JEDDAH, 22 June 2004 — Since their establishment in 2000, the Jeddah Child and Adolescent Psychiatric Services have not had a moment’s rest, according to its founder Dr. Nihal Erfan.
Dr. Nihal Erfan is a child and adolescent psychiatrist trained in Canada, and she is joined by Dr. Omnia Amin, another psychiatrist, Dania Madani, a language pathologist and Ronda Manchester, a counseling psychologist. They also work in liaison with the pediatric department at Erfan Hospital when dealing with severely depressed and suicidal or schizophrenic patients who are a danger to themselves and others.
Parents have been bringing their children to JCAPS even from remote areas or calling from neighboring countries. “The level of awareness is high because of the media. Many programs are very educational and many parents now are very knowledgeable from TV, the Internet and books,” Dr. Nihal Erfan said.
Specialists find it helpful to deal with educated, aware parents. A serious problem is compliance with the doctor’s instructions in following up on treatment, especially with non-medical therapy. “Maybe the idea is not very much in our system that treatment can take a year, for example. We get a quicker response when we prescribe medication. On the other hand, there are people who from the start refuse any medication for their child and we have to explain that it depends on the problem,” she said. Once a treatment plan is agreed on by joint decision, parents are more likely to cooperate.
Dr. Nihal established a referral system with organizations that work with children with mental or behavioral problems.
“You want to catch the problem before it is too late and prevent it from becoming chronic. As kids get older they become harder to treat.” Recognizing the symptoms comes first. “With any kind of mental illness, it takes away from the child’s vitality and off the route of normal development. Kids who are depressed and anxious almost to the point of being housebound are heartbreaking.”
The youngest patient Dr. Nihal Erfan had was a girl who has just turned one. Her parents are from different cultures and wanted consultation on normal development. “We get phone calls enquiring whether a certain behavior is normal or not and if we can help over the phone, we do,” she said.
Parents sometimes worry that bringing in their child to see a psychiatrist would ruin their life. Dr. Nihal explains that if the child is at an age they can understand things then it’s important to be open with them. However, children aged nine and above tend to be defensive if told they were going to a psychiatrist. Here it can help if the parents try to take some of the responsibility.
JCAPS mainly deals with attention deficit hyperactivity disorder, depression, aggression, anxiety and sleep problems. “ADHD has been an unrecognized problem and its prevalence is the same as in other places, but there is more awareness of it now,” she said.
Treatment for these children can make a big difference in their life. “ADHD is mostly a genetic problem, but sometimes it is related to an organic problem such as viral infection, epilepsy, or head trauma.”
Depression can affect children. Dr. Erfan has seen patients as young as eight depressed and suicidal, and a nine-year-old schizophrenic. While these disorders tend to be genetic, psychiatrists never start treating patients as psychiatric cases without checking that everything else is completely normal: some medical problems might seem psychiatric but turn out to be thyroid abnormalities and brain abnormalities.
Anxiety is another widespread problem. “Every kid is afraid of something — that is normal — but when fear becomes incapacitating, if they are not sleeping, eating, dropping out of school, having panic attacks, there we have to intervene.”
Causes can be environmental or social. “Children whose parents are going through a divorce, separation or a death in the family need an adjustment phase, which could cause them to be depressed or anxious.”
There is also child abuse, “I think it’s a major problem, and something we always screen. We ask about inappropriate touching or physical reprimands.” Although there is more awareness about abuse, people still do not want to talk about it, and many parents do not educate their kids about physical and sexual abuse, Dr. Nihal said.
Other more intangible causing factors might be out-of-control sibling rivalry, academic problems or poor self-esteem. “Parents might bring their child not necessarily because of a disorder but simply because they want to improve some part of their selves.” Treatment is a process, and Dr. Nihal starts by agreeing with the child and family over the process and on family or individual sessions. “I assure the child that everything they say is private, unless they are suicidal then I have to tell the parent.”
Some disorders are more common among boys, others among girls. ADHD is in the first category. Depression, by contrast, is more of a girl problem, especially in adolescence. It can be tricky to diagnose at a young age. “They might be depressed for a year before they are noticed.”
Schizophrenia again is a bigger problem among boys. Again it often goes unnoticed because the symptoms are so subtle in the beginning. But early detection is important.
Eating disorders is classically a problem mainly for girls. The media is often blamed for featuring ultra-thin models and movie stars. “I had a girl who lost ten kilos before her parents noticed because she was wearing loose clothes and hiding her anorexia; it is a secretive disorder. The parents didn’t know the girl was purging, exercising for hours, and even though she’s so skinny, she saw herself as fat.”
Dr. Nihal does not think there is enough awareness on eating disorders here. “I think bulimia is a very common disorder,” she said. One of the difficulties in approaching these disorders is that there are no statistics here on any of them. “We’re starting to compile data on ADHD and autism because we’re seeing more of these cases, but nothing is published yet.”
