Uncertainty in peer attitudes toward children with autism spectrum disorder in Chinese inclusive preschools: a mixed-methods study

Peer acceptance remains a critical challenge for children with autism spectrum disorder (ASD) in inclusive preschool settings. From an ecological systems perspective, this mixed-methods study examined peer acceptance toward children with ASD among typically developing children in China. Participants included 219 typically developing children from five inclusive kindergartens in Zhejiang Province, supplemented by semi-structured interviews with 15 children and 5 teachers. Quantitative data were collected through a peer acceptance questionnaire assessing cognitive, affective, and behavioural intention dimensions. We analysed the qualitative data using reflexive thematic analysis. Approximately 40–50% of children expressed explicit acceptance across the three dimensions, while “don’t know” responses ranged from 28.3% to 37.9% across items, with nearly all items at or above 30%. Uncertainty responses were highly consistent within children, suggesting a systematic response pattern. Correlation analyses showed significant positive associations among the three dimensions ( r = .59–0.73, p < .001), with the cognitive–behavioural intention association significantly stronger than the cognitive–affective association (Meng–Rosenthal–Rubin test, Z = 3.37, p < .001). We developed four themes: cognitive misunderstanding and gaps, difficulties in interaction initiation and response, the coexistence of affective closeness and estrangement, and the critical role and limitations of teacher support; teachers perceived structured activities as more conducive to peer engagement than free play. These findings highlight the prevalence of uncertainty in typically developing children’s attitudes toward ASD peers and the need for targeted support. Implications include supporting children’s movement from uncertainty toward active acceptance and refining teacher scaffolding practices in inclusive classrooms.