Cultural Considerations for Assessments of Child Development in Ghana
Ghana presently lacks a widespread technique for identifying children with special needs. This may be due to the term “disability” being poorly defined in Ghana as well as a stigma surrounding mental disorders. This is influenced by traditional beliefs such as “spirits or witchcraft are the causes of disability and…disorders like Down’s syndrome are contagious.” Historically, those with disabilities have been killed, abandoned, or isolated from society. While efforts have been put forth to dispel these beliefs and practices, there is still a lack of proper assessment and treatment for individuals with disabilities in Ghana.
Ghana passed the Persons with Disabilities Act in 2006, which aimed to protect the rights of people with disabilities. However, there still is not a policy in place to handle the process of screening children with developmental disabilities and placing them in special education programs. Some physiotherapists use the Evaluation of a Child’s Level of Physical Development, which shows a picture of developmental skills and an estimate of when those milestones should occur. This tool does not, however, have established reliability or validity for diagnostic use and it is not specific to the Ghanaian population. The Ages and Stages Questionnaire has also been used in research to screen rural Ghanaian children (Bello, Quartey, and Appiah, 2013). However, this tool is based on developmental milestones of children in the United States and therefore does not reflect the Ghanaian culture.
Barlow & Reynolds (2018) sought to begin the process of gathering information from Ghanaian communities to adapt the Denver Developmental Screening Test-II (DDST-II). This screening tool has been widely adapted for use by other countries and can be administered by professionals and paraprofessionals. Importantly, it has been successfully adapted for Malawi, another sub-Saharan African country. Twenty-eight Ghanaian parents were recruited to complete interview questions and developmental items directly from the DDST-II.
The results showed several cultural factors that need to be taken into consideration for a standardized screening for Ghanain children. Specifically, five global themes emerged from the qualitative analysis of the interviews:
- Developmental milestones in Ghana differ from U.S. developmental milestones.
- Ghanaian mothers have a close relationship with their children.
- Most Ghanaian parents seek advice from a doctor when their children are not meeting the expected developmental milestones.
- Participation in religious activities is important for Ghanaians.
- Children are given chores, responsibility for money, and start school earlier than children in the U.S.
Additionally, out of the 20 developmental milestones assessed on a picture-identification task, eight were not reported due to lack of responses. Three of the eight items caused confusion based on ambiguity. Five of the eight items seemed culturally irrelevant (e.g., playing peek-a-boo). It is important to acknowledge the need for cultural adaptation, as no single screening tool can be adapted globally. Cultural differences require unique developmental milestones to be considered.
The author’s final recommendations for modification can be found in the table below.
Barlow, K. G., & Reynolds, S. (2018). A mixed-methods study examining developmental milestones and parental experiences in Ghana. The Open Journal of Occupational Therapy, 6(2), 5.
Bello, A. I., Quartey, J. N., & Appiah, L. A. (2013). Screening for developmental delay among children attending a rural community welfare clinic in Ghana. BMC pediatrics, 13(1), 1–7.
