Child and Adolescent Psychiatry: Asian Perspectives

497 Pages·2016·5.34 MB·English

by  Savita Malhotra

Savita Malhotra · Paramala Santosh
Editors
Child and
Adolescent
Psychiatry
Asian Perspectives
Child and Adolescent Psychiatry
Savita Malhotra · Paramala Santosh
Editors
Child and Adolescent
Psychiatry
Asian Perspectives
1 3
Editors
Savita Malhotra Paramala Santosh
Post Graduate Institute of Medical Centre for Interventional Paediatric
Education and Research (PGIMER) Psychopharmacology and Rare
Chandigarh Diseases (CIPPRD)
India National and Specialist Child
and Adolescent Mental Health
Services, Michael Rutter Centre
Maudsley Hospital
London
UK
and
Department of Child and Adolescent
Psychiatry
Institute of Psychiatry, Psychology
and Neuroscience (IoPPN),
King’s College London
London
UK
ISBN 978-81-322-3617-7 ISBN 978-81-322-3619-1 (eBook)
DOI 10.1007/978-81-322-3619-1
Library of Congress Control Number: 2016950746
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Foreword
“Perspective,” from the Latin perspicere, or “to see through,” is a particular atti-
tude toward or way of regarding something, in the present instance, child and
adolescent psychiatry in Asia. In essence, this “perspective” offers a point of view
or frame of reference for this rapidly emerging scientific and clinical discipline
in the most populated region of our globe. While Asia has an extraordinary intel-
lectual and cultural history, the study of child development and developmental
psychopathology has been relatively neglected until recently and it remains a rela-
tively new and, as Malhotra and her colleagues demonstrate, an eagerly nourished
element of medical practice in this rapidly growing and changing region.
Before proceeding further, one must take note that “perspective” has an
alternative meaning that may be even more important to this volume of work.
“Perspective” also means the art of using a two-dimensional medium or surface
to present objects that that appear to be three-dimensional and have height, width,
depth, and position in relation to each other when viewed from a particular point.
Perspective was a hard earned skill for human beings. Despite the human urge to
draw spanning a period 20,000 years or more (see the caves at Lascaux), it was
not until about 500 years ago, in the fifteenth century, that our forbearers mastered
the ability to truly represent objects in perspective; and, it took many more years
of work to refine this ability and then transfer it to books, movie theaters, televi-
sion and, now, the internet. This serves to point out that true perspective is hard
earned and requires considerable craftsmanship. Furthermore, to provide the full
dimensionality of perspective takes the hearts and minds of many distinguished
individuals who are willing and able to put themselves and their own work to the
test of careful scrutiny, as was done at the conference preceding this volume as
well as in the preparation of this book. Indeed, this volume ably presents the mul-
tidimensionality of child and adolescent psychiatry, and hence its richness, on a
flat page (or computer screen) but with a depth, height, and breadth that offers an
impressive vision of the field. With this “perspective” the authors allow us to peer
through the complexities of childhood and human development to understand its
variation and perturbations we now know as developmental psychopathology.
v
vi Foreword
When I first saw the title of this work, I was struck by the concept of “Asian
perspectives.” Indeed, I initially found the idea disquieting. How can there possi-
bly be an “Asian perspective” on anything? After all, Asia may be the most incred-
ibly diverse and disparate region of our world. By some estimates it includes about
one-third of the Earth’s land surface and two-third of the world’s population in
more than 50 countries. It is the birthplace of the world’s major religions and the
home to innumerable languages, as well as social and cultural traditions. Even
without the hand of a skilled artist, Asia is surely multidimensional and cannot
be fully captured without a richly developed capacity for perspective. And, that is
what we see in this interesting volume.
So, what do we learn about the “Asian perspective?” First of all, we learn
that to provide such a perspective it takes the efforts, minds, and hearts of many
distinguished individuals because there are so many topics to address. Second,
Malhotra and her colleagues teach us that while there are many unique elements to
the “Asian perspective,” at its very heart, children, adolescents, and their families
share a great deal with their brothers and sisters around the world proving that we
are all more alike than different. But, “more alike” does not mean the same. The
authors help us understand these similarities and differences.
