The appraisal of roadway environment and infrastructure by drivers with autism: A qualitative study

Highlights

• Roadway environment/infrastructure can contribute to positive and negative feelings.

• Examples of experienced feelings are a sense of safety, or stress and anger.

• Experience and automatization of the driving task are important for ASD drivers.

• Coping strategies are used to deal with interfering elements (e.g., noise, rush)

• Behavioral adaptation or alternative transport are examples of coping strategies.

Abstract

People with an autism spectrum disorder (ASD) might experience difficulties while driving, for instance, related to hazard perception. These difficulties may be related to cognitive issues (internal) such as attention-shifting, sequential performance, and multitasking. Possibly related to these issues, some people with ASD experience stress and anxiety while driving. Among other reasons, stress could relate to the roadway environment and infrastructure design, e.g., sensory overload due to lighting conditions. Yet, the relationship between roadway environment and infrastructure and driving experiences of people with ASD is somewhat overlooked in previous research. This study aimed to (1) explore how people with ASD experience roadway environment/infrastructure while driving (2) identify coping strategies to deal with interfering elements related to roadway environment/infrastructure. There were twelve participants (mean age: 34.8, of which 66.7% were female), semi-structured interviews to examine the appraisal of roadway environment and infrastructure. The interviews were analyzed based on a phenomenological hermeneutical approach. Each participant reported both positive (e.g., environment and infrastructure can be supporting, enhance predictability) and negative appraisals (e.g., stress, anxiety) to roadway environment/infrastructure. Various elements such as light, noise, and, being rushed caused additional pressure on (1) the driving performance (e.g., driving too slowly, not noticing important elements), (2) traffic analyzing skills (e.g., difficulties in overseeing new situations), (3) and the efficient application of traffic rules. The participants described different coping mechanisms to deal with the influence of interfering elements; for example, alternative transport means or adjusting behavior (e.g., switch off radio, early departure). This demonstrates that besides internal factors such as attention, external factors like roadway environment and infrastructure can also influence the driving experience of ASD drivers, potentially leading to driving-related stress and anxiety. Policymakers could consider the current findings when designing new guidelines and roadway environment and infrastructure design principles.

Introduction

Autism spectrum disorder (ASD) is a commonly diagnosed neurobiological developmental disorder (American Psychiatric Association, 2013). Adults with ASD have reported that they experience emotional difficulties at the age of 21 as they transition from school to working life (Smith et al., 2012). Among other causes, the experience of emotional issues could be related to problems with transportation. In a study by Feeley et al. (2015), several people with ASD reported that they felt isolated, depressed, and lacked self-confidence due to their transportation problems. Driving is an important step toward autonomy. It facilitates adults in finding a job, maintaining social relationships, and fulfilling an individual’s educational needs (Ellaway et al., 2003). The ability to drive contributes to the quality of life, enhances psychological well-being, and creates opportunities in one’s daily life (e.g., work, healthcare, etc.) (Chee et al., 2015, Feeley et al., 2015, Dickerson et al., 2007). Therefore, driving directly influences the physical, social, and economic well-being of a person with ASD (Feeley et al., 2015).

Cars are still the most common transportation mode in Belgium, especially for people who live and work in rural areas where public transportation is limited (Vias institute, 2020). However, it is not always easy to obtain a driver’s license for people with ASD (Feeley et al., 2015; Feeley, 2010). Research showed that people with ASD obtained their driver’s license significantly less often and later in life, compared to neurotypical (NT) peers (Curry et al., 2017, Feeley et al., 2015). In general, ASD drivers tend to adapt their responses slower to several stimuli and are less flexible in modifying their reactions. Therefore, they will react less adequately (Fournier et al., 2010), which can negatively influence their learning process as ASD drivers need more time to learn to drive than NT drivers (Silvi et al., 2018).

