Psychometric Evaluation of the Spanish Translation of the Disruptive-Behavior Disorder Rating Scale
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| Title: | Psychometric Evaluation of the Spanish Translation of the Disruptive-Behavior Disorder Rating Scale |
|---|---|
| Language: | English |
| Authors: | Carolina Ramirez (ORCID |
| Source: | Journal of Attention Disorders. 2026 30(9):1163-1177. |
| Availability: | SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com |
| Peer Reviewed: | Y |
| Page Count: | 15 |
| Publication Date: | 2026 |
| Sponsoring Agency: | Institute of Education Sciences (ED) |
| Contract Number: | R324A210221 |
| Document Type: | Journal Articles Reports - Research |
| Education Level: | Early Childhood Education Elementary Education Kindergarten Primary Education Grade 1 |
| Descriptors: | Spanish, Translation, Behavior Problems, Media Adaptation, Attention Deficit Hyperactivity Disorder, Latin Americans, Preschool Children, Kindergarten, Grade 1, Language Role, Child Behavior, Screening Tests, Questionnaires, Hispanic Americans, Parent Surveys, Psychometrics |
| Assessment and Survey Identifiers: | Strengths and Difficulties Questionnaire |
| DOI: | 10.1177/10870547261438171 |
| ISSN: | 1087-0547 1557-1246 |
| Abstract: | Introduction: Evidence-based assessments for ADHD include the collection of standardized ratings of Diagnostic and Statistical Manual of Mental Disorders symptoms. There is limited research on ADHD diagnostic procedures in Hispanic/Latino children and a growing concern that ADHD may be underdiagnosed due to language barriers that exist between parents and the standardized measures. To address this gap, we examined potential language related biases in the assessment of ADHD among Spanish-speaking parents. Methods: The sample was 107 Hispanic/Latino, Spanish-speaking parents of children in kindergarten or first grade. The Spanish translated versions of the Disruptive Behavior Disorders Rating Scale (DBD-RS), Strength and Difficulties Questionnaire (SDQ), and Impairment Rating Scale (IRS) were administered to assess ADHD symptoms, concurrent validity, and the influence of time since arrival in the United States on parent ratings. Results: The Spanish DBD-RS demonstrated strong internal consistency for both Inattention (α = 0.85) and Hyperactivity/ Impulsivity (α = 0.85) subscales. Parent ADHD ratings were positively correlated with SDQ Hyperactivity/Inattention scores (r = 0.38, p < 0.001), supporting concurrent validity. In regression analyses, parent time in the U.S. significantly predicted IRS impairment scores beyond ADHD symptoms (ΔR² = 0.036, p = 0.035). Conclusion: Despite limitations such as reliance on self-report measures and cultural heterogeneity in the sample, this research contributes to understanding ADHD assessment in an under-studied ethnic group. Our findings contribute to ongoing efforts to refine diagnostic tools and promote equitable access to ADHD evaluations that are culturally appropriate for Hispanic/Latino children. |
| Abstractor: | As Provided |
| IES Funded: | Yes |
| Entry Date: | 20260101 |
| Accession Number: | EJ1513413 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwE0u96du2C2pQmknyituXdwAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDBTTDm9oGDdMje_w7AIBEICBmtY4KoC0EFElFXlY09keFqMcLYjRWhdDJ0LhocVS3j_b89K6K2KM0sAZADrsjI91Nmm7QnhaKGU33AIkjGbDVOuufr2hRSfMaKtdWwqIi9m2eUwE4Oh7kqTXZRaB47mUlLd1CIfMA-EIYtgXcH0TzYFbBrBKyVVYyxtftaGY9GiSmy_Q8VqJNrNuHXtfAcA7YmPg1jS7XCLEHgQ= Text: Availability: 1 Value: <anid>AN0195587727;gs001sep.26;2026Jul27.01:37;v2.2.500</anid> <title id="AN0195587727-1">Psychometric Evaluation of the Spanish Translation of the Disruptive-Behavior Disorder Rating Scale </title> <p>Introduction: Evidence-based assessments for ADHD include the collection of standardized ratings of Diagnostic and Statistical Manual of Mental Disorders symptoms. There is limited research on ADHD diagnostic procedures in Hispanic/Latino children and a growing concern that ADHD may be underdiagnosed due to language barriers that exist between parents and the standardized measures. To address this gap, we examined potential language related biases in the assessment of ADHD among Spanish-speaking parents. Methods: The sample was 107 Hispanic/Latino, Spanish-speaking parents of children in kindergarten or first grade. The Spanish translated versions of the Disruptive Behavior Disorders Rating Scale (DBD-RS), Strength and Difficulties Questionnaire (SDQ), and Impairment Rating Scale (IRS) were administered to assess ADHD symptoms, concurrent validity, and the influence of time since arrival in the United States on parent ratings. Results: The Spanish DBD-RS demonstrated strong internal consistency for both Inattention (α =.85) and Hyperactivity/Impulsivity (α =.85) subscales. Parent ADHD ratings were positively correlated with SDQ Hyperactivity/Inattention scores (r =.38, p &lt;.001), supporting concurrent validity. In regression analyses, parent time in the U.S. significantly predicted IRS impairment scores beyond ADHD symptoms (Δ R &lt;sup&gt;2&lt;/sup&gt; =.036, p =.035). Conclusion: Despite limitations such as reliance on self-report measures and cultural heterogeneity in the sample, this research contributes to understanding ADHD assessment in an under-studied ethnic group. Our findings contribute to ongoing efforts to refine diagnostic tools and promote equitable access to ADHD evaluations that are culturally appropriate for Hispanic/Latino children.</p> <p>Keywords: ADHD; Disruptive Behavior Disorders Rating Scale (DBD); Spanish language; child assessment</p> <hd id="AN0195587727-2">Introduction</hd> <p>ADHD is among the most common mental health disorders affecting children, characterized by persistent and impairing symptoms of inattention, hyperactivity, and impulsivity ([<reflink idref="bib14" id="ref1">14</reflink>]). ADHD symptoms can impair a child's ability to effectively function in academic, social, and familial settings. Children with ADHD may be more disruptive in classrooms, struggle to make friendships, and evidence low academic performance ([<reflink idref="bib22" id="ref2">22</reflink>]; [<reflink idref="bib41" id="ref3">41</reflink>]; [<reflink idref="bib54" id="ref4">54</reflink>]; [<reflink idref="bib62" id="ref5">62</reflink>]). In the United States, ADHD is typically diagnosed through a comprehensive evaluation process that includes clinical interviews with parents/caregivers, behavioral assessments, and gathering input from multiple sources such as teachers and coaches who are involved in the child's daily activities. Standardized rating scales, observational tools, and the diagnostic criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) are often used in the diagnostic process ([<reflink idref="bib2" id="ref6">2</reflink>]; [<reflink idref="bib44" id="ref7">44</reflink>]). In the United States, it is estimated that approximately 10% of children have ADHD, making it one of the most prevalent childhood disorders ([<reflink idref="bib42" id="ref8">42</reflink>]).</p> <p>ADHD is often identified during early childhood when a child enters school, as academic and behavioral demands become more challenging ([<reflink idref="bib19" id="ref9">19</reflink>]). However, while ADHD is a common and impairing neurodevelopmental disorder, it is particularly understudied, under-detected, and underserved in the Hispanic/Latino communities ([<reflink idref="bib28" id="ref10">28</reflink>]). The most recent U.S. census reports that there are an estimated 62 million individuals of Hispanic or Latino origin residing in the United States ([<reflink idref="bib58" id="ref11">58</reflink>]). The Hispanic community has faced challenges in accessing accurate diagnosis and treatment for ADHD. These challenges are often heightened by both access factors and cultural factors ([<reflink idref="bib28" id="ref12">28</reflink>]).</p> <hd id="AN0195587727-3">Mental Health Challenges in the Hispanic/Latino Community</hd> <p>Hispanic children are disproportionately less likely to be diagnosed and receive appropriate treatment for ADHD ([<reflink idref="bib18" id="ref13">18</reflink>]; [<reflink idref="bib26" id="ref14">26</reflink>]; [<reflink idref="bib40" id="ref15">40</reflink>]). The lack of clinical research on Latino families has made it difficult to identify the specific barriers between them and utilizing mental health services ([<reflink idref="bib28" id="ref16">28</reflink>]). A few of the contributing factors to this disparity that have been identified are linguistic differences, socioeconomic status, and limited awareness within the community.</p> <p>Hispanic/Latinos are less likely than Caucasians to report knowledge of ADHD in large national surveys ([<reflink idref="bib51" id="ref17">51</reflink>]) and are more likely to assign alternative attributions for ADHD behaviors being a result of poor parenting approaches or to be typical child behavior that will resolve as the child gets older ([<reflink idref="bib4" id="ref18">4</reflink>]; [<reflink idref="bib28" id="ref19">28</reflink>]). Early qualitative work suggested that ADHD might not be recognized within specific Hispanic groups. For example, in a preliminary study involving seven Cuban American mothers of children with ADHD, they reported difficulty in finding an explanation for their children's ADHD-like behavior, which led to the suggestion that ADHD might not be recognized within the Cuban culture ([<reflink idref="bib3" id="ref20">3</reflink>]). More recent studies provide stronger evidence that cultural context plays a key role in ADHD recognition. [<reflink idref="bib40" id="ref21">40</reflink>] found that Latino parents' interpretations of inattentive and hyperactive behaviors were shaped by cultural values which often led to alternative explanations than endorsement of ADHD symptoms as pathological. Similarly, [<reflink idref="bib52" id="ref22">52</reflink>] demonstrated that immigrant parents rated externalizing behaviors as more problematic when they violated cultural norms but were less likely than parents of the majority-culture to interpret other disruptive behaviors as impairing. These findings highlight that Hispanic/Latino parents may not recognize or under-report ADHD symptoms because cultural values and socialization beliefs impact whether disruptive behaviors are perceived as clinically significant. This also suggests that attributions about behavior, and ascribing behaviors to ADHD symptoms, may be influenced by acculturation, or by the amount of time living in the United States.</p> <p>It is also possible that stigma surrounding mental health has resulted in an under-reporting of ADHD symptoms. In the Hispanic/Latino community, studies suggest that mental health concerns are associated with "weakness" or lack of faith in God ([<reflink idref="bib30" id="ref23">30</reflink>]), and therefore resultant stigma. This stigma can impact the recognition and acceptance of ADHD as a neurodevelopmental condition despite the strong support for the neurological and genetic etiology of ADHD ([<reflink idref="bib40" id="ref24">40</reflink>]; [<reflink idref="bib64" id="ref25">64</reflink>]). Due to fears of social judgment and labeling, Hispanic parents may be hesitant to seek out ADHD assessment and treatment.