A Cognitive Behavioral Intervention for Driving for Autistic Teens and Adults: A Pilot Study

Abstract

Background: For many autistic individuals approaching adulthood, interventions to promote skills toward independence are lacking. Driving is an important ability to cultivate as it may be a critical step to attaining independence, securing and maintaining work, and fostering relationships. Only about one third of able autistic individuals drive independently, and fear to drive is a common reason for not driving. Methods: This initial pilot study was a 3-month open trial to investigate the feasibility, acceptability, and initial estimates of outcomes for the newly developed Cognitive Behavioral Intervention for Driving (CBID) intervention, a manualized curriculum to enhance executive functioning (EF) and emotional regulation (ER) skill development for driving, combined with individualized commentary-based driving simulator practice, in autistic teens and adults within a community research environment. Nineteen participants received the CBID intervention in 1.5-hour group sessions for 10 weeks, across two cohorts, with approximately five individualized driving simulator sessions. Data were collected on anxiety symptoms, driving cognitions, driving attitudes, and simulated driving performance at pre-and post-intervention assessments. Results: Program completion rate was 81%. Participants and parents rated both the intervention and simulator practice sessions with high satisfaction. All the participants (100%) reported both a positive attitude change (interest toward driving) and a desire to drive in the future at the post-intervention assessment. Significant changes occurred for driving cognitions, attitudes, and behaviors, and 47% of participants obtained a driver's permit or license by 2 months post-intervention. Conclusions: For autistic individuals, the CBID intervention appeared to directly impact the pursuit toward driving goals by both increasing driving attitudes and behaviors and reducing anxiety/apprehension. This highlights the need for driving intervention programs designed specific to autistic teens/adults that focus on EF and ER skills coupled with individualized simulator practice. CBID could be provided in community services to increase the number of autistic individuals driving.

Perceived Driving Difficulty, Negative Affect, and Emotion Dysregulation in Self-Identified Autistic Emerging Drivers

“…Overall, these elevations begin to contribute to the relationship of emotion dysregulation and negative affect and perceived DD in new autistic drivers. These findings also align with the idea that autistic individuals may need specific support for socio-emotional differences when learning to drive as, for example, the intervention recently described in Baker-Ericzén et al (2020). In addition, virtual reality driving simulations can transform generalized skill instruction for autistic learners, highlighted as a unique learning difficulty by Klin et al (2003), by providing adaptive driving instructions that can respond to their real-time physiological arousal (Bian et al, 2019).…”

The use of virtual reality and augmented reality in psychosocial rehabilitation for adults with neurodevelopmental disorders: A systematic review

“…Two studies utilized VR driving simulators to train driving skills and executive functioning for adults with ASD ( 18 , 21 ). Lastly, a study reported on the use of a VR application installed onto tablets to train community living skills such as shopping at a supermarket and preparing a suitcase ( 25 ).…”

“…Two studies targeted the functional skills of driving in adults with ASD using VR driving simulators. The Cognitive Behavioral Intervention for Driving (CBID) consisted of cognitive behavioral strategies to enhance executive functions and generalizing them to driving ( 18 ). Intervention was carried out weekly over 10 sessions.…”

Virtual Reality Utilized for Safety Skills Training for Autistic Individuals: A Review

“…Fornasari et al trained individuals with ASD in urban virtual environments to navigate and explore the area [21]; Dixon et al taught children with ASD how to recognize safe road-crossing conditions in an immersive VR environment [19]. In addition to street-crossing skills, driving skills are also needed to foster individual independence, and 45% (n = 9) of studies focused on training driving skills for people with ASD [22][23][24][25][26][27][28][29][30], e.g., embedding an adaptive model within a driving simulator in VR, adjusting the task difficulty through the acquisition and analysis of multimodal data from the user's driving task, and the personalization of the driving task to achieve the optimal…”

“…Fornasari et al trained individuals with ASD in urban virtual environments to navigate and explore the area [21]; Dixon et al taught children with ASD how to recognize safe road-crossing conditions in an immersive VR environment [19]. In addition to street-crossing skills, driving skills are also needed to foster individual independence, and 45% (n = 9) of studies focused on training driving skills for people with ASD [22][23][24][25][26][27][28][29][30], e.g., embedding an adaptive model within a driving simulator in VR, adjusting the task difficulty through the acquisition and analysis of multimodal data from the user's driving task, and the personalization of the driving task to achieve the optimal training effect [23,24]; helping ASD individuals to reduce their fear of driving and improve their driving cognition and performance [29]. Meanwhile, 10% (n = 2) of the studies focused on training ASDs in air travel skills [31,32], e.g., Miller et al conducted a training program for ASD patients using an iPhone X and Google Cardboard device that lasted 3 consecutive weeks, followed by a real air travel rehearsal at San Diego International Airport in the fourth week [32].…”