A Thematic Analysis Exploring the Experiences of Ableism for People Living with Cerebral Palsy

Abstract

Disabled people commonly report experiencing predetermined perceptions and assumptions of disability that form barriers towards understanding and treating disabled people equally. This process is known as ableism; a specific type of ableism called benevolent ableism intends to help and solicit assistance towards disabled people, but instead dismisses their capacity to advocate for their own needs, resulting in help that is deemed overly enforced, assumptive, and unwanted. A focus group and one informal interview were conducted to investigate the views and experiences of people living with cerebral palsy (CP), highlighting how benevolent ableism operates in their own lives, with additional forms of ableism also explored. Thematic analysis (TA) was applied to the data, resulting in three broad themes: benevolent ableism, strategies to improve and reduce ableism, and othering. The findings revealed that benevolent ableism was present when help was assumed, overly requested despite rejections of help, and belittling in nature; positive forms of assistance allowed the person with CP to instigate help and was accommodating; other forms of ableism were encountered, such as invasive staring, being treated like a child, charitable praise, being ignored within the medical setting, and lowered perceptions of capabilities. In order to diminish these difficult experiences and encourage practices, behaviours, and ideologies that promote less prejudice, participants mentioned education and improved interaction as being important aspects. Furthermore, this research poses wider implications for family members, teachers, medical professionals, and the general public to learn appropriate approaches toward disabled people and gain a better understanding of disability.

1. Literature Review

Between 2020 and 2021, disability prevalence in the UK was 22%, equating to approximately 14.6 million people. Reduced mobility, such as difficulties walking short distances and climbing stairs, ranked as the highest prevalence at 46% [1]. Traditionally, the medical model posits that disability is a source of limitations for disabled people, with little or no consideration given to the social environment [2,3,4]. By contrast, the social model of disability challenges the pathologising and eugenics views of the medical model, arguing that societies’ beliefs, attitudes, and environmental structures create the real barriers to the lives of disabled people [5,6,7]. However, critics of the social model argue that the social model over-emphasises the social dimensions whilst downplaying the embodied experiences of disability, suggesting that the social model insufficiently explains the physical implications of living with a disability [2]. Other scholars, instead, contend that disability is a part of someone’s life and identity, and it can be limiting towards the individual regardless of society, and that should not be ignored [2,8]. Scholars supporting the social model argue that the model itself does not repudiate disability as an embodied/physical experience, but its main purpose is to illustrate disability discrimination within social environments [2,3,9]. Considering these arguments, the social model provides a comprehensive socio-political explanation of what is faced by disabled people. It highlights how societal constructions, such as negative stereotypes, shape perceptions of disability [10]. These behaviours and attitudes towards disabled people reflect how the social context can limit the freedom and self-determination of people with CP. Self-determination is where individuals with CP determine the extension of the help they choose to have or not have. These behaviours are referred to in the literature as ableism, pre-conceived judgments, beliefs, and attitudes which tend to favour non-disabled individuals [10]. These socio-cultural notions of the self and the body, defining what it means to be fully human and ‘normal’, are especially enacted against disability, which is perceived as a diminished state of being [10,11]. According to Wolbring [12], the discourse of ableism has been exacerbated by technological enhancements, particularly in the form of biotechnology and other sciences aimed at modifying the functioning of biological life forms, including humans. Ableism privileges ‘species-typical abilities’, implicitly framing any deviation from it as ‘sub-species-typical’: a disordered version of the species. The framework positions “sub–species-typical” individuals as less acknowledged or valued within societal expectations of bodies and abilities. Bogart and Dunn [13] (p. 651) describe ableism as “stereotyping, prejudice, discrimination, and social oppression toward disabled people.” There are different forms of ableism covering most subtle forms such as benevolent ableism, which includes childlike talking (infantilisation), pitying the individual, exerting unwanted help and charitable praise; to hostile ableism, that consists of direct and dehumanising assaults; and ambivalent ableism which is a combination of benevolent and hostile ableism’ [14]. Researchers pose different arguments as to what causes ableism. Ableism is argued to stem from an able-bodied narrative blueprint of ‘normalcy’ about the body that disability is viewed to deviate from, confining the body to normalised ideals [11,15]. Calder-Dawe et al. [16] explains that ableist mindsets originate from Western ideologies that distinguish the disabled from non-disabled populations, believing that disability impacts the overall individual’s functionality. In contrast, Nario-Redmond et al.’s [14] research explores the stereotype content model (SCM), which theorises that disabled people are more likely to be perceived as warm and incompetent, promoting a sense of protection which invokes sympathy and pity, and in this way, triggers over-help [17,18]. On the other hand, Keller and Galgay [19] suggest that the potentiality of experiencing disability promotes unwanted help and poor apprehension about disability. This strongly illustrates how ableism functions as a divisive discourse that separates disabled people from the majority, shaped by societal conceptions of disability. Disablism is therefore the act of social oppression, unequal treatment, and institutional exclusion that is consciously directed at people with physical, sensory, cognitive, or psychological differences; particularly from lifelong learning and the workforce, stemming from these introjected negative narratives on disability [11]. The exclusion is deeply rooted in capitalistic and neoliberal ideologies of skilled abled bodies that prioritise ‘the movement of capital’ [20] (p. 10). Disablism produces exclusions at a material level, which in turn affects the emotional, cultural, and relational spheres of life of disabled people.

