College Students With Autism Spectrum Disorder’s Experiences Maintaining Romantic Relationships: Counseling Implications

According to the Centers for Disease Control and Prevention (CDC, 2023), there is a growing prevalence rate of individuals being diagnosed with autism spectrum disorder (ASD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revised (DSM-5-TR) delineates a diagnosis of ASD through the diagnostic criteria of continual impairment in reciprocal social communication and interaction as well as repetitive interests and behaviors (American Psychiatric Association [APA], 2022). Due to these concerns, social interactions in general, and romantic relationships specifically, may be difficult for those diagnosed with ASD to understand, develop, and maintain (APA, 2022).

Reported marriage rates of individuals with ASD indicate that only 5% to 14% of individuals with ASD get married (Farley et al., 2018; Howlin & Moss, 2012) compared to 29.6% of the general population (Westrick-Payne, 2022). Research suggests that individuals with ASD may struggle with attaining and maintaining romantic relationships more than their neurotypical peers (Farley et al., 2018; Hancock et al., 2020; Howlin & Moss, 2012). Therefore, research indicates that individuals with ASD may struggle with merely maintaining romantic relationships (Byers et al., 2013), much less experiencing a subjectively positive, quality experience within their relationships (Cheak-Zamora et al., 2019; Hancock et al., 2020). Quality romantic relationships have a significant impact on a person’s overall sense of wellbeing (Kansky, 2018) and can have a positive impact on areas of an individual’s life including career (Kornblum et al., 2021). Specifically, for adolescence and emerging adults, romantic relationships can significantly contribute to their overall sense of wellbeing (Gómez-López et al., 2019). While individuals with ASD indicate the same level of interest in maintaining romantic relationships (Strunz et al., 2017), they may struggle with the social skills necessary to maintain a relationship (Jobe & White, 2007). To maintain quality romantic relationships at the same rate as the general population, individuals with ASD may need additional support (Hancock et al., 2020). Due to the deeply personal nature of romantic relationships, mental health professionals’ knowledge of interpersonal communication, and their ability to address the unique needs of each client, mental health professionals including counselors are uniquely positioned to provide this necessary support to aid individuals with ASD in maintaining the romantic relationships that they desire. With the goal of assisting mental health professionals in supporting individuals with ASD in maintaining relationships, this study sought to understand the romantic relationship experiences of college students with ASD. Through increased knowledge and awareness of the unique experiences college students with ASD encountered in their romantic relationships, mental health professionals can more fully support this population in not only maintaining their romantic relationships but thriving in these relationships.

Purpose of the Study

This study is one in a series of studies that explores college students with ASD’s romantic relationships experiences. Unlike the previous study focusing on seeking and attaining romantic relationships (Noble et al., 2023), this study focuses solely on maintaining romantic relationships after they have already been established. This article is unique in that the skills required to attain romantic relationships are not necessarily the same skillset needed to maintain romantic relationships. Specifically, through analyzing nearly a decade of data from a college program supporting high functioning college students with autism, the research questions in this study considered “what were the romantic relationship experiences of college students with ASD” and “How did college students with ASD maintain romantic relationships?” The themes identified through this study may assist counselors in understanding and addressing unique concerns involved with maintaining romantic relationships experienced by this population. Implications for counseling practice regarding maintaining romantic relationships are provided.

Program

This study examined the romantic experiences of college students with ASD who participated in a service program geared to support their transitions to college including the pursuit of personal as well as career goals. The program titled, Connections for Academic Success and Employment (CASE), assists students in attaining their educational, social, and vocational goals through scheduled meetings with Learning Specialists who help their students identify and utilize appropriate resources on campus to achieve their goals. The ultimate outcome of the program is for students to establish autonomous and independent living through career and social success. Criteria to participate in the program include enrollment at the university, selection of a major and therefore career path, and a diagnosis of ASD or a developmental disability.

