School Participation in Autistic Girls and Boys: The Role of Social-Communication Abilities and Extrinsic Barriers
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| Title: | School Participation in Autistic Girls and Boys: The Role of Social-Communication Abilities and Extrinsic Barriers |
|---|---|
| Language: | English |
| Authors: | Adeline Lacroix (ORCID |
| Source: | Autism: The International Journal of Research and Practice. 2026 30(5):1242-1262. |
| Availability: | SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com |
| Peer Reviewed: | Y |
| Page Count: | 21 |
| Publication Date: | 2026 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Autism Spectrum Disorders, Early Adolescents, Children, Executive Function, Interpersonal Communication, Interpersonal Relationship, Interpersonal Competence, Student Participation, Barriers, Gender Differences, Intellectual Disability, Environmental Influences, Perceptual Impairments, Teacher Attitudes, Peer Relationship, Attitudes toward Disabilities, Foreign Countries, Age Differences, Behavior Problems, Comorbidity |
| Geographic Terms: | France |
| DOI: | 10.1177/13623613261428668 |
| ISSN: | 1362-3613 1461-7005 |
| Abstract: | This study aimed to offer a depiction and comprehensive understanding of school participation in autistic youth, which has received limited exploration. Parents of 871 autistic youth aged 7 or 15 were invited to participate in a study, among whom 600 agreed, allowing data collection on diagnosis, comorbidities, school, professional support, and parental characteristics. They were asked to fill in questionnaires assessing executive functions, social-communication difficulties, and school participation, completed by 241. Structural equation modeling and descriptive methods were employed to examine factors influencing school participation and the desire for change. Social-communication abilities stand out as the sole intrinsic determinant associated with school participation. Being a female and having an intellectual disability might negatively impact mainstream school attendance, without exerting a similar influence on activity attendance and involvement. Caregivers identified school demands and the sensory environment as extrinsic barriers to school participation, while teachers' attitudes and peer relationships were seen as both potential barriers and facilitators. Finally, 36%-58% indicated a desire for increased participation in at least one school activity. Our findings highlight the need to reduce stigma around autism, improve school support, and give special consideration to the schooling experiences of autistic girls. |
| Abstractor: | As Provided |
| Notes: | https://osf.io/h6wb9/overview |
| Entry Date: | 2026 |
| Accession Number: | EJ1503270 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwFHqCIcGepBW3HE_bD0BGfqAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDCz7A74110os3utxpwIBEICBmgELOfyjzhk6hqdlA_ckG5s5Mp6MHou_I0dUfN9Y38D2NgsqTA2hguYwBAqP99oVEuiTaug-BkzCMEfYZZ7m7Nvk68cOOl_Wto7yTCT1Floq5F82lpY5Y_m3VDOdpHvhYdHYBDB2xzEQv1-GKUjMaCxBGnVDUgjrVY-M07I7U90G8TnadSBVYJQ5XThEKu9WXVn8axUQIL1p2nQ= Text: Availability: 1 Value: <anid>AN0193059426;f9d01may.26;2026Apr20.02:44;v2.2.500</anid> <title id="AN0193059426-1">School participation in autistic girls and boys: The role of social-communication abilities and extrinsic barriers </title> <p>This study aimed to offer a depiction and comprehensive understanding of school participation in autistic youth, which has received limited exploration. Parents of 871 autistic youth aged 7 or 15 were invited to participate in a study, among whom 600 agreed, allowing data collection on diagnosis, comorbidities, school, professional support, and parental characteristics. They were asked to fill in questionnaires assessing executive functions, social-communication difficulties, and school participation, completed by 241. Structural equation modeling and descriptive methods were employed to examine factors influencing school participation and the desire for change. Social-communication abilities stand out as the sole intrinsic determinant associated with school participation. Being a female and having an intellectual disability might negatively impact mainstream school attendance, without exerting a similar influence on activity attendance and involvement. Caregivers identified school demands and the sensory environment as extrinsic barriers to school participation, while teachers' attitudes and peer relationships were seen as both potential barriers and facilitators. Finally, 36%–58% indicated a desire for increased participation in at least one school activity. Our findings highlight the need to reduce stigma around autism, improve school support, and give special consideration to the schooling experiences of autistic girls. School participation factors in autism have received limited attention. We examined this question using structural equation modeling and descriptive methods. Our findings indicate that heightened social-communication difficulties, rather than executive dysfunctions and comorbidities, are associated with decreased school participation of autistic youths. Furthermore, exploratory analyses showed that being female and having an intellectual disability negatively affect attending mainstream school for autistic children and teenagers, but not their attendance and involvement in school activities. Caregivers point out school demands, sensory environment, and teachers' and peers' attitudes as major factors affecting participation, often expressing a desire for increased participation for their child. These results hold significant implications for improving educational environments for autistic girls and boys.</p> <p>Keywords: autism; autistic behaviors; executive functions; participation; school; SEM; sex differences; structural equation modeling</p> <hd id="AN0193059426-2">Introduction</hd> <p>Autism spectrum disorders ([<reflink idref="bib3" id="ref1">3</reflink>]), hereafter referred to as autism ([<reflink idref="bib15" id="ref2">15</reflink>]; [<reflink idref="bib60" id="ref3">60</reflink>]), are characterized by social-communication challenges, specific interests, stereotyped behaviors, and atypical sensory profiles ([<reflink idref="bib50" id="ref4">50</reflink>]). Autism frequently co-occurs with other conditions, including intellectual disability (ID), attention-deficit hyperactivity disorder (ADHD), anxiety, sleep disorders, epilepsy, and challenging behaviors ([<reflink idref="bib75" id="ref5">75</reflink>]). Challenging behaviors are defined as behaviors that compromise the physical safety of the individual or others or that restrict access to community settings ([<reflink idref="bib32" id="ref6">32</reflink>]). This combination of autism characteristics and co-occurring conditions can result in difficulties with school participation, influenced by both these challenges and environmental factors that may not adequately accommodate individuals' specific needs.</p> <p>Participation is a broad concept with no universal definition ([<reflink idref="bib54" id="ref7">54</reflink>]). Nevertheless, participation, and therefore school participation (i.e. participation within mainstream or specialized school settings), is consistently recognized to encompass both attendance and involvement components ([<reflink idref="bib54" id="ref8">54</reflink>], [<reflink idref="bib55" id="ref9">55</reflink>]). Attendance refers to the frequency of attending a life situation, while involvement pertains to the quality of the experience during attendance and is related to engagement ([<reflink idref="bib54" id="ref10">54</reflink>], [<reflink idref="bib55" id="ref11">55</reflink>]). Furthermore, the operationalization of participation varies significantly. In a review of 25 studies, [<reflink idref="bib54" id="ref12">54</reflink>] identified 38 different measures for assessing participation, some published and others developed for specific research purposes. Several scales focus on one aspect of participation only. For example, the child and adolescent scale of participation (CASP—[<reflink idref="bib11" id="ref13">11</reflink>]) evaluates attendance in specific activities (e.g. "educational activities") through parental reports. Other tools attempt to capture both attendance and involvement dimensions of participation, such as the Children Participation Questionnaire–School (CPQ-School - [<reflink idref="bib90" id="ref14">90</reflink>]) and the Participation and Environment Measure for Children and Youth (PEM-CY) questionnaire ([<reflink idref="bib25" id="ref15">25</reflink>]), both of which gather information from parents about their children's participation in home, school, and community activities.</p> <p>School participation is closely related to school inclusion ([<reflink idref="bib74" id="ref16">74</reflink>]), which is defined as integrating all students into general education with practices tailored to ensure equitable learning experiences. Recognized as fundamental human rights ([<reflink idref="bib104" id="ref17">104</reflink>]; [<reflink idref="bib107" id="ref18">107</reflink>]), school inclusion and participation, along with social-communication skills, have been shown to mediate the link between diagnostic status (i.e. autism with ID vs ID only) and thriving ([<reflink idref="bib110" id="ref19">110</reflink>]). On the contrary, reduced school participation and school exclusion have detrimental effects ([<reflink idref="bib16" id="ref20">16</reflink>]; [<reflink idref="bib56" id="ref21">56</reflink>]). Furthermore, children with disabilities benefit from spending more time alongside their non-disabled peers, showing improved academic performance compared to those with limited interactions ([<reflink idref="bib48" id="ref22">48</reflink>]). Despite these benefits and global progress toward inclusive education for autistic children ([<reflink idref="bib107" id="ref23">107</reflink>], [<reflink idref="bib106" id="ref24">106</reflink>], [<reflink idref="bib105" id="ref25">105</reflink>]), France lags behind ([<reflink idref="bib10" id="ref26">10</reflink>]). This issue was underscored by the European Committee of Social Rights, which has repeatedly found France in violation of Article 15§1 of the Revised European Social Charter ([<reflink idref="bib10" id="ref27">10</reflink>]). The Committee specifically highlighted the failure of French authorities to implement effective measures for including children and adolescents with disabilities, and particularly autistic individuals, into mainstream schools ([<reflink idref="bib33" id="ref28">33</reflink>]) (for more details, see Supplementary Materials). This condemnation followed a complaint filed by parent associations, highlighting families' strong desire for change regarding inclusive education in France.</p> <p>In this context, gaining a deeper understanding of the school participation of autistic youth, particularly in France, is essential. This inquiry should address both attendance (i.e. school attendance frequency and school activity attendance) and involvement in school activities. Furthermore, factors influencing school participation must be examined to provide actionable recommendations for improving the inclusion and participation of autistic children in educational settings.