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Una Disertación Presentada en Cumplimiento Parcial de Los Requisitos para El Grado de Doctor en Filosofía
Una Disertación Presentada en Cumplimiento Parcial de Los Requisitos para El Grado de Doctor en Filosofía
by
Rachel VanDaalen
August 2021
ABSTRACT
variations that can form a central component of one’s identity. Despite the attention in
disciplines outside of psychology and academia, there has been little attention paid to
neurodiversity framework with respect to autism. Diverse samples of adults were utilized
correlated with activist engagement and self-esteem, and that endorsement of the
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DEDICATION
ii
ACKNOWLEDGMENTS
There have been so many people who have helped me along my journey to my
PhD and my dissertation. First and foremost, I would like to thank Carlos Santos, who
has provided mentorship, guidance, and support from the beginning of my graduate
career, even as he moved to California. Throughout the obstacles I’ve faced, there have
been many times that I have seriously considered dropping out of the program, but your
consistent encouragement and kindness have inspired me to keep going and not succumb
to self-doubt. Your support has meant so much to me, and I hope to live up to your
example.
researcher and psychologist: Frank Dillon, Cristalis Capielo, Kelly Cue Davis, and Miwa
Yasui. Dr. Dillon, thank you for taking me on as an advisee in the middle of my program,
for providing helpful feedback about my dissertation along the way, and for being
helpful guidance within my dissertation process. To Dr. Davis, I’m very glad that we met
and got the opportunity to work together. I’ve appreciated your willingness to serve as a
mentor to me and integrate me into your lab. Finally, Dr. Yasui, thank you for all of your
support and guidance throughout my undergraduate years. Working in your lab opened
particular, thank you to Kristen Gillespie, Susan Golubock, Jac den Houting, and Steven
Kapp for reviewing and providing feedback on my scale items. Thank you to Jason
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Bunn-Parsons, the Autism Ambassadors Corps, and the Phoenix autism community for
providing feedback for the study and showing interest in this project. I’d like to thank all
of the study participants as well as organizations and groups that promoted my project.
Additionally, thank you to Arizona State University’s Graduate and Professional Student
On a personal note, I would also like to thank all of the other people in my life
who have helped get me to this point: my parents and grandparents, Tad Komacek and
his family, fellow graduate students (especially Alison Mirin and Francis O’Rourke), the
Tucson and Phoenix DIY communities (especially Logan Greene, Sophie McTear, Katie
Ratliff, and Lucille Petty), friends from college and back home, colleagues and clients
from all of my clinical placements, my former students, and my cat, Pierogi. In particular,
journey and for the sacrifices you have made to get me to this point. Thank you to Tad
for always believing in me and supporting me, making sure I have enough coffee,
encouraging me to explore the outdoors, and always knowing what types of video games
I like. Thank you for the hours you have spent driving between Tucson and Phoenix and
flying between Chicago and Phoenix, as well as the many months you have spent
quarantined with Pierogi and me. In all, I am very glad that we met. Thank you to all of
my friends who have supported me, distracted me, fed me, and/or played music for me. I
know my cat can’t read, but she deserves my thanks as well for always brightening my
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TABLE OF CONTENTS
Page
CHAPTER
1 INTRODUCTION ............................................................................................. 1
Overview ......................................................................................................1
3 METHODS ..................................................................................................... 14
4 RESULTS ....................................................................................................... 23
v
CHAPTER Page
5 DISCUSSION ................................................................................................. 31
6 CONCLUSIONS ............................................................................................. 41
REFERENCES ..................................................................................................................43
APPENDIX
B IRB APPROVAL.................................................................................................69
vi
LIST OF TABLES
Table Page
vii
LIST OF FIGURES
Figure Page
1. Path Diagram of Revised CFA Model with Standardized Parameter Estimates .68
viii
CHAPTER 1
INTRODUCTION
Overview
The neurodiversity movement promotes the idea that neurological differences and
disabilities (e.g., autism spectrum disorder) are natural human variations that should be
(Brownlow, 2010; Bumiller, 2008; Graby, 2015; Griffin & Pollak, 2009; Meyerding,
psychology, there has been little attention paid to it—or disability activism in general—
within counseling psychology literature (Foley-Nicpon & Lee, 2012; Goodley &
Lawthom, 2006; Olkin & Pledger, 2003; Woo et al., 2016). Therefore, this dissertation
project consists of the development and initial validation a scale to assess endorsement of
neurodiversity attitudes with respect to autism. This was accomplished through reviewing
relevant literature, consulting with neurodiversity and disability experts, and conducting
implications for better understanding disability rights activism and disability identity, as
1
Neurodivergent is the term commonly used to describe individuals who fit within conditions under the
neurodiversity umbrella (Graby, 2015; Ortega, 2009).
1
well as for educating mental health professionals in working with neurodivergent
individuals.
Potential Contributions
impact and its utility in understanding disability and mental health, there has been little
psychological work with this construct—and little psychological scholarship that utilizes
disability studies constructs in general (Dirth & Branscombe, 2018; Olkin & Pledger,
currently exists. The creation of a scale would help to create a shared understanding and
allow psychologists and other social scientists to use their methodologies in order to
understand how people relate to this construct. Psychological methods have much to offer
to the study of disability and neurodiversity. However, without a valid scale for
can study a construct that has been widely discussed in disability studies, activist
attention to disability studies and the neurodiversity movement, I hope to help the
counseling psychology field to better recognize and advocate for the needs of clients and
students with disabilities and to better recognize the potential that movements such as the
Organization of Dissertation
neurodiversity and the study of disability within psychological literature (Chapter Two). I
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then discuss the need for a scale that assesses endorsement of neurodiversity attitudes and
(Chapter Three), I outline how I created and refined an item pool, conducted an
exploratory factor analysis, and conducted a confirmatory factor analysis. In the results
chapter (Chapter Four), I provide the results of the factor analyses, as well as hypothesis
testing. Finally, in the last chapter (Chapter Five), I discuss the implications of these
3
CHAPTER 2
DEVELOPMENT AND VALIDATION OF NEURODIVERSITY ATTITUDES SCALE
cured, or normalized (Brownlow, 2010; Bumiller, 2008; Graby, 2015; Griffin & Pollak,
2009; Kapp, 2020; Meyerding, 1998). Member of the autistic self-advocacy movement
are credited with developing and using this terminology in the 1990s (e.g., Blume, 1998;
Meyerding, 1998; Singer, 1999), and much of the subsequent research and discussion
surrounding the neurodiversity movement has focused on the autism spectrum. However,
the neurodiversity movement has also included diagnostic categories such as ADHD,
dyspraxia, dyslexia, Tourette’s syndrome, epilepsy, and bipolar disorder, among other
neurological and psychiatric diagnoses (Blume, 1998; Fenton & Krahn, 2007; Graby,
2015; McGee, 2012; Runswick-Cole, 2014). The neurodiversity movement and autistic
general, as well as more specific disability rights movements (e.g., the Deaf movement),
among other societal and scientific developments (Dekker, 1999; Singer, 1999).
disability, which emphasizes the ways in which societal and cultural values, practices,
and institutions have contributed to the difficulties faced by people with disabilities
the “problem” of neurodevelopmental disabilities within society and its practices rather
4
than in the individual with a particular diagnosis. The rise of the Internet also has allowed
Given the nature of the development of the neurodiversity movement (i.e., many
complex and multifaceted. Some proponents emphasize different aspects of the definition
than others, and—as referenced above—the breadth of the neurodiversity umbrella is ill-
movement, I have consulted several sources, including those given credit to coining the
term “neurodiversity” (Blume, 1998; Singer, 1999), disability studies literature (e.g.,
Baker, 2006). Literature within anthropology (e.g., Bagatell, 2010), empirical literature
Gillespie-Lynch et al., 2017), sociological literature (e.g., McGee, 2012), narratives and
articles by autistic2 and neurodivergent individuals (e.g., Meyerding, 1998), and literature
in the medical humanities (e.g., Ortega, 2009), among other sources. The definitions of
neurodiversity and the neurodiversity movement articulated in these sources fall into
several themes: (a) conditions under the neurodiversity umbrella are either neutral or
positive differences rather than deficits, (b) such conditions are hard-wired in the brain
and immutable, (c) such conditions are central to one’s identity, (d) people with such
2
Individuals in the autistic self-advocacy and neurodiversity movement generally prefer identity-first (i.e.,
“autistic woman”) rather than person-first (“woman with autism”) language (Sinclair, 2012).
