If you want to develop an effective autism training, ask autistic students to help you

Factors underlying differences in knowledge, explicit stigma and implicit biases towards autism across Hong Kong, the United Kingdom and the United States

A growing literature suggests that there is cross-cultural variation in levels of autism-related stigma, which may partially be explained by differences in cultural orientation or autism-related knowledge between countries. This literature has relied heavily on self-report measures of explicit attitudes towards autism; little research has examined implicit biases, and whether these implicit biases vary across cultures. Thus, here we had two aims: (1) to assess the contribution of knowledge and cultural orientation to both explicit stigma and implicit biases, and (2) to compare autism-related knowledge, explicit stigma, and implicit biases across university students in Hong Kong (n = 119), the United Kingdom (n = 120), and the United States (n = 122). Replicating prior work, we found that explicit stigma was predicted by less accurate knowledge, lower horizontal collectivism, greater vertical individualism, and higher implicit biases. Implicit biases were directly predicted by age and explicit stigma, and indirectly predicted by vertical individualism (positively) and horizontal collectivism (negatively) via explicit stigma. Knowledge and explicit stigma differed across countries, even after accounting for covariates: students in Hong Kong displayed less accurate knowledge, and higher explicit stigma towards autism, than those in the United Kingdom and United States. However, implicit biases did not differ between countries.Lay abstractAttitudes towards autism vary across countries. Some of this variation could reflect differences in cultural values across countries, or differences in how much people know about autism. Until now, most research on this topic has asked people directly about their attitudes towards interacting with autistic people. As a result, we understand little about why some people unconsciously hold negative attitudes towards autism, and whether these unconscious attitudes vary across countries. We studied explicit attitudes (willingness to interact), implicit attitudes (unconscious beliefs), knowledge about autism, and cultural values in university students from Hong Kong, the United Kingdom and the United States. We found that people were less willing to interact with autistic people if they knew less about autism, aligned with a competitive and hierarchical society ('vertical individualism'), did not see themselves as part of a collective whose members are equal (less 'horizontal collectivism'), and if they unconcsciously associated autism with negative attributes. Students in Hong Kong were less willing to interact with autistic people and had less understanding of autism compared to those in the United Kingdom and the United States. Unconscious biases did not differ across countries. Our findings highlight the need to combat misconceptions about autism to improve attitudes towards autistic people, especially in Hong Kong. Unfortunately, our results suggest that acquiring more accurate knowledge may not be sufficient to alter unconscious biases. Further research is needed to determine the factors underlying unconscious biases.

"A Good Transition Is Just Key": The Views and Experiences of Disability Support Staff in Supporting Autistic Students Transition to University

Background

The transition to university can be challenging for all students. However, the transition to university might be especially challenging for autistic students because of changes in routines, environments, and expectations. Support during this period is important for well-being and academic success, yet autistic students report facing barriers when accessing adequate support. Although disability support staff play a vital role, their perspectives regarding effective transition support have been overlooked.

Methods

We conducted semi-structured interviews with 11 disability support staff from seven UK universities to examine the following: (1) the support they offer autistic students during the transition to university and (2) their recommendations for improving support. We analyzed the data using content analysis and reflexive thematic analysis.

Results

Staff described the transition to university as an ongoing process rather than an event in time. They also highlighted that the transition to university transition is complex and multidimensional, involving simultaneous changes across various life domains. Relatedly, they reported offering diverse academic (e.g., in-class support) and nonacademic (e.g., social groups) transition supports. Nonetheless, they acknowledged barriers in providing comprehensive support, including lacking resources and relying on students to self-advocate their needs. We generated three overarching themes related to staff's recommendations for improving transition support for autistic students: (1) a need for comprehensive preparation and sustained support, (2) fostering positive communication between stakeholders, and (3) curating an accessible and inclusive university culture.

Conclusion

Although disability support staff demonstrate dedication toward facilitating successful transitions for autistic students, barriers exist limiting effective support provision. Implementing universal design principles may foster accessibility and alleviate pressures on individual services. Enhancing communication between stakeholders could also optimize transition support.

Abstract

Transitioning to university can be stressful for all students. However, university transitions can be more challenging and stressful for autistic students because of changes in their routines, environments, and expectations. Accessing timely and sensitive support during this time is especially important for autistic students' academic, social, and emotional adjustment. Yet, research has shown that autistic students find it hard to access the support they need. Disability support staff at universities play an important role in helping autistic students adjust to university. However, little research has examined their experiences.

Abstract

The purpose of this study was to find out how disability support staff support autistic students transitioning to university and hear their ideas for improving this support. Our research questions were as follows: (1) What support do universities offer autistic students during the transition to university and (2) how can university transition support for autistic students be improved, from the perspective of disability support staff?

Abstract

We interviewed 11 disability support staff from seven universities in the United Kingdom. We asked questions about the academic and nonacademic help they provide to autistic students during the university transition. We also asked the staff to share their recommendations for how to better support autistic students. We analyzed the interview transcripts to identify common themes.

Abstract

Staff said going to university involves lots of changes all at once, and this can be overwhelming for autistic students. They discussed the importance of offering autistic students academic support (e.g., classroom adjustments) and nonacademic support (e.g., social groups for autistic people). However, they said there were not enough resources and that they relied too much on students asking for what they need. The staff suggested needing to help students build skills earlier and support them longer at university, improve communication between universities and students/parents, and make university culture more inclusive so fewer individual adjustments are needed.

Abstract

Past research shows that transitions are hard for autistic university students. This study highlights the barriers disability support staff face in providing enough support and their ideas for improving university transition support. Their perspectives were missing from previous research.

Abstract

The study only included disability support staff perspectives. Talking directly to autistic students would give a fuller picture of what support they need and want.

Abstract

The suggestions from staff, such as starting transition support earlier and providing training, could lead to universities making changes that improve autistic students' health, happiness, and success at university. More research is still needed from the student perspective.

