What does Culturally Informed Assessment Look Like?

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. In our clinical practice, we frequently encounter clients grappling with intricate challenges that extend beyond their current circumstances and are deeply rooted in their past experiences. Through close collaboration with our clients and understanding their story, we hear stories emerge that highlight the overlapping symptoms of neurodivergence and trauma. Many individuals with neurodivergent traits, as they navigate their inherent complexities alongside external interactions with the world, often develop mental health difficulties due to sustained exposure to distressing experiences. This isn't just theory. It has real impacts for our community. When I was attending the Yellow Ladybugs Conference this year, Akii Ngo's speech resonated deeply with me, highlighting just what happens when we're missed. For the record, they're Asian, non-binary, from a refugee background, an IPV survivor with multiple physical and invisible disabilities and an incredible disability advocate, and being able to see representation like that was astounding. 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. So where does this leave us? Here are some patterns that I see in practice:

1. 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.
   

2. 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 Reflection: 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. Neurodivergence, mental health and culture have to be examined hand in hand. This is at the heart of culturally-informed assessment practices. How do they all fit together?

Building upon the work of psychologist Anna Clarke, who explored the realms of trauma and neurodivergence, we have deepened our understanding of this intersection through our experiences working closely with clients from diverse referral concerns and backgrounds.

To aid comprehension for both viewers and fellow professionals, we have developed a Chinese-language Venn Diagram illustrating how these psychological elements intersect and manifest.

Ultimately, it’s not enough to be culturally aware. We need contextual awareness too — so we can see how neurodivergence, trauma, and culture intersect for each person.

That’s the only way to provide truly ethical, affirming assessments. About the Author: 

Sharen Lui (she/her) is a neurodivergent Educational and Developmental Psychologist, a Board-Approved Supervisor and an Autism and ADHD assessor. She is the Director of Sprout Psychology in Melbourne, which provides a niche service for neurodivergent clients, including psychotherapy, assessments, supervision, and workshops from a diverse clientele. You can find her work at: Instagram: multilingual.psych

LinkedIn: Sharen Lui | LinkedIn