Abstract
Background:
Inclusive health and education services require diverse professionals to inform service delivery, which meet the needs of a diverse population. There is a need to reduce inequalities in employment, and to develop neuro-affirming public services. This requires enhanced understanding of the challenges facing neurodivergent professionals, and solutions informed by lived experience.
Methods:
This systematic review explored peer-reviewed literature describing the training, recruitment, and employment experiences of autistic professionals working in health and education services. Researchers followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Researchers last searched databases, which included Medline, CINAHL, and PsycINFO, in October 2024. Eligible studies presented data describing the experiences of autistic health or education professionals in employment or training, published in English within the last 15 years. Researchers appraised study quality using the Mixed Methods Appraisal Tool. Researchers synthesized data using a narrative approach. The research team received funding from the Scottish Government. Researchers registered the research protocol a priori with PROSPERO #CRD42023483391.
Results:
Researchers retrieved 14 studies describing the experiences of 529 autistic professionals working in health or education, although nested studies explored subsets of the same participant populations. Participants described work-related needs, differences, and coping strategies relating to unsuitable environments, stigma, discrimination following disclosure, and inconsistent support. They reported that a neuro-affirming approach was helpful but also used strategies to manage their mental health, including taking time off, using leave, and in some cases resigning from posts altogether. Some participants enjoyed their work and felt they had enhanced understanding of autistic patients and learners.
Conclusions:
Institutions need to implement policies that assign accountability and responsibility for implementing and maintaining reasonable adjustments and increasing accessibility. Flexibility and acceptance are key to creating an inclusive workplace.
Community Brief
Why is this an important issue?
Autistic people require health and education services that meet their needs. Autistic professionals may communicate more effectively with autistic people due to their shared experiences. However, autistic people are less likely than graduates with any other disability to work in a post that requires graduate or postgraduate qualifications or to have supervisory responsibilities. It is important to see what can help make employment fairer for autistic people.
What is the purpose of the review?
We explored published literature to find out about the employment experiences of autistic professionals working in health and education. We wanted to know what was difficult when they were training, applying for jobs, and when they were working. We also wanted to find out what was helpful for them.
What did the authors do to review the literature?
The authors searched databases for articles in English published in the last 15 years. We looked for articles where autistic people told us about their personal experiences of working in professional roles in health or education.
What studies did the authors find?
The authors found 14 articles that explored the experiences of 529 participants working in professional roles in health or education, including teacher, doctor, nurse, and academic. Research methods included interview, survey, written reflection, and autoethnography.
In summary, what did those studies show?
The studies showed that there are autistic people who are employed as professionals in health and education. Autistic professionals struggle if workplaces are busy, bright, or noisy and when there are last-minute changes. Colleagues and employers often treat them unfairly, which causes stress and depression, possibly because they have poor understanding of autism. Participants supported their health by reducing their working hours, taking annual leave, or resigning from their jobs. Some participants did not tell their colleagues that they were autistic. Thinking about autism as a difference rather than a disability could also be helpful. Some participants identified as autistic earlier in life had more positive self-identity. Participants wanted to act as role models and to support other autistic people who were using health or education services.
What are the remaining gaps in the literature?
We need to know more about how to make workplaces fair and inclusive of everyone. The research did not consider all professionals within health and education, and so, there is a need for greater understanding of the situation for other professionals, including physiotherapists and social care workers. There is a need for research that explores how professional roles can be adapted without compromising safety or quality. We need to know how to increase knowledge and understanding about autism to reduce stigma and discrimination.
Based on this review, what do the authors recommend?
Future research should look at policies and processes that make workplaces fairer for everyone. The authors think that employers and colleagues need to listen to colleagues and try to change the workplace so that people are happier at work. Professional bodies should adapt professional standards to make them more inclusive of autistic people.
