Childhood Behavioral and Mental Health Problems in Jordan
Authors: Nasir Arwa , Nasir Laeth , Masri Amira 
Published: May 2020

AbstractIntroductionPediatric behavioral and mental health disorders are a leading cause of childhood morbidity worldwide. International and regional data from Arab countries confirm the high prevalence and societal cost of these problems. No data exist that describe the range of childhood behavioral problems encountered by pediatricians in Arab countries.MethodsQualitative phenomenological methodology was used to collect information. We conducted 8 focus group interviews with physicians in different practice settings across the capital of Jordan. A total of 36 physicians participated in the interviews.ResultsThemes that emerged were organized in 4 categories:Specific behavioral disorders: A number of behavioral and mental health disorders were commonly encountered. Autism was reported to be the most commonly encountered severe neurodevelopmental disorder. The scarcity of effective and affordable management and referral options compounded the impact on families and physicians.System related themes: Physicians perceived deficiencies in training, detection and management of behavioral disorders, a lack of mental health services and quality referral options.Family related themes: Several factors were perceived to contribute to behavioral morbidity such as family structure and parenting practices.Sociocultural themes: Societal perceptions that childhood behavioral problems were a family responsibility resulting in reluctance of medicalization or discussion with physicians. Cultural differences in the interpretation and tolerance of certain childhood behaviors rendered ‘standard’ diagnostic criteria problematic.Discussion and conclusionsPediatricians frequently encounter childhood behavioral problems in clinical practice. Barriers to management of these issues include inadequate training and unique sociocultural, family and system factors. Tailored strategies will need to be developed to improve the detection and management of childhood mental health and behavioral problems in Jordan. Further research to explore, develop and test culturally grounded strategies to address these disorders in Arab countries is needed.What is already known?Pediatric behavioral problems are antecedents of adult mental health problems. Little is known about pediatric behavioral and mental health problems encountered by pediatricians in Arab countries or the specific barriers to addressing these problems from the perspective of practicing clinicians.What are the new findings?Jordanian pediatricians encountered a range of pediatric behavioral problems in their clinical practices. The specific factors that contributed to the prevalence of and perceived difficulty in the diagnosis and management of pediatric behavioral and mental health problems were identified. These related to medical systems, family factors and psychosocial factors.What do the new findings imply?A contextual and holistic understanding of specific problems encountered by pediatricians in practice as well as the barriers to addressing them is critical to the development of culturally informed interventions to detect and effectively manage pediatric behavioral and mental health problems in Arab countries.