“Just Invite Us”: Autistic Adults' Recommendations for Developing More Accessible Physical Activity Opportunities

Abstract

Background:

Autistic adults engage in lower levels of physical activity (PA) than their nonautistic peers, and over 60% do not meet national guidelines for PA. In addition, autistic adults face myriad barriers to PA participation that can make accessing activities challenging. To support the inclusion of autistic adults in PA, this study sought to explore first-hand recommendations for PA participation from autistic adults' perspective.

Methods:

We interviewed 23 autistic adults aged 18 to 75 years about their PA experiences across their lifespan, including querying the participants' recommendations for supporting autistic adults in PA. A qualitative descriptive design with a constructivist lens guided the thematic analysis.

Results:

The analysis resulted in two overarching themes: (1) It's helpful to have someone there to support; and (2) It's that sensory thing, it always is. Each theme includes participant-provided recommendations to guide professionals in the field of PA.

Conclusions:

The autistic adult voice, long absent from conversations about PA, is a valuable and needed addition to understand how to improve PA experiences for this population. Recommendations from this study include (1) listening to the perspectives and insight of autistic adults, (2) consideration of sensory stimulus when planning for PA participation, and (3) encouraging and providing social supports for PA participation.

Lay summary

Why was this study done?

Autistic adults have many health concerns such as anxiety, depression, and obesity. Physical activity can improve these health concerns. Yet, professionals lack knowledge about how to provide optimal physical activity experiences for autistic individuals. Very little research has engaged autistic adults to directly ask their recommendations about their own physical activity needs.

What was the purpose of this study?

This study wanted recommendations from autistic adults on how to make physical activity more accessible and enjoyable. By doing this, the authors hope to increase the voices of autistic adults in physical activity research.

What did the researchers do?

The researchers asked 23 autistic adults for their recommendations on how to improve physical activity experiences.

What were the results of the study?

Participants' responses were grouped into two categories: (1) It's helpful to have someone there to support and (2) It's that sensory thing, it always is. The first theme highlights the social supports that many autistic adults feel they need to be successful. Supports include individuals within the close social circles of the autistic adults, such as parents, friends, and other close people. They can also include professionals, such as teachers or exercise trainers. The second theme highlights the need to address the sensory sensitivities of the individual before activity can take place; if an environment or activity is not “sensory friendly” or is not accommodating, then autistic adults are less likely to engage.

What do these findings add to what was already known?

Autistic adults face many barriers to physical activity participation. These findings offer first-hand accounts by autistic adults about how to improve their physical activity experiences. These results also offer ideas on how to increase physical activity engagement for autistic individuals. Other research has focused on improving physical activity in those who are autistic, but this research is rarely from the perspective of the autistic individual. This study is one of a very small number of studies that has done this and is the first to ask autistic adults to give recommendations for physical activity participation.

What are potential weaknesses in the study?

This study only interviewed autistic adults who prefer to communicate verbally, and so the study sample is not representative of all autistic adults. Many participants in the sample were from the United States, and autistic adults in other countries may have different opinions about physical activity participation. Finally, the researchers may have recruited individuals with an interest in physical activity—autistic adults who are not interested or dislike physical activity may have different recommendations.

How will these findings help autistic adults now or in the future?

This study will help professionals provide more appropriate physical activity experiences to autistic adults. Also, this research could help practitioners and researcher make physical activity spaces more welcoming and enjoyable for autistic adults.

Introduction

Autistic adults are reported to engage in lower levels of physical activity (PA) than nonautistic peers.¹ Addressing physical inactivity among autistic adults is an urgent public health need as PA is a key modifiable risk factor for a host of health issues that are more prevalent among autistic populations, including obesity,² hypertension,³ and depression, anxiety, as well as other psychiatric issues.⁴ Moreover, PA is noted to have significant additional benefits for this population; a 2018 meta-analysis² examined 29 studies to determine the effect of PA interventions on autistic individuals. The authors found an overall positive effect for participants exposed to PA interventions, especially on skill development (e.g., manipulative and locomotor skills), skill-related fitness, social functioning, and muscular skill and endurance.

