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Culture Clash in Early Intervention Services

Sep 14, 2021

Margaret Ritchey, UCSF Benioff Children’s Hospital Oakland, Oakland, California


This article discusses how increasing diversity within a community requires health care professionals to reassess the developmental assessment tools being used, or at the least, what implications one can derive from resultant identification of delays. The author describes a culture clash between her training and developmental expectations as a physical therapist practicing in the San Francisco Bay Area and the upbringing and cultural expectations of a recently immigrated young Guatemalan Maya Mam mother and her medically fragile infant. The author explores the concepts of cultural humility and mentalization as strategies to aid in development of a therapeutic relationship when working with families from diverse cultural backgrounds.

Most of the world’s developmental assessments, such as the Bayley Scales of Infant and Toddler Development (Bayley, 1969), are based on a century of research with resourced, if not wealthy, White children (Adolph et al., 2009; Bayley, 1969; Gupta, 2019). In the latter half of the 20th century several studies identified different rates of developmental milestone achievement around the world (Brazelton, 1972; Brazelton et al., 1969; Hopkins & Westra, 1988; Super, 1976), but these findings were not reflected in the assessment tools used worldwide. In the early 2000s the World Health Organization (WHO) attempted to formally broaden research on infant development with data from five countries: Ghana, India, Norway, Oman, and the US, with an eye to establishing more universal developmental milestone expectations (Martorell et al., 2006). However, they based their observations on the Bayley tool which primarily held the development of White U.S. infants as the standard.

Researchers have come to refer to this standard as WEIRD—Western, Educated, Industrialized, Rich, and Democratic. This acronym was coined in a 2010 article by three Canada-based psychologists who questioned the assumption that there are universal norms of development and laid bare the fact that these “norms” were based on a finite and unique population of White subjects (Heinrich et al., 2010). They emphatically declared that these “norms” were not representative of all cultures. So one has to ask: Whose developmental expectations are being assessed?

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