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Examining the Authenticity of Autistic Portrayals in US Adult and Children's Television Shows Using Medical and Social Models of Disability

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Title: Examining the Authenticity of Autistic Portrayals in US Adult and Children's Television Shows Using Medical and Social Models of Disability
Language: English
Authors: Willow S. Sauermilch (ORCID 0000-0003-4625-886X), Michelle L. Ivey (ORCID 0009-0001-4982-2035), Eric E. Rasmussen (ORCID 0000-0002-4432-9348), Christina J. Najera (ORCID 0000-0002-7547-5903)
Source: Journal of Autism and Developmental Disorders. 2025 55(2):524-539.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 16
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Television Viewing, Programming (Broadcast), Symptoms (Individual Disorders), Individual Characteristics, Coping, Incidence, Childrens Television, Social Attitudes
DOI: 10.1007/s10803-023-06215-z
ISSN: 0162-3257
1573-3432
Abstract: Television programs have introduced viewers to characters on the autism spectrum (e.g., "Sesame Street," "The Good Doctor"), impacting audiences' knowledge and attitudes. Thus, it is essential that character representations convey accurate health information. This study explores how autistic portrayals across six adult and children's television programs align with the medical (e.g., American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 5th ed., text rev., 2022, https://doi.org/10.1176/appi.books.9780890425787) and social models of disability. A content analysis methodology was used to investigate defining characteristics of autism (i.e., medical model) and how characters navigated their environment (i.e., social model) in 252 scenes (across six characters in 22 episodes). Measures included the frequency with which autism characteristics (e.g., social-communicative difficulties, restrictive repetitive behaviors) were present across autistic portrayals and the valence (e.g., positive, negative, neutral) with which characters interacted with their environment (e.g., character and neurodiversity affirming valence). Findings indicate that (a) television portrayals depict social-communication difficulties significantly more than behavioral characteristics, (b) children's programming portrays autistic characters with significantly more positive personal attributes (i.e., character valence) than adult programs, and (c) the majority of programs portray characters navigating autism in positive or neutral ways (i.e., neurodiversity affirming valence). Results offer stakeholders (e.g., writers, advocates, neurodiverse community) insight into how autistic characters are portrayed on television, adding to a growing body of literature examining how such representations impact public knowledge, attitudes, and behaviors towards individuals on the autism spectrum. Collectively, such studies highlight how changes in diagnostic criteria, legal protections, and social inclusivity are presented to viewers, who are seeking entertainment but gaining public health information.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1460655
Database: ERIC
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  Value: <anid>AN0182958582;aut01feb.25;2025Feb13.05:25;v2.2.500</anid> <title id="AN0182958582-1">Examining the Authenticity of Autistic Portrayals in US Adult and Children's Television Shows Using Medical and Social Models of Disability </title> <p>Television programs have introduced viewers to characters on the autism spectrum (e.g., Sesame Street, The Good Doctor), impacting audiences' knowledge and attitudes. Thus, it is essential that character representations convey accurate health information. This study explores how autistic portrayals across six adult and children's television programs align with the medical (e.g., American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 5th ed., text rev., 2022, https://doi.org/10.1176/appi.books.9780890425787) and social models of disability. A content analysis methodology was used to investigate defining characteristics of autism (i.e., medical model) and how characters navigated their environment (i.e., social model) in 252 scenes (across six characters in 22 episodes). Measures included the frequency with which autism characteristics (e.g., social-communicative difficulties, restrictive repetitive behaviors) were present across autistic portrayals and the valence (e.g., positive, negative, neutral) with which characters interacted with their environment (e.g., character and neurodiversity affirming valence). Findings indicate that (a) television portrayals depict social-communication difficulties significantly more than behavioral characteristics, (b) children's programming portrays autistic characters with significantly more positive personal attributes (i.e., character valence) than adult programs, and (c) the majority of programs portray characters navigating autism in positive or neutral ways (i.e., neurodiversity affirming valence). Results offer stakeholders (e.g., writers, advocates, neurodiverse community) insight into how autistic characters are portrayed on television, adding to a growing body of literature examining how such representations impact public knowledge, attitudes, and behaviors towards individuals on the autism spectrum. Collectively, such studies highlight how changes in diagnostic criteria, legal protections, and social inclusivity are presented to viewers, who are seeking entertainment but gaining public health information.</p> <p>Keywords: Entertainment-education messaging; Content analysis; Representation; Autism characteristics; Television; Model of disability; Psychology and Cognitive Sciences Psychology</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>Known as the "invisible minority," 26% of adults in the United States live with a disability (Nelson, [<reflink idref="bib19" id="ref1">19</reflink>]; Okoro et al., [<reflink idref="bib22" id="ref2">22</reflink>]). Although televised portrayals of individuals with disabilities have increased in the last decade (Gay and Lesbian Alliance Against Defamation [GLAAD] Media Institute, [<reflink idref="bib13" id="ref3">13</reflink>]), fictional depictions continue to underrepresent individuals with disabilities in terms of prevalence, diversity of symptoms, and quality of life (Belcher & Maich, [<reflink idref="bib4" id="ref4">4</reflink>]; Bond, [<reflink idref="bib5" id="ref5">5</reflink>]). This is particularly evident for characters with autism (GLAAD Media Institute, [<reflink idref="bib13" id="ref6">13</reflink>]), a condition with increasing prevalence, impacting an estimated 1 in 36 children in the United States (Maenner et al., [<reflink idref="bib17" id="ref7">17</reflink>]).</p> <p>Since the debut of <emph>Parenthood</emph> and the character "Max" in 2010, the number of autistic characters in major television roles has become more frequent thus garnering increased public attention and news coverage about the condition (Nordahl-Hansen, [<reflink idref="bib21" id="ref8">21</reflink>]). However, this awareness may not always provide the highest quality of information. For instance, television and streaming platforms (e.g., Netflix, Amazon Prime) feature a variety of programs used by the public to access medical and health-related information; however, 66% of viewers surveyed feel that writers prioritize entertainment over the accuracy of health information (Pew Research Center, [<reflink idref="bib24" id="ref9">24</reflink>]). Despite their entertainment focus, 38% of viewers report that watching such programs helps them understand medical topics compared to the 12% who say it hurts their understanding (Pew Research Center, [<reflink idref="bib24" id="ref10">24</reflink>]). Thus, television programs have the potential to shape public awareness and knowledge on issues surrounding autism, regardless of the quality of those depictions.</p> <p>Despite limited information on the authenticity of fictional autistic character portrayals on television, recent studies indicate such portrayals are positively shifting public knowledge and attitudes concerning the diagnosis (see Jones et al., [<reflink idref="bib16" id="ref11">16</reflink>]). Therefore, the first research aim evaluates how fictional portrayals of autistic characters in adult and children's television programming align with the characteristics of autism spectrum disorder [ASD] outlined by <emph>The Diagnostic and Statistical Manual of Mental Disorders (</emph>5th edition; <emph>DSM-5</emph>) and the recent text revision, <emph>DSM-5-TR</emph>, which provide clinical criteria for educational and medical professionals to differentially diagnose ASD (American Psychiatric Association [APA], [<reflink idref="bib1" id="ref12">1</reflink>], [<reflink idref="bib3" id="ref13">3</reflink>]). The second aim explores the positive and negative ways in which characters on the autism spectrum are portrayed within storylines.</p> <hd id="AN0182958582-2">Inclusion and Representation of Disabled Characters</hd> <p>Characters with disabilities are underrepresented, and under researched, within mass media content. In the top U.S. box office fictional films from 2007 to 2016, only 2.7% of characters with a speaking role were portrayed with a disability (Smith et al., [<reflink idref="bib30" id="ref14">30</reflink>]) compared to population prevalence (26%; Okoro et al., [<reflink idref="bib22" id="ref15">22</reflink>]). Among regular series characters in scripted broadcast television programming, only 3.5% of characters were identified in storylines as having a visible (e.g., cerebral palsy, amputee, etc.) or hidden (e.g., HIV, post-traumatic stress disorder, etc.) disability (GLAAD, [<reflink idref="bib13" id="ref16">13</reflink>]). Similarly, only 4.4% of children's television programming contained a character with a physical disability discernible to the audience (Bond, [<reflink idref="bib5" id="ref17">5</reflink>]).</p> <p>The ways in which characters with disabilities are portrayed in mass media is a growing concern. Only 5% of the characters with a disability featured in top-rated scripted broadcast programming and 12.5% on streaming-based programming were portrayed by actors with a disability (Woodburn & Kopić, [<reflink idref="bib36" id="ref18">36</reflink>]). By casting non-disabled actors as characters with a disability (i.e., disability drag), portrayals may lack authenticity; perpetuate negative stereotypes (e.g., violent, incapable, etc.), stigmas, ableism, and/or displace or erase the contributions of disabled actors (GLAAD, [<reflink idref="bib13" id="ref19">13</reflink>]; Sandahl, [<reflink idref="bib27" id="ref20">27</reflink>]).</p> <hd id="AN0182958582-3">Autism Spectrum Disorder</hd> <p>The medical model of disability, which largely dominates how autism is characterized and discussed within professional literature, examines autism through a diagnostic lens. The model promotes a deficit-based view that disabilities are a biological abnormality with debilitating characteristics requiring medical and/or therapeutic intervention necessary to eliminate or ameliorate symptoms and restore normative functioning (Ellis & Goggin, [<reflink idref="bib10" id="ref21">10</reflink>]). Based on this model, ASD is a neurodevelopmental condition characterized by difficulties in personal, social, behavioral, academic, and/or occupational skills (APA, [<reflink idref="bib3" id="ref22">3</reflink>]). The <emph>DSM-5-TR</emph> provides the definitive definition of autism used by medical, clinical, and educational professionals when diagnosing autism. In doing so, the <emph>DSM-5-TR</emph> describes two major areas of difficulty significantly impacting one's participation in social, educational, and/or vocational activities within daily life: (a) social communication skills (i.e., difficulties with social-emotional reciprocity, nonverbal communicative behaviors, and social relationships), and (b) the display of "restrictive, repetitive patterns of behavior, interests, or activities;" (i.e., repetitive behavior, ritualized routines, fixated interests, and sensory sensitivity; APA, [<reflink idref="bib3" id="ref23">3</reflink>]). In terms of prevalence, boys are formally diagnosed with autism 3.8 times more than girls in the U.S. population sample (Maenner et al., [<reflink idref="bib17" id="ref24">17</reflink>]).