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Culturally Inclusive Autism Assessment

Let’s consider the intersectionality of autism and culture.

Key points

  • Autism assessment relies heavily on behavioral criteria, but cultural norms on "typical" behavior vary.
  • Here are practical steps for professionals to achieve cultural competence.
  • For example, you can address implicit bias through tools like the Implicit Association Test.

Cultural competence is a core value of professional psychology. While it's not a novel concept (cultural competence has been articulated for more than half a century.), cross-cultural practice may be more relevant now than ever, given the increasing diversification of the U.S. population. Autism assessment through a cultural lens is particularly important given the contextual impact of culture on autism and the strong relationship between social cognition, behavior, and culture.

The Intersectionality of Autism and Culture

While the diagnostic criteria for autism are largely consistent across cultures, the ways autism is expressed and perceived can vary significantly (deLeeuw et al., 2020). Autism assessment relies heavily on behavioral criteria, but cultural norms determine what's considered "typical" behavior.

For example, in China, a child's limited eye contact with an adult is a sign of respect (Hus and Segal, 2021). In the East, imaginative play is less prevalent than in Western cultures (deLeeuw et al., 2020). Culture also greatly influences communication styles. For example, a formal greeting may be perceived as scripted in our culture, but it is a tradition in Ethiopia (Zeleke et al., 2018). It's crucial to acknowledge this intersectionality in assessment because context plays such a significant role.

Culturally Inclusive Assessment: What You Can Do

Be aware of implicit bias. Implicit bias contributes to disparities in healthcare. Understanding (and correcting) it is a professional responsibility. Consider completing the Implicit Association Test to become more aware and reflect on bias.

Adopt a cultural framework. Cross-cultural frameworks ensure all aspects of the client's identity are considered. The ECLECTIC framework developed by Daryl Fujii has been used by autism researchers. It includes consideration of education and literacy, culture and acculturation, language, economics, communication, testing situation, intelligence conceptualization, and context of immigration.

The ADDRESSING framework developed by Pamela Hays, Ph.D., includes consideration of age, developmental disabilities, acquired disabilities, religion, ethnicity, sexual orientation, socioeconomic status, indigenous group membership, nationality, and gender.

Pay attention to language. Language is a powerful tool that shapes our understanding of the world. When conducting autism assessments, it's essential to consider linguistic diversity. Some individuals may express themselves more comfortably in their native language, impacting the accuracy of the assessment. Being open to multilingual assessments and having access to interpreters can bridge this gap.

Be sensitive to stigma. The cultural stigma surrounding neurodevelopmental disorders can hinder accurate assessment. Some cultures may attach negative connotations to being on the spectrum, making it challenging for individuals to disclose their experiences. Creating a safe and nonjudgmental environment encourages open communication and breaks these barriers.

Collaborate with communities. Building partnerships with diverse communities is key to fostering cultural competence. Establishing trust and open communication channels ensures that individuals and their support systems feel heard and understood. Seek input from cultural community leaders and engage in ongoing dialogue to improve the cultural relevance of assessment tools and interventions.

Cultural competence is not a static skill; understanding the diverse intersections of culture and autism requires continuous learning and adaptation. Stay informed about the latest research on autism within diverse cultural contexts.

Attend workshops, engage in discussions, and consult with colleagues. Perhaps most importantly, listen to autistic voices and acknowledge and respect lived experience. Because embracing cultural competence in autism assessment is not just necessary; it's a responsibility.


de Leeuw, A., Happé, F., & Hoekstra, R. A. (2020). A conceptual framework for understanding the cultural and contextual factors on autism across the globe. Autism Research, 13(7), 1029–1050.

Hus, Y., & Segal, O. (2021). Challenges surrounding the diagnosis of autism in children. Neuropsychiatric Disease and Treatment, 17, 3509–3529.

Zeleke, W. A., Hughes, T., & Chitiyo, M. (2018). The path to an autism spectrum disorders diagnosis in Ethiopia: Parent perspective. The American Journal of Orthopsychiatry, 88(3), 316–327.

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