"My whole life has been a process of finding labels that fit": A Thematic Analysis of Autistic LGBTQIA+ Identity and Inclusion in the LGBTQIA+ Community.

Background: Being nonheterosexual and noncisgender appears to be more common among autistic people. This intersection of identities is often stigmatized in research and society. However, we know that community involvement can protect against negative mental health outcomes associated with being a minority; researchers found this effect in separate studies examining participation in the autistic and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual plus other gender and sexual orientation-based identity (LGBTQIA+) communities. This study examined how autistic LGBTQIA+ individuals navigate their multiple marginalized identities and the LGBTQIA+ community. Methods: Twelve autistic LGBTQIA+ people from the United Kingdom took part in semistructured interviews. Questions focused on identity and community. We analyzed the interviews using reflexive thematic analysis. Results: We identified four overarching themes-Identity (Re)Development, Navigating Authenticity, Exclusion from Community Spaces, and Creating Change. Participants viewed accessing a community of similar others as a means of increasing understanding, self-knowledge, and self-acceptance. We identified several barriers to inclusion, including accessibility and gatekeeping. Participants discussed strategies to combat these obstacles, such as the creation of intersectional community spaces and activism and representation as a means of increasing autism understanding. Conclusions: This study suggests that similar to other marginalized groups, autistic LGBTQIA+ individuals are motivated to engage in communities relevant to their identities. However, community spaces for autistic LGBTQIA+ are often inaccessible due to social, sensory, and identity-based barriers. Participants highlighted autism understanding as a barrier to coming out both in community and noncommunity settings. This suggests that improving autism acceptance and understanding is crucial to achieve accessible, intersectional, and inclusive community spaces.

Why is this an important issue?: Autistic people are more likely to be part of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual plus other gender- or sexual orientation-based identity (LGBTQIA+) communities. Being part of a community may boost well-being. Because of a history of viewing autistic and LGBTQIA+ identities in a negative medicalized way, we have limited understanding of autistic people's experiences of having both identities and being part of both communities. We think everyone could listen and learn more from autistic LGBTQIA+ people and think about ways of creating accessible spaces where autistic LGBTQIA+ people can flourish. What was the purpose of this study?: We looked at autistic LGBTQIA+ people's experiences of the LGBTQIA+ community. We were also interested in understanding how autistic LGBTQIA+ people experienced their different identities (e.g., being both autistic and LGBTQIA+, and how these connect). What did the researchers do?: We developed interview questions with a trans autistic collaborator. The questions were about experiences and identities as an autistic LGBTQIA+ person and getting involved in communities. We did interviews with 12 LGBTQIA+ autistic adults from the United Kingdom, who were diverse in age, gender identity, and sexuality. We then identified patterns in what the interviewees said. What were the results?: Interviewees talked about how they had made sense of "who they were" over time and tried to be true to themselves. However, they mentioned many barriers when trying to access the LGBTQIA+ community. These barriers included community spaces that were overwhelming in social and sensory ways. Although nonautistic LGBTQIA+ individuals might welcome autistic people into the community, they did not really understand autism. Interviewees were also concerned about "gatekeeping," which means that some LGBTQIA+ community members decided who belonged in the community. Despite these barriers, interviewees still wanted to be part of LGBTQIA+ communities and suggested solutions, such as flexible online spaces, more autistic LGBTQIA+ role models, and fighting for change in society. What do these findings add to what was already known?: These findings help us to better understand a topic there is not much research on­the experiences of autistic LGBTQIA+ people. Our findings tell us about how our interviewees came to appreciate their different identities, and the benefits and challenges of being included in LGBTQIA+ communities. What are potential weaknesses in the study?: Our findings reflect the experiences of a small group of people in the United Kingdom, so their experiences will not apply to everyone. Our group lacked diversity in some ways­all interviewees were White and no one reported having a co-occurring learning disability. We do not know how our findings would apply to people with other minority identities. How will these findings help autistic adults now or in the future?: This study helps us better understand the experiences of autistic LGBTQIA+ people and the barriers they face. Community spaces specifically for autistic LGBTQIA+ could be good, to help people explore their identities and find similar people. These spaces need funding, and we must make sure that they are accessible to everyone, regardless of how they identify.

