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Are Cultural Differences Truly Developmental Delays?

Miguel is 19 months old and lives with a large family that includes his parents, three older siblings, an aunt, and his grandparents. He qualified foshutterstock_155014598r early intervention due to delays in gross motor development and low muscle tone. He’s also showing some slight delays in his expressive communication. During his assessment and subsequent intervention visits, you notice that Miguel’s family often carries him around or keeps him in a pack-n-play during the day. His family is also very skilled at meeting his needs, so much so that he barely has to vocalize to get what he wants. The more you get to know the family, the more you wonder…does Miguel truly have developmental delays or are his developmental differences due to how he is cared for?

What’s Causing Miguel’s Delays?

Wondering why Miguel is showing delays is a normal part of the detective work we do as early interventionists. We believe that when we can find an environmental factor, then maybe we can help the family make changes to eliminate it. Sometimes this is true, such as when a child is in an under-stimulating child care environment and we can help the family find a better option. Other times, though, the factors in the environment are grounded in family values and cultural beliefs that are much harder to change. We have to question whether or not it is even appropriate to try to change family values or beliefs? Is that our place?

Cultural Differences in Child Rearing & Independence

Based on their cultural beliefs, Miguel’s family defines their role in his child rearing as taking complete care of him and ensuring his safety. Miguel is included in all family activities and is well-cared for and very well-loved. The female caregivers in his life (mom, aunt, sisters, grandmother) all share the responsibility of caring for him, carrying him around, and meeting his needs. They use the pack-n-play to keep Miguel safe from all of the traffic in the home, fearing that he would be stepped on if left on the floor to play since he can’t move out of the way yet. Developing Miguel’s independence is not a priority for them as, in their culture, he is considered a baby for the first few years of his life. This is different from our typical American view of infancy and early milestones. This difference doesn’t make their cultural view wrong. It does complicate matters, though, since our assessments and intervention processes don’t often adequately consider cultural differences.

Does It Matter?

You might be thinking “does the cause really matter?” and I’d say that yes, it does. Perhaps a more important question to ask is what Miguel’s parents think. Asking them when children are expected to walk and talk in their culture can give you an important clue. If they say that they think Miguel should be walking and talking by now, then the door is open to discuss intervention. If they say no, then talk about their interest in early intervention. It’s fine to talk about what we expect developmentally in typical American culture so that they understand why we are concerned (our perspective) and have information on which to base their decision. It’s important to have this discussion, though, with respect for their cultural values and beliefs.

If you were Miguel’s service provider, how would you support his family? Would you address your observations? How would you provide intervention suggestions that were sensitive to his family’s cultural beliefs? 

Does it matter that his delays might be related to his caregiving and culture? Why or why not?

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For more information about cultural competence, visit the VA Early Intervention Professional Development Center’s Cultural Competence topic page and the Cultural Competence resource landing pad.

 

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50 Comments to “Are Cultural Differences Truly Developmental Delays?”

  1. If I were Miguel’s service provider I would support his family by taking into consideration their beliefs and values. I would first ask what they expect from Miguel’s development for his age. Once I get an answer from the family related to their development, I would relate it to the typical American culture and explain that as a program this is our observations and our concerns.
    Knowing that Miguel’s delay is related to his caregiving and culture is important because as a service coordinator I can work with the family in understanding the impact taking into consideration their cultural beliefs and respecting that.

    • I like how you would start by asking Miguel’s family about their expectations. It would be great to ask about their priorities and concerns for his development too. Connecting the dots between their expectations and ours in American culture is so important because these dots are often missed, especially if professionals focus on items achieved/missed on tests (without considering functional development). As the service coordinator, you can help the whole team bridge any differences in expectations. When it comes down to it, like you said, we have to respect the family’s wishes while also providing information about what we see so that they can make informed decisions about their next steps. Service coordinators are SO important for navigating cultural issues across teams and supporting family decision-making! Thanks Jessica!

