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MENTAL HEALTH

Issues and Observations

American Indian and Alaska Native children’s mental health is an area in need of additional study and has been described as the largest unmet health need for Indian people today (Neligh, 1990). Researchers have noted that AI-AN children may experience high rates of various disturbances, including developmental delays, learning disorders, mental retardation, affective disorders, attention deficit disorders, anxiety, phobic disorders, conduct disorders, other “personality” disorders, and substance abuse problems (Manson et al., 1997; Neligh, 1990). Other studies, however, have noted that previous perceptions of higher rates of mental illness or disorders among AI-AN children are not supported by the data or may be due to misdiagnoses attributable to problems with a given assessment tool.

  • The mental health needs of American Indian communities need to be studied from both an individual developmental and an epidemiological point of view (Berlin, 1983).

  • Early intervention with preschool children may be effective for dealing with developmental disturbances (Berlin, 1983; Clay, 1998; Paul, 1991), but caution should be used in interpreting test scores that may not accurately reflect children’s abilities (Brachlow et al., 2001; Crowe et al., 1999; Plank, 2001).

  • AI-AN children may experience higher rates of depression, abuse, and neglect, and abused or neglected children are more prone to behavioral problems, psychiatric symptoms, and risk-taking behaviors (Piasecki et al., 1989; Manson et al., 1997).

  • Symptoms of attention deficit disorder and hyperactivity, which are problems affecting some children, their families, and their schooling, are not culture bound (Beiser et al., 2000).

  • All mothers of children in Head Start may face challenges such as chronic health problems, homelessness, and very low income. These challenges, in turn, have been found to be risk factors for depression across all racial and ethnic populations. Programs aimed at decreasing poverty, improving maternal support, and providing medical care may help improve conditions for mothers at risk for depression (Lanzi et al., 1999).

Research Findings: Mental Health
Author Sample, Measures, and Methods Major Findings Reported by Author
Beiser, Dion, and Gotowiec, 2000 A study of 1,555 Native and 489 non-Native children in 2nd or 4th grade, 1,118 parents, and 49 teachers at four locations in the United States and Canada was conducted to assess children’s behavior patterns. Community members collected data from parents in their homes, and child data were collected at school. Instruments used were the Teacher Interview Form, the Child’s Assessment by a Parent, and the Student’s Observation of Self. Each instrument contained items from the Child Behavior Checklist, the Conners Parent and Teacher Rating Scales, and the Diagnostic Interview Schedule for Children. Symptoms of attention deficit and hyperactivity are not culture bound. Direct comparisons of symptom levels indicated more similarity than difference in the extent to which these behavior patterns affect Native and non-Native children in early school years.
Bruneau, 1984 The Preschool Behavior Questionnaire, an instrument used by teachers to assess children for possible emotional disturbance, was administered to a group of Head Start teachers. A total of 58 AI and white preschoolers enrolled in Head Start were selected to take the Primary Self-Concept Inventory, which measures self-concept related to school success. There were no differences in the scores of AI and white children on self-concept and behavior, but AI preschoolers reported being happier than the white preschoolers. The data support a relationship between emotional adjustment and self-concept. The authors suggest that preschoolers with emotional disturbances may view themselves negatively as learners. School programs may positively impact children’s self-concepts by providing opportunities for academic success.
Chester, Mahalish, and Davis, 1999 Bilingual staff interviewed 156 adults, 28 adolescents, and 51 parents of children age 12 and under to determine mental health needs of off-reservation American Indians in Northern Arizona. 75 percent of the sample were Navajo and 25 percent were from other tribes. The interview protocol included the Child Behavior Checklist, the Youth Self-Report, the Personal Problems Checklist for Adults, and an Acculturation Questionnaire. Parents report more competence in school performance for their children age 12 and under, as compared to adolescents’ reports of their own performance; adolescents self-reported a higher prevalence of internalizing problems than parents reported for children age 12 and under. Children experienced fewer nightmares (40 percent) than adolescents (58 percent). The authors suggest that there is a progression of problems and coping mechanisms for AI children; if these problems are addressed at key points in development, crises may be reduced and coping enhanced for adolescents and adults. The authors conclude that a bilingual, bicultural outreach component is necessary for off-reservation mental health programs.
Dion, Gotowiec, and Beiser, 1998 Depression and conduct disorder were assessed in 1,251 Native and 457 non-Native children in 2nd and 4th grade at four sites in North America. Children completed a 109-item Student’s Obser-vation of Self checklist, teachers completed a 132-item Teacher Information Form, and parents completed a 189-item Children’s Assessment by Parents checklist. All measures were adapted from the Child Behavior Checklist and the Diagnostic Interview Schedule for Children. Non-Native children and their parents report higher levels of depression for the children than Native children and their parents. As for conduct disorder, the children’s self-ratings and the parents’ ratings did not differ between Native and non-Native groups. Teachers, however, rated Native children higher on both depression and conduct disorder. Native teachers, compared to non-Native teachers, rated Native children as having lower levels of depression and conduct disorder. The authors conclude that non-Native teachers may interpret the behavior of Native children more negatively than they would the same types of behavior among children from their own culture. They also conclude that bias, rather than actual psychopathology, may have caused greater rates of referral for mental health services among Native children.
Piasecki, Manson, Biernoff, Hiat, Taylor, and Bechtold, 1989 55 health/mental health providers for all 26 reservations in the Albuquerque IHS area and 7 reservations in the Phoenix IHS area identified children in need of mental health treatment or known to have been abused or neglected. Providers then responded to a written questionnaire reporting children’s demographic characteristics, medical history, the presence/absence of behaviors associated with the DSM–III classification disorders, drug use, treatment needs, and services received. Completed questionnaires were received for a total of 1,155 children, representing 50 tribes. In the sample, 67 percent of the children were described as neglected or abused. A greater percentage of boys were neglected than girls, but girls suffered more abuse or a combination of abuse and neglect. The researchers found that the percentage of abused children increased with age; neglected children tended to be younger. The authors noted several limitations to this study: (1) the sample represents a treatment population rather than the general AI community, which may skew results; and (2) the knowledge and experience of health care providers differed greatly (some providers had more knowledge of psychological symptoms, disorders, and children’s history than others).
Tikalsky and Wallace, 1988 A comparative study of 92 3rd grade Navajo children and 92 3rd grade Anglo children was conducted using the Louisville Fear Survey for Children. The Navajo children in the sample showed higher levels of fear. However, traditional views of fear may not be appropriate for understanding the fears of Navajo children. Bias in psychological approaches to the study of fear may affect a clinician’s determination of when fear responses are abnormal. Among Navajo children, high fear frequencies may not indicate any pathology.
Wright, Mercer, Mullin, Thurston, and Harned, 1994 This was a comparative study of 60 American Indian children ages 4-11 referred for psychological services and 60 matched (based on gender and age) non-Indian controls. Data for 121 physical and 13 social variables (including prenatal and neonatal history, developmental progress, medical history, medications, immunizations, childhood illnesses, and parental alcohol use) were drawn from children’s case files. AI children referred to psychological services differed significantly from their non-Indian counterparts. They have a greater incidence of risk factors that may affect intellectual, emotional, behavioral, and learning status. These factors include otitis media, communicable diseases, jaundice, heart problems, vision disorders, and maternal prenatal alcohol and substance abuse.

 



 

 

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