An Expert Discussion on Strengths-Based Approaches in Autism

Introduction

Historically autism research and practice has been deficit focused. Only in recent years have we seen a shift away from deficit-based approaches toward strengths-based approaches. Current literature now includes work exploring and using strengths-based approaches in autism in a variety of clinical and research contexts. For example, clinical guidance for autism diagnostic assessments recommends using a strengths-focused approach to ensure that the strengths, skills, and interests of the individual are recognized.¹ Research has explored the use of strength-based language by multidisciplinary clinicians in autism diagnostic reports,² the use of strengths-based interventions to support young autistic adults prepare for leaving school,³ and called for new strength-based models for aging well on the autism spectrum.⁴

Our editorial board feels strongly about adopting a strengths-based approach in Autism in Adulthood. That is why our author guidelines specify to use strengths-based language in favor of deficits-based language. For example “typically developing” or “nonautistic” rather than “healthy” or “normal”; “autistic traits” “characteristics of autism,” or “features of autism” instead of “symptoms of autism”; and “communication differences” instead of “communication deficits.”

Although there has been an uptake of strengths-based approaches in autism research and practice of late, we still lack a nuanced understanding of these approaches; what defines a strengths-based approach? What are the downsides to using strengths-based approaches? How do strengths-based approaches affect the way we research autism and work with autistic individuals clinically? How do they affect autistic individuals’ lives? To help answer these and other questions, we brought together five panelists from across the globe with different perspectives and expertise in strengths-based approaches. Following is a transcript of our discussion, with minor edits for clarity.

Dr. Anna Urbanowicz: Today we have brought together five different panelists with expertise on strength-based approaches in autism. They come from different disciplines with diverse experiences and perspectives, and two of them are autistic themselves. Strength-based approaches are used across disciplines with a variety of individuals, families, groups, and organizations. Our goal today is to discuss strength-based approaches in autism with a particular focus on adulthood. Thank you very much to everyone for joining today's discussion. I would like to start with each of you briefly introducing yourselves.

Dr. Jacquiline (Jac) den Houting: I am a postdoctoral researcher at Macquarie University, and a psychologist by training. At the moment, I am working with Liz Pellicano on a number of different projects, in particular focusing on participatory autism research in Australia, with the goal of developing a framework to support the engagement of autistic people and other stakeholders in autism research. I am also an autistic advocate and I do a number of different things in the advocacy space here in Australia.

Dr. Katie Gaudion: I am a designer. I work as a Senior Research Associate at the Helen Hamlyn Centre for Design, which is part of the Royal College of Art in London. And I am also currently starting my own design consultancy called Design for Mind. Over the past 10 years, I have worked extensively with autistic adults across the spectrum, within a wide range of environments including the workplace, supported living accommodation, hospitals, and outdoor spaces.

An important aspect of what I do is to develop new and creative ways to collaborate with people to ensure they are active participants in the design process so that the environment, products, and services meet their needs, strengths, and desires. My research, in particular, is focused on exploring ways to involve autistic adults with limited verbal speech with additional learning disabilities into the design process. To help me with this, I developed a design framework called the Triad of Strengths,⁵ which supports the idea that by understanding a person's sensory preferences, their interests and action capabilities, an important palette of ingredients is created that can inform the design of environments, products, and services to enhance positive experiences for that person.

Dr. Sonya Girdler: I am a Professor of Occupational Therapy and Director of the Curtin Autism Research Group (CARG) in Western Australia. CARG has 100 members and includes academics, PhD students, and autistic individuals and the autistic community. A large part of our research focuses on examining strengths-based approaches, frameworks, and developing and evaluating interventions. One of our largest projects now is looking at computer coding for autistic teenagers.

Dr. Ralph James Savarese: I am an English professor working in the field of disability studies. This past year, I published a book called See It Feelingly: Classic Novels, Autistic Readers and the Schooling of a No-Good English Professor.⁶ I am also the father of an autistic 26-year-old man who types to communicate. He was Oberlin College's first nonspeaking autistic student and I guess the reason I am here is to think about strengths—different kinds of strengths that you would not typically associate with this group. And so, thinking about literature, literary study, that sort of thing.

