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Child psychiatry and mental health in Latin America
´ ´ ´ RODRIGO CHAMORRO OSCHILEWSKY1, CRISTOBAL MARTINEZ GOMEZ2, 3 & EDGARD BELFORT
International Institute of Cognitive Development, Central University of Chile, Chile, University of Moron, Argentina, Department of Psychiatry, Faculty of Medicine, University of Havana, Cuba, and 3Department of Psychiatry, Central University of Venezuela, Caracas, Venezuela
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Abstract The review of epidemiological studies of psychiatric disorders in children and teenagers in Latin America, is validated and updated in this article. The present article incorporates variants that are contributed from the neurosciences, which allow us to see difficulties as opportunities, across such mechanisms as the plasticity neuronal, trying to change paradigms, frequently pessimistic in this type of review, and we call for the active participation of all the scientific societies of our countries in the development of public policies, based on prevention, for the vulnerability of the rights of our children and teenagers suggesting a multidisciplinary boarding in mental health.
Introduction It is not uncommon that when making reports on the mental health situation in Latin America, factors such as poverty, multi-racial or ethnic terms, the number of psychiatrists in our countries, the number of psychiatric beds, the scholarship, etc. are variables to be included in any report as factors explaining the situation to work with our patients, and there is little or no description of the role that scientific societies impact in the development of mental health public policy in our governments. From the field of neuroscience there have been reports, in parallel, with significant changes that must be considered for inclusion in our diagnostic criteria, therapeutic and preventive, as this is where public policy should settle (Chamorro, 2007; Kendler, 1995). Analysis of epidemiological information It is estimated that about 7 to 22% of children and adolescents have a disabling mental illness and that suicidialidity is the third cause of death in teenagers. Other studies have shown a prevalence of 21% in children and adolescents between 9 and 17 years (MECA; Kandel, 1999). In a study in a pediatric hospital in Colombia it was established that the most prevalent diseases in the population of children and adolescents were impaired learning, attention deficit disorder with hyperactivity, depression and suicide associated
disorders anxiety, pervasive developmental disorders, disorders of eating behaviour (DEB), the disorders associated with psychoactive substance use, conduct disorders and psychotic disorders (Rohde, Celia, & Berganza, 2004). Although this study was conducted in a pediatric hospital, comparing studies should be considered that the prevalence of these conditions change as the population studied. Similarly, the records obtained from the populations attending specialized services have specific characteristics (UNICEF, 1999). Patients treated at a pediatric hospital of high complexity have some special features, as a local reference site, regional and/or national level. In this study, the patients treated had an average age of 10 years, and two thirds were boys. Between 90% and 100% of patients have comorbidity, and consulting service for the first time almost 45% do not return to controls. He found that the number has tripled interconsultation with respect to data of 2000 in the same hospital. The studies presented here do not differ significantly from the results presented in 2003 in the MECA study (Shaffer et al., 1996). Latin American countries have great contrast in mental health public policies in children and adolescents, in research and training of mental health teams. The differences range from the most high and complex interdisciplinary programmes in child mental health programmes based on comprehensive primary care models such as Chile and Cuba, strong
Correspondence: Dr Rodrigo Chamorro Oschilewsky, Department of Neuropsychology, University of Moron, Argentina. Tel: 56-2-2417684. E-mail: firstname.lastname@example.org ISSN 0954–0261 print/ISSN 1369–1627 online ß 2010 Institute of Psychiatry DOI: 10.3109/09540261.2010.503692