5
conditions should be treated as the experts of their experience, and I society should be
changed rather than the individual. Each of these themes will be discussed in turn.
neurodiversity umbrella are not deficits and should not be treated as such (i.e.,
stigmatized) (Brownlow, 2010; Graby, 2015; Griffin & Pollak, 2009; Nicolaidis, 2012;
Ortega, 2009; Robertson, 2010; Runswick-Cole, 2014; Walker, 2012). While some
‘normal’ style of human brain or human mind, any more than there is one ‘normal’ race,
desirable and positive. For example, Blume (1998)—one of the individuals credited with
may be every bit as crucial for the human race as biodiversity is for life in general.” In
into the brain and/or one’s genetic makeup (Bumiller, 2008; Graby, 2015; Jurecic, 2007;
Kapp et al., 2013; Ortega, 2009; Runswick-Cole, 2014; Sarrett, 2016; Singer, 1999).
Viewing conditions in such a way reduces the stigma associated with these conditions, by
removing the blame and fault for the condition from the individual or their upbringing
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(e.g., blaming “refrigerator mothers” for autism) (Bumiller, 2008). Therefore, many
neurological differences because, “they are not a formerly ‘normal’ person who has been
‘broken,’ but were different—and equally ‘whole—type of person from the beginning”
social explanations for their conditions, while at the same time emphasizing the barriers
that society has enacted—and the psychological effects of such barriers—in preventing
the full participation of neurodivergent individuals in society (Graby, 2015; Ortega, 2009;
Singer, 1999). Some neurodiversity advocates and scholars have drawn parallels between
the neurodiversity movement and LGBTQ rights movements in this regard. Many
increase acceptance of LGBTQ individuals and portray efforts to change one’s sexual
(Arsenaeu et al., 2013; Kirkham, 2017). Similarly, many neurodiversity advocates have
identity (Bagatell, 2010; Bumiller, 2008; Kapp et al., 2013; Kapp, 2018; Nicolaidis,
2012; Ortega, 2009). This is often practiced in terms of the language used to refer to
preference for identity-first language (i.e., “autistic person”) rather than person-first
language (i.e., “person with autism”) because they do not view themselves as being
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separate from their autism (Kapp et al., 2013; Sinclair, 2012). Additionally, many autistic
so bad that it isn’t even consistent with being a person” (Sinclair, 2012, p. 224). Thus,
a collective, politicized identity (Bumiller, 2008; McGee, 2012). This collective identity
can then be employed to organize for desired changes within society and its institutions.
Like other social and political movements that have sought to center marginalized
al., 2017; Sarrett, 2016; Yergeau, 2018). This pushes against traditions of viewing
medical and psychological professionals, as well as nonprofits and organizations that are
(e.g., Autism Speaks), as the primary authorities on autism (Graby, 2015). Instead,
neurodiversity advocates promote the idea that neurodivergent individuals have valuable
knowledge and insights regarding their life experiences and how they would like to be
By building on the social model of disability and valuing the perspectives and
change society to accept neurodiversity rather than change the neurodivergent individual
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to fit societal standards of normalcy (Bagatell, 2007; Cascio, 2012; Graby, 2015; Kapp,
neurodiversity critique therapeutic methods that seek to change unusual but harmless
behaviors (e.g., not maintaining eye contact, repetitive self-soothing behaviors) (Graby,
critique rhetoric that advocates for finding a cure for conditions under the neurodiversity
umbrella (Bagatell, 2007; Gillepsie-Lynch et al., 2017; Graby, 2015; Ortega, 2009).
neurodevelopmental differences are natural and neutral or positive aspects of one’s brain
primarily through informal online venues (Brownlow & O’Dell, 2006; Griffin & Pollak,
2009; Jordan, 2010). This positive and contextual reframing of stigmatized conditions has
also shown promise as foundations for interventions that could improve the well-being of
research has largely paid little attention to the movement. Indeed, psychological research
has generally paid little attention to disability, especially outside of a medical model
9
Despite the advances within other fields (e.g., sociology, humanities, history) in
the critical study of disability and disability scholarship, researchers within psychology
have rarely engaged in the critical study of disability (Goodley & Lawthom, 2006; Olkin
& Pledger, 2003). Instead, psychologists have primarily studied disability from the
perspective of the medical model, in which the individual’s impairment and professional
the experience of disability (Goodley & Lawthom, 2006; Olkin & Pledger, 2003).
disability and to understand disability outside of a medical model (Barker, 1948; Dirth &
Branscombe, 2018; Fine & Asch, 1988; Olkin & Pledger, 2003).
topics related to disability. For example, a 20-year content analysis found that disability
between 1990 and 2010 (Foley-Nicpon & Lee, 2012). Additionally, in a content analysis
2003 and 2013, only 29 of 2591 published articles addressed disability (Woo et al.,
2016). This shortage of research on disability issues within the domain of counseling
many counseling, clinical, and school psychology programs, which can lead to
inadequate training of mental health professionals for working with clients with
10
psychological and helping professions (Andrews et al., 2019; Artman & Daniels, 2010;
Kemp & Mallinckrodt, 1996; Lund, 2021; Olkin, 2002; Strike et al., 2004). It is necessary
for clinicians to receive training on working with disability communities and individuals
with disabilities, given the multicultural and social justice frameworks valued by
counseling psychology programs and given the prevalence of disability within the general
neurodiversity movement.
psychological research, much of the research that does exist shows the potential of the
and a sense of belonging to a disability community have been shown to predict several
positive mental health outcomes among individuals with a variety of disabilities (Bogart,
2014; Bogart, 2015; Nario-Redmond et al., 2012), including autism (Cooper et al., 2017;
disability rights advocacy has been shown to have potential for mental health benefits and
reduction in disability stigma among people with disabilities (Bogart et al., 2018; Nario-
Redmond & Oleson, 2016). The neurodiversity movement provides a positive revaluation
who may have been isolated from others. Therefore, it is likely that involvement within
the neurodiversity movement and/or endorsement of its attitudes would predict positive
mental health outcomes. However, without a scale to assess attitudes that endorse
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neurodiversity principles, the question of whether endorsing attitudes congruent with
Previous researchers (e.g., Kapp et al., 2013) have attempted to create a scale to
assess neurodiversity attitudes, but it was limited in terms of its validation and
approach that included qualitative questions (e.g., “What is the neurodiversity movement
in your words?”) and coding the valence of responses, as well as a quantitative scale
within psychological research, Kapp and colleagues (2013) recommend formal scale
create a more unified definition of neurodiversity and to serve as the foundation for future
Current Study
disability prejudice, and endorsement of the medical and social models of disability. I
12
I hypothesize that endorsement of neurodiversity attitudes will be positively
correlated with endorsement of the social model of disability (i.e., the philosophy that
the theoretical influence that the social model of disability has had in the formation of the
construct of neurodiversity (Singer, 1999). Since the medical model (i.e., the philosophy
leads to impairment) and social model of disability are frequently construed as opposing
correlated with endorsement of the medical model of disability (Pledger, 2003). In terms
hypothesize that there will be a positive association between the two due to the role that
autistic self-advocacy movements) (Dekker, 1999; Singer, 1999). Given that the
it seems likely that people who identify as neurodivergent are more likely to endorse
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CHAPTER 3
METHODS
Scale draws from the work of DeVellis (2016), who outlined procedures for
psychological researchers to use when developing scales. The first step in scale
being measured. This is based on both the interests of the researcher and the literature.