Literature on differences in driving behavior between ASD drivers and their neurotypical counterparts has been increasing. ASD drivers drive one day less per week, rate themselves as poorer drivers (Feeley et al., 2015), and indicated more self-reported crashes and violations (Daly et al., 2014, Classen et al., 2013). Some ASD drivers tend to experience stress and anxiety while driving. The latter can also occur when other drivers do not follow the traffic rules, as ASD drivers are more rule-bound while driving (Chee et al., 2015, Ross et al., 2018, Ross et al., 2018). When examining novice ASD drivers' attitudes, their parents reported less positive and more negative attitudes towards driving from their children compared to parents of NT peers. However, after receiving a training program, there was a significant increase in positive attitudes (Ross et al., 2018a). Novice drivers with ASD also reported the process of learning to drive as very stressful (Almberg et al., 2017, Chee et al., 2015). A mixed-method study by Ross et al. (2018b) examined the learning experiences of young persons with ASD, their parents, and driving instructors. The individuals with ASD reported multitasking, violating traffic rules, and reacting to unpredictable situations as the most common problems. They experienced more stress and indicated that they needed more time compared to NT peers. Concerning basic driving ability, an on-road study by Chee et al. (2017) revealed that they are also less adapt at maneuvering, especially when turning left or right and crossing a crosswalk. Yet, a driving simulator study by Ross et al. (2019) found no differences between ASD and NT drivers in collisions, stops at traffic lights, and the standard deviation of the lateral lane position (SDLP). ASD drivers also experience difficulties with hazard perception (Chee et al., 2019; Sheppard et al., 2017). In some studies, issues with respect to social hazards were found. Compared to NT drivers, ASD drivers tended to turn turn their attention more slowly towards social stimuli while driving, and therefore they showed a delayed reaction to social hazards. No differences were found in reaction time to non-social hazards (Bischop et al., 2017, Sheppard et al., 2010). Multiple studies reported decreased executive functions (EF) in ASD drivers and link driving errors to executive functioning difficulties (Daly et al., 2014, Brooks et al., 2016; Chee, YeungLeea, Patomella, & Falmker, 2019). A more recent study by Ross et al. (2019) indicated lower working memory and attention performance compared to NT drivers. However, they showed that, even though they performed worse on EF-tasks, once people with ASD learned how to drive, they could be considered capable drivers. Thus, the relationship between autism and driving does not automatically have to be negative. For example, while some ASD drivers experience driving as a stressful and challenging activity, others also experience a feeling of freedom and independence as they are driving. To give another example, the above-mentioned rule-boundness was mentioned as a positive asset by driving instructors (Feeley et al., 2015, Almberg et al., 2017, Cox et al., 2020, Ross et al., 2015, Ross et al., 2018, Ross et al., 2015, Cox et al., 2020, Lindsay, 2017). The mix in negative and positive relations between ASD and driving (ability) reflects our target group's essential characteristic. Indeed, it is important to keep in mind that ASD is a spectrum diagnosis, with individual and ASD-related characteristics varying within and between individuals (Ross et al., 2015).

Although negative attitudes, anxiety, and stress are recurring disturbing factors in the driving experiences of ASD drivers, little is known about what specifically influences and contributes to these problems. Roadway environment and infrastructure could be possible contributors to these problems. Previously, multiple quantitative studies have investigated how people with autism react and behave to certain roadway elements (Remington et al., 2012; Vanmarcke, 2017; Chee et al., 2019; Reimer et al., 2013, Wade et al., 2016; Elwin et al., 2017; Feeley et al., 2015). However, previous research was not focused on the appraisal of roadway environment and infrastructure. Instead, they focused on other topics such as gaze patterns, hazard perception, executive functioning, etc. Based on these studies, we can make assumptions about how and why people with ASD react to certain roadway environment and infrastructure elements. However, to this date, no study has researched which specific roadway elements hinder and facilitate ASD drivers, how they experience certain elements, and how they cope with difficult situations.

We propose that, among others, stress and anxiety could be negatively influenced by roadway environment and infrastructure design. The current paper uses the terminology as proposed by Castro (2008) regarding roadway environment and infrastructure. She suggested making a distinction between environment and infrastructure as external factors while driving. The environment consists of all the elements located on and adjacent to the road (e.g., road users, trees, lights, houses, etc.). The infrastructure consists of physical elements that are part of or related to the road (e.g., roundabouts, road markings, etc.). Both the environment and the infrastructure can influence driving behavior. In the next paragraphs, we will focus on the autism-related characteristics and their relationship to the experiences and appraisal of roadway environment and infrastructure.

