The Experience of Autistic Professionals Working in Health and Education: A Systematic Review

Abstract

Background: Inclusive health and education services require diverse professionals to inform service delivery, which meet the needs of a diverse population. There is a need to reduce inequalities in employment, and to develop neuro-affirming public services. This requires enhanced understanding of the challenges facing neurodivergent professionals, and solutions informed by lived experience. Methods: This systematic review explored peer-reviewed literature describing the training, recruitment, and employment experiences of autistic professionals working in health and education services. Researchers followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Researchers last searched databases, which included Medline, CINAHL, and PsycINFO, in October 2024. Eligible studies presented data describing the experiences of autistic health or education professionals in employment or training, published in English within the last 15 years. Researchers appraised study quality using the Mixed Methods Appraisal Tool. Researchers synthesized data using a narrative approach. The research team received funding from the Scottish Government. Researchers registered the research protocol a priori with PROSPERO #CRD42023483391. Results: Researchers retrieved 14 studies describing the experiences of 529 autistic professionals working in health or education, although nested studies explored subsets of the same participant populations. Participants described work-related needs, differences, and coping strategies relating to unsuitable environments, stigma, discrimination following disclosure, and inconsistent support. They reported that a neuro-affirming approach was helpful but also used strategies to manage their mental health, including taking time off, using leave, and in some cases resigning from posts altogether. Some participants enjoyed their work and felt they had enhanced understanding of autistic patients and learners. Conclusions: Institutions need to implement policies that assign accountability and responsibility for implementing and maintaining reasonable adjustments and increasing accessibility. Flexibility and acceptance are key to creating an inclusive workplace. Community Brief – Why is this an important issue? – Autistic people require health and education services that meet their needs. Autistic professionals may communicate more effectively with autistic people due to their shared experiences. However, autistic people are less likely than graduates with any other disability to work in a post that requires graduate or postgraduate qualifications or to have supervisory responsibilities. It is important to see what can help make employment fairer for autistic people. What is the purpose of the review? – We explored published literature to find out about the employment experiences of autistic professionals working in health and education. We wanted to know what was difficult when they were training, applying for jobs, and when they were working. We also wanted to find out what was helpful for them. What did the authors do to review the literature? – The authors searched databases for articles in English published in the last 15 years. We looked for articles where autistic people told us about their personal experiences of working in professional roles in health or education. What studies did the authors find? – The authors found 14 articles that explored the experiences of 529 participants working in professional roles in health or education, including teacher, doctor, nurse, and academic. Research methods included interview, survey, written reflection, and autoethnography. In summary, what did those studies show? – The studies showed that there are autistic people who are employed as professionals in health and education. Autistic professionals struggle if workplaces are busy, bright, or noisy and when there are last-minute changes. Colleagues and employers often treat them unfairly, which causes stress and depression, possibly because they have poor understanding of autism. Participants supported their health by reducing their working hours, taking annual leave, or resigning from their jobs. Some participants did not tell their colleagues that they were autistic. Thinking about autism as a difference rather than a disability could also be helpful. Some participants identified as autistic earlier in life had more positive self-identity. Participants wanted to act as role models and to support other autistic people who were using health or education services. What are the remaining gaps in the literature? – We need to know more about how to make workplaces fair and inclusive of everyone. The research did not consider all professionals within health and education, and so, there is a need for greater understanding of the situation for other professionals, including physiotherapists and social care workers. There is a need for research that explores how professional roles can be adapted without compromising safety or quality. We need to know how to increase knowledge and understanding about autism to reduce stigma and discrimination. Based on this review, what do the authors recommend? – Future research should look at policies and processes that make workplaces fairer for everyone. The authors think that employers and colleagues need to listen to colleagues and try to change the workplace so that people are happier at work. Professional bodies should adapt professional standards to make them more inclusive of autistic people.