Arab Americans with Disabilities and Their Families: a Culturally Appropriate Approach for Counselors Jamal M

Received 07/19/13 Revised 12/09/13 Accepted 03/11/14 DOI: 10.1002/j.2161-1912.2014.00057.x application: theory to culturally competent practice Arab Americans With Disabilities and Their Families: A Culturally Appropriate Approach for Counselors Jamal M. Al Khateeb, Muna S. Al Hadidi, and Amal J. Al Khatib

The authors present a brief introduction to Americans of Arab descent and a brief overview of Arab culture. Then, culturally appropriate counseling considerations related to family, attitudes toward disability, religion, communication, acculturation, help-seeking behaviors, and stereotypes are highlighted. In the last section, the authors provide conclusions and recommendations for culturally appropriate considerations in working with Arab Americans with disabilities and their families. Keywords: Arab Americans, minorities, disabilities, special needs, culturally appropriate counseling Los autores presentan una breve introducción sobre los americanos de origen árabe y un breve resumen de la cultura árabe. Después, se destacan consideraciones para la consejería culturalmente apropiada relacionadas con la familia, actitudes sobre discapacidad, religión, comunicación, aculturación, comportamientos de búsqueda de ayuda, y estereotipos. En la última sección, los autores proporcionan conclusiones y recomendaciones para consideraciones culturalmente apropiadas a la hora de trabajar con americanos de origen árabe con discapacidades y sus familias. Palabras clave: americanos de origen árabe, minorías, discapacidades, necesidades especiales, consejería culturalmente apropiada stimating the number of Arab Americans with disabilities is a daunting undertaking for at least two reasons. First, the U.S. Census does not Euse an Arab American classification. Instead, people of Arab descent are classified under the “White” or “Some Other Race” category in surveys using federal standards for race and ethnicity (Hixson, Hepler, & Kim, 2011), so knowing the exact figure of Arab Americans is extremely difficult (Arab American Institute, 2012). Obviously, it is even more difficult to estimate the numbers of Arab Americans with disabilities. Second, disability prevalence is influenced by general health, the social environment, economic conditions, social mores, culture, available resources, demographic factors, and environ-

Jamal M. Al Khateeb and Muna S. Al Hadidi, Counseling and Special Education Department, University of Jordan, Amman, Jordan; Amal J. Al Khatib, Department of Child Education, Queen Rania College of Childhood Education, Zaraq, Jordan. Correspondence concerning this article should be addressed to Jamal M. Al Khateeb, Counseling and Special Education Department, College of Educational Sciences, University of Jordan, Amman 11942, Jordan (e-mail: [email protected]).

232 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 mental factors (World Health Organization, 2011), but little information is available on these factors with regard to the Arab American population. Considering the growth of this population, it is expected that counselors and other service providers are increasingly likely to work with Arab Ameri- can students with disabilities and their parents (Brown, Guskin, & Mitchell, 2012; Donovan, 2013; Goforth, 2011; Haboush, 2007). Abudabbeh (2005) mentioned that an increasing number of Arab Americans have been seeking professional help and consultation for various problems, including learn- ing disabilities and attention-deficit/hyperactivity disorder. Yet empirical research on the prevalence of disabilities among Arab Americans is lacking (Abadeh, 2006; Al Khatib, Al Hadidi, & Al Khatib, 2014; Campbell-Wilson, 2012; Donovan, 2013). The only exception is Dallo, Al Snih, and Ajrouch’s (2009) study, which used 2000 U.S. Census data to estimate the prevalence of physical disability and self-care disability among Arab Americans. Both types of disabilities were found to be higher among foreign-born Arab Americans than among U.S.-born Arab Americans. By applying the data on the total number of persons with disabilities in the United States to Arab Americans, we roughly estimated the number of Arab Americans of all ages having disabilities to be around 336,600, with approximately 23,400 of Arab American school-age children expected to have a disability. The number of Arab Americans with disabilities in the top 10 states with the largest Arab American communities are shown in Table 1. These numbers are based on the following data: (a) the number of Arab Americans (1.8 million), as reported by the U.S. Census Bureau (2011); (b) the prevalence of disability among the U.S. population (18.7%, with 5.2% among school-age children), as reported by Brault (2011, 2012); (c) the num- TABLE 1 Rough Estimate of the Number of Arab Americans of All Ages and Arab American School-Age Children With Disabilities in the United States

