Autism traits that are universal among all cultures could lead to a global diagnostic and screening tool for autism, according to a new study by psychologists in Israel and the U.K. On the flip side, autism traits that are specific to certain cultures could also be taken into account when assessing and diagnosing the condition.
Rosa Hoekstra, a senior lecturer at the Institute of Psychiatry, Psychology, and Neuroscience at Kings College London, headed the study, which involved 154 children from India, 306 from Japan, and 1,020 from the U.K., all between four and nine years old. The researchers examined which items on a 50-item questionnaire known as the Autism Spectrum Quotient (AQ) were most effective at distinguishing autistic children in Japan, India, and the U.K. from their non-autistic peers.
The AQ questionnaire was provided to the parents and caregivers of the children, to be answered in their native language. The adults rated their child on 50 common autism traits using a four-point scale, with the two highest points indicating an autism trait. Each item on the questionnaire was assigned a rating by the researchers based on how well it managed to identify autism. 16 of the items were deemed “excellent” at identifying autism in the Indian group, 15 in the Japanese group, and 28 in the group of children from the U.K. The researchers determined 28 items “acceptable” at identifying autism throughout all of the countries, while only 5 were described as “excellent” for all three.
The researchers found four items on the questionnaire that identified autism in only one of the three countries. For example, parents from the United Kingdom reported that their child disliked spontaneity, a trait reported much less frequently by parents from India and Japan. A child speaking in a monologue was an autistic trait reported exclusively by Japanese parents.
Hoekstra believes some of these results may be attributable to cultural norms, such as parenting styles in Japan and India not allowing for as much spontaneity as the U.K. The results of the test might also have been affected by the translation, with the word “spontaneous” being translated as “I do things on my own initiative” rather than “I do things without planning.”
Autism often goes undetected in countries without the screening and diagnostic tests developed in Europe and North America. The Autism Diagnostic Observation Schedule (ADOS), an instrument for diagnosing autism, requires that children sing “Happy Birthday” and pretend to blow out candles. However, this custom isn’t practiced in rural South Africa. In Japan, shyness and modesty are valued traits, and would not be perceived as red flags for autism in children, the way they might in other countries.
Overall, Hoekstra said she was “quite surprised how well the items worked.”
“Hopefully, this can be one building block towards the bigger body of work exploring where culture sits in the puzzle of autism.”
According to a January 2019 report on the summary by Spectrum News, Hoekstra is now interviewing caregivers from different cultures within the United Kingdom to investigate their perception of autism, and why autistic traits vary across different cultures.