Brief Report: Self-Reported Academic, Social, and Mental Health Experiences of Post-Secondary Students with Autism Spectrum Disorder

Supporting Autistic College Students: Examining the Mentoring, Organization and Social Support for Autism Inclusion on Campus (MOSSAIC) Program

Recent trends suggest that autistic young adults are increasingly accessing postsecondary education than in years past. However, these students often face unique challenges that negatively impact their college experience resulting in high dropout. The Mentoring, Organization and Social Support for Autism Inclusion on Campus (MOSSAIC) Program is a peer-mentorship college transition program intended to support autistic students with executive functioning, social, and self-advocacy skills. This study investigated the experiences of 13 autistic mentees and 12 non-autistic mentors enrolled in the MOSSAIC program. Program feedback was collected using semi-structured interviews in order to understand student experiences, highlight benefits, and identify areas of improvement. Participants reported a general positive experience and improved skills in the domains of socialization, executive functioning, academic performance, and professional development. The most common suggestion for the program was the inclusion of autistic peer mentors. Mentees noted difficulty relating with non-autistic peers and feeling burdened with the need to educate their mentor on how to support autistic adults. These data provide valuable insight into how colleges can better improve support for autistic college students to ensure postsecondary success. Future peer mentorship programs should consider recruiting neurodiverse mentors from diverse backgrounds to improve congruence between mentor and mentee identities.

The emotional support plan: Feasibility trials of a brief, telehealth-based mobile intervention to support coping for autistic adults

LAY ABSTRACT

Autistic adults may have difficulty coping during stressful periods, which could make them more vulnerable to depression and anxiety. We designed the emotional support plan (ESP) to help autistic people find ways to cope in stressful situations. Thirty-six autistic adults created an ESP and answered questions about their opinions of the ESP. Most autistic adults found the ESP to have a positive impact on them and many would recommend the ESP to another person. Feedback from autistic adults suggested ways that we might test the ESP in future studies. Overall, autistic adults in this study found the ESP to be useful and a worthwhile intervention to study more in the future. While more research is clearly needed, we hope that the brief nature of the ESP will make it helpful for autistic people who are trying to handle negative feelings during stressful life events.

Measuring depression and anxiety in autistic college students: A psychometric evaluation of the PHQ-9 and GAD-7

LAY ABSTRACT

Anxiety, depression, and suicidality are major concerns among college students, though less is known about these constructs in autistic college students. Given the rising number of autistic individuals entering college, adequate screening and diagnosis of mental health difficulties is necessary to provide care to this population. For example, despite widespread usage of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), it is unknown if the two instruments accurately measure depression and anxiety the same way between non-autistic and autistic individuals. Thus, the current study was the first to examine how these instruments measure depression and anxiety symptoms in autistic versus non-autistic college students. Utilizing tests of construct measurement in a sample of autistic (n = 477) and non-autistic (n = 429) university students aged 18-29, results showed that while the GAD-7 and PHQ-9 appear to be accurately capturing anxiety and depression in autistic college students, the PHQ-9 item assessing suicidality was found to be measuring different things. This indicates that autistic college students are not interpreting this question the way non-autistic students are, and thus, the measure is failing to capture suicidality in autistic people. Future investigators should continue to assess the appropriateness of using common screening measures, originally created by non-autistic people, in autistic populations.

Exploring Autistic College Students' Perceptions and Management of Peer Stigma: An Interpretative Phenomenological Analysis

Autistic college students are often forced to navigate stigma on campus, but little is known about how autistic college students manage communicated stigma. Semi-structured interviews with ten autistic college students were conducted to explore how they manage peer stigma. Interpretative Phenomenological Analysis (IPA) was used to identify three themes from the data: First, participants seek to avoid peer stigma by concealing attributes associated with autism. Next, participants buffer against peer stigma by engaging in favorable social comparison. Finally, participants perceive the autism label as highly stigmatizing, necessitating limited disclosure on campus. These results can help researchers and practitioners focus efforts to promote neurodiversity to both autistic students and their peers on campus.

Meeting the mental health needs of autistic college students: a survey of university and college counseling center clinicians

OBJECTIVE

University and college counseling centers (UCCCs) are a front-line support for the mental health needs of autistic students, though little is known about clinician attitudes, comfort level, and training in autism.

PARTICIPANTS

89 UCCC clinicians were recruited via email listservs.

METHODS

The authors developed a survey which assessed attitudes, comfort level, and training in autism.

RESULTS

The majority of clinicians (82.0%, n = 73) had interacted with autistic students in the past year, and reported high levels of comfort with treating anxiety and depression. However, a smaller number reported confidence in their ability to diagnose autism. Training on autism emerged as an important deficit, as 31.5% of the clinicians denied receiving training either in their educational program or the UCCC.

CONCLUSIONS

In this pilot study, clinicians reported a discrepancy between self-reported levels of comfort with autistic college students and past training, highlighting continuing education as an important area for future intervention.

Basic Management Strategies by Life Cycle for Treatment of the Persons With Autism Spectrum Disorder

Interventions for targeted symptoms are important when setting treatment strategies for individuals with autism spectrum disorder (ASD) and developmental disabilities. Especially, the goal should be to achieve individual "niche construction" by allowing them to select and adjust an environment where they can demonstrate their special characteristics and strengths. In addition, these choices should vary depending on the stage of development of each person with ASD and developmental disabilities. It is necessary to establish a detailed and systematic plan for diagnosis and treatment necessary for infants and toddlers, school placement in school age, and employment or self-reliance in adult transition period to establish customized treatment strategies that fit the individual level of people with ASD and developmental disabilities.

Teaching higher education staff to understand and support autistic students: evaluation of a novel training program

Background

Autistic students are particularly vulnerable to stressors within a university environment and are more likely to experience poor mental health than their non-autistic peers. Students' experiences of stigma from staff and peers, and the masking behaviors they deploy to minimize it, can also result in worsening mental health. Despite these concerns, there is a lack of tailored support for autistic students at university. The current project assesses a co-created training course for university staff focused on debunking stereotypes, educating about the autistic experience at university, mental health presentation among autistic individuals, and practical strategies to improve interactions with autistic students.