Rough Estimate of the Number of Arab Total Arab American Americans With Disabilities State Population All Ages School Age All states 1,800,000 336,600 23,400 California 272,485 50,955 3,542 Michigan 191,607 35,831 2,491 New York 149,627 27,980 1,945 Florida 100,627 18,817 1,308 Texas 91,568 17,123 1,190 New Jersey 85,956 16,074 1,118 Illinois 85,465 15,982 1,111 Ohio 65,813 12,307 856 Massachusetts 65,150 12,183 847 Pennsylvania 60,870 11,383 791 Other states 630,832 117,965 8,201 Note. From Arab American Institute (2012), Brault (2011, 2012), Frisby and Reynolds (2005), Goforth (2011), and U.S. Census Bureau (2011).

JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 233 ber of Arab American school-age children (450,000, representing 25% of the Arab American population), as reported by Frisby and Reynolds (2005) and Goforth (2011); and (d) the distribution of Arab Americans in the United States (Arab American Institute, 2012). However, if the number reported by the Arab American Institute (2012) and most other estimates (i.e., 3.5 million Arab Americans) are used, the numbers of Arab Americans with a disability might be almost double those given above (Al Khatib et al., 2014). arab americans: an introduction Arab immigration to the United States occurred in three distinct waves (Abra- ham, n.d.; Arab American National Museum, 2010; Derose, 2009; Nobles & Sciarra, 2000). The first wave of Arab immigration occurred in the late 1880s and continued until the mid-1920s. Motivated by the dream of providing better lives for themselves and their families, a large number of Arabs during this period came to the United States from what was known as Greater Syria (present-day Syria, Lebanon, Jordan, Palestine, and Israel). By 1924, approximately 200,000 Arabs were living in the United States, and the majority of those immigrants were Christian. These early groups of Arab immigrants identified with their country of origin or religion, and many of them settled in cities such as New York, Boston, Pittsburgh, and Detroit, where they often faced economic and political difficulties. Because of the decline in the United States’ economic growth during World War I, Arab immigration started to slow down around 1917. The second wave of Arab immigration (1940s–1960s), which occurred in the post–World War II period, included significantly more diverse groups from Arabic-speaking countries. These immigrants tended to be more educated and were both Christian and Muslim. During this period, three other major groups of Arabs arrived in the United States: Yemenis; Palestinians, who were allowed to come to the United States following the creation of the State of Israel; and Arab students, many of whom ended up staying in the United States. During this period, the “Arab American” identity started to emerge. The third wave (1970s–present) is the most diverse in terms of country of origin, religion, and socioeconomic status. This wave is also distinguished by its high percentage of war refugees, such as those from Palestine, Iraq, Leba- non, Sudan, and Somalia. More recently, immigrants from the Arab Maghreb (the Arab North African countries of Libya, Tunisia, Algeria, and Morocco) have begun to arrive in the United States. The employment rate among Arab Americans is similar to the national average. They work in all sectors of society, but they are more likely to be self-employed or to work in managerial, professional, sales, or administra- tive fields. Median income for Arab American households is higher than the national median income (Arab American Institute, 2012). Arab Americans are also highly educated: 85% of Arab Americans over age 25 have at least a

234 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 high school diploma, 45% of Arab Americans hold at least a bachelor’s degree, and 18% hold a postgraduate degree (Arab American Institute, 2012). Representing more than 20 different countries and ethnicities, Arab Ameri- cans are considerably heterogeneous in their cultural adaptation. Pertinent literature commonly points to intragroup differences that exist among native-born, assimilated, and recently immigrated Arab Americans in terms of second-culture acquisition and cultural identity (Boulos, 2011; Erickson & Al-Timimi, 2001; Hakim-Larson, Kamoo, Nassar-McMillan, & Porcerelli, 2007). The literature also documents considerable differences in family relations, education, language ability, economic status, and cultural identities among Arab Americans based on their religion (Christian or Muslim), place of birth (native- or foreign-born), and time of immigration (old or new immigrants), among other variables (Abraham, n.d.; Hammad, Kysia, Rabah, Hassoun, & Connelly, 1999; Nobles & Sciarra, 2000; Read, 2003; Weaver, 2010). According to Weaver (2010), the term Arab American

covers a broad spectrum of people from both Asia and Africa, of both Christian and Muslim cultures, and a large variety of denominations within those religions. In addition, Arab Americans belong to different socioeconomic groups, are first- and second-generation [or even older] immigrants, have come as refugees, sojourners and immigrants, and have a variety of different physical characteristics. (p. 33)

