View in EDS HTML Full Text PDF Full Text

How Pupils on the Autism Spectrum Make Sense of Themselves in the Context of Their Experiences in a Mainstream School Setting: A Qualitative Metasynthesis

Saved in:
Bibliographic Details
Title: How Pupils on the Autism Spectrum Make Sense of Themselves in the Context of Their Experiences in a Mainstream School Setting: A Qualitative Metasynthesis
Language: English
Authors: Williams, Emma I., Gleeson, Kate, Jones, Bridget E.
Source: Autism: The International Journal of Research and Practice. Jan 2019 23(1):8-28.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: http://sagepub.com
Peer Reviewed: Y
Page Count: 21
Publication Date: 2019
Document Type: Journal Articles
Reports - Research
Information Analyses
Education Level: Elementary Secondary Education
Postsecondary Education
Descriptors: Autism, Pervasive Developmental Disorders, Self Concept, Interpersonal Relationship, Student Attitudes, Sensory Experience, Educational Environment, Self Esteem, Well Being, Inclusion, Adolescents, Children, Elementary Secondary Education, Postsecondary Education, Special Education, Bullying, Victims, Peer Relationship, Accessibility (for Disabled)
DOI: 10.1177/1362361317723836
ISSN: 1362-3613
Abstract: Evidence that interpersonal interactions and self-appraisal in social context are crucial in developing self-understanding raises concerns about how pupils with autism spectrum disorder make sense of themselves in school settings where many experience social marginalisation. Metasynthesis was used to systematically extract and integrate findings from qualitative studies examining the mainstream school experiences of these students. Synthesised findings identified three, intermeshing, aspects of experience which contribute to many pupils with autism spectrum disorder making sense of themselves as 'different' to typical peers in a negative way: difficulties linked to autism spectrum disorder; interpersonal relationships, particularly with peers; and accessibility of the school environment. Typical pupils' attitudes and responses towards peers with autism spectrum disorder, unusual sensory reactions to the physical school environment and individual sense-making about the self are highlighted as key areas requiring further research and intervention to improve the experiences, self-esteem and well-being of pupils with autism spectrum disorder in inclusive settings and to inform educational policy and practice.
Abstractor: As Provided
Number of References: 121
Entry Date: 2018
Accession Number: EJ1200857
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwF0RDskn_e7IZDuox2IQXT5AAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDMQ4QsYgx432LC1FigIBEICBmp1h_getXkJqD2Ikiu-Rxkc0UI_3PTyqgdn2JKvXNeoWPtsFFt_-bplHtpaQpWZfVGe2Yk6VlNuTX_C6EBWsVG7n5Qr9nfV4rPqc5XnWDilT9rPdzS76D74rVikea0vxAA3qcIs7mPxuP5G_ZXzgTSbtN7nBrrBbhlgbrRQlUVyazoLNn0KXLRwgbP_cUCJqyLFhR9Xz34SN8No=
Text:
  Availability: 1
  Value: <anid>AN0133743172;f9d01jan.19;2019Feb06.07:22;v2.2.500</anid> <title id="AN0133743172-1">How pupils on the autism spectrum make sense of themselves in the context of their experiences in a mainstream school setting: A qualitative metasynthesis </title> <p>Evidence that interpersonal interactions and self-appraisal in social context are crucial in developing self-understanding raises concerns about how pupils with autism spectrum disorder make sense of themselves in school settings where many experience social marginalisation. Metasynthesis was used to systematically extract and integrate findings from qualitative studies examining the mainstream school experiences of these students. Synthesised findings identified three, intermeshing, aspects of experience which contribute to many pupils with autism spectrum disorder making sense of themselves as 'different' to typical peers in a negative way: difficulties linked to autism spectrum disorder; interpersonal relationships, particularly with peers; and accessibility of the school environment. Typical pupils' attitudes and responses towards peers with autism spectrum disorder, unusual sensory reactions to the physical school environment and individual sense-making about the self are highlighted as key areas requiring further research and intervention to improve the experiences, self-esteem and well-being of pupils with autism spectrum disorder in inclusive settings and to inform educational policy and practice.</p> <p>Keywords: adolescents; autism spectrum disorder; lived experience; metasummary; metasynthesis; qualitative research; school-aged children; self-understanding</p> <hd id="AN0133743172-2">Introduction</hd> <p>The recent dominance of the global ideology of inclusion on social and educational policy ([<reflink idref="bib51" id="ref1">51</reflink>]; [<reflink idref="bib82" id="ref2">82</reflink>]) has meant that pupils with autism spectrum disorder (ASD) are increasingly likely to be included into mainstream school settings in a locational sense. However, research strongly suggests that many remain socially and emotionally excluded. Studies using social networking surveys to examine peer relationships in mainstream classrooms containing at least one pupil on the autism spectrum have found that students with ASD are less accepted by peers and have fewer reciprocal friendships than typically developing (TD) classmates ([<reflink idref="bib56" id="ref3">56</reflink>]; [<reflink idref="bib91" id="ref4">91</reflink>]). Even when involved in social networks, they are more likely to be isolated and on the periphery ([<reflink idref="bib23" id="ref5">23</reflink>]; [<reflink idref="bib56" id="ref6">56</reflink>]). In turn, lack of peer acceptance and friends increases their risk of being victimised at school ([<reflink idref="bib52" id="ref7">52</reflink>]). Parent, teacher, and self-reports all suggest that students with ASD experience significantly higher levels of bullying than TD pupils ([<reflink idref="bib52" id="ref8">52</reflink>]; [<reflink idref="bib97" id="ref9">97</reflink>], [<reflink idref="bib108" id="ref10">108</reflink>]) and most other groups with special educational needs ([<reflink idref="bib54" id="ref11">54</reflink>]; [<reflink idref="bib92" id="ref12">92</reflink>]).</p> <hd id="AN0133743172-3">Social context of self-understanding and self-appraisal</hd> <p>The potential implications of experiencing isolation, marginalisation and bullying at school on the development of self-understanding and self-appraisal in students with ASD can only be fully understood when set in the context of empirically supported self and identity theories which converge in grounding self-development in day-to-day interactions with both individuals and relevant social groups (e.g. [<reflink idref="bib16" id="ref13">16</reflink>]; [<reflink idref="bib26" id="ref14">26</reflink>]; [<reflink idref="bib71" id="ref15">71</reflink>]; [<reflink idref="bib72" id="ref16">72</reflink>]; [<reflink idref="bib98" id="ref17">98</reflink>]; [<reflink idref="bib110" id="ref18">110</reflink>]). Self-development is seen as inherently socially constituted through interactions with (and perceptions of) others, while these interpersonal experiences are themselves informed by a socially acquired understanding of both the nature of relationships and the individual's thoughts and feelings about themselves ([<reflink idref="bib76" id="ref19">76</reflink>]).</p> <p>As young people spend a significant amount of time in school, interpersonal processes operating there will have a powerful impact on sense-making about the self. Children as young as 5 years begin to recognise ways in which they differ from others ([<reflink idref="bib99" id="ref20">99</reflink>]). In particular, the homogeneity of school classes focuses their attention on comparing themselves to peers ([<reflink idref="bib78" id="ref21">78</reflink>]). Evidence indicates that social comparisons, which increase and become more subtle over time, play a pivotal role in shaping self-appraisal ([<reflink idref="bib17" id="ref22">17</reflink>]; [<reflink idref="bib18" id="ref23">18</reflink>]; [<reflink idref="bib32" id="ref24">32</reflink>]; [<reflink idref="bib78" id="ref25">78</reflink>]). From around the age of 8 years, children's self-acceptance and self-evaluation become increasingly linked to others' appraisal ([<reflink idref="bib43" id="ref26">43</reflink>]; [<reflink idref="bib61" id="ref27">61</reflink>]). Developmental changes in peer relationships at dyadic and group level make further key contributions to how young people understand and value themselves. By age 11, most peer interactions occur in the context of voluntary, friendship-based peer groups ([<reflink idref="bib83" id="ref28">83</reflink>]), membership of which is linked to social status ([<reflink idref="bib117" id="ref29">117</reflink>]), self-definition and feelings of being accepted ([<reflink idref="bib83" id="ref30">83</reflink>]). For adolescents, high-quality, close, friendships confer a sense of belonging and have a strong positive impact on overall self-worth and long-term mental health ([<reflink idref="bib8" id="ref31">8</reflink>]). Conversely, lack of peer acceptance is linked to negative self-appraisal ([<reflink idref="bib61" id="ref32">61</reflink>]; [<reflink idref="bib96" id="ref33">96</reflink>]) and poor mental health ([<reflink idref="bib8" id="ref34">8</reflink>]; [<reflink idref="bib41" id="ref35">41</reflink>]).</p> <hd id="AN0133743172-4">ASD and the social context of self-understanding and self-appraisal</hd> <p>Evidence that interpersonal relationships and self-appraisal in social context are crucial in the development of self-understanding, taken together with research suggesting that many students with ASD are socially and emotionally excluded at school, raises serious concerns that the school experiences of these pupils may impact on sense-making about the self in adverse ways, increasing their risk of developing low self-esteem and mental health problems ([<reflink idref="bib52" id="ref36">52</reflink>]). So far, this issue has received relatively little research attention, perhaps in part because some theorists contend that self-understanding in those with ASD is less anchored in social relationships and activities, as a result of problems comprehending others' attitudes and beliefs towards them ([<reflink idref="bib34" id="ref37">34</reflink>]; [<reflink idref="bib49" id="ref38">49</reflink>]; [<reflink idref="bib62" id="ref39">62</reflink>]), deficits in empathising ([<reflink idref="bib11" id="ref40">11</reflink>]), or social motivation ([<reflink idref="bib31" id="ref41">31</reflink>]). This may have led to an assumption that the social world is less relevant to their self-understanding and self-appraisal ([<reflink idref="bib6" id="ref42">6</reflink>]). However, a growing body of qualitative research strongly suggests that social relations play a key role in shaping sense-making about the self of those with ASD ([<reflink idref="bib6" id="ref43">6</reflink>]; [<reflink idref="bib86" id="ref44">86</reflink>], [<reflink idref="bib87" id="ref45">87</reflink>]; [<reflink idref="bib89" id="ref46">89</reflink>]; [<reflink idref="bib121" id="ref47">121</reflink>]). A number of qualitative studies in which adults with ASD are asked to reflect on their life experiences report that repeated adverse social interactions (most notably with school peers) led them to feel 'different' from other people ([<reflink idref="bib6" id="ref48">6</reflink>]; [<reflink idref="bib87" id="ref49">87</reflink>]; [<reflink idref="bib89" id="ref50">89</reflink>]). They also identify a link between internalising the negative attitudes and reactions of others and the possession of a more negative self-identity, exacerbating mental health issues.</p> <hd id="AN0133743172-5">Current study</hd> <p>Collectively, existing evidence highlights a need to investigate further how pupils with ASD make sense of themselves in the context of their experiences in school settings. Qualitative research, with its focus on understanding the (often complex) processes at work in particular situations, together with the meaning-making ([<reflink idref="bib59" id="ref51">59</reflink>]) of individuals, is especially well suited to this task. However, while there is a growing number of qualitative studies exploring the school experiences of students on the autism spectrum, their ability to inform us about processes of self-development is limited by small sample sizes and variation in topics focussed on. A synthesis of their findings will increase impact, in the same way that meta-analysis boosts the power and precision of quantitative research ([<reflink idref="bib1" id="ref52">1</reflink>]). Qualitative synthesis aims to create a 'systematic logic' ([<reflink idref="bib112" id="ref53">112</reflink>]: 571) with which diverse findings from a specific field can be brought together and integrated systematically to produce credible and more transferable knowledge claims. We conducted a systematic review followed by a metasynthesis of published qualitative studies investigating the experiences of pupils with ASD in the context of life at school to determine the direction of further research and yield new insights for policy and practice ([<reflink idref="bib42" id="ref54">42</reflink>]). In light of [<reflink idref="bib12" id="ref55">12</reflink>] claim that qualitative studies may currently be undervalued and underutilised in autism research in part because of their perceived poor scientific quality, we also undertook a detailed critical appraisal of the qualitative papers identified from the systematic review, in order to provide a methodological critique as a step towards improving the rigour of qualitative research in the field of autism.</p> <hd id="AN0133743172-6">Method</hd> <p>The qualitative metasynthesis followed [<reflink idref="bib95" id="ref56">95</reflink>] five stage process: (<reflink idref="bib1" id="ref57">1</reflink>) identifying a research question, (<reflink idref="bib2" id="ref58">2</reflink>) searching for and retrieving relevant qualitative studies, (<reflink idref="bib3" id="ref59">3</reflink>) critically appraising the papers found, (<reflink idref="bib4" id="ref60">4</reflink>) undertaking a metasummary to extract and aggregate the findings and (<reflink idref="bib5" id="ref61">5</reflink>) interpreting findings through performing a metasynthesis.</p> <hd id="AN0133743172-7">Identifying a research question</hd> <p>The research question was 'How do young people on the autism spectrum make sense of themselves in the context of their experiences at school?' While relevant existing empirical and theoretical literature suggested that interpersonal encounters at school may be of particular interest, we decided on a broader focussed question to ensure it was capable of fully capturing the phenomenon under investigation ([<reflink idref="bib36" id="ref62">36</reflink>]).</p> <hd id="AN0133743172-8">Search and retrieval of qualitative studies</hd> <p>Studies to include were identified following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; [<reflink idref="bib74" id="ref63">74</reflink>]). The inclusion criteria were as follows:</p> <p></p> <ulist> <item> Participants were on the autism spectrum, aged between 5 and 21 years and either at school (any type of provision) or had left within the last 3 years. This was to maintain currency and avoid problems associated with the credibility of accounts generated more than 3 years after leaving school.</item> <p></p> <item> Articles focussed on, or included, pupils' own accounts of their school experiences. Studies which also presented other perspectives (e.g. teachers, parents) were included, providing these views could be clearly disaggregated from students' accounts.