Cultural Sensitivity and Ethical Practices · dukkha, aging is, sickness is, death is, sorry, lamentation, pain, grief and despair, association with the loathed, dissociation with

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Cultural Sensitivity and Ethical Practices

Andy Bondy, Ph.D. Pyramid Educational Consultants, Inc.

Cambridge Center Ethics workshop MA

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What is culture?

• Culture is the characteristics of a particular group of people, defined by everything from language, religion, cuisine, social habits, music and arts.

• Anthropologist Edward B. Tylor in his book, Primitive Culture, published in 1871, said that culture is "that complex whole which includes knowledge, belief, art, law, morals, custom, and any other capabilities and habits acquired by man as a member of society."

Copyright, 2014, Pyramid Educational Consultants, Inc. 2

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Two types of culture to consider today

National, ethnic group

• National differences

• People from one country/ethnic group living in another country/ethnic group

Cultural groups within a society

• Public vs. Private vs. Government providers

• Secular vs. religious/spiritual perspective


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Publication related to culture and autism

• Mandell & Maytali (2005). MR and DD Research Reviews

• “It is likely that variations in the use of nontraditional treatment strategies are at least in part the result of the interplay of culture and communities.”

• “Because some of these nontraditional treatments are iatrogenic or may replace proven effective treatments, and because use of these treatments may also result from disparities in access to appropriate care, understanding the relationship of culture and treatment decisions takes on a particular urgency.”


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Parental beliefs about causes and course of their child’s autism

• Chinese American families: punishment of past violations of religious, ethical, or cultural code as etiology of disability.

• Traditional Jewish Oriental: Religious or magical causes

• Cultures in which reincarnation is a belief, disability may be viewed as result of transgression in past life


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Link between beliefs and intervention

• Latino children: after a new diagnosis of autism 6x more likely to receive non-traditional treatment strategies

• Ethnic minorities: more likely to have explanatory

beliefs for mental health disorders that are different than

professional communities, then less likely to seek

services

• African-Americans: less likely to receive diagnosis on first visit

• Asian Indian families: more likely to notice social difficulties vs. speech delays

• Haitian Creole: may use more non traditional treatments – Roula Choueiri, 2012, Tufts Un.


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Racial Disparity in Autism Identification

• Travers, Tincani & Krezmien, 2011. J Spec Ed

“…a main finding is that the representation of racially diverse students with autism revealed a considerably and statistically significant different profile in comparison with White students for years 1998 to 2006….The risk indices indicated underrepresentation of diverse students with autism… Consequently, students are not receiving early intensive behavioral interventions during the critical time period in which they are likely to confer the greatest benefit.”


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Racial Disparity in Autism Symptoms

• Landa & Tek (2012). J Aut and DD

“… the toddlers in the minority group were significantly further behind than the non-minority group in development of language and motor skills and showed more severe autism symptoms in their communication abilities"


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How ethnicity may influence what is ‘functional’

• Within the Pyramid Approach we begin with an emphasis on functional activities and materials in anticipation of greater involvement in life’s activities and responsibilities

• One family from India living in Delaware….and a Saudi family in NY…


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Are there no time-machines? Visit France…

Psychoanalysts still rule…

• Court ordered a banning of video showing ABA and PECS helping children while direct interviews with leading Psychoanalysts showed very bizarre interpretations- but they were protected by courts!

– Update- Case overthrown Jan 2014!!

• Also, when shown videos of children responding well to intervention- a common reaction was “These are not French children…”


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From “Le Mur” transcript • (AS) Sometimes, when the mother is depressed, when she is pregnant or at birth,

sometimes the child can be autistic.

• (DW) For example, deep deficiency. For instance, a mother who, for reasons of depression does not take any care of her child, stays mute in front of him, clotted, while the child is there, starting to hang on to her, looking for contact. …the young adult who will keep being very cold, inhibited from an affective perspective, because, when he was a child, he unfortunately had a very cold mother.

• (ES) What we can notice when we take care of autistic children is precisely that autistic children are sick of language That autism is a way to defend themselves from language

• (LD) The fundamental point in my attitude as a psychoanalyst with respect to these children it is to abdicate the idea of a progress.

• http://deevybee.blogspot.com/2012/01/psychoanalytic-treatment-for-autism.html


http://deevybee.blogspot.com/2012/01/psychoanalytic-treatment-for-autism.html







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A Chinese perspective…

• Hsiao & Magyar (2006). Int J of Pscychosocial Reh

“An absence of appropriate identification and treatment for individuals with AD ... is the result of the religious practice and Traditional Chinese Medicine (TCM) of the 18th century. … the general perspective was that mental disturbances were the consequence of bad deeds perpetrated either by oneself or by members of one’s family.”


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Our recent trip to China


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Recently in Brazil…


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Recent trip to Poland

Everyone wears a hat! Communication everywhere

Supportive parents


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And while in Romania


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Consider the problem of teaching children to report about their own pain

Comment or tact about a private event

How is this acquired?

Skinner’s analysis

1) Someone tells the child what he/she is feeling

2) The child responds echoicly and then generalizes


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How can we teach such tacts?