Despite this diversity, Arab Americans share much in common in terms of history, religion, cultural heritage, and language (Arab American National Museum, 2010). Arab Americans have encountered sweeping stereotypes and negative perceptions (Haboush, 2007; Haddad, 2004; Read, 2003; Wingfield & Karaman, 1995). Lee, Blando, Mizelle, and Orozco (2007) commented on demeaning stereotypes of Arab Americans as follows:

Middle Eastern Americans are routinely negatively portrayed in the media and entertain- ment and are often the victims of stereotypes. . . . These stereotypes not only present serious challenges to Middle Eastern Americans’ development of positive ethnic identity . . . , but also lead to biases and mistaken assumptions among the mental health professionals who serve them. These biases and assumptions can significantly compromise the effectiveness of mental health services for Middle Eastern Americans. (pp. 190–191)

Nobles and Sciarra (2000) added that stereotyping, discrimination, and prejudice exacerbate the acculturative stress Arab Americans face in the United States. brief overview of arab culture To help counselors and other service providers better understand the unique behaviors, perceptions, and needs of Arab Americans with disabilities and their families, we provide a general overview of Arab culture. However, Nobles and Sciarra (2000) emphasized that general descriptions of any cultural group

JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 235 run “the risk of engendering stereotypes and overlooking intragroup differences” (p. 182), and they cautioned against treating cultural attributes as stereotypes to be applied to any Arab American. As Ezenkwele and Roodsari (2013) asserted, “it is very important to remember that universality of cultural guidelines is a misnomer and does not exist. Rather, these guidelines can be perceived as generalizations that can and should be applied on an individual basis” (p. 172). The Arab culture is one of the oldest on Earth and is strongly associated with Islam. Muslims believe that there is one God (Allah) and that Mu- hammad is his prophet. They also believe in all the prophets of the Jewish and Christian tradition, including Noah, Abraham, Moses, Isaac, Jacob, Solomon, David, and Jesus. Other tenets of Islam are prayer, fasting, zakat (i.e., almsgiving—giving a small percentage of one’s annual savings as alms or charity), and pilgrimage to Mecca. However, Arabs are not a monolithic group. Significant Christian minorities can be found in several Arab countries. Furthermore, Arabs are not all Muslim, nor are all Muslims Arab. Fewer than 20% of Muslims worldwide are Arab (Hasnain, Shaikh, & Shanawani, 2008). Although the 22 countries that make up the Arab world share much in common in terms of religion, culture, and language, they also differ economically, socially, politically, and geographically. Of the languages in the Arab region (e.g., original Aramaic, Berber, and Kurdish), the Arabic language, which belongs to the Semitic group of languages, is an important and unifying characteristic of Arabs. However, there are colloquial dialects, which differ from the standard official version of the language. According to Martin (2009),

Arab American parents often encourage their children to learn Arabic as a means of maintaining their cultural or ethnic identity. . . . In fact, 69% of first-generation Arab Americans speak Arabic at home although parents in mixed marriages or who are second- or third-generation Arab Americans tend to speak English at home. . . . In areas with high concentration of Arab Americans, some parents even send their children to public schools that teach Arabic. (p. 7)

The Arab culture is described as collectivist because individuals have a close, long-term commitment to their family (Goforth, 2011; Hammad et al., 1999). The family is the foundation of Arab society, and a family’s honor is most important (Goforth, 2011). Arab societies are patriarchal and hierarchical where fathers and elders dominate. The Arab family also endorses mutual commitments and relationships of interdependence and reciprocity. Parents often remain financially supportive and responsible for children into adult- hood, and when parents begin to age, children are expected to care for their parents (Barakat, 1993). Gender segregation is practiced to different extents in Arab countries. Arab dress for men ranges from the traditional flowing robes to blue jeans, T-shirts, and Western business suits. Even though dress codes and customs for women also differ from country to country, Islam requires women to dress modestly

