Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 45

Julia was a 16-year-old Asian American girl who was referred to our clinic by her oncologist after she was diagnosed with a rare form of cancer. Julia refused to participate in radiation therapy or to take medication for her illness. Her physician suspected that Julia was paranoid because she flew into a rage when he tried to examine her in his office.

Julia reluctantly agreed to meet with a therapist in our clinic who was aware of Julia’s social–cultural background. Julia was the American-born daughter of Hmong immigrants from Laos in Southeast Asia. Julia’s parents sought asylum in the United States because of the Laotian civil war and genocide of the Hmong people. Julia’s parents did not speak English and had limited contact with individuals outside the Hmong community. Julia attended a public high school and had good English language skills but was mistrustful of American culture and Western medicine.

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Julia admitted that she was scared about her cancer diagnosis and wanted to receive treatment. However, she also wanted to respect her parents and to honor her family’s traditional values and way of life. Her therapist suggested that a Hmong faith healer talk with her physician to identify which aspects of medical treatment might be acceptable to Julia and her family. Over time, Julia was able to successfully participate in Western medical treatment by having community elders attend all of the radiation therapy sessions, purify the medications prescribed by the oncologist, and perform other remedies important to Julia and her family.

Differentiating abnormal symptoms from culturally sanctioned behavior is especially challenging when clinicians are asked to assess youths from other cultures (Causadias, Vitriol, & Atkin, 2019). Consider Julia, an Asian American adolescent from a diverse background.

Children’s culture, race, and ethnicity can affect the diagnostic process in at least four ways. First, members of minority groups living in the United States often have different cultural values that affect their views of children, beliefs about child-rearing, and behaviors they consider problematic. For example, non-Latino White parents often place great value on fostering children’s social–emotional development and encouraging child autonomy. These parents often provide warm and responsive behavior during parent–child interactions. In contrast, many African American parents place relatively greater value on children’s compliance; consequently, they may have high expectations for their children and adopt less permissive parenting strategies. Clinicians need to be aware of cultural differences in socialization goals and parents’ ideas about appropriate and inappropriate child behavior (Comas-Diaz & Brown, 2018).

Second, recent immigrants living in the United States often encounter psychosocial stressors associated with acculturation. Acculturation stressors can include assimilation into the mainstream culture, separation from extended family and friends, language differences, limited educational and employment opportunities, and prejudice. Some immigrants do not share the same legal status as members of the dominant culture. For these reasons, the sheer number of psychosocial stressors encountered by these families is greater than those encountered by families who are members of the dominant culture (Vu, Castro, Cheah, & Yu, 2019).

Third, language and cultural differences can cause problems in the assessment and diagnosis of minority youths. The assessment and diagnostic process was designed predominantly for English-speaking individuals living in the United States and other Western societies. The words that describe some psychological symptoms are not easily translated into other languages. Furthermore, many symptoms reported by individuals from other cultures do not readily map onto DSM-5 diagnostic criteria. Psychological tests are almost always developed with English-speaking children and adolescents in mind. For example, children raised in Columbus, Ohio, will likely find the following question on an intelligence test fairly easy: “Who was Christopher Columbus?” However, immigrant children who recently moved to the city might find the question extremely challenging. Psychologists must be aware of differences in language and cultural knowledge when interpreting test results (Benisz, Dumont, & Kaufman, 2018).

Fourth, ethnic minorities are often underrepresented in mental health research. Over the past 2 decades, researchers have made considerable gains in understanding the causes of and treatment for a wide range of child and adolescent disorders. However, researchers know relatively little about how differences in children’s ethnicity and cultural backgrounds might place them at greater risk for certain disorders or affect treatment. Furthermore, researchers have only recently begun to create treatment programs designed specifically for ethnic minority youths. For example, special therapies have been developed to help Latino children cope with traumatic events using culturally relevant support. Youths meet in groups to learn mindfulness techniques and other coping strategies that are consistent with their social–cultural attitudes and values. Clearly, more research needs to be done to investigate the interplay between psychopathology and culture (Hoskins, Duncan, Moskowitz, & Ordóñez, 2018).

Review

 Children’s development and functioning must be understood in light of their culture, race, ethnicity, and identities.

 Mental health professionals should be especially sensitive to (1) the way social and cultural factors affect families’ expectations for their children and ideas about child-rearing, (2) families’ immigration history and degree of acculturation, (3) the way language can influence how families describe their children’s behavior, and (4) the degree to which ethnic minority families are underrepresented in mental health research.