Contemporary School Psychology

, Volume 19, Issue 1, pp 54–62 | Cite as

Understanding ADHD from a Biopsychosocial-Cultural Framework: A Case Study

  • Andy V. PhamEmail author


The biopsychosocial-cultural framework is a systemic and multifaceted approach to assessment and intervention that takes into account biological, psychological, and socio-cultural factors that influence human functioning and service delivery. Although originally developed to assess physical health and medical illness, this contemporary model can be used as a framework for school psychologists to address the mental health needs of culturally and linguistically diverse youth with Attention-Deficit/Hyperactivity Disorder (ADHD). School psychologists can apply this model when conceptualizing academic, behavioral, and social-emotional functioning of children and adolescents, while also considering cultural barriers relating to treatment acceptability when working with families. Because it encourages school psychologists to address presenting problems in a culturally sensitive and contextual manner, this model may reduce bias and result in more equitable mental health outcomes. The purpose of this article is to discuss the biopsychosocial-cultural model, its advantages and disadvantages, and its application in a case study of a Hispanic child with ADHD.


Assessment Intervention Treatment acceptability Biopsychosocial ADHD 


  1. Achenbach, T. M. (2006). As others see us: clinical and research implications of cross-informant correlations for psychopathology. Current Directions in Psychological Science, 15, 94–98.CrossRefGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.CrossRefGoogle Scholar
  3. Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., Kassouf, K., Moone, S., & Grantier, C. (2013). EEG neurofeedback for ADHD double-blind sham-controlled randomized pilot feasibility trial. Journal of Attention Disorders, 17, 410–419.PubMedCentralPubMedCrossRefGoogle Scholar
  4. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.PubMedCrossRefGoogle Scholar
  5. Bauermeister, J. J., Canino, G., Bravo, M., Ramírez, R., Jensen, P. S., Chavez, L., Martínez-Taboas, A., Ribera, J., Alegría, M., & García, P. (2003). Stimulant and psychosocial treatment of ADHD in Latino/Hispanic children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 851–855.PubMedCrossRefGoogle Scholar
  6. Brassett-Harknett, A., & Butler, N. (2007). Attention-deficit/hyperactivity disorder: an overview of the etiology and a review of the literature relating to the correlates and lifecourse outcomes for men and women. Clinical Psychology Review, 27, 188–210.PubMedCrossRefGoogle Scholar
  7. Bronfenbrenner, U., & Ceci, S. J. (1994). Nature-nurture reconceptualized in developmental perspective: a bioecological model. Psychological Review, 101, 568–586.PubMedCrossRefGoogle Scholar
  8. Bussing, R., Zima, B. T., Gary, F. A., & Garvan, C. W. (2003). Barriers to detection, help-seeking, and service use for children with ADHD symptoms. Journal of Behavioral Health Services and Research, 30, 176–189.Google Scholar
  9. Carlson, J. S., Demaray, M. K., & Hunter-Oehmke, S. (2006). A survey of school psychologists’ knowledge and training in child psychopharmacology. Psychology in the Schools, 43, 623–633.CrossRefGoogle Scholar
  10. de Ramírez, R. D., & Shapiro, E. S. (2005). Effects of student ethnicity on judgments of ADHD symptoms among Hispanic and White teachers. School Psychology Quarterly, 20, 268–287.CrossRefGoogle Scholar
  11. Dufton, L. M., Dunn, M. J., & Compas, B. E. (2009). Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders. Journal of Pediatric Psychology, 34, 176–186.PubMedCentralPubMedCrossRefGoogle Scholar
  12. Eiraldi, R. B., & Power, T. J. (2001). Culturally-responsive, biopsychosocial intervention for ADHD and related problems. Journal of Cognitive and Behavioral Practice, 8, 181–189.CrossRefGoogle Scholar
  13. Eiraldi, R. B., Mazzuca, L. B., Clarke, A. T., & Power, T. (2006). Service utilization among ethnic minority children with ADHD: a model of help-seeking behavior. Administration and Policy in Mental Health, 33, 607–622.PubMedCrossRefGoogle Scholar
  14. Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196, 129–136.PubMedCrossRefGoogle Scholar
  15. Faraone, S. V., Perlis, R. H., Doyle, A. E., Smoller, J. W., Goralnick, J. J., Holmgren, M. A., & Sklar, P. (2005). Molecular genetics of attention deficit hyperactivity disorder. Biological Psychiatry, 57, 1313–1323.PubMedCrossRefGoogle Scholar
  16. Fiks, A. G., Mayne, S., DeBartolo, E., Power, T. J., & Guevara, J. P. (2013). Parental preferences and goals regarding ADHD treatment. Pediatrics, 132, 692–702.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Gidwani, P. P., Opitz, G. M., & Perrin, J. M. (2006). Mothers’ views on hyperactivity: a cross- cultural perspective. Journal of Developmental and Behavioral Pediatrics, 27, 121–126.PubMedCrossRefGoogle Scholar
  18. Gutierrez-Clellen, V. F., Calderon, J., & Ellis Weismer, S. (2004). Verbal working memory in bilingual children. Journal of Speech, Language, and Hearing Research, 47, 863–876.PubMedCrossRefGoogle Scholar
  19. Heartland Area Education Agency. (2002). Improving children’s educational results through data-based decision making. Johnston: Author.Google Scholar
