Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. According to the new international classification of diseases (ICD-11) by the World Health Organization (WHO), which came into effect in 2022, ASD has two defined characteristics for a diagnosis: 1. difficulties in interaction and social communication; and 2. restricted interests and repetitive behaviours. A recent systematic review revealed that one out of 100 children is diagnosed with ASD globally. Furthermore, the review found that the prevalence of diagnoses has increased since 2012. The authors explain this increase with improved detection and identification, and higher awareness amongst clinicians and the public (Zeidan et al., 2022). While the focus is often on children, there has also been some research activity around prevalence, assessment and diagnosis of autism in adults. A recent systematic review (Huang et al., 2020) summarised that the prevalence of adult autism is around 11 in 1000 people. Again, this review found that the prevalence has increased in recent years.

Autism and the mainstream media

Many reviews and papers suggest that the increase in the prevalence of autism may be due to higher awareness. Yet, sources of this awareness have not been definitively established. Among others, higher awareness could stem from a more frequent and more detailed representation of autistic people in mainstream media. Media in general often acts as a platform for health discourses, for example in news coverage (Jones & Harwood, 2009), and mass media is an impactful source when it comes to shaping opinions on mental disorders (Nairn et al., 2001). In recent years, autism has been featured more prominently in mainstream media, with television shows, movies and books exploring the experiences of people with autism and their families. This has led to the media being one of the main sources of information about autism for the general public (Nordahl-Hansen, Øien, et al., 2018), and has shaped attitudes towards autism (Draaisma, 2009; John et al., 2018).

Mainstream media like movies and TV have great potential of increasing awareness about autism that goes beyond academic interest, and the ability to reach people who have no personal experience with autism, including people who are neither autistic themselves nor have had contact with autistic people (Nordahl-Hansen & Øien, 2021). Likewise, reading about characters can also increase awareness and understanding (Mar et al., 2008). Yet, there is an ongoing discussion if such representation benefits or harms people with a diagnosis of autism. While raising awareness, representations might also lead to stereotyping and stigmatisation (Nordahl-Hansen, Øien, et al., 2018). For disability in general, literature suggests that mainstream media has led to more stereotyping (Berger, 2016), which might also be true for autism. For example, savantism seems to be overrepresented in the media (Nordahl-Hansen, Øien, et al., 2018), leading to the belief that most people with autism have extraordinary skills. This is not accurate, as less than 30% of people with autism actually have savant skills (Howlin et al., 2009). Additionally, most portrayals seem to represent young white males (Dean & Nordahl-Hansen, 2022; Prochnow, 2014). While it is true that autism is more common in males (with a ratio of 4.3:1; Fombonne, 2003) this stereotypical representation still fails to cover the diverse distribution of all genders and races (Pham et al., 2022).

A growing body of literature, including reviews, is starting to examine this topic, leading to mixed results. For example, Dean and Nordahl-Hansen (2022) found in their review about film and TV representation that autistic characters are moving towards a more diverse portrayal with less stigmatisation around disability, but Fontes and Pino-Juste (2022) found in their review about autism portrayal and social awareness that characters are often portrayed with exaggeration that can lead to stigma.

The current study

Considering the relevant implications of media portrayals of autistic characters for forming attitudes and beliefs in the general populations, findings from research are especially important to address potential shortcomings of such representation and inform practical guidelines to improve portrayals. Therefore, this scoping review aims to summarise the scope of existing research around this topic. We add to a recent and growing body of literature on the media portrayal of mental disorders by including all types of media, such as fiction, non-fiction and social media. This might allow us to compare different forms of media and their differing ways of portrayal of autism. We strive to answer the following questions: “In the current literature, what are the characteristics and range of records that describe the representation of autism in the mainstream media?”. More specifically we aim to explore: Who is being portrayed? In which media are they being portrayed? By whom are they being portrayed? How are autistic characters portrayed? What are the effects on consumers?

Methods

Scoping reviews

Scoping reviews have emerged as a novel method for synthesising evidence. Unlike systematic reviews that focus on a specific research question and its outcomes, scoping reviews are more appropriate when the extent of available evidence is not fully understood. They serve the purpose of identifying and mapping the existing evidence landscape (Arksey & O'Malley, 2005; Munn et al., 2018). In the context of this manuscript, we decided to use a scoping review instead of a systematic review to account for the fact that we did not know the extent to which evidence existed regarding the different forms of media. We followed guidelines from Peters et al. (2015) for conducting scoping reviews.

