40 Chapter 3
psychiatric disorders – much higher rates than those found among children
and adolescents with chronic non-cerebral disorders that result in com-
parable disability and stigmatisation. This persuasive evidence for direct
brain–behaviour links is perhaps not surprising given the key role of the
brain as the seat of the mind.
Cross-cultural differences
In a multicultural society there is obvious interest and importance in
epidemiological studies examining whether children and adolescents from
different communities have different psychiatric profiles. How else could
one determine whether minority groups were being appropriately served?
In addition, our current knowledge of child and adolescent psychiatry
is largely based on studies of white samples, so cross-cultural studies
are needed to show whether our current ideas on classification, aeti-
ology, prognosis, treatment and prevention apply equally to children
and adolescents from all backgrounds. It is important to remember that
cross-cultural differences in mental health could arise from many factors,
including cultural differences in child-rearing practices; physical and social
consequences of migration; different experiences of racism or poverty; or
biological differences. Here are a few interesting findings from epidemio-
logical studies in this field:
1 In Britain, a comparison of 5–16-year-olds with ‘British Indian’ and
‘White’ ethnicities showed that the British Indians had less than half
the rate of psychiatric disorders of British Whites. This British Indian
advantage was primarily for behavioural and hyperactivity disorders;
was as evident from teacher and clinician ratings as from parent or
self-ratings; and was not removed by adjusting for likely confounders
such as family composition or functioning. Among the British White
sample, there was a strong socio-economic gradient, with middle-class
children and adolescents having fewer problems. Among the British
Indian sample, there was no such gradient. In effect, the British Indians
from all socio-economic groups did as well as the middle-class British
Whites – and much the same has been shown for reading ability. Why?
This is not yet known, though it is tempting to suppose that a strong
cultural commitment to education could be relevant.
2 A London study showed that by comparison with British White chil-
dren, British African-Caribbean children were more likely to have
conduct disorders at school, but were no more likely to have conduct
disorders at home. One possible explanation is that the disruptive
behaviour of the African-Caribbean children at school was commonly
a response to their experience of racism in the school environment.
However, the fact that African-Caribbean adolescents self-report more
delinquent acts outside the home or school suggests the causes are
complex.
3 Several studies from different countries have reported higher rates
of autism in the children of immigrants. One possible but unproven