College students with ASD who enroll in the CASE program are required to attend weekly meetings with Learning Specialists, monthly meetings with a WRAParound team, and participate in at least eight events each semester designed to assist students in meeting their personal and career-oriented goals. The WRAParound team consists of the student, their Learning Specialist, and professionals from other departments across campus or in the community including counselors, disability support professionals, and career counselors. The WRAParound meetings provide students with the opportunity to discuss their progress toward their personal, social, and career goals and strategize opportunities for improvement as they work to achieve their goals.

Method

For our data analysis approach, the methodology utilized in this study was Thematic Analysis (TA). TA was an ideal methodology for this study because it allowed us to analyze pre-existing data that spanned nearly a decade and is applicable with a variety of theoretical and epistemological approaches (Braun & Clarke, 2006). To investigate the participants’ direct experiences, we used an essentialist/realist approach. This approach allowed us to consider the content of the participants’ direct experiences and identify themes based on these experiences. Further, an inductive approach provided us the ability to determine themes from the data. During the process of initially determining our themes and refining them, we incorporated a latent approach identifying the meaning of the data behind the explicitly depicted meaning.

Context of the Study

Participants in this study consisted of undergraduate college students with a diagnosis of ASD or a developmental disability who are enrolled in a service delivery program to assist them in transitioning to college. The institution in which the participants were enrolled is a large research university that is nonreligiously affiliated and located in the Southwestern region of the United States.

Research Team

Six research team members were involved in the research of this study. The first author of the study is an assistant professor, counselor educator at a research university, and licensed professional counselor with a supervisor (LPC-S) designation with more than a decade of counseling experience and expertise in qualitative research methods. The second author of the study is a master’s student in the field of counseling. The third through sixth authors are doctoral students in the field of counselor education with experience in counseling ranging from holding an LPC-S, to an LPC, to working toward an LPC. The combined experience of the research team has a total of 45 years of counseling experience. All research team members have some experience working with or counseling individuals with ASD. None of the research members have been personally diagnosed with ASD, but one member’s close family member was diagnosed with ASD.

Participants

This study consists of 124 participants. The participants attended the CASE program that supports college students diagnosed with ASD from Spring 2012 to Fall 2021. While data was reviewed for all participants who were enrolled in the program, 30 students withdrew from CASE at some point prior to graduating, and 33 students entirely withdrew from the institution during this time. The participants included 104 males or 83.9%, 17 females or 13.7%, two transgender-females or 1.6%, one transgender-male or .8%, and zero nonbinary individuals, and zero individuals who identified as another gender. The majority of participants 64.5% (80) self-identified as White or Caucasian, 12.1% (15) participants identified as another ethnicity that had no more than two individuals identifying within that ethnicity such as identifying with a variety of ethnicities within multiracial, 9.7% (12) participants self-identified as Hispanic, 7.3% (9) participants preferred not to share their ethnicity, and 4.8% (6) participants self-identified as Black or African American. The ages of the participants when beginning the program ranged from 18 to 25 years old with a mean range of 19.8 years old. Although the program is designed specifically to support individuals with ASD, only 88.7% (110) participants provided documentation that supported this diagnosis.

Procedure

This study is one in a series that examines the same dataset of 1,805 meeting notes and follows the same data analysis procedures of Thematic Analysis (Noble et al., 2023); however, this study expands on the previous research because it considers the participants’ experiences involved in maintaining a romantic relationship. Utilizing this same large dataset for multiple projects allows for more extensive opportunities to investigate the social experiences of individuals with ASD and avoid causing this population to be over researched. From Spring 2012 to Fall 2021, Learning Specialists wrote WRAParound notes regarding the college students with ASD’s monthly meetings with their teams of support professionals discussion of personal and academic goals. Following Institutional Review Board approval, all meeting notes were de-identified and analyzed by two members in the research team.

