Abstract
IMPORTANCE: Development of lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other gender and sexual minority (LGBTQIA+) identities and a disability identity is critical for positive mental health outcomes for LGBTQIA+ autistic individuals. OBJECTIVE: To understand identity development and evaluate the resonance of support among a large sample of LGBTQIA+ autistic adults. DESIGN: A sequential mixed-methods, participatory approach. SETTING: Data collection for both phases occurred remotely. PARTICIPANTS: LGBTQIA+ autistic adults completed the qualitative phase and the survey (Ns = 57 and 107, respectively). OUTCOMES AND MEASURES: Phase 1, the qualitative phase, included semistructured interviews and focus groups based on queer, crip, and intersectionality theories. Questions related to identity exploration and development. Themes regarding barriers and supports were used to develop a survey, used in Phase 2, to collect quantitative data to confirm the resonance of the findings. RESULTS: Participants described exposure, personal research, trial and error, and individuals external to the LGBTQIA+ and autistic communities as contributing to their evolving identities. If these contributing factors were positive, people described experiencing narrative gain, whereby they felt a sense of relief and pride over their identities, and if they were negative participants reported going through a journey toward self-acceptance. CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners can support LGBTQIA+ autistic adults in the identity development process by fostering connections with other LGBTQIA+ autistic individuals, providing accessible sexual health education supporting personal research and providing accessible resources, offering opportunities to explore identities through creative means, and creating supportive environments and safe spaces for self-exploration. Plain-Language Summary: Identity development is the process of understanding who you are. Occupational therapy practitioners can help support positive identity development for LGBTQIA+ autistic clients. In Phase 1 of the study, we talked to 57 LGBTQIA+ autistic people and asked them how they learned they were LGBTQIA+ and autistic. We used what we learned from those people to create survey questions, and we asked another 107 LGBTQIA+ autistic people whether the findings from our conversations in Phase 1 resonated with them as well. LGBTQIA+ autistic participants reported that they found it helpful to be exposed to people with diverse LGBTQIA+ and autistic identities; to be connected with articles, blogs, and people online who held diverse LGBTQIA+ and autistic identities; and to trial different identities. They also said it was helpful if people who were not LGBTQIA+ or autistic were supportive during this process. When people had more help, they had better acceptance of themselves. When people had less help, they said they had to learn to accept themselves. Positionality Statement: In this article, we use the term LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other gender and sexual minority identities) to refer to a spectrum of marginalized sexual orientations (e.g., lesbian, gay, bisexual, asexual), gender identities (e.g., transgender, nonbinary, agender), and biological variations in sex characteristics (e.g., intersex). We recognize that these identities are distinct but often interrelated, and unless otherwise specified we use LGBTQIA+ inclusively to reflect participants' self-identification. The first author is a White, straight, cisgender female with a history of generalized anxiety disorder. The second author is a mixed-race, queer, cisgender woman who is multiply neurodivergent, including autism, attention deficit hyperactivity disorder, and posttraumatic stress disorder. The third author is a White, queer, nonbinary autistic person. The fourth author is a White, straight, cisgender female. The research team has varied experience and expertise in conducting research. The first author has a PhD and is a licensed occupational therapist, the second author has worked for many years in research laboratories as a research assistant and coordinator and is a licensed occupational therapist, the third author has a background in quantitative designs and statistical analyses and has worked as a research assistant, and the fourth author worked as a research assistant while in graduate school and is a licensed occupational therapist.