Moreover, the definition of behavioral symptoms rests on Western – and specifically American – expectations about the behavior of children and adults. But what is “autistic” in this context may be “normal” in another. In rural South Africa, for instance, young children avoid direct eye contact with adults because their culture considers it disrespectful.At Scientific American, Sarah C. Bauer, Jessica Winegar, Sandra Waxman make a similar point:
Another behavior that is used in diagnosing autism is how a child interacts and plays with an unfamiliar adult. But this, too, varies according to culture. In many communities, extending from the United States to parts of rural Kenya, children rarely play with adults. In cultural contexts like this, children may be wary when an unfamiliar adult invites them to play.
An additional tool in diagnosing autism is language development, including the age when children first begin to say words or to speak in phrases. Here, diagnosticians are on somewhat firmer footing since major milestones in language acquisition appear to be consistent across languages and communities. But it is important to bear in mind that children may be reluctant to talk directly to an adult, especially if they are from a different cultural group. Dr. Sarah Bauer has undertaken autism-specific medical education outreach, including extensive teaching and discussions with families, therapists, and physicians in the United States and abroad in Eastern and Southern Europe. She’s learned that these kinds of cultural differences are why it is crucial to work closely with people from the child’s own cultural community, people who understand intimately the expectations within that community for what autism means to them.