While there are many examples of the unique elements of the Asian
perspective, several are quite striking. Certainly, the challenges of applying diag-
nostic systems that were developed in the West is but one of them. It is striking
how culture changes perspectives on developmental psychopathology. This strug-
gle is clear in many forms but not clearer than ADHD that Sood et al. (Chap. 3)
so nicely illustrate. Another culturally sensitive perspective is provided in Benegal
and Jayarajan’s “reframing” of addiction (Chap. 6). And, while the description and
treatment options for psychopathology are challenges, the lack of resources in this
vast region is brought clearly into focus by Konar and Balachander’s discussion of
psychopharmacology (Chap. 17) and Kapur’s effort to identify “low cost solutions
for learning disabilities” (Chap. 22). In these chapters, we can all learn how to do
much more for children in need with much less. This is impressive, especially for
those of us in relatively resource-rich nations.
Equally striking in this volume is the authors’ willingness to address environ-
mental factors that cross cultures and continents. Hong’s chapter on the impact of
rapid sociocultural change on child-rearing (Chap. 8) is a cogent reminder to all
of us on how the pressures of globalization and the “cyber” era (also covered by
Boon and Fung in Chap. 10) are creating an enormous impact on how parents and
children are managing in an increasingly complex world. We are also reminded
that economic disparity may have the greatest impact on our youth with a very
poignant description in Banaag’s chapter (Chap. 9) on “street children.”
So, with so many points of view, do we have a clear “Asian perspective” on
child and adolescent psychiatry? The answer is a resounding, “Yes!” From Asia,
we have much to learn from our incredibly determined and thoughtful colleagues
about how to understand the challenges facing children and families in a very
rapidly changing world. We can also admire the courage and commitment of our
Foreword vii
colleagues in Asia who are creatively providing care to as many youth as possible
with limited resources. The challenges are great but so are the opportunities.
But, perhaps, what we have learned most from the “Asian perspective” is that
the Earth is a very small planet and that while we must recognize our diversity and
differences, we have so much more in common and so many lessons to learn. In
children and families, we can find both need and hope. In diversity, we can find
strength. In the face of adversity, we can find creativity and courage. And, in Asia,
we find wonderful colleagues who are very much a part of the worldwide commu-
nity of professionals, who are determined to understand, prevent, and treat child
and adolescent psychiatric disorders wherever and whenever we find them. This is
a good perspective for all.
Prof. Bennett L. Leventhal, MD
Child and Adolescent Psychiatry
The University of California
San Francisco, USA
Preface
Child and Adolescent Psychiatry: Asian Perspectives is a compilation of resources
in child mental health from a perspective applicable to Asia. There are differences
in many areas of child and adolescent mental health such as child-rearing prac-
tices, societal acceptance of psychopathology, resilience, availability of newer
treatments, and professionals between Asia and the West. Fundamentally, most
of the knowledge guiding the theory and practice of child psychiatry in the world
has been derived from studies done in Europe and America. In this context, we
attempted to gather available information from within Asia that could provide
a strong evidence base to inform professionals in the field during the 7th Asian
Society for Child and Adolescent Psychiatry and Allied Professions (ASCAPAP)
Congress held in New Delhi, India in September 2013. Leading experts in child
and adolescent psychiatry from Asia and other parts of the world discussed their
research and provided valuable insights into various issues of contemporary
importance in child mental health and psychiatry. We decided to capture this infor-
mation in its updated form for purposes of this book.
The majority of neurodevelopmental disorders persists along the entire lifes-
pan of the individual and can have a deleterious impact on the quality of life of
the individual and their families. To manage this in part, where there are limited
resources, treatment strategies ought to involve comprehensive and multidisci-
plinary approaches. In recent years, there has gradually been some pertinent lit-
erature emanating from Asia. There are, however, at present no major child
psychiatry books from this region.