Methods

The Autism Stigma and Knowledge Questionnaire [ASK-Q] was administered before and after the training, to examine changes in trainees' understanding and acceptance of autism and autistic people. Post-training interviews and surveys were also conducted with trainees, covering the impact the training has had on their perceptions of autism, the strategies they found beneficial, and how they will use the materials in future.

Results

There were no statistically significant differences between pre- and post-training scores on the ASK-Q, likely due to ceiling effects as pre-training scores were high. Thematic analysis of interviews identified five themes: value of lived experience; developing nuanced, in-depth knowledge of autism; training as acceptable and feasible; links to professional practice; and systemic barriers.

Conclusion

Although ceiling effects meant there were no changes to participant's knowledge about autism and autistic people statistically, the qualitative data reveals the extensive benefits they gained from taking part in the training programs. Scoring highly on the ASK-Q did not mean that people could not learn important new information and benefit from the course. This more nuanced understanding of autism led to practical changes in their practice. Listening to and learning from autistic people was seen as particularly important, highlighting the value of co-production. Our results also emphasize the need for varied approaches to evaluating training effectiveness, as reliance on quantitative data alone would have missed the subtler, but impactful, changes our participants experienced. This has important implications for professional practice, both within higher education and more broadly.

Discrimination and Harassment Experiences of Autistic College Students and Their Neurotypical Peers: Risk and Protective Factors

This study examines autistic and non-autistic college students' experiences of discrimination and harassment and identifies protective and risk factors. A nationwide survey was used to match autistic students (N = 290) and non-autistic students (N = 290) on co-occurring diagnoses and demographic characteristics. Multiple regression and interaction analysis revealed that faculty support was protective against discrimination and harassment regardless of autism status. Habits of mind was particularly protective for autistic students against harassment. Any student who engaged in school-facilitated events was more likely to experience discrimination and harassment, but the risk was heightened for autistic students. Findings highlight the importance of faculty support in fostering positive interpersonal experiences on campus, and demonstrate the need to address deeper college campus issues with respect to neurodiversity.

A mixed method examination: how stigma experienced by autistic adults relates to metrics of social identity and social functioning

A recent meta-analysis reveals almost half of autistic individuals experience some form of victimization in their lifetime, including bullying and other forms of stigma. Research among caregivers of autistic individuals demonstrates that stigma can have a long-lasting impact on other aspects of a social identity, such as self-esteem, but less research has specifically examined this among autistic adults themselves, in spite of research suggesting these are likely constructs that contribute to the internalization of stigma and subsequent mental health consequences. The current study used a mixed method approach to assess the relation between stigma and several components of social identity and social functioning. More specifically, among 45 autistic young adults, three dimensions of self-reported stigma (discrimination, disclosure, and positive aspects) were examined in relation to self-esteem, self-efficacy, social satisfaction and adaptive social functioning. Quantitative analyses revealed higher reported discriminative and disclosure stigma were significantly associated with lower self-efficacy. Increased experience with all types of stigma were associated with lower social satisfaction. Greater reported disclosure stigma was also associated with lower self-esteem. Qualitative interviewing among eight autistic young adults helped to better understand the nature of stigma and the impact of these experiences. Thematic analysis of the qualitative data revealed that all of the participants experienced stigma in the form of exclusion or isolation and that a majority also experienced verbal bullying. Many of the negative interactions came from educators, peers, and family members. Most participants indicated that these stigmatizing interactions directly contributed to decreased social satisfaction, diminished self-efficacy, and lowered self-esteem. A greater understanding of the negative consequences of stigma can inform efforts to increase awareness and acceptance of autism.

Autistic Traits and College Adjustment

This study evaluated the association of autistic traits (RAADS-14) with academic and social outcomes among college students using data from an online survey (N = 2,736). In the academic domain, the total trait score and all subscale scores (mentalizing deficits, social anxiety, sensory reactivity) were associated with course failure and academic difficulties independent of an autism diagnosis; the total score and mentalizing deficits also predicted lower grade point average (GPA). In the social domain, the total trait score and subscale scores were associated with lower odds of having a confidant, lower friendship quality, and higher odds of social exclusion. Subgroup analyses revealed that autistic traits had more consistently negative associations with social outcomes for students without an autism diagnosis than for students with a diagnosis. Associations were also more often significant for women than men. These results support the development of programs and services for students with autistic traits regardless of diagnostic status.

Autism, Discrimination and Masking: Disrupting a Recipe for Trauma

Outcomes of discrimination for autistic people include masking, social isolation and exclusion, trauma, and mental health problems. This discursive paper discusses the discrimination experienced by autistic people in health, education, employment, and media settings; and considers how to reduce the impact of discrimination. Addressing the impact of discrimination requires an improved understanding of the lived experience of the autistic person, the embedding of inclusive practices in communities, developing the person's life skills and supports, and enabling the person to work through their psychological trauma. Further research can aid in minimizing and preventing discrimination against people with autism.

Understanding the Needs of Autistic Post-Secondary Students

Autistic students are a growing subgroup within post-secondary schooling; however, little is known about barriers to their success in that context. Research suggests autistic students face more challenges to completing post-secondary education than neurotypical students, but findings often rely on expert opinion and fail to incorporate first-hand perspectives. To address this gap, a qualitative inquiry into barriers to success for autistic post-secondary students was conducted. Thematic Analysis yielded 10 themes in three categories, while two separate cross-cutting themes emerged; themes interact with one another, intensifying concerns of autistic students. Findings can support post-secondary institutions to reflect on the extent to which these barriers are present for their autistic students and modify support services accordingly.

