On SAGE Insight: The prevalence of autistic traits in a homeless population

From Autism

This study aims to explore the relationship between autism and homelessness, by making an initial estimate of the prevalence of autistic traits in a homeless population. This work was initially motivated by anecdotal reports from autism clinicians and keyworkers in a homeless support service that rates of autism may be elevated in this population. In line with this, there is indirect empirical evidence to support the idea that autism is a risk factor for homelessness. Autistic adults, compared to those without autism, experience elevated rates of mental health problems, greater difficulties attaining independent living conditions, lower educational and occupational attainment, and a higher risk of social isolation. All of these characteristics are known risk factors for homelessness.

Homelessness is an umbrella term which covers a range of different situations. It refers to rough sleepers, that is, people who sleep or bed down in the open air, or in buildings or other places not intended for human habitation. It also includes people who do sleep in a place designed for habitation, but who do not have any legal title to their accommodation or access to any private spaces for their social relations. Homelessness both arises from and contributes to vulnerability: it has severe negative effects on physical and mental health If autistic people are more likely to become homeless, it is important to research pathways into homelessness for autistic people, to understand the mechanisms of risk. This can then be used to design preventive strategies to help autistic adults avoid homelessness.


Anecdotal evidence suggests that autistic people experience an elevated risk of homelessness, but systematic empirical research on this topic is lacking. As a step towards filling this gap in knowledge, we conducted a preliminary investigation of the prevalence of Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism symptoms in a group of long-term homeless people. The entire caseload (N = 106) of a UK homeless outreach team was screened (excluding individuals born outside of the United Kingdom or Republic of Ireland) using an in-depth, semi-structured interview with keyworkers, based on Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic criteria. This showed adequate inter-rater reliability, as well as evidence of criterion and construct validity. Of the sample, 13 people (12.3%, 95% confidence interval (7.0, 20.4)) screened positive, meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism criteria by keyworker report. A further nine people (8.5%, 95% confidence interval (4.5, 15.3)) were ‘marginal’, having autistic traits that were not quite sufficient to meet Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Those with elevated autistic traits, compared to those without, tended to be more socially isolated and less likely to use substances. This study has provided initial evidence that autistic traits are over-represented among homeless people and that autistic homeless people may show a distinct pattern of characteristics and needs. Further investigation is required to build upon these provisional findings

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Article details
The prevalence of autistic traits in a homeless population
Alasdair Churchard, Morag Ryder, Andrew Greenhill and William Mandy
First Published April 10, 2018
DOI: 10.1177/1362361318768484



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