Abstract
Background:
Given the high likelihood of Autistic individuals also being sexual and gender minorities, it is important to understand how Autistic-LGBTQ+ people understand prejudice events in the context of their intersectional identities.
Methods:
In this study, we used reflexive thematic analysis guided by an intersectional lens to explore experiences of heterosexism among 49 Autistic-LGBTQ+ adults. Specifically, we explored two issues as follows: (1) the nature of the heterosexist events they experienced and (2) the identities Autistic LGBTQ participants thought were related to a distressing heterosexist event they had experienced.
Results:
Heterosexist events were characterized by four themes, including rejection, harassment, invalidation, and discrimination. Participants often felt that several identities were salient when considering their heterosexist event. The four themes that described the experience of intersectional stressors for Autistic-LGBTQ+ participants are abbreviated here as follows: (1) assumptions about autism, (2) gender “as a bit of a double blow,” (3) queerness as “abhorrent,” and (4) “too young to know better.”
Conclusion:
We use intersectionality theory to frame stigma experiences for Autistic people who are also sexual and gender minorities, exploring clinical implications and future directions for research.
Community Brief
Why is this an important issue?
Autistic people are highly likely to identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+). Research has shown that Autistic-LGBTQ+ people experience higher stress and worse mental health concerns. This distress may be due to how they are treated by others and society, so we seek to learn about their experiences of being mistreated and how Autistic people make sense of these events.
What was the purpose of this study?
The purpose of this study was to explore the ways Autistic-LGBTQ+ people were mistreated by others because of their sexual orientation and what other identities were related to this mistreatment.
What did the researchers do?
Our data come from a more extensive online study focused on coping with sexual orientation-based stigma through writing. We asked 49 participants what social identities were important in understanding the event they chose to write about for this study.
What were the results of the study?
Autistic-LGBTQ+ people shared that several identities were very important to understand as part of their stigma event including autism/neurodivergence, gender, age, and religion. There were four types of stigma events that were described by participants as follows: rejection, invalidation, harassment, and discrimination. Participants spoke to the ways their multiple identities were important to understanding their stigma event. The themes were as follows: (1) If you’re Autistic, you can’t be queer: Assumptions about autism, (2) Gender as “a bit of a double blow,” (3) “Queerness as abhorrent”: Religiously influenced heterosexism, and (4) “Too young to know better”: The intersection of age and LGBTQ+ identities.
They also described different forms of mistreatment by others in their lives, such as the use of offensive language, others’ questioning their sexual or gender identities because of their autism, others saying they would not accept them, and refusing to let them in public spaces because of their sexual or gender identities.
What do these findings add to what was already known?
These findings extend what we know about the ways Autistic people experience mistreatment from others based on their Autistic identity, sexual orientation, gender identity, and the ways these identities together create a new type of stigma. We demonstrated that Autistic-LGBTQ people experience similar kinds of stigma events that have been studied among LGBTQ+ people. Participants also identified the ways that biases about autism and their younger age led to dismissing their LGBTQ+ identity, which highlights the ways that stereotypes can lead to mistreatment. These findings support the importance of other aspects of identity in developing supports and interventions for Autistic-LGBTQ+ people.
What are potential weaknesses in the study?
The sample was predominantly White, and our participants did not identify their race or ethnicity as being important in understanding their upsetting event. Hence, future research on the experiences of racial and ethnic minority Autistic-LGBTQ+ people is in order. Because our study examined archival data, we were not able to ask our participants follow-up questions.
How will these findings help Autistic adults now or in the future?
These findings can help us to understand external stressors that are harmful to Autistic-LGBTQ+ people. They can help Autistic people examine upsetting events through semi-structured prompts that focus on the influence of multiple social identities. In addition, they inform therapists who want to provide support, but do not know much about being both Autistic and LGBTQ+ and the stigma across these dual identities.
Background
Individuals living at the intersection of multiple oppressed identities experience complex stressors. For instance, LGBTQ+ individuals with disabilities are often targeted for harassment due to heterosexism and/or cissexism, which is compounded by ableism. 1 The current study aims to qualitatively explore how Autistic-LGBTQ+ people make sense of experiences of heterosexism in the context of their other identities.
