After reading
"Korean Culture and Autism Spectrum Disorders" published in
the the Journal of Autism and Developmental Disorders
it became apparent that while some research has been done on the
issue of autism, there is still much to learn and study in the
context of autism and culture. This article mainly examined 13
current articles regarding Korea and autism. Some issues that I
noticed as I read this article were misdiagnosis, limited resources,
limited therapies and treatments available, and difficulty in
accessing appropriate resources. Instead of diagnosing autism, many
practitioners diagnose reactive attachment disorder (RAD), which
seems to be an easier thing for the parents to deal with socially.
Only one academic hospital is currently employing a clinician
certified to administer the Autism Diagnostic Observation Schedule
and the Autism Diagnostic Interview. According to the researchers
"the only therapies for children with ASD described in the
Korean literature were music therapy, massage therapy, play therapy,
psychotherapy, and attachment promotion"(Kang-Yi, Grinker, and
Mandell 2012). And even though more impaired children are getting
some services, "most children, especially those with above
average intelligence, are not" (Kang-Yi et al., 2012). Learning
about these issues from this article makes me wonder if the same
things are being experienced in other countries as well.
I
also read "Prevalence of Autism Spectrum Disorder among Nigerian
Children with Intellectual Disability: A Stopgap Assessment"
published in the Journal of Health Care for the Poor and
Underserved. This was more of a
snapshot of children who have autism in one particular part of
Nigeria, and its focus was primarily to provide some numbers by which
to compare other articles and other countries. One of the issues that
came to my attention was that there simply has not been enough recent
research on autism in African countries. This study was the result of
a small sample size from one facility in Nigeria, and therefore it is
hard to say if it is representative of the whole country of Nigeria,
let alone other countries in sub-Saharan Africa. However, it is a
starting place for other research to be conducted, and provides a
reference point with which other researchers can compare their
findings.
In
the Nigerian article, this section came to my attention: "The
prevalence of childhood autism among children with intellectual
disability as found in this study was 11.4%. This is substantially
higher than the prevalence of about 0.7% found by Lotter more than
three decades ago. This may be part of a worldwide increase in the
prevalence of autism spectrum disorder over the past three decades"
(Bakare, Ebigbo, and Ubochi, 2012, p.516). They go on to note that
their biggest limitation was their small sample size (44 children).
It seems fair to point out that the study that found 0.7% prevalence
was conducted in nine major cities in 6 different countries in Africa
(a total of 1,312 children). That study, though conducted more than
thirty years ago, had a much larger sample size, and this could
definitely make it difficult to compare the two numbers.
Some
of the similarities between the two articles are that both show the
need for more research to be done, especially in regard to the
context of culture in relation to autism. They both demonstrate the
lack of resources available for those with autism, more obviously in
the Korean culture article. The article on Nigeria doesn't mention
many resources, but it is safe to assume that where there is little
research, there are even less resources.
The
two articles differ in that the Korean culture article is interested
more in the cultural aspect of autism, and the Nigerian article is a
stopgap assessment. There has been more research in Korea than in
Nigeria, but both would benefit from more research being conducted.
In the Korean culture article, there was more focus on the diagnosis,
treatment, and impact on the families, but the Nigerian article
really was just focusing on establishing a baseline of numbers from
which to compare. The Nigerian article didn't look at the context of
culture, and thus fails to include the possibility of those with
autism who are perhaps hidden from view because of social stigma as a
result of cultural beliefs.
The
implications for education, health care and rehabilitation are that
these numbers influence policy making and therefore possibly funding
that can go towards each of those categories. In education, it is
important for teachers to have resources and knowledge in order to
help children with autism make the most of their education. In health
care and rehabilitation, practitioners need to feel confident in
their ability to help people with autism, and they need to be aware
of the cultural contexts of those they may be serving.
I
believe that looking at autism in relation to culture is a very
important thing for healthcare providers, parents, and society to do.
For instance, what may be considered socially impolite varies from
culture to culture, as do the rules on eye contact. After a brief
internet search, I found several references to cultures that consider
direct eye contact rude or otherwise impolite.
This could be a problem if you are using eye contact as a way to
determine if a person might have signs of autism. There are many
other ways that culture could directly impact diagnosis and treatment
of autism spectrum disorder, eye contact is only one example.
In
addition, cultures vary in the way that they view autism, and this
impacts not only legislation, but quality of life for those on the
spectrum. If difference is viewed as a positive thing, then those
with autism are more likely to be welcomed in society, but if it is
viewed as a negative then the stigma is harder to eradicate. These
articles raise questions for me about how autism is viewed around the
world, aside from whether or not the numbers are increasing.
References
Bakare, M. O., Ebigbo, P. O., &
Ubochi, V. N. (2012). Prevalence of autism spectrum disorder among
Nigerian children with intellectual disability: A stopgap assessment.
Journal of Health Care for the Poor and Underserved, 23,
513-518.
Kang-Yi, C. D., Grinker, R. R., &
Mandell, D. S. (published online 22 June 2012). Korean culture and
autism spectrum disorders. Journal of Autism and
Developmental Disorders,
DOI:10.1007/s10803-012-1570-4
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