Imperial College London

Rafael A. Gonzalez, PhD CPsychol

Faculty of MedicineFaculty of Medicine Centre

Honorary Clinical Lecturer
 
 
 
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Contact

 

r.gonzalez

 
 
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Location

 

Sir Alexander Fleming BuildingSouth Kensington Campus

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Summary

 

Publications

Publication Type
Year
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19 results found

Gonzalez RA, Velez-Pastrana MC, McCrory E, Kallis C, Aguila J, Canino G, Bird Het al., 2019, Evidence of concurrent and prospective associations between early maltreatment and ADHD through childhood and adolescence, SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY, Vol: 54, Pages: 671-682, ISSN: 0933-7954

Journal article

Coid JW, Hu J, Kallis C, Ping Y, Zhang J, Hu Y, Zhang T, Gonzalez R, Ullrich S, Jones PB, Kirkbride JBet al., 2018, Urban Birth, Urban Living, and Work Migrancy: Differential Effects on Psychotic Experiences Among Young Chinese Men, SCHIZOPHRENIA BULLETIN, Vol: 44, Pages: 1123-1132, ISSN: 0586-7614

Journal article

Pérez-Pedrogo C, Martínez-Taboas A, González RA, Caraballo JN, Albizu-García CEet al., 2018, Sex differences in traumatic events and psychiatric morbidity associated to probable posttraumatic stress disorder among Latino prisoners., Psychiatry Res, Vol: 265, Pages: 208-214

Latinos comprised 17.1% of the U.S. population and 33.1% of US prisoners, yet they are underrepresented in the psychopathology literature. Despite higher rates of trauma among incarcerated individuals than in the general population, most of the previous research in this area focused primarily on women samples, and very few studies examined sex differences in PTSD and traumatic experiences. In addition, there is a need for research assessing traumatic experiences and probable PTSD in men and women Latino inmates to inform culturally competent care and sex sensitive care for this vulnerable and underserved population. Our study examined whether men and women Latino inmates with probable Posttraumatic Stress Disorder (PTSD), based on the cut off 40 or more symptoms on the Davidson Trauma Scale (DTS), differed significantly by the number of event types experienced, the type of potentially traumatizing event, and in co-occurring psychiatric conditions. A multi-stage sample design was used to select a probabilistic sample of 1,331 inmates from 26 penal institutions in PR of which 1179 participated in the study. Bivariate associations were calculated for each type of traumatic event and probable PTSD. Mean number of types of potentially traumatizing event experienced was comparable for both sexes (F = 3.83, M = 3.74) yet sex differences were found in the nature of the event. Women with probable PTSD had higher rates of experiencing rape and sexual abuse. Men had higher rates of experiencing combat in war, a life-threatening accident, of witnessing violence, and being threatened with a weapon. Men with significant ADHD symptoms in childhood and with Generalized Anxiety Disorder (GAD) during adulthood were almost 5 and 7 times as likely to score above threshold on the DTS whereas women were >3 times as likely in the presence of ADHD symptoms in childhood or depression during adulthood. This study underscores the need to improve understanding of the clinical manifestations

Journal article

Roman-Ithier JC, Gonzalez RA, Velez-Pastrana MC, Gonzalez-Tejera GM, Albizu-Garcia CEet al., 2017, Attention deficit hyperactivity disorder symptoms, type of offending and recidivism in a prison population: The role of substance dependence, CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Vol: 27, Pages: 443-456, ISSN: 0957-9664

Journal article

Young S, González RA, Wolff K, Mutch L, Malet-Lambert I, Gudjonsson GHet al., 2017, Transitions and Motivations for Substance Misuse in Prison Inmates With ADHD and Conduct Disorder: Validation of a New Instrument., J Dual Diagn, Vol: 13, Pages: 91-100

OBJECTIVE: There is a reasonable theoretical base for understanding the possible causes and motivations behind substance misuse and its dependency. There is a need for a reliable and valid measure that delineates the markers of substance use from its initiation and identifies different motivations for drug use transitioning, maintenance, and dependency. We addressed this gap in the United Kingdom by examining and validating the Substance Transitions in Addiction Rating Scale (STARS). METHODS: For this review, 390 male prisoners were screened for conduct disorder and assessed with a clinical diagnostic interview for attention deficit/hyperactivity disorder (ADHD). They completed the four STARS subscales regarding their substance use. Exploratory structural equation modeling was performed to assess the STARS structure and to derive factors to assess validity against ADHD and conduct disorder diagnostic categories. RESULTS: Each of the subscales produced meaningful and reliable factors that supported the self-medication and behavioral disinhibition hypotheses of substance use motivation. The findings robustly show that ADHD is significantly associated with the need for coping as a way of managing primary and comorbid symptoms, but not conduct disorder. The findings were strongest for the combined ADHD type. DISCUSSION: STARS has a great potential to further the understanding of the motivation behind substance use and its dependency in different populations.