According to minority stress theory, sexual and gender minority (SGM) health disparities are primarily explained by a heterosexist and cissexist culture, which results in harassment, maltreatment, discrimination, and victimization.2,3 Heterosexism is an ideological system that denies, denigrates, and stigmatizes any nonheterosexual form of behavior, identity, relationship, or community. 4 This belief can often manifest in society through heterosexist events involving discrimination, harassment, and rejection of LGBTQ+ people. 5 Such events and experiences can lead to sexual and gender minorities internalizing negative societal views of their LGBTQ+ identities. This process is known as internalized heterosexism and involves adapting one’s self-concept to be congruent with the stigmatizing societal responses related to sexual orientation.2,5 Sexual and gender minorities experience distal stressors, including discrimination, harassment, and invalidation. 6 These experiences can then be internalized and, in turn, contribute to health disparities in LGBTQ+ people.2,6 These stressors can include chronic and acute prejudice and discrimination, the expectation of minority stress, the internalization of negative societal attitudes, and the concealment of sexual orientation.2,6 Although initially focused on the experiences of LGBTQ+ people, the minority stress has been extended to understand the stigma experiences of other groups, including Autistic people. 7
Stigma about autism
The majority of research examining the intersection of stigma and autism has focused primarily on the perceptions of neurotypical people rather than of those with Autistic identities. 8 Such research has found that neurotypical individuals rate Autistic individuals as less socially competent and have less desire to engage with them socially 9 and that Autistic people are weird, 10 have difficult personalities, 11 or have advanced intellectual abilities. 12 Behaviors associated with autism often elicit stigmatization and rejection, as neurotypical individuals tend to have negative implicit attitudes toward Autistic individuals.8,13 Autistic people have reported being very aware that autism is viewed as “inherently ‘bad,’” which then leads to struggle with both concealment and outness, typically being met with stigma regardless of their decision. 14 As found among LGBTQ+ people, expectations of stigma, internalized stigma, and experiences of discrimination are associated with heightened psychological distress among Autistic people. 7 In one study, authors described “stigma as inescapable” for participants, noting that this occurred in the larger society and across settings and was often related to additional minoritized identities (e.g., sexuality, gender). 14
Anti-Autistic stigma occurs within health care settings as well. Autistic people may be hesitant to disclose their autism due to worry about provider attitudes and mistreatment. 15 Challenges stemming from provider biases are particularly evident for Autistic people who are also women, transgender or nonbinary, and racial and ethnic minorities.16–18 If Autistic people do not fit their stereotypes, which often reflect a White, cisgender male presentation, providers may doubt a person’s clinical presentation and whether or not they meet the criteria for autism.16,19,20 Such disparities highlight the need for an intersectional approach to research examining the needs of Autistic communities.
Intersectionality and autism
As Crenshaw highlighted in her seminal article exploring the intersection of race and gender, 21 intersectional marginalized identities exacerbate societal oppression and cannot be examined without privileged ones. An intersectional approach refers to how forms of stigma related to (but not limited to) race, ethnicity, gender, and disability do not stand alone but rather interact with one another.21,22 Examining intersectional, marginalized identities in a nuanced way remains an important area of exploration for helping professionals23,24 particularly as intersectionality becomes an increasingly used framework. Moradi and Grzanka 24 call attention to how using phrases like “intersecting identities” seems to serve as a “check box” at times for acknowledging multiple forms of oppression, without engaging deeply with what it means to have multiple oppressed identities. 25 Such discourses also fail to consider critical examinations of privilege, for example, by exploring how White, middle-class, cisgender identity norms may harm communities. 24 Autism, in particular, is associated with stereotypes of Whiteness, high socioeconomic status, and masculinity, 26 which contribute to inequities across systems.
In recent years, there has been increased use of intersectionality theory in research to understand better experiences of Autistic people, 27 including two special issues in Autism and Adulthood focused on the intersection of race and culture 28 and the intersection of LGBTQ+ identity. 29 Intersectionality theory can be useful in highlighting disparities in diagnosis across race and gender, 30 including differing diagnostic experiences 31 and rates of employment. 32 One systematic literature review of articles focused on Autistic youth found that racial/ethnic minority and low-income youth were more likely to be disconnected from occupational, educational, and social activities when entering adulthood. 33 Despite increased popularity, there are inconsistencies with how substantially researchers engage with intersectionality in autism research. For instance, in a narrative review, authors found that although intersectionality was discussed directly at times, in many cases, intersectionality was discussed indirectly or was not discussed at all. 26 Taking an intersectional approach involves not reducing autistic people to that identity alone. 27 Many have highlighted the importance of looking intersectionally at the experiences of Autistic SGM individuals,34–36 which we set out to do in this study. As stated by Botha and Gillespie-Lynch, 14 “intersectionality teaches us that we must understand differences within the Autistic community if we wish to help all Autistic people experience the dignity they deserve” (p. 107).