</p> <hd id="AN0182958582-4">Inclusion and Representation of Characters on the Autism Spectrum</hd> <p>A review of the literature indicates that the percentage of film and television characters on the autism spectrum is unknown, and few studies have explored how these characters are depicted. Nordalh-Hanse et al. ([<reflink idref="bib21" id="ref25">21</reflink>]) examined how autistic traits are portrayed by characters either diagnosed with or displaying autistic-like characteristics across 22 films and four television series from 11 countries. Findings suggest that a majority of characters exhibited characteristics of autism strongly correlated to the <emph>DSM-5-TR</emph> (APA, [<reflink idref="bib3" id="ref26">3</reflink>]); however, the authors did not specify how findings align with the seven major characteristics used by the APA. Conversely, cinematic portrayals often overrepresent autistic characteristics, including traits associated with a severe impairment, stereotypical behavior, and/or the possession of exceptional abilities solving uncharacteristically difficult life situations (e.g., preventing disasters/apocalyptic events, predicting the future, etc.; Belcher & Maich, [<reflink idref="bib4" id="ref27">4</reflink>]; Garner et al., [<reflink idref="bib12" id="ref28">12</reflink>]). Given the disproportionately low number of characters on the autism spectrum featured in mass media, such portrayals risk producing "model neurominority," in which an ideal and unrealistic version of autism is presented to audiences. For instance, the portrayal of savant skills, which is not part of the criteria set forth in the <emph>DSM-5-TR,</emph> potentially overshadows the portrayal of more realistic but less positive characteristics (Belcher & Maich, [<reflink idref="bib4" id="ref29">4</reflink>]).</p> <hd id="AN0182958582-5">Exposure to Media-Based Disability Portrayals</hd> <p>Fictional depictions help inform audiences about specific disabilities, thus shaping public attitudes about individuals with disabilities. Samsel and Perepa ([<reflink idref="bib26" id="ref30">26</reflink>]) found that teachers who watched television shows or films featuring a character with a disability reported greater awareness and understanding of that condition. Similar media effects are seen in children as young as 4 years of age, who can identify individuals with a physical disability as well as demonstrate understanding that the disability can make one's life harder (Favazz & Odom, 1997). Although most kindergarteners report positive attitudes towards individuals with disabilities, only half have friendships with disabled peers (Dyson, [<reflink idref="bib9" id="ref31">9</reflink>]). Thus, the portrayal of characters with disabilities in television programming has the potential to educate viewers about variations in the life experiences of those with autism, including associated social barriers.</p> <hd id="AN0182958582-6">Importance of Authentic Autistic Portrayals</hd> <p>The persuasive properties of health-related entertainment-education media content connects audiences with program characters on an emotional and cognitive level, in turn reducing audience resistance to embedded health messages (Moyer-Gusé, [<reflink idref="bib18" id="ref32">18</reflink>]). For instance, compared to viewing an informational lecture about autism, young adults who watch one episode of <emph>The Good Doctor</emph> exhibited greater knowledge about autism, more positive attitudes towards individuals on the autism spectrum, and greater interest in learning more about autism (Stern & Barnes, [<reflink idref="bib32" id="ref33">32</reflink>]). For younger audiences, research as far back as 1976, indicates that preschoolers who watched other preschoolers of differing ethnicities on television were more likely to choose a friend of different ethnicity during play (Gorn et al., [<reflink idref="bib14" id="ref34">14</reflink>]). Furthermore, when it comes to public attitudes, positive television portrayals of historically marginalized communities are associated with more positive viewer attitudes towards stigmatized populations (Schiappa et al., [<reflink idref="bib28" id="ref35">28</reflink>]; Wong et al., [<reflink idref="bib35" id="ref36">35</reflink>]). The ways in which social and behavioral characteristics associated with autism are portrayed play a more significant role in the development of stigmatizing attitudes towards autistic individuals than the diagnostic label of autism itself (Butler & Gillis, [<reflink idref="bib6" id="ref37">6</reflink>]).</p> <p>The use of health-related entertainment-education media content may suggest that these positive audience effects involve more than the mere presence of autistic characters and information about autism. Rather, it requires audience investment in the program's narrative and characters through perceived similarity (i.e., viewer sees self in a character) and social attraction (i.e., viewer renders a positive judgment about a character; Moyer-Gusé, [<reflink idref="bib18" id="ref38">18</reflink>]). Knowing that the ways in which autistic characters are portrayed in media content influence viewers' knowledge, attitudes, and behaviors, regardless of the authenticity of those portrayals, it is therefore important to examine how closely the portrayal of autism in television programming mirrors the clinical definition of autism outlined by the <emph>DSM-5-TR</emph>. Thus, the following research questions are asked:</p> <p></p> <ulist> <item> RQ1How frequently are each of the seven clinical characteristics used to diagnose autism within the <emph>DSM-5-TR (APA, </emph>[<reflink idref="bib3" id="ref39">3</reflink>]<emph>)</emph> portrayed by autistic characters in television programming?</item> <p></p> <item> RQ2Which of the seven clinical characteristics of autism co-occur within portrayals of characters on the autism spectrum?</item> <p></p> <item> RQ3How does the type of television programming (i.e., adult versus child) influence the portrayal of each of the seven clinical characteristics of autism?</item> </ulist> <hd id="AN0182958582-7">Social Model of Disability</hd> <p>A major limitation of the medical model of disability is that it minimizes the lived experiences of individuals with disabilities, giving rise to and perpetuating discriminatory and ableist ideologies within society (Ellis & Goggin, [<reflink idref="bib10" id="ref40">10</reflink>]). Rather than objectifying the characteristics of autism specifically mentioned in the <emph>DSM-5-TR</emph>, the social model of disability takes a strengths-based approach which is more holistic and individual-centric. As a result, the model is based on the interaction of one's physical, psychological, intellectual, and social-emotional needs in relation to the social, cultural, political, and/or economic barriers present in one's environment (World Health Organization [WHO], [<reflink idref="bib37" id="ref41">37</reflink>]). Fueled by the autism community and allies who advocate that autism is not a disorder but rather a neurological variation (i.e., neurodiversity) from what is typically expected, this model promotes individuals' strengths over their weaknesses, offering greater autonomy, dignity, and independence within continually evolving social norms and institutions that seek to be both inclusive and equitable (Ellis & Goggin, [<reflink idref="bib10" id="ref42">10</reflink>]; WHO, [<reflink idref="bib37" id="ref43">37</reflink>]).</p> <p>Little research explores how television programming positively and negatively portrays characters within the storyline (a) as individuals independent of their diagnosis (i.e., character valence) and (b) how characters navigate differences associated with their autism within the context of a scene's storyline (i.e., neurodiversity affirming valence; see Table 2 for conceptual definitions). Warzak et al. ([<reflink idref="bib34" id="ref44">34</reflink>]) examined how characters with physical disabilities were portrayed in television programming and commercials, including character valence and disability valence (i.e., how characters cope with difficulties associated with a physical disability). Findings indicated that 25% of portrayals were classified as thematic, meaning the character's disability was essential to the program's storyline. Characters with a physical disability were largely depicted in neutral ways (64%, character valence; 78% disability valence), followed by positive (32%, character valence; 5%, disability valence) and negative portrayals (4%, character valence; 18%, disability valence; Warzak et al., [<reflink idref="bib34" id="ref45">34</reflink>]).</p> <p>Moyer-Gusé ([<reflink idref="bib18" id="ref46">18</reflink>]) posited that in order to reap the benefits of entertainment-education messages, audiences must first connect with the characters and story narrative in positive ways—ways that impact the likelihood of adopting disability-specific messages. Within the context of this study, such connections possibly unfold in ways that mirror the inclusivity advocated by the social model of disability. However, given that past research found that the limited number of characters with a disability included in mass media portrays were depicted in neutral and nonessential storylines (GLAAD, [<reflink idref="bib13" id="ref47">13</reflink>]; Warzak et al., [<reflink idref="bib34" id="ref48">34</reflink>]), it is necessary to re-examine such portrayals in light of the advancement of disability awareness, attainment of disability civil rights, and social acceptance during the past 35 years. Thus, the following research questions are asked to help better understand how entertainment-education messages portray neurodivergent characters within the broader social context of narrative storytelling:</p> <p></p> <ulist> <item> RQ4In terms of character valence, how are characters on the autism spectrum portrayed in (a) scripted programming series and (b) adult versus children's scripted programs?</item> <p></p> <item> RQ5In terms of neurodiversity affirming valence (i.e., in lieu of disability valence), how are characters on the autism spectrum portrayed in (a) scripted programming series and (b) adult versus children's scripted series?</item> </ulist> <hd id="AN0182958582-8">Methods</hd> <p></p> <hd id="AN0182958582-9">Sample Selection</hd> <p>The sample included six adult and children's television programs selected using the following inclusionary criteria: (a) original, scripted programming series distributed through broadcast, cable, or streaming; (b) featured a main or ensemble fictional character on the autism spectrum as stated in the series' description (including those under the <emph>DSM-IV-TR</emph> [APA, [<reflink idref="bib2" id="ref49">2</reflink>]], e.g., Asperger's disorder); (c) originally broadcasted in the United States between 2007 and 2017, representing a period in which the number of disabled television series regulars nearly doubled, including a number of characters on the autism spectrum, garnering public interest (Deggans, [<reflink idref="bib8" id="ref50">8</reflink>]; GLAAD, [<reflink idref="bib13" id="ref51">13</reflink>]; Stahl, [<reflink idref="bib31" id="ref52">31</reflink>]); (d) English-speaking series; and (e) the character on the autism spectrum ranged in age from childhood to young adulthood. Exclusionary criteria included: (a) TV talk shows, movies, or mini-series; (b) unavailable to the public; and (c) science-fiction series, as storylines may include representations uncharacteristic of autism outlined in the <emph>DSM-5-TR</emph> (e.g., character predicts the future, time travels, etc.).</p> <p>Series were located using the International Movie Database (IMDB, [<reflink idref="bib15" id="ref53">15</reflink>]), an online database containing more than 138,056 television series and 3,054,974 television episodes yielding three eligible adult programs (i.e., <emph>Parenthood, Atypical, The Good Doctor</emph>), and one children's program (i.e., <emph>Sesame Street</emph>)<emph>.