Journal article

Davoren M, Kallis C, Gonzalez RA, Freestone M, Coid JWet al., 2017, Anxiety disorders and intimate partner violence: can the association be explained by coexisting conditions or borderline personality traits?, JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY, Vol: 28, Pages: 639-658, ISSN: 1478-9949

Journal article

Coid JW, Gonzalez R, Igoumenou A, Zhang T, Yang M, Bebbington Pet al., 2017, Personality disorder and violence in the national household population of Britain, JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY, Vol: 28, Pages: 620-638, ISSN: 1478-9949

Journal article

Gonzalez RA, Igoumenou A, Kallis C, Coid JWet al., 2016, Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment, BMC Psychiatry, Vol: 16, ISSN: 1471-244X

Journal article

Vélez-Pastrana MC, González RA, Rodríguez Cardona J, Purcell Baerga P, Alicea Rodríguez Á, Levin FRet al., 2016, Psychometric properties of the Barkley Deficits in Executive Functioning Scale: A Spanish-Language Version in a community sample of puerto rican adults., Psychol Assess, Vol: 28, Pages: 483-498

Performance-based measures have shown some limitation in the assessment of executive functioning (EF) and rating scales have been proposed as an alternative. Our aim was to conduct a comprehensive psychometric evaluation of the Barkley Deficits in Executive Functioning Scale (BDEFS), as administered in 452 Latino community adults (65.5% female). The BDEFS was back-translated into Spanish. We performed exploratory factor analysis (EFA) to assess the structure of the translated BDEFS and to compare it with the original five-factor structure based on the English-language version. Confirmatory factor analysis (CFA) was performed to test the original language structure of the instrument, and also a modified version with items that loaded equally in both versions. The Adult Self-Report Scale was used to screen for ADHD symptoms. We assessed invariance on the latent factor's mean by age and gender, and to estimate associations with ADHD symptom dimensions. The five-factor structure of the BDEFS was partially supported by EFA/CFA, in which 78 out of 89 items loaded similar to the original English-language structure. Factor scores were significantly associated with ADHD symptom dimensions. Model-based contrasts revealed that inattention was primarily associated with disorganization, time-management and motivational aspects of EF; hyperactivity was predominantly related to self-restraint and self-regulation factors. The BDEFS seemingly assesses similar dimensions of the EF construct in English and in the present Spanish-language versions. Factor scores were differentially associated with ADHD subtypes. Replication and confirmation of the Spanish-language BDEFS in a larger sample is advised. (PsycINFO Database Record

Journal article

Barnicot K, Gonzalez R, McCabe R, Priebe Set al., 2016, Skills use and common treatment processes in dialectical behaviour therapy for borderline personality disorder, Journal of Behavior Therapy and Experimental Psychiatry, Vol: 52, Pages: 147-156, ISSN: 0005-7916

BACKGROUND AND OBJECTIVES: Dialectical behaviour therapy (DBT) trains participants to use behavioural skills for managing their emotions. The study aimed to evaluate whether skills use is associated with positive treatment outcomes independently of treatment processes that are common across different therapeutic models. METHOD: Use of the DBT skills and three common treatment processes (therapeutic alliance, treatment credibility and self-efficacy) were assessed every 2 months for a year in 70 individuals with borderline personality disorder receiving DBT. Mixed-multilevel modelling was used to determine the association of these factors with frequency of self-harm and with treatment dropout. RESULTS: Participants who used the skills less often at any timepoint were more likely to drop out of DBT in the subsequent two months, independently of their self-efficacy, therapeutic alliance or perceived treatment credibility. More frequent use of the DBT skills and higher self-efficacy were each independently associated with less frequent concurrent self-harm. Treatment credibility and the alliance were not independently associated with self-harm or treatment dropout. LIMITATIONS: The skills use measure could not be applied to a control group who did not receive DBT. The sample size was insufficient for structural equation modelling. CONCLUSION: Practising the DBT skills and building an increased sense of self-efficacy may be important and partially independent treatment processes in dialectical behaviour therapy. However, the direction of the association between these variables and self-harm requires further evaluation.