Data suggest that autistic adults engage in less PA^5–7 and experience more PA barriers than neurotypical adults.¹ For example, Hillier et al.¹ surveyed 30 young autistic adults and a comparison sample of 30 neurotypical adults demonstrating that autistic adults engage in less strenuous PA, had more negative attitudes toward PA, perceived there were more barriers to engage in PA, and had a harder time engaging in PA than the nonautistic comparison group. No differences were found between groups about PA expectations or beliefs, although the autistic group reported less intent to perform PA. To support the PA participation of autistic individuals, a first-hand understanding of their experiences in PA and their recommendations for improving these experiences is much needed.

Research on PA participation among autistic adults is sparse, although increasing in the last 5 years.^7–9 Primarily, this research has focused on eliciting the perspective of parents and caregivers of autistic adults to construct the PA experiences of their adult children or clients.^10,11 Identified barriers to PA for autistic adults include limited motor skills, increased hypersensitivity, the family's socioeconomic status,¹¹ as well as inaccessibility of community programs or spaces and lack of acceptance.¹⁰ Conversely, facilitators to PA for this population include support from parents/caregivers and accessible PA opportunities. Although this research has supplied a preliminary insight into PA participation among autistic adults and the barriers they may face, this perspective is second hand and, therefore, ancillary to the actual lived experiences of autistic individuals. To identify how to provide accessible supportive PA experiences, the direct input of autistic adults is also required to understand their needs.¹²

Even with a growing body of literature that has sought to understand the autistic experience, most of the identified studies have lacked first-hand accounts of autistic individuals. It has been observed that those who are autistic and those who are not can have vast differences in opinions.¹³ Therefore, as ones' understanding of the world is constructed through their individual experiences,¹⁴ it is vital to understand how autistic adults experience PA and what they view as obstacles to PA participation. This insider knowledge will be critical to inform better accessibility practices. By capturing what autistic adults believe are best practices to provide PA experiences will help professionals and families provide a more supportive environment for autistic participants of all ages. To this end, the purpose of this study was to explore the first-hand recommendations for PA participation from autistic adults. In doing so, this study has sought to amplify the accounts of autistic adults so that practitioners have practical solutions to better include autistic individuals into PA experiences.

Methods

This study used a qualitative descriptive design with a constructivist lens to examine autistic participants' recommendations in PA. “Constructivism sees the world, and what we can know about the world, as socially constructed.”¹⁵ Therefore, we considered a constructivist lens most appropriate for analyzing the present data due to the interconnected individual and societal factors that may influence the recommendations described by participants. In other words, this approach allowed us to situate participants' responses into the social and environmental contexts that occurred during data collection while also respecting the complexities and subtle nuances, which are influenced by society, of the participants' lived experiences. Through this lens, we explored the differing experiences of each participant with an understanding that these experiences may be guided by the specific instance of the individual; yet, we were also able to, through these experiences, construct a broader explanation for commonalities of experiences and situational factors that contribute to that experience. These data were part of a larger grounded theory study exploring the adoption and maintenance of PA among autistic adults.¹⁶

Participants

We recruited participants through online groups, university autism clinics, and networks, and snowball sampling to use the personal connections of autistic participants. Participants were included if they (1) identified as being autistic, (2) were 18 years or older, (3) communicated verbally, and (4) were willing to participate in interviews. The authors used the AQ-10¹⁷ as a confirmatory measure for the likelihood of an autistic diagnosis.

Participants were predominantly from the United States; two participants were from the United Kingdom. As this study is the first known attempt to elicit autistic adult recommendations to PA, we included all interested participants, regardless of their home country, if they met the above inclusion criteria.

The University of North Texas Institutional Review Board approved all research activities. This study included a purposeful sample of 23 participants ranging from 18 to 75 years (m = 40.45, SD = 17.79). Twelve participants identified as male and 11 as female. The sample ranged widely in both economic and educational backgrounds (Table 1). Twenty participants had a formal diagnosis of autism and three were self-diagnosed. Participants did not receive compensation for taking part in this study.