</p> <p>However, research on school participation of autistic children remains limited and often relies on descriptive methods, that is, primarily documenting participation patterns such as activity frequency ([<reflink idref="bib7" id="ref29">7</reflink>]). Key findings indicate that autistic children are disproportionately excluded from school, with high rates of absenteeism frequently attributed to school refusal ([<reflink idref="bib1" id="ref30">1</reflink>]; [<reflink idref="bib41" id="ref31">41</reflink>]; [<reflink idref="bib102" id="ref32">102</reflink>]). In addition, studies using tools such as the PEM-CY ([<reflink idref="bib64" id="ref33">64</reflink>]) or the Friendship Survey ([<reflink idref="bib93" id="ref34">93</reflink>]) reveal that autistic students participate less in school compared to their non-autistic peers. When participation occurs, it is more often limited to attendance rather than active involvement ([<reflink idref="bib101" id="ref35">101</reflink>]).</p> <p>There are relatively few studies examining the factors influencing school participation in autistic youth. According to the International Classification of Functioning ([<reflink idref="bib115" id="ref36">115</reflink>]), participation is shaped by both intrinsic factors, related to the individual, and extrinsic factors, related to the environment (see also [<reflink idref="bib5" id="ref37">5</reflink>]; [<reflink idref="bib55" id="ref38">55</reflink>]). These factors often interact; for instance, individual characteristics can influence the attitudes of school peers and professionals, potentially leading to stigmatization ([<reflink idref="bib8" id="ref39">8</reflink>]; [<reflink idref="bib103" id="ref40">103</reflink>]). In addition, some factors may be associated with school participation either directly (i.e. having a straightforward link to participation) or indirectly, by acting through intermediary variables.</p> <p>Regarding intrinsic factors, increased autism characteristics have been associated with reduced enrollment of autistic children in mainstream school ([<reflink idref="bib63" id="ref41">63</reflink>]) and decreased school activities' attendance (measured by the CASP—[<reflink idref="bib68" id="ref42">68</reflink>]). Specifically, communication difficulties and atypical social functioning in autistic children predict lower participation in daily-life activities, including education (measured by the CPQ—[<reflink idref="bib91" id="ref43">91</reflink>]). While studies on the direct impact of social-communication difficulties on school participation are scarce, research highlights associations between conversational challenges, atypical social functioning, and reduced social participation in autistic youth and adults ([<reflink idref="bib69" id="ref44">69</reflink>]; [<reflink idref="bib97" id="ref45">97</reflink>]). These findings suggest that social-communication difficulties in autism may reduce school participation.</p> <p>Executive function difficulties, which might be associated with social-communication and pragmatic language difficulties in autism ([<reflink idref="bib35" id="ref46">35</reflink>]; [<reflink idref="bib53" id="ref47">53</reflink>]), may further hinder participation. More specifically, a study using the School Function Assessment ([<reflink idref="bib26" id="ref48">26</reflink>]) and the Behavior Rating Inventory of Executive Function (BRIEF—[<reflink idref="bib38" id="ref49">38</reflink>]) indicates that difficulties in emotion regulation, as well as inhibition of responses and behaviors, could play a critical role in participation in school activities of autistic children ([<reflink idref="bib116" id="ref50">116</reflink>]). School participation is also reduced in non-autistic children with executive function difficulties ([<reflink idref="bib36" id="ref51">36</reflink>]). Indeed, school being a structured environment, behavioral regulation and monitoring abilities as well as organization are required ([<reflink idref="bib36" id="ref52">36</reflink>]). Executive function difficulties tend to worsen from childhood to adolescence in autistic individuals ([<reflink idref="bib92" id="ref53">92</reflink>]), likely due to increasing cognitive and social demands with age, which may indirectly impact school participation through age-related increases in demands. In addition, executive function difficulties may have a cumulative effect when both autism and ADHD are present, as each condition is independently associated with executive difficulties (for a review, see [<reflink idref="bib27" id="ref54">27</reflink>]). Executive function difficulties may also be linked to higher levels of psychopathology, including anxiety and depression ([<reflink idref="bib66" id="ref55">66</reflink>]). Therefore, a greater number of comorbidities might be associated with increased executive function difficulties.</p> <p>Co-occurring conditions, including ID and challenging behaviors, also negatively affect school attendance in autistic youth ([<reflink idref="bib16" id="ref56">16</reflink>]; [<reflink idref="bib47" id="ref57">47</reflink>]; [<reflink idref="bib89" id="ref58">89</reflink>]). Thus, a higher number of comorbidities may further hinder school participation, as each condition brings additional challenges, suggesting a direct effect of co-occurring conditions and challenging behaviors on school participation. In addition, [<reflink idref="bib18" id="ref59">18</reflink>] showed that higher autism traits, measured by the Social Communication Questionnaire ([<reflink idref="bib94" id="ref60">94</reflink>]), were associated with increased physical aggression but decreased verbal aggression in autistic youth. This may reflect greater difficulties in expressing needs and suggests a link between social-communication difficulties and some components of challenging behaviors. Supporting this idea, one study found that anger, another component of challenging behavior, appears more quickly and with less control in autistic than in non-autistic youth ([<reflink idref="bib86" id="ref61">86</reflink>]). Nevertheless, the relationship between autistic traits and aggression should be interpreted with caution given the heterogeneity of the results (e.g. [<reflink idref="bib30" id="ref62">30</reflink>]). Challenging behaviors are also linked with co-occurring mental health conditions ([<reflink idref="bib61" id="ref63">61</reflink>]; [<reflink idref="bib67" id="ref64">67</reflink>]), although these studies often use a broad definition of challenging behaviors, including stereotyped behaviors. Physical and verbal aggression, as well as oppositional defiant disorder, are also associated with executive function difficulties ([<reflink idref="bib71" id="ref65">71</reflink>]; [<reflink idref="bib87" id="ref66">87</reflink>]; see also [<reflink idref="bib37" id="ref67">37</reflink>]), which can further impair behavioral regulation. Although challenging behaviors, particularly aggressive behaviors, tend to decrease with age in autism ([<reflink idref="bib65" id="ref68">65</reflink>]; [<reflink idref="bib86" id="ref69">86</reflink>]; [<reflink idref="bib98" id="ref70">98</reflink>]), they represent a potential pathway through which autistic traits, comorbidities, and executive function difficulties may indirectly hinder school participation.</p> <p>Chronological age and age at autism diagnosis may also influence school participation through indirect effects. On one hand, autism symptoms, particularly communication skills, tend to improve with age ([<reflink idref="bib111" id="ref71">111</reflink>]), despite variations ([<reflink idref="bib23" id="ref72">23</reflink>]; [<reflink idref="bib109" id="ref73">109</reflink>]). Masking behaviors also increase with age ([<reflink idref="bib80" id="ref74">80</reflink>]), potentially reducing the visibility of autistic characteristics and facilitating participation. On the other hand, studies have reported decreased inclusion in mainstream schools as autistic children grow older ([<reflink idref="bib63" id="ref75">63</reflink>]). This may reflect the increasing academic demands, which can exceed what is reasonably expected from autistic students, even when individual progress is substantial, leading to reduced participation with age. Moreover, masking has been linked to poorer mental health in autistic youth ([<reflink idref="bib12" id="ref76">12</reflink>]; [<reflink idref="bib43" id="ref77">43</reflink>]), which may in turn reduce school participation. Finally, early diagnosis appears to support mainstream school attendance ([<reflink idref="bib23" id="ref78">23</reflink>]). At the same time, children diagnosed earlier are often those with more pronounced social-communication difficulties and co-occurring ID ([<reflink idref="bib88" id="ref79">88</reflink>]), which may hinder school participation. Together, these findings underline the complex and sometimes contradictory effects of age at diagnosis and chronological age on school participation, warranting further investigation.</p> <p>Finally, biological sex is another potential intrinsic factor to consider in school participation. Research suggests that autistic females exhibit better social-communication skills than autistic males ([<reflink idref="bib113" id="ref80">113</reflink>]), greater social motivation ([<reflink idref="bib96" id="ref81">96</reflink>]), experience less social isolation at school ([<reflink idref="bib29" id="ref82">29</reflink>], [<reflink idref="bib28" id="ref83">28</reflink>]), and are often better at camouflaging their autism characteristics ([<reflink idref="bib24" id="ref84">24</reflink>]; [<reflink idref="bib28" id="ref85">28</reflink>]; [<reflink idref="bib80" id="ref86">80</reflink>]; [<reflink idref="bib114" id="ref87">114</reflink>]). This unique profile of autism in females, potentially influenced by a combination of biological and social factors, might suggest enhanced school participation in females. However, the only study reporting sex differences in school participation to our knowledge found that autistic females participated in fewer school activities compared to autistic males, as reported by the PEM-CY ([<reflink idref="bib77" id="ref88">77</reflink>]), although there is no mention in the study of the type of school and intellectual ability, limiting the understanding of the results. Overall, these findings suggest the need for further investigation into sex-based differences in school participation.</p> <p>Regarding extrinsic factors, [<reflink idref="bib89" id="ref89">89</reflink>] observed increased school attendance in French autistic youth whose parents had higher educational attainment. While this factor remains underexplored in autism-specific research, broader studies involving children with ID indicate that parents with higher academic achievement and socioeconomic status are more engaged in their children's education, which is associated with better academic outcomes for the children ([<reflink idref="bib62" id="ref90">62</reflink>]; [<reflink idref="bib79" id="ref91">79</reflink>]). Improved language skills in autistic children have also been linked to higher education levels in parents ([<reflink idref="bib78" id="ref92">78</reflink>]; [<reflink idref="bib82" id="ref93">82</reflink>]), who may have greater access to educational resources and external interventions that support their child's development. These findings suggest potential links between parental education and school participation.