Introduction
Autistic people require services that have been developed with consideration of their experiences and meet their needs, but health and education providers often struggle to be culturally competent and affirming to the individual. 1 People working in health and education can be an important part of the support network for autistic people and are in an ideal position to challenge prejudice and model neuro-affirming language and practices.2,3 When professionals are autistic themselves, they can have a deeper understanding and communicate more effectively with other autistic people due to shared experience.4–6 Autistic teachers describe acting as role models and facilitating inclusion for autistic learners.7,8 In addition, the presence of autistic teachers provides learners with opportunities to learn about autism, which can reduce negative attitudes and stigma. 9 Autistic health care professionals also describe having increased awareness of the needs of their autistic patients, which can inform effective health care provision.10,11 Reducing the challenges associated with accessing health care can reduce adverse consequences for autistic people, including excess mortality and reduced life expectancy.12,13 Inclusion of autistic professionals within health and education irrespective of the model of service provision may help to reduce the marginalization of autistic learners and patients and thereby limit inequalities9,14 and could offer opportunities for neurodivergent people to see themselves in professional roles. 15 To make inclusive health and education provision a reality, further research is required regarding the challenges faced by autistic people within these professions and how these can be overcome. 1
Workplace ableism and historic employment practices may discourage autistic people from entering health care or teacher education and training, contributing to the lack of diversity among clinicians and teachers.16–18 Autistic graduates are less likely than graduates with any other disability to be employed in a post requiring graduate or postgraduate qualifications, or to have supervisory responsibilities.19–22 Inaccessible environments, limited support, negative attitudes, discrimination, and additional challenges required to enter professional employment such as practice placements have all prevented the inclusion and progression of autistic people in professional employment.18,23,24 In addition, autistic people may employ masking strategies to avoid stigma and discrimination, which reduces their visibility in the workplace,25,26 although legally the obligation to adapt rests with the employing organization rather than the individual. 27 Also, professional bodies restrict access to professional careers by adopting inflexible, ableist positions that do not account for the needs of people with disabilities.11,28 For example, program leaders may refuse accommodations to professional programs and ableist technical standards, citing patient safety reasons.17,23,28 Such arbitrary and inconsistent application of policies designed to promote equality leaves individuals to navigate accommodation requests with different educators, supervisors, and managers alone. 29 This may increase the lack of diversity within professions, likely to increase the disparities people with disabilities commonly face in health and education services. 17
Inclusive work practices can support positive shifts in societal perceptions and attitudes toward people with disabilities.16,30 Exploring the needs and challenges facing autistic professionals in health and education can both support the employment of autistic people in these sectors and advance the inclusivity of health and education services for autistic people. There is an obligation to understand the perspectives of autistic professionals who work in health and education to inform positive change within these sectors. 2
This study was conducted by members of the National Autism Implementation Team (NAIT), which is a multidisciplinary team funded by the Scottish Government focused on the development of public sector health and education services in Scotland for autistic and neurodivergent people within a neurodiversity informed paradigm. 31
We conducted a systematic review of published studies providing data on the training, recruitment, and employment experiences of autistic professionals employed in the health and education sectors. This research intended to represent the priorities of autistic people and inform the Scottish Government autism policy although we did not restrict the study to professionals working within public sector organizations or service models. Findings from this review are part of a larger body of work
32
to create resources to support autistic people to achieve successful employment. Considering these principles, our objectives for this review were to:
Explore peer-reviewed published literature describing the experiences of autistic professionals working in health or education. Describe the challenges facing autistic professionals during training, recruitment, and employment. Investigate supports and neuro-affirming practices that helped autistic professionals during training, recruitment, and employment.
Research questions:
What are the employment experiences of autistic health care and education professionals? What supports the well-being and progression of autistic health care and education professionals?
Methods
Researchers followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.33,34 Researchers registered the protocol a priori (PROSPERO #CRD42023483391).
Inclusion criteria
Researchers included studies if: (a) participants were autistic (including self-identification or clinical diagnosis), (b) participants were employed in professional roles (defined for the purposes of this study as roles that require advanced education or training 35 ), within health or education OR participants were training for a professional role within health or education, (c) they were reported in English, (d) they were published within the last 15 years, and (d) they included empirical data describing the lived experience of autistic professionals’ training, recruitment, or employment from the autistic professional’s viewpoint.
Exclusion criteria
Excluded studies: (a) described experiences related to supported employment, (b) related to higher education experiences of students enrolled on courses not directly related to careers in health or education, or (c) were opinion pieces (including commentaries, editorials, reviews, and correspondence).
Search strategy
Researchers conducted a systematic search of MEDLINE, CINAHL, and PsycINFO through EBSCOhost using Medical Subject Headings and keywords related to Autism AND Employment OR Career AND health or education (see Supplementary Data). Database selection was based on current guidance.36,37 Researchers updated searches in October 2024.
Study selection
Researchers uploaded retrieved citations to Covidence. 38 Following removal of duplicates, two researchers (E.C. and N.J.) independently examined citation titles and abstracts and excluded irrelevant titles. Two researchers (E.C. and N.J.) independently reviewed full text against inclusion criteria. Researchers resolved disagreements through discussion and did not require reference to a third party (M.R.). We have provided citations for excluded articles (see Supplementary Data). Two reviewers (N.J. and E.C.) hand searched reference lists and forward citations of included articles. Researchers assessed inter-rater agreement using Cohen’s kappa.
Data extraction
Two researchers (E.C. and N.J.) developed and piloted data extraction sheets. Extracted data included citation details, sample size, and participant characteristics; sex/gender, age, occupation, employment, country of residence, method of autism diagnosis, and age of autism diagnosis; and study methodology and key findings. Where articles included reflections of autistic participants alongside reflections of participants with other needs, researchers only extracted data relevant to autistic participants where possible. Two researchers (E.C. and T.M.) independently produced study commentaries during data extraction. These commentaries summarized key aspects of the studies in relation to employment experiences. Other research team members reviewed the commentaries to ensure accuracy and completeness.
Evaluation or risk of bias
Studies included in the systematic review were assessed for risk of bias using the Mixed Methods Appraisal Tool (MMAT) 39 by two reviewers independently (E.C. and N.J.). This assessment includes five questions that focus on methodological quality for different study designs and require yes or no responses.
Synthesis methods
E.C. undertook narrative synthesis for qualitative data to describe common factors from heterogeneous studies describing personal views of employment-related experiences. 40 Other autistic and non-autistic team members (M.R., L.J., D.M., M.K., H.D., A.G., I.U., and J.M.) reviewed this synthesis, checking for accuracy and to ensure it included all the reported research findings. Researchers (E.C. and T.M.) identified broad categories within the data, including needs, differences, and coping strategies. Within these broad categories, researchers identified a list of detailed subcategories from data included in the narrative synthesis. Other research team members checked this list for accuracy and completeness. E.C. drafted the article and then all the authors reviewed and agreed on the final version.
Positionality and community involvement
The authors of this study are associated with the NAIT, which receives funding from the Scottish Government to develop neuro-affirming practices across public sector health and education services in Scotland.31,41 The Scottish Government has identified reducing inequalities in employment for neurodivergent people as a priority for action.42–44 The multidisciplinary NAIT includes autistic and non-autistic researchers who have experience working with autistic populations in professional roles, which include teacher, speech and language therapist, occupational therapist, and clinical psychologist. An autistic co-author provided the idea for this study. The authors anticipate that the findings from this study will underpin resources to support neurodivergent people in employment, which will be available from NAIT (https://nait.scot/) alongside guides to implementing accommodations at work.45,46
Results
The database searches returned 14 peer-reviewed articles (Fig. 1). There was a good level of inter-rater reliability for title and abstract review (k = 0.63), and for full-text review (k = 0.77). 47
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flowchart.