Autistic-LGBTQ+ experiences
One area of autism research that has been steadily growing is the intersectional experiences of having both Autistic and SGM identities. Prior research suggests a high co-occurrence of Autistic individuals who are transgender, nonbinary, or gender diverse37–39 along with greater diversity of sexual orientation. 40 Some Autistic people may experience their identities as being interrelated, such as seeing their experience of gender being influenced by their autistic identity, 17 although this is not the case for all Autistic people. Autistic individuals who are also LGBTQ+ are faced with complex experiences due to holding several marginalized identities. For instance, Autistic sexual minority people have been found to have higher rates of mental health concerns compared with their neurotypical, heterosexual counterparts, 41 whereas transgender Autistic adults are more frequently exposed to negative experiences than cisgender and neurotypical adults. 42 Such experiences may include people in LGBTQ+ communities not always understanding their Autistic identity and vice versa and having to manage isolation. 34 These challenges extend to health care and mental health care settings, as Autistic SGM people report barriers to finding service providers who are knowledgeable about their intersectional identities.34,43,44
Given the higher likelihood of being LGBTQ+ identified and thus being exposed to multiple forms of stigma, it is essential to understand how Autistic-LGBTQ+ people experience prejudice events, such as heterosexism, to inform clinical practice and interventions. Although there is research highlighting worse mental health and higher distress among Autistic sexual and gender minorities, 45 research has not explored the types of heterosexist events experienced by Autistic-LGBTQ+ people. We posit that it is impossible to separate heterosexism from other forms of identity-based stigma (e.g., cissexism, ableism, racism, ageism, ethnocentrism, and religious discrimination). As such, we were interested in exploring the following questions: (1) What types of heterosexist events do Autistic sexual minority individuals report as most distressing? (2) How do sexual minority Autistic individuals understand/make sense of heterosexist events in the context of other marginalized/oppressed identities?
Methods
Participants
The final sample included 49 Autistic, sexual minority participants ages 18–56 (M = 27.4, SD = 8.36) who reported a broad range of sexual orientations, including lesbian (26.5%), queer (26.5%), and bisexual/pansexual (18.7%). Participants were required to identify a heterosexist event that was still bothering them (i.e., something that had not been worked through) to meet the study’s criteria. The majority of participants in this study (57.1%) were transgender, nonbinary, or gender diverse (TNG) and White (69.4%). Most preferred identity-first language (i.e., Autistic person), and the majority had received a formal Autism Spectrum Disorder or related diagnosis (68%); however, this was not required to be included in this study. See Table 1 for more detailed information.
Participant Demographics
Researcher reflexivity statement
Our research team consisted of all sexual minority researchers in the field of counseling or clinical psychology. The first author is a White, neurotypical, lesbian cisgender woman working as an assistant professor. The second author is a White, cisgender, able-bodied bisexual woman and a core faculty member at a university. The third author is a racially diverse/ambiguous, lesbian, Autistic woman (autigender) doctoral student. The fourth author is a White, lesbian cisgender woman who is a tenured professor in clinical psychology. The fifth author is a White, lesbian/queer cisgender woman tenured in counseling psychology. We bracketed our assumptions before coding the qualitative data by reflecting on how our identities and experiences might influence our data interpretation. 46 Specifically, we anticipated that participants would identify aspects of autism/neurodivergence related to their heterosexist event; how others perceived them (ableist/othering), and how they navigated the social interaction. We took steps to manage these perspectives, which are detailed in the data analysis section.
Procedure
This study is part of a larger expressive writing intervention project in which participants completed three days of consecutive writing designed to facilitate coping with a heterosexist event. We received IRB approval from the University of Massachusetts Boston to conduct this study. Participants were enrolled in the study through a two-part screening, which included a brief eligibility survey and phone call to ensure they met criteria (i.e., LGBTQ+, Autistic, and able to identify a heterosexist event that was still causing some distress). During the phone call, participants were free to ask questions about study participation, research team identities and values, and plans for the data collected as part of this study. After being accepted to the study, participants received an invitation to begin the study by completing preintervention survey to collect data about their identities, diagnoses, and relevant measures such as mental health (e.g., depression, anxiety, traumatic stress), LGBTQ+ identity (e.g., outness, connection to community), heterosexist event, and relationship to intersectional identities (detailed below). In addition, participants were randomly assigned to one of two conditions and told they would be writing for three days beginning the next day.
Across both conditions, participants were asked to explore their heterosexist event through 15-minutes of daily expressive writing for a period of three consecutive days. Each day, participants were asked to describe their heterosexist event before engaging in guided or open writing, depending on the assigned condition. Although we only screened for heterosexist events, we found that participants also wrote about cissexist events. Participants were contacted one month later to further reflect on their experience participating in the study and how they understood their heterosexist event, including one question about the role of intersectionality. In a separate study focused on racial minority and gender minority LGBTQ+ people’s experiences with heterosexism, allistic participants reported increased insights about the ways their intersectional, oppressed, and privileged identities impacted their understanding of the heterosexist event over one to two months after completing the intervention.