• If children are to learn to report about their pain they must be experiencing it at the moment

We can teach either through

1) Capture- take advantage of a ‘natural’ opportunity

2) Create- make the opportunity arise…cause pain intentionally


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Obviously this is fraught with ethical concerns

• Peer Review and Human Rights Committee Review- NOT individual review

• Of course parental and LEA involvement is a necessity

• What is the proper comparison?

– NOT pain vs. no pain……… rather

Pain plus lesson outcome

VS.

No pain but no skill development


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Reaction?

• Most professionals and parents strongly support strategy (>98%) but…

– Strong protest by 4 SLPs in UK

• Reaction in Romania….

–Reaction from a Roman Catholic Priest..


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The Buddha-ful Eightfold Path to Effective Consulting

GoYo Andy Bondy


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Why Buddhism and behavior analysis?

• In behavior analysis we study “behavior under what conditions” (not simply ‘behavior’

• In Buddhism we speak about ‘conditioned arising’

– When this is, that is. From the arising of this comes the arising of that. When this isn't, that isn't. From the cessation of this comes the cessation of that

• What is the role of ‘agency’?

• This humankind is attached to self-production or holds to other-production. Those who have not understood this have not seen it as a dart. But one who sees having drawn out the dart, does not think, “I am the agent,” nor does he think, “Another is the agent.” (Skinner or The Buddha?)


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The Four Noble Truths

• Dukkha- the wobbly nature of life (Birth is

dukkha, aging is, sickness is, death is, sorry, lamentation, pain, grief and despair, association with the loathed, dissociation with the loved, not getting what one wants…)

• Samudaya- responses that co-arise with dukkha

• Nirodha- The containment, confinement and capture of co-arising reactions

• Marga- The Middle Way- the Path- the 8-fold Path…


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Right Understanding

• Everything is impermanent, interrelated and empty (of a separate self)

• Without impermanence there could be no learning…

– Response variations lead to shaping, generalization, thinning schedules of R+

• Implications- The ‘bad’ will improve- but the ‘good’ can disappear without you changing something systematically…


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Right View • Know and see the world as it is- not how you’d

like it to be or fear it to be

– Do not rely upon the experiences or words of others

• What does an orange taste like?

– (Tact ≠ environmental stimuli)

• Systematically study things (use all of science)

– Share your notes- get reactions

– Keep asking “Are you sure?”

• Implications- Don’t do things in isolation- Science is a group activity


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Right Speech

• Listen with care, speak about things you know to be true

• Speak thoughtfully (mindfully) and with sincerity to reduce the suffering of others

• Don’t yell, scream, hoot, holler, tease, mock, speak down to, gossip or complain

Today is not the right day to convince people of the rightness of your ways- tomorrow’s not looking any better

• Implications- Speak for the good of others, not for yourself-

Do not ridicule even if you disagree.


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Right Actions/Behaviors

• Don’t kill, lie, cheat/steal, engage in sexual abuse or use intoxicants

• Be generous/helpful, ethical, patient, enthusiastic, mindful and wise

• Implications- Don’t try- do. Help everyone- including the jerk who doesn’t deserve it


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Right Mindfulness • Don’t dream about the future- don’t dwell in the

past- concentrate on the present moment (this doesn’t

deny the past or future…)

It’s always here- it’s always now. It’s never there- it’s never then.

– This moment is just as good as the next…

• Implications- Would you change your behavioral choices if you knew you were going to die this afternoon? So…


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Right Livelihood

• Have a job that reducing suffering in the world and makes the world a better place Have a job that brings you joy, makes you proud Have a job that gives you (and others) financial security

• Implications- Ethical decisions are always being made within the work place- don’t pretend otherwise. Talk about ethics openly


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Right Concentration/Meditation

• Take time to meditate, concentrate, engage in self-evaluations (Do you brush your teeth daily?) Talk about your private-events as if they were publically available- be both speaker and listener Don’t multitask in a multipurpose world…

• Implications- When you are at work, don’t bring the rest of the world into it. When you leave work, continue with the analysis.


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Right Effort • Keep on going- take one more step

– That’s all

– Leave ugly things behind you

– Leave beautiful things behind you

– Don’t get attached to either- both are impermanent!

• Implications- You may not control the outcome but you can control the effort- you must change what you are doing if those you consult with are to change their ways. If they don’t change, you are not effective


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5 Remembrances • This body is of the nature to get old

– I will get old • So I will enjoy this day based on my many experiences

• This body is of the nature to get sick – I will get sick

• So I will enjoy this day based on my relative good health

• This body is of the nature to die – I will die

• So today is a good day because I am alive

• This body is of the nature to lose connection with all friends/relatives – I will lose connection with all friends/relatives

• So I will cherish the connections with friends/relative today

• This body is of the nature to be responsible for its actions – I am responsible for my actions

• So I will choose my actions carefully and monitor the impact of all- both intentional and unintentional (operant and elicited)


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Conclusion

• Be aware and sensitive to cultural variations

• Behavioral approaches can help improve lives within a variety of cultures

• Other approaches to ethics can help improve the provision of effective behavior analysis


Documents

Cultural Sensitivity and Ethical Practices · dukkha, aging is, sickness is, death is, sorry, lamentation, pain, grief and despair, association with the loathed, dissociation with