Table 1.

Participant Demographics

Self-identified gender
Female	9 (39.13%)
Male	14 (60.86%)
Age range (in years)
18–24	6 (26.09%)
25–34	4 (17.39%)
35–44	4 (17.39%)
45–54	3 (13.04%)
55+	6 (26.09%)
Diagnosis
Formal	20 (86.96%)
Self	3 (13.04%)
Highest level of education
High school	8 (34.72%)
College	13 (56.52%)
Not reported	2 (8.70%)
Employment
Unemployed	6 (26.08%)
Self-employed	8 (34.78%)
Part time	2 (8.70%)
Full time	3 (13.04%)
Retired	3 (13.04%)
Not reported	1 (4.34%)
Income ($)
>10K	10 (43.48%)
10–29K	1 (4.34%)
30–49K	1 (4.34%)
50–69K	1 (4.34%)
70–89K	1 (4.34%)
90K+	3 (13.04%)
Not reported	6 (26.08%)
Marital status
Single	9 (39.13%)
Married	10 (43.48%)
Relationship	2 (8.70%)
Divorced	1 (4.34%)
Not reported	1 (4.34%)
Living situation
Lives with family (either partner or partner+kids)	14 (60.87%)
Living with parent	6 (26.08%)
Living independently	3 (13.04%)
Location
United States	21 (91.30%)
United Kingdom	2 (8.70%)

Data generation

We developed interview questions to query the participants' perspective of PA experiences across their lifespan. To see an abridged version of the full interview schedule, please refer to Colombo-Dougovito et al.¹⁶ Within this broad interview schedule, we embedded questions to allow participants an opportunity to share recommendations for improving PA experiences for individuals “like themselves.” Defining PA in a meaningful way for a specific population can be elusive. Previous research¹⁸ has indicated that allowing subjects to define PA can lead to a broader definition of PA that may be more suited to the individual and/or their family. For this study's purpose, the authors invited participants to define what PA meant to them and frame their responses to that definition. Though responses varied, all subjects self-defined physical activity as their engagement in movement activities that increased heart rate, breathing and/or perspiration.

The authors established follow-up prompts to these questions to gain a depth of information from the participants. Both autistic and nonautistic autism researchers independently reviewed the interview guide for clarity. Specific interview questions within the overall interview sought recommendations for improving PA participation; the specific questions were (1) how can PA experiences be improved for autistic adults, (2) how could professionals and teachers improve PA for autistic children, (3) how could families improve PA for their autistic child, and finally (4) how might organizations such as gyms or sports venues better include autistic individuals? The researchers used follow-up probes, as needed, to increase the depth of response.

The first and second author individually conducted each interview. The first and second authors are tenure track faculty at universities in the United States, and the first author is also a mother of autistic twins. Each interviewer had extensive prior experience conducting interviews, including with autistic individuals. We supplied participants with an overview of the main interview questions ahead of the interview to alleviate potential anxiety and allow participants to prepare. We conducted interviews using the participants' preferred medium of communication (i.e., video interview [Skype or FaceTime], phone interview, or in-person). Interviews ranged in length from 20 minutes to over 2 hours, although the majority took approximately 1 hour to complete. Participants spent approximately 5 to 30 minutes discussing recommendations for improving PA experiences.

Data analysis

Interview data were transcribed verbatim. We sent transcripts to participants to ensure accuracy and allow for clarification.

We then conducted a thematic analysis, using an inductive approach, at a semantic level, with a constructionist paradigm, following the steps outlined by Braun and Clarke²¹: (1) familiarization with the data; (2) coding, which consisted of using a first-cycle coding method, looking for exploratory categories from preliminary codes²⁰; (3) searching for themes; (4) reviewing themes; (5) defining and naming themes; and (6) writing up.