The literature review section of this dissertation articulates the constructs of interest to be
measured. The second step is to generate in item pool representing these constructs. In
order to do this, the theoretical literature on neurodiversity was thoroughly reviewed and
a comprehensive pool of 48 potential items was created using a Likert-type scale, as well
as one qualitative free response item (i.e., “What is your opinion of the neurodiversity
The next step outlined by DeVellis (2016) Is to consult with experts In the
relevant field to maximize content validity. These experts had the opportunity to make
suggestions regarding the content and clarity of items with a Likert-style rating scale of
content coverage and clarity, as well as the opportunity to provide qualitative comments.
neurodiversity that may be missing from the item pool. In addition to including experts in
the scholarship of neurodiversity who have some familiarity with psychological scales, I
neurodiversity activism. Although there is some overlap between these two types of
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experts, I wanted to ensure that the development of a Neurodiversity Attitudes Scale was
faithful to the roots of the neurodiversity movement and the motto adopted by many
disability rights activists—"nothing about us without us.” Thus, I recruited four outside
and/or autism. Three of these individuals worked in academic fields and were engaged in
conducting research, while the other individual was a retired occupational therapist who
was highly involved in her local autism community as an autistic self-advocate and
organizer of support groups. Three out of the four experts consulted for the item pool
These four experts rated proposed items in terms of clarity and conceptual
qualitative feedback on individual items and/or the entire item pool. Based on the
feedback from these expects, I revised the item pool, with a final number of 44 items for
the factor analysis, as well as five items assessing level of agreement with the
received feedback that autistic and neurodivergent survey participants may experience
distress when responding to items that were aimed at addressing stigmatizing attitudes
(e.g., “People with autism are broken”). Therefore, some items were removed based on
this feedback, and an introduction to the scale was added that aimed to prepare study
participants for potentially polarizing and/or emotionally-laden items (e.g., “You might
find yourself strongly agreeing or disagreeing with these opinions, or you may find
15
yourself feeling strong emotions like anger or confusion regarding some attitudes”).
Finally, the initial proposed item pool was not specific to any particular diagnosis (e.g.,
autism, learning disability), and instead a non-specific placeholder was used. Given the
potential for an individual to hold different attitudes about different disabilities and
conditions, as well as the strong connection between the neurodiversity movement and
Adults were recruited through social media (e.g., Facebook, Reddit) and local
participate in an online survey. Special attention was given to recruiting participants who
social media groups related to disability or autism. A large (N = 508) sample was
recruited, and data were randomly split into two halves to conduct exploratory and
proposed scale and mental health and activist behaviors was also completed with the
After completing informed consent and meeting inclusion criteria (i.e., at least 18
years of age, United States residents), participants completed the questionnaire, which
Endorsement of the medical model of disability was measured using the medical
model subscale of the Questionnaire on Disability Identity and Opportunity (Darling &
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Heckert, 2010). This scale consists of 8 statements, for which participants rate their
endorsement of the medical model of disability. Items include statements such as,
“People should try to overcome their disabilities.” In the original sample of a diverse
group of individuals with disabilities, Darling and Heckert (2010) report a Cronbach’s
alpha level of .63, demonstrating suspect evidence of reliability. The EFA sample for the
present study had a Cronbach’s alpha level of .52, while the CFA sample for the present
study had a Cronbach’s alpha level of .35, both showing evidence of low levels of
internal consistency for this scale. Due to the poor internal consistency, analyses utilizing
Endorsement of the social model of disability was measured using the social
model subscale of the Questionnaire on Disability Identity and Opportunity (Darling &
accessibility and discrimination by employers are the main reasons why disabled people
are unemployed”) on a 5-point Likert-style scale, with higher scores indicating higher
levels of endorsement of the social model of disability. Darling and Heckert’s (2010)
original sample of diverse adults with disabilities responded to this scale with a
Cronbach’s alpha of .72, demonstrating acceptable reliability. The EFA sample for the
present study had a Cronbach’s alpha level of .60, while the CFA sample for the present
study had a Cronbach’s alpha level of .59. Due to the poor internal consistency, analyses
Disability Prejudice
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An adapted version of the Modern Attitude Scale Toward People with Intellectual
Disabilities (Akrami et al., 2006) was used to assess prejudicial attitudes toward people
with disabilities. Participants rate their level of agreement on 5-point Likert-style scale to
11 items. This scale includes three subscales: denial of continuing discrimination (e.g.,
toward demands (e.g., “There have been enough societal efforts in favor of people with
disabilities”), and resentment about special favors (e.g., “Society takes more care of
people with disabilities than is fair to other groups”). In the original scale development
samples, Akrami and colleagues (2006) reported a Cronbach’s alpha ranging from .71 to
.82, indicating evidence of good reliability. The original scale was adapted to assess
attitudes toward disability in general, rather than intellectual disability specifically. The
EFA sample for the present study had a Cronbach’s alpha level of .84 for the total score,
whereas the CFA sample for the present study had a Cronbach’s alpha level of .82 for the
total score.
Activism
Involvement measure. This scale has six items that assess frequency of activist behaviors
day), with higher scores indicating higher levels of activism on behalf of oppressed
groups. Similar adaptations of this scale have reported Cronbach’s alphas ranging from
.84 to .85, demonstrating evidence of strong reliability (VanDaalen & Santos, 2017) and
18
scale and willingness to engage in high-risk activism (Santos & VanDaalen, 2018). The
current study’s EFA had a Cronbach’s alpha level of .70, whereas the CFA sample had a
Well-Being
below.
