According to the CDC, about 1 in 100 children have been diagnosed with autism spectrum disorder globally. Autism is diagnosed in all socioeconomic and ethnic groups and makes up about 1% of the world’s population. However, a dominating factor calls this statistic into question: cultural differences throughout the world. 

In a scientific article published in Dementia & Neuropsychologia, researchers defined culture as “a dynamic system of bidirectional influences among individuals and their environment, including psychological and biological processes, which facilitate adaptation and social interaction.” When you consider clinical neuropsychology as it pertains to this definition of culture, a strong relationship is established between the two where culture can affect the perception of diagnoses and therefore, treatment. The relationship proves that the definition and prevalence of autism in different regions is influenced by culture. Due to this, the presentation of autistic symptoms will look different across different countries. 

One common example of this is the ability to make and maintain eye contact. According to a blog in Scientific American, Dr. Jessica Winegar found that young children in southern Egypt often avoid eye contact in the face of authority, while in many European-American families, children are more likely to make eye contact with others because it is encouraged through culture. Many cultures, including those of African-American communities and some Asian groups, believe that eye contact is disrespectful and therefore it is frowned upon. In some Asian countries, eye contact is not normal and not considered deviant. The avoidance of eye contact is viewed as a considerable concern when determining an autism diagnosis in the United States and some other areas but due to cultural differences, it shouldn’t be used for other populations where maintaining eye contact isn’t necessarily a neurotypical trait. 

Unfortunately, there are no specific biological criteria for diagnosing autism through blood tests nor brain scans. It has to be diagnosed through clinical observations which can still be ambiguous and vary between different cultures. These clinical observations are based on parental perceptions and the child’s behavioral tendencies when it comes to language, motor skills, communication, etc. Race and ethnicity significantly impact neuropsychological tests and therefore cross-cultural assessments are really not meaningful in autism diagnoses. Overall, when considering or assigning a diagnosis, researchers and scientists must consider the cultural background of the child. Without keeping this perspective in mind, the child may be affected through misdiagnosis or even mistreatment and incorrect intervention. At the end of the day, diagnoses vary in every child with autism because no child with autism is the same. However, going into the future with research and advocacy, we need to become more inclusive and view autism as a global perspective where cultural differences can affect expectations of behavior and forms of communication. It is so important to focus on the child’s ability to function in their community and culture rather than use assessment tools that are prone to systematic bias in different cultures and misdiagnosis.

In association with this idea, cultural factors also influence acceptance and understanding, which in turn affects the prevalence of autism throughout the world. For example, studies in China have shown that mental health promotes negative attitudes and perspectives, which in turn creates stigma in society. China is one of the countries where a gap surrounding autism understanding still exists between the country and western countries. According to an article in Neurodiversity, Eva Li writes, “One explanation is that Asian individuals define autism differently: compared to those of Western countries, people in Asia are more likely to view autism as an intellectual disability.” In another explanation she writes, “Chinese parents in particular feel more stress and stigma, as they are found to focus more on their social status and identity.” Even in regions in India some mental health conditions are considered taboo, partially due to a lack of awareness. It’s interesting because the overall autism prevalence in Asia is continuously increasing with more awareness and knowledge. Hopefully, as new diagnosis measures are created and more people extend that awareness, then stigma surrounding autism will fade and significant changes will come.

References

1. Bauer, S. C., Waxman, S., & Winegar, J. (2016, April 1). How Cultural Differences Affect Autism Diagnoses [web log]. Retrieved from https://blogs.scientificamerican.com/guest-blog/how-cultural-differences-affect-autism-diagnoses/.
2. Bougeard, C., Picarel-Blanchot, F., Schmid, R., Campbell, R., & Buitelaar, J. (2021). Prevalence of autism spectrum disorder and co-morbidities in children and adolescents: A systematic literature review. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.744709
3. Li, E. (2018, March 2). Global Perceptions of Autism: Eastern Asia [web log]. Retrieved from https://intr100neurodsp18burk.sites.wm.edu/2018/03/02/global-perceptions-of-autism-eastern-asia/.
4. Stone-MacDonald, A., & Cousik, R. (2016). Global Perspectives: Autism Education and Treatment in other Nations. Autism Spectrum Disorders, 4.
5. Wajman, J., Gauthier, S., & Bertolucci, P. H. F. (2017). Culture as a variable in neuroscience and clinical neuropsychology: A comprehensive review. Dementia & Neuropsychologia, 11(3), 312–312. https://doi.org/10.1590/1980-57642016dn11-030016