908976

research-article2020
AUT0010.1177/1362361320908976AutismCrompton et al.

Original Article

Autism

‘I never realised everybody felt as happy 2020, Vol. 24(6) 1438­–1448

© The Author(s) 2020

as I do when I am around autistic people’: Article reuse guidelines:

https://doi.org/10.1177/1362361320908976

A thematic analysis of autistic adults’ sagepub.com/journals-permissions

DOI: 10.1177/1362361320908976
journals.sagepub.com/home/aut
relationships with autistic and neurotypical
friends and family

Catherine J Crompton1 , Sonny Hallett2, Danielle Ropar3,

Emma Flynn4 and Sue Fletcher-Watson1

Abstract
Many autistic people are motivated to have friends, relationships and close family bonds, despite the clinical characterisation
of autism as a condition negatively affecting social interaction. Many first-hand accounts of autistic people describe
feelings of comfort and ease specifically with other autistic people. This qualitative research explored and contrasted
autistic experiences of spending social time with neurotypical and autistic friends and family. In total, 12 autistic adults
(10 females, aged 21–51) completed semi-structured interviews focused on time spent with friends and family; positive
and negative aspects of time spent with neurotypical and autistic friends and family; and feelings during and after
spending time together. Three themes were identified: cross-neurotype understanding, minority status and belonging.
Investigation of these themes reveals the benefits of autistic people creating and maintaining social relationships with
other autistic people, in a more systematic way than previous individual reports. They highlight the need for autistic-led
social opportunities and indicate benefits of informal peer support for autistic adults.

Lay abstract
Although autistic people may struggle to interact with others, many autistic people have said they find interacting
with other autistic people more comfortable. To find out whether this was a common experience, we did hour-long
interviews with 12 autistic adults. We asked them questions about how it feels when spending time with their friends
and family, and whether it felt different depending on whether the friends and family were autistic or neurotypical. We
analysed the interviews and found three common themes in what our participants said. First, they found spending with
other autistic people easier and more comfortable than spending time with neurotypical people, and felt they were
better understood by other autistic people. Second, autistic people often felt they were in a social minority, and in order
to spend time with neurotypical friends and family, they had to conform with what the neurotypical people wanted and
were used to. Third, autistic people felt like they belonged with other autistic people and that they could be themselves
around them. These findings show that having time with autistic friends and family can be very beneficial for autistic
people and played an important role in a happy social life.

Keywords
autism, mental health, neurodiversity, peer support, social interaction

1
The University of Edinburgh, UK Corresponding author:
2
Autistic Mutual Aid Society Edinburgh, UK Catherine J Crompton, Patrick Wild Centre, Division of Psychiatry,
3
The University of Nottingham, UK The University of Edinburgh, Kennedy Tower, Royal Edinburgh
4
Queen’s University Belfast, UK Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK.
Email: [email protected]
Crompton et al. 1439

Introduction peers (Hull et al., 2017). The aim of camouflaging is to fit

in with the neurotypical people around you, not raise con-
Despite differences in social interaction, autistic people do cerns of peers, and can result in what appears at surface
not necessarily differ from their neurotypical peers in their level to be ‘successful’ social functioning. Camouflaging
desire for social relationships (Bauminger & Kasari, 2000; requires a prolonged and fatiguing effort for autistic people
Cresswell et al., 2019). Many autistic people are motivated (Bargiela et al., 2016; Hull et al., 2017). Sustained autistic
to have friendships and sustain meaningful and lasting camouflaging is related to significant mental distress,
social relationships (Bargiela et al., 2016; Daniel & including depression (Cage et al., 2018), and increased sui-
Billingsley, 2010; Sedgewick, Crane, Hill, & Pellicano, cidality (Cassidy et al., 2018), with particularly high asso-
2019; Sinclair, 2010). However, initiating, maintaining ciations to mental health difficulties when switching
and navigating these relationships may be difficult for between camouflaging in multiple contexts (Cage &
autistic people, due to differences in autistic social cogni- Troxell-Whitman, 2019). This significant relationship
tion. These social cognitive differences may include diffi- between camouflaging and mental distress is of particular
culties in interpreting social cues (Morrison et al., 2019) importance given the high rates of mental illness in the
and social reciprocity (American Psychiatric Association, autistic population, with studies finding 77% and 79% of
2013), understanding the mental states of others (Frith & autistic adults also having diagnosable mental health condi-
Happé, 1994), identifying basic and complex facial emo- tions (Eaves & Ho, 2008; Lever & Geurts, 2016).
tions (Baron-Cohen et al., 1997) and identifying tone of There is an emerging literature highlighting feelings of
voice (Rutherford et al., 2002), sarcasm (Persicke et al., ease and comfort with other autistic people (Sinclair,
2013) and social faux pas (Baron-Cohen et al., 1999). 2010), and a supporting theoretical model termed the ‘dou-
Autistic people tend to have fewer friendships than their ble-empathy problem’ (Milton, 2012; Milton et al., 2018).
neurotypical peers, and autistic relationships may have The double-empathy problem states that when people with
less reciprocity, and centre around activities rather than very different experiences of the world (such as a neuro-
emotional bonding (Orsmond et al., 2004, 2013; Petrina typical person and an autistic person) interact with each
et al., 2014). Autistic people may also value more time other, they will struggle to empathise with one another.
either alone or in smaller social groups (Calder et al., Communication may break down due to differences in lan-
2013). Although some recent research has qualitatively guage and comprehension, but importantly, this is as a
explored autistic people’s friendships from their own per- result of a bidirectional difficulty rather than a specific
spective (e.g. Sedgewick, Crane et al., 2019; Sedgewick, deficit on the part of the autistic person (Milton et al.,
Hill & Pellicano, 2019), little is known about whether 2018). Autistic people have written autobiographical
autistic people experience self-reported differences in rela- accounts of feeling more comfortable with other autistic
tionships with autistic and non-autistic people. people than with non-autistic people (Sinclair, 2010). New
Relationships and social connectivity play an important empirical research that directly compares how autistic and
role in physical and psychological well-being (Cohen, neurotypical people exchange information using a diffu-
2004; House et al., 1988; Kawachi & Berkman, 2001). sion chain paradigm demonstrates that autistic people
Relationships are also important for autistic well-being; transfer information more efficiently with other autistic
autistic loneliness is related to poor mental health, includ- people than with neurotypical people, and additionally
ing increased depression and anxiety (Mazurek, 2014), experience higher interactional rapport when with other
self-harm (Hedley et al., 2018) and suicidality (Cassidy autistic people (Crompton & Fletcher-Watson, 2019). In
et al., 2018). Close relationships with others give autistic addition, some emerging quantitative research has high-
people a space to experience emotional reciprocity, to lighted the role that a lack of understanding from neuro-
express their emotions, exchange ideas, collaborate and typical people plays in the social interaction experiences of
cooperate, and practise interpersonal skills (Cresswell autistic people; neurotypical people are less willing to
et al., 2019). interact with autistic people (Sasson et al., 2017), overesti-
However, time with others might not always be positive mate how helpful they are towards autistic people
for autistic people. Recently, research has focused on how (Heasman & Gillespie, 2019) and struggle to interpret
many autistic people use compensatory strategies to mask autistic people’s mental states and social cues (Edey et al.,
their overtly autistic behaviours when spending time with 2016; Sheppard et al., 2016). Autistic adults have reflected
others, thus allowing them to fit into their social surround- that during their school years, they felt significantly better
ings (Bargiela et al., 2016; Lai et al., 2017; Leedham et al., understood by their autistic peers than their non-autistic
2020; Livingston et al., 2019). This ‘camouflaging’ of classmates (Macmillan et al., 2019).
autistic traits may be motivated by a desire to make friends There is, however, a lack of research investigating autis-
(Tierney et al., 2016) and often involves the autistic person tic experiences of spending time with autistic friends and
effortfully adopting a constructed, neurotypical persona in family members, and asking whether there are subjective
order to seem socially competent and confident around differences compared with interactions with neurotypical
1440 Autism 24(6)

