Grant numbers: 121-F112T 8/18/2000 to 12/31/2000
Meg Brin, CDHS Unit Director,
CC02 Child Welfare/Child Protective Services Outcome-based Training
This annotated bibliography covers research articles from journals, books, and other media to review the academic literature related to Southeast Asian Refugees and Immigrants with a concentration on children and adults. There is an emphasis on the developmental stages experienced by children and adolescents in general and the factors related to their successful adaptation to adulthood and life in the United States. Domains of interest include bilingualism, delinquency, academic success, and traumatic experiences.
Abueg, F.R. & Chun, K.M.(1998). Traumatization stress among Asians and Asian Americans. In P.B. Organista, K.M. Chun, & G. Marin, (Eds.) Readings in ethnic psychology. New York: Routledge.
The study of traumatic experiences among Asians and Asian Americans is characterized by a comparatively small body of literature. The subset of studies devoted specifically to the examination of posttraumatic stress disorder is very limited. Even the discussion of the application of the construct PTSD has only recently been broached for such topics as Asian refugees and Asian war veterans. Nevertheless, the literature that exists strongly demonstrates the vast suffering endured by members of the various Asian ethnic minority groups. The aim of this chapter is to draw a clear link between ethnic-specific traumatization, psychopathology, and the fledgling literature concerned with PTSD, especially that concerning Southeast Asian refugees settled in North American and Asian American Vietnam veterans.
Southeast Asian refugees present a high risk for mental illness because of exposure to traumatic events during premigration, migration, encampment, and postmigration. The first of these include brutalization and death of family members and friends and loss of property due to war. Migration issues involve separation loss. Encampment involves prolonged detainment in unsafe conditions. Postmigration stressors involve building a new life in a foreign environment with the urgent need to learn new skills and norms while dealing the loss from the other recent events. This chapter is very helpful in describing the different experiences of various Southeast Asian groups because of the wide range of political and cultural differences. Vietnamese, Khmers from Cambodia, Laotians, and Hmong and Mien were described separately providing an understanding that is not found in much of the literature.
There are only a few studies that have looked at the prevalence rates of PTSD among Southeast Asian refugees using valid instruments and diagnostic criteria. Differences in sample composition and diagnostic criteria have limited the use of the data in most studies. It is known however that the rates are elevated for this general population because of the nature and extent of the traumatization. The manifest clinically shows significant levels of general anxiety and depressive symptoms. Khmer, Hmong, and Mien represent the three most traumatized groups. The majority arrived during the last decade. Research on Lao refugees is lacking. Vietnamese have been here the longest with language barriers and employment now being the major stressor. The authors suggest that an understanding of the differences in the traumatic experiences for these various groups will build in the empathic quality of the interviewer’s questions and may lead to creative interventions adapted to the particular group.
Arnett, J. J. (1999). Adolescent storm and stress, reconsidered. American Psychologist, 54(5). 317-326.
G. S. Hall’s view that adolescence is a period of heightened “storm and stress” is reconsidered in light of contemporary research. The author provides a brief history of the storm-and stress view and examines 3 key aspects of this view: conflict with parents, mood disruptions, and risk behavior. In all 3 areas, evidence supports a modified storm-and-stress view that takes into account individual differences and cultural variations. Not all adolescents experience storm and stress, but it is more likely during adolescence than at other ages. Adolescent storm and stress tends to be lower in traditional cultures than in the West but may increase as globalization increases individualism. Similar issues apply to minority cultures in American society. Finally, although the general public is sometimes portrayed by scholars as having a stereotypical view of adolescence storm and stress, both scholars and the general public appear to support a modified version of this perspective.
A recent meta-analysis concluded that within adolescence, conflict frequency is highest in early adolescence and conflict intensity is highest in midadolescence. One study reported in early adolescence a rate of 2 conflicts every 3 days, or twenty a month between parents and teens. Declines occur in the amount of time they spend together and in their reports of emotional closeness. Conflict is especially frequent and intense between mothers and early adolescent daughters. There are substantial individual differences with many parents and adolescents with little conflict. Conflict is more frequent when the adolescent is experiencing depressed mood, when the adolescent is experiencing other problems such as substance abuse, and when an early-maturing adolescent is female.
