969887

research-article2020
NRJXXX10.1177/0739532920969887Newspaper Research JournalYu and Farrell

Article
Newspaper Research Journal

Autism in the
2020, Vol. 41(4) 489­–505
© 2020 NOND of AEJMC
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media DOI: 10.1177/0739532920969887

https://doi.org/10.1177/0739532920969887
journals.sagepub.com/home/nrj

A longitudinal study of
stigma cues and framing
of attribution
By Nan Yu and Laura Farrell

Abstract
This study examined 16 years of newspapers’ presentation of
a prominent health issue, autism spectrum disorder (ASD). The
presence of attribution of autism and stigma cues in national
and local newspapers were particularly focused on. Our results
illuminated intriguing trends regarding how newspapers have
framed the attribution of autism and how various stigma cues have
been chosen by national and local newspapers to identify autistic
individuals over time. We suggest that given the evolving medical
findings of autism, journalists should be alert to the changing,
complex nature of this disability.

Keywords
newspaper, framing, autism spectrum disorder, disability, autism,
attribution, stigma

N
ews media depictions of mental disabilities have piqued the public’s interest
for decades, and the attention to autism spectrum disorder (ASD) has increased
due to its high prevalence, controversies surrounding its causes and treatments,

Yu is associate professor, Nicholson School of Communication and Media,

University of Central Florida. Farrell is adjunct professor, Communication
Studies, Minnesota State University.
Yu is the corresponding author: nan.yu@ucf.edu.
490 Newspaper Research Journal 41(4)

and insufficient public understanding of this disability (Gillespie-Lynch et al., 2015;

McKeever, 2012). Pew Research Center’s Project for Excellence in Journalism (2008)
conducted an analysis of more than 3,500 health news articles published in U.S. news
media outlets and discovered that autism was one of the top five diseases or disorders
included in health news.
Scholars have suggested that news media representations of autism have been a
major source of information that shaped the lay understanding of autism (Holt &
Christensen, 2013; Holton et al., 2014; John et al., 2018). However, news media can
create a mixed and unhealthy space for autism (Holton et al., 2014), attribute inaccu-
rate blame to a health problem (Clarke, 2010; Holton et al., 2012), focus on negative
and medical portrayal of autism (Wolbring & Mosig, 2017) or add to the existing
social stigma toward people with autism (Huws & Jones, 2010). This research extends
current scholarship regarding news media presentation of autism through a content-
analytic study of 16 years of newspapers’ coverage of this disability.

Literature Review
Mixed Understanding of ASD
ASD is a complex developmental disability that can cause significant social, com-
munication and behavioral challenges. Centers for Disease Control and Prevention
(CDC, 2020b) reported that about one in 54 children in the United States is identified
with autism per year. Scientific research suggests that the factors linking to higher risk
of autism include genetic influence, parents’ age or exposure to drugs containing val-
proic acid and thalidomide during pregnancy (CDC, 2020b). The signs and symptoms
can vary greatly among children and adults with autism. Autistic individuals may have
different ways of learning, paying attention or reacting to things (CDC, 2020b). These
may, among the 15 common symptoms listed by CDC, include avoiding eye contact,
preferring not to be held or cuddled, repeating actions and/or having unusual reactions
to the way things smell, taste, look, feel or sound (CDC, 2020b). Even though no treat-
ment has been shown to completely cure autism, early intervention and treatment can
reduce symptoms and improve children’s cognitive ability and daily living skills
(CDC, 2020a).
The topic of autism was launched into mainstream newspapers with the Wakefield
et al. (1998) study, which announced evidence of the connection between the MMR
(i.e., measles, mumps and rubella) vaccine and autism. This scientific finding had
upset the belief that ASD was majorly a biomedical or neurological disorder and
caused heated debate over the cause of this disability (Clarke, 2010; Holton et al.,
2012). However, that study was eventually retracted, and the leading author of that
project underwent investigation for misleading, unethical research practices (Whalen,
2010).
Research has suggested that the lay public commonly have misconceptions of ASD
and a lack of understanding its causes, symptoms or treatments (Bie & Tang, 2015;
Holt & Christensen, 2013; Huws & Jones, 2010; John et al., 2018). For example,
Huws and Jones (2010) discovered that people often believe that autistic individuals
can behave in ways that deviate from social norms and expectations, they often have
lack of capability of function and live independently or they usually have learning
Yu and Farrell 491

