A qualitative exploration of the range of strategies used to cope in social situations: A framework analysis with data from 342 autistic and non-autistic adults in Hong Kong

Abstract

<p><strong>Background:</strong> Current conceptualisations of the coping strategies used to compensate for social difficulties or increase social acceptance in autism stem from Western research (Hull et al., 2017; Livingston et al., 2019). However, social conventions (e.g., expectations of socially acceptable behaviours) and socialisation goals are culture-dependent, and potentially shape differences in the development and use of social coping strategies. Taking a broader sociocultural perspective, growing research in the East has centred on masking and camouflaging, here referred to as shallow compensation. There remains a lack of exploratory qualitative research using open-ended questions to investigate a wider range of social coping strategies (i.e., more flexible and proactive strategies than just shallow compensation) beyond Western contexts.</p><p><br></p><p><strong>Objectives:</strong> This qualitative study aimed to broadly explore various strategies used by autistic and non-autistic adults in Hong Kong to cope in social situations, ranging from behavioural and cognitive to environmental-mediated processes.</p><p><br></p><p><strong>Methods:</strong> We extended Livingston et al.’s (2019) methodology to a Hong Kong convenience sample. Participants were 69 autistic adults, 50 self-identifying autistic adults (who did not have a formal diagnosis), and 223 non-autistic adults aged 18 to 72 years (<em>M</em> = 26.2, <em>SD</em> = 9.70; with 62% identified as females). They completed an online survey comprising open-ended and semi-open questions on their experiences of using social coping strategies, and self-report questionnaires measuring autistic traits and cultural orientations, as part of a larger cross-cultural study. Framework analysis was conducted to identify themes and subthemes that represent various social coping strategies.</p><p><br></p><p><strong>Results:</strong> Five superordinate themes were identified: 1) ‘regulate behaviours to meet social functions’, which involves suppression and enactment of behaviours to avoid social faux pas and/or display social interest; 2) ‘information-seeking for social reasoning’, which includes both explicit (e.g., asking directly) and implicit (e.g., observing for verbal and non-verbal cues) sources of information to infer others’ inner states via non-social cognitive means; 3) ‘cognitive reappraisal’ (‘a mental game’), such as adjusting expectations and applying self-compassionate thinking in social situations; 4) ‘remove interpersonal stressors’ through full/partial absence from a social situation; and 5) ‘seek person-environment fit’ through attempts to select or create an optimal environment and play to one’s strengths in a setting to promote positive social experiences. All themes and subthemes were shared between autistic and non-autistic people, and largely mapped to the strategy repertoire reported by Livingston et al. (2019). We additionally found cognitive reappraisal to be a novel group of strategies that is conceptually distinct from other strategies identified in previous Western findings. More specific cultural variations in the ‘how-to’ (e.g., more indirect ways for applying a strategy), rather than ‘what kinds’ of strategies, were observed within subthemes.</p><p><br></p><p><strong>Conclusions:</strong> This is the first study to report qualitative findings on the repertoire of social coping strategies from a non-Western sample. The findings will inform a cross-culturally applicable conceptual framework for social coping strategies in autism, and our subsequent development of a new comprehensive questionnaire measure of social coping strategies.</p><p><br></p>