Re-conceived judgments, beliefs, and attitudes which tend to favour non-disabled individuals. These socio-cultural notions of the self and the body, defining what it means to be fully human and ‘normal’, are especially enacted against disability, which is perceived as a diminished state of being [11,12]. According to Wolbring [13], the discourse of ableism has been exacerbated by technological enhancements, particularly in the form of biotechnology and other sciences aimed at modifying the functioning of biological life forms, including humans. Ableism privileges ‘species-typical abilities’, implicitly framing any deviation from it as ‘sub-species-typical’: a disordered version of the species. The framework positions “sub–species-typical” individuals as less acknowledged or valued within societal expectations of bodies and abilities. Bogart and Dunn [14] (p. 651) describe ableism as “stereotyping, prejudice, discrimination, and social oppression toward disabled people.” There are different forms of ableism covering most subtle forms such as benevolent ableism, which includes childlike talking (infantilisation), pitying the individual, exerting unwanted help and charitable praise; to hostile ableism, that consists of direct and dehumanising assaults; and ambivalent ableism which is a combination of benevolent and hostile ableism’ [15]. Researchers pose different arguments as to what causes ableism. Ableism is argued to stem from an able-bodied narrative blueprint of ‘normalcy’ about the body that disability is viewed to deviate from, confining the body to normalised ideals [12,16]. Calder-Dawe et al. [17] explains that ableist mindsets originate from Western ideologies that distinguish the disabled from non-disabled populations, believing that disability impacts the overall individual’s functionality. In contrast, Nario-Redmond et al.’s [15] research explores the stereotype content model (SCM), which theorises that disabled people are more likely to be perceived as warm and incompetent, promoting a sense of protection which invokes sympathy and pity, and in this way, triggers over-help [18,19]. On the other hand, Keller and Galgay [20] suggest that the potentiality of experiencing disability promotes unwanted help and poor apprehension about disability. This strongly illustrates how ableism functions as a divisive discourse that separates disabled people from the majority, shaped by societal conceptions of disability. Disablism is therefore the act of social oppression, inequal treatment, and institutional exclusion that is consciously directed at people with physical, sensory, cognitive, or psychological differences; particularly from lifelong learning and the workforce, stemming from these introjected negative narratives on disability [12]. The exclusion is deeply rooted in capitalistic and neoliberal ideologies of skilled abled bodies that prioritise ‘the movement of capital’ [21] (p. 10). Disablism produces exclusions at a material level, which in turn affects the emotional, cultural, and relational spheres of life of disabled people.

The narrative of the abled body is particularly detrimental in relation to disabilities like CP, which is often judged for its visible clues. Cerebral palsy (CP) is characterised as a physical and neurological difference that affects mobility, coordination, and posture [21]. Ableist views of CP have been assessed by Gilmore and Wotherspoon [22], who conducted a quantitative study surveying the Australian community to explore public perceptions of CP. The results showed that 21% of respondents (1217 adults) viewed people with CP as having physical impairments, often associating them with wheelchair use. These findings indicate that societal perceptions of cerebral palsy are framed in limiting and negative ways, shaping interactions between people with CP and those without. Furthermore, a study by Read et al. [23] explored the impact of social stigma on individuals with CP. The authors found that participants were acutely aware of both their personal and social identities, where the former reflected a recognition of their unique needs, and the latter was shaped by society’s tendency to label individuals as disabled based on physical differences, rather than acknowledging environmental or social barriers. Crucially, participants reported that to access support, they often had to enact their social identity as a disabled person. This finding clearly demonstrates that concepts of ability and disability are co-constructed at the societal level and shaped by socio-cultural and political factors, significantly affecting how individuals experience and perceive disability, particularly in relation to physical differences [15].

Shah et al. [24] surveyed working-age adults with CP in the UK regarding their risk of falling, and found that an existing stigma around functioning, such as the belief that working-age individuals with CP should not fall, was embedded even within services like UK fall clinics, which upheld disabling attitudes and policies. Rehabilitation programmes are still largely unavailable for the younger population, as services are primarily designed for older adults. This stigma often prevents individuals from accessing appropriate mobility aids, such as wheelchairs: ultimately compromising their autonomy, independence, and functional ability. However, a significant gap in the literature remains regarding CP in the UK, as research specifically exploring the intersection of CP and ableism is limited. Existing studies tend to focus broadly on disability, often overlooking the distinct experiences of individuals with CP. This makes the current study particularly important. While all disabled people may encounter ableism and disablism, CP is a unique difference, and the experiences of those who live with it off er distinct insights into how it manifests, and how it is sustained. These unique forms of stigma must be critically examined and constructively addressed to challenge the specific barriers that people with CP face in their daily lives. Furthermore, whilst overt discrimination is more prominently addressed in the literature, covert discrimination remains an underexplored area of studies, which contributes to the continued exclusion of people with CP from full participation in society.

The existing body of research on benevolent ableism suggests that helping behaviours which invade personal space, expressions of pity, and overprotective families were commonly reported in the experiences of disabled people [14,16,25]. Moreover, the help offered was often perceived to be uncomfortable and unnecessary in relation to the disabled people’s actual capabilities, and despite the innocent and well-intentioned nature of it, this could cause harmful effects on disabled people [14,16,19,25]. For example, disabled people’s experience reduced mental health and academic achievement, and this is associated with the disabling use of ability judgements [26,27]. Furthermore, Wang et al.’s [28] study investigated how blind and non-blind participants perceived imaginary interactions that displayed both belligerent or subtle condescension between a blind woman and a member of the public. The results showed that blind participants perceived both exchanges as patronising, although non-blind participants were oblivious to the patronising circumstances, believing that help was a positive and caring intention to assist. However, these studies are not without their limitations.