As data are derived from a larger study, the first author reread the transcripts and analysis from the original data focusing on participant recommendations. She recorded data that were specific to the present inquiry and supplied context for their individual experience. She used an inductive coding process to interpret, give meaning, and examine the relationships of the constructs captured within the participants' responses while considering each response's interconnectedness and the researchers' interpretations of these responses. Iteratively, during this process, all three authors discussed and resolved any differences in interpretation through critical dialogue until they reached a consensus. We used Dedoose Analytic Software¹⁹ for qualitative data management.

Results

Two themes emerged during the data analysis processⁱ: (1) It's helpful to have someone there to support and (2) It's that sensory thing, it always is. The identified themes are discussed below, with supporting quotations from participants. A pseudonym has replaced participants' names.

It's helpful to have someone there to support

This theme encapsulates the importance of having vocal advocates willing to encourage and support the autistic persons in both individual and group activities. Support from a loved one—whether a sibling, parent, close friend, spouse, or significant other—was the key for most participants starting and/or maintaining PA. Participants also deemed professionals who supported PA participation such as teachers, coaches, and trainers to be important; these individuals could act as major motivator or demotivator to engagement and success in school-based or structured PA settings.

Participants, reflecting on their childhood PA experiences, often recalled the importance of their parents' support. For example, Ashley shared about how others could be motivational like her mother. Ashley reflected that when she was a child, her mother said: “‘You can do it,’ motivational kind of things.” She also said that people like her mother were vital to “get[sic] [autistic people] to keep trying and not give up after, you know, not—maybe not being so successful the first time.” Participants also shared that their parents and other family members were frequent advocates to their inclusion in activities. Nicole stated:

‘cause like my mom would tell people like, “Oh, these are, you know, the strategies. Like you have to be able to talk to her, you have to give her reasons,” stuff like that. The teachers who took that to heart and really followed it tended to be really good with me.

Support for PA most frequently came from the participants' parents who were perceived to know when appropriate to push and when to hold back with their children.

I think when mum instinctively, without knowing how I was different, instinctively understood that I needed to try everything. And she would encourage me even if I decided no to [inaudible], “No, I don't really want it.” She would encourage me to take two or three weeks out and then try again for two weeks. Planning it ahead, saying, “What if you leave it for three weeks, have a rest, go back for two weeks and leave it again? (Sandra)

In addition, it was important for participants to have family and a supportive community that continued to help them seek PA activities individualized to their abilities and needs. Susan shared that their parents were always trying to be encouraging and suggested that when programming PA to “just try and find out what they're interested in, I suppose and encourage them to sort of get walking or something.” Encouragement from parents was a frequent comment made by participants and is highlighted in this comment by Steve:

Well, just that kind of—it helps if at least one parent I suppose is born with the—I call it the cheerleader gene. “Come on you guys. It'll be fun. Just try it once.” That seems to be more helpful I think for a kid. If I'd ever had that I would imagine it would-be than just, “Take the garbage out.” Or, “Get out of this house. You're driving me crazy. Go for a walk.” It seems to me that kind of more helpful, “Come on. I'll go with you. It'll be fun.”

Participants reflected that parents and family members often helped educate professionals about how best to work with them in the schools. As Samuel stated, “It's helpful to have someone being there to support. I do it for my girlfriend. Staff do it for me. It's helpful to have people that know what's going on and can help you.” In particular, parents were reported as being important advocates for professionals to collaborate with other professionals. William's recollection of his mother's role in advocating for him reflects this sentiment:

[M]eeting with any of the professionals who are already working with the kid, and ideally get, um, you know, as complete as possible, uh, of a profile on the kid, like their personality and why they do what they do. Like a lot of the time, my mom would tell teachers how to work with me and they, you know, would either listen or they wouldn't.

