Today, I’ll be continuing my assault on the idea that everybody should be forced to attend all-inclusive mainstream schools with a sixth post on the subject.  We’ve already heard how autistic students in the mainstream can be bullied and isolated.  Furthermore, I’ve argued that the mainstream does little to help us learn social skills and instead probably delays social learning.  We’ve also discussed how educational placement decisions are made and we’ve discussed why all of this is so critically important.

In that final post, on the importance of educational placements, I claimed that “ensuring that autistic students are in the right [school] environment can protect against anxiety and depression.”  I want to expand on that a little.

Mental Health in Autism

We know that autistic people suffer from very high rates of anxiety and depression.  That’s very unfortunate for multiple reasons.  Obviously, it’s bad because we want people to be happy and to feel confident about themselves.  However, it’s also bad because anxiety and depression are impairing.  When an autistic person has social anxiety, this is going to make it even harder for the autistic person to navigate social situations, on top of existing social difficulties due to autism itself.  Furthermore, depression can affect autistic people’s ability to motivate themselves to get things done, which can then affect their academic performance and their success in the job market.

Mental health problems are particularly concerning in the context of the transition to adulthood, which so many autistic people struggle with.  One study which followed a group of young autistic adults longitudinally for twelve years found that around a third of them never had a job and never attended a postsecondary educational institution – even though all the participants in the study had intellectual functioning in the average range! (Taylor et al., 2015).  Sure, there are lots of barriers to autistic people’s entry into the labour market, but could those external barriers alone really account for this?  Perhaps participants in this disengaged group were struggling with depression and anxiety, leaving them unable to summon up the motivation to achieve their goals?

So, mental health is important.  I think we can all agree on that.  But why would mental health be connected to school experiences?

We have to ask ourselves why autistic people have anxiety and depression.  Are they symptoms of autism, or are they somehow caused by the same etiological factors that cause autism?  Or are they caused by something else – by something farther downstream?

Wood and Gadow (2010) argue that for the latter view.  They remind us that, every day, autistic people face daily stressors that could, over time, cause autistic people to become anxious.  Wood and Gadow identify several such stressors: unpredictable social interactions, social rejection, peer victimization, aversive sensory experiences, and people who prevent us from doing things we want to do (like stimming or pursuing intense interests).  When you know bad things are going to happen, you’re going to fear them, and then you’ll be anxious.

Furthermore, when bad things constantly happen, you might get depressed.  Not only are you persistently miserable because of the bad things, but you can expect to remain miserable in the foreseeable future.  You might even conclude that the bad things are your fault, because they happen to you and not to others around you.

Some Negative Experiences

Unfortunately, a lot of the negative experiences that can cause anxiety and depression are things that we know can be associated with the mainstream schools.  Remember we said that bullying is often a problem in the mainstream?  Well, guess what – autistic people’s experiences of bullying are associated with anxiety, depression, internalizing, panic, and personal distress (Adams et al., 2014; Cappadocia et al., 2012; Chiu et al., 2018; Storch et al., 2012; Ung et al., 2016; van Schalkwyk et al., 2018; Weiss et al., 2015; Zeedyk et al., 2014).  Autistic children report experiencing anger, sadness, loneliness, nervousness, fear, stomach butterflies, headaches, stomach pains, and nausea after being bullied (Bitsika & Sharpley, 2014).  Autistic children and their parents also link experiences of victimization to suicidal ideation (Carter, 2009, p. 150; Cook et al., 2016, p. 264) and suicide attempts (Carter, 2009, p. 150; Penney, 2013, p. 89).  Finally, peer victimization is specifically associated with fear of going to school, less enjoyment of school, less belonging in school, and less feeling safe in school (Adams et al, 2016).  When an autistic adult, Nita Jackson (2002, p. 24), reflected on her experiences of being bullied at school, she admitted that she “actually didn’t feel worthy to be liked” afterwards.

What else have we said was linked to the mainstream schools?  Social isolation.  Unsurprisingly, social exclusion is associated with autistic children’s experiences of personal distress, while good relationships with friends are linked to lower levels of personal distress (Chiu et al., 2018).  Autistic children who have better social relationships have less anxiety (Eussen et al., 2012).  Furthermore, autistic children with closer friendships have higher overall self-worth (Bauminger et al., 2004).  One autistic adult suggested to Attwood (2007, p. 63) that she thought friendship was the best cure for low self-esteem.

