• By Kevin Mount
  • Posted on Friday 20th August, 2010

North or South it's the same – only different

The experiences of children brought up in Bangladesh, Brazil and Britain differ. The ethnic and cultural backgrounds of Somali and Swedish children are worlds apart. But what constitutes the well-being of children, rich or poor, in the North or the Global South, is marked more by similarity than difference.We know this from good measurement. In this year’s Journal of Child Psychology and Psychiatry research review, Thomas Achenbach and colleagues write about findings generated by two of the most robust measures of children’s mental health – the Achenbach System of Empirically Based Assessment (ASEBA) and the Strengths and Difficulties Questionnaire (SDQ). Based on this fresh evidence, the review concludes that differences are much more marked within populations than between them and that there is considerable overlap between apparently quite distinct cultural groups. So the majority of Armenian and Australian children (to choose two more groups at random) fall within the same range of scores.ASEBA has emerged from over three decades of research around the better known Child Behavior Checklist or CBCL. It screens for children at risk of eight syndromes: anxiety, depression, somatic complaints, social problems, cognitive problems, attention difficulties, rule breaking behavior and aggressive behavior. Developed in the US it has much in common with the SDQ but there are also some important differences. Based on measures pioneered by Michael Rutter and colleagues as part of epidemiological studies of children in London and the Isle of Wight in the 1960s, the SDQ is a 25-item measure that screens for emotional and conduct disorders, hyperactivity and peer problems, as well as pro-social behavior.One or both measures have been used and the results published from work with more than 75 cultural groups widely dispersed around the world.That there is more similarity than difference is one verdict. The importance of socioeconomic factors also figures strongly. Thus, the mental health of poor and otherwise economically disadvantaged children is worse in all societies. Boys generally score less well than girls on the behavioral aspects of the measures. Boys do better than girls in relation to the emotional sub-scales. The pattern of problems by age is also similar across countries.Writing in the same edition of the Journal of Child Psychology and Psychiatry Glorisa Canino and Margarita Alegria consider the difficulty, despite the weight of evidence, of formulating solid conclusions about similarities and difference across cultures. They rightly point out that there is little consensus around the world about what is counted as a psychiatric disorder or syndrome. Since culture is so important in shaping children’s development, many commentators have pointed to the benefit of its inclusion in classification systems such as DSM-IV and ICD-10. ASEBA and SDQ are “culture blind”.Tom Achenbach distinguishes between what he calls the etic and emic aspects of cultural difference. He focuses on the etic, a distinction borrowed from linguisitics and the definitions of phonetics – the repertoire of sounds available to all human languages – and phonemics – the sound patterns employed in a particular language. “Findings obtained by etic methods in diverse cultures can advance knowledge in ways analagous to meta-analytic findings from methodologically diverse studies,” he explains. “Just as meta-analytic findings deserve more confidence than findings from one study or a handful of methodologically similar studies, findings that are consistent across diverse cultures deserve more confidence than findings from one culture or a handful of similar cultures. “Equally important, findings that are consistent in most but not all cultures and findings that differ markedly among most cultures invite emic investigations to identify reasons for the differences.”From either perspective, it is striking that children, parents and teachers around the world are prepared to complete measures such as ASEBA and SDQ. The challenge as far as Achenbach and his colleagues is concerned is to extend the use of these instruments and better understand the results. How, for example, do immigrant children develop as they are assimilated into new societies? What is going on inside those few cultural groups where results are markedly different from the norm? How can we bring together the etic and emic views of cultural difference to help policy makers and practitioners make more informed decisions?ReferencesAchenbach T, Becker A, Dopfner M, Heirvang E, Roessner V, Steinhausen H-C and Rothenberger A, “Multi-cultural Assessment of Child and Adolescent Psychopathology with ASEBA and SDQ instruments: Research findings, applications, and future directions”, Journal of Child Psychology and Psychiatry, 49, 3, pp 251-275, 2008Canino G and Alegria M, “Psychiatric diagnosis -is it universal or relative to culture?”, Journal of Child Psychology and Psychiatry, 49, 3, pp 237-250, 2008

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