  2. As Miguel’s service coordinator I would take into consideration the family’s cultural belief and how that relates and shapes the caregiving style of the family. From the description I can tell that the family is highly involved in caring for Miguel so I would validate that as a way to show support. I would then ask them what developmental expectations they have for Miguel. I would explain to them my concerns as a service coordinator based on what I have observed and make recommendations based on the family dynamic. I would help the family find an appropriate intervention method that is considerate of their beliefs and caregiving style.

    • So well-said, Astrid! I like how you integrate your respect for the family and sharing your expertise. How do you handle it when your observations differ from the developmental expectations of the family and these differences relate to their cultural beliefs and styles?

  3. As Miguel’s service coordinator, I would ask the family what their goals for Miguel’s development are. I would ask the family what are their concerns. These concerns may differ from the ones the program has for Miguel, but the family are seeking help for their own concerns for Miguel not the program’s concerns. After developing a relationship with the family, I would discuss milestones the PCP look for to be met by children Miguel’s age and discuss if that is something they would like to address with the program. I would not press any issues with them and allow them to customize their therapy for their child because they are supposed to be able to do that.

    • Thanks Tiffany! I really like how you said that Miguel’s family should have the opportunity to “customize” early intervention for their child. That’s what it’s all about. We do have to be prepared for differences between our priorities and concerns and the family’s. This discussion can be most effective when we help families understand how those milestones relate to a child’s everyday, functional abilities and what is expected within his family and his culture. It can be tricky to explain, but service coordinators often do a great job of this and they have the rest of the professionals on the team to help as well.

  4. It would first be good to know who put in for the referral. There is certain information not provided in this blog that would be beneficial. If the family made the referral, they are aware that there are some delays and are wanting help. If someone else made the referral, they may be unaware of the concerns that should be present. Asking the family about their priorities in regards to Miguel’s development would be my first step. If a goal is set that is important to the family, they are more likely to implement the strategies that we practice during each session.

    The reason for delay does matter, because it is beneficial to know the cause. If the cause is merely environmental, that is important to communicate to the family. If the delay is dependent upon the child only, the family should be understanding of that.

    • Thanks so much for joining the conversation, Hannah! The source of the referral really does make a difference, especially in how you approach that first contact. I love what you said about goals. Sounds like you are doing a great job!

  5. If I was working with the family, I would, like Hannah stated, see who referred them, because if it was the family, then it would be easier to address their concerns and see what they wanted to work on. I would bring up some observations I have seen and approach the topic as if I were complimenting their techniques. Saying that, I would also bring in some suggestions as to what they can do to incorporate improvements on their child’s milestones.I would definitely be aware of the family’s cultural beliefs when doing this. Since their family is focused on his safety, I would bring up the idea of having play interaction with Miguel and his caregivers on bigger floor space. They would still be able to ensure his safety by being with him and working on building some muscles. I would even bring up the idea that him building his muscle tone can help ensure his safety that much more.
    In my belief, it does matter that his delays might be related to his caregiving and culture. If this was the main factor, then it would give us a chance to try and find another method they could use that would not violate their beliefs and be more beneficial to Miguel.

    • Well said, Angela! I really like how you said you would try to compliment their techniques as you talk about intervention strategies. That’s a beautiful way of saying that you would integrate intervention with what they are already doing and what’s important to the family – which is exactly how EI should work. I agree that a skillful interventionist can weave support with what parents are already doing while being mindful of cultural values and preferences.

  6. As Miguel’s provider I would build rapport with his family by not only respecting and understanding their culture but also by being flexible and understanding from their point of view. It is important to understand their culture in order to avoid offending or to jeopardize good rapport. Although our culture may see it as a problem, Miguel’s culture may not.
    Understanding the goals the family would wish Miguel would reach and adjusting the program to their wishes. If their parenting style clearly intervenes with his growth potential, I would talk about his potential in a way that does not offend their style or culture. If they wish to explore some adjustments to help their child’s fullest potential I will be there to help them with the transition and to support their journey.