</p> <p>Finally, one of the main critical factors for school inclusion identified by parents is teachers' attitudes and knowledge related to autism and inclusive schools (for a review, see [<reflink idref="bib34" id="ref94">34</reflink>]; see also [<reflink idref="bib79" id="ref95">79</reflink>]). More specifically, a teacher's understanding of a child's specific characteristics, combined with individualized teaching, is associated with a higher perception of inclusion. However, teachers tend to hold less-positive attitudes toward including autistic students with greater behavioral or cognitive challenges ([<reflink idref="bib58" id="ref96">58</reflink>]). Beyond the classroom, school-level and societal factors are equally significant ([<reflink idref="bib34" id="ref97">34</reflink>]). Supportive schools with flexible structures, tailored accommodations addressing cognitive, social, and sensory needs, and inclusive policies are essential for fostering school inclusion and participation for autistic children ([<reflink idref="bib34" id="ref98">34</reflink>]).</p> <p>This literature review highlights the limited number of studies examining factors influencing school attendance and inclusion among autistic children, with even fewer studies focusing on school participation (encompassing both attendance and involvement). Hence, the present study aims to provide a comprehensive overview of school participation among French autistic girls and boys, using administrative data from a systematic register of autistic children in two French counties and the PEM-CY, a parent-report questionnaire. The PEM-CY was selected for its comprehensive scope and its suitability for assessing school participation across a wide age range and all levels of intellectual and language abilities. To achieve this objective, we first examined the influence of intrinsic factors on school participation using structural equation modeling (SEM). Our primary hypotheses focused on the roles of social-communication and executive function difficulties. Specifically, we expected that increased difficulties in social-communication and executive function would be correlated, and both would be associated with lower school participation. Based on further literature review, the model was extended to account for other potential intrinsic factors. Hence, we also hypothesized that the presence of challenging behaviors and a greater number of comorbidities would also be associated with lower school participation. Furthermore:</p> <p></p> <ulist> <item> Greater social-communication difficulties and executive function difficulties, as well as a higher number of comorbidities, were each expected to be associated with an increased likelihood of challenging behaviors. Conversely, older age was expected to be associated with a lower likelihood of exhibiting challenging behaviors. Thus, executive function difficulties, social-communication difficulties, comorbidities, and age were also hypothesized to have indirect effects on school participation through challenging behaviors.</item> <p></p> <item> Age was also expected to have indirect positive effects on school participation through its association with social-communication difficulties (which are expected to decrease with age) and executive function difficulties (which are expected to become more pronounced with age, as demands increase).</item> <p></p> <item> Finally, a greater number of comorbidities was hypothesized to contribute to increased executive function difficulties and challenging behaviors, thereby indirectly reducing school participation.</item> </ulist> <p>Sex, ID, parental education, and age at diagnosis were originally included in the SEM model but were removed due to poor model fit (see Method—Analyses for details). However, we explored the effects of these variables on school participation using an exploratory multivariate analysis of covariance (MANCOVA).</p> <p>Second, we examined extrinsic factors assessed by the PEM-CY, such as peer and teacher attitudes, sensory environments, and school requirements. For this part, we used descriptive analyses, as these item-level data could not be meaningfully summarized into a single score for quantitative analysis without losing important information. Finally, we reported parents' desire for change in their child's school participation as collected by the PEM-CY scale, as well as qualitative strategies they employ to support it. Overall, this research seeks to enhance understanding and formulate strategies for meaningful and inclusive school experiences for French autistic youth to improve their well-being.</p> <hd id="AN0193059426-3">Method</hd> <p></p> <hd id="AN0193059426-4">Participants and sample size</hd> <p>We conducted a cross-sectional observational study involving children born in 2012 and 2013 and adolescents born in 2004 and 2005, who were aged 7 and 15, respectively, in 2019–2020 or 2020–2021. Participants were previously identified by the French population-based register of child disability called RHEOP, which aimed to monitor neurodevelopmental disorders in children aged 7 in the French counties Isère and Savoie. This approach has the advantage of allowing the identification of all diagnosed autistic children in these regions. Children were included in the study if their medical file (filled by a physician), submitted as part of their application to the Departmental House of Disabled Persons (Maison Départementale des Personnes Handicapées -MDPH) for access to medical or social support, indicated a diagnosis falling within the F84 category (pervasive developmental disorders) of the International Classification of Diseases (ICD) 10th revision, either through the diagnostic code or through the diagnostic label. Exceptionally, some youth were identified outside the MDPH via additional sources, such as hospital child psychiatry departments or Early Medico-Social Action Centers (Centre d'Action Médicosocial Précoce -CAMSP). In line with the register's methodology, referring child psychiatrists from these sources were consulted to confirm or invalidate the autism diagnosis, as only ICD codes were available in these cases, without access to detailed medical reports.</p> <p>A participation rate of 80% was observed in a recent study by the RHEOP conducted by phone (unpublished), leading to a similar estimation for the current study. However, after contacting and following up with over 75% of the families (out of 865 identified in July 2023), we observed a participation rate of 27.5%, resulting in an estimated 238 participants. This was lower than the anticipated rate but aligns with other online studies ([<reflink idref="bib21" id="ref99">21</reflink>]; [<reflink idref="bib112" id="ref100">112</reflink>]). At this stage, we conducted a power analysis based on this estimation (detailed in the preregistration: https://osf.io/udyjp/overview), which showed that this sample size was sufficient for our SEM.</p> <p>Among the 871 eligible participants, and after the exclusion of unreachable cases and firm refusals without acceptance of data use, the population analyzed included 600 families. Of these, 50 parents (8%) did not confirm the autism diagnosis and were excluded, while 241 families (40%) completed online questionnaires on school participation, executive function, and autistic behaviors (see Figure 1). However, 2 participants were excluded due to incomplete data, and 4 due to an incoherence score ⩾9 in the executive functions questionnaire (see <emph>preregistration</emph> for exclusion criteria), resulting in a final sample of 235 participants (111 children and 124 teenagers; 44 females), close to our estimation of 238.</p> <p>Graph: Figure 1. Flowchart of participation in the online questionnaires. The number and reasons for exclusion are specified at each step.</p> <p>This study is part of a broader investigation, the PARTDIAG-TSA project, with a second goal related to the diagnostic journey. The project was approved by the Ethics Committee Sud-Méditerranée under agreement 2020-A03385-34, obtained on 26 January 2021. CNIL agreement on GDPR compliance was obtained on 9 December 2021 (number 921318).</p> <hd id="AN0193059426-5">Data collection</hd> <p>For each eligible participant, 150 variables were collected. These data included the child's characteristics covering sex, autism diagnosis details (e.g. ICD code or diagnostic label, date, place, professionals consulted, comorbidities), support received, schooling information (e.g. type of school, class), and parents' information (e.g. year of birth, educational level, marital status, employment). Data were first extracted from MDPH files or from additional sources such as hospital child psychiatry departments or CAMSP. Thus, all medical data regarding autism diagnosis and comorbidities were extracted from physician reports, which are usually supplemented by additional assessments by professionals such as psychologists, neuropsychologists, speech therapists, or occupational therapists, depending on the individual's needs. In addition, data regarding schooling and autism diagnosis were confirmed and supplemented by parents during phone interviews. Data collection was performed following a standardized protocol by four trained professionals working individually, used to include children in the RHEOP register according to definitions of child disability. Any uncertainties were resolved through discussion within the team. Parents were then invited to complete the online questionnaires. The questions focused on the school year 2019–2020 for those born in 2004 and 2012 and on the school year 2020–2021 for those born in 2005 and 2013. All the data were registered using the secure, web-based REDCap data capture tools ([<reflink idref="bib45" id="ref101">45</reflink>], [<reflink idref="bib44" id="ref102">44</reflink>]).</p> <hd id="AN0193059426-6">Instruments and studied variables for SEM</hd> <p></p> <hd id="AN0193059426-7">Latent variables</hd> <p></p> <ulist> <item> <emph>Participation</emph>: Within our SEM models, the dependent variable was a latent variable representing school participation of autistic children, structured around two elements: Attendance (divided into two parts) and Involvement. <emph>School Attendance</emph> was scored based on the percentage of time the child was present in a setting and the type of schooling setting. This choice enabled us to reflect the fact that full-time attendance in specialized settings outside of mainstream schools in France often results in a notably reduced amount of school time (see Supplementary Materials). A score of 4 indicates full-time attendance in a mainstream school (either in a regular or specialized class). A score of 3 represents attendance &gt;50% in a mainstream school, 2 corresponds to attendance ⩽50% in a mainstream school or &gt;50% in a specialized institution, 1 signifies attendance ⩽50% in a specialized institution, and 0 is assigned to children not attending school (homeschooling or no schooling). <emph>Activity Attendance</emph> was appraised using the school subscale of the PEM-CY ([<reflink idref="bib25" id="ref103">25</reflink>]—French version) by considering the number of school activities the child engaged in. The score ranges from 0 (no activity attended) to 5 (all activities attended: 1 = activities in the classroom, 2 = school trips and events, 3 = school-sponsored teams/clubs/organizations, 4 = meet peers outside the classroom, for example, recess and break, 5 = special role in school). The questionnaire was not filled for children whose parents reported that they were not attending school (<emph>N</emph> = 24) and a score of 0 was applied to them. <emph>Activity Involvement</emph> was measured by assessing the child's level of active participation (i.e. engagement) in the attended activities using the school subscale of the PEM-CY questionnaire. For each activity attended, the parent rated the child's involvement between 1 (little involvement) and 5 (high involvement). The final score is the sum of involvement responses divided by the number of activities attended. A score of 1 was attributed to children whose parents reported that they were not attending school.