2004). however. domestic work. living in poverty. environmental variations must include both the family and the school (Belfer & Rohde. 2005). moral precepts. violence and unprotected sex. including mental health (Inciardi & Surratt. Poverty forces many children to live in the streets and predisposes them to participate very early in their lives in drug use. We must remember that dropping out of school can play a significant role in mental health status compared with those who remain in school. with few exceptions. such that intervention programmes in mental health prevention. and/or studies to address specific mental health problems such as attention deficit hyperactivity disorder (ADHD) (Chamorro. as in Brazil and Costa Rica. Drop-out rates are high in some Latin American countries due to the need for children to work for income generation in their families or because they must stay home to care for younger siblings. 1984). or led to research groups associated with generating training programmes in Argentina. Many programmes are designed to improve access to services and to reduce historical exclusion from appropriate services. The few studies found have been conducted with population samples drawn from relatively small and homogeneous local areas within countries. as they change the dynamics that become the ambioma [environmental factors]. school dropout rates can also be regarded as an indicator of risk.000 children are involved in armed conflicts in Latin America.356 R. 1999). 2008. Today. Latin America shows some of the most dramatic discrepancies in income distribution in the world. with limited access to education or in foster care. 2002). and are mostly neglected populations in Brazil and many other parts of Latin America. Some studies have suggested that approximately 10% of the population earns 90% of total revenue (Jolly & Cornia. several Latin American countries have some of the highest risk children with mental health and vulnerability. specifically mental health.. This has serious health consequences.. Chamorro Oschilewsky et al. with abandoned children or ‘the streets’ at high risk to engage in criminal behaviour or quickly enter the world of addiction.com by HINARI on 06/01/11 For personal use only. External causes represented 10% of all causes of death. who are assigned some of these resources. and self-esteem Int Rev Psychiatry Downloaded from informahealthcare. undernourished. 2007).. with regard to the framework established by the signing of many countries that ascribe to the Declaration of the Rights of the Child to the United Nations (UN). the situation the situation is critical. Most Latin American nations lack data using nationally representative samples that provide the necessary guidance for public policy development in this area (Duarte et al. and over 10. It is estimated that 6000 to 14. Infant mortality increased from 73. as a survival strategy. As we know. In the possibility of requiring health care and public programmes or private. public policy in many Latin American countries has been lining up on the responsibility forbreaking the inequality. so this situation poses a major problem in the Latin American countries.3 in 2000.000 children are in the army in Paraguay (Belfort. with the reality in Haiti. this contrasts. 2003). many children in Latin American countries face risk factors of enormous proportions. In the psychosocial domain. after the earthquake. for example. (Rohde et al. Exclusion in health is an important indicator in the case of children with possible mental health problems. Another major risk of harm in adolescent mental health in some countries of Latin America has to do with social and political conflicts. In the 5–14 age groups. or on the street. an endemic situation in parts of Brazil and Mexico. economic improvements in some Latin America countries have made possible the allocation of additional resources which are important for programmes devoted to promoting child development and improve the lives of children in general. marked particularly by the latest global economic crisis. deficiencies in the health system and the impact of the AIDS epidemic. In recent years. This increase is associated with increased poverty. compared with children who still live with their lowincome families (Rohde et al. not quantifiable. 2005). and till now. These programmes are designed to address problems identified as priorities by the countries. crime. Before the earthquake. This point is crucial and makes these programmes sustainable and efficient over time (Chamorro. 1998). These homeless children demonstrate significant deficits in development related to social reciprocity. Brazil and Chile. based on rights. . In the last decade. Different economic problems in Latin American nations over the past two decades have resulted in a substantial reduction in the proportion of people in the middle class and a huge decline in investment in social and health programmes (UNICEF. However. Epidemiological studies of mental health specific to Latin American countries are essential for developing programmes that meet the needs of affected populations in children and adolescents. related for example to use of inhalants. these programmes have not been systematically evaluated or made part of a sociological monitoring study (Belfer & Rohde. however.8 per 1000 live births in 1996 to 80. 2004). the creation of public health programmes should be monitored regularly for flexible strategies. intervention programmes generated from government institutions. it was estimated that up to 20% of those under 15 years old are vulnerable. infectious and parasitic diseases accounted for 24% of total deaths.