Dr. Stephen M. Shore: I am also an autistic person. I am a Professor of Special Education at Adelphi University, concentrating mostly on issues related to the autism spectrum. My focus is on empowering autistic people to lead fulfilling and productive lives, to the greatest extent possible. And I have just completed, in collaboration with Teal Benevides, Alex Plank, and Patricia Duncan, a Patient Care Outcome Research Institute (PCORI) research project, Autistic Adults and Other Stakeholders Engaged Together (AASET), and the engagement piece focused on promoting meaningful and authentic autistic participation in research.

Dr. Urbanowicz: Our first question will be, what do we mean when we say a strengths-based approach and what is unique about this approach? What elements are required for something to be considered strengths-based?

Dr. Shore: So often, I see people constrained on the deficit-based approach, which is evident in the definition of autism as it calls forth deficits in social interaction, communication, and so on. Instead, I would like to turn away from the deficit approach toward an abilities or strengths-based approach and ask the question: what can the autistic person do? Turning the paradigm upside down, where instead of looking at reports, as my colleague Dr. Kristie Patten-Koenig often mentions, that have a whole bunch of weaknesses and with a tiny little line for strengths at the bottom, let us start with the strengths. And I think if we start off by asking, “what can the autistic person do?” then when there are those challenges, and they are real and they are present, what can we do to mitigate those challenges so that the strengths can shine through?

Dr. Gaudion: My perspective is very similar to what Stephen was saying. So, my response to this question was that it is about focusing on what people can do rather than what they cannot. When I first started designing with autistic adults, I was really shocked and overwhelmed by the amount of research in autism that was framed around deficits, like the triad of impairments, where autistic people are generically characterized around impairments in social interactions, social communications, and imagination. Rarely did an autistic person's strengths and interests feature in autism research. Although it is important to be mindful of the challenges, I think it is important that they do not dominate the conversation. I would not describe myself on the things I cannot do, so why would we describe other people in this way? So in response to this and the fact I have rarely met an autistic person who neatly slots into the triad of impairment characterization, I created the Triad of Strengths framework⁵ that supports a more positive and personalized design approach.

Dr. Girdler: I concur with both Stephen and Katie. For me, a strengths-based approach also includes leveraging those strengths, understanding the individual and person-centered approaches, but also leveraging those strengths for employment, for looking at how we can support the person, to actually leveraging those in interventions.

Dr. den Houting: I also agree with the other panel members' comments. In terms of the elements that are required for an approach to be considered strengths based, I have not come across a really clear definition of what is necessary for something to be considered strengths based, aside from simply a focus on strengths. And ideally, as Sonya said, also leveraging those strengths.

I think it is really important to note that the concepts of strengths and difficulties are, to an extent, socially constructed. Saying that somebody has, for example, difficulties with social skills may just mean that they do not socialize in the way that is typical and in the way that is expected. Often that is perceived as being a difficulty because it is not the norm. But whether or not it actually is a difficulty for that person can be debatable, and the same goes for strengths. There are attributes that may be beneficial for a particular person in a particular context, and other attributes that may be detrimental for that person. But which particular attributes are seen as strengths or difficulties is, to a large extent, socially constructed.

Dr. Savarese: If we are going to talk about strength-based approaches to autism, let us also talk about them with respect to neurotypicality. The idea can be deployed paternalistically, condescendingly. And if we remember that no human is all strengths, no neurotype is all strengths, I think we are going to be better suited to practice this approach in a way that is utterly respectful and mindful of the fact that everyone has challenges and everyone has strengths, whether we are able to immediately recognize them or not.

Dr. Urbanowicz: We might move on to the next question, which is about what potential challenges or concerns do you have about using strengths-based approaches?

Dr. Shore: Riffing off of what Jac was saying, it is important that people are not blinded by our often significant strengths. It is part and parcel of autism to have a widely varying skill set. So, although we may have incredible strengths in certain areas, it is also important to realize there are often significant challenges in need of need support.

Dr. Girdler: I would agree with what Stephen just said. I think one concern is that in focusing on strengths the challenges of autistic people can be overlooked. I have experienced this at university where a lecturer will say to me, “There is a student with autism. They have an amazing high IQ and they have got so many strengths and talents.” Then they say, “Well, why is their diagnosis relevant?” I say, “Well, the same student might have difficulties buying a cup of coffee on campus and has difficulties coping with the noise and the campus environment.” So, I think the danger is that with an overfocus on strengths, actually people forget to consider that autistic people have challenges and have difficulties and forget that they need supports in some areas. So that, to me, is my main concern.