</p> <hd id="AN0195587727-4">ADHD Assessment Measures</hd> <p>In addition to potential cultural/ethnic influences on ADHD assessment, there is little research on the key components of an ADHD diagnosis in Hispanic children ([<reflink idref="bib18" id="ref26">18</reflink>]). Considering the high prevalence of ADHD in children, the assessment process should be as efficient and cost-effective as possible to promote diagnosis and treatment while minimizing the time and financial strain on mental health professionals and families ([<reflink idref="bib25" id="ref27">25</reflink>]; [<reflink idref="bib45" id="ref28">45</reflink>]). Among these assessment tools is the Strengths and Difficulties Questionnaire (SDQ), used to screen emotional and behavioral concerns in children and adolescents. The SDQ has been translated and validated into 80 languages, and it is psychometrically sound ([<reflink idref="bib56" id="ref29">56</reflink>]). Another common assessment is the Impairment Rating Scale (IRS) used to assess ADHD-related impairment in children, allowing for caregivers to provide narrative descriptions of child impairment and ratings ([<reflink idref="bib20" id="ref30">20</reflink>]; [<reflink idref="bib22" id="ref31">22</reflink>]). One of the most common ADHD assessment tools, the Disruptive Behavior Disorder Rating Scale (DBD-RS) ([<reflink idref="bib46" id="ref32">46</reflink>]) has been used to evaluate symptoms of ADHD and related disruptive behavior disorders. The DBD-RS, like many diagnostic instruments, was primarily developed and normed within English-speaking populations, prompting questions about its applicability and validity when administered in different languages and to respondents from varied ethnicities and cultures ([<reflink idref="bib27" id="ref33">27</reflink>]). These measures represent distinct but complementary approaches to ADHD assessment, with each scale focusing on different domains such as symptom presence, functional impairment, or broader emotional and behavior concerns. Their availability in Spanish, combined with their coverage of both symptomatology and impairment, makes them particularly relevant for evaluating ADHD in Spanish-speaking Hispanic/Latino populations.</p> <p>As previously mentioned, there is a concern that ADHD may be under-diagnosed due to language barriers that exist between parents and the measures administered by healthcare providers ([<reflink idref="bib17" id="ref34">17</reflink>]). This is particularly important given that these rating scales are the primary mechanism for facilitating an evidence-based assessment for ADHD ([<reflink idref="bib45" id="ref35">45</reflink>]; [<reflink idref="bib63" id="ref36">63</reflink>]). In a study including 203 Spanish-speaking Latino parents, language difficulties were amongst the most common barriers to accessing health care for children ([<reflink idref="bib24" id="ref37">24</reflink>]), and there may not be accurate translations for Spanish terms ([<reflink idref="bib51" id="ref38">51</reflink>]). Prior work has emphasized that even when Spanish-language versions of parenting and behavioral measures demonstrate adequate psychometric properties, cultural context and acculturation may still influence how items are interpreted and endorsed by families ([<reflink idref="bib32" id="ref39">32</reflink>]). This highlights the importance of examining not only reliability and validity, but also the contextual factors that may shape parent report. Language barriers create a risk of inadequate assessment or delayed diagnosis which can result in negative consequences for a child's academic, social, and emotional development ([<reflink idref="bib33" id="ref40">33</reflink>]). Improper translation hinders the ability of primarily Spanish-speaking parents/caregivers to adequately understand and respond to the questions, and for clinicians to adequately evaluate for key behaviors, resulting in inaccurate assessment. Further, understanding the immigration history and acculturation level among Hispanics/Latinos in the United States is a crucial aspect of tailoring assessments and services that meet a family's specific needs ([<reflink idref="bib40" id="ref41">40</reflink>]). As parents view the child's behavior through the lens of their culture, perceptions of normative behavior in children may differ based on acculturation, impacting the rating of ADHD-related symptoms. Cultural differences, combined with limited familiarity with diagnostic tools used in the host country, may lead parents to feel more comfortable using more specific assessments of functional impairment, as captured by measures such as the IRS, which allows parents to provide a broad rating and narrative description of their child's behavior compared to ADHD symptom assessments such as the DBD-RS.</p> <p>Several Spanish-translated ADHD symptom rating scales have been validated across Spanish-speaking populations. For example, the Vanderbilt ADHD Diagnostic Parent Rating Scale has been translated and tested in Spanish-speaking families, demonstrating adequate psychometric properties ([<reflink idref="bib12" id="ref42">12</reflink>]). The ADHD Rating Scale-IV and its updated ADHD-RS-5 have also been validated in Spanish, with studies supporting their internal consistency and diagnostic accuracy in both European and Latin American Spanish samples ([<reflink idref="bib59" id="ref43">59</reflink>]). Also, the ADHD-FX Scale ([<reflink idref="bib31" id="ref44">31</reflink>]), developed with input from Latino communities, provides a culturally sensitive measure of functional impairment related to ADHD and has shown good reliability and validity in both English and Spanish versions. Together, these studies show that multiple Spanish translations of ADHD symptom measures exist; however, most have not explicitly examined how immigration-related factors such as acculturation may influence parent responses.</p> <p>[<reflink idref="bib27" id="ref45">27</reflink>] tested the psychometric properties, cultural meaning, and diagnostic utility of the Spanish translation of the Disruptive Behavior Disorders Rating Scale (DBD-S) with a sample of Spanish-speaking Latino parents. The results supported the reliability and validity of the scale but also revealed cultural limitations—most notably, that the Hyperactive/Impulsive subscale showed lower diagnostic utility and a positive correlation with Anglo acculturation, indicating possible cultural bias. The authors also discovered that Latino parents, especially those who were less acculturated, were less likely to view hyperactive-impulsive behaviors as problematic and were not always predictive of clinical ADHD diagnoses in their community sample. Gerdes and colleagues emphasized the need for culturally sensitive assessments and the inclusion of functional impairment measures as symptom-focused tools may not be the most appropriate measures for Latino communities.</p> <p>Further, although many Hispanics/Latinos speak the same language and have similar foundations, they have varied cultural backgrounds and immigration experiences ([<reflink idref="bib51" id="ref46">51</reflink>]). The Hispanic/Latino community is far from monolithic, speaking to the importance of creating assessment measures that are not only in Spanish but also culturally appropriate. Thus, there is a need to evaluate commonly deployed assessments for ADHD in diverse Hispanic/Latino ethnic groups.</p> <p>The present study extends prior Spanish-language psychometric research in several important ways. First, it focuses on ADHD assessment at the point of early identification in kindergarten and first grade, a period when diagnostic decisions are often first considered and when cultural and contextual factors may be especially salient for parent report. Second, the study integrates symptom endorsement with functional impairment, addressing calls to move beyond symptom counts alone when evaluating ADHD in culturally diverse populations. Third, the study examines an immigration-related context—operationalized as time since arrival in the United States—as a factor that may shape parental perceptions of child impairment. Together, these contributions situate the Spanish DBD-RS within a broader cultural and contextual framework and underscore the need for studying its relevance for clinical assessment with Spanish-speaking families.</p> <hd id="AN0195587727-5">Current Study</hd> <p>By examining how Spanish-speaking parents rate ADHD symptoms in comparison to other Spanish-speaking parents from a similar cultural context, we aspire to identify whether there are potential language-related biases in the assessment, if present. Our goal is to ensure the accuracy of ADHD assessment.</p> <hd id="AN0195587727-6">Aim 1</hd> <p>We sought to identify any inconsistencies in the diagnostic effectiveness of the Spanish translation of the Parent DBD-RS ([<reflink idref="bib8" id="ref47">8</reflink>]; [<reflink idref="bib46" id="ref48">46</reflink>]) among Spanish-speaking Hispanic/Latino parents by testing the item-to-total correlation. It was predicted that there would be acceptable levels of reliability within items, affirming its consistency as an assessment tool in the Hispanic community. It was also predicted that there will be significant differences in endorsed ADHD symptoms between parents and teachers, with teachers endorsing greater symptoms of ADHD. However, inter-rater reliability estimates would be within conventional ranges for inter-rater reliability across settings (i.e., home and school).</p> <hd id="AN0195587727-7">Aim 2</hd> <p>The Strengths and Difficulties Questionnaire (SDQ; [<reflink idref="bib29" id="ref49">29</reflink>]) is widely used, and it has been normed in various languages including Spanish ([<reflink idref="bib56" id="ref50">56</reflink>]). Using it as a reasonable comparison, the concurrent validity was assessed between the average ADHD score on the Spanish translated version of the DBD-RS and the hyperactivity/inattention factor on the Spanish SDQ. It was predicted that there would be a significant positive correlation between scores on the DBD-RS and the SDQ, reinforcing the concurrent validity of the Spanish-language DBD-RS in providing an accurate rating of the presence of ADHD symptoms.