Exploring cultural biases that lead to misdiagnosis, misunderstanding, and missed support
Same Brain, Different Label
A child who’s considered gifted in one country might be labeled rude or disruptive in another. A girl praised for being quiet and polite in her culture might actually be masking severe anxiety and sensory overwhelm. The same traits that point to ADHD or autism in one place might go unnoticed or be punished in another.
As someone who has worked with neurodivergent children and adults in Serbia, the UK, and across cultures like India, Japan, France, Nigeria, and the US, I’ve seen how profoundly cultural context shapes how ADHD and autism are perceived, diagnosed, or misunderstood. This article isn’t a scientific study—it’s drawn from years of working with people and personal experience as a mother and professional navigating multiple systems and assumptions. You may see things differently based on your background—and that’s exactly the point.
This article explores how cultural biases influence diagnosis, behavior interpretation, and the kind of support (or judgment) neurodivergent individuals receive. And why that matters more than ever in a world of increasing cultural diversity, migration, and global parenting.
What Counts as ‘Normal’ Is Cultural
Neurodivergent traits don’t change based on where you live. But how people around you interpret those traits does. For example, research comparing how parents in Hong Kong and the UK perceive ADHD symptoms found striking differences: what one culture views as a clear red flag, another may see as typical childhood energy or stress-induced behavior (ADHD in Cultural Context – PMC).
In Japan, children are expected to be quiet, compliant, and respectful of hierarchy. A highly verbal, emotionally expressive autistic child might be seen as rude or oppositional rather than neurodivergent. In Nigeria, where obedience and respect are key values, impulsive behavior or meltdowns may be seen as a result of poor parenting. In the US, hyperactivity might trigger an early ADHD evaluation, whereas in Serbia or France, it might be brushed off as immaturity—or a sign of bad discipline.
Even something as simple as eye contact—a diagnostic marker in many autism checklists—is culturally complex. In some African and Asian cultures, avoiding eye contact is a sign of respect, not a red flag.
The bottom line? What’s considered problematic—or pathological—is shaped by social norms. And those norms are not universal.
The Parenting Blame Game
In many cultures, a child’s behavior is viewed as a direct reflection of parenting. I’ve experienced this a lot in Serbia, where I’ve seen parents shamed for their child’s restlessness or emotional outbursts. In India, where extended families are involved in raising children, a diagnosis like ADHD might be dismissed as a “Western excuse for poor parenting.”
Mothers, especially, carry the emotional burden. I’ve worked with families where the mother was pressured to “discipline more” or “control the child,” even when it was clear the child was struggling with executive function, sensory overload, or social anxiety. These parents often delay seeking help—not because they don’t care, but because they fear judgment from their own communities.
In contrast, in the UK or US, parents may be quicker to seek a label—but even then, cultural expectations play a role. Families from immigrant or minority backgrounds may still face stigma within their own communities, even if the broader system is more accepting.
School Readiness and the Sitting-Still Myth
Education systems vary drastically across countries—and those differences can determine who gets diagnosed, when, and how.
In the UK, children start school as young as four, and are expected to sit still, focus, and follow structured learning early on. In Serbia, most children attend preschool or nursery until age six or seven, with more emphasis on play. Scandinavian countries delay formal schooling even longer and emphasize outdoor learning and flexibility.
This means that a Serbian child who struggles to sit for long periods might not stand out until much later—when the academic demands increase. But a British child with the same traits might already be flagged for ADHD in Reception.
Diagnosis often hinges not on the child’s traits—but on how well they fit the system’s expectations. And those expectations are shaped by culture. A recent study reviewing teachers’ perceptions of ADHD symptoms across countries shows that educators’ cultural values and classroom norms significantly impact how and when children are referred for diagnosis (Cross-Cultural Teacher Reports – Springer).
Girls, Culture, and Double Invisibility
Girls with ADHD and autism are underdiagnosed globally—but cultural expectations make this even worse.
In Japan, girls are expected to be polite, quiet, and helpful. A girl who daydreams, fidgets subtly, or avoids eye contact is often praised, not questioned. Teachers don’t see the inner anxiety, masking, or sensory discomfort. In Serbia, girls with similar traits are often labeled as shy but ‘well-behaved,’ which can also delay recognition of underlying neurodivergent traits.
In Japan, masking is deeply ingrained. Autistic girls are more likely to conform outwardly and suffer silently. In France, emotional outbursts may be pathologised as behavioral issues, but internal struggles are overlooked. In the US, despite growing awareness, many girls still slip through the cracks—especially if they perform well academically.
