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A multitude of research demonstrates that ADHD is associated with negative psychological correlates and outcomes among children, such as academic difficulties and peer relationship problems. Youth with ADHD also experience high rates of comorbidity or co-occurring conditions, including mood, anxiety, oppositional defiant, and conduct disorders. However, few studies have investigated the development of co-occurring psychological symptoms among youth with ADHD over time and across different developmental periods. Shared risk factors likely contribute to the development of ODD, CD, anxiety, and depression among youth with ADHD. Emotion regulation and parenting style may confer risk or resilience for the development of co-occurring symptoms, but research is wanting. The current study examined an existing sample of youth who were recruited at age 10-12 and were followed at age 12-14 and 16. Analyses aimed to (a) identify subgroups of youth varying in type and levels of ADHD and co-occurring symptoms at three different time points using latent class analyses, (b) examine stability of membership and transitions to classes that differ in levels of ADHD and co-occurring symptoms using latent transition analyses, and (c) investigate emotion regulation and parenting style as predictors of stability and transitions among classes. Results revealed different patterns of ADHD and co-occurring symptoms, including a Low Symptoms class at each time point. Classes of youth with ADHD+Externalizing problems and ADHD+Internalizing problems emerged at ages 10-12 and 12-14. At age 16, two classes with qualitatively and quantitatively different externalizing and internalizing symptoms were identified. Latent transition analyses revealed transitions into the Low Symptoms class from each time point, but also stability and transitions to other symptomatic classes. Predictor analyses indicated that emotion regulation and parenting style were associated with transitions among and stability within classes, but findings were dependent on whether classes were defined primarily by co-occurring externalizing or internalizing symptoms. Results of the present study indicate that children with ADHD are likely to exhibit a range of psychological symptoms, but the frequency and quality of co-occurring symptoms may change over time. Emotion regulation and parenting may be potential targets for enhanced interventions among youth with ADHD with and without co-occurring symptoms. / Psychology

There are approximately 1.3 million youth who have been diagnosed with a co-occurring disorder. The purpose of this study was to analyze the relationship between the type of therapy (brief strategic family therapy or family functional therapy), demographic factors (age, race, type of drug used), and therapy discharge status (successful or unsuccessful) in male youth with a co-occurring disorder of attention-deficit hyperactivity disorder and substance use disorder. A correlational research design of a cross-sectional nature was used for this study and secondary data were obtained from a mental health agency located in Hampton Roads Virginia. The theoretical basis for this study was Bowens family systems theory. A purposeful convenience sample was used from archival data (n=392). Independent sample t-Tests were conducted to analyze differences between demographic groups and discharge status, and it was found that males whose drug of choice was alcohol had a statistically significant lower successful discharge rate (p=.031). Type of therapy unrelated to discharge status at a statistically significant level (p=.418). Results of a multiple logistic regression analysis showed that non-White/Caucasian males were 1.86 times more likely to have a successful discharge status from the program (p=.048). Age, drug type, and therapy used were unrelated to discharge status at statistically significant levels (p>.05). This study can educate therapists about their preconceived notions regarding ethnicity and the potential to successfully complete therapy. This could result in more empowerment shared with clients of these ethnic groups which could positively impact completion of therapy.

Early stages of the co-occurring, mental health and substance use disorder (MH-SUD) recovery process present various social and physical challenges to the recovering person, including habitual cigarette smoking. Presenting smoking cessation to a person with a co-occurring disorder could also depend on behavioral health professional’s perceptions of implementing supplemental services in early recovery. Behavioral health professionals also face the challenge of assessing people’s motivation to quit smoking. Data was collected through an online survey that shaped this quantitative, cross-sectional study focused on understanding perceptions of smoking cessation in early MH-SUD recovery. The study’s data highlighted that the participants (N = 61) perceive smoking cessation as an appropriate intervention while also reporting high levels of self-confidence when assessing motivation to quit to smoking. Identifying as a smoker and former smoker, highest level of education and gender did not have a significant impact on perceptions of smoking cessation in early MH-SUD recovery. The study created an overview on how behavioral health professionals understand and support smoking cessation that contributes additional knowledge to social work’s existing research on habitual cigarette smoking and co-occurring disorders.