What other things about mainstream schools might be related to mental health?  Well, if we look back at Wood and Gadow’s list of stressors, we see that navigating unpredictable social interactions could be a source of stress.  These stressful interactions could be more common in mainstream school settings, where autistic people would face the extremely challenging task of interacting with neurotypicals, than in specialized schools, where autistic people might face the easier task of interacting with fellow autistics.

Furthermore, let’s not forget about another thing on Wood and Gadow’s list: sensory distress.  I’ll probably write a whole post about this soon, but there’s a lot of negative sensory experiences one can have in a mainstream school.  I’m not saying it’s impossible to experience sensory distress in a specialized school, but these schools are usually smaller and therefore less overwhelming.  Furthermore, because they may specifically cater to autistic students, physical spaces can be designed and activities and routines structured with autistic people’s sensory needs in mind.

Now, if we cared to, we could probably keep on like this for a while, finding more bad things about the mainstream and showing that they can lead to mental health challenges.  However, I think there’s just one other we should cover before moving on: social comparison.  We, as humans (autistic or otherwise), constantly compare ourselves to others and judge ourselves accordingly.  If autistic people are constantly surrounded by neurotypical children in a mainstream setting, they’ll be comparing themselves to those neurotypicals, and that could be a problem.  As Sinclair (1998, para. 7) writes:

“Being in a peer group where one always finds things more difficult than everyone else, always needs more help than anyone else, and always has to work harder than anyone else but still makes slower progress is not conducive to the development of a positive self-image.”

And indeed, a review of qualitative studies investigating autistic students in mainstream settings indicates that many feel different from their classmates in a negative way: they identify things that they can’t do as well as their peers, and they suggest that they somehow fell short of normality (Williams, Gleeson, & Jones, 2017).  Autistic adolescents who rate themselves as less similar to others report higher levels of depressive symptoms (Hedley & Young, 2006).

Okay, But Are Autistic Students in Specialized Settings Actually Less Anxious and Depressed?

Well, my personal experiences and subjective observations certainly suggest so, at least when we’re talking about people who have chosen to be in specialized schools!  I was awfully anxious when I was still in a mainstream middle school, but my anxieties largely disappeared after I left that context and started homeschooling.  (Which was a good thing, because I doubt I’d have done as well in adulthood if I was horribly anxious all the time.)  I’ve also seen autistic kids in specialized schools and, subjectively, I think they tend to look happier and less anxious than autistic kids in the mainstream.

Furthermore, there are a few studies (that I know of, anyway) that have empirically looked at this question.  Admittedly, there are a couple of studies that seem to provide null results, showing that school placement is not related to any differences in emotional problems or internalizing symptoms (Simonoff et a., 2013; Stoutjesdijk, 2014).  There’s also one other study in which autistic participants in mainstream settings were twice as likely to have anxiety disorders as those in specialized settings, but despite the size of the effect, that relationship wasn’t statistically significant (Simonoff et al., 2008).  However, another paper reports that autistic students in special education classes have significantly less personal distress than those in resource rooms and general education classes (Chiu et al., 2018), and yet another study found that autistic children in mainstream settings have significantly more social anxiety symptomatology than those in specialized settings (Zainal & Magiati, 2016).

Unfortunately, we do need more studies to investigate this, because autistic children aren’t being randomly assigned to specialized and mainstream settings.  On the one hand, autistic children in mainstream settings might have higher IQs, which could place them at greater prior risk for mental health challenges.  On the other hand, autistic children in specialized settings might be fleeing the mainstream due to poor mental health.  Furthermore, we can’t say that all autistic children in these studies were in specialized settings by choice: some may have preferred the mainstream but been sent to specialized schools against their will, which is not at all something I support.  I fear being forced to attend a specialized school against one’s will could actually cause mental health problems.  Thus, we can’t be sure that these effects are actually caused by educational placements, let alone by access to choice about educational placements.

Still, while we wait for better studies to come out, we can see there are a number of good theoretical reasons to think that at least some autistic people will do better in specialized settings than mainstream ones.  This is yet another reason to give autistic people and their families access to meaningful choices about educational placement: to give them an inviolable right to the mainstream if that’s where they want to be, but also the option of trying other placements if the mainstream is failing them.

References

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Adams, R., Taylor, J., Duncan, A., & Bishop, S. (2016). Peer victimization and educational outcomes in mainstreamed adolescents with autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 46(11), 3557-3566. https://doi.org/10.1007/s10803-016-2893-3

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