    • Well said, Adriana! Yes, building rapport is really the foundation of every interaction with have families. I like how you write about “adjusting the program to their wishes” while also discussing the child’s potential. Managing that balance can be difficult for some of us, but it’s a wonderful way to approach working with any family. Thanks!

  7. I believe it is very important to take into the cultural beliefs of the family before making recommendations. As mentioned above, just because the family views development differently, does not mean that their way is wrong. Therefore, I think it’s important to open the conversation with what concerns the family has. Then, the interventionist can talk about the differences in culture, and how these “delays” may be a concern in American culture. However, it’s important to explain that you feel that the family is doing an exceptional job caring for their son and if they don’t have concerns, there is no reason to intervene in those areas.

    • Well said, Lindsey! It’s so easy to think that because our assessment tool says that an 18 month old has to do —– at a certain age, that that means it must be right for all children. Many of our tools weren’t normed on children from different cultures, or even very young children with disabilities for that matter. Combining our informed clinical opinion with cultural considerations and info from the assessment is a wonderful skill that takes time, practice, and awareness to develop!

  8. If I were Miguel’s service provider, I would support his family by first taking into consideration his family’s customs and cultural values, and asking them about what they expect to be within the limits of ‘normal’ in their culture for a child Miguel’s age. I would also ask them about what their priorities or concerns are about Miguel’s development to get a better picture of their familial settings. I would then observe Miguel’s behavior and compare it to American ideals of typical development at his age, and address my observations based on the family’s concerns and goals for Miguel, even though this may not align exactly with American developmental milestones. To provide intervention services, I must be able to understand their culture to the best of my ability to avoid offending Miguel’s parents on their parenting techniques, because most of his ‘developmental delays’ could just be in complete normal limits of his culture! I would then make sure to sit down with his parents and explain how some of his delays (in American culture) could be of concern, and make recommendations & provide information out of pure respect for the family’s wishes.

    • Thanks Loana. It can be a real challenge to find the balance between cultural differences and our expectations when we are not of the same culture. Approaching the discussion from a respectful point of view, as you describe, is always a good idea. I like how you describe trying to bring everything together – viewing his behavior from both perspectives and in the context of the family’s priorities and goals. You’ve got the right idea!

  9. I would ask his family what they are concerned about, or if they’re concerned at all. I’d ask them if they’ve considered playing with him in a closed room so he can explore different skills and still stay out of the family traffic. I might say something like, “typically a 19 month old would be walking and getting pretty independent by now, is that something that you would like for Miguel to be doing?”
    If they have experienced that even though their kids are delayed by normal standards at young ages but catch up well when they’re older, I would respect that. I would also ask them if they themselves have any goals for Miguel right now.

    • I really love your last sentence…asking about the family’s goals and priorities for Miguel is actually a great first place to start! Regarding the discussion with Miguel’s family, it’s important to keep in mind, though, that “normal standards” are somewhat relative…there could be very normal standards within their culture that are different from what we find on our tests (that may not have been normed to include their culture). That’s why it’s a careful balance. I remember, years ago, being fascinated to read about a different set of developmental milestones for infants and toddlers with significant visual impairments. The milestones were what was “normal” for them. It really made me think differently.

  10. As one who sees this run in my own culture and family, it is hard to say that it is not the cause of the delay. Parents do tend to cater to every single need even when sometimes we must push our children to get better and improve their growth. However, no matter what the cause of the developmental delay entails, as a service provider we must respect the family’s wishes and do what is best for the child’s development. If it is something the family brings up, it would help to have an open conversation about it.

    • I really appreciate how you wrote this, Rhonda. Cultural and family interactions certainly do contribute so much to how a child develops. It’s hard to say for sure that yes or no, those things cause a delay. I think the key is to remember, as you said, that we have to respect how the family works and be open to working with them within the boundaries of their priorities and preferences.

