4.2 Diagnosing autism in different cultures
In many developing countries, access to diagnosis is extremely limited, which contributes to strikingly lower prevalence estimates (Elsabbagh et al., 2012). There is also evidence for variations in diagnosis rates between different ethnic communities within a given country (Begeer et al., 2009).
Most diagnostic criteria and tools have been developed in the UK and US and reflect the majority Western understanding of what is typical behaviour and what constitutes significant difference. Beyond the challenge of making diagnosis available wherever it is needed, there is the issue of what diagnostic criteria and instruments are appropriate to use; cultural norms for behaviour must be considered (Norbury and Sparks, 2013).
Activity 6 What factors affect varying prevalence estimates across cultures?
In these clips, Dr Prithvi Perepa, of Northampton University, draws on his own research to consider the implications of cross-cultural factors for diagnosis of autism. As you watch the clips, note the main factors he mentions.
Clips 1 and 2
Prithvi acknowledges that limited access to diagnostic services will have an impact on prevalence estimates: fewer diagnosed cases means lower prevalence. However, he also stresses that culturally different understandings of autism, may affect whether particular behavioural traits are seen as atypical or not.
Culturally different expectations may be particularly marked concerning children’s early developmental milestones. For example, whereas imaginative pretend play is considered an important milestone in the West, some cultures prefer their children’s play to be ‘functional’ e.g. the ability to stack toy bricks would be considered more important than using them as ‘cups’ for pretending to drink. In certain African cultures, children are not expected to refer to themselves with personal pronouns such as ‘I’, and in India, boys are not expected to develop speech early. Such differences are likely to affect whether and when a parent forms concerns about their child’s development.
Besides differences in cultural expectations for developmental milestones, there may be differences concerning acceptable social behaviour. Such cultural differences may exist in UK-based ethnic minorities, as well as across different world cultures, as Dr Perepa explains.
Besides different expectations for development, acceptable social behaviour may differ. For instance, in some countries, it is considered disrespectful for a child to engage in eye contact with an adult. So lack of eye contact would not give a parent cause for concern. Such cultural differences may exist in UK-based ethnic minorities, as well as across different world cultures