</p> <hd id="AN0195587727-8">Aim 3</hd> <p>Finally, to investigate the influence of time since United States arrival on parental reporting, we tested whether parents' length of time in the U.S. predicted impairment ratings on the IRS ([<reflink idref="bib22" id="ref51">22</reflink>]) after accounting for ADHD symptom severity on the DBD-RS. To assess this, we used a hierarchical regression model which allowed us to test whether immigration-related contextual factors (time since U.S. arrival as a proxy for acculturation) uniquely contributed to parent-reported impairment beyond what would be expected based on symptom severity alone. It was predicted that shorter time in the U.S. would be associated with higher parent-reported impairment on the IRS, even after accounting for parent-reported ADHD symptoms on the Spanish DBD-RS. This hypothesis reflects the possible impact of differences in culture and contextual factors on ADHD symptom recognition and acceptance, which may be more apparent due to longer time in the United States (e.g., more opportunity to discuss ADHD symptoms with medical providers or teachers; more exposure to ADHD through media or discussions with other caregivers; greater familiarity with U.S. classroom expectations).</p> <hd id="AN0195587727-9">Methods</hd> <p></p> <hd id="AN0195587727-10">Participants</hd> <p>Participants were from a larger treatment-based project that investigated behavior intervention methods for Spanish-speaking English language learners (Schatz et al., in preparation). The study sample consisted of Spanish-speaking Hispanic/Latino parents of children in kindergarten and first grade (N = 107). Table 1 lists demographic characteristics for the total sample. Based on reported country-of-birth information for the child, families represented a range of cultural backgrounds, including Cuban, Colombian, Venezuelan, Dominican, and other Hispanic/Latino origins, reflecting the cultural heterogeneity of South Florida. Participants were recruited from local public elementary schools that collaborated with the study. Families were invited to participate in the study from flyers and teacher recommendations.</p> <p>Table 1. Demographics.</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" colspan="2"&gt;Child information&lt;/th&gt;&lt;th align="center" colspan="2"&gt;Caregiver information&lt;/th&gt;&lt;th align="center" colspan="2"&gt;Teacher information&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt;Age (years)&lt;/td&gt;&lt;td&gt;6.42 (&lt;italic&gt;SD&lt;/italic&gt; = 1.22)&lt;/td&gt;&lt;td&gt;Age (years)&lt;/td&gt;&lt;td&gt;35.28 (&lt;italic&gt;SD&lt;/italic&gt; = 8.67)&lt;/td&gt;&lt;td colspan="2"&gt;Gender&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; Male&lt;/td&gt;&lt;td&gt;1.9%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; Female&lt;/td&gt;&lt;td&gt;89.7%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="2"&gt;Child biological sex&lt;/td&gt;&lt;td colspan="2"&gt;Relationship to the child&lt;/td&gt;&lt;td colspan="2"&gt;Race&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Male&lt;/td&gt;&lt;td&gt;64.5%&lt;/td&gt;&lt;td&gt; Biological Mother&lt;/td&gt;&lt;td&gt;94.3%&lt;/td&gt;&lt;td&gt; White&lt;/td&gt;&lt;td&gt;72%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Female&lt;/td&gt;&lt;td&gt;33.6%&lt;/td&gt;&lt;td&gt; Biological Father&lt;/td&gt;&lt;td&gt;5.6%&lt;/td&gt;&lt;td&gt; Black/African American&lt;/td&gt;&lt;td&gt;1.9%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="2"&gt;Race&lt;/td&gt;&lt;td colspan="2"&gt;Race&lt;/td&gt;&lt;td&gt; Asian&lt;/td&gt;&lt;td&gt;0.9%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; White&lt;/td&gt;&lt;td&gt;77.6%&lt;/td&gt;&lt;td&gt; White&lt;/td&gt;&lt;td&gt;81.2%&lt;/td&gt;&lt;td&gt; American Indian/Alaska Native&lt;/td&gt;&lt;td&gt;0&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Black/African American&lt;/td&gt;&lt;td&gt;5.6%&lt;/td&gt;&lt;td&gt; Black/African American&lt;/td&gt;&lt;td&gt;5.9%&lt;/td&gt;&lt;td&gt; Native Hawaiian or Other Pacific Islander&lt;/td&gt;&lt;td&gt;0&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Asian&lt;/td&gt;&lt;td&gt;0%&lt;/td&gt;&lt;td&gt; Asian&lt;/td&gt;&lt;td&gt;0&lt;/td&gt;&lt;td&gt; Other&lt;/td&gt;&lt;td&gt;13.1%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; American Indian/Alaska Native&lt;/td&gt;&lt;td&gt;1.9%&lt;/td&gt;&lt;td&gt; American Indian/Alaska Native&lt;/td&gt;&lt;td&gt;0&lt;/td&gt;&lt;td colspan="2"&gt;Ethnicity&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Native Hawaiian or Other Pacific Islander&lt;/td&gt;&lt;td&gt;1.9%&lt;/td&gt;&lt;td&gt; Native Hawaiian or Other Pacific Islander&lt;/td&gt;&lt;td&gt;2%&lt;/td&gt;&lt;td&gt; Hispanic/Latino&lt;/td&gt;&lt;td&gt;79.4%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="2"&gt;Ethnicity&lt;/td&gt;&lt;td colspan="2"&gt;Ethnicity&lt;/td&gt;&lt;td&gt; Not Hispanic/Latino&lt;/td&gt;&lt;td&gt;4.7%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Hispanic/Latino&lt;/td&gt;&lt;td&gt;97.2%&lt;/td&gt;&lt;td&gt; Hispanic/Latino&lt;/td&gt;&lt;td&gt;98.1%&lt;/td&gt;&lt;td&gt; Not answered&lt;/td&gt;&lt;td&gt;15.9%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Not Hispanic/Latino&lt;/td&gt;&lt;td&gt;0&lt;/td&gt;&lt;td&gt; Not Hispanic/Latino&lt;/td&gt;&lt;td&gt;0&lt;/td&gt;&lt;td colspan="2"&gt;Grade level&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Not Answered&lt;/td&gt;&lt;td&gt;2.8%&lt;/td&gt;&lt;td&gt; Not Answered&lt;/td&gt;&lt;td&gt;1.9%&lt;/td&gt;&lt;td&gt; Kindergarten&lt;/td&gt;&lt;td&gt;29.9%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Born in the U.S.&lt;/td&gt;&lt;td&gt;54.2%&lt;/td&gt;&lt;td&gt;Born in the U.S.&lt;/td&gt;&lt;td&gt;3.7%&lt;/td&gt;&lt;td&gt; First grade&lt;/td&gt;&lt;td&gt;60.7%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Born outside the U.S.&lt;/td&gt;&lt;td&gt;43.9%&lt;/td&gt;&lt;td&gt;Born outside the U.S.&lt;/td&gt;&lt;td&gt;94.4%&lt;/td&gt;&lt;td colspan="2"&gt;Total years teaching&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Age of Immigration&lt;/td&gt;&lt;td&gt;4.81 (&lt;italic&gt;SD&lt;/italic&gt; = 1.26)&lt;/td&gt;&lt;td&gt; Age of Immigration&lt;/td&gt;&lt;td&gt;27.23 (&lt;italic&gt;SD&lt;/italic&gt; = 9.34)&lt;/td&gt;&lt;td&gt; 1&amp;#8211;5 years&lt;/td&gt;&lt;td&gt;7.5%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; 6&amp;#8211;10 years&lt;/td&gt;&lt;td&gt;2.8%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="2"&gt;Grade Level&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; 11&amp;#8211;15 years&lt;/td&gt;&lt;td&gt;10.3%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Kindergarten&lt;/td&gt;&lt;td&gt;34.6%&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; 16&amp;#8211;20 years&lt;/td&gt;&lt;td&gt;24.3%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; First Grade&lt;/td&gt;&lt;td&gt;65.4%&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; More than 20 years&lt;/td&gt;&lt;td&gt;43.9%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="2"&gt;ESOL Level&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td colspan="2"&gt;Language Spoken to Student&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; 1&lt;/td&gt;&lt;td&gt;57%&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; English only&lt;/td&gt;&lt;td&gt;18.7%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; 2&lt;/td&gt;&lt;td&gt;14%&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; Spanish only&lt;/td&gt;&lt;td&gt;2.8%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; 3&lt;/td&gt;&lt;td&gt;17.8%&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt; English and Spanish&lt;/td&gt;&lt;td&gt;64.5%&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; 4&lt;/td&gt;&lt;td&gt;9.3%&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>1 <emph>Note.</emph> Percentages may not sum to 100% due to rounding.</p> <p>For inclusion, the child was in kindergarten or first grade, primarily Spanish-Speaking, enrolled in English for Speakers of Other Languages (ESOL) level 1–4, and illustrating evidence of behavior concerns (difficulties in attention, hyperactivity/impulsivity that interfered with functioning at home and/or at school) reported by caregiver or teacher. ESOL levels reflect English proficiency in Florida public schools: Level 1 = minimal English proficiency; Level 2 = limited proficiency; Level 3 = developing proficiency; and Level 4 = expanding proficiency, with continued support services provided.</p> <p>To determine eligibility, parents first completed a phone screen to collect demographic information, school history, and behavioral data. As part of this screen, the ADHD subsection of the DBD-RS was administered. Afterward, both the parent and the child's teacher were emailed behavior questionnaires to gather additional information on the child's behaviors at home and at school. Families were considered potentially eligible if their child exhibited at least 6 ADHD symptoms and was in the required grade and ESOL level.</p> <p>Parents who provided informed consent were then asked to participate in semi-structured clinical interviews. For the purposes of the present study only the rating scale portion of the DBD-RS was analyzed. Parents either completed the DBD-RS independently via REDCap ([<reflink idref="bib35" id="ref52">35</reflink>], [<reflink idref="bib34" id="ref53">34</reflink>]) or had the items read aloud to them over the phone by a trained study staff member. The child was administered the Wechsler Nonverbal Scale of Ability ([<reflink idref="bib61" id="ref54">61</reflink>]) by trained study staff to confirm an IQ score of 70 or higher. All procedures were approved by the Institutional Review Board.</p> <p>The current study aimed to evaluate the psychometric properties and validity of the Spanish translated version of the DBD-RS among Spanish-speaking Hispanic/Latino parents by examining internal consistency, inter-rater agreement with teachers, and identify the influence of time since arrival to the U.S. on parental reporting on the IRS compared to symptom endorsement in the DBD-RS.</p> <hd id="AN0195587727-11">Assessment Measures</hd> <p></p> <hd id="AN0195587727-12">Family Information Form (FIF)</hd> <p>Each caregiver in the study completed a Family Information Form to gather sociodemographic information, including child age/grade, child and parent race/ethnicity, parent's country of origin, parent's date of arrival to the U.S., parent level of education, and number of members living in the household.