There are also methodological limitations that need to be addressed. Previous published studies have largely relied on open-ended surveys that, whilst appropriate for gathering personal experiences and rich quality details, could not illustrate the interactional dynamics within groups from the same community. As a result, there are limited studies that off er an insight into how disabled people, as a group, experience ableism [14,26,27,29]. An exception is Olkin et al. [25], who facilitated the use of focus groups to explore ableism in depth. The use of focus groups allowed for the emergence of a collective synergy of the group, enabling participants to share personal interpretations of ableism and to construct meaning through shared experiences [30]. Nevertheless, Olkin et al.’s [25] research only explored women’s experiences, which, despite being beneficial for investigating the intersection of gender and disability [31], offers a limited generalisation of results for men. Studies using focus groups with individuals with CP are also sparse across the literature. A study using iterative focus groups by Sarmiento et al. [32] proved that focus groups were effective in discussing preventive care for individuals with CP. This study has therefore employed focus groups as an alternative method of data collection to amplify the voice of individuals with CP and to facilitate a collective understanding of ableism. Interactional dynamics within groups meant that additional perspectives and meanings were constructed, which enabled more profound depth and richness of discussion [33,34,35,36].

Additionally, there is limited published data on how individuals with CP experience and apprehend help from others, particularly in regard to benevolent ableism, which involves well-intentioned yet patronising behaviours and attitudes towards disabled people. For instance, studies tend to focus on broader samples of people with a wide variety of disabilities that would not accurately capture the differences between specific conditions and their experiences of ableism. Some researchers have recommended that future studies should investigate how different types of ableism are associated with specific groups of disabled people [14,25,29]. Additionally, research has found individuals who have more visible conditions, such as those with physical differences or who utilise walking aids, are more likely to experience unwanted help and higher incidences of ableism [14,29,37]. Moreover, benevolent and other forms of ableism can manifest inconspicuously, with reports finding higher occurrences of implicit prejudicial behaviours compared to explicit prejudicial behaviours; thus, these indirect experiences warrant further investigation [37,38,39]. Data for this study were collected using focus groups and informal interviews to provide deeper investigation into how those with a specific disability, such as individuals with CP, experience benevolent ableism. As CP varies in the way individuals move, coordinate, and maintain posture [40], as well as in the way they communicate and use language [41], there is a higher likelihood of exposure and vulnerability to ableist experiences for them. This makes it a vital area of investigation for critical inquiry. Focus groups in this study amplified what is already known in the literature on benevolent ableism [42,43]. It also allowed expression of the individual’s experiences of disability, as CP has a community that has historically been left out, and thereby, resulted in being more empowering for the participants [43,44,45].

Extending the previous research, this study therefore focuses on the experiences of ableism, and, in particular, benevolent ableism for people with CP: specifically, benevolent help indicated by assistance that is provided instinctively, without asking the individual, or aiding despite the individual declining the off er of help [14]. Examination of this problem is necessary for promoting change and eradicating restrictive beliefs about disability, so disabled people can lead lives that are free from assumption and differential treatment.

Hence, the research question is ‘How do people living with cerebral palsy experience ableism, specifically benevolent ableism?’ The study’s objectives are as follows:

• To investigate how people with CP understand and perceive benevolent ableism in their daily lives.
• To examine how restrictions on independence occur in social domains such as community, family, and work.
• To explore the emergence of other forms of ableism in disabled people’s experiences.

This manuscript begins with a description and critical appraisal of the methodology used to collect and analyse the data. The findings are then presented in the results section, followed by a discussion of the findings, and finally, a conclusion.

2. Methodology Design

The epistemological standpoint of the research is based on the social constructionist theory. Social construction is the idea that all objects, concepts, and knowledge are assembled and given meaning through social processes [46]. Therefore, people’s perceptions and knowledge around disability are shaped and constructed by society [47].

The decision to apply a qualitative methodology in this research was based on the understanding that this method incorporates a naturalistic means to understanding social phenomena, with a focus on human ‘experience, meaning and perspective’ [48] (p. 499), and how these are formed and responded to, both emotionally and physically [35,49]. This methodology was considered valuable for gaining a detailed and nuanced understanding of ableism and benevolent ableism, as opposed to quantitative measures, which would limit insight into this topic by reducing complex experiences to numerical data and disregarding social conditions [33,50].

2.1. Participants and Recruitment

The research project mostly used opportunity sampling methods to recruit participants through advertisements on CP social media pages and locations such as physiotherapy and CP charity events. Another method involved the lead researcher approaching people who had CP with whom they had personal connection. The inclusion and exclusion criteria which were used to recruit participants are indicated in

Table 1. Inclusion and exclusion criteria.

Inclusion Criteria	Exclusion Criteria
Cerebral Palsy (CP)	Do not have CP
Lived in UK
Age range of 19–55	Under 18
Include participants with language barriers who can communicate through translators to speak on their behalf.

.

As shown in

Table 2. Profiles of participants.

Pseudonyms	Gender	Age	Condition
Lucas and Paul	Male	35	Cerebral Palsy
Charlotte	Female	25	Cerebral Palsy
Claire	Female	55	Cerebral Palsy
Ryan	Male	19	Cerebral Palsy
Ben	Male	26	Cerebral Palsy

, five participants were successfully recruited, two females and three males, aged 19–55. Lucas had language barriers due to his CP, so his brother, Paul, spoke on his behalf.

2.2. Data Collection

The method of data collection for each participant is listed in

Table 3. Method of data collection.

Pseudonyms	Method of Data Collection
Claire	Focus group
Charlotte	Focus group
Lucas and Paul	Focus group
Ryan	Informal interviews
Ben	Informal interviews

. As illustrated, the first three participants took part in the focus group (Table 3). Focus groups were originally the preferred method for data collection. However, two participants who wanted to join were unable to do so, as they reached out once the focus groups had already been conducted. Therefore, informal dual interviews were carried out instead. Furthermore, following the focus group, one person continued to engage via email, which was also recorded in the data.

The focus group sample consisted of three people, which is within the usual range, despite limitations [34]. While the amount of a traditional-sized focus group is suggested to be between 3 and 12 within research, smaller groups could be beneficial because they can result in a more meaningful and detailed discussion of individual accounts [34].

