Adaptation and field testing of an observational assessment tool for autism diagnosis in Western Kenya

Abstract

Background: The development and implementation of culturally appropriate, easy-to-administer, open-source assessment tools are critical for advancing autism detection and research in low- and middle-income countries. Methods: The ASD-PEDS, an open-source semi-structured observational tool for assessing autism-related behaviors in young children, was adapted for use in Kenya via iterative refinement throughout the process of forward-backward translation (English-Kiswahili), cognitive interviews with clinicians and caregivers, and field testing to ensure cultural relevance. Results: Cognitive interviews revealed culturally normative early social communication and play skills aligned with key behaviors assessed by the ASD-PEDS. Field testing further identified targets for adaptation including development of bilingual administration guidelines and cultural modifications to assessment activities. During field testing, ASD-PEDS categorical risk matched the child's diagnosis in 100% of cases, demonstrating initial alignment with clinical classification. Conclusions: With minor adaptations, the ASD-PEDS demonstrates preliminary feasibility as an observational assessment tool to support standardized autism evaluation of young children in low-resource settings. Given the early-stage nature of this adaptation study, findings should be interpreted as preliminary. Study of psychometric performance in a heterogeneous larger sample of children is a necessary next step for cultural validation.