The results of this study in Brazil and other epidemiological studies of mental health among youths tend to suggest that. associations of relatives of patients with mental disorders in some Latin American countries have been working to . gender differences. 2005). studies show the role played in the evolution of the environment of different mental disorders associated with the variation with which these occur depending on the different cultural contexts (Fleitlich-Bilyk & Goodman. Less than 25% of the population is covered by this type of service. particularly those who have a clear biological basis may have a similar clinical presentation in both developing and developed countries (Rohde et al.2%). as well as residential facilities and vocational training.com by HINARI on 06/01/11 For personal use only. This foundation focuses on preventing human rights violations via the exchange of information.. human and financial resources to implement the policy and failure to follow policy once these have been implemented. welfare and a structured interview informant assessment. Disruptive behaviour disorders (oppositional defiant disorder or conduct disorder) were the most frequent conditions (7%). education. 2004). and depressive disorder (1%).8%). Regular training for primary care professionals is not carried out in the field of mental health. developing countries and developed countries have similar results in terms of estimated prevalence. training. A referral system is in place. 2005). For example. Although some child psychiatric disorders. however. Health Organization (WHO. Primary health care doctors and nurses are responsible for taking care of patients with mental disorders in the community (WHO.. home interventions. Thus. followed by anxiety disorders (5. The diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (APA) (DSM-IV) in evaluating the development. any conclusion about the overall prevalence of mental health disorders among children and youths in Latin American countries should be considered as an estimate. rural and urban public). A study in Brazil evaluated the prevalence of psychiatric disorders in school children and adolescents aged 7 to 14 years in the state of Sao Paulo (Fleitlich-Bilyk & Goodman. The 12. Bolivia Mental health is a part of primary health care system in Bolivia. preventive and promotion interventions. age trends. Some importance derived from this study is the confirmation that there is a large gap between the written rules and their implementation. Other NGOs are participating in mental health programmes for children and adolescents of Latin America in many other ways. when using similar methodologies. and without adequate cross-cultural validation. public. The overall weighted prevalence of psychiatric disorders was 12. as epigenetic variables do not appear ambyomic [environmental factors] considered in the studies. 2003). work in communities and public campaigns. and 4) creating the largest database of child welfare in Central America. 2004). There are community care facilities for patients with mental disorders. 2005). The sampling was random schools (stratified into private. This seems to be associated with the lack of political will to develop and maintain public policy.Child psychiatry and mental health Rohde et al. A sample of 1251 subjects was evaluated. Actual treatment of severe mental disorders is not available at the primary level. The Atlas project and other sources have also documented the importance of non-governmental organizations (NGOs) in the health care systems in Latin American countries (WHO. Most epidemiological investigations carried out in Latin American countries have used instruments which are similar to research conducted in developed countries. The Paniamor Foundation aims to protect the human rights of children.7%. 3) reintegration of high-risk adolescents into schools and/or job training. despite what we initially supposed.7% overall weighted prevalence of mental disorders was significantly higher than the prevalence of 9. Further studies about Latin American countries were included in the Atlas Project of the World 357 Int Rev Psychiatry Downloaded from informahealthcare. which show the country’s resources for the study of the mental health among adolescent boys. 1999). Mental health care consists of primary health care provided by psychiatrists. 2005). 1999). these services are available for less than 25% of the population. we must consider that very few studies have been performed with adequate methodologies to investigate the impact of risk factors and protective prevalence rates of mental disorders of children in Latin American countries.. However. Lowest prevalence was found for hyperkinetic disorder (1. and the pattern of comorbidity (Duarte et al. 2) the promotion and participation in the development of new legislation to improve the mental health of children and protect their human rights. The survey from a questionnaire documented the presence or absence of children’s mental health policies at national or local level in many countries of Latin America. A notable example of this is also observed in Costa Rica. The latter instrument was extensively tested for validity across cultures. The community care system for the mentally ill includes outpatient clinics. The results of their efforts have shown: 1) increased awareness and prevention of child abuse.7% given in Britain in a study with similar diagnostic procedures (Belfer & Rohde.