236 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 and to wear the veil (hijab) in public and in the presence of men who are not close relatives. Hospitality represents a main feature of Arab customs (Donovan, 2013; Dwairy, 2006; Nobles & Sciarra, 2000). Among Arabs, hospitality is a matter of honor and a sacred duty. Regardless of personal cost, Arabs extend hospitality to their guests and expect it to be returned. One way for Arabs to show hospitality is through food, so they tend to serve large quantities and varieties of food (Nobles & Sciarra, 2000). considerations for counselors and other service providers The increasing number of Arab Americans with disabilities creates a need among service providers for better information about these individuals. Sev- eral authors have provided suggestions for mainstream counseling, social work, education, and health practitioners who work with Arab Americans (e.g., Erickson & Al-Timimi, 2001; Haboush, 2007; Hakim-Larson et al., 2007; Hammad et al., 1999; Hammoud, White, & Fetters, 2005; Nassar-McMillan & Hakim-Larson, 2003; Nobles & Sciarra, 2000). Many of these suggestions are generally applicable to those who provide counseling and other support services to Arab Americans with disabilities. This section draws from these sources, online literature pertinent to Arab Americans with disabilities, and our extensive fieldwork experiences with individuals with disabilities and their families in Arab countries.

CONSIDERATIONS RELATED TO FAMILY In Arab culture, the individual’s situation reflects on the entire family (Nobles & Sciarra, 2000). Thus, the effect of disability on the family may be significant, and counselors are encouraged to build trust with family members, not just with the client (Ezenkwele & Roodsari, 2013). Because women in Arab culture, as in many other cultures, may assume the ultimate responsibility of caring for children with disabilities, disability may have a profound effect on mothers (Donovan, 2013). The possibility of being overinvolved and over- protective of family members may lead to nurturing dependence in members with disabilities (Donovan, 2013). As is true in other cultures, Arab American parents experience a series of reactions (e.g., shock, denial, disbelief, anger, guilt, stress) upon the diagnosis of a disability in their child (Donovan, 2013). However, because Arab American parents may be influenced by their cultural view of disability as a stigma, they can be more devastated than parents from other cultures to learn that their child has a disability (Al Khatib et al., 2014; Diken, 2006; Reiter, Mar’i, & Rosenberg, 1986). The family is the single most important social and economic institution for most Arabs. In fact, Arab society is built around the extended family system (Nydell, 1987). During stressful times (e.g., crisis, illness, disability diagno-

JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 237 sis), parents can rely on the whole family, including the extended family, to help them cope (Abudabbeh & Aseel, 1999). The extended family system provides emotional support and financial assistance but may limit the individual’s independence. Arab American extended families usually live near each, other spend a lot of time together, and are involved in each other’s lives (Arab American National Museum, 2013). Arab immigrant families who transform from extended families to nuclear families commonly feel isolated and disengaged (Nobles & Sciarra, 2000). Furthermore, many Arab Americans experience isolation and loneliness because of the stark differences between American lifestyle and the collectivist culture and community they had in their native country (Moradi & Hasan, 2004).

CONSIDERATIONS RELATED TO ATTITUDES TOWARD DISABILITY By acknowledging attitudes toward disability, counselors and other service providers will be better equipped to help Arab Americans with disabilities and their families. Some studies reported that attitudes toward persons with disabilities are more negative in collectivistic societies, such as Arab societies, which emphasize group goals above individual needs (Nakamura, 1996 [as cited in Watanabe, 2003]; Westbrook, Legge, & Pennay, 1993; Zaromatidis, Papadaki, & Glide, 1999). Literature published in the last decade confirms that Arab societies perceive disability more negatively than do Western societies (Al Thani, 2006; Gharaibeh, 2009; Haboush, 2007; Nagata, 2007; Turmusani, 2003). As a result, Arab Americans may seek counseling and other supportive services as a last resort (Donovan, 2013; Nobles & Sciarra, 2000). Parents’ reluctance to seek help might deprive their children with disabilities of needed services, such as early childhood intervention. Thus, intensive effort may be needed to convince Arab American families who have children with disabilities to seek early intervention and counseling services. Disability-related laws in the United States emphasize developing collab- orative partnerships between service providers and families of persons with disabilities (Turnbull & Turnbull, 2001). Extensive literature also provides strong evidence that family involvement has significant benefits for intervention programs (Bailey, Raspa, & Fox, 2012; deFur, 2012; Heward, 2012). Service providers are encouraged to recognize that Arab American families may be hesitant about involvement in counseling and other programs (Aba- deh, 2006; Moosa, Karabenick, & Adams, 2001). Thus, family training and guidance are important. Many Arab Americans may find special education and related services in the United States complicated and confusing. As Donovan (2013) noted,

