Factors underlying differences in knowledge, explicit stigma and implicit biases towards autism across Hong Kong, the United Kingdom and the United States

A growing literature suggests that there is cross-cultural variation in levels of autism-related stigma, which may partially be explained by differences in cultural orientation or autism-related knowledge between countries. This literature has relied heavily on self-report measures of explicit attitudes towards autism; little research has examined implicit biases, and whether these implicit biases vary across cultures. Thus, here we had two aims: (1) to assess the contribution of knowledge and cultural orientation to both explicit stigma and implicit biases, and (2) to compare autism-related knowledge, explicit stigma, and implicit biases across university students in Hong Kong (n = 119), the United Kingdom (n = 120), and the United States (n = 122). Replicating prior work, we found that explicit stigma was predicted by less accurate knowledge, lower horizontal collectivism, greater vertical individualism, and higher implicit biases. Implicit biases were directly predicted by age and explicit stigma, and indirectly predicted by vertical individualism (positively) and horizontal collectivism (negatively) via explicit stigma. Knowledge and explicit stigma differed across countries, even after accounting for covariates: students in Hong Kong displayed less accurate knowledge, and higher explicit stigma towards autism, than those in the United Kingdom and United States. However, implicit biases did not differ between countries.Lay abstract Attitudes towards autism vary across countries. Some of this variation could reflect differences in cultural values across countries, or differences in how much people know about autism. Until now, most research on this topic has asked people directly about their attitudes towards interacting with autistic people. As a result, we understand little about why some people unconsciously hold negative attitudes towards autism, and whether these unconscious attitudes vary across countries. We studied explicit attitudes (willingness to interact), implicit attitudes (unconscious beliefs), knowledge about autism, and cultural values in university students from Hong Kong, the United Kingdom and the United States. We found that people were less willing to interact with autistic people if they knew less about autism, aligned with a competitive and hierarchical society ('vertical individualism'), did not see themselves as part of a collective whose members are equal (less 'horizontal collectivism'), and if they unconcsciously associated autism with negative attributes. Students in Hong Kong were less willing to interact with autistic people and had less understanding of autism compared to those in the United Kingdom and the United States. Unconscious biases did not differ across countries. Our findings highlight the need to combat misconceptions about autism to improve attitudes towards autistic people, especially in Hong Kong. Unfortunately, our results suggest that acquiring more accurate knowledge may not be sufficient to alter unconscious biases. Further research is needed to determine the factors underlying unconscious biases.