Identity Development for LGBTQIA+ Autistic Adults in the United States: A Mixed-Methods Study.

This study looked at how LGBTQIA+ autistic adults learn about their identities. Researchers talked to 164 people and found that having access to diverse role models, supportive resources, and accepting people helped with positive identity development. When people had good support, they felt relief and pride. Without support, they struggled more with self-acceptance.

The study suggests ways therapists can help, like connecting people with similar peers and providing safe spaces to explore identity.

This mixed-methods study examined identity development in LGBTQIA+ autistic adults (N=164 total across two phases) using interviews, focus groups, and surveys. Participants reported that positive identity development occurred through exposure to diverse LGBTQIA+ and autistic identities, personal research, trial and error, and support from non-LGBTQIA+/non-autistic individuals. When these factors were positive, participants experienced 'narrative gain' with feelings of relief and pride. Negative experiences led to longer journeys toward self-acceptance.

The study identified specific ways occupational therapists can support identity development, including fostering peer connections, providing accessible resources, and creating safe exploration environments.

Occupational therapists should focus on facilitating peer connections, providing accessible LGBTQIA+ and autism resources, supporting personal research, offering creative identity exploration opportunities, and creating safe therapeutic environments. This holistic approach to identity development may improve mental health outcomes for LGBTQIA+ autistic clients.

The study does not report specific demographic details or methodological limitations in the abstract. The generalizability may be limited to the US context, and the abstract does not specify recruitment methods or potential selection biases.

Development of lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other gender and sexual minority (LGBTQIA+) identities and a disability identity is critical for positive mental health outcomes for LGBTQIA+ autistic individuals. To understand identity development and evaluate the resonance of support among a large sample of LGBTQIA+ autistic adults. A sequential mixed-methods, participatory approach. Data collection for both phases occurred remotely.

LGBTQIA+ autistic adults completed the qualitative phase and the survey (Ns = 57 and 107, respectively). Phase 1, the qualitative phase, included semistructured interviews and focus groups based on queer, crip, and intersectionality theories. Questions related to identity exploration and development. Themes regarding barriers and supports were used to develop a survey, used in Phase 2, to collect quantitative data to confirm the resonance of the findings.

Participants described exposure, personal research, trial and error, and individuals external to the LGBTQIA+ and autistic communities as contributing to their evolving identities. If these contributing factors were positive, people described experiencing narrative gain, whereby they felt a sense of relief and pride over their identities, and if they were negative participants reported going through a journey toward self-acceptance. Occupational therapy practitioners can support LGBTQIA+ autistic adults in the identity development process by fostering connections with other LGBTQIA+ autistic individuals, providing accessible sexual health education supporting personal research and providing accessible resources, offering opportunities to explore identities through creative means, and creating supportive environments and safe spaces for self-exploration. Plain-Language Summary: Identity development is the process of understanding who you are.

Occupational therapy practitioners can help support positive identity development for LGBTQIA+ autistic clients. In Phase 1 of the study, we talked to 57 LGBTQIA+ autistic people and asked them how they learned they were LGBTQIA+ and autistic. We used what we learned from those people to create survey questions, and we asked another 107 LGBTQIA+ autistic people whether the findings from our conversations in Phase 1 resonated with them as well. LGBTQIA+ autistic participants reported that they found it helpful to be exposed to people with diverse LGBTQIA+ and autistic identities; to be connected with articles, blogs, and people online who held diverse LGBTQIA+ and autistic identities; and to trial different identities.

They also said it was helpful if people who were not LGBTQIA+ or autistic were supportive during this process. When people had more help, they had better acceptance of themselves. When people had less help, they said they had to learn to accept themselves. Positionality Statement: In this article, we use the term LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other gender and sexual minority identities) to refer to a spectrum of marginalized sexual orientations (e.g., lesbian, gay, bisexual, asexual), gender identities (e.g., transgender, nonbinary, agender), and biological variations in sex characteristics (e.g., intersex).

We recognize that these identities are distinct but often interrelated, and unless otherwise specified we use LGBTQIA+ inclusively to reflect participants' self-identification. The first author is a White, straight, cisgender female with a history of generalized anxiety disorder. The second author is a mixed-race, queer, cisgender woman who is multiply neurodivergent, including autism, attention deficit hyperactivity disorder, and posttraumatic stress disorder. The third author is a White, queer, nonbinary autistic person.

The fourth author is a White, straight, cisgender female. The research team has varied experience and expertise in conducting research. The first author has a PhD and is a licensed occupational therapist, the second author has worked for many years in research laboratories as a research assistant and coordinator and is a licensed occupational therapist, the third author has a background in quantitative designs and statistical analyses and has worked as a research assistant, and the fourth author worked as a research assistant while in graduate school and is a licensed occupational therapist.