Table 1. Participant demographic information. participants were female. A number code was generated
for each participant, and identifying details redacted from
Participant Age Gender Age of autism IQa AQb
ID diagnosis reported quotes.

1 21 Female 16 103 25
2 24 Female 18 140 38 Procedure
3 46 Female 46 111 46 All participants provided written informed consent before
4 42 Male 40 102 38 taking part in the study. Interviews were conducted by the
5 21 Female 6 99 25 first author either face-to-face, over the phone or via vide-
6 26 Female 26 114 33
oconferences depending on the preference of the partici-
7 33 Female 31 139 47
pant. All participants completed measures of IQ and
8 34 Female 33 135 36
autistic traits with a research assistant in a prior research
9 36 Female 32 123 42
session approximately 1 week before their interview
10 42 Female 42 104 31
11 51 Female 49 129 29
(Crompton & Fletcher-Watson, 2019).
12 27 Male 5 104 37 Before starting the interview, participants were
informed that (1) they could ask for a break at any time for
AQ: autism quotient; WASI-II: Wechsler Abbreviated Scale of any reason, (2) they did not have to talk about anything
Intelligence–II. they did not want to talk about and (3) if they wanted to
a
IQ as assessed by the WASI-II.
b
AQ score. talk about something in more detail, they could ask to go
back to a question or answer it in more detail.

friends and family. Given that camouflaging is driven by a

desire to fit in with a neurotypical social world, it is also Measures
important to examine whether autistic people feel required
to camouflage when around other autistic people, and how Semi-structured interview
that may influence their experience of spending time with Data were collected using a semi-structured interview
others. In this study, we use a qualitative methodology to schedule specifically developed for this study by the
explore the lived experience of autistic people, and improve research team in consultation with autistic collaborators. A
understanding of behaviours by providing insight into the semi-structured approach is designed to be used flexibly
subjective ‘autistic experience’ (Robertson et al., 2018). and allows the interviewer to explore a participant’s line of
response, probing ambiguities and allowing researchers to
Methods validate the meaning of participants’ answers (Barriball &
While, 1994). We scoped the literature and found no pre-
Methodological approach existing schedules that were suitable for our questions.
This study adopted a qualitative design, using semi-struc- This research closely targeted the question of how autistic
tured interviews analysed thematically. Ethical approval people experienced autistic and non-autistic interactions
was obtained from the University of Edinburgh Psychology with both autistic and neurotypical people. Wording was
Research Ethics Committee. designed to be neutral and not leading, and wording was
reviewed with autistic people to make it accessible. The
interview first explored autistic adults’ relationships and
Participants social experiences with important non-autistic people in
Participants were 12 autistic adults (see Table 1 for demo- their lives, before exploring their relationships with the
graphic information), who met the following eligibility important autistic people in their lives. In the final four
criteria: (1) aged over 18, (2) clinically diagnosed with an questions, participants were shown a quote, taken from
autism spectrum disorder by a certified professional, (3) Savarese (2009) and Sinclair (2010), and asked for their
spoke fluent English, (4) without a diagnosis of Social thoughts about it. The purpose of this was to introduce
Anxiety Disorder and (5) without an intellectual disabil- more controversial ideas without asking leading questions
ity, as indicated by an IQ of below 70. Participants were and to embed autistic writing and perspectives into the
recruited online through social media including Twitter, interview (Tsai et al., 2018). By using published quotes,
through our project website and through local autism we separated the opinions in them from what the researcher
organisations, and were all UK based. Participants had a thought, decreasing the chances that the respondent felt
mean age of 33.58 (standard deviation (SD) = 10.06), on they ought to respond in a particular way. The interview
average 18 years of education (SD = 2.15), had a mean IQ schedule is in Table 2. In each case, ‘person X’ referred to
of 116.92 (SD = 15.51) and mean autism quotient (AQ) in the interview was identified and defined by the partici-
score of 33.58 (SD = 7.32). The large majority of pant in the initial introductory questions (Questions 1 and
Crompton et al. 1441

Table 2. Semi-structured interview schedule.