</item> <p></p> <item> <emph>Executive functions</emph>: The BRIEF scale ([<reflink idref="bib38" id="ref104">38</reflink>]), a tool with 86 items rated on a 3-point Likert-type scale (1 = never, 2 = sometimes, 3 = often), across eight subscales (initiation, working memory, plan/organize, organization of material, monitor, inhibition, shifting, and emotional control) was used to evaluate real-life executive functions and served as a latent predictor variable. The score of each subscale is the sum of the item scores. Higher scores indicate greater executive function difficulties.</item> <p></p> <item> <emph>Social-communication</emph>: The Children's Communi-cation Checklist [CCC; [<reflink idref="bib13" id="ref105">13</reflink>]; French validation: [<reflink idref="bib72" id="ref106">72</reflink>]] consists of 70 items across nine subscales, scored as "does not apply" = 0, "applies somewhat" = 1, "applies completely" = 2, or "don't know" = 0. For each subscale, the starting score is 30, and for positive (respectively negative) items, 1 or 2 points are added (respectively subtracted) to the score. Lower scores indicate greater communication difficulties. The CCC served as the tool for assessing social-communication difficulties, which was the second latent predictor in the models. The language structure (range 40–70) encompasses speech and syntax subscales. The pragmatic composite (range 86–162) includes inappropriate initiation, coherence, stereotyped conversation, use of context, and rapport subscales. The non-linguistic aspects of autistic behavior (range 14–68) cover social relationships and interests subscales.</item> </ulist> <hd id="AN0193059426-8">Observed variables</hd> <p></p> <ulist> <item> <emph>Sex</emph> indicates the sex at birth (Female/Male).</item> <p></p> <item> <emph>Age</emph> distinguishes between two age groups, children (7 years old in 2019/2020) and teenagers (15 years old in 2019/2020).</item> <p></p> <item> <emph>Diagnostic Age</emph> categorizes participants into early (before 8 years old) and late diagnoses (between 8 and before 16 years old).</item> <p></p> <item> <emph>Parental educational attainment</emph> reflects the highest parental educational attainment, measured on a nine-category scale (1 = no diploma to 9 = PhD and more).</item> <p></p> <item> <emph>ID</emph> indicates the presence or absence of ID (Yes/No).</item> <p></p> <item> <emph>Challenging behaviors</emph> indicate the presence or absence (Yes/No) of items documented in the medical record by a physician. These items included aggressive behavior, violence, anger, and oppositional/defiant behaviors, which align with definitions commonly used in the literature. Other items, such as lying or obsessive–compulsive behaviors, were also sporadically documented in the medical files and recorded in this category, although these do not correspond consistently to standard definitions of challenging behaviors.</item> <p></p> <item> <emph>Comorbidities number</emph> is the sum of comorbidities reported in the medical record filled by a physician and includes chronic illnesses (i.e. epilepsy, diabetes, asthma, allergy, tumor, digestive disease, cardiac disease, metabolic disease, or other history of disease), associated disorders (i.e. eating disorder, sleep disorder, anxiety, school phobia, depression, or personality disorder), sensory-motor disorders (i.e. motor deficiency, severe visual impairment, severe auditory impairment, or other deficiency), dys disorder (i.e. dyslexia, dyspraxia, dysphasia, dyscalculia, dysorthographia, dysgraphia, dysexecutive, or other dys disorders), and other neurocognitive disorders (i.e. ADHD and other attentional or hyperactivity disorders with no ADHD diagnosis, oral language disorder, memory disorders, or other learning disability).</item> </ulist> <hd id="AN0193059426-9">Analyses</hd> <p></p> <hd id="AN0193059426-10">Sample description and representativeness</hd> <p>To evaluate the representativeness of participants who completed the questionnaires compared to the whole studied population, we compared those who responded to the questionnaires with those who did not. Data were analyzed using Pearson's chi-square test with Yates' correction for categorical variables and linear models for continuous variables. Holm-Bonferroni adjustment was applied to account for multiple testing.</p> <hd id="AN0193059426-11">Preregistered data analysis: SEM</hd> <p>SEM was conducted using the Lavaan package in R, employing maximum likelihood estimation with robust standard errors (MLR) and full information maximum likelihood for missing data (<emph>n</emph> = 2). Goodness-of-fit indices were used, defining a good fit as having a robust Comparative Fit Index (CFI), corrected for non-normality ([<reflink idref="bib17" id="ref107">17</reflink>]), ⩾.90 ([<reflink idref="bib20" id="ref108">20</reflink>]), a robust root mean square error of approximation (RMSEA) ⩽.08 ([<reflink idref="bib9" id="ref109">9</reflink>]; [<reflink idref="bib17" id="ref110">17</reflink>]), and a standardized root mean square residual (SRMR) ⩽.08. The chi-square index was not considered, as it assumes multivariate normality ([<reflink idref="bib57" id="ref111">57</reflink>]), which did not align with the characteristics of our data.</p> <p>Three preregistered models, increasing in complexity, were adjusted to enhance overall fit while maintaining the integrity of the research question. The adjustments were made according to both modification indices and theory ([<reflink idref="bib39" id="ref112">39</reflink>]; e.g. the factor structure of the BRIEF has been shown to differ between autistic and non-autistic individuals—[<reflink idref="bib40" id="ref113">40</reflink>]). This mainly resulted in merging some indicators ([<reflink idref="bib19" id="ref114">19</reflink>]; as residual correlations should be avoided—[<reflink idref="bib49" id="ref115">49</reflink>]). Thus, instead of the eight subscales of the BRIEF initially employed for the measurement model, four indices were considered. Inhibition, Shifting, and Emotional Control subscales were combined into a single Behavioral Regulation Index. Plan/Organize, Monitor, and Material Organization subscales were merged into an Organization/Monitoring Index. Initiation and Working Memory were kept as independent subscales (see Model 1 in Supplementary Materials for details). Similarly, three subscales were considered for the measurement model of the CCC: communication (merging language structure and pragmatic composite; see Model 1 revised in Supplementary Materials), social relationships, and interests. In addition, sex, parental educational attainment, and diagnostic age was excluded from the SEM analyses to reduce complexity, since Model 2 in Supplementary Materials suggested no significant impact on the latent variable representing school participation. Finally, ID was repositioned within the comorbidities construct (see Model 3 in Supplementary Materials). The results section focuses on the revised third model for conciseness. Detailed information on the three preregistered models, their outputs, and justifications for modifications is provided in Supplementary Materials. Like the preregistered models, the final model examines the impact of executive function difficulties and social-communication difficulties on school participation, along with the influence of comorbidities, challenging behaviors, and age, as stated in the hypotheses.</p> <hd id="AN0193059426-12">Exploratory analyses (not preregistered)</hd> <p>To nonetheless examine the effects of sex, ID, parental educational attainment, and diagnostic age on the three outcome variables related to school participation (School Attendance, School Participation, and School Involvement), an exploratory MANCOVA was conducted. This approach was chosen due to the correlation between the participation variables. This analysis controlled for age, challenging behaviors, number of co-occurring conditions, global executive function score, and social-communication difficulties (represented by the global CCC score), which were included as covariates in the model.</p> <hd id="AN0193059426-13">Descriptive analyses</hd> <p>Descriptive analyses were based on the data collected in the PEM-CY, both in the desire for change part and in the school environment part.</p> <hd id="AN0193059426-14">Desire for change</hd> <p>In the PEM-CY, participants rated activity attendance from 1 (each day) to 8 (never) and expressed desires for change in activity attendance (increasing or decreasing frequency; increasing the diversity of activity) and involvement (becoming more or less involved). These measures provided insights into their desires for change in their child's school participation in comparison to their current level of engagement.</p> <hd id="AN0193059426-15">Barriers and facilitators</hd> <p>PEM-CY assessed barriers and facilitators identified by the parents, offering information on extrinsic factors influencing school participation. It covered the physical and sensory environment, peer relationships and teacher attitudes. It also assessed the availability/adequacy of resources supporting the child's participation at school, such as services, school procedures, transportation and family time and finances. For each item, participants indicated whether it was usually not an issue or not needed in supporting school participation, usually helpful/available/adequate, sometimes helpful/available/adequate and sometimes made it harder or was unavailable/inadequate, or usually made participation harder or was unavailable/inadequate.</p> <hd id="AN0193059426-16">Qualitative information</hd> <p>An open-ended question from the PEM-CY gathered strategies employed by parents to enhance their children's participation. Each individual response was reviewed and categorized based on its content by the first author (A.L.). Categories were not predefined but emerged from the participants' responses. These were then organized into two overarching themes to synthesize the main insights. A second author (M.D.) independently classified the responses using the initial set of categories, without access to the original coding. When discrepancies arose between AL and MD's classifications, a third co-author (M.P.B.) independently assessed the responses. Final categorization was determined through discussion among the three authors to reach consensus and ensure consistency and reliability in the classification (consensus coding).</p> <hd id="AN0193059426-17">Community involvement</hd> <p>There was autistic representation within the research team, including individuals involved in autism organizations. Their input helped guide the research and discussion, particularly as school inclusion and participation are major concerns for parents of autistic children in France.