To that point, many participants also advocated for autistic children's voices being prioritized and not buried by their parents' beliefs of what they needed:

[G]et the input from the person themselves, who actually hold the diagnosis. I know some families try to get their children involved in a lot of activities, but maybe it's not necessarily what the child wants. Like have they ever sat down with the child and said, “what do you or not—do not want? Instead of making all the decisions. I think its kind of ableist to go about it that way. (Nicole)

Participants also shared their dismay with both the overly positive and the, often, overtly negative behavior of professionals toward autistic individuals. David shared his exasperation with professionals who try too hard to champion autistic individuals: “Quit tempering them. Quit being SJWs, you know, social justice warriors!” While other individuals shared their frustration with the other end of the spectrum, Susan shared, “I can remember being told off…teachers need to be sensitive that we don't understand things quickly.” Although participants described both positive and negative behaviors, negative experiences were far more prevalent among the responses.

It's that sensory thing, it always is

This theme highlights the critical role that sensory factors play in the success of PA experiences for autistic adults across the lifespan, and how unique sensory needs may be met. For the participants in this study, sensory needs played an influential role in how successful, or unsuccessful, an individual could be in any given space—regardless of the individual's physical ability. An overstimulating environment was often perceived as too great a barrier to overcome even if the individual typically enjoyed the PA that was being offered.

Sensory overload played out in diverse ways for the autistic adults in this study. David shared that his “senses were constantly under attack” in a gym setting. Even when David tried to take part in PA by using workout videos and apps, the “videos caused visual overload.” For William, being in group settings was challenging; yet, he has learned to cope: “when people start to get rowdy, it just makes me very uncomfortable, but I have gotten used to it.” Nicole, Ashley, and Zebo also shared the overwhelming feelings of being in crowds. Sandra talked about crowds and movement in a unique way and the need to mitigate too many bodies in a shared space: “Not always the sound, but the movement loudness, that's right—would be too much [to want to participate].”

Autistic adults in this study often wanted to work out in a gym-based setting, but the sensory experiences often made that not possible. In addition to sensory-friendly hours, or space modifications, Nicole recommended:

Open up some sort of gym that's very welcoming and conducive to the people who have sensory challenges. So instead of walking in and blasting the music, maybe don't have any music.

Common gym practices such as equipment alignment, wiping down equipment, or touching spaces that others have been in were also overwhelming for some participants. “I don't like the feelings of, like, the slime, like sweat people leave behind. It just gets very overwhelming for me” (Nicole). For Elizabeth, the organization of the space was immensely helpful, and she had positive experiences in a gym setting when the equipment was aligned in a way that helped mitigate overload from seeing other peoples' faces:

But the way the machines were organized was so that they all kinda—I d—I don't know how to describe it without drawing a picture, but none of—the machines weren't facing each other in a way—-that you were—you couldn't see each other's faces when you were using the machines—like in a way that people weren't like—it didn't feel like we were looking at each other.

To make spaces more accessible, participants in the study recommended providing proper lighting that “would not mess with them so much” (David). Among the sensory issues expressed, lighting was a frequently mentioned variable in settings that could be easily modified to provide a more inclusive experience in classroom, gym, and sport event settings. Cynthia shared that “if any of the local gyms might offer autism time like maybe for people with lighting and sound sensitivities maybe, accommodate that, and then make it so that, um, people really feel welcome.” In addition, Cynthia recommended, “shade the blinders in class to help the sun or the lighting not mess with them and have stuff that you can actually put on towards the light.”

In addition to suggesting that physical activities' sensory demands could be aversive to the autistic participant, the interviewees also shared that PA could help them cope with their sensory needs when designed correctly. Elizabeth shared, “the more I exercise, also the better my sensory experience is.” Jessica shared that “moving multiple times a day really helps. If autistic adults need some sensory input, getting up and walking around or standing may help mitigate sensory stresses in environments, such as work, where they may not feel they can express themselves. Heather shared:

My sensory issues mainly affect my joints to where I guess I describe it as, um, always feeling like there are air bubbles in my joints, and I always need to give it a good shake to get it out ‘cause—it's kind of annoying. It's just like something's sitting in there and they need to like be waggled out of my body.