"What does 'often' even mean?" Revising and validating the Comprehensive Autistic Trait Inventory in partnership with autistic people

BACKGROUND

In this study, we revised the comprehensive autistic trait inventory (CATI)-a self-report inventory of autistic traits, in collaboration with autistic people and provided preliminary evidence for its validity as a self-report measure of autistic traits in the general population. An established strength of the CATI is its ability to capture female autistic traits. Our project aimed to extend this further, to increase the inventory's accessibility, and to minimise stigma induced by deficit-based representations of autistic experience.

METHODS

Together with 22 individuals from the autism and autistic communities, we created the Revised Comprehensive Autistic Trait Inventory (CATI-R). Revisions included rewording items to increase clarity or reduce stigma and expanding items to capture diverse autistic experiences. We also present a series of guidelines for developing self-report inventories of subclinical neurodivergent traits. We validated the CATI-R within a large sample (n = 1439), comprising people with a self-reported autism diagnosis (n = 331), people who self-identified as autistic (n = 44), and non-autistic participants (n = 1046).

RESULTS

We successfully validated a revision of the CATI. A confirmatory factor analysis supported the six-subscale structure (two-factor bifactors model: Chi-squared = 2705.73, p < .001, RMSEA = .04, SRMR = .03, CFI = .95, TLI = .94). Spearman's rank correlations showed positive relationships between all subscales (all rs >  .56, ps < .001). Convergent validity was demonstrated by significant correlations between the CATI-R and two contemporary inventories of autistic traits: the AQ (rho = .86, p < .01) and BAPQ (rho = .82, p < .01). Finally, a measurement invariance analysis indicated that total-scale scores can be compared across genders.

LIMITATIONS

Our study presents only initial evidence for the validity of the CATI-R that should be enriched with further analyses and types of data, including a larger number of participants who do not identify as male or female.

CONCLUSIONS

This project provides a revised trait inventory that resonates with actual autistic experience, along with guidelines for creating self-report measures that are sensitive, accessible, and non-stigmatising.

The Impact of an Autistic Character Media Portrayal on Autistic Stereotypes : MEDIA PORTRAYAL

PURPOSE

Research has demonstrated that neurotypical college students view their autistic peers more negatively than their neurotypical peers and endorse stereotypes related to autism. One way to improve attitudes towards autistic individuals is to induce vicarious intergroup contact through the media in which seeing the lived experiences of an autistic character may reduce stereotypes via social learning. The current study sought to examine whether exposure to an autistic character in a television show would impact the stereotypes that neurotypical college students have about autism.

METHODS

College student participants (n = 147) viewed one of three short video clips depicting an autistic character who spoke about her experiences with ASD (i.e., informational condition), behaved in a relatable manner to neurotypical students (i.e., relatable condition), or engaged in stereotypical autistic behaviors (i.e., stereotypical condition).

RESULTS

Results indicated that stereotypes about autistic people were less negative for participants who watched the informational clip than the relatable clip, and liking for the character mediated this relationship.

CONCLUSION

Our findings suggest that a short video featuring a likeable autistic person may reduce stereotypes about autism.

A Cross-Cultural Examination of Blatant and Subtle Dehumanization of Autistic People

PURPOSE

This cross-cultural study examined various domains of dehumanization, including both blatant (viewing autistic people as animal-like, child-like, or machine-like) and subtle (denying agency and experience capabilities) dehumanization, of autistic individuals by Koreans and Americans.

METHODS

A total of 404 Koreans and 229 Americans participated in an online survey, assessing blatant and subtle dehumanization, knowledge about autism, stigma toward and contact with autistic people, cultural factors, and demographic information. Robust linear mixed-effects regressions were conducted to examine the impact of the target group (autistic vs. non-autistic) and the country (South Korea vs. the US) on dehumanization. Additionally, correlations and multiple regressions were employed to identify individual variables associated with dehumanization.

RESULTS

Both Koreans and Americans exhibited more dehumanizing attitudes towards autistic individuals than non-autistic individuals across all domains. Koreans showed greater dehumanization of autistic individuals than Americans in all domains except for the machine-like domain. Stigma toward autistic people was associated with all dehumanization domains among Koreans and with some of the domains among Americans. Individual variables associated with dehumanization varied across countries and domains. Positive contact quality frequently predicted lower dehumanization in both cultures.

CONCLUSIONS

Non-autistic individuals consistently rated autistic people as less human than non-autistic people. Future research examining how autistic characteristics or societal perceptions that influence the consideration of an autistic person's humanness vary across cultures is needed. Implementing interventions aimed at enhancing non-autistic people's understanding of autistic individuals' agency and experience capabilities and promoting high-quality contact opportunities with autistic individuals may help reduce dehumanizing attitudes.

Changing Outcomes for Job Candidates with Autism Spectrum Disorder: The Benefits of Neurodiversity Training and ASD Disclosure

PURPOSE

Job interviews are often an integral component of the hiring process, but for individuals with autism spectrum disorder (ASD), job interviews can pose an unfair barrier to employment. Although employers may perceive candidates with ASD as qualified, they tend to reject those candidates in interviews because of atypical social interactions. This is true in situations in which evaluators are naïve to candidates' ASD diagnosis and have no training about neurodiversity. The present study explored whether diagnostic disclosure and/or increased ASD knowledge can reduce bias against ASD candidates.

METHODS

We included three conditions: Disclosure-Only, Training-Only, and Training + Disclosure. In all conditions, participants watched mock job interviews of candidates with and without ASD, rated each candidate on several social dimensions, and indicated how likely they were to hire each candidate. In the Disclosure-Only condition, participants were informed prior to each video whether each interviewee had ASD. In the Training-Only condition, participants first completed a neurodiversity training session before watching and evaluating the interviews. The Training + Disclosure condition combined these interventions.