Self-Esteem
the whole, I am satisfied with myself”) on a 4-point Likert-type scale, with higher scores
indicating more positive views of the self. This scale has been widely used to assess self-
esteem, including among individuals with disabilities (Nario-Redmond, Noel, & Fern,
2013) and among autistic individuals (Cooper, Smith, & Russell, 2017), and has been
symptoms (Sowislo & Orth, 2013). Rosenberg (1986) and Blascovich and Tomaka
(1993) reported Cronbach’s alphas ranging from .77 to .88. The EFA sample for the
present study demonstrated a Cronbach’s alpha of .80, and the CFA sample showed a
Resilience
The Brief Resilience Scale (Smith et al., 2008) was used to measure participants’
endorsement of their own resilience. An example item includes, “I tend to bounce back
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quickly after hard times.” Smith and colleagues (2008) report Cronbach’s alphas ranging
from .80 to .91 among diverse adults, indicating evidence of good reliability.
correlations with optimism, purpose in life, active coping, and positive affect, and
and physical symptoms (Smith et al., 2008). Despite the evidence of strong reliability in
other samples, the EFA sample for the present study had a Cronbach’s alpha level of .32,
while the CFA sample for the present study had a Cronbach’s alpha level of .28, both
demonstrating poor reliability. Due to the poor internal consistency, analyses utilizing
Anxiety Symptoms
The GAD-7 (Spitzer et al., 2006) was used to measure participants’ self-reported
anxiety symptoms. Participants rate the frequency they have experienced 7 anxiety
symptoms (e.g., “Not being able to stop or control worrying”) on a 4-point scale, with
higher scores indicating higher levels of anxiety. Among the original sample of diverse
adults in the United States, Spitzer and colleagues (2006) reported a Cronbach’s alpha of
.92, indicating excellent reliability. This scale demonstrates diagnostic criterion validity,
as mean GAD-7 scores were higher among individuals who were diagnosed with
those without generalized anxiety disorder diagnoses (Spitzer et al., 2006). The
Cronbach’s alpha for anxiety frequency in the EFA sample was .90, while the Cronbach’s
alpha in the CFA sample was .89, both demonstrating strong reliability.
20
Data Analytic Plan
procedures to account for missing data—if needed. As described in the previous section, I
planned on conducting an exploratory factor analysis (EFA) in order to assess the number
of latent variables underlying the item pool and to assess the performance of each item in
the scale. Before EFA, I tested the assumption of factorability (Tabachnick & Fidell,
2001) with Bartlett’s test of sphericity (Bartlett, 1950) and The Kaiser-Meyer-Olkin
(KMO) measure of sampling adequacy. Next, principal axis factoring was used as the
specifically a direct Oblimin rotation, was used because the potential factors were
Specifically, the potential factors consisted of distinct constructs (e.g., stigma, identity
centrality) that were brought together under the umbrella of the larger construct of
Worthington & Whittaker, 2006), the criteria used to determine factor retention included
a) the Scree test (Cattell, 1966), b) Parallel Analysis (Horn, 1965), c) a minimum loading
of at least 3 items per factor, and d) conceptual interpretability. Item retention was based
.35, c) the difference between an item’s strongest factor loading and other loadings must
be > .15, and d) items must be logically related to the other items on the factor (Nunally
& Bernstein, 1994; Tabachnick & Fidell, 2001; Worthington & Whittaker, 2006). Next,
21
to provide initial internal consistency reliability estimates, Cronbach’s alphas (Cronbach,
1951) would be calculated for potential subscale and total scale scores.
For the confirmatory factor analysis, the survey data were exported to Mplus. The
fit of the CFA model to the data was evaluated using standard SEM fit indices (cf. Kline,
2010 as follows: two “absolute” fit indices which compare the covariance structure
implied to the model against the covariance structure observed in the data and two
“relative” fit indices which compare the fit of the specified model against that of a null
model with no paths or latent variables. As absolute fit indices, I used the root mean
square error of approximation (RMSEA) and the standardized root mean square residual
(SRMR). As relative fit indices, I used the comparative fit index (CFI) and the non-
normed fit index (NNFI) which is known as the Tucker-Lewis Index (TLI). I planned to
follow the guidelines proposed by Kline (2010): CFI ≥ .95, NNFI ≥ .90, RMSEA ≤ .08,
and SRMR ≤ .06. If the model does not fit the data adequately, I planned to delete
indicators that only pattern weakly on their respective latent factors and then re-estimate
the model until arriving at an acceptable fit. In order to assess the validity of the
scale and scales assessing the endorsement of the social and medical models of disability.
22
CHAPTER 4
RESULTS
Per the recommendations of Schlomer and colleagues (2010), survey data were
responses in EFA sample ranged from 5.2 to 5.6%, while the percentage of missing scale-
level variable responses in CFA sample ranged from 3.5 to 7.3%. The final EFA and
CFA sample were deemed suitable for analyses because less than 10% of scale-level data
were missing for each variable, which is recommended to avoid biased results (Schlomer
et al., 2010).
Participant Characteristics
EFA and CFA, the data were randomly divided in half, leading to samples of 249 for the
EFA and 259 for the CFA, validity tests, and hypothesis testing (i.e., testing how
activism, and indicators of mental health). Each sample included a diverse group of U.S.
adults across gender, racial/ethnic, educational, political, and geographic lines, with a
large portion identifying as having a disability (see Table 3). There were no significant
Previous research has indicated that individuals may have varying responses to
(Bogart et al., 2017). Additionally, many individuals remain unfamiliar with the
neurodiversity movement or may be confused about the change in autism criteria in the
23
identification as neurodivergent, autistic, and/or disabled. Table 4 provides information
regarding the distribution of individuals who self-identify under particular labels and
autistic participants indicated that they had more social connections to other autistic
participants were more likely to endorse that at least one of their immediate [X2 (3, N =
249) = 33.21, p < .01] or extended [X2 (3, N = 249) = 35.40, p < .01] family members,
romantic partner [X2 (3, N = 249) = 10.70, p = .01], or friends [X2 (3, N = 249) = 42.29, p
< .01] were autistic. Within the CFA sample, compared to non-autistic participants,
autistic participants were more likely to endorse that at least one of their immediate
family members [X2 (3, N = 259) = 38.49, p < .01] or at least one of their coworkers or
work supervisors [X2 (2, N = 259) = 8.67, p = .01] were autistic. Additionally, in the CFA
sample, non-autistic participants were more likely to report that they had never met an
autistic person, compared to autistic participants [X2 (4, N = 259) = 16.60, p < .01].
Before conducting the EFA, the assumption of factorability (Tabachnick & Fidell,
2001) was tested using Bartlett’s test of sphericity (Bartlett, 1950) and The Kaiser-
Meyer-Olkin (KMO) measure of sampling adequacy. The final proposed EFA model had
a significant Bartlett’s test of sphericity, with χ2 (276) = 1827.96, p < .001 and a KMO of
0.84, indicating that the data was appropriate for factor analysis (Kaiser, 1974; Pett et al.,
2003).
As stated in the data analytic plan, principal axis factoring with a direct Oblimin
rotation was utilized as the factor extraction method to identify underlying factor
24
structure by analyzing the communality among items (Kahn, 2006). An iterative series of
EFA’s was conducted in order to determine the most appropriate model that fit the
no cross-loadings with a difference of less than .15 from the main factor, d) conceptual
coherence between items on a particular scale (Nunally & Bernstein, 1994; Tabachnick &
Fidell, 2001; Worthington & Whittaker, 2006). Additionally, as described in the data
analytic plan, the Scree test (Cattell, 1966), parallel analysis (Horn, 1965), a minimum
loading of at least 3 items per factor, and conceptual interpretability were used in order to
determine factor retention. Using these criteria, a three-factor solution was found, after
removing 20 items due to poor item loading or high cross-loadings (see Table 5).
The first factor, Autism Stigma, consists of 14 items that indicate stigmatizing
views toward autism or autistic people (e.g., “Being diagnosed with autism is a tragedy”).
All items would be negatively scored. This factor accounted for 39.66% of the variance
in the model. The second factor, Autism Identity, includes 7 items that portray autism as
a central, fundamental part of identity that is viewed either neutrally or positively (e.g.,
“Autism is a central part of an autistic individual’s identity”). This factor accounted for
11.04% of the variance. Finally, the third factor, Autism Separability, has 3 items that
portray the conceptual and/or linguistic inseparability of autism from an autistic person’s
experience [e.g., “I prefer using identity-first language to describe people (i.e., ‘autistic
person’ instead of ‘person with autism’)”]. This factor accounts for 8.16% of the
variance.