</p> <hd id="AN0193059426-18">Results</hd> <p></p> <hd id="AN0193059426-19">Sample description and representativity</hd> <p>Participant characteristics of the samples who did and did not complete the online questionnaires are summarized in Supplementary Table 1. Overall, the two samples did not show significant differences in age, diagnostic age (early diagnosis = 71%), sex (female = 18.7%), ID (20.5%), challenging behaviors (60.8%), epilepsy (3.3%), sleep disorders (73.7%), anxiety disorders (53.7%), depression (6.7%), ADHD or other attention or hyperactivity disorders (65.3%), and mean number of associated disorders (mean (<emph>SD</emph>) = 1.2(<reflink idref="bib1" id="ref116">1</reflink>)). In addition, there was no significant difference regarding school attendance score, school type (mainstream = 63.7%, localized unit for inclusive education—mainstream = 17.6%, medico-educational institute—specialized = 10.6%, other specialized school = 2.8%, home schooling = 1.6%, no school = 3.7%), percentage of school time for youth attending mainstream school (full time = 71%; &gt;50% = 16.3%; ⩽50% = 12.5%), percentage of time spent in specialized settings (&gt;50% = 32.6%; ⩽50% = 67.4%). However, parents who filled the online questionnaires had higher educational attainment (<emph>p</emph> &lt; 0.001, <emph>d</emph> = 0.47) and were more represented in executive and higher intellectual professions, while being less represented in worker professions, compared to parents who did not fill the online questionnaires (fathers: <emph>p</emph> &lt; 0.001, <emph>w</emph> = 0.22; mothers: <emph>p</emph> &lt; 0.001, <emph>w</emph> = 0.25).</p> <hd id="AN0193059426-20">Intrinsic factors influencing participation: SEM</hd> <p>SEM was used to examine factors influencing participation. The model fit the data well (CFI = 0.92; RMSEA = 0.07 [0.06; 0.09]; SRMR = 0.06). It is represented in Figure 2, with standardized coefficients (Std. all), to allow easier comparison of effect sizes across variables, while the Results section reports unstandardized path coefficients to facilitate interpretation of the effect sizes in the original metric, along with their 95% confidence intervals (CIs) and <emph>p</emph> values. All the BRIEF subscales, CCC subscales, and participation subscales have loadings &gt;.40 and are significant indicators of their respective factors. There is a direct effect of the CCC scores on participation (<emph>β</emph> = 0.02, 95% CI [0, 0.05], <emph>p</emph> = 0.025), indicating that increased social-communication difficulties are associated with reduced participation in autistic children. However, the direct effects of executive function scores (<emph>β</emph> = 0.01, 95% CI [0, 0.03], <emph>p</emph> = 0.142), challenging behaviors (<emph>β</emph> = –0.17, 95% CI [–0.35, 0.01], <emph>p</emph> = 0.068) and the number of comorbidities (<emph>β</emph> = 0, 95% CI [–0.02, 0.03], <emph>p</emph> = 0.8) on school participation are not statistically significant. Age has a direct effect on executive function difficulties, as evidenced by higher BRIEF scores (<emph>β</emph> = 3.83, 95% CI [1.41, 6.25], <emph>p</emph> = 0.002), suggesting that higher age is associated with increased executive function difficulties. The number of comorbidities is also directly associated with increased executive function difficulties (<emph>β</emph> = 0.51, 95% CI [0.19, 0.82], <emph>p</emph> = 0.002). In addition, age has a direct effect on CCC scores (<emph>β</emph> = 2.89, 95% CI [0.33, 5.45], <emph>p</emph> = 0.027), indicating that older age is associated with lower social-communication difficulties. Executive function difficulties (higher BRIEF scores) are correlated with more social-communication difficulties (lower CCC scores) (<emph>β</emph> = –45.81, 95% CI [–69.54, –22.09], <emph>p</emph> ⩽ 0.001). The effects of executive function difficulties (<emph>β</emph> = 0, 95% CI [–0.01, 0.01], <emph>p</emph> = 0.927), social-communication difficulties (<emph>β</emph> = 0, 95% CI [–0.02, 0.01], <emph>p</emph> = 0.597), age (<emph>β</emph> = 0, 95% CI [–0.15, 0.14], <emph>p</emph> = 0.96) and comorbidities (<emph>β</emph> = 0.02, 95% CI [0, 0.04], <emph>p</emph> = 0.089) on challenging behaviors are not statistically significant. The indirect effects are not statistically significant either.</p> <p>Graph: Figure 2. Model 3—Revised. This structural equation model predicts that latent executive function (higher BRIEF scores indicate greater difficulties), latent social-communication (lower CCC scores indicate greater difficulties), and comorbidities have direct effects on school participation. In addition, it predicts indirect effects of comorbidities via executive function and challenging behaviors; indirect effects of age via executive function, social-communication difficulties, and challenging behaviors; and indirect effects of executive functions and social-communication difficulties via challenging behaviors. Statistics are standardized regression coefficients. Colored lines indicate significant effects, with green representing positive coefficients and red representing negative coefficients. N = 235.</p> <hd id="AN0193059426-21">Exploratory analyses: influence of ID, sex, and parental educational attainment</hd> <p>The exploratory MANCOVA analysis tested the effects of four key predictors removed from the final SEM model (sex, ID, parental educational attainment, and diagnostic age) on three indicators of school participation (School Attendance, School Participation, and School Involvement), controlling for challenging behaviors, age, number of co-occurring conditions, BRIEF Global scores, and CCC scores. The analysis showed significantly reduced <emph>School Attendance</emph> for youth with ID compared to those without ID (<emph>F</emph>(<reflink idref="bib1" id="ref117">1</reflink>, 225) = 13.49, <emph>p</emph> &lt; 0.001, <emph>η</emph><sups>2</sups> = 0.0582) and for autistic females compared to autistic males (<emph>F</emph>(<reflink idref="bib1" id="ref118">1</reflink>, 225) = 6.01, <emph>p</emph> = 0.015, <emph><emph>η</emph></emph><sups>2</sups> = 0.0259). However, neither parental educational attainment nor diagnostic age had a significant effect on any measure. Regarding the covariates, challenging behaviors were also significantly associated with reduced <emph>School Attendance</emph> (<emph>F</emph>(<reflink idref="bib1" id="ref119">1</reflink>, 225) = 6.49, <emph>p</emph> = 0.012, <emph><emph>η</emph></emph><sups>2</sups> = 0.028), <emph>Activity Attendance</emph> (<emph>F</emph>(<reflink idref="bib1" id="ref120">1</reflink>, 225) = 10.77, <emph>p</emph> = 0.001, <emph><emph>η</emph></emph><sups>2</sups> = 0.0474), and <emph>Activity Involvement</emph> (<emph>F</emph>(<reflink idref="bib1" id="ref121">1</reflink>, 225) = 6.97, <emph>p</emph> = 0.009, <emph><emph>η</emph></emph><sups>2</sups> = 0.031). Similarly, increased age was associated with reduced <emph>Activity Attendance</emph> (<emph>F</emph>(<reflink idref="bib1" id="ref122">1</reflink>, 225) = 5.36, <emph>p</emph> = 0.022, <emph><emph>η</emph></emph><sups>2</sups> = 0.0236) and <emph>Activity Involvement</emph> (<emph>F</emph>(<reflink idref="bib1" id="ref123">1</reflink>, 225) = 5.84, <emph>p</emph> = 0.017, <emph><emph>η</emph></emph><sups>2</sups> = 0.026). Finally, higher BRIEF global scores were associated with reduced <emph>Activity Involvement</emph> (<emph>F</emph>(<reflink idref="bib1" id="ref124">1</reflink>, 225) = 4.72, <emph>p</emph> = 0.031, <emph><emph>η</emph></emph><sups>2</sups> = 0.021). No other effects were significant.</p> <hd id="AN0193059426-22">Descriptive analysis: extrinsic barriers and facilitators influencing participation</hd> <p>According to parental perspectives, school participation was challenging for 52% of youth due to social demands (e.g. communication, interaction with others), for 50% due to the sensory environment at school (e.g. noise, crowds, lighting), and for 47% due to the cognitive demands of school activities (e.g. concentration, attention, problem-solving). Opinions were mixed concerning teachers' attitudes, peer relationships, and physical requirements, as all these factors were reported to either facilitate or hinder participation (see Figure 3(a)). Finally, physical settings (e.g. classroom layout, outdoor spaces), weather conditions (e.g. temperature and climate) and school security posed no issue for 73%, 69%, and 51% of the respondents, respectively.</p> <p>Graph: Figure 3. Extrinsic barriers and facilitators to school participation. Percentage of caregivers who identify (a) some type of barriers/support as supporting or making more difficult their child's school participation and (b) resources that are available to support their child's school participation, collected with the PEM-CY. For personal/family time, information, personal/family money and furniture, the option "not needed" was not provided. (N = 211; 24 did not answer as they were not schooled).</p> <p>In addition, the results presented in Figure 3(b), indicate that personal transport was the main available resource supporting school participation (or not needed). Meanwhile, services (e.g. extracurricular activities, educational assistants and resources for special needs), school policies and procedures, as well as public transport, were not or only partly available for respectively 34%, 35%, and 23% of the participants. In addition, family time, information (regarding activities, services, programs), family finances, and furniture were not or only partly available for 60%, 52%, 49%, and 41% of the participants.</p> <hd id="AN0193059426-23">Descriptive analysis: evaluation of the desire for change</hd> <p>Figure 4 depicts the desire for change in each activity based on the frequency of the activity. Answers representing the desire for fewer activities are not represented, as they correspond to less than 1% of the parents. Between 51% and 63% of respondents (depending on the activity) expressed no desire for change, even when their child had low participation levels in certain activities like school roles and clubs. However, 36% to 58% expressed a desire to increase activity frequency, involvement, or variety, with the highest proportions observed for school events and outings (58%) and activities with peers (56%). Among those desiring more activities, children who were already involved daily were less represented.</p> <p>Graph: Figure 4. Parents' desire for change in school participation (N = 211; 24 did not answer as they were not schooled). Percentages reflect the proportion of parents expressing "Desire for more participation" or "No desire for change in participation" for each activity type. Activity types: ClassActivity = activities in the classroom; ClubPart = school-sponsored teams/clubs/organizations; SchoolEvent = school trips and events; SchoolPeer = meet peers outside the classroom; SchoolRole = special role in school.</p> <hd id="AN0193059426-24">Qualitative responses</hd> <p>The PEM-CY featured an open question about the strategies families employ to promote school participation. After reviewing all responses from parents who provided strategies (<emph>N</emph> = 144), and classifying them, we identified seven categories that can be grouped into two main groups. The first category involves <emph>direct assistance to the child</emph>. It includes understanding and encouragement (e.g. listening to the child, discussing, positive reinforcement, explanation, encouragement, and facilitation of social interactions; <emph>N</emph> = 32; 22.2%), parental support (e.g. emotional control training, homework help, training before the activity, practicing. and coaching social skills such as managing frustration and coping with mistakes; <emph>N</emph> = 31; 21.5%), material and organizational adjustments (e.g. timer, timetable, computer, headphones; routines; <emph>N</emph> = 26; 18%), and professional support (e.g. private support and school assistant; <emph>N</emph> = 10; 6.9%).</p> <p>The second category is related to <emph>parental life adaptations</emph>. It includes increased communication with teachers/educators (<emph>N</emph> = 19; 13.2%), adjusting work/personal schedules or taking holidays to make them available for their child (e.g. school trips, medical appointments, and lunch time; <emph>N</emph> = 14; 9.7%), relocating to facilitate transportation or avoid the lunchroom, and utilizing/purchasing individual transport (<emph>N</emph> = 8; 5.5%). Four responses could not be classified because they consisted of a single, imprecise term (e.g. "support").</p> <hd id="AN0193059426-25">Discussion</hd> <p>This study aimed to describe school participation and explore the factors influencing it in autistic youth from two French counties, with the goal of providing recommendations for improvement. Parents of autistic youth aged 7 or 15 completed online questionnaires. The findings indicate that the majority of autistic youth are enrolled in mainstream schools. The main intrinsic factor with a global impact on their participation appears to be social-communication difficulties. In addition, about half of the parents reported that extrinsic factors, including specific school demands (cognitive and social) and sensory environments, contributed to reduced school participation, whereas the attitudes of teachers and peers were perceived as either facilitating or impeding participation. Notably, about half of the parents expressed a desire to see greater participation from their child in school.</p> <p>In the present study, 81.4% of autistic children were enrolled in mainstream schools (including those in specialized sections within mainstream schools). This represents a potential improvement compared to 2009, when 64% of autistic children were estimated to attend mainstream schools in another French cohort ([<reflink idref="bib63" id="ref125">63</reflink>]). Such progress may reflect governmental efforts through autism plans and the growing recognition of milder forms of autism, which can still vary between French regions ([<reflink idref="bib31" id="ref126">31</reflink>]). However, 28.8% of these youth attended school only part-time. In addition, 13.2% were enrolled in specialized settings, which often lack a primarily educational focus ([<reflink idref="bib33" id="ref127">33</reflink>]). Alarmingly, 3.5% of autistic youth were not enrolled in school at all, and 2.3% were home-schooled, a rate significantly higher than the 0.3% home-schooling rate observed in the general French population ([<reflink idref="bib14" id="ref128">14</reflink>]).</p> <p>SEM model results indicate that lower CCC scores were associated with reduced participation. This suggests that the distinctive functioning of autistic children, particularly their social-communication challenges, may hinder school participation ([<reflink idref="bib63" id="ref129">63</reflink>]; [<reflink idref="bib68" id="ref130">68</reflink>]; [<reflink idref="bib90" id="ref131">90</reflink>]). These difficulties may act as intrinsic barriers to participation ([<reflink idref="bib50" id="ref132">50</reflink>]), as social-communication abilities are essential for interactions with both teachers and peers. Interestingly, this appears to be a global effect: the CCC global score was not a significant covariate for any specific participation component in the exploratory MANCOVA model. This could indicate that social-communication difficulties impact overall participation, rather than any single aspect.</p> <p>Importantly, the association between social-communication challenges and participation may also reflect the presence of extrinsic barriers, such as non-adapted school environments. Indeed, social and cognitive demands, as well as sensory environments, were reported by half of the parents as making participation harder. Although these results are descriptive only, they are consistent with the literature ([<reflink idref="bib34" id="ref133">34</reflink>]; [<reflink idref="bib68" id="ref134">68</reflink>]).</p> <p>The association between social-communication difficulties and reduced school participation may also stem from the ostracization of autistic youth due to the challenges they pose ([<reflink idref="bib58" id="ref135">58</reflink>]) or perceived inabilities ([<reflink idref="bib50" id="ref136">50</reflink>]). Indeed, autistic youth are frequently excluded from schools or school activities ([<reflink idref="bib1" id="ref137">1</reflink>]; [<reflink idref="bib41" id="ref138">41</reflink>]; [<reflink idref="bib102" id="ref139">102</reflink>]), which likely explains why half of the parents in our study expressed a desire to increase their child's school participation, particularly when the youth is less frequently included in school activities. Hence, teachers' and peers' attitudes, identified by parents as either barriers or facilitators in the descriptive analyses, play a key role in participation, in line with previous research ([<reflink idref="bib34" id="ref140">34</reflink>]; [<reflink idref="bib58" id="ref141">58</reflink>]; [<reflink idref="bib68" id="ref142">68</reflink>]).</p> <p>Thus, improving school participation of autistic children would primarily require reducing autism-related stigma through increased awareness, tailored support and tailored environments, and opportunities that respect the unique characteristics of autistic youth ([<reflink idref="bib50" id="ref143">50</reflink>]). To achieve this, developing policies and tailored services such as individualized educational support or adapted materials, identified by around one-third of parents in the current study as not always available to support school participation, is critical (see also [<reflink idref="bib34" id="ref144">34</reflink>]; [<reflink idref="bib50" id="ref145">50</reflink>]). Implementing self-regulating systems involving trained teams providing personalized adaptations for autistic children and supporting teachers could also enhance participation ([<reflink idref="bib4" id="ref146">4</reflink>]), while reducing the necessity for family adaptations, which were often spontaneously reported in the qualitative data as a factor helping school participation in our study. School-based interventions and peer-implemented programs also show promise in increasing participation ([<reflink idref="bib22" id="ref147">22</reflink>]; [<reflink idref="bib59" id="ref148">59</reflink>]; [<reflink idref="bib108" id="ref149">108</reflink>]).</p> <p>In line with our expectations and with the literature, increased social-communication difficulties were associated with increased executive function difficulties ([<reflink idref="bib35" id="ref150">35</reflink>]; [<reflink idref="bib53" id="ref151">53</reflink>]). However, contrary to our predictions, we did not find an association between school participation and executive function difficulties. This discrepancy could stem from the latent construct of school participation used in our study, which encompasses school and activity attendance as well as involvement, whereas previous studies focused on only one of these aspects. Indeed, the exploratory analyses suggested that higher executive function difficulties were associated specifically with reduced <emph>Activity Involvement</emph>, aligning with [<reflink idref="bib116" id="ref152">116</reflink>], who reported a negative impact of executive function difficulties on school activities in autistic children. This makes theoretical sense, as executive function difficulties may not directly prevent school or activity attendance per se, but may instead reduce activity engagement. To be involved in an activity requires the ability to initiate activities, stay organized, adjust flexibly to changes, inhibit distractions, and sustain attention. Overall, this suggests that certain variables may influence only specific dimensions of school participation.</p> <p>More surprisingly, challenging behaviors were not significantly associated with school participation in the SEM model (<emph>p</emph> =.068), whereas in the MANCOVA model, they were significantly related to all three aspects of school participation. This discrepancy may reflect the greater complexity and statistical demands of SEM, which simultaneously estimates latent constructs and indirect pathways. The marginal significance in SEM suggests that the effect may be attenuated due to reduced statistical power and shared variance with other predictors. Nonetheless, and in line with the MANCOVA results, it remains very likely that autistic students who exhibit aggressive or oppositional behaviors are more likely to be excluded from school settings ([<reflink idref="bib16" id="ref153">16</reflink>]; [<reflink idref="bib47" id="ref154">47</reflink>]) and from various activities or may be less inclined to engage in them.</p> <p>Contrary to our expectations, the number of comorbidities was not associated with reduced school participation in the SEM model and did not emerge as a significant covariate in the exploratory MANCOVA model either. One possible explanation is that the comorbidities included in this variable were broad and heterogeneous. Hence, some of them, such as diabetes or dyspraxia, may have a limited impact on school participation, whereas others, like ID, may be more detrimental. In line with this hypothesis, when ID was examined separately in the exploratory MANCOVA model, it was associated with lower <emph>School Attendance</emph>, likely reflecting the cognitive challenges related to ID that can limit school enrollment. However, ID was not linked with reduced <emph>Activity Attendance</emph> or <emph>Activity Involvement</emph>, suggesting that once enrolled, autistic children with ID may participate in school activities at levels comparable to their peers. Overall, while the total number of comorbidities was included as a proxy to account for co-occurring conditions, this aggregated measure may lack sufficient specificity to capture their differential impact on school participation.</p> <p>The limitation related to the aggregated measure of comorbidities might also explain their absence of significant association with challenging behavior in SEM. For example, sensory-motor disorder or chronic illness might not increase challenging behaviors, whereas the association with some psychiatric comorbidities would be more significant ([<reflink idref="bib67" id="ref155">67</reflink>]; [<reflink idref="bib83" id="ref156">83</reflink>]). Indeed, the association between comorbidities and challenging behavior in autism appears to be complex ([<reflink idref="bib61" id="ref157">61</reflink>]).</p> <p>Nevertheless, a higher number of comorbidities was associated with increased executive function, in line with our predictions. Indeed, several psychopathologies, such as anxiety and depression, have been related to executive function difficulties in autism ([<reflink idref="bib66" id="ref158">66</reflink>]). More importantly, ADHD and attention disorders, which are highly prevalent in our population, usually increase executive function difficulties in autism ([<reflink idref="bib27" id="ref159">27</reflink>]).