The Experience of Autistic Professionals Working in Health and Education: A Systematic Review

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.

Keywords

systematic review inclusion accessibility employment

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 inequalities^9,14 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 work³² to create resources to support autistic people to achieve successful employment. Considering these principles, our objectives for this review were to: 1.

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: 1.

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 training³⁵), 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

FIG. 1.

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 studies^8,56–59 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

Table 1.

Reported Characteristics of Autistic Participants

Research article	N	Gender	n (%)	Age (years)	n (%)	Occupation and employment	n (%)	Setting	n (%)	Autism diagnosis	n (%)
⁷	1	Male	1 (100)	NS		TA and trainee teacher	1 (100)	UK	1 (100)	NS
⁸ ^f	12	Female	9 (75)	Range 26–63		Former roles included teacher, therapeutic, and/or visiting professional, senior leadership, volunteer, and TA	12 (100)	UK	12 (100)	Clinical diagnosis	10 (83.3)
		Male	2 (16.7)							Seeking or awaiting diagnosis	2 (16.7)
		Nonbinary	1 (8.3)							Aware they were autistic when working in school	5 (41.7)
⁴⁸ ^f	149	Female	119 (80)	Range 19–62 (median = 40)		Working in school	100 (67)	UK	149 (100)	Professional diagnosis	93 (62.4)
		Male	30 (20)	Range 19–62 (median = 40)		No longer working in school	49 (33)			Self-identified	36 (24.2)
		Identified as female	98 (72)			Teacher	78 (52.3)			Awaiting diagnosis	20 (13.4)
		Identified as male	27 (20)			TA	40 (26.8)
		Identified as other	10 (8)			SENCO	8 (5.4)
						Other therapeutic or professional support role	8 (5.4)
						Assistant/deputy head teacher or member of the senior leadership team	5 (3.3)
						Trainee teacher	5 (3.3)
						Head teacher	4 (2.7)
						Early years teacher	2 (1.3)
⁴⁹ ^f	21	Female	19 (90.5)	Range 25–56 (median = 41)		Worked in mainstream schools (8 primary schools, 2 special schools, 2 both, 3 mainstream schools with an autism or disability base)	14 (66.7)	UK	21 (100)	Clinical diagnosis	17 (80.9)
		Male	2 (9.5)							Self-identified	1 (4.8)
		Identified as female	13 (61.9)								3 (14.3)
		Identified as male	1 (4.8)
		Identified as nonbinary	2 (9.5)			Teacher	9 (42.8)
		Did not specify	5 (23.8)			TA	3 (14.3)
						SENCO	1 (4.8)
						Visiting professionals	4 (19.0)
						Deputy head teacher and SENCO	1 (4.8)
						Deputy head teacher or another senior role	3 (14.3)
⁴⁸	4	NS	NS	21–65		Schoolteachers who work or had worked in a school in Ireland	4 (100)	Ireland	4 (100)	“Formally assessed or self-identified Autistic”
⁴⁹	2^d	Female	2 (100)	NS		Primary teacher	1 (50)	UK	2 (100)	NS
						Trainee teacher	1 (50)	UK	2 (100)	NS
⁵⁰	225	Female	178 (81.3)	20–29	29 (12.9)	Doctor	183 (82)	UK	136 (61)	Formal diagnosis	143 (64)
		Male	26 (11.9)	30–39	81 (36.2)	Not practicing	32 (14)	Australia	27 (12.1)	M_{age at diagnosis} = 36 (range 3–61). Diagnosed <18	8 (6)
		Other	15 (6.8)	40–49	66 (29.5)	Never worked as a doctor after graduating from medical school	9 (4)	USA	16 (7.2)	M_{age at diagnosis} = 36 (range 3–61). Diagnosed <18	8 (6)
				50–59	32 (14.3)		9 (4)	Canada	11 (4.9)	Self-identified	82 (36)
				60–69	12 (5.4)	Consultant/attending or general practitioner	84 (46)			Did not know they were autistic when at medical school	164 (74)
				70 or older	4 (1.8)	Trainee/junior doctor or resident	73 (40)			Did not know they were autistic when at medical school	164 (74)
						Nontraining grade associate specialist	20 (11)
						Other	5 (3)
						Permanent position	113 (51)
						Temporary position	59 (27)
						Unemployed	25 (11)
						Self-employed	24 (11)
						Full-time	96 (50)
						Part-time	97 (50)
						General practice/family practice	67 (31)
						Psychiatry	37 (18)
						Anesthetics	24 (11)
						Internal medicine	13 (6)
						Pathology	8 (4)
						Surgery	6 (3)
						Other specialty	54 (26)
						Member of Autistic Doctors International	255 (100)
⁵¹	8	Male	2 (25)	35–40	2 (25)	Retired	1 (12.5)	UK	8 (100)	Formally diagnosed autistic in childhood, pervasive developmental disorder, not otherwise specified, and identified as autistic as an adult, self-identified as autistic adults	2 (25)
		Female	6 (75)	40–45	3 (37.5)	Full-time	5 (62.5)				1 (12.5)
				45–50	1 (12.5)	Part-time	2 (25)				5 (62.5)
				50–55	1 (12.5)	Consultant psychiatrist	6 (75)
				75–80	1 (12.5)	Senior associate specialists	2 (25)
						Child and adolescent psychiatrist	4 (50)
						Old age, liaison and general adult psychiatrists	4 (50)
⁵²	3	NS	NS	NS		Trainee doctors	3 (100)	UK	3 (100)	Formal diagnosis	3 (100)
⁵³	17	Female	16 (94.1)	Range 22–51 (median = 32)		Nurse	17 (100)	Sweden	17 (100)	^bADHD	11 (64.7)
		Male	1 (5.9)	Range 22–51 (median = 32)		Clinical nurse	15 (88.2)			Autism	3 (17.6)
						Administrative nursing jobs	2 (11.8)			ADHD and Autism	3 (17.6)
						Full-time	6 (35.3)			^cAge at diagnosis: <20	4 (23.5)
						Part-time	4 (23.5)			20–30	8 (47.0)
						Sick leave	5 (29.4)			31–40	4 (23.5)
						Leave of absence to train to become a specialist nurse	2 (11.8)			>40	2 (11.8)
⁵⁴	1^a	Male	1 (100)	NS		Academic	1 (100)	UK	1 (100)	Formal diagnosis	1 (100)
⁵⁰ ^e	37	Female	21 (56.8)	NS		Working in academia	26 (70.3)	Australia	13 (35.1)	Formal diagnosis	32 (86.5)
		Male	9 (24.3)			Previously worked in academia	7 (18.9)	USA	11 (29.7)
		Other	7 (18.9)			Doctoral students	12 (32.4)	Canada	5 (13.5)
								UK	5 (13.5)
								NZ	NS
								Europe	NS
⁵¹ ^e	37	Female	21 (57)	20–29	5 (13)	Research only	7 (19)	Australia	13 (35)	Autism diagnosis	32 (86)
		Male	9 (24)	30–39	13 (35)	Teaching only	3 (8)	USA	11 (30)	In process	2 (5)
		Nonbinary	7 (19)	40–49	11 (30)	Research and teaching	19 (51)	Canada	5 (13)	Self-identified	3 (8)
				50–59	8 (22)	Governance/admin	3 (8)	UK	5 (13)
						Other	5 (13)	Europe	2 (5)
								NZ	1 (3)
⁵⁵	12	Female	NS	“Early 30s to mid-50s”		Academic	12 (100)	UK	12 (100)	NS
		Male		“Early 30s to mid-50s”		Doctoral student	3 (25)
		Nonbinary				Part-time researcher	5 (41.7)
						Researcher and lecturer	4 (33.3)
						Participatory Autism Research Collective Members	12 (100)

