Self-Reported Psychosocial Outcomes of Autistic Adults Living in China and The Netherlands

Abstract

Background:

Despite an estimated population of 10 million autistic individuals in China, little is known about Chinese autistic adults. Cultural and contextual factors may impact objective and subjective psychosocial outcomes of autistic adults. In this descriptive study, we aim to compare the psychosocial outcomes of autistic adults between China, an Eastern Asian country, and The Netherlands, a Western European country.

Method:

Based on self-report online questionnaires, we compared objective psychosocial functioning (employment, living situation, friendship), life satisfaction, and internalized autism-related stigma of 36 Chinese (23 males and 13 females) and 29 Dutch (18 males and 11 females) autistic adults. The majority of participants in both countries (Chinese: 66.7%; Dutch: 82.8%) self-reported having an IQ above 70.

Results:

Chinese and Dutch participants exhibited similar levels of employment, quality of friendships, and life satisfaction (M_Chinese = 5.81; M_Dutch = 6.28). Chinese autistic adults more often lived with their parents and reported more autism-related internalized stigma than Dutch adults (M_Chinese = 2.25; M_Dutch = 1.79, p < 0.001). Autism-related internalized stigma was negatively correlated with friendships and life satisfaction across both samples.

Conclusions:

Heightened internalized stigma among Chinese autistic adults compared with the Dutch may reflect cultural differences in attitudes toward autism. Strategies aimed at reducing internalized stigma could help to improve the social connections and life satisfaction of autistic adults within the global autistic community. This cross-country study is a first step in understanding the psychosocial outcomes of autistic adults in China.

Community Brief

Why is this an important issue?

The lives of autistic adults are influenced by cultural and contextual factors, such as societal values, norms, and stigma. By comparing the outcomes of autistic adults from China and The Netherlands, we investigated in what ways their outcomes are similar and different.

What was the purpose of this study?

The study aimed to explore the objective and subjective outcomes of autistic adults living in China and compare these with those of autistic adults in The Netherlands. We focused on (a) whether they have a job, live on their own, and have friends (this is called psychosocial functioning), (b) their life satisfaction, and (c) the impact of internalized stigma (i.e., negative feelings they might have about themselves because of their autism) on their psychosocial functioning and life satisfaction.

What did the researchers do?

In total, 36 Chinese (23 males and 13 females) and 29 Dutch autistic adults (18 males and 11 females) filled in a survey. The survey had questions about work, living situation, friendships, how satisfied they were with their lives, and their experiences of internalized stigma. The groups were comparable in sex, intellectual ability, age, and age of autism diagnosis. We compared the outcomes of the two groups to see if there were any differences.

What were the results of the study?

In both countries, a similar majority of participants were employed and had friends. Chinese autistic adults more often lived with their parents compared with Dutch autistic adults. Both groups reported similar moderate levels of satisfaction with their lives. Chinese adults felt more negatively about themselves because of their autism compared with Dutch adults. In both countries, lower internalized stigma was linked with closer friendships and higher life satisfaction.

What do these findings add to what was already known?

These findings offer new insights into the lives of autistic adults in mainland China, a group that has not been studied much before. We found that heightened autism-related internalized stigma among Chinese autistic adults compared with Dutch adults may reflect cultural differences in attitudes toward autism. Despite differences in autism-related internalized stigma, autistic self-reporting adults in China and The Netherlands shared similar experiences in some key areas of life.

What are potential weaknesses in the study?

The study relied on estimated self-reported IQ and used a small sample. Also, the measures used were based on Western standards, which might not fully fit with the Chinese culture or context.

How will these findings help autistic adults now or in the future?

Internalized stigma may be a bigger problem for autistic adults in China. Lower internalized stigma was linked with closer friendships and higher life satisfaction across both countries, suggesting that strategies aimed at reducing internalized stigma could help to improve the social connections and life satisfaction of autistic adults within the global autistic community.