</item> <p></p> <item> Qualitative methods of data collection and analysis were used within a qualitative paradigm, often referred to as Big Q (as opposed to small q) qualitative research ([<reflink idref="bib14" id="ref64">14</reflink>]; [<reflink idref="bib57" id="ref65">57</reflink>]). Data analysis had to be inductive rather than imposing predefined categories.</item> <p></p> <item> Articles were published in English, between January 2000 and August 2014, in either a peer-reviewed journal or book.</item> </ulist> <hd id="AN0133743172-9">Literature scoping</hd> <p>Prior to commencing the main review, the first author scanned databases for existing systematic reviews (Cochrane Library, PsycINFO, ERIC, CINAHL and MEDLINE). None being found,1 [<reflink idref="bib1" id="ref66">1</reflink>] several sources were examined to help identify common keyword descriptors for qualitative studies to use in the subsequent main search, including systematic reviews of qualitative research ([<reflink idref="bib66" id="ref67">66</reflink>]; [<reflink idref="bib119" id="ref68">119</reflink>]) and papers focussing on issues surrounding database searches for qualitative studies ([<reflink idref="bib33" id="ref69">33</reflink>]; [<reflink idref="bib102" id="ref70">102</reflink>]). A citation 'pearl-growing' exercise was conducted whereby the index records of two articles already known by the first author to meet the eligibility criteria, as they appeared in all databases used in the main literature search, were scrutinised for further keywords to include as search terms ([<reflink idref="bib21" id="ref71">21</reflink>]; [<reflink idref="bib53" id="ref72">53</reflink>]).</p> <hd id="AN0133743172-10">Search strategy</hd> <p>A multipronged search strategy was adopted, given the propensity for the content of abstracts and titles of qualitative articles in electronic databases to be less amenable to keyword searching and for such research to be indexed less systematically ([<reflink idref="bib20" id="ref73">20</reflink>]; [<reflink idref="bib33" id="ref74">33</reflink>]; [<reflink idref="bib66" id="ref75">66</reflink>]). The search strategies included a broad range search of electronic databases, hand-search of the online content lists of journals yielding two or more eligible papers and examination of the reference lists of articles identified as suitable for inclusion.</p> <hd id="AN0133743172-11">Search results</hd> <p>Using the search terms identified during literature scoping (see Table 1), searches were conducted by the first author on 12 bibliographic databases from July to August 2014: PsycINFO, PsycARTICLES, CINAHL, ERIC, BEI (British Education Index), AEI (Australian Education Index), MEDLINE, ASSIA, IBSS (International Bibliography of Social Science), Sociological Abstracts, SSCI (Social Science Citation Index) and Academic Onefile. These yielded 4350 unique citations in total after combining searches and removing duplicates. A two-stage process was used to determine inclusion/exclusion of these studies (see Figure 1). The titles and abstracts of all articles retrieved were initially reviewed by the first author to establish whether they met the inclusion criteria. From this, 82 studies were selected for stage 2 of the screening process, including those providing insufficient information in the titles/abstracts to apply eligibility criteria. In stage 2, a full-text version of each paper was retrieved and independently assessed against the inclusion/exclusion criteria by the first and second authors (inter-rater reliability 92%) who discussed any disagreements. Sixteen papers were finally selected for inclusion.</p> <p>Graph</p> <p>Search terms used.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">No.</th><th align="left">Category</th><th align="left">Search terms</th></tr></thead><tbody><tr><td colspan="2">Population and setting </td><td /></tr><tr><td>1</td><td>Population</td><td>autis* OR Asperger* OR (Pervasive Developmental Disorder*) OR ASD</td></tr><tr><td>2</td><td>Age</td><td>adolescen* OR teen* OR youth OR child* OR young OR school age* OR school child* OR pupil* OR student* OR peer*</td></tr><tr><td /><td /><td /></tr><tr><td>3</td><td>Setting</td><td>school* OR college* OR academ* OR secondary OR comprehensive OR high school OR primary OR elementary education* OR classroom* OR learning* OR mainstream* OR special education OR special needs OR inclus*</td></tr><tr><td colspan="2">Study design </td><td /></tr><tr><td>4</td><td>Qualitative analysis</td><td>grounded theory OR thematic OR theme* OR narrative* OR phenomenolog* OR ethnograph* OR ethnomethodolog* OR content analys?s OR discourse analys?s OR discurs* OR narrative analys?s OR constant compar* OR action research OR 'case stud*' OR qualitative</td></tr><tr><td>5</td><td>Qualitative data collection</td><td>Interview* OR focus group* OR diar*</td></tr></tbody></table> </ephtml> </p> <p>1 ASD: autism spectrum disorder.</p> <p>Adapted PRISMA flow diagram indicating decisions made in study selection.</p> <p>Graph</p> <p>Thirty-one papers in total were identified from hand searching the content lists of journals in which two or more included papers and the reference lists of included articles had been found. Following the same two-stage process outlined above, most of these were excluded after reading the abstract (n = 24); five were excluded after full-text screening, meaning one further paper was added, resulting in 17 studies in total.</p> <hd id="AN0133743172-12">Characteristics of included studies</hd> <p>Data were extracted about the study location, participants, educational context, research question(s)/aim(s) and study design (see Table 2 for full details). Note that the corpus of papers represented largely the voice of verbally and cognitively able, male pupils in mainstream secondary schools in Western societies. The experiences of students with ASD who are female, younger than 11, less verbally/cognitively able and who attend a specialist school setting or live in non-Western societies were largely missing.</p> <p>Graph</p> <p>Summary table showing key methodological details of included studies.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Study</th><th align="left" rowspan="2">Location</th><th align="left" colspan="4">Participant details</th><th align="left" rowspan="2">Other perspectives</th><th align="left" rowspan="2">Educational context</th><th align="left" rowspan="2">Research question(s)/aim(s)</th><th align="left" rowspan="2">Study design: Data collection</th><th align="left" rowspan="2">Data analysis</th><th align="left" rowspan="2">Quality ratings</th></tr><tr><th align="left">n</th><th align="left">Age (years)</th><th align="left">Gender</th><th align="left">Diagnosis</th></tr></thead><tbody><tr><td><xref ref-type="bibr" rid="bibr9">Baines (2012)</xref></td><td>Northern California, USA</td><td>2</td><td>16–18</td><td>2M</td><td>AS (n = 1) Autism (n = 1)</td><td>No</td><td>Mainstream secondary (high) school, 11th and 12th grades</td><td>To investigate how secondary school pupils construct their identities through social interactions to belong, compete and participate</td><td>Ethnographic approach. Series of interviews over 2 years and video-recorded observations</td><td>GT (Timmer mans and Tavory, 2007) and positioning theory (Harré, 2003)</td><td>H</td></tr><tr><td><xref ref-type="bibr" rid="bibr19">Calder et al. (2013)</xref></td><td>London, UK</td><td>12</td><td>9–11</td><td>8M, 4F Ps include 1 pair of Male MZA twins</td><td>ASD Parent report</td><td>Mothers (n = 11) and teachers (n = 8)</td><td>Mainstream primary school, years 5 and 6</td><td>To investigate the functional role of friendships for students with ASD and their experiences of, and satisfaction with, their friendships and peer interactions</td><td>Semi-structured interviews with all participants Mixed methods study</td><td>TA (<xref ref-type="bibr" rid="bibr13">Braun and Clarke, 2006</xref>)</td><td>M<xref ref-type="table-fn" rid="table-fn3">a</xref></td></tr><tr><td><xref ref-type="bibr" rid="bibr21">Carrington and Graham (2001)</xref></td><td>Queensland, Australia</td><td>2</td><td>13</td><td>2M</td><td>AS</td><td>Mothers (n = 2)</td><td>1 participant in 1st year of high school, the other in last year of a catholic primary school; both regular/mainstream schools</td><td>To investigate the perceptions of school and challenges faced by students with AS and their mothers</td><td>Semi-structured interviews with all participants</td><td>Constant comparative method – GT (<xref ref-type="bibr" rid="bibr39">Glaser and Strauss, 1967</xref>)</td><td>L</td></tr><tr><td><xref ref-type="bibr" rid="bibr22">Carrington et al. (2003)</xref></td><td>Australia</td><td>5</td><td>14–18</td><td>4M, 1F</td><td>AS</td><td>No</td><td>Mainstream secondary school with a special education centre, from which Ps received differing levels of support</td><td>To investigate the perception of friendships by students with AS</td><td>Semi-structured interviews</td><td>Constant comparative method – GT (<xref ref-type="bibr" rid="bibr39">Glaser and Strauss, 1967</xref>)</td><td>L</td></tr><tr><td><xref ref-type="bibr" rid="bibr25">Connor (2000)</xref></td><td>UK</td><td>16</td><td>11–16</td><td>15M, 1F</td><td>AS</td><td>SENCOs (n = 9)</td><td>Mainstream secondary comprehensive school, years 7–11</td><td>To investigate the opinions and experiences of young people with AS attending local comprehensive schools</td><td>Structured interviews and discussions</td><td>Analytic procedure not reported; appears to be a Qualitative Content Analysis</td><td>L</td></tr><tr><td><xref ref-type="bibr" rid="bibr28">Daniel and Billingsley (2010)</xref></td><td>Virginia, USA</td><td>7</td><td>10–14</td><td>7M</td><td>AS (n = 5) HFA (n = 2) Diagnosis confirmed by psychologists</td><td>Parents (n = 10) and teachers (n = 7)</td><td>Children included in mainstream secondary classroom with special educational support</td><td>To investigate the perspectives youth with ASD have of establishing and maintaining peer friendships</td><td>3 or 4 semi-structured interviews with young people Parents and teachers interviewed for supportive information</td><td>States IPA, but analytic procedure reported appears closer to a GT approach</td><td>M</td></tr><tr><td><xref ref-type="bibr" rid="bibr44">Hay and Winn (2005)</xref></td><td>Queensland, Australia</td><td>9</td><td>13.5–15.5</td><td>7M, 2F</td><td>AS Independent diagnosis made by qualified medical doctors using DSM-IV (2000)</td><td>Teachers (n = 89), special education teachers (n = 7), and parents (n = 7)</td><td>Co-educational secondary school with a Special Education Unit for students on the autism spectrum or learning difficulties</td><td>To investigate the educational issues associated with secondary students with AS, from the perspectives of general teachers, SEN teachers, students with AS, and their parents</td><td>Focus groups and interviews</td><td>TA (<xref ref-type="bibr" rid="bibr73">Miles and Huberman, 1994</xref>)</td><td>L</td></tr><tr><td><xref ref-type="bibr" rid="bibr45">Healy et al. (2013)</xref></td><td>Limerick, Republic of Ireland</td><td>12</td><td>9–13</td><td>11M, 1F</td><td>ASD Formal diagnosis using DSM-IV (2000)</td><td>No</td><td>Mainstream primary school</td><td>To gain an insight into the experiences of students with autism in PE</td><td>Semi-structured interviews</td><td>TA (<xref ref-type="bibr" rid="bibr13">Braun and Clarke, 2006</xref>)</td><td>M</td></tr><tr><td><xref ref-type="bibr" rid="bibr46">Hebron and Humphrey (2014)</xref></td><td>North Wales and North West England, UK</td><td>5</td><td>11–17</td><td>4M, 1F</td><td>AS</td><td>Not for qualitative component of study</td><td>Mainstream secondary schools</td><td>To identify influences on, and responses to, mental health difficulties of adolescents with AS from their perspective</td><td>Semi-structured interviews Mixed methods study</td><td>Combination of IPA (<xref ref-type="bibr" rid="bibr106">Smith and Osborn, 2008</xref>) and TA (<xref ref-type="bibr" rid="bibr13">Braun and Clarke, 2006</xref>)</td><td>M<xref ref-type="table-fn" rid="table-fn3">a</xref></td></tr><tr><td><xref ref-type="bibr" rid="bibr48">Hill (2014)</xref></td><td>South of England, UK</td><td>6</td><td>Not given</td><td>Not given</td><td>ASD</td><td>No</td><td>Mainstream secondary school</td><td>To explore the mainstream experiences of young people with ASD</td><td>Photo elicitation discussions. Informal interviews based around photos taken by pupils of places important to them in school.</td><td>IPA (<xref ref-type="bibr" rid="bibr107">Smith et al. 2009</xref>)</td><td>M</td></tr><tr><td><xref ref-type="bibr" rid="bibr53">Humphrey and Lewis (2008)</xref></td><td>North West England, UK</td><td>20</td><td>11–17</td><td>Not reported</td><td>AS or HFA (terms used inter-changeably)</td><td>No</td><td>4 mainstream secondary schools</td><td>To explore (1) views of pupils with AS about mainstream education and (2) their everyday experiences in school</td><td>Semi-structured interviews, diaries and pupil drawings</td><td>IPA (<xref ref-type="bibr" rid="bibr105">Smith and Osborn, 2003</xref>)</td><td>H</td></tr><tr><td>Humphrey and Symes (2010b)</td><td>North West England, UK</td><td>36</td><td>11–16</td><td>32M, 4F</td><td>ASD 17 rated using GARS supporting diagnosis as very likely or possible for 13/17 pupils</td><td>No</td><td>12 mainstream secondary schools</td><td>To identify (1) the role social support plays in defining pupils' responses to bullying and (2) barriers to the development and utilisation of social support when bullying occurs</td><td>Semi-structured interviews</td><td>TA (<xref ref-type="bibr" rid="bibr13">Braun and Clarke, 2006</xref>)</td><td>M</td></tr><tr><td><xref ref-type="bibr" rid="bibr70">McLaughlin and Rafferty (2014)</xref></td><td>UK</td><td>6</td><td>14–18</td><td>5M, 1F</td><td>AS</td><td>No</td><td>2 mainstream secondary schools</td><td>To investigate 'what life was like' for mainstream adolescents with AS</td><td>Semi-structured interviews</td><td>TA (<xref ref-type="bibr" rid="bibr13">Braun and Clarke, 2006</xref>)</td><td>M</td></tr><tr><td><xref ref-type="bibr" rid="bibr75">Molloy and Vasil (2004)</xref></td><td>Singapore and UK</td><td>6</td><td>12–18</td><td>4M, 2F</td><td>AS</td><td>Parents (n = 9)</td><td>Mainstream international school (n = 1), SEN class in mainstream international school (n = 1), local college (n = 1), special school for girls at risk in mainstream (n = 1), mainstream school with special unit (n = 1), private secondary school (n = 1)</td><td>To explore AS, adolescence and identity through the collaborative generation of life stories</td><td>Semi-structured interviews Also examined reports, letters and records</td><td>Narrative analysis No specific details given of particular NA approach used</td><td>L</td></tr><tr><td><xref ref-type="bibr" rid="bibr94">Saggers et al (2011)</xref></td><td>Brisbane, Australia</td><td>9</td><td>13–16</td><td>7M, 2F</td><td>ASD diagnosed by medical professionals</td><td>No</td><td>Mainstream secondary school with extensive special education support programme</td><td>To investigate the lived experience of inclusive education for students with ASD</td><td>Semi-structured interviews</td><td>Constant comparative method – GT (<xref ref-type="bibr" rid="bibr38">Glaser, 1992</xref>)</td><td>L</td></tr><tr><td><xref ref-type="bibr" rid="bibr85">Penney (2013)</xref></td><td>Province of Newfoundland and Labrador, Canada</td><td>4</td><td>16–21</td><td>3M, 1F</td><td>ASD with co-occurring mental health disorder</td><td>Mothers (not mothers of participants; n = 9)</td><td>Mainstream secondary school</td><td>To explore the experiences of young people with ASD and a co-occurring mental health disorder in relation to issues associated with home and school</td><td>Face-to-face unstructured interview (n = 2); online unstructured interview (n = 3)</td><td>Cites <xref ref-type="bibr" rid="bibr103">Smith (2004)</xref> and IPA, but reported process appears closer to TA</td><td>L</td></tr><tr><td><xref ref-type="bibr" rid="bibr116">Tobias (2009)</xref></td><td>UK</td><td>10</td><td>14–16</td><td>Not reported</td><td>ASD</td><td>Parents (n = 5)</td><td>Mainstream secondary school with a special support centre for students with SEN</td><td>To examine the attitudes of students and their parents towards the support received at secondary school</td><td>Focus groups</td><td>IPA (<xref ref-type="bibr" rid="bibr104">Smith et al., 1997</xref>)</td><td>L</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 M: male; AS: autism spectrum; F: female; ASD: autism spectrum disorder; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders (4th ed.); GT: Grounded theory; Ps: Participants; MZA: Monozygotic (identical) twins; SENCO: Special Educational Needs Co-ordinator; HFA: High functioning autism; IPA: Interpretative Phenomenological Analysis; SEN: Special Educational Needs; TA: Thematic Analysis; PE: Physical Education; GARS: Gilliam Autism Rating Scale; NA: Narrative Analysis.