The focus group was held virtually on Microsoft Teams and lasted 1 h and 50 min. Open-ended semi-structured questions were asked; the initial questions focused on building rapport and later questions encouraged discussion of ableism and benevolent ableism occurring in day-to-day life. The focus group and informal interview was recorded and subsequently transcribed using Microsoft Teams. The informal interview followed the focus group structure and ran for 57 min.

After facilitating contrasting methods of focus groups and interviews, upon reflection, I believe interviews would be better to use in future, due to the logistical challenges present when organising focus groups, such as recruiting participants. Planning availability for the focus group proved to be more difficult than originally anticipated due to individuals’ schedules, varying levels of interest, resistance, and participants dropping out. Initially, the lead researcher expected that the physical advertisement flyers would generate interest; however, this approach was ineffective, so online advertisements proved to be a more successful strategy.

The informal interview revealed that people who already knew each other elicited easier conversation from the onset, due to already having that established rapport, and this allowed a sense of comfort within the focus group that may not always transpire or could take a long time to develop. One participant had trouble with their speech due to their CP, which the lead researcher did not realise initially. However, when liaising with their translator, the lead researcher was able to accommodate them into the focus group.

2.3. Data Analysis

Thematic analysis (TA) facilitated the identification of themes and patterns emerging in the participants’ accounts [51]. TA enabled the exploration of people’s opinions, thoughts, and expressions on benevolent ableism [52]. Previous research on ableism favourably implements TA to investigate this phenomenon because it expresses personal experiences of disabled people that capture this group’s collective understanding of this topic [53].

The steps outlined by Braun and Clarke [51] were followed; firstly, transcripts were read thoroughly to ensure familiarity with the data. In the second stage, initial codes began to emerge and were subsequently grouped; the third stage involved organising the codes in themes by using thematic maps. These themes were evaluated and reviewed to determine whether any codes needed to be added or removed. In the final stage, the themes were refi ned, leading to the writing-up of the analysis. Regular meetings with the supervisor of this project supported the review process, clarifying the interpretation of certain themes, and providing the triangulation of findings.

Both inductive and deductive approaches were used to analyse the data, since prior research and the data itself informed the development of findings. Additionally, a latent coding technique was applied, therefore offering a deeper investigation of underlying concepts and experiences [54]. This allows flexibility around decisions about the identification of themes and theoretical frameworks, whilst also cultivating meaning from participants’ experiences [51,53]. Meetings with the dissertation supervisor and the inclusion of participants to explore the same topic ensured the reliability of the study. Confirmability is demonstrated by the study’s alignment with previous focus group methodologies that have been facilitated to explore ableism [16,25]. Themes in this study are considered dependable, as they resonate with existing research that is focused on benevolent help, othering, and the need for improved interaction and education [10,14,16].

Peer debriefing with the supervisor who brought an external perspective, lacking the lived experience of cerebral palsy but with expertise in neurodiversity, supported the lead researcher’s ongoing reflection, and enriched the research design, ethical considerations, and data interpretation. It contributed to triangulation and data verification, and fostered deeper critical engagement with disability, particularly through the alignment to critical disability studies and the neurodiversity paradigm throughout the research process. The neurodiversity paradigm subscribes to the idea of disability as an embodied difference, in line with the social model of disability lens adopted in this study.

3. Ethical Considerations

Ethical approval was obtained by the Manchester Metropolitan University (ID 49681). Participants’ information sheets and consent forms were provided in advance, outlining the details of the study and informing participants that the meeting would be both video- and audio- recorded on Teams. Participants were given the option to be off -camera if they did not wish to be filmed. Following the focus group, debriefs were sent to provide details of the withdrawal process and supportive wellbeing contacts. Research involving disabled people has resulted in ethical issues of exploitation. For instance, previous research has either excluded or taken advantage of disabled people’s experiences and knowledge, by extracting information from them but then excluding their opportunity to view the results [55,56]. Therefore, participants were updated on the findings.

Moreover, the protection of participants is central to ensuring that participants avoid harm; therefore, in line with research rigour procedures, pseudonyms were used throughout this study to maintain anonymity. During the recruitment stage, some participants expressed reluctance to participate in a disability-focused study, indicating a desire to keep their involvement confidential. This was further brought to light when one participant withdrew from the study due to an administrative error that exposed their email address to other participants. Although the research design included pseudonymisation, this occurrence highlighted how crucial it is to have strong safeguards in place to protect confidentiality, especially for those with disabilities.

4. Findings and Discussion

As shown in Figure 1, three broad themes emerged from the focus group and dyadic informal interview data, which were all related to participants’ lived experiences of ableism and disablism: ‘benevolent ableism’, with a sub-theme of ‘positive helping experiences in everyday life’ (including instances of charitable praise); ‘strategies to reduce and improve ableism’; and ‘othering’, which included behaviours such as staring and infantilisation, and had sub-themes of ‘being ignored or not listened to’ and ‘perceptions and attitudes of capabilities’.

4.1. Theme 1: Benevolent Ableism

This theme discusses experiences of benevolent ableism in the form of unwanted help, which is when assistance is assumed to be needed and is offered without consent. Participants recalled their experiences of unsolicited help and how it limited their independence. Claire recalled a time when non-disabled people presumed the type of help she required, resulting in support being ultimately inappropriate:

‘I find that being belittled is the worst bit about it (…) and sometimes it is worse than not helping at all. If they assume that they know what you need or what you want. Sometimes—because I do not have the use of both hands, I only have the use of one and they hand me things to the wrong side, and you are going (…) why are you doing that? Because you are too busy assuming and not seeing what I find quite challenging’.