For the purpose of this study, we examined data from a question asked at baseline, which asked participants to consider intersectionality, alongside data from a question asking them to describe their heterosexist event. We did not include data from the postintervention follow-up in this study, meaning that participants’ intersectional understanding of their heterosexist event may have changed. The intersectionality question prompted participants in the following way: “As you reflect upon the experience above, does this heterosexist experience intersect with other identities or marginalized statuses that you hold (e.g., race, ethnicity, gender identity, age, ability status, religion, etc.)?” Given the open-ended nature of this question, participant responses ranged from one word (e.g., gender) to several paragraphs.
Recruitment
Participant recruitment began by reaching out to members of the Autistic-LGBTQ+ community through snowball sampling, which is an effective way to access hard-to-reach populations, such as sexual minority individuals. 48 We sent flyers to listservs, organizations, and individuals and posted to online communities that centered the experiences of Autistic or SGM individuals.
Guiding paradigm
Abrams et al. 49 highlighted the factors to consider when using an intersectional framework, which we followed to guide our analysis and writing processes. The first factor to consider was how social categories or concrete social relations of interest framed the research questions. The second factor to consider was which societal arenas were relevant to research questions. The third factor was what historical processes or outcomes were of interest to the research questions. 49 We also considered the types of anti-LGBTQ+ experiences SGM people often report which was informed by the minority stress theory,2,3 to explore how these types of experiences manifest among Autistic-LGBTQ+ people, if at all. The present study explores how those with intersectional, marginalized identities (e.g., LGBTQ+, Autistic, and others) experience heterosexism while considering interlocking systems of oppression.
Data analysis
Our data analyses used an inductive approach to reflexive thematic analysis. 50 Thematic analysis was used because it is flexible but standardized as a way to recognize patterns within a dataset, 51 in which codes are seen as subjective and inseparable from the researcher’s identities and experiences. 52 The six main phases of thematic analysis included familiarization, coding, searching for themes, reviewing themes, defining and naming themes, and writing the report50,51 and were approached recursively. The first two authors familiarized themselves with the data before coding and wrote short labels to summarize the codes. The authors then met to discuss themes and patterns in the data, along with discussions about how our own positionality informed our interpretation of the data. Specifically, we reflected on our privileged identities as non-Autistic, White, women with high levels of socioeconomic and education privilege and took steps to manage these perspectives through regular conversations and memoing. 53 The authors then split the codes into preliminary codes for the first and second halves of the data. The authors met together to corroborate themes and reach agreement. We noticed the high representation of White Autistic perspectives, which we acknowledge perpetuates invisibility of the experiences of Autistic racial and ethnic minority individuals and remains a large gap in current peer-reviewed research. We considered epistemic privilege when choosing an auditor with lived experiences relevant to the topic of study, knowing that their interpretation of the data as a racially diverse/ambiguous Autistic person is a form of valued expertise that enhanced our analysis. 53
To establish the trustworthiness and credibility of our data, 54 we reached agreement about our themes from the two coders, and the third author acted as an auditor who reviewed our themes. The third author was then able to provide feedback on our themes and provide additional context through collaborative discussions guided by intersubjective recognition. 53 The auditor also provided input on potential missing codes and important contextual components. The fourth and fifth authors reviewed the themes and provided recommendations to strengthen the framing of intersectional stigma. Themes were reviewed, and representative quotes demonstrating the intersectional nature of stigma events were confirmed.
Results
We begin this section by presenting the types of heterosexist events participants detailed and conclude by sharing the intersectional identities that participants felt were important in understanding their heterosexist events. Approximately 87.5% (n = 49) of participants in the study reported that at least two identities influenced how they understood their heterosexist event. Participants endorsed the following identities as being important: autism/neurodivergence (n = 26), gender (n = 17), religion (n = 12), age (n = 7), race (n = 3), social class (n = 3), ethnicity (n = 1), mental health (n = 1), nationality (n = 2), and weight (n = 1). Themes and frequencies are presented in Table 2.
Themes and Frequencies
Characterizing heterosexist events
There were four types of heterosexist events that were described by participants as follows: rejection, invalidation, harassment, and discrimination.
Rejection
Participants identified experiences of rejection as still causing distress, which tended to intersect with their Autistic identity. The majority of these events involved family and included a reported rejection of identity when participants came out, outright stating that they would “never accept” participants for who they were or viewing “queerness as a problem” (Lesbian, White, Nonbinary). Across these events, Autistic participants primarily described rejection from meaningful people and relationships, including family and close friends, making it all the more painful. As stated by one participant, this rejection was difficult to work through in relation to their Autistic identity, “This has been very difficult for me to process, both because of her disdain and the fact that I have a hard time integrating a full and whole construct of myself given my autism and Black and White thinking” (Neuroqueer, White, Agender/Male). Even in the description of the event, participants’ use of evocative language was evident as they reported feeling “horribly rejected,” alone, “like an outsider,” humiliated, and angry. Participants also reported experiences of rejection in peer or support settings, such as being “ostracized” from a men’s group. Finally, one participant chose to process employment-based rejection stemming from their sexual minority identity, which resulted in being fired for public displays of affection with their partner.
