and outcomes from a cultural adaptation of an evidence-based intervention for Latino youth with ADHD.

  45. Wong DF, Ng TK, Ip PS, Chung ML, Choi J. Evaluating the effectiveness of a group CBT for parents of ADHD children. J Child Fam Stud. 2018;27(1):227–39.

    Google Scholar 

  46. Fong EH, Catagnus RM, Brodhead MT, Quigley S, Field S. Developing the cultural awareness skills of behavior analysis. Behav Anal Pract. 2016;9(1):84–94. This article summarizes how culture influences behavioral assessment and intervention when working with culturally diverse families and children.

    PubMed  PubMed Central  Google Scholar 

  47. Salend SJ, Taylor LS. Cultural perspectives: missing pieces in the functional assessment process. Interv Sch Clin. 2002;38(2):104–12.

    Google Scholar 

  48. American Academy of Pediatrics. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128:1007–22. https://doi.org/10.1542/peds.2011-2654.

    Article  Google Scholar 

  49. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.

    Google Scholar 

  50. Ramirez-Stege AM, Yarris KE. Culture. Culture in la clinica: evaluating the utility of the Cultural Formulation Interview (CFI) in a Mexican outpatient setting. Transcult Psychiatry. 2017;54(4):466–87.

    PubMed  Google Scholar 

  51. Graves SL, Blake JJ. Psychoeducational assessment and intervention for ethnic minority children: evidence-based approaches. Washington, DC: American Psychological Association; 2016.

  52. Garbacz SA, Sheridan SM, Koziol NA, Kwon K, Holmes SR. Congruence in parent–teacher communication: implications for the efficacy of CBC for students with behavioral concerns. School Psych Rev. 2015;44(2):150–68. This article discusses the efficacy of a school-based behavioral consultation model that can be used in fostering parent engagement and establishing positive relationships with families.

    Google Scholar 

  53. Sheridan SM, Kratochwill TR. Conjoint behavioral consultation: promoting family-school connections and interventions: Springer Science & Business Media; 2007.

  54. Cole EK, Pelham WE III, Fabiano GA, et al. Randomized trial of first-line behavioral intervention to reduce need for medication in children with ADHD. J Clin Child Adolesc Psychol. 2019:1–15. This recent study discusses the effectiveness of behavioral consultation in schools, which can potentially eliminate the need for medication for children with ADHD.

  55. Fabiano G, Pelham WE, Coles EK, et al. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev. 2009;29:129–40. https://doi.org/10.1016/j.cpr.2008.11.001.

    Article  PubMed  Google Scholar 

  56. Power TJ, Hom J, Huang P. Current best practices for assessing and treating children and adolescents with attention-deficit/hyperactivity disorder. Curr Treat Options Pediatr. 2018;4:94–107. https://doi.org/10.1007/s40746-018-0111-6.

    Article  Google Scholar 

  57. Deno SL, Reschly AL, Lembke ES, et al. Developing a school-wide progress-monitoring system. Psychol Sch. 2009;46:44–55.

    Google Scholar 

  58. Achenbach TM. The Achenbach system of empirically based assessment (ASEBA): development, findings, theory, and applications. Burlington: University of Vermont Research Center for Children, Youth, & Families; 2009.

    Google Scholar 

  59. Achenbach TM, McConaughy SH, Ivanovaa M, Rescorla LA. Brief Problem Monitor manual. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families. 2017. Available in: https://aseba.org/wp-content/uploads/2019/02/ASEBA-Brief-Problem-Monitor-Manual.pdf. Accessed 19 January 2020.

  60. Reynolds CR, Kamphaus RW. Behavior assessment system for children, third edition manual. Bloomington: NCS Pearson, Inc.; 2015.

    Google Scholar 

  61. Reynolds CR, Kamphaus R. W. BASC–3 Flex Monitor. Bloomington: NCS Pearson, Inc.; 2016.

    Google Scholar 

  62. Chafouleas SM, Riley-Tillman TC, Christ TJ. Direct Behavior Rating (DBR): an emerging method for assessing social behavior within a tiered intervention system. Assess Eff Interv. 2009;34:195–200. https://doi.org/10.1177/1534508409340391.

    Article  Google Scholar 

  63. Fabiano GV, Vujnovic R, Naylor J, Pariseau M, Robins M. An investigation of the technical adequacy of a daily behavior report card (DBRC) for monitoring progress of students with attention-deficit/hyperactivity disorder in special education placements. Assess Eff Interv. 2009;34(4):231–41.

    Google Scholar 

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Correspondence to Andy V. Pham.

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Dong, Q., Garcia, B., Pham, A.V. et al. Culturally Responsive Approaches for Addressing ADHD Within Multi-tiered Systems of Support. Curr Psychiatry Rep 22, 27 (2020). https://doi.org/10.1007/s11920-020-01154-3

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