**Acknowledgement**

base in relation to autism is especially pertinent as reliance on assessment and intervention tools from other cultures may prove inadequate. Equally there is an onus on professionals in Western countries to become better attuned to the cultural issues they may face with immi‐ grant communities [9] as part of the endeavour to find more effective and efficient tools for

A third aspect arises from the previous two; namely the relationships between parents and professionals. Recent guidance in relation to autism in the UK, emphases the need for pro‐ fessionals to take seriously parental concerns [36]. Also diagnostic information often has to be obtained through sensitive and careful questioning about the child's typical behaviours in natural settings as well as observations of the child in clinic or school contexts. This is best done through a trusted relationship between parents and professionals. Moreover parents may experience elevated levels of stress and poorer health because of their child's behaviour and will personally benefit from support offered by professional advisers [37]. Thus profes‐ sionals may need to acquire wider communication and inter-personal skills in order to effec‐

These broader issues relating to the identification and diagnosis of autism are not peculiar to Iran and future cross-cultural research would help to identify practical means of addressing

The findings also have international application in another sense. They confirm the uni‐ versality of certain indicators of autism in children; most notably in Iranian culture of re‐ petitive and stereotyped behaviours and atypical social interactions. Items relating to communication and language were apparently less indicative of autism. As yet there is no directly comparable data with that obtained from other cultures although future re‐ search might provide this. However studies that have directly compared children in the UK and USA with those from South Korea and Israel [6] found significant differences in the extent to which items relating to socialisation, verbal communication and restricted interests were reported although all were present across the four countries. It is likely that this cultural variation in parental perceptions of autistic traits reflects the behaviours in children that parents value or perceive as being unusual within their particular cul‐ ture. Future research could usefully explore this proposition further as it may also ac‐ count for differences between the perceptions of parents from different socio-economic

It is possible though that some of the inter-cultural differences and perhaps the intra-coun‐ try variation may arise from other environmental factors. Walker et al [39] have identified from international epidemiological studies the key risks that prevent children from attaining their developmental potential, such as lack of cognitive stimulation, intrauterine growth re‐ striction, maternal stress and exposure to societal violence. It is possible that some of these environmental factors could trigger particular behaviour patterns within children that fall within the broad category of autism. To date much energy has been expended on identify‐ ing the genetic bases for autism and even if these were to be found, there may well be envi‐

ronmental factors that mediate the genetic disposition for autistic traits.

them, especially when health, social care and educational resources are limited [38].

the diagnosis of autism spectrum disorders [42].

44 Recent Advances in Autism Spectrum Disorders - Volume I

tively support families.

backgrounds.

Our sincere thanks to Miss Ameneh Mahmoodizadeh from the Iranian Special Education Organisation for her assistance with Study 2.