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 study⁸ were reported in another retrieved article.⁵⁶ A study exploring the experiences of autistic doctors⁵⁰ 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.

Table 2.

Retrieved Study Methods and Findings

Study	Occupational field	Objectives	Study design and methods	Key findings for autistic participants	Limitations	MMAT (%)
⁷	Teaching	To generate knowledge grounded in human experience. It takes the position of valuing the understanding of experiences, actions, and events as interpreted by the participant and seeks to investigate how that individual makes sense of his own experiences. It is a study of the “real-life” or “life-world” experiences of the participant and aims to describe the phenomena of teaching and teacher education as they appear to the participant	One-hour unstructured interview	1. Insight into the experiences of neurodivergent learners 2. Teachers and parents need to work together to support autistic learners 3. Confidence and self-esteem are more important than academic learning 4. Support autistic learners 5. Autistic teachers would benefit from support with time management and prioritizing tasks 6. Difficulties associated with placements in different locations with new routines	No background information on the participant such as age or details of diagnosis	100
⁴⁸	Teaching	1. Explore the experiences of autistic teachers in the Irish education system and the experiences they perceive as positive or negative 2. Discover the perspectives of autistic teachers regarding their relationships in schools, both with their colleagues and with their pupils	Interview	1. Autistic identity included monotropism, sensory differences, meltdowns and shutdowns, masking, feeling left out 2. Rich relationships with neurodivergent learners based on connection, coregulation, and empathy	No information on recruitment of participants	100
⁴⁹	Teaching	To explore 1. The working lives of disabled teachers in English schools 2. How inclusive the discourse about the inclusive education agenda is of disabled teachers 3. Challenges and enablers to positive change to the development of inclusive schools	Interview	1. Terminology/language is important 2. Participants wanted to be teachers to follow a childhood dream, and as they were good with children and had skills to offer them 3. Participants could offer more support and understanding to autistic children as they were aware of sensory differences which neurotypical people don’t get 4. Participants were more aware of making accessibility adjustments than colleagues 5. There is a focus on inclusivity and adjustments for children but not on adulthood 6. Mentors are an important source of support 7. Participants didn’t disclose as they feared colleagues judging them 8. Need for quiet working zones or sensory rooms for teachers that are sensory avoidant	No details of participant age, limited details on analysis. Not all participants were autistic	80
⁸	Teaching	1. What are the work experiences of former school staff? 2. What insights can be provided through an analysis of the language they use to describe their experience? 3. What lessons can be learned from this analysis to enable better experiences for autistic school staff and neurodiverse pupils?	Interview by email, or one-to-one basis via Microsoft teams or phone. Participants were recruited for previous study.⁵⁶ Discourse analysis	1. Participants described “pain” caused by loud noise, crowds, and smells 2. Sensory environment impacted on ability to do job or to make social connections 3. Unpredictability of school environment and of work expectations presenting a problem 4. Participants were ‘‘embarrassed” by reactions to tactics taken to avoid unpleasant environments 5. Social events increased feelings of alienation. Colleagues tagged participants as ‘‘antisocial” or “not a team player” for declining social events. Participants felt bewildered when they didn’t know what would happen at events 6. Autistic school staff felt able to add benefit to pupils, including a sense of understanding and belonging 7. Most interviewees felt happier after leaving their roles in schools 8. Creating an inclusive environment for staff would improve the environment for pupils 9. Schools should facilitate diversity, develop understanding of autistic staff, and promote open and flexible communication	Limited description of data collection	80
⁵⁶	Teaching	1. What are the views and experiences of autistic people working in an education role in the school sector in the United Kingdom? 2. What is needed to improve the employment, well-being, and progress of autistic people in the school education sector? 3. What can be learned from autistic school staff about the inclusion of autistic pupils?	Online survey	1. Participants struggled with the environment, including noise and bright light. Change in environment was challenging. Some staff struggled as they didn’t have their own classroom. Hotdesking was difficult 2. Change was difficult, including fixed-term contracts and redundancy, last minute management decisions, changing equipment such as computers, new management staff 3. Lack of support contributed to mental health difficulties, including burnout and fatigue. It also resulted in some participants leaving the teaching profession 4. Social interaction could be stressful and tiring 5. Participants were frustrated by the poor treatment received by autistic learners 6. Many participants had not disclosed their autism diagnosis at work. Others experienced prejudice following disclosure. Participants were concerned that disclosure would lead to discrimination. Impair their professional standing, or reduce their chance of getting supply work 7. Sometimes disclosure resulted in positive experience of support and understanding. Disclosed participants felt they could be a positive role model for autistic learners 8. Participants could empathize with autistic learners and facilitate their inclusion		100