We have reported the characteristics of 529 participants in Table 1. There was overlap between participants included in two sets of studies8,56–59 so overall there were 459 individual participants. Participant occupations included teacher,7,8,48,49,56,57 doctor,50–52 nurse, 53 and academic.54,55,58,59 Participants ranged in age from 19 to over 75 years. Five studies did not provide age data.7,49,52,54,58 Participants were female (n = 342, 74.5%), male (n = 70, 15.2%), other (n = 22, 4.8%), missing (n = 6, 1.3%), or not reported (n = 19, 4.1%).48,52,55 Studies included participants formally diagnosed (n = 275, 56.2%), self-identified autistic participants (n = 126, 27.4%), and people awaiting an autism diagnosis (n = 22, 4.8%). There were no data on autism identification for participants in five studies (n = 36, 7.8%).7,48,49,53,55 Three studies (n = 250)50,51,53 reported that participants were working full-time (n = 107, 42.8%), part-time (n = 103, 41.2%), or retired (n = 1, 0.4%). Two studies presented data on both autistic participants and non-autistic participants, but we only extracted data relevant to autistic participants for this review.49,54 In one study, researchers could not distinguish data relating only to autistic participants. 53 Four articles included data describing the experiences of autistic participants in both professional and nonprofessional roles such as teaching assistant.8,49,56,57
Reported Characteristics of Autistic Participants
Study included two participants, researchers only extracted data relevant to the autistic participant for this review.
Six of 17 participants were autistic.
N = 17 but study provides “age at diagnosis” data for 18 participants.
Two of the 10 participants were autistic.
Participants in these two studies are the same.
Participants overlap across these three studies.
NS, not specified; NZ, New Zealand; SENCO, special educational needs coordinator; TA, teaching assistant; USA, the United States of America; UK, the United Kingdom.
Table 2 includes a narrative summary of retrieved studies, which includes reported information on study objectives, research methods, findings, limitations, and quality appraisal. Quality appraisal (MMAT) scores are presented as percentages where 20% is added for each positive response to MMAT questions (i.e., five positive responses =100%). 39 Appraisal scores were high although points were lost for insufficient reporting of data analysis,49,52,54,55 and inadequate reporting of data collection in individual articles.8,50 Although details of one nested study 8 were reported in another retrieved article. 56 A study exploring the experiences of autistic doctors 50 adapted a survey previously used for exploring the experiences of autistic school staff, 56 to include questions relating to medical school experiences, specialty selection, medical training experiences, and experiences with Autistic Doctors International (ADI). Neither study presented the survey used in its entirety.
Retrieved Study Methods and Findings
CV, curriculum vitae; ADD, attention deficit disorder; ADHD, attention-deficit/hyperactivity disorder; ADI, Autistic Doctors International; HR, human resources; IT, information technology; MMAT, Mixed Methods Appraisal Tool 39 ; PTSD, post-traumatic stress disorder.
Researchers categorized key findings from across the studies into needs and differences, workplace challenges, and supports and coping strategies (Table 3). Participants viewed some characteristics such as processing differences, communication differences, and focus on special interests, as both strengths and needs depending on the situation.
Autistic Professional Needs and Differences, Challenges, Supports, and Coping Strategies
Individual needs and differences
Ten studies reported communication differences, including difficulty with small talk, humor, and how inconsistent social rules made bonding with colleagues challenging.7,53,57,58 Using the telephone was difficult and participants preferred email and other asynchronous methods of communication.53,54 Participants also felt disadvantaged at interview, 7 and in professional situations where colleagues may interpret disagreement as rudeness. 57 Eight studies reported experiences relating to sensory differences. Participants described the physical pain, increased sensitivity, and exhaustion that could result from noise, lighting, air conditioning, and other sensory impressions.8,49,50,53,58 They dreaded busy, bright, smelly, or noisy environments, including staffrooms, dining halls, and group training.8,54 This led to participants seeking opportunities to leave or avoid situations to avert sensory overload, migraine, or meltdown, and could result in the individual being reprimanded for their absence or experiencing subsequent difficulties connecting socially with colleagues.8,54 Seven studies discussed experiences related to cognitive or processing differences. For example, participants could manage large amounts of complex information that colleagues struggled with, but had trouble identifying key points, multitasking, or switching focus.53,58,59 This meant they could be a useful resource for colleagues seeking information 53 but struggle to provide a concise answer to an interview question or distill information down as required for academic writing. 58 Participants were able to use their own experiences and increased awareness to identify autism in colleagues, and patients who could provide a sense of community and belonging.50,51 Participants reported that they enjoyed their work, particularly when work coincided with their interests.
