Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this manuscript, titled “What can the retrospective experiences of autistic women reveal about supporting autistic or potentially autistic girls in school? An exploration of school experiences based on diagnosis during or post-school”. This is an important and relevant piece of work, aiming to understand the experiences of autistic women during their early education. It contributes to a growing field of understanding the experiences of a marginalised and underserved group. I would recommend acceptance of this paper, with minor revision to enhance clarity in some areas. Please see below for specific recommendations.

In the abstract, the aims need to be more clearly stated, not simply that the authors aim to address the gap in understanding.

In the introduction, the summary of literature on autism in women is good, though brief. Some areas may benefit rom providing more detail or examples (e.g., how do girls engage in social relationships differently from men? What does internalisation of difficulties look like?). It would also be useful to be provided with a definition of “internalisation” as this is referenced frequency without explanation as to what this is or what it looks like. Nonetheless, there is good and interesting consideration of difficulties specific to secondary school

With the research question – if I read it literally, it would imply that you’re trying to understand how useful retrospective accounts are (what can they reveal), whereas my understanding is that the question relates more to, what are the experiences of undiagnosed autistic girls in school? I would find it helpful to have this reworded for clarity

In regard to the participant eligibility criteria, why was age 11 chosen? I’m assuming it relates to this being the start of secondary school, but someone diagnosed at 12 (in their first year) vs. as an adult, would have different experiences. It might be useful to add in a sentence justifying this eligibility criteria for transparency. This is commented on later in the discussion.

It would be helpful to have more detail about how the interview was developed. The research question is very broad, but the interview questions quite specific and closed (e.g., did you feel you needed to mask to fit in? did you develop self-soothing strategies?). To be able to understand how the research team went from their initial idea and question, to the interview schedule, would shed light on potential biases of the researchers, in terms of what they were looking for, and to understand why certain themes might have come up. It feels like a deductive approach was taken, which would be helpful to acknowledge. Additionally, it was great to see the inclusion of the positionality and reflectivity statement.

The results were well presented and easy to follow, supported by a simple Figure. I might be wrong but the font size feels smaller in the results to the earlier sections? It’s a little hard to read as its quite small!

The discussion is also well written, with good relating of the results to existing work. Under point 4.2.1., it would be helpful to know what staff are you talking about training? This might be as simple as stating “school staff”.

This is not a change but a thought regarding the suggestion for flexible curricula – I think New Zealand is implementing this in some of their SEN schools so there might be more research available to add empirical evidence and specificity to this recommendation (sorry that I don’t know of any specific research to recommend, just something I’ve heard of through my clinical practice!).

Could you add an explanation/definition of a “multidimensional approach”

Regarding the recommendations about identifying autistic girls earlier and providing tailored support, I would encourage the authors to expand on this, thinking about HOW this should be done. From your research, how can we start to break down the barriers women are facing in diagnosis?

With the limitations, I think it is appropriate to comment on not recording ethnicity data as this may be an important factor impacting on the results due to specific intersectional experiences.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

 

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this interesting paper on a very important topic. It is critically important that we explore the experiences of autistic females as a marginalised group, and that we think proactively about how to develop support mechanisms for autistic girls at school. This paper is likely to attract wide interest from those who are keen on taking more neurodiversity-affirming approaches within education.  

I think that this is overall a clearly written paper describing a well designed study, with important implications. My comments below are minor and could mostly be addressed very quickly and easily.  

Abstract 

The abstract is clear and summarises the study well.  

Introduction 

This is clearly written and well structured, and introduces the topic and the previous research relevant to this area well, providing important context for the study. The aims and research questions are made clear.  

I have only one minor comment related to the Introduction:  

• Page 3, Lines 90-93 – this sentence is very long and potentially hard to understand. I wonder if it could be split up and reworded to increase clarity. 

Methods 

Information on participants, including recruitment methods and inclusion criteria is clear, and table 2 is a good summary of the participants, including detailed information on co-occurring conditions which may have an impact on participants’ experiences. I also appreciated having the interview schedule provided within the Supplementary Materials. The positionality statement is highly reflective and it is clear how rigour was ensured within the coding process.  

I have only one comment related to the Methods:  

• As someone unfamiliar with the contextualist approach, I found the definition on Page 3, Lines 103-105 a little hard to interpret. I wonder if a little more could be added here to clarify what this approach consists of and how it may differ from other approaches which could be taken.  

Results 

These are clearly written with interesting participant quotes interspersed at relevant points to exemplify the themes.  

I have three small suggestions to develop this section further: 

• Figure 1 provides a clear representation of the three themes; I assume the themes that come under “we found ways of coping but at what cost?” are subthemes of this theme? This may benefit from being explicitly stated where Figure 1 is referenced within the text.  

• Page 7, Line 233 - “in lessons” is repeated twice in this sentence and therefore rewording may be beneficial, unless this repetition is significant to the authors.  

• Page 8, Line 265 – I think that “How Schools could help someone like me” should be labelled as 3.3 here? 

Discussion 

The beginning paragraph of the Discussion reminds the reader of the aims of the study and summarises the results well. The rest of the discussion is clear and provides a good interpretation of the results in context. The conclusion is clear and matches with the findings of the study.  

I have a few suggestions to consider to further develop this section: 

• Page 10, Line 343 – I think a “they” may be missing here which would make this sentence feel more complete.  

• Page 10, Line 355 – it might be beneficial to remind the reader which coping strategy is being referred to here.  

• Page 10, Line 371 – an in-text author, date reference is used here which may need adapting to the numbered referencing format. 

• Section 4.2.2 - you may wish to refer to attempts to develop materials and programmes to improve awareness of neurodiversity amongst young people in schools. For example, the LEANS programme targets primary school classes, but could be mentioned in terms of how this could be extended for secondary school. You can find information here: https://salvesen-research.ed.ac.uk/leans  and here: Alcorn, A. M., McGeown, S., Mandy, W., Aitken, D., & Fletcher-Watson, S. (2024). Learning About Neurodiversity at School: A feasibility study of a new classroom programme for mainstream primary schools. Neurodiversity, 2. https://journals.sagepub.com/doi/10.1177/27546330241272186  

Author Response

Please see the attachment

Author Response File: Author Response.pdf