In The Politics of Autism, I note that siagnosis depends on observation of behavior. There are multiple problems with this approach, including cultural differences.
At the University of Virginia, Michaela DuBay, an assistant professor and speech-language pathologist, explains the difference between translation and cultural adaptation:
A standard translation is just a linguistic adaptation. You’re just trying to take the words and put them into a new code, if you will. But when you’re talking about switching languages, the vast majority of the time, you’re talking about switching cultures as well. And the way that you understand concepts from one culture to another can be completely different.
I was translating an autism assessment questionnaire that included the question, “When you clap your hands, shake your head, or stick out your tongue, does your child imitate you?”
We would ask families this question, and they would get really uncomfortable. And they would say, “No, my child would never stick out their tongue. I would never teach them that.” Because that particular gesture is viewed as completely inappropriate in some cultures. So if you translate that directly, parents interpret it as asking about polite behaviors rather than imitation skills.