Question number Question

We are going to start by talking about the people you spend time with who are not autistic
1 Who are the non-autistic people you spend time with?
2a/b/c How do you know them? When and how did you meet?
3 What kind of things do you do together?
4 Now, let’s focus on person X. Can you tell me some of the good things about spending time with this person?
5 Can you tell me about some of the difficult things or challenges about spending time with this person?
6a/b How do you feel when you are with them? Why do you think you feel like that?
7a/b How do you feel after spending time with them? Why do you think you feel like that?
8 Is there anything else you want to tell me about how you relate to the non-autistic people in your life?
Now, we’re going to talk about the autistic people in your life
9a/b Do you know any autistic people? Who are the autistic people you spend time with?
10a/b/c How do you know them? When and how did you meet?
11 What kind of things do you do together?
12 Now, let’s focus on person X. Can you tell me some of the good things about spending time with this person?
13 Can you tell me about some of the difficult things or challenges about spending time with this person?
14a/b How do you feel when you are with them? Why do you think you feel like that?
15a/b How do you feel after spending time with them? Why do you think you feel like that?
16 Is there anything else you want to tell me about how you relate to the autistic people in your life?
I am now going to show and read you four statements, one at a time. I will ask you what you think about each statement and
whether you agree or disagree with it according to your experiences. Please don’t feel obliged to agree! Some of the statements
might really fit your experiences and some might not be true for you at all.
17 •• ‘In autistic spaces, I am accepted for who I am’.
18 •• ‘Being autistic in shared autistic space may be easier than being autistic in neurotypical space – or it may be
harder’.
19 •• ‘There are benefits that neurotypical people bring to social situations’.
20 •• ‘I notice that non-autistic people don’t understand autistic people any better than autistic people tend to
understand non-autistic people’.
Thank you for sharing your experiences with me. Do you have anything else that you want to ask, or is there anything I didn’t ask
you that you would like to talk about?

9), and was either an individual person or a group of peo- Data analysis
ple who the participant spent a significant amount of time
with on a regular basis. Interviews were professionally transcribed and then
checked for accuracy by the first author. Thematic analysis
was applied using the six-phase framework of Braun and
The AQ Clarke (2006) to identify key patterns in the data. This pro-
cess involves familiarisation with the data through reading
The AQ is a 50-item, multiple-choice questionnaire, which and re-reading the transcriptions (completed by the first
provides an approximate measure of autistic traits (Baron- author), generating initial codes relevant to interesting fea-
Cohen et al., 2001). Participants completed this individu- tures in the data (completed by the first author), searching
ally, and a score over 32 indicates high levels of autistic for themes (completed by first and second authors),
traits. reviewing the themes to ensure they relate back to the ini-
tial codes (completed by the final author), defining and
The Wechsler Abbreviated Scale of naming themes (all authors) and relating the findings back
to the research literature (all authors) (Braun & Clarke,
Intelligence–II 2006). This analysis was chosen for its inductive process,
The Wechsler Abbreviated Scale of Intelligence–II as it does not rely on an existing framework to interpret the
(WASI-II) is a neuropsychological assessment tool, which data, allowing new knowledge to be created, as suitable for
provides a reliable and brief measure of intelligence this emerging and under-researched area (Willig, 2013).
(Wechsler, 2011). This was used to establish whether par- The following example in Table 3 provides a snapshot of a
ticipants were able to verbalise their experiences of rela- piece of analysis to illustrate this process more clearly.
tionships with others and to ensure they met the inclusion The first and second authors led the analysis. The first
criteria for no intellectual disability. author is a neurotypical researcher with a background and
1442 Autism 24(6)

Table 3. Illustrative analysis example, indicating the pathway from initial quotes to theme.

Initial quotes Codes Sub-themes Theme

‘I have friends . . . who say ‘you should meet these Difficulties with neurotypical Majority social Minority
people, they are great, lets all go out to a pub’ and I social activities activities and contexts Experience
find it really hard, but also I want to be involved and
. . . that is when I feel most upset’. (Participant 2)
‘The physical spaces we have to go to are extremely Difficulties with the space during Majority social
challenging’. (Participant 8) neurotypical social interactions activities and contexts
‘I don’t know how to be formal, where I should look Not knowing social rules of Majority social norms
and when’. (Participant 7) neuro-majority
‘I talk too much. I don’t know if you have managed to Feeling like your style/method Majority social norms
guess that. But I talk too much’. (Participant 4) of communication does not fit
with others
‘I feel really annoyed with myself because it is a really Self-directed negative feelings Impact of being in a
normal thing to go to the pub with your friends. But around/after social events minority
I find it really hard and I really don’t like it . . . but I
wish I did’. (Participant 2)
‘My neurotypical family can say ‘you are difficult to be Pressure from others to behave Impact of being in a
around’ if I don’t mask’. (Participant 2) in a more ‘neurotypical’ way minority

training in neuropsychology. They adopt participatory

frameworks in all their autism research, and so this analy-
sis is influenced by mainstream psychological theory and
also the lived experience perspective of autistic collabora-
tors. The second author is an autistic adult with a back-
ground in autistic advocacy and founder of an advocacy
organisation, so they are able to bring in representative
lived experiences of autistic adults.

Results
Participants discussed the time they spent with important
autistic and non-autistic people in their lives, reflecting on
their relationships and how they feel when they are
together. Three main themes were identified from these
Figure 1. Structure of themes and subthemes.
interview data: cross-neurotype understanding, minority
status and belonging, each comprising of several sub-
themes (see Figure 1). I wouldn’t spend time with people if I didn’t enjoy it, they
wouldn’t be my friends . . . regardless of neurotype . . . but
neurotypical people . . . are a lot harder to read, and I don’t
Theme 1: Cross-neurotype understanding feel relaxed. (Participant 9)
Participants identified that they often felt they were better
I’m tired afterwards. It’s not that it is bad, it is just tiring. It
understood by other autistic people than non-autistic peo-
takes effort to be around them. I am always thinking ‘should I
ple, and that there were specific difficulties when spending speak now, what should I say, has this moved on? Is this okay,
time with non-autistic people. is that appropriate, will that offend someone? And who is
speaking, and what are they saying, and do they really mean
Subtheme 1: Across-neurotype difficulties. Participants dis- that?’ (Participant 2)
cussed their difficulties during interactions with non-autis-
tic friends and family, saying that differences in verbal and These experiences were associated with increased feel-
non-verbal communication styles during social interac- ings of anxiety in advance of and during spending time
tions required a high amount of energy and effort when with neurotypical friends and family: ‘I get anxious
spending time together. In particular, difficulties in reading because I have to behave well, to behave neurotypically,
non-autistic expressions and following the unspoken rules to do the right things’ (Participant 2). A recurring topic
of social interaction made time spent with non-autistic was feelings of exhaustion and emotional fatigue after
friends and family difficult: spending time with neurotypical people: ‘I do like my
Crompton et al. 1443