Invalidation
Another prominent aspect of heterosexist events that participants shared was experiences of invalidation. Specifically, participants reflected on how others “disregarded their gender or sexuality” (Queer, White, Nonbinary) and avoided asking about their identity and romantic relationships. In many cases, casual heterosexism was perpetrated by language conveying that participants were “experimenting” (Bisexual, White, Bigender) or that their identity was “just a phase” (Asexual, White, Woman). Others talked about how family members attempted to deny or devalue their identity explicitly, particularly in relation to both Autistic and LGBTQ+ identities: “My ex-husband constantly used my attraction to women to berate and belittle me and threatened to use my sexuality as a weapon to take away the child I was forced to have…I still have to keep my autism and sexuality a secret in order to keep custody of my child.” (Lesbian, Indigenous, Genderqueer). Furthermore, for bisexual and pansexual participants, even when authentically sharing their sexual orientations, participants received messages that they were not who they said they were and were, in fact, straight.
Harassment
Participants reflected on experiences of harassment that occurred in both online and in-person relationships, which included the constant use of derogatory language or disparaging comments about sexual minority people, as well as being “mercilessly bullied” for not conforming to neurotypical social norms. As highlighted by one participant, “I was often called the he-she, and in P.E. I was once smacked with cricket bats because I was ‘perving’ on the other girls. This, of course, was not true” (Queer, White, Transgender). In this case, the individual was not yet aware of their sexual minority identity, but was due to perceived violation of what is expected for a cisgender, heterosexual (i.e., cishet) neurotypical girl, whereas others noted that harassment began after sharing an identity with people in their life. For instance, an asexual, multiracial, transgender participant reflected on an event that was most concerning to them, “I had someone who I used to be friends with start calling me racist and ableist and a problem (in terms of desexualizing people of color and Autistic people, even though I am both), specifically because I am asexual.” As highlighted within this category, harassment appeared related to other visible identities, such as gender expression and race, as shown in the following quote: “I was identified as male back then and tried to convince myself that I was completely straight throughout that time. Others said things like “Are you gay or what” to insult someone if they did something too “feminine” (Bisexual, White/Multicultural, Trans Woman). This harassment appeared to take place when Autistic individuals violated an unwritten social norm.
Discrimination
The final type of heterosexist event that participants reported in this study was experiences of discrimination. This was operationalized as a prejudicial treatment that often occurred in public settings. Participants detailed challenges finding housing and employment that were accepting or even tolerant of LGBTQ+ people. This discrimination occurred on the basis of their intersectional Autistic and sexual minority identities, highlighting the unique aspects of stigma. For instance, “I think my experience of this event was affected by my status as an Autistic person. It was always so hard for me to keep jobs and then when I found one I was good at, I got fired for being a lesbian” (Queer, White, Metagender). In addition, participants reported times when they were denied entry into public spaces, including a public swimming pool, a high school locker room, and a nightclub. As shared by one participant, their gender presentation led to this discrimination, “At the door, the guard stopped me and pushed me. He let everyone in except me. My friend tried to help me to get in and finally, the guard said: “I don’t know what that is. It can’t get in” (Questioning, Latinx, Female/Agender). In two of the aforementioned instances, participants were denied entry because of their sexual minority identity or relationship status as a same-gender couple, and also noted intersections with autism, as evidenced in the following quote, “I am naturally uncomfortable in interactive situations as an Aspie and the added stress of it going poorly due to sexuality is uncomfortable” (Gay, White, Male). In these examples, participants reported being singled out from their partners or peers and being treated in heterosexist ways related to their sexual minority identity.
Intersectional stigma
In this section, we present four themes that demonstrate the importance of intersectionality when understanding heterosexist experiences below: (1) If you’re Autistic, you can’t be queer: Assumptions about autism, (2) Gender as “a bit of a double blow,” (3) “Queerness as abhorrent”: Religiously influenced heterosexism, and (4) “Too young to know better”: The Intersection of age and LGBTQ+ identities.
If you’re autistic, you can’t be queer: Assumptions about autism
For the first theme, participants spoke about the intertwined nature of autism when considering their heterosexist events, particularly rooted in stereotypes about autism and sexuality, as well as what relationships can look like. Some of these harmful assumptions included that Autistic people are “not interested in romantic relationships” (Gay, White, Man) or are not capable of identifying sexual orientation. In contrast, others were focused on abilities, as evidenced by the following quote: “Autism. Others think people on the spectrum cannot love and be good parents. This also applies to dating. They thought it would cure me of being gay and that it was necessary because being Autistic meant I didn’t know what was best for myself” (Lesbian, Indigenous, Genderqueer). The impact of stereotypes about autism was evident in therapy settings as well, “I told a therapist I thought I was gay she said, ‘No you don’t strike me as gay you are probably ace because lots of people on the spectrum are’” (Queer, White, Female).