RESULTS

In the Disclosure-Only and Training-Only conditions, candidates with ASD were rated less favorably on social dimensions and were less likely to be hired relative to neurotypical (NT) candidates. In the Training + Disclosure condition, ASD candidates were equally likely to be hired as NT candidates, despite receiving less favorable ratings on some social dimensions.

CONCLUSION

Combining knowledge of ASD with diagnostic disclosure improves hiring outcomes for individuals with ASD.

The Impact of Metaphoric Language Intervention on Psychological Perceptions of Students with Autism

This study aimed to investigate the influence of metaphoric language intervention (MLI) on students' psychological perception in bilingual learning, focusing on both autistic and students with non-autism. Students with autism often exhibit apprehension toward engaging in bilingual learning with their peers, resulting in reduced enjoyment and unfavorable language learning outcomes. A cohort of 108 students with autism and 102 students with non-autism, who demonstrated psychological perception engagement through MLI, was recruited for the study. The findings revealed that autistic male students reported higher levels of enjoyment in MLI compared to autistic female students, with metaphoric expressions being preferred over literal ones. Additionally, a positive correlation was observed between the quality of MLI and increased psychological perception, receptiveness, and enjoyment in bilingual learning, leading to favorable perceptual outcomes for students with autism. These findings highlight the critical role of integrating MLI and implementing targeted psychological perceptions to enhance the quality of bilingual learning for students with autism. This approach shows promise as a practical and universally applicable language therapy that effectively addresses challenges in bilingual learning and fosters a deeper interest in communication, particularly among individuals with autism.

Can a Culturally Adapted Autism Training Reduce Stigma Towards Autistic People in South Korea?

This randomized controlled trial examined the effectiveness of an online autism training intervention in reducing stigma toward autistic individuals. Participants were 208 Korean undergraduate students who were blinded to group allocation, with 106 assigned to the autism training and 102 assigned to a control intervention. All participants completed an online Qualtrics survey that included a pre-test survey (perceived similarity to different minority groups), the training, and a post-test survey (perceived similarity, stigma toward autistic people, knowledge about autism, confidence in their knowledge, and open-responses question asking for descriptions of autism). We conducted independent sample t tests and a mixed-effects model to examine group-level differences, and a reliable change index (RCI) analysis to examine individual changes in the perceived similarity score. The responses to the open-ended questions were analyzed using qualitative content analysis. Results revealed that the experimental group reported reduced stigma toward autistic individuals, increased perceived similarity with autistic individuals, and increased confidence in their autism knowledge and demonstrated increased knowledge about autism compared to the control group. At the individual level, the RCI analysis indicated that the training was effective for a notable subset of participants (25%). At post-test, the experimental group recognized the strengths of autistic people and described autistic individuals as "people like us," while many in the control group mentioned misconceptions about autism. Future research should employ more robust intervention designs and tailor materials for diverse target populations, including administrators, to foster systemic destigmatization.

How are Autistic People Involved in the Design of Extended Reality Technologies? A Systematic Literature Review

The primary aim of this systematic review is to investigate the inclusion of autistic individuals in the design process of immersive technologies. This study follows the preferred reporting items for systematic reviews and meta-analyses standards for systematic literature reviews. To ensure the research questions and subsequent stages of the review incorporate pertinent parameters, the problem, interest, context framework has also been employed. Findings highlight that, while early proponents of immersive technology emphasized the importance of user involvement in design of new technology, immaturity of the technology often limited the implementation of direct user input to the design process. Nonetheless, analysis of the literature published between 2002-2022 identified 20 studies in which substantial influence of autistic individuals and stakeholders was found in the design process of immersive technologies. The roles of autistic individuals varied from active co-designers and co-creators to essential contributors in refining prototypes and providing critical feedback, ensuring the final products align with their needs and preferences. Results underscore the need to align research and design of immersive technologies more closely with the priorities and preferences of autistic individuals. Further is needed regarding actively involving autistic individuals in the design and implementation of immersive technology applications. On this basis, we maintain that more inclusive and effective deployment of immersive technologies is needed in order to ensure that resultant technologies are fit for purpose and address the actual needs of the autistic community.

The Neurodiversity Attitudes Questionnaire: Development and Initial Validation

LAY ABSTRACT

Neurodiversity refers to the idea that brain differences (including disabilities) are valuable and should be accepted. Attitudes toward neurodiversity can have real-life impacts on the lives of neurodivergent people (those whose brains do not fit society's "standard"). These impacts can include effects on daily interactions, as well as how professionals such as teachers and doctors deliver services to neurodivergent people. In order to identify negative attitudes toward neurodiversity and potentially improve them, we first need to measure these attitudes. This article describes the development of the Neurodiversity Attitudes Questionnaire (NDAQ). NDAQ development included revision of questionnaire items based on feedback from experts and neurodivergent people, systematically evaluating the way participants responded to questionnaire items, and analysis of how the NDAQ items are grouped into different factors. A preliminary analysis with 351 individuals mostly living in the United States who were currently working or planning to work in a helping profession (e.g. doctors, teachers, therapists, and so on) indicates that the NDAQ measures attitudes toward neurodiversity, is well understood by participants, and fits a five-factor structure. While the NDAQ represents the first instrument designed to specifically assess attitudes toward the broad idea of neurodiversity, further work is still needed.

Career progression for autistic people: A scoping review

LAY ABSTRACT

Lots of autistic people are unemployed. Even when they are employed, autistic people might be given fewer opportunities than non-autistic people to progress in their careers. For example, assumptions about autistic people's differences in social communication might mean they are not given as many promotions. Indeed, we know that many autistic people are in jobs lower than their abilities (known as 'underemployment'). We reviewed 33 studies that tell us something about career progression for autistic people. Our review found that lots of autistic people want to progress in their careers, but there are many barriers in their way. For example, when they told their employer about being autistic, some people were given fewer opportunities. Research has also shown that autistic people do not get enough support to progress and that gaps in their employment history can make it difficult to progress. Our review suggested that good employment support (e.g. mentors) might help autistic people to progress in their careers. However, not much research has evaluated employment support for autistic people, which means we do not know how useful it is. Future research should find the best support that allows autistic people to live and work in ways that are meaningful to them.

