Approximately 1 in 100 children diagnosed worldwide, the assessment of ASD relies on standardized criteria such as the DSM-5-TR and ICD-11. However, cultural differences influence how ASD-related behaviors are interpreted, leading to variations in diagnosis. For instance, while ASD is characterized by observable socio-emotional behaviors, cultural expectations of child development and communication shape how symptoms are perceived. A behavior like avoiding eye contact, which is considered a trait of ASD in Western cultures, may be viewed as a sign of respect in some Asian cultures, highlighting the challenges of applying uniform diagnostic criteria globally.
The reliance on standardized diagnostic tools such as the Autism Diagnostic Observation Schedule (ADOS-2) raises concerns about their validity across different cultures. Since ASD lacks specific biomarkers, its diagnosis depends on observations made by professionals, parents, and caregivers. However, cultural norms impact how symptoms are identified and reported. The International Test Commission (ITC) emphasizes the importance of accurate translation and contextual understanding to ensure assessments remain reliable across cultures. Despite efforts to improve cross-cultural validation, significant gaps remain in recognizing how cultural differences shape ASD diagnoses
Research comparing ASD assessments across different countries suggests that while some autistic traits are universal, others vary depending on cultural context. A study examining parent-reported data from India, Japan, and the UK revealed that cultural perceptions influence how behaviors like spontaneity and social conversation are interpreted. Furthermore, within a single country, factors such as race and ethnicity can affect how ASD symptoms are perceived and diagnosed. These findings highlight the need to refine diagnostic tools to account for cultural variability.
Beyond ASD, the article underscores the broader implications of cultural differences in diagnosing other neurodevelopmental conditions such as ADHD and intellectual disabilities. Cultural expectations regarding social behavior and adaptive functioning impact how developmental delays or deficits are assessed. For example, what is considered a developmental delay in one culture may be perceived as typical behavior in another, affecting diagnostic accuracy.
This calls for expanded cross-cultural research to improve ASD diagnosis and enhance the global understanding of neurodevelopmental conditions. Collaborative efforts among clinicians, researchers, and policymakers are crucial to bridging the gap between standardized diagnostic tools and cultural nuances. By acknowledging cultural influences in assessments, the medical community can work toward more accurate and sensitive diagnoses, ensuring that individuals with ASD and other neurodevelopmental conditions receive appropriate support worldwide.
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Autism spectrum disorder diagnosis across cultures: Are diagnoses equivalent?
January 31, 2024 Tally Lichtensztejn Tafla, Maria Cristina Triguero Veloz Teixeira, Sophie Sowden-Carvalho, Kate Anne Woodcock
https://journals.sagepub.com/doi/10.1177/27546330241226811
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