Genesis, modelling and methodological remedies to autism heterogeneity

Diagnostic criteria used in autism research have undergone a shift towards the inclusion of a larger population, paralleled by increasing, but variable, estimates of autism prevalence across clinical settings and continents. A categorical diagnosis of autism spectrum disorder is now consistent with large variations in language, intelligence, comorbidity, and severity, leading to a heterogeneous sample of individuals, increasingly distant from the initial prototypical descriptions. We review the history of autism diagnosis and subtyping, and the evidence of heterogeneity in autism at the cognitive, neurological, and genetic levels. We describe two strategies to address the problem of heterogeneity: clustering, and truncated-compartmentalized enrollment strategy based on prototype recognition. The advances made using clustering methods have been modest. We present an alternative, new strategy for dissecting autism heterogeneity, emphasizing incorporation of prototypical samples in research cohorts, comparison of subgroups defined by specific ranges of values for the clinical specifiers, and retesting the generality of neurobiological results considered to be acquired from the entire autism spectrum on prototypical cohorts defined by narrow specifiers values.

A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability

BACKGROUND

Suicidality is highly prevalent in autistic people without co-occurring intellectual disabilities, and high autistic traits are found in adults who have attempted suicide. However, prevalence rates for both autistic and possibly autistic people have not been synthesised meta-analytically.

AIMS

To (1) calculate pooled prevalence estimates of suicidality in autistic people and possibly autistic people without co-occurring intellectual disability; (2) evaluate the influence of participant and study level characteristics on heterogeneity; and (3) determine the quality of evidence.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PsycINFO, Embase, MEDLINE and Web of Science were systematically searched from 1992 to January 25, 2022. Empirical quantitative studies reporting prevalence of suicidal ideation, suicide plans, or suicide attempts and behaviours were considered for inclusion. Random effects models were used to estimate pooled prevalence of each suicidality outcome with 95% confidence intervals. Heterogeneity was explored using sensitivity and moderator analyses.

RESULTS

Data from 48,186 autistic and possibly autistic participants in 36 primary studies were meta-analysed. Pooled prevalence of suicidal ideation was 34.2% (95% CI 27.9-40.5), suicide plans 21.9% (13.4-30.4), and suicidal attempts and behaviours 24.3% (18.9-29.6). High levels of heterogeneity (I² > 75) were observed in all three analyses. Estimates did not differ between autistic or possibly autistic samples. Geographical location (p = 0.005), transgender or gender non-conforming samples (p < 0.001) and type of report (p < 0.001) significantly moderated suicidal ideation, whereas age group (p = 0.001) and measure of suicidality (p = 0.001) significantly moderated suicide plans. There was a significant association between the proportion of male participants and prevalence of suicide plans, with a decrease in the proportion of males for every unit change of suicide plan prevalence (p = 0.013). No variables were found to moderate estimates of suicide attempts and behaviours.

CONCLUSIONS

The results confirm suicidality is highly prevalent in both autistic and possibly autistic people without co-occurring intellectual disability and highlights potential moderators. Possibly autistic individuals require more attention in clinical and research considerations going forward to further understand and prevent suicide in both groups.

Longitudinal Analysis of Mental Health in Autistic University Students Across an Academic Year

BACKGROUND

Autistic people have worse mental health (MH) than non-autistic people. This proof-of-concept study explored feasibility of longitudinal research with autistic university students, focusing on their MH and coping styles across an academic year.

METHODS

Twenty-two students took part at all timepoints. They completed four rounds of online MH questionnaires.

RESULTS

Over 80% of students were retained. They started the year with high levels of all MH issues, which remained stable across the year. Network Change analysis showed the connections between MH and coping style changed over time.

CONCLUSIONS

Autistic students are engaged participants who are likely to take part in longitudinal research. While MH levels were stable, it may be that coping styles are a useful target for intervention.

Sex differences in friendships and loneliness in autistic and non-autistic children across development

BACKGROUND

Autistic children have been shown to have less complete definitions of friendships and higher levels of loneliness than their non-autistic peers. However, no known studies have explored sex differences in autistic children's understanding of friendships and reported loneliness across development. Autistic girls demonstrate higher levels of social motivation than autistic boys and appear to "fit in" with their peers, but they often have difficulty recognizing reciprocal friendships during middle childhood. As autistic girls develop a more complex understanding of friendship during adolescence, they may begin to redefine their friendships and experience heightened loneliness. Here, we explored how autistic and non-autistic boys and girls define the meaning of friendship and report feelings of loneliness across development. We also examined their perceptions of friendships and loneliness.

METHODS

This mixed-methods study analyzed the transcribed clinical evaluations of 58 autistic children (29 girls) matched to 42 non-autistic children (21 girls) on age and IQ. Transcripts were coded for four categories that children used to define friendships-personality, companionship, dependability, and intimacy-and for reported loneliness. We then compared these codes across diagnosis, sex, and age. Content analyses were further implemented to gain a more holistic understanding of children's perceptions of friendships and loneliness.

RESULTS

Girls, regardless of diagnosis, were more likely than boys to refer to personality when defining the meaning of friendship, and the likelihood of referring to dependability and intimacy increased with age. Most children reported having at least one friend, though some autistic adolescents reported not having friends or were uncertain whether they had friends. While autistic and non-autistic boys and girls were equally likely to report feeling lonely at times, several autistic girls and boys reported being frequently lonely.

LIMITATIONS

This study was a secondary data analysis. The standardized set of questions on the ADOS limited the amount of information that children provided about their friendships and perceptions of loneliness.

CONCLUSION

As with non-autistic children, autistic children acquire a more complex understanding of friendship throughout development. However, as children begin to prioritize dependability and intimacy in friendships, autistic adolescents may have difficulty developing friendships characterized by these constructs. Furthermore, the quantity and/or quality of autistic children's friendships may not be sufficient to alleviate loneliness.

A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor

Autistic adults are a high-risk population for suicidal thoughts and behaviors (STBs). Accordingly, this systematic review aims to review the prevalence of STBs among autistic adults, review the risk and protective factors for STBs in autistic adults, and formulate a disorder-specific conceptualization of risk in this population. We systematically searched PsycINFO and Google Scholar for all studies published prior to March 28th, 2022. We included empirical articles focused on autistic adults, ages 18 years and older, reporting on suicide-related outcomes. In total, 45 peer-reviewed empirical articles were included in the current systematic review. The most frequently studied factors in relation to suicide risk among autistic adults were interpersonal constructs (42.4% of total studies looking at risk/protective factors) and depressive symptoms (36.4% of total studies looking at risk/protective factors). We conclude by summarize two key content areas: exploring social and interpersonal constructs and better understanding the role of depressive symptoms in autism. As researchers continue to explore STBs among autistic adults, it will be necessary to addressing the overreliance on autistic symptoms instead of autism diagnoses, measurement issues of STBs, and a need for treatment adaptations.