Data sources and search strategy

An initial limited search on Google Scholar as well as the two included databases PubMed and PsychInfo led to the refinement of search strings and eligibility criteria. For our primary search, we included the two databases PubMed and PsychInfo. We decided for these two databases as leading databases from the fields of medicine and psychology respectively, as this covers both the medical and the psychological / social science aspects of autism research.

This review was part of a broader systematic literature search on media portrayal and mental disorders. The initial search, title and abstract screening were done as part of the broader search. Our search string for both databases was “(representation OR portrayal) AND media AND (disorder OR autism OR depression OR anxiety)” with an applied filter for publication date from 2010 – 2023. Eligibility criteria were defined specifically for this review, and full text screening and secondary search were conducted separate from the broader review. Reference lists of all included studies were scanned for additional records. All records were imported in EndNote 20. Duplicates were removed with the program’s included option, and publication types that were not “journal article” were removed manually.

Eligibility criteria and data characterisation

Eligibility criteria can be found in Table 1. For all included articles, the following characteristics were retrieved: General publication characteristics (authors, title, year, country of origin, sector, paper length); mental disorder type; media type; study information if any (population, setting, design, methods, analysis, results, effect sizes); effects on consumers. The data was summarised in an Excel spreadsheet.

Table 1 Eligibility Criteria
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Results

Search and selection of articles

The search was conducted on 01.02.2023. Two raters (GM, VS) screened all records for both abstract and full-text level. Disagreements were discussed between the two raters until consensus was reached. The full selection process can be found in the flow chart (Fig. 1). Thirty-one records met the inclusion criteria.

Fig. 1
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Flow Chart of The Selection Process

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Characteristics of included records

Out of the 31 papers that were included in the analysis, 15 focused on non-fiction media while 17 focused on fiction media (some records cover more than one category). The majority of records explored either newspaper articles (n = 12) or movies & television (TV) productions (n = 10). It is worth noting that one paper which examined magazines was categorised under the newspaper category, while another paper that investigated video games was sorted into the movies & TV category. The sample of papers included in the analysis exhibited a bias towards media in the United States, with 55% of the studies focusing on US media. There is an upward trend for research around this topic, with the most records stemming from 2022 (see Fig. 2). In fictional media, authors often included both canon (e.g. Shaun Murphy; The Good Doctor) and non-canon autistic characters (e.g. Sheldon Cooper; The Big Bang Theory), meaning that the characters are either explicitly labelled as being autistic or just exhibit behaviour relating to the autism spectrum (Tharian et al., 2019).

Fig. 2
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Publication Date of Included Records

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Portrayal of autism in non-fiction media

Newspapers

Eleven of the included studies covered autistic representation in newspapers (Table 2). Two main points were made in terms of prevalence of news articles covering autism. First, there is a visible upward trend of number of published articles even though most of the stories still only include incidental references to autism, and autistic people had a leading role in less than 20% of articles (Bie & Tang, 2015). Second, most accounts seem to be about autistic children, not adults (Akhtar et al., 2022; Tang & Bie, 2016). Newspapers in general still seem to endorse stigmatising portrayal, such as the use of negative language (Huws & Jones, 2011), a focus on negative aspects (Clarke, 2012; Holton et al., 2014; Mann, 2019) or the medical model of disability (Baroutsis et al., 2021; Clarke, 2012; Tang & Bie, 2016). Baroutsis et al. (2021) found that only 26% of articles had a positive valence. In a study spanning 16 years, Yu and Farrell (2020) found that stigma cues decreased, but are still present in one third of all articles. Lewin and Akhtar (2021) found an increase of positive valence in US newspapers, with more focus on strengths. Despite one record finding that more individual personal stories are being covered (Wendorf Muhamad & Yang, 2017), in more than half of the included records, a missing representation of autistic individuals in the news stories was mentioned, making this the most important finding (Baroutsis et al., 2021; Bie & Tang, 2015; Clarke, 2012; Holton et al., 2014; Huws & Jones, 2011; Lewin & Akhtar, 2021). For example, this means that instead of interviews with autistic individuals themselves, only parents or clinical experts were included.

Table 2 Characteristics of Records Analysing Portrayals of Autism in Newspapers
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Online / social media

Four records explored how autism is portrayed on social media and the internet (Table 3). One study examined representation of both children and adults on websites and found that while children still dominate, there has been an increase in adult representation (Akhtar et al., 2022). Another study analysed forum posts and found that autistic individuals tend to positively represent themselves as normal and autonomous (Parsloe, 2015). On Twitter, posts were found to be informative and supportive towards people with autism (Gauld et al., 2022). However, one study that focused on self-representation in YouTube videos found a negative tone with emphasis on the medical aspects and that challenges of autism prevail in these videos (Angulo-Jiménez & DeThorne, 2019).