Dr. Savarese: One thing that I have been seeing is the way in which a certain stereotype about autistic strengths drives the way that we talk about strength-based approaches. So, for example, every time I tell people that I have been for 10 years reading literature with autistics across the spectrum by Skype, and that they participate in my research as we talk about these literary works, people are dumbfounded because of the stereotype that autistics would not be good at literature. And so, it seems to me that part of thinking about a strengths-based approach is recognizing that we still have no idea what autistic people can do, even though it is early in the 21st century. Recently I was talking with Temple Grandin, and she reminded me that if she had not been sent out at 14 to Arizona to her new aunt's ranch, she would not only have never discovered cattle, but she would also never have discovered that she had a strength involving working with cattle. And I have heard these kinds of stories all the time. So, I would also want the notion of exposure to be absolutely central to the business of a strengths-based approach. Can we expose autistic folks to a range of activities and discover these things, rather than letting a stereotype about, let us say, math or engineering or computers, necessarily drive how we think about where we are going to find those strengths and how we are going to develop them.

Dr. Gaudion: I have a couple of responses to this question. One of the challenges might be that one person's strengths may not be considered a strength to another person. Within my design research, I think there is a close relationship between a person's strengths and interests. In my experience, not everyone appreciates a person's more idiosyncratic interests, which may lead to social isolation as people may perceive a persons' unusual interest or strength as strange, which could have a negative impact on that person. I think it is an interesting challenge to try and bridge empathy and understanding so more people can appreciate a person's interests and strengths, whatever they may be. I was thinking about Temple Grandin as well, because she credits her science teacher, who helped her realize her abilities. Temple's interest in automatic doors inspired her teacher to encourage her to investigate this further and who knows if that is what got her into engineering? But obviously, at that time, automatic doors might be considered quite an unusual interest to other people.

A second challenge that has also been spoken about is this overfocus on savant abilities. We need to be mindful of the whole spectrum of autism and the variety of strengths and interests it brings. I have worked a lot with autistic people with additional learning disabilities, and some of their strengths and interests were things such as drawing vacuum cleaners, collecting desktop fans, and watching things spin. I think these interests should not be underestimated, as they can be a clue to what might be meaningful for a person. Within my design work, understanding what a person likes to do and what they are good at can help generate ideas on how a product, service, or environment can be designed to enhance positive experiences for that person. Design should not just be restricted to functional need with an overemphasis on things such as safety, robustness, accessibility, and durability, but also consider “delight” and how a product, service, or environment can support a person's strengths, interests, and aspirations.

Dr. den Houting: I agree with Katie's comments, and to build on that, it is also important to keep in mind that there can be a risk with strengths-based approaches of taking everything that somebody enjoys and turning it into a therapeutic opportunity. I think we need to be careful not to do that. People need to be allowed to be good at something and just enjoy something for the sake of it. Not everything needs to be a therapeutic opportunity just because a person is autistic.

Also, to build on my earlier comments, my main concern with strengths-based approaches is that they do not necessarily take into account the societal barriers and the impact that society has on a person's ability to function in the world. An autistic person might have all of the “strengths” in the world, but if they live in an environment that is filled with barriers, then it does not matter what we do to build on that person's strengths, because those environmental barriers are still going to be in place. What we really need to start seeing is context-based approaches, in combination with strengths-based approaches, so that we are addressing the environmental barriers as well as building on the person's strengths. Using purely strengths-based approaches puts a lot of onus on that individual person to change themselves to fit more easily into society, or to develop particular skills, or whatever it may be. Although skill building can be a good thing in and of itself, it is also important to develop a society that is more accommodating, more accepting, and more enabling to autistic people.

Dr. Urbanowicz: Thank you so much, everyone. I think that has been a really interesting start to our discussion about what are strength-based approaches, what are strengths, and what are some of the challenges and concerns with using strengths-based approaches. In our introduction, some of you talked about your own personal work, but I would like to hear from everyone now, a bit more about your field of work in strength-based approaches. What are you currently working on? And how do you hope your work will inform others?

Dr. Girdler: Okay, I will start. I work at Curtin University with an amazing group of researchers and people with lived experience. And about 5 years ago, we had many requests from parents of teenagers to help work with them to leverage the young people's interest in Science, Technology, Engineering, and Math (STEM)-related activities, particularly computer coding, robotics, and technology-based activities. So, a wonderful colleague of mine, Tele Tan, set up a computer coding club on Saturday mornings for autistic teenagers. And we started out with about 7 teenagers and now we are up to about a 100, with a wait list of 40. So that has been one of the most amazing programs I have ever been involved in, and this computer coding club we run for teenagers on Saturday morning is an environment that provides opportunities. So, someone was talking about Temple Grandin before, providing opportunities for kids to play with robotics, such as robotics coding, to talk to engineers who are experts in STEM-based areas, and then to work with them on projects throughout the term. And I have never seen autistic teenagers so excited and so engaged and having so much fun, as these computer coding clubs. So, we have been doing some research looking at the framework that underpins that strengths-based intervention and looking at the outcomes for the teenagers, which we are only just starting to pull that research together at the moment.⁷ But it has just been the most wonderful experience to actually provide an environment where it is free from judgment. Every teenager there has autism—and that, to me, was a bit of an ideological challenge, but the teenagers themselves told us that is what they wanted. So, every teenager in that group has autism, but they say the shared experience and lived experience of having autism gives them a safe place, a place where they feel understood and a place where they can be themselves.⁷ We also have occupational therapy and engineering student mentors that actually work together. The occupational therapy mentors focus on the social side and managing more of the social challenges of autism, and the engineering mentors work with the occupational therapy mentors to bring in the STEM and the tech side. And it has just been the most wonderful, organic intervention that I have probably seen in my career, so that has been quite exciting.

Dr. Shore: I will go back to our PCORI-funded AASET project, where 50% of the research project team was autistic. Our team of four consisted of myself and Alex Plank who are autistic, with Teal Benevides and Patricia Duncan as the nonautistic members. Our goal was to find what are the most challenging health care issues facing autistic individuals. We certainly had ideas we felt could be proposed, studied, and published. However, we thought it much better to ask the autistic community this important question about the most challenging medical issues facing us. Therefore, we set up a community council of mostly autistic people and asked how do we best research into this issue, what questions need to be asked, how can our research improve health care? We had a conference of mostly autistic people, and found that the biggest health care challenge on the minds of autistic people is mental health issues and related areas. It was also interesting to learn that Autistica, in the United Kingdom, independently researched on the same topic and found the same answer—that mental health was most on the minds of autistic people.

Meaningful involvement or engagement of autistic people in research was the other half of the PCORI initiative. The first was to conduct research to determine the greatest medical health care issues facing autistic people by asking autistic people, as well as developing best practice for meaningful engagement of autistic adults in research. The deliverable we developed was an engagement guide for research, which we are happy to share, providing information on how researchers can best engage autistic individuals authentically in research. It was very exciting to work on this project. I am hoping it will do a lot of good and serve as a springboard for engaging autistic people in future research.

Dr. den Houting: That is a good lead-in to my work, because what I do is quite similar to what Stephen has been doing. What I am doing at the moment is examining how much engagement with the autistic community and other stakeholders is happening in Australian autism research, and how effective that engagement is. Based on those findings, I will look to then develop something similar to what Stephen has already developed, which will be a framework to evaluate participatory autism research. For me, the whole premise of conducting participatory research, coproducing research, and conducting community-controlled research is very much based on the understanding that the autistic community has strengths to bring to research, and that the lay autistic community can make valuable contributions to the research that we, as researchers, are undertaking.^8,9 More than that, the autistic community is actually entitled to be in control of autism research, because autistic people are the ones who are most impacted by autism research. It not only makes sense, in terms of improving research quality,¹⁰ but it is ethically and morally necessary that autistic people should have a significant input into autism research.

Dr. Savarese: I think back almost two decades ago, when—after my wife and I adopted our son from foster care and immediately included him—it became clear that these very good people who were open to inclusion had ideas about where he would flourish. And it was only natural that his father, who is a creative writer and a scholar, said, “I do not buy this. Let us make sure that he is in language arts classes, regular language arts classes, as well.” And he did terrifically. As I think I told you, he is nonspeaking and, you know, over the past two decades, I have seen tons and tons of nonspeaking folks who have not had the opportunities he has had for a whole range of reasons. And so, I started these free online Skype sessions reading books with nonspeaking folks and then encouraging them to engage in creative writing. And I have a buddy, Chris Martin, in Minneapolis, who started a press, very ironically called Unrestricted Interest where nonspeaking folks with autism read poetry, write their own poetry, and produce chapbooks. Now we might not think of this as research per se, but the very fact that these books are moving out into the world and that more and more students are presenting themselves in language arts classrooms as astonishingly competent creative writers I think is having an impact. I am thinking about just how diverse and heterogeneous the autistic population is and what those interests might be. So that is my sort of writerly contribution here.

Dr. Gaudion: If we think about design, especially inclusive design, so much of it is about how design can support and/or help people. Although this is important, I am really interested in flipping this around to explore how autistic people can support and/or help design. From my own experience, autistic people can offer unique ideas for innovation that are often excluded from mainstream ways of thinking. So the project I am currently working on aims to enrich the broader design field to encourage more designers to collaborate with autistic people and vice versa. I am also in the process of setting up a design consultancy called “Design for Mind” that undertakes research and design projects that contribute toward improving environments, products, and services for neurodivergent people.

Dr. Urbanowicz: What are some ways that we can conduct strengths-based research and how can we research and discuss challenges from a strengths-based perspective?

Dr. Shore: It is very encouraging to see so much good work happening within our small group. Perhaps this suggests that there is more work going on that we do not know about. Moving forward, having groups of like-minded people like the Participatory Autism Research Collaborative in the United Kingdom, directed by Dr Damien Milton, would be great—perhaps even creating branches of that research collaborative in other countries conducting research focused on autistic strengths as a central principle.

Dr. den Houting: If you are empowering autistic people and the autistic community to be directing the research, then that research is inherently grounded in a strengths-based approach, even when you are researching challenges. If autistic people are empowered to be leading or coproducing that research, then you are implicitly assuming and recognizing that autistic people have strengths and skills. It is also important to focus not only on challenges that are intrinsic to the person, but also on the challenges that are external. Societal attitudes, sensory environments, we need to consider all of the systemic and environmental challenges, and focus on context rather than just framing individual differences as challenges.

Dr. Savarese: This probably does not even need to be said, but it is really important to remember that we need to include people across the spectrum—in particular, the part of the spectrum that includes nonspeaking folks or folks whose competence might be questioned more regularly. There is just not anywhere near enough research about these folks and what they need. And you know, if I think about the fact that my son is only the 10th nonspeaking autistic person to ever earn a college degree, and he is the first to have lived in a small residential liberal arts college dorm, wow, are we behind in terms of autistic civil rights. We really have to think differently and heterogeneously about what different groups and different people on the spectrum might need, and about how to help this group, in particular, to appear as competent as they actually are. There is still so much stigma surrounding those who do not speak or those who have very little control at all over their bodies or what might be judged to be a “behavior.”

Dr. Shore: Ralph, I think you are absolutely right. I know many nonspeaking autistic people having the ability to be involved in research with the rest of us. We need make sure that happens.

Dr. Girdler: And not to be a boring academic but, in evaluation, a realistic evaluation and I think that triangulation of data collection methods where we have done questionnaires, interviews and focus groups, and participatory observation and we have talked to parents, autistic teenagers themselves, and the facilitators and really looking at the holistic picture. I do wonder as we get better at implementing strengths-based approaches that maybe one of the key words is holistic. It has to take a holistic perspective.

Dr. Urbanowicz: We have got some of these views already, but how can strength-based approaches be used in care and practice?

Dr. den Houting: There is a phrase that is fairly commonly used in the autistic community that I think is important to keep in mind here, which is “presume competence.”¹¹ That is particularly relevant when we are talking about the subset of our community that Ralph has been referring to, people who are often presumed to lack competence—for example, people who are nonspeaking, people who have co-occurring intellectual disability, and people with higher support needs. We need to ensure that all autistic people have agency over the care that they receive, that people are being supported to have input, where possible, into decisions about their care. We need to work with people to identify what is important to them, what their goals are, what support will be most beneficial for them as an individual, and most improve their subjective quality of life.