Cronbach’s alphas were calculated for the subscale and total scale scores in order
to provide internal consistency estimates. The Autism Stigma subscale had a Cronbach’s
25
alpha of .93. Autism Identity had a Cronbach’s alpha of .73, and Autism Separability had
a Cronbach’s alpha of .63. Finally, the Cronbach’s alpha for all 24 items of the revised
scale was .93. Additionally, the Autism Stigma scale was significantly and positively
correlated with the other two subscales, though the Autism Identity and Separability
subscales were not significantly related to each other (see Table 6) Per Cohen’s (1988)
conventions for effect size, the correlation between Autism Stigma and Autism Identity
subscales demonstrates a somewhat large effect size, and the correlation between Autism
A CFA was conducted using the three-factor model with 24 items described in the
previous section with a sample of 259 participants. Nine of participants did not complete
the Neurodiversity Attitudes Scale, so their data was not included in the CFA, leaving a
final sample of 250. A robust maximum likelihood estimator was used to account for any
resulted in a significant chi-square test [χ2(249) = 347.44, p < .01], initially indicating
potential poor model fit. However, scholars have noted that chi-square tests of model fit
may frequently be significant with large sample sizes, even if the model fits well (Brown,
2006). Therefore, additional model fit indices were used. The RMSEA of the model used
in the CFA was 0.04, indicating good model fit (Brown, 2006; Kline, 2010). The SRMR
was greater than the 0.06 cutoff at 0.07, indicating potentially poor model fit (Kline,
2010). However, other scholars assert that SRMR values below 0.08 indicate acceptable
model fit (Browne & Cudeck, 1993; Hu & Bentler, 1999). Additionally, the TLI of 0.88
26
and CFI of 0.89 were close, but slightly lower than the predetermined cutoffs of 0.90 and
In order to improve model fit, model modification indices were examined. When
the residuals of items 1 and 2 were correlated, CFI > .90, indicating stronger model fit.
Allowing these residuals to be correlated was theoretically justified due to (a) each of the
items loaded on the same factor and similarly measured constructs related to autistic
identity. The new model resulted in a significant chi-square test [χ2 (248) = 334.03, p <
.01], so once again additional model fit indices were used. The RMSEA of the model
used in the CFA was 0.04, and the SRMR was .06, both indicating good model fit (Kline,
2010). The model also demonstrated good relative fit in terms of the TLI being 0.89
(Kline, 2010). Comparison between model fit of the two models is illustrated in Table 7.
Because the second model with correlated residuals demonstrated a stronger fit than the
original hypothesized model, the second model is used in the path diagram (see Figure 1).
Cronbach’s alphas for the total scale and three subscales were calculated with the
CFA sample, resulting in α = 0.93 for the Autism Stigma subscale, α = 0.71 for the
Autism Identity subscale, α = 0.46 for the Autism Separability subscale, and α = 0.93 for
the overall scale. Additionally, all subscales were significantly correlated with each other
(see Table 8). The Autism Stigma subscale was positively and moderately correlated with
the Identity (r = .44, p < .01) and Separability (r = .30 p < .01) subscales, and the Identity
subscale was positively correlated with the Separability (r = .14, p < .05) subscale,
27
Bivariate correlations were conducted between study variables in the second half
of the dataset (i.e., the dataset used for the CFA) to test hypotheses and examine the
validity of the proposed Neurodiversity Attitudes Scale. The Neurodiversity total score
was positively correlated with engaging in activism (r = .16, p < .05), self-esteem (r =
.230, p < .05), age (r = .22, p < .05), and education level (r = .18, p < .05), though effect
sizes were small. On the other hand, the Neurodiversity total score was negatively
correlated with negative attitudes toward people with disabilities (r = -.69, p < .05) with a
large effect size and subjective socioeconomic status (-.43, p < .05) with a moderate-to-
large effect size. There was no significant association between the Neurodiversity total
score and anxiety symptom frequency or severity. The negative associations between the
Neurodiversity total score negative view towards people with disabilities provides
support for construct validity of the Neurodiversity Attitudes Scale because this
of medical and social models of disability were correlated with the Neurodiversity total
score in the hypothesized directions. However, due to low internal consistencies of these
subscales, further analyses should be conducted regarding construct validity and models
of disability.
the Neurodiversity Attitudes Scale, as shown in Table 8. Importantly, the direction and
negatively associated with anti-disability prejudice with large effect sizes. The measures
28
Neurodiversity Attitudes Scale with small effect sizes. Although self-esteem was
positively related to the stigma and identity subscales, it was not related to the
or severity were not significantly associated with any of the subscales of the
population. Since not all individuals were familiar with the neurodiversity framework,
autistic vs. those who did not. Given the gender, racial/ethnic, immigration status, age-
analysis included those who self-identified as autistic but lacked professional diagnoses
in the autism category (Constantino & Charman, 2012; Kuehn, 2012; Shefcyk, 2015;
Travers, Tincani, & Krezmien, 2013; Wiggins et al., 2019; Zuckerman et al., 2017). As
framework more than non-autistic individuals [t(103) = -3.82, p < .01], with a medium-
to-large effect size (Cohen’s d = -0.77). Exploratory analyses regarding group differences
on the subscales were also conducted, using Bonferroni corrections to account for
multiple t-tests (i.e., significant p-value less than .0125). These t-tests revealed that
autistic individuals endorsed moderately higher levels on the Autism Stigma subscale
[t(103) = -2.98, p < .01, d = -0.60] and greatly higher levels on the Autism Separability
29
Therefore, compared to non-autistic participants, autistic participants were more likely to
report lower levels of autism-related stigma and greater beliefs that autism cannot be
30
CHAPTER 5
DISCUSSION
The primary purpose of this project was to develop and initially validate a scale
for assessing endorsement of the neurodiversity framework with respect to autism. Factor
analyses with diverse groups of participants revealed that a three-factor model best fit the
hypotheses regarding correlations of this scale and its subscales with other constructs
Facets of Neurodiversity
The factor that explained the majority of variance in the Neurodiversity Attitudes
Scale was Autism Stigma. These items combined a variety of stigmatizing views toward
autism or autistic people, including perspectives that frame autism or autistic people as a
problem for neurotypical loved ones or mainstream society (e.g., “People with autism are
a burden to their loved ones”), perspectives that evoke pity for autistic people or their
loved ones (e.g., “I feel sorry for families of autistic people”), perspectives that frame
important to find a cure for autism”), and perspectives that position autistic people as
untrustworthy or unreliable (e.g., “I would not trust an autistic person to give me reliable
information about autism”). Although the stigmatizing statements within this subscale are
at times explicitly hostile, many of them take more subtle forms that reflect stigmatizing
microaggressions, which discusses the ways in which ableism can be expressed subtly or
indirectly but ultimately communicates messages that people with disabilities are
31
helpless, are not fully human or “normal,” or are too demanding in their accommodation
neurodivergent conditions, whether this means taking pride in one’s differences (Blume,
1998), viewing these differences as neutral and natural (Singer, 1999), and/or questioning
the standard by which these differences are evaluated (Walker, 2012). Thus, this large
factor related to Autism Stigma within the Neurodiversity Attitudes Scale is highly
disability microaggressions.
