Educational Programs Supporting Higher Education Individuals with Autism Spectrum Disorder: A Systematic Literature Review

Abstract

Young individuals with autism spectrum disorder (ASD) seem to attend higher education more frequently. Yet, the academic performance of students with ASD and the graduation rate appear to be poorer than those of typical development students. Moreover, college students with ASD face several challenges in their everyday and social lives. Students with ASD seem not to receive the appropriate social and educational support in higher education. This article reports the results of a systematic literature review of research programs and services designed to meet the needs of students with ASD enrolled in higher education. Several interventions are available and appear to be effