Driving support interventions for autistic people: systematic review and participatory synthesis

Background: Autistic people can face remediable barriers and difficulties 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 participants who have a diagnosis of autism (or directly associated condition). No specifications on study design, outcomes, or comparators were made. Risk of bias was appraised using the Cochrane ROB and 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 synthesised, while focal delivery components and mechanisms of action were examined using realist synthesis. All analyses were co-produced and developed by autistic adults. Results: Only 17 relevant studies (involving 402 autistic participants) were identified, which utilised 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-behavioural programmes 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 programmes, but evidence was lacking with regards to intervention mechanisms. Conclusion: Our participatory syntheses of data highlight that research is urgently required to address the barriers and challenges faced by autistic drivers. Despite promising but inconclusive evidence for simulation training and holistic cognitive-behavioural programmes, widespread limitations are evident in existing studies and rigorous, generalisable intervention assessments are lacking.