The second facet of the Neurodiversity Attitudes Scale was Autism Identity,
which includes items that frame autism as a central and immutable part of one’s identity
(e.g., “Autism is a fundamental part of who someone is”). Some items in this subscale
frame this identity as positive (e.g., “Autism can be a source of pride”). These
perspectives are consistent with those articulated from individuals within the
individual who can be separated from their disability (Bumiller, 2008; Graby, 2015, p.
239; Singer, 1999). One argument articulated by some neurodiversity activists to support
the idea that autism can form a central part of one’s identity is that autism is immutable
and located within the brain (Ortega, 2009). Thus, attempts to alter autistic ways of being
(e.g., self-soothing behaviors, social mannerisms, sensory sensitivities) are seen by some
Ortega, 2009). Several autistic self-advocates have drawn parallels between Applied
32
Behavior Analysis (ABA) interventions for autistic individuals and conversion therapy
for LGBTQ individuals, noting their shared histories in Lovaas’ influence in behavioral
or gender transitioning among children (Gibson & Douglas, 2018; Kirkham, 2017;
Rekers & Lovaas, 1974). Despite the potential drawbacks of utilizing such a framework
for promoting LGBTQ rights in Western societies, this essentialist perspective served to
challenge harmful practices that were based on the assumption that it was desirable and
possible for people to purposefully change their sexual orientation or gender identity to
& Raymaker, 2020). Nevertheless, it is likely that lay interpretations of neuroscience and
the relative success of this framing with respect to LGBTQ rights have laid the
foundation for this essentialist framing of neurodiversity to serve as a useful strategy for
promoting the rights and dignity of neurodivergent individuals (Ortega, 2009). This
The third factor of the Neurodiversity Attitudes scale was Autism Separability, or
the extent that individuals view autism as separable from one’s core identity and
Autism isn’t something a person has, or a ‘shell’ that a person is trapped inside. There’s
no normal child hidden behind the autism. Autism is a way of being. It is pervasive; it
colors every experience, every sensation, perception, thought, emotion, and encounter,
every aspect of existence. It is not possible to separate the autism from the person—and if
33
it were possible, the person you’d have left would not be the same person you started
with. (para. 6)
Sinclair (1993) explains that autism cannot be accurately viewed as a distinct entity or
Instead, from this perspective, autism is a critical core component of the self that cannot
purposely utilize identity-first language (Kapp et al., 2013; Sinclair, 2012). Thus, the
majority of items in this subscale reflect preferences regarding terminology and language.
The results of hypothesis and validity testing with the CFA sample supported
some of the proposed hypotheses. Due to the theoretical influence of the social model of
of the social model of disability and negatively correlated with the medical model of
disability (Kapp, 2020; Singer, 1999). Indeed, results indicated that endorsement of
were positively correlated with endorsement of the social model of disability. Likewise,
the results indicated that the total score and each of the subscales of the Neurodiversity
Attitudes Scale were negatively correlated with endorsement of the medical model of
disability, which has been frequently contrasted with the social model (Pledger, 2003;
Shakespeare, 2017). Although the above results should be interpreted with extreme
caution due to the low level of reliability for the social and medical model measures with
34
this sample, these results indicate that the Neurodiversity Attitudes Scale potentially tap
into the theoretical underpinnings of the neurodiversity movement with respect to the
models of disability. At the same time, the lack of significant association between
endorsement of the social model of disability and the Separability subscale of the
proposed measure indicates some of the potential ways that the neurodiversity movement
has extended beyond the social model of disability into a unique perspective.
Given the role that the neurodiversity framework has played in activist
and endorsement of the neurodiversity framework (Dekker, 1999; Singer, 1999). Indeed,
behavior. This is consistent with literature on the origins of the neurodiversity movement,
as well as the focus of much of disability activist work related to reducing stigma (Pripas-
Kapit, 2020). It is important to note that the current study assessed self-reported activist
behavior in general for oppressed groups, not just with respect to disability rights. This
critical consciousness or activist orientation. Many disability rights activists and scholars
have noted how such work takes place from an intersectional perspective, as disabled
Breshears, 2019). It is possible that this framework extends into those who identify with
35
With respect to the aims of neurodiversity and disability rights activism in
found that endorsement of the neurodiversity framework in general, as well as each of its
because two of the subscales (i.e., Identity and Separability) do not explicitly address
stigma or prejudice. This may indicate that holding ableist attitudes is inconsistent with
viewing autism as a central and potentially positive aspect of one’s identity. This is
reflected in many autistic self-advocates’ position that person-first language or the idea
that autism is separate from the rest of one’s identity and experience imply that autism is
an undesirable characteristic that does not reflect one’s “true” character (Sinclair, 1993;
Sinclair, 2012). For example, many autistic activists have critiqued metaphorical
language that frames autism as an entity that has “stolen” children from their parents, an
groups such as Autism Speaks (Sinclair, 1993; Gross, 2012). Although many professional
the use of person-first language in order to center the humanity and dignity of autistic
individuals, critics have noted that this use of language further stigmatizes autism and
leads to misunderstanding of autistic experiences (Dunn & Andrews, 2015; Maya, 2019;
36
Sinclair, 2012). The present study does not directly examine the motivations or impact of
person- vs. identity-first language. However, it does indicate that individuals who endorse
higher levels of anti-disability prejudice are less likely to view autism as a central,
endorse attitudes congruent with the neurodiversity movement compared to the general
may reflect the richer and more varied experiences with autism among those with lived
personal experience compared to the neurotypical peers. It may also reflect the pattern
observed that autistic participants endorsed knowing other autistic people (e.g., family,
friends, coworkers) more frequently than that endorsed by neurotypical participants. Such
social contact may also inform the richness of personal experience that informs
and one’s disability (Kapp, 2020; Pripas-Kapit, 2020). Thus, viewing autism with this
perspective may be a greater priority for autistic individuals compared to the general
population.
37
Despite the strengths of this scale, there were some limitations to this project.