</p> <p>Contrary to our initial hypotheses, challenging behaviors were not significantly associated with increased social-communication difficulties, increased executive function difficulties, or younger age in the SEM model. This contrasts with studies reporting associations between challenging behaviors and autistic traits ([<reflink idref="bib73" id="ref160">73</reflink>]), executive function difficulties ([<reflink idref="bib71" id="ref161">71</reflink>]; [<reflink idref="bib87" id="ref162">87</reflink>]), or younger age ([<reflink idref="bib98" id="ref163">98</reflink>]). Several factors may account for this result. First, challenging behaviors were assessed using a binary variable based on the presence of behaviors such as anger, violence, and oppositionality, rather than a validated scale. Although the prevalence in our sample (60.8%) is consistent with previous reports in autistic populations—such as 42% for self-injury ([<reflink idref="bib100" id="ref164">100</reflink>]), 53% for challenging behaviors in youth in special education settings ([<reflink idref="bib76" id="ref165">76</reflink>]), and up to 80% using broader scales of aggression, stereotypy, and self-injury ([<reflink idref="bib46" id="ref166">46</reflink>])— this lack of granularity may have limited our ability to capture meaningful variation. Second, this variable may overlap with other predictors in the model, particularly comorbidities involving behavioral dysregulation (e.g. ADHD), which could reduce its unique explanatory power. Future research would benefit from using dimensional, validated measures of challenging behaviors to better capture their specific associations with autistic traits, and particularly with social-communication difficulties and executive function difficulties, in their relation to school participation.</p> <p>Older age was significantly associated with fewer social-communication difficulties, in line with our predictions and with [<reflink idref="bib111" id="ref167">111</reflink>]. In addition, as reported above, fewer social-communication difficulties were, in turn, linked to greater school participation. However, the indirect effect of age on participation via CCC did not reach significance. This suggests that the association between age and participation is not fully mediated by social-communication difficulties, and that other age-related factors, such as increasing academic demands, may counteract the potential benefits of improved communication skills over time. This interpretation is consistent with our MANCOVA exploratory analysis, which showed that older age was associated with reduced <emph>Activity Attendance</emph> and <emph>Activity Involvement</emph>, possibly reflecting a growing gap between school demands and autism-specific characteristics, but not <emph>School Attendance</emph>. This latter finding contrasts, however, with [<reflink idref="bib63" id="ref168">63</reflink>], who reported a decrease in school enrollment with age in French autistic students. Such discrepancies may reflect methodological differences between the two studies. Notably, [<reflink idref="bib63" id="ref169">63</reflink>] used longitudinal data and included adolescents over the age of 15, corresponding to the beginning of high school, a stage at which (in the French educational system) specialized classes within mainstream schools are no longer available. After middle school, autistic youth are usually directed either to general mainstream classrooms in high school or to specialized schools, which may contribute to a sharper drop in school attendance.</p> <p>Being female was also linked to reduced <emph>School Attendance</emph> but not <emph>Activity Attendance</emph> or <emph>Activity Involvement</emph>, in exploratory MANCOVA analyses. Although these findings should be taken with caution due to their exploratory nature, they partly align with [<reflink idref="bib77" id="ref170">77</reflink>], who reported reduced participation in autistic females in terms of the number of activities. However, this result may seem counterintuitive, given the typically better social-communication skills observed in autistic females ([<reflink idref="bib113" id="ref171">113</reflink>]). We suggest that autistic behaviors in females might have a higher tendency to lead to their exclusion from school, possibly due to societal norms and expectations regarding communication and social interactions. In addition, autistic girls often experience more peer conflicts than non-autistic girls and face significant challenges in managing these conflicts ([<reflink idref="bib95" id="ref172">95</reflink>]), potentially decreasing their school participation. They may also be particularly vulnerable to bullying ([<reflink idref="bib2" id="ref173">2</reflink>]; [<reflink idref="bib52" id="ref174">52</reflink>]), which can lead to mental health issues ([<reflink idref="bib52" id="ref175">52</reflink>]) that could then reduce their school participation or lead to challenging behaviors and, ultimately, exclusion ([<reflink idref="bib99" id="ref176">99</reflink>]). To avoid bullying and rejection and to better conform to social (including school) norms, autistic females may engage in camouflaging behaviors ([<reflink idref="bib24" id="ref177">24</reflink>]; [<reflink idref="bib28" id="ref178">28</reflink>]; [<reflink idref="bib80" id="ref179">80</reflink>]; [<reflink idref="bib114" id="ref180">114</reflink>]). However, while camouflaging may temporarily support inclusion, it has been associated with poorer mental health outcomes ([<reflink idref="bib12" id="ref181">12</reflink>]; [<reflink idref="bib43" id="ref182">43</reflink>]), which may in turn negatively impact school participation. Self-exclusion is another strategy some girls adopt when they fail to receive adequate support ([<reflink idref="bib81" id="ref183">81</reflink>]), which could also apply to autistic girls. Sex and gender disparities in the school participation of autistic youth warrant further investigation to confirm their consistency and understand their underlying causes. Notably, the sex distribution in our study, with a male-to-female ratio of 4.3:1, aligns with findings in other childhood studies ([<reflink idref="bib85" id="ref184">85</reflink>]). However, this ratio might reflect overlooked diagnoses in some autistic girls, as the overall sex ratio is likely closer to 3:1 ([<reflink idref="bib70" id="ref185">70</reflink>]), or even as low as 2:1 in adulthood ([<reflink idref="bib85" id="ref186">85</reflink>]). Consequently, undiagnosed autistic girls may be attending mainstream schools, facing challenges without receiving appropriate support.</p> <p>Finally, age at diagnosis was not associated with school participation in the exploratory MANCOVA, unlike in [<reflink idref="bib23" id="ref187">23</reflink>]. This may reflect differences in both diagnostic cut-offs to define "early diagnosis" (before age 7 in our study vs 3 in theirs) and the operationalization of school participation, as [<reflink idref="bib23" id="ref188">23</reflink>] focused solely on school placement.</p> <hd id="AN0193059426-26">Limitations</hd> <p>This study has limitations. Not all autistic youth may have been captured due to historically low diagnosis rates in France, with an overall prevalence of 0.24% in 2022, among which 44% had F84.8 or F84.9 codes, typically assigned when diagnostic criteria are not fully met ([<reflink idref="bib31" id="ref189">31</reflink>]; Ha, Chin, &amp; Chee, 2020; [<reflink idref="bib84" id="ref190">84</reflink>]). In the French context, these codes may reflect a historical reluctance to assign an autism diagnosis, as many clinicians relied on the restrictive French CFTMEA classification ([<reflink idref="bib42" id="ref191">42</reflink>]). Over time, the use of F84.0 and F84.5 has increased, while F84.8 and F84.9 have decreased ([<reflink idref="bib42" id="ref192">42</reflink>]), suggesting that these cases are now considered autistic. We therefore included all diagnoses falling within F84 codes in our sample, consistent with other French prevalence studies (Ha, Chin, &amp; Chee, 2020; [<reflink idref="bib84" id="ref193">84</reflink>]), although this may introduce minor inconsistencies. Given the regional prevalence in our study remains below 1%, it is more likely that the diagnostic threshold excludes milder cases rather than including children who are not autistic.</p> <p>In addition, the questionnaires also presented limitations. First, the CCC and PEM-CY, although translated into French, have not yet undergone formal psychometric validation in this language. However, they were selected because they are widely used internationally and were well-suited to the constructs of interest. Furthermore, the measures were used in a non-normative way (i.e. through global scores or as latent variables), which limits the impact of this lack of validation on the validity of our results. Second, the BRIEF scale, although being the most widely recognized questionnaire for assessing executive functioning in everyday life, might not be the most suitable for individuals with ID. Third, the questionnaires were relatively lengthy to complete. This likely contributed to the 28% participation rate and the under-representation of parents with lower socio-educational status, limiting the intended representativeness of the study and potentially explaining the absence of an effect of educational attainment in the exploratory analyses. This participation rate may have also resulted in reduced statistical power for the SEM analysis. It should also be noted that the participation questionnaire did not allow for the collection of the desire for change in parents whose child did not attend school, which is another limitation.</p> <p>Certain variables, such as family income or parental professional status, known to influence participation ([<reflink idref="bib6" id="ref194">6</reflink>]; [<reflink idref="bib89" id="ref195">89</reflink>]), were not included. Some data also lacked precision due to the collection methods and their heterogeneous content. For example, challenging behaviors were defined using broad categories rather than precise terms, and these categories were highly diverse, including constructs that may differ from standard definitions of challenging behaviors (e.g. lying, OCD), potentially influencing the results.</p> <p>Finally, some analyses are exploratory (e.g. MANCOVA, open-ended questions without a formal thematic analysis). As such, these results should be interpreted with caution and as indicative, but they can be considered as a preliminary step to guide hypothesis generation for future studies.</p> <p>Despite these limitations, the study is commendable for its comprehensive approach, which considers multiple facets of school participation in a population that is representative of autistic children and adolescents in two French counties. It also integrates both qualitative and quantitative data, enabling the development of practical recommendations to enhance the school participation of autistic youth in France.</p> <hd id="AN0193059426-27">Conclusion</hd> <p>This study highlights the positive aspects of school participation among French autistic children, notably their substantial inclusion in regular schools. However, it also emphasizes the role of social-communication difficulties in limiting participation, with stigma and potentially ineffective inclusion practices exacerbating the issue, as reflected by parents' strong desire for increased participation. To address these challenges, policies should focus on training teachers and other school staff to enhance understanding of autistic children's characteristics and needs. Finally, addressing the needs of autistic girls is essential, considering the potential for underdiagnosis and exclusion from mainstream schools.