  11. As a service provider, I would definitely address my observations of how the family cares for their child. But first, I would ask the family questions on what their expectations are of their child at the moment. I would then explain to them the typical American culture’s expectations of children around Miguel’s age. I would not express my observations in a worrisome manner, rather, I would state that these are simply observations I have noticed and that I would like to discuss the possibility of ECI for Miguel. But i’s important to not make them feel like they are not up to American standards or that they aren’t doing a great job as caretakers already. I do think that it matters that his delays might be related to his caregiving and culture. In these situations, it would be important to work with their culture in order to determine the best methods for Miguel instead of enforcing typical American standards and practices on them and make them do things they are not comfortable with.

  12. If I was Miguel’s server provider, first I would respects the families beliefs and values while I am trying to better his developmental delays. I would work with the family as much as I could and give them the opportunity to be apart of the strategies and solutions from for the child. Since is delay is caused by his care giving and cultural beliefs, I would have to work with the family to know about the activities and the type of caregiving they provide for the child s that I can come up with different interventions for the child to be better

    • The collaboration you describe is so important. Keep in mind that you are not expected to come up with intervention strategies on your own…we know that developing intervention strategies through coaching and collaboration with the family in the context of their everyday routines and activities is the best way to go. When you work as partners with the parents in these contexts, you and the parent both share what you know and develop individualized, meaningful strategies together. That’s true regardless of the cause of the delay!

  13. I would definitely start with asking what goals do the parents have for Miguel. Then I would try and see what practices align exactly with those goals and to see what sort of things could be compromised on. I might show them the typical developmental milestones but ultimately let the parents make it clear on what they want for their child

  14. First things first, I would ask the family what is important to them and what goals they had in mind. It is important to consider that what is culturally appropriate for them may be different than what is culturally appropriate in America, and that is okay. Making the family feel comfortable and a part of the process is a huge component of successful intervention. It would be difficult to teach the family strategies based on a culture that they don’t understand. In order to bridge the gap, I would inform them about American norms as best as I could, and then let them decide if they would like to proceed with a hybrid plan infused with both cultures.

  15. Since our intervention standards don’t always align with other cultures, I believe that there should be clearly defined assessments that allow for cultural exceptions. I believe that knowing the family’s concerns are key. If they are concerned about the implications that their cultural standards will have on his assimilation, then there is an opening for further discussion. If not, it is not our job to intervene since these services are voluntary.

    • I really wish we did have clearly defined assessments as you describe, Anne. Some tools do provide guidance on adapting items for cultural and developmental differences, but since many don’t, and you really can’t account for everything anyway, I think that is why we are required by law to use our “informed clinical opinion” with assessments. Same goes for intervention – if the family is interested in EI and you suspect that their cultural practices are affecting the child’s development, you have to tread lightly, learn about their beliefs and practices, and adapt what you know about development to work with the family. When I did this, sometimes I ended up learning probably more than the family did! 🙂

  16. I would take into consideration his families beliefs and values, and make sure I emphasize my respect for their views when talking about early intervention. I would definitely open up a dialogue about early intervention to see if they would be interested in that, explaining the time frames in which a child can typically begin walking. At the end of the day, I would let them know that their family goals and how they want to achieve them are what is most important for me, as the service coordinator.

    • Well said, Maryam. Conveying that respect, especially as the service coordinator who is often the first contact the family has with the EI team, is vital!

  17. I agree that culture does take a large effect on determining whether a child has any developmental delays. Certain cultures push for independence early on for their child and this allows for their child to experience his or her environment, but if they are protected by everything this could limit experience with certain senses. This could lead further developmental delays

    • Yes, determining this can be tricky because what we may view as a delay could be viewed as a normal variance in another culture. Learning as much as you can about the culture of a particular family, by reading about it, talking to other EIs who have worked with families of the same culture, and perhaps asking the family for more information, can be a good place to start.