community work and seminars for parents. this type of research will assess the impact on children’s health in general and on mental health. Caldas. proper nutrition. epilepsy. biological psychiatry. doctors and the types of services provided. Most services and training in Latin America are concentrated in large cities. 2005). The mental health components reported are morbidity. Chamorro Oschilewsky et al. 2005). Some countries have many psychologists. and other similar professionals who can participate in the development of a continuum of care. as well as with what is intended to alter health indicators associated with the objective of the program. drug abuse and dependence. The study of the WHO Atlas Project has documented that Latin American countries vary in terms of guidance. It was also implemented by 10% less than expected by regional and national authorities. Costa Rica. suicide. they have designed a plan with a strategy based on the community. 2005). The law states that all Brazilian municipalities must have a child rights council and a council of guardianship of the child. mental retardation. or a safe place to live. and cognitive neurobiological model. and actually mandates the implementation of these rights. There is also a mental health reporting system in the country. probably because there was no specific budget for its implementation.358 R.). important changes have taken place. This research also describes the importance that actions related to health varies with the child’s age.com by HINARI on 06/01/11 For personal use only. This could have to be an effective way to help children who normally have no access to health care. It is also stated that the main psychiatric problems are alcohol abuse and dependence (7. The ´ Departamento Nacional de Estatısticas (National Department of Statistics) is in charge of the data collection system for mental disorders. Colombia. etc. Information is recorded utilizing ICD-10 (Sartorius. Its main components are strategy of services reform. Historical and cultural roots are often the basis of differences in the clinical services available. Depression. Nations vary in the amount used by people who have no mental health training to provide care to children with mental disorders. psychosocial problems such as domestic violence and child abuse (WHO. and location. In particular. thus affecting a paradigm shift in diagnostic and therapeutic approaches. learning specialists. Jamaica The work to be developed in this country is based on the observation that there is significant impairment of optimal development in the years of infancy. The Atlas and other sources reported a virtual absence of access to medications in some regions of Latin American countries. Autism syndrome. and development of specialized services. The country has a data collection system and an epidemiological study on mental health. Levav. child health promote better treatment of children with mental illness (e. Ecuador A national mental health programme is present in Ecuador. Currently the Pan American Health Organization (PAHO) has assumed an important role in identifying and supporting research that is relevant to public policy concerns. rather than public policies. Chile. and Jamaica have already been identified. whether in public or private universities. violence and child abuse are the conditions covered. both in the training and practice of mental health professionals which have evolved from orthodox psychoanalysis to systemic therapies. 1995).g. but is particularly common in developing countries. There is relatively little information available about the factors that contribute to developmental disorders in children from developing countries. the Child and Adolescent Rights Act goes beyond a declaration of child rights. education. Some of the research objectives in this regard are as follows: 1) identify principles that should guide the development of child mental health policy in the Latin American countries and 2) initiate a debate on specific principles. objectives and strategies related to the formulation and implementation of mental health policy of children from Latin American countries (WHO. Representative projects from Brazil. and its impact on school failure in elementary and secondary school years. this happens in many countries. affective disorders. gender. integration of mental health services within primary health care. Directed to a population at high risk from negative results observed in previous Int Rev Psychiatry Downloaded from informahealthcare. policies. (Kohn. The existing initiatives depend most of the time on personal and institutional efforts. ADHD. . Jamaica’s research and intervention programmes are expected to include early childhood education. socioeconomic status. Brazil Enacted in 1990. psychosis. admissions and discharges. Moreover.4%). while other nations have virtually none of these specialists. particularly depression (approximately 16%). both theoretical and practical. The programme was formulated in 1980 and it was revised in 1999. PAHO and WHO are working closely with the Medical Schools of Harvard University and Columbia University to support the development of research projects resulting from a model of assessment of key issues of some countries of Latin America.
