In 2021, one in every 127 people were estimated to be on the autism spectrum globally (Santomauro et al., 2021). The number of autistic students at university increasing both in the UK and Europe (Gormley et al, 2024, HESA, 2024). Universities have embraced a culture of inclusivity and diversity when recruiting students, including for professional degrees (degree study that includes practice-based learning (PBL) and which is likely to result in accreditation to a profession-specific body). Autistic students face significant and unique barriers in both academic and PBL (Cheriyan et al., 2021) and have large attrition rates. Placement experiences affect students’ intention to persist with their studies and employment plans after graduation (Pesonen et al, 2021). Additionally, speech and communication lie at the heart of teaching and learning since they are one of the main ways teachers provide instruction and support their students as well as being the means through which most students engage and are assessed. This has implications for autistic students since they are likely to experience challenges with social communication and interaction (DSM-5 TR, APA 2022).

Our actual and perceived ability to communicate ‘effectively’ (including understanding verbal and non-verbal communication) is influenced by our intersectional experiences, cultural differences and other factors including neurotype. Awareness and adaptation of one’s own communication skills is a key part of practice education including speech and language therapy (SaLT) (Dantuma, 2021). For autistic SaLT students, the core interactional differences between autistic and neurotypical people can pose both challenges and opportunities for those practicing in a majority neurotypical society. However, SaLT, whose aim is to maximise an individual’s communication potential, has been traditionally and historically rooted in a conventional medical paradigm (Pellicano and Houting, 2022) in contrast to the social model of disability, which attributes barriers to environmental and cultural factors. Although listening to neurodivergent perspectives can progress equity and deconstruct ableism, research exploring the views, priorities and experiences autistic students have of their interactions within these social and physical environments (i.e. education and employment) is still emerging. Given this context, we wanted to explore the experience and perceptions of PBL from the perspective of students and recently qualified autistic SaLTs, and their placement educators (some of whom will themselves be autistic). We posed the following research questions:

1. What challenges and support do autistic SaLT students experience during PBL?

2. How much do autistic SaLT students perceive these PBL experiences contribute to their motivation and identity?

3. What suggestions for support and reasonable adjustments do autistic SaLT students identify during PBL?

By posing the above questions, we set out to address the following objectives:

• To identify effective ways to support placement educators in meeting the needs of this group of students;

• To produce recommendations and resources to support the practice-based education of autistic SaLTs;

• To share the information gained to enable the above to be carried forward into/inform Higher Education Institutes (HEIs) and future workplaces.

Taking a neurodiverse affirming approach, the research adopts a critical realist paradigm (Bhaskar, 1975) to examine lived realities and the internal and external factors contributing to these.Tension between neurotypical standards deemed ‘professional’ and neurodivergent ways of being are likely to impact engagement and identity and are therefore interrogated by applying the social determination theory of motivation (Mylrea et al, 2017). Examining autistic SaLT students and practitioners and their placement educators’ experiences of competence, relatedness and autonomy - including how they shape their motivation and identity -has relevance across HEI disciplines, particularly practice-based disciplines like SaLT, given the fact that communication underpins teaching, learning and assessment in all fields of education and practice.

This research sought to discover which aspects of PBL are most important from the perspective of autistic SaLT students, practitioners and their placement educators. Seven autistic level 6 SaLT students, six autistic SaLTs, four autistic SaLT placement educators and five non-autistic placement educators who have supported an autistic SaLT student were recruited opportunistically in Autumn 2024. Recruitment involved emailing and circulating adverts to all HEIs in the UK offering SaLT as an undergraduate route; the RCSLT neurodivergent SaLTs’s and disabled working group; a regional placement educator’s group; and via social media contacts and groups. An exploratory sequential mixed-methods research design (Creswell & Creswell, 2023) was created to investigate the observable and underlying factors involved in the PBL experiences of autistic SLT students. University ethical approval was obtained prior to data collection and responses were recorded anonymously and stored securely and confidentially on encrypted password protected university laptops. Phase one involved an online questionnaire created to explore themes present in the literature and was administered during November-December 2024. This captured both numerical data (e.g. when diagnosed) and descriptive qualitative data from twenty-two participants. Numerical data was analysed using descriptive statistics and descriptive qualitative data was analysed by research assistants trained on inductive reflexive thematic analysis (Joy et al., 2023). Eleven participants took part in phase two, when online semi-structured interviews were conducted in January-February 2025 to probe and further explore the themes identified in phase one using thematic analysis. Finally, six participants took part in the phase 3 focus group interviews to confirm and gain insight into their experience of the identified themes. The focus groups were moderated by the two main research investigators, with two new research assistant being in attendance, who transcribed and analysed the data using a thematic/inductive analytical approach The research team discussed the content, meaning, definitions and conceptual links of the themes generated. This reflexive approach was particularly important given the unique experiences of the research team, all of whom were aware of autism and the range of disability models withing education and psychology that contributed to their consideration of themes related to support, diagnosis, identity and belonging (Joy et al., 2023).

Phase one data identified 40% of practicing SLTs who are autistic and 57% of current autistic final year students received their diagnosis after starting their SLT post or studies, and that experience during their PBL or the placement educators supporting this were a catalyst in pursuing this. Phase two data identified further information around seeking a diagnosis and emotional wellbeing and regulation, and detail about shared understandings (or not), honesty, openness and transparency, and strengths versus prejudicial deficits. We are currently finalising the focus group data analysis. What is emerging is detail around belonging (when safety is/is not present and so when masking is intentional or when true identities are shared or suppressed, and the reality of liminal disability), competence (purpose and intrinsic motivation versus challenges due to academic and ableist barriers or misinterpretations which vary depending on placement educator perspectives) and autonomy (strategies and adjustments that support and progress students and how the intuition and insight of autistic SLTs can enhance their support of clients with speech, language and communication needs). PBL enhances employability (Cheriyan et al., 2021). Whilst the literature argues improving experience and outcomes for neurodivergent students should be a priority for universities aiming to produce graduates equipped to tackle the complex problems of contemporary society (Hamilton and Petty, 2023; Oates and Bean, 2023), intersectional combinations mean PBL experiences and outcomes vary between individual students and contexts. Experiences of discrimination and stereotyping during PBL means the lived reality currently often falls short of rhetoric around study and future employment. In line with the Strategy for the Rights of Persons with Disabilities 2021-2030 (EC, 2021), our findings contribute to the removal of barriers to learning by enabling access to quality PBL, with implications for equality of opportunity, identity formation, employment possibilities, career trajectory and advocacy.

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