Table 3 Characteristics of Records Analysing Portrayals of Autism in Social Media
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Portrayal of autism in fiction media

Movies & TV

Nine records were found for the fictional media in the movies & TV category (Table 4). Most records describe stigmatising portrayal, such as a focus on negative aspects of autism and a lack of diversity. Characters represented in movies & TV display very high to extreme levels of autism measured with clinical tools (Garner et al., 2015; Nordahl-Hansen et al., 2018), and more than half (n = 6) of the records mention the prevalence of savantism in this category (Belcher & Maich, 2014; Garner et al., 2015; Hannam, 2014; Nordahl-Hansen et al., 2018; Poe & Moseley, 2016; Ressa, 2021). One study (Tharian et al., 2019) also examined video games. Unlike movies & TV, they found that not only the representation has increased, but the valence for autistic characters in video games is positive with a focus on resiliency.

Table 4 Characteristics of Records Analysing Portrayals of Autism in Movies & TV
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Literature

Five studies were identified that investigated the representation of autism in literature and books (Table 5). Examining 474 books, Akhtar et al. (2022) found that 81% of characters were children. One of the studies revealed that most books tend to centre on repetitive behaviour rather than social difficulties (Kelley et al., 2018). Another study, which only examined one book (The Boy on the Bridge), reported that it portrayed autism in a negative light, potentially contributing to stigmatisation (Maich et al., 2022). However, other studies show that many books are capable of portraying autistic characters in a positive, authentic and nuanced manner, emphasising autistic individuals’ resilience (Belcher & Maich, 2014; Tharian et al., 2019).

Table 5 Characteristics of Records Analysing Portrayals of Autism in Fiction
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Effects of portrayal on consumers

In total, we found four records that examined the effects of autistic portrayal on consumers. Bury et al. (2022)’s questionnaire study investigated where autistic adults learn about autism and if this is related to accuracy of knowledge, internalised stigma and how they endorse their own identity. They found that participants learned most from books, journals and online research and less from TV / movies. Stigma was most related to TV and movies, whereas social media and online research was positively correlated with knowledge and autism identity.

Three studies tested effects of media portrayal in a pre-post test design. In two, participants watched one episode of a series depicting a character with autism. In the first study, Chow and Hayakawa (2022) investigated how young children’s understanding and perception of autism would change after watching an episode of the show Hero Elementary. They found that while prior knowledge of children about autism was scarce and erroneous, perception was more empathetic and positive after watching the show. In the second study, Stern and Barnes (2019) employed an experimental design, with participants being randomly assigned to watching part of an episode of The Good Doctor or watching a lecture about ASD. Results showed no differences for the two groups concerning understanding and identifying autism. Yet, participants in the experimental group chose more positive and fewer negative traits to describe autism and showed more interest in learning more about autism. The third study tested pre-service teachers’ perceptions about students with ASD after reading young-adult literature books with characters with autism (Barrio et al., 2019). They found that differences in teachers’ prior perceptions declined after reading the books. Their qualitative data further reinforced an increase in knowledge and understanding of children with ASD.

Discussion

This scoping review aimed to map the literature on how autism is portrayed in different types of media, including non-fiction and fiction. The study included 31 records from PubMed and PsychInfo databases, and secondary searches. The research found that most studies between 2010 and 2023 focused on newspapers and movies & TV, and the least on social media. The media types differ in terms of stigmatisation, with movies & TV and newspapers being more stigmatising than literature and social media. Stigmatisation often involves negative portrayals of autism and exaggeration of symptoms, such as savantism. The review highlights the need for autistic individuals to be included in media representation discussions. Overall, our scoping review underscores the importance of examining the portrayal of autism in the media and provides valuable insights into how different types of media can influence public attitudes and beliefs about autism.

The media type associated with the highest level of stigmatisation, negative connotation or misinformation seems to be movies & TV. All included records of this media type criticise the examined media for one or more of these. One study compared U.S. movies and their Indian remakes (Ejaz, 2020). They found that the Indian remakes are less stigmatising. Furthermore, savantism seems to be exaggerated in this media type, while it is less common in other media types. On a similar note, another point that was frequently made by the included records was that autism symptoms were often exaggerated or stuck too much to the diagnostic criteria. Including representatives from the autistic community in the creation of media would most likely also add diversity and nuances to the symptoms and characteristics. Negative portrayals in movies & TV could be particularly damaging because a large proportion of people watch movies and series frequently, often on a daily basis, more so than they read literature. Additionally, some of the reviewed movies and series are highly popular on platforms like Netflix (e.g. The Good Doctor), while the reviewed literature may not have such a large consumer base. Our review suggests that the media type that may have the greatest influence on consumers due to its large reach is actually the one with the most stigmatising effects.