</item> <item>3 Mixed-design studies, meaning relatively limited space was available to present the qualitative findings. The rating for methodological rigour relates to the qualitative component only.</item> </ulist> <hd id="AN0133743172-13">Critical appraisal of included studies</hd> <p>Included studies were critically evaluated using 17 criteria2 [<reflink idref="bib2" id="ref76">2</reflink>] adapted from [<reflink idref="bib109" id="ref77">109</reflink>] quality framework (QF) for assessing qualitative research. These criteria, which have been widely applied in other metasyntheses (e.g. [<reflink idref="bib4" id="ref78">4</reflink>]; [<reflink idref="bib37" id="ref79">37</reflink>]; [<reflink idref="bib68" id="ref80">68</reflink>], [<reflink idref="bib69" id="ref81">69</reflink>]), related to the study's findings, aspects of methodology (design, objectives, sampling, data collection), analysis and reporting and research conduct (reflexivity, ethics, auditability). Each article (or qualitative part in mixed methods studies) was appraised independently by the first two authors, both of whom are experienced qualitative researchers, and then rated as high (H), medium (M) or low (L) in quality using the assessment guidelines developed by [<reflink idref="bib69" id="ref82">69</reflink>]. High-quality studies had good description, rich (nuanced and contextualised) analytic detail and an explanatory framework. Medium quality studies provided good descriptive detail and an adequate analysis, but weaker explanatory or theoretical frameworks for the findings. Low-quality studies presented weak description and evidence, and/or had a major methodological flaw. Following independent evaluation, the reviewers compared quality ratings and resolved differences. Initial agreement, prior to discussion, was relatively high (13/17; 76%). Disagreements were quickly settled (see Table 2 for quality ratings).</p> <hd id="AN0133743172-14">High rated studies</hd> <p>Studies rated as high quality (n = 2) contextualised their research within an existing body of relevant empirical and theoretical knowledge and clearly specified the epistemological and theoretical perspectives that shaped data collection and analysis. They described methods clearly and provided a convincing argument for all design features. The analytic process was well explained and sufficient concrete examples of the original data were presented to both illustrate the analytic procedure(s) used and provide evidence that the findings were well grounded. The data were appropriately (neither under- nor over-) analysed, with nuances and complexities clearly portrayed and diversity considered and explained. High-quality papers made effective use of contextual details about individual pupils to facilitate within- and cross-case analysis. Findings were set in the context of relevant extant theory and research and ideas deriving from them (e.g. concepts, themes) were well defined, fully developed, and clearly linked together, resulting in a coherent new analytic framework for understanding the experiences of pupils with ASD in school settings.</p> <hd id="AN0133743172-15">Medium rated studies</hd> <p>Studies rated as medium quality (n = 7) typically had two or three shortcomings relating to the methodological approach, analytic process or reporting. Some provided limited background information about participants, recruitment or educational settings. While descriptions and interpretations of data were detailed and well grounded in the textual extracts presented, there was no (or limited) interpretative use of concepts/themes to re-frame the experiences of pupils with ASD reported. All but one lacked evidence of reflexivity, representing the analysis as a passive rather than active process ([<reflink idref="bib111" id="ref83">111</reflink>]). Most medium rated studies did not comprehensively set their research and/or findings in the context of an existing body of relevant empirical and theoretical knowledge.</p> <hd id="AN0133743172-16">Low rated studies</hd> <p>Studies rated low in quality (n = 8) all had one or more major methodological flaws in the study design and/or in the ways in which the data were analysed and presented. In some low-rated multi-perspective papers, there was a lack of coherence between the stated research question(s)/aim(s) and the methods of investigation and analysis undertaken. While they aimed to give voice to the personal perspectives of pupils with ASD in educational settings, other viewpoints (e.g. parents and/or teachers) overshadowed students' accounts. Several low-ranked studies either failed to name a specific analytic procedure, or the findings appeared incongruent with the analytic procedure specified. The findings presented also appeared to be under-analysed, failing to fully explore complexities in the data, diversity or negative cases.</p> <p>Studies rated low in quality were not automatically excluded from the metasynthesis, following recognition by qualitative researchers that methodologically flawed papers can still provide potentially valuable evidence ([<reflink idref="bib84" id="ref84">84</reflink>]; [<reflink idref="bib95" id="ref85">95</reflink>]; [<reflink idref="bib113" id="ref86">113</reflink>]). For example, the fact that an analytic procedure is described as grounded theory but appears more consistent with thematic analysis does not necessarily undermine the credibility of the findings presented, so long as sufficient detail relating to those findings is presented to enable the reader to still discern what was done ([<reflink idref="bib95" id="ref87">95</reflink>]). Three low-ranked studies ([<reflink idref="bib25" id="ref88">25</reflink>]; [<reflink idref="bib75" id="ref89">75</reflink>]; [<reflink idref="bib116" id="ref90">116</reflink>]), however, had to be excluded, as failure to include sufficient extracts from the textual data meant that the presentation of the findings lacked transparency.</p> <hd id="AN0133743172-17">Qualitative metasummary</hd> <p>Metasummary integrates the manifest content of qualitative findings of summaries or surveys of data organised into topics or themes, as opposed to interpretative syntheses represented by integrating concepts, models or metaphors ([<reflink idref="bib95" id="ref91">95</reflink>]; [<reflink idref="bib114" id="ref92">114</reflink>]). It can be used as an end in itself, or (as we are doing here) to provide an empirical foundation for a qualitative metasynthesis. The metasummary process involves (<reflink idref="bib1" id="ref93">1</reflink>) extracting relevant statements of findings from included studies, then (<reflink idref="bib2" id="ref94">2</reflink>) consolidating these statements into a smaller set of abstracted findings.</p> <hd id="AN0133743172-18">Extraction</hd> <p>A working definition of findings of relevance was established to guide data extraction: 'any findings relating to the experiences of young people with ASD in school settings and/or about anything related to their educational provision which they themselves report'. The findings from each paper were extracted independently by the first and third authors from other elements of each report, including original data (e.g. quotations), data and findings not consistent with the above working definition, findings from other studies and/or theories referred to by researchers, accounts of the analytic procedures used and researchers' discussions about the theoretical or applied significance of their findings. To be extracted, findings had to be clearly supported by evidence, for example, from participant quotations or summary tables of specific topics showing frequency of mention by pupils. Any disagreements between researchers were discussed and resolved. In this way, 479 findings were extracted and edited into complete sentences understandable to a new reader while keeping close to the original words used by the researchers of the included papers and preserving any relevant contextual information (e.g. age and gender). Next, the 479 findings were further consolidated by grouping them based on subject matter to determine whether the findings within each cluster might be similar to, extend or even contradict each other.</p> <hd id="AN0133743172-19">Abstraction</hd> <p>The statements produced were further reduced by moving back and forth between them and any developing statements of abstracted findings until a smaller set of 83 statements was arrived at which captured precisely and comprehensively the content of all the findings extracted and preserved the context in which they occurred. These were finally organised into six main sections (see Table 3) as a function of the originating study. A frequency effect size was calculated for each statement by dividing the number of articles containing that finding by the total number of articles (n = 14). Only findings with effects greater than 20% (included in three or more papers) are presented in Table 3 (n = 45). Frequency is relevant as an indicator of having sufficient data to interpret rather than as a measure of salience or representativeness.</p> <p>Graph</p> <p>Metasummary finding statements with frequency effect greater than 20%, as a function of the study in which they were found.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Metasummary finding statements</th><th align="left">Effect size</th><th align="left"><xref ref-type="bibr" rid="bibr9">Baines (2012)</xref></th><th align="left">Calder et al (2012)</th><th align="left"><xref ref-type="bibr" rid="bibr21">Carrington & Graham (2001)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr22">Carrington et al (2003)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr28">Daniel and Billingsley (2010)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr44">Hay & Winn (2005)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr45">Healy et al. (2013)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr46">Hebron & Humphrey (2014)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr48">Hill (2014)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr53">Humphrey & Lewis (2008)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr54">Humphrey & Symes (2010)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr70">McLaughlin & Rafferty (2014)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr85">Penney (2013)</xref></th><th align="left"><xref ref-type="bibr" rid="bibr94">Saggers (2011)</xref></th></tr></thead><tbody><tr><td>Making sense of self as different</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Pupils report a clear sense of feeling different from other people.</td><td>0.43</td><td /><td /><td>•</td><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /><td>•</td><td>•</td><td /></tr><tr><td>Pupils express a desire to be treated like the rest of their peers.</td><td>0.36</td><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /><td>•</td><td /><td>•</td></tr><tr><td>For pupils who talk about AS in negative terms, the notion of 'being different' or 'not normal' appears to underlie their comments.</td><td>0.21</td><td>•</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td /><td>•</td><td /><td /></tr><tr><td>Although students are supportive of the teaching staff, most do not wish to be 'identified' as needing help and thereby seen as different by their peers.</td><td>0.29</td><td /><td /><td /><td /><td /><td>•</td><td /><td /><td /><td>•</td><td /><td>•</td><td /><td>•</td></tr><tr><td>Some pupils report not wanting to be 'different' from their peers, but not being sure how to fit in.</td><td>0.29</td><td /><td /><td>•</td><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td>•</td><td /><td /></tr><tr><td>The perception that peers will think negatively of those who are different appears to underpin pupils' attempts to fit in.</td><td>0.21</td><td>•</td><td /><td>•</td><td /><td /><td /><td /><td /><td /><td>•</td><td /><td /><td /><td /></tr><tr><td>Some pupils choose not to disclose their diagnosis for fear of being treated or viewed differently from peers</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /><td /></tr><tr><td>A subset of pupils have grown to accept and even celebrate their differences.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td>•</td><td /><td>•</td><td /><td>•</td><td /><td /></tr><tr><td>In some cases pupils' understanding of themselves as being 'different' centres on comparisons to, or reactions from, the rest of their peers.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td>•</td><td /><td /><td>•</td><td /><td>•</td><td /><td /></tr><tr><td>Some pupils make positive social comparisons between themselves and their peers, for example describing themselves as being more intelligent than other students or less 'disabled' than those with more severe ASDs.</td><td>0.21</td><td>•</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td /><td>•</td><td /><td /></tr><tr><td>Some pupils feel forced to adapt themselves in order to fit in and in so doing compromise their identities.</td><td>0.21</td><td>•</td><td /><td /><td>•</td><td /><td /><td /><td /><td /><td>•</td><td /><td /><td /><td /></tr><tr><td>Perceived impact and understanding of ASD</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Some pupils explicitly state their AS/autism causes them to have difficulties fitting in with their peer group.</td><td>0.36</td><td /><td /><td>•</td><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /><td /></tr><tr><td>Some pupils talk about themselves and their AS in negative terms, for example describing themselves as 'a freak', or as 'having a bad brain'.</td><td>0.21</td><td>•</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td /><td>•</td><td /><td /></tr><tr><td>Some pupils conceive of their AS or autism as having a negative impact on their lives, for example taking away things they would otherwise have had (such as friends), or resulting in them not having 'any kind of life'.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /></tr><tr><td>Some pupils experience a positive change in their behaviour, attitude, or view of their 'condition', which has led them to act differently on the social world now compared to the past, whilst others view ASD as permanent and unchangeable.</td><td>0.21</td><td>•</td><td /><td>•</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td /><td /></tr><tr><td>Teasing and bullying</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Experiences relating to teasing and bullying</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Pupils report being teased, bullied and made fun of at school by peers.