As the diversity of U.S. society continues to expand and interrelate, so do the training needs of counselors in training and early counseling professionals who encounter these very diverse populations and needs. The purpose of this qualitative research study was to explore the perceptions of advanced masters'-level mental health counseling students and recent graduates regarding multicultural awareness, knowledge, and skills to provide effective counseling services and interventions to African American women who have co-occurring histories of childhood sexual abuse and substance abuse. During a 2-month period, in-depth interviews were conducted with counselors in training and early counseling professionals who were working with African American women at the time of the study or who were likely to work with them in the future. This study arose partially from the personal experiences of the researcher who is an African American woman and masters'-level counselor who previously encountered women with these co-occurring histories. The study was also derived from a review of current research that indicated this ever-growing population lacks the level of engagement and effective therapeutic services that focus specifically on their needs. The participants engaged in individual interviews consisting of a demographic survey, vignettes, and a structured open-ended interview guided process. Three methods of inquiry were utilized to promote triangulation of the data, thereby ensuring trustworthiness of the study. The results of this study promote awareness of participant perceptions of their multicultural competence as identified in the American Counseling Association Code of Ethics and Association for Multicultural Counseling and Development's Multicultural Counseling Competencies. The findings also contribute to future training and supervision experiences provided by counselor educators and supervisors who are gatekeepers for the profession and who assist in the multicultural development of counselors in training and early counseling professionals. Findings from this study revealed that current practice in multicultural counseling training promoted some level of awareness, knowledge, and/or skills in the ability of counselors in training and early counseling professionals to counsel African American women with dual diagnoses of childhood sexual abuse and substance abuse. Emerging themes from the participants' responses included awareness of personal strengths and limitations in multicultural competencies, significance of the relationship with population-specific clients, desire for increased exposure to population-specific content and interactions during the training process, desire for increased experiential opportunities to promote interactions with lesser known populations, and supportive and diverse supervision experiences. Recommendations for specific multicultural competencies related to counseling African American women with the dual diagnoses of childhood sexual abuse and substance abuse and for future research are included.

Many women and children in North America and other parts of the world are impacted by male perpetrated violence and often experience responses to this violence in the form of sadness, anxiety, and fear. Some of these women use substances to cope with their frightening and traumatic life situations. These mothers and their children often engage with multiple systems and agencies including, but not limited to, Health Services, Child Protection Services, and Transition Houses. Women often do not receive positive social responses when they seek help from these services. This qualitative research project shares the stories of three mothers with histories of violence, mental illness, and substance abuse. Using Narrative Inquiry the researcher shares the stories as they have been presented by the women, exploring how their life experiences have influenced their sense of identity and choices in seeking support in their communities. Using feminist, mothering, and response-based discourse lenses, the women’s narratives are presented and discussed.

eer victimization is a common experience that is associated with later psychopathology. However, there is inconsistency in the strength and statistical significance of this effect. The current study used two methods to try to understand this inconsistency. First, co-occurring internalizing and externalizing symptoms were considered dimensionally. Second, the present study considered temperament as a potential moderator to explain the multifinality of outcomes that occur following peer victimization. A community sample (N = 387; 52% female) of early adolescents (11-15) from a longitudinal study of risk and resilience factors for psychopathology was utilized to test hypotheses. Cross-lagged examinations between victimization and psychopathology were examined, including the moderating effect of temperament. No longitudinal relationship between victimization and psychopathology was found. A significant interaction between victimization and effortful control predicted externalizing and co-occurring symptoms. Future researchers should consider improving the measurement of victimization and temperament to get a better understanding of the effect.