</p> <hd id="AN0195587727-13">DBD-RS</hd> <p>The Disruptive Behavior Disorder Rating Scale (DBD-RS; [<reflink idref="bib46" id="ref55">46</reflink>]) consists of 45 items rated on a four-point scale that assess the presence and severity of symptoms of ADHD and related disruptive behavior disorders. The Spanish translated version of the DBD-RS ([<reflink idref="bib8" id="ref56">8</reflink>]) was used for the current study. Parents were given the option to complete the rating scale online via REDCap, a secure, HIPAA-compliant data collection platform or orally over the phone. They were asked to rate the frequency and severity of ADHD-related behaviors observed for their children on the scale. Scores could range from 0 to 3, with higher scores indicating a greater frequency of the symptom occurrence. ADHD symptom counts were calculated for the 18 ADHD symptom items, with items rated as 2 ("pretty much") or 3 ("very much") counted as present symptoms, consistent with established scoring conventions. Symptom counts were derived separately for the Inattention (9 items) and Hyperactivity/Impulsivity (9 items) subscales and were used in analysis examining ADHD symptom severity. In addition, mean item scores were calculated by averaging item ratings within each subscale (range = 0–3). Mean item scores were used for descriptive statistics and for comparisons across informants and administration methods, as they facilitate comparison across raters. Teachers completed the standard English version of the DBD-RS, which parallels the parent-report version in item count, structure, and scoring, differing only by informant. To examine the relationship between individual symptoms and their relationship to the overall scales of the DBD-RS, item-to-total correlation analysis was performed. To examine if administration method impacted ratings, an independent samples <emph>t</emph>-test was conducted comparing total DBD-RS scores across groups. No statistically significant difference was observed, <emph>t</emph> (<reflink idref="bib96" id="ref57">96</reflink>) = 1.67, <emph>p</emph> =.098 (two-tailed), with slightly higher scores reported during oral administration (<emph>M</emph> = 2.87, <emph>SD</emph> = 1.19) than self-directed survey completion (<emph>M</emph> = 2.47, <emph>SD</emph> = 1.21). The effect size was small (<emph>d</emph> = 0.34), and the confidence interval included zero.</p> <hd id="AN0195587727-14">SDQ</hd> <p>The Strengths and Difficulties Questionnaire (SDQ; [<reflink idref="bib29" id="ref58">29</reflink>]) consists of 25 items rated on a three-point scale that assess emotional and behavioral concerns in children and adolescents. The SDQ, a well-established measure normed in various languages including Spanish—which was the version used for this current study—served as the comparison measure for assessing concurrent validity. Scores ranged from 0 to 2; higher scores indicated a greater frequency of the behavior. For this study, the Hyperactivity/Inattention subscale (5 items) was used, and raw sum scores were calculated.</p> <hd id="AN0195587727-15">IRS</hd> <p>The IRS ([<reflink idref="bib22" id="ref59">22</reflink>]) consists of 7 items rated on a seven-point scale ranging from "Not a problem" to "Severe problem" and parents provided a description of child's behavior for each domain. This scale assesses the impact of ADHD symptoms on various domains of child functioning. Ratings are from 0 ("No Problem; Definitely does not need treatment or special services") to 6 ("Extreme Problem; Definitely needs treatment or special services"). For the current study, an overall impairment score was calculated by averaging ratings across all seven items with higher scores reflecting greater impairment. The Spanish translation of the IRS was used in the current study ([<reflink idref="bib8" id="ref60">8</reflink>]). The Spanish versions of the DBD-RS and IRS were developed through a standardized translation and back-translation process.</p> <hd id="AN0195587727-16">Procedure</hd> <p>Parents were invited to participate in the study through flyers, outreach at school events, and teacher recommendations. Upon expressing interest, they were screened for eligibility through a phone interview, provided written informed consent, scheduled for a clinical intake interview, and sent data collection forms. Data collection involved parents completing the DBD-RS, SDQ, IRS, and FIF. Teachers of participating children were also contacted with parental consent and asked to complete corresponding behavioral rating forms, including the teacher version of the DBD-RS and IRS, to provide an external perspective on the child's functioning in school.</p> <hd id="AN0195587727-17">Data Analysis</hd> <p></p> <hd id="AN0195587727-18">Item-to-Total Correlation and Reliability Analysis</hd> <p>To evaluate the internal consistency of the Spanish DBD-RS, item-to-total correlations were calculated. To assess internal consistency reliability, Cronbach's alpha was calculated for the inattention and hyperactive/impulsive subscales. To analyze potential correspondence (or lack thereof) in ADHD symptoms endorsed across parents and teachers, paired t-tests were used.</p> <hd id="AN0195587727-19">Concurrent Validity with the SDQ</hd> <p>Concurrent validity was assessed by calculating Pearson's correlation coefficients between the ADHD scores on the Spanish DBD-RS and the Spanish SDQ.</p> <hd id="AN0195587727-20">Influence of Time Since Arrival on Parent-Reported Impairment</hd> <p>A multiple regression analysis was conducted to analyze the relationship between the time since arrival in the U.S. predicting impairment ratings beyond ADHD symptom severity. In Step 1, the total ADHD symptom count from the DBD-RS (18 ADHD symptom count items) was entered to account for symptoms. In the next step, years since arrival in the U.S. was entered using forced entry to test whether this immigration-related contextual factor predicted impairment beyond that attributable ADHD symptom severity.</p> <p>Methods in the study did not ask parents on what date they arrived at the U.S. Parents were asked their current age and the age in which they moved to the U.S. To calculate the variable of "parent time in the U.S." we subtracted parents age when they arrived and their current age. This was used as a proxy for U.S. acculturation in the sample (<emph>M</emph> = 8.64, <emph>SD</emph> = 9.25). Although less precise than a validated measure of U.S. acculturation, due to the reliance on archival data for this investigation, this proxy measure was deemed appropriate for this exploratory analysis. Proxy indicators are commonly used in applied research contexts when comprehensive acculturation measures are not feasible and previous work has found that time in host country may be a useful proxy of acculturation in samples of immigrant Latinos (e.g., [<reflink idref="bib13" id="ref61">13</reflink>]). A small number of parents (3.7%, <emph>n</emph> = 4) reported being born in the United States; these cases were kept in the analysis, as their self-reported time in the U.S. was used as a continuous predictor in the regression model.</p> <hd id="AN0195587727-21">Results</hd> <p>Descriptive statistics and bivariate correlations for the main study measures are presented in Table 2. The table includes parent and teacher reported ADHD symptom scores on the DBD-RS, parent reported impairment on the IRS, and parent ratings on the SDQ hyperactive/inattention subscale. These values provide an overview of the relationships among measures examined in the study and offer preliminary evidence for the validity and multi-informant consistency of the included measures. More detailed analyses of each study aim are presented in the paragraphs that follow.</p> <p>Table 2. Means, Standard Deviations, and Bivariate Correlations Among Parent and Teacher Ratings of ADHD Symptoms and Impairment.</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;Variable&lt;/th&gt;&lt;th align="center"&gt;&lt;italic&gt;n&lt;/italic&gt;&lt;/th&gt;&lt;th align="center"&gt;&lt;italic&gt;M&lt;/italic&gt;&lt;/th&gt;&lt;th align="center"&gt;&lt;italic&gt;SD&lt;/italic&gt;&lt;/th&gt;&lt;th align="center"&gt;1&lt;/th&gt;&lt;th align="center"&gt;2&lt;/th&gt;&lt;th align="center"&gt;3&lt;/th&gt;&lt;th align="center"&gt;4&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt;1. Parent DBD-RS (Severity Score)&lt;/td&gt;&lt;td&gt;98&lt;/td&gt;&lt;td&gt;1.34&lt;/td&gt;&lt;td&gt;0.61&lt;/td&gt;&lt;td align="center"&gt;&amp;#8212;&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;2. Teacher DBD-RS (Severity Score)&lt;/td&gt;&lt;td&gt;97&lt;/td&gt;&lt;td&gt;1.16&lt;/td&gt;&lt;td&gt;0.78&lt;/td&gt;&lt;td&gt;.25&lt;xref ref-type="table-fn" rid="tfn3"&gt;&amp;#42;&lt;/xref&gt;&lt;/td&gt;&lt;td align="center"&gt;&amp;#8212;&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;3. Parent IRS&lt;/td&gt;&lt;td&gt;99&lt;/td&gt;&lt;td&gt;1.46&lt;/td&gt;&lt;td&gt;1.33&lt;/td&gt;&lt;td&gt;.49&lt;xref ref-type="table-fn" rid="tfn3"&gt;&amp;#42;&amp;#42;&lt;/xref&gt;&lt;/td&gt;&lt;td&gt;.18&lt;/td&gt;&lt;td align="center"&gt;&amp;#8212;&lt;/td&gt;&lt;td /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;4. Parent SDQ&lt;/td&gt;&lt;td&gt;98&lt;/td&gt;&lt;td&gt;5.85&lt;/td&gt;&lt;td&gt;1.61&lt;/td&gt;&lt;td&gt;.47&lt;xref ref-type="table-fn" rid="tfn3"&gt;&amp;#42;&amp;#42;&lt;/xref&gt;&lt;/td&gt;&lt;td&gt;0.23&lt;xref ref-type="table-fn" rid="tfn3"&gt;&amp;#42;&lt;/xref&gt;&lt;/td&gt;&lt;td&gt;.05&lt;/td&gt;&lt;td align="center"&gt;&amp;#8212;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;5. Parent DBD-RS Inattention Symptom Count&lt;/td&gt;&lt;td&gt;98&lt;/td&gt;&lt;td&gt;3.77&lt;/td&gt;&lt;td&gt;2.90&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;6. Parent DBD-RS Hyperactivity/Impulsivity Symptom Count&lt;/td&gt;&lt;td&gt;98&lt;/td&gt;&lt;td&gt;3.72&lt;/td&gt;&lt;td&gt;2.53&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;7. Parent DBD-RS Total ADHD Symptom Count&lt;/td&gt;&lt;td&gt;98&lt;/td&gt;&lt;td&gt;7.49&lt;/td&gt;&lt;td&gt;4.94&lt;/td&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <ulist> <item>2 <emph>Note.</emph> DBD-RS severity scores reflect average ADHD symptom severity (0–3). DBD-RS symptom counts reflect the number of ADHD symptoms endorsed at ratings of 2 or 3. IRS scores reflect mean impairment across domains. SDQ Hyperactivity/Inattention scores represent summed item scores. All parent measures were completed using Spanish-translated versions. DBD-RS = Disruptive Behavior Disorders Rating Scale; IRS = Impairment Rating Scale; SDQ = Strengths and Difficulties Questionnaire.</item> <item>3 <emph>p</emph> &lt;.05. **<emph>p</emph> &lt;.01.</item> </ulist> <p>The first aim of this study was to assess the reliability of the Spanish translation of the Parent DBD-RS in measuring ADHD symptoms among Spanish-speaking Hispanic/Latino parents. To evaluate this aim, analyses to evaluate acceptable internal consistency were conducted. This included calculation of Cronbach's alpha for the Inattention and Hyperactivity subscales of the Spanish DBD-RS. An alpha value of 0.70 or higher was considered acceptable, indicating appropriate internal consistency. Internal consistency was calculated separately for the 9-item Inattention and Hyperactivity/Impulsivity subscales. For convergent validity, however, the combined 18-item ADHD total score was used. Additionally, item-to-total correlations were calculated to assess how well each item contributed to the overall scale. All analyses were performed using SPSS Version 29.