</emph> To broaden the children's programming sample, inclusionary criteria were expanded to include: (a) the character's autism diagnosis was disclosed in the storyline, and (b) the character guest starred in more than one episode; yielding two additional eligible programs (i.e., <emph>Dinosaur Train, Arthur</emph>). The final sample consisted of both live-action and animated programs and included six characters on the autism spectrum (i.e., three humans, "Max," "Sam," and "Shaun;" two animals, "Carl" and "Dennis;" and one Muppet, "Julia"). For coding purposes, the unit of analysis was a scene (i.e., visual sequence sharing the same time and location; Orlebar, [<reflink idref="bib23" id="ref54">23</reflink>]) in which the character on the autism spectrum was seen and/or heard (e.g., dialogue, voice over).</p> <hd id="AN0182958582-10">Coding Sample</hd> <p>The final coding sample consisted of 252 scenes spanning 14 episodes available through the 2017–2018 season (see Table 1). Adult programming included: (<reflink idref="bib1" id="ref55">1</reflink>) the episode in which the autistic character disclosed their autism to the audience, and (<reflink idref="bib2" id="ref56">2</reflink>) randomly selected episodes in which the autistic character played a predominant role in the storyline (i.e., character included in episode's description). Given that "Max," from <emph>Parenthood</emph>, was part of a large ensemble cast of actors and thus received less screen time per episode, twice as many <emph>Parenthood</emph> episodes were included in the study sample creating a more comparable sample between shows. Children's programming consisted of a census of the 14 available episodes, which were shorter in length.</p> <p>Table 1 Descriptives of study sample organized by program</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Program</p></th><th align="left"><p>Character name</p></th><th align="left"><p>Character role</p></th><th align="left"><p>Number of episodes in sample</p></th><th align="left"><p>Average length of the episodes in sample</p></th><th align="left"><p>Number of scenes featuring character in sample</p></th><th align="left"><p>Total Time character is on screen in sample ASD screen time</p></th><th align="left"><p>Total program length included in sample</p></th><th align="left"><p>Percentage of screentime autistic character is present in sample</p></th></tr></thead><tbody><tr><td align="left" colspan="9"><p>Adult programming</p></td></tr><tr><td align="left"><p><italic> Parenthood</italic></p></td><td align="left"><p>Max</p></td><td align="left"><p>Ensemble</p></td><td char="." align="char"><p>4</p></td><td align="left"><p>42 m, 54 s</p></td><td char="." align="char"><p>31</p></td><td align="left"><p>17 m, 46 s</p></td><td align="left"><p>2 h, 51 m, 34 s</p></td><td char="." align="char"><p>10.36</p></td></tr><tr><td align="left"><p><italic> Atypical</italic></p></td><td align="left"><p>Sam</p></td><td align="left"><p>Main</p></td><td char="." align="char"><p>2</p></td><td align="left"><p>34 m, 46 s</p></td><td char="." align="char"><p>56</p></td><td align="left"><p>28 m, 58 s</p></td><td align="left"><p>1 h, 6 m, 31 s</p></td><td char="." align="char"><p>43.55</p></td></tr><tr><td align="left"><p><italic> The Good Doctor</italic></p></td><td char="." align="char"><p>Shaun</p></td><td align="left"><p>Main</p></td><td char="." align="char"><p>2</p></td><td align="left"><p>41 m, 57 s</p></td><td char="." align="char"><p>78</p></td><td align="left"><p>44 m, 28 s</p></td><td align="left"><p>1 h, 23 m, 54 s</p></td><td char="." align="char"><p>53.52</p></td></tr><tr><td align="left" colspan="2"><p> Adult sub-sample</p></td><td align="left" /><td char="." align="char"><p>8</p></td><td align="left"><p>40 m, 16 s</p></td><td char="." align="char"><p>165</p></td><td align="left"><p>1 h, 31 m, 12 s</p></td><td align="left"><p>5 h, 21 m, 59 s</p></td><td char="." align="char"><p>28.32</p></td></tr><tr><td align="left" colspan="9"><p>Children's programming</p></td></tr><tr><td align="left"><p><italic> Sesame Street</italic></p></td><td align="left"><p>Julia</p></td><td align="left"><p>Ensemble</p></td><td char="." align="char"><p>6</p></td><td align="left"><p>24 m, 57 s</p></td><td char="." align="char"><p>21</p></td><td align="left"><p>14 m, 14 s</p></td><td align="left"><p>7 h, 5 m</p></td><td char="." align="char"><p>3.35</p></td></tr><tr><td align="left"><p><italic> Dinosaur Train</italic></p></td><td align="left"><p>Dennis</p></td><td align="left"><p>Ensemble</p></td><td char="." align="char"><p>2</p></td><td align="left"><p>11 m</p></td><td char="." align="char"><p>21</p></td><td align="left"><p>8 m, 52 s</p></td><td align="left"><p>22 m</p></td><td char="." align="char"><p>40.32</p></td></tr><tr><td align="left"><p><italic> Arthur</italic></p></td><td align="left"><p>Carl</p></td><td align="left"><p>Ensemble</p></td><td char="." align="char"><p>6</p></td><td align="left"><p>11 m, 20 s</p></td><td char="." align="char"><p>45</p></td><td align="left"><p>14 m, 28 s</p></td><td align="left"><p>1 h, 8 m</p></td><td char="." align="char"><p>21.28</p></td></tr><tr><td align="left" colspan="2"><p> Children sub-sample</p></td><td align="left" /><td char="." align="char"><p>14</p></td><td align="left"><p>16 m, 9 s</p></td><td char="." align="char"><p>87</p></td><td align="left"><p>37 m, 34 s</p></td><td align="left"><p>8 h, 35 m</p></td><td char="." align="char"><p>7.30</p></td></tr><tr><td align="left"><p> Sample total</p></td><td align="left" /><td align="left" /><td char="." align="char"><p>22</p></td><td align="left"><p>2 h, 47 m, 18 s</p></td><td char="." align="char"><p>252</p></td><td align="left"><p>2 h, 8 m, 46 s</p></td><td align="left"><p>13 h, 56 m, 59 s</p></td><td char="." align="char"><p>15.39</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph> Percentages represent the relative frequency with which each character on the autism spectrum was present within each program sub-sample. For each character, percentages were calculated by taking the total number of minutes the character is seen and/or heard within the selected program episodes (i.e., total time character is on screen in sample) divided by the total number of minutes in the selected program episodes, regardless of whether or not the character is seen and/or heard (i.e., total program length included in sample)</p> <hd id="AN0182958582-11">Coding Procedures</hd> <p>Coders were two speech-language pathologists certified by the American Speech-Language-Hearing Association, with a combined total of 43 years of clinical experience, including working with children and adolescents on the autism spectrum. The codebook was developed using the diagnostic criteria outlined in the <emph>DSM-5-TR</emph> (APA, [<reflink idref="bib3" id="ref57">3</reflink>])<emph>,</emph> which provides professionals with guidance but is not a standardized diagnostic instrument in and of itself. Mirroring the <emph>DSM-5-TR</emph> criteria<emph>,</emph> the codebook is comprised of the seven characteristics of autism (including associated examples and exclusionary considerations; see Table 2). The presence/absence of each categorical characteristic of autism was dichotomously coded (present, coded as 1; absent, coded as 0) within the social and/or environmental context of each scene (i.e., latent coding; Riffe et al., [<reflink idref="bib25" id="ref58">25</reflink>]). Coding did not capture nor differentiate between specific difficulties or behaviors listed within each of the seven characteristics of autism (e.g., understanding relationships vs. imaginative play within the difficulties in social relationships category) as such a differentiation is not required by the <emph>DSM-5-TR</emph>. Given that individuals can exhibit multiple autism characteristics simultaneously, it was possible that two or more characteristics could be coded as present within a single scene. Furthermore, the duration of specific characteristics within a scene were not measured as they are not a consideration within the <emph>DSM-5-TR</emph>. Character and neurodiversity affirming valence were coded using descriptive definitions adapted from Warzak et al., ([<reflink idref="bib34" id="ref59">34</reflink>]; i.e., negative, coded as 1; neutral, coded as 2; or positive valence, coded as 3; see Table 2). Coders participated in extensive reliability training reaching 90% consensus on each of the nine coding variables using programming not included in the study sample. Coding discrepancies were discussed and, when needed, resulted in codebook refinement. The final sample was coded in two parts: (a) the first 20% of the sample (<emph>n</emph> = 52 scenes evenly distributed across each series) was randomly selected and coded, achieving an interrater reliability of 0.70 or higher using Cronbach's alpha for each of the nine coding categories (see Table 2); and (b) after coding differences were resolved, the remaining sample was randomly divided among the two coders and independently coded.</p> <p>Table 2 Abridged codebook of autism characteristics in adult and children's programming</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Category</p></th><th align="left"><p>Description</p></th><th align="left"><p>Examples</p></th><th align="left"><p>α</p></th></tr></thead><tbody><tr><td align="left" colspan="4"><p><italic>Difficulties with social communication skills</italic></p></td></tr><tr><td align="left"><p>Difficulties in social-emotional reciprocity</p></td><td align="left"><p>"Deficits in social-emotional reciprocity, ranging, for example from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions."</p></td><td align="left"><p>• Demonstrates emotional states not in sync with others' behavior (e.g., finding something funny/sad when no one else does, vice versa)</p><p>• Difficulty with "complex social cues" provided verbal/non-verbal by others (e.g., difficulty joining, sustaining, and/or ending conversations in terms of timing or what to say; flirting; etc.)</p></td><td char="." align="char"><p>0.72</p></td></tr><tr><td align="left"><p>Difficulties in nonverbal communicative behaviors</p></td><td align="left"><p>"Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication."</p></td><td align="left"><p>• "Eye contact, gestures, facial expressions, body orientation, or speech intonation" (prosody) is absent, reduced, and/or used in an atypical manner (e.g., skills are present, appear rehearsed, scripted, or unnatural)</p><p>• Joint attention is altered, as evidenced "by a lack of pointing, showing, or bringing objects to share interest with others;" failure or difficulty understanding the communicative partner's intent when looking at or pointing to an object, or activity, even for social communication</p></td><td char="." align="char"><p>0.77</p></td></tr><tr><td align="left"><p>Difficulties in social relationships</p></td><td align="left"><p>"Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers."</p></td><td align="left"><p>• Social interest is absent, reduced, or atypical as evidenced by the "rejection of others, passivity, or inappropriate."</p><p>• Difficulties understanding the various ways language can be used to communicate messages (e.g., "irony," "white lies," figurative language, sarcasm, slang, jargon, etc.)</p></td><td char="." align="char"><p>0.71</p></td></tr><tr><td align="left" colspan="4"><p><italic>Restrictive repetitive behaviors </italic></p></td></tr><tr><td align="left"><p>Stereotyped or repetitive behavior</p></td><td align="left"><p>"Stereotyped or repetitive motor movements, use of objects, or speech."</p></td><td align="left"><p>• Uses objects in repetitive ways (e.g., lining up toys, flipping objects)</p><p>• Uses echolalic speech (i.e., immediate or delayed repetition of overhead words</p><p>• Uses stereotypic prosodic patterns (e.g., monotone, sing-songy speech)</p></td><td char="." align="char"><p>0.72</p></td></tr><tr><td align="left"><p>Inflexible or ritualized routines</p></td><td align="left"><p>"Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or non-verbal behavior."</p></td><td align="left"><p>• Strictly adheres to ritualized routines (e.g., travels same way to same place, follows same sequence of steps)</p><p>• Difficulty with novelty</p><p>• Demonstrates rigid thinking pattern (e.g., things are black/white, right/wrong)</p></td><td char="." align="char"><p>0.73</p></td></tr><tr><td align="left"><p>Fixated interests</p></td><td align="left"><p>"Highly restricted, fixated interests that are abnormal in intensity or focus."