Intersectional Experiences of Stigma and Their Relation to Mental Health Outcomes Among Black and White Autistic Adults

Non-autistic adults often harbor negative attitudes about autism and show a reluctance to interact with autistic people. Despite common misconceptions, many autistic adults express a strong desire for interaction, friendships, and romantic relationships but can struggle to achieve them. This gap between autistic social desires and actual social experiences can increase the risk for poor mental health outcomes for autistic adults. For those with multiple marginalized identities, the compounding effects of stigma based on both race and disability may further worsen mental health outcomes. Understanding the psychosocial factors that contribute to poor mental health in autistic adults is of great significance, yet no study to date has investigated the direct connection between social experiences, mental health status, and stigma for Black and White autistic adults. This dissertation investigated this relationship using a mixed-method approach. In phase one, autistic adults (N = 32) stratified by race (50% Black, 50% White) completed victimization and mental health questionnaires, qualitative interviews about their social and mental health experiences, an implicit association test to assess internalized stigma, and a videotaped semi-structured conversation with the investigator. To assess the prevalence and severity of their victimization and mental health challenges, a separate sample of Black and White non-autistic participants (N = 32, 50% Black, 50% White) also completed the questionnaire measures as a basis of comparison. In the second phase of the study, videos of autistic participants from phase one were shown to non- autistic raters, who provided their first impressions of each participant. Black autistic people were rated as more likeable and trustworthy, and raters endorsed a greater interest in interacting with these participants compared to White autistic people. Evidence of intersectional effects of race, gender, and autism were also observed, with Black autistic men evaluated more favorably than non-males, whereas White autistic men were evaluated less favorably than non-males. Peer evaluations and internalized stigma significantly predicted mental health outcomes, with more negative trait ratings, more positive social interest ratings, and greater internalized stigma associated with more adverse mental health outcomes. Black and White autistic people did not differ significantly in prevalence for most of the stigma and mental health measures, with autistic participants overall reporting high levels of stigma, anxiety, and suicidality. However, the nature of peer victimization, rather than the quantity of it, differed for Black and White autistic participants. Qualitative data were analyzed using thematic analysis, with results revealing that while many experiences of stigma are specific to one’s race or gender identity, Black and White autistic adults experience several commonalities in their social experiences. In particular, autistic adults across racial and gender identities reported that stigma and inaccessible social structures often contributed to their social difficulties, with many choosing to withdraw from social engagements to avoid potential stress, burnout, and meltdowns. These results suggest that holding multiple marginalized identities can moderate experiences of stigma in autistic adults and demonstrate the significant impacts that stigma can have on mental health in a diverse group of autistic adults.