</td><td>0.71</td><td /><td /><td /><td>•</td><td /><td>•</td><td>•</td><td>•</td><td>•</td><td>•</td><td>•</td><td>•</td><td>•</td><td>•</td></tr><tr><td>Pupils with AS report being targets of physical violence and intimidation</td><td>0.29</td><td /><td /><td /><td /><td /><td /><td>•</td><td /><td /><td>•</td><td /><td>•</td><td>•</td><td /></tr><tr><td>Pupils describe being verbally abused by classmates, including name-calling (e.g. 'freak', 'fat slob') and taunting about their special interests or things they find difficult to do (e.g. catch a ball).</td><td>0.36</td><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td>•</td><td /><td>•</td><td>•</td><td /></tr><tr><td>Some pupils report that the bullying and teasing they experience is persistent</td><td>0.36</td><td /><td /><td /><td>•</td><td /><td /><td /><td>•</td><td /><td>•</td><td /><td>•</td><td>•</td><td /></tr><tr><td>Coping with teasing and bullying</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Pupils use a variety of strategies to cope with bullying: seeking help from school staff; enlisting support from a school friend, sibling or other family member; ignoring/avoiding the bullies and; resorting to violence.</td><td>0.21</td><td /><td /><td /><td /><td /><td>•</td><td /><td /><td /><td /><td>•</td><td /><td>•</td><td /></tr><tr><td>Friends were perceived by some pupils as a significant form of social support, e.g. making them feel less anxious, or happier, when their friends were in school.</td><td>0.21</td><td /><td /><td /><td>•</td><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td /><td /></tr><tr><td>Perceived impact of teasing and bullying</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Experiences of being teased and bullied by classmates resulted in some pupils not trusting their peers. This, in turn, led to reluctance in seeking out future friendships or disclosing their diagnosis.</td><td>0.29</td><td /><td /><td /><td /><td>•</td><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /><td /><td /></tr><tr><td>Teasing and bullying sometimes resulted in pupils' experiencing one or more of the following: emotional distress, depression or anxiety.</td><td>0.21</td><td /><td /><td>•</td><td /><td /><td /><td /><td /><td /><td>•</td><td /><td /><td>•</td><td /></tr><tr><td>Peer relationships</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Positive and negative aspects of friendship</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Most, but not all, pupils said making friends is the most difficult aspect of friendship.</td><td>0.21</td><td /><td /><td>•</td><td /><td>•</td><td /><td /><td /><td /><td /><td>•</td><td /><td /><td /></tr><tr><td>Most, but not all, pupils report that they have peers in school who they regard as friends.</td><td>0.21</td><td /><td>•</td><td /><td /><td>•</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td></tr><tr><td>Pupils report that sharing interests and/or participating in common activities is part of friendship.</td><td>0.36</td><td /><td /><td /><td>•</td><td>•</td><td /><td /><td>•</td><td /><td /><td /><td>•</td><td /><td>•</td></tr><tr><td>For some pupils there is a stronger discourse of peer difficulties than of friendships.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td></tr><tr><td>For a few pupils, friends were perceived as a significant form of social support.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td>•</td><td /></tr><tr><td>Some pupils report a strong desire for more friends.</td><td>0.21</td><td /><td>•</td><td /><td /><td /><td /><td /><td /><td>•</td><td /><td /><td>•</td><td /><td /></tr><tr><td>Pupils are acutely aware of their difficulties interpreting social situations.</td><td>0.21</td><td /><td /><td>•</td><td /><td /><td /><td /><td>•</td><td /><td /><td /><td /><td>•</td><td /></tr><tr><td>In a subset of pupils a desire for solitude is evident.</td><td>0.36</td><td /><td>•</td><td /><td /><td /><td /><td /><td>•</td><td /><td /><td>•</td><td>•</td><td /><td>•</td></tr><tr><td>ASD and the school environment</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>The school environment itself is a considerable source of anxiety for some young people.</td><td>0.29</td><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /><td /><td>•</td><td /></tr><tr><td>Anxiety was experienced by pupils in less predictable, unstructured social situations.</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td /><td /><td /><td /></tr><tr><td>Some pupils report a heightened sensitivity to noise and/or crowds.</td><td>0.36</td><td /><td /><td /><td /><td /><td>•</td><td /><td>•</td><td /><td>•</td><td /><td /><td>•</td><td>•</td></tr><tr><td>Some pupils report that they avoid places where peers tend to congregate outside of lessons, due to noise and crowding, seeking sanctuary in quiet and unpopulated places, such as libraries and support base.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td /><td /><td>•</td></tr><tr><td>Pupils had particular areas in school in which they experienced anxiety or stress, including corridors, entrances and exits, the canteen and the playground.</td><td>0.29</td><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td>•</td><td /><td /><td>•</td><td /></tr><tr><td>Some students perceive their sensory issues as impeding learning in school, making it difficult to concentrate and work in groups.</td><td>0.29</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td /><td>•</td><td>•</td></tr><tr><td>A few pupils describe their fear or fascination with a particular object at school can impair concentration and/or limit full participation in school.</td><td>0.21</td><td /><td /><td>•</td><td /><td /><td /><td>•</td><td /><td>•</td><td /><td /><td /><td /><td /></tr><tr><td>Some pupils describe independently making adaptations to help them avoid aspects of the school environment they find difficult, such as deliberately avoiding crowding by using different entrances and exits to those used by peers at the start and end of the day.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td /><td /><td /><td>•</td><td>•</td></tr><tr><td>Schools helped pupils devise strategies to help overcome difficulties experienced in relation to the environment and particular characteristic associated with ASD, e.g. hypersensitivity to noise and crowd and a need for order and predictability.</td><td>0.29</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td /><td>•</td><td>•</td></tr><tr><td>Perceptions of teaching staff</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td>Students found support from teaching staff for managing personal matters and academic work beneficial.</td><td>0.29</td><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td>•</td><td /><td>•</td></tr><tr><td>Teachers had the potential to make pupils feel good (and bad) about themselves.</td><td>0.21</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>•</td><td>•</td><td /><td>•</td><td /></tr></tbody></table> </ephtml> </p> <hd id="AN0133743172-20">Qualitative metasynthesis</hd> <p>In the final stage of the analysis, the first two authors performed a metasynthesis to interpret the findings obtained from the metasummary, with the aim of developing a coherent description/explanation of the phenomenon under investigation. Following [<reflink idref="bib95" id="ref95">95</reflink>] guidelines, a process of constant targeted comparison was used to facilitate interpretation and provide a proposed model (Figure 2) for the key processes relating to how pupils with ASD make sense of themselves in the context of their experiences at school. Constant targeted comparison involves a deliberate search for similarities and differences between the abstracted findings and external phenomena regarded as having a resemblance to identify overlapping attributes, thereby minimising the possibility of over-emphasising the uniqueness of the target phenomenon. Here, findings were compared with how (<reflink idref="bib1" id="ref96">1</reflink>) TD young people of school age, (<reflink idref="bib2" id="ref97">2</reflink>) people with disability generally and (<reflink idref="bib3" id="ref98">3</reflink>) young people who experience disrupted peer relationships for reasons other than ASD made sense of themselves.</p> <p>A model of the experiences and sense-making processes about self which inform how pupils with ASD come to understand themselves in a mainstream setting as being 'different'.</p> <p>Graph</p> <hd id="AN0133743172-21">Results</hd> <p>Analysis of the synthesised findings suggests that three, intermeshing, areas of day-to-day experience in mainstream settings contribute to many pupils with ASD making sense of themselves as being 'different' from TD peers: difficulties associated with ASD; interpersonal relationships, mainly with peers but also school staff; and accessibility of the school environment. In turn, transactional relationships between the intermeshing experiences and individual sense-making processes about the self as compared to peers appear to inform whether pupils with ASD construe this difference as primarily negative, which most do, or positive (see Figure 2). This is not presented as a complete model of all factors involved in shaping how students with ASD make sense of themselves in the context of their school experiences, only those able to be identified in our analysis. Other factors, such as parents ([<reflink idref="bib120" id="ref99">120</reflink>]) and educational setting, are likely to play a key role but have not yet been explored in qualitative research in this area, so cannot be included in our model. Findings from the metasynthesis are presented in detail below, beginning with a discussion of the central finding that many pupils with ASD appear to understand and position themselves as being 'different' from their peers. Next follows a consideration of each of the three aspects of day-to-day experience identified as contributing to this, with particular regard to the interplay between these and the individual sense-making of pupils with ASD about themselves in relation to their peers.</p> <hd id="AN0133743172-22">Making sense of self as 'different'</hd> <p>Developmental research indicates that from early to middle childhood, young people's need to fit in with their peers and avoid rejection increases ([<reflink idref="bib93" id="ref100">93</reflink>]). Analysis of the findings statements indicates that many pupils with ASD share this desire, but report not being able, or not knowing how, to fit in ([<reflink idref="bib21" id="ref101">21</reflink>]; [<reflink idref="bib48" id="ref102">48</reflink>]; [<reflink idref="bib53" id="ref103">53</reflink>]; [<reflink idref="bib70" id="ref104">70</reflink>]). Most describe themselves as being 'different' from classmates in a negative way ([<reflink idref="bib21" id="ref105">21</reflink>]; [<reflink idref="bib46" id="ref106">46</reflink>]; [<reflink idref="bib48" id="ref107">48</reflink>]; [<reflink idref="bib53" id="ref108">53</reflink>]; [<reflink idref="bib70" id="ref109">70</reflink>]; [<reflink idref="bib85" id="ref110">85</reflink>]), construing themselves as falling short in some way or not 'being normal' ([<reflink idref="bib9" id="ref111">9</reflink>]; [<reflink idref="bib53" id="ref112">53</reflink>]; [<reflink idref="bib70" id="ref113">70</reflink>]). This is illustrated by their use of the following terms to describe themselves: 'weirdo'/'weird' ([<reflink idref="bib22" id="ref114">22</reflink>]), 'different from normal people' ([<reflink idref="bib70" id="ref115">70</reflink>]), 'retard' ([<reflink idref="bib9" id="ref116">9</reflink>]; [<reflink idref="bib53" id="ref117">53</reflink>]), 'freak', 'mentally disabled' or '[having] a bad brain' ([<reflink idref="bib53" id="ref118">53</reflink>]). These likely reflect, at least in part, an internalisation of the negative responses of peers towards them, as they resonate with vocabulary associated with reports of teasing/bullying ([<reflink idref="bib46" id="ref119">46</reflink>]; [<reflink idref="bib53" id="ref120">53</reflink>]; [<reflink idref="bib70" id="ref121">70</reflink>]; [<reflink idref="bib85" id="ref122">85</reflink>]). However, not all pupils view themselves or ASD in this way. A few interpret their perceived difference and ASD more positively, accepting it either as something to celebrate, an essential 'part of who I am' ([<reflink idref="bib46" id="ref123">46</reflink>]; [<reflink idref="bib53" id="ref124">53</reflink>]) or as simply unproblematic ([<reflink idref="bib53" id="ref125">53</reflink>]; [<reflink idref="bib70" id="ref126">70</reflink>]).</p> <hd id="AN0133743172-23">Passing as 'normal'</hd> <p>Some pupils with ASD attempt to negotiate their sense of difference by observing and copying the behaviour, ideas and interests of TD peers to blend in and be accepted, resulting in considerable stress and anxiety ([<reflink idref="bib9" id="ref127">9</reflink>]; [<reflink idref="bib22" id="ref128">22</reflink>]; [<reflink idref="bib53" id="ref129">53</reflink>]; [<reflink idref="bib70" id="ref130">70</reflink>]). In their efforts to access a mainstream identity, some students seek to hide/suppress visible behaviours or aspects of their lives they associate with ASD (such as hand-flapping or having no friends), fearing these will mark them out as 'disabled' or 'different', leading others to view them negatively ([<reflink idref="bib9" id="ref131">9</reflink>]; [<reflink idref="bib22" id="ref132">22</reflink>]; [<reflink idref="bib53" id="ref133">53</reflink>]). This behaviour is termed 'passing as normal' in the wider disability literature where it refers to concealing social markers of impairment to avoid the stigma of disability, often with considerable psychological and emotional cost ([<reflink idref="bib15" id="ref134">15</reflink>]). Several authors in the included papers comment that masking 'deficits' forces some pupils to compromise their identities by focussing on others' views rather than their own ([<reflink idref="bib9" id="ref135">9</reflink>]; [<reflink idref="bib22" id="ref136">22</reflink>]; [<reflink idref="bib53" id="ref137">53</reflink>]). Evidence of hiding perceived 'impairments' is consistent with the decision made by many pupils not to disclose their diagnosis to avoid discrimination by peers and teaching staff ([<reflink idref="bib53" id="ref138">53</reflink>]; [<reflink idref="bib70" id="ref139">70</reflink>]).</p> <hd id="AN0133743172-24">Making social comparisons</hd> <p>Finding statements from several studies indicate that pupils with ASD engage in social comparisons with peers that inform their self-evaluations ([<reflink idref="bib9" id="ref140">9</reflink>]; [<reflink idref="bib45" id="ref141">45</reflink>]; [<reflink idref="bib53" id="ref142">53</reflink>]; [<reflink idref="bib70" id="ref143">70</reflink>]; [<reflink idref="bib85" id="ref144">85</reflink>]). These mostly revolve around the concept of normality and seem to contribute to an awareness of being 'different', rather than enhancing self-esteem as is usually the case in typical development ([<reflink idref="bib32" id="ref145">32</reflink>]; [<reflink idref="bib78" id="ref146">78</reflink>]). In particular, upward social comparisons ([<reflink idref="bib35" id="ref147">35</reflink>]) highlight things they do less well than peers, accentuating the impact of limitations associated with aspects of ASD rather than fostering improvement. Though less predominant, some pupils made positive (downward) social comparisons, particularly between themselves and young people perceived to have more severe ASD, considering themselves closer to 'normal' compared to these students ([<reflink idref="bib70" id="ref148">70</reflink>]) and peers with more visible disabilities ([<reflink idref="bib9" id="ref149">9</reflink>]). Others describe themselves as being better than their peers in relation to particular abilities ([<reflink idref="bib9" id="ref150">9</reflink>]; [<reflink idref="bib53" id="ref151">53</reflink>]; [<reflink idref="bib85" id="ref152">85</reflink>]).</p> <hd id="AN0133743172-25">Difficulties associated with ASD</hd> <p>Difficulties experienced as a result of ASD, which most commonly arise in the context of interactions with peers and specific sensory aspects of the school environment (see Table 3), appear to contribute to students' reported feelings of being 'different' from peers in a negative sense. However, their perceived impact seems to depend not only on the nature of the experience itself and any contextual factors but also on the specific way a student interprets it in terms of how it positions them relative to peers. Several studies highlight pupils' perceptions of being disadvantaged compared to TD peers by having these problems, which some pupils explicitly link to their diagnosis. ASD in this context is construed negatively, as limiting them in specific ways, taking something away that they otherwise would have had (such as friends), being a barrier to getting on with other people, causing others not to 'respect' them, making them stand out from peers as odd ([<reflink idref="bib9" id="ref153">9</reflink>]; [<reflink idref="bib22" id="ref154">22</reflink>]; [<reflink idref="bib53" id="ref155">53</reflink>]) or as distancing them from their peer group by taking them down an alternative 'pathway' ([<reflink idref="bib9" id="ref156">9</reflink>]; [<reflink idref="bib53" id="ref157">53</reflink>]; [<reflink idref="bib54" id="ref158">54</reflink>]; [<reflink idref="bib70" id="ref159">70</reflink>]; [<reflink idref="bib85" id="ref160">85</reflink>]). Analysis also indicates that the perceived impact of problems linked to ASD may be intensified by specific beliefs about them, such as that they are permanent and unalterable ([<reflink idref="bib70" id="ref161">70</reflink>]).</p> <p>Evidence that some pupils experience difficulties arising from ASD as having a restrictive effect on their lives supports [<reflink idref="bib100" id="ref162">100</reflink>] contention that, contrary to the strong social model of disability ([<reflink idref="bib80" id="ref163">80</reflink>]), problems associated with particular conditions can play a key role in shaping the experiences and sense-making about the self of those concerned. However, this is not inevitable. A notable exception is a pupil who emphasises achievements and good friends, suggesting their self-identity resides more in what they can do and what they have, rather than in perceived limitations ([<reflink idref="bib53" id="ref164">53</reflink>]). This is consistent with research examining the accounts of people with other conditions, which demonstrates that difficulties are not always integrated into self-identity ([<reflink idref="bib101" id="ref165">101</reflink>]; [<reflink idref="bib118" id="ref166">118</reflink>]).</p> <hd id="AN0133743172-26">Interpersonal relationships</hd> <p>Finding statements relating to bullying and friendship highlight an interplay between the attitudes and reactions of peers, difficulties associated with ASD and how pupils on the spectrum construe themselves in relation to peers. Collectively, the evidence suggests that negative peer responses, as in persistent teasing and bullying, can greatly exacerbate existing difficulties and negative perceptions of difference. Conversely, positive attitudes and behaviours, as in supportive friendships, can minimise problems, engendering a positive sense of self and feelings of being accepted.</p> <hd id="AN0133743172-27">Bullying</hd> <p>Peer victimisation, including name calling, physical violence and teasing, is reported in most included papers, with a number highlighting its persistent nature ([<reflink idref="bib22" id="ref167">22</reflink>]; [<reflink idref="bib46" id="ref168">46</reflink>]; [<reflink idref="bib53" id="ref169">53</reflink>]; [<reflink idref="bib70" id="ref170">70</reflink>]; [<reflink idref="bib85" id="ref171">85</reflink>]). Some pupils believe that they are targeted due to being seen as 'different' by TD peers and/or because they are known to have ASD ([<reflink idref="bib22" id="ref172">22</reflink>]; [<reflink idref="bib46" id="ref173">46</reflink>]; [<reflink idref="bib53" id="ref174">53</reflink>]). A number describe experiencing emotional distress, depression and/or anxiety as a result of persistent bullying ([<reflink idref="bib21" id="ref175">21</reflink>]; [<reflink idref="bib53" id="ref176">53</reflink>]; [<reflink idref="bib54" id="ref177">54</reflink>]; [<reflink idref="bib85" id="ref178">85</reflink>]).</p> <p>Characteristics associated with ASD appear initially to heighten the risk of being victimised. In turn, the way students respond further increases the possibility of future bullying, resulting in a progressively worsening situation. For example, pupils with ASD describe experiencing problems in discerning peers' intentions towards them, being unable to discriminate between teasing and a friendly approach ([<reflink idref="bib48" id="ref179">48</reflink>]; [<reflink idref="bib53" id="ref180">53</reflink>]; [<reflink idref="bib85" id="ref181">85</reflink>]; [<reflink idref="bib94" id="ref182">94</reflink>]). Over time, this, together with repeated bullying, reduces their trust in peers and lessens initiation of interactions ([<reflink idref="bib28" id="ref183">28</reflink>]; [<reflink idref="bib48" id="ref184">48</reflink>]; [<reflink idref="bib54" id="ref185">54</reflink>]). This, in turn, increases social isolation which research suggests itself raises the chances of future bullying ([<reflink idref="bib97" id="ref186">97</reflink>]). Two studies describe this process ([<reflink idref="bib53" id="ref187">53</reflink>]; [<reflink idref="bib54" id="ref188">54</reflink>]), while several report enforced isolation at school because of peer rejection/exclusion ([<reflink idref="bib19" id="ref189">19</reflink>]; [<reflink idref="bib21" id="ref190">21</reflink>]; [<reflink idref="bib46" id="ref191">46</reflink>]; [<reflink idref="bib53" id="ref192">53</reflink>]; [<reflink idref="bib54" id="ref193">54</reflink>]; [<reflink idref="bib70" id="ref194">70</reflink>]; [<reflink idref="bib85" id="ref195">85</reflink>]; [<reflink idref="bib94" id="ref196">94</reflink>]). These findings are consistent with the transactional model proposed by [<reflink idref="bib83" id="ref197">83</reflink>] to explain findings from studies of children and adolescents in TD and clinical populations who experience difficult peer relationships. They outline a downward spiralling cycle of influence whereby peer rejection negatively influences how young people view themselves and others. This then leads them to behave in further maladaptive ways to other pupils, adversely influencing peers' responses towards them, so increasing the likelihood of future rejection.</p> <hd id="AN0133743172-28">Friendship and support</hd> <p>While perceived negative peer reactions can create additional barriers to engagement, the finding statements also suggest that positive attitudes and friendships can facilitate peer interaction, ameliorating some of the social problems associated with ASD. A number of included studies highlight that school friends provide an important source of support, particularly in protecting against teasing and bullying ([<reflink idref="bib22" id="ref198">22</reflink>]; [<reflink idref="bib53" id="ref199">53</reflink>]; [<reflink idref="bib54" id="ref200">54</reflink>]). In general, developmental research indicates that vulnerable children who have friends are less likely to be victimised ([<reflink idref="bib50" id="ref201">50</reflink>]). Additional benefits of support from friends cited include being less anxious at school ([<reflink idref="bib54" id="ref202">54</reflink>]), feeling positive about themselves ([<reflink idref="bib53" id="ref203">53</reflink>]) and facilitating integration in team games ([<reflink idref="bib45" id="ref204">45</reflink>]). In some instances, pupils describe the important role that friends play in counteracting their sense of being 'different' by accepting them for who they are ([<reflink idref="bib46" id="ref205">46</reflink>]; [<reflink idref="bib53" id="ref206">53</reflink>]; [<reflink idref="bib70" id="ref207">70</reflink>]). These findings are consistent with developmental research demonstrating the strong positive impact friends have on overall sense of self-worth ([<reflink idref="bib8" id="ref208">8</reflink>]).</p> <hd id="AN0133743172-29">Feedback from teaching staff</hd> <p>Feedback given by staff to students appears to impact on how they conceive of themselves and their ASD, with favourable feedback engendering positive self-evaluations and vice versa ([<reflink idref="bib53" id="ref209">53</reflink>]; [<reflink idref="bib54" id="ref210">54</reflink>]; [<reflink idref="bib85" id="ref211">85</reflink>]). Some pupils comment that staff can either accentuate or minimise their sense of difference depending on their management of teaching support. A subtle approach, such as seeming available to all students in a class rather than just to them, helps them feel they 'fit in a little better' ([<reflink idref="bib44" id="ref212">44</reflink>]; [<reflink idref="bib53" id="ref213">53</reflink>]; [<reflink idref="bib70" id="ref214">70</reflink>]; [<reflink idref="bib94" id="ref215">94</reflink>]). Conversely, ever-present support visibly accentuates difference to peers, erecting a barrier to peer interaction ([<reflink idref="bib70" id="ref216">70</reflink>]; [<reflink idref="bib94" id="ref217">94</reflink>]).</p> <hd id="AN0133743172-30">Accessibility of the school environment</hd> <p>The unusual reactions some pupils with ASD report to particular stimuli in the school environment can serve to visibly mark them out as 'different' from TD peers. Finding statements suggest a link between sensory issues, the need for order and predictability (both common characteristics of ASD) and physical aspects of the school environment. In particular, some pupils report a heightened sensitivity to noise and crowds ([<reflink idref="bib44" id="ref218">44</reflink>]; [<reflink idref="bib46" id="ref219">46</reflink>]; [<reflink idref="bib53" id="ref220">53</reflink>]; [<reflink idref="bib85" id="ref221">85</reflink>]; [<reflink idref="bib94" id="ref222">94</reflink>]), increasing their stress and anxiety ([<reflink idref="bib46" id="ref223">46</reflink>]; [<reflink idref="bib48" id="ref224">48</reflink>]; [<reflink idref="bib53" id="ref225">53</reflink>]; [<reflink idref="bib85" id="ref226">85</reflink>]). The most stressful places for them include corridors, entrances and exits; the school canteen and playgrounds, where social interactions tend to be unstructured; as well as unpredictable, and where there are lots of noise and overcrowding ([<reflink idref="bib46" id="ref227">46</reflink>]; [<reflink idref="bib48" id="ref228">48</reflink>]; [<reflink idref="bib53" id="ref229">53</reflink>]; [<reflink idref="bib85" id="ref230">85</reflink>]). This hypersensitivity and need for order can further distance pupils with ASD from peers if they avoid places where other pupils congregate informally outside of lessons, seeking sanctuary in quieter, less populated places, such as libraries or the music room ([<reflink idref="bib48" id="ref231">48</reflink>]; [<reflink idref="bib53" id="ref232">53</reflink>]; [<reflink idref="bib94" id="ref233">94</reflink>]). Some pupils describe sensory issues as impeding their learning, with noise in particular making it hard for them to concentrate and work with peers ([<reflink idref="bib48" id="ref234">48</reflink>]; [<reflink idref="bib53" id="ref235">53</reflink>]; [<reflink idref="bib85" id="ref236">85</reflink>]; [<reflink idref="bib94" id="ref237">94</reflink>]). Others note that their fear of and/or fascination with particular objects, another common feature of ASD, can make it more difficult to focus on schoolwork or fully participate in school activities ([<reflink idref="bib21" id="ref238">21</reflink>]; [<reflink idref="bib45" id="ref239">45</reflink>]; [<reflink idref="bib48" id="ref240">48</reflink>]).</p> <hd id="AN0133743172-31">Discussion</hd> <p></p> <hd id="AN0133743172-32">Overview of findings</hd> <p>The metasynthesis identifies three, intermeshing, areas of experience which appear to contribute to many pupils with ASD making sense of themselves as being 'different' from TD peers: difficulties linked to ASD, interpersonal relationships and accessibility of the school environment. In turn, how pupils construe themselves, mainly in relation to TD peers, in the context of these experiences seems to inform whether they perceive this difference as being primarily negative, as most did, or positive. The key finding that pupils with ASD often view themselves as being 'different' from TD peers suggests that inclusive mainstream settings may inadvertently accentuate, rather than minimise, difference. This raises concerns given [<reflink idref="bib47" id="ref241">47</reflink>] finding that pupils with AS who rated themselves as more dissimilar to others on the perceived group belonging dimension of the Social Comparison Scale (SCS; [<reflink idref="bib2" id="ref242">2</reflink>]) also reported more depressive symptoms. Note that these findings are not presented as evidence against the inclusion of pupils with ASD into mainstream. The lack of papers examining their experiences in alternative settings precludes consideration of the relative merits of different educational contexts. Rather, the problems identified are seen as issues which need addressing to enable these pupils to be more effectively included and to enhance their well-being in mainstream settings.</p> <hd id="AN0133743172-33">Role of interpersonal relationships</hd> <p>While findings from the metasynthesis cannot address the relative extent to which self-understanding in TD students and those with ASD is anchored in social relations ([<reflink idref="bib11" id="ref243">11</reflink>]; [<reflink idref="bib31" id="ref244">31</reflink>]; [<reflink idref="bib62" id="ref245">62</reflink>]), they suggest that how pupils with ASD make sense of themselves is shaped and modified by similar interpersonal processes to those identified in TD young people. In particular, consistent with self-reports of adults on the autism spectrum ([<reflink idref="bib6" id="ref246">6</reflink>]; [<reflink idref="bib86" id="ref247">86</reflink>]; [<reflink idref="bib89" id="ref248">89</reflink>]), self-acceptance and self-evaluation in pupils with ASD appear to be linked to their perceptions of how others view them ([<reflink idref="bib43" id="ref249">43</reflink>]; [<reflink idref="bib61" id="ref250">61</reflink>]), as well as to self-other evaluations ([<reflink idref="bib78" id="ref251">78</reflink>]). Internalisation of the negative attitudes and reactions of other people towards them, especially other students but also teaching staff, and unfavourable social comparisons with TD peers, seem to foster in many the emergence and growth of a sense of being 'different' in a negative way, including being less able, less 'normal' and more limited than TD peers, exacerbating existing difficulties in engaging with other people and lowering self-esteem. Conversely, more tolerant TD peers and supportive friendships seem to facilitate inclusion, ameliorate some of the social difficulties linked to ASD and, as in TD individuals ([<reflink idref="bib8" id="ref252">8</reflink>]), have a positive impact on overall sense of self-worth. This resonates with evidence from qualitative studies in which high-functioning adults with ASD identify others' understanding attitudes towards them as facilitating their social participation ([<reflink idref="bib40" id="ref253">40</reflink>]; [<reflink idref="bib60" id="ref254">60</reflink>]; [<reflink idref="bib77" id="ref255">77</reflink>]).