Translation and cultural appropriateness of the Autism Diagnostic Observation Schedule-2 in Afrikaans

Abstract

Autism Diagnostic Observation Schedule-2 is the 'gold standard' autism spectrum disorder observational assessment, and it is increasingly used in South Africa. However, its use is limited to English speakers, as it has not been translated into the country's other 10 official languages. Moreover, the cultural appropriateness of this tool has not been explored in South Africa. The Autism Diagnostic Observation Schedule-2 was translated into Afrikaans and assessed for cultural appropriateness to the 'coloured' population from low-middle socioeconomic status backgrounds in the Western Cape Province. Using a mixed-methods approach, three components associated with method bias in the Autism Diagnostic Observation Schedule-2 were investigated: language used, social interactions and activities, and materials. An ethnographic investigation of play, social interaction and social activities was conducted in a community sample ( n = 40), and the Afrikaans Autism Diagnostic Observation Schedule-2 was pre-piloted in a clinical sample ( n = 7). Results highlighted unique aspects of the language ('Kaaps') that need to be considered during Autism Diagnostic Observation Schedule-2 administration. The social interaction demands of the Autism Diagnostic Observation Schedule-2 appeared appropriate, and sufficient familiarity with Autism Diagnostic Observation Schedule-2 materials and activities was found to support the use of the Autism Diagnostic Observation Schedule-2. Guidelines for administration of the Autism Diagnostic Observation Schedule-2 to this population were generated to improve cultural sensitivity and cultural appropriateness and to reduce method bias.

A Systematic Review of Research on Autism Spectrum Disorders in Sub-Saharan Africa

“…Following these adaptations, the authors reported excellent discriminative validity and acceptable levels of sensitivity and specificity. Two recent studies in South Africa have also examined and evaluated the cultural adaptability of ASD measures in their context [14, 15]. The study by Smith and colleagues evaluated the cultural appropriateness of the Autism Diagnostic Observation Schedule-2 (ADOS-2) [15].…”

“…Two recent studies in South Africa have also examined and evaluated the cultural adaptability of ASD measures in their context [14, 15]. The study by Smith and colleagues evaluated the cultural appropriateness of the Autism Diagnostic Observation Schedule-2 (ADOS-2) [15]. Participants were requested to evaluate the cultural appropriateness of the materials and procedures for administering the ADOS.…”

“…Our research indicates that they are very few tools that have been validated for the African context. The use of tools from other continents does provide challenges for various reasons including methodological and resource availability [15, 61]. These challenges are the impetus towards the development and validation of tools in the African context.…”

Autism spectrum disorder in sub‐saharan africa: A comprehensive scoping review

“…Researchers need to consider the cultural appropriateness, acceptability, and affordability of all screening and diagnostic tools and should evaluate the potential of introducing method bias when evaluating tools developed in high‐income settings in low‐income settings (e.g., language use, materials used, literacy levels, activities, expectations of the child). In some SSA settings, we may find that instruments can be used with high fidelity and validly with only minor modifications [Chambers et al, ; Smith, Malcolm‐Smith, & de Vries, ].…”

The diagnosis of autism and autism spectrum disorder in low- and middle-income countries: Experience from Jamaica

“…No changes were made to ADOS/ADOS-2 administration procedures. Translation and cultural adaptation of instruments often build on the experience obtained through prior use in a population, and involve data collection and analytical procedures specific to validation (Smith et al 2016). …”