disability or mental retardation. People also frequently link the causes of ASD to genes
of parents, “act of God,” MMR vaccine, parental neglect or their living environment
(Bie & Tang, 2015; Huws & Jones, 2010). Holt and Christensen (2013) found that
even though some people can correctly identify a few symptoms related to autism,
they do not know that some of these traits and behaviors are not specific to this dis-
ability. John et al. (2018) discovered that people can view autistic individuals as refus-
ing social interactions, having a special talent, or being dangerous or mentally unstable.
Many of these beliefs deviate from what scientific findings have suggested.

News Coverage of Autism

A number of research on news media representation of autism have identified
biases and inaccuracies in the journalistic coverage (Clarke, 2008; Huws & Jones,
2010) while suggesting the role of news media in contributing to the mixed under-
standing of autism (Holton et al., 2014; Wendorf Muhanmad & Yang, 2017). News
coverage can make certain autism frames salient over time (Bie & Tang, 2015;
McKeever, 2012) and attribute causes, responsibility and blames to different groups
(Bie & Tang, 2015; Holton et al., 2012).
McKeever (2012) conducted a study of coverage of autism between 1996 and 2006
in The New York Times and The Washington Post. The study suggested that more
articles discussed solutions or remedies for autism than those that discussed possible
causes of autism. Over the years, the presence of a science frame decreased over time,
but a policy frame spiked in later years. A human frame was the most common frame
found in the news coverage (McKeever, 2012). Similarly, Wendorf Muhanmad and
Yang (2017) found that a human interest frame was frequently seen in local and
national newspapers.
Bie and Tang (2015) conducted a 10-year (2003–2012) longitudinal study of news-
paper coverage of autism in China. They found that autistic individuals were often
depicted as savants with special talents, and family responsibility was the focus of the
news stories. The study also discovered that within the limited discussion of the causes
of autism, genetic reasons were more frequently mentioned in the news. An analysis
of newspaper coverage of autism in Canada (Wolbring & Mosig, 2017) revealed that
Canadian newspapers mostly covered it from medical and negative perspectives, dis-
regarding alternative views and social problems surrounding the issue.
In a study of newspaper coverage of autism, Holton et al. (2014) examined how
newspaper representation of autism might have stigmatized the disability. They dis-
covered that the stigma cues were more likely to be found in episodic frames, and
journalists frequently reported labels and psychiatric symptoms associated with autism
(Holton et al., 2014). Similarly, Jones and Harwood (2009) found that people with
ASD were depicted as either dangerous or uncontrollable and were often poorly treated
in the news coverage during 1996–2005. Based on the previous literature, the current
study complements previous scholarship by examining how newspapers presented the
issue of autism in regard to the presence of the stigma cues and attribution frames.

Framing of Autism Attribution

Much research has focused on the news framing of autism (Bie & Tang, 2015;
Holton et al., 2014; McKeever, 2012; Wendorf Muhanmad & Yang, 2017). Entman
492 Newspaper Research Journal 41(4)

(1993, 2007) stated that news media framing involves selection of certain aspects of
an issue and promoting an emphasis and salience of these aspects over the others
among the audience. In addition, Reese (2001) noted that framing is “the way events
and issues are organized and made sense of, especially by media, media professionals,
and their audiences” (p. 7).
Contrary to previous studies of news framing of autism, this study focused on
examining the attribution frames based on Weiner’s (2005, 2006) attribution theory.
Based on the attribution theory, a health risk can be conceptualized in three dimen-
sions: cause, preventability (i.e., controllability) and stability. These dimensions
involve dichotomous perceptions: (a) whether the cause of an outcome is internal or
external, (b) whether an outcome is preventable or unpreventable and (c) whether an
outcome is stable or unstable. When the attribution model was applied to a health risk,
scholars linked disease attributions to personal responsibilities, emotional responses
and behavioral inclinations (P. Corrigan et al., 2003; Dijker & Koomen, 2003; Weiner,
1993). Specifically, when a health risk is perceived as controllable or preventable, the
person with the illness is judged to be responsible for the negative outcome. As a
result, the feeling of anger can arise that can lead to neglect. When a health risk is
perceived as unpreventable, the feeling of sympathy can arise that can lead to helping
behaviors (P. Corrigan et al., 2003; Weiner, 1993).
The cause of ASD is defined as whether ASD can be triggered by internal or exter-
nal factors. Associating autism with genetic reasons refers to the causes as internal,
whereas linking exposure drugs containing valproic acid and thalidomide during preg-
nancy to ASD belongs to external causes. The term preventability is defined as whether
(or not) ASD is seen as a disability that can be cured or certain steps can be taken to
stop the condition of ASD. The term stability refers to whether the symptoms will
remain stable and are unlikely to be improved after being treated.
Aiming at examining how autism attributions were depicted in the newspapers and
how these depictions varied over time and across different types of newspapers in the
United States, the following two questions were proposed:

RQ1a:
How were autism attributions portrayed in local versus national newspapers?

RQ1b:
How were autism attributions portrayed over time?

Stigma Cues
Stigma is defined as a social phenomenon in which members from a subgroup are
treated with disgrace or discredit and are disqualified from full social acceptance
(Clair, 2018; Goffman, 1963). Stigma associated with autism comprises negative cog-
nitive, affective or behavioral reactions to autistic individuals and their family mem-
bers (Gillespie-Lynch et al., 2015; Kinnear et al., 2016).
Scholars have identified four types of cues that may signal stigmatic beliefs (P. W.
Corrigan, 2000; Holton et al., 2014). Labeling cues associate the disability with
Yu and Farrell 493

abnormal qualities or characteristics (e.g., crazy, clunky). Social skill deficit cues
depict the minimal or problematic social interactions or difficulties in verbal and non-
verbal communication that inhibit autistic individuals from social engagement (e.g.,
disrupted communication, inappropriate social skills). Aberrant behavior cues can be
detected through reference to autistic individuals’ feelings or actions to external stim-
uli, or other symptoms that may obstruct one’s quality of life (e.g., struggling with
daily norms, self-destruction). Physical appearance cues can be identified through
mention of autistic individuals stunted physical development or abnormality (i.e.,
disheveled hair, weird looking).
It is important to note that some of these words or phrases may be considered as
standard reporting language for health and science news stories. But in the case of
autism, these types of wordings have negative or judgmental undertones toward the
disability because they are not correctly associated with the diagnosis. We used the
term stigma cues because these depictions may lead to misconceptions of autistic indi-
viduals and their conditions and, as a result, may enhance stigmatic perceptions of this
group (P. W. Corrigan, 2000; Holton et al., 2014). The following two research ques-
tions were proposed to examine the presence of stigma cues in newspaper coverage of
autism:

RQ2a:
How were stigma cues presented in the local versus national newspapers’ coverage
of autism?

RQ2b:
How were stigma cues presented in the newspaper coverage of autism over time?

Method
Sampling
A content analysis was used to examine newspaper coverage of ASD. In particular,
newspaper articles regarding ASD were collected from U.S. newspapers over a 16-year
time frame (January 1, 1998–December 31, 2013). The particular time frame of 1998–
2013 was chosen because the appearance of ASD in newspapers was limited before
1998. In 1998, the release of Wakefield’s study suggested a link between ASD and
MMR vaccine, which brought an alarm among parents and fueled a rise in newspa-
pers’ coverage of the disability, particularly in the United States and the United
Kingdom (Clarke, 2008, 2010). The year of 2013 was the most current data that were
available to the authors when the study was first designed.
A longitudinal population of news stories published in U.S. newspapers was gath-
ered through LexisNexis Academic. A search using the keyword(s) “ASD,” “autism
spectrum disorder(s),” and/or “autism,” between January 1998 and July 2013, was
executed to obtain an initial population. This initial population yielded 60,327 news
stories.
494 Newspaper Research Journal 41(4)

Table 1
Sample Size by Time and Newspaper Type
No. of articles from No. of articles from local
Year national newspapers newspapers Total articles

1998 8 28 36
1999 12 42 54
2000 13 55 68
2001 16 29 45
2002 21 35 56
2003 15 33 48
2004 17 36 53
2005 23 38 61
2006 15 49 64
2007 24 48 72
2008 20 53 73
2009 24 44 68
2010 36 50 86
2011 25 47 72
2012 33 47 80
2013 11 35 46
Total 313 669 982