Learning from the experts: Evaluating a participatory autism and universal design training for university educators

LAY ABSTRACT

Autistic university students have many strengths. They also go through difficulties that professors may not understand. Professors may not understand what college life is like for autistic students. They might judge autistic students. A team of autistic and non-autistic researchers made a training to help professors understand autistic students better. This training also gave professors ideas to help them teach all of their students. Ninety-eight professors did an online survey before the autism training. They shared how they felt about autism and teaching. Before our training, professors who knew more about autism appreciated autism more. Professors who thought people should be equal and women also appreciated autism more. Then, 89 of the professors did our training and another survey after the training. This helped us see what they learned from the training. They did one more survey a month later. This helped us see what they remembered. Our training helped professors understand and value autism. It also helped them understand how they can teach all students better. The professors remembered a lot of what we taught them. This study shows that a training that autistic people helped make can help professors understand their autistic students better.

Experiences and insights of college students with autism spectrum disorder: an exploratory assessment to inform interventions

Objective: College students with autism spectrum disorder (ASD) experience elevated drop-out rates, peer difficulties, and mental health concerns compared to their neurotypical counterparts. Thus, the firsthand concerns of college students with ASD were examined, so that supports can be appropriately tailored. Methods: Responses of 31 college students with ASD were examined in relation to 39 demographically similar neurotypical students regarding students' college experiences (e.g., social interactions, mental health, daily living habits). Students with ASD also provided recommendations for improving college support programs. Results: Difficulties unique to students with ASD included trouble conversing with peers, feeling isolated despite preferences to be alone, inaccessible extra-curricular activities, and experiencing anxiety and depression resulting from social demands. Notably, these students endorsed desire for a "social group" to learn from the experiences of successful students. Conclusions: Practical targets were identified for university-implemented support groups, such as navigating social interactions and processing experiences with peers.

Loneliness in autistic adults: A systematic review

LAY ABSTRACT

Recently, researchers have been interested in how autistic people experience loneliness. Yet, most of this research has focused on loneliness in autistic children and young people. We present the results of a systematic review on loneliness in autistic adults. A systematic review is a rigorous way of searching for all existing research on a topic and summarizing the findings about specific questions. We searched for all research published on this topic until 9 April 2021. We found 34 articles that investigated loneliness in autistic adults. This research showed that (1) there is fairly little research that has involved directly asking autistic adults about their first-hand experiences of loneliness (e.g. what loneliness feels like for them); (2) few research studies have used loneliness questionnaires specifically developed for autistic adults (this was attempted in just one research study); (3) collective loneliness (i.e. loneliness associated with how much an autistic person feels they 'fit in' to society) seems important to autistic adults but has not been investigated as commonly as other aspects of loneliness (e.g. loneliness associated with romantic relationships or friendships); (4) things that might increase loneliness in autistic adults include anxiety and depression, and a lack of autism understanding and acceptance, for example; and (5) things that might reduce loneliness in autistic adults include having relationships and self-acceptance, for example. In our article, we discuss the kinds of future research on loneliness in autistic adults that might be useful.

Adaptive behavior and psychiatric symptoms in university students with ASD: One-year longitudinal study

In recent years, more young adults with ASD are attending post-secondary education, and several support programs have been proposed for this population. However, research regarding the long-term effects of university enrollment on outcomes among students with ASD is scarce. This study examined adaptive behavior and psychiatric symptoms during the first semester of two consecutive academic years (T1, T2) among 39 students with ASD, 29 students without ASD and high levels of social anxiety symptoms (High SA), and 32 students without ASD and low levels of SA symptoms (Low SA). Students with ASD participated in a university support program and resided with a peer mentor student without ASD, which encouraged social interaction. At T1, students with ASD reported lower levels of adaptive behavior and higher levels of social anxiety and obsessive-compulsive symptoms compared to the other groups. However, at follow-up (T2), significantly higher conceptual adaptive skill levels (specifically communication skills) and significantly lower depression symptom levels from T1 were reported only among students with ASD. The levels of social anxiety and obsessive-compulsive symptoms at T1 were negatively associated with adaptive functioning a year later (T2). Implications regarding adults with ASD attending university are discussed.

Loneliness in Autism and Its Association with Anxiety and Depression: A Systematic Review with Meta-Analyses

Objectives

This systematic review aimed to quantify differences in loneliness levels between autistic and neurotypical samples and investigate the association between loneliness and mental health in autistic individuals.

Methods

Three meta-analyses were conducted. Studies were methodologically appraised using established tools.

Results

Overall, 39 studies were included. The majority of these achieved moderate methodological quality ratings. The primary meta-analysis (N = 23) found autistic samples reported higher loneliness compared with neurotypical samples (Hedges’ g = .89). The meta-analyses on the associations between loneliness and anxiety (N = 14) and depression (N = 11) in autistic samples found significant pooled correlations (r = .29 and r = .48, respectively).

Conclusions

This review highlights numerous limitations within current autism and loneliness research. Nevertheless, loneliness in autism merits targeted clinical and research attention.

The effect of learning to drum on behavior and brain function in autistic adolescents

SignificanceThere is an acknowledged need for improved service provision in the context of autism spectrum disorders. Previous studies have demonstrated the positive role drum training can play in improving behavioral outcomes for children and adolescents with emotional and behavioral difficulties. However, to date, none of these studies has explored how these behavioral changes translate at the neural level. Our study provides strong evidence that drumming not only reduces hyperactivity and inattention in autistic adolescents but also strengthens functional connectivity in brain regions responsible for inhibitory control and action outcome monitoring.