neurotypical friends, but they make me tired, they don’t With my autistic friends . . . people are very sensitised to
understand me. Even if it’s good it’s exhausting’ people being or feeling left out . . . so many of them seem to
(Participant 8). make a really big effort to stop that from happening. So it’s a
This exhaustion often affected the autistic persons’ abil- much more accessible community for me, because I don’t
have to make all the effort, which is how I feel with
ity to function in the period after the interaction, albeit to
neurotypical people. Autistic people are willing to meet
varying degrees:
halfway. (Participant 7)
After spending time with neurotypical people there will be a
significant amount of time doing something to let my brain
In contrast to the feelings of fatigue reported after
switch off a bit, sometimes afterwards it is a challenge to cook spending time with non-autistic family and friends, many
myself a meal or something like that. (Participant 12) autistic participants highlighted feeling less tired after
spending time with their autistic family and friends: ‘It is
After spending time with neurotypical friends, I feel wiped tiring [interacting with neurotypicals], I have only realised
out, completely exhausted. I need to lie in a darkened room this since I got autistic friends. It is so much easier . . . it is
for 3–4 hours and when I do, I don’t sleep, I just shut off. I effortless’ (Participant 10).
can’t even move and the only way I can communicate is in Although the vast majority of reports described feelings
humming noises. (Participant 3) of ease and comfort with other autistic people, two partici-
pants brought up difficulties in autistic–autistic relation-
While overwhelmingly participants spoke of the vari- ships. One participant reported that honesty could be hurtful,
ous difficulties in interactions with neurotypical people, though that they understood that it may be unintentional:
two participants also mentioned that neurotypical people ‘Autistic people . . . can kind of hurt my feelings . . . by
could be beneficial in a social situation. In both cases, they being honest . . . but I also understand it. You are not being
mentioned the benefits of neurotypical people being able cruel, you are just kind of being pedantic, and I understand
to explain to the autistic person in a 1:1 context what was that’ (Participant 2). Another participant stated that they
happening in a group conversation, or wider social event: found being with unknown autistic people difficult as they
‘I can be like “what is going on here?” and then tell them may be unpredictable, though this was not the case with
about something, and they can tell me “this is what is hap- people they were familiar with: ‘Being with autistic people
pening”’ (Participant 2). I don’t know, who may exhibit unpredictable behaviours,
can be more difficult than being around neurotypicals that I
Subtheme 2: Within-neurotype ease. Participants frequently already know. It’s about predictability, if I know what to
described feelings of comfort and ease when spending expect then I find things easier’ (Participant 3).
time with autistic friends and family. Many stated that
communication styles were similar between autistic peo-
ple, and this made interactions more comfortable that it
Theme 2: Minority status
was easier to follow conversations and understand what When spending time with non-autistic friends and family,
people mean: ‘With autistic people, I have a much better participants experienced feeling in a minority and often
idea of what people are doing, what they mean, and pick- felt pressure to conform to the communicative styles and
ing up on things’ (Participant 2). preferences of the non-autistic majority. This affected how
Participants noted that there is flexibility with their they felt about being autistic, often in negative ways.
autistic friends and family about what constitutes a ‘good’
interaction and that whether there is a problem during an Subtheme 1: Majority social norms. The unspoken social
interaction that their autistic family and friends will under- rules of non-autistic people could make it hard for autistic
stand: ‘There is no pressure to talk. If there are silences it is people to navigate interactions with their non-autistic fam-
not awkward because there is a shared understanding that ilies and friends. Subtleties of interactions often presented
silence is nice’ (Participant 1) and ‘It feels comfortable. It a challenge to autistic people: ‘I often miss subtle things,
doesn’t matter if interactions go wrong, it is not stressful, it when people are talking. I don’t always pick up on what
is nice’ (Participant 4). There was less of a need to mask or they actually mean because they don’t say it. Until some-
camouflage around other autistic people, because there was one points it out later, I don’t get it’ (Participant 7).
an assumed mutual understanding and acceptance of autis- Often, non-autistic friends and relatives were not
tic behaviours and ways of interaction: ‘You can let your accommodating of autistic people’s social needs and pref-
guard down, you can let your mask down. You don’t have erences, and as a result, autistic people felt obligated to
to be a certain way with them, because they totally get it’ minimise or mask their natural behaviours and prefer-
(Participant 10). Autistic people were also mindful of the ences in social situations with neurotypical people. These
potential difficulties that their autistic friends and family comments were interpreted as examples of autistic people
face in everyday interactions, and were proactive in making feeling that they were in a social minority and felt obliged
interactions supportive and inclusive: to conform to the majority way of communicating in
1444 Autism 24(6)

social interactions, or face being excluded. ‘My neuro- I’m the only autistic one and I find it very difficult to keep up
typical family can say “you are difficult to be around” if I with conversations and I lose words . . . the others think I’m
don’t mask’ (Participant 2) and ‘If I am surrounded by drunk sometimes (although I’ve not been drinking), and I let
neurotypical people, I can’t let my autistic-ness out’ them think that because I get embarrassed at mixing my words
up. (Participant 3)
(Participant 12).
Some participants felt that while they tried hard to fit in
with their non-autistic friends and family, that their non- Theme 3: Belonging
autistic friends and family did not try to make the same
Participants reported feeling a sense of belonging when
accommodations for them:
around autistic family and friends. With other autistic peo-
ple, participants described feeling understood and able to
I work very hard to pass as ‘normal’ with non-autistic people.
I understand them and I see how they interact. But because
be their authentic autistic self. Maintaining relationships
they’ve never had to study autistic people in the same way I with other autistic people allowed autistic people to feel
study them, they don’t understand me, or consider my needs. that they belong as part of a community, which for some
(Participant 3) was a new experience:

