Autism and Delayed Speech – An International Multicultural View
Introduction –
Cultural studies is an interdisciplinary field that combines a variety of critical approaches to study cultural phenomena in various societies and historical periods. Cultural studies researchers generally investigate how cultural practices relate to wider systems of power associated with, or operating through, social phenomena. These include ideology, class structures, national formations, ethnicity, sexual orientation, gender, and generation.
Autism
Autism, also known as Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder characterised by persistent difficulties in social interaction and communication; along with restricted and repetitive patterns of behaviour, interests, or activities. It is a lifelong condition that typically emerges in early childhood and affects individuals across all racial, ethnic, and socioeconomic backgrounds.
Social Deficits in children with autism can manifest in multiple ways such as –
Deficits in social-emotional reciprocation, for example : difficulty in normal to and fro conversations, abnormal or reduced emotion and affect and failure to initiate or maintain social interactions.
Along with social deficits the restricted and repetitive patterns can manifest in different ways such as – fixation, inflexibility, hypo or hypersensitivity to sensory input and stereotyped repetitive motor and speech functions.
Symptoms of Autism usually are present in the early developmental stage but may not manifest until social demands exceed the capacity of an individual. They also cause clinically significant impairment in social, occupational, or other important areas of current functioning.
Delayed Speech
Till the age of 3, the brain is intensely susceptible to sounds in the environment and vicariously learns language and speech. The development of speech and language have been marked with certain milestones ranging from understanding that crying gets them food and care to being able use perfect sentences. Now, as Autism is termed as a neurodevelopmental disorder, it disrupts this ‘developmental’ process of language. Children who fail to or delay to achieve speech milestones generalised for their age, are termed to have Delayed Speech.
Delayed Speech is an indicator of Autism but not necessarily every instance suggests Autism. Late talkers are children who have started speaking later than the usual age. Late talkers without autism still attempt to engage and communicate through other means, such as babbling sounds, pointing, and body language. However, children with autism-related speech delays may not use these non-verbal methods and may exhibit other specific signs, such as a lack of response to verbal communication, limited vocabulary, or reliance on pictures or sign language.
Autism entails difficulty in emotion labelling and regulation, which makes social interactions difficult. It can facilitate Delayed Speech because the lack of emotion labelling leads to miscommunication. Where the child misattributes or is unable to understand the emotion expressed by others. For example : A frustrated parent might be frowning in anger but an autistic child might not understand that the parent is angry, Inability to identify sarcasm and other social cues. With such confusion in emotion labelling the development of speech is stunted or faulty learning takes place.
Diagnosis Differences
The diagnostic process for ASD and the accuracy of diagnosis can vary within and across countries. A study from Taiwan suggests that specialised services may be concentrated in urban areas, leading to longer processes and delayed diagnoses in suburban and rural areas. Furthermore, cultural beliefs and practices can affect the identification and integration of individuals with ASD into society. Inconsistent medical record keeping and differing definitions of ASD across cultures can hinder accurate prevalence estimates.
While parenting behaviour and style do not cause autism spectrum disorder (ASD), parental perspectives and responses to a diagnosis can influence educational and treatment choices. Cross-cultural studies highlight how culture shapes the understanding and treatment of developmental disorders within families, communities, and professional settings.
The behaviours considered significant and noticed first by parents may vary depending on cultural background. For example, White families may be keenly aware of language delays and are concerned with communication problems, whereas families from other cultures with a focus on social conformity, such as Indian culture, may focus more on the socially disruptive behaviours.Cultural beliefs and values can lead to delayed diagnosis, as symptoms may be misinterpreted or attributed to cultural norms.
Examples of misinterpretation of symptoms leading to delayed diagnosis include the following cases:
1. A parent with a 3-year-old girl who did not relate socially with peers her age considered her a mature child because she responded well to adults.
2. A mother was not alarmed that her son was still not speaking at age 4 years because Indian boys talk later.
3. A child who keeps quiet and to oneself was perceived as a good child because he or she is trouble free.
Influence on Intervention
The literal or ‘concrete’ thinking style commonly observed in children with autism which refers to rigid and inflexible thinking, can further contribute to challenges in communication, understanding and intervention. ASD interventions typically involve modifying parental interactions to encourage social engagement and communication. However, culturally bound child-rearing practices and attitudes towards disability can influence parents’ expectations and the roles they assign to professionals. Different cultural backgrounds may shape the type of learning parents expect for their child and the adaptation required by professionals.
Children with autism often use augmentative and alternative communication (AAC) systems to aid their learning and participation. However, cultural and linguistic backgrounds can impact the use and interpretation of AAC systems. Differences in perception of graphic symbols in AAC systems among adults from various cultural/ethnic groups can lead to unintended or incorrect meanings being taught. If the meaning and response to the AAC system varies across communication partners, the child with autism may become confused and cease using the AAC system.
Conclusion
Interpretations and treatments of autism are particularly susceptible to the influence of culture because there is no agreed-upon cause for the disorder; diagnosing autism relies heavily on behavioural norms which vary considerably across cultures. Additionally, the absence of any universally accepted, scientifically valid treatments, and the variety of treatments available, makes it more likely that treatment decisions will be based on local beliefs and values. This emphasises the importance of understanding the subjective culture of each child to provide better diagnosis and intervention for the same.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008392/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9132155/
- https://www.researchgate.net/publication/247893493_Cross-cultural_practice_and_autism
- https://www.eccm.org/blog/the-difference-between-speech-delays-and-autism
- Psychopathology, Families, and Culture: Autism
Raphael Bernier, PhD a, Alice Mao, MDb, Jennifer Yen, MDc.
Pratham Tibrewal
Psychologist
Neuro Revolution International.