College as a Developmental Context for Emerging Adulthood in Autism: A Systematic Review of What We Know and Where We Go from Here

Autistic individuals often struggle to successfully navigate emerging adulthood (EA). College is an increasingly common context in which individuals learn and hone the necessary skills for adulthood. The goal of this paper is to systematically review and assess the existing research on college as a context of EA development in autistic individuals, particularly in terms of understanding whether and how this context might be critically different for those who are typically developing or developing with other disabilities. Our findings indicate that ASD college students report feeling prepared academically, but exhibit weaknesses in daily living and social skills. Interventions largely focus on social skills, and rarely evaluate outcomes relevant to college success or longer-term emerging adulthood independence. We conclude with hypotheses and recommendations for future work that are essential for understanding and supporting ASD students as they navigate potentially unique challenges in college and their transition to independence during EA.

Associations Between Autism Symptomatology, Alexithymia, Trait Emotional Intelligence, and Adjustment to College

It has been asserted that the socio-emotional challenges associated with autism spectrum disorder (ASD) may be explained, in part, by the higher rates of alexithymia in individuals with autism. Alexithymia refers to difficulties in identifying one's own emotional states and describing those states to others. Thus, one goal of the present study was to examine levels of alexithymia in relation to ASD symptomatology and trait emotion intelligence (EI). Trait EI is a multifaceted concept that captures emotional competencies and behavioral dispositions A second goal was to assess whether alexithymia, ASD symptomatology and trait EI served as significant predictors of adjustment to college, including academic, social, and personal-emotional adjustment. In addition to keeping with the spectrum nature of autism, our research strategy allowed us to capture those students who may not have received a formal diagnosis of ASD but report symptoms that can be indicative of ASD. This includes women, who are less likely to receive a diagnosis of ASD even when ASD symptomatology is present. The results of the study showed that students reporting higher levels of ASD symptomatology also reported significantly higher levels of alexithymia and lower trait emotional intelligence (trait EI) than those with less or no symptomatology. Alexithymia was also negatively related to trait EI, and both alexithymia and ASD symptomatology were found to be significant predictors of trait EI. However, only trait EI was a significant predictor of adjustment to college and only for social adjustment. These findings suggest that support programs that develop trait EI skills may improve the college experience for students with ASD, regardless of alexithymia or ASD symptomatology.

Adjustment Across the First College Year: A Matched Comparison of Autistic, Attention-Deficit/Hyperactivity Disorder, and Neurotypical Students

Background

Although the number of autistic students attending higher education has grown substantially in recent decades, little is known about factors that support their retention and persistence in college. First-year experiences and adaptability to the college environment greatly impact students' decisions to remain enrolled. Despite the importance of first-year adjustment to persistence and retention, few studies have examined the adjustment experiences of first-year autistic students compared to those of matched nonautistic students.

Methods

This study used national survey data to compare the first-year college adjustment experiences of 222 freshmen, including 74 self-identified autistic students, 74 students with attention-deficit/hyperactivity disorder (ADHD), and 74 students without diagnoses (referred to as neurotypical; NT), matched on mental health and demographic characteristics. Students were compared on measures of academic, social, emotional, and institutional adjustment at the end of freshman year. Separate general linear models were used to investigate predictors of positive self-reported first-year adjustment.

Results

Autistic students reported significantly lower levels of social self-confidence than their NT and ADHD peers at the end of freshman year. On all other adjustment domains, students in the autism, ADHD, and NT groups did not significantly differ. Autistic students were not significantly different from their ADHD and NT peers in terms of satisfaction with their college experience or sense of belonging to their institution. Social factors, including social self-confidence and ease of making friends, emerged as important contributors to positive first-year adjustment outcomes across all groups.

Conclusions

When controlling for demographic factors and mental health characteristics entering college, autistic students do not significantly differ from their NT and ADHD peers on several domains of college adjustment. Future studies should further investigate the impact of mental health and student characteristics on college trajectories and outcomes for autistic students.

Mental health Project ECHO Autism: Increasing access to community mental health services for autistic individuals

LAY ABSTRACT

Although many autistic individuals have additional mental health conditions, most have a hard time getting services from mental health providers. One reason why these services can be hard to access is that many mental health providers do not feel confident in their ability to provide services to autistic individuals. To share autism expertise with local community providers and boost their confidence in working with autistic individuals, we created a mental health version of the Extension for Community Healthcare Outcomes (Project ECHO) Autism virtual teleconsultation program. In this pilot study, we recruited 51 community mental health providers to participate in Project ECHO Autism. During each biweekly session, providers received information from autism experts about how to tailor mental health interventions (e.g. attention-deficit hyperactivity disorder or anxiety interventions) for use with autistic individuals. They also had the opportunity to ask questions and get advice on their current cases. At the end of the 6-month study, mental health providers showed improvements in their confidence, in their knowledge of autism, and in their problem-solving skills. Nearly half (45%) of these providers participated from rural counties, suggesting that the Project ECHO Autism teleconsultation model was able to reach mental health providers who might not have been able to get training otherwise. This study supports the feasibility of using Project ECHO Autism to share autism knowledge with mental health providers, consequently expanding mental health service options for autistic individuals with co-occurring mental health conditions.

Assessment of Anxiety in Cognitive-Behavior Therapy in Young University Students with Autism Spectrum Disorders: A Review

The university provides academic support to disabled students, however, few institutions provide academic, extra-academic or preventive support to students with Autism Spectrum Disorders High-Functioning (ASD-HF). Among the most commonly requested needs is support for coping with anxiety arising from academic and social activity itself. When planning an intervention program, it is necessary to screen those who have problems and are likely to benefit from such a program. In this article we propose a systematic search for measures of anxiety for young people and adults with ASD-HF. Of a total of 683 documents, only 7 met the selection criteria. Of these, a total of 35 tools were detected, of which only 11 mediated anxiety. Screening should be carried out for all students, so that we can detect the "risk" of anxiety disturbance in all cases and, in particular, in students with ASD-HF. However, the instruments eligible for assessing intervention outcomes should be agreed upon in order to be able to compare results from different trials.