Neurotypical people do not get why certain things might be We can talk and laugh and challenge ideas and be
difficult or an issue for someone with autism. You try to philosophical, or we can sit together and draw and be silent.
explain it but they are constantly seeing it from a neurotypical We simply allow each other to be and accept everything that
perspective. (Participant 9) we are. (Participant 3)

Subtheme 2: Majority social activities and context. Often, Subtheme 1: Understanding. When with autistic family and
neurotypical friends and family do not take autistic prefer- friends, participants said they felt understood and that they
ences into account when organising social events, which understood others. Some autistic participants reflected that
can compound anxiety and stress during these occasions: this is how they imagine non-autistic people feel all the
This was indicated by autistic participants’ comments that time:
activities were inaccessible to them, or that they posed sig-
nificant challenges due to the physical or sensory environ- As lovely as all my neurotypical friends are, I feel I belong
ment: ‘The physical spaces we go to are extremely there [with autistic people], and I am like everybody else. I
challenging. They often want to go to places that are busy have never had that before . . . I feel like I understand people
and they understand me. (Participant 2)
or noisy’ (Participant 8).
Sometimes autistic people like me, you try really hard to be
One of the most difficult things when your friends say ‘you
normal . . . and if I was in an autistic space I feel like there is
should meet these people, they are great, let’s all go out to a
no pressure really. (Participant 4)
pub’ and I find it really hard, but also I want to be involved
and . . . that is when I feel most upset because . . . on the
Since getting autistic friends I think ‘this is how neurotypical
other hand I don’t want to, I want everybody to go somewhere
people must feel all the time’ and that is quite sad actually. To
that is not noisy. But I also don’t want to be the person that
realise that people have felt this their whole life, and at ease
makes us all go to a library . . . and speak in hushed tones.
around people, and felt they belonged as much as I do now.
(Participant 2)
It’s a shame it didn’t happen sooner. (Participant 2)

Subtheme 3: Impact of being in a minority. As a result of

The autistic participants also said that they felt under-
being expected to behave neurotypically with their non-
standing and empathy for their autistic friends and family:
autistic friends and family, autistic people often noted that
more so than if they had been neurotypical:
people developed neurotypical expectations of them. This
sometimes led to increased feelings of frustration for the I have got a lot more patience [with autistic people] . . . if
autistic person, both directed at the neurotypical people somebody is going on and on about something and I am like,
they were spending time with and directed internally at that is really boring but it’s fine, ’cause I do the same. Whereas
themselves for not being able to cope with ‘normal things’: I don’t have the same patience for neurotypical people who
just go on about things. (Participant 2)
I feel awkward and ashamed [when interacting with
neurotypical people . . . I still have a lot of internalised I know that they [an autistic person] might be telling me for
ableism about how I ‘should’ be able to do things that I find 20 minutes about some bird that they saw, but I know how
difficult. (Participant 9) they are feeling, because I feel happy when I see things that I
like and I will go on about it. So even though I have no
Sometimes my [neurotypical] friend, her [neurotypical] interest in what you are saying I understand how you feel.
partner and my [neurotypical] partner get together for dinner. (Participant 7)
Crompton et al. 1445

Subtheme 2: Being your authentic autistic self. When with and friends using a thematic analysis framework. Social
other autistic people, participants felt they did not have to relationships are an important, though often complicated,
conceal overtly autistic aspects of their behaviour or com- part of autistic people’s lives. Previous research has tended
munication style as they would have around non-autistic to focus on autistic people’s relationships with (assumed)
friends and family. ‘I can be totally relaxed and totally non-autistic friends and family. Here, we specifically con-
myself. Anything goes’ (Participant 5). Behaviours such as trasted relationships across and within neurotypes. The
stimming, rocking and communicating in autistic ways analysis revealed three themes: cross-neurotype under-
were implicitly accepted by their autistic family and standing, minority status and belonging. The themes help
friends. Participants felt they could be their authentic, us understand why relationships between autistic and non-
autistic self in their company: autistic people might be so challenging, and how relation-
ships between autistic people are different.
It’s fab when we get together, autistic space is so validating The results align with previous research on the chal-
compared with the outside world, it’s wonderful to see people lenges that autistic people face when interacting with
stimming away without feeling self-conscious. (Participant 9) non-autistic others, but highlight that interactions with
other autistic people are fundamentally different. All par-
I feel free as a bird. No effort is needed. I don’t need to mask
ticipants reported that spending time with non-autistic
and I don’t feel stupid if I don’t understand something. I feel
able just to ask. We’re all always getting our words mixed up
family and friends involved specific difficulties, which
or losing them and we lost the thread of our conversations but were not experienced when interacting with other autistic
we laugh at it. We all do it and we all get it. (Participant 3) friends and family. This aligns with the double-empathy
theory of autism which suggests that autistic and non-
The language above was echoed in many participant autistic people have a mutual difficulty in understanding
responses who used words like ‘genuine’ and ‘accepting’ and empathising with one another due to differences in
to describe their experiences. how each person understands and experiences the world,
rather than because of a communicative deficit on the
Subtheme 3: Happiness, well-being and resilience. Spending part of the autistic person (Milton, 2012). Neurotypical
time with autistic friends and family was an important people have been shown to overestimate how ego-centric
source of happiness for these participants: ‘Autistic people their autistic family members are (Heasman & Gillespie,
make me happy flap’ (Participant 9) and ‘If I know I am 2018), and overestimate how helpful they are to autistic
going to see one of my autistic friends, I get really excited people (Heasman & Gillespie, 2019). Our findings sug-
and I am really happy because I know I am going to have gest that this translates into real-world difficulties in
a great time’ (Participant 10). interactions with neurotypical friends and family that
Spending time with autistic family and friends was also may affect the mental health, well-being and self-esteem
highlighted as an important factor in maintaining mental of autistic people.
health and well-being, and in building resilience to man- One example of how interacting with non-autistic
age everyday life in a majority non-autistic world: peers could have a negative impact was that it made them
more acutely aware of their own minority status within a
It’s very important to have autistic space for people . . . majority neurotypical society. Having to adapt to neuro-
sometimes people fear this is a form of self silo-ing or typical ways of interacting and socialising caused feelings
segregation and I’m not trying to say we don’t need to survive of inadequacy and shame. Similar findings have been
in the non-autistic world too . . . but it’s such a lifeline for described by Humphrey and Lewis (2008), who found
many of us. (Participant 9) that autistic adolescents surrounded by neurotypical
pupils in mainstream secondary schools experienced neg-
There is so much emotional support that comes from spending ative self-image relating to autism. After time spent with
time with autistic people, because sometimes, there is
majority neurotypical peers, autistic pupils often charac-
something that other people see as quite small and actually it
can be soul destroying . . . they just get it, and they can help
terised their differences negatively, believing they had a
accordingly. (Participant 12) ‘bad brain’ and wanted to ‘fit in’ with their peers
(Humphrey & Lewis, 2008).
Autistic people are better at giving advice about your mental Living outside of any majority can cause additional
health because they have a better idea of what your problem stress. Minority stress is a phenomenon that has been
is. Neurotypical people don’t get it in the same way. explored in other stigmatised minority groups, including
(Participant 2) sexual, gender and ethnic minorities (Cokley et al., 2013;
Meyer, 2003). It is related to poor social support, discrimi-
nation and interpersonal prejudice, all of which cause a
Discussion
stress response that may accrue over time, leading to poor
This study aimed to examine the experiences of autistic mental and physical health (Clark et al., 1999; Dohrenwend,
adults spending time with autistic and non-autistic family 2000; Pascoe & Smart Richman, 2009). While most
1446 Autism 24(6)