⁵⁷	Teaching	1. What are the experiences of autistic school staff during the COVID-19 pandemic? 2. What additional insights can be gained from comparing these experiences with those before the pandemic?	Phase 1: Online survey (results reported in Ref.⁵⁶)Phase 2: Interview (online, by phone, or by email)	1. Environmental challenges, including noise, flickery lighting, lack of agency (e.g., centrally controlled heating) exacerbated sensory difficulties 2. COVID-associated changes included smaller group sizes, better ventilation, social distancing, part-time attendance, no assemblies, own choice of clothing, removal of wall displays, no school bells, which all contributed to making the work environment calmer; homeworking addressed sensory issues and increased productivity. Participants did not like when they had to move classrooms 3. Telephone conversations could be difficult due to limited visual information. A script prepared in advance could be a support, although increases workload 4. Social conversation and events could be tiring and stressful. Participants felt “alien,” frustrated, or that the situation was a “nightmare.” 5. Repetitive work can be challenging 6. IT could enhance accessibility for pupils and staff 7. Increased use of IT to deliver teaching and attend meetings was stressful for some participants, particularly attending meetings 8. Boundaries between work and home reduced when working from home. Participants struggled to manage childcare and housework. They also found work and home identities became blurred 9. Frequent change to curricula, staffing, environments, etc. is characteristic of work in education. While change itself was acceptable, last-minute changes with no clear rationale were very stressful		100
⁵²	Medicine	Explore the impact of receiving a diagnosis of autism and the effect on developing insight into specific challenges in medical training	Semistructured face-to-face interviews	1. Diagnosis led to insight regarding previous difficulties but also held potential for stigma and discrimination 2. Receiving a diagnosis was only helpful in the workplace if it led to improvements 3. Disclosing autism diagnosis could lead to distressing responses, and lack of understanding, including an attempt to remove one participant from the training course	Limited detail about analysis	80
⁵⁰	Medicine	Explore the experiences of autistic clinicians and the benefits of participation in a supportive community of those with similar experiences	Online survey, cross-sectional study	1. Participants experienced high rates of co-occurring mental ill-health, including anxiety (40%), depression, ADHD/ADD (29%), PTSD (18%), eating disorder (13%), social anxiety (10%), burnout, masking, suicidal thoughts (77%), self-harm (49%) 2. Most participants did not disclose autism at medical school. Of those who disclosed only half received adjustments. A quarter took longer to compete medical school than their peers 3. Most enjoyed their work as doctors. A total of 73% felt that being autistic helped their work as doctors. A total of 73% felt that being autistic hindered their work as doctors 4. Most experienced challenges with executive functioning and sensory issues at work, 75% had communication challenges; with peers (76%), supervisors (74%), management (75%). A total of 21% reported challenges in communication with patients, 65% reported challenges from judgment or attitudes of other people at work. A total of 24% had issues at work requiring HR or a disciplinary process, 9% had formal/ regulatory process, 30% required union or legal representation 5. Few participants felt able to disclose “the luxury of disclosure may be unavailable, excessively burdensome, or even harmful”; participants disclosed to their supervisor/consultant (32%), colleagues (30%), occupational health (19%), HR (16%), patients (8%), no-one at work (29%) 6. A total of 46% requested reasonable adjustments, 49% of those who requested adjustments had them implemented. A total of 75% of those who received adjustments found them helpful 7. Participants indicated the following changes would be helpful: A manageable workload (50%), being able to disclose being autistic (49%), better work environment (less noise, different lighting) (48%), more autism understanding from colleagues (44%), more flexibility from employers (44%), more autism understanding from employers (42%) 8. A total of 49% engaged in self-harm, 77% had considered suicide, 24% had attempted suicide. Considering autism to be a disorder was associated with having attempted suicide (p = 0.019). Self-harm was associated with having requested adjustments at work (p = 0.039) (64% of participants who requested adjustments but did not receive them self-harmed), disclosing to consultant/supervisor (p = 0.002), disclosing to occupational health (p = 0.001), sexual orientation (p = 0.007), current grade (p = 0.003), stage when they realized they may be autistic (p = 0.01), having never worked with another doctor who they suspected was autistic (p = 0.022). Participants who did not disclose were less vulnerable to self-harm and suicidal ideation. Membership of ADI was beneficial (88%), and positive for mental health (72%)	Limited detail about study recruitment	80
⁵¹	Medicine/Psychiatry	What are the experiences of autistic psychiatrists in relation to recognizing autism?	Interpretive phenomenological methodology, online interview	1. Recognizing oneself as autistic, participants recognized they were autistic following diagnosis of family members, encounters with autistic patients, or discussion with friends 2. Recognizing autistic colleagues, participants recognized shared identity, they watched others follow the same path toward realization that they had experienced 3. Self-recognition led to improved recognition of patients being autistic 4. Lack of exposure to heterogeneity among autistic people during training meant participants had limited and stereotypical views of autism and did not recognize it in themselves 5. Neurodiversity-affirming framing of autism benefited participant mental health, and participants were keen to use this knowledge to benefit patients 6. One participant diagnosed during childhood, displayed positive self-identity and self-assurance compared with other participants		100
⁵³	Nursing	To describe how nurses with ADHD and/or autism experience their working life	Semistructured interviews	1. Their job is a great interest for them 2. Their strengths and talents are useful at work 3. Work environment (physical, social, and sensory) can be stressful 4. Participants liked their colleagues but preferred work-based interactions over socialization 5. Managers intend well but lack resources 6. Participants fear loss of adaptations and support 7. Participants feel different from colleagues 8. Participants use masking strategies, including not disclosing diagnoses at work 9. Participants identified strategies that help at work, including organizing own time, home working, working part-time, taking breaks, using organizational aids, and developing self-awareness of needs 10. Employers mostly left participants to organize their own adaptations	Not all participants were autistic	100
