Skip Navigation
Dr Liam Cross and Dr Gray Atherton, whose paper suggests autism diagnosis can overlook cultural differences, stand close together and smile at the camera.

News story

Edge Hill research suggests autism diagnoses overlook cultural differences

May 17, 2023

Edge Hill researchers have published a paper highlighting how the standard model of autism diagnosis can overlook cultural differences.

Dr Gray Atherton and Dr Liam Cross, both senior lecturers in Psychology at Edge Hill University, are calling into question the way autism is diagnosed outside the UK and US. 

Their research suggests diagnoses in other countries, with a specific focus on Japan, are being measured against Western ideals of what is “normal”. 

Dr Atherton said:

“Autism is something we diagnose by assessing the way people appear to us and that will vary from one culture to another. 

“Autistic traits as we define them have been constructed in relation to what is considered ‘typical development’ in Western cultures. But in other countries some of those traits may be considered neurotypical; the idea of ‘normal’ is culturally subjective. 

“It could be quite empowering to autistic people to think that the traits they are told are most atypical could be very typical in other places. We need to remember that when we think about conditions like autism.” 

The theoretical research was carried out in collaboration with academics in Japan – Yuko Morimoto and Satoshi Nakashima – and was published in the Journal of Cross-Cultural Psychology. It explores the Diagnostic and Statistical Manual of Mental Disorders (DSM), the official manual of the American Psychiatric Association, in relation to Western and Japanese cultural practices. 

Dr Cross said:

“There really hasn’t been a great deal of research in this area, the issue has been largely overlooked.

“Tools like the DSM and a lot of autistic measures are very rooted in Western culture, they do not take cultural differences into account. This could also lead to people from different cultural backgrounds within the UK and US missing out on a diagnosis. 

“Our paper explores whether these measures could be personalised for different cultures.” 

The paper found that Japanese culture makes life as an autistic person easier in some respects and more challenging in others. The formality of many social interactions in Japanese culture may be helpful for autistic people who like to learn the ‘rules’ of social interactions. 

However, Dr Atherton added:

“Being neurodiverse is more accepted in the UK and US now, particularly among young people, whereas in Japan you can be stigmatised for having conditions like autism.  Neurodiverse people often don’t feel accepted in Japanese society.” 

But an “obsession” for work or a hobby and being very rules-focussed, which are common attributes in people with autism, are much more prevalent in Japanese culture, and the widespread use of face masks can level the playing field for those who struggle to read emotion in facial expressions. 

The research also highlights the higher prevalence of “autistic traits” in the Japanese general population and a high rate of diagnosis in children, though in the context that screening of young children is widespread, unlike in the UK or US. 

Dr Cross added:

“Our findings call into question the way autism is diagnosed in countries outside of the UK and US. Those countries have so dominated autism research and the development of assessment tools like the DSM that maybe other countries get lost in the shuffle.”

To discover more about studying psychology and other courses at Edge Hill University, please visit

May 17, 2023


For media enquiries only, please contact the Press Office: