Awareness and social attitudes about Autism Spectrum Disorder in a sample of medical students: a single-centre cross-sectional study

Abstract Objectives This cross-sectional study examined the knowledge and social attitudes of medical students at Ankara University Faculty of Medicine regarding Autism Spectrum Disorder (ASD), and, uniquely, compared them by completion of the Child and Adolescent Mental Health and Diseases internship. Methods The study protocol was developed from September 2023; participant recruitment and data collection took place after institutional ethics approval, between 23 February and 27 May 2024. All 1171 students in terms 4, 5 and 6 were invited; 300 volunteered (25.6%) and completed a sociodemographic questionnaire, the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire and the Societal Attitudes Towards Autism (SATA) scale. Group comparisons used the Mann-Whitney U and Kruskal-Wallis tests with effect sizes (r, epsilon-squared) and Dunn’s post-hoc test, and the Spearman correlation. Multivariable linear regression with heteroscedasticity-consistent (HC3) standard errors, entering academic term and both internships simultaneously, tested whether internship completion was independently associated with the outcomes; ordinal logistic regression, nonparametric bootstrapping and a within-term analysis served as sensitivity analyses. Significance was set at 0.05. Results Knowledge scores differed across terms (H(2) = 26.74, p < 0.001, epsilon-squared = 0.089); term 5 and term 6 students scored higher than term 4 students, with no difference between terms 5 and 6 (Dunn, Bonferroni-adjusted p = 1.000). Attitudes did not differ across terms (H(2) = 5.41, p = 0.067). In unadjusted analyses, completion of the Child and Adolescent Mental Health and Diseases internship was associated with higher knowledge (Z = 5.92, p < 0.001, r = 0.34) and, marginally, with more favourable attitudes (Z = -1.96, p = 0.050, r = 0.11); completion of the Mental Health and Diseases internship was associated with higher knowledge (Z = 5.25, p < 0.001, r = 0.30) but not with attitudes ( p = 0.275). With academic term and both internships entered in the same model, each internship remained independently associated with higher knowledge (Child and Adolescent: adjusted beta = + 1.49, 95% CI + 0.35 to + 2.64, p = 0.010; Mental Health: adjusted beta = + 1.50, 95% CI + 0.52 to + 2.48, p = 0.003), whereas neither was associated with attitudes ( p = 0.869 and p = 0.931), indicating that the unadjusted attitude association reflected academic seniority rather than the internship. Knowledge and attitude scores were not correlated (Spearman rho = -0.03, p = 0.614). Scores did not differ by parental education, family psychiatric history or acquaintance with an autistic person. Faculty lectures were the most common information source (224/291, 77.0%), followed by social media (150/291, 51.5%). Only 48 students (16.0%) had received any formal ASD training. Conclusion Completion of structured clinical mental-health rotations was independently associated with greater ASD knowledge after adjustment for academic term, whereas the more favourable attitudes observed among internship completers were accounted for by academic seniority rather than by the internship itself. Because the design is cross-sectional, these are associations and no causal effect of the rotations can be inferred. Knowledge and attitudes were uncorrelated, and only a minority of students had received any formal ASD training. The findings support integrating autism-focused clinical training into medical curricula to build knowledge, while suggesting that improving attitudes may require dedicated, contact-rich interventions beyond existing rotations.