⁵⁸	Academia	To explore the perspectives and experiences of autistic individuals working in academia across various disciplines on the benefits and barriers to pursuing a career in the academy	Each month, over a 12-month period, researchers invited participants to provide a written reflection on a specific topic, with prompts provided by researchers, participants were encouraged to write about any aspect of the topic that was of interest or relevance to them. Inductive reflexive thematic analysis	1. Social interaction is complicated. Participants required emotional to “fit in” at work. Colleagues viewed autistic people as rude, hostile, or disinterested. Prosopagnosia (inability to recognize faces) made social interaction more complicated especially with new intakes of students every year. Participants enjoyed helping others, sharing their knowledge, making positive changes 2. Academic jobs require flexibility. Staff must negotiate lack of job security, heavy workload, rigid processes and protocols, lack of autonomy, performance aspects of teaching. Participants enjoyed autonomy and flexibility around when and where to work, capacity to make own decisions, to focus on areas of research and teaching of interest to them, to work in ways that suit their cognitive processes and sensory needs, potential for career progression and job stability, being able to follow routine, visible indicators of success (winning grants, publishing articles), employment conditions, including generous leave provisions and superannuation 3. Autistic people have different operating systems, differences in information processing, learning styles, processing speed, dealing with change, and information synthesis. This can be an advantage when working with complex data. Perseverance, perfectionism, and attention to detail can be strengths. Difficulties were associated with identifying key points, separating detail from big picture, managing deadlines, organizing data, switching between activities, maintaining focus, initiating activities. Coping strategies included writing lists, calendar reminders, organizational tools, working part-time. Others reported pushing themselves to the extreme, constant feeling of not meeting set goals 4. Communication challenges include difficulty finding the right words, not understanding questions, expressions and tone of voice, participants expected to respond, knowing how to start and end conversations, feeling that others don’t understand their communication, sensitive to criticism. Participants enjoyed connecting with others over shared interests and goals 5. Senses working overdrive—constant sensory input can lead to sensory overload and meltdown 6. Institutional policies can exacerbate challenges by restricting access to environmental adjustments		100
⁵⁹	Academia	To provide advice for autistic people considering a career in academia from the perspective of people already working in this environment	As⁵⁸	1. Know the role; research the opportunity and organization before accepting the role 2. Find the right people, network, find other autistic people, work out the best way to communicate with colleagues 3. Know and value yourself, know your own skills, weaknesses and strengths, be prepared for failure and rejection 4. Maintain balance with self-care, be prepared to teach others about autism and your personal experience, complexity of decision to disclose 5. Proceed with caution but passion. Benefits include opportunity to focus on personal interests		100
⁵⁴	Academia	Reflect on experiences during the rapid shift of working practices experienced by people working in higher education in the United Kingdom during the COVID-19 pandemic	Autoethnography	1. Importance of routine. Anxiety arises when routines change—need to establish new routines agreed with work and family 2. The participant managed challenges associated with communication, including phone calls and video calls by asking colleagues to provide notice before calling, or using alternative methods (e.g., email). Participants could opt not to attend online meetings but to catch up via meeting minutes. Difficulties interpreting facial expressions. Participant maintained social interactions through social media 3. Sensitivity to noise, light, uncomfortable clothing, social interaction can result in migraine 4. Thinking style differences. Aphantasia. Need for predictability, executive function, working memory 5. Temporal and spatial boundaries—need space assigned for work. Tasks are associated with locations. Transition from home to work marked by exercising. Displayed information on pinboard to indicate work area 6. Working from home means you can be yourself more, including wearing what is most comfortable 7. Regulation strategies included stimming or pacing, use of noise canceling headphones 8. Benefits of choice and flexibility	No information on participant’s age, employment status, employment history, or background	80
⁵⁵	Academia	To explore challenges that autistic lecturers and researchers, including doctoral students, experience around university employment	Questionnaire. Thematic analysis	1. Lack of transparency around promotion conventions. Uncertainty regarding the replication of support following promotion 2. Transitioning into university employment can be difficult for autistic people who may have CVs with gaps around traditional work experience and qualifications 3. Recruitment processes do not play to autistic strengths 4. Inadequate induction 5. Bureaucracy 6. Insensitivity to diversity in the workplace. Reasonable adjustments should enable autistic talent to thrive 7. Unclear communication creates unnecessary anxiety 8. Benefits of peer support and supportive workplace culture and colleagues 9. There is a mismatch between rhetoric of inclusion and people’s practical experiences 10. Utilizing benefits of universal design could circumvent many barriers	Limited reporting of data analysis	80

