Some autism traits look the same across cultures, and they could form the basis of a global screening tool, a new study suggests1. Other traits, however, are specific to particular cultures, and this must be accounted for when designing autism screens and diagnostic tools.
Autism often goes undiagnosed in some countries, giving an artificially low estimate of prevalence. Most screening and diagnostic tests for the condition were developed in Europe and North America, and are based on Western cultural norms. But caregivers in non-Western settings may have different expectations of how children should behave, and children may be unfamiliar with cultural references in the tests.
In rural South Africa, for example, children are unaccustomed to singing “Happy Birthday” and blowing out candles on a cake — an activity they are asked to pretend to do when completing the Autism Diagnostic Observation Schedule. And a 2011 study suggests that Japanese parents often perceive a child’s disinterest in peers as shyness or modesty, valued traits in that culture rather than a red flag for autism2.
The new study examines which items on the Autism Spectrum Quotient (AQ) — a 50-item questionnaire that caregivers complete — best distinguish children with autism in three countries from their typical peers. Overall, 28 items proved at least ‘acceptable’ for identifying autism in all of the countries, and 5 are ‘excellent,’ the researchers found.