Dr. Shore: You are absolutely right. Presumed competence and meaningful inclusion of autistics in the conversation. And related to your statement of presuming competence is the maxim of “nothing about us without us.” These concepts require us to continually search for ways of increasing meaningful participation of people, as Ralph mentioned, who may have more challenges and may outwardly seem less aware of their environment. However, the key word is outwardly. Assume that people with more significant challenges are aware and also have something meaningful to contribute to our work in strengths-based approaches and meaningful participation in research.

Dr. Savarese: This may not fit perfectly here but I remembered it was something that I wanted to talk about with respect to strengths-based approaches in research. I too use a kind of ethnographical approach that has this constant sort of loop, where we are all constantly reassessing what we are doing when we are discussing a book, the terms under which we do it. If we are Skyping, some people want the video monitor on, some not on, etc. But it seems to me, one of the things I have tried to really do consistently is to actually foreground, if not dramatize, the mistakes I make as a researcher, the interpretative mistakes I make. Because I think too often in any kind of research, no matter how progressive it is, we sometimes clean up, those of us who are not autistic, the mistakes we make. And I think those mistakes, and showing them, showing the peril that is always involved in not just speaking for somebody else, but also the conclusions we draw from our encounters with her or him, that seems really, really important to me. I was just at the University of Virginia 2 days ago with some students in psychology and they were stunned at my willingness to show that I was wrong. And I thought, wow, I mean that is what we need on some level, especially if autistic participation is not as vigorous as we would like it to be. You have to have the nonautistic researchers willing to foreground their interpretive mistakes, and then you have to make them part of loop of ethnographical research.

Dr. Girdler: Ralph, what you were just saying about your mistakes and something that has really hit me about our strengths-based work is we thought we were running a computer coding club looking at STEM, but actually one of the most powerful outcomes is actually the social side of the program. We were actually running a social club. That has been my “ah-ha” moment of you make these assumptions and you make these mistakes. I think putting them at the foreground is actually quite important.

Dr. Savarese: I just want to add to that. I recently read some short stories with Temple Grandin. It turns out her favorite undergraduate course 50 years ago was a literature course. She spoke quite articulately about Dante's Inferno, quoted from memory lines from Wordsworth's poetry. This is nowhere in any of the interviews online. I was surprised—this, too, was a kind of mistake. Suddenly, you know, Temple's leaving messages on my phone about other works of literature she has read. No one would conceive of her as doing that. I really tried in my book to dramatize how many ways you can make a mistake, but also how many ways, if there is vigorous autistic participation, that such mistakes can become the greatest learning opportunity.

Dr. den Houting: To build on Ralph's comments, I think you are absolutely right that the mistakes can be remedied if you have genuine autistic participation. Also, if you have meaningful autistic participation and engagement in research from the very early stages, then you may be able to avoid making those mistakes in the first place. That is also something that we should be aiming for, autistic engagement through the whole process of research, and through the whole process of care and support, making sure that every step is informed by autistic perspectives.

Dr. Savarese: You would be surprised at how many mistakes I can make even if there is that kind of participation from beginning to end. I think your idea is a good one.

Dr. den Houting: The mistakes are necessary as well, it is a good way to learn.

Dr. Gaudion: I do not know whether this really relates to the question being asked but the word “meaningful” has come up a lot. An important aspect of my design work is to explore and understand what is meaningful to the people who I am working with. One client who provides support and accommodation for autistic adults with additional learning disabilities wanted to understand how the people they support could be more meaningfully engaged in everyday tasks, such as vacuum cleaning and washing clothes. This was an interesting design brief because with some of the autistic people I was working with, their motivation for using a washing machine was very different to my own. I use a washing machine to wash my clothes, however, some of the participants in the research particularly enjoyed and engaged with the by-product of operating their washing machine, for example, watching it spin. So to make the activity of washing clothes more meaningful for them, I accentuated and celebrated their preference for watching their machine spin and developed “Spinny Disc,” which adds an extra—and pleasurable—fun step into the process of washing clothes. Spinny Disc is attached to the inside of the washing machine door and creates different visual effects as it spins with the washing. The idea behind this is that by incorporating and enhancing a person's interest and sensory preference into an activity, it could make that activity more meaningful for that person.

