Ｃｈｉｌｄｒｅｎ　ａｔ　Ｒｉｓｋ:Value at Risk

　　At a party for her seventh birthday in January, Tao Honghong smashed her birthday cake on the floor after wrangling with her friends. Over the next few months, she threw things at the slightest provocation. Her parents tried to get her to change her habit, but were unsuccessful.
　　More recently, Honghong had trouble sleeping and a poor appetite, and sometimes felt lightheaded. These symptoms gradually caught the attention of her parents. Her father took her to several hospitals and spent a lot of money, but with little effect. A doctor then suggested Honghong’s parents take her to the hospital’s mental health department.
　　Honghong has always been a good student and is regarded as a perfect child by her neighbors. However, to her parents’ great surprise, Honghong was diagnosed as having obsessive-compulsive disorder.
　　Psychological consultant Zhou Zhenyou said that children with excellent school performance suffer from the illness not because of problems related to performance, but because their parents do not view their strengths and good performance in an appreciative way. Chinese parents tend to judge their children by a standard of perfection and are intolerant of flaws, which leads to serious mental problems in the children.
　　As Zhou described the syndrome, Honghong’s father recalled scenarios that conformed to the expert’s description. For instance, he deliberately avoided praising his daughter even if she did an excellent job at school, for fear that “she would become too proud.” He found that Honghong has a habit of checking doors and windows again and again to see whether they are closed, but instead of considering it an illness he thought it is because his daughter is “responsible.” Moreover, Honghong likes to wash her hands over and over again, and he was glad, thinking that she likes to be clean, which is good for a girl. Even if Honghong behaved unusually, her parents never related this to psychological illness.
　　Experts say this case is very typical. Many parents do not treat their children’s unusual behavior or emotions as a kind of illness, believing they are a natural part of growing up. “As a matter of fact, those unusual behaviors are signals that the children are seeking psychological support,” said Dr. Liu Jin from the Chinese Center for Disease Control and Prevention.
　　Liu noted that the psychological problems of children can be classified into three categories: emotion, cognition and behavior. She said the majority of parents, and even doctors, lack knowledge of psychological illness, resulting in ignorance about the unusual behavior of children and a delay in medical treatment.
　　“When looking for medical treatment, the parents usually go to a children’s hospital first, or the pediatric department in a comprehensive hospital. Then they will go to the neuropathic department, then the traditional Chinese medicine department. After all those efforts end in vain, some of them will finally go to the psychology department. But at this stage, their children may have suffered a long time from the illness,” she said.
　　
　　Developing complications
　　
　　“If not treated promptly, there are many opportunities for complications,” Liu said. For instance, one of her patients initially suffered from attention deficit disorder, which developed into a more serious illness that began to affect his social ability. Gradually, the child found it difficult to study and encountered emotional problems in adolescence. “It becomes very difficult [to cure a child] when several illnesses complicate the situation,” she said.
　　Zhao Rongfeng, head of the Beijing Association for Mental Health, said that if a psychological problem is detected earlier, it can be cured. “It is a pity that the parents cannot make it in time,” she added.
　　Dr. John B. Sikorski, an adolescent psychiatrist in California, believes that the biggest impediment to early treatment is the sense of shame about an illness. He noted that first of all, the patient cannot accept the fact that he or she has mental problems and the parents fear that others will learn about the situation and give the child strange looks. But, he noted that the danger brought about by the feeling of shame toward psychological problems is greater than that for any other illness.
　　“Who can tell people comfortably that his or her child is receiving medical treatment at a psychological hospital?” said a parent who brought his son to the Beijing Anding Hospital for treatment and admitted that his family could not hide the truth any longer in the neighborhood.
　　A recent survey conducted by the Anding Hospital found that 32 percent of primary and middle school students in Beijing have varying degrees of mental problems, which can be divided into three groups: interpersonal relations, emotional stability and the ability to study. However, only a few of these children have received professional psychological treatment.
　　Feelings of shame prevent the children and their parents from cooperating well with the doctors’ efforts. Many parents stop bringing their children for further consultation with a doctor, and the children are taken off medication when they have shown some improvement. Liu said she could tolerate the children’s ignorance of mental illness, but not their parents’ attitude. “Parents, as the children’s guardians, should not instill the wrong mindset in their children, that mental illness is something shameful,” she said.