One of the primary limitations of the media coverage of autism is the lack of inclusion of perspectives from autistic individuals themselves. This has been prominently criticised by articles that cover the topic. However, it appears that the quality of coverage varies depending on the media outlet. For instance, in non-fiction media, newspapers tend to have stigmatising content, and our included research papers highlight the limitations of newspaper portrayals of autism. In contrast, social media tends to portray autistic individuals more positively. This pattern may be explained by the fact that social media platforms are more likely to feature content created by autistic individuals themselves, whereas newspapers often fail to include voices from the autistic community. In fiction media, the distinction is not as clear, though there seems to be a trend for more accurate, diverse and positive portrayal in books than in movies & TV. In line with our findings, a recent study by Orm et al. (2023) found that the four main changes that autistic individuals would encourage to improve media representation are autistic actors, autistic writers, greater diversity in autistic characters and making autism incidental instead of the main story.

Our included studies testing the effects on consumers clearly demonstrate an influence of media portrayal on how people view autistic people, showing the importance of a correct, positive and diverse representation. Bury et al. (2022) found that movies & TV were more related to learning stigma than other types of media, which coincides with the results of our review. Yet, other studies found that movies and TV can influence both children and adults positively. While the portrayal of savantism (e.g. in The Good Doctor) might not represent a statistical correctness, results still show that having a main character with autism leads to a more positive perception of autism (Stern & Barnes, 2019).

Practical implications and future research

Considering the results of this scoping review, we identify three main implications both for future media portrayal and for research about this topic: First, media portrayal of autistic individuals is still often stigmatising, negative and either represents autistic individuals without diversity or overrepresents characteristics like savantism. Considering that adults are the main audience and that especially fiction media often portrays autistic adults, this has major implications. Many adults with autism go undiagnosed or self-diagnosed (Huang et al., 2020; McDonald, 2020) and may relate to the characters they see on screen. This can be beneficial if it helps them recognise issues with their own behaviour and encourages them to seek help. However, if the representation in the media perpetuates stigma and negativity, they may be discouraged from seeking help and even begin to view their own characteristics in a negative light. As a consequence, media representation of autistic people should include the voices of autistic people themselves, as there is often very little self-representation, except on social media. The second implication is that autistic adults seem to be underrepresented especially in newspaper coverage. Finally, the third implication is that more research focus should be put on newer media. This includes video games, but especially social media, as social media seems to be a medium where autism can and already is being portrayed by autistic people themselves, leading to a more diverse, more realistic and more positive representation. Yet, it is also important to examine the reach of specific media outlets. While self-portrayal in social media by autistic people themselves is highly important and shows a new and diverse picture of the community, they might not have as much reach as popular series portraying autistic characters. Note for example that forum posts might only reach autistic individuals. Such representation might shape views of the autistic community, which is of great value, but might not reach the general population.

Limitations of the current review

Secondary search strategies yielded almost as many relevant articles as our primary search strategies. This shows that the topic is highly interdisciplinary, and a lot of research comes from outside psychology and medicine. Furthermore, the broad heterogeneity of the included papers makes it difficult to draw comparative conclusions. For example, while some papers included several hundreds of news articles, other papers only investigated one specific book. Our results are therefore not generalisable to all existing media, but map and highlight the current literature existing on the topic of media portrayal.

Additionally, the results of this scoping review may be biased by different methodological aspects. Firstly, we used only the databases Pubmed and Psychinfo, which cover a great amount of relevant literature, but exclude all articles covered only by other databases. Also, we excluded all articles written in other languages than German and English. This may limit the representation of certain cultural contexts or regions. Articles published after the cut-off date (Feb. 1st 2023) as well as grey literature and conference abstracts are also excluded. Like all reviews, this scoping review is likely affected by publication bias, the tendency to publish studies with significant findings or positive outcomes, which may result in an overrepresentation of certain perspectives or themes related to the portrayal of autism in media.

Conclusion

This scoping review provides an overview of the literature on how autism is portrayed in the media. Although there has been an increase in the portrayal of autism in various types of media, including fiction and non-fiction, the content still tends to be stigmatising and negative, often failing to show the perspective of autistic individuals. While future research should put more focus on newer forms of media, such as social media, content creators should strive to incorporate the perspectives of autistic individuals themselves in media portrayal. By actively involving autistic individuals in the content creation process, media can become more authentic and accurate, promoting a better understanding and acceptance of autism.