Cultural Differences in Endorsed Symptoms of Autism Spectrum Disorders

In a recent study, Dr. Johnny Matson and colleagues identified cultural differences in endorsed symptoms of autism spectrum disorders (ASD). While it has been reported that diagnostic criteria and behavioral manifestation of ASD is virtually the same worldwide, cultural differences may impact how ASD symptoms are interpreted around the world. For this reason, Dr. Matson and colleagues set out to investigate cultural differences in reported ASD symptoms across four countries including Israel, South Korea, the United Kingdom (UK), and the United States (US).

Participants included 145 children with ASD, ages 2 to 16 years. Of the participants, 38 resided in Israel, 40 resided in South Korea, 27 resided in the UK, and 40 resided in the US. Participants were evaluated using the Autism Spectrum Disorders-Diagnostic for Children (ASD-DC), which consists of four subscales measuring nonverbal communication/socialization, verbal communication, social relationships, and insistence on sameness/restricted interests. The ASD-DC was completed for each participant by either a parent, guardian, caretaker, or teacher.

Results revealed significant differences in endorsed ASD symptoms in three of the four subscales: nonverbal communication/socialization, verbal communication, and insistence on sameness/restricted interests. In regards to the nonverbal communication/socialization subscale, participants from the UK and the US received significantly higher scores than the participants from South Korea and Israel, with higher scores indicating greater deficits. For the verbal communication subscale, the participants from the UK received significantly higher scores than the participants from the US and Israel, while the participants from South Korea received significantly higher scores than the participants from Israel. Finally, in regards to the insistence on sameness/restricted interests subscale, the participants from the UK and the US received significantly higher scores than the participants from South Korea and Israel, while the participants from South Korea received significantly higher scores than the participants from Israel. Overall, the participants from the UK were found to have the highest item endorsement across all symptom domains while the participants from Israel were found to have the lowest.

Findings suggest that there are cross-cultural differences in reported ASD symptoms. Dr. Matson and colleagues speculate that these differences may be the result of varied cultural expectations regarding child development. For instance, particular behaviors that are considered early signs of ASD in one country may be considered typical behaviors in another. The authors also speculate that differences in endorsed ASD symptoms may stem from varied diagnostic practices across the different countries.

Exploring ASD across various cultures is highly important, especially considering current efforts to globalize effective ASD treatment. It is crucial that we begin to investigate how cultural influences, traditions, and stigmas impact ASD in regards to estimates of prevalence, average age of diagnosis, parental report of symptoms, clinical standards and best practices in diagnosis and treatment, and so on. A clearer cross-cultural understanding of ASD will allow for more effective dissemination of treatment services to children with ASD around the world. Thus, further research exploring ASD across different cultures is warranted.

References

Matson, J. L., Worley, J. A., Fodstad, J. C., Chung, K. M., Suh, D., Jhin, H. K.,… Furniss, F. (in press). A multinational study examining the cross cultural differences in reported symptoms of autism spectrum disorders: Israel, South Korea, the United Kingdom, and the United States of America. Research in Autism Spectrum Disorders. doi: 10.1016/j.rasd.2011.03.007

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