</p></td><td align="left"><p>• Exhibits strong or persistent attachment to unusual or random items without an apparent emotional connection (e.g., carrying an item around, such as a string; examining a pan)</p><p>• Spends a prolonged amount of time with a perseverative interest (e.g., preoccupied with vacuum cleaners; knowledge of Asian rivers)</p></td><td char="." align="char"><p>0.76</p></td></tr><tr><td align="left"><p>Increased or decreased sensitivity to sensory input</p></td><td align="left"><p>"Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment."</p></td><td align="left"><p>• "Indifferent to pain or temperature" (e.g., wears shorts in winter, doesn't notice they are bleeding, etc.)</p><p>• Extreme or "adverse responses to specific sounds or textures" (e.g., fire alarm, everyone is talking at once, etc.)</p><p>• Excessively smells or touches objects (e.g., running fingers along walls)</p></td><td char="." align="char"><p>0.72</p></td></tr><tr><td align="left"><p><italic>Character valence</italic></p></td><td align="left"><p>The affective quality of a character's personal attributes or traits without explicitly considering their disability within the context of a scene's storyline, including information provided by supporting characters</p></td><td align="left" /><td char="." align="char"><p>0.70</p></td></tr><tr><td align="left"><p>Negative character valence</p></td><td align="left"><p>• Character exhibits undesirable personal attributes or qualities without explicitly considering their autism diagnosis</p><p>• Audience is likely to conclude that the autistic character is someone he or she would not want to interact with, either personally or professionally</p><p>• Social exchanges are moderate to severely awkward disrupting the social interaction within the scene</p></td><td align="left"><p>• Character not attentive or appears uninterested in social interactions</p><p>• Based on social norms, other characters view character's behavior as inappropriate and/or terminate social interaction</p></td><td align="left" /></tr><tr><td align="left"><p>Neutral character valence</p></td><td align="left"><p>• Character is involved in <underline>both</underline> a positive and negative action resulting in a neutral view of the character</p><p>• Character is involved in <underline>neither</underline> a positive nor negative action resulting in a neutral view of the character</p></td><td align="left"><p>• Within the scene, the autistic character is moderately adverse to social interactions disrupting the social exchange; however, later in the scene, displays friendly characteristics in proximity to others</p></td><td align="left" /></tr><tr><td align="left"><p>Positive character valence</p></td><td align="left"><p>• Character exhibits admirable personal attributes or qualities without explicitly considering their autism diagnosis</p><p>• Audience is likely to conclude that the character with autism is someone he or she would want to interact with</p><p>• Character exhibits mildly awkward attributes or qualities without disrupting the social interaction</p></td><td align="left"><p>• Character's behavior may appear awkward; however, supporting characters respond in a positive manner</p><p>• Character's nonverbal communication appears rehearsed, but supporting characters laugh at the joke and continue the social interaction</p></td><td align="left" /></tr><tr><td align="left"><p><italic>Neurodiversity affirming valence</italic></p></td><td align="left"><p>The affective quality associated with how an autistic character navigates differences associated with autism within the context of a scene's storyline, including information provided by supporting characters</p></td><td align="left" /><td char="." align="char"><p>0.73</p></td></tr><tr><td align="left"><p>Negative neurodiversity affirming valence</p></td><td align="left"><p>• Character exhibits difficulty navigating environmental and/or social barriers associated with autism independent of character traits</p><p>• Character negatively copes with barriers associated with autism independent of character traits</p></td><td align="left"><p>• Character is bullied by peers and unsure how to respond</p><p>• Character independently completes the desired action but appears awkward and stuck in a perseverative loop</p><p>• Avoids situations based on perceived difficulty</p></td><td align="left" /></tr><tr><td align="left"><p>Neutral neurodiversity affirming valence</p></td><td align="left"><p>• Character exhibits <underline>neither</underline> a difficulty nor success navigating environmental and/or social barriers associated with autism</p><p>• Character exhibits <underline>both</underline> difficulty and success navigating environmental and/or social barriers associated with autism</p></td><td align="left"><p>• Character attempts to solve a problem but does so in a way that other characters view as inappropriate based on social norms</p><p>• Appropriate for youth to refuse parental guidance as they exhibit increased independence, which may or may not always be appropriate</p></td><td align="left" /></tr><tr><td align="left"><p>Positive neurodiversity affirming valence</p></td><td align="left"><p>• Character successfully navigates environmental and/or social barriers associated with autism independent of character traits</p><p>• Character <underline>does not limit</underline> activity due to characteristics of autism</p><p>• Character positively copes with barriers associated with autism independent of character traits</p></td><td align="left"><p>• Other characters accept and support autistic character; characteristics do not negatively impact interactions</p><p>• Character identifies a problem and attempts to remedy the situation by verbally advocating for others</p></td><td align="left" /></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph> Quoted items are taken directly from the ASD Diagnostic Criteria in Section II of the <emph>DSM-5-TR</emph> (APA, [<reflink idref="bib3" id="ref60">3</reflink>]). Negative character valence was coded as 1, neutral character valence was coded as 2, and positive character valence was coded as 3. Negative neurodiversity affirming valence was coded as 1, neutral neurodiversity affirming valence was coded as 2, and positive neurodiversity affirming valence was coded as 3</p> <hd id="AN0182958582-12">Data Analysis</hd> <p>A variety of descriptive and inferential statistical tests were utilized to identify patterns and determine meaningful differences within the data. Relative frequencies were used to visualize the prevalence with which the seven major characteristics of autism were portrayed by each character within the selected programming sample. To answer the stated research questions, t-tests and repeated measures analysis of variances (ANOVAs) were primarily used to identify significant differences in the portrayal of autism characteristics when examining different contexts (i.e., social communication vs. restrictive repetitive behaviors [RRBs], across television shows, adult vs. child programming, and variations in the valence of character and neurodiversity portrayals). A correlation analysis was utilized to identify the presence and strength of relationships between the frequency with which clinical characteristics were portrayed across the sample.</p> <hd id="AN0182958582-13">Results</hd> <p></p> <hd id="AN0182958582-14">Clinical Characteristics of Autistic Portrayals</hd> <p>The first research question examined how frequently each of the seven major characteristics of autism outlined in the <emph>DSM-5-TR</emph> (APA, [<reflink idref="bib3" id="ref61">3</reflink>]) were portrayed by characters on the autism spectrum. Descriptively, percentages representing the relative frequency with which characters exhibited each of the seven characteristics of autism across the entire sample were calculated by taking the total number of scenes in which characters exhibited a specified characteristic within the sample and dividing by the total number of scenes present within the sample (n = 252; see Table 3). Broadly, autistic characters portrayed difficulties with nonverbal communication skills the most (56%) while sensitivity to sensory stimuli was portrayed the least (12.3%). The prevalence with which each of the seven characteristics of autism were exhibited by the six characters across the entire sample were summed and averaged to create two corresponding frequency means used for analysis. A paired sample t-test indicated that autistic characters portrayed difficulties with social communication skills (<emph>m</emph> = 0.48, <emph>sd</emph> = 0.41) significantly more than RRBs (<emph>m</emph> = 0.22, <emph>sd</emph> = 0.21), <emph>t</emph>(<reflink idref="bib251" id="ref62">251</reflink>) = 10.37, <emph>p</emph> < 0.001 (two-tailed test).</p> <p>Table 3 Prevalence of autistic characteristics exhibited by each character across the sample</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Autistic characteristic</p></th><th align="left" colspan="2"><p>Julia</p></th><th align="left" colspan="2"><p>Carl</p></th><th align="left" colspan="2"><p>Dennis</p></th><th align="left" colspan="2"><p>Max</p></th><th align="left" colspan="2"><p>Sam</p></th><th align="left" colspan="2"><p>Shaun</p></th><th align="left"><p>Characteristic frequency</p></th><th align="left"><p>Characteristic mean</p></th><th align="left"><p>Characteristic standard deviation</p></th></tr><tr><th align="left" /><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left" /><th align="left" /></tr></thead><tbody><tr><td align="left" colspan="16"><p>Social communication skills</p></td></tr><tr><td align="left"><p> Difficulties in social-emotional reciprocity</p></td><td char="." align="char"><p>23.81</p></td><td char="." align="char"><p>5</p></td><td char="." align="char"><p>33.33</p></td><td char="." align="char"><p>15</p></td><td char="." align="char"><p>47.62</p></td><td char="." align="char"><p>10</p></td><td char="." align="char"><p>45.16</p></td><td char="." align="char"><p>14</p></td><td char="." align="char"><p>41.07</p></td><td char="." align="char"><p>23</p></td><td char="." align="char"><p>55.13</p></td><td char="." align="char"><p>43</p></td><td char="." align="char"><p>43.70</p></td><td char="." align="char"><p>0.44<sup>a</sup></p></td><td char="." align="char"><p>0.50</p></td></tr><tr><td align="left"><p> Difficulties in nonverbal communication</p></td><td char="." align="char"><p>57.14</p></td><td char="." align="char"><p>12</p></td><td char="." align="char"><p>46.67</p></td><td char="." align="char"><p>21</p></td><td char="." align="char"><p>76.19</p></td><td char="." align="char"><p>16</p></td><td char="." align="char"><p>61.29</p></td><td char="." align="char"><p>19</p></td><td char="." align="char"><p>44.64</p></td><td char="." align="char"><p>25</p></td><td char="." align="char"><p>61.54</p></td><td char="." align="char"><p>48</p></td><td char="." align="char"><p>56</p></td><td char="." align="char"><p>0.56<sup>b</sup></p></td><td char="." align="char"><p>0.50</p></td></tr><tr><td align="left"><p> Difficulties in social relationships</p></td><td char="." align="char"><p>19.05</p></td><td char="." align="char"><p>4</p></td><td char="." align="char"><p>35.56</p></td><td char="." align="char"><p>16</p></td><td char="." align="char"><p>38.10</p></td><td char="." align="char"><p>8</p></td><td char="." align="char"><p>48.39</p></td><td char="." align="char"><p>15</p></td><td char="." align="char"><p>58.93</p></td><td char="." align="char"><p>33</p></td><td char="." align="char"><p>46.15</p></td><td char="." align="char"><p>36</p></td><td char="." align="char"><p>44.40</p></td><td char="." align="char"><p>0.44<sup>a</sup></p></td><td char="." align="char"><p>0.50</p></td></tr><tr><td align="left" colspan="16"><p>Restrictive repetitive behaviors</p></td></tr><tr><td align="left"><p> Stereotyped behavior</p></td><td char="." align="char"><p>66.67</p></td><td char="." align="char"><p>14</p></td><td char="." align="char"><p>8.89</p></td><td char="." align="char"><p>4</p></td><td char="." align="char"><p>14.29</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>9.67</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>10.71</p></td><td char="." align="char"><p>6</p></td><td char="." align="char"><p>55.13</p></td><td char="." align="char"><p>43</p></td><td char="." align="char"><p>29</p></td><td