Autism research is heavily skewed toward western high‐income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low‐ and middle‐income settings where the majority of the global autism population lives. To date, a clear overview of the possible cultural and contextual factors that may affect the process of identifying and diagnosing individuals with autism spectrum disorders (ASD) is missing. This study aims to outline these factors by proposing a conceptual framework. A multidisciplinary review approach was applied to inform the development of the conceptual framework, combining a systematic review of the relevant autism research literature with a wider literature search spanning key texts in global mental health, cultural psychiatry, cross‐cultural psychology, and intellectual disability research. The resulting conceptual framework considers the identification, help‐seeking, and diagnostic process at four interrelated levels: (a) the expression; (b) recognition; (c) interpretation; and (d) reporting of autism symptoms, and describes the cultural and contextual factors associated with each of these levels, including cultural norms of typical and atypical behavior, culture‐specific approaches to parenting, mental health literacy, cultural beliefs, attitudes and stigma, as well as the affordability, availability, accessibility, and acceptability of services. This framework, mapping out the cultural and contextual factors that can affect the identification, help‐seeking, and diagnosis of ASD may function as a springboard for the development of culturally appropriate autism screening and diagnostic instruments, and inform future cross‐cultural autism research directions. The framework also has relevance for clinicians and policy makers aiming to improve support for underserved autism populations worldwide. Autism Res 2020, 13: 1029‐1050. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

中文翻译：

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理解全球自闭症文化和背景因素的概念框架。

自闭症研究严重偏向西方高收入国家。在全球大多数自闭症人口居住的大多数低收入和中等收入环境中，缺乏适合文化的自闭症筛查和诊断工具。迄今为止，缺少对可能影响自闭症谱系障碍 (ASD) 个体识别和诊断过程的可能文化和背景因素的清晰概述。本研究旨在通过提出一个概念框架来概述这些因素。采用多学科审查方法为概念框架的发展提供信息，将相关自闭症研究文献的系统审查与更广泛的文献搜索相结合，涵盖全球心理健康、文化精神病学、跨文化心理学和智力障碍研究的关键文本. 由此产生的概念框架在四个相互关联的层面上考虑了识别、寻求帮助和诊断过程：（a）表达；(b) 认可；(c) 口译；(d) 自闭症症状的报告，并描述与每个级别相关的文化和背景因素，包括典型和非典型行为的文化规范、特定文化的育儿方法、心理健康素养、文化信仰、态度和耻辱感，以及服务的可负担性、可用性、可访问性和可接受性。这个框架列出了可能影响 ASD 的识别、寻求帮助和诊断的文化和背景因素，可以作为开发适合文化的自闭症筛查和诊断工具的跳板，并为未来的跨文化自闭症研究方向提供信息。该框架还与临床医生和政策制定者相关，旨在改善对全球服务不足的自闭症人群的支持。自闭症研究2020，13：1029-1050。© 2020 国际自闭症研究协会，Wiley Periodicals, Inc.