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

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.

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.

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.

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.