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Does culture inflate Korea’s autism stats?

In the SF Chronicle’s blogs, Dr. Winston Chung writes that Korea’s exceptionally high autism numbers may in fact be a case of culture padding the stats:

Some researchers suggest autism is underdiagnosed, citing a study from South Korea that estimated 1 in 38 South Korean children had some form of autism – compared with 1 in 88 in the U.S. from the most recent CDC report. How do cultural differences come into play when applying the DSM-IV, which was developed in the culture of the United States, to the people of South Korea?

My family lives in South Korea, but that fact alone doesn’t influence my opinion that some Korean parents tend to shelter their children. This tendency is concretely reflected in a Korean custom of not taking a newborn out of the home for at least 100 days, with the 100th day marking a cause for celebration known as baek-il. Does less social exposure lead to decreased social aptitude that could be seen as pathology through the eyes of the DSM-IV?

The aforementioned study of South Korean children found that many of the children identified with an autism spectrum disorder in the study had higher I.Q.s with poor socialization skills. Pressure for academic achievement is so intense in South Korea, it’s not uncommon for kindergarten age students to stay up until midnight studying at private, after-hours tutoring academies, known as hagwons. It’s gotten to the point where the South Korean government has set up agencies to crack down – with limited success – on children studying at hagwons after 10:00pm. How might an early and gargantuan emphasis placed on academic development affect social skills in children in South Korea?

Not sure how much the baegil has to do with anything, but sure, I can see how academic pressure might lead to poor social skills, which might in turn look like autism on a scale designed for Americans.

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  • http://dok.do/4aVK41 Year of the Dragon

    Children and adolescents with low Social Aptitudes are at increased risk of mental health problems, particularly Autistic Spectrum Disorders.

    Parents have the greatest impact on their childrens development.

    The earlier fathers become involved in their children’s learning and socialization, the better for their children. Fathers who are moderately or highly involved in their children’s school life, have children who are significantly more likely to receive high marks and have good social skills.

    I think Korean children growing up sheltered by “mommy” then going to kindergarten and elementary school where usually the teachers is also a female, and not usually getting much social action from their fathers causes social problems.

  • Granfalloon

    The DSM-IV states that failing to make eye contact is a symptom of autism. Just sayin’.

  • http://dok.do/4aVK41 Year of the Dragon

    Oh, No i must be autistic!

    Actually, when I talk to people – I never know what eye to look at…
    Do I look at their right eye?
    or
    Do I look at their left eye?

    Sometimes, I just look at the top of their nose, between their eyes, and hope they think I am making eye contact with them.

  • fanwarrior

    Pressure for academic achievement is so intense in South Korea, it’s not uncommon for kindergarten age students to stay up until midnight studying at private, after-hours tutoring academies, known as hagwons.

    This is a pretty high level of BS right there.
    Frankly I can’t take anything this clown wrote as serious.

  • http://askakorean.blogspot.com thekorean

    I am familiar with this study, and this post is Grade A bullshit.

    The study conducted in Korea took a new approach — instead of estimating the prevalence of autism in a large population of children based on smaller samples, the researchers actually took the entire large population (in this case, all school aged children in Ilsan, if I remember correctly) and interviewed them one-by-one. That’s how the researchers came to the conclusion that autism may be under-diagnosed.

    In other words, it is not the case that Korea actually has a higher incidence of autism. Rather, Korea is the only place in the world (so far) in which autism estimates have been made based on a very close observation.

  • numberoneoppa

    @4: Yeah, pretty much.

  • Charles Tilly
  • Lliane

    I’m skeptical, I doubt western methods make a distinction between medical autism which is a medical condition and “acute koreanism” which is a cultural/social conditions. It would be interesting to see if similar statistical studies have been done on jewish for instance.

  • Sonagi

    Dr. Chung’s attempt to link Korea’s high autism rate with its culture is bullshit. Anyone who’s actually worked with children diagnosed with ASD know that poor social skills do not cause or are by themselves an indicator of autism.

