Cultural variations in assessment and diagnosis of childhood behavioral disorders

¶ … Culture on Developmental Psychopathology

The objective of this work is to examine how conceptualization, assessment, diagnosis and treatment of childhood mental health disorders may vary by culture. Specific questions addressed in this research are the following: (1) How do psychologists define culture? How does our definition of culture guide us in our understanding of mental health problems? (2) What are critical components of our cultural experience that are important in how we assess and diagnose behavioral disorders? Finally this work will suggest ways that psychologists might better incorporate culture into their study and treatment of childhood behavioral disorders.

Impact of Culture: Assessment of Developmental Psychopathology of Children

Culture impacts the view of developmental psychopathology a great deal and that impact is differentiated by various cultural beliefs and customs and this includes religious beliefs and superstitions whether founded or unfounded according to factual evidence or science. The work of Hoagwood and Jensen (1997) states that it is hard to imagine a term that is "more slippery...than culture. One need not venture far into theories of culture to see the way sin which the use of this term has been vast, imprecise, and inconsistent." (Hoagwood and Jensen, 1997) p.108

In fact, it is stated that the complications resulting from the "uses of the term culture have constituted a serious impediment to generating empirical knowledge and aligning cultural psychology with the study of developmental psychopathology." (Hoagwood and Jensen, 1997)

These difficulties are stated to include:

(1) Ideological uses;

(2) Extreme relativism;

(3) Circularity; and (5) Overinclusiveness. (Hoagwood and Jensen, 1997)

III. Latino-Specific Study Reported

The work of Weiss, Goebel, Page, Wilson and Warda (1998) reports a study that "...examined the impact of financial, cultural, and family variables on the incidence of behavioral and emotional problems in a group of two- and three-year-old Latino children. Findings in this study stated that in terms of the children as a group "the mean score for total behavioral problems falls within the normal range, and well below the range suggestive of clinical concern." (Weiss, Goebel, Page, Wilson and Warda, 1998)

However, it is stated that 7% of the children in the study "had scores indicating risk for mental health problems and 14$ showed enough symptoms to warrant substantial clinical concern." (Weiss, Goebel, Page, Wilson and Warda, 1998) it is reported that the study was focused on the determination of the degree to which behavioral and emotional problems may be related to the family's financial status, cultural heritage, degree of acculturation, and family functioning." (Weiss, Goebel, Page, Wilson and Warda, 1998)

Results stated in the work of Weiss, Goebel, Page, Wilson and Warda (1998) are stated to suggest that "...as a group, Latino preschoolers are quite well adjusted, experiencing a range of emotional and behavioral problems typical for their age group. However, a small proportion of the sample demonstrated behaviors indicative of substantial mental health problems. Boys seem more likely to warrant clinical concern as a result of both their externalizing and internalizing problems." (Weiss, Goebel, Page, Wilson and Warda, 1998)

IV. DSM-IV Cultural Formulation Guidelines

Parron states that the components of the DSM-IV Cultural Formulation Guidelines are:

(1) cultural identity of the individual;

(2) cultural explanations of the individual's illness;

(3) Cultural factors related to psychosocial environment and functioning;

(4) Cultural elements of the relationship between the individual and the clinician; and (5) Overall cultural assessment for diagnosis and care. (Parron, 1997)

Analysis

Assessment of the behavioral and emotional state and factors of the individual is an initiative that requires that one understand the target culture or the culture of origination of the individual undergoing assessment. Different behavioral expectations exist among and between various cultures of the world and what might appear to be problem behavior in one culture may be viewed as normal behavior in another culture. Because of this assessment of certain behavioral and emotional aspects of the individual is characterized by a great deal of difficultly and challenge. That which is viewed as normal or expected behavior in the culture of North America individuals is viewed quite differently by other cultures who may be either more or less conservative in their approach or interactions with other cultures. Behavioral problems in the Latino community may not be viewed as behavioral problems in the traditional American household and vice-versa. Therefore, it is critically important that the psychological profile of an individual give consideration to the customs and culture of the individual undergoing assessment as there is not a generic umbrella assessment that can be used across all cultures and belief systems. Parron (1997) urges researchers in the next century to move beyond "superficial descriptive conclusions on their research efforts...and delve more deeply into understanding those factors that make ethnic and nonethnic children and adolescents so similar and yet so different." (Parron, 1997)