Autism and EAL: interventions to meet cultural needs

Autism is a neurodevelopmental difference that affects people of all ages, races and cultures throughout the whole of their lives. In this article I refer to children of families who are culturally and linguistically diverse (CLD) as a way of describing this group which includes those who have English as an Additional Language (EAL). Some autistic people will be able to speak English and their mother tongue fluently, others may never speak at all.

Why it matters

Autistic children are expected to be able to operate successfully across multiple cultures. This can present particular issues in schools.

• Our cultural biases lead us to making significant mistakes in supporting children.
• Everything starts from communication which is difficult for autistic pupils.
• People in CLD families communicate in ways we can find unfamiliar.
• Understanding how a young person communicates helps you to work with them.

Is autism different across cultures?

What is defined as autism is driven by the American Psychological Society’s DSM Manual and reflects linguistic, behavioural and cultural frameworks in the Western medical tradition. It frames autism in terms of impairment which is rejected by many autistic people who see autism as a difference and not a deficit.

You are less likely to get a diagnosis (or get one later) if you are: 

• not white
• have English as an additional language
• female
• a refugee
• a looked after child
• from a lower socio-economic group.

A young person from a CLD group may be autistic but they are less likely to have had access to a diagnosis or receive support. It has an impact on their development but is no reflection of their intelligence or potential.

Family experiences and support

Some cultures do not recognise autism.  The concept is sometimes new and strange to them. 

A 2019 study by Despina Papoudi looked at autistic and CLD children across many cultures and found the same themes recurring time and again.

1. Lack of knowledge
2. Social stigma
3. Difficulty accessing services

This means that parents are less likely to understand autism and seek support, and to find it harder to access when they do.

Role of religion

Don’t make assumptions about religion, culture or values – ask about experiences.

How a family sees their autistic child, and how they will respond to your suggestions can be affected by the views of the religious community they are in. These can be hugely supportive and a source of comfort as well as being challenging to our own preconceptions. Professionals need to be aware that religion may be a significant influence in many families, but NOT to make assumptions as a result. Ask respectful, open questions.

Some possible views identified in research are listed below.

• South Asian families interviewed felt autism was the result of sin or a punishment from God.
• In Sub-Saharan Africa, there is a view that autistic children are possessed by spirits, are witches, and some have been sent to Africa for exorcism.
• Suggestions that autism is caused by the evil eye or a curse are common in Latin American, Haitian and Mexican families living in the USA.
• Some Muslim families thought their child was a gift from Allah and a test of their strength.
• Shia Muslim families interviewed felt that their child was to help them reach salvation, which gave them strength and helped them to accept autism. 
• Unorthodox Jewish families interviewed said that their children had a higher spiritual status because of their purity.

Differences in play

Culture affects WHAT children play with and WHO they play with. Most early autism interventions assume that parents will play with the child, but the role of the parent varies across cultures. 

Autistic pupils struggle to generalise to things that don’t look and feel familiar. Consider: 

• toys and role-playing materials that are culturally appropriate
• music and books from the home culture
• whether play partners should be adults, parents, siblings or other children.

Communication challenges

Common autism interventions may not work as well when:

• visuals have a different meaning in their culture, so check with the family
• it would be normal to use visual, or AAC (Alternative and augmentative communication) for a non-verbal autistic pupil, but a particular culture puts more emphasis on speech
• singing is not considered appropriate. It may be forbidden for men to hear women sing
• there are differences in the way that pupils communicate for example, in UK and US black culture, needing more movement, being more verbal and expressive etc but this can be misinterpreted as being threatening and leads to higher rates of exclusion
• pointing is rude, so interventions have to find alternative ways to express choice.

Culture affects WHAT children play with and WHO they play with.

Social communication challenges

Rules for successful communication in social groups are defined in relation to their context. Autistic children are expected to be able to operate successfully across multiple cultures. This can present particular issues in schools.

• Some Asian and African children are taught that it is rude to speak or question adults, so participate in class less.
• Understanding language, idioms and jokes in the playground is doubly difficult if autistic. 
• Cultures that value collective working struggle more with independent working, but that might suit an autistic pupil better, leading to conflict with peers.
• Gender expectations and communication vary, so any differences will need to be explicitly taught.
• Code-switching (adjusting language, behaviour and syntax to fit in) is especially difficult for autistic people.

A pre-verbal pupil may benefit more from developing communication within cultural rules before working on a second set of social behaviour. However, a study into bilingualism in autism suggests that bilingual exposure may be positive. 

To understand how to manage this complexity, think first of the pupil. 

• How they function in their life and in their community? 
• What will make the biggest difference to them?
• Start with simple communication and work from there.