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 Tool³⁹; 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.

Table 3.

Autistic Professional Needs and Differences, Challenges, Supports, and Coping Strategies

	Number of studies	Studies
Individual needs and differences
Communication differences, particularly around social interaction	10	^{7,8,48,49,51–53,55–57}
Sensory differences	8	^{8,48,51–53,56,57,59}
Cognitive/Executive function/Processing differences	7	^{7,8,48,51,53,54,57}
Focusing on special interests	6	^{8,48,51,53,54,56}
Deeper understanding of neurodivergent patients and learners	6	^{7,8,49,56,58,59}
Increasing diversity and acting as a role model	6	^{8,49,51,53,56,59}
Having other minoritized identities	3	^8,48,53
Motor skills differences	1	⁵¹
Workplace challenges
Colleagues’ limited knowledge and understanding of autism	9	^{8,48–51,53–56}
Workplace physical and sensory environment	7	^{8,51–53,56,57,59}
Bullying, discrimination, exclusion, marginalization of autistic people	7	^{7,8,48,50,51,53,56}
Limited information and unpredictability	7	^{7,8,52,53,55–57}
Decisions about disclosing their neurodivergent identity to managers and colleagues, to access support or to act as a role model, while avoiding discrimination or stigma	7	^{8,48–51,56,59}
Failure/challenge of employers to implement reasonable adjustments	6	^{8,48,51,53,55,59}
Unclear or discriminatory processes around recruitment, induction, work expectations, and promotion	5	^7,8,48,53,55
Mental ill-health, anxiety, depression, suicidality	3	^48,55,56
Supports and coping strategies
Autistic peer support	5	^{8,48,49,54,55}
Supportive colleagues and managers	5	^7,8,54–56
Work from home, remote working	5	^{51–53,55,57}
Use of technology, tools, and aids to support organization and communication, including workplan, timetable	5	^51–54,57
Time out, shutdown, breaks, holiday	4	^8,51,53,56
Diagnosis to support self-understanding	3	^48–50
Working reduced hours, or leaving	3	^8,48,56
Masking and social scripting	3	^49,51,56
Self-awareness, self-care, self-advocacy	2	^51,54
Self-regulation activities including stimming	1	⁵²
Neurodiversity-affirming approach	1	⁴⁹

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 information⁵³ 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 Collective⁵⁵ 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.

Supplemental Material

References

Hotez

, Phan

, Truong

. Addressing stigma-related health disparities for autistic individuals through cultural competemility: Insights from research and lived experience. Curr Psychiatry Rep. 2024; 26(12):761–770; doi: 10.1007/s11920-024-01551-y

Battalova

, Bulk

, Nimmon

, et al. “I can understand where they’re coming from”: How clinicians’ disability experiences shape their interaction with clients. Qual Health Res. 2020; 30(13):2064–2076; doi: 10.1177/1049732320922193

Mckinlay

, Thorpe

, Cage

, Grainger

, Jasper

, Stewart

. A systematic review: Which psycho-social-environmental factors do autistic students identify as being important for positive experiences in mainstream secondary school? Autism. 2024; doi: 10.1177/13623613241285974

Milton

DEM

. On the ontological status of autism: The ‘double empathy problem’. Disability & Society. 2012; 27(6):883–887; doi: 10.1080/09687599.2012.710008

Jones

, Botha

, Ackerman

, King

, Sasson

. Non-autistic observers both detect and demonstrate the double empathy problem when evaluating interactions between autistic and non-autistic adults. Autism. 2024; 28(8):2053–2065; doi: 10.1177/13623613231219743

Crompton

, Hallett

, Ropar

, Flynn

, Fletcher-Watson

. ‘I never realised everybody felt as happy as I do when I am around autistic people’: A thematic analysis of autistic adults’ relationships with autistic and neurotypical friends and family. Autism. 2020; 24(6):1438–1448; doi: 10.1177/1362361320908976

Lawrence

. “I can be a role model for autistic pupils”: Investigating the voice of the autistic teacher. Teacher Education Advancement Network Journal. 2019; 11(2).

