Rethinking cultural competence in parent coaching for diverse families

Developmental paediatrician Najat Fadlalla highlights the importance of culturally sensitive approaches in parenting advice, advocating for tailored strategies that respect diverse familial values within clinical practice.

In a clinical setting, parenting advice can become a test of assumptions as much as a discussion of child behaviour. Najat Fadlalla, a developmental behavioural paediatric fellow, argues that clinicians often misread families when they treat one cultural model of parenting as the default. In a recent KevinMD podcast tied to her article on cultural competence in parent coaching, Fadlalla said the aim is not to weaken evidence-based care but to widen it so that families are not judged against a narrow set of norms.

That matters because parent coaching is one of the main evidence-based treatments for children with ADHD or those at risk of developing it. The Centres for Disease Control and Prevention says behaviour therapy can improve self-control, self-esteem and day-to-day functioning, and that parent training is a core part of that approach. Fadlalla described formal parent coaching as structured group programmes that typically run for weeks, alongside the more informal version that happens in ordinary paediatric visits when clinicians offer advice about routines, discipline and behaviour. But she said the evidence base behind much of this work has often drawn from a limited population.

Her concern is not abstract. Parenting research and popular frameworks such as authoritative, authoritarian, permissive and uninvolved styles are widely used, but summaries from several parenting education sources note that these categories were developed largely in Western settings and do not always translate cleanly across cultures. Fadlalla pointed to studies suggesting that strict, highly structured parenting can have very different meanings and outcomes depending on the social values around hierarchy, respect and emotional expression. In some communities, what might look to a clinician like excessive control may be understood as care, responsibility or a way of teaching children how to function within the family and wider society.

Fadlalla said the practical response is to start with curiosity rather than correction. Instead of reacting immediately to a practice that looks unfamiliar, she urged clinicians to ask why a family values it, what it is meant to achieve and whether there is a way to preserve that value while still offering evidence-based guidance. She gave an example of working with a mother who rejected what she called “positive, modern, Western parenting” and wanted consequences for her daughter’s behaviour. Rather than challenging her outright, Fadlalla validated the value the mother placed on consequences, then worked from there to add strategies that would also teach alternative behaviours. The point, she said, is to tailor advice so that it fits the family in front of the clinician, not an imagined universal parent.