Do Types of Information in an Animated Video Intervention Affect University Students' Autism Knowledge and Openness Towards Peers on the Autism Spectrum?

This pre-test post-test control group design sought to compare the effectiveness of delivering different types of information ([1] factual information vs. [2] factual information + descriptive and explanatory information vs. [3] factual information + descriptive, explanatory + directive information) in an animated video intervention in increasing university students' autism knowledge and openness toward peers on the autism spectrum. The sample consisted of 92 undergraduates (27 males, 65 females; age range = 18-36) from various universities in Singapore. Participants were randomly assigned to one of the three experimental conditions/videos, where they completed a measure of their autism knowledge and openness scale, before viewing a 5-minute long animated video containing different types of information about autism. After which, participants completed the measure of autism knowledge and openness scale again, followed by a measure of their empathy level. Results indicated that participants' autism knowledge improved following the viewing of the animated video. However, the three different videos containing different types of information did not differ in influencing participants' openness toward peers on the autism spectrum. Nevertheless, qualitative responses proposed that the video containing factual information, with descriptive, explanatory, and directive information was useful in helping participants to know how to interact with their peers on the autism spectrum. The findings of this study provide preliminary support for the most effective method to educate and raise awareness about autism, among the general student population in order to foster a supportive and inclusive environment.

Recognizing and Resisting Ableist Language in Schools: Suggestions for School-Based Speech-Language Pathologists and Related Professionals

PURPOSE

The language that school professionals use to describe disabled students can reveal and perpetuate ableist assumptions. Professionals' language choices can also challenge ableist attitudes to help create more inclusive, equitable learning environments. This tutorial seeks to guide speech-language pathologists (SLPs) and other school professionals to identify ableist language, understand the ableist ideologies that such language reveals, and develop strategies to implement ways of communicating with and about disabled students that align with an anti-ableist stance. We offer a brief description of ableism in schools, describe models of disability and their varying alignments toward ableist ideologies, and identify ways in which language can reflect and perpetuate ableism. Using Individualized Education Program goals as an example, we examine the ways in which ableist language can manifest in school practices. Finally, we provide suggestions to guide SLPs and other school professionals to examine and change their language to better align with an anti-ableist stance.

CONCLUSIONS

School professionals' language use is not neutral and may reveal and maintain ableist assumptions about disability and disabled students. While dismantling ableism requires systemic change, we suggest that individual professionals can use language in ways that resist ableism and powerfully impact their students' educational experiences.

Parental Perceptions of Community and Professional Attitudes Toward Autism

The purpose of this study was to examine parent perceptions of professional and community attitudes about autism through the lens of parenting their autistic children from birth through adulthood. Implications of this research may assist with future development and study of professional and community supports of individuals on the autism spectrum and their families. The study participants consisted of 51 parents who had an adult-aged child on the autism spectrum. One-on-one interviews were conducted with parents about their experiences raising a child with autism. Data were double-coded and analyzed using a qualitative, phenomenological approach to explore parents' experiences with and perceptions of society members' attitudes towards autism. Positive and negative themes were identified across parents' perceptions of professionals and of community members. Themes regarding professional attitudes included cooperating with family requests, presuming competence of individuals with autism, complacency towards the needs of families and individuals with autism, and discrimination towards the individual with autism based on age or level of need. Themes regarding community member attitudes included valuing the strengths of individuals with autism, accommodating autistic differences, intolerance of autistic traits, and prejudice towards individuals with autism. Findings indicate that professional and community members presented with both positive and negative attitudes towards autism and individuals on the autism spectrum, with negative attitudes proving more prevalent in parent recollections. Results suggest a need for further research and related training to improve interactions with and support of individuals with autism and their families.

The effect of autism phenotype and diagnosis disclosure on students' desire for social distance from autistic peers

LAY ABSTRACT

Autistic students experience loneliness, rejection from peers, which might negatively affect both their well-being, as well as academic results. Others have studied this topic, however, the existing research does not analyze the desire for social distance from autistic female students in higher education. The goal of this study was to evaluate whether the way autism is expressed and disclosing the autism diagnosis had an effect on students' willingness to interact with autistic male and female students. We also analyzed participants' knowledge about autism, contact with autistic people in the past and its pleasantness in relation to their willingness to interact with autistic students described in the scenarios of the present study. We found that students were less willing to interact with autistic male students compared to autistic female students, as well as with autistic students whose diagnosis was not disclosed compared to autistic students whose diagnosis was disclosed to the raters. In addition, students who reported more pleasant contact with autistic individuals in the past were more willing to socially interact with autistic students if their diagnosis was disclosed. Students with higher knowledge of autism expressed greater willingness to interact with autistic males and autistic students regardless of diagnosis disclosure. Findings suggest that autistic males and individuals who prefer not to disclose their diagnosis are more vulnerable to social exclusion. More subtle expressions of autism need to be researched further.

Parent-reported environmental factors and strategies to support home and community participation in children on the autism spectrum

PURPOSE

Participating in home and community activities can be influenced by environmental factors and parent strategies. Children on the autism spectrum are reported to participate less in home and community activities than their neurotypical peers. Little is known about environmental factors that may influence their participation, and ways parents support their child's participation.

MATERIALS AND METHODS

Parents of children on the autism spectrum aged 5-6 years (n = 72) and 10-11 years (n = 94) completed the Participation and Environment Measure for Children and Youth. This study reports on the perceived support, barriers, and resources in the home and the community environment. Parents reported strategies they used to support their child's participation in home and the community.