Wood

. Happier on the outside? Discourses of exclusion, disempowerment and belonging from former autistic school staff. Research in Spec Educ Needs. 2024; 24(1):39–52; doi: 10.1111/1471-3802.12612

Gámez-Calvo

, Muñoz-Jiménez

, Gozalo

. The importance of positive attitudes toward disability among future health and education professionals: A Comparative Study. Educ Sci (Basel). 2025; 15(1):61; doi: 10.3390/educsci15010061

10.

Doherty

, Johnson

, Buckley

. Supporting autistic doctors in primary care: Challenging the myths and misconceptions. Br J Gen Pract. 2021; 71(708):294–295; doi: 10.3399/bjgp21x716165

11.

Granger

, Hameed

, Kelly

. Neurodivergence and the healthcare workforce: A hidden facet within equality, diversity and inclusion? BMJ Leader. 2023; 7(Suppl 2):1.7–7; doi: 10.1136/leader-2023-000809

12.

Doherty

, McCowan

, Shaw

. Autistic SPACE: A novel framework for meeting the needs of autistic people in healthcare settings. Br J Hosp Med (Lond). 2023; 84(4):1–9; doi: 10.12968/hmed.2023.0006

13.

Doherty

, Neilson

, O’Sullivan

, et al. Barriers to healthcare and self-reported adverse outcomes for autistic adults: A cross-sectional study. BMJ Open. 2022; 12(2):e056904; doi: 10.1136/bmjopen-2021-056904

14.

Marjadi

, Flavel

, Baker

, et al. Twelve tips for inclusive practice in healthcare settings. Int J Environ Res Public Health. 2023; 20(5):4657; doi: 10.3390/ijerph20054657

15.

Nevarez

, Jouganatos

, Wood

. Benefits of teacher diversity. JSARD. 2019; 4(1):24–34; doi: 10.32674/jsard.v4i1.1940

16.

Neca

, Borges

, Pinto

. Teachers with disabilities: A literature review. International Journal of Inclusive Education. 2022; 26(12):1192–1210; doi: 10.1080/13603116.2020.1776779

17.

Lindsay

, Fuentes

, Ragunathan

, Lamaj

, Dyson

. Ableism within health care professions: A systematic review of the experiences and impact of discrimination against health care providers with disabilities. Disabil Rehabil. 2023; 45(17):2715–2731; doi: 10.1080/09638288.2022.2107086

18.

Saltes

. ‘It’s all about student accessibility. No one ever talks about teacher accessibility’: Examining ableist expectations in academia. International Journal of Inclusive Education. 2022; 26(7):674–700; doi: 10.1080/13603116.2020.1712483

19.

Drakeley

. What Happens Next? A report on the outcomes of 2019 disabled graduates. 2022. Available from: https://www.agcas.org.uk/write/MediaUploads/Resources/Research%20and%20knowledge/WHN_2022.pdf

20.

Vincent

, Ralston

. Uncovering employment outcomes for autistic university graduates in the United Kingdom: An analysis of population data. Autism. 2024; 28(3):732–743; doi: 10.1177/13623613231182756

21.

Vincent

, Fabri

. The ecosystem of competitive employment for University Graduates with Autism. International Journal of Disability, Development and Education. 2022; 69(5):1823–1839; doi: 10.1080/1034912x.2020.1821874

22.

Davies

, Romualdez

, Pellicano

, Remington

. Career progression for autistic people: A scoping review. Autism. 2024; 28(11):2690–2706; doi: 10.1177/13623613241236110

23.

Bulk

, Easterbrook

, Roberts

, et al. ‘We are not anything alike’: marginalization of health professionals with disabilities. Disability & Society. 2017; 32(5):615–634; doi: 10.1080/09687599.2017.1308247

24.

Gross

, Jarus

, Mayer

, et al. Professional practice placement as a unique challenge for students with disabilities in health and human service educational programmes. International Journal of Inclusive Education. 2025; 29(4):534–552; doi: 10.1080/13603116.2023.2195858

25.

Romualdez

, Walker

, Remington

. Autistic adults’ experiences of diagnostic disclosure in the workplace: Decision-making and factors associated with outcomes. Autism Dev Lang Impair. 2021; 6:23969415211022955; doi: 10.1177/23969415211022955

26.

Pryke-Hobbes

, Davies

, Heasman

, et al. The workplace masking experiences of autistic, non-autistic neurodivergent and neurotypical adults in the UK. PLoS One. 2023; 18(9):e0290001; doi: 10.1371/journal.pone.0290001

27.

Coney

. What should be done to ensure autistic graduates succeed in the workplace? The. Journal of Inclusive Practice in Further and Higher Education. 2021; 13(1).

28.

Jarus

, Krupa

, Mayer

, et al. Negotiating legitimacy and belonging: Disabled students’ and practitioners’ experience. Med Educ. 2023; 57(6):535–547; doi: 10.1111/medu.15002

29.

Jarus

, Liao

, Battalova

, et al. Policies as barriers for disabled medical learners: Exploratory study of learners’ perspectives. Disability & Society. 2023; 38(10):1763–1778; doi: 10.1080/09687599.2022.2041403

30.

Nagtegaal

, De Boer

, Van Berkel

, Derks

, Tummers

. Why do employers (fail to) hire people with disabilities? A systematic review of capabilities, opportunities and motivations. J Occup Rehabil. 2023; 33(2):329–340; doi: 10.1007/s10926-022-10076-1

31.

