Independent Community Mobility and Driving Experiences of Adults on the Autism Spectrum: A Scoping Review

Evidence Map of Autism Community Mobility Research for Children and Adults

Most studies were from the United States (n = 27) and Australia (n = 10), with a small number of studies from Europe (n = 5), Canada (n = 1), the United Kingdom (n = 2), and Israel (n = 1). Most research was on driving (n = 27). Other research topics included pedestrian safety (children or adults) or teaching adolescents and children to ride bicycles (n = 9), general community mobility needs (n = 4), public transportation (n = 4), car passenger transportation safety (n = 2), and school transportation (n = 2). A paucity of research involving and privileging the voices of autistic people to express real-world experiences was identified, and many studies used simulators and virtual-reality technology (n = 20) or surveys (n = 10) rather than natural contexts (n = 14).

Scoping Review of Community Mobility and Driving Experiences of Autistic Adults

We selected articles for this scoping review that focused solely on describing autistic adults’ experiences with community mobility and driving (n = 13). All studies are described in Appendix A and are categorized as follows: (1) systematic reviews investigating needs and barriers in driving and public transportation, (2) studies examining experiences of needs and barriers across all community mobility and driving modes, (3) studies examining public transportation experiences, and (4) studies examining experiences of learning to drive and being an experienced driver. The studies were conducted in Australia (n = 7), the United States (n = 3), and Europe (n = 3). Study designs were primarily descriptive (n = 6) and cross-sectional (n = 4).

Experiences of difficulties were recorded for pedestrian navigation of community environments, public transportation, and beginning and experienced driver contexts; however, sample characteristics differed, with some studies focusing on high-functioning autism (n = 7), some with mixed functional levels (n = 2), and some undeterminable (n = 2). Few studies elicited experiences from the autistic person’s perspective, with most studies using parents’ perspectives (studies, n = 3; participants, n = 855), survey responses of autistic people (studies, n = 3; participants, n = 125), retrospective analysis of public viewpoints of autistic people (studies, n = 2; participants, n = 107), and interviews and focus groups involving autistic people (studies, n = 4; participants, n = 77).

Systematic Reviews Investigating Needs and Barriers in Driving and Public Transportation

In the first of the two systematic reviews identified, Lindsay (2017) focused on factors affecting driving and vehicular transportation of autistic adults and children. The review synthesized studies (n = 22) relating to school, assisted transportation, public transportation, and driving. The second review (Silvi et al., 2018) synthesized studies (n = 9) contributing to understanding road safety risks and challenges that adolescents experience as beginning drivers. The combined total of studies in these reviews (n = 31) included 5 studies that appeared in both. These reviews indicated that autistic adults and adolescents face challenges affecting driving and community mobility and concluded that it is essential to elicit firsthand perspectives of autistic people to better understand these experiences.

Studies Examining Experiences of Needs and Barriers Across all Community Mobility and Driving Modes

Three empirical studies investigated general needs and barriers in community mobility, across driving, public transportation, assisted transportation, and pedestrian modes. Two studies, which originated from the same project, investigated travel issues for autistic adults in New Jersey through the use of a survey (Deka et al., 2016) and focus groups (Lubin & Feeley, 2016). The third study (Kinnaer et al., 2016) was a qualitative analysis of published autobiographies of autistic adults (n = 6) that synthesized experiences of community environments. Although these studies represent a broad spectrum of functional levels of autistic adults, they reflect common experiences of feeling vulnerable, concerns with the social demands of traversing community spaces, and increased difficulty in environments of sensory complexity. These studies indicate that early, targeted community mobility training and attention to meeting the needs of autistic adults regarding public transportation and urban design are needed.

Studies Examining Public Transportation Experiences

Two empirical studies specifically focused on the experience of autistic adults using public transportation in Australian urban environments (Falkmer et al., 2015; Haas et al., 2020). These studies offer evidence that autistic adults experience social, sensory, and cognitive demands in public transportation and community environments. These demands intersect with personal autistic expressions of social communication challenges, sensory processing issues, and cognitive demands that can contribute to anxiety. These studies indicate the importance of autistic adults’ practicing and learning strategies to become confident and independent.

Studies Examining Experiences of Learning to Drive and Being an Experienced DriverExperiences of learner, novice, and reluctant autistic drivers.