RESULTS

Home environmental factors were identified as more supportive by the parents of younger children. The sensory quality of activities and social demands were factors identified as making community participation harder for both groups. Parents used a range of different strategies in the home and the community to support their child's participation.

CONCLUSIONS

Identifying environmental barriers and supports to participation can assist in developing interventions to support meaningful participation in activities for children on the autism spectrum.Implications for rehabilitationSkills required for the activity and preferences of children on the autism spectrum are important considerations when supporting their participation in activities.When exploring a child's level of participation, it may be helpful to ask parents about what their child can do with or without their support.The sensory quality of the environment is a consideration when supporting the participation of children on the autism spectrum in community activities.As sensory processing is an individual experience, the impact of sensory elements of the environment may differ for individuals.

'Who, When, How to Share': Pilot study of a new disclosure decision-making programme for autistic adults

LAY ABSTRACT

'Who, When, How to Share' is a new programme that aims to support autistic adults in making decisions around sharing their autistic identity with others. The programme involves working through a self-help guide independently over 3 weeks with optional peer support. We wanted to find out if autistic adults would join the programme and find it useful. Thirty-two autistic adults took part in the programme and 19 of them completed it. Most participants who completed the programme liked the programme and found it helpful, but some felt that they needed more time and support to complete it. They suggested that the programme would be more accessible if it was more interactive, such as including videos and other ways to gain feedback on their progress. Surveys filled in by participants before and after the programme suggested that they became more confident and less stressed about sharing their autistic identity with others, but some felt they still needed to build more confidence in order to handle negative attitudes from others. More work is needed to improve and test the programme further.

'Does that mean you will be violent?': A qualitative exploration into Autistic women's experiences of relationships with lecturers at university

LAY ABSTRACT

It is documented that more Autistic woman are becoming university students, but their experiences are not often explored. Eleven Autistic women students made artefacts (such as writing, paintings or poems) and took part in interviews to share their experiences at university. Five participants were undergraduate students and six participants were postgraduate students. The artefacts and words participants shared were looked at closely and some common themes were decided. How lecturers talk to Autistic women students was looked at. Participants said they were lucky if they met helpful lecturers. Also, autism acceptance was explored. Overall, how lecturers treat Autistic women at university is very important. Also, Autistic women students' opinions about making university a more welcoming place need to be listened to.

'It's a symbolic violence': Autistic people's experiences of discrimination at universities in Australia

LAY ABSTRACT

Autistic students experience many challenges at university. One significant barrier identified in past research was autistic students' experiences of discrimination (i.e. being treat differently) and stigma (being judged differently). Our research team included both autistic and non-autistic researchers who designed a project to help explore autistic students' experiences of stigma and discrimination at Australian universities. We interviewed 21 autistic students who went to a university - some had completed qualifications, and some had not. From our interviews, we identified four themes: (1) 'My disability is something that people just don't have a clue about', (2) 'the system is really stacked against you', (3) the onus is on autistic students, and (4) 'grit and stubbornness'. As a result, we recommended changes in the way courses are written and taught so that autistic people have opportunities that meet their ways of learning. It is also important for university staff to understand the impact of trauma experienced by autistic people and that universities work together with autistic people to design courses and supports that include autistic ways of learning, accessible university processes and identify support needs.

The Knowledge of Autism Questionnaire-UK: Development and Initial Psychometric Evaluation

Tools to measure autism knowledge are needed to assess levels of understanding within particular groups of people and to evaluate whether awareness-raising campaigns or interventions lead to improvements in understanding. Several such measures are in circulation, but, to our knowledge, there are no psychometrically-validated questionnaires that assess contemporary autism knowledge suitable to the UK context. We aimed to produce a brief measure to assess between-respondent variability and within-respondent change over time. A pool of questionnaire items was developed and refined through a multi-stage iterative process involving autism experts and a lay sample. Attention was paid to face validity, clarity, consensus on correct responses, and appropriate difficulty levels. Initial validation data was obtained from a lay sample of 201 people. Difficulty and discrimination ability were assessed using item response theory and low-performing items were removed. Dimensionality was evaluated with exploratory factor analysis, which revealed a one-factor structure of the questionnaire. Further items were removed where they did not load strongly on their main factor. This process resulted in a final 14-item questionnaire called the Knowledge of Autism Questionnaire-UK. Internal consistency was satisfactory, and the final questionnaire was able to distinguish between parents of autistic people and those without an affiliation to autism. The KAQ-UK is a new, freely-available measure of autism knowledge that could be used to assess between-respondent variability and within-respondent change over time. Further evaluation and validation of its measurement properties are required.

'Most people have no idea what autism is': Unpacking autism disclosure using social media analysis

LAY ABSTRACT

Autism disclosure - that is sharing their autism diagnosis or identity with a person or people - is a difficult decision for many autistic people. While telling people they are autistic can be positive and helpful, it can also create a lot of problems. What we have learnt is that disclosure is really complicated. Rather than asking research participants questions about what might happen, we looked at what people were saying on public social media posts (Reddit and Twitter) about what did happen. We used three years of posts that were related to autism disclosure from a wide range of adults (autistic and non-autistic). Four main ideas were created from our data, with the key finding being that society does not understand autism. This lack of understanding creates problems for autistic people in work, dating, healthcare and mental health. The remaining ideas were that autistic people should have privacy and be treated with respect, that autistic representation can help society and that non-autistic people need to do more to help autistic people. Our findings support that society needs to do more through autism advocacy, better media representation and more public role models. Increasing the accuracy of understanding of autism across society will mean that autistic people can feel safer to disclose if they want to.