There is a pressing need to make available resources that are credible in order
to provide perspectives for professionals to interpret and adapt knowledge that will
benefit their patients in routine clinical practice. We hope that this volume will
allow readers to take a more considered approach when treating and managing
children with mental health problems in Asia. To a certain extent, extrapolating
principles and guidelines from developed countries is useful; however, information
regarding prevailing child psychiatry theories and practices, and their applicability
across populations, taking into account the local sociocultural context, need to be
contextually examined and evaluated.
ix
x Preface
This volume focuses on several child psychiatry disorders and mental health
issues from an Asian perspective, as applicable. The contributors are leading
authorities from Asia and other parts of the world in their respective fields.
The book has 26 chapters divided into 7 parts. Part I deals with some of the
major psychiatric disorders seen in children and adolescents, including pediat-
ric bipolar disorders (Chap. 1), dissociative disorders (Chap. 2), attention defi-
cit hyperactivity disorder (Chap. 3), affective disorders, highlighting current
status and controversies (Chap. 4) and suicide (Chap. 5). Part II deals with sub-
stance abuse disorders (Chap. 6) and tobacco use amongst children and adoles-
cents (Chap. 7), and focuses on the impact that these substances might have on the
developing brain. Part III focuses on the role of environment and cultural issues in
shaping the growing brain and emerging personality of children. The chapter on
parenting and child-rearing practices in the globalizing world (Chap. 8) highlights
contemporary issues in parenting and consequences for child development. There
is also a chapter on resilience among street children (Chap. 9). Cyberage and child
mental health is also discussed (Chap. 10) as is child sexual abuse (Chap. 11). The
chapter on parental loss (Chap. 12) provides a psychoanalytic view of long-term
consequences of early childhood parental loss. Early diagnosis and intervention
is dealt with in Part IV, focusing on early diagnosis and intervention, underscor-
ing the importance of infancy and early childhood in recognizing and treating
psychopathology (Chap. 13). Chapters on temperament (Chap. 14) and childhood
antecedents of personality disorders (Chap. 15) provide insights into developmen-
tal trajectories leading on to the evolution of personality and adaptation patterns
through childhood experiences. Part V includes pharmacological and biological
treatments in children. The chapters in this part deal with the paradigm shift in
child psychopharmacology (Chap. 16) and from a low resource country perspec-
tive (Chap. 17). It also includes a lucid discussion and review of psychopharma-
cology of neurodevelopmental disorders in children (Chap. 18); which provide
valuable insights into web-based health monitoring and wearable sensor tech-
nology for managing neuropsychiatric symptoms in rare diseases. The last chap-
ter in this part (Chap. 19) discusses electroconvulsive therapy for severe mental
disorders in children and adolescents. Part VI on non-pharmacological interven-
tions includes chapters on play therapy (Chap. 20), psychosocial interventions in
poor scholastic performance (Chap. 21), and low cost solutions in learning dis-
abilities (Chap. 22). The last part, Part VII, refers to services and policy for chil-
dren and focuses on the progress and promise of mental health policy (Chap. 23)
and describes an innovative model of telepsychiatry service developed in India for
treating children and adolescents, using nonspecialists, in remote areas (Chap. 24).
Following on from this, mental health gaps between needs and resources in Asia
are discussed (Chap. 25) and finally, teaching of child psychiatry from a transcul-
tural perspective is discussed (Chap. 26).
We hope that mental health professionals, students and researchers in Asia and
other parts of the world with sizeable Asian communities will find this book to be
Preface xi
a useful addition to the literature. Students of child psychiatry and psychology will
also benefit from exploring the chapters in an analytical and an adaptive manner in
particular sociocultural issues that are relevant to child mental health. We would
be happy if this volume serves this purpose.
Chandigarh, India Savita Malhotra
London, UK Paramala Santosh