</p> <p>Collectively, these findings substantiate [<reflink idref="bib29" id="ref256">29</reflink>] recommendation, based on a review of four papers exploring the school experiences of pupils with ASD in the context of student well-being, that it is essential for schools to foster a culture of acceptance for all. In particular, the findings identify TD peer attitudes and responses towards pupils with ASD as a crucial target area for interventions aimed at improving the experiences, self-appraisal and well-being of the latter in mainstream settings.</p> <hd id="AN0133743172-34">Accessibility of the school environment</hd> <p>The finding that unusual sensory perceptual responses to aspects of the physical environment, a common feature of ASD ([<reflink idref="bib10" id="ref257">10</reflink>]; [<reflink idref="bib63" id="ref258">63</reflink>]), can disrupt learning activities and socialising outside the classroom, further distancing pupils with ASD from TD peers, is consistent with previous research suggesting that unusual sensory perceptual responses can derail parents' efforts to share experiences, meanings and feelings ([<reflink idref="bib7" id="ref259">7</reflink>]). It highlights the need for schools to provide alternative opportunities for students with ASD to socialise informally with other pupils in relatively distraction-free settings, such as at small lunchtime clubs centred on areas of interest. Findings in this and previous research that atypical sensory perceptual experiences can cause great discomfort ([<reflink idref="bib55" id="ref260">55</reflink>]), as well as having negative social and academic ramifications, suggest that pupils with ASD should be encouraged to talk about them with professionals involved in their care. This would enable schools, where possible, to make adjustments to minimise impact. Students with ASD could be supported to develop coping strategies to avoid or manage potential environmental triggers so as to reduce anxiety. Analysis of firsthand web accounts by adults with declared high-functioning ASD suggests that these can be effective in reducing anxiety levels to help individuals engage more fully with the world around them ([<reflink idref="bib55" id="ref261">55</reflink>]).</p> <hd id="AN0133743172-35">The importance of individual sense-making</hd> <p>Evidence from the metasynthesis suggests that there is considerable diversity in how individual pupils with ASD make sense of themselves, their diagnosis, other people and their environment. This highlights a need to examine whether certain ways of making sense of experiences in relation to the self and others are linked to better outcomes for self-esteem, sense of self-worth and mental health than others. There is recognition within models of coping with both physical and mental health problems of the key role a person's perceptions of their experiences and understanding of their 'condition' play in adjustment and outcome ([<reflink idref="bib64" id="ref262">64</reflink>]; [<reflink idref="bib65" id="ref263">65</reflink>]). Research investigating the sense-making of pupils with ASD who appear to have successfully negotiated the mainstream environment may be particularly informative.</p> <hd id="AN0133743172-36">Methodological limitations</hd> <p></p> <hd id="AN0133743172-37">Gaps in the literature</hd> <p>The metasynthesis provides more credible and potentially transferable claims to knowledge than is possible from any single qualitative study. However, given that it is based on articles which largely represent Western cultures, secondary mainstream settings and verbally/cognitively able male pupils with ASD, the findings cannot be transferred to other populations, cultures and educational settings, highlighting gaps in the literature. More qualitative investigations involving pupils with ASD in specialist settings and schools in other cultures would enrich our understanding of how educational and cultural contexts impact school experiences and self-understanding. Evidence of significant gender differences in peer relationship processes ([<reflink idref="bib90" id="ref264">90</reflink>]), identity formation and emotional development ([<reflink idref="bib5" id="ref265">5</reflink>], [<reflink idref="bib24" id="ref266">24</reflink>]) suggests that the experiences and meaning-making of female pupils with ASD may differ from that of their male counterparts in distinct ways, identifying a need for girls to be more thoroughly investigated in their own right.</p> <p>Research indicating that marked changes in various aspects of development from childhood through to adolescence are accompanied by corresponding shifts in pupils' concerns and social needs ([<reflink idref="bib27" id="ref267">27</reflink>]; [<reflink idref="bib67" id="ref268">67</reflink>]; [<reflink idref="bib88" id="ref269">88</reflink>]) suggests there is a need for more studies involving younger (4–10 years) pupils with ASD. Qualitative longitudinal research tracking the individual pathways of pupils with ASD through their school 'journey' would inform us how later experiences build on earlier ones and how particular meaning-making processes about the self unfold over time in light of these.</p> <p>It is likely that use of semi-structured interviews as the main means of collecting data in qualitative investigations has led to an under-representation of the perspectives of younger students and those who are less verbally/cognitively able, because it is seen as a less effective method of gaining information from these populations ([<reflink idref="bib121" id="ref270">121</reflink>]). Thus, there is a need for methodological innovation aimed at developing better ways of accessing the perspectives of these students, including methods that support memory and communication such as photo-elicitation ([<reflink idref="bib58" id="ref271">58</reflink>]) and story completion tasks using images ([<reflink idref="bib79" id="ref272">79</reflink>]).</p> <hd id="AN0133743172-38">Methodological limitations of papers identified</hd> <p>While the metasummary part of the metasynthesis process enabled some findings to be extracted from most studies, critical appraisal highlighted several methodological weaknesses, particularly in papers rated as low-quality, including the provision of limited details about participants and their educational context, making it difficult to assess the range of persons and situations to which findings might be relevant; a lack of transparency in reporting analytic processes and/or findings; under-analysis of data; and a tendency to obscure the accounts of young people with ASD when multiple perspectives were considered together. The analyses of most multi-perspective papers appeared to have been shaped predominantly by researchers' interpretations of parents' reported experiences, with most themes being drawn principally or solely from parent rather than pupil data. Addressing these issues would enable qualitative studies to better contribute to our understanding of the experiences and sense-making of pupils with ASD in school settings, as well as improve the quality of future metasyntheses, strengthening the capacity of this type of analysis to inform educational policy and practice.</p> <hd id="AN0133743172-39">Conclusion</hd> <p>Findings from the metasynthesis suggest that inclusive mainstream settings may currently accentuate many pupils with ASD's sense of being 'different' from TD peers in a negative way, heightening their risk for developing low self-esteem, poor sense of self-worth and mental health problems. The nature of their engagement with peers and sense-making about themselves in relation to TD classmates appear to play a particularly powerful role in shaping self-understanding and evaluation in pupils with ASD. In addition, unusual sensory perceptual responses to the physical environment can disrupt opportunities for mutual engagement in learning activities and socialising outside the classroom, further distancing them from TD peers. Finally, we propose that attending to significant gaps in the existing corpus of papers, as well as to the methodological weaknesses identified may increase the potential of future qualitative research in the area to inform educational policy and practice.</p> <hd id="AN0133743172-40">Supplemental Material</hd> <p>AUT723836_Lay_Abstract – Supplemental material for How pupils on the autism spectrum make sense of themselves in the context of their experiences in a mainstream school setting: A qualitative metasynthesisSupplemental material, AUT723836_Lay_Abstract for How pupils on the autism spectrum make sense of themselves in the context of their experiences in a mainstream school setting: A qualitative metasynthesis by Emma I Williams, Kate Gleeson and Bridget E Jones in Autism</p> <hd id="AN0133743172-41">Acknowledgements</hd> <p>The authors would like to thank all the young people who contributed their views and experiences to the included papers. We would also like to thank the anonymous reviewers for their invaluable comments on earlier versions of this review. Finally we thank Dr Sue Jackson for her indispensable advice in conducting the metasynthesis. Access to the data and any materials relating to the metasynthesis can be obtained by contacting the first author.</p> <hd id="AN0133743172-42">Funding</hd> <p>The author(s) received no financial support for the research, authorship, and/or publication of this article.</p> <ref id="AN0133743172-43"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref52" type="bt">1</bibl> <bibtext> Two review papers have since been published ([29]; [30]) which have a related, but not identical, focus.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref58" type="bt">2</bibl> <bibtext> Only 17 of the 18 criteria defined in [109] quality framework were used, as one criterion that specifically addressed evaluation research was not applicable to the set of papers being appraised.</bibtext> </blist> </ref> <ref id="AN0133743172-44"> <title> References </title> <blist> <bibtext> Alderson P, Green S, Higgins JPT (eds) (2004). Cochrane Reviewers' Handbook 4.2.2 [updated March2004]. In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons.</bibtext> </blist> <blist> <bibtext> Allan S, Gilbert P (1995) A Social Comparison Scale: psychometric properties and relationship to psychopathology. Personality and Individual Differences19(3): 293–299.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref59" type="bt">3</bibl> <bibtext> American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref60" type="bt">4</bibl> <bibtext> Andersen MF, Nielsen KM, Brinkmann S (2012) Meta-synthesis of qualitative research on return to work among employees with common mental disorders. Scandinavian Journal of Work, Environment & Health38(2): 93–104.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref61" type="bt">5</bibl> <bibtext> Archer S (1989) Gender differences in identity development: Issues of process, domain and timing. Journal of Adolescence12(2): 117–138.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref42" type="bt">6</bibl> <bibtext> Bagatell N (2007) Orchestrating voices: autism, identity and the power of discourse. Disability and Society22(4): 413–426.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref259" type="bt">7</bibl> <bibtext> Bagby MS, Dickie VA, Baranek GT (2012) How sensory experiences of children with and without autism affect family occupations. The American Journal of Occupational Therapy66(1): 78–86.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref31" type="bt">8</bibl> <bibtext> Bagwell CL, Newcomb AF, Bukowski WM (1998) Preadolescent friendship and peer rejection as predictors of adult adjustment. Child Development69(1): 140–153.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref111" type="bt">9</bibl> <bibtext> *Baines AM (2012) Positioning, strategizing, and charming: how students with autism construct identities in relation to disability. Disability & Society27(4): 547–561.</bibtext> </blist> <blist> <bibtext> Baranek GT, Boyd BA, Poe MD, et al. (2007) Hyperresponsive sensory patterns in young children with autism, developmental delay and typical development. American Journal on Mental Retardation112(4): 233–245.</bibtext> </blist> <blist> <bibtext> Baron-Cohen S (2005) Autism – 'autos': literally, a total focus on the self? In: Feinberg TE, Keenan JP (eds) The Lost Self Pathologies of the Brain and Identity. Oxford: Oxford University Press, pp.166–180.</bibtext> </blist> <blist> <bibtext> Bölte S (2014) The power of words: is qualitative research as important as quantitative research in the study of autism?Autism18(2): 67–68.</bibtext> </blist> <blist> <bibtext> Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology3(2): 77–101.</bibtext> </blist> <blist> <bibtext> Braun V, Clarke V (2013) Successful Qualitative Research: A Practical Guide for Beginners. London: SAGE.</bibtext> </blist> <blist> <bibtext> Brune JA, Wilson DJ (eds) (2013) Disability and Passing: Blurring the Lines of Identity. Philadelphia, PA: Temple University Press.</bibtext> </blist> <blist> <bibtext> Bruner J (1990) Acts of Meaning. Cambridge, MA: Harvard University Press.</bibtext> </blist> <blist> <bibtext> Butler R (1998) Age trends in the use of social and temporal comparison for self-evaluation: examination of a novel developmental hypothesis. Child Development69(4): 1054–1073.</bibtext> </blist> <blist> <bibtext> Buunk BP, Kuyper H, Van der Zee YG (2005) Affective response to social comparison in the classroom. Basic and Applied Social Psychology27(3): 229–237.</bibtext> </blist> <blist> <bibtext> *Calder L, Hill V, Pellicano E (2013) 'Sometimes I want to play by myself': understanding what friendship means to children with autism in mainstream primary schools. Autism17(3): 296–316.</bibtext> </blist> <blist> <bibtext> Campbell R, Pound P, Morgan M, et al. (2011) Evaluating metaethnography: systematic analysis and synthesis of qualitative research. Health Technology Assessment15(43): 1–164. Available at: https://<ulink href="http://www.ncbi.nlm.nih.gov/books/NBK84046/">www.ncbi.nlm.nih.gov/books/NBK84046/</ulink> (accessed 20 June 2014).</bibtext> </blist> <blist> <bibtext> *Carrington S, Graham L (2001) Perceptions of school by two teenage boys with Asperger syndrome and their mothers: a qualitative study. Autism5(1): 37–48.</bibtext> </blist> <blist> <bibtext> *Carrington S, Templeton E, Papinczak T (2003) Adolescents with Asperger syndrome and perceptions of friendship. Focus on Autism and Other Developmental Disabilities18(4): 211–218.</bibtext> </blist> <blist> <bibtext> Chamberlain B, Kasari C, Rotherham-Fuller E (2007) Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders37(2): 230–242.</bibtext> </blist> <blist> <bibtext> Chaplin TM, Aldao A (2013) Gender differences in emotion expression in children: a meta-analytic review. Psychological Bulletin139(4): 735–765.</bibtext> </blist> <blist> <bibtext> Connor M (2000) Asperger syndrome (ASD) and the self-reports of comprehensive school students. Educational Psychology in Practice16(3): 285–296.</bibtext> </blist> <blist> <bibtext> Cooley CH (1902) Human Nature and the Social Order. New York: Scribner.</bibtext> </blist> <blist> <bibtext> Damon W, Hart D (1988) Self-Understanding in Childhood and Adolescence. New York: Cambridge University Press.