Data Analysis

There were multiple rounds of data analysis involved in this study. The data analysis began with the first and second authors analyzing the complete dataset notes that were related to social concerns. The first and second authors agreed on all raw data relevant to social concerns. Next all members of the research team separately evaluated all social concern raw data using Braun and Clarke’s (2006) six phases of TA to answer the research questions concerning the participants’ experiences maintaining a romantic relationship. The six phases followed included (1) becoming well acquainted with the raw data, (2) finding initial codes, (3) discerning potential themes, (4) labeling and naming potential themes, (5) refining the themes, and (6) writing this work about the themes (Braun & Clarke, 2006). Throughout the process, each member of the research team made an audit trail of their codes and themes, attended weekly meetings throughout an academic year to consider areas of potential bias, and checked the themes with the raw data to improve consistency and accuracy within the themes. The data analysis process concluded when agreement on the themes generated unanimously occurred.

Findings

The analysis of WRAParound monthly meeting notes with 124 participants indicated that Learning Specialists only included 15 participants romantic relationships experiences in their meeting notes. This inclusion in meeting notes may indicate that the Learning Specialist perceived the participants’ romantic relationship experience as impactful on their personal or career goals established in their support meetings. However, exclusion of a romantic relationship experience from the meeting notes may not necessarily have indicated any specific impact or lack thereof with their romantic relationship experience on their goals. Regardless of the reasoning for including participants’ romantic relationship experiences in the meeting notes, several themes within the romantic relationships described were identified utilizing Braun and Clarke’s (2006) TA. The research team found two overarching themes of (1) positivity resulting from romantic relationships and (2) difficulty connecting with romantic partner and struggles maintaining romantic relationships. Within the second overarching theme, we identified the following three subthemes: (1) fears experienced within romantic relationships, (2) romantic partner rejection, and (3) difficulty engaging in reciprocal communication of needs within romantic relationships.

Positivity Resulting From Romantic Relationships

Unsurprisingly, a clear major theme generated from the data was the positive influence that some participants experienced resulting from their romantic relationships. Specifically, participants described improved support systems, enhanced moods, and boosted confidence as some of the positivity resulting from romantic relationships. An example of this positivity recognized by participants came from Participant 80 and her Learning Specialist noting many positive changes because of her supportive and respectful romantic relationship. “80 is making strides to find relationships that are encouraging, positive, and productive. She has recently started dating a boyfriend that has been very supportive and respectful of her.” During this same meeting note, the Learning Specialist commented that Participant 80 is “taking responsibility for actions, taking initiative, making better decisions” and reported that the student was selected as a candidate for a prestigious internship program. In future notes this participant specifically noted how helpful the support of her boyfriend was in improving her academics and “placing school in perspective.” Further, “80 explained that her new relationship has helped her improve her mental health.” An overall feeling of positivity and sense of identity as a whole was present throughout the data describing participants experiences in romantic relationships.

When the romantic relationships were “good” they were depicted in the notes as providing almost a state of euphoria, but when relationship experiences were “bad” they created deep concerns in the participants that influenced almost every aspect of their lives. From academics, relationships with others, to earth shattering concerns these bad romantic relationship experiences created extreme loss in some participants. One such participant describe a “need to, in his words, ‘fill the gap’ that was created when he and his ex-girlfriend broke up.” Therefore, in opposition to this theme, for individuals who did not recognize clear positivity resulting from their romantic relationships, this created struggles with maintaining romantic relationships which were derived from difficulty connecting with romantic partners.

Difficulty Connecting With Romantic Partner Causing Struggles in Maintaining Romantic Relationships

The overarching theme of difficulties connecting with romantic partner was prevalent throughout the data. Unfortunately for participants this difficulty connecting frequently caused participants to struggle to maintain their romantic relationships with several participants breaking up with their romantic partners throughout this study. Specifically, the struggle for participants was finding a balance of reciprocal and meaningful connections that helped them sustain their interest in their romantic partners as well as feel a sense of value, support, respect, or love from them. Challenges included difficulties creating quality time to connect with their romantic relationship partners, feeling like they are not a priority in relationships, feeling like partner made unreasonable requests of them, feelings of insecurity creating distance in relationships, being in long-distance in relationships, seeking to avoid adopting partners bad habits, being unable to negotiate needs with partner, and fears of difficulty sustaining interest with partner. This difficulty maintaining connection with romantic partners was identified to have been classified into the following three subthemes.

