Date Presented 04/20/2023

This study explored supports and barriers to identity development (ID) for 57 sexual and gender minority (SGM) autistic adults using a qualitative, participatory approach. OTs can support ID through advocacy, fostering connections, encouraging creative outlets and self-exploration, creating safe spaces, and addressing sensory differences.

Primary Author and Speaker: Elizabeth Schmidt

Contributing Authors: Sage Michaud, Lindsey Clausen, Rachel Hickman

PURPOSE: Experience of self and time (identity development (ID)), is a mental function that influences one’s reality in their context (AOTA, 2020). The purpose of this study was to understand the experiences, supports and barriers to ID for sexual and gender minority (SGM) autistic adults.

DESIGN: Authors utilized a qualitative, participatory approach to describe ID for 57 SGM autistic adults who were recruited online.

METHOD: A team of researchers, including 3 SGM autistic adults, developed research materials using queer, crip and intersectionality theory, recruited, screened, and consented participants, conducted interviews, and analyzed data using interpretative phenomenological analysis (Smith & Osborn, 2007). Trustworthiness was established using an audit trail, checking for representativeness, and negative case analysis.

RESULTS: Participants reported relationships with people with shared identities and online communities supported intersectional ID. Creative outlets (fandom, journaling, role playing) supported autistic ID and self-exploration (labels, pronouns, gender expression) supported SGM ID. Participants described barriers such as family, regional/cultural differences, and stereotypes prevented their intersectional ID, limited representation and medical sexism, ableism, and the diagnostic process impeded autistic ID, and safety concerns, exclusion of certain SGM identities in SGM spaces, denial, and sensory differences impeded SGM ID. Participants reported experiencing either narrative gain, a powerful moment of clear ID with a sense of belonging, or a gradual process of self-acceptance.

CONCLUSION: Practitioners can support ID through occupational justice. Specifically by advocating against medical sexism and ableism in the diagnostic process and by fostering connections, creative outlets, self-exploration, creation of safe spaces, and through suggested modifications for gender expression to meet individual sensory needs.


American Occupational Therapy Association. (2020). The Occupational Therapy Practice Framework, 4th Edition. American Journal of Occupational Therapy, 74(2), 1–26.

Smith, J.A., & Osborn, M. (2003). Interpretative phenomenonological analysis. In J.A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 51–80). Sage Publications, Inc.