  20. Ingraham, C. L. (2000). Consultation through a multicultural lens: multicultural and cross-cultural consultation in schools. School Psychology Review, 29, 320–343.Google Scholar
  21. Kazdin, A. E. (1981). Acceptability of child treatment techniques: the influence of treatment efficacy and adverse side effects. Behavior Therapy, 12, 493–506.CrossRefGoogle Scholar
  22. Lawton, K. E., Gerdes, A. C., Haack, L. M., & Schneider, B. (2014). Acculturation, cultural values, and Latino parental beliefs about the etiology of ADHD. Administration and Policy in Mental Health and Mental Health Services Research, 41(2), 189–204.PubMedCrossRefGoogle Scholar
  23. Loscalzo, M., Clark, K., Pal, S., & Pirl, W. F. (2013). Role of biopsychosocial screening in cancer care. The Cancer Journal, 19, 414–420.PubMedCrossRefGoogle Scholar
  24. Merrell, K. W., & Wolfe, T. M. (1998). The relationship of teacher‐rated social skills deficits and ADHD characteristics among kindergarten‐age children. Psychology in the Schools, 35, 101–110.CrossRefGoogle Scholar
  25. MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073–1086.CrossRefGoogle Scholar
  26. Olvera, P., & Cerrillo-Gomez, L. (2011). A bilingual approach (English & Spanish) psychoeducational assessment MODEL grounded in Cattell-Horn Carroll (CHC) Theory: a cross battery approach. Contemporary School Psychology, 15, 113–123.Google Scholar
  27. Ortiz, S. (2008). Best practices in nondiscriminatory assessment. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology (Vol. V, pp. 661–678). Bethesda: National Association of School Psychologists.Google Scholar
  28. Ortiz, S. O., & Ochoa, S. H. (2005). Conceptual measurement and methodological issues in cognitive assessment of culturally and linguistically diverse individuals. In R. L. Rhodes, S. H. Ochoa, & S. O. Ortiz (Eds.), Assessing culturally and linguistically diverse students: a practical guide (pp. 153–167). New York: Guilford Press.Google Scholar
  29. Pelham, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatment for attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 37, 184–214.CrossRefGoogle Scholar
  30. Pham, A. V., Carlson, J. S., & Kosciulek, J. F. (2010). Ethnic differences in parental beliefs of attention-deficit/hyperactivity disorder and treatment. Journal of Attention Disorders, 13, 584–591.PubMedCrossRefGoogle Scholar
  31. Plante, T. G. (2010). Contemporary clinical psychology. Hoboken: Wiley.Google Scholar
  32. Polanczyk, G., de Lima, M., Horta, B., Biederman, J., & Rohde, L. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry, 164, 942–948.PubMedCrossRefGoogle Scholar
  33. Power, T. J., Mautone, J. A., Soffer, S. L., Clarke, A. T., Marshall, S. A., Sharman, J., Blum, N. J., Glanzman, M., Elia, J., & Jawad, A. F. (2012). A family–school intervention for children with ADHD: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 80, 611–623.PubMedCentralPubMedCrossRefGoogle Scholar
  34. Rapport, M. D., Chung, K. M., Shore, G., & Isaacs, P. (2001). A conceptual model of child psychopathology: implications for understanding attention deficit hyperactivity disorder and treatment efficacy. Journal of Clinical Child Psychology, 30, 48–58.PubMedCrossRefGoogle Scholar
  35. Rhodes, R. L., Ochoa, S. H., & Ortiz, S. O. (2005). Assessing culturally and linguistically diverse students: a practical guide. New York: Guilford Press.Google Scholar
  36. Sanchez, S. V., Rodriguez, B. J., Soto-Huerta, M. E., Villarreal, F. C., Guerra, N. S., & Flores, B. B. (2013). A case for multidimensional bilingual assessment. Language Assessment Quarterly, 10, 160–177.CrossRefGoogle Scholar
  37. Schotte, C. K., Van Den Bossche, B., De Doncker, D., Claes, S., & Cosyns, P. (2006). A biopsychosocial model as a guide for psychoeducation and treatment of depression. Depression and Anxiety, 23, 312–324.PubMedCrossRefGoogle Scholar
  38. Shelley, B., Trimble, M., & Boutros, N. (2008). Electroencephalographic cerebral dysrhythmic abnormalities in the trinity of nonepileptic general population, neuropsychiatric, and neurobehavioral disorders. The Journal of Neuropsychiatry and Clinical Neurosciences, 20, 7–22.PubMedCrossRefGoogle Scholar
  39. Sibley, M. H., Waxmonsky, J. G., Robb, J. A., & Pelham, W. E. (2013). Implications of change for the field: ADHD. Journal of Learning Disabilities, 46, 34–42.PubMedCrossRefGoogle Scholar
  40. Sprenger, L., Gerhards, F., & Goldbeck, L. (2011). Effects of psychological treatment on recurrent abdominal pain in children—a meta-analysis. Clinical Psychology Review, 31, 1192–1197.PubMedCrossRefGoogle Scholar
  41. World Health Organization (Ed.). (2007). International classification of functioning, disability, and health: Children & youth version: ICF-CY. Author.Google Scholar
  42. Yeh, M., Hough, R. L., McCabe, K., Lau, A., & Garland, A. (2004). Parental beliefs about the causes of child problems: exploring racial/ethnic patterns. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 605–612.PubMedCrossRefGoogle Scholar

Copyright information

© California Association of School Psychologists 2014

Authors and Affiliations

  1. 1.College of EducationFlorida International UniversityMiamiUSA

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