Masking may be a survival strategy—but it also delays diagnosis, increases emotional exhaustion, and leads to burnout later in life.
Stories From the Field: The Same Traits, Different Reactions
I once worked with an autistic girl in Serbia who often cried in class and talked out of context. Teachers saw her as overly emotional and disruptive, and her parents were frequently blamed for spoiling her or failing to instill discipline. But what was really happening was that this child was overwhelmed, misunderstood, and struggling to communicate in the way others expected her to. It took a lot of time, trust-building, and careful, non-confrontational conversations with educators to help them see what was beneath the surface of her behaviour. Once they began to understand the reasons behind her reactions, their approach shifted, and with that, so did the girl’s ability to feel safe and begin to thrive in her learning environment.
An Indian family I supported was overwhelmed by their daughter’s hyperactivity and emotional meltdowns. They’d been told to be stricter. When we reframed it as ADHD and began offering structure and tools instead of punishment, the child’s confidence blossomed—and so did the parent-child relationship.
I also worked with a Nigerian family living in the UK whose son frequently interrupted, asked very direct questions, and sometimes reacted with big emotional outbursts. In their home culture, certain behaviors were interpreted differently, and they were unsure how to navigate the British school system’s expectations. Teachers often saw the boy as defiant or aggressive, and the parents were hesitant to challenge the school’s view, feeling both judged and confused. It took time to help both the family and the educators understand that these behaviors were consistent with autism—not defiance—and rooted in communication differences and sensory sensitivities. With understanding and collaboration, the support plan became more tailored and respectful of both the child’s needs and the family’s cultural background.
These stories aren’t rare. They’re everywhere. We’re not always diagnosing different children—we’re diagnosing the same children differently based on the lens we’re looking through.
Why It Matters
When we fail to account for cultural bias, children suffer.
- They’re punished for traits they can’t control.
- Parents are blamed and isolated.
- Diagnoses are delayed or denied.
- Girls and minority children are overlooked.
But it goes deeper than that. When children are misunderstood from an early age, the consequences ripple outward. A child who is constantly told they are naughty, lazy, or not trying hard enough may begin to believe it. Their confidence erodes, their self-worth shrinks, and they start internalising the idea that they are the problem.
In educational settings, this can translate into lower expectations, reduced support, and fewer opportunities. Children who don’t ‘fit the mould’ may be overlooked for enrichment activities or written off as troublemakers. Over time, these early experiences shape not just academic outcomes but also long-term mental health.
Many adults I’ve worked with—especially those who grew up in cultures where neurodivergence was not recognised—describe a lingering sense of failure. Not because they lacked potential, but because the environment didn’t understand how to nurture it.
This matters even more for cross-cultural families—expats, migrants, or mixed-culture households—whose children might not fit neatly into any system, often facing double misunderstanding both at home and in school.
We can’t claim to support neurodiversity if we’re only doing it through one cultural lens. We need a broader, more compassionate perspective that sees children in context—not just through checklists.
A Call for Cultural Humility
Professionals working with neurodivergent individuals—whether educators, clinicians, or coaches—need to ask more questions:
- What does this behavior mean in this child’s culture?
- How do the parents interpret it?
- Is this “disruptive” or just different?
We need less judgment and more curiosity. Less labeling and more listening. Less pathologising and more perspective.
Cultural humility means recognising our blind spots—and being willing to learn from the people we serve.
That also means we must actively push this conversation, especially in communities or cultures where it isn’t yet common. It is far easier to suspect ADHD or autism when the terms are already circulating in schools, media, or parenting circles. But in places where neurodivergence is rarely discussed, families can feel completely alone. Children suffer in silence, and support systems remain outdated or nonexistent. The more we speak up—even when it feels unfamiliar or uncomfortable—the more we make space for recognition, understanding, and growth.
Final Thoughts: A Global Lens on Neurodivergence
I’ve worked across countries, cultures, languages, and belief systems—and one truth keeps coming up:
ADHD and autism don’t look the same everywhere. Not because people are different—but because the systems around them are.
We must stop pretending there’s a universal picture of what ADHD or autism “looks like.”
There isn’t.
There are only humans—with brains wired differently—and cultures trying to make sense of that. The more inclusive our lens, the better chance we have at building a world where neurodivergent people are understood, supported, and empowered—no matter where they live.