Journal article

Young SJ, Gonzalez RA, Mutch L, Mallet-Lambert I, O'Rourke L, Hickey N, Asherson P, Gudjonsson Get al., 2016, Diagnostic accuracy of a brief screening tool forAttention Deficit/Hyperactivity Disorder in UK prison inmates, Psychological Medicine, Vol: 46, Pages: 1449-1458, ISSN: 1469-8978

Background: Attention Deficit/Hyperactivity Disorder (ADHD) is overrepresented in prison, makingit imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder.We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHDRating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen wasthen developed in order to simplify its use in the prison context, and maximise its diagnosticproperties. Methods: A cross-sectional study of 390 male prison inmates performed in the UnitedKingdom, who were all screened and interviewed via the Diagnostic Interview for ADHD in Adults2.0 (DIVA-2). Results: A total of 47 (12.1%) inmates screened positive for ADHD using the fullBAARS-IV, and 96 were clinically diagnosed (24.6%), for a sensitivity of 37.9 and specificity of96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted OddsRatios (OR) ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation, with weighted probabilityscores producing AUC of 0.89 and 0.82, respectively. Conclusions: The original BAARS-IVperformed poorly at identifying prison inmates with ADHD. Our developed brief scale substantiallyimproved diagnostic accuracy. The brief screening instrument has great potential to be used as anaccurate and resource effective tool to screen young people and adults for likely ADHD in thecriminal justice system.

Journal article

Gonzalez RA, Kallis C, Ullrich S, Barnicot K, Keers R, Coid JWet al., 2016, Childhood maltreatment and violence: Mediation through psychiatric morbidity, Child Abuse & Neglect, Vol: 52, Pages: 70-84, ISSN: 0145-2134

Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21–34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.

Journal article

Young SJ, Gonzalez R, Mutch L, Mallet-Lambert L, O'Rourke L, Hickey N, Asherson P, Gudjonsson Get al., 2015, Diagnostic accuracy of a brief screening tool, Psychological Medicine, ISSN: 1469-8978

Journal article

Gudjonsson GH, Sigurdsson JF, Sigfusdottir ID, Asgeirsdottir BB, Gonzalez RA, Young SJet al., 2015, A national epidemiologial study investigating risk factors for police interrogation and false confession among juveniles and young persons, Social Psychiatry and Psychiatric Epidemiology, Vol: 51, Pages: 359-367, ISSN: 1433-9285

PurposeThe principal aims of this study are to identify risk factors associated with police arrest and false confessions and to investigate whether the severity of the ADHD condition/symptoms increases the risk.Methods22,226 young persons in Iceland anonymously completed self-report questionnaires screening for conduct disorder and ADHD. In addition, they stated whether they had a diagnosis of ADHD and had received ADHD medication, and their history of offending, police interrogation and false confession. Participants were stratified into two age groups, 14–16 and 17–24 years.ResultsThe older group was significantly more likely to have been interrogated by the police but the younger group were much more vulnerable to false confession during interrogation. Males were more likely to be at risk for both than females. The severity of the ADHD condition increased the risk of both interrogation and false confession. Negative binomial regressions showed that age, gender, conduct disorder, offending, and ADHD symptoms were all significant predictors of both interrogations and number of false confessions. Conduct disorder was the single best predictor of police interrogation, but the findings were more mixed regarding false confessions. Young people presenting with a combination of severe ADHD and comorbid conduct disorder had the worst outcome for both interrogation and false confessions.ConclusionsThe findings endorse the need for support of persons with ADHD to be put in place to ensure fair due process and to prevent miscarriages of justice.