Maciver

, Rutherford

, Johnston

, Curnow

, Boilson

, Murray

. An interdisciplinary nationwide complex intervention for lifespan neurodevelopmental service development: Underpinning principles and realist programme theory. Front Rehabil Sci. 2022; 3:1060596; doi: 10.3389/fresc.2022.1060596

32.

Curnow

, Maciver

, Johnston

, et al. Learning from the experiences of autistic professionals working in health and education. Autism in Adulthood. 2025; doi: 10.1089/aut.2024.0168

33.

Page

, McKenzie

, Bossuyt

, et al. PRISMA 2020 Statement: An updated guideline for reporting systematic reviews. BMJ. 2021; 372(71):n71; doi: 10.1136/bmj.n71

34.

Moher

, Liberati

, Tetzlaff

, Altman

, PRISMA Group. The PG. Preferred reporting items for systematic reviews and meta-analyses. PLoS Med. 2009; 6(7):e1000097.

35.

Collins English Dictionary. Profession. HarperCollins Publishers; 2025. Available from: https://www.collinsdictionary.com/dictionary/english/profession [Last accessed: April 2, 2025].

36.

Lefebvre

, Glanville

, Briscoe

, et al. Searching for and selecting studies. In: Higgins

JPT

, Thomas

, Chandler

, et al. eds. Cochrane Handbook for Systematic Reviews of Interventions. version 6.3. Cochrane; 2022:chap 4.

37.

Hartling

, Featherstone

, Nuspl

, Shave

, Dryden

, Vandermeer

. The contribution of databases to the results of systematic reviews: A cross-sectional study. BMC Med Res Methodol. 2016; 16(1):127.

38.

Covidence systematic review software. Available from: www.covidence.org

39.

Hong

, Fàbregues

, Bartlett

, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. EFI. 2018; 34(4):285–291; doi: 10.3233/efi-180221

40.

Lucas

, Baird

, Arai

, Law

, Roberts

. Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Med Res Methodol. 2007; 7(1); doi: 10.1186/1471-2288-7-4

41.

Rutherford

, Johnston

. Rethinking Autism Assessment, Diagnosis, and Intervention Within a Neurodevelopmental Pathway Framework. In: Autism Spectrum Disorders—Recent Advances and New Perspectives [Working Title]. IntechOpen; 2022.

42.

The Buckland Review of Autism Employment: report and recommendations. HMSO; 2024.

43.

Scottish Government. Fair Work action plan: Becoming a leading Fair Work Nation by 2025. Scottish Government. Public sector and the role of leadership—Fair Work action plan: becoming a leading Fair Work nation by 2025–gov.scot. Available from: www.gov.scot [Last accessed: July 25, 2024].

44.

Scottish Government. Learning Disabilities, Autism and Neurodivergence Bill: Consultation. Scottish Government Mental Health Directorate. Available from: https://www.gov.scot/publications/learning-disabilities-autism-neurodivergence-bill-consultation/documents/ [Last accessed: July 19, 2024].

45.

Curnow

, Rutherford

, Maciver

, et al. Beyond Accommodations: Supporting Autistic Health Professionals. Practice based guide for employers and employees. Queen Margaret University: Edinburgh, UK; 2024.

46.

Curnow

, Rutherford

, Maciver

, et al. Beyond Accommodations: Supporting Autistic Professionals in Education. Practice based guide for employers and employees. Queen Margaret University: Edinburgh, UK; 2024.

47.

Dettori

, Norvell

. Kappa and beyond: Is there agreement? Global Spine J. 2020; 10(4):499–501; doi: 10.1177/2192568220911648

48.

O’Neill

, Kenny

. “I Saw Things through a Different Lens…”:An Interpretative Phenomenological Study of the Experiences of Autistic Teachers in the Irish Education System. Educ Sci (Basel). 2023; 13:670; doi: 10.3390/educsci13070670

49.

Ware

, Singal

, Groce

. The work lives of disabled teachers: Revisiting inclusive education in English schools. Disability & Society. 2022; 37(9):1417–1438; doi: 10.1080/09687599.2020.1867074

50.

Shaw

SCK

, Fossi

, Carravallah

, Rabenstein

, Ross

, Doherty

. The experiences of autistic doctors: A cross-sectional study. Front Psychiatry. 2023; 14:1160994; doi: 10.3389/fpsyt.2023.1160994

51.

Doherty

, Chown

, Martin

, Shaw

SCK

. Autistic psychiatrists’ experiences of recognising themselves and others as autistic: A qualitative study. BJPsych Open. 2024; 10(6):e183; doi: 10.1192/bjo.2024.756

52.

Price

, Lusznat

, Mann

, Locke

. Doctors with Asperger’s: The impact of a diagnosis. Clin Teach. 2019; 16(1):19–22; doi: 10.1111/tct.12743

53.

Hedlund

, Jordal

. Feeling like an untapped resource. Experiences of working life among nurses with ADHD and/or autism: An interview study. Int J Nurs Stud. 2024; 158:104857; doi: 10.1016/j.ijnurstu.2024.104857

54.

Hannam-Swain

, Bailey

. Considering Covid-19: Autoethnographic reflections on working practices in a time of crisis by two disabled UK academics. Soc Sci Humanit Open. 2021; 4(1):100145; doi: 10.1016/j.ssaho.2021.100145

55.

