NASP Center

Cultural Considerations in Discussing Mental Retardation

by Nancy Gronroos, M.S.
California Department of Education, Diagnostic Center, South

Working with parents who have different cultural traditions presents additional challenges. The school psychologist may not be familiar with the manners, expectations for professionals, values, and assumptions that are dominant in the parents' culture, especially in districts with great diversity.

Working with a Translator

When a second language is involved, a translator familiar with both the culture of the family and that of American educators can be invaluable. The translator can explain the expected courtesies in interacting with the parents, how mental retardation is likely to be viewed, and other cultural factors that may be significant during assessment and when discussing a diagnosis of mental retardation. Sometimes the parents offer to bring their own translator to the meeting; however, using a translator from the district is recommended. The parents may not anticipate a diagnosis of mental retardation. Having a family member or a person from their community hear this diagnosis may be humiliating.

Before speaking to the parents about the diagnosis, dialogue with the translator about the possible implications for the family, and how best to give the message with clarity and compassion. Discuss the importance of confidentiality regarding the child's diagnosis. The translator may dread having to convey to the parents that the child has mental retardation. Explore these feelings and any reservations and give support. Anticipate problems that may occur and possible responses. Practice what will be said when explaining the diagnosis to the parents. Emphasize the importance of an unembellished translation without interpretations or omissions. Parent comments should also be translated as precisely as possible. After meeting with the parent, discuss the translator's impressions of how the message was understood and received and whether follow-up contact with the parents prior to an IEP meeting is advisable.

Visiting the Home

If the parents are willing, including a home visit in the assessment process can help establish a positive relationship. The visit is evidence of desire to elicit the child's best performance by observing him or her in a comfortable, familiar setting. It permits the parents to show what their child can do, provide background information, and, in their own surroundings, discuss their concerns and hopes for the child. The psychologist can better assess the degree to which the child is meeting family expectations, the type of support caretakers use to elicit performance, and the stimulation offered in the environment.

Recognizing Individuality

Individuals do not always share the values and traditions associated with their ethnicity or nationality. As in the United States, values and traditions may vary due to factors such as religious beliefs, membership in subcultures, education, awareness of other cultures, and relative interest in assimilation versus maintaining one's own traditions. Some of the dimensions to be considered when establishing a relationship with parents of any ethnicity, including parents born and raised in the United States, include:

Comfort with informality. The parents may regard being addressed by their first name as disrespectful. In some cultures there are rules about who should be greeted first and who may propose dropping formal titles. Casual dress may also lead to questioning of the examiner's professionalism.
Amount of eye-contact that is considered to be courteous, and the degree of proximity and touching that is comfortable.
Pacing. Many Americans tend to introduce the main issue rather quickly and directly. This approach may feel abrupt and even rude to people accustomed to conversing or leading up to issues indirectly.
Comfort with self-revelation. Personal questions are considered intrusive by people of many cultures, here as well as abroad. Some districts use questionnaires designed for a medical/research model. Questions on parental behavior that will neither clarify the diagnosis nor lead to differential interventions should be omitted.
Comfort with dialogue and joint decision-making. Some parents expect professionals to make recommendations based on their specialized knowledge and are not comfortable with the degree of parent participation encouraged in most districts. Disagreement or reservations may not be openly expressed, but may be the basis for lack of follow-through. The advice and support of the extended family or community leaders may be more important than that of the assessment team.
Showing emotion. Some parents may suffer deeply without outward emotional display. Stoicism does not necessarily mean the message was not understood.

Possible Outcomes

Cultural factors influence outcomes for the child that may not be anticipated or under the control of the assessment team. Some of these factors are:

Belief in the cause of the child's disability. Attributions may include an accident of nature; genetic predisposition; the consequence of one or both parents behavior; divine punishment for sins of parent(s), extended family members, or ancestor; or even demon possession. Alternative viewpoints can be offered, but are not likely to change deeply held beliefs; professionals need to respectfully work with the parents, regardless. Some beliefs may work to the child's advantage. For example, parents who believe in divine punishment may also believe that caring for the child well will earn divine forgiveness.
Belief in potential for change with interventions. Some parents may spurn offers of special education, believing in tutorial or religious interventions. Others with limited financial or emotional resources may commit them to their children without disabilities.
Impact of child's disability on the family's standing in their cultural community. Because the marriageability of siblings may be affected, parents may reject services that would make it clear to others that their child has a disability.

Because of factors such as these, it is especially important to speak in terms of the support that the child is likely to need to maximize his or her future independence and of the educational and community resources available. The assistance of a translator should be offered to help the parents work with relevant public agencies. The phone number of a parent from the same culture who has a child with a similar disability and agrees to be a resource may be helpful. Psychologists will need to be informed about parent support groups offered in the parents' language. Possible resources are the offices of state and national organizations and community service providers for children and adults with developmental disabilities.