This review of the literature provides substantial evidence that it does not take cataclysmic events such as loss of employment or death of a loved one to induce the experience of high stress. Many people experience a high degree of stress from an accumulation of minor irritations and aggravations in daily life. The frequent conflicts between adolescents and their parents concern relatively mundane day-to-day issues. Many of these mundane issues serve as proxies for arguments over serious issues such as automobile driving safety and sex. These issues may be argued about in an indirect way through issues that are mundane and seem safe on the surface. No clear mores currently exist in American society concerning sexual behavior of unmarried young people in the adolescent period. Because of this lack of consensus, many parents are left with questions with no easy answers.
The claim of a link between adolescence and extremes of emotion is perhaps the most ancient and enduring part of this storm-and-stress view. Studies have found that adolescents do report greater extremes and more frequent changes. Longitudinal studies concur that negative affect increases in the transition between preadolescence to adolescence. The use of beepers in recording the moods of adolescents in one study provided an unprecedented look into the daily lives of adolescents including how emotions vary in the course of a day and how these differ among different age groups. Adolescents vary in the degree to which they experience mood disruptions. Low popularity with peers, poor school performance, family problems such as marital discord and parental divorce are common events leading to mood disruptions.
Research confirms that in Western countries, teens are the years of highest prevalence of risk behavior. This pattern exists for crime, risky automobile driving, and risky sexual behavior. This peaks in late adolescence/emerging adulthood. Then they drop steeply. Age of substance abuse peak at the age of twenty. Rates of sexually transmitted diseases peak in the early twenties.
Current evidence indicates that biological changes make some contribution to these general differences such as the effects of hormones on moods, especially in early adolescence when the rate of hormonal change is highest. These influences may be small and exist in interaction with other factors. Recently “delayed phase preference” has been identified as a tendency for adolescents to prefer to stay up late and sleep during the day. Biologically, this cultural practice of teens may lead to a sleep-deprived state with mood disruptions. Not all cultures experience the same level of this storm-and-stress. The difference may be linked to the degree of independence allowed by adults and expected by adolescents. It might be expected that adolescent storm and stress will increase with the number of generations the adolescent’s family has lived in the United States. Research needs to be done on minority groups to explore if adolescents experience the same levels of storm-and-stress. There is no indication that most people in the public view this as universal and inevitable. Negative beliefs could have consequences that lead parents to have authoritarian techniques of parenting as a way of thwarting the storm and stress they anticipate. There is danger that if this condition is viewed as normal it may be dismissed and serious problems go untreated or the reverse problem of many simple problems being treated as pathological when they are just development stages. This period is also paradoxically a time of exuberant growth in addition to one of storm-and-stress.
Baer, J. (1999). Family relationships, parenting behavior, and adolescent deviance in three ethnic groups. Families in Society: The Journal of Contemporary Human Services, 80(3), 279.
This was a study of adolescent deviance from a family and developmental perspective. Seventh-, eighth-, and ninth-grade boys and girls from Mexican American, African American, and European American ethnic groups were surveyed about their family relationships, parental behavior, and their deviant activities. Some significant ethnic and gender differences were found. Implications for practice and prevention are discussed.
This study examined the theory that family bonding and parental monitoring reduce the tendency of adolescents to engage in deviant behavior. The purpose was to determine if adolescent perceptions of dyadic communication, family bonding, and parental monitoring were significantly associated with their reports of deviant behavior. A nonclinical sample was used to explore normative trends that could be correlated with ethnicity and gender. Communication and parenting were investigated separately for mothers and fathers. Previous studies have found that white males who had minimal parental monitoring committed more deviant acts compared with those who had more supervision. No data was found for females. Adolescents have been found to participate in less deviance if they have strong attachment to their parents. This was true only when the parents had positive communication with the adolescent. None of the previous studies explored ethnicity nor placed the influence of familial processes within the context of adolescent development. It is important, according to this article, to identify these processes because of the salient aspects of development that may be influenced by patterns of communication in the family.
The question of how families shift to meet the changing needs of their youth has received little attention in the literature.
Multiple regression procedures were used to test the predictor variables of communication with mother, communication with father, mother monitoring, father monitoring, family cohesion, parents facilitate independence, and detachment on the dependent variable of deviance.