　　The feeling of shame can lead to addiction to drugs, such as anti-anxiety medications, stimulants and sleeping pills. Those drugs have a big market, and some are specially designed for children. The new medicines for children’s psychological health developed by pharmaceutical companies on the one hand can help the patients, but on the other hand can cause dependence. In some cases, the child’s illness is not that serious, and sometimes a change in environment may be more effective, experts say.
　　The excessive dependence on drugs sometimes causes tragedy. Not long ago, a child was sent to the Beijing Anding Hospital, suffering from the severe effects of taking the wrong medication. Professor Zheng Yi, a psychology expert at the hospital, said the child’s parents were afraid the child would be labeled psychotic and sought help from some doctors who had little knowledge of mental illness but were aggressive in prescribing drugs. The wrong prescription nearly claimed the life of the child.
　　Zheng said that given the difficulty in diagnosing mental illness as well as its treatment, only 20 percent of children with mental problems receive the right diagnosis and treatment. “But China is far behind this proportion,” said Zheng, “Many children are misdiagnosed or suffer a delay in treatment.”
　　In the middle of April, the Beijing Anding Hospital’s pediatric section was opened to the public. After visiting, many people found that the facilities for mentally disturbed children were not as they had imagined. “It’s more like a nursery,” one woman said. One parent who brought her middle school child to the hospital said that her son had developed the habit of biting his fingernails. “I want to see how professional psychiatrists deal with those kinds of problems, and if time permits, I will bring my son here for a medical checkup,” said the mother.
　　
　　A shortage of child psychiatrists
　　
　　Although many families are troubled by the feeling of shame for having a child with a mental problem, thousands of others are worried about the difficulty of finding a qualified child psychiatrist.
　　Statistics from the Chinese Center for Disease Control and Prevention indicate that the total number of professional child psychiatrists is no more than 150. But China has millions of children suffering from mental problems, which means that there is only one doctor for tens of thousands of children.
　　Moreover, the child psychiatrists are not spread evenly across the country. There are six senior child psychiatrists in the Beijing Anding Hospital, for example, while there are none in some provinces or cities. “It takes much more time to treat a child patient than an adult,” Dr. Liu of the Chinese Center for Disease Control and Prevention said. “As a result, one doctor is able to diagnose only a few patients.”
　　Experts estimate that, based on population size and societal demand, China needs at least 8,000 child psychiatrists, but the outlook is not that optimistic.
　　For medical college graduates, the road to becoming a child psychiatrist is long. First, they have to qualify as general psychiatrists, who must be familiar with typical adult psychological illnesses and treatments. But, compared with adults, children’s problems often are not obvious or typical. Moreover, since children lack strong communication skills, it is hard for doctors to get the necessary information, which further complicates the diagnosis. Therefore, child psychiatrists need a great deal of patience and keen powers of observation.
　　“It takes at least six years of training and practice before a graduate becomes a qualified and trustworthy child psychiatrist,” said Liu.
　　
　　Schools fill a gap
　　
　　The psychological health of children is drawing more and more attention from society.
　　Recently, in some cities such as Beijing, training courses lasting two to three years were launched with the goal of training mental health teachers in primary and middle schools.
　　The Beijing Education Commission stated that a psychological counseling office should be set up in all primary, middle and vocational schools in two years to provide mental health services to students, parents and teachers.
　　According to a guideline issued by the commission, each psychological counseling office should have at least one professional or part-time worker who has received comprehensive psychological health training. It also stipulated that the psychological counseling office should be open regularly, at least 10 hours every week.
　　It is reported that schools will file psychological profiles for students who have special needs or mental problems. The commission suggests using euphemisms for the counseling office, such as “chat room” or “emotion bar.”
　　In addition, the office should be set up in a location far from the classrooms in order to make visitors feel safe and to preserve privacy. Books and periodicals are required to be placed in the office to provide information for students.
　　As a matter of fact, some schools in Beijing have already set up psychological counseling offices, which have generated positive results. For instance, since 1996, the middle school affiliated with Renmin University of China has provided psychological services to over 3,000 students. Currently, the school has five psychologists, including one with a Ph.D degree and four with master’s degrees. They provide various psychological services to students in all grades. The school’s counseling office is open regularly and mainly deals with such problems as difficulties in studying, exam anxiety and career planning.
　　“The number of students suffering from psychological problems is increasing these days, as some psychological problems are not resolved properly at an early age, which leads to more serious problems,” said Zang Chaoying, a psychological counselor at Beijing No. 7 Middle School. “The establishment of the counseling office is to prevent such a thing from happening.”
　　

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