PA and simple movement could sometimes mitigate negative sensory input as well. When performing one specific activity, Mary shared the following:

The sensory is—sometimes it's there. It's not that bad, but for some things, it's really bad. For instance, I cannot do jumping jacks to save my life because partway into the first one, I get very overstimulated. The universe feels like it's falling apart.

The repetitive nature of some activities was also discussed as being soothing for some participants. Mark shared, “I like the sensation of swimming, biking. I can bike in circles. I get a lot out of that.” For some individuals, PA may act as a regulatory mechanism. Elizabeth also commented on swimming, sharing that it “helps to maintain body temperature. Like I can be outside doing an activity, and not be sweaty.” Jason also shared that the “consistent pressure of the weight of the water, being able to be submerged, that I'll be able to feel my body” aided his PA participation. Mark shared, “so my own recommendation is that, for myself, and maybe others, is exercise is, is essential for me. It works for me.”

When appropriately supported and in an accessible environment, for some adults, PA provided sensory benefits long after the single bout of PA. Elizabeth shared that:

The more I exercise, also the better my sensory experience is. Like I found—since I've noticed that, my office has fluorescent lights, and I start to get a headache. If I stand up and move, stretch it helps a lot. It tides me over.

Participants also mentioned that unless the sensory concerns for the autistic individual are not addressed, PA may not be successful. Jason stated, “the sensory issues are so powerful that, uh, until those things are addressed, don't even try to do physical activities.” The influence of negative—predominantly indoor—sensory stimuli might be responsible for most adults' tendency to prefer participating in PA outside in nature, in activities such as walking, biking, and swimming.

Discussion

Autistic adults are the experts of their own lives. Within this study, the authors sought to amplify the self-identified needs and recommendations of autistic adults regarding their participation in PA. Consistent with prior research,^10,11 autistic adults in this study faced a multitude of barriers to accessing PA. Yet, uniquely within this study, we asked adults to give recommendations for how they believe those barriers should be addressed. Using a constructivist lens, we thought it important to allow participants to construct their experiences to ensure outcomes aligned with making more accessible experiences for autistic individuals. The findings demonstrate (often) simplistic straight-forward methods of making PA more accessible for autistic adults: (1) listening to the perspectives and insight of autistic adults, (2) consideration of sensory stimuli when planning for PA participation, and (3) encouraging and providing social supports for PA participation.

Encouraging continued learning for practitioners

As evidence suggests,^20–22 practitioners in many PA and health-related fields have insufficient training to support autistic individuals' needs. In multiple cases, participants of this study named well-meaning (and, in some cases, insensitive) persons who were not trained well enough to understand their need. Practitioners working with autistic adults such as personal trainers, physical educators, and physical therapists should continue to stay current with the evidenced practices of their field regarding working with autistic populations, as well as consulting their autistic clients for areas that need to be addressed or accommodated or as one participant succinctly suggested, “Just invite us.” In addition, it is the organization's responsibility to ensure that its practitioners are offered opportunities to learn these strategies.

It is equally important for those developing these evidence practices to include autistic individuals as coequal members of the development teams, thus ensuring the outcomes will align with areas of need. In addition, through participatory inclusion of autistic stakeholders, the protocols for providing evidence-based practices in “the real world” will be more sensitive to their autistic recipients' potential needs. Furthermore, researchers must make information available in outlets accessible for practitioners and families—too often, the most up-to-date information about current practices remains behind a journal's paywall. If this information continues to be inaccessible, families and practitioners will be far less likely to use it or receive help from it.

Leveraging social support

Findings from this study suggest the importance of social support—particularly from family members. Research has shown the evidence of this for children on the autism spectrum,²³ and this study shows it may be equally important for autistic adults. By incorporating existing social supports, autistic adults may be more comfortable engaging with certain PA pursuits and may more easily maintain motivation to be physically active. This, however, runs counter to held stereotypes about the social desires of autistic individuals. According to Colombo-Dougovito et al.,¹⁶ social supports are imperative for adopting and continuing engagement in PA among autistic adults. Family members, significant others, and friends often are the catalyst for young children on the autism spectrum to engage in new or difficult PA opportunities. This support also serves to balance potential environmental or sensory barriers. The present findings suggest that this need for support continues into adulthood and is highly motivational for autistic adults. Moreover, social supports have been identified as key to the quality of life for autistic adults⁹ and as a mediator between functional status and quality of life in nonautistic adults.²⁴ Therefore, enlisting social support from trusted individuals may be critical for increasing PA engagement and enjoyment among autistic adults.