char="." align="char"><p>0.29<sup>c</sup></p></td><td char="." align="char"><p>0.46</p></td></tr><tr><td align="left"><p> Inflexible or ritualized routines</p></td><td char="." align="char"><p>0</p></td><td char="." align="char"><p>0</p></td><td char="." align="char"><p>35.56</p></td><td char="." align="char"><p>16</p></td><td char="." align="char"><p>14.29</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>32.26</p></td><td char="." align="char"><p>10</p></td><td char="." align="char"><p>30.36</p></td><td char="." align="char"><p>17</p></td><td char="." align="char"><p>25.64</p></td><td char="." align="char"><p>20</p></td><td char="." align="char"><p>26.20</p></td><td char="." align="char"><p>0.26<sup>c</sup></p></td><td char="." align="char"><p>0.44</p></td></tr><tr><td align="left"><p> Fixated interests</p></td><td char="." align="char"><p>4.76</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>20</p></td><td char="." align="char"><p>9</p></td><td char="." align="char"><p>23.81</p></td><td char="." align="char"><p>5</p></td><td char="." align="char"><p>19.35</p></td><td char="." align="char"><p>6</p></td><td char="." align="char"><p>41.07</p></td><td char="." align="char"><p>23</p></td><td char="." align="char"><p>6.41</p></td><td char="." align="char"><p>5</p></td><td char="." align="char"><p>19.40</p></td><td char="." align="char"><p>0.19<sup>c,d</sup></p></td><td char="." align="char"><p>0.40</p></td></tr><tr><td align="left"><p> Sensitivity to sensory input</p></td><td char="." align="char"><p>14.29</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>13.33</p></td><td char="." align="char"><p>6</p></td><td char="." align="char"><p>4.76</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>12.90</p></td><td char="." align="char"><p>4</p></td><td char="." align="char"><p>19.64</p></td><td char="." align="char"><p>11</p></td><td char="." align="char"><p>7.69</p></td><td char="." align="char"><p>6</p></td><td char="." align="char"><p>12.30</p></td><td char="." align="char"><p>0.12<sup>d</sup></p></td><td char="." align="char"><p>0.33</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph> Characteristic means not sharing a common superscript differ at the <emph>p</emph> =.05 level as determined by a Bonferroni post hoc analysis</p> <p>A one-way, repeated measures within-subjects ANOVA incorporating a Huynh–Feldt correction (ε = 0.87) was used to examine comparisons between the seven major autistic characteristics. The prevalence with which each of the seven characteristics of autism were exhibited by the six characters across the entire sample were summed and averaged to create a corresponding frequency mean for each characteristic used for analysis (see Table 3). Results indicate significant differences in the portrayal of autistic characteristics, <emph>F</emph>(5.20, 1305.91) = 36.82, <emph>p</emph> < 0.001, partial η<sups>2</sups> = 0.13. A Bonferroni post hoc test indicates that characters on the autism spectrum exhibited difficulties with nonverbal communication skills (<emph>m</emph> = 0.56, <emph>sd</emph> = 0.50) significantly more than any other characteristics (see Table 3). Subsequent difficulties with social-emotional reciprocity (<emph>m</emph> = 0.44, <emph>sd</emph> = 0.50) and social relationships (<emph>m</emph> = 0.44, <emph>sd</emph> = 0.50) were evident followed by stereotyped behavior (<emph>m</emph> = 0.29, <emph>sd</emph> = 0.46), ritualized routines (<emph>m</emph> = 0.26, <emph>sd</emph> = 0.44), and fixed interests (<emph>m</emph> = 0.19, <emph>sd</emph> = 0.40). Sensitivity to sensory input (<emph>m</emph> = 0.12, <emph>sd</emph> = 0.33) was portrayed significantly less than any other characteristic. Descriptively, some autistic traits were portrayed more frequently than others by individual characters as evidenced by the relative frequency with which the character exhibited the difficulty or behavior (e.g., nonverbal communication difficulties, 76.20%, "Dennis;" stereotyped behavior, 66.70%, "Julia;" difficulties with social relationships, 58.90%, "Sam;" percentages were calculated by dividing the number of scenes in which the character exhibited the skill or behavior by the total number of scenes in which the character was present).</p> <hd id="AN0182958582-15">Co-occurrence of Clinical Characteristics</hd> <p>The second research question asked which of the seven characteristics of autism outlined in the <emph>DSM-5-TR</emph> (APA, [<reflink idref="bib3" id="ref63">3</reflink>]) co-occur in scripted programming. The prevalence with which each of the seven characteristics of autism were exhibited by the six characters across the entire sample were summed and averaged to create a corresponding frequency mean for each characteristic used for analysis. A correlation analysis reveals that portrayals involving difficulties with social-emotional reciprocity were the most prominent, positively correlated with difficulties with nonverbal communication (<emph>r</emph> = 0.57, <emph>p</emph> < 0.001), difficulties with social relationships (<emph>r</emph> = 0.57, <emph>p</emph> < 0.001), stereotyped behavior (<emph>r</emph> = 0.18, <emph>p</emph> = 0.004), ritualized routines (<emph>r</emph> = 0.13, <emph>p</emph> = 0.038), and fixated interests (<emph>r</emph> = 0.15, <emph>p</emph> = 0.014; See Table 4). Character portrayals involving nonverbal communication difficulties were positively correlated with difficulties with social relationships (<emph>r</emph> = 0.47, <emph>p</emph> < 0.001) and stereotyped behavior (<emph>r</emph> = 0.25, <emph>p</emph> < 0.001). Additionally, portrayals involving difficulties with social relationships were positively correlated with ritualized routines (<emph>r</emph> = 0.23, <emph>p</emph> < 0.001) and fixated interests (<emph>r</emph> = 0.17, <emph>p</emph> = 0.008). Stereotyped behavior was negatively correlated with fixated interests (<emph>r</emph> = − 0.16, <emph>p</emph> = 0.011), while fixated interests were positively correlated with sensitivity to sensory input (<emph>r</emph> = 0.18, <emph>p</emph> = 0.004).</p> <p>Table 4 Descriptive statistics and correlations for autistic characteristics</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Variable</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>1</p></th><th align="left"><p>2</p></th><th align="left"><p>3</p></th><th align="left"><p>4</p></th><th align="left"><p>5</p></th><th align="left"><p>6</p></th><th align="left"><p>7</p></th></tr></thead><tbody><tr><td align="left"><p>(1) Difficulties in social-emotional reciprocity</p></td><td char="." align="char"><p>252</p></td><td char="." align="char"><p>–</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>(2) Difficulties in nonverbal communication</p></td><td char="." align="char"><p>252</p></td><td char="." align="char"><p>0.57**</p></td><td char="." align="char"><p>–</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>(3) Difficulties in social relationships</p></td><td char="." align="char"><p>252</p></td><td char="." align="char"><p>0.57**</p></td><td char="." align="char"><p>0.47**</p></td><td char="." align="char"><p>–</p></td><td char="." align="char" /><td char="." align="char" /><td align="left" /><td char="." align="char" /></tr><tr><td align="left"><p>(4) Stereotyped behavior</p></td><td char="." align="char"><p>252</p></td><td char="." align="char"><p>0.18**</p></td><td char="." align="char"><p>0.25**</p></td><td char="." align="char"><p>0.12</p></td><td char="." align="char"><p>–</p></td><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>(5) Inflexible or ritualized routines</p></td><td char="." align="char"><p>252</p></td><td char="." align="char"><p>0.13*</p></td><td char="." align="char"><p>0.11</p></td><td char="." align="char"><p>0.23**</p></td><td char="." align="char"><p>0.04</p></td><td char="." align="char"><p>–</p></td><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p>(6) Fixated interests</p></td><td char="." align="char"><p>252</p></td><td char="." align="char"><p>0.15*</p></td><td char="." align="char"><p>0.03</p></td><td char="." align="char"><p>0.17**</p></td><td char="." align="char"><p>− 0.16*</p></td><td char="." align="char"><p>0.12</p></td><td char="." align="char"><p>–</p></td><td char="." align="char" /></tr><tr><td align="left"><p>(7) Sensitivity to sensory input</p></td><td char="." align="char"><p>252</p></td><td char="." align="char"><p>0.11</p></td><td char="." align="char"><p>0.07</p></td><td char="." align="char"><p>0.03</p></td><td char="." align="char"><p>0.08</p></td><td char="." align="char"><p>− 0.00</p></td><td char="." align="char"><p>0.18**</p></td><td char="." align="char"><p>–</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph> For each characteristic of autism, <emph>n</emph> represents the number of scenes in which the corresponding difficulty or behavior was coded as present or absent *<emph>p</emph> <.05 (2-tailed); **<emph>p</emph> <.01 (2-tailed)</p> <hd id="AN0182958582-16">Impact of Program Type on Clinical Characteristics</hd> <p>Research question three examined variations in the portrayal of autism characteristics outlined in the <emph>DSM-5-TR</emph> (AAP, [<reflink idref="bib3" id="ref64">3</reflink>]) within adult and children's programming. Descriptively, difficulties with nonverbal communication were portrayed the most (56%, adult; 56%, children), while sensitivity to sensory input was portrayed the least (13%, adult; 11.50%, children; see Table 5). Percentages represent the relative frequency with which each characteristic was present in each type of programming and were calculated by dividing the total number of scenes within the entire sample in which the corresponding difficulty or behavior was exhibited by one of the six characters with autism by the total number of scenes featuring characters within each type of programming (see Table 5). The greatest range in frequencies between the two types of programs was evident with difficulties with social relationships (51%, adult; 32%, children) and difficulties with social-emotional reciprocity (48.50%, adult; 34.50%, children). To evaluate statistical differences in the frequency with which each trait was portrayed, two mean scores were created (one for each programming type) by summing and averaging the frequency of occurrence (see Table 5). A one-way, between-subject ANOVA indicated that adult programs (<emph>m</emph> = 0.51, <emph>sd</emph> = 0.50) portrayed difficulties with social relationships significantly more than children's programs (<emph>m</emph> = 0.32, <emph>sd</emph> = 0.47), <emph>F</emph>(<reflink idref="bib1" id="ref65">1</reflink>, 182.46) = 4.72, <emph>p</emph> = 0.031, ω<sups>2</sups> = 0.01 with a Welch's F correction for homogeneity. This trend continued with adult programs (<emph>m</emph> = 0.48, <emph>sd</emph> = 0.50) portraying difficulties with social-emotional reciprocity significantly more than children's programs (<emph>m</emph> = 0.34, <emph>sd</emph> = 0.48), <emph>F</emph>(<reflink idref="bib1" id="ref66">1</reflink>, 185.26) = 8.63, <emph>p</emph> = 0.004, ω<sups>2</sups> = 0.03 using Welch's F. However, no significant differences were found with nonverbal communication, <emph>F</emph>(<reflink idref="bib1" id="ref67">1</reflink>, 250) = 0.01, <emph>p</emph> = 0.932, ω<sups>2</sups> = − 0.004; stereotyped behavior, <emph>F</emph>(<reflink idref="bib1" id="ref68">1</reflink>, 250) = 1.50, <emph>p</emph> = 0.221, ω<sups>2</sups> = 0.002; ritualized behaviors, <emph>F</emph>(<reflink idref="bib1" id="ref69">1</reflink>, 250) = 1.30, <emph>p</emph> = 0.256, ω<sups>2</sups> = 0.001; fixated interests, <emph>F</emph>(<reflink idref="bib1" id="ref70">1</reflink>, 250) = 0.41, <emph>p</emph> = 0.523, ω<sups>2</sups> = -0.002; and sensory sensitivity, <emph>F</emph>(<reflink idref="bib1" id="ref71">1</reflink>, 250) = 0.08, <emph>p</emph> = 0.778, ω<sups>2</sups> = − 0.004.