research into autism and mental health has focused on phone and face-to-face options for interview enhanced the
direct links via co-occurring diagnoses or elevated symp- diversity of the participant sample. However, there were
tom profiles, recent research has explored the effect that some limitations to the study. First, the study included 12
being in an identity-based-minority has on autistic peo- speaking, adult participants, all of whom had an IQ close to
ple’s mental health (Botha & Frost, 2018). Botha and Frost 100, or well above, and most of whom had been diagnosed in
(2018) found that for autistic people, minority stressors adulthood. Therefore, the study findings may not transfer to
include everyday discrimination, internalised stigma and the wider autistic population, including children and young
camouflaging, and that these factors significantly pre- people, non-speaking autistic people, autistic people diag-
dicted poorer mental health. These factors are echoed in nosed in childhood and autistic people with a coexisting
the words of participants in the current study. Given that learning disability. Second, most of our sample were female,
the prevalence of both physical and mental illness is sig- and therefore findings may not transfer to autistic men and
nificantly higher in autistic populations (Dunn et al., 2019; non-binary people. In particular, studies have found higher
Hirvikoski et al., 2016; Rydzewska et al., 2018), future rates of camouflage in autistic women (Lai et al., 2017), and
research should focus on the experience of minority stress social expectations vary by gender in the United Kingdom.
for autistic people, asking whether increasing public Therefore, the social behaviour and social pressures on autis-
knowledge and understanding of autism can alleviate it, tic males could produce a different experience of the topics
and what stress-reducing factors may be available to the examined here. Third, all participants were also based in the
autistic population (Botha & Frost, 2018). United Kingdom: their experiences of social interactions are
Many autistic people felt a sense of comfort and belong- based on UK social norms, and findings may not transfer to
ing when spending time with their autistic family and autistic people living outside the United Kingdom. In fact,
friends. Being a part of an autistic community was impor- cross-cultural explorations of autistic people’s experiences
tant: it allowed them to be their authentic self and to be of navigating the social world are required.
understood. Previous research has highlighted that, for
autistic people, inclusion can be characterised by a sense of
belonging, feeling valued and given the necessary support Conclusion
to thrive (Goodall, 2018). For autistic people, receiving a Delineating precisely what makes interacting with non-
diagnosis can open up a new social world – encourage autistic people difficult for autistic people may mean that
more self-compassion and a greater sense of agency and non-autistic people can become more effective social
autonomy (Leedham et al., 2020). Our results indicate that interaction partners, when spending time with autistic fam-
spending time with autistic family and friends gives autistic ily and friends. These results suggest that spending time
people the opportunity to extend that compassion, under- with other autistic people and within autistic spaces may
standing and agency to the autistic people around them. be beneficial to the mental health of autistic people. In the
Spending time with other autistic people was highlighted context of calls for better mental health interventions
as important for building resilience to manage day-to-day (Cusack & Sterry, 2016), it is important to develop evi-
life, improving well-being, and as a source of happiness. dence-based, feasible and acceptable models of autistic
Participants felt validated by spending time with other autis- peer support and evaluate these for potential mental health
tic people as highlighted by their comments on not feeling benefits. These findings may also be helpful for autistic
wrong, broken or bad when around other autistic people. A people in environments in which they are a social minority,
recent systematic review found very limited support for the such as in education and employment, by enhancing
efficacy of social support interventions on the mental health understanding of autistic communication. We hope that a
or well-being of autistic adults without learning disability greater understanding of the contexts in which autistic
(Lorenc et al., 2018), and there have been calls for explora- people can have comfortable, natural and easy social inter-
tion of the effectiveness of support interventions such as actions will contribute to an evidence base that service
peer support and mentoring (Iemmi et al., 2017; Lorenc providers can draw on to develop better healthcare and
et al., 2018). Our findings, in the context of these previous education for autistic people.
studies, suggest that future research should develop and
evaluate peer support models, to provide improvements to
autistic people’s mental health and quality of life. Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
Strengths and limitations respect to the research, authorship, and/or publication of this
article.
This research is the first examination of autistic people’s
relationships with autistic and non-autistic people. While
first-person accounts reflecting on these phenomena exist, Funding
this study aimed to explore the question in a more systematic The author(s) disclosed receipt of the following financial support
way than previous individual accounts. Online messaging, for the research, authorship, and/or publication of this article:
Crompton et al. 1447