Five empirical studies explored the experiences of learner or novice autistic drivers (Almberg et al., 2017; Chee et al., 2015; Cox et al., 2012; Ross et al., 2018; Vindin et al., 2019). Parents indicated that learner drivers experienced difficulty with learning to interpret and anticipate actions of other drivers, managing unexpected changes in the driving environment, tolerating road rule violations, regulating emotions, and sustaining attention (Cox et al., 2012; Ross et al., 2018). Learner drivers experienced anxiety, driving only when necessary because of concerns about parking, managing lane changes, heavy traffic, and not reacting in time or crashing (Chee et al., 2015). They also expressed difficulty with concentration, multitasking, and assessing and reacting to unpredictable situations, especially when needing to break traffic rules (Ross et al., 2018). Studies that used professional driving instructor observations and self-report indicated experiences of difficulty with (1) translating theory to practice, (2) adjusting to unfamiliar driving situations (Almberg et al., 2017), (3) executive function, (4) motor coordination, (5) social communication, and (6) emotional regulation, consistent with difficulties observed in simulated contexts (Patrick et al., 2018; Sheppard et al., 2017). Instructors also described learner difficulties with multitasking, concentration, predicting other road users’ actions, and handling situations in which road rule application is unclear (Ross et al., 2018).

In natural contexts, the most considerable challenges were maintaining attention and cognitive inflexibility (Vindin et al., 2019). Lubin and Feeley (2016) found that nondrivers and licensed drivers who were reluctant to drive had anxiety about getting lost, being in a crash, or handling law enforcement stops. They also expressed difficulties with driving skills, such as maintaining attention, navigating, anticipating the actions of other drivers, reacting quickly, and reading the driving environment. Motivation to learn also affected outcomes for autistic people learning to drive (Ross et al., 2018; Vindin et al., 2019). These studies suggest that learning to drive is difficult and that learner, novice, and reluctant autistic drivers need targeted support. Real-world driving can challenge cognitive flexibility and attention, increasing anxiety. Motivation to learn to drive and mature emotional regulation may be predriving considerations.

Perspectives of experienced autistic drivers.

Two empirical studies contained data relating to more experienced drivers. One study conducted a limited number of focus groups containing 30% drivers with mixed experience levels (Lubin & Feeley, 2016), in which nondrivers and drivers expressed anxieties around dealing with high-stress situations and certain road features they found difficult to navigate. In contrast, more experienced autistic drivers indicated feeling safe and confident with driving (Lubin & Feeley, 2016) and preferred driving over public transportation (Falkmer et al., 2015). Experienced autistic drivers reflected that it was important to have insight into personal factors affecting driving ability, such as self-regulation and awareness of their personal triggers for autism-related functional changes, to know when to self-limit driving (Lubin & Feeley, 2016).

Sensory Processing Experiences

Sensory processing challenges differ across community mobility and driving environments. In community spaces, sensory sensitivity results in the need for environments to innately reflect their purpose and to have a sense of enclosure or retreat (Kinnaer et al., 2016). On public transportation, autistic adults can experience discomfort related to the sensory demands of crowding or being touched (Falkmer et al., 2015; Haas et al., 2020).

Autistic learner drivers need to quickly process sensory information in complex driving environments (Cox et al., 2012), such as freeways, or when changing lanes (Chee et al., 2015), and they experience anxiety about reacting in time or having a crash (Chee et al., 2015). Experiences of sensory overload are documented for both learner (Vindin et al., 2019) and experienced autistic drivers (Silvi & Scott-Parker, 2018).

Spatial Awareness Experiences

Difficulties with spatial awareness are experienced by autistic people for wayfinding and traffic judgment during community mobility and driving. In the United States, studies have found that autistic adults experience difficulty with navigation and wayfinding when using public transportation (Deka et al., 2016). In Australia, autistic adults indicated that bus travel was more difficult than services with defined stations (Haas et al., 2020). Experienced autistic adult commuters did not report these navigation issues (Falkmer et al., 2015), a finding that may highlight benefits of practice. Difficulty reading maps and following directions were reported by experienced, reluctant, and novice drivers and by nondrivers (Lubin & Feeley, 2016).