Back onto the subject of mistakes, one mistake I made, in particular, when I first started designing with autistic adults was that I made the assumption that participatory design methods such as cocreation workshops were the answer. However, I soon realized that it was important to question the validity and appropriateness of participatory design for a person who might dislike social interaction or feel uncomfortable in a group situation. I have met many autistic people who do not want to be in a group setting, so the idea of actually participating in a cocreation workshop was quite inappropriate for that person. So I have had to really check my own assumptions and biases along the way.

Dr. Urbanowicz: It sounds like one of the things that is coming out of the discussion so far is that researchers need to be flexible in their research, being open to the fact that they may make mistakes and being open to working collaboratively with autistic adults and understanding that autistic adults have inherent strengths. What effect, if any, do such models have on the lives of people on the spectrum?

Dr. Shore: The model of strengths-based collaborative research with autistics has a great effect in validating our experience. As we bring the authentic autistic voice forward, people will realize that it is us talking about us, as opposed to others talking about us.

Dr. Girdler: That is great, Stephen. And I think from my experience in the computer coding clubs we have been running—we have been running them for about 5 years now, I have seen some of the teenagers grow up and, you know, from the skills they have built in our Saturday morning computer coding clubs, they went on to study software engineering at university. And to see their confidence improve, their skills improve, then to leverage that into employment and then hopefully eventually see that sort of move on to better lives and better futures, is really what I hope we can start to do.

Dr. Savarese: I am just putting a word on what I have just heard: namely, empowerment. With all of the young folks I have worked with, first of all, there is just extraordinary pleasure in working hard on something and crafting a beautiful object made of words. I mean, I do this is in my regular job with nonautistic folks and I have a few autistic students at my college. But I think no one suffers from learning—or having the experience of really, really working on something and producing a beautiful object. But in the case of the autistic folks, I work with on creative writing, they are also doing what Stephen is talking about. They are giving voice to something that is authentic and they are devoting themselves to thinking quite critically about what is the best way to express their voice. What is the best way to explain sensory differences or challenges in a kind of creative context? And that pleasure is palpable. It is also often compensatory because many of my collaborators are not—have not been allowed to be included in regular schools. So, it is also a question of compensating for the big structural inequalities that continue to exist. I mean, inclusion is this thing that seems to be almost randomly distributed across the United States and it depends on so many fluky things and lots of resources and capital and so forth. But anyway, empowerment, you really see folks believe that they learn and grow, which is what happens in typical classrooms as well.

Dr. den Houting: I absolutely agree with Ralph's comments. Using a strengths-based approach can change other peoples' perceptions of autistic people. But more importantly, it can change autistic peoples' perceptions of ourselves. Particularly given that so much autism research and practice has historically been heavily deficit focused and still, to a large extent, is deficit focused. As an autistic person, you grow up in a society that teaches you that you do things “wrong” and you have to learn to be more “normal” if you are ever going to be successful or happy. Strengths-based approaches can be beneficial in the sense that they can foster self-confidence and empower autistic people to be happy and to live fulfilled lives, as we are, as authentic autistic people. I do believe we need to be wary of dichotomizing particular behaviors and abilities as just strengths or just challenges because those judgments are really context bound. But, I do not think it is ever going to be a bad thing for somebody to be empowered and to realize that they do have strengths and not just deficits.

Dr. Urbanowicz: I am going to give a brief overview of what I have heard comes out of the discussion. I will ask Christina to give a summary as well, as she has been listening attentively.

One of the things that I have heard quite strongly throughout the discussion is there seems to be a link between strengths-based approaches and the meaningful participation of autistic adults. That it is really hard to do something that is strengths-based without also including the voices and lived experiences of those on the spectrum, regardless of whether it is in conducting research or whether it is making care and practice decisions. One of the other things that I have heard is that it is not just strengths versus weaknesses or strengths versus deficits, that the environment, whether that is the physical or the social environment, in which individuals live is also really important to consider.

Christina, would you like to add your summary and thoughts?

Dr. Christina Nicolaidis: Yes I do think those were the most prominent themes that have been coming through. We started with a contrast between strength-based approaches and deficit-based approaches—that is, thinking about what the person can do versus what they cannot do or what their impairments are. It has been nice to see the discussion build a more nuanced understanding. I will summarize some of the key issues I heard:

• As Jac said, we should be wary of the dichotomy between strengths and weaknesses and instead think of strengths and weaknesses in the context of societal and environmental barriers.

