Changing College Students' Conceptions of ASD: Benefits of an Online Training for Undergraduates in the United States and Lebanon

Background:  Despite evidence that ASD may be increasing in prevalence internationally (Elsabbagh et al., 2012), misconceptions (e.g. Japan: Koyama et al., 2008; Nepal: Kharti et al., 2011; Nigeria: Bakare et al., 2009; Saudi Arabia: Alqahtani, 2012) and stigma associated with ASD are apparent worldwide  (e.g. Australia: Gray, 2002; Iran; Dehvani et al., 2011; South Korea: Grinker & Cho, 2013). Cross-cultural comparisons of knowledge and stigma towards autism have not previously been published. We used an online survey to compare baseline conceptions of ASD, and changes in knowledge and stigma following an online training, among undergraduates in Lebanon and the U.S. These two cultural contexts vary widely in available services for people with ASD (Daou, 2014).

Objectives:  (1) Compare knowledge of and stigma towards ASD among college students in Lebanon and the U.S; (2) Evaluate effects of an online-training on knowledge and stigma associated with ASD in both countries.

Methods: Participants recruited from universities in Lebanon (N=387) and the U.S. (N=561) completed a demographics questionnaire, pre-test, online training, post-test, and the Broader Autism Phenotype Quotient (Hurley et al., 2007). The pre-test/post-test included an adapted version of Stone’s (1987) Autism Awareness Survey, a social distance scale assessing stigma towards autism (Bogardus, 1933), and an open-ended opportunity to define ASD.  Definitions of ASD were coded into non-mutually-exclusive categories by independent coders after they achieved reliability. Chi-square tests were used for categorical variables and Wilcoxon tests were used for ordinal variables (Jamieson, 2004).

Results:  In both countries, women (but not nuclear family members of people with ASD) exhibited less stigma toward ASD than men (ps < .008). Lebanese students had less knowledge and more stigma towards ASD than U.S. students at pre-test (ps<.001). Stigma decreased and knowledge increased in both groups after training (Figure 1 and 2; ps<.001). Lebanese students (21.7%) more frequently attributed ASD to negative parenting than U.S. students (6.8%; p<.001), but were also more likely to indicate that ASD diagnosis is affected by disparities in access to care (Lebanon: 34.3%; U.S: 13.5%; p < .001). More U.S. students (22.0%) confused ASD with other disorders (e.g., ADHD or cognitive difficulties) than Lebanese students (11.2%; p<.001). Lebanese students more often correctly defined ASD in terms of social-communicative difficulties (Lebanon: 51.6%; U.S: 32.5%, p<.001), but more often incorrectly stated that people with ASD lack social interest (15.8%) than U.S. students (3.0%, p<.001). Both Lebanese (5.8%) and U.S. (3.9%) students infrequently defined ASD in terms of restricted interests and repetitive behaviors (p=.25).

Conclusions:  While stigma towards ASD was higher in Lebanon than the U.S., specific misconceptions were more common in each country. In Lebanon, where fewer resources are available to support those with ASD, students were more aware of how disparities in access to care contribute to differences in diagnosis. Mirroring findings in South Korea (Grinker & Cho, 2013), Lebanese students more often defined ASD in terms of social differences and less often in terms of cognitive difficulties than U.S. students.  Findings suggest that online training could reduce misconceptions about ASD internationally.