A capabilities approach to understanding and supporting autistic adulthood

Why is this research important??

There is little research on how best to support autistic people to live a flourishing life. These authors examine current research literature on autistic adults applying Martha Nussman’s Capabilities approach (2000, 2011) to shed light on where autistic adults thrive and where they struggle. Their approach differs from typical research on autism because they use a model for outcomes that allows consideration of not only the strengths of the person but the supports and constraints of the environment.?

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What did they do??

They highlighted the strengths and challenges of autistic people under each of ten central capabilities, based on current research findings.??

In this approach, Capability refers to the opportunity to be or do something. It includes a consideration of both the features of the person, and the broader context which surround them, for example, their family, community, economic factors, and the broader social, and political context.?

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Results of the study:?

1.? Life. This refers to not dying prematurely.?

Autistic people are twice as likely to die prematurely as non-autistic people, but little is known about the social and economic factors related to this. More research is needed.?

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2. Bodily help. This refers to having good physical health, includes including adequate nourishment and shelter.??

Current research shows that autistic adults have poor access to healthcare and are more concerned about homelessness than non-autistic adults. There are currently reasons for grave concern about this Capability because of poor service provision and the social economic contexts within which many autistic people live.?

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3. Bodily integrity. This refers to a person being able to feel safe and secure against violent assault, to have opportunities for sexual satisfaction and for choice in having children.??

There is much research to indicate that autistic people are vulnerable to interpersonal victimisation and abuse, particularly autistic women, those who identify as a gender minority, and those who are members of the LGBTQI+ community. Research has shown that autistic adults desire sexual relationships to a similar extent as non-autistic adults.?

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4.? Senses, imagination and thought. This refers to being able to use the senses, to imagine, to think and to reason within educational settings and for creativity.??

The dominant autism paradigm understands different sensory processing as being only problematic, and there is a stereotype that autistic people have poor higher cognition, and those who are nonspeaking have low intelligence. Autistic people have in general suffered within educational environments, often being excluded and not completing. There is more Capability than stereotypes portray, and many barriers that need to be overcome for autistic people to thrive in this area.?

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5. Emotions. This refers to being able to have attachment to things and people outside ourselves, and not having our emotional development disabled by fear and anxiety. In the past, autistic people were considered to have too many emotional difficulties to be able to have the capacity for Love. However, research shows autistic adults in relationships report high satisfaction and strong, loving bond with their partners and children. However, there are autistic adults who desire a partner and friendship, but are unfulfilled, and these adults are at risk for depression and loneliness. Autistic adults report a high number of unmet support needs, and often suffer anxiety and depression. The authors identified a strong need for interventions for mental health to be adapted to autistic people was noted.?

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6. Practical reason. This refers to being able to choose what one wants to do, critically reflect on the choice and then make a plan to realise it. Traditional thought about autistic people was that they have impaired self-awareness. Also, a minority of autistic adults Are intellectually impaired (29%). Some are not fluent with speech, which can make it difficult for them to share their thinking with others. However, there is research to show that autistic people can deeply reflect on many aspects of self, regardless of their speech or intellectual capacity. Many autistic people have two difficult difficulties with executive function, which is also linked to their adaptive abilities, and these can be real obstacles to their own goals.??

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7. Affiliation. This refers to being respected as a social being who can recognise and show concern for others. One of the defining features of autism is difficulty with reciprocal relationships, and research has shown that autistic children, adolescence and adults, face social exclusion and bullying. It makes sense that interventions often focus on social skills training to assist autistic people to secure this Capability.? Also, newer research has shown that autistic-to-autistic interactions can be very positive leading to increased self-esteem and well-being.??

8. Other species. There are many studies that show the importance of nature and animals that contribute to a good autistic life.?

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9. Play. This refers to being able to laugh and enjoy recreational activities. Autistic people often have passions that are a great source of joy and enjoyment. They often view these capacities as an advantage and as affirming for their self-concept. The passions can inform the basis of long-lasting friendships.??

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10. Control over one’s environment. This refers to being able to be involved in the political choices that govern one’s life. There is almost no research on autistic adults’ engagement in political processes. There are a number of high profile, autistic activists and political commentators, and the autistic self-advocacy movement has been largely run by autistic people.?

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In Summary:?

The authors comment that using a different approach to understand how autistic people could lead flourishing lives has demonstrated that there are many Capabilities in which autistic people have the potential to excel, even though conventional stereotypes exist to the contrary. These areas include their senses, imagination and thought, emotional life, affiliations, play, connections to nature and animals, ability for practical reason, and control over their own environment. The authors draw attention to the constraints that exist for autistic people, including stigma, false stereotypes about autism, and poor access to services. They recommend more research into how to overcome these barriers.??

Article Reference

Pellicano E, Fatima U, Hall G, Heyworth M, Lawson W, Lilley R, Mahony J, Stears M. A capabilities approach to understanding and supporting autistic adulthood. Nat Rev Psychol. 2022;1(11):624-639. doi: 10.1038/s44159-022-00099-z. Epub 2022 Sep 5. PMID: 36090460; PMCID: PMC9443657.?

Additional References?

Nussbaum, M. (2000). Women and Human Development: The Capabilities Approach. Cambridge University Press.?

Nussbaum, M. (2011). Creating Capabilities. Harvard University Press.?

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