Treatment of children and adolescents

Given the cultural values and beliefs about mental health in most Asian cultures, forming a social and cultural connection with the family would be essential for encouraging them to entrust their children to the process. This needs to be established during the first session when working with children and adolescents. The following pointers are adapted from Lee (1997):

• Establish expertise, credibility and authority.
• Define the problem clearly using cultural metaphors.
• Include the family's explanation of the problem.
• Acknowledge the family's shame (in having to approach mental health services).
• Ensure and explain about confidentiality (because of strong stigma).
• Apply a family psycho-educational approach (Asians typically value education highly).
• Build alliances with key family members to support the process.
• Re-frame issues so that they can be accepted within a cultural context (e.g. a mother's over-protection can be re-framed as 'loving too much', and a father's excessive working hours as 'sacrificing himself for the economical well-being of the family').
• Decide on the most appropriate therapeutic intervention.
• Include traditional approaches as appropriate and as the family require.
• Collaborating about treatment plans with the support of the whole family will enhance the likelihood of a mutually satisfactory outcome.

Support from various sources in the community, like a school teacher, school counselor, sports coach, community leader, religious leader/elder, and mentors can be helpful for children or families who cannot or are reluctant to receive Western mental healthcare.

Suitable modalities

There is very limited research reported for treatment with Asian children. Much of the research is conducted on Western cultural groups. There is some information on working with refugee children. Knowledge about evidence-based treatment is also very generalised.

In the absence of empirical evidence, the choice of treatment should be determined by cultural factors, age of child, language proficiency, attitude of family and their willingness to be involved, as well as the nature of the problem.

Psychotherapy

Psychotherapy can be used for children from diverse cultures given its adaptability for play, making it easily acceptable to children. However, the Te Pou Report (2010) notes that there is no research on the use of psychotherapy with Asian children in particular, in New Zealand. Clinicians using this approach would need to explain its potential benefits to parents, and would also need a cultural context for interpretations. Family and cultural advisors can be consulted.

Testimonial therapy

This modality is particularly useful for working with children and adolescents who have suffered abuse and/or trauma. It was devised following the Chilean war and has proven to be effective in adolescent Sudanese refugees. This therapy involves recording the child's account and modifying them over a period of time, until the child is happy that it is an accurate account of events. The recording is then transcribed and presented as a document, which is signed, signaling an end. This therapy incorporates the oral tradition of storytelling. There is no research indicating this as specifically appropriate for Asian children, however, its use of storytelling may make it suitable.

Narrative exposure therapy (for children - KIDNET)

This is a combination of CBT and Testimonial Psychotherapy and has been adapted for use in children older than eight (Ehntholt & Yule, 2006). It uses more illustrative material than that used with adults. For example, a piece of string is used to indicate a lifeline, and the placing of flowers and stones to indicate positive and negative events. The benefit of this therapy is that it revisits events through narrative therapy as well as extending beyond the present to incorporate the child's hopes and aspirations.

Pharmacological treatments

The use of pharmacology has not been proven to be beneficial and is not recommended in the United Kingdom for treatment of PTSD with children (Ehntholt & Yule, 2006). Family therapy and group meetings with a parent or caregiver have been proven to be beneficial.

Abright and Chung (2002) highlight the differential rates of metabolism of both anti-depressants and anxiolytics in Asian clients. Given the limited knowledge base about pharmacological and psychotherapeutic treatment of depression in Asian children, it is recommended that primary care clinicians seek psychiatric assessment for depressed children and adolescents before selecting specific forms of treatment. (Abright & Chung, 2002).