Workplace challenges
Nine studies discussed the difficulties participants encountered due to colleagues’ limited knowledge about autism. Participants reported experiencing stigma, discrimination, prejudice and negative misconceptions, challenges, and judgment.50,52 One study found that a quarter of participants experienced issues involving human resources (HR) or disciplinary processes, 50 and most reported challenges relating to the judgment or attitudes of colleagues.50,55 Participants reported being accused of being antisocial or removing themselves from stressful busy situations. 8 Seven studies discussed the workplace physical and sensory environment. Participants expressed a need for quiet areas for focused work, to recharge, and which met their sensory preferences.49,54 Environments such as busy hospital wards could be stressful and participants required regular scheduled breaks to self-regulate. 53 Teachers sought opportunities to alter their environment by teaching outdoors or working with smaller groups.8,57 Institutional policies regarding who is entitled to their own office space or classroom, hotdesking, limited agency over the sensory environment (such as centrally controlled heating), and restricted support for adjustments made it more difficult to find a suitable working environment.56,57,59 Participants reported difficulty having workplace adjustments agreed, implemented, and maintained. 49 Colleagues were unwilling to accommodate differences, resulting in discrimination and exclusionary procedures and processes.8,49,55 Participants reported becoming anxious when plans changed at short notice without justification, when required to attend social events, when required to work in an unfamiliar environment such as clinical or teaching placements, 7 or when they witnessed poor treatment of autistic people.7,8 Participants felt that being recognized as neurodivergent was stigmatizing, which discouraged them from revealing their diagnosis thereby restricting access to workplace accommodations or adjustments and blocking them from acting as a role model.50,59 Revealing their autistic identity meant supervisors or managers viewed some participants as weak or inferior and unable to fulfill a professional role.50,52 One study identified associations between self-harm and disclosing to their consultant or supervisor (p = 0.002), disclosing to occupational health (p < 0.001), gender (p < 0.001), sexual orientation (p = 0.007), and requesting workplace adjustments (p = 0.039). 50
Supports and coping strategies
Research findings also included supports and strategies that participants used to help them cope with work. Most frequently reported supports were neurodivergent colleagues, other colleagues or managers,51,55 and peer support organizations such as Participatory Autism Research Collective 55 and ADI. 50 ADI was reported to have a positive effect on mental health for doctors who had previously considered suicide (p = 0.017), and 72% of study participants found that ADI membership had been positive for their mental health. 50 A total of 44% of participants in one study wanted more autism understanding from their medical colleagues. 50 The study authors suggest that medics are not familiar with the heterogeneous ways autism can present. When participants recognized colleagues as autistic, they experienced a sense of community and belonging.50,51 Participants in four studies found that technology assisted with planning or communication. An academic participant found that technology offered an opportunity to prerecord presentations that benefited students who were nervous presenting in front of lecturers. 54 The participant also provided prerecorded narration of lectures facilitating engagement from students reluctant to attend “live” sessions. 54 Other useful “aids” included making lists, and using a pinboard to display information.53,54 Working from home was beneficial as participants could control their environment, avoid social interaction, and self-regulate, for example, by stimming, without judgment.53,54 Some participants reduced their working hours, used annual leave, sick leave, and some left employment altogether to protect their mental health.8,53,58 One participant reported the positive effects of a neuro-affirming approach, which recognizes autism as a difference rather than a disability, on self-esteem and suggested this may have a role in preventing mental illness. 51 Another study described the experience of a participant who was diagnosed in childhood and displayed positive self-identity and self-assurance compared with some of the participants diagnosed in adulthood. 50 When participants realized they were autistic, this provided insight and an explanation for some difficulties they had experienced.51,52
Some of the suggested supports and coping strategies may provide benefit in particular circumstances or as a short-term fix. However, suggestions such as changing job, working reduced hours, or masking may not resolve workplace challenges. Masking, for example, has been associated with mental ill-health.26,60 These strategies perhaps allow the individual to continue working in their chosen field in the meantime while they find an alternative role with reduced challenges. 8
Discussion
Our review explored literature describing the experiences of autistic professionals employed in health or education. Autistic professionals face challenges associated with their physical and sensory environments, their need for routine and predictability, social interaction, recognizing that they are autistic regardless of outdated perceptions, negotiating disclosure and reasonable adjustments, and dealing with ineffective support and negative attitudes. These challenges increase the incidence of co-occurring mental ill-health and exclude autistic professionals from career progression opportunities. Participants described adjustments that helped them, including environmental adaptations and peer support. They also described strengths such as interests that aligned with work goals, and how their lived experience led to an enhanced understanding of neurodivergence. Findings from this review reinforce the importance of environment and culture for creating inclusive workplaces.
