Cultural Influences on Perceptions of Health, Illness, and Disability: A Review and Focus on Autism

This conceptual paper considers the role of culture in shaping family, professional, and community understanding of developmental disabilities and their treatments. The meanings of health, illness, and disability vary greatly across cultures and across time. We use Bronfenbrenner’s ecological model to provide a theoretical framework for examining disability, with special attention to autism spectrum disorders. Cultural beliefs about the cause of a disorder influence families’ decision-making about what treatments to use and what outcomes to expect. Autism provides an example that is especially challenging, as there is no agreed-upon cause. Also, an overwhelming array of treatments is available in the West for autism, including behavioral, cognitive, pharmaceutical, sensory, relational, vitamin, and diet therapies. Other cultures contribute additional views on cause (e.g., Karma, Allah’s will) and treatments (e.g., acupuncture, herbal medicines, Ayurveda). We suggest how a broad cultural view can help us understand treatments and the treatment delivery system of a nation and a culture. For the best course of care, professionals need to understand and respect families’ views of autism and work toward mutually agreeable treatments that may involve a combination of biomedical and cultural practices. Although a family-focused, open teamwork model that aims to acknowledge the context of the child, take into consideration the strengths and limitations of the child and the family, and introduce appropriate, sustainable, and sensitive interventions is regarded as best practice in the United States, it will take sensitive work to find out whether it will suit other cultural groups across the world.