'Someone like-minded in a big place': Autistic young adults' attitudes towards autistic peer support in mainstream education.

LAY ABSTRACT: Autistic young people may struggle in mainstream schools and feel disconnected from their peers and their school. We know that autistic adults can benefit from spending time with other autistic people, but we don't know if this is the case for younger autistic people. We conducted interviews with 13 autistic young adults in the United Kingdom who recently left mainstream schooling. We asked them if they would have been interested in being involved in autistic peer support when they were at school, and if so, what that peer support should look like. Results indicated that autistic young people were enthusiastic about the idea of peer support. They thought it was important that peer support was flexible to suit their needs at different times, as well as inclusive, positive, and embracing neurodiversity. They also discussed the potential benefits and difficulties of having a peer support system within a school setting. This adds to the growing body of research on the potential benefits of autistic-autistic interactions on autistic people's well-being and sense of belonging. Findings can be used to help design pilot peer support projects in schools that can be tested to see how effective they are.

"A Group of Fellow Travellers Who Understand": Interviews With Autistic People About Post-diagnostic Peer Support in Adulthood.

Receiving a diagnosis of autism in adulthood can be a life changing event, impacting identity, relationships, and mental health. A lack of post-diagnostic support has been highlighted by autistic adults, their allies, clinicians, and service providers. It can be a source of distress for autistic adults, reinforcing feelings of social isolation and rejection. Peer support could be a cost-effective, flexible, and sustainable model to provide community-based support for autistic adults. However, there is little research on the value of peer support, despite calls from the autistic community. This qualitative study explored autistic experiences and needs post-diagnosis, identifying specific ways that peer support may benefit them, and exploring the limitations of peer support. Twelve autistic adults who had all received an autism diagnosis in adulthood completed a semi-structured interview focussing on the diagnostic experience, post-diagnostic support needed and provided, engagement with the autistic community, and post-diagnostic peer support. Thematic analysis of interview transcripts resulted in four themes: (1) Mismatch in support needed and provided; (2) Community connection; (3) Flexible and personalised support; and (4) Sustainability. Participants indicated that peer support may be a useful mechanism to support autistic adults' post-diagnosis and offers unique opportunities not available through other support channels. Though informal peer support exists, it could be more sustainable and effective if well-supported and funded.

Is the prescription right? A review of non-vitamin K antagonist anticoagulant (NOAC) prescriptions in patients with non-valvular atrial fibrillation. Safe prescribing in atrial fibrillation and evaluation of non-vitamin K oral anticoagulants in stroke prevention (SAFE-NOACS) group.

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) are a major advance for stroke prevention in atrial fibrillation (AF). Use of the vitamin K antagonist (VKA), warfarin, has dropped 40% since 2010 in our institution. There is limited Irish hospital data on NOAC prescribing for stroke prevention. METHOD: Single centre, retrospective observational cohort study of consecutive AF patients at increased risk of stroke and/or awaiting electrical cardioversion. Data on prescribed NOACs from February 2010 till July 2015 was collected from the electronic inpatient record. Appropriateness of prescriptions was based on CHA2DS2-VASC score and accuracy on individual NOAC SPCs. Potential drug interactions and bleeding risk were also quantified. RESULTS: A total of 348 patients AF and increased risk of stroke (CHA2DS2-VASC score > 1 for men and > 2 for women) were studied. Forty-eight percent were female with a mean age 71 ± 18.6 years, 52% of whom were > 75. Mean CHA2DS2-Vasc and HAS-BLED scores were 4.1 ± 1.8 and 1.4 ± 0.8, respectively. Rivaroxaban, dabigatran and apixaban were prescribed to 154 (54.2%), 106 (34.3%) and 41 (13.2%) patients, respectively. 20.4% had inaccurate prescriptions; 92.9% (n = 65) underdosed and 7.1% (n = 5) on inappropriately higher doses. Neither choice of NOAC, age, history of anaemia, previous bleeding or co-prescribed antiplatelets influenced the accuracy of prescription (p = NS), but decreased renal function appeared to do so (p = 0.05). CONCLUSION: Our study highlights significant inaccuracies in NOAC prescribing. Patients commenced on NOACs should be assessed and followed up in a multidisciplinary AF clinic to ensure safe and effective prescribing and stroke prevention.

