Autism spectrum disorder (ASD) is a source of neurodiversity that relies on behavioural criteria to be diagnosed in individuals (Deweerdt, 2012). Despite the progress that has been made in finding an effective screening test to assist in diagnosis, what prevents these tests from being wholly accurate and reliable is cultural variation. That is to say, it is quite difficult to rely on behavioural criteria to classify someone as autistic when behavioural norms vary between cultures. Most of the research and diagnostic tests for autism originate from the West, and consequently, as Canadians, we have become accustomed to seeing autism depicted through a single cultural lens. We must collectively become more cognizant of how cultural values, perceptions, and attitudes in a society shape both autistic individuals and the people around them (Carruthers, 2019). Doing otherwise only limits our understanding of autism and consequently the support that can be offered to those on the spectrum. Despite the core characteristics of autism being universal, autistic traits tend to be both expressed and perceived differently depending on where you are located in the world. It is still being discovered today how cultural identity and cultural differences can specifically alter an individual’s expression of traits (Carruthers, 2019).  

 

The Autism Spectrum Quotient test was created at Cambridge University in 2001 and serves as a tool to classify individuals on or off the spectrum, based on how they respond to the 50-item questionnaire (Baron-Cohen, S., 2001). The 50 questions, which correspond to 50 common autistic traits, are answered by either individuals themselves or caregivers (Baron-Cohen, 2001). A study was performed to assess the strength of the quotient test in several countries to determine if it can potentially serve as a global screening tool. Both autistic and neurotypical children from the UK, Japan, and India were invited to join the study to analyze the prevalence of autistic traits across different countries and cultures (Carruthers, 2018). Researchers determined that the number of items out of the 50 that were considered ample evidence for marking children as autistic varied for each country (Williams, 2019).

 

It was found that the presence of an autistic trait is related to the country’s values and norms.

For example, UK parents reported that their autistic child disliked spontaneity more often than parents in India or Japan did (Williams, 2019). This indicates that the consideration of a trait as “autistic” or not relates to the country of origin and its norms. Spontaneity is seen as more common for children in the UK, so for a child to not display this in this country is considered more significant than in a country where it was never a norm in the general population to begin with (Deweerdt, 2015). Similarly, the trait of maintaining eye contact is more common in countries like England, while in rural South Africa, it is considered disrespectful to make direct eye contact for too long, especially with those of a higher status (Ntuli, 2012). This provides evidence that while in England, lack of eye contact would be a marker for autism, in rural South Africa, this same trait may not offer much insight into any underlying neurological differences (Deweerdt, 2015). 

 

Despite study results showing that the United Kingdom, Japan, and India respectively had 28, 15 and 16 traits that were considered excellent markers of autism, only five of the 50 traits were shared and deemed excellent as an indicator across all three countries (Williams, 2019). The five traits that were seen in children from all three countries could be used potentially as universal key indicators of autism. Two of the five traits were finding it hard to understand the intentions of others and being able to keep track of several different conversations at once. Despite these traits clearly not applying to everyone with ASD due to naturally imperfect study design and the very nature of autism as a spectrum, this opens new doors for a more accurate screening tool that will account for the variation in cultural norms and values. 

 

While many Western countries pride themselves on their diversity, mainly resulting from immigration, a disservice is done to the autistic community when they are not accurately assessed due to where they originate from. For children who weren’t born in or accustomed to a country’s values, it may take longer for them to be diagnosed compared to individuals fitting that country’s cultural model. This can lead to less support earlier on to assist both children in their development and parents in best supporting their child. In cases where individuals don’t end up getting diagnosed until adulthood, they may have gone through life feeling like they were missing part of their true identity. It’s through understanding the complexity of autism as a spectrum and how it can present itself in various cultures can our collective efforts be placed towards proper accommodation and support for everyone on the spectrum regardless of cultural background.

References

 

Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001, December). The autism-spectrum

quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Retrieved February 01, 2021, from https://pubmed.ncbi.nlm.nih.gov/11439754/

 

Carruthers, S., Kinnaird, E., Rudra, A., Smith, P., Allison, C., Auyeung, B., Chakrabarti, B., Wakabayashi, A., Baron-

Cohen, S., Bakolis, I., & Hoekstra, R. A. (2018). A cross-cultural study of autistic traits across India, Japan and the UK. Molecular autism, 9, 52. https://doi.org/10.1186/s13229-018-0235-3

 

Deweerdt, S. (2015, October 26). Culture: Diverse diagnostics: Spectrum: Autism Research News. Retrieved

November 24, 2020, from https://www.spectrumnews.org/news/culture-diverse-diagnostics/

 

Ntuli, C.D. (2012). Intercultural Misunderstanding in South Africa: An Analysis of Nonverbal Communication

Behaviour in Context. Retrieved January February 01, 2021, from https://www.semanticscholar.org/paper/Intercultural-Misunderstanding-in-South-Africa%3A-An-Ntuli/684e2dfc4d628e5728e65432042ac929f8700030

 

Williams, C. (2019, January 11). Core set of autism traits shows up in diverse cultures. Retrieved November 24,

2020, from https://www.spectrumnews.org/news/core-set-autism-traits-shows-diverse-cultures/