To clean the population and to create a representative sample, a series of steps were
implemented. First, because our study focused on news stories of ASD, articles that
were not about ASD or autism, international sources, letters to the editor, entertain-
ment articles, book reviews, news briefs (150 words or less) and duplicate articles
were removed. This procedure was conducted by two trained coders thoroughly going
through all of the articles. If a wire story was published with multiple publications, the
one that was published first was chosen. The publication time was determined by the
date and time stamped. When each duplication was identified and removed, the two
coders went through the sampled stories again to ensure all noneligible stories were
excluded. This procedure significantly reduced the population to a total of 6,538 news
stories.
Second, we used the stratified sampling strategy to segment the remaining news
articles by year so as to create a group of articles for each year. Third, a systematic
sampling strategy was used to select 15% of the articles from each stratified group. In
the each stratified yearly subgroup, we ranked the study by dates first, and then every
seventh article was selected within each chronological group. Systematic sampling
yielded a sample of 982 news stories. Table 1 demonstrates the number of articles
chosen in each year. Each news story was treated as one unit of analysis.
Yu and Farrell 495

Coding Scheme
Newspaper type and time
During coding, the coders were asked to record the name of the publication for each
article on the coding sheet and then searched for the area(s) each newspaper circulated
in. National newspapers that were identified in our sample included The New York
Times, USA Today and Investor’s Business Daily. Besides the three national newspa-
pers, our sample included newspapers that circulated in several states, in one state, or
in a large metropolitan area. To simplify the term used in this project, we referred these
newspapers as local newspapers, which comprised both regional and local newspa-
pers. The data showed that our sample consisted of 108 local newspapers circulated in
40 states (see Table 2). Time of publication was coded based on the year that the news
story was published.

Labeling cues
The presence and absence of different stigma cues were coded following the defini-
tions in Holton et al. (2014). Labeling cues combine references to autism with adverse
connotations through nouns and adjectives that associate the disability with irregular
qualities or characteristics. Examples of descriptive words and phrases included ago-
nizing, chasm of autism, clunky, crazy, dark world of autism, devastating, disease,
epidemic, isolating, odd, off-kilter, unusual and victim.

Social skill deficit cues

Social skill deficit cues were identified through reference to impaired or limited
social interactions or difficulties in verbal and nonverbal communication that impede
an individual from social engagement. Some examples of social skill deficit cues
included disrupted communication, inappropriate social skills, lower intellectual and
communicative ability, needing help with social interactions, reference to language
problems, reference to limited vocabulary, social challenges, social delays, social
problems and stopped speaking after a certain amount of time.

Aberrant behavior cues

Aberrant behavior cues can be observed through mentions of autistic individuals’
emotional or behavioral responses to external stimuli, or other symptoms that may
hinder quality of life. Examples of aberrant behavior cues included bolting into traffic,
climbing on things (not for climbing), eating inedible objects, inappropriate actions or
behaviors, inappropriate exposure, repetitive body movements, restricted behavioral
abilities, screaming unexpectedly, self-destruction, self-injury, struggling with every-
day behavior norms, thrashing and wandering.

Physical appearance cues

Physical appearance cues can be observed through reference to stinted physical
development, impairments or abnormalities of autistic individuals. Examples of physi-
cal appearance cues included bleeding wrists, comparison with certain body types
(e.g., frail, ill, high school fullback), disheveled hair, generally weird looking, mis-
matched clothing, scarring, shaky limbs, trembling and unusual marks.
496 Newspaper Research Journal 41(4)

Table 2
List of National and Local Newspapers Identified in the Sample
Areas Newspaper name