Students and their parents who are recent emigrants from the Arab world might experience confusion or strong reactions to special education in the United States. Their reactions could relate to their knowledge of special education practices based in the Arab world. (p. 46)

238 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 The special educational system in Arab countries, which is currently undevel- oped, has no clear and actionable laws, lacks financial resources, and works differently from the special educational system in the United States. In an article on the delivery of health care among Muslim Americans of Middle Eastern descent, Ezenkwele and Roodsari (2013) attributed this confusion to

language barriers; cultural misconceptions; and perceptions of disrespect, discrimination, lack of knowledge about their religious and cultural practices, and gender preferences in seeking and accepting health care. . . . In addition, as a cultural norm arising from mod- esty and politeness, patients are frequently quiescent, more accepting of the health care hierarchy, and often try to remain unobtrusive. Patients do not verbalize their problem and may expect health care providers to anticipate their needs and situation. (p. 170)

Arab American families who have a member with a disability need to know that the rights of individuals with disabilities in the United States are protected under both federal and state laws (i.e., the Rehabilitation Act of 1973, the Education for All Handicapped Children Act of 1975, the Americans With Disabilities Act of 1990, and the Individuals With Disabilities Education Act of 1997). Some Arab Americans, like other linguistic and ethnic minority persons, may have limited English proficiency (de la Cruz & Brittingham, 2003). Thus, gathering information about English language proficiency and providing bilingual (English/Arabic) information might prove helpful (Goforth, 2011).

CONSIDERATIONS RELATED TO RELIGION The role of religion in the life of Arab families must be considered. Religion serves as an important context where problems are constructed and resolved (Al-Krenawi & Graham, 2000). Although the majority of Arab Americans are Christian, the percentage of Arab Americans who are Muslim has increased (Arab American National Museum, 2010). Published literature typically emphasizes the need to consider the role of religion, whether Islamic or Christian, in moderating the effect of mental health problems or disability on Arab American individuals and families (Al-Krenawi & Graham, 2000; Al Thani, 2006; Boulos, 2011; Crabtree, 2007; Erickson & Al-Timimi, 2001; Nobles & Sciarra, 2000). According to Read (2003), both Christian and Muslim Arabs

share an ethnic heritage greatly influenced by Islamic values, especially those regarding gender roles and family relations. . . .The family is considered the foundation of the Arab community, and there is a strong emphasis on traditional gender roles. . . . Arab women have primary responsibility for childbearing, childrearing, and socializing future generations with Arab values. . . . [However], there is considerable variability in the degree to which Arab Americans support these ideals. (p. 210)

Read (2003) examined the effect of religion on gender role attitudes among a national sample of Arab American women, and his study revealed that women’s roles were affected more by Arab cultural norms than by Christian or Muslim religions. Hamdy (n.d.) asserted that religion may not be a good predictor of family values among Arab Americans: “Arab

JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 239 families are tightly knit well beyond the nuclear family itself. Christian and Muslim Arabs alike may keep a family-oriented way of conducting their lives while adapting to their immigrant environment in the [United States]” (p. 4). Considering this religious context, a few statements about persons with disabilities from an Islamic perspective are relevant. According to Islam, individuals are entitled to various rights: the right to life, identity, family cohesion, personal freedoms, sound upbringing, education, appropriate social living standards, protection from all forms of abuse, and physical and psychological care (Organisation of Islamic Cooperation, 2005). The covenant of the Organisation of Islamic Cooperation (2005) includes an article about children with disabilities that emphasizes the right of the child with a disability to appropriate education, multidisciplinary care, and integration into society. However, Islam does not say a great deal about disability per se (Al Thani, 2006; Miles, 2007). Even the statements found in the Qur’an (the religious text of Islam) about disability (e.g., blindness and deafness) are ambiguous and are often best understood figuratively or metaphorically (Al Thani, 2006; Miles, 2007). In Islam, disability is neither a blessing nor a curse; it is accepted as a fact of life that must be addressed appropri- ately by society (Almusa & Ferrell, 2004). Positive social attitudes toward persons with disabilities or illnesses are clearly encouraged. One of the fundamental propositions of Islam is to respect and support all human life and to value the potential of every individual, and this fact does not change when a person has a disability (Almusa & Ferrell, 2004; Guvercin, 2008). Furthermore, Islam opposes prejudice against and exclusion of any group of people. Instead, Islam calls for accepting all people and encour- ages including them.