Considering sensory needs

Most participants in the present sample named at least one sensory concern related to their PA. By recognizing the sensory overload that PA spaces can present, simple adjustments to lighting, sound, and organization may alleviate some or all potential issues. However, these adjustments should not be limited to an “autism-friendly” hour, but applied universally; especially, as it is not only autistic persons who have sensory issues in public spaces.²⁵ Meaning, organizations should work to incorporate accommodations to lighting, noise, and physical spaces pervasively about the building, gymnasium, or event. In doing so, spaces will be more accommodating to all. It is also important to highlight that in addition to the physical space becoming accessible, all of what occurs within that space must also be accessible. The Autistic Self Advocacy Network,²⁶ for example, has developed a resource toolkit for making accommodations for autistic persons; sensory accommodations are a large part of the guide. It is important, though, to highlight that universal principles will not meet every person's needs appropriately all the time. Organizations should look to build adaptive procedures that can be flexible and responsive in the moment. Although it is understood that PA may help alleviate or fulfill certain sensory needs for autistic adults, most PA opportunities remain inaccessible to many.¹⁶

Limitations

While this study can positively impact PA engagement for autistic individuals, it is not without limitations. First, this study only included autistic adults with high expressive verbal capabilities. As such, the experiences and recommendations of those with minimal expressive verbal skills or those who use augmented communication devices are not included. Future research should aim to include these populations. Second, the recruitment process included those who had an interest, and thus investment, in PA. Those who have highly negative views of PA or, due to poor experiences, do not have an investment in PA may have been excluded from this analysis. In addition, individuals did not report or discuss having co-occurring conditions that impact their PA experiences. As co-occurring health conditions (e.g., depression, anxiety, epilepsy, and Ehlers–Danlos syndrome) are common among autistic adults, how these conditions might moderate autistic adults' experiences requires exploration.²⁷ Finally, perspectives of PA may also differ by age (e.g., young adults versus older adults). Although comparisons of perspective by age were beyond this study's scope, future researchers would be well served to limit their sample by age or recruit a sufficiently large sample so as comparisons in perspective between young and old autistic adults can be made.

Conclusion

Hallett¹² called for a shift in approach for studying PA in autistic adults. In moving away from the praxis of “fixing” autism, researchers should focus on exploring suitable environments and activities, developing programs with participants in mind, and giving careful consideration to study participants. More succinctly, researchers should focus on fixing society to provide environments that are sensitive to individuals' needs and do not prioritize the experience of a presumed “majority”. To support this shift in approach, the present findings represent authentic recommendations from autistic adults. Though simple, the presented areas of concern would show a radical balancing of the power dynamic between practitioners and autistic clients. By strategically addressing the areas of concern presented in these findings, practitioners could develop programs and create spaces that meet the needs of individuals, as well as foster greater feelings of inclusion. Educators, service providers, and families should take these recommendations not only as direction from those who understand autistic adults best, but also as a way to explore with those you work with and love how to provide PA programming and access best.

Authorship Confirmation Statement

A.J.B. conceptualized the article, recruited participants, collected data, analyzed data, and prepared the article. A.M.C.-D. conceptualized the article, recruited participants, collected data, analyzed data, and prepared the article. S.H. conceptualized the article, analyzed data, and prepared the article. All coauthors have reviewed and approved the article before submission. This article has been submitted solely to this journal and is not published, in press, or submitted elsewhere.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This work was funded through a Research Seed Grant from the Office of Research & Economic Development at the University of North Texas.