Exploring the Barriers and Facilitators in the Management of Childhood Trauma and Violence Exposure Intervention in the Vhembe District of the Limpopo Province, South Africa

Research has shown that barriers and facilitators in psychotherapy exhibit similarities. The authors of this study are of the view that to effectively address the difficulties encountered in psychotherapy for children and adolescents, it is crucial to consider the points of view of professionals who have firsthand encounters with children. The purpose of this study was to effectively explore barriers and facilitators in the treatment of children exposed to trauma and violence. Exploratory and descriptive methods, as components of a qualitative research design, were employed to investigate and articulate the barriers and facilitators involved in managing childhood trauma. An advertisement was used to recruit participants. It was developed and distributed to psychologists and social workers recommended by the Thohoyandou Victim Empowerment Programme. Seventeen professionals were individually interviewed using semi-structured interview schedules. The interviews were recorded, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). The findings of the study indicated a lack of commitment from parents in honouring appointments, financial challenges, a fear of perpetrators associated with the poor reporting of incidences, professional boundaries, and referral route challenges. Familiar facilitators in the management of childhood trauma included continuous training and workshops for all people working with childhood trauma and violence, the employment of more victim advocates, and awareness campaigns. Additionally, the referral pathway for traumatised children presents logistical, psychological, and educational hurdles, underscoring the complex nature of meeting the needs of these vulnerable populations within the healthcare system. In conclusion, even while the currently available research supports the barriers and facilitators for this population, more investigation is required to examine how these factors affect treatment outcomes, particularly in community-based settings.

Time to level up: A systematic review of interventions aiming to reduce stigma toward autistic people

LAY ABSTRACT

How non-autistic people think about autistic people impacts autistic people negatively. Many studies developed trainings to reduce autism stigma. The existing trainings vary a lot in terms of study design, content, and reported effectiveness. This means that a review studying how the studies have been conducted is needed. We also looked at the quality of these studies. We collected and studied 26 studies that tried to reduce stigma toward autistic people. The studies often targeted White K-12 students and college students. Most trainings were implemented once. Trainings frequently used video or computer. Especially, recent studies tended to use online platforms. The study quality was poor for most studies. Some studies made inaccurate claims about the intervention effectiveness. Studies did not sufficiently address study limitations. Future trainings should aim to figure out why and how interventions work. How intervention changes people's behavior and thoughts should be studied. Researchers should study whether the training can change the societal stigma. Also, researchers should use a better study design.

Stigma and knowledge about autism in Brazil: A psychometric and intervention study

LAY ABSTRACT

To promote the full inclusion of autistic people, we must change the knowledge and attitudes of non-autistic individuals. Unfortunately, access to autism information and support remains limited in Brazil, and stigma is also common. Brazilian researchers reached out to a researcher in the United States to co-develop Brazilian surveys to measure autism stigma and knowledge. Together, they made Brazilian versions of stigma and knowledge surveys which autistic people in the United States had helped make. They also adapted an online autism training used in other countries with help from three Brazilian autistic people and the mother of an autistic child. They used the new measures to see if the autism training improved autism stigma and knowledge among Brazilians. The surveys, called EARPA and ECAT in Brazil, were translated into Portuguese in a previous study. In the first study in this article, 532 Brazilians completed the stigma measure and 510 completed the knowledge measure. The researchers used exploratory graph analysis, which uses the connections between items in a survey to understand which items belong together. Seventy-nine Brazilians participated in the training. They were mostly white, female university students. The EGA showed that the stigma survey measured one big idea while the knowledge survey measured four ideas: diagnosis/cause; socio-communicative development; stimming and special interests; and autism in adulthood. Both scales are promising and may be helpful in future Brazilian and cross-cultural studies about autism. Participants reported more knowledge and less stigma after the autism training, which has been found in other countries too.

Teaching higher education staff to understand and support autistic students: evaluation of a novel training program

Background

Autistic students are particularly vulnerable to stressors within a university environment and are more likely to experience poor mental health than their non-autistic peers. Students' experiences of stigma from staff and peers, and the masking behaviors they deploy to minimize it, can also result in worsening mental health. Despite these concerns, there is a lack of tailored support for autistic students at university. The current project assesses a co-created training course for university staff focused on debunking stereotypes, educating about the autistic experience at university, mental health presentation among autistic individuals, and practical strategies to improve interactions with autistic students.

Methods

The Autism Stigma and Knowledge Questionnaire [ASK-Q] was administered before and after the training, to examine changes in trainees' understanding and acceptance of autism and autistic people. Post-training interviews and surveys were also conducted with trainees, covering the impact the training has had on their perceptions of autism, the strategies they found beneficial, and how they will use the materials in future.

Results

There were no statistically significant differences between pre- and post-training scores on the ASK-Q, likely due to ceiling effects as pre-training scores were high. Thematic analysis of interviews identified five themes: value of lived experience; developing nuanced, in-depth knowledge of autism; training as acceptable and feasible; links to professional practice; and systemic barriers.

Conclusion

Although ceiling effects meant there were no changes to participant's knowledge about autism and autistic people statistically, the qualitative data reveals the extensive benefits they gained from taking part in the training programs. Scoring highly on the ASK-Q did not mean that people could not learn important new information and benefit from the course. This more nuanced understanding of autism led to practical changes in their practice. Listening to and learning from autistic people was seen as particularly important, highlighting the value of co-production. Our results also emphasize the need for varied approaches to evaluating training effectiveness, as reliance on quantitative data alone would have missed the subtler, but impactful, changes our participants experienced. This has important implications for professional practice, both within higher education and more broadly.