</p> <p>Table 5 Prevalence of autistic characteristics, by programming type</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="4"><p>Adult programming</p></th><th align="left" colspan="4"><p>Children's programming</p></th></tr><tr><th align="left" /><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>Mean</p></th><th align="left"><p><italic>SD</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>Mean</p></th><th align="left"><p><italic>SD</italic></p></th></tr></thead><tbody><tr><td align="left" colspan="9"><p>Social communication skills</p></td></tr><tr><td align="left"><p> Difficulties in social-emotional reciprocity</p></td><td char="." align="char"><p>48.50</p></td><td char="." align="char"><p>80</p></td><td char="." align="char"><p>0.48**</p></td><td char="." align="char"><p>0.50</p></td><td char="." align="char"><p>34.50</p></td><td char="." align="char"><p>30</p></td><td char="." align="char"><p>0.34</p></td><td char="." align="char"><p>0.48</p></td></tr><tr><td align="left"><p> Difficulties in nonverbal communication</p></td><td char="." align="char"><p>55.80</p></td><td char="." align="char"><p>92</p></td><td char="." align="char"><p>0.56</p></td><td char="." align="char"><p>0.50</p></td><td char="." align="char"><p>56.30</p></td><td char="." align="char"><p>49</p></td><td char="." align="char"><p>0.56</p></td><td char="." align="char"><p>0.50</p></td></tr><tr><td align="left"><p> Difficulties in social relationships</p></td><td char="." align="char"><p>50.90</p></td><td char="." align="char"><p>84</p></td><td char="." align="char"><p>0.51*</p></td><td char="." align="char"><p>0.50</p></td><td char="." align="char"><p>32.20</p></td><td char="." align="char"><p>28</p></td><td char="." align="char"><p>0.32</p></td><td char="." align="char"><p>0.47</p></td></tr><tr><td align="left" colspan="9"><p>Restrictive repetitive behaviors</p></td></tr><tr><td align="left"><p> Stereotyped behavior</p></td><td char="." align="char"><p>31.50</p></td><td char="." align="char"><p>52</p></td><td char="." align="char"><p>0.32</p></td><td char="." align="char"><p>0.47</p></td><td char="." align="char"><p>24.10</p></td><td char="." align="char"><p>21</p></td><td char="." align="char"><p>0.24</p></td><td char="." align="char"><p>0.43</p></td></tr><tr><td align="left"><p> Inflexible or ritualized routines</p></td><td char="." align="char"><p>28.50</p></td><td char="." align="char"><p>47</p></td><td char="." align="char"><p>0.28</p></td><td char="." align="char"><p>0.45</p></td><td char="." align="char"><p>21.80</p></td><td char="." align="char"><p>19</p></td><td char="." align="char"><p>0.22</p></td><td char="." align="char"><p>0.42</p></td></tr><tr><td align="left"><p> Fixated interests</p></td><td char="." align="char"><p>20.60</p></td><td char="." align="char"><p>34</p></td><td char="." align="char"><p>0.21</p></td><td char="." align="char"><p>0.41</p></td><td char="." align="char"><p>17.20</p></td><td char="." align="char"><p>15</p></td><td char="." align="char"><p>0.17</p></td><td char="." align="char"><p>0.38</p></td></tr><tr><td align="left"><p> Sensitivity to sensory input</p></td><td char="." align="char"><p>12.70</p></td><td char="." align="char"><p>21</p></td><td char="." align="char"><p>0.13</p></td><td char="." align="char"><p>0.33</p></td><td char="." align="char"><p>11.50</p></td><td char="." align="char"><p>10</p></td><td char="." align="char"><p>0.11</p></td><td char="." align="char"><p>0.32</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph> For each characteristic of autism, <emph>n</emph> represents the number of scenes in which the corresponding difficulty or behavior was exhibited by one of the six characters with autism. Percentages represent the relative frequency with which each characteristic was present within each type of programming and were calculated by dividing <emph>n</emph> by the total number of scenes featuring characters with autism within each type of programming (adult programs, <emph>n</emph> = 165; children's programs, <emph>n</emph> = 87) *p <.05; **p <.01</p> <hd id="AN0182958582-17">Character Valence</hd> <p>To examine character portrayals using a social lens, research question four investigated character valence (a) in scripted programming and (b) in adult versus children's programming. For each program, valence scores for each scene were summed and averaged to create a corresponding frequency mean representing the mean character valence (see Table 6). A one-way, between-subject ANOVA with a Welch's F correction indicates that across programming, character valence differed significantly, <emph>F</emph>(<reflink idref="bib5" id="ref72">5</reflink>, 88.40) = 11.20, <emph>p</emph> < 0.001, ω<sups>2</sups> = 0.03. A Bonferroni post hoc test indicated that "Julia" (<emph>m</emph> = 2.86, <emph>sd</emph> = 0.36), "Carl" (<emph>m</emph> = 2.67, <emph>sd</emph> = 0.71), and "Dennis" (<emph>m</emph> = 2.71, <emph>sd</emph> = 0.56) were portrayed in significantly more positive ways than other characters in the sample (see Table 6). Conversely, <emph>Parenthood'</emph>s portrayal of "Max" (<emph>m</emph> = 1.87, <emph>sd</emph> = 0.92) was the least positive, but significantly comparable to "Sam" (<emph>m</emph> = 2.16, <emph>sd</emph> = 0.78) and "Shaun" (<emph>m</emph> = 2.29, <emph>sd</emph> = 0.72). To determine differences by programming type, character valence scores were summed and averaged creating a corresponding mean, one for each program type. Using an independent t-test, children's programs (<emph>m</emph> = 2.72, <emph>sd</emph> = 0.60) portrayed characters on the autism spectrum with significantly more admirable character traits than adult programming (<emph>m</emph> = 2.17, <emph>sd</emph> = 0.79), <emph>t</emph>(218.73) = 6.20, <emph>p</emph> < 0.001.</p> <p>Table 6 Prevalence of character valence and Bonferroni test differences</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="2"><p>Negative valence</p></th><th align="left" colspan="2"><p>Neutral valence</p></th><th align="left" colspan="2"><p>Positive valence</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th></tr><tr><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left" /><th align="left" /></tr></thead><tbody><tr><td align="left"><p>Series</p></td><td char="." align="char" /><td char="." align="char" /><td align="left" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /><td char="." align="char" /></tr><tr><td align="left"><p><italic> Sesame Street</italic></p></td><td char="." align="char"><p>0</p></td><td char="." align="char"><p>0</p></td><td char="." align="char"><p>14.30</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>85.70</p></td><td char="." align="char"><p>18</p></td><td char="." align="char"><p>2.86<sup>a</sup></p></td><td char="." align="char"><p>0.36</p></td></tr><tr><td align="left"><p><italic> Dinosaur Train</italic></p></td><td char="." align="char"><p>4.80</p></td><td char="." align="char"><p>1</p></td><td char="." align="char"><p>19</p></td><td char="." align="char"><p>4</p></td><td char="." align="char"><p>76.20</p></td><td char="." align="char"><p>16</p></td><td char="." align="char"><p>2.71<sup>a,b</sup></p></td><td char="." align="char"><p>0.56</p></td></tr><tr><td align="left"><p><italic> Arthur</italic></p></td><td char="." align="char"><p>13.30</p></td><td char="." align="char"><p>6</p></td><td char="." align="char"><p>6.70</p></td><td char="." align="char"><p>3</p></td><td char="." align="char"><p>80</p></td><td char="." align="char"><p>36</p></td><td char="." align="char"><p>2.67<sup>a,c</sup></p></td><td char="." align="char"><p>0.71</p></td></tr><tr><td align="left"><p><italic> The Good Doctor</italic></p></td><td char="." align="char"><p>15.40</p></td><td char="." align="char"><p>12</p></td><td char="." align="char"><p>39.70</p></td><td char="." align="char"><p>31</p></td><td char="." align="char"><p>44.90</p></td><td char="." align="char"><p>35</p></td><td char="." align="char"><p>2.29<sup>b,c,e</sup></p></td><td char="." align="char"><p>0.72</p></td></tr><tr><td align="left"><p><italic> Atypical</italic></p></td><td char="." align="char"><p>23.20</p></td><td char="." align="char"><p>13</p></td><td char="." align="char"><p>37.50</p></td><td char="." align="char"><p>21</p></td><td char="." align="char"><p>39.30</p></td><td char="." align="char"><p>22</p></td><td char="." align="char"><p>2.16<sup>e</sup></p></td><td char="." align="char"><p>0.78</p></td></tr><tr><td align="left"><p><italic> Parenthood</italic></p></td><td char="." align="char"><p>48.40</p></td><td char="." align="char"><p>15</p></td><td char="." align="char"><p>16.10</p></td><td char="." align="char"><p>5</p></td><td char="." align="char"><p>35.50</p></td><td char="." align="char"><p>11</p></td><td char="." align="char"><p>1.87<sup>e</sup></p></td><td char="." align="char"><p>0.92</p></td></tr><tr><td align="left" colspan="9"><p>Program type</p></td></tr><tr><td align="left"><p> Adult</p></td><td char="." align="char"><p>24.20</p></td><td char="." align="char"><p>40</p></td><td char="." align="char"><p>34.50</p></td><td char="." align="char"><p>57</p></td><td char="." align="char"><p>41.20</p></td><td char="." align="char"><p>68</p></td><td char="." align="char"><p>2.17</p></td><td char="." align="char"><p>0.79</p></td></tr><tr><td align="left"><p> Children's</p></td><td char="." align="char"><p>8</p></td><td char="." align="char"><p>7</p></td><td char="." align="char"><p>11.50</p></td><td char="." align="char"><p>10</p></td><td char="." align="char"><p>80.50</p></td><td char="." align="char"><p>70</p></td><td char="." align="char"><p>2.72</p></td><td char="." align="char"><p>0.60</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph> Programs are ranked from most positive (top) to least positive (bottom). Means not sharing a common superscript differ at the <emph>p</emph> =.05 level for the Bonferroni test. For each valence rating, <emph>n</emph> represents the number of scenes within the show sub-sample in which the corresponding valence rating was observed. Percentages represent the relative frequency with which each valence rating was present within each show sub-sample and were calculated by dividing <emph>n</emph> by the total number of scenes featuring the show's character in the sample (see Table 1)</p> <hd id="AN0182958582-18">Neurodiversity Affirming Valence</hd> <p>The last research question examined neurodiversity affirming valence (a) in scripted programming and (b) in adult versus children's programming pertaining to the social model of disability. The majority of programs portrayed characters navigating autism in neutral or positive ways (90.50%, "Julia;" 81.90%, "Dennis;" 75.50%, "Carl;" 75.40%, "Shaun;" and 71.40%, "Sam;" see Table 7). Percentages represent the relative frequency with which each valence rating was present within each show and were calculated by dividing the total number of scenes within the show in which the corresponding valence rating was observed by the total number of scenes featuring the show's character in the sample. For each program, valence scores for each scene were summed and averaged to create a corresponding frequency mean representing the mean neurodiversity affirming valence. Using a one-way, between-subjects ANOVA with a Welch's F correction, findings show that neurodiversity affirming valence differed significantly between programs, <emph>F</emph>(<reflink idref="bib5" id="ref73">5</reflink>, 82.68) = 5.55, <emph>p</emph> < 0.001, ω<sups>2</sups> = 0.02. A Bonferroni post hoc test indicates that although there are statistically significant differences between programs, many programs were statistically comparable (see Table 7). In other words, the neurodiversity affirming valence of "Julia" (<emph>m</emph> = 2.71, <emph>sd</emph> = 0.64) was statistically comparable to "Carl" (<emph>m</emph> = 2.38, <emph>sd</emph> = 0.86), "Dennis" (<emph>m</emph> = 2.43, <emph>sd</emph> = 0.81), and "Shaun" (<emph>m</emph> = 2.17, <emph>sd</emph> = 0.81), which were all significantly higher than "Sam" (<emph>m</emph> = 1.95, <emph>sd</emph> = 0.72), and "Max" (<emph>m</emph> = 1.84, <emph>sd</emph> = 0.93). To evaluate differences in programming type, neurodiversity affirming valence was summed and averaged creating two corresponding means, one for each program type. An independent t-test showed that children's programming (<emph>m</emph> = 2.47, <emph>sd</emph> = 0.81) depicted characters navigating autism in significantly more positive ways than adult programming (<emph>m</emph> = 2.03, <emph>sd</emph> = 0.82), <emph>t</emph>(<reflink idref="bib250" id="ref74">250</reflink>) = 4.10, <emph>p</emph> < 0.001.