Effect of Diagnostic Disclosure on First Impressions of Autistic Adults Made By Autistic and Neurotypical Observers

Background: Although adults on the autism spectrum (ASD) receive unfavorable first impressions from typically-developing (TD) adults, impressions improve when TD adults are made aware of their diagnosis (Sasson & Morrison, 2017). It is unclear, however, whether these patterns extend to autistic adults evaluating other autistic adults. Some work suggests autistic adults evaluate other autistic adults similarly to TD controls (Grossman et al., 2018), yet other evidence indicates autistic adults perceive autistic adults differently than TD peers (Milton, 2012).

Objectives: This study compared the first impressions of ASD and TD adults made by ASD and TD raters and examined how diagnostic disclosure affected those impressions.

Methods: ASD (n = 32) and TD raters (n = 62) adults served as rater participants. Each viewed 10 second videos of ASD (n =20) and TD (n = 20) stimulus participants introducing themselves (Sasson et al., 2017). Each video was presented with either an accurate diagnostic label (e.g. ASD adults as “this person has autism” and TD adults as “this person has no diagnosis”), or no label. Raters were then asked to give their first impression of the stimulus participant, rating six traits (e.g., awkwardness) and four behavioral intentions (e.g., desire to live near; Sasson et al., 2017).

Results: TD stimulus participants were rated more favorably than ASD stimulus participants on awkwardness, attractiveness, and dominance, and received stronger interest in hanging out with, sitting near, and having a conversation with from all raters (ps<.002). Compared to ASD raters, TD raters evaluated stimulus participants as less attractive but were more willing to hang out with them (ps<.02). ASD raters were more willing than TD raters to live near TD and ASD stimulus participants (ps<.03), but TD raters were more comfortable sitting near TD stimulus participants than they were ASD raters (p=.03).

Including an accurate diagnostic label was related to more favorable ratings on likeability and trustworthiness, and greater willingness to hang out with and start a conversation with stimulus participants (ps<.02), relative to when a diagnosis was withheld.

TD raters gave more favorable ratings to ASD stimulus participants when an accurate diagnostic label was provided compared to no label on awkwardness, likeability, comfort living near, and willingness to start a conversation with (ps<.01). In contrast, these patterns did not extend to ASD raters, whose ratings for ASD stimulus participants did not improve with a diagnostic label, and actually worsened for awkwardness ratings (p=.04).

Conclusions: Results suggest similarities and differences in how autistic adults are evaluated by TD and ASD adults. Overall, ASD participants were rated less favorably than TD participants by both groups. ASD raters expressed lower interest in hanging out with participants regardless of their diagnosis, and reduced comfort sitting next to TD participants. Further, only TD raters improved their ratings of ASD participants when a diagnosis was provided. ASD raters even evaluated ASD participants as more awkward when their diagnosis was known. Diagnostic disclosure therefore appears to improve first impressions of autistic adults made by TD but not by ASD raters.