</p> <p>The authors thank all participants for their involvement in the study, as well as the interviewers—Corinne CAMARADA (RHEOP), Marianne PACHOUD (RHEOP), and Marion CHABERT (Master's student at the LPNC)—for their invaluable work in data collection. They are especially grateful to Professor Gavin BROWN for his insightful guidance and expertise on structural equation modeling, which greatly helped this work. They also extend their gratitude to the members of the steering committee for their thoughtful feedback and valuable insights during the study's development: Jean-François BLATIER (RHEOP), Agathe BILLETTE (RHEOP), Michel GILOT (Réseau Anaïs), Jean-Louis GUILLON (Réseau Anaïs), Michel GUINOT (Envol Isère Autisme), Marielle LACHENAL (HandiRéseaux38), Anne MONGE (former PCO TSA, Réseau Anaïs), Agnès MONTOVERT (RHEOP), Isabelle PALACIOS (CADIPA), Élodie SELLIER (RHEOP), and Catherine TRONC (RHEOP).</p> <ref id="AN0193059426-28"> <title> References </title> <blist> <bibl id="bib1" idref="ref30" type="bt">1</bibl> <bibtext> Adams D. (2022). Child and parental mental health as correlates of school non-attendance and school refusal in children on the autism spectrum. Journal of Autism and Developmental Disorders, 52(8), 3353–3365. https://doi.org/10.1007/s10803-021-05211-5</bibtext> </blist> <blist> <bibl id="bib2" idref="ref173" type="bt">2</bibl> <bibtext> Adams R. E., Taylor J. 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Research in Autism Spectrum Disorders, 3(2), 429–437. https://doi.org/10.1016/j.rasd.2008.09.002</bibtext> </blist> </ref> <ref id="AN0193059426-29"> <title> Footnotes </title> <blist> <bibtext> Adeline Lacroix</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0001-6990-5949 Morgane Burnel</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-9383-4893 Monica Baciu</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0002-6842-1317 Marcela Perrone-Bertolotti</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0001-9981-7042 Anne Ego</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-1025-910X</bibtext> </blist> <blist> <bibtext> Adeline Lacroix: Data curation; Formal analysis; Investigation; Methodology; Visualization; Writing—original draft; Writing—review &amp; editing.Morgane Burnel: Conceptualization; Funding acquisition; Visualization; Writing—original draft; Writing—review &amp; editing.Monica Baciu: Funding acquisition; Supervision; Writing—original draft; Writing—review &amp; editing.Pauline Occelli: Data curation; Investigation; Writing—original draft; Writing—review &amp; editing.Marcela Perrone-Bertolotti: Conceptualization; Data curation; Funding acquisition; Methodology; Supervision; Writing—original draft; Writing—review &amp; editing.Marie David: Conceptualization; Data curation; Funding acquisition; Investigation; Methodology; Project administration; Writing—original draft; Writing—review &amp; editing.Anne Ego: Conceptualization; Funding acquisition; Methodology; Project administration; Supervision; Writing—original draft; Writing—review &amp; editing.</bibtext> </blist> <blist> <bibtext> The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a grant from the Fondation de France (grant no. N00111596).</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> During the preparation of this work, the first author used ChatGPT to perform grammatical checks and to improve readability. After using this tool/service, all authors reviewed and edited the content extensively. The authors take full responsibility for the content of the published article.</bibtext> </blist> <blist> <bibtext> The data collected for this study are not publicly available due to absence of a public data sharing statement in the informed consent form signed by the participant. The data may be available on request from the corresponding author Adeline Lacroix.</bibtext> </blist> <blist> <bibtext> All statistics were performed using R 4.2.3 and R studio 2023.12.0 + 369. The script, included in the Rmarkdown document, is available on OSF https://osf.io/h6wb9/overview.</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> </ref> <aug> <p>By Adeline Lacroix; Morgane Burnel; Monica Baciu; Pauline Occelli; Marcela Perrone-Bertolotti; Marie David and Anne Ego</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib15" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib60" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib50" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib75" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib32" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib54" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib55" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib11" firstref="ref13"></nolink> <nolink nlid="nl9" bibid="bib90" firstref="ref14"></nolink> <nolink nlid="nl10" 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| Items | – Name: Title Label: Title Group: Ti Data: School Participation in Autistic Girls and Boys: The Role of Social-Communication Abilities and Extrinsic Barriers – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Adeline+Lacroix%22">Adeline Lacroix</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6990-5949">0000-0001-6990-5949</externalLink>)<br /><searchLink fieldCode="AR" term="%22Morgane+Burnel%22">Morgane Burnel</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9383-4893">0000-0002-9383-4893</externalLink>)<br /><searchLink fieldCode="AR" term="%22Monica+Baciu%22">Monica Baciu</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-6842-1317">0000-0002-6842-1317</externalLink>)<br /><searchLink fieldCode="AR" term="%22Pauline+Occelli%22">Pauline Occelli</searchLink><br /><searchLink fieldCode="AR" term="%22Marcela+Perrone-Bertolotti%22">Marcela Perrone-Bertolotti</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9981-7042">0000-0001-9981-7042</externalLink>)<br /><searchLink fieldCode="AR" term="%22Marie+David%22">Marie David</searchLink><br /><searchLink fieldCode="AR" term="%22Anne+Ego%22">Anne Ego</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1025-910X">0000-0002-1025-910X</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2026 30(5):1242-1262. – Name: Avail Label: Availability Group: Avail Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 21 – Name: DatePubCY Label: Publication Date Group: Date Data: 2026 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Early+Adolescents%22">Early Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Executive+Function%22">Executive Function</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Relationship%22">Interpersonal Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Participation%22">Student Participation</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Environmental+Influences%22">Environmental Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Perceptual+Impairments%22">Perceptual Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Teacher+Attitudes%22">Teacher Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Peer+Relationship%22">Peer Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Attitudes+toward+Disabilities%22">Attitudes toward Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidity%22">Comorbidity</searchLink> – Name: Subject Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22France%22">France</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1177/13623613261428668 – Name: ISSN Label: ISSN Group: ISSN Data: 1362-3613<br />1461-7005 – Name: Abstract Label: Abstract Group: Ab Data: This study aimed to offer a depiction and comprehensive understanding of school participation in autistic youth, which has received limited exploration. Parents of 871 autistic youth aged 7 or 15 were invited to participate in a study, among whom 600 agreed, allowing data collection on diagnosis, comorbidities, school, professional support, and parental characteristics. They were asked to fill in questionnaires assessing executive functions, social-communication difficulties, and school participation, completed by 241. Structural equation modeling and descriptive methods were employed to examine factors influencing school participation and the desire for change. Social-communication abilities stand out as the sole intrinsic determinant associated with school participation. Being a female and having an intellectual disability might negatively impact mainstream school attendance, without exerting a similar influence on activity attendance and involvement. Caregivers identified school demands and the sensory environment as extrinsic barriers to school participation, while teachers' attitudes and peer relationships were seen as both potential barriers and facilitators. Finally, 36%-58% indicated a desire for increased participation in at least one school activity. Our findings highlight the need to reduce stigma around autism, improve school support, and give special consideration to the schooling experiences of autistic girls. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: Note Label: Notes Group: Note Data: https://osf.io/h6wb9/overview – Name: DateEntry Label: Entry Date Group: Date Data: 2026 – Name: AN Label: Accession Number Group: ID Data: EJ1503270 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1177/13623613261428668 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 21 StartPage: 1242 Subjects: – SubjectFull: Autism Spectrum Disorders Type: general – SubjectFull: Early Adolescents Type: general – SubjectFull: Children Type: general – SubjectFull: Executive Function Type: general – SubjectFull: Interpersonal Communication Type: general – SubjectFull: Interpersonal Relationship Type: general – SubjectFull: Interpersonal Competence Type: general – SubjectFull: Student Participation Type: general – SubjectFull: Barriers Type: general – SubjectFull: Gender Differences Type: general – SubjectFull: Intellectual Disability Type: general – SubjectFull: Environmental Influences Type: general – SubjectFull: Perceptual Impairments Type: general – SubjectFull: Teacher Attitudes Type: general – SubjectFull: Peer Relationship Type: general – SubjectFull: Attitudes toward Disabilities Type: general – SubjectFull: Foreign Countries Type: general – SubjectFull: Age Differences Type: general – SubjectFull: Behavior Problems Type: general – SubjectFull: Comorbidity Type: general – SubjectFull: France Type: general Titles: – TitleFull: School Participation in Autistic Girls and Boys: The Role of Social-Communication Abilities and Extrinsic Barriers Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Adeline Lacroix – PersonEntity: Name: NameFull: Morgane Burnel – PersonEntity: Name: NameFull: Monica Baciu – PersonEntity: Name: NameFull: Pauline Occelli – PersonEntity: Name: NameFull: Marcela Perrone-Bertolotti – PersonEntity: Name: NameFull: Marie David – PersonEntity: Name: NameFull: Anne Ego IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 1362-3613 – Type: issn-electronic Value: 1461-7005 Numbering: – Type: volume Value: 30 – Type: issue Value: 5 Titles: – TitleFull: Autism: The International Journal of Research and Practice Type: main |
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