First, the Neurodiversity Attitudes Scale was limited in scope to autism. This decision
was made based on the strong link between the neurodiversity movement and the autistic
social movements, and lived experiences of the wide array of diagnoses that may fit
framework with respect to other diagnoses, the current scale is currently unequipped to
diagnoses outside of the autism spectrum. Future research should assess how the
Another limitation of the present study is the size of the third factor of the
Neurodiversity Attitudes Scale. Given the item retention criteria, the EFA results
indicated that the model best fit with three items in the third factor of Autism
Separability. Due in part to the low number of items in this factor, the resulting
Cronbach’s alphas with the EFA and CFA samples are not as high as those from the other
two factors. Model fit decreased when additional items were added to the Autism
Separability factor and when the factor itself or its three items were deleted. Thus, the
current set of items and factors have been retained in the final models. Future research
could develop and test additional items for this factor in order to improve internal
38
One final limitation is the low levels of internal consistency in some of the study
scales with the current sample, particularly the Brief Resilience Scale (Smith et al., 2008)
and endorsement of the social and medical models of disability from the Questionnaire
on Disability Identity and Opportunity (Darling & Heckert, 2010). Given the low levels
of reliability in these scales, the present study is limited in terms of the results from
analyses that involve these scales. One potential reason for the low levels of internal
consistency in certain scales is the composition of the study sample, which consisted
mostly of people with disabilities. Although the Brief Resilience Scale (Smith et al.,
2008) was initially developed and tested with subsamples of people with disabilities (i.e.,
cardiac rehabilitation patients and women with fibromyalgia), it is possible that the items
in this scale represent different constructs for people with different disabilities, as well as
nondisabled participants. For example, a person with a chronic illness or disability might
endorse that they disagree with statements such as, “I tend to bounce back quickly after
hard times [emphasis added]” or, “It does not take me long to recover from a stressful
limitations they experience. However, endorsing items in this way does not mean that
people with disabilities cannot cope with difficult life experiences, just that it can be
difficult and time-consuming to do so. The Brief Resilience Scale was utilized in the
wellbeing and life satisfaction. However, future research utilizing diverse samples of
participants with and without disabilities should utilize measures that have stronger
internal consistency within diverse samples and place less emphasis on extraneous factors
39
It is less clear why the measures of endorsement of the social and medical models
of disability had low Cronbach’s alphas for the present sample. It is possible that because
these scales were developed with a diverse group of adults with disabilities, the reliability
is less strong in samples with a wider range of participants (i.e., both participants with
and without disabilities; Darling & Heckert, 2010). Alternatively, it is possible that the
dichotomy of the medical vs. social models of disability resonate less strongly with a
sample that has a high proportion of individuals with invisible disabilities, chronic
illnesses, and/or autism. Many disability studies scholars and activists have critiqued the
framework of the social model of disability due to its formulation primarily among White
disability activists with visible mobility or physical impairments and its limited ability to
fully account for the experiences of people who face chronic pain or illness (Goodley et
al., 2019; Hughes & Paterson, 1997). Thus, future researchers should develop or refine
scales to assess conceptualizations of disability that are reliable and valid across disability
status.
40
CHAPTER 6
CONCLUSIONS
psychology due to its destigmatizing framework of autism and other conditions and its
identity within scholarly literature and training programs (Andrews et al., 2019; Foley-
Nicpon & Lee, 2012). Therefore, I have developed and provided initial validation for a
a 24-item scale with three factors: Autism Stigma, Autism Identity, and Autism
neurodiversity with respect to autism, as well as the opportunity to utilize this construct
difficulties and suicidality (Hofvander et al., 2009; Zahid & Upthegrove, 2017),
victimization from abuse and maltreatment (Ficher et al., 2019; Weiss & Fardella, 2018),
research to utilize methods and frameworks that empower people with disabilities and
challenge ableism in society as well as in the field. Psychological methods have much to
contribute to the study of disability and neurodiversity. For example, future researchers
can assess how endorsement of the neurodiversity framework may help autistic
individuals or their loved ones cope with the challenges associated with ableism in
41
marginalization and identity, or how endorsement of the neurodiversity framework
translator between the worlds of psychological measurement and autistic activism, I hope
to bring the two realms closer together to co-create change within counseling psychology.
42
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APPENDIX A
53
Table 1. Preliminary Item Pool
Number Potential Items:
1 [CONDITION]^ is a central part of one’s identity
2 [CONDITION] is a fundamental part of who someone is
3 I prefer using identity-first language to describe people (e.g., “autistic
person”)
4 *It is possible to separate the person from the [CONDITION]
5 *I prefer using person-first language to describe people (e.g., “person with
autism”)
6 [CONDITION] is hard-wired into the way someone’s brain works.
7 If someone has [CONDITION], it cannot be changed.
8 Having [CONDITION] is permanent.
9 [CONDITION] is caused by biology.
10 People with [CONDITION] are born that way
11 *People with [CONDITION] can function in a “typical” way if they have
enough therapy
12 *If people with [CONDITION] try really hard, they could be “normal.”
13 [CONDITION] is a difference, not an illness
14 There is no “normal” style of human brain or human mind.
15 [CONDITION] is just a form of natural human variation, not a disease or
disorder
16 People with [CONDITION] should be accepted for who they are
17 The main problems faced by those with [CONDITION] are caused by how
other people treat them
18 There is nothing wrong with [CONDITION] people
19 [CONDITION] is an aspect of human diversity
20 *[CONDITION] is more than just a difference; it is a disorder.
21 *[CONDITION] is something that requires medical or therapeutic treatment
22 *Most of the problems experienced by people with [CONDITION] are
caused by the [CONDITION] itself
23 *People with [CONDITION] are broken
24 [CONDITION] can be a source of pride
25 Although people with [CONDITION] have a lot of challenges associated
with [CONDITION], [CONDITION] also gives them a lot of strengths
26 I understand why someone with [CONDITION] would be proud to have it
27 It is good for our world to have people with [CONDITION] in it
28 *Being diagnosed with [CONDITION] is a tragedy
29 *I feel sorry for parents and family of people with [CONDITION]
30 *People with [CONDITION] are a burden to their families and loved ones
31 *People with [CONDITION] should try to hide it
32 It is harmful to promote searching for a cure for [CONDITION]
33 Wanting to cure [CONDITION] is the same as not wanting people with
[CONDITION] to exist
54
34 Trying to make people with [CONDITION] appear to be “normal” is
harmful to these individuals
35 We should change society so that it is more accepting of people with
[CONDITION]
36 It is more important that therapies and treatments focus on improving the
quality of life of people with [CONDITION] than making them appear the
same as most people
37 *It is important to find a cure for [CONDITION]
38 *People with [CONDITION] need to be cured
39 *We should help people with [CONDITION] change in order to fit into
society better
40 *[CONDITION] has become an epidemic
41 *We must fight against [CONDITION]
42 *It is important that people with [CONDITION] learn to act like most
people do
43 People with [CONDITION] are the most knowledgeable about
[CONDITION].
44 If I wanted to know more about [CONDITION], I would talk to someone
with [CONDITION]
45 People with [CONDITION] should be the people making decisions about
their lives
46 *Professionals (e.g., doctors, therapists) are the best source of information
on the experience of having [CONDITION]
47 *When dealing with [CONDITION], we should trust the professional
experts first.
48 *I would not trust someone with [CONDITION] to give me information
about [CONDITION]
^The placeholder [CONDITION is used in the preliminary item list due to the wide range
of conditions under the neurodiversity umbrella. Expert reviewers were asked for
feedback regarding the use of a general vs. specific condition for the scale.
*Asterisks indicate that the item is intended to be negatively scored
55
Table 2. Revised Item Pool
Instructions: The following statements describe different opinions and attitudes people
may have about various topics. You might find yourself strongly agreeing or disagreeing
with these opinions, or you may find yourself feeling strong emotions like anger or
confusion regarding some attitudes. We are looking for how strongly you agree or
disagree with the following statements. Remember, your responses are anonymous and
are not linked to your name or contact information.
Many of the next few questions have to do with Autism Spectrum Disorder (ASD). A few
years ago, the diagnostic system in the United States changed in order to combine several
conditions under the same category. When this questionnaire asks about “autism” or “on
the autism spectrum,” it refers to the following conditions:
Autism
Asperger’s Syndrome
Pervasive Developmental Disorder – Not Otherwise Specified (PDD-
NOS)
Additionally, there has been a lot of debate regarding how to refer to individuals on the
autism spectrum (e.g., “autistic person” vs. “person with autism”). For the purposes of
this survey, I will be using several different types of language.
Please rate how much you agree or disagree with the following statements.