</p> <p>Table 7 Prevalence of neurodiversity affirming valence and Bonferroni test differences</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Negative valence</p></th><th align="left" colspan="2"><p>Neutral valence</p></th><th align="left" colspan="2"><p>Positive valence</p></th><th align="left"><p>Mean</p></th><th align="left"><p>SD</p></th></tr><tr><th align="left"><p>Series</p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left"><p>%</p></th><th align="left"><p><italic>n</italic></p></th><th align="left" /><th align="left" /></tr></thead><tbody><tr><td align="left"><p><italic>Sesame Street</italic></p></td><td char="." align="char"><p>9.50</p></td><td char="." align="char"><p>2</p></td><td char="." align="char"><p>9.50</p></td><td char="." align="char"><p>2</p></td><td char="." align="char"><p>81</p></td><td char="." align="char"><p>17</p></td><td char="." align="char"><p>2.71<sup>a</sup></p></td><td char="." align="char"><p>0.64</p></td></tr><tr><td align="left"><p><italic>Arthur</italic></p></td><td char="." align="char"><p>24.40</p></td><td char="." align="char"><p>11</p></td><td char="." align="char"><p>13.30</p></td><td char="." align="char"><p>6</p></td><td char="." align="char"><p>62.20</p></td><td char="." align="char"><p>28</p></td><td char="." align="char"><p>2.38<sup>a,b</sup></p></td><td char="." align="char"><p>0.86</p></td></tr><tr><td align="left"><p><italic>Dinosaur Train</italic></p></td><td char="." align="char"><p>19</p></td><td char="." align="char"><p>4</p></td><td char="." align="char"><p>19</p></td><td char="." align="char"><p>4</p></td><td char="." align="char"><p>61.90</p></td><td char="." align="char"><p>13</p></td><td char="." align="char"><p>2.43<sup>a,c</sup></p></td><td char="." align="char"><p>0.81</p></td></tr><tr><td align="left"><p><italic>The Good Doctor</italic></p></td><td char="." align="char"><p>25.60</p></td><td char="." align="char"><p>20</p></td><td char="." align="char"><p>32.10</p></td><td char="." align="char"><p>25</p></td><td char="." align="char"><p>42.30</p></td><td char="." align="char"><p>33</p></td><td char="." align="char"><p>2.17<sup>a,d,e</sup></p></td><td char="." align="char"><p>0.81</p></td></tr><tr><td align="left"><p><italic>Atypical</italic></p></td><td char="." align="char"><p>28.60</p></td><td char="." align="char"><p>16</p></td><td char="." align="char"><p>48.20</p></td><td char="." align="char"><p>27</p></td><td char="." align="char"><p>23.20</p></td><td char="." align="char"><p>13</p></td><td char="." align="char"><p>1.95<sup>b,c,e,f</sup></p></td><td char="." align="char"><p>0.72</p></td></tr><tr><td align="left"><p><italic>Parenthood</italic></p></td><td char="." align="char"><p>51.60</p></td><td char="." align="char"><p>16</p></td><td char="." align="char"><p>12.90</p></td><td char="." align="char"><p>4</p></td><td char="." align="char"><p>35.50</p></td><td char="." align="char"><p>11</p></td><td char="." align="char"><p>1.84<sup>b,c,d,f</sup></p></td><td char="." align="char"><p>0.93</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note</emph> Programs are ranked from most positive (top) to least positive (bottom). Means not sharing a common superscript differ at the <emph>p</emph> =.05 level for the Bonferroni test. For each valence rating, <emph>n</emph> represents the number of scenes within the show sub-sample in which the corresponding valence rating was observed. Percentages represent the relative frequency with which each valence rating was present within each show sub-sample and were calculated by dividing <emph>n</emph> by the total number of scenes featuring the show's character in the sample (see Table 1)</p> <hd id="AN0182958582-19">Discussion</hd> <p>Entertainment television programming provides a popular vehicle transmitting health-related information across society. The ways in which individuals with disabilities are portrayed teach, challenge, and reinforce audience knowledge about disabilities. Moreso, programming helps shift societal attitudes creating more accessible environments for those with disabilities (Jones et al., [<reflink idref="bib16" id="ref75">16</reflink>]; WHO, [<reflink idref="bib37" id="ref76">37</reflink>]). Included in this, the introduction of dynamic autistic characters and storylines sparks public awareness and conversations about autism (e.g., Stahl, [<reflink idref="bib31" id="ref77">31</reflink>]). However, little is known about the degree to which characters on the autism spectrum, often played by neurotypical actors, authentically portray the condition in adult and children's television programming.</p> <p>Based on the medical model of disability, the current study found that characters on the autism spectrum exhibited all seven major features of autism with varying frequency. Characters met the <emph>DSM-5-TR</emph>'s diagnostic criteria, which stipulates that, at a minimum, individuals diagnosed with autism must exhibit persistent difficulties with all three types of social communication and three of the four behavioral characteristics (APA, [<reflink idref="bib3" id="ref78">3</reflink>]). The creation of well-developed autistic characters who interact with their environment in socially and behaviorally diverse ways presents television audiences with opportunities to learn more about how individuals with autism navigate daily life. Currently data regarding the prevalence of each characteristic of autism is not available within the clinical literature; however, characters in the sample portrayed difficulties with social communication skills significantly more than behavioral characteristics. While it is possible that behavioral characteristics (e.g., hand flapping, lining up objects, covering ears in loud environments) may be easier to convey visually and without explanation within storylines, the dialogue driven nature of television narratives may make embedding social communication differences within interpersonal interactions and conversations a natural medium to portray autism traits.</p> <p>Although some autism traits were more correlated than others within the sample, overall results suggest that character development was more dynamic and complex than the amplification of a few characteristics, thereby oversimplifying the lived experiences of individuals on the autism spectrum. Thus, each autistic character in the study is heterogeneous, uniquely illustrating the sentiment coined by Stephen Shore, "If you've met one person with autism, you've met one person with autism" (Flannery & Wisner-Carlson, [<reflink idref="bib11" id="ref79">11</reflink>], p. 319). By presenting diverse characters on the autism spectrum, television shows provide audiences with opportunities to expand their knowledge about autism. Considering that television programming is equally effective as health lectures in teaching audiences about autism (Stern & Barnes, [<reflink idref="bib32" id="ref80">32</reflink>]), the authenticity of dynamic and complex portrayals of autism potentially plays a critical role in correcting misconceptions, lowering stigma, adjudicating stereotypes (e.g., geniuses, savant-like skills), and increasing positive attitudes and social interest (Belcher & Maich, [<reflink idref="bib4" id="ref81">4</reflink>]; Jones et al., [<reflink idref="bib16" id="ref82">16</reflink>]). Thus, when mass media content presents audiences with diverse character portrayals, audiences may develop a more comprehensive understanding of autism.</p> <p>Current findings indicate that adult programming highlighted difficulties with social relationships and social-emotional reciprocity significantly more than children's programming. One possible reason for such programming differences may be related to addressing specific audience needs. Adult programming tends to concentrate on storylines involving interpersonal interactions, conversations, and relationships while children's programming utilizes action sequences, special effects, and music to increase viewer attention and comprehension (Calvert et al., [<reflink idref="bib7" id="ref83">7</reflink>]). Considering that young audiences are in the process of developing language and social pragmatic skills themselves and are less attentive to the dialogic features of television programming, portrayals of social difficulties may be too nuanced for children to fully recognize or understand, let alone associate with autism. Thus, children's programming may elect to focus less on difficulties with social relationships and social-emotional reciprocity compared to adult programming.</p> <p>For character valence, the majority of television programs in the sample portrayed characters on the autism spectrum positively. It is possible that by depicting complex characters who experience the concerns and desires of today's youth (e.g., peer acceptance, job success, altruism, pursuing a romantic partner, etc.), storylines avoided depicting disability stereotypes (e.g., the sweet innocent, avenger, all-knowing sage, etc.). Furthermore, character valence was significantly more positive among children's rather than adult programming. This was an expected finding considering the prosocial nature of children's programming, which has been shown to increase prosocial behavior among young viewers (Zielinska & Chambers, [<reflink idref="bib38" id="ref84">38</reflink>]). For instance, "Julia" and her storylines were developed to "foster greater empathy and understanding," necessary to achieve public acceptance of individuals on the autism spectrum (Sesame Workshop, [<reflink idref="bib29" id="ref85">29</reflink>], October 4, para. 6) – an important goal since most children exhibited positive attitudes towards those with disabilities, but only half reported friendships with peers having a disability (Dyson, [<reflink idref="bib9" id="ref86">9</reflink>]). Theoretically speaking, positive character valence may help audiences, particularly young ones, establish and maintain the social attraction needed to adopt prosocial and health-related messaging (Moyer-Gusé, [<reflink idref="bib18" id="ref87">18</reflink>]). When characters on the autism spectrum are fully developed and not solely defined by their autism, it is possible that audiences are more likely to develop increased levels of perceived similarity and social attraction necessary for message adoption, thereby fostering the development of positive attitudes towards autistic individuals (Moyer-Gusé, [<reflink idref="bib18" id="ref88">18</reflink>]; Stern & Barnes, [<reflink idref="bib32" id="ref89">32</reflink>]).</p> <p>In terms of neurodiversity affirming valence, most programs within the sample portrayed characters on the autism spectrum in positive and neutral ways, a marked improvement from the findings of Warzak et al. ([<reflink idref="bib34" id="ref90">34</reflink>]). Considering that television programs offer audiences an unintrusive, yet intimate look at how autism impacts different people in different ways within daily life (i.e., viewers get to be a fly on the wall), it is possible that positive disability portrayals may encourage viewers to seek support services (e.g., diagnostic, therapeutic, educational, recreational, etc.). Although such a media outcome has not yet been studied, Stern and Barnes ([<reflink idref="bib32" id="ref91">32</reflink>]) found that compared to health-oriented lectures, narrative stories not only teach viewers about autism, but elicit greater audience interest in learning more. Conversely, the exclusion of negative storylines may be counterintuitive to the natural arc of storytelling as they can oversimplify or sugar coat the authentic experiences of individuals on the autism spectrum in false and unsustainable ways (Ellis & Goggin, [<reflink idref="bib10" id="ref92">10</reflink>]). The creation of authentic and diverse television characters reflecting the lived experiences of autistic individuals navigating the human experience (e.g., sense of belonging, feeling self-conscious, masking, hiding perceived differences, etc.) can likely resonate with neurotypical and neurodivergent audiences alike. This may even be applicable to characters who appear to be on the autism spectrum but who's diagnoses are not explicitly stated within the storyline (e.g., "Sheldon" from <emph>The Big Bang Theory</emph>/<emph>Young Sheldon</emph>, "Saga" from <emph>The Bridge</emph>). Consequently, television programming has the power to encourage audiences to become allies, reject harmful messages and stereotypes, and better understand ableist barriers in need of rectifying (Ellis & Goggin, [<reflink idref="bib10" id="ref93">10</reflink>]). To accomplish these goals, it is critical that autistic portrayals authentically intertwine health-related information concerning the characteristics of autism (e.g., medical model of disability), with environmental (e.g., barriers or accessibility supports) and personal factors (e.g., motivation, self-esteem, etc.) associated with the social model of disability (WHO, [<reflink idref="bib37" id="ref94">37</reflink>]).