CONSIDERATIONS RELATED TO COMMUNICATION STYLES To stress the importance of what they are saying, Arabs may use repetitions of phrases and themes, along with exaggerated descriptions (Nobles & Sciarra, 2000). Arab communication styles tend to be formal, impersonal, and restrained (Al-Krenawi & Graham, 2000). Feghali (1997) reported that features of Arab communicative style include the following: (a) repeti- tion (reiterations at the phonological, morphological, lexical, syntactic, and semantic levels), (b) elaboration (rich and expressive language use), and (c) affectiveness (affective style of emotional appeal). On the level of nonverbal and paralinguistic patterns, variations occur in gestural usage across Arab societies; however, Arabs generally tend to interact with a direct body orientation, stand close together, touch frequently (within gender but not between genders), and demonstrate unique use of paralinguistics (e.g., speaking fast and loudly, using unique patterns of intonation and silence).

240 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 CONSIDERATIONS RELATED TO ACCULTURATION The acculturation experiences of Arab Americans are influenced by many social and psychological factors, including the level of prejudice and discrimination they are exposed to, religion, gender, language skills, education, reasons for immigration, economic status, and presence or absence of family support (Ajrouch & Jamal, 2007; Barry, 2005; Boulos, 2011; Derose, 2009; Ferguson, 2004; Jackson & Nassar-McMillan, 2006; Nassar-McMillan & Hakim-Larson, 2003; Nobles & Sciarra, 2000). According to Nobles and Sci- arra (2000), well-acculturated Arab Americans tend to “have distant ancestral ties, be successful, have high leadership positions, advocate secularism, or identify with Christianity” (p. 185). However, like other ethnic and linguistic minority groups that experience acculturative stress, many Arab Americans encounter difficulties assimilating into the dominant American culture (Arab American National Museum, 2013). Because of stereotyping, prejudice, and discrimination, which complicate acculturation and affect mental health, Arab Americans may experience additional stress (Barazangi, 1989; Nobles & Sciarra, 2000; Shaheen, 1984). Several studies have indicated an association between acculturation and health and disease among Arab Americans (El-Sayed & Galea, 2009; Hata- het, Khosla, & Fungwe, 2002; Jaber et al., 2003). In a study on mental health service provision for Arab Americans, Sayed (2003) emphasized that this population’s unique characteristics affect the therapeutic process for those individuals who are not acculturated to the American way of life. Sayed (2003) suggested that therapists fully appreciate the relationship between culture and psychotherapy. It can be inferred from Sayed’s (2003) study that providing counseling services to Arab American individuals with disabilities and their families who are not acculturated to the American way of life presents similar challenges to counselors and other service providers. This challenge is expected because of the contrasting cultural perceptions of disability and the service provision process. ,However we were unable to identify similar studies on acculturation issues and disability. Thus, research exploring the relationship between acculturation and disability management in this population is warranted.

CONSIDERATIONS RELATED TO HELP-SEEKING BEHAVIORS Cultural factors affect parents’ help-seeking behaviors (Donovan, 2013; Lau & Takeuchi, 2001). As mentioned earlier, some Arab families tend to hide mental health problems and would only seek treatment as a last resort (Nassar-McMillan & Hakim-Larson, 2003; Nobles & Sciarra, 2000). Similarly, Arab and Muslim families may hide disability and may be reluctant to obtain disability-related services and personal support (Al-Krenawi & Graham, 2000; Diken, 2006; Donovan, 2013; Goforth, 2011; Haboush, 2007; Hasnain et al., 2008). This reluctance may occur because of a stigma regarding disability or the belief that the disability must be endured because it is God’s will. More-

JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 241 over, Arab Americans, like many other ethnic minorities, may be less likely to seek disability-related services because of factors such as language barriers, cultural and religious beliefs about special education and disabilities, gender role limitations, levels of acculturation, social class differences, differing perceptions of disability, lack of bilingual service providers, lack of culture-fair assessment tools, and perceived discrimination and negative stereotyping (Boulos, 2011; Donovan, 2013; Hasnain et al., 2008).