Fears experienced within romantic relationships

Participants engaged in several behaviors that indicated that they experienced fears throughout their romantic relationships. From feelings of awareness and uncertainty regarding appropriate behaviors to express themselves, to being entirely unwilling to broach certain topics or communicate needs, participants revealed deep fears experienced within their relationships. Although some participants were aware of their fears and expressive of them during their relationships, sometimes it took time away from the relationship and distance to become completely aware of these deep-seated fears. This need for space from the relationship before being able to understand the deeper impact of a relationship was illustrated by Participant 80, who openly stated that “she felt less expressive when she was dating her previous boyfriend.” It appeared that the fears experienced within the relationships primarily were detrimental to participants ability to connect with their partners, but these fears did have some benefits such as causing participants to be careful with who they continued a relationship with or seek assistance from others before providing negative feedback to their romantic partners to sensitively and supportively foster change in behaviors and moderate their expectations of their partners. The fears experienced and expressed as a result of these relationships all stemmed from the fear of an individual who was so important to the participant as well as their identity and sense of security, their romantic partners, rejecting them.

Romantic partner rejection

Whether through outright rejections such as not being reliable about attending important life events including a participant’s birthday party or more unintended rejections such as having differing opinions on topics or habits, a prevalent subtheme that was present in this study was that participants experienced romantic partner rejection and engaged in rejecting romantic partners in their relationships. Of course, the ultimate form of rejection that participants encountered throughout the study was breaking up with their romantic partners. Participants ranged in these experiences from feeling unsure of the reasons for the breakup, to feeling deep insecurity and emotional pain, to assessing “the relationship and quickly putting it in perspective,” finally to demonstrating resilience and “capability to find humor” in the situation. Participants who set boundaries within their relationships and effectively communicated their needs in an agreeable manner that fostered their partners’ desire to meet their needs were more likely to experience fewer and less severe forms of rejection.

Difficulty engaging in reciprocal communication of needs within romantic relationships

Engaging in a relationship that meets the majority of the parties needs in a relationship is challenging for the most experienced and emotionally communicative healthy relationships. For the participants this challenge of effectively communicating needs in a way that created the desired change appeared to be particularly difficult. Difficulty communicating simple needs such as making a date a priority or wanting to change their study schedule to a different time posed such a great challenge that these events frequently ended relationships. As an example, Participant 87 had an ongoing issue with a past girlfriend in which she would pressure him to spend time with her late into the night, leading him to be unproductive and exhausted during the day. As the issue continued, it became clear that the negative impact it was having on 87’s life was too significant to ignore, and he decided to end things. In his words, “this relationship was causing a lot of pressure for him to stay up later than needed and spend time with her rather than doing schoolwork. 87 noted that he will set clear boundaries at the beginning of his next relationship, due to what he learned in this relationship.” Another example of difficulty communicating needs was Participant 100’s experience with his long-distance relationship. Specifically, Participant 100 found it difficult for him and his girlfriend to prioritize their relationship to interact with each other much less maintain a deeper more meaningful connection that fostered a sense of being known and seen by each other. Despite this challenge, Participant 100 was able to navigate these additional impediments to communication such as time difference in their long-distance relationship and successfully remained in this relationship throughout the duration of his involvement in the CASE program. Although the theme of difficulty communicating and supporting their partners’ needs was prevalent in this study, some participants successfully communicated their needs and from all available evidence appeared to be meeting their partners needs such as Participant 113, who did “not feel the rejection he had previously with some of the people he was talking to” and sought to make sure that his girlfriend was “comfortable in their relationship and [was] taking things slow.”