Findings indicate that autistic professionals are keen to act as role models to champion the needs of neurodivergent patients and learners. However, this requires them to disclose their autism, which opens them to judgment, discrimination, and stigma.2,25 These challenges may arise because autistic professionals are pressured to conform to an identity that is opposed to their preexisting or autistic identity. 61 Boundaries between professional and personal identities can become confused when autistic professionals attempt to share experiential knowledge while also maintaining legitimacy as a competent professional. 28 Ableist views diminish the worth and potential of disabled people. 18 Autistic professionals also highlighted the irony of institutions promoting inclusivity and adjustments for patients and learners, but not for employees. 18 A positive autistic identity can offer a protective effect,62,63 indicating a benefit to diagnosis or identifying as autistic.64,65 External acceptance and support are associated with positive autistic identity. 62
Review findings support previous assertions that the success of neurodivergent professionals can be dependent upon whether colleagues offer support and accommodations or report them as unable to fulfill the requirements of their course or job. 29 Professionals may camouflage or choose not to share their identity to avoid discrimination although this can be associated with ill health.23,66 Some feel it is not safe to disclose their autism as this may impair their professional standing or job security.25,26 Previous research highlighted that harassment and discrimination contribute to hostile environments within health and education. 17 Misconceptions include that neurodivergent professional pose a risk, perform at a lower level than neurotypical colleagues, or that reasonable accommodations lower competency standards.26,28 These views contribute to increased frequency of disciplinary processes and contact with HR reported by autistic professionals.8,50,67 This creates stress, restricts career progression, and results in job retention problems for autistic professionals.17,22 Ultimately, this diminishes the number of autistic professionals in senior roles who can favorably influence workplace conditions.8,17,22
Participants struggled with social interaction and identified challenges related to social or dynamic situations that required them to plan for different situations and environments.12,24 Neurodivergent people are often dependent upon colleagues, particularly managers, supervisors, or HR professionals, to sanction, implement, and maintain accommodations. These people can create further inconsistencies, varying the support they provide, based upon their own knowledge, perspectives, expectations, capacity, and awareness of the needs of the neurodivergent individual.24,28 Consistent application of policy and legislation is required to increase predictability and reduce the frustration associated with obtaining reasonable adjustments. 29 This will not always be straightforward and will require ongoing communication and negotiation to tailor workplaces to suit the needs and preferences of staff. Improved understanding of the needs of neurodivergent employees can also inform services provided for neurodivergent patients and learners.