This study was supported by a grant from the Templeton World Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999).
Charity Foundation (grant number: TWCF0200). Racism as a stressor for African Americans: A biopsychoso-
cial model. American Psychologist, 54(10), 805–816.
ORCID iDs Cohen, S. (2004). Social relationships and health. American
Psychologist, 59(8), 676–684.
Catherine J Crompton https://orcid.org/0000-0001-5280-1596
Cokley, K., McClain, S., Enciso, A., & Martinez, M. (2013).
Sue Fletcher-Watson https://orcid.org/0000-0003-2688-1734 An examination of the impact of minority status stress
and impostor feelings on the mental health of diverse eth-
References nic minority college students. Journal of Multicultural
Counseling and Development, 41(2), 82–95.
American Psychiatric Association. (2013). Diagnostic and sta- Cresswell, L., Hinch, R., & Cage, E. (2019). The experiences of
tistical manual of mental disorders (DSM-5®). American peer relationships amongst autistic adolescents: A system-
Psychiatric Publishing. atic review of the qualitative evidence. Research in Autism
Bargiela, S., Steward, R., & Mandy, W. (2016). The experi- Spectrum Disorders, 61, 45–60.
ences of late-diagnosed women with autism spectrum con- Crompton, C. J., & Fletcher-Watson, S. (2019, May 2). Efficiency
ditions: An investigation of the female autism phenotype. and interaction during information transfer between autistic
Journal of Autism and Developmental Disorders, 46(10), and neurotypical people [Poster presentation]. International
3281–3294. Society for Autism Research Annual Conference, Montreal,
Baron-Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. Ontario, Canada.
(1997). Another advanced test of theory of mind: Evidence Cusack, J., & Sterry, R. (2016). Your questions: Shaping future
from very high functioning adults with autism or Asperger autism research. Autistica. https://www.autistica.org.
syndrome. Journal of Child Psychology and Psychiatry, uk/downloads/files/Autism-Top-10-Your-Priorities-for-
38(7), 813–822. Autism-Research.pdf
Baron-Cohen, S., O’Riordan, M., Stone, V., Jones, R., & Plaisted, Daniel, L. S., & Billingsley, B. S. (2010). What boys with an
K. (1999). Recognition of faux pas by normally develop- autism spectrum disorder say about establishing and
ing children and children with Asperger syndrome or high- maintaining friendships. Focus on Autism and Other
functioning autism. Journal of Autism and Developmental Developmental Disabilities, 25(4), 220–229.
Disorders, 29(5), 407–418. Dohrenwend, B. P. (2000). The role of adversity and stress in
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & psychopathology: Some evidence and its implications for
Clubley, E. (2001). The autism-spectrum quotient (AQ): theory and research. Journal of Health and Social Behavior,
Evidence from Asperger syndrome/high-functioning autism, 41, 1–19.
males and females, scientists and mathematicians. Journal of Dunn, K., Rydzewska, E., MacIntyre, C., Rintoul, J., & Cooper,
Autism and Developmental Disorders, 31(1), 5–17. S.-A. (2019). The prevalence and general health status of
Barriball, K. L., & While, A. (1994). Collecting data using a people with intellectual disabilities and autism co-occurring
semi-structured interview: A discussion paper. Journal of together: A total population study. Journal of Intellectual
Advanced Nursing, 19(2), 328–335. Disability Research, 63(4), 277–285.
Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism
high-functioning children with autism. Child Development, spectrum disorders. Journal of Autism and Developmental
71(2), 447–456. Disorders, 38(4), 739–747.
Botha, M., & Frost, D. M. (2018). Extending the minority stress Edey, R., Cook, J., Brewer, R., Johnson, M. H., Bird, G., & Press,
model to understand mental health problems experienced C. (2016). Interaction takes two: Typical adults exhibit
by the autistic population. Society and Mental Health, 10, mind-blindness towards those with autism spectrum disor-
20–34. der. Journal of Abnormal Psychology, 125(7), 879–885.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psy- Frith, U., & Happé, F. (1994). Autism: Beyond ‘theory of mind’.
chology. Qualitative Research in Psychology, 3(2), 77–101. Cognition, 50(1), 115–132.
Cage, E., Di Monaco, J., & Newell, V. (2018). Experiences Goodall, C. (2018). Inclusion is a feeling, not a place: A quali-
of autism acceptance and mental health in autistic adults. tative study exploring autistic young people’s conceptu-
Journal of Autism and Developmental Disorders, 48(2), alisations of inclusion. International Journal of Inclusive
473–484. Education. https://doi.org/10.1080/13603116.2018.1523475
Cage, E., & Troxell-Whitman, Z. (2019). Understanding the rea- Heasman, B., & Gillespie, A. (2018). Perspective-taking
sons, contexts and costs of camouflaging for autistic adults. is two-sided: Misunderstandings between people with
Journal of Autism and Developmental Disorders, 49(5), Asperger’s syndrome and their family members. Autism,
1899–1911. 22(6), 740–750.
Calder, L., Hill, V., & Pellicano, E. (2013). ‘Sometimes I want Heasman, B., & Gillespie, A. (2019). Participants over-estimate
to play by myself’: Understanding what friendship means how helpful they are in a two-player game scenario toward
to children with autism in mainstream primary schools. an artificial confederate that discloses a diagnosis of autism.
Autism, 17(3), 296–316. Frontiers in Psychology, 10, Article 1349.
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Hedley, D., Uljarević, M., Wilmot, M., Richdale, A., &
Risk markers for suicidality in autistic adults. Molecular Dissanayake, C. (2018). Understanding depression and
Autism, 9(1), Article 42. thoughts of self-harm in autism: A potential m ­ echanism
1448 Autism 24(6)

