There are cultural considerations in comparing international data. From "Culture: Diverse Diagnostics," by
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. “Most autism research originates in the West, and we have a particular view of what autism is, a particular view about how children behave and interact with adults,” says Courtenay Norbury at Royal Holloway, University of London, who worked with children with autism from ethnically diverse backgrounds in east London1. “Other cultures might have very different expectations of how children behave.”
This viewpoint makes it challenging to use behavioural diagnostic tests for autism in places where the disorder may look — and even be — different from in the West. But with growing interest in autism’s true prevalence worldwide and the need for autism services in poor countries, researchers are grappling with the best ways to objectively diagnose the disorder.
1. Norbury, C. F. & Sparks, A. Dev. Psychol. (published online 5 March 2012).Previous posts have discussed research on adults and adolescents with ASD. From "Adulthood: Life Lessons, by Lindsay Borthwick:
Whether therapies — vocational, educational, behavioural or drug-based — can help adults with autism meet those expectations is still unclear. Only 32 studies conducted so far of therapies for autism are aimed at adolescents or adults with the disorder (aged 13–30 years), most of which were of poor quality, according to a report published in August 2012 by the US Agency for Healthcare Research and Quality5. Compare that with a previous report of 159 studies of treatments that enrolled children 12 years old and under with autism.
Another 2012 review, by psychologist Al Poling of Western Michigan University in Kalamazoo and his colleagues, found that fewer than 2% of participants in studies of behavioural interventions are aged 20 or older6.
5. Lounds Taylor, J. Comparative Effectiveness Review 65 (Agency for Healthcare Research and
6. Edwards, T. L.. et al. Res. Aut. Spec. Dis. 6, 996–996 (2012).