Tips for screening children from diverse cultures

In the course of your screening program, you’re sure to work with children from families who don’t speak English at home or who come from different cultures. You can use ASQ to check the development of children from diverse cultures as long as you consider the possibility of needed adaptations. You want to be sure that language and cultural differences don’t result in an inaccurate picture of a child’s development.

From the beginning

From the very beginning, focus first on establishing a respectful relationship and understanding the family’s cultural values and childrearing beliefs. Be prepared to set aside your own biases and try to see through the lens of the family. If you encounter practices that you don’t subscribe to (such as parents carrying their children all the time), recognize those as cultural judgments and set them aside.

If you are unfamiliar with the family’s language and culture, enlist the help of an interpreter and/or a “cultural broker.” Seek advice on introducing the purpose of screening and ASQ through a cultural lens and ask for insight on cultural considerations you should keep in mind (for instance, what is appropriate dress, or should elders or others be present when meeting the family?). Some families may be mistrustful. Caregivers may be concerned that children will be labeled and possibly excluded from programs as a result of screening.

Often someone who speaks the family’s language and comes from the same community, a cultural broker can review the ASQ questionnaires in advance for appropriateness; can advise the practitioner on cultural considerations such as how to greet the family, how to dress, who to speak with, who should be present, whether eye contact is appropriate; and can help to explain cultural reasons why a family might be mistrustful of the process.

The value of a cultural broker

A cultural broker, also referred to as a community health worker, can serve as a bridge between the practitioner/program and the family.

Cultural adaptations

Someone familiar with the community may also be helpful in determining whether cultural adaptations are necessary. Items on ASQ have been carefully selected, but there may be items that are not appropriate for a given family, culture, or geographic area.

For instance, in many cultures, children play with their own reflection, but some hold the belief that using a mirror can steal a child’s spirit or cause their teeth not to grow in; in such a case, you would want to omit the item that asks parents whether their child pats a mirror. In another example, some cultures have strong beliefs against putting children on the floor to play until a certain age, which precludes completion of many of the gross motor items.

Practitioners can, however, see if caregivers are comfortable trying activities on a table or bed, which respects the values of the families while at the same time obtaining crucial information about the child’s developmental progress.

Sample cultural substitutions

In working with researchers around the world to translate ASQ for study in their cultures, Kimberly Murphy, a researcher and co-developer of ASQ, discovered many practices and routines in common, as well as differences particular to each culture.

Alternate version 1. Does your child serve herself, taking food from one container to another using utensils? For example, does your child use a large spoon to scoop rice from a bigger bowl to a smaller one?

Alternate version 2. (For cultures where it is not common practice for children to “serve themselves” food) Is your child able to take sand from one container (such as a play bucket) with a shovel or large spoon and put it into another?

Original: When you ask, “What is your name?” does your child say both her first and last names?

Alternate version: When you say, “What is your name?” does your child say her first name and her family name?

ASQ allows you to substitute familiar and common materials and tasks for materials or activities that are offensive, unfamiliar, or unavailable to families, as long as the substitutions retain the intent of the original item.

Substitutions may be appropriate for items in cultures that:

• encourage independence later than Western cultures do
• focus more on family interactions than playing with toys
• place importance on children being quiet or unobtrusive
• have gender expectations in which girls, for instance, aren’t encouraged to play with balls

You can improvise in cases where families have no access to suggested materials. Children in Hawaii, for example, rarely use zippered coats, making items requiring the use of zippers difficult to observe. In order to assess these items, you can provide a large purse with a zipper that could be substituted for the zippered coat.

When items aren’t available in the home, another option is to encourage parents to look for objects outside the home. Many parks, child care centers, and schoolyards may have the needed objects. For example, in the southwestern United States, many homes are built without stairs. To complete gross motor items involving stairs, parents may use playground equipment in a local park or building.

Interpreting results and providing feedback

As with your initial introduction to the family, consult with a cultural broker if you can for advice on what is appropriate for communicating screening results and deciding follow-up (who should be involved in the discussion, for instance).

In interpreting results to begin with, weigh the cultural information you have gathered and consider that children from other countries may develop at different rates. It’s critical to listen and learn from families about their beliefs about rearing their kids. Be sure to gather the family’s feedback about what concerns they have, what they think is the cause of any issues, and what interventions they think are appropriate. Parent concerns are highly predictive of school-aged problems and behavioral issues. Listen for cues of what can be done to address concerns.

You may be knowledgeable about the evidence base, but even more important is collaborating with the family to devise next steps that are meaningful within their cultural context (which will improve the odds of follow-through). Don’t be too quick to jump to advice-giving; rather, follow the family’s lead.