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Patterns of correlates, comorbidity and impairment associated with attention-deficit hyperactivity disorder (ADHD) in children and youth were examined in representative samples from the community and from treatment facilities serving medically indigent youth in Puerto Rico. Information from caretakers and youths was obtained using the Diagnostic Interview Schedule for Children, (version IV), measures of global impairment, and a battery of potential correlates. In the community (N = 1,896) and the treated samples (N = 763), 7.5 and 26.2% of the children, respectively, met criteria for DSM-IV ADHD in the previous year. Although the prevalence rates and degree of impairment differed, the general patterns of correlates, comorbidity and impairment were similar in both populations. The exceptions were associated with conduct disorder, anxiety, impairment in the ADHD comorbid group, and age factors that appeared to be related to selection into treatment.

Background: Research comparing treatment-referred boys and girls with attention-deficit/hyperactivity disorder (ADHD) has yielded equivocal results. Contradictory findings may be associated with differential referral practices or unexplored interactions of gender with ADHD subtypes. Method: We examined possible gender differences in ADHD and its subtypes among children aged 4 to 17 in a representative community sample (N = 1896) in Puerto Rico. Caretakers provided information through the Diagnostic Interview Schedule for Children (version IV) and a battery of impairment, family relations, child problems, comorbidity and treatment measures. Results: ADHD was 2.3 times more common in boys than girls, but with one exception there was little evidence that the patterns of associations of ADHD with correlates were different for boys and girls. The exception was school suspension, which was more common among ADHD boys than girls. Additional gender interactions were found when ADHD subtypes were considered. Among those with combined type (n = 50), boys were more likely to be comorbid with mood disorders than girls. For those with the inattentive type (n = 47), girls were more likely to be comorbid with anxiety disorders than boys. Conclusions: Our findings lend cross-cultural generalizability to recent reports that gender does not interact with correlates for ADHD overall, but that it may play a role in subtypes.

Cultural differences may explain the difference in the rate of depression among different countries. A study of 10 countries found that the annual rates of major depression varied from .8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The incidence of depression was higher in women than men. However, the rates of manic depression were similar in most countries and affected men and women equally. Major depression struck most people in their mid-20s, while those with manic depression were often affected in their teens.

Reliability is usually greater with externalizing disorders than with internalizing disorders on the Diagnostic Interview Schedule for Children (DISC-2.1) used on a Hispanic population. These levels of reliability are compared between clinic and community samples, and between younger and older children. While parent's reports are more reliable than those of children, this difference is not seen with older children. Reliability is also greater when the second interviewer is a psychiatrist rather than a lay interviewer.

Objectives. Based on an epidemiologic field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the United States mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. Methods. Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents aged 17 to 68 years who were selected by multistage probability sampling of island households. Results. An estimated 8.2% of the population had a history of illicit drug use and 1.2% qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4% of the male drug users and 7.7% of the female drug users met criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. Conclusions. The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables. (Am J Public Health. 1993;83:194-200), The frequency of drug abuse and illicit drug use appears to be lower in Puerto Rico than on the mainland US. Of 912 Puerto Ricans between 17 and 68 years old, 8% reported using illicit drugs and 1% could be classified as drug abusers or drug dependent. It is estimated that in the US, about 30% of adults have used illicit drugs. Gender differences of drug use were more pronounced in Puerto Rico with 12% of men reporting illicit drug use compared with only 5% of the women. In the US, 36% of men have a history of illicit drug use and so do 25% of women. Few of the Puerto Rican drug users received any treatment for alcohol, drug or mental health problems. Alcohol abuse or dependence and antisocial personality were associated with illicit drug use. Interestingly, use of illicit drugs was strongly linked with levels of childhood misbehavior.

Type, distribution, and comorbidity of functional somatic symptoms were examined in four community samples, three Hispanic and one non-Hispanic white. Important intergroup and intragroup differences between Hispanic and non-Hispanic white groups were identified. Of the four groups, Puerto Rican respondents reported the highest level of somatic symptoms; this finding was apparently independent of sociodemographic factors.

Objective: The study reports the process of translation into Spanish and adaptation to the Hispanic culture of the Alcohol Use Disorder and Associated Disabilities Schedule (AUDADIS). This instrument is a structured diagnostic interview schedule specifically developed for the assessment of substance-related disorders and their comorbid disorders and disabilities. Method: A random sample (N = 169) of adults from a primary health care clinic in Puerto Rico was selected. The test-retest reliability of the instrument was examined across time and across interviewers, and the validity was assessed by comparing computer-derived diagnoses obtained through the administration of lay interviewers with best estimate diagnoses given by board-certified psychiatrists. Results: For most diagnoses and symptoms studied, as well as for most of the alcohol consumption measures, the test-retest reliability of the Spanish AUDADIS was consistent with results reported in other national and international studies using this instrument. Good to excellent test-retest reliability was obtained for the diagnoses of alcohol dependence and major depression. Similarly, good to excellent agreement was obtained between the lay administered AUDADIS and best estimate diagnoses for most diagnostic categories, with the exception of dysthymia. As in other studies, the reliability and validity of the substance abuse category was poor. When agreement for this category was estimated independent of lifetime dependence, both the reliability and validity coefficients were considerably improved. Conclusions: The Spanish AUDADIS generally demonstrates good to excellent levels of reliability and validity that are comparable to findings reported for this instrument in other national and international studies. (J. Stud. Alcohol 60: 790-799, 1999), THE APPLICATION of consistent diagnostic and examination methods is particularly pertinent in the cross-cultural study of substance abuse and dependence. Members of different societies differ in how they view substance [...]