57
Additional Items:
Item Response Options
1. How familiar are you with the 0. Never heart of it
neurodiversity movement?^ 1. Heard of it, but don’t know what it
is
2. Somewhat familiar
3. Very Familiar
98. No answer
2. How much do you agree with the 1. Strongly disagree
goals of the neurodiversity 2. Disagree
movement? 3. Neither agree nor disagree
4. Agree
5. Strongly agree
98. No answer
3. How important is the 1. Not important at all
neurodiversity movement, in your 2. Mostly not important
opinion? 3. Neutral
4. Somewhat important
5. Very important
98. No answer
4. How necessary is the 1. Very unnecessary
neurodiversity movement, in your 2. Somewhat unnecessary
opinion? 3. Neutral
4. Somewhat necessary
5. Very necessary
98. No answer
5. How beneficial is the 1. Not beneficial at all
neurodiversity movement to 2. Not very beneficial
society? 3. Neutral
4. Somewhat beneficial
5. Very beneficial
98. No answer
6. How helpful is the neurodiversity 1. Very harmful
movement to people with 2. Somewhat harmful
disabilities? 3. Neither helpful nor harmful
4. Somewhat helpful
5. Very helpful
98. No answer
7. How would you define the goals of Free response
the neurodiversity movement?
8. What is your opinion of the Free response
neurodiversity movement?
^Respondents who do not answer “Somewhat familiar” or “Very familiar” do not
proceed with the following questions
58
Table 3. Demographic Information Across Samples
Identification as Trans
Yes 19 7.6% 19 7.4%
No 227 91.2% 236 91.1%
Unsure 1 0.4% 3 1.2%
Other 1 0.4% 0 0.0%
No answer 1 0.4% 1 0.4%
Race
Asian, South Asian, 27 10.8% 20 7.7%
and/or Asian American
Native Hawaiian and/or 19 7.6% 24 9.3%
Pacific Islander
African American and/or 17 6.8% 23 8.9%
Black
Native American and/or 25 10.0% 22 8.5%
American Indian and/or
Alaska Native
White and/or Caucasian 136 54.6% 130 50.2%
Multiracial 22 8.8% 35 13.5%
Other 0 0.0% 1 0.4%
No answer 4 1.6% 4 1.5%
Latinx Ethnicity
Not Latinx 221 88.8% 237 91.5%
Latinx 27 10.8% 19 7.3%
No answer 1 0.4% 3 1.2%
Sexual Orientation
Bisexual or pansexual 31 12.4% 22 8.5%
Gay or lesbian 11 4.4% 9 3.5%
Heterosexual or straight 184 73.9% 212 81.9%
Asexual 11 4.4% 5 1.9%
Unsure or questioning 5 2.0% 4 1.5%
Other 5 2.0% 5 1.9%
59
No answer 2 0.8% 2 0.8%
Education Level
9th-12th grade (no 1 0.4% 5 1.9%
diploma)
High school graduate or 33 13.3% 41 15.8%
GED
Some college (no degree) 49 19.7% 52 20.1%
Associate’s degree 26 10.4% 38 14.7%
Trade or vocational 31 12.4% 29 11.2%
school degree
Bachelor’s degree 67 26.9% 66 25.5%
Master’s degree 30 12.0% 20 7.7%
Doctorate degree 8 3.2% 8 3.1%
Other 1 0.4% 0 0.0%
No answer 3 1.2% 0 0.0%
Region of Residence in US
New England (CT, ME, 16 6.4% 20 7.7%
NH, RI, VT)
Mideast (DE, MD, NJ, 49 19.7% 31 12.0%
NY, PA, DC)
Great Lakes (IL, IN, MI, 27 10.8% 26 10.0%
OH, WI)
Plains (IA, KS, MN, MO, 18 7.2% 23 8.9%
NE, ND, SD)
Southeast (AL, AR, FL, 45 18.1% 39 15.1%
GA, KY, LA, MS, NC, SC,
TN, VA, WV)
Southwest (AZ, NM, OK, 37 14.9% 50 19.3%
TX)
Rocky Mountain (CO, 16 6.4% 24 9.3%
ID, MT, UT, WY)
Far West (AK, CA, HI, 37 14.9% 41 15.8%
NV, OR, WA)
Other 0 0.0% 2 0.8%
No answer 4 1.6% 3 1.2%
Student Status
Yes, full time 25 10.0% 27 10.4%
Yes, part time 123 49.4% 153 59.1%
No 95 38.2% 75 29.0%
No answer 6 2.4% 4 1.5%
60
Employment Status
Yes, full time 61 24.5% 54 20.8%
Yes, part time 142 57.0% 165 63.7%
No 38 15.3% 35 13.5%
No answer 8 3.2% 5 1.9%
Political Affiliation
Very liberal 69 27.7% 63 24.3%
Somewhat liberal 59 23.7% 68 26.3%
Moderate 27 10.8% 41 15.8%
Somewhat conservative 29 11.6% 31 12.0%
Very conservative 22 8.8% 26 10.0%
Other 34 13.7% 16 6.2%
No answer 9 3.6% 14 5.4%
61
Table 4. Disability Identification Across Samples
62
Table 5. Final 24-Item Neurodiversity Attitudes Scale Factor Loadings
11. People with autism should try really hard 0.87 0.11 -0.06
to be “normal”*
36. We should help people with autism 0.84 0.23 0.20
change in order to fit into society better*
25. Being diagnosed with autism is a 0.82 -0.11 -0.02
tragedy*
35. People with autism need to be cured* 0.81 -0.11 0.09
38. We must fight against autism* .80 -0.13 0.02
39. It is important that autistic people learn to 0.76 0.05 0.07
act the same way that most people do*
26. I feel sorry for families of autistic 0.73 0.14 0.12
people*
28. People with autism should try to hide it* 0.69 -0.24 -0.31
27. People with autism are a burden to their 0.67 0.03 -0.23
loved ones*
44. I would not trust an autistic person to 0.66 0.06 0.14
give me reliable information about autism*
34. It is important to find a cure for autism* 0.66 -0.26 0.11
10. People with autism should be taught to 0.61 0.00 -0.01
function in a “typical” way*
37. Autism is an epidemic* 0.49 -0.33 0.05
43. When dealing with autism, we should 0.47 -0.24 0.14
trust the professional experts above other
views*
63
6. Autism is hard-wired into the way -0.21 0.35 -0.30
someone’s brain works.
64
Table 6. Bivariate correlations, means, and standard deviations for Neurodiversity
Attitudes Scale subscales: EFA sample
Factor 1: Factor 2: Factor 3: Means (SD)
Stigma Identity Separability
Factor 1: Stigma - .49** .25** 3.27 (0.79)
65
Table 7. Confirmatory Factor Analysis Fit Indices Comparison Summary
χ2 347.44** 334.03**
df 249 248
66
Table 8. Bivariate correlations, means, and standard deviations for study variables: CFA
sample
Variables 1 2 3 4 5 6 7 8 9 10 11 Mean
(SD)
1. Autism -- 3.27
Stigma (0.78)
4. NAS -- -- -- -- 3.28
Total1 (0.64)
9. Age .21** .18** -.04 .22** -.30** .05 .13* -.06 -- 30.07
(9.61)
10. Educ. .14** .20** .01 .18** -.30** -.00 .16* .01 .20** -- 5.40
(1.78)
11. SES -.35** -.46** -.08 -.43** .50** -.02 -.10 -.15* -.09 -.00 -- 7.69
(2.66)
67
Figure 1. Path Diagram of Revised CFA Model with Standardized Parameter Estimates
68
APPENDIX B
IRB APPROVAL
69
The University Human Subjects Institutional Review Board (IRB) of Arizona State
Attitudes Scale (IRB ID: STUDY00011291) for human subjects research on January 8,
70