  18. I do believe that it is important to consider their cultural beliefs but you should also have an open dialogue with the family and respectfully let them know some of the implications of not allowing Miguel to go off on his own. Be respectful because they may not actually be aware of the cultural norms here in the US. Allow them to make the decision and decide if this is something that they would like to focus on. Maybe let the family know that every child is different and that even though this method may have worked for their other children it may not work for Miguel.

  19. As Miguel’s service provider, I would ask the family about their expectations of development and of ECI and myself. I would explain how our program works and how our development checklists look. I would inform the family that they have a right to choose to be enrolled in ECI or not. I believe cultural differences should be valued and taken into consideration. If we are working on what we value, and not the family, there will be no follow through and eventually will ruin the rapport with the family.

    • I agree, Kimberly. You make a great point about the importance of valuing cultural differences and what’s important to the family. Building that rapport and checking our own biases are so important!

  20. If I were Miguel’s service provider, I don’t know if I could keep myself from having a conversation with the family about my own cultural values and typical American standards for development. Since the family is living in the United States, I feel it’s important to make sure they know what daycares and schools will expect once Miguel arrives. It is so important to respect a family’s cultural values, priorities, and beliefs. At the same time, when a family lives in a society with different belief systems, it’s important that they at least be aware of what are considered typical developmental milestones and what kids of certain ages are generally expected to do. This is especially relevant considering that Miguel will likely join a mainstream school system that does not always accommodate developmental and cultural differences. Of course, the decision is always up to the family, so although I would provide them with the information, I would never force the family to alter their caregiving style or change their priorities to accommodate external cultural pressures.

    • I really appreciate your honesty here, Megan. It would be very hard NOT to share that information. I think if you do it from a place of respect and openness, then you will be supporting the family rather than imposing your views on them. Balancing respecting their cultural values and experiences with sharing information about what to expect can be a bit challenging. It’s important to remember that cultural differences in developmental milestones and parenting practices are not necessarily wrong, just different. Maybe a good place to start is by making sure that we are aware of the research on cultural differences and developmental delays, so that we can present that balanced, accurate point of view. We will be presenting a 2-part Talks on Tuesdays webinar series on communication development in children how are dual language learners in March and April 2018. Stay tunes for more info. I hope you can join us!

  21. I have a very similar experience with my baby cousin. His parents watch over him 24/7. Many of the priorities I value such as self feeding his parents do not agree with. He is almost 3 and does not feed himself because his parents don’t see that as a priority so I think the way he is being raised is heavily influenced by the culture around him. If I were Miguel’s service provider, I would definitely address those observations. Regardless of difference in cultural values, I think it’s’ important to express any concerns as his service provider. Suggesting intervention can be really difficult and I think providing suggestions for intervention should be approached in a very professional manner that doesn’t seem like Miguel’s family and their cultural beliefs are being attacked.

    • Thank you, Natalie, for sharing your experience. Your example is one we often encounter because of child rearing practices in many different cultures do not place heavy emphasis on teaching children to be independent at a young age. Educating parents on typical development is important. I always like to see what opportunities the child has to still practice the same skills and build confidence. One approach is to discuss the value of identifying learning opportunities for each child with the family. We know it may take a child hundreds of opportunities to master skills as they learn and grow. Asking the family to identify and reflect on these opportunities can be a great way to value their culture and address the family’s concerns at the same time.

  22. I think the first step would be to build a sense of trust with the family. Through active listening, responding with empathy, and remaining open-minded, the service provider can learn what the family considers to be a priority for their son. Through learning what the family cares about, that can be related to the child’s developmental delays and goals could be determined from there. I think it would be good to explain implications of the delays and intentionally speak about how they relate to typical American culture so both the provider and family can work together to be on the same page. (This should be done in a way that does not place judgment.) Together, this team can reflect and decide how they would like to move forward with Miguel and early intervention.