Discussion

Expectedly, the findings of this study showed that college students with ASD perceived both positives resulting from their romantic relationships and difficulties in connecting with romantic partners. These opposing perspectives indicate that participants experiences varied regarding their perceived subjective quality of their romantic relationships. For the lucky participants who described the positivity in their life that resulted from quality positive romantic relationships, the findings supported previous research identifying positive influences of healthy romantic relationships on overall wellbeing and other life areas (Gómez-López et al., 2019; Kansky, 2018; Kornblum et al., 2021). Regarding the positive outcomes of engaging in romantic relationships, for individuals seeking to maintain romantic relationships the duration of the relationship can serve as a clear indicator of the potential perceived success and intrinsic value of the relationship. Therefore, the mere fact that participants in the study maintained their relationships throughout the duration of their participation in the CASE program can serve as a measure to assess the positive perceptions of these romantic relationships.

Regarding the theme of the struggles encountered in connecting with their relationship partners and maintaining their romantic relationship, participants seemed to encounter struggles that were related to the ASD diagnosis. Specifically, participants sometimes engaged in behaviors that implied a potential lack of flexibility within their relationships and a desire to create rigid rules within the relationship such as scheduling their time in a specific way. This theme may be related to individuals with ASD’s social communication and restricted pattern of interests (APA, 2022). A subtheme was that college students with ASD in this study experienced heightened difficulty with navigating different opinions and communicating or understanding needs (Jack, 2021) particularly regarding structuring their time. Simple issues such as being pressured to stay up too late or interruptions to their study schedules caused intense fears regarding negotiating their needs and even resulted in some participants dismantling the romantic relationship altogether. Based on these experiences, the research team observed participants struggling with communicating their needs due to communication barriers as well as participants rigid routines that they engaged in which are common among individuals with ASD but may have created additional stressors in their romantic relationships. Further as described previously, some of the struggles encountered in maintaining relationships resulted in some participants inability to maintain their romantic relationships.

Another subtheme within in struggles to connect with their romantic partners was the participants fears within the relationships. This theme aligns with previous research that suggests that individuals with ASD have elevated anxiety within their romantic relationships (Hancock et al., 2020). These fears included the next subtheme which was fear of romantic partner rejection illustrated through outright rejections and lesser rejections such as differing opinions or lack of meeting uncommunicated needs. Previous research indicates that individuals with ASD may be more likely to encounter social rejections than their neurotypical peers (Sasson et al., 2017). It is possible that the participants in this study had exaggerated fears of rejection due to previous more frequent social rejections and emotional dysregulation following these rejections (McPartland et al., 2011) which was likely the result of engaging in social communication and social interactions differently than their neurotypical peers. Previous research indicates that individuals with ASD experience more limited social participation than that of their peers (Orsmond et al., 2013) and this limited social participation extends to romantic relationships as well (Byers et al., 2013; Hancock et al., 2020; Strunz et al., 2017). Therefore, the participants in this study’s increased fears of romantic partner rejection may be well founded. Regarding participants avoiding romantic partner rejection based on the findings, it appeared that participants experienced fewer rejections when they were more discerning with their relationships and enforced boundaries including behaviors that would cause them to have to end their romantic relationships.

The themes identified in this study likely would be themes present in neurotypical college romantic relationships in general; however, the extent to which the themes were present among the college students with ASD may differ. The unique aspects of the themes emerged related to individuals with ASD’s focus on rigid routines and rules as well as their heightened fears within their relationships including the fear of romantic partner rejection. Further, while all individuals in romantic relationships struggle to effectively connect with their romantic partners and successfully communicate to meet their needs, individuals with ASD in this study had even more difficulty in these areas. Thus, the frequency and intensity of these concerns may be heightened for individuals with ASD. The findings of this study could benefit not only individuals with ASD in maintaining romantic relationships, but also these findings may aid all individuals striving to maintain romantic relationships.

