Culturally-Informed Neurodivergence Assessment

Another reflection from my day-to-day work as a Key Assessor and Supervisor

We are all increasingly aware of cultural competence and culturally-informed practices. Many psychologists and allied health professionals come with good intentions, striving to navigate the complexities of assessing and diagnosing neurodivergence in culturally-diverse clients. We are bound by ethical responsibilities not to draw conclusions based on assumptions of cultural expectations. However, in my attendance to the Yellow Ladybug Conference 2 days ago, as Akii Ngo (Asian women, refugee background, multiple physical and invisible disabilities, IPV survivor, disability advocate) noted, failing to diagnose someone who is diagnosable (Type II error) can be equally harmful.

We must recognize the unique value of culturally AND neurodivergence-competent assessors, especially given the potential of medical trauma and harm arising from the dismissal many clients experience in their search for validation. I've noticed a significant gap:

• Some assessors, despite sharing the client's culture, may dismiss an autism or ADHD diagnosis due to an unawareness of stigma, internalized, or externalized ableism within that culture.

• Conversely, those not from the client's culture, even when seeing enough traits to make a diagnosis, may underestimate the extent to which neurodivergence impacts their clients' daily life. This often results in an underestimation of severity rating for the diagnosis.

My Latest Refecltion: Contextual & Cultural Considerations in Neurodivergence Assessment

When the assessment process and clinical interviews are conducted by culturally-aligned assessors, it creates a comfortable environment, allowing for in-depth exploration beyond cultural and language barriers. Assessors from the client's cultural background, who are well-versed in the Neurodiversity-Affirmative Paradigm, are invaluable in gaining a comprehensive understanding of the intersections between Asian identity (including its multiple vulnerabilities), the manifestation and experiences of neurodivergence across the lifespan, cultural expectations, and culturally-specific internalized ableist ideals.

Furthermore, utilizing Anglo-population normed tests, questionnaires, and screenings often undermines these cultural differences in areas like social communication, repetitive or restrictive behaviour, and cognition. This discrepancy is sometimes evident in higher self-reported stress, anxiety, and depression among clients. In my earlier interview with the Neurodivergent Women Podcast hosts, Monique and Michelle, I mentioned that many multicultural clients who sought assessments in the past were primarily based on psychiatric support and referrals, highlighting the problem of under-diagnosing when assessors and examiners are not fully capturing the full context.

Critically, contextual awareness is just as important as cultural awareness when making accurate clinical decisions regarding the severity of a client’s presenting traits and current needs, especially when compared to their own cultural norms.

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