Objective

We sought to develop and provide preliminary validation for a questionnaire evaluating functioning related to ADHD (i.e., the FX-II) with a particularly underserved group (i.e., Mexican youth).

Method

191 Mexican raters completed the FX-II alongside measures of ADHD symptoms, impairment, cultural values, and demographics: 127 raters were caregivers of treatment-naïve youth (i.e., community sample); 32 raters were caregivers and 32 raters were teachers of youth participating in a school-based program for attention/behavior concerns (i.e., clinical sample).

Results

We created the 52-item FX-II Scale by adapting a culturally appropriate and psychometrically sound measure of impairment (i.e., the ADHD-FX) to assess functioning most relevant to Spanish-speaking families of children with ADHD (i.e., academic, social/emotional, and familial functioning). The FX-II demonstrated strong reliability, convergent and divergent construct validity, and predictive validity.

Conclusion

The FX-II appears to be a beneficial tool for evaluating functioning related to ADHD in Mexican children and future validation efforts in broader populations are warranted.

ADHD problem recognition serves as the first step of help seeking for ethnic minority families, such as Latinos, who underutilize ADHD services. The current mixed-method study explores underlying factors influencing recognition of ADHD problems in a sample of 159 school-aged youth. Parent-teacher informant discrepancy results suggest that parent ethnicity, problem domain, and child age influence ADHD problem recognition. Emerging themes from semi-structured qualitative interviews/focus groups conducted with eighteen Spanish-speaking Latino parents receiving school-based services for attention and behavior concerns support a range of recognized ADHD problems, beliefs about causes, and reactions to ADHD identification. Findings provide recommendations for reducing disparities in ADHD problem recognition and subsequent help seeking.

Abstract: Childhood conditions of inattention and disruptive behavior, such as Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), are prevalent but undertreated worldwide. One promising solution is harnessing digital technology to enhance school clinician training and ADHD/ODD intervention programs. We conducted a school-clustered randomized controlled trial of CLS-R-FUERTE: a program featuring training/consultation for school clinicians to deliver a six-week intervention comprised of weekly parent and student skills groups, as well as support teachers’ classroom management in the form of a Daily Report Card, all facilitated by electronic program manuals/materials and videoconferencing. A total of N = 163 (n = 6–8 students/school [ages 6–12] and their parents, teachers, and school clinicians) participated across eight public schools in Sinaloa, Mexico. We randomly assigned four schools to receive CLS-R-FUERTE immediately and four schools to receive school services as usual. We compared groups post-treatment on parent- and teacher-rated ADHD/ODD and impairment. We observed the program implementation in vivo, tracking trainer and school clinician program fidelity, as well as participant attendance and adherence, to evaluate feasibility. We also collected participant ratings of satisfaction and usability on the System Usability Scale to evaluate acceptability. Our CLS-R-FUERTE trial demonstrated high rates of program feasibility and acceptability comparable to prior in-person program trial findings. Students receiving CLS-R-FUERTE showed greater improvement in parent- and teacher-rated ADHD, as well as parent-rated ODD and impairment, compared to students receiving school services as usual. Results support the utility of global digital mental health programs training school clinicians to implement ADHD/ODD interventions, which have the potential to increase evidence-based treatment access and uptake across worldwide contexts.