Self-regulation predicts companionship in children with autism

 Self-regulation is associated with many positive outcomes in children with and without autism, including increased mental health and academic achievement, and decreased problem behavior. Less is known regarding whether and how self-regulation and symptoms of mental health challenges (internalizing and externalizing problems) relate to social outcomes, such as friendship quality and loneliness. Parents and teachers of 106 children with autism aged 5-12 reported on children's self-regulation difficulties and externalizing and internalizing symptoms. Four-to-five months later, children reported on the quality of their friendship with their best friend (companionship, conflict, helpfulness, sense of relationship security, closeness), and their feelings of loneliness. Linear regression was used to examine the effects of self-regulation and symptoms of mental health challenges on friendship quality and loneliness. Less self-regulation difficulties predicted stronger companionship and girls had better quality friendships with their best friend than did boys, in terms of companionship, helpfulness, security and closeness, confirming that they have a protective advantage in friendship development. Autism symptoms, IQ, and age were not associated with friendship quality or loneliness. Results highlight the importance of self-regulation and mental health interventions for school-aged children with autism.

A Systematic Review of Self-Reported Stress Questionnaires in People on the Autism Spectrum

Background

The goal of this systematic review was to provide an overview of self-report measures of stress in populations on the autism spectrum. In addition, information regarding psychometric properties was discussed as well.

Methods

Four databases were systematically searched following the PRISMA guidelines and using strict eligibility criteria. Risk of bias assessment was performed using the COSMIN checklist.

Results

Eight questionnaires were previously used in populations on the autism spectrum, reported over 31 studies.

Discussion

Future research should focus more on examining psychometric properties of these self-report measures in this population as current evidence is scarce. In addition, it is important to consider which concept of stress one aims to measure as not all questionnaires cover the same aspects of stress.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40489-021-00293-4.

Exploring the concurrent use of standardised and idiographic measures to assess cognitive behavioural therapy in a university student with autistic spectrum condition – a single case experimental design

Limited research has directly addressed the challenges of higher education for students with autism, who face additional difficulties in navigating social, personal and academic obstacles. With more students experiencing mental health difficulties whilst at university, therapeutic interventions on offer need to be suitable for those accessing support. Cognitive behavioural therapy (CBT) is widely used to support university students, as it is firmly established as an effective treatment for a range of issues, including social and generalised anxiety in typically developing populations (NICE, 2013; NICE, 2019). However, the efficacy of CBT for individuals with autistic spectrum condition (ASC) is less well known, despite the high prevalence rates of anxiety in this population. This paper seeks to address a gap in the literature and uses a single-case (A-B) experimental design over 16 sessions to reduce co-morbid social and generalised anxiety in a university student with high-functioning ASC. Clark’s (2001) cognitive model of social anxiety and Wells’ (1997) cognitive model of generalised anxiety were employed to formulate anxiety experienced in this case. Standardised outcome measures were used for social anxiety, i.e. the Social Phobia Inventory (SPIN), and generalised anxiety, i.e. the Generalised Anxiety Disorder-7 (GAD-7), in conjunction with idiographic ratings to assess the impact of therapy. Findings indicate that CBT was an acceptable and useful intervention with mixed results; discrepancies were found between clinical change recorded on standardised measures compared with idiographic ratings. This paper discusses the use of standardised measures of anxiety for individuals with ASC and identifies directions for further research.

Key learning aims

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"I Spent Most of Freshers in my Room"-A Qualitative Study of the Social Experiences of University Students on the Autistic Spectrum

Autistic university students face extra challenges in both their academic and social life. Barriers to socialising appear to be less well understood and supported by universities than academic requirements. Semi-structured interviews were conducted with ten autistic university students to explore their social experiences. Questions explored their social experiences, satisfaction with social life, disclosure of ASD to others, and the impact of mental wellbeing on university life. Thematic analysis indicated most participants were unsatisfied with their social lives and experienced mental health issues. Factors exacerbating social isolation included lack of suitable social events, lack of social support and feeling unable to disclose to peers. Factors which reduced social isolation included joining an autism or special interest society and receiving social mentoring.

Estudiantes universitarios con trastornos del espectro del autismo: revisión de sus necesidades y notas para su atención

En los últimos 10 años hemos visto incrementar el número de publicaciones relacionadas con la inclusión en las aulas universitarias de estudiantes con Trastornos del Espectro del Autismo, síndrome de Asperger o Autismo de alto funcionamiento. En este artículo, se resume la literatura sobre la presencia de estudiantes con Trastornos del Espectro del Autismo en la Universidad y se reflexiona sobre la necesidad de desarrollar programas específicos para su atención en el marco de los servicios de apoyo a los estudiantes con discapacidad u otras estructuras de servicios similares. Entre las medidas específicas, hemos encontrado experiencias sobre programas de sensibilización a profesores y estudiantes con la finalidad de generar una cultura sobre “el autismo”, programas para tratar la ansiedad, programas de prevención de salud mental, etc. En definitiva, medidas que, aunque están dirigidas a un colectivo en particular, pueden beneficiar a toda la comunidad universitaria.

Anxiety and Depression Reduction as Distal Outcomes of a College Transition Readiness Program for Adults with Autism

Young adults with autism spectrum disorder (ASD) experience increased rates of anxiety and depression which can impact academic success. The Stepped Transition in Education Program for Students with ASD (STEPS) applies cognitive-behavioral principles to help young adults with ASD improve their adjustment to postsecondary education. We aimed to determine if STEPS had an effect on anxiety and depression. Treatment-seeking adults with ASD (n = 32; Mage = 19.74) were randomized to STEPS or transition as usual (TAU; i.e., waitlist control group). STEPS participants evinced significantly greater declines in depressive symptoms from pre-treatment to post-treatment compared to the waitlist. Anxiety symptoms did not significantly change. Results suggest that transition support for young people with ASD may improve mental health.

Stakeholders’ views on effective employment support strategies for autistic university students and graduates entering the world of work

Purpose

This paper aims to examine effective support strategies for facilitating the employment of autistic students and graduates by answering the following research question: What constitutes effective employment support for autistic students and graduates?

Design/methodology/approach

Data were collected using the method of empathy-based stories (MEBS) as part of a multinational European project’s Web-based survey. The data consisted of 55 writings about effective strategies and 55 writings about strategies to ]avoid when working with autistic students and graduates. The material was analysed using qualitative inductive content analysis. Narratives were created to illustrate desirable and undesirable environments and processes as they would be experienced by students, supported by original excerpts from the stories.

