From access to agency: how assistive and emerging technologies mediate self-determination in autistic adulthood.

Assistive and emerging technologies matter not only for the access they provide, but for what they enable autistic adults to decide and do. Guided by the Causal Agency Theory, this cross-sectional qualitative descriptive study used semi-structured interviews with 106 autistic adults in Chile to examine how everyday technologies shape choice, self-regulation, and beliefs about one's capacity to act. We analysed the data using a hybrid inductive-deductive reflexive thematic approach, which yielded five thematic areas: technology as a context for choice-making; digital scaffolds for planning, pacing, and adaptive replanning; empowerment through feedback calibrated to personal goals; autonomy negotiated through consented interdependence; and barriers and ethical tensions that undermine control. Technology supported self-determination when it preserved authorship of decisions, provided simple refusal and reversible settings, protected attention, and respected privacy and sensory needs. Agency was compromised when configurations were imposed by others, automation was opaque, or notifications and sensory stimuli were excessive The findings may inform rehabilitation and inclusive design by outlining possible mechanisms linking features-such as reminders, permissions, feedback, and adjustable sensory profiles-to processes of choice, regulation, and confidence valued by autistic adults.