  • Iang nio

    #8 “I doubt western methods make a distinction between medical autism which is a medical condition and “acute koreanism” which is a cultural/social conditions. It would be interesting to see if similar statistical studies have been done on jewish for instance.”

    Thanks for making me laugh… Very funny…of course, one has to appreciate the irony here…

  • http://dok.do/4aVK41 Year of the Dragon

    During my Psychology degree course at uni – we learnt that Autism is caused by:

    MMR (Mumps-Measles-Rubella) vaccine may cause intestinal problems leading to the development of autism.

    Genetic problems. A number of genes appear to be involved in autism. Some may make a child more susceptible to the disorder; others affect brain development or the way brain cells communicate.

    Environmental factors. Many health problems are due to both genetic and environmental factors, and this is likely the case with autism as well.

    This guy goes along with a crap of shit – probably he knows that Koreans buy into anything, and just wants to talk shit to pretend to be an expert, to raise money [for himself] to pretend to be an expert.

  • Granfalloon

    YoD,
    I’m sorry you went to such a shitty university. Hope it didn’t cost you much.

  • http://rjkoehler.com Robert Koehler

    In other words, it is not the case that Korea actually has a higher incidence of autism.

    I don’t think that’s what Dr. Chung was arguing. In fact, I believe he was arguing quite the opposite—that certain cultural factors were leading to false positives, if you will, in the Korean study. As he says, “Variability in the reported rates of autism amongst different geographic, ethnic and racial groups and the unusually high prevalence in the South Korean study reveal limitations of current diagnostic practices and poor cultural adaptation of the DSM-IV.”

  • Sonagi

    You have paraphrased his argument correctly, Robert. Evaluation of behavior is in the eye of the beholder. I can see a Western psychologist possibly misdiagnosing a Korean child using the DSM-IV tool, but not a Korean, who would naturally use Korean behavioral norms as the yardstick. Introverted / solitary types or neglected / malnourished children would show one or more behaviors from the first group and possibly one or more from the second, but the third group, a list of abnormal behaviors like repetitive actions and obsessions with objects or routines are classic red flags for parents, physicians, and educators.

  • http://dok.do/4aVK41 Year of the Dragon

    YoD,
    I’m sorry you went to such a shitty university. Hope it didn’t cost you much.

    No need to be sorry… I ended up with a “nice” degree, a good job, and never paid anything to the uni – the government paid it all.

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  • http://www.gordsellar.com gordsellar

    @7 That’s interesting, but I was under the (vague) impression that epigenetic explanations for autism were gaining popularity too. From the little I know about those, the environmental conditions of parents, grandparents, or even great-grandparents can alter (ie. muck up) gene expression even of genes that aren’t mutated in themselves.

    If there were an epigenetic dimension to autism, then perhaps higher levels of actual autism could be explained by that, *maybe*, if indeed actual autism levels did turn out to be higher here. The environmental factors of the parents/grandparents at around the middle of the 20th century were probably among the most dire on Earth at the time. I have no idea if that’s plausible, but it came to mind. (Starvation, exposure to toxins, stress, high levels of pollution, high stress, and all kinds of other things supposedly can have epigenetic effects, if I remember right.)

    Of course, you’d expect a surge in similar disorders in many populations following WWII, though I’m not sure the poverty was so protracted as here in most of the places they’d be doing such autism screenings. But that’d be something interesting to look at…

    As for culture inflating the numbers, I would have expected the opposite, given the taboos, the number of people I’ve seen pass for “normal” here who clearly weren’t, and the amount of loud, energetic dismissal I’ve seen of the very possibility of someone having some kind of problem even when it’s clear that person’s problem is severe and debilitating. I think a lot of people seem to think it’s sympathetic to dismiss the idea of a mental impairment, condition, or health problem, rather than seeing it as an important step to addressing the problem.

    That’s my experience, anyway.