</bibtext> </blist> <blist> <bibtext> *Daniel LS, Billingsley BS (2010) What boys with an autism spectrum disorder say about establishing and maintaining friendships. Focus on Autism and Other Developmental Disabilities25(4): 220–229.</bibtext> </blist> <blist> <bibtext> Danker J, Strnadová I, Cumming TM (2016) School experiences of students with autism spectrum disorder within the context of student wellbeing: a review and analysis of the literature. Australasian Journal of Special Education40(1): 59–78.</bibtext> </blist> <blist> <bibtext> DePape A, Lindsay S (2016) Lived experiences from the perspectives of individuals with Autism Spectrum disorder. Focus on Autism and Other Developmental Disabilities31(1): 60–71.</bibtext> </blist> <blist> <bibtext> Dvash J, Ben-Zèev A, Noga A, et al. (2014) The road not taken: social vs. private comparisons in Asperger's syndrome and high functioning autism. Psychiatry Research216(3): 385–390.</bibtext> </blist> <blist> <bibtext> Dweck CS (2002) The development of ability conceptions. In: Wigfield A, Eccles JS (eds) Development of Achievement Motivation. San Diego, CA: Academic Press, pp.57–90.</bibtext> </blist> <blist> <bibtext> Evans D (2002) Database searches for qualitative research. Journal of the Medical Library Association90(3): 290–293.</bibtext> </blist> <blist> <bibtext> Farley A, López B, Saunders G (2010) Self-conceptualisation in autism: knowing oneself versus knowing self-through-other. Autism14(5): 519–530.</bibtext> </blist> <blist> <bibtext> Festinger L (1954) A theory of social comparison processes. Human Relations7(2): 117–140.</bibtext> </blist> <blist> <bibtext> Finfgeld DL (2003) Metasynthesis: the state of the art-so far. Qualitative Health Research13(7): 893–904.</bibtext> </blist> <blist> <bibtext> Gewurtz R, Kirsh B (2009) Disruption, disbelief and resistance: a meta-synthesis of disability in the workplace. Work34(1): 33–44.</bibtext> </blist> <blist> <bibtext> Glaser BG (1992) Emergence vs. Forcing: Basics of Grounded Theory Analysis. Mill Valley, CA: Sociology Press.</bibtext> </blist> <blist> <bibtext> Glaser BG, Strauss AL (1967) The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL: Aldine Publishing Company.</bibtext> </blist> <blist> <bibtext> Griffith GM, Totsika V, Nash S, et al. (2012) 'I just don't fit anywhere': support experiences and future support needs of individuals with Asperger syndrome in middle adulthood. Autism16(5): 532–546.</bibtext> </blist> <blist> <bibtext> Grills AE, Ollendick TH (2002) Peer victimization, global self-worth, and anxiety in middle school children. Journal of Clinical and Child Adolescent Psychology31(1): 59–68.</bibtext> </blist> <blist> <bibtext> Halberg IR (2009) Moving nursing research forward towards a stronger impact on health care practice?International Journal of Nursing Studies46(4): 407–412.</bibtext> </blist> <blist> <bibtext> Harter S (1982) The Perceived Competence Scale. Child Development53(1): 87–97.</bibtext> </blist> <blist> <bibtext> *Hay I, Winn S (2005) Students with Asperger's syndrome in an inclusive secondary school environment: teachers', parents', and students' perspectives. Australasian Journal of Special Education29(2): 140–154.</bibtext> </blist> <blist> <bibtext> *Healy S, Msetfi R, Gallagher S (2013) 'Happy and a bit nervous': the experiences of children with autism in physical education. British Journal of Learning Disabilities41(3): 222–228.</bibtext> </blist> <blist> <bibtext> *Hebron JS, Humphrey N (2014) Mental health difficulties among young people on the autistic spectrum in mainstream secondary schools: a comparative study. Journal of Research in Special Educational Needs14(1): 22–32.</bibtext> </blist> <blist> <bibtext> Hedley D, Young R (2006) Social comparison processes and depressive symptoms in children and adolescents with Asperger syndrome. Autism10(2): 139–153.</bibtext> </blist> <blist> <bibtext> *Hill L (2014) 'Some of it I haven't told anybody else': using photo elicitation to explore the experiences of secondary school education from the perspective of young people with a diagnosis of autistic spectrum disorder. Educational and Child Psychology31(1): 79–89.</bibtext> </blist> <blist> <bibtext> Hobson RP (2002) The Cradle of Thought. Basingstoke: Macmillan Publisher.</bibtext> </blist> <blist> <bibtext> Hodges E, Boivin M, Vitaro F, et al. (1999) The power of friendship: protection against an escalating cycle of peer victimization. Developmental Psychology35(1): 94–101.</bibtext> </blist> <blist> <bibtext> Hodkinson A (2016) Key Issues in Special Educational Needs and Inclusion. 2nd ed.Los Angeles, CA: SAGE.</bibtext> </blist> <blist> <bibtext> Humphrey N, Hebron J (2015) Bullying of children and adolescents with autism spectrum conditions: a 'state of the art review'. International Journal of Inclusive Education19(8): 845–862.</bibtext> </blist> <blist> <bibtext> *Humphrey N, Lewis S (2008) 'Make me normal': the views and experiences of pupils on the autistic spectrum in mainstream secondary schools. Autism12(1): 23–46.</bibtext> </blist> <blist> <bibtext> *Humphrey N, Symes W (2010) Perceptions of social support and experience of bullying among pupils with autistic spectrum disorders in mainstream secondary schools. European Journal of Special Needs Education25(1): 77–91.</bibtext> </blist> <blist> <bibtext> Jones RSP, Quigney C, Huws JC (2003) First-hand accounts of sensory perceptual experiences in autism: a qualitative analysis. Journal of Intellectual and Developmental Disability28(2): 112–121.</bibtext> </blist> <blist> <bibtext> Kasari C, Locke J, Gulsrud A, et al. (2011) Social networks and friendships at school: comparing children with and without ASD. Journal of Autism and Developmental Disorders41(5): 533–544.</bibtext> </blist> <blist> <bibtext> Kidder L, Fine M (1987) Qualitative and quantitative methods: when stories converge. In: Mark MM, Shotland RL (eds) Multiple Methods in Program Evaluation (New Directions for Program Evaluation, No. 35). San Francisco, CA: Jossey-Bass, pp.57–75.</bibtext> </blist> <blist> <bibtext> King M, Williams E, Gleeson K (2017) Using photographs to elicit self-understanding in adolescent boys with an autism spectrum condition. Journal of Intellectual and Developmental Disability. Epub ahead of print 5July. DOI: 10.3109/13668250.2017.1326586.</bibtext> </blist> <blist> <bibtext> Krauss SE (2005) Research paradigms and meaning-making: a primer. The Qualitative Report10(4): 758–770.</bibtext> </blist> <blist> <bibtext> Krieger B, Kinebanian A, Birgit P, et al. (2012) Becoming a member of the workforce: perceptions of adults with Asperger syndrome. Work43(2): 141–157.</bibtext> </blist> <blist> <bibtext> Ladd GW, Trooper-Gordon W (2003) The role of chronic peer difficulties in the development of children's psychological adjustment problems. Child Development74(5): 1344–1367.</bibtext> </blist> <blist> <bibtext> Lee A, Hobson RP (1998) On developing self-concepts: a controlled study of children and adolescents with autism. Journal of Child Psychology & Psychiatry & Allied Disciplines39(8): 1131–1144.</bibtext> </blist> <blist> <bibtext> Leekam SR, Nieto C, Libby SJ, et al. (2007) Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders37(5): 894–910.</bibtext> </blist> <blist> <bibtext> Leventhal H, Benyamini Y, Brownlee S, et al. (1997) Illness representations: theoretical foundations. In: Petrie K, Weinman J (eds) Perceptions of Health and Illness: Current Research and Applications. London: Taylor & Francis, pp.19–46.</bibtext> </blist> <blist> <bibtext> Lobban F, Barrowclough C, Jones S (2003) A review of the role of illness models in severe mental illness. Clinical Psychology Review23(2): 171–196.</bibtext> </blist> <blist> <bibtext> McDermott E, Graham H, Hamilton V (2004) Experiences of being a teenage mother in the UK: a report of a systematic review of qualitative studies. Available at: <ulink href="http://www.sphsu.mrc.ac.uk/Evidence/Research/Review%2010/SR%20Executive%20Summary.pdf">www.sphsu.mrc.ac.uk/Evidence/Research/Review%2010/SR%20Executive%20Summary.pdf</ulink> (accessed 20 September 2014).</bibtext> </blist> <blist> <bibtext> McDougall P, Hymel S (2007) Same-gender versus cross-gender friendship conceptions: similar or different?Merrill-Palmer Quarterly53(3): 347–380.</bibtext> </blist> <blist> <bibtext> MacEachen E, Clarke J, Franche RL, et al. (2006) Systematic review of the qualitative literature on return to work after injury. Scandinavian Journal of Work and Environmental Health2(4): 257–269.</bibtext> </blist> <blist> <bibtext> MacEachen E, Kosny A, Scott-Dixon K, et al. (2010) Workplace health understandings and processes in small businesses: a systematic review of the qualitative literature. Journal of Occupational Rehabilitation20(2): 180–198.</bibtext> </blist> <blist> <bibtext> *McLaughlin S, Rafferty H (2014) Me and 'It': seven young people given a diagnosis of Asperger's Syndrome. Educational and Child Psychology31(1): 63–78.</bibtext> </blist> <blist> <bibtext> Markus HR, Mullally P, Kitayama S (1997) Selfways: diversity in modes of cultural participation. In: Neisser N, Jopling D (eds) The Conceptual Self in Context: Culture, Experience, Self-Understanding. Cambridge: Cambridge University Press, pp.13–61.</bibtext> </blist> <blist> <bibtext> Mead GH (1934) Mind, Self and Society: From the Standpoint of a Social Behaviourist. Chicago, IL: University of Chicago Press.</bibtext> </blist> <blist> <bibtext> Miles MB, Huberman AM (1994) Qualitative Data Analysis: An Expanded Sourcebook. 2nd ed.Thousand Oaks: SAGE.</bibtext> </blist> <blist> <bibtext> Moher D, Liberati A, Tetzlaff J, et al. (2009) Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Medicine6(7): e1000097.</bibtext> </blist> <blist> <bibtext> Molloy H, Vasil L (2004) Asperger Syndrome, Adolescence, and Identity: Looking beyond the Label. London: Jessica Kingsley Publishers.</bibtext> </blist> <blist> <bibtext> Morf CC, Mischel W (2012) The self as a psycho-social dynamic processing system: toward a converging science of self-hood. In: Leary MR, Tangney JP (eds) Handbook of Self and Identity. 2nd ed.New York: Guildford, pp.21–49.</bibtext> </blist> <blist> <bibtext> Müller E, Schuler A, Yates GB (2008) Social challenges and supports from the perspective of individuals with Asperger syndrome and other autism spectrum disabilities. Autism12(2): 173–190.</bibtext> </blist> <blist> <bibtext> Mussweiler T (2003) Comparison processes in social judgement: mechanisms and consequences. Psychological Review110(3): 472–489.</bibtext> </blist> <blist> <bibtext> Nind M (2008) Conducting qualitative research with people with learning, communication and other disabilities: methodological challenges. Project Report, National Centre for Research Methods. Available at: <ulink href="http://eprints.ncrm.ac.uk/491/">http://eprints.ncrm.ac.uk/491/</ulink> (accessed 3 March 2015).</bibtext> </blist> <blist> <bibtext> Oliver M (1990) The Politics of Disablement. Basingstoke: Macmillan Publisher.</bibtext> </blist> <blist> <bibtext> Oswalt A (2014) Adolescent development (ed C Zupanick). Available at: <ulink href="http://www.sevencounties.org/poc/view%5fdoc.php?type=doc&id=41158&cn=1310">www.sevencounties.org/poc/view%5fdoc.php?type=doc&id=41158&cn=1310</ulink> (accessed 14 September 2015).</bibtext> </blist> <blist> <bibtext> Paliokosta P, Blandford S (2010) Inclusion in school: a policy, ideology or lived experience? Similar findings in diverse school cultures. Support for Learning25(4): 179–186.</bibtext> </blist> <blist> <bibtext> Parker JG, Rubin KH, Erath SA, et al. (2006) Peer relationships, child development and adjustment: a developmental psychopathology perspective. In: Cicchetti D, Cohen DJ (eds) Developmental Psychopathology: Theory and Method, vol. 2. 2nd ed.Hoboken, NJ: John Wiley & Sons, pp.96–161.</bibtext> </blist> <blist> <bibtext> Pawson R (2007) Digging for nuggets: how 'bad' research can yield 'good' evidence. International Journal of Social Research Methodology9(2): 127–142.</bibtext> </blist> <blist> <bibtext> *Penney SC (2013) Qualitative investigation of school-related issues affecting individuals diagnosed with autism spectrum disorder and co-occurring anxiety and/or depression. Autism Insights5: 75–91.</bibtext> </blist> <blist> <bibtext> Portway S, Johnson B (2003) Asperger syndrome and the children who 'don't quite fit in'. Early Child Development and Care173(4): 435–443.</bibtext> </blist> <blist> <bibtext> Portway S, Johnson B (2005) Do you know I have Asperger's syndrome? Risks of a non-obvious disability. Health, Risk and Society7(1): 73–83.</bibtext> </blist> <blist> <bibtext> Poulin F, Chan A (2010) Friendship stability and change in childhood and adolescence. Developmental Review30: 257–272.</bibtext> </blist> <blist> <bibtext> Punshon C, Skirrow P, Murphy G (2009) The 'not guilty verdict': psychological reactions to a diagnosis of Asperger syndrome in adulthood. Autism13(3): 265–283.</bibtext> </blist> <blist> <bibtext> Rose AJ, Rudolph KD (2006) A review of sex differences in peer relationship processes: potential trade-offs for the emotional and behavioural development of girls and boys. Psychological Bulletin132(1): 98–131.</bibtext> </blist> <blist> <bibtext> Rotheram-Fuller E, Kasari C, Chamberlain B, et al. (2010). Social involvement of children with autism spectrum disorders in elementary school classrooms. Journal of Child Psychology and Psychiatry51(11): 1227–1234.</bibtext> </blist> <blist> <bibtext> Rowley E, Chandler S, Baird G, et al. (2012) The experience of friendship, victimization and bullying in children with an autism spectrum disorder: associations with child characteristics and school placement. Research in Autism Spectrum Disorders6(3): 1126–1134.</bibtext> </blist> <blist> <bibtext> Rubin KH, Chen X, Coplan R, et al. (2005) Peer relationships in childhood. In: Bornstein MH, Lamb ME (eds) Developmental Science: An Advanced Textbook. 5th ed.London: Taylor and Francis Books, pp.469–512.</bibtext> </blist> <blist> <bibtext> *Saggers B, Hwang YS, Mercer L (2011) Your voice counts: listening to the voice of high school students with autism spectrum disorder. Australasian Journal of Special Education35(2): 173–190.</bibtext> </blist> <blist> <bibtext> Sandelowski M, Barroso J (2007) Handbook for Synthesizing Qualitative Research. New York: Springer.</bibtext> </blist> <blist> <bibtext> Sandstrom MJ, Cillessen AHN, Eisenhower A (2003) Children's appraisal of peer rejection experiences: impact on social and emotional adjustment. Social Development12(4): 530–550.</bibtext> </blist> <blist> <bibtext> Schroeder JH, Cappadocia MC, Bebko JM, et al. (2014) Shedding light on a pervasive problem: a review of research on bullying experiences among children with autism spectrum disorders. Journal of Autism and Developmental Disorders44(7): 520–534.</bibtext> </blist> <blist> <bibtext> Sedikides C, Brewer MB (eds) (2001) Individual Self, Relational Self, and Collective Self. Philadelphia, PA: Psychology Press.</bibtext> </blist> <blist> <bibtext> Shaffer DR (2009) Social and Personality Development. 6th ed.Belmont, CA: Wadsworth.</bibtext> </blist> <blist> <bibtext> Shakespeare T (2014) Disability Rights and Wrongs Revisited. New York: Routledge.</bibtext> </blist> <blist> <bibtext> Shakespeare T, Thompson S, Wright MJ (2009) No laughing matter: medical and social factors in restricted growth. Scandinavian Journal of Disability Research12(1): 19–31.</bibtext> </blist> <blist> <bibtext> Shaw RL, Booth A, Sutton AJ, et al. (2004) Finding qualitative research: an evaluation of search strategies. BMC Medical Research Methodology4(1): 1–5.</bibtext> </blist> <blist> <bibtext> Smith JA (2004) Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology1: 39–54.