Firstly, people with autism have a higher perceptual capacity than neurotypical persons. They can process more information from a scene, but they also find it harder to filter the irrelevant items. They are more easily distracted by irrelevant stimuli, such as flashing lights or sounds (Remington, Swettenham, & Lavie, 2012). These difficulties are exacerbated when complex information is being presented at a fast pace. People with ASD frequently cope with this by processing all details of the environment separately rather than processing it as a whole, which can cause dangerous driving situations (Vanmarcke, 2017). ASD drivers also tend to fixate and spend more time scanning the central visual field and do not focus on other fields where a potential risk may occur (e.g., parked cars on the left side of the road) (Chee et al., 2019; Reimer et al., 2013). However, it is suggested that, after ASD drivers receive training, they are also able to have proficient scanning patterns (Wade et al., 2016).

People with autism frequently report sensory processing problems, such as hyper- and hypo-reactivity (Chien et al., 2019, American Psychiatric Association, 2013). Hyperreactivity is characterized by experiencing intense reactions to sounds, touch, and visual stimuli (Grandin & Scariano, 2005). This can lead to high-stress levels and can often cause sensory overload reactions (Smith and Sharp, 2013, Top et al., 2019). Such sensory overload reactions happen when people receive a higher sensory input than their brain can process or when they feel emotionally or physically overwhelmed (Stewart et al., 2009). Because of their delicate sensory system, most people with ASD get easily overloaded. However, the triggers are different for every person (Crane et al., 2009, Mikropoulos et al., 2020). Some suffer from hyporeactivity problems where they react less intensely to certain stimuli than neurotypical persons (Elwin et al., 2013). Elwin et al. (2017) suggested that due to the hypo-reactivity, people with ASD might miss information in the environment. Both hyper- and hypo-reactivity can influence the experience and appraisal of roadway environment and infrastructure. Drivers may experience particular elements as too intense and therefore experience stress and anxiety. On the other hand, they may not react adequately to certain stimuli because they miss crucial information from the environment and infrastructure.

According to Vermeulen (2009 & 2015), many of the obstacles that people with ASD experience in their daily lives are attributable to difficulties with contextual sensitivity or ‘context blindness.’ People with ASD experience difficulties in using context when giving meaning. The theory has emphasized the weak central coherence hypothesis (Vermeulen, 2009). Central coherence is the ability to integrate information in context for higher-level meaning (Frith and Happé, 1994, Booth and Happé, 2010). To give meaning to a situation while driving, drivers need to use information from both themselves and the environment (Feeley et al., 2015). However, this may not be easy for ASD drivers, as they may not give enough weight to important elements and give too much weight to unimportant details (Vermeulen, 2015). For instance, you are approaching a traffic light, and the light turns amber. This is a warning that the light is about to turn red and that you should stop if it is safe to do so. The appropriate reaction to that amber light depends on the context: the following distance from the car behind you, your distance to the traffic lights, the speed you are going, etc. In other words, you have to use the context to decide what the appropriate action is, continue, or stop. Because people with ASD experience difficulties using the context when giving meaning, they might be inclined to stop while continuing to drive would have been the better option, for example, if they needed to brake harshly due to the imminent change from the amber to the red phase.

Context blindness is also linked to theory of mind and executive functioning. Theory of mind is the ability to comprehend mental states from others to explain and predict their behavior (Baron-Cohen, 1995). Vermeulen (2015) suggested that theory of mind problems in people with autism arise from difficulties in using the context to actively read others’ mental states rather than specific deficits in mind reading. Executive functioning (EF) skills are the higher mental processes that enable us to plan, form abstract concepts, stay focused, etc., to self-monitor our behavior (Liss, Fein, Allen, Dunn, & Feinstein, 2001). People with autism experience deficits in specific EF areas: attention shifting, planning, and cognitive flexibility (Hill, 2004). When understanding others’ behavior, taking the context into account is crucial (Klin et al., 2003). However, it is equally important in guiding one’s behavior. People with ASD might experience impairments in social interaction resulting in difficulties in using the context to interpret others and guide their behavior (Vermeulen, 2015). In conclusion, we suggest that the experienced problems with contextual sensitivity can influence the appraisal of roadway environment and infrastructure in ASD drivers. They create difficulties in correctly understanding, using, and interpreting the context and environment.

As stated above, it is important to describe experiences and insights from the participants’ viewpoint. Hence, by using a qualitative interviewing method, we aimed to obtain a comprehensible picture of the experiences, insights, and reactions of ASD drivers, taking their viewpoint into account (Watkins et al., 2017). Therefore the current study aimed to:

• Explore how drivers with an autism spectrum disorder experience certain elements of the roadway environment and infrastructure.

• Identify potential coping strategies used to deal with interfering roadway environment and infrastructure elements.