Cultural Competence in Bilingual Social Communication Assessment: A Case Study

Abstract

The purpose of this article is to highlight how cultural considerations impact assessment and diagnostic decision making. This article addresses the steps involved in conducting a culturally sensitive, comprehensive evaluation of social communication skills using the Autism Diagnostic Observation Schedule-2nd Edition (ADOS-2). This evaluation was conducted with a 13-year-old, bilingual Cantonese-English speaking teenage girl. She had a history of atypical social behaviors and language disorder, diagnosed at age two. Her complex social difficulties were previously overlooked by professionals and misunderstood as related to her Chinese culture and/or prior history of language disorder. Conducting a culturally appropriate assessment was further complicated by the family's lack of English proficiency and low socioeconomic status, and related challenges they experienced with accessing and navigating the healthcare and special education system. Lisa was referred to a multidisciplinary team, which included a native Cantonese-speaking speech-language pathologist (SLP), to determine the nature of this teenager's social challenges. The team's understanding of the layers of cultural influence on social development—overarching Chinese values, local Chinese community, and the family environment—played a key role in determining whether this teenager's social behaviors were acceptable in either the Chinese or mainstream American culture. Evaluation results shed light on this teenager's long-standing social interaction difficulties, and were consistent with a diagnosis of autism spectrum disorder (ASD). With this newly understood diagnosis, the family reported they felt relief in knowing how to best support their daughter.