Environmental adaptations can appear straightforward to implement, however, participants found that even after they identified and negotiated such changes, employers did not instigate them, or they initiated adaptations but then failed to maintain them in the longer term. 45 In keeping with previous research, participants had to research suitable accommodations, negotiate and then renegotiate adaptations, or cope without them.61,68 Previous research indicates that neurodivergent people can be unaware of which adaptations may support them, or to which they are entitled. 69 Identifying appropriate supports is particularly difficult for newly diagnosed people, or when a work environment is unfamiliar.46,70 Inclusive practices need integrating across health and education organizations such as a single point of contact, defined responsibility, and accountability for providing support and accommodations.28,29
Accommodations differ from accessibility as they are modifications based on individual need rather than design, which is accessible in the first place. 18 Applying accommodations based upon individual need may leave other areas inaccessible, and unavailable to other employees. 71 Improving accessibility can reduce the need to disclose, which means individuals may experience reduced exposure to stigma or discrimination.22,42 This will also benefit people who are unaware that they are autistic. Increasing the accessibility of the environment will be advantageous to everyone using the environment.72,73 These principles also apply to recruitment, employment, and career development processes and procedures. 74
Inclusive work cultures should allow people to be their true selves. Flexibility and acceptance are key. People are not the same, and we need to welcome difference and variation throughout society, including professional roles. 15 Professionals in health and education are well-placed to demonstrate acceptance of divergent populations and to facilitate knowledge and understanding regarding the accessibility and adaptation of environmental and social conditions to meet individual needs and preferences.7,9 This could be supported by updated and neuro-affirming professional training. 51 Small changes can make a big difference to people’s stress levels. Neurodivergent professionals can inform services that better meet the needs of neurodivergent patients and learners through shared understanding and experience. 75
Summary
This review revealed insights into the experiences of autistic professionals working in professional roles in health and education. Autistic professionals in health and education are important as they can support autistic people, act as role models, and highlight practices that are not inclusive or neuro-affirming. Many of the findings support previous research in different work roles, which advocate for flexibility around the social, physical, and sensory work environment to allow for variation in accordance with individual needs and preferences. Importantly, the review confirmed discriminatory practices within health and education professions that restrict access to adaptations and subject autistic professionals to disciplinary processes rather than accommodating their needs. This indicates a need for further work in this field and recent publications suggest that there is interest in improving inclusion and accessibility in professional career paths.32,76,77
Limitations
This review explored articles published in English only. The literature may not accurately reflect the experiences of all autistic people as many remain undisclosed or undiagnosed. Studies included participants with a clinical diagnosis of autism, and those who self-identified as autistic. Researchers did not include terms relating to social care professions in database searches and future research should rectify this. Searches revealed studies describing the experiences of autistic people in a limited range of health and education professions indicating a need for further research concerning the experiences of autistic professionals working in other fields such as pharmacy, allied health professions, and psychology. There is a need to know if published studies reflect occupations held more often by autistic people, and why this might be the case. Future research should explore the prevalence and experiences of autistic people working in other health and education roles. In addition, this study retrieved articles describing the experiences of autistic academics in health and education fields. It would be useful to explore how these findings relate to academia in other fields of study and to determine the challenges facing autistic people in different roles. The study focused on empirical evidence; however, we acknowledge that there is other gray literature available, which may also add to our understanding of the experiences of autistic professionals. Some studies presented limited demographic data, which restricted the calculation of summary statistics.
Footnotes
Author Disclosure Statement
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding Information
Funding from the Scottish Government supported this study. The funders had no role in the study design, data collection, data analysis, decision to publish, or preparation of the article.
Acknowledgements
Authorship Confirmation Statement
E.C.: Conceptualization, methodology, validation, formal analysis, investigation, data curation, writing—original draft, writing—review and editing, and project administration. D.M.: Conceptualization, methodology, formal analysis, investigation, writing—review and editing, and supervision. T.M.: Validation, formal analysis, investigation, and writing—review and editing. J.M.: Conceptualization and writing—review and editing. L.J.: Formal analysis, writing—review and editing, supervision, and funding acquisition. A.G.: Formal analysis and writing—review and editing. H.D.: Formal analysis and writing—review and editing. M.K.: Formal analysis and writing—review and editing. I.U.: Formal analysis and writing—review and editing. M.R.: Formal analysis, writing—review and editing, supervision, and funding acquisition. The article has been submitted solely to Autism in Adulthood.
Data Availability
All relevant data are within the article and its supporting information files.
Ethical Considerations
The Queen Margaret University Research Ethics Committee does not require researchers undertaking systematic review to apply for ethical approval.
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References
Supplementary Material
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