Participants also noted the ways being Autistic also impacted the interpersonal process or interactive component in heterosexist events. For instance, one participant shared that their family members refused to learn about autism or accommodate them. Others noted it was challenging to stand up for themselves or navigate self-advocacy when experiencing heterosexism and difficulty interacting with neurotypical people acting in heterosexist ways. Finally, others reflected on the judgment within the LGBTQ+ community surrounding their Autistic identities or interpersonal styles. One participant shared that they communicated in a “blunt” manner, which led to being misunderstood and eventually being blocked from an LGBTQ+ supportive group, “I tried to explain what I meant but they pointed out that if I don’t speak the same coded language that they do then that means I had no idea what it’s like to be LGBTQ” (Bisexual, Black, Woman). Many of these experiences highlighted communication differences between Autistic and neurotypical individuals, which compounded heterosexist experiences.
Gender as “a bit of a double blow.”
Participants viewed their gender identity and expression as playing a significant role in how they were treated regarding their heterosexist event. They described that their gender, in addition to their sexual orientation, compounded the impact of the event and led to additional stigma, as stated by this White, Asexual, Androgynous participant: “Agender. Because I appear female, I often get the added bonus of (mis)gendered insults like bitch, frigid and prude.” Some participants within this theme noted that their TNG identity was very connected to their experience, noting that “people seem less able to accept different gender identities than sexual identities” (Queer, White, Genderqueer). For participants who held both SGM identities, sometimes the heterosexist experiences invalidated their gender identity as well. This was the case for an Asexual, Genderqueer, Multiracial participant whose father commented that “gay/transgender people shouldn’t be allowed to use bathrooms/locker rooms with “normal” people.” This participant felt that the “disparaging comment” also targeted their “gender, which made it a bit of a double blow.” Their words highlight an additive understanding of stigma events, in that it felt the weight of being multiply stigmatized due to their intersectional oppressed identities. One participant spoke about autism, sexuality, and being genderless/agender as interrelated, commenting that “As such, my gender identity, being genderless/agender, is directly related to my autism. Because of this my disability and my gender and my sexuality are all the same to me.” This exemplifies the inseparable way they viewed their identities. In general, participants commented that their gender expression often prompted others to mistreat them, due to assumptions about how a person of the perceived gender should act, often reflecting traditional gender norms or roles.
“Queerness as abhorrent”: religiously influenced heterosexism
Within this theme, participants spoke about the ways religiosity shaped their heterosexist experiences. Participants reflected on their religious upbringings exposing them to stigma from family members who used religion to justify heterosexist behavior or attempted to use religion to convince them that they needed to “come to Jesus in order to not be gay anymore” (Lesbian, White, Woman Adjacent). Others shared that involvement in religious communities or environments subjected them to an environment where they experienced stigma from members of a religious community. For instance, participants shared examples of being rejected by their family or church after coming out or harassment when attending a service. As shared by one participant, “a few [people at my family’s church] have sneered at myself and my wife simply for briefly holding hands or because she was rubbing my back to calm me during an anxiety attack” (Queer, White, Transgender). Finally, participants reported that differences in religious beliefs (e.g., devout and atheist) contributed to heterosexist behaviors: “He was extremely religious (Mormon), and I was not” (Bisexual, White, Female). In many instances, religion was used to control or attempt to convince participants to act in ways they preferred such as insinuating the need for a heterosexual marriage, children, or virginity.
“Too young to know better”: the intersection of age, autism, and LGBTQ+ identities
Several participants spoke about the impact of age as a factor in their heterosexist event. This was evident in how others perceived them, and often reported as an intersection with their autism. One participant reflected this tension by stating, “I feel like my age and my neurodiversity also [led] to my mother assuming I was unable to make these decisions” (Queer, White, Female). Interestingly, all participants who identified age as contributing to heterosexism spoke about being young or younger than the person perpetrating heterosexism (e.g., “my identity as a disabled person, and as a young person”) or conversations with someone who felt they “knew better.” The intersection of age, autism, and heterosexism was particularly salient during interactions with families (both birth and chosen), in which family members questioned capacity for Autistic-LGBTQ+ adults to make decisions about their lives or recognize their identity. A participant reflected on comments made by their mother-in-law who stated, “I know you think you’re a lesbian, but if you found a goofy, kind, intelligent man, I know he’d sweep you off your feet” (Lesbian, White, Genderqueer). Participants also felt that their age also led others to take advantage of them as a young, sexual minority Autistic person. “My age definitely influenced this experience, since I was too young and unaware that workplace anti-discrimination laws exist” (Queer, White, Genderqueer/Nonbinary). In other cases, being young appeared to be connected to skills or knowledge participants had not yet experienced or navigated, such as self-advocacy or boundary setting, which in turn was complicated by stigma about autism.