Psychosocial factors associated with camouflaging in autistic people and its relationship with mental health and well-being: A mixed methods systematic review

Camouflaging involves hiding one's autistic characteristics in social situations. This mixed methods systematic review synthesized research on psychosocial factors associated with camouflaging and its relationship with mental well-being. Six databases were searched. The 58 included studies (40 qualitative, 13 quantitative, five mixed methods), encompassed 4808 autistic and 1780 non-autistic participants, and predominantly featured White, female, and late-diagnosed autistic adults with likely at least average intellectual and/or verbal abilities. Following a convergent integrated approach, quantitative data were transformed and synthesized with qualitative data for thematic synthesis. We identified three themes on psychosocial correlates of camouflaging: (1) social norms and pressures of a largely non-autistic world, (2) social acceptance and rejection, and (3) self-esteem and identity; and four themes on psychosocial consequences of camouflaging for well-being: (1) a pragmatic way of exerting individual agency and control; (2) overlooked, under-supported, and burnt out; (3) impact on social relationships; and (4) low self-esteem and identity confusion. Camouflaging emerges as primarily a socially motivated response linked to adverse psychosocial outcomes. A whole society approach towards acceptance and support for autistic individuals to express their authentic selves is needed. Future studies examining psychosocial influences on camouflaging should include participants who more broadly represent the autistic population.

Do Autistic People's Support Needs and Non-Autistic People's Support for the Neurodiversity Movement Contribute to Heightened Autism Stigma in South Korea vs. the US?

We examined stigma towards vignette characters representing diverse autistic characteristics (social, non-speaking, or repetitive interests or restricted behaviors; RIRB) among 259 South Korean and 240 American participants (age range = 18 ~ 74). Within each domain, participants were randomized to read a vignette depicting low or high support needs. Koreans reported greater stigma towards autistic characteristics and less awareness of and support for the neurodiversity movement than Americans. Autistic characters' support needs and rater characteristics (autism knowledge, neurodiversity endorsement, and contact quantity) predicted stigma in at least one domain, and after accounting for these variables, participants' nationality was suggestively associated only with stigma towards social characteristics and RIRB. Findings highlight the need for culturally adapted-training that provides contact with diverse autistic people.

A mixed method comparison of stigma toward autism and schizophrenia and effects of person-first versus identity-first language

Introduction

While stigma toward autistic individuals has been well documented, less is known about how autism is perceived relative to other stigmatized disabilities. As a highly stigmatized condition with similar social cognitive features to autism, schizophrenia may offer a useful comparison for stigma. Previous studies have found that autistic people may be perceived more favorably than those with schizophrenia, but little is known about the underlying volitional thoughts that contribute to differences in how these conditions are perceived.

Methods

The present study utilizes a mixed-methods approach, allowing for a detailed understanding of how young adults perceive different diagnostic labels. 533 college undergraduates completed questionnaires reflecting their perceptions of one of eight diagnostic labels: four related to autism (autism, autistic, autism spectrum disorder, or Asperger's), two related to schizophrenia (schizophrenia or schizophrenic), and two related to an unspecified clinical condition (clinical diagnosis or clinical disorder). Participants also completed an open-ended question regarding their thoughts about, and exposure to, these labels. Responses were compared across broader diagnostic categories (autism, schizophrenia, general clinical condition), with thematic analysis used to assess the broader themes occurring within the open-ended text.

Results

While perceptions did not differ significantly for person-first and identity-first language within labels, several differences were apparent across labels. Specifically, quantitative results indicated greater prejudice towards autism and schizophrenia than the generic clinical condition, with schizophrenia associated with more perceived fear and danger, as well as an increased preference for social distance, compared to autism. Patterns in initial codes differed across diagnostic labels, with greater variation in responses about autism than responses about schizophrenia or the general clinical condition. While participants described a range of attitudes toward autism (patronizing, exclusionary, and accepting) and schizophrenia (fear, prejudice, and empathy), they refrained from describing their attitudes toward the general clinical label, highlighting the centrality of a cohesive group identity for the development of stigma. Finally, participants reported a number of misconceptions about autism and schizophrenia, with many believing features such as savant syndrome to be core characteristics of the conditions.

Conclusion

These findings offer a more detailed account of how non-autistic individuals view autism and may therefore aid in the development of targeted programs to improve attitudes toward autism.

Anti-ableism and scientific accuracy in autism research: a false dichotomy

It was recently argued that autism researchers committed to rejecting ableist frameworks in their research may sacrifice "scientifically accurate" conceptualizations of autism. In this perspective piece, we argue that: (a) anti-ableism vs. scientific accuracy is a false dichotomy, (b) there is no ideology-free science that has claim to scientific accuracy, and (c) autism science has a history of false leads in part because of unexamined ableist ideologies that undergird researcher framings and interpretations of evidence. To illustrate our claims, we discuss several avenues of autism research that were promoted as scientific advances, but were eventually debunked or shown to have much less explanatory value than initially proposed. These research programs have involved claims about autism etiology, the nature of autism and autistic characteristics, and autism intervention. Common to these false leads have been ableist assumptions about autism that inform researcher perspectives. Negative impacts of this work have been mitigated in some areas of autism research, but these perspectives continue to exert influence on the lives of autistic people, including the availability of services, discourses about autism, and sociocultural conceptualizations of autistic people. Examining these false leads may help current researchers better understand how ableism may negatively influence their areas of inquiry. We close with a positive argument that promoting anti-ableism can be done in tandem with increasing scientific accuracy.

Evaluation of an Autism Training in a Much-Needed Context: The Case of France

Background

Autistic people in France have called for community education to reduce autism stigma. As such, training is needed to help university students appreciate autistic peers and autistic people they may work with in their future careers.

Methods

We adapted an autistic-affirming training from a training developed in other cultural contexts and evaluated it with 107 university students in France using a pretest-post-test design.

Results

Questionnaire responses suggested that our brief online training helped improve attitudes toward inclusion, autism knowledge, and stigma among future educators and psychologists in France. Participants' open-ended definitions of autism revealed increased alignment with the neurodiversity movement after training.

Conclusions

Findings suggest that wider-scale autistic-led adaptations of autism trainings like the one described in this report could begin to ameliorate autism stigma in France.