(Claire, 64–71)

Claire describes her frustration when recalling instances where non-disabled individuals offered unsolicited help based on their assumptions about her abilities (i.e., not being self-sufficient because she cannot use both hands), but also clearly overlooking her real needs. In such an interaction, offering help reflects an underlined belief that non-disabled individuals are more competent and all-knowing. Claire’s observation clearly suggests that such help can feel belittling and counterproductive, particularly when failing to consider her needs. Her experience aligns with previous findings on benevolent ableism that document the negative reactions of disabled individuals towards benevolent help [14,16,19,25]. The perception that disability equates lack of physical functioning for disabled people can explain the assumptions that trigger unwanted help [16]. For example, Shildrick [57] argues that societal constructions of the human body place high scrutiny on disability. These social norms perceive certain appearances and functionalities of bodies as ‘subnormal’, therefore excluding those who do not conform to ‘normal’ standards. Claire’s CP potentially acts as a physical marker that prompts the help-giver to perceive her condition as limiting, leading them to assume that assistance is necessary [57,58]. Shildrick [57] elaborates that embodiment should be perceived beyond differences, and that views should resist societal categorisation of bodies, which restricts disability to limited functionality. The rejection of medical ideologies that categorise bodies with perceived anomalies by critical disability scholars reflects a challenge to the pathologisation of human beings who do not conform, such as disabled people [11,16,57]. Additionally, gender is a key factor in interpreting the non-disabled response in this interaction. The feminist literature argues that both women’s and disabled bodies are often perceived as incapable: a perception deeply dominant in Western discourses. This framing contributes to the ongoing separation between those disabled and non-disabled people, particularly when gender is also at play, reinforcing conditions of societal vulnerability [59,60]. Essentially, this ableist narrative leads to misunderstanding Claire’s actual needs, and people do not see her as a person, ultimately transgressing her personal boundaries and triggering her withdrawal from the interaction [19].

The other participants shared similar views regarding unwanted help, highlighting a disconnect between the non-disabled giver offering assistance and how these actions are experienced by individuals with CP. This is specifically noted by both Lucas and Ryan, who stated:

‘They are just trying to help, but it just comes off wrong’.

(Lucas, 51)

‘I understand that when someone tries to help me, they are doing so with good intentions. The problem is that they keep asking even though I can do it myself’.

(Ryan, 209–213)

The nature of these comments concerning interactions between the helper and the recipient reveals distinct intergroup and outgroup dynamics that warrant closer examination. Responses from disabled people to certain forms of assistance can be understood through the lens of unequal power relations between the dominant ingroup (the majority of non-disabled individuals) and the marginalised outgroup (disabled people), shaped by culturally and institutionally embedded ableist views of disability [20,61]. This elucidates why the participants’ felt interactions were condescending and the people without disabilities were unaware of their impact.

These power discourses often operate unconsciously and are expressed through acts of benevolence, which, while seemingly well-intentioned, can be patronising and reinforce assumptions of inferiority and dependence that are attributed to disabled individuals [10,14,62]. Ben argues that the protection being offered by his family evokes overhelping, which although rooted in care, undermines his independence.

‘Doing stuff like cooking—my mum will just like try and get involved and she’s just like, are you struggling? No, mom, please let me do this. Like I need to learn. I know she’s doing because she cares, but you know you need to do it for your independence’.

(Ben, 377–380)

Previous research has indicated that families are viewed as protective towards people living with CP, which is believed to result from lowered expectations of disabled people [40,41,63]. Protective help inhibits the opportunity to progress independence and self-advocacy in activities that respect the perceived capabilities of disabled people and can impact self-esteem and motivation for autonomy [63]. Significantly, these protective actions, though often intended as care by family members, can limit the person’s ability to grow and develop.

Furthermore, Claire recalled experiencing exaggerated praise for performing the everyday task of tying her shoelaces.

‘We were leaving and I stopped to do my shoe up. The gentleman in question gave me a round of applause! It was unnecessary and very condescending’.

(Claire, email)

Charitable praise from the majority group reflects the perception of low capabilities of disabled people, which reinforces the association of disability with reduced expectations regarding their skills and autonomy [14,63,64] For instance, the simple task of tying shoelaces was viewed as a major achievement for Claire, which highlights how severely she was underestimated [64]. This aligns with previous research that shows that disabled people frequently experience charitable praise on the assumption that disability corresponds to poorer performance capabilities [65]. Subtle forms of ableism often operate through processes of ‘othering’. By portraying Claire as regressive or child-like, this example of charitable praise reinforces dominant assumptions about ability, leaving existing expectations about what bodies “should” do unexamined [28].

Subtheme 1: Positive Helping Experiences in Everyday Life

Some participants also emphasised the benefits of assistance coming from their families, education, and public places.

‘I didn’t think I was different from everyone else because my parents enabled me. We did things together so that I could take part in activities that were really inspiring for me’.

(Claire, 347–351)

Parents not viewing disability as a barrier positively influenced Claire’s view of herself. The way Claire’s parents assumed her competence supported Claire’s self-growth [66,67]. Research shows that the rejection of disability stereotypes can influence parenting positively, consequently promoting more independence and participation in activities for their children [68].

Moreover, Claire described an incident at a train station where her husband requested assistance on her behalf. Nonetheless, she perceived this as reasonable, as it was based not on assumption, but on her deliberate consent to seek support when needed. This active choice framed her husband’s action as advocacy from an ally, affirming both his support and her sense of agency.

In turn, she described this support as ‘absolutely empowering,’ continuing to express that ‘I want to do many more things because of it’ (Claire, 934–952).

Similarly, Ben discussed his choice in accessing support within an education setting, which felt more beneficial because it was requested by the recipient, rather than imposed:

‘What I liked about university is that it was independent; the support was there if I needed it, and it wasn’t actually in the classes, which I preferred because then I could just be like everybody else’.