National newspapers The New York Times, USA Today and Investor’s Business Daily
Local newspapers
 Arizona Arizona Capitol Times
 California Contra Costa Times, Los Angeles Daily News, Inland Valley Daily
Bulletin, Los Angeles Times, Marin Independent Journal, Monterey
County Herald, Orange County Register, San Gabriel Valley
Tribune, The Mercury News, The Record, Tri-Valley Herald
 Illinois Daily Herald, The State Journal-Register
 Colorado Colorado Springs Business Journal, The Denver Post
  DC, Maryland, Virginia The Washington Post
 DC The Hill
 Florida The Florida Times-Union, Orlando Sentinel, The Palm Beach Post,
Sarasota Herald-Tribune, Tampa Bay Times, The Tampa Tribune,
The Ledger, St. Petersburg Times
 Georgia The Augusta Chronicle, The Atlanta Journal-Constitution
 Idaho Lewiston Morning Tribune
 Indiana South Bend Tribune
  Iowa, Illinois, Wisconsin Telegraph Herald
 Kansas The Topeka Capital-Journal
 Kentucky Messenger-Inquirer
 Maine Bangor Daily News, Portland Press Herald, Sunday Telegram
 Maryland The Baltimore Sun, Maryland Gazette
 Massachusetts Berkshire Eagle, The Herald News, Lowell Sun, Sentinel &
Enterprise, Telegram & Gazette, The Patriot Ledger
 Minnesota St. Paul Pioneer Press, Star Tribune
 Missouri St. Louis Post-Dispatch, The Daily Star-Journal
 Nebraska Lincoln Journal Star, Omaha World Herald
 Nevada Las Vegas Review-Journal
  New Hampshire New Hampshire Union Leader
  New Jersey Suburban Trends, The Ridgewood News, Wayne Today
  New Mexico Santa Few New Mexican, Alamogordo Daily News, Deming
Headlight, Las Cruces Sun-News, The Taos News
  New York Buffalo News, Long Island Business News, New York Post
  North Carolina The Chapel Hill Herald, Star-News, The Herald-Sun
  North Dakota The Bismark Tribune, Grand Forks Herald
 Ohio Akron Beacon Journal, Dayton Daily News
 Oklahoma The Oklahoman, Journal Record Legislative Report, The Sunday
Oklahoman, Tulsa World
(continued)
Yu and Farrell 497

Table 2  (continued)
Areas Newspaper name

 Pennsylvania Intelligencer Journal, Lancaster New Era, Lebanon Daily News, The
Morning Call, The Philadelphia Inquirer, Pittsburgh Post-Gazette,
Pittsburgh Tribune-Review, Lancaster Sunday News, The York
Dispatch, Times Leader
  Rhode Island The Providence Journal
  South Carolina The Sun News (Myrtle Beach), The Herald
  South Dakota Aberdeen American News
 Tennessee The Daily News, Knoxville News Sentinel
 Texas Austin American-Statesman, The Dallas Morning News
 Utah Deseret News, The Salt Lake Tribune
 Vermont Brattleboro Reformer
 Virginia The Virginian-Pilot, Richmond Times-Dispatch, The Roanoke Times
 Washington The Seattle Times, The Spokesman Review, The Columbian
  West Virginia The Charleston Daily Mail, Charleston Gazette-Mail
 Wisconsin The Capital Times, Duluth News Tribune, Wisconsin State Journal

Cause attribution
Cause attribution was coded with three levels—presence of internal cause, pres-
ence of external cause and no cause mentioned. Internal cause was identified when the
cause of autism is directly related to the human body (e.g., genetic predisposition,
genetic mutation, genetic deletion, genetic duplication, copy number variant). External
cause was identified when the cause of autism is clearly linked to a source outside of
the human body (e.g., environmental toxins, chemical exposure, vaccinations). Given
that multiple causes of autism were occasionally mentioned within a single news story,
the primary cause attribution was assessed based on the cause that was mentioned the
most frequently (determined by calculating the number of sentences referring to the
cause).

Preventability attribution
Preventability attribution was coded with three levels: presence of autism as pre-
ventable, presence of autism as unpreventable or no mention of preventability. Stories
that portrayed autism as preventable emphasized how there was a way to avert autism
from developing. Stories that depicted autism as unpreventable focused on how noth-
ing can be done to change the condition of autism from happening.

