Driving Support Interventions for Autistic People: Systematic Review and Participatory Synthesis

Abstract

Background:

Autistic people can face remediable barriers and challenges with driving, yet there is no consensus around effective support methods. This review therefore sought to evaluate the implementation and effectiveness of driving support interventions for autistic people.

Methods:

We conducted a multimethod, participatory synthesis of evidence. Studies were obtained from MEDLINE, Social Policy and Practice, ASSIA, PsycINFO, CINAHL, ERIC, Scopus, and Epistemonikos. Data were extracted from those that implemented a driving support intervention with autistic people. No specifications on study design, outcomes, or comparators were made. Risk of bias (ROB) was appraised using the Cochrane ROB and Risk Of Bias in Non-Randomized Studies (ROBINS) tools (for controlled quantitative studies), as well as the EPPI-Centre (for qualitative studies) and NHLBI (for other uncontrolled studies) quality tools. The application and effectiveness of support interventions were narratively synthesized, while focal delivery components and mechanisms of action were examined using realist synthesis. All analyses were coproduced and developed by autistic adults.

Results:

Only 17 relevant studies (involving 402 autistic participants) were identified, which utilized varying designs and were generally appraised to be low in quality. The most well-researched form of support was simulation training; however, e-learning applications, anti-anxiety medication, listening to music, and cognitive-behavioral programs were also studied. Although positive results were documented for all interventions, at least in some form, assessments typically consisted of simulated driving tests and various contextual factors were overlooked. Specific delivery components were identified from the effective support programs, but evidence was lacking with regard to intervention mechanisms.

Conclusion:

Our participatory syntheses of data highlight that research is urgently required to address the driving barriers and challenges faced by autistic people. Despite promising but inconclusive evidence for simulation training and holistic cognitive-behavioral programs, widespread limitations are evident in existing studies and rigorous, generalizable intervention assessments are lacking.

Community Brief

Why is this an important issue?

Many autistic people face barriers or challenges with driving a car, which can prevent them from traveling independently. If research can identify effective driving support methods for autistic people, then we could potentially reduce these negative experiences and improve broader quality of life (e.g., by increasing access to employment, health services, and wide-ranging social opportunities).

What is the purpose of the review?

We examined various different driving support methods for autistic people that have been studied so far. We explored which methods are effective, what impacts they have on a person’s driving experiences, and which specific features or processes are common in successful support programs.

What did the authors do to review the literature?

We searched through seven scientific databases, looking for studies that focused on a form of driving support for autistic people. Once eligible studies were found, we examined what each support method consisted of, how they were practically delivered, and the effects that they have on various driving outcomes. We also examined information about the studies themselves (e.g., details about the measurements taken and population involved) and the overall “quality” of this evidence (using well-established assessment criteria). When analyzing this information, we worked with a group of autistic research partners (including both qualified drivers and non-drivers), who used their personal insight and lived experiences to develop findings and conclusions with our team.

What studies did the authors find?

Although 1216 articles were checked by our team, only 17 of these were relevant for our review. These 17 studies covered a range of support methods, including simulation training, e-learning apps, anti-anxiety medication, listening to music, and cognitive-behavioral programs. However, the studies that we assessed were generally low in quality.

In summary, what did those studies show?

Some positive results were reported for all support methods, particularly simulation training, but there is not enough evidence yet to make strong conclusions about any of them. It seems that programs have success when they try to reduce people’s anxiety, or when they use combined support packages (e.g., by delivering specialist driving sessions with classroom activities or occupational therapy). Programs that used personalized methods and extra learning materials also appear effective (e.g., workbooks, onboarding tutorials, guidance for instructors). However, it is likely that “effectiveness” will depend on various individual factors, such as how accessible support is and whether co-occurring conditions/difficulties are being suitably accommodated for.

What are the remaining gaps in the literature?

There is a general lack of studies examining driving support methods for autistic people. Existing studies often overlook important factors that might influence their results and rarely measure people’s driving skills or experiences during real-world road tests.

Based on this review, what do the authors recommend?

Our research team and partners conclude that there is an urgent need for future studies. Researchers and practitioners (e.g., organizations in the driving industry) must work together to develop new, evidence-based support tools that allow autistic people to overcome key barriers associated with driving.