</p> <p>The inclusion and representation of authentic portrayals of characters on the spectrum is critical beyond a public health perspective, and audiences are willing to financially advocate for it. Forty-eight percent of U.S. audiences surveyed support the inclusion of authentic disability portrayals, and roughly 43% would subscribe to a content provider committed to supporting both characters and actors with disabilities to the tune of $10.4 billion in provider subscriptions (Nissim, [<reflink idref="bib20" id="ref95">20</reflink>]). Such evidence may indicate that audiences have developed cognitive and emotional connections to authentic portrayals of characters with disabilities as the number of such portrayals steadily increases (GLAAD, [<reflink idref="bib13" id="ref96">13</reflink>]). Theoretically, it is possible that audiences who regularly tune in to watch popular programs featuring authentic representations of autism may exhibit perceived similarity and social attraction to such characters, leading to reduced audience resistance to embedded health messages about autism, thereby increasing social acceptance as they are more willing to financially support such programming (Moyer-Gusé, [<reflink idref="bib18" id="ref97">18</reflink>]). Although the present study only examined the authenticity of portrayals involving characters on the autism spectrum, and not audience outcomes related to such portrayals, these findings shed light on the fictional portrayals underscoring recent research showing the positive impact these characters have on audience attitudes and interest regarding autistic individuals (e.g., Stern & Barnes, [<reflink idref="bib32" id="ref98">32</reflink>]).</p> <p>The present study may offer the entertainment industry guidance, informing future character and story development within the context of expanded diversity initiatives. As the inclusion and representation of individuals on the autism spectrum grows and evolves, shows are featuring a greater diversity of autistic characters who are representative of the larger autism community. This growth includes historically marginalized communities reflective of race/ethnicity (e.g., "Max", <emph>Daniel Tiger's Neighborhood; "</emph>BeBe", <emph>The Proud Family: Louder and Prouder</emph>), sexual orientation (e.g., "Nicholas", <emph>Everything's Gonna Be Okay</emph>), the need for varying levels of support (e.g., "Renee," who is non-speaking, <emph>Loop</emph>), and roles for autistic actors across genres (e.g., reality shows, <emph>Autism in Love</emph>). Public focus has also shifted beyond what is seen on the small screen. Individuals on the autism spectrum play vital, yet unrecognized, roles throughout all aspects of media production, where they can cultivate and reshape disability narratives (Ellis & Goggin, [<reflink idref="bib10" id="ref99">10</reflink>]). However, the majority of writers' rooms lack disabled writers, resulting in diminished opportunities to fully capture the richness and diversity of authentic representations within storylines (Think Tank for Inclusion & Equity, [<reflink idref="bib33" id="ref100">33</reflink>]).</p> <hd id="AN0182958582-20">Limitations</hd> <p>While the current study revealed some interesting results, several notable limitations should be taken into consideration when interpreting and generalizing findings. First, considering the limited number of autistic characters on television, the sample contained only six predominantly male characters with strong verbal language skills. The sample underrepresents characters on the autism spectrum who are female, non-speaking, experiencing co-occurring difficulties (e.g., anxiety, attention deficit hyperactivity disorder, intellectual disabilities, etc.), or, in the case of human characters, from a variety of backgrounds (e.g., racial/ethnic, LGBTQIA+) thus limiting the generalization of findings to broader media depictions.</p> <p>Additionally, although the development of a codebook based on the <emph>DSM-5-TR</emph> (APA, [<reflink idref="bib3" id="ref101">3</reflink>]) provided coders a comprehensive observational guide, the <emph>DSM-5-TR</emph> is not a diagnostic tool in and of itself and only provides conceptual definitions of each of the seven characteristics of autism. Therefore, coders were confined by the degree to which operational definitions could be clarified within the codebook without inadvertently changing the fundamental definition of ASD. Such a limitation is acknowledged within the <emph>DSM-5-TR</emph>, which states that, "diagnostic criteria are offered as guidelines for making diagnoses, and their use should be informed by clinical judgment" (APA, [<reflink idref="bib3" id="ref102">3</reflink>], p. 21). Given that autism is a highly heterogeneous condition (APA, [<reflink idref="bib3" id="ref103">3</reflink>]), an individual's surrounding environment may either minimize or adversely impact observable characteristics of autism (e.g., the social model of disability). Thus, coders employed latent coding in which the context of scenes influenced coding decisions, thereby increasing coding subjectivity.</p> <hd id="AN0182958582-21">Future Research</hd> <p>The current study lays the foundation for future research exploring the quality of media-based autistic character portrayals and the subsequent impact such portrayals have on audiences. Specifically, as programming becomes more inclusive and audiences are exposed to more diverse portrayals in which autistic people live full and successful lives, it is critical to consider the authenticity of fictional television characters on the autism spectrum given the role mass media plays in educating the public about autism. Furthermore, studies shedding light on the evolution of autistic portrayals over time and how such portrayals mirror changes in diagnostic criteria, legal protections, social inclusivity, and so on may help inform the development of more authentic representations free of ableism not only in the United States but globally. By limiting the sampling time frame from 2007 to 2017, authors provide future researchers the opportunity to continue this line of research using not only newer character portrayals as they become available but to expand upon this work as discussions of diagnostic criteria within the neurodiversity movement evolve. In extending this research stream, it is imperative that future research focuses on understanding how diverse autistic character portrayals impact changes in audience knowledge, attitudes, and behavior (i.e., media processing and effects). Such interdisciplinary research aims have the potential to benefit entertainment, public health, and clinical professionals alike in supporting both neurotypical and neurodiverse audiences as they make decisions about locating and accessing autism resources within their community; a growing need as the number of autism diagnoses continues to rise (CDC, 2023). Lastly, and most importantly, future research on these topics would benefit from input from the autism community, particularly in the development of prosocial programming and the role autistic characters play in shaping a neurodiverse affirming society.</p> <hd id="AN0182958582-22">Author Contributions</hd> <p>All authors contributed to the study conception and design. Material preparation, data collection and analysis were primarily performed by Willow Sauermilch and Michelle Ivey with input from Eric Rasmussen and Christina Najera. The first draft of the manuscript was written by Willow Sauermilch and all authors commented on and contributed to previous versions of the manuscript. All authors read and approved the final manuscript.</p> <hd id="AN0182958582-23">Declarations</hd> <p></p> <hd id="AN0182958582-24">Competing Interests</hd> <p>The authors report there are no competing interests, financial or non-financial, to declare.</p> <hd id="AN0182958582-25">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0182958582-26"> <title> References </title> <blist> <bibl id="bib1" idref="ref12" type="bt">1</bibl> <bibtext> American Psychiatric Association. (2013). Autism spectrum disorder. 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  Data: Examining the Authenticity of Autistic Portrayals in US Adult and Children's Television Shows Using Medical and Social Models of Disability
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  Data: <searchLink fieldCode="AR" term="%22Willow+S%2E+Sauermilch%22">Willow S. Sauermilch</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-4625-886X">0000-0003-4625-886X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Michelle+L%2E+Ivey%22">Michelle L. Ivey</searchLink> (ORCID <externalLink term="http://orcid.org/0009-0001-4982-2035">0009-0001-4982-2035</externalLink>)<br /><searchLink fieldCode="AR" term="%22Eric+E%2E+Rasmussen%22">Eric E. Rasmussen</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-4432-9348">0000-0002-4432-9348</externalLink>)<br /><searchLink fieldCode="AR" term="%22Christina+J%2E+Najera%22">Christina J. Najera</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-7547-5903">0000-0002-7547-5903</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(2):524-539.
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  Data: 10.1007/s10803-023-06215-z
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  Data: Television programs have introduced viewers to characters on the autism spectrum (e.g., "Sesame Street," "The Good Doctor"), impacting audiences' knowledge and attitudes. Thus, it is essential that character representations convey accurate health information. This study explores how autistic portrayals across six adult and children's television programs align with the medical (e.g., American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 5th ed., text rev., 2022, https://doi.org/10.1176/appi.books.9780890425787) and social models of disability. A content analysis methodology was used to investigate defining characteristics of autism (i.e., medical model) and how characters navigated their environment (i.e., social model) in 252 scenes (across six characters in 22 episodes). Measures included the frequency with which autism characteristics (e.g., social-communicative difficulties, restrictive repetitive behaviors) were present across autistic portrayals and the valence (e.g., positive, negative, neutral) with which characters interacted with their environment (e.g., character and neurodiversity affirming valence). Findings indicate that (a) television portrayals depict social-communication difficulties significantly more than behavioral characteristics, (b) children's programming portrays autistic characters with significantly more positive personal attributes (i.e., character valence) than adult programs, and (c) the majority of programs portray characters navigating autism in positive or neutral ways (i.e., neurodiversity affirming valence). Results offer stakeholders (e.g., writers, advocates, neurodiverse community) insight into how autistic characters are portrayed on television, adding to a growing body of literature examining how such representations impact public knowledge, attitudes, and behaviors towards individuals on the autism spectrum. Collectively, such studies highlight how changes in diagnostic criteria, legal protections, and social inclusivity are presented to viewers, who are seeking entertainment but gaining public health information.
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        PageCount: 16
        StartPage: 524
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Television Viewing
        Type: general
      – SubjectFull: Programming (Broadcast)
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      – TitleFull: Examining the Authenticity of Autistic Portrayals in US Adult and Children's Television Shows Using Medical and Social Models of Disability
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