</p> <p>The reliability of the Spanish translation of the Parent DBD-RS Inattention subscale was assessed using <emph>Cronbach's alpha</emph>. The overall <emph>Cronbach's alpha</emph> for the 9-item scale was.87, indicating acceptable internal consistency. Item-to-total correlations ranged from moderate to strong (<emph>r</emph> ranged from.46 to.74), with the weakest correlation observed for item 18 ("often does not seem to listen when spoken to directly"). Despite this, the removal of this item negligibly decreased the overall <emph>Cronbach's alpha</emph> from.866 to.864. These results suggest that the Spanish translation of the DBD-RS Inattention subscale demonstrated acceptable internal reliability. Results are displayed in Table 3.</p> <p>Table 3. Item-Total Statistics of the DBD-RS in Spanish Inattention Symptom Items.</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;DBD-RS inattention symptom items&lt;/th&gt;&lt;th align="center"&gt;Item-total correlation&lt;/th&gt;&lt;th align="center"&gt;Cronbach's alpha if item deleted&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt; 9. is often easily distracted by extraneous stimuli&lt;/td&gt;&lt;td&gt;.52&lt;/td&gt;&lt;td&gt;.86&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;18. often does not seem to listen when spoken to directly&lt;/td&gt;&lt;td&gt;.46&lt;/td&gt;&lt;td&gt;.86&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;23. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities&lt;/td&gt;&lt;td&gt;.61&lt;/td&gt;&lt;td&gt;.85&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;27. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)&lt;/td&gt;&lt;td&gt;.74&lt;/td&gt;&lt;td&gt;.84&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;29. often has difficulty sustaining attention in tasks or play activities&lt;/td&gt;&lt;td&gt;.61&lt;/td&gt;&lt;td&gt;.85&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;34. often loses things necessary for tasks for activities (e.g., toys, school assignments, pencils, books, or tools)&lt;/td&gt;&lt;td&gt;.59&lt;/td&gt;&lt;td&gt;.85&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;37. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)&lt;/td&gt;&lt;td&gt;.55&lt;/td&gt;&lt;td&gt;.86&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;42. often has difficulty organizing tasks and activities&lt;/td&gt;&lt;td&gt;.74&lt;/td&gt;&lt;td&gt;.84&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;44. is often forgetful in daily activities&lt;/td&gt;&lt;td&gt;.57&lt;/td&gt;&lt;td&gt;.86&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>4 <emph>Note.</emph> Cronbach's alpha values greater than.70 are typically considered acceptable for internal consistency reliability.</p> <p>The reliability of the DBD-Hyperactivity scale was assessed using <emph>Cronbach's alpha</emph>, which was found to be.803, indicating good internal consistency for the 9 items. Item-to-total correlations ranged from moderate to strong (<emph>r</emph> ranged from.40 to.61), with the weakest correlation observed for item 7 ("often talks excessively"). Despite this, the removal of this item negligibly decreased the overall Cronbach's alpha from.803 to.796. These findings support the reliability of the Spanish translation of the DBD-RS Hyperactivity subscale in assessing ADHD symptoms. Results are displayed in Table 4.</p> <p>Table 4. Item-Total Statistics of the DBD-RS in Spanish Hyperactivity Symptom Items.</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;DBD-RS hyperactivity symptom items&lt;/th&gt;&lt;th align="center"&gt;Item-total correlation&lt;/th&gt;&lt;th align="center"&gt;Cronbach's alpha if item deleted&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt; 1. often interrupts or intrudes on others (e.g., butts into conversations or games)&lt;/td&gt;&lt;td&gt;.42&lt;/td&gt;&lt;td&gt;.79&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; 7. often talks excessively&lt;/td&gt;&lt;td&gt;.40&lt;/td&gt;&lt;td&gt;.80&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;12. often fidgets with hands or feet or squirms in seat&lt;/td&gt;&lt;td&gt;.48&lt;/td&gt;&lt;td&gt;.79&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;19. often blurts out answers before questions have been completed&lt;/td&gt;&lt;td&gt;.41&lt;/td&gt;&lt;td&gt;.79&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;22. often has difficulty playing or engaging in leisure activities quietly&lt;/td&gt;&lt;td&gt;.56&lt;/td&gt;&lt;td&gt;.78&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;25. often leaves seat in classroom or in other situations in which remaining seated is expected&lt;/td&gt;&lt;td&gt;.49&lt;/td&gt;&lt;td&gt;.79&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;30. often has difficulty awaiting turn&lt;/td&gt;&lt;td&gt;.54&lt;/td&gt;&lt;td&gt;.78&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;33. is often on the go or often acts as if driven by a motor&lt;/td&gt;&lt;td&gt;.61&lt;/td&gt;&lt;td&gt;.77&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;35. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)&lt;/td&gt;&lt;td&gt;.55&lt;/td&gt;&lt;td&gt;.78&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>5 <emph>Note</emph>. Cronbach's alpha values greater than.70 are typically considered acceptable for internal consistency reliability.</p> <p>For Aim 1, Hypothesis 2, which predicts significant differences in ADHD symptom ratings between parents and teachers, a paired samples t-test was conducted. The test compared the mean ADHD ratings on the DBD-RS between parents and teachers, with the hypothesis that teachers will endorse higher symptom levels. Parents completed the Spanish DBD-RS and teachers completed the English DBD-RS. A one-tailed test was used because the hypothesis predicts a specific direction—teachers are expected to report higher ADHD symptoms. This approach is based on prior expectations and tests for a difference in only one direction. To handle missing data, listwise deletion was applied. Participants with missing data on either the parent or teacher ADHD ratings were excluded from the analysis. The final sample size for the paired samples <emph>t</emph>-test was reduced to 92 parent-teacher dyads (from an initial 107), resulting in approximately 14% missing data. This approach was selected to obtain comparability on each parent-teacher dyad for the t-test ([<reflink idref="bib47" id="ref62">47</reflink>]).</p> <p>A paired-samples <emph>t</emph>-test comparing parent and teacher reported mean ADHD severity scores on the DBD-RS indicated no statistically significant difference between informants, <emph>t</emph> (<reflink idref="bib91" id="ref63">91</reflink>) = 1.96, <emph>p</emph> =.053 (two-tailed). Although teachers were hypothesized to report higher ADHD severity than parent, parent reported slightly higher ADHD severity (<emph>M</emph> = 1.33, <emph>SD</emph> = 0.61) than teachers (<emph>M</emph> = 1.15, <emph>SD</emph> = 0.79). This difference was small in magnitude (<emph>d</emph> = 0.21). A modest positive correlation was observed between parent and teacher ratings, <emph>r</emph> (<reflink idref="bib92" id="ref64">92</reflink>) = 0.25, <emph>p</emph> = 0.018, indicating limited agreement across informants regarding children's ADHD symptoms. The second aim of this study was to assess the concurrent validity of the Spanish translated version of the DBD-RS by comparing its ADHD subset scores with the hyperactivity/inattention scores from the Spanish version of the SDQ. To evaluate Hypothesis 1, which predicts a significant positive correlation between the ADHD scores on the DBD-RS and the hyperactivity/inattention scores on the SDQ, a Pearson correlation analysis was conducted. A moderate positive correlation was found between the two measures, <emph>r</emph> =.47, <emph>p</emph> &lt;.001, suggesting that higher ratings of ADHD symptoms on the DBD-RS were associated with higher hyperactivity/inattention scores on the SDQ, demonstrating moderate concurrent validity. Results are displayed in Table 2.</p> <p>The third aim of this study examined whether parents' time since arrival in the United States predicted parent-reported functional impairment on the IRS after accounting for ADHD symptom severity (operationalized as the total ADHD symptom count on the DBD-RS). To explore this, a hierarchical regression was conducted with IRS average scores as the dependent variable. In Step 1, ADHD symptom count was entered to account for variance in impairment attributable to symptom level. In Step 2, parent time in the U.S. was entered to test whether time since arrival explained additional variance in impairment beyond symptom severity. To handle missing data, listwise deletion was applied. Participants with missing data on any of the measures were excluded from the analysis. The final sample size for the multiple regression analysis was reduced to 92 participants (from an initial 107), resulting in approximately 14% missing data.</p> <p>In Model 1, ADHD symptom count was a significant predictor of IRS scores, <emph>F</emph> (<reflink idref="bib1" id="ref65">1</reflink>, 89) = 33.76, <emph>p</emph> &lt;.001, <emph>R</emph><sups>2</sups> =.275). In Model 2, the addition of parent time in the U.S. significantly improved model fit, <emph>F</emph>(<reflink idref="bib1" id="ref66">1</reflink>, 88) = 4.60, <emph>p</emph> =.035, <emph>R</emph><sups>2</sups> change =.036). In the final model, both ADHD symptom count (<emph>b</emph> = 0.146, <emph>p</emph> &lt;.001) and time in the U.S. (<emph>b</emph> = 0.028, <emph>p</emph> =.002) were significant predictors of impairment, such that greater ADHD symptom ratings and longer time in the U.S. were associated with higher parent-reported impairment on the IRS. Results are displayed in Table 5.</p> <p>Table 5. Hierarchical Regression Predicting Parent-Reported Impairment (IRS).</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left"&gt;Effect&lt;/th&gt;&lt;th align="center"&gt;Estimate&lt;/th&gt;&lt;th align="center"&gt;&lt;italic&gt;SE&lt;/italic&gt;&lt;/th&gt;&lt;th align="center"&gt;95% CL [LL, UL]&lt;/th&gt;&lt;th align="center"&gt;&lt;italic&gt;p&lt;/italic&gt;&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td colspan="5"&gt;Model 1&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Intercept&lt;/td&gt;&lt;td&gt;.34&lt;/td&gt;&lt;td&gt;.22&lt;/td&gt;&lt;td&gt;[&amp;#8722;0.10, 0.78]&lt;/td&gt;&lt;td&gt;.123&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Parent ADHD ratings&lt;/td&gt;&lt;td&gt;.15&lt;/td&gt;&lt;td&gt;.03&lt;/td&gt;&lt;td&gt;[0.10, 0.19]&lt;/td&gt;&lt;td&gt;&amp;#60;.001&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="5"&gt;Model 2&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Intercept&lt;/td&gt;&lt;td&gt;0.10&lt;/td&gt;&lt;td&gt;.24&lt;/td&gt;&lt;td&gt;[&amp;#8722;0.39, 0.58]&lt;/td&gt;&lt;td&gt;.694&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Parent ADHD ratings&lt;/td&gt;&lt;td&gt;.15&lt;/td&gt;&lt;td&gt;.02&lt;/td&gt;&lt;td&gt;[0.10, 0.19]&lt;/td&gt;&lt;td&gt;&amp;#60;.001&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Parent time in the U.S.