Stability attribution
Stability attribution was coded with three levels: presence of autism as a stable
condition, presence of autism being unstable (i.e., treatable) or no reference to stability
of the condition. Stories that emphasized symptoms of autism were unlikely to improve
were coded as stable condition. Stories that emphasized symptoms of autism were
likely to improve were coded as unstable condition.
498 Newspaper Research Journal 41(4)

Coding Process
A team of four students from a southeastern university was recruited to assist in
coding the sample. Coders participated in a series of training sessions in which they
were introduced to the variable definitions and coding instructions. Coders indepen-
dently conducted the intercoder reliability test using 10% of the study sample.
Krippendorff’s alpha scores revealed high reliability for each of the seven key vari-
ables: labeling cues = .95, social skill deficit cues = .99, aberrant behavior cues = .96,
physical appearance cues = .91, cause attribution = .96, preventability attribution =
.84 and stability attribution = .98. After the intercoder reliability tests were completed,
coders worked independently to code their respective portions of the sample. The data
were analyzed using SPSS 23.

Results
General Patterns
When examining the general patterns of the news coverage, we discovered that
cause attribution appeared in 42.5% of the total 982 articles with a relatively equal
representation of internal (21.3%) and external (21.2%) causes. Only 4.1% of the arti-
cles discussed the preventability attribution with 2.9% portraying autism as a prevent-
able disability. Stability appeared in 38% of the total number of articles. The percentage
of articles displaying autism’s conditions as unstable, meaning the disability can be
improved by medical interventions, was 31.5%. About 6.5% of the coverage depicted
the health risk as unchangeable (i.e., stable). Social skill deficit cues appeared the most
often, 51.5% of the total, followed by labeling cues (42.9%), aberrant behavior cues
(42.1%) and physical appearance cues (5.5%).

Framing of Autism Attribution

RQ1a prompted examination of how newspaper types (national vs. local) have
depicted the cause, preventability and stability attributions. A 2 (circulation: national
vs. local) × 2 (cause attribution: internal vs. external) chi-square test revealed the
presence of cause attribution varied by newspaper type, χ2(1, N = 417) = 5.30, p =
.02, V* = .11. National newspapers (57.6%) were more likely to present external
causes of ASD than local newspapers (45.8%). The presence of internal causes
appeared more often in local newspapers (54.2%) than in national newspapers (42.4%)
(see Table 3).
In addition, chi-square tests showed that the presence of preventability attribute
(p = .72) and stability attribute (p = .35) did not differ by newspaper type. However,
a noteworthy trend emerged. Both national and local newspapers more frequently por-
trayed autism as preventable (national: 73.3%, local: 68.0%) than as unpreventable
(national: 26.7%, local: 32.0%). Both national (84.2%) and local (82.1%) newspapers
were also more likely to depict autism as an unstable disability (e.g., conditions can be
improved) than to portray it as a stable disability (national: 15.8%, local: 17.9%).
RQ1b prompted examination of the changes of portrayals of attribution over time.
Internal cause of autism peaked in the years of 1998 (30.6%), 2000 (33.8%), 2003
Yu and Farrell 499

Table 3
Presence of Cause Attribution by Newspaper Type
Cause of Autism National Local

Internal cause 42.4% 54.2%

External cause 57.6% 45.8%

Note. χ2(1, N = 417) = 5.30, p = .02, V* = .11.

(31.3%) and 2006 (29.7%), but gradually decreased over the past 16 years. Between
2011 and 2013, mentions of internal cause appeared much less, with a small spike in
2012 (16.3%). External cause of autism was only referenced 2.8% of the time in 1999;
it peaked during 2002 (33.9%) and 2006 (35.9%). The presence of external cause
dropped significantly in 2009 (5.9%) and then increased periodically during 2010–
2013 (see Figure 1).
An emphasis on the preventability of autism was scarce overall. In 1998, 2002,
2003, 2004, 2005 and 2013, preventability attribution did not appear at all in the news-
paper coverage. Emphasis on autism as preventable peaked in 1999 (11.1%) and resur-
faced in 2006–2008 and 2010–2012. References to autism as unpreventable first
surfaced in 2000 (1.5%) and disappeared for a few years. Depictions of autism as
unpreventable peaked in 2010 (10.5%; see Figure 2).
Over the years, autism had consistently been portrayed as an unstable disability,
indicating that the conditions associated with ASD can be improved by medical assis-
tance. Depictions of the unstable attribution reached an all-time high in 2003 (58.3%)
and tapered off from 2006 to 2013. In 2013, mentions of the unstable attribution of
ASD appeared minimally (6.5%). Depictions of ASD as a stable disability (i.e., hard
to improve) started to emerge in 1999; references peaked in 2001 (13.3%) and 2008
(13.7%). Between 2009 and 2013, newspaper portrayals of ASD as a stable disability
dropped (see Figure 3). But, overall, presence of ASD as a disease that can be improved
appeared much more often in the newspaper coverage over 16 years.