Findings

The analysis revealed that effective employment support for autistic students and graduates comprised three dimensions of support activity: practices based on the form and environment of support, social interaction support and autism acceptance and awareness. These dimensions were present in both recommended and not recommended support strategy writings.

Originality/value

The results add to the literature on autism and employment with its focus on the novel context of autistic university students and graduates. Effective strategies will be based on person-centred planning, to include not only the individual impact of autism but also individual career goals, workplace characteristics in the chosen field, employer needs and allocation of the right support. There is no one-size-fits-all strategy, but rather an individualized process is needed, focused on the identification of strengths, the adaptation of employment and work processes and improved understanding and acceptance of autism by management, colleagues and administration in the workplace.

Advancing Mental Health Supports for Autistic Postsecondary Students: A Call for Research

Research has documented elevated rates of co-occurring depression and anxiety in autistic adults, with some noting particularly high rates for autistic students enrolled in postsecondary education. Difficulty coping with the stressors that accompany daily life as they navigate college campuses may contribute to development or exacerbation of co-occurring conditions. Autistic students have reported that depression, anxiety and stress interfere with their success in college, but that they have difficulty identifying and accessing the supports that they need. Though many postsecondary institutions have established programs that provide academic supports to autistic students, few programs directly support mental health and wellness. Recently, stakeholders have advocated for mental health to be prioritized in adult autism research. We suggest that a specific focus on autistic students in postsecondary education is warranted and provide a brief overview of the relatively limited literature in this area. To inform development of mental health services and supports that will be both accessible and acceptable to the range of autistic students attending postsecondary education, research is recommended in four areas: factors positively and negatively affecting mental health; types of supports; outreach; on-campus training and education. It will be essential for researchers to establish community partnerships with autistic individuals to inform study design and specific research questions. This will ensure that autistic voices guide development of supports that will foster positive mental health in postsecondary education and beyond.

Health Needs and College Readiness in Autistic Students: The Freshman Survey Results

With an increase in the diagnosis of autism spectrum disorder in the United States, many of whom have higher intellectual ability, there is a predicted increase in the number of college-bound students. Affected young adults face a "Services Cliff" as they transition into adulthood. Our study examined a nationally represented sample of freshman students and found that academic achievements in autistic students are comparable to their peers when they first enter college. The students however have more mental health and physical health problems compared to their non-autistic peers. Poor health maybe a major contributing factor to the lower graduation rates among autistic students. College-bound autistic students may continue to require services through college for them to be successful and graduate.

'I have more control over my life': A qualitative exploration of challenges, opportunities, and support needs among autistic university students

BACKGROUND

Autistic people are known to experience more mental health issues than non-autistic people, and the same is true among university students. These difficulties can have long-term consequences, such as dropping out of university and unemployment. Understanding the challenges autistic students face can help institutions to better support this group, while allowing celebration of the opportunities higher education offers.

METHODS

12 autistic university students took part in semi-structured interviews about their mental health, the impact of university on their mental health, and their experiences of support while in higher education. Interviews were subject to thematic analysis.

RESULTS

Three key themes were identified from autistic student accounts: Relationships, Independence, and Support. While each of these encompassed positive and negative elements, Relationships were described as tying everything together - when these were supportive, things went well, but when they were characterized by stigmatizing attitudes, students experienced much greater difficulties at university.

CONCLUSIONS

Autistic students can and do thrive at university, as shown by many of our participants. However, all faced significant challenges with their mental health at times, and experienced varying levels of support. Improving autism knowledge among staff, with emphasis on enabling better relationships, would make a significant difference to the autistic student experience.

Supporting the needs of college students with autism spectrum disorder

Young adults with autism spectrum disorder (ASD) are enrolling in colleges at increasing rates. This case highlights the need for college mental health clinicians to be aware of features of ASD in emerging adults. Participants: A case of a young woman with dysphoria and anxiety who also met ASD criteria during a diagnostic evaluation. Methods: The author describes diagnostic criteria for ASD, common psychiatric co-morbidities, and commonly used campus services. Results: The student in this case was diagnosed with ASD during the course of treatment for dysphoria and anxiety. Knowledge of this diagnosis led to better self-understanding and discovery of new supports. Conclusions: College mental health clinicians will increasingly encounter students with ASD whose social and communication challenges impact their success in post-secondary educational environments. Clinicians should be knowledgeable of ASD features, common mental health challenges, and how best to support students.

Evaluation of a Transition to University Programme for Students with Autism Spectrum Disorder

Applying to university can be an anxiety-provoking time for many autistic students, though enrolment can be increased by actively involving them in transition planning. We provide an evaluation of a transition to university pilot programme (Autism Summer School) for autistic students (16–19 years) who are seeking to apply/attend university. The content focused on introducing students to various aspects of university life including academic (sample lectures), social (e.g., clubs and societies), and daily living (eating in university canteen and staying in student accommodation). Students’ quantitative and qualitative feedback are positive and promising, showing significant reduction across a range of concerns related to transition to university after the programme, as well as general optimism related to starting university.

Comparing the writing skills of autistic and nonautistic university students: A collaboration with autistic university students

LAY ABSTRACT

We do not know very much about the writing skills of autistic university students. Studies with autistic children and teenagers show that some autistic young people have difficulties writing. Other autistic people are talented writers. In fact, some autistic people would rather write than speak. Good writers often imagine other people's points of view when writing. Autistic people sometimes have difficulties understanding others' points of view. Yet, autistic people often work much harder to understand others' points of view than not-autistic people do. We collaborated with autistic university student researchers to see if autistic university students are better or worse at writing than nonautistic students. Autistic university students in our study were better writers than nonautistic students. Autistic students in our study had higher nonverbal intelligence than nonautistic students. Autistic students also put themselves under more pressure to write perfectly than nonautistic students did. Autistic students did not show any difficulties understanding other minds. This study shows that some autistic university students have stronger writing skills and higher intelligence than nonautistic university students. Yet, autistic students may be too hard on themselves about their writing. Fun activities that help students explore their ideas without pressure (like theater games) may help autistic students be less hard on their writing. Teachers can help autistic students express themselves through writing by encouraging them to write about their interests, by giving them enough time to write, and by letting them write using computers if they want to. This study shows that collaborations with autistic people can help us understand strengths that can help autistic people succeed.