Journal article

Young SJ, Sedgwick O, Fridman M, Gudjonsson G, Hodgkins P, Lantigua M, Gonzalez RAet al., 2015, Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis, Psychological Medicine, Vol: 45, Pages: 2499-2510, ISSN: 1469-8978

Background. Rates of psychiatric disorders are highly prevalent among prison inmates, and recent evidence confirmsover-representation of youths and adults with attention deficit hyperactivity disorder (ADHD). The risk for psychiatricco-morbidity may be greater among offenders with ADHD. We undertook a systematic review and meta-analysis ofreported rates of co-existing psychiatric morbidity with ADHD in prison samples.Method. Studies published from 1980 to 2015 were identified using five bibliographic indexes, review articles and referencelists. Included studies had a defined ADHD group and provided additional prevalence on at least one of the following:conduct disorder, substance use disorder, mood disorder, anxiety disorder, or personality disorder. Weperformed meta-analytical estimates of the prevalence of each co-morbid disorder within ADHD, and estimated therisk for co-existing disorders among prisoners with ADHD by pooling odds ratios (OR) with 95% confidence intervals.Results. Eighteen studies with data for 1615 with ADHD and 3128 without ADHD were included. The risk (OR) of allpsychiatric morbidity is increased among adult inmates with ADHD. Associations in youths with ADHD were restrictedto mood disorder (OR 1.89, 95% confidence interval 1.09–3.28).Conclusions. This study quantifies the extent of co-morbidity presented by offenders with ADHD, especially adults. Thedifferences between risk estimates for youths and adults indicate an incremental effect in both frequency and severity forthe development of further co-morbid pathology through adulthood. The findings have implications for clinical interventionand for criminal justice policy.

Journal article

González RA, Vélez-Pastrana MC, Ruiz Varcárcel JJ, Levin FR, Albizu-García CEet al., 2015, Childhood ADHD symptoms are associated with lifetime and current illicit substance-use disorders and in-site health risk behaviors in a representative sample of Latino prison inmates., J Atten Disord, Vol: 19, Pages: 301-312

OBJECTIVE: This study aimed to explore retrospective childhood ADHD symptomatology, psychiatric comorbidity, rates of substance-use disorders (SUD), as well as their association with high-risk health behaviors in prison and adverse health outcomes. METHOD: A randomly selected representative sample of inmates in the Puerto Rico correctional system (N = 1,179) was assessed with the Spanish-language Wender Utah Rating Scale (WURS); the Composite International Diagnostic Interview (CIDI) modules for lifetime/current major depression disorder (MDD), generalized anxiety disorder (GAD), and SUD; the Davidson Trauma Scale (DTS; posttraumatic stress disorder [PTSD]); and self-reports of in-site high-risk behaviors. RESULTS: Wald χ(2) tests revealed significant associations of ADHD with MDD and PTSD, as well as increased risk for overdosing and intravenous drug use in prison. A logistic regression model adjusted for mood and anxiety comorbidity predicted lifetime SUD diagnosis (odds ratio = 2.38; 95% confidence interval = [1.15, 4.94]). CONCLUSION: Our results provide further evidence on the association of drug dependence and ADHD symptoms, and their overrepresentation among prison inmates.

Journal article

Gonzalez RA, Kallis C, Ullrich S, Zhang T, Coid JWet al., 2014, The protective role of higher intellectual functioning on violence in the household population of Great Britain, PERSONALITY AND INDIVIDUAL DIFFERENCES, Vol: 61-62, Pages: 80-85, ISSN: 0191-8869

Journal article

Gonzalez RA, Kallis C, Coid JW, 2013, Adult Attention Deficit Hyperactivity Disorder and Violence in the Population of England: Does Comorbidity Matter?, PLOS ONE, Vol: 8, ISSN: 1932-6203

Journal article

Gonzalez RA, Gudjonsson GH, Wells J, Young Set al., 2013, The Role of Emotional Distress and ADHD on Institutional Behavioral Disturbance and Recidivism Among Offenders, Journal of Attention Disorders, Vol: 20, Pages: 368-378, ISSN: 1557-1246

Objective: The aim of this study was to examine the role of emotional distress as well as ADHD symptomatology in explaining (a) recidivism, (b) behavioral disturbances in prison, and (c) violent and nonviolent offending. Method: In all, 196 male prisoners from Aberdeen prison completed the Symptom Checklist-90, which examines various clinical symptoms and emotional distress. Current adult symptoms were assessed by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for ADHD. Results: Emotional distress and ADHD explained the variance in prison records of behavioral disturbance above and beyond antisocial personality (ASP) traits; however, much of the effect of emotional distress was mediated by ADHD symptoms. Only ADHD symptoms were significantly associated to history of violent offending, whereas ASP and age mostly explained nonviolent offenses and overall recidivism. Conclusion: Our results provide support for the conceptual association between ADHD and its related emotional dimension with behavioral disturbance in prison, suggesting a link to reactive violence. (J. of Att. Dis. 2013; XX(X) 1-XX).

Journal article

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