Direct parental control was significant for all mothers of boys and girls and in all ethnic groups. Father monitoring was only significant in the European American group. The fact that mothers’ monitoring of the adolescent was a deterrent to deviance implies that certain intervention strategies such as functional family therapy may be helpful. Social support theory postulates that family cohesion is a type of social support that buffers the adolescent from some of the psychological stressors inherent in development. Higher levels of family cohesion protected adolescents from psychological distress and deviance. This is particularly found true for boys. Structural family therapy, which targets family cohesion, has been efficacious in the treatment of adolescent deviance. It has also been demonstrated to be effective with multiethnic families, especially Latino, because it can be adapted to fit culturally specific values and beliefs. Detachment was positively associated with deviance except for African American females where it was marginal and for European American males. Parents facilitating independence was negatively associated with deviance, but was only significant for Mexican American males, African American females, and European American females. The findings highlight small ethnic and gender differences that may guide treatment. They may be helpful in formulating ethnic and gender specific intervention goals. The data may be most helpful in working with families who present problems such as resistance to change, familial realignments in parent-adolescent relationships related to unilateral authority and interdependence, the toll of adolescent parenting on the parents’ well-being, and problems in emotional engagement. The findings have implications for prevention since it was found that monitoring by mothers for both boys and girls makes a difference. Parent education programs need to be used to promote closer parental monitoring.
Berthold, S. M. (1999). War trauma and community violence: Psychological behavioral, and academic outcomes among Khmer refugee adolescents. Journal of Traumatic Stress, 12, p. 455-471.
This cross-sectional survey study examined the relationship between exposure to war trauma and community violence and the academic achievement, behavioral outcomes, and psychological well-being among Khmer refugee adolescents. The study used a sample of 144 adolescents exposed to high rates of violence. One third had PTSD symptoms, and two third had clinical depression. The number of events of trauma was a significant predictor of the level of PTSD, personal risk behavior, and grade point average, but not the level of depression or behavioral problems reported by the school.
Since the fall of Saigon and the Khmer Rouge reign, one third of a million Khmer refugees have resettled in the Unites States. Twenty to forty percent of the population of Cambodia has survived multiple traumatic experiences. Hundreds of thousands of Khmer population were forced to flee to the Thai-Cambodia border. Many were exposed during the escape to rape, witnessing deaths, injuries, land mines, imprisonment, and torture while in Thailand. There was separation from the family, isolation, discrimination, stress from adapting to a new country, and community violence. The perceptions of social support in the resettlement process made a difference and predicted better outcomes for these adolescents.
Chou, C. M. (1992). The inner heart: Therapy with Southeast Asian families. In L. A. Vargas & J. D. Koss-Chioino (Eds.). Working with culture: Psychotherapeutic interventions with ethnic minority children and adolescents. San Francisco: Jossey-Bass Publishers.
This chapter presents some of the generalities and particulars of Asian culture as a whole and the dynamics operating in various subgroups to more effectively work with Southeast Asian children, adolescents, and their families. It touches on certain psychological dynamics that a therapist should keep in mind when dealing with this population. It is important for a positive therapeutic outcome that the family’s culture be understood and explored.
This chapter describes the role of therapist as an expert of the inner heart and reframes the concept of helping in a culturally appropriate context. Since many Asians view turning to psychiatric help as a violation of filial piety by causing family members to lose face or feel shame, the premise of psychological help is rethought. The Chinese characters for the word “psychologist” are read “expert of the heart or soul.” It is understood that one does not delve into the heart lightly and clients are encouraged to take their time to become comfortable. Some of their psychological ailments will be labeled as suffering from headaches, aches in the joints, and a general feeling of fatigue. The worker needs to listen to these and help the client understand them as manifestations of things going on in the heart. It is important to honor the symptoms and spend time with them.
The incidence of “coining” was described. This is a practice of rubbing a coin or sometimes a spoon along various muscle groups to relieve aching muscles or other complaints. It often leaves red markings and has often been reported to social service agencies leading to accusations of child abuse. The coin is rubbed along the same meridians used in acupuncture or acupressure and is a cultural practice of Southeast Asians. Other healing practices that may be unknown to Western practitioners include cupping and moxibustion. Cupping will leave a red circular patch because a glass container or bamboo tubes evacuated by heat draws blood to the surface of the body. In moxibustion, a cone of medicinal herbs is made and put along the points used in acupuncture.
Cole-Kelly, K. (1993). Assessing the family. In M. I. Singer, L. T. Singer & T. M. Anglin (Eds.), Handbook for screening adolescents at psychosocial risk. (pp. 1-40). New York: Lexington Books.