Cuba Mental health is a part of primary health care system in Cuba. coherent and integrated with activities and services carried out simultaneously or in succession. modulated by a culturally relevant professional to record child development. and also becoming an integral part of the community. This model is intended to prevent depression from parents and. Any treatment approach for depressed parents should take into account known risk as well as factors for depression. Regular training of primary care professionals is carried out in the field of mental health. In the last two years. that is. 2005). the disease affects not only them but also all areas of family functioning. avoid consequences for their children. The approach of these three aspects is clinical. Mental health care is provided by primary health care physicians and psychiatrists. A family-based strategy seems to be particularly suitable for carrying out these tasks. in-service training for the care and training of primary school teachers directed to support them in providing appropriate educational materials on child development in nursery and primary schools (WHO. and with ongoing advice and continuing education. the analysis of this situation. magnitude of the damage. The programme consists of three essential aspects: the health related diagnosis. we proceed to analyse the health status. Special emphasis is placed on the family’s mental health as the determining factor for the child’s mental health. ‘deepening’ our knowledge of the community as well as the use of the community resources for its own benefit. Once we have diagnosed the child’s or adolescent’s mental health status. community participation and intersectoral coordination. thus. The research efforts used in this programme are incorporated in the programme with the objective of finding answers to all the problems detected in this programme. This project in Costa Rica will test the validity of a model of depression treatment that has already been used elsewhere.com by HINARI on 06/01/11 For personal use only. In turn. The philosophy behind our work is based on how we ‘introduce ourselves’ in the community. community participation. It is centred on the community. 2005). . A system of referral is also in place. Cuba has developed a system that prioritized primary care and preventive care. the analysis of the health status. More than 95% of the population is covered by this type of service.Child psychiatry and mental health programmes and development screening. at the level of primary care. assessment of the real possibility of modifying the problem. There are available community care facilities for patients with mental disorders. It puts a special emphasis on the mental health of the family as a determinant factor of the mental 359 health of the child. Actual treatment of severe mental disorders is available at the primary care level. thus. 2005). at the level of primary care through the family doctor. and the plan of action for the solution of the problems. The plan of action is defined as follows: jointed organized. Cuba has a particular programme based on the approach of risk. as well as taking into account the needs felt and not felt by the residents of the community. epidemiological and social (WHO. and using methods such as discussion groups. and education in health centres. epidemiological and social. and the inter-sector coordination. The applied (hardworking) and the investigation (research) included in this programme has the focus to give a response to all the problems that are detected. The country has currently one doctor for about 200 persons. Child and adolescent mental health programme This programme is based on risk factors. via our advising and continued education. these professionals are responsible for training other local health professionals to propagate and extend the coverage of the intervention of depressed parents and their families (WHO. The community care system for the mentally ill provides this coverage. and the plan of action for troubleshooting of the problems encountered. and across the family doctor. and with the necessary resources in order to Int Rev Psychiatry Downloaded from informahealthcare. as well as rates comparison and indicators. the world’s highest doctor–patient ratio. This makes the integration of mental health in primary care a little easier. This project will also train local health workers in using this model. population opinion and impact. Also. about 120 personnel were provided training. The focuses of these three aspects are: clinical. Costa Rica A model of depression treatment to protect children and strengthen families exists in Costa Rica based on the premise that when parents are depressed. It is centred on the community. This approach should be done with the joint participation of the team and the community. Costtime-resources: to achieve certain effects are also taken into consideration. It is based on three essential aspects: The diagnosis of the health situation. to identify and prioritize the problems encountered. and should have a prevention component. We then proceed with the interdisciplinary teamwork to identify which are the ‘health problems’. The criteria used for prioritizing our approaches are as follows: social transcendence. Each year between 4% and 5% of primary care personnel from a wide range of disciplines are trained.