Implications, Limitations, and Recommendations for Future Research

Due to individuals with ASD experiencing difficulties with developing and maintaining relationships (APA, 2022), this population may encounter even more challenges with seeking and maintaining romantic relationships than their neurotypical peers (Farley et al., 2018; Hancock et al., 2020; Howlin & Moss, 2012). Adding to this challenge, counselors and mental health professionals may lack adequate resources to assist individuals with ASD in maintaining romantic relationships as there is limited information on this topic as well as limited recommendations concerning strategies to assist professionals in assisting this population (Hancock et al., 2020; Laugeson, 2017). Further, counselors need to be adaptive in their counseling techniques to best address the needs of neurodiverse individuals (Mitran, 2022). Therefore, the purpose of this study was to contribute to the limited body of research concerning identifying supportive strategies to foster positive romantic relationship outcomes. Specifically, this study provides implications for counselors to better assist individuals with ASD in maintaining their romantic relationships. In order to competently assist individuals with ASD in maintaining romantic relationships, counselors need to be aware of some of the unique challenges this population encounters. Among the challenges identified in this study, individuals with ASD experienced heightened romantic relationship anxiety, increased romantic relationship fears, excessive fears of rejection, inflexibility within their romantic relationships, and difficulty expressing and understanding needs within the romantic relationship. Among some of the unique benefits of romantic relationships were the participants gratitude and recognition of the advantages that these romantic relationships had on themselves and their identity. While there is a trend for individuals to wait longer to enter committed romantic relationships (Fry, 2023a, 2023b), the findings of the study indicate that perhaps the best teacher of the skills necessary to maintain a romantic relationship is participating in a romantic relationship itself. Romantic relationships require constant give and take and compromise which may help foster these skills more than any other avenue. Further, maintaining romantic relationships requires facing fears concerning connecting, communicating needs, and tactfully receiving and sometimes giving small rejections within the romantic relationship. Helping individuals with ASD recognize these normal romantic relationships struggles and engage in intentional behaviors such as continuing to try to connect with their romantic partners despite fears or considering their romantic partners perspectives when they feel they have been rejected would be helpful skills for counselors to work with their clients seeking to maintain romantic relationships. Counselors should recognize that the skills necessary to attain a romantic relationship may not necessarily be the same to maintain a relationship and therefore should be considered and practiced distinctly. Counselors may wish to remind individuals with ASD that successful romantic relationships require vulnerability to create and maintain an intimate connection and increased feelings of connection may also require increase vulnerability. As with assisting any client population and topic, counselors should seek to tailor their approach to the unique needs of their specific clients and use their clinical judgment regarding best practices with each individual.

There are several limitations to this study. The first limitation was that there was a single data source. Further, the single data source was not written for the purposes of investigating individuals with ASD’s experiences maintaining romantic relationships, but rather was written to assist students with their overall social and career goals in college. This pre-existing data provided us with the opportunity to explore participants experiences maintaining romantic relationships over almost a decade of data but did not provide the research team with an opportunity to ask follow-up questions. Another limitation of this study is that study is not based on counselors’ experiences counseling individuals with ASD as they navigate goals of maintaining romantic relationships, but rather are based on Learning Specialists experiences assisting college students with maintaining romantic relationships. Additionally, the meeting notes were not written by the participants in the study, but rather by Learning Specialists. This meant that the data is not a direct narrative experiences of the participants, but instead is a secondhand observation of their experiences which may be both more and less reliable than the direct participants’ narrative experiences.

For counseling practitioners who wish to investigate future research regarding individuals with ASD’s goals of maintaining romantic relationships, they may focus on the efficacy of various counseling theories and techniques to best assist this population. Future research may focus on the areas of the positive benefits individuals with ASD identify from participating in romantic relationships and their struggles to connect with their romantic partners and maintain romantic relationships. Additionally, future research may explore individuals with ASD’s fears within romantic relationships, concerns with rejection, and difficulty communicating their needs. Finally, future research might specifically investigate the reasons that individuals with ASD break up with their romantic partners and end their romantic relationships.