(Ben, 651–654)

Attributions of decisional autonomy and disabled people’s ability to instigate instrumental support is valued among disabled people. Since the absence of such opportunities is associated with dependence and restriction, when their freedom of choice was valued, participants perceived this as a positive experience [69,70,71]. This implies that receiving help that is enforced is perceived as unhelpful, meaning the capacity to assess one’s own capabilities is significant for disabled people. Fundamentally, people living with CP react more positively towards deciding the amount of help needed; such interactions can be enhanced through education and communication.

4.2. Theme 2: Strategies to Improve and Reduce Ableism

This theme discusses suggestions from the participants to potentially reduce ableism towards individuals with CP and disabled people and foster greater reciprocity and equality in interactions between non-disabled and disabled individuals.

Two participants emphasised the significance of awareness and education in shaping positive interactions with disabled people, stating the following:

‘Education is essential because once we have it, interactions become much more comfortable for both people’.

(Charlotte, 1897–1898)

‘Having the right awareness shapes the way you approach the situation (interactions with disabled individuals’.

(Ryan, 2238)

Educational strategies could help challenge and inform assumptions about an individual’s need for assistive support, fostering more respectful, informed, and person-centred approaches to interactions. Implementing educational programmes focusing on disability awareness in both school and workplace contexts, for example, can encourage people to ask if help is required, rather than automatically providing assistance to those with disabilities. In addition, initiatives, when used in many contexts—including family, public, and educational domains—have the potential to create more respectful and successful approaches toward disabled people [10,25,28]. However, other academics argue that education may not permanently eradicate prejudice and may instead fuel it if it focuses only on negative experiences. For example, solely emphasising disadvantages without highlighting resilience may prompt perceptions of incompetence and paternalistic attitudes [18]. Nevertheless, Dunn [10] asserts that education broadens perspectives on disability and increases positive intergroup relations. Campbell [11] suggests that amplifying the voices of disabled lectures in HE could be key, as they introduce perspectives that displace normativity and decolonise mainstream knowledge in academia.

Participants called for a change in how individuals interact with disabled people, with Charlotte emphasising the need for greater openness: ‘being open, but in a polite way’ (Charlotte, 1903). The participant stressed the need to approach conversations with honesty and sensitivity. In this sense, being “polite” is expressing genuine curiosity while respecting personal boundaries, using sensitive language, and refraining from intrusive or reductive questions. It exemplifies a method of engagement that acknowledges lived experience without making the individual feel singled out or diminished, thereby encouraging openness via respect and patience:

‘I’d also appreciate it if the person was patient, since while we may appear different, patience helps you to get to know us better and discover who we are as individuals, beyond the challenges you may see on the surface’.

(Charlotte, 1390–1393)

Cultural competence and qualities such as patience and openness are required to understand disabilities. Whilst patience entails taking the time to learn from interactions and truly listen to disabled people, openness consists of keeping a curious attitude towards situations and not urging to draw conclusions. Interactions that treat disabled people as lesser or in a condescending manner often elicit negative self-evaluation within receiving participants; these exchanges imply difference and subtly disregard treating disabled people as equal to the majority [72]. Charlotte suggests that knowing disabled people better can promote exchanges centred around inclusivity and reduce ableism [73,74].

Both Claire and Lucas expressed their preference for being directly asked if they needed help, and if so, which kind of help was required:

‘Do you need any help, or is it okay if I talk about the help you need?’—‘Yeah, of course it is’.

(Claire, 1489–1490)

‘More direct, but conscientious’ and ‘without overdoing it’.

(Lucas, 1449)

These extracts relate to the balancing help-related interactions, which proves to be a key consideration for reducing the overwhelming nature of unsolicited help [19]. This is supported by the prior literature, showing that disabled people prefer to initiate requests for help, thereby encouraging greater autonomy and avoiding perceptions of lacking capability [68,70].

4.3. Theme 3: Othering

This theme discusses the rhetoric of ‘othering’ in the context of disability. ‘Othering’ refers to the marginalising and stereotyping of minority groups which are viewed as separate from the dominant majority [75]. For instance, those who do not have a disability can perceive disabled people as different, possibly resulting in their social alienation [75]. ‘Othering’ practices can manifest in behaviours which either feel patronising, controlling, pitiful, or even inspirational. Different forms of othering were described by participants, specifically staring and infantilisation.

This can be seen in Paul’s recollection of a time when Lucas was being stared at for his disability:

‘Couldn’t stop staring at him ‘’…’’ he just could not take his eyes off him’.

(Lucas, 493–500)

Charlotte also described becoming more self-conscious from being stared at, and the negative impact it had on her condition:

‘I also hate it when people stare; it makes me feel so uncomfortable ‘’…’’ I get more shaky because I get more self-conscious’.

(Charlotte, 1388–1390)

Staring was perceived as uncomfortable by participants because it evoked feelings of perceived difference. Historically, those with bodies deemed abnormal have been labelled as “monstrous” or “freaks,” reinforcing the separation with disabled people from others, and underpinning the act of staring [76]. Therefore, disability often arouses intense curiosity via staring, which decodes disabled bodies [16,61]. This invasive social behaviour reduces the individuals to their physicality, causing embarrassment and constructing a sense of ‘othering’ that the participants experience. However, some researchers document that disabled people can transform negative experiences of staring into positive ones, by using such instances to initiate interaction and improve positive social interactions [77]. Participants also recalled experiences of conversations in which they were spoken to as children. The tone of these conversations was considered infantilising and undermining to their intelligence.

‘It feels a bit patronising when they ask, ‘So, would Lucas like a drink?’ as if he were a child. He’s 35, not 5. He’s perfectly capable of being spoken to like any other adult’.