Discussion
In the current study, intersectionality theory was used to explore the ways Autistic-LGBTQ+ people understood an experience of heterosexism in light of their intersectional identities. By analyzing data from 49 participants who engaged in a larger expressive writing intervention project, we were able to explore the nature of intersectional stigma events faced by individuals at the intersection of Autistic and LGBTQ+ identities. This manifested in different ways, including interpersonal stigma which was represented by disregarding queer identity on the basis of autism or the harassment of Autistic queer people who did not conform to a binary expression of gender. In addition, participants also reflected on the ways being Autistic were related to experiences of attempting to navigate heterosexist events while also managing neurotypical communication norms. Much of the prior literature using an intersectional SGM lens has focused on the intersection of autism and gender diversity,17,44 including how Autistic people experience their gender as related to their autism, which was described in our study, but is not a universal experience among Autistic gender minority people.
Despite the increased focus on gender and autism, there has been little emphasis on the broad LGBTQ+ and Autistic intersection, 29 which we aim to address in this study by examining heterosexist events among Autistic-LGBTQ+ people.
Intersectional minority stress
In part one of our study, we highlighted distal stressors experienced by Autistic-LGBTQ+ participants, which consisted of experiences of harassment, discrimination, invalidation, and rejection. Although prior research has demonstrated a worsening of mental health with increased membership in autistic, sexual minority, and gender minority groups, 45 our study characterized the types of heterosexist events that may be contributing to poor mental health outcomes from a minority stress lens.2,7 In addition, participants highlighted the importance of conceptualizing these distal stressor events (i.e., heterosexist stigma) through an intersectional lens informed by Autistic-LGBTQ+ experiences. This is similar to research on intersectional minority on the experiences of ethnic minority LGBTQ+ people, which provides a helpful overview of the process of developing a model of intersectional minority stress, 55 which may be a future direction of research.
In the second part of the results section, participants identified the ways that neuronormativity (i.e., privileging neurotypical norms and experiences), cisnormativity, religiosity, and other forms of oppression intertwined with heterosexism. For instance, participants reflected on the ways their autistic identity was used to desexualize them or to deny their sexual minority identity. In many cases, these responses were from families of origin, who may be continuing to view their Autistic offspring as children, rather than emerging adults or adults with sexual needs and awareness of their identities. Such beliefs that Autistic people are not sexual 56 or cannot identify a sexual minority identity despite an increased likelihood of identifying as LGBTQ+ 38 seem to illustrate intersecting ableism, heterosexism, and infantilization. The vast majority of Autistic people experience infantilization, where Autistic adults continue to be treated in child-like ways and fail to be recognized as cognitively adept adults. 57 The additive impact of harmful assumptions such as believing that an LGBTQ+ identity is a choice and that Autistic people are incapable of making their own informed decisions may lead to Autistic-LGBTQ+ people feeling disenfranchised and unable to authentically self-advocate, as shown in our study. The impact of intersecting heterosexism, ableism, and desexualization, rooted in infantilization, was reflected in our data through one participant’s therapist projecting their assumptions of asexuality, pointing to the importance of educating providers about possible areas of bias for Autistic-LGBTQ+ adults. Implicit negative biases about autism can also manifest by failing to recognize capacity and agency among Autistic adults making choices about their own lives. 56 In fact, recent research showed that Autistic people were viewed as more likely to experience hardship and feel pain, which authors theorized could have implications for perceptions of vulnerability and agency of autistic adults (i.e., being less able to navigate hardship 57 ).
Participants reflected on the ways that family religious doctrine was used to pressure Autistic adults to change their identity or behavior to align with family preferences. Although the use of faith as a tool of discrimination against LGBTQ+ people has been historically present, 58 there is a uniqueness present for those with intersecting Autistic-LGBTQ+ identities. Some research has indicated that Autistic people are found to have a lower preference for following existing religious scripts or partaking in organized religious ceremonies and a higher likelihood of identifying as agnostic, 59 which may have complicated their responses as religiously informed stigma. Overall, the intersection of heterosexist stigma, neuronormativity, and religiosity among Autistic adults appears important to explore further, as it was a painful strategy used to justify discrimination against Autistic-LGBTQ+ adults in this study.
