Cross-Cultural Comparison of Everyday Participation in Males and Females with Asperger's Syndrome/High-Functioning Autism Living in Australia and Taiwan

Background: Adolescents and adults with Asperger’s syndrome (AS)/high-functioning autism (HFA) commonly have limited social participation stemming from social deficits and concurrent social anxiety. Previous researchers have identified better sociability in females with AS/HFA than males. Because of increased stigma, Chinese people with disability may experience more restricted daily participation than peers in Western countries. However, no comparison has been done regarding the social participation between males and females living in different cultural contexts. Exploring how the personal characteristics and country of residence affect participation will help identify person-centered intervention targets. 

Objectives: The purpose of this study was to compare everyday participation of individuals with AS/HFA in Australia and Taiwan under the effects of autism symptoms and social anxiety. 

Methods: Fourteen Australians (4 males; aged 16-43 years) and 16 Taiwanese (12 males; aged 19-45 years) with AS or HFA participated in the study. Participants carried an iPod Touch/iPhone which prompted them randomly, 7 times/day for 7 days, to record where they were, what they were doing, and who they were with. We conducted multilevel analyses to identify the relationships between the patterns of everyday participation and potentially associated factors which include gender, country of residence, and severity of autism and social anxiety measured by Social Responsiveness Scale and Social Interaction Anxiety Scale respectively. 

Results: Taiwanese were more likely to stay at home than Australians and less likely to converse with people at school/work. Additionally, individuals with milder autism symptoms and/or higher levels of social anxiety had higher chances of not engaging in conversation. Conversely, females and/or individuals with more severe autism symptoms had higher probability of participating in social situations. Compared with Australian females, other participants were more likely not to engage in conversation. Males in both countries were less likely to participate in social activities, and Taiwanese males had the lowest chances of engaging in productive activities. 

Conclusions: The findings of the study shed light on ways that culture and gender impact social engagement, and highlight the relationships of autism severity and social anxiety to social participation. Researchers and service providers should consider different needs and targets for interventions that are specifically tailored for adolescents and adults with AS/HFA. Further research investigating their perception and experience in everyday participation is required.