Positive Predictors of Life Satisfaction for Autistic College Students and Their Neurotypical Peers

Background

Positive psychological traits are associated with higher life satisfaction, academic success, and fewer mental health problems in neurotypical (NT) college students. However, it is unclear whether this is similar for autistic students. This study explores college-specific positive traits, including academic satisfaction, self-efficacy, gratitude, and school connectedness, and their relationship with life satisfaction in autistic college students and their NT peers.

Method

Autistic (n = 42) and NT (n = 50) college students completed an online survey containing measures of autistic traits, college well-being, and life satisfaction. We explored differences in life satisfaction and college well-being between groups using analysis of variances and explored these relationships based on self-reported autistic traits across groups using correlations. We assessed whether a relationship between college-specific well-being and life satisfaction was moderated by autistic traits using linear regression.

Results

Results showed emerging differences in school connectedness such that autistic students were less likely to report feeling connected despite similar scores on other domains of college well-being and life satisfaction; correcting for multiple comparisons this difference was no longer significant. However, autistic traits were significantly related to life satisfaction and school connectedness across the full sample. Differences in school connectedness also explained a significant amount of variance in life satisfaction over and above the influence of autistic traits. The interaction between connectedness and autistic traits was not significant.

Conclusions

Results suggests that students who experience higher levels of connection with their university and peers, regardless of the number of autistic traits they endorse, report higher satisfaction with life. Given the importance of social connectedness in college-specific and overall well-being, significant attention should be paid to the protective role of social support systems in addition to academic services when understanding how to support autistic individuals as well as individuals who do not meet diagnostic criteria, but share some similar clinical traits.

Lay summary

What was the purpose of this study?: College well-being is related to life satisfaction in neurotypical (NT) college students. However, it is unclear whether this is similar for autistic college students. The purpose of this study was to understand how different aspects of college well-being support life satisfaction in autistic college students compared with their NT peers.What did the researchers do?: We invited both autistic and NT college students to complete an online survey. The survey asked about college well-being and life satisfaction. We looked at similarities and differences in responses between autistic and NT students. We also looked at whether college well-being was related to life satisfaction and whether that depended on the number of autistic traits that individuals selected to describe themselves.What were the results of the study?: We found that there were no group differences between autistic and NT college students in their overall college well-being or life satisfaction. However, there were differences in life satisfaction and one individual aspect of college well-being, school connectedness, based on autistic traits. Students with more autistic traits were less likely to report feeling connected to their university and peers and were less satisfied with life overall. We also found that school connectedness and the number of autistic traits, rather than diagnostic status, were related to life satisfaction. Students who feel more connected to their university and peers, regardless of the number of autistic traits they endorse, report higher satisfaction with life.What do these findings add to what was already known?: While there are many studies of life satisfaction in autistic individuals, most focus on the negative aspects. Our study is the first to look at positive factors, such as college well-being, in autistic students and their NT peers. This is important because both autistic and NT students struggle with academics, social isolation, and mental health in college. However, understanding the positive traits that can help counteract those challenges is important in supporting all students in college. Our findings show that both autistic traits and school connectedness are important, but separate, components for understanding life satisfaction in college students with and without autism.What are the potential weaknesses in the study?: This study only recruited autistic participants from disability resource centers of 4-year colleges, so students who were attending community colleges, private institutions, or who did not disclose their diagnosis to the disability resource centers were not included. As autistic students may be more likely to attend community or private colleges or may not disclose their diagnostic status, our results may not apply to other people. Our sample of students was also small, which limits our ability to find differences and have confidence in the results.How will these findings help autistic adults?: These findings show the importance of social integration for the well-being of neurodivergent and NT college students and support ongoing requests from autistic students for more nonacademic supports in college. Screening for college well-being and improving social integration are potential ways to increase life satisfaction for neurodivergent college students.

Meeting the Mental Health Needs of College Students with ASD: A Survey of University and College Counseling Center Directors

An increasing number of individuals with Autism Spectrum Disorder (ASD) are enrolling in post-secondary education. Though many students may use services provided by university and college counseling centers (UCCCs), little is known about the landscape of care for students with ASD in this setting. UCCC directors (n = 79) completed an online survey to assess current utilization, clinician experience with ASD, and campus collaborations. While the majority of directors (69.7%) reported an increase in students with ASD requesting mental health services at their centers, the survey identified a discrepancy between their intention to improve services and current reported levels of expertise, training, and resources. Directors identified barriers to improving UCCC services to students with ASD, providing direction for future improvement.

Prospective College Students With Autism Spectrum Disorder: Parent Perspectives

Young adults with autism spectrum disorder (ASD) are attending university in increasing numbers. While those with ASD may be very knowledgeable within their chosen field, a range of academic-related and nonacademic challenges may hinder their success including executive functioning challenges and interpersonal issues. The purpose of this study was to conduct a preliminary investigation into the perspective of parents of high schoolers with ASD regarding their son/daughters' transition to college. Qualitative analysis of parent interviews examined the concerns and challenges they anticipated their son/daughter might experience in a university setting, as well as supports they are seeking as they consider postsecondary options. Prominent themes that emerged as areas of concern were social skills, executive functioning, academics, campus living, and support services. These findings highlight some key potential pitfalls for students with ASD which may be useful targets for prevention and remediation, as well as informing policy for colleges and universities as they consider cost-effective interventions to improve the academic success of students with ASD.

Perspectives of Former Students with ASD from Australia and New Zealand on Their University Experience

The university experience of students with ASD was explored through a qualitative study of 11 former university students and six significant others from Australia and New Zealand. A range of key issues were identified including difficulties encountered when studying, reasons for completion and non-completion, supports used, and coping strategies used by the participants. Many switched to part-time to manage their poor mental health and/or executive function and most had slow rates of progress. Also, some felt they had made poor discipline choices. The participants offered suggestions for future students and for making universities more autism friendly, and the possible need for transition and more structured study supports was identified.