• As Ralph commented, everybody has challenges and we should not only be thinking about strength-based approaches within autism. If we are going to use these approaches in autism, we have to be thinking about strengths and challenges for everyone.

• There is a danger in overlooking challenges. We want strength-based approaches to be highlighting strengths, but not to do so in a way that makes us overlook challenges.

• We need to avoid stereotypes of autistic strengths. For example, autistic strengths do not have to be related to technology or be savant skills. When we talk about strengths, we need to think about strengths across the entire spectrum.

• Strengths-based approaches may go hand-in-hand with participatory approaches. It is critical to include autistic adults across the spectrum in research, practice, and policy. And doing so means tackling methodologic challenges, because it is easier to include folks who have an easier time communicating, who may speak fluently, or who may have fewer intellectual disabilities.

• Assuming we use a more nuanced understanding of what these approaches mean, strengths-based approaches may have a real effect on people's lives—in concrete ways such as increasing practical skills and employment, but also in empowering autistic people and changing society's perspectives. And maybe as Jac says, even also changing autistic people's perspectives of themselves, building self-confidence, and allowing people to be able to then express their strengths better.

Those were the things that stood out to me. The message I heard was that strengths-based approaches need to be much more than just highlighting the good and forgetting the bad. We must think about strengths in a contextual way, and in a way that includes all different types of strengths, the whole spectrum, and the acknowledgment that sometimes there can be really difficult challenges.

Dr. Urbanowicz: Thank you, Christina. So thinking about Christina's summary and everything that we have talked about today, I have two more final questions for each of you. The first one is I would like you to tell me what you found was the most interesting or useful in today's discussion. And then I would also like you to answer whether we should be promoting strength-based approaches in autism research and practice. And if so, how should we promote these approaches? And if not, what should we be doing instead?

Dr. Girdler: I would go back to Jac's comment that I think strengths-based approaches can be a powerful influence for the autistic person themselves. I guess, you know, as a researcher, you do your research, but actually if you use a strengths-based coproduced approach, you can actually have a really powerful influence in the research process. And as you were saying, Jac, change people's perception of themselves. I think that is really powerful. I do not think there are too many other research methodologies that can do that. Doing a questionnaire, I do not think can do that.

Dr. Shore: I agree with you. In addition to changing perceptions about oneself, it is also good for changing perceptions of others about autistic people. And what I see is increasing number of us doing strength-based authentic research. Involving meaningful participation of autistic people in research will eventually become a sort of norm or an expectation that we involve autistic people in research to the best of our abilities.

Dr. den Houting: For me, I think something that stands out are some of Ralph's comments around people who have higher support needs. Both in research and in advocacy, we have struggled to meaningfully include and represent that subset of our community. That is something we really need to focus on doing more, and doing better. It is something that can be very difficult, and I do not have the answers—I wish I did. But it is, I think, something that we need to prioritize.

Dr. Savarese: First of all, I just want to bring back Stephen's comment because I have the same response, wow, look at all this good stuff that is happening and it must be reflective of lots of other stuff that is happening around the world. So, it is nice to know that, we are not all alone in our tiny little pockets. That there are actually many little colonies out there. So, that is the first thing.

And then what you said, Jac, we cannot forget this sort of central tenet of disability studies, which is that the whole notion of disability is something that arises in an inhospitable environment. So, this especially relates to nonspeaking people but we really have to think about strengths, and this is hard to do in the context of all of the obstacles that make it impossible for autistic people to show their strengths, discover their strengths, live their strengths, and employ their strengths. And you reminded me of something really important, we cannot make strength-based approaches lean so much on individuals. It has to lean on structural change so that there is a greater chance that many people will be able to show what they are good at.

Dr. Gaudion: So much of it has been really interesting. I think what I really enjoyed about this conversation is that we have all been very honest and open and talked about the mistakes and challenges we have experienced. I think if we can keep that dialogue going, that would be really useful, in terms of exploring ways in which to involve people, particularly those who have limited verbal speech in autism research. I know that I do not have all the answers and would definitely like to do more sharing around that particular subject.

Dr. Urbanowicz: Thank you all so much for joining in today's discussion. We really appreciate your time and input. For me personally, it has been a really interesting discussion, hearing from many different perspectives, and how in all these different fields of research, we can do strengths-based autism research.