Stigma Cues
RQ2a aimed at examining the presence of stigma cues to identify ASD individuals.
We discovered social skill deficit cues were more likely to appear in local newspapers
(53.8%) than in national newspapers (46.6%), χ2(1, N = 982) = 4.38, p = .036, V* =
.067 (see Table 4). Although overall physical appearance cues rarely appeared, they
were more likely to appear in national newspapers (8.0%) than in the local newspapers
(4.3%), χ2(1, N = 982) = 5.45, p = .02, V* = .075.
The presence of labeling cues (p = .98) and aberrant behavior cues (p = .82) did
not differ based on newspaper type. Overall, labeling cues appeared in 42.8% of news
stories in national newspapers and 42.9% in local newspapers. Aberrant behavior cues
appeared in 41.5% of news stories in national newspapers and 42.3% in local
newspapers.
500 Newspaper Research Journal 41(4)

Figure 1
Presence of Cause Attribution by Year
40%

33.9% 35.9%
33.8%
30.6%
30% 29.7%

23.6%
22.2% 23.0%
20%

16.3% 17.4%

10%

5.9% 4.3%
2.8% 4.2%

0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Internal Cause External Cause

Figure 2
Presence of Preventability Attribution by Year
12%
11.1%
10.5%
10%

8%

6% 5.5%

4.2%
4.4%
4%

2%
1.5%

0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Preventable Unpreventable

RQ2b was posed to investigate the presence of stigma cues over time. Figure 4
illustrates the longitudinal patterns of the depictions. Labeling cues were referenced in
almost 70% of ASD news stories in the late 1990s and hit an all-time high in 2000
(72.1%). After that the presence of labeling cues slowly tapered off until 2009 (20.6%).
Yu and Farrell 501

Figure 3
Presence of Stability Attribution by Year
70%

60% 58.3%

54.1%
50%

40% 41.7%
41.5%

30% 28.8%
23.2%
20%
13.3% 13.7% 16.7%
10% 8.1%
5.6% 6.5%
2.1% 4.3%
2.9%
0% 0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Stable Unstable

Table 4
Presence of Social Skill Deficit Cues by Newspaper Type
Social Skill Deficit Cues National Local

No presence 52.4% 45%

Presence 47.6% 55%

Note. χ2(1, N = 982) = 4.38, p = .036, V* = .067.

From 2010 to 2013, the presence of labeling cues slightly increased again and reached
36.3% in 2013. Social skill deficit cues reached its peak in 2001 (73.3%). From that
point on, social skill deficit cues started to gradually decrease and reached 21.7% in
2013. Aberrant behavior cues peaked in 2001 (73.3%) and then slowly decreased in its
presence over the years. By 2013, the presence of aberrant behavior cues dropped to
21.7%. Physical appearance cues were fairly sparse over the years, ranging from no
presence at all to its peak time in 2005 (11.5%).

Summary of Results
Our findings have discovered some important patterns regarding the coverage of
autism over a relatively recent 16 years period. First, national newspapers were more
likely to depict autism as a disability caused by external factors comparing with local
newspapers. Local newspapers more often referred the cause of autism to internal
502 Newspaper Research Journal 41(4)

Figure 4
Presence of Stigma Cues by Year
80.0%
73.3%
70.0% 69.4% 66.7%

63.9% 62.5%
60.0%
55.6%
50.0% 46.3%
46.6%
43.8%
40.0% 41.5% 36.3%

30.0%
30.4%

20.0%
20.6% 21.7%

10.0% 10.3% 11.5%

4.2% 4.3%
0.0% 0%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Labeling Cues Social Skill Deficit Cues

Aberrant Behavior Cues Physical Appearance Cues

reasons. Social skill deficit cues were found more likely to appear in local newspapers
than in national newspapers.
Over time, preventability attribution was rarely discussed in the newspapers. Within
the limited depictions, we found that newspapers consistently portrayed autism as a
disorder that can be altered with medical assistance, giving hope to people with autism
and their families.
The presence of stigma cues decreased over time. Physical appearance cues least
often appeared in newspapers compared with the other three types of cues. This sug-
gests that autism was rarely portrayed as a disability that can be easily identified with
physical appearance.

