Nature has a fascinating article on the diagnosis of autism and how it clashes with cultures that have different forms of everyday social interaction and different standards for how children should behave.
In rural South Africa, young children may look at adults’ faces while having a conversation, but they don’t usually make direct eye contact because it is considered disrespectful. Yet a lack of eye contact is a hallmark of social deficits in people with autism, and as such it is something Western clinicians look for when diagnosing the disorder.
There are other examples of children’s behaviour – such as finger pointing to draw attention to something, or conversing with adults as if they are peers – that are commonplace in the West and included in tests of autism.
The ‘gold standard’ for diagnosing autism is a combination of the ADOS, a set of structured tasks to observe interaction with the person concerned, and the ADI, an interview with the caregiver to see how any difficulties have emerged over time.
As both were developed in London, they are based on Western / European model of social interaction. The risk is that other forms of cultural interaction can be wrongly interpreted as signs of impairment.
It’s worth saying that many cases of autism are unmistakeable as difficulties in social interaction can be quite marked.
However, as the concept of the autism spectrum has become more common, what can be variously and unsatisfactorily described as ‘high functioning’, ‘atypical’ or ‘mild’ autism, usually where difficulties are not immediately obvious, is where there is more room for cultural confusion.
The Nature article describes how various cultural tendencies eddy and flow around the concept of autism and how clinicians are now attempting to navigate the choppy waters of diagnosis.
Link to excellent Nature article on culture and autism.