This book chapter provides a list of several qualities and characteristics of healthy families when there are adolescents involved. It presents important family systems considerations for workers including the family life cycle and family genogram. It addresses special considerations for family subtypes of the blended or remarried family, the single-parent family, and families with either a chronically ill son or daughter or when the parent has an illness. A guide to family observation and assessment is presented that directs the worker in using questions in a systematic and organized protocol.
The chapter highlights the fact that couples have the fastest growth in divorce rates at the adolescent family phase of the life cycle emphasizing the significant stress often accompanying this phase. Major adjustments are often required. Some of these transitions include the adolescent moving from being dependent to being less so, the potentially new and threatening emphasis on the marital relationship as the children’s dependency diminishes, the increasing needs and problems of the couple’s aging parents, the influence of the adolescents’ peer culture, and the midlife evaluation of each parent’s life. Many of the rules that the family operated by are no longer effective. They need to maintain control over the adolescent while encouraging opportunities for developing independence and autonomy in them. Parents have not had preparation for these new demands and draw from experiences of being an adolescent themselves. This is an important area for the clinician to focus by using a genogram of the family of origin.
The guide to assessment provides assistance in helping workers organize data on the family. There is an emphasis on gaining an understanding of how the parents view the developmental needs of the youth. It assesses whether the parents have an appreciation for what it is like to be an adolescent in this culture at this time, an appreciation of what the struggle is for them to separate from family, the need to be competent, to develop an identity. It assesses the adolescent’s strengths and desired behaviors.
Research has shown that families enduring difficult crises are less affected if the family maintains its family rituals (daily traditions and celebrations). This might include whether meals are eaten together as a family.
A few treatment recommendations were made. The front-line professional involved with adolescents generally needs to make triage decisions related to treatment. A flow chart was provided to assist in this process. The first priority is to assess the degree of physical danger present in the situation. The next question is to determine if substance abuse is a part of the problem and if so, must be addressed first. The next area to explore is whether there are any school-related problems. Then overall family functioning needs to be assessed.
Conger, R. D., Conger, K. J., & Elder, G. H., Jr. (1997). Family economic hardship and adolescent adjustment: Mediating and moderating processes. In G. J. Duncan & J. Brooks-Gunn (Eds.) Consequences of group up poor. New York: Russell Sage Foundation.
This chapter considers the influence of economic hardship on the school performance of rural adolescents over a four-year period from seventh to tenth grade. The researchers replicated a study by the Infant Health and Development Program using a sample of adolescents who provided information on their grade point averages. In a second phase, they substituted externalizing and internalizing problems for grade point average. In the third stage, they proposed a set of mediating processes through which family economic disadvantage would affect school performance during adolescence. They predicted that economic hardship would create daily strains and conflicts in families. They hypothesized that financial conflicts between parents would affect the academic competencies of boys more adversely than girls implicating gender as an important moderator of these stress processes.
The data clearly show that economic advantage facilitated cognitive abilities as manifested by improved school performance whereas economic disadvantage impaired intellectual functioning. The results of the study showed that the impact of economic hardship on adolescent adjustment problems must be assessed with great care. The association between economic status and developmental difficulties may be either direct or indirect through interruptions in child-rearing behaviors. All the reported research indicates that economic problems are associated with maladjustment. It may be independently significant or dependent on the parental response to economic stress. The results are distressing because the less advantaged segment of the United States appears to be getting relatively poorer. If current economic trends continue, the processes that disrupt school performance will become more common. This disadvantage jeopardizes cognitive development during the early childhood years but also academic achievement during adolescents.
Coontz, S. (2000). Historical perspectives on family studies. Journal of Marriage & the Family, 62(2), 283-297.
This article explores the relationship of historical research to contemporary family studies. Family history was influenced greatly by fields such as sociology and anthropology, leading it to make several contributions to those fields in turn. The continuing collaboration of these disciplines can significantly enrich current family research, practice, and policy making. History’s specific contribution lies in its attention to context. Although historical research confirms sociologic and ethnographic findings on the diversity of family forms, for example, it also reveals that all families are not created equal. The advantage of any particular type of family at any particular time is constructed out of contingent and historically variable social relationships. Historical research allows researchers to deepen their analysis of family diversity and family change by challenging widespread assumptions about what is and what is not truly new in family life. Such research complicates generalizations about the impact of family change and raises several methodological cautions about what can be compared and controlled for in analyzing family variations and outcomes.