(Lucas, 32–35)

Infantilisation refers to treating an adult like a child: for instance, using childlike tones toward someone considered to be lacking in capacity and speaking to them in a condescending and simple manner [78]. Consistent with this study, disabled people reported experiencing high levels of infantilisation due to disability being commonly associated with infant features [14,25,78]. According to the spread effect theory, when a physical disability is visibly noticeable, some people are more inclined to assume lower cognitive ability. This can lead to infantilisation—treating disabled people as children by speaking to them in a simplistic or patronising fashion, as was the case with Lucas, who was spoken to like a child when someone gave him a drink [78,79]. Goff man [61] believed that giving negative attributions to disabled people leads to infantilisation. However, Liesner and Mills [79] contested this, arguing that such behaviours are not related to negative schemas, since children do not elicit those perceptions. Ultimately, infantilisation poses a negative prospect by challenging the adult’s capacity to function by imposing child-like treatment.

4.3.1. Subtheme 1: Being Ignored/or Not Listened to

‘Othering’ can also manifest in the form of being ignored, or epistemic ableism [80]. This subtheme explores how individuals with CP felt unheard in contexts where they expected to have a voice; in matters concerning their own condition, their knowledge and credibility was devalued and undermined as being less valid and trustworthy. Participants voiced medical frustration, noting that they often are not listened to. Charlotte emphasised that disabled people should be included in medical discussions, as they possess valuable knowledge regarding their condition that could complement doctors’ expertise.

‘I’ve also had experience where doctors (...) they make their own decisions for me and it can be quite frustrating, because we know more about our body, about the difficulties that we have (...) because yes they have an abundance of knowledge but it is pretty frustrating when they don’t acknowledge, that you also have knowledge about what you’re suffering’.

(Charlotte, 1097–1108)

Peña-Guzmán and Reynold’s [80] (p. 219) theory elucidates how ableist schemas are integrated and perpetrated within medical discourse. One such schema involves doctors’ uncertainty about the credibility of disabled people, stemming from perceptions of diminished capacity. Another, named ‘epistemic overconfidence’, describes the tendency of doctors to perceive their medical authority as absolute and indisputable. These schemas explain why disabled people’s accounts are often dismissed, due to doctors’ overreliance on their knowledge of disability, and the assumption that they know more than disabled people with lived experience [80]. Although research reports this issue among both people with and without disabilities [81], it does not diminish its significance for disabled people. Since medical models of disability have been historically embedded into medical practice, they likely continue to inform judgement and interactions with disabled people, as evidenced by people living with CP [80].

In a similar vein, Claire described workplace ignorance, recalling experiences of ableism in the form of accommodations not being provided:

‘I said I need some reasonable adjustments for this, and they didn’t get it (...) the things I was asking for weren’t that difficult’.

(Claire, 1699–1719)

Sometimes, non-disabled people may misunderstand and perceive reasonable accommodations as illegitimate, making it difficult for disabled people to implement specific adaptations [82]. Kwon [82] argues that such perceptions stem from neoliberal ideologies that emphasise work efficiency and proficiency and ableist views of ‘abled bodies’. As Claire illustrates, denying accommodations creates inequality for disabled people. If her request was fulfilled, it would have ensured greater comfort and optimal work performance, whereas a lack of accommodation not only led to an unpleasant work experience, but reinforced the perception of limited capabilities and efficiency for disabled people. The inability to deviate from perceived normative ways of working to accommodate reasonable adjustments to allow the inclusion of disabled people highlights a clear manifestation of ableism [82]. Ultimately, this reinforces an ableist privilege upholding social norms which exclude people with CP.

4.3.2. Subtheme 2: Perceptions and Attitudes of Capabilities

This second subtheme builds on the first by illustrating how disabled people are often subjected to a lowered perception of their capabilities and intelligence in mainstream education, being defined as benevolent ableism, whilst also intersecting systemic ableism [83]. Participants refer to the ableism they have experienced in the classroom.

Charlotte experienced being separated from her classmates due to her intelligence being underestimated and teachers holding lower expectations of her.

‘I think it’s easy to put us into boxes (...) teachers think it is best for you to be in small classrooms or doing something that’s less complex (...) and it does affect your future essentially (...) you think that I could only achieve certain things. I think it holds you back as you grow older and how you perceive yourself’.

(Charlotte, 92–115)

Charlotte’s account clearly describes experiencing ableism in a mainstream school, where teachers judged and classified disabled children and moved them to separated classroom environments in an attempt to accommodate their perceived differences [84]. In reality, Charlotte explains that this is an attitude based on stereotypes of intelligence and disability, which is evident in her experience of being assigned to a lower-ability group because of her disability. However, these distorted perceptions deprive students with disabilities from developing social connections, learning from more age- and knowledge-appropriate resources, and achieving higher academic success [83,84].

Additionally, Charlotte, who accessed material accommodations during her exams, was accused of cheating by her classmates.

‘When there was a test and if I got a high score students would say oh, she got help from that scribe, that really knocked down my confidence’.

(Charlotte, 753–755)

Resentment often arises when accommodations provided to disabled people are perceived as privileges by non-disabled others and viewed as unfair advantages and a tool to cheat the system [14]. Both these experiences lend themselves to the previously mentioned spread effect theory, by exhibiting a general perception that disability is associated with differences in cognitive capability [79]. This perspective may cause others to underestimate the individual’s overall capabilities, supporting ableist beliefs about competence and independence.

5. Study Limitations and Advantages

There are several limitations in this study. Firstly, experiences around benevolent help did not emerge in the data as much as originally anticipated, possibly due to the specific nature of this topic, as it may be difficult for participants to understand what constitutes benevolent ableism. Thus, the interview questions could have been ambiguous and limited the extraction of benevolent experiences in the context of the focus groups and informal interview. Future studies could improve the possible confusion around benevolent help by including vignettes or case studies about scenarios of unsolicited helping situations that have been effective in exploring benevolent ableism in prior research [28].