Study questions: Does the proportion of neural tube defects (NTDs) in which there are co-occurring anomalies of other systems vary by geographical area and time in Europe between 1980 and 2015? Which group of factors, e.g., sex, age, family history, condition at discovery, and prenatal screening during pregnancy that potentially affect ascertainment of isolated NTD cases and co-occurring anomalies, are associated with the presence of these anomalies? Methods: Data on fetuses or births with NTDs recorded in 28 European Surveillance of Congenital Anomalies (EUROCAT) registries operating throughout or during a part of the period 1980-2015, were obtained and analysed. Information on the corresponding denominators of total births for each registry were compiled, comprising approximately 15.7 million births. We developed algorithms to classify NTDs that occurred as part of certain recognized genetic and unknown etiology syndromes, isolated NTD cases (either with no other anomaly reported or only an anomaly considered to be secondary to the NTD), and NTDs not occurring as part of recognized syndromes but with one or more co-occurring anomalies. We assessed factors that could impact ascertainment of isolated NTD cases and NTD cases with co-occurring anomalies. We also conducted a sensitivity analysis to evaluate the effect of family history and consanguinity on NTD outcomes. Lastly, we reported on the prevalence of NTDs across Eastern, Western, Northern, and Southern Europe as defined by the World Bank. Results: A total of 14,703 fetuses or births with NTDs were recorded in the EUROCAT registries. The total number of births (live and stillbirths) that occurred during the periods when the EUROCAT registries were operating was 15.7 million. The overall prevalence at birth of NTDs in Eastern Europe was 11.6 per 10,000 births, in Western Europe 11.0 per 10,000 births, in Northern Europe 10.5 cases per 10,000 births and in Southern Europe 6.7 per 10,000 births. The most prevalent genetic syndromes were chromosomal anomalies, particularly trisomy 18. The most common secondary anomaly was Arnold-Chiari syndrome which occurred mostly with spina bifida. The most prevalent associated anomalies were limb defects, followed by congenital heart defects, abdominal wall, and urinary system defects. We found anencephaly to be most prevalent in isolated NTD cases without secondary anomalies and spina bifida in secondary anomalies and most of the co-occurring anomalies. For factors that could affect ascertainment, we found that birth type, birth weight, family history, maternal and paternal age (≥30 years) were risk factors for isolated NTD cases and for co-occurring anomalies. Lastly, approximately 48% of NTDs occurred in Northern Europe, followed 29% in Western Europe, 16% in Southern Europe, and 7.6% in Eastern Europe. Conclusion: In the absence of folate fortification, isolated NTD cases showed higher prevalence than NTDs with co-occurring anomalies over the past 35 years across Europe. This research suggests that Europe should develop and implement policies and guidelines for folate fortification to help prevent simpler NTD cases. Further research and data are needed for newer EUROCAT registries to predict trends and prevalence of NTDs. Contribution and involvement: This project was done in collaboration with the experts from the School of Epidemiology and Public Health (SEPH) and dysmorphologists that provided support with regards to NTD classification. AB spearheaded the development of the research protocol and thesis manuscript with funding and support from JL and TR. Evaluation of the output of cases from the algorithm was provided to AB by JL, TR, JE, FB, AN, EB, ML, and the EUROCAT Joint Research Centre.

The accurate evaluation of substance use is a critical component of forensic assessment due to the well-established link between drug use sentencing issues and risk of recidivism. Due to limited resources and chronic time constraints, practitioners typically rely only on self-report measures to assess substance use (SU) patterns. As these measures directly inquire about SU patterns, they remain vulnerable to response distortion. This can lead to ineffective treatment recommendations made to the Court and misuse of resources. The present study investigated the utility of the PAI and SASSI-3 in identifying SU patterns in offenders mandated to a long-term treatment facility. As a second major component, offenders were examined post-release to identify predictors for poor treatment outcomes. Results found the direct questioning approach best identified SU patterns in the present sample. In addition, while statistically significant differences in treatment outcomes were not observed between offenders who endorsed a more severe course of their SU problem versus those who endorsed a much less problematic pattern of use, they were trending in the expected direction. Specifically, offenders who used "hard" drugs regularly (e.g., cocaine, heroin), had more negative consequences directly related to their use (e.g., more arrests, prior treatment), and had a more complex clinical presentation (e.g., endorsing more personality pathology) did have worse outcomes by follow up. Methodological and statistical limitations are discussed in depth, and future directions to improve on this study and clarify these relationships are emphasized.