involving loneliness. Research in Autism Spectrum adolescents and adults with autism. Journal of Autism and
Disorders, 46, 1–7. Developmental Disorders, 34(3), 245–256.
Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Orsmond, G. I., Shattuck, P. T., Cooper, B. P., Sterzing, P. R., &
Lichtenstein, P., & Bolte, S. (2016). Premature mortality in Anderson, K. A. (2013). Social participation among young
autism spectrum disorder. The British Journal of Psychiatry, adults with an autism spectrum disorder. Journal of Autism
208(3), 232–238. and Developmental Disorders, 43(11), 2710–2719.
House, J. S., Landis, K. R., & Umberson, D. (1988). Social rela- Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimi-
tionships and health. Science, 241(4865), 540–545. nation and health: A meta-analytic review. Psychological
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, Bulletin, 135(4), 531–554.
S., Lai, M.-C., & Mandy, W. (2017). ‘Putting on my best Persicke, A., Tarbox, J., Ranick, J., & Clair, M. S. (2013).
normal’: Social camouflaging in adults with autism spec- Teaching children with autism to detect and respond to
trum conditions. Journal of Autism and Developmental sarcasm. Research in Autism Spectrum Disorders, 7(1),
Disorders, 47(8), 2519–2534. 193–198.
Humphrey, N., & Lewis, S. (2008). ‘Make me normal’: The Petrina, N., Carter, M., & Stephenson, J. (2014). The nature of
views and experiences of pupils on the autistic spectrum in friendship in children with autism spectrum disorders: A
mainstream secondary schools. Autism, 12(1), 23–46. systematic review. Research in Autism Spectrum Disorders,
Iemmi, V., Knapp, M., & Ragan, I. (2017). The autism dividend: 8(2), 111–126.
Reaping the rewards of better investment. National Autism Robertson, A. E., Stanfield, A. C., Watt, J., Barry, F., Day, M.,
Project. Cormack, M., & Melville, C. (2018). The experience and
Kawachi, I., & Berkman, L. F. (2001). Social ties and mental impact of anxiety in autistic adults: A thematic analysis.
health. Journal of Urban Health, 78(3), 458–467. Research in Autism Spectrum Disorders, 46, 8–18.
Lai, M. C., Lombardo, M. V., Ruigrok, A. N., Chakrabarti, B., Rutherford, M. D., Baron-Cohen, S., & Wheelwright, S. (2002).
Auyeung, B., Szatmari, P., . . . MRC AIMS Consortium. Reading the mind in the voice: A study with normal adults
(2017). Quantifying and exploring camouflaging in men and adults with Asperger syndrome and high functioning
and women with autism. Autism, 21(6), 690–702. autism. Journal of Autism and Developmental Disorders,
Leedham, A., Thompson, A., Smith, R., & Freeth, M. (2020). 32(3), 189–194.
‘I was exhausted trying to figure it out’: The experiences Rydzewska, E., Hughes-McCormack, L. A., Gillberg, C.,
of females receiving an autism diagnosis in middle to late Henderson, A., MacIntyre, C., Rintoul, J., & Cooper, S.-A.
adulthood. Autism, 24, 135–146. (2018). Prevalence of long-term health conditions in adults
Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring with autism: Observational study of a whole country popu-
symptoms and disorders in young, middle-aged, and older lation. BMJ Open, 8(8), e023945.
adults with autism spectrum disorder. Journal of Autism and Sasson, N. J., Faso, D. J., Nugent, J., Lovell, S., Kennedy, D.
Developmental Disorders, 46(6), 1916–1930. P., & Grossman, R. B. (2017). Neurotypical peers are less
Livingston, L. A., Shah, P., & Happé, F. (2019). Compensatory willing to interact with those with autism based on thin slice
strategies below the behavioural surface in autism: A quali- judgments. Scientific Reports, 7, 40700.
tative study. The Lancet Psychiatry, 6(9), 766–777. Savarese, E. T. (2009). What we have to tell you: A roundta-
Lorenc, T., Rodgers, M., Marshall, D., Melton, H., Rees, R., ble with self-advocates from AutCom. Disability Studies
Wright, K., & Sowden, A. (2018). Support for adults with Quarterly, 30(1). http://dsq-sds.org/article/view/1073
autism spectrum disorder without intellectual impairment: Sedgewick, F., Crane, L., Hill, V., & Pellicano, E. (2019).
Systematic review. Autism, 22(6), 654–668. Friends and lovers: The relationships of autistic and neuro-
Macmillan, K., Goodall, K., & Fletcher-Watson, S. (2019). Do typical women. Autism in Adulthood, 1(2), 112–123.
autistic individuals experience understanding in school? Sedgewick, F., Hill, V., & Pellicano, E. (2019). ‘It’s different for
https://doi.org/10.31219/osf.io/awzuk girls’: Gender differences in the friendships and conflict of autis-
Mazurek, M. O. (2014). Loneliness, friendship, and well-being tic and neurotypical adolescents. Autism, 23(5), 1119–1132.
in adults with autism spectrum disorders. Autism, 18(3), Sheppard, E., Pillai, D., Wong, G. T., Ropar, D., & Mitchell,
223–232. P. (2016). How easy is it to read the minds of people
Meyer, I. H. (2003). Prejudice, social stress, and mental health in with autism spectrum disorder? Journal of Autism and
lesbian, gay, and bisexual populations: Conceptual issues and Developmental Disorders, 46(4), 1247–1254.
research evidence. Psychological Bulletin, 129(5), 674–697. Sinclair, J. (2010). Being autistic together. Disability Studies Quarterly,
Milton, D. E. M. (2012). On the ontological status of autism: 30(1). http://www.dsq-sds.org/article/view/1075/1248
The ‘double empathy problem’. Disability & Society, 27(6), Tierney, S., Burns, J., & Kilbey, E. (2016). Looking behind the
883–887. mask: Social coping strategies of girls on the autistic spec-
Milton, D. E. M., Heasman, B., & Sheppard, E. (2018). Double trum. Research in Autism Spectrum Disorders, 23, 73–83.
empathy. In F. Volkmar (Ed.), Encyclopedia of autism spec- Tsai, H. W. J., Cebula, K., Liang, S. H., & Fletcher-Watson, S.
trum disorders (pp. 1–8). Springer. (2018). Siblings’ experiences of growing up with children
Morrison, K. E., Pinkham, A. E., Kelsven, S., Ludwig, K., Penn, with autism in Taiwan and the United Kingdom. Research
D. L., & Sasson, N. J. (2019). Psychometric evaluation of in Developmental Disabilities, 83, 206–216.
social cognitive measures for adults with autism. Autism Wechsler, D. (2011). WASI-II: Wechsler Abbreviated Scale of
Research, 12(5), 766–778. Intelligence–Second edition. Psychological Corporation.
Orsmond, G. I., Krauss, M. W., & Seltzer, M. M. (2004). Peer Willig, C. (2013). Introducing qualitative research in psychol-
relationships and social and recreational activities among ogy. McGraw-Hill Education.