    • Excellent point! The service provider can absolutely share information about typical American cultural expectations for development, but must be sure to do so in a sensitive, objective, and nonjudgmental manner. This doesn’t mean that we will expect Miguel’s family to change their interactions to accommodate these expectations…we must also respect Miguel’s cultural expectations and understand that they are equally important and relevant to the discussion. Providing information so that his family can make informed decisions, and being accepting of information from them, will help us all learn together and hopefully create IFSP outcomes that are meaningful for him.

  23. If I were his service provider I would be very careful not to step on the families toes in terms of cultural differences. I would include them in everything I did with the child and make them feel very involved and hands on. You could also try to come up with ways to help without hindering the family. If they believe that they should help him through everything, then I would come up with tasks/games etc that involve them. There is still room to speak with the family about taking a step back to help him become more independent without feeling like you are interjecting into their beliefs. It is definitely a sensitive subject, but if the provider goes about it with respect and understanding then everyone can help to make Miguel’s progress a reality.

    • Thanks Laura. I like how you are suggesting that we start from a perspective that matches the family’s approach to raising their child. Sensitively providing information and guidance while remaining open to the family’s way of doing things is always an important balance in EI!

  24. I would begin gathering as much information about the family as I could. Beginning with very open questions like “What brings you here today?” or “What are your expectations for Miguel?”, I think open communication is the key for successful intervention because we need to be on the same page as the family. I would share my observations in a very respectful manner and if I had specific concerns, I would be very sensitive in explaining why I feel this is a concern. The family may not realize there are alternatives to the concerning behavior. Miguel has a very supportive family system and I think keeping everyone informed and included in the process would be most beneficial for Miguel.

    • Using open questions like that is a great way to learn from the family! It can be easy to make cultural assumptions about a family just because of what we think we know. Inviting the family to share what they know and what they need to know is a respectful way to start the conversation.

  25. I feel like this is such a difficult topic to discuss with family’s because cultural beliefs are something that should always be respected, but at the same time I feel that a family should be aware of the milestones Miguel should be at. If I was Miguel’s service provider I would study his behavior and compare to a child of his age at normal development. If there is something extremely off between Miguel and a child of his age at normal development I would express my concerns to the parents and try to come up with a solution that benefits the child but at the same time respects the cultural beliefs of a family.

  26. If I were Miguel’s service provider, I would first ask the family about their goals and expectations for their child. Since culture is such a sensitive topic, we must tread lightly. If they are concerned about Miguel’s progress in the area of motor movement then we can begin to discuss that the care giving techniques may be hindering him in that area and we might suggest some new options. Many cultures and individuals do not realize the impact some actions may have on their child’s development and the families have the right to know this information as long as they are open to the idea.

  27. “Are cultural differences truly developmental delays?”
    I believe from a medical standpoint that a person or families cultural viewpoint or way of life can hinder a child’s development. Anything that hinders a child’s development should be considered a developmental delay because there are obstacles therapist or doctors still have to work around or adjust to in order to help the child. However, looking at Miguel’s case and family, this blog shares with us that he has siblings who most likely grew up in the same way. When looking at them and comparing them to Miguel, did they grow up in the same way and did they have the same struggles and if so how is there development now at an older age?

  28. If I was Miguel’s service provider, I would support his family by being politely expressive, and making suggestions rather than telling and demanding. I would most definitely address my observations. I would provide intervention suggestions that were sensitive to his family’s cultural beliefs by creating a dynamic relationship, one that both offers a developmental path with or without adjusting the way they take care of Miguel. Developmental activities can be provided and can help regardless of if they choose to change any sort of caretaking techniques. It definitely matters that his delays may be related to caregiving and culture, because early interventionists/families need to know that true developmental progress might not occur without a change in caregiving.

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