&lt;/td&gt;&lt;td&gt;.03&lt;/td&gt;&lt;td&gt;.01&lt;/td&gt;&lt;td&gt;[0.00, 0.05]&lt;/td&gt;&lt;td&gt;.002&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <ulist> <item>6 <emph>Note. n</emph> = 92. Parent ADHD ratings refers to the number of ADHD symptoms endorsed at ratings of 2 or 3 on the Spanish version of the DBD-RS.</item> <item>7 IRS = Impairment Rating Scale; CI = confidence interval; LL = lower limit; UL = upper limit.</item> </ulist> <hd id="AN0195587727-22">Discussion</hd> <p>The results of this study provide valuable insights into the reliability, validity, and contextual influences on the Spanish translation of the DBD-RS in measuring ADHD symptoms among Spanish-speaking Hispanic/Latino parents. Overall, findings suggest that the Spanish DBD-RS demonstrates acceptable reliability, moderate concurrent validity, and preliminary evidence that immigration-related factors influence parental reporting of child impairment.</p> <p>The first aim of this study was to assess the reliability of the Spanish translation of the Parent DBD-RS for measuring ADHD symptoms among Spanish-speaking Hispanic/Latino parents. The results of this analysis provided strong evidence for the internal consistency of both the Inattention and Hyperactivity subscales of the Spanish DBD-RS. This suggests good to excellent reliability in assessing ADHD symptoms within this population, which is crucial to ensure that the scale measures the intended constructs of ADHD symptoms across different samples of Spanish-speaking Hispanic/Latino parents. These results are comparable to estimates of reliability within English-language versions of the scales ([<reflink idref="bib22" id="ref67">22</reflink>]; [<reflink idref="bib46" id="ref68">46</reflink>]). The Inattention subscale showed moderate to strong item-to-total correlations (ranging from.462 to.737). Similarly, the Hyperactivity/Impulsivity subscale showed item correlations ranging from.397 to.614, with variability among items. However, removing any item did not substantially affect the subscale's overall reliability, further supporting the Spanish DBD-RS as a reliable tool for measuring ADHD symptoms in Spanish-speaking populations. Although the DBD-RS Spanish version reliability estimates are slightly lower than findings from other, similar ADHD symptoms ratings scales (e.g., [<reflink idref="bib59" id="ref69">59</reflink>]; <emph>Cronbach's alpha</emph> &gt;.90), the range of reliability estimates are within conventional standards for adequate psychometric properties. This is important, as many ADHD assessment tools, including the DBD-RS, were originally developed in English and may not have been tested for use in diverse cultural and linguistic groups. The acceptable internal consistency found in both the Inattention and Hyperactivity subscales supports the utility of the Spanish DBD-RS as a reliable tool for assessing ADHD symptomology.</p> <p>Although reliability findings supported the psychometric soundness of the DBD-RS, cultural considerations must be considered when interpreting the use of ADHD assessment tools in Hispanic/Latino populations. As stated previously, cultural perceptions about child behaviors may differ, with some of the behaviors associated with ADHD being viewed as normative given specific cultural contexts ([<reflink idref="bib6" id="ref70">6</reflink>]; [<reflink idref="bib9" id="ref71">9</reflink>]). This may impact symptom endorsement within standardized measures, including the DBD-RS, and create some discrepancies noted between parents' ratings and that of other informants, like teachers. The results of a paired-samples <emph>t</emph>-test indicated a significant difference between parent and teacher ratings, with parents endorsing greater symptoms of ADHD. This finding contrasts with some previous research suggesting that teachers may observe and report ADHD symptoms more frequently, especially in academic settings, where such behaviors as inattention and hyperactivity are more salient ([<reflink idref="bib10" id="ref72">10</reflink>]). However, it aligns with studies highlighting cultural and contextual influences on parental perceptions of ADHD ([<reflink idref="bib37" id="ref73">37</reflink>]; [<reflink idref="bib39" id="ref74">39</reflink>]; [<reflink idref="bib53" id="ref75">53</reflink>]). Recent research has found that immigrant students' cultural backgrounds influence their self-regulation abilities in academic environments, especially in cultures that emphasize deferred gratification and self-control ([<reflink idref="bib23" id="ref76">23</reflink>]).</p> <p>Importantly, teacher-level factors may shape how ADHD-related behaviors are interpreted across contexts, even when mean levels of symptom severity do not significantly differ between parents and teachers. In the same way that parents vary in cultural background and level of acculturation, so do teachers. Teachers' levels of acculturation and numbers of years teaching culturally and linguistically diverse students can influence their interpretation of behavior related to ADHD ([<reflink idref="bib16" id="ref77">16</reflink>]; [<reflink idref="bib36" id="ref78">36</reflink>]). Teachers with more experience in diverse classrooms or shared cultural backgrounds with students may be more adept at differentiating between culturally normative behavior and clinically significant symptoms. Conversely, teachers with limited exposure to immigrant populations or limited understanding of different cultures, may be less likely to recognize or endorse certain behaviors as problematic ([<reflink idref="bib49" id="ref79">49</reflink>]). Also, teachers may have factored the children's ESOL classification into their ratings, potentially leading to underreporting of ADHD symptoms if classroom challenges were interpreted as temporary language-related challenges rather than behavioral in nature ([<reflink idref="bib5" id="ref80">5</reflink>]). Together, these contextual factors may help explain the modest agreement observed between parent and teacher ratings and why our original hypothesis, that teacher would report higher ADHD symptoms than parents, was not supported in this sample. Consequently, even though the Spanish DBD-RS seems to be a reliable measure, the nuances in culture and context that impact symptom endorsement remain important to consider in diagnosing and treating these populations, particularly immigrant and minority populations, with accuracy.</p> <p>The results from the second aim of the study, which assessed the concurrent validity of the Spanish-translated version of the DBD-RS, largely supported the hypothesis that there would be a significant positive correlation between the ADHD scores on the DBD-RS and the hyperactivity/inattention scores on the Spanish-translated version of the SDQ. A moderate positive correlation exists between the ADHD scores on the DBD-RS and the hyperactivity/inattention scores on the SDQ (<emph>r</emph> =.38, <emph>p</emph> &lt;.001), suggesting that these two measures are evaluating related constructs. This finding is consistent with previous studies supporting the concurrent validity of the DBD-RS in English-speaking samples ([<reflink idref="bib22" id="ref81">22</reflink>]; [<reflink idref="bib45" id="ref82">45</reflink>]). The two measures are moderately correlated, indicating that although they seem to measure what apparently are overlapping domains of behavior, they are not interchangeable. The SDQ was designed to measure general behavioral and emotional difficulties, whereas the DBD-RS is focused on DSM symptoms, and this may explain non-overlap. However, the combination of measures may include the DBD-RS and SDQ for a comprehensive view of the child's behavioral and emotional functioning.</p> <p>The third aim, exploring the effect of time since arrival in the U.S. on parental reporting of ADHD symptoms. Contrary to our original hypothesis, greater time in the U.S. was associated with higher parent-reported impairment, even after controlling for ADHD symptom count. Although we initially expected that more recently arrived parents might be more likely to endorse impairment due to unfamiliarity with ADHD-specific diagnostic framework, the observed pattern suggests a different process. Over time, parents may become more attuned to how their child's behavior is evaluated within U.S. educational and clinical contexts. It is also possible that the broader questions embedded within an analysis of impairment also address associated difficulties, beyond ADHD symptoms, that may be experienced by immigrants (e.g., [<reflink idref="bib43" id="ref83">43</reflink>]). Thus, greater time in the U.S. may be associated with increased recognition of how children's difficulties interfere with daily functioning within U.S. systems. It is also possible that recently arrived parents conceptualize child behavior using culturally grounded frameworks that are not fully captured by standardized impairment measures, which may contribute to variability in impairment ratings across levels of time in the U.S. This is in line with previous research that suggests cultural differences in understanding ADHD and its presentation may lead to discrepancies in symptom endorsement ([<reflink idref="bib28" id="ref84">28</reflink>]). Taken together, these findings highlight that acculturation-related contextual factors may shape parents' perceptions of child impairment over time, above and beyond ADHD symptom severity, highlighting the importance of culturally responsive assessment practices when interpreting parent-reported impairment among immigrant families.</p> <hd id="AN0195587727-23">Limitations and Future Directions</hd> <p>While this study provides valuable insights into the psychometric properties of the Spanish-translated DBD-RS and its application in Hispanic/Latino populations, several limitations must be considered when interpreting the findings that may affect the generalizability, accuracy, and comprehensiveness of the results.