Culture and child development
of instruments and diagnostic categories, and
accessibility of services.
Cross-cultural epidemiological studies are too
varied for firm conclusions to be drawn about
worldwide rates and patterns. There is little evi-
dence for culture-specific syndromes, but disso-
ciative disorders such as trance and possession in
adolescence related to rapid social change in parts
of the world where possession beliefs exist, are
reported [16].
The systematic review of the mental health
of children of the main ethnic groups in Britain
by Goodman
et al
. [17] shows comparable, if
not better mental health in minority children,
given the socioeconomic deprivation of Pakistanis,
Bangladeshis and Afro-Caribbeans in Britain, and
it underscores the need to research the interplay
between risk and protective factors for different
communities. A few child psychiatry disorders will
be used to explore the complexities involved.
A systematic review of attention deficit hyper-
activity disorder [18] estimated the worldwide
pooled prevalence at 5.29%, although notably
approximately two-thirds of the 102 studies were
from North America and Europe. The authors
emphasize caution in interpreting the results
because of the variability in findings. Variation
in prevalence ranged from 1% to 20%. Despite
attempts at standardization, significant differences
between raters from different countries remain.
This has provoked a debate about cultural
constructions in diagnosis and treatment, and
whether the differences in ADHD rates also
reflect different thresholds in tolerance for
non-conforming behaviours in children [19].
The evidence for the role of culture in the
aetiology of eating disorders related to weight con-
sciousness is evidenced by wide variation in rates
worldwide, and rising rates attributed to culture
change through urbanization and modernization.
In The Netherlands, Van Son [20] found a five-
fold increase of bulimia with urbanization between
1985 and 1999.
A review of non-fatal self-harm in the UK
[21] described higher rates amongst South Asian
female adolescents. Notably, a high prevalence
is not reported from South Asia. Although the
authors refer to culture conflict, other explanations
need to be considered. For example, Reese [22]
found that migrant parents who perceive a higher
risk for young people in the new environment
exercise greater boundary control over adoles-
cents than would be exercised in the country
of origin, resulting in greater inter-generational
conflict. Self-harming behaviour itself may be an
appropriated cultural way of expressing distress
by South Asian girls in the UK.
CONCLUSION
As culture and ethnicities are always evolving,
a foreclosure of the debate is never possible. A
more productive alternative is the development of
a framework for understanding the centrality of
culture in child development based on the exten-
sive cross-cultural literature available. However, as
familiarity with one’s own cultural norms is often
the starting point for studying difference, ‘cultural
difference’ is often subsumed by the issue of ‘differ-
ent moralities’. But for mental health professions
culture is a potent tool for promoting reflexivity,
and widening our horizons by including knowledge
about the everyday lives of children from parts of
the world where the majority of children live.
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