Social Ecology and Diagnostic Visibility: A Cross-National Analysis of Autism Spectrum Disorder Prevalence in 55 Countries
This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.
About the autistic author markerSnow, I. S. (2026). Social Ecology and Diagnostic Visibility: A Cross-National Analysis of Autism Spectrum Disorder Prevalence in 55 Countries [Preprint]. Center for Open Science. https://doi.org/10.31235/osf.io/y3wc9_v1
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Abstract
Cross-national variation in autism spectrum disorder (ASD) prevalence is commonly attributed to differences in diagnostic infrastructure and case ascertainment. We tested whether cultural individualism predicts this variation independently of detection capacity, and whether the result is robust to known limitations of Hofstede's widely used but methodologically dated Individualism Index (IDV). Using 55 countries (GBD 2019 ASD prevalence, World Bank GDP, an author-constructed diagnostic infrastructure index, Hofstede's IDV, and a recently validated individualism-collectivism index built from nationally representative survey data; Akaliyski et al., 2025), we found the raw individualism-ASD correlation is robust to measurement choice (Hofstede: r = 0.702; validated index: r = 0.624; both p <.001, n = 47 non-screening countries with both measures available). However, its apparent independence from detection capacity is not robust: partial correlations controlling for GDP and diagnostic infrastructure remain significant with Hofstede's IDV (partial r = 0.30-0.39) but collapse to non-significance with the validated index (partial r = -0.14 to 0.09, ns), because the validated index correlates far more strongly with diagnostic infrastructure (r = 0.919) than Hofstede's IDV does (r = 0.818). The four mandatory-screening countries (Japan, South Korea, Singapore, Taiwan) exceed their IDV-predicted prevalence under both measures, though less dramatically using the validated index (1.57x vs. 2.84x), indicating measurement error in Hofstede's scores inflated the original screening-policy estimate. These findings show the bivariate cultural-prevalence association is genuine, but caution against treating it as evidence independent of detection capacity without testing robustness to cultural measurement choice.
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