long-term health care as well as intervention programs for people with autism. Experience In certain areas, diagnosis and treatment of autism may be difficult because of the lack of facilities or physicians capable of autism recognition. Some families must travel for hours or days to reach an area in which diagnostic facilities are available. Stigma is also a salient issue. Families of children with autism in Hong Kong and China may experience stigmatization from others, which can lead to self-stigmatization in cultures where people focus on their social identity rather than their individual identity. This suggests that parents in China and Hong Kong may experience more stress from raising a child with autism than parents in other areas. Support from friends, families, and professionals is critical to enhance the psychological well-being of parents experiencing stigma. Autism may be of particular significance in India because of its characteristic abnormalities in social relationships, which may cause particular concern due to the value of social relatedness and conformity to social norms in India. Questions about a potential cause of the Hikikomori phenomenon in Japan have been hypothesized. Because Hikikomori is similar to the social withdrawal exhibited by some people with autism spectrum disorders, some psychiatrists suggest that it may be related to autism spectrum disorders and other disorders that may affect social integration, but that their disorders are altered from their typical Western presentation because of Japanese sociocultural pressures. Developing countries As recently as 1984, researchers questioned whether autism was a universal phenomenon. Some scientists believed that autism was a condition limited to Western and technologically developed nations; however, now there is evidence of increased prevalence of and knowledge about ASD cross-culturally and internationally. Although autism has a biological basis and there are clear criteria for an autism diagnosis, its symptoms may be viewed differently across cultures. These differences may extend to the perception of autism in different cultures and perceptions of the most effective treatment options. Western countries Diagnosis The median prevalence rate of autism spectrum disorders in Europe is 59 per 10,000 people, while the median prevalence estimated in North America is 86 per 10,000. In western nations, children who show developmental problems are referred for evaluation by a pediatrician. Preliminary screening instruments include the Modified Checklist for Autism in Toddlers (M-CHAT), Social Communication Questionnaire (SCQ), and Autism Spectrum Screening Questionnaire (ASSQ). Autism spectrum evaluations are typically conducted by professionals who