To understand mental health problems of childhood, and corresponding clinical referral patterns, may require knowledge of the impact of culture. Culturally mediated values, and concomitant child-rearing practices, may influence the kinds of behavior problems children show. Cultural values may also influence adult attitudes toward child problems, with certain types of problems regarded as more serious and more in need of professional intervention in some cultures than in others. Adult attitudes are particularly important because it is adults (usually parents, teachers, or clinicians)--not children themselves--who make child referral decisions. The proposed research is designed to explore cultural differences in both prevalence patterns and adult attitudes. Some 118 clinically significant problem behaviors will be studied in all, but the pricipal focus will be on problems falling within two empirically-derived, broad-band child syndromes: Internalizing (e.g., worrying, somaticizing) and Externalizing (e.g., aggression, disobedience). The research will compare two cultures that appear to differ markedly in their orientation toward Internalizing and Externalizing child behavior. In contrast to U.S. culture, the heavily Buddhist, highly pacific culture of Thailand appears to condone and perhaps encourage diverse Internalizing behaviors, but actively discourage diverse Externalizing behaviors in children, especially boys. In the proposed research, Thai and U.S. patterns are to be compared in two ways. The Prevalence Study will address the question of whether child problems (Internalizing, Externalizing, and other) differ in prevalence across the two cultures and as a function of age and gender. Parents and teachers of Thai boys and girls aged 6-7, 8-9, and 10-11, will rate the children, using the Child Behavior Checklist; these ratings will be compared to parent and teacher ratings for U.S. children of the same gender and age. The Adult Attitudes Study will explore adult attitudes toward Internalizing and Externalizing behavior patterns as a function of culture and child gender. In Thailand and the U.S., parents, teachers, and clinical psychologists who work with children will rate the seriousness (e.g., likelihood of spontaneous improvement, need for treatment) of Internalizing and Externalizing problem patterns as presented in vignettes describing either boys or girls of their culture.
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