Discussion and Conclusion

Some findings in this research were in line with the current scientific discoveries
about autism, some suggested an improvement in news reporting and some were con-
cerning results.
The most encouraging result we discovered was the decrease of the presence of the
stigma cues over the 16 years—meaning journalists were becoming increasing cau-
tious and less judgmental when reporting autism. Despite such uplifting findings,
negative cues still appeared in about one quarter to one third of the coverage in 2013.
We can appreciate the decline in stigma cues, but it did not end here. Journalists should
continue being cautious of the words they use to describe autistic individuals.
Yu and Farrell 503

Our results suggested that newspapers have emphasized social skill deficit cues,
aberrant behavior cues and labeling cues much more than physical appearance cues
over the years. This may due to the history of how autism was diagnosed medically.
Characteristics of autism were most notably known for social and behavioral abnor-
malities (American Psychiatric Association, 2020). The reason why these depictions
were concerning is that many people with autism have mild intellectual delays or
normal intelligence (American Psychiatric Association, 2020), and they may have no
or very minor signs of these abnormalities. Therefore, highlighting the problematic
and undesirable social skills and behaviors related to autism can reinforce stereotyping
views (i.e., challenging, awkward or even dangerous) toward people with autism. We
found some concerning words when describing aberrant behavior cues, including
“screaming unexpectedly,” “self-destruction,” or “self-injury.” These depictions may
bolster the public’s misconceptions that people with autism are dangerous or mentally
unstable (John et al., 2018). We suggest that journalists should take on a more bal-
anced perspective when reporting autism—acknowledging that autistic individuals
can vary in terms of the symptoms they demonstrate; they can differ in regard to the
degree of their communication and behavioral abnormalities, and some can look or
behave just like normal individuals after early intervention.
Another positive trend we found was that much more coverage suggested that con-
ditions of autism can be improved. This is consistent with medical findings that early
intervention can improve children’s cognitive and daily living skills (CDC, 2020b).
Also, portraying autism as an unstable disability (i.e., conditions can be improved)
offers hope for autistic individuals and their families, and encourages actions to make
a change to the lives of people with autism.
The preventability attribute was the least-frequently appeared attribution. Over a
16-year span, several years showed no mention of preventability. Newspapers may
have purposely avoided the discussion of the preventability of autism because no sci-
entific findings have suggested that autism can be prevented (CDC, 2020b).
We found a similar performance in coverage of autism among national versus local
newspapers. National newspapers were more likely to attribute external factors to the
causes of autism, whereas local newspapers more often referred the cause to internal
factors (i.e., genes). Given the facts that both internal and external factors can increase
the risk for ASD, we suggest that journalists can take a more balanced approach in
their reporting of autism, rather than highlighting certain cause attributions over
others.
Our study is meaningful for journalists in that it offered comparisons between the
evolving scientific development of autism and the accuracies of the depictions of
autism over the 16-year time period. Our data suggest that media presentations in gen-
eral improved in a long run by reducing their stigmatizing depictions of autism signifi-
cantly. Continued learning is vital for reporters who follow a subject like autism,
which misconceptions were found common among audience (Holt & Christensen,
2013; Huws & Jones, 2010; John et al., 2018). Our study is also paramount for health
professionals in nongovernmental organizations (NGOs) who work on the field to
raise awareness of autism among the lay public. The results show a need for more
timely communication regarding autism causes, symptoms and treatment options so
the audiences can benefit from more recent discoveries surrounding this disability.
504 Newspaper Research Journal 41(4)

Limitations and Future Research

One limitation of the study was that it focused solely on newspapers from the
United States. Future research can conduct cross-cultural comparisons to understand
the images of autism in the news in different countries. Moreover, more recent data
can be collected to discover the latest trend in news media presentation of autism. It is
also meaningful to study how the public has debated autism on social media over time,
which may be different than or similar to news coverage of autism. To examine how
autism has been presented in entertainment programs (i.e., movies or TV dramas) can
also advance our understanding of media construction of the image of people with
autism. The findings of cause, preventability and stability attribution of autism can
serve as a base for future research regarding emotional and behavioral responses
toward people with autism.

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