</p> <p>Although the sample included families with children born in a range of Latin American countries (e.g., Cuban, Colombian, Venezuelan, Dominican)., all families were living in South Florida, an area with a large and culturally influential Hispanic/Latino population. Parent country of origin was not assessed; therefore, child birthplace should not be interpreted as a proxy for caregiver cultural background. This geographic focus may limit the generalizability of the findings to other regions of the U.S., where Hispanic/Latino communities may be smaller or less culturally prominent. The study also focuses on specific Spanish-speaking parents of kindergarten- and first-grade children; therefore, findings may be limited to these age groups or other populations that could involve bilingual, non-Spanish-speaking Hispanic/Latino, or non-immigrant families. Conclusions based on this study may not be generalizable to other ethnic and cultural groups with different child-rearing practices or different levels of ADHD awareness. It is also worth mentioning that results may differ in samples that have a broader or older age range. Second, the use of archival data limited the ability to control all potential confounding variables and hindered the inclusion of additional measures that may have enhanced the study through additional concurrent validity analyses or assessments of construct validity ([<reflink idref="bib15" id="ref85">15</reflink>]). Another limitation is the potential for method bias, as the same parents completed both the DBD-RS and the SDQ. This may have artificially inflated estimates of concurrent validity due to shared method variance. In addition, there is notable item-content overlap between the DBD-RS ADHD items and the SDQ Hyperactivity/Inattention subscale, which could further contribute to inflated correlations. Future studies should incorporate measures with distinct item content and multiple informants to reduce method bias and strengthen validity estimates. Additionally, the DBD-RS was administered either online via REDCap or orally over the phone, depending on parent preference. While oral administration ensured that reading ability did not interfere with comprehension of the assessment (Jensen et al., 2005), this may have introduced variability in how questions were understood and answered. Although efforts were made to standardize procedures across administration methods, no statistically significant difference emerged between oral and REDCap completion of the DBD-RS. A small, non-significant trend toward higher scores in oral administration was observed, which may reflect minor contextual effects (e.g., clarification or social desirability during phone administration) and highlights the importance of considering administration modes in future work.</p> <p>Further, the language discrepancy between the versions of the DBD-RS completed by parents and teachers may have influenced the accuracy of symptom endorsement. Although both versions of the tool aim to assess the same constructs, Spanish/English language differences could result in varied interpretations of certain items, potentially affecting the consistency of ADHD symptom reporting between parents and teachers. Since time in the U.S was used only as a proxy for acculturation and the regression was exploratory in nature, it should not be taken as definitive evidence of acculturation effects. Instead, it highlights the need for future research using validated acculturation scales and longitudinal designs to more precisely evaluate how contextual factors influence ADHD impairment reporting.</p> <p>Future studies could enhance generalizability by sampling Hispanic/Latino families from different parts of the United States, especially from regions where the Hispanic/Latino population is smaller or less dominant. This would help in better understanding the regional and cultural variations in perceiving and reporting ADHD symptoms. Other areas of future research might involve the refinement of cultural sensitivity in diagnostic instruments for ADHD, either by revising existing measures or developing new ones that better capture ADHD symptoms and impairments among the Hispanic/Latino population. Future research may also explore whether language proficiency influences ADHD symptom reporting by comparing bilingual Hispanic/Latino families to those speaking only Spanish. Such a study would be able to highlight how the barriers of language might influence parents' understanding of ADHD and their ability to report behavior appropriately. One promising direction would be the use of sentiment analysis ([<reflink idref="bib60" id="ref86">60</reflink>]). Sentiment analysis of emotional tone in the narrative descriptions provided by parents might elucidate cultural and emotional nuances in symptom reporting.</p> <p>It is also crucial to distinguish ADHD symptoms from other conditions that may present similarly, such as trauma, anxiety, adjustment difficulties, or language-related challenges. Immigrant children may experience stressors related to relocation, acculturation, and instability in their environment ([<reflink idref="bib7" id="ref87">7</reflink>]; [<reflink idref="bib43" id="ref88">43</reflink>]). These different stressors may manifest behaviorally as symptoms of inattention, hyperactivity, or impulsivity—which overlap significantly with ADHD but might be trauma-related or responses to their environment. Without trauma-informed assessments, clinicians may misinterpret trauma-related dysregulation (hyperarousal, emotional reactivity, and inattention) as ADHD, leading to inappropriate treatment approaches that are often centered on medications rather than addressing the root causes of distress ([<reflink idref="bib11" id="ref89">11</reflink>]; [<reflink idref="bib57" id="ref90">57</reflink>]). Disparities in diagnostic trends also continue among children of immigrant parents, as they are less likely to receive anxiety or depression diagnosis than their peers – even when ADHD is present ([<reflink idref="bib1" id="ref91">1</reflink>]). Furthermore, cultural beliefs, limited mental health knowledge and language barriers influence all stages of the ADHD care continuum, from diagnosis to treatment ([<reflink idref="bib55" id="ref92">55</reflink>]). Accurate diagnosis must account for the intersection of trauma exposure, cultural context, and immigration stressors to avoid misdiagnosis. The findings that more recent immigrating families endorsed greater rates of impairment may indicate that there were other factors in the sample impacting ratings, though this speculation would need to be verified through additional research.</p> <hd id="AN0195587727-24">Summary and Future Directions</hd> <p>This study contributes to the growing literature on ADHD assessment in Hispanic/Latino populations by examining the reliability, concurrent validity, and cultural considerations of the Spanish-translated Disruptive Behavior Disorder Rating Scale (DBD-RS). While the results suggest that the DBD-RS is a useful and valid instrument to measure ADHD symptoms in this population, they also highlight the requirement for culturally and linguistically responsive assessment tools that could help make diagnosis more accurate. The roles of these measures beyond diagnosis for other purposes of assessment (e.g., progress monitoring, treatment outcome) also need to be assessed ([<reflink idref="bib21" id="ref93">21</reflink>]; [<reflink idref="bib45" id="ref94">45</reflink>]). All this work points toward establishing mental health services that are equitable for Hispanic/Latino children and their families, which will translate into better diagnostic practices and better applications of treatments for ADHD.</p> <ref id="AN0195587727-25"> <title> References </title> <blist> <bibl id="bib1" idref="ref65" type="bt">1</bibl> <bibtext> Adzrago D., Sulley S., Williams F. (2025). Mental health in children with and without ADHD: The role of physical activity and parental nativity. Child and Adolescent Psychiatry and Mental Health, 19(1), 2.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref6" type="bt">2</bibl> <bibtext> American Psychiatric Association. (2022). 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Fabiano</bibtext> </blist> <blist> <bibl id="bib11" idref="ref89" type="bt"></bibl> <bibtext>Graph</bibtext> </blist> <blist> <bibl id="bib12" idref="ref42" type="bt"></bibl> <bibtext>https://orcid.org/0000-0001-9029-8493 Rosalia F. Gallo</bibtext> </blist> <blist> <bibl id="bib13" idref="ref61" type="bt"></bibl> <bibtext>Graph https://orcid.org/0009-0003-3876-9499</bibtext> </blist> <blist> <bibtext> The larger study from which these data were drawn was approved by the WCG Institutional Review Board for Florida International University (IRB #1312637).</bibtext> </blist> <blist> <bibtext> Written informed consent to participate was obtained from all participants as part of the larger IRB-approved study conducted at Florida International University. The current study involved secondary analysis of de-identified, anonymized data.</bibtext> </blist> <blist> <bibtext> Not applicable.</bibtext> </blist> <blist> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A210221 awarded to Florida International University. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education. The larger clinical trial from which data for this study were drawn is registered at ClinicalTrials.gov (Identifier: NCT05918991).</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The data that support the findings of this study are available from the corresponding author upon reasonable request.</bibtext> </blist> </ref> <aug> <p>By Carolina Ramirez; Nicole K. Schatz; Odette Fernandez; Beth M. Phillips; Christopher J. Lonigan; Gregory A. Fabiano and Rosalia F. Gallo</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> <p></p> <p>Carolina Ramirez is a PhD student in Clinical Psychology at Florida International University. She holds an MS in Psychology from FIU. Her research focuses on childhood ADHD, with a particular emphasis on the psychometric evaluation of assessment measures for Hispanic/Latino populations, ensuring they are culturally and linguistically appropriate for diverse communities.</p> <p>Nicole K. Schatz is a Research Associate Professor in the Psychology Department at Florida International University (FIU) and serves as the Clinical Director for the FIU Center for Children and Families. She is a clinical psychologist whose clinical work and program of research emphasizes evidence-based interventions for youth with ADHD.</p> <p>Odette Fernandez is a Program Manager at the Center for Children and Families at Florida International University. She holds an MS in Professional Counseling Psychology. Her work focuses on clinical research with children and adolescents, particularly in ADHD, behavioral assessment, and school-based mental health interventions.</p> <p>Beth M. Phillips is a Professor of Educational Psychology at the College of Education, Health, and Human Sciences at Florida State University and an Associate Director of the Florida Center for Reading Research. She researches the development of language and reading, early childhood education, professional development, and parent-support for early learning.</p> <p>Christopher J. Lonigan, Ph.D. is the Barbara H. and John L. Wasik Professor and Distinguished Research Professor in the Department of Psychology, and he is an associate director of the Florida Center for Reading Research at Florida State University. His research focuses on the assessment and development of early reading skills and externalizing behaviors, as well as interventions to improve child outcomes in these domains.</p> <p>Gregory A. Fabiano is a Professor of Psychology at Florida International University and core faculty in the Clinical Science program and Center for Children and Families. His research focuses on developing, validating, and implementing assessments and interventions for youth with ADHD, including school-based, family, and clinical approaches.