</bibtext> </blist> <blist> <bibtext> Smith JA, Jarman M, Osborn M (1997). Doing interpretative phenomenological analysis. In Murray M, Chamberlain K (eds). Qualitative Health Psychology: Theories and Methods. London: SAGE, pp.218–240.</bibtext> </blist> <blist> <bibtext> Smith JA, Osborn M (2003) Interpretative Phenomenological Analysis. In: Smith JA (ed.) Qualitative Psychology. London: SAGE, pp.51–80.</bibtext> </blist> <blist> <bibtext> Smith JA, Osborn M (2008) Interpretative phenomenological analysis. In Smith JA (ed.) Qualitative Psychology: A Practical Guide to Methods. 2nd ed.London: SAGE, pp.51–80.</bibtext> </blist> <blist> <bibtext> Smith JA, Flowers P, Larkin M (2009) Interpretative Phenomenological Analysis: Theory, Method and Research. London: SAGE.</bibtext> </blist> <blist> <bibtext> Sofronoff K, Dark E, Stone V (2011) Social vulnerability and bullying in children with Asperger syndrome. Autism15(3): 355–372.</bibtext> </blist> <blist> <bibtext> Spencer L, Ritchie J, Lewis J, et al. (2003) Quality in qualitative evaluation: a framework for assessing research evidence. Government Chief Social Researcher's Office, Occasional Papers Series 2. Available at: https://<ulink href="http://www.heacademy.ac.uk/system/files/166%5fpolicy%5fhub%5fa%5fquality%5fframework.pdf">www.heacademy.ac.uk/system/files/166%5fpolicy%5fhub%5fa%5fquality%5fframework.pdf</ulink> (accessed 24 March 2015).</bibtext> </blist> <blist> <bibtext> Tajfel H, Turner JC (1979) An integrative theory of intergroup conflict. In: Austin WG, Worchel S (eds) The Social Psychology of Intergroup Relations. Monterey, CA: Brooks/Cole, pp.33–48.</bibtext> </blist> <blist> <bibtext> Taylor GW, Ussher JM (2001) Making sense of S&M: a discourse analytic account. Sexualities4(3): 293–314.</bibtext> </blist> <blist> <bibtext> Thorne S (2009) The role of qualitative research within an evidence-based context: can metasynthesis be the answer?International Journal of Nursing Studies46(4): 569–575.</bibtext> </blist> <blist> <bibtext> Thorne S (2017) Metasynthetic madness: what kind of monster have we created?Qualitative Health Research27(1): 3–12.</bibtext> </blist> <blist> <bibtext> Thorne S, Jensen L, Kearney M, et al. (2004) Qualitative metasynthesis: reflections on methodological orientation and ideological agenda. Qualitative Health Research14(10): 1342–1365.</bibtext> </blist> <blist> <bibtext> Timmermans S, Iddo T (2007) Advancing ethnographic research through grounded theory practice. In Bryant A, Charmaz K (eds) Handbook of Grounded Theory. London: SAGE, pp.493–513.</bibtext> </blist> <blist> <bibtext> Tobias A (2009) Supporting students with autistic spectrum disorder (ASD) at secondary school: a parent and student perspective. Educational Psychology in Practice25(2): 151–165.</bibtext> </blist> <blist> <bibtext> Tonnsen BL, Hahn ER (2015) Middle school students' attitudes toward a peer with autism spectrum disorders: effects of social acceptance and physical inclusion. Focus on Autism and Other Developmental Disabilities30: 1–13.</bibtext> </blist> <blist> <bibtext> Watson N (2002) Well I know this is going to sound very strange to you, but I don't see myself as a disabled person: identity and disability. Disability and Society17(5): 509–523.</bibtext> </blist> <blist> <bibtext> Westbrook JD, Fong CJ, Nye C, et al (2013) Pre-graduation transition services for persons with autism disorders: effects on employment outcomes. Available at: <ulink href="http://www.thehealthwell.info/node/579890">www.thehealthwell.info/node/579890</ulink> (accessed 23 February 2015).</bibtext> </blist> <blist> <bibtext> Williamson S, Craig J, Slinger R (2008) Exploring the relationship between measures of self-esteem and psychological adjustment among adolescents with asperger syndrome. Autism12(4): 391–402.</bibtext> </blist> <blist> <bibtext> Winstone N, Huntington C, Goldsack L, et al. (2014) Eliciting rich dialogue through the use of activity-oriented interviews. Childhood21(2): 190–206.</bibtext> </blist> </ref> <p>An asterisk [*] against a paper in the reference list indicates that it was included in the metasynthesis.</p> <aug> <p>By Emma I. Williams; Kate Gleeson and Bridget E. Jones</p> </aug> <nolink nlid="nl1" bibid="bib51" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib82" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib56" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib91" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib23" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib52" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib97" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib108" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib54" firstref="ref11"></nolink> <nolink nlid="nl10" bibid="bib92" firstref="ref12"></nolink> <nolink nlid="nl11" bibid="bib16" firstref="ref13"></nolink> <nolink nlid="nl12" bibid="bib26" firstref="ref14"></nolink> <nolink nlid="nl13" bibid="bib71" firstref="ref15"></nolink> <nolink nlid="nl14" bibid="bib72" firstref="ref16"></nolink> <nolink nlid="nl15" bibid="bib98" firstref="ref17"></nolink> <nolink nlid="nl16" bibid="bib110" firstref="ref18"></nolink> <nolink nlid="nl17" bibid="bib76" firstref="ref19"></nolink> <nolink nlid="nl18" bibid="bib99" firstref="ref20"></nolink> <nolink nlid="nl19" bibid="bib78" firstref="ref21"></nolink> <nolink nlid="nl20" bibid="bib17" firstref="ref22"></nolink> <nolink nlid="nl21" bibid="bib18" firstref="ref23"></nolink> <nolink nlid="nl22" bibid="bib32" firstref="ref24"></nolink> <nolink nlid="nl23" bibid="bib43" firstref="ref26"></nolink> <nolink nlid="nl24" bibid="bib61" firstref="ref27"></nolink> <nolink nlid="nl25" bibid="bib83" firstref="ref28"></nolink> <nolink nlid="nl26" bibid="bib117" firstref="ref29"></nolink> <nolink nlid="nl27" bibid="bib96" firstref="ref33"></nolink> <nolink nlid="nl28" bibid="bib41" firstref="ref35"></nolink> <nolink nlid="nl29" bibid="bib34" firstref="ref37"></nolink> <nolink nlid="nl30" bibid="bib49" firstref="ref38"></nolink> <nolink nlid="nl31" bibid="bib62" firstref="ref39"></nolink> <nolink nlid="nl32" bibid="bib11" firstref="ref40"></nolink> <nolink nlid="nl33" bibid="bib31" firstref="ref41"></nolink> <nolink nlid="nl34" bibid="bib86" firstref="ref44"></nolink> <nolink nlid="nl35" bibid="bib87" firstref="ref45"></nolink> <nolink nlid="nl36" bibid="bib89" firstref="ref46"></nolink> <nolink nlid="nl37" bibid="bib121" firstref="ref47"></nolink> <nolink nlid="nl38" bibid="bib59" firstref="ref51"></nolink> <nolink nlid="nl39" bibid="bib112" firstref="ref53"></nolink> <nolink nlid="nl40" bibid="bib42" firstref="ref54"></nolink> <nolink nlid="nl41" bibid="bib12" firstref="ref55"></nolink> <nolink nlid="nl42" bibid="bib95" firstref="ref56"></nolink> <nolink nlid="nl43" bibid="bib36" firstref="ref62"></nolink> <nolink nlid="nl44" bibid="bib74" firstref="ref63"></nolink> <nolink nlid="nl45" bibid="bib14" firstref="ref64"></nolink> <nolink nlid="nl46" bibid="bib57" firstref="ref65"></nolink> <nolink nlid="nl47" bibid="bib66" firstref="ref67"></nolink> <nolink nlid="nl48" bibid="bib119" firstref="ref68"></nolink> <nolink nlid="nl49" bibid="bib33" firstref="ref69"></nolink> <nolink nlid="nl50" bibid="bib102" firstref="ref70"></nolink> <nolink nlid="nl51" bibid="bib21" firstref="ref71"></nolink> <nolink nlid="nl52" bibid="bib53" firstref="ref72"></nolink> <nolink nlid="nl53" bibid="bib20" firstref="ref73"></nolink> <nolink nlid="nl54" bibid="bib109" firstref="ref77"></nolink> <nolink nlid="nl55" bibid="bib37" firstref="ref79"></nolink> <nolink nlid="nl56" bibid="bib68" firstref="ref80"></nolink> <nolink nlid="nl57" bibid="bib69" firstref="ref81"></nolink> <nolink nlid="nl58" bibid="bib111" firstref="ref83"></nolink> <nolink nlid="nl59" bibid="bib84" firstref="ref84"></nolink> <nolink nlid="nl60" bibid="bib113" firstref="ref86"></nolink> <nolink nlid="nl61" bibid="bib25" firstref="ref88"></nolink> <nolink nlid="nl62" bibid="bib75" firstref="ref89"></nolink> <nolink nlid="nl63" bibid="bib116" firstref="ref90"></nolink> <nolink nlid="nl64" bibid="bib114" firstref="ref92"></nolink> <nolink nlid="nl65" bibid="bib120" firstref="ref99"></nolink> <nolink nlid="nl66" bibid="bib93" firstref="ref100"></nolink> <nolink nlid="nl67" bibid="bib48" firstref="ref102"></nolink> <nolink nlid="nl68" bibid="bib70" firstref="ref104"></nolink> <nolink nlid="nl69" bibid="bib46" firstref="ref106"></nolink> <nolink nlid="nl70" bibid="bib85" firstref="ref110"></nolink> <nolink nlid="nl71" bibid="bib22" firstref="ref114"></nolink> <nolink nlid="nl72" bibid="bib15" firstref="ref134"></nolink> <nolink nlid="nl73" bibid="bib45" firstref="ref141"></nolink> <nolink nlid="nl74" bibid="bib35" firstref="ref147"></nolink> <nolink nlid="nl75" bibid="bib100" firstref="ref162"></nolink> <nolink nlid="nl76" bibid="bib80" firstref="ref163"></nolink> <nolink nlid="nl77" bibid="bib101" firstref="ref165"></nolink> <nolink nlid="nl78" bibid="bib118" firstref="ref166"></nolink> <nolink nlid="nl79" bibid="bib94" firstref="ref182"></nolink> <nolink nlid="nl80" bibid="bib28" firstref="ref183"></nolink> <nolink nlid="nl81" bibid="bib19" firstref="ref189"></nolink> <nolink nlid="nl82" bibid="bib50" firstref="ref201"></nolink> <nolink nlid="nl83" bibid="bib44" firstref="ref212"></nolink> <nolink nlid="nl84" bibid="bib47" firstref="ref241"></nolink> <nolink nlid="nl85" bibid="bib40" firstref="ref253"></nolink> <nolink nlid="nl86" bibid="bib60" firstref="ref254"></nolink> <nolink nlid="nl87" bibid="bib77" firstref="ref255"></nolink> <nolink nlid="nl88" bibid="bib29" firstref="ref256"></nolink> <nolink nlid="nl89" bibid="bib10" firstref="ref257"></nolink> <nolink nlid="nl90" bibid="bib63" firstref="ref258"></nolink> <nolink nlid="nl91" bibid="bib55" firstref="ref260"></nolink> <nolink nlid="nl92" bibid="bib64" firstref="ref262"></nolink> <nolink nlid="nl93" bibid="bib65" firstref="ref263"></nolink> <nolink nlid="nl94" bibid="bib90" firstref="ref264"></nolink> <nolink nlid="nl95" bibid="bib24" firstref="ref266"></nolink> <nolink nlid="nl96" bibid="bib27" firstref="ref267"></nolink> <nolink nlid="nl97" bibid="bib67" firstref="ref268"></nolink> <nolink nlid="nl98" bibid="bib88" firstref="ref269"></nolink> <nolink nlid="nl99" bibid="bib58" firstref="ref271"></nolink> <nolink nlid="nl100" bibid="bib79" firstref="ref272"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1200857
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: How Pupils on the Autism Spectrum Make Sense of Themselves in the Context of Their Experiences in a Mainstream School Setting: A Qualitative Metasynthesis
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Williams%2C+Emma+I%2E%22">Williams, Emma I.</searchLink><br /><searchLink fieldCode="AR" term="%22Gleeson%2C+Kate%22">Gleeson, Kate</searchLink><br /><searchLink fieldCode="AR" term="%22Jones%2C+Bridget+E%2E%22">Jones, Bridget E.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. Jan 2019 23(1):8-28.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: http://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 21
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2019
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Information Analyses
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Concept%22">Self Concept</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Relationship%22">Interpersonal Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Sensory+Experience%22">Sensory Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Environment%22">Educational Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Esteem%22">Self Esteem</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Inclusion%22">Inclusion</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink><br /><searchLink fieldCode="DE" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Education%22">Special Education</searchLink><br /><searchLink fieldCode="DE" term="%22Bullying%22">Bullying</searchLink><br /><searchLink fieldCode="DE" term="%22Victims%22">Victims</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Relationship%22">Peer Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Accessibility+%28for+Disabled%29%22">Accessibility (for Disabled)</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/1362361317723836
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1362-3613
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Evidence that interpersonal interactions and self-appraisal in social context are crucial in developing self-understanding raises concerns about how pupils with autism spectrum disorder make sense of themselves in school settings where many experience social marginalisation. Metasynthesis was used to systematically extract and integrate findings from qualitative studies examining the mainstream school experiences of these students. Synthesised findings identified three, intermeshing, aspects of experience which contribute to many pupils with autism spectrum disorder making sense of themselves as 'different' to typical peers in a negative way: difficulties linked to autism spectrum disorder; interpersonal relationships, particularly with peers; and accessibility of the school environment. Typical pupils' attitudes and responses towards peers with autism spectrum disorder, unusual sensory reactions to the physical school environment and individual sense-making about the self are highlighted as key areas requiring further research and intervention to improve the experiences, self-esteem and well-being of pupils with autism spectrum disorder in inclusive settings and to inform educational policy and practice.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 121
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2018
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1200857
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1200857
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/1362361317723836
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 21
        StartPage: 8
    Subjects:
      – SubjectFull: Autism
        Type: general
      – SubjectFull: Pervasive Developmental Disorders
        Type: general
      – SubjectFull: Self Concept
        Type: general
      – SubjectFull: Interpersonal Relationship
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Sensory Experience
        Type: general
      – SubjectFull: Educational Environment
        Type: general
      – SubjectFull: Self Esteem
        Type: general
      – SubjectFull: Well Being
        Type: general
      – SubjectFull: Inclusion
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Elementary Secondary Education
        Type: general
      – SubjectFull: Postsecondary Education
        Type: general
      – SubjectFull: Special Education
        Type: general
      – SubjectFull: Bullying
        Type: general
      – SubjectFull: Victims
        Type: general
      – SubjectFull: Peer Relationship
        Type: general
      – SubjectFull: Accessibility (for Disabled)
        Type: general
    Titles:
      – TitleFull: How Pupils on the Autism Spectrum Make Sense of Themselves in the Context of Their Experiences in a Mainstream School Setting: A Qualitative Metasynthesis
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Williams, Emma I.
      – PersonEntity:
          Name:
            NameFull: Gleeson, Kate
      – PersonEntity:
          Name:
            NameFull: Jones, Bridget E.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2019
          Identifiers:
            – Type: issn-print
              Value: 1362-3613
          Numbering:
            – Type: volume
              Value: 23
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Autism: The International Journal of Research and Practice
              Type: main
ResultId 1