CONSIDERATIONS RELATED TO STEREOTYPES As previously mentioned, Arab Americans are frequently subjected to stereotypes. Arab Americans and their families want to feel respected; therefore, service providers should seek out information about culture and religion to promote understanding (Aburumuh, Smith, & Ratcliffe, 2009; Schwartz, 1999). Further- more, Arab Americans may feel alienated because of perceived stereotyping, prejudice, and ridicule of their cultural rituals (Jackson, 1997). Discrimination can lead to a number of psychosocial problems, including depression, psychological distress, and low self-esteem (Al-Hazza & Bucher, 2010). conclusion and clinical recommendations The importance of culturally appropriate approaches with racially and linguistic diverse persons with disabilities and their families has been emphasized in recent years (Lichtenstein, Lindstrom, & Povenmire-Kirk, 2008; National Center on Secondary Education and Transition, 2004). Consistent with this approach, this article provided an overview of some culturally relevant information on Arab Americans with disabilities and their families. The following are our clinical recommendations:

1. The lack of information and awareness may pose difficulties for both Arab Americans with disabilities and human service practitioners. When working with Arab Americans with disabilities and their families, particularly those not acculturated to American culture, counselors and other service providers need to understand issues related to acculturation, experiences in native countries, and cultural influences on perceptions of disability (see Haboush, 2007; Hakim- Larson et al., 2007; Sayed, 2003). However, overgeneralizations based on the information provided in this article should be avoided. As Aburumuh et al. (2009) noted, Americans of Arab descent are an extremely heterogeneous group. Thus, counselors and other service providers should apply the information presented in this article with discretion, while being mindful of the tremendous diversity of this population.

242 JOURNAL OF MULTICULTURAL COUNSELING AND DEVELOPMENT • October 2014 • Vol. 42 2. Because perceptions of individuals with disabilities vary by culture (Thomas & Thomas, 1999; Westbrook et al., 1993), it is important that counselors and other service providers working with Arab Americans develop an understanding of cultural characteristics and practices. If culturally specific patterns of Arab Americans with disabilities and their families remain unidentified or misunderstood, service providers’ ability to offer appropriate programs for them risks being undermined. 3. Special education and related services in the United States may be complicated and confusing for some Arab Americans. Parent involvement in these services may be hindered by language difficulties, parents’ perception of the school as the authority, parents’ previous experiences with service providers in the country of origin, or other factors. Accordingly, intensive guidance and training are important when working with Arab American families. 4. Because Arab Americans frequently encounter negative stereotypes and perceptions, services offered for this population can be compro- mised. Counselors and other service providers must overcome their own prejudices, misconceptions, and gaps in knowledge to ensure that Arab Americans with disabilities and their families are treated equitably and without prejudice. 5. Counselors are encouraged to appreciate that disability can be stig- matizing and dehumanizing to the family in Arab culture. They also need to think of methods to overcome obstacles they may encounter as a result of this stigma. Because of the shame associated with disability, counselors and other service providers may need to overem- phasize the confidentiality of information regarding individuals and their family. 6. Because religion is important to Christian and Muslim Arab Ameri- cans, consideration should be given to religious persuasion, without stereotyping or assumptions. 7. Many Arab Americans have unique verbal and nonverbal communication styles, and some of them may face language barriers. Accord- ingly, counselors and other service providers will be better equipped to help Arab Americans with disabilities and their families if they attend to issues related to communication styles. 8. Because of significant differences in acculturation, it is important that counselors assess the level of acculturation among Arab Ameri- can clients and modify their style and intervention accordingly. references Abadeh, H. (2006). Perceptions of Arab American parents with children with special needs regarding home-school communications (Doctoral dissertation). Available from digitalcommons. wayne.edu

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