Evaluation of mental health first aid training in a diverse community setting.

Mental health first aid (MHFA) training has been disseminated in the community and has yielded positive outcomes in terms of increasing help-seeking behaviour and mental health literacy. However, there has been limited research investigating the effectiveness of this programme in multicultural communities. Given the increasing levels of multiculturalism in many countries, as well as the large number of barriers presented to these groups when trying to seek help for mental illnesses, the present study aimed to investigate the effectiveness of MHFA in these settings. A total of 458 participants, who were recruited from multicultural organizations, participated in a series of MHFA training courses. Participants completed questionnaires pre and post the training course, and 6-month follow-up interviews were conducted with a subsample of participants. Findings suggested that MHFA training increased participant recognition of mental illnesses, concordance with primary care physicians about treatments, confidence in providing first aid, actual help provided to others, and a reduction in stigmatizing attitudes. A 6-month follow up also yielded positive long-term effects of MHFA. The results have implications for further dissemination and the use of MHFA in diverse communities. In addition, the results highlight the need for mental health training in health-care service providers.

Practitioner perceptions of the use of the Triple P - Positive Parenting Program with families from culturally diverse backgrounds.

Parenting programs are effective as a means of preventing and treating child emotional and behavioural problems; however, engagement of families from culturally diverse populations has been low. The perceptions of practitioners who conduct parent consultations with families from culturally diverse backgrounds were assessed to examine the perceived suitability of the Triple P - Positive Parenting Program. Practitioners rated the program as moderately acceptable. Previous training in parenting intervention and years of experience working with parents impacted on practitioner ratings, as did the type of practitioner profession. Practitioners identified certain barriers to parents' participation and preferred traditional face-to-face delivery formats. Practitioner perceptions may influence parental access to parenting programs. To enhance parental access to parenting interventions, practitioners may require additional training and education about parental preferences and evidence based practice.

Training GPs in parent consultation skills. An evaluation of training for the Triple P-Positive Parenting Program.

BACKGROUND: The Triple P-Positive Parenting Program is a behavioural family intervention program that aims to prevent severe behavioral, emotional and developmental problems in children by enhancing the knowledge, skills, and confidence of parents. OBJECTIVE: This study evaluated the effect of training general practitioners in the use of the primary care version of the TPP on their consultation skills, satisfaction and confidence in conducting consultations with parents. STUDY DESIGN: Participants were assigned to an experimental condition that involved a brief behaviorally oriented parent consultation skills training program or to a wait-list comparison group. Thirty-two GPs participated in the training. Fifteen participants attended the first workshop (intervention group) and 17 attended the second (wait-list comparison group). RESULTS: GPs who participated in the training reported greater satisfaction with the outcomes of their parent consultations and showed significantly greater use of targeted parent consultation skills than GPs in the wait-list comparison group. Observations of GP consultation skills during simulated patient interviews with parents showed there was a significant overall improvement in their interactional skills during parent consultations. There was a high level of satisfaction with the quality of training received by the GPs. CONCLUSION: This was a brief, cost effective program that had significant effects on participating GPs' skills, confidence and satisfaction with child consultations involving behavioral problems. Implications for public health approaches to the prevention of child psychopathology are discussed.