Spatial awareness for judging distance and speed can be challenging for some autistic adults, both for crossing the road as a pedestrian (Deka et al., 2016; Kinnaer et al., 2016) and for judging distance for parking as an experienced driver (Lubin & Feeley, 2016). Some autistic learner drivers reported experiencing spatial awareness difficulties (Vindin et al., 2019); however, other studies have indicated no difficulty with the maneuvering and spatial elements of driving, such as lane positioning and turning in T junctions (e.g., Cox et al., 2012).

Experiences of Distraction and Attention

Difficulty with maintaining attention and managing distractions has been identified across community mobility environments. For autistic pedestrians, attention and distractibility were identified by parents as concerns in traffic environments (Deka et al., 2016). Maintaining attention (Cox et al., 2012; Lubin & Feeley, 2016; Ross et al., 2018; Vindin et al., 2019) and shifting attention to different aspects of the driving environment, such as road signs and other road users (Almberg et al., 2017; Cox et al., 2012), are challenging for autistic learner drivers.

Intolerance of Uncertainty in Unpredictable Community Environments

Anxiety arising from uncertainty is experienced across community mobility environments (Haas et al., 2020). Predictable, familiar landmarks may help to ameliorate feelings of chaos and unpredictability in community environments (Kinnaer et al., 2016). The unpredictability of public transportation can create anxiety; however, detailed planning, preparation, family support to undertake new routes (Deka et al., 2016; Haas et al., 2020; Lubin & Feeley, 2016), and transportation apps (Haas et al., 2020) can foster confidence and success. Likewise, autistic learner drivers experience stress in new situations (Almberg et al., 2017; Chee et al., 2015; Vindin et al., 2019) and have difficulty tolerating unpredictable traffic environments (Chee et al., 2015; Cox et al., 2012; Ross et al., 2018). Difficulties with cognitive flexibility (Vindin et al., 2019) and frustration with other drivers breaking road rules (Almberg et al., 2017; Cox et al., 2012) may also contribute to a sense of unpredictability in the driving environment.

Experiences of Social Communication

Autistic adults experience difficulties with social communication across community mobility environments. Public transportation environments host a microcosm of human diversity and present particular social communication challenges. Parents indicated concern about autistic traits that may attract negative responses from community members (Lubin & Feeley, 2016), such as transit operators or other passengers (Deka et al., 2016), and about situational awareness of human behavior hazards (Lubin & Feeley, 2016). When things go wrong on public transportation, autistic adults prefer contacting family rather than transit operators (Haas et al., 2020), indicating difficulty communicating under stress in community environments.

Understanding social communication and the hidden language of driving is also a common challenge for autistic learner drivers (Lindsay, 2017; Silvi et al., 2018). Difficulty reading traffic, such as predicting hazards (Almberg et al., 2017; Lubin & Feeley, 2016; Ross et al., 2018; Vindin et al., 2019), and interpreting the actions of other drivers (Cox et al., 2012; Lubin & Feeley, 2016; Vindin et al., 2019) are specific driving social communication challenges.

Experiences of Executive Skills

Planning, preparation, and cognitive strategies to use public transportation have been found to be strengths for autistic adults with low support needs (Haas et al., 2020). However, some higher level executive skills are challenging for autistic learner drivers, who can experience difficulty with translating theory to on-road environments (Almberg et al., 2017) and flexibly applying road rules (Almberg et al., 2017; Cox et al., 2012; Ross et al., 2018). These difficulties are not reflected in the views of experienced autistic drivers (Chee et al., 2015; Lubin & Feeley, 2016; Silvi & Scott-Parker, 2018), suggesting that further research with larger sample sizes is needed to ascertain whether these issues are overcome with practice.

Lack of Skill Development

A lack of community mobility skill development before finishing school can make transition to independent adult roles difficult (Deka et al., 2016; Lubin & Feeley, 2016). Studies of driving and public transportation have indicated that autistic adults need extra time and practice but can become confident through preparation and use of global positioning system and smartphone technologies (Deka et al., 2016; Haas et al., 2020; Lubin & Feeley, 2016). Critically, independence in pedestrian, cycling, public transportation, community navigation, and living skills may be important precursors to successfully learning to drive, but practicing independence is not necessarily recognized as important or undertaken by parents (Myers et al., 2019).