The aim is based on two elements: 1) a programme that can intervene in the growth and development of children in early stages. Recently. proteomics and psychopharmacology allow us to understand how genes dialogue with the synapse. not maintain rigid educational schemes.com by HINARI on 06/01/11 For personal use only. and provide a timely treatment and rehabilitation of childhood mental disorders. Colombia developed a pilot programme in Medellin. This intervention is applied based on the social ecology concept developed by Earls and colleagues (Muzzio. mediating with various groups. based on the policy framework of citizenship rights (WHO. for instance. research has shown that an integrated health intervention that transforms the experience of a child’s life improves outcomes of child development. where we found gender differences in various behavioural problems as teachers: higher scores for men in disobedience/aggression. study. with 11 million population. Chile Based on the evidence of the development of health services in Chile. such as when the collapse of dendritic pruning produces serotonin or the recent description of the activation of brain circuits or description of a group of neurons called mirror neurons. but also augmentation strategies are timely implemented. The strives for a strong community focus are based on: 1) We have established work objectives to strengthen the protective factors. as well as an organized primary healthcare system. This current initiative has not achieved the expected success. ensure early diagnosis. where the motivation for learning is the fortress. 2005). which forces us to rethink educational plans adjustments.360 R. and vulnerability of family and social system. but modulated by applying different teaching sociocultural environments (De La Barra. The purpose of this research in a middle-income area of Chile is to improve knowledge about child development. which has used public education to raise awareness. The children had a lower proportion of repeaters that the whole group. Rizzolatti & Fabbri-Destro. 2) We have as the main purpose of the Programa Nacional de Atencion Materno Infantil.. in public community health centres not only do we identify the risk factors of development. Kentros. Today. legislative. trained educators and joint strategies are developed from health and education is given from early childhood to children. strong emphasis in controlling the risk factors. regulated environmentally. non-governmental organizations. education. 2009. and 2) an initiative to create modular and healthy schools. Muzzio et al. A mental health study in two cohorts of school children in an area of Santiago de Chile. we also attempt to consolidate and improve the levels of health and mental health of the mother and the child. however. pointing to the need for health care systems that are designed to improve health in development. and contribute to policy formulation on child development through scientific evidence on health care. ` achieve the desired objectives vis-a-vis the health problems of the defined population (community). cognitive deficits. called the Coexistence Programme. social security. both in first and in sixth grade. to ensure a strong mental health status for children and adolescents. 2005). hyperactivity and concentration problems. research in neurosciences has been very productive. Toledo. Int Rev Psychiatry Downloaded from informahealthcare. On the other hand the difficulties reported by teachers at both behavioural and cognitive levels were higher than those reported by parents. we count with a workforce of 204 child and adolescent psychiatry specialists distributed throughout the 14 provinces of the country. according to the population that is being educated. The reviews of gender differences in various aspects of development show that they depend largely on social stereotypes. 2010). To operate this programme. & Rodriguez. 2009. and international agencies are all ready to coordinate their efforts in order to ensure a high quality of life for our children and adolescents. 2005). As compared in this study the magnitude of problems between repeaters and non-repeaters ensures that the former have more problems. allowed determining of the early behavioural and cognitive predictors. 2009). neuroplasticity phenomena described in hippocampal areas and the risk of inhibiting the development of new neuronal populations in this important area. community leaders and scholars are convinced that an intervention of this nature can prevent violence. Parents reported no gender differences in the prevalence of behavioural problems in this Current challenges and future perspectives Advances in the neurosciences should be considered. Colombia In recent years. It is important to remember that most mental illnesses are polygenic. along with the concept of life course health development used for many years by the World Health Organization (WHO. Chamorro Oschilewsky et al. & Kandel. 3) The health. such as empathy (Kandel. and the . Advances in human genome. altering the brain and its functions in a sort of plastic dance. which have recently been associated with phenomena not only cognitive but also emotional.