</p> <p>Rosalia F. Gallo, PhD, Research Associate Professor/Adjunct Faculty, Florida International University. Over 35 years in special education including district level program supervision focusing on English Learners with disabilities in the Miami-Dade County Public Schools. ADHD and teacher- preparation are her current research interest with recent publications in both areas.</p> </aug> <nolink nlid="nl1" bibid="bib14" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib22" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib41" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib54" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib62" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib44" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib42" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib19" firstref="ref9"></nolink> <nolink nlid="nl9" bibid="bib28" firstref="ref10"></nolink> <nolink nlid="nl10" bibid="bib58" firstref="ref11"></nolink> <nolink nlid="nl11" bibid="bib18" firstref="ref13"></nolink> <nolink nlid="nl12" bibid="bib26" firstref="ref14"></nolink> <nolink nlid="nl13" bibid="bib40" firstref="ref15"></nolink> <nolink nlid="nl14" bibid="bib51" firstref="ref17"></nolink> <nolink nlid="nl15" bibid="bib52" firstref="ref22"></nolink> <nolink nlid="nl16" bibid="bib30" firstref="ref23"></nolink> <nolink nlid="nl17" bibid="bib64" firstref="ref25"></nolink> <nolink nlid="nl18" bibid="bib25" firstref="ref27"></nolink> <nolink nlid="nl19" bibid="bib45" firstref="ref28"></nolink> <nolink nlid="nl20" bibid="bib56" firstref="ref29"></nolink> <nolink nlid="nl21" bibid="bib20" firstref="ref30"></nolink> <nolink nlid="nl22" bibid="bib46" firstref="ref32"></nolink> <nolink nlid="nl23" bibid="bib27" firstref="ref33"></nolink> <nolink nlid="nl24" bibid="bib17" firstref="ref34"></nolink> <nolink nlid="nl25" bibid="bib63" firstref="ref36"></nolink> <nolink nlid="nl26" bibid="bib24" firstref="ref37"></nolink> <nolink nlid="nl27" bibid="bib32" firstref="ref39"></nolink> <nolink nlid="nl28" bibid="bib33" firstref="ref40"></nolink> <nolink nlid="nl29" bibid="bib59" firstref="ref43"></nolink> <nolink nlid="nl30" bibid="bib31" firstref="ref44"></nolink> <nolink nlid="nl31" bibid="bib29" firstref="ref49"></nolink> <nolink nlid="nl32" bibid="bib35" firstref="ref52"></nolink> <nolink nlid="nl33" bibid="bib34" firstref="ref53"></nolink> <nolink nlid="nl34" bibid="bib61" firstref="ref54"></nolink> <nolink nlid="nl35" bibid="bib96" firstref="ref57"></nolink> <nolink nlid="nl36" bibid="bib47" firstref="ref62"></nolink> <nolink nlid="nl37" bibid="bib91" firstref="ref63"></nolink> <nolink nlid="nl38" bibid="bib92" firstref="ref64"></nolink> <nolink nlid="nl39" bibid="bib37" firstref="ref73"></nolink> <nolink nlid="nl40" bibid="bib39" firstref="ref74"></nolink> <nolink nlid="nl41" bibid="bib53" firstref="ref75"></nolink> <nolink nlid="nl42" bibid="bib23" firstref="ref76"></nolink> <nolink nlid="nl43" bibid="bib16" firstref="ref77"></nolink> <nolink nlid="nl44" bibid="bib36" firstref="ref78"></nolink> <nolink nlid="nl45" bibid="bib49" firstref="ref79"></nolink> <nolink nlid="nl46" bibid="bib43" firstref="ref83"></nolink> <nolink nlid="nl47" bibid="bib15" firstref="ref85"></nolink> <nolink nlid="nl48" bibid="bib60" firstref="ref86"></nolink> <nolink nlid="nl49" bibid="bib57" firstref="ref90"></nolink> <nolink nlid="nl50" bibid="bib55" firstref="ref92"></nolink> <nolink nlid="nl51" bibid="bib21" firstref="ref93"></nolink> |
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| Items | – Name: Title Label: Title Group: Ti Data: Psychometric Evaluation of the Spanish Translation of the Disruptive-Behavior Disorder Rating Scale – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Carolina+Ramirez%22">Carolina Ramirez</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0003-5381-5748">0009-0003-5381-5748</externalLink>)<br /><searchLink fieldCode="AR" term="%22Nicole+K%2E+Schatz%22">Nicole K. Schatz</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4934-191X">0000-0002-4934-191X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Odette+Fernandez%22">Odette Fernandez</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0002-7321-1135">0009-0002-7321-1135</externalLink>)<br /><searchLink fieldCode="AR" term="%22Beth+M%2E+Phillips%22">Beth M. Phillips</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-7997-2843">0000-0002-7997-2843</externalLink>)<br /><searchLink fieldCode="AR" term="%22Christopher+J%2E+Lonigan%22">Christopher J. Lonigan</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8173-0723">0000-0001-8173-0723</externalLink>)<br /><searchLink fieldCode="AR" term="%22Gregory+A%2E+Fabiano%22">Gregory A. Fabiano</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9029-8493">0000-0001-9029-8493</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rosalia+F%2E+Gallo%22">Rosalia F. Gallo</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0003-3876-9499">0009-0003-3876-9499</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2026 30(9):1163-1177. – Name: Avail Label: Availability Group: Avail Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 15 – Name: DatePubCY Label: Publication Date Group: Date Data: 2026 – Name: SourceSuprt Label: Sponsoring Agency Group: SrcSuprt Data: Institute of Education Sciences (ED) – Name: NumberContract Label: Contract Number Group: NumCntrct Data: R324A210221 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Audience Label: Education Level Group: Audnce Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Kindergarten%22">Kindergarten</searchLink><br /><searchLink fieldCode="EL" term="%22Primary+Education%22">Primary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Grade+1%22">Grade 1</searchLink> – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Spanish%22">Spanish</searchLink><br /><searchLink fieldCode="DE" term="%22Translation%22">Translation</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Media+Adaptation%22">Media Adaptation</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Latin+Americans%22">Latin Americans</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Kindergarten%22">Kindergarten</searchLink><br /><searchLink fieldCode="DE" term="%22Grade+1%22">Grade 1</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Role%22">Language Role</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Behavior%22">Child Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Screening+Tests%22">Screening Tests</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Hispanic+Americans%22">Hispanic Americans</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Surveys%22">Parent Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Psychometrics%22">Psychometrics</searchLink> – Name: SubjectThesaurus Label: Assessment and Survey Identifiers Group: Su Data: <searchLink fieldCode="SU" term="%22Strengths+and+Difficulties+Questionnaire%22">Strengths and Difficulties Questionnaire</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1177/10870547261438171 – Name: ISSN Label: ISSN Group: ISSN Data: 1087-0547<br />1557-1246 – Name: Abstract Label: Abstract Group: Ab Data: Introduction: Evidence-based assessments for ADHD include the collection of standardized ratings of Diagnostic and Statistical Manual of Mental Disorders symptoms. There is limited research on ADHD diagnostic procedures in Hispanic/Latino children and a growing concern that ADHD may be underdiagnosed due to language barriers that exist between parents and the standardized measures. To address this gap, we examined potential language related biases in the assessment of ADHD among Spanish-speaking parents. Methods: The sample was 107 Hispanic/Latino, Spanish-speaking parents of children in kindergarten or first grade. The Spanish translated versions of the Disruptive Behavior Disorders Rating Scale (DBD-RS), Strength and Difficulties Questionnaire (SDQ), and Impairment Rating Scale (IRS) were administered to assess ADHD symptoms, concurrent validity, and the influence of time since arrival in the United States on parent ratings. Results: The Spanish DBD-RS demonstrated strong internal consistency for both Inattention (α = 0.85) and Hyperactivity/ Impulsivity (α = 0.85) subscales. Parent ADHD ratings were positively correlated with SDQ Hyperactivity/Inattention scores (r = 0.38, p < 0.001), supporting concurrent validity. In regression analyses, parent time in the U.S. significantly predicted IRS impairment scores beyond ADHD symptoms (ΔR² = 0.036, p = 0.035). Conclusion: Despite limitations such as reliance on self-report measures and cultural heterogeneity in the sample, this research contributes to understanding ADHD assessment in an under-studied ethnic group. Our findings contribute to ongoing efforts to refine diagnostic tools and promote equitable access to ADHD evaluations that are culturally appropriate for Hispanic/Latino children. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: CodeSource Label: IES Funded Group: SrcInfo Data: Yes – Name: DateEntry Label: Entry Date Group: Date Data: 20260101 – Name: AN Label: Accession Number Group: ID Data: EJ1513413 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1177/10870547261438171 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 15 StartPage: 1163 Subjects: – SubjectFull: Spanish Type: general – SubjectFull: Translation Type: general – SubjectFull: Behavior Problems Type: general – SubjectFull: Media Adaptation Type: general – SubjectFull: Attention Deficit Hyperactivity Disorder Type: general – SubjectFull: Latin Americans Type: general – SubjectFull: Preschool Children Type: general – SubjectFull: Kindergarten Type: general – SubjectFull: Grade 1 Type: general – SubjectFull: Language Role Type: general – SubjectFull: Child Behavior Type: general – SubjectFull: Screening Tests Type: general – SubjectFull: Questionnaires Type: general – SubjectFull: Hispanic Americans Type: general – SubjectFull: Parent Surveys Type: general – SubjectFull: Psychometrics Type: general – SubjectFull: Strengths and Difficulties Questionnaire Type: general Titles: – TitleFull: Psychometric Evaluation of the Spanish Translation of the Disruptive-Behavior Disorder Rating Scale Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Carolina Ramirez – PersonEntity: Name: NameFull: Nicole K. Schatz – PersonEntity: Name: NameFull: Odette Fernandez – PersonEntity: Name: NameFull: Beth M. Phillips – PersonEntity: Name: NameFull: Christopher J. Lonigan – PersonEntity: Name: NameFull: Gregory A. Fabiano – PersonEntity: Name: NameFull: Rosalia F. Gallo IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 09 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 1087-0547 – Type: issn-electronic Value: 1557-1246 Numbering: – Type: volume Value: 30 – Type: issue Value: 9 Titles: – TitleFull: Journal of Attention Disorders Type: main |
| ResultId | 1 |