What barriers could impede access to mental health services for children and adolescents in Africa? A scoping review

BACKGROUND

Few studies have examined the mental health needs of African children and teenagers. Based on this gap, this scoping review aims to identify barriers to mental health services, treatments and services sought, and where mental health services are received.

METHODS

To pursue the stated objectives, we searched the following databases a) PsycINFO, b) CINAHL, c) Medline, and d) Web of Science. The search yielded 15,956 records in total.

RESULTS

Studies included in this review were conducted in six African countries: Ethiopia, Mali, Egypt, South Africa, Nigeria, and Tunisia. The majority of the studies were conducted in South Africa (33.32%), followed by Ethiopia (25%), and Egypt (16.67%). In terms of treatments and services sought, both professional and traditional/alternative treatments were reported. The most frequently noted services were psychiatric treatments (25%), screening and diagnostic assessment (16.67%), as well as psychiatric and psychological consultations (16.67%). The most frequently reported treatment centers were psychiatric hospitals. As for treatment barriers, the three most frequently encountered barriers were: a preference for traditional/alternative and complementary treatments (33.33%), followed by stigma (25%), and a lack of knowledge/unfamiliarity with the mental health condition (25%).

CONCLUSION

The results of this study are alarming due to the significant barriers to accessing mental health services coupled with the use of potentially harmful interventions to treat those mental health conditions. We hope this scoping review will help shed light on this important issue and help tomorrow's generation reach its full potential.

Clinician factors related to the delivery of psychotherapy for autistic youth and youth with attention-deficit hyperactivity disorder

LAY ABSTRACT

Autistic children and youth often experience mental health problems, such as anxiety, depression and behavioural challenges. Although there are therapy programmes that have been found helpful in reducing these issues, such as cognitive behaviour therapy, autistic children often struggle to receive adequate mental health care. Clinicians' knowledge, attitudes, confidence and beliefs about treating mental health problems in autistic people may be related to their choices in providing psychotherapy. Across Ontario, Canada, 611 mental health clinicians, working in publicly funded agencies, completed an online survey about their experiences and opinions on delivering therapy for autistic clients compared to those with attention-deficit hyperactivity disorder. Clinician knowledge was associated with their intention to treat autistic clients or clients with attention-deficit hyperactivity disorder, partly because of their attitudes and the social pressures or values they felt. Clinicians reported feeling less intent on providing therapy to autistic youth compared to youth with attention-deficit hyperactivity disorder because of differences in their attitudes, social pressures and knowledge. This research can inform the training and educational initiatives for mental health practitioners.

Explicit stigma and implicit biases toward autism in South Korea versus the United States

This cross-cultural study examined Koreans’ and Americans’ explicit stigma and implicit biases toward autism to examine potential mechanisms underlying recent evidence for heightened explicit autism stigma in South Korea relative to the United States. This evidence is somewhat at odds with other evidence that individuals living in collectivistic cultures such as South Korea may be more prone to present themselves favorably than those living in relatively individualistic cultures such as the United States. A total 224 American and 536 Korean non-autistic adult participants completed an online survey. Implicit biases were measured using the implicit association test. Koreans reported greater explicit stigma and exhibited more implicit biases toward autism than Americans. Explicit stigma was not correlated with implicit biases in either country. Less autism knowledge and pleasant contact with autistic people predicted greater explicit stigma among both Koreans and Americans. Less frequent contact and heightened assimilation ideology toward ethnic minorities predicted greater stigma only among Koreans. The variance in implicit biases explained by predictors was small, emphasizing the need for follow-up research investigating predictors of implicit biases. Informing Koreans about the shortcomings of assimilationist approaches and fostering an appreciation of the plurality of cultures may reduce stigma toward autistic individuals in South Korea.

Lay abstract

How people report their feelings about autism may be different from how they actually think about autism because some people may not want to reveal their true feelings. People who value the group’s goal tend to present themselves as more socially acceptable than people who value one person’s interests. We studied how people in South Korea and the United States report their feelings about autism and think about autism. Koreans tend to value the group’s goals. Americans tend to prefer one person’s goals. Koreans reported that they wanted more space from autistic people than Americans did. Koreans were more likely to think about autism with negative words (and think more negatively about autism). How Koreans and Americans report their feelings about autism was not related to their thoughts about autism. People who knew about autism and liked meeting with autistic people wanted to get closer to autistic people in South Korea and the US, Koreans who had met autistic people and thought that people who newly came to Korea from abroad should be more like Koreans did not want to get very close to autistic people. This could be because very few foreign people live in South Korea compared to the United States. Teaching Koreans that all cultures have values and should be appreciated will help them like autistic people more.

A capabilities approach to understanding and supporting autistic adulthood

There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum's capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives.

Understanding Stigma in Autism: A Narrative Review and Theoretical Model

The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.

A systematic review on autistic people's experiences of stigma and coping strategies

Autism can be understood as a concealable stigmatized identity. This is the first systematic review to synthesize the literature on autistic people's experiences of stigma and coping strategies. 2877 studies were screened and 27 were included in this review. The reviewed literature demonstrates that autistic individuals are acutely aware of being stereotyped, judged, and discriminated by others. Autistic people also show signs of internalizing stigma, rendering them more vulnerable to low self-worth and poorer mental health. To manage the impact of stigma, the included studies suggest that autistic individuals may use these strategies: concealment and camouflaging, selective disclosure and self-advocacy, as well as positive reframing and reconstructing identity. However, the evidence is limited and mixed in terms of how helpful and effective these strategies are. Future studies should include autistic populations with a wider range of intellectual abilities and explore interventions that can support autistic people in managing stigma to supplement interventions that seek to reduce stigma towards autistic people. The power of language in perpetuating and challenging stigma also has important implications for research and practice, underscoring the need for researchers and practitioners to reflect carefully on the messages they are communicating about autism.