Although among the participants, there was strong identification with the dual identity of being both Autistic and LGBTQ+, there was also a minimal expression of racial, class, mental health, and obesity identities beyond one-word responses. The result that race or ethnicity did not play a more central role was surprising given the strong emotions that were expressed when it came to intersectionality surrounding Autistic and LGBTQ+ identities, as we anticipated similar sentiments regarding intersecting racism, heterosexism, and ableism. In addition, of those who reported a personal racial or ethnic minority identity, their responses on the subject were largely written in one-word answers, so there were insufficient data to develop this theme further. This could be due to the wording of the question, in that it did not further prompt participants to expand on their experience, or use of the phrase intersecting identities, which was not defined beyond giving examples of possible identities that may have been salient. In addition, we only included data from baseline (i.e., writing from participants engaged in the expressive writing prompts), which may have impacted the responses we received. In prior research on this intervention, we found that allistic LGBTQ+ participants did not speak about privileged identities when reflecting on stigma events, likely due to the way our prompt is worded (Authors, personal communication, October 2024). However, a racially diverse sample or modified wording may have provided an opportunity to further explore the role of intersecting racism and heterosexism.
Interventions to cope with intersectional stressors
As demonstrated in our findings, stigma events experienced by Autistic-LGBTQ+ participants were often intersectional, and participants were able to speak to this when explicitly asked about it. This study took place in the context of a larger expressive writing intervention 47 for more about the impact of the intervention, which provided a structure and an outlet for reflection using a self-directed model of change. Autistic-LGBTQ+ adults in this study reported that they were not always aware of the nuanced ways their dual identities may have related to stigma responses, particularly when feeling like they had to respond in the moment. Time to reflect along with guided questions allowed them to identify how they wished to respond to future events, which has important implications for self-advocacy. As such, it is critical that therapists are aware of the impact of intersectional stigma and the nature of heterosexist events for Autistic-LGBTQ+ clients to help with tentatively naming and processing experiences through these lenses.
Considering stigma events in the context of intersecting systems of oppression appeared to facilitate meaning making for participants in our study and may be a helpful direction for researchers developing interventions to cope with identity-based stigma. Future research is needed on interventions to facilitate coping with intersectional stigma that can be used in session and as a complement to ongoing therapeutic work. Our previously tested intervention was focused on coping with the impact of stigma events, 47 and future interventions may wish to target those perpetrating heterosexism and related forms of oppression. We observed that participants wrote about cissexist experiences along with their heterosexist events and have since expanded the intervention to recruit LGBTQ+ with experiences of heterosexism and cissexism, given the inseparable nature of these events. The development and study of interventions that promote affirmative and accepting behaviors among neurotypical cishet (i.e., cisgender and heterosexual) people are warranted to reduce the high frequency of heterosexist, ableist, and cissexist behavior. Reducing the incidence of heterosexist behaviors impacting Autistic people parallels calls to provide autism acceptance training to non-Autistic people,60,61 rather than expecting Autistics to conform to neurotypical and heterosexual norms. Results from a study exploring didactic and perspective-taking interventions designed to target multiple dimensions of heterosexism are encouraging 61 and could be adapted to focus on the experiences of Autistic-LGBTQ+ people.
Limitations
There are limitations to the present study. The intersectional analysis framework that guided the study 49 encouraged us to consider how intersectional marginalized identities (e.g., LGBTQ+, Autistic, and others) experience heterosexism while attending to interlocking systems of oppression. Future research should explore the intersectional stigma experiences of those who are racial and ethnic minority individuals, particularly given the history of homogeneity in ASD prevalence rates, with a high portion of middle-class, heterosexual, White, cisgender males. 62 Moreover, much still needs to be explored about the experience of Autistic persons with different LGBTQ+ identities. Autistic people are more likely to report comfort with no labels or monosexual identities, 40 making it imperative that future research attends to differences within sexual minority identities and the role of intersectional minority stressors.
Conclusion
Findings from our study suggest the importance of utilizing an intersectional lens to understand the experiences of heterosexism. Participants identified that several salient identities, including their age, Autistic identity, religion, and gender, were inseparable from their heterosexist event. The types of heterosexist events they endorsed were aligned with distal stressors found in the minority stress model; however, participants also noted the ways the event itself or how they responded to the heterosexism often intersected with their Autistic identity. As such, we have articulated recommendations for future research on the stigma experiences of Autistic-LGBTQ+ people using an intersectional minority stress framework.
Footnotes
Authorship Confirmation Statement
H.M.L. conceived of and developed the larger intervention study, and M.R.M. and S.G.H. contributed to study conception and design of this project. M.R.M. performed material preparation and data collection. M.R.M. and R.C. conducted the initial analyses, E.C. served as an auditor, and H.M.L. and S.G.H. provided feedback on final themes. The first draft of the article was written by M.R.M., R.C., and E.C., and all authors commented on previous versions of the article. M.R.M. led revisions, and all authors read and approved the final article. The article has been submitted solely to Autism in Adulthood.
Author Disclosure Statement
The authors have no relevant financial or nonfinancial conflicts of interest to disclose.
Funding Information
This project was funded by the Craig R. Bollinger Dissertation Research Grant at the University of Massachusetts Boston.