Factors Underlying Cross-Cultural and Gender Differences in Stigma Towards ASD: Insights from an Online Training for College Students in Lebanon and the United States

Background:  

In previous work, we documented that stigma towards ASD was heightened in more collectivistic countries (Lebanon and Japan) than in the US. Collectivism has been positively associated with mental health stigma in the UK (Papadopoulos et al., 2013). In our prior work, stigma was higher among males than females in the US; such gender differences were less apparent in Lebanon and Japan. This pattern may arise from individualism-collectivism as gender differences in personality are heightened in more individualistic countries (Costa et al., 2001). Higher quality contact with individuals with ASD is associated with increased acceptance (Gardiner & Iarocci, 2013). We hypothesized that individualism-collectivism, quality of contact, and personality differences might underlie cross-cultural and gender differences in stigma towards ASD.

Objectives:  

Examine (1) factors contributing to differences in ASD stigma in Lebanon and the US, and (2) factors that contribute to reductions in stigma following training.

Methods:  

College students in Lebanon (N=672) and the US (N=563) completed an online survey, which included pre-tests (assessing ASD knowledge and stigma), an ASD training, which included a manipulation of contact, post-tests, and assessments of individualism-collectivism,  social desirability, openness to experience, trait emotional intelligence, autism symptoms, and quality of contact with individuals with ASD. Participants were randomly assigned to one of three “contact” conditions, varying the alleged creator of the training (an autism researcher or a nonverbal or verbal person with autism).

Results:

Due to large numbers of comparisons, α=.001. An initial regression analysis with country and gender as predictors of baseline stigma replicated findings of higher stigma in Lebanon, and among men (ps<.001). When the following predictors were included, lower ASD knowledge, lower quality of contact, less openness, lower collectivism, and being male were associated with heightened stigma (ps <.001). Country (p=.009), individualism (p=.013) and social desirability (p=.022) were marginally associated with stigma. Emotional intelligence and symptoms were unrelated to stigma.

Following training, participants reported less stigma (p<.001), with the magnitude of the reduction positively associated with quality of contact (p<.001) and marginally associated with knowledge (p=.004), emotional intelligence (p=.013) and openness (p=.039). The manipulation of contact, social desirability, and symptoms were unrelated to stigma reductions.

Conclusions:  

Counter to our hypothesis, greater collectivism was associated with less stigma. The measure of individualism-collectivism used has a vertical dimension (acceptance of inequality) and a horizontal dimension (viewing people as equal) that intersects with the dimension of individualism-collectivism. Greater acceptance of inequality was associated with higher stigma in the current sample.  Greater quality of contact and ASD knowledge were associated with lower stigma; both were low in Lebanon where autism resources are scarce. Prior contact predicted the degree to which stigma was reduced with training, which suggests that interventions should include direct contact with people on the spectrum. Our manipulation of “contact” (via the alleged creator of training materials) lacked actual engagement and was ineffective. Findings suggest that equalizing experiences (such as contact) and personality characteristics that contribute to such experiences (such as openness) may reduce stigma towards ASD.