Martin

. Perspectives on UK university employment from autistic researchers and lecturers. Disability and Society. 2021; 36(9):1510–1531; doi: 10.1080/09687599.2020.1802579

56.

Wood

, Happé

. What are the views and experiences of autistic teachers? Findings from an online survey in the UK. Disability & Society. 2021; doi: 10.1080/09687599.2021.1916888

57.

Wood

, Crane

, Happé

, Moyse

. Learning from autistic teachers: Lessons about change in an era of COVID-19. Educ Rev (Birm). 2024; 76(5):1209–1231; doi: 10.1080/00131911.2022.2103521

58.

Jones

. Autistics working in academia: What are the barriers and facilitators? Autism. 2023; 27(3):822–831; doi: 10.1177/13623613221118158

59.

Jones

. Advice for autistic people considering a career in academia. Autism. 2023; 27(7):2187–2192; doi: 10.1177/13623613231161882

60.

Beck

, Lundwall

, Gabrielsen

, Cox

, South

. Looking good but feeling bad: “Camouflaging” behaviors and mental health in women with autistic traits. Autism. 2020; 24(4):809–821; doi: 10.1177/1362361320912147

61.

Edelist

, Zaman

, Katzman

, Jarus

. ‘Patient’ or ‘Professional’? Negotiating accommodations and identity in fieldwork education. Med Educ. 2024; 58(9):1107–1116; doi: 10.1111/medu.15365

62.

Davies

, Cooper

, Killick

, et al. Autistic identity: A systematic review of quantitative research. Autism Res. 2024; 17(5):874–897; doi: 10.1002/aur.3105

63.

Overton

, Marsà-Sambola

, Martin

, Cavenagh

. Understanding the Self-identification of Autism in Adults: A Scoping Review. Rev J Autism Dev Disord. 2024; 11(4):682–702; doi: 10.1007/s40489-023-00361-x

64.

Cooper

, Russell

, Lei

, Smith

LGE

. The impact of a positive autism identity and autistic community solidarity on social anxiety and mental health in young people. Autism. 2023; 27(3):848–857; doi: 10.1177/13623613221118351

65.

Holtom

, Lloyd-Jones

. Review of the Demand, Capacity and Design of Neurodevelopmental Services: Full Report. Welsh Government: Cardiff, UK; 2022.

66.

Romualdez

, Heasman

, Walker

, Davies

, Remington

. “People might understand me better”: diagnostic disclosure experiences of autistic individuals in the workplace. Autism in Adulthood. 2021; 3(2):157–167; doi: 10.1089/aut.2020.0063

67.

Raymaker

, Sharer

, Maslak

, et al. “[I] don’t wanna just be like a cog in the machine”: Narratives of autism and skilled employment. Autism. 2023; 27(1):65–75; doi: 10.1177/13623613221080813

68.

Brownlow

, Werth

, Keefe

. Autism Spectrum Disorder: Emotion Work in the Workplace. Work and Identity. Springer International Publishing; 2018:23–37.

69.

Davies

, Heasman

, Livesey

, Walker

, Pellicano

, Remington

. Autistic adults’ views and experiences of requesting and receiving workplace adjustments in the UK. PLoS One. 2022; 17(8):e0272420; doi: 10.1371/journal.pone.0272420

70.

Lindsay

, Osten

, Rezai

, Bui

. Disclosure and workplace accommodations for people with autism: A systematic review. Disabil Rehabil. 2021; 43(5):597–610; doi: 10.1080/09638288.2019.1635658

71.

Petty

, Tunstall

, Richardson

, Eccles

. Workplace adjustments for autistic employees: What is ‘reasonable’? J Autism Dev Disord. 2023; 53(1):236–244; doi: 10.1007/s10803-021-05413-x

72.

Burgstahler

, Russo-Gleicher

RRJ

. Applying universal design to address the needs of postsecondary students on the autism spectrum. J Postsecond Educ Disabil. 2015; 28(2):199–212.

73.

Man

, Zhu

, Sun

. The positive effect of workplace accommodation on creative performance of employees with and without disabilities. Front Psychol. 2020; 11:1217; doi: 10.3389/fpsyg.2020.01217

74.

Davies

, Heasman

, Livesey

, Walker

, Pellicano

, Remington

. Access to employment: A comparison of autistic, neurodivergent and neurotypical adults’ experiences of hiring processes in the United Kingdom. Autism. 2023; 27(6):1746–1763; doi: 10.1177/13623613221145377

75.

General Medical Council. Welcomed and valued: Supporting disabled learners in medical education and training. Available from: https://www.gmc-uk.org/-/media/documents/welcomed-and-valued_pdf-78466923.pdf?la=en&hash=F5094C539A5F889830D51FF57CBE6A98BD016C9E [Last accessed: April 3, 2025].

76.

Wood

, Gagat-Matula

, Domagała-Zyśk

, Mazur Vel Butynski

. ‘We are here and we deserve it’: Being an autistic teacher in Poland. International Journal of Inclusive Education. 2025; 2025:1–16; doi: 10.1080/13603116.2025.2518393

77.

Jack

, Crane

, Kenny

, Blaisdell

, Davis

. “There’s only so much the school can change about itself … Before you need to change something about yourself”—A qualitative analysis of the experiences of neurodivergent student teachers. Autism in Adulthood. 2024:2024; doi: 10.1089/aut.2024.0047

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.04 MB

0.03 MB

0.02 MB

0.00 MB