R. which undoubtedly will affect physical responses. both in the field of behaviour. not only from the prevalence. (2002). 1995). whose role is to delay the expression of the gene. Child and adolescent mental health in Latin America and the Caribbean: Problems. Maturation is a gradual process and is genetically determined. the review of recent research on the genomic and epigenetic studies focusing on chromosome 17. 38–42. ‘‘Boletin Electronico’’ . but from the phenomenological and clinical evolution as well. For example.Child psychiatry and mental health influences are many. 2007). with periods of greatest vulnerability connected to structural processes (Chamorro. Psiquiatria y Salud Integral [Thinking about the mental health infantile in the context of Latin America. generating high to low activation of neural systems that process the threat. Chamorro. NGOs and multinational agencies (WHO) to generate appropriate strategies for the care of children and adolescents in mental health services. we must enable the development of appropriate resilience in our children and teenagers and transform their deficits in opportunities. this variable has been modified in some countries. macroeconomic developments. based on the current knowledge of genomics and neuroscience. Declaration of interest: The authors report no conflicts of interest. Neurodevelopment involves the transformation of human beings in time and this is accomplished by two mechanisms: first maturation. Terremotos y sonadores. as well as cognitive and emotional changes that are determined by this variation (Gelernter. Revista Electronic de la Asociacion ´ ´ Peruana de Deficit de Atencion [Electronic Magazine of the Peruvian ADHD Association]. both from initiatives of their own societies and/or their governments. TDAH Journal [Intelligence. access to more sophisticated technological means. R. and the classic look of the medical model can be inefficient. and often too quick to diagnose disorders. cognitive-emotional diversity. however. Conclusion 361 Int Rev Psychiatry Downloaded from informahealthcare. as the outstanding participation of APAL in promoting conventions and suggestions in this area: working with governments. Pakstis. Available at http:// www.html (accessed July 2008). There are individual variations acting as a sort of regulator. and the other is learning. The genetic interaction of dispositional and environmental inhibition or activation is responsible for the clinical expression of these disorders (Kandel. On the other hand it is already a fact that epigenetic changes modulated by our changing lifestyle from psychotherapy and the use of psychotropic drugs. which results in constraints of exophenotype to be processed in a particular way. a gene promotes the formation of the serotonin transporter.. It is from this precept. 2009). generating polymorphisms in the nucleotide sequence of the trigger button. and policy research. Psychiatry and Integral Health].com by HINARI on 06/01/11 For personal use only. are more easily moulded than the change that we make from the genome. including pervasive developmental disorders. schooling. incidence. 12(5). Thus. It is therefore important for the mental health teams involved with these children to understand that the processes are evolutionary. ´ Chamorro. 359–365. the number and levels of training for those mental health infant juvenile variants that hamper epidemiological studies. defined as the permanent change in behaviour as a result of experience or activity of the individual with the environment. 2009). modulated by the ethnic composition. M. the difficulties which face children and adolescents in Latin America can be transformed into opportunities. based on experiences from other regions of the world that have faced or are now facing similar challenges. Inteligencia. epidemiological studies of infant-juvenile psychiatry have evolved and require developmental epidemiological outlook (De La Barra.org/m-dicos-/trastorno-por-d-ficitatencional-una-disfunci-n-ejecutiva. Revista Panamericanca de Salud Publica. Another variable is related to the percentage of disorders expressed as psycho-neuro-development disturbances. (2007). (2008). impulse control and emotional self-regulation or cognitive disorders. We cannot consider variables such as inequality within Latin American countries. family and school environment. E. implementing training and research in Latin American countries. the environmental risk and/ or fear. Belfort. co morbidity and treatment perspectives. diversidad cognitive-emocio˜ nal. Reflexiones sobre la salud mental infantile en el context de Latinoamerica. 9–12.-aportes-de-la-neurocienciacognitiva. & Rohde. Argentine TDAH Journal]. that psychopathology on children and adolescents in Latin America must be investigated. L. 18(4–5). The role of scientific societies such as the World Psychiatric Organization (WPA) and the Latin American Psychiatric Association (APAL) will be essential.deficitdeatencionperu. but must also involve these scientific groups actively involved in child and youth mental health activities in the region in order to conduct comprehensive and multidisciplinary projects. & Kidd. but not the understanding of the relationship between these biological processes specific to the child and adolescent. progress. there has been a modest influence on the participation of our scientific societies in public mental health policy. References Belfer. 2. The authors alone are responsible for the content and writing of the paper. which is the actualization of the potential transmitted by heredity. (2005). Earthquakes and dreamers. Finally.
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