Secondly, recruiting participants proved to be a difficult process, since they would either drop out or did not show interest in taking part, which meant only a small sample was recruited. Future studies could use different sampling techniques, such as contacting a gatekeeper of a charity to improve access to participants.

Thirdly, the focus group was limited in scope, with only three participants taking part, one of whom required verbal support, which was a strong limitation on the methodology. This was largely due to accessibility challenges and a combined agenda that both accounted for the needs of the participants and the lead researcher. Nonetheless, from an ethical standpoint, accessing participants’ cultural niches is inherently difficult in disability research. The lead researcher considered the efforts and time contributed by the participants, as well as the privilege of accessing their expertise and the importance of these voices to be heard in the research [15,85,86]. Future researchers working in this area may consider conducting on-to-one interviews, which may be more suitable. A more individualised approach may help prevent participants from dropping out and enhance their engagement.

Despite these limitations, the study adds to the understanding of how disabled people experience benevolent help and broader forms of ableism. Importantly, this research enabled the voices of disabled people to be heard; historically, disabled people have advocated for more representation within research, even creating the campaign ‘Nothing about us without us’ [86,87]. Another favourable outcome was that participants expressed enjoyment about being involved in this research with the focus group, which enabled a unifying experience and provided comfort for people who shared similar experiences [25,44,88]. An example of this was demonstrated by one of the participants (Claire) who emailed further experiences subsequent to the focus group session, thereby reflecting trust and a further interest in contributing to this research.

6. Future Research and Implications

Overall, this study provided a deeper insight into the everyday experiences of ableism and, in particular, benevolent ableism for people living with CP. Future research could build on existing work by examining the rejection of help and the strategies individuals with cerebral palsy (CP) use to navigate these interactions. This line of inquiry is essential for gaining a deeper understanding of the lived experiences of people with CP, amplifying their voices, and using these insights to inform education and training in health, social care, and higher education settings. It would also be valuable to investigate educational practices and professional training within health and care services that support individuals with CP. Exploring the presence of unconscious biases among professionals could help to assess how training shapes attitudes and behaviours, and how ableist assumptions may be inadvertently reinforced within these systems. Moreover, examining the role of educational institutions in promoting inclusion, integration, and a deeper understanding of disability is vital. Curriculum development should incorporate disabled voices in academia and integrate disability studies within psychology courses. This call for inclusion extends beyond psychological and health-related sectors to areas like environmental education, where disabled voices are evidently absent. According to Salvatore and Wolbring [89], disabled people are underrepresented in the environmental education literature, although they are disproportionately affected by environmental concerns. This exclusion reflects the larger gaps identified in the UN Flagship Report on Disability and Development [90] and the Realization of the Sustainable Development Goals by, for, and with Disabled People: Disability and the 2030 Agenda for Sustainable Development, both of which emphasise the importance of disability inclusion in achieving sustainability goals. Since sustainability has become increasingly incorporated in higher education curricula, incorporating disabled lecturers’ viewpoints is critical to furthering equity and the 2030 Agenda’s goal to leaving no one behind.

Findings also shed light on participants’ perceptions and suggestions for improvements towards these types of ableist interactions that previous studies do not commonly consider. The findings could have several implications for teachers, family, and the public: for instance, encouraging them to address their own biases around disability in order to develop understanding and improve interactions, to reduce stereotypical assumptions and avoid limiting disabled people [62]. Families could benefit by lessening overprotective notions and encouraging freedom for disabled people to explore their own autonomy and capabilities. Future research could also explore topics not fully covered in this study, such as the impact of support assistants on disabled people, experiences of disclosure, the role of pity, and the relationship between disability and identity. These areas were briefly touched upon by participants and warrant more in-depth investigation.

7. Conclusions

The project was undertaken to gain an understanding of the experiences and understanding of perceptions, and feelings towards benevolent ableism for people living with CP and how this operates within everyday interactions and environmental settings such as community, work, and family. The results of this investigation show that benevolent ableism, and other forms of ableism, act as detrimental barriers for societal integration and understanding surrounding disability. Ableist encounters were perceived as patronising, degrading, dehumanising, and ostracising for participants, posing a challenging and frustrating prospect in their daily interactions. Moreover, benevolent help that assumes and overly enforces assistance can impose limitations, which is achieved through helping without requesting, patronising the individual, and persistent enquiry despite denied requests. This invades personal physical boundaries and simultaneously undermines the individual’s capacity to decide their own capabilities or needs for help. Additionally, perceptions and attitudes of capabilities were found to be severely underrated, producing assumptions of a diminished capacity that are damaging for the self-perception of disabled people. On the other hand, positive help, which embodied a more enabling and respectful approach towards disabled people by allowing them the freedom to make their own decisions, was regarded as beneficial. Education and improvements on interpersonal communication were prioritised as the most effective way to improve ableism.

Due to my own condition of CP, my position within this research is that of an insider; this influenced my interest in this field of research but also gave me insight into this topic due to my own experiences of living with a disability. Some disability scholars criticise non-disabled researchers as possessing overly objective standpoints that do not relate to disabled people and therefore could ‘distort’ or misinterpret results, due to not being a part of the community [91] (p. 284). Thus, being an insider to the disability community meant that, whilst conducting focus groups, participants’ personal experiences resonated with myself and inspired further passion and hard work toward this research project. Nevertheless, I found it quite difficult at times to maintain the role of focus group moderator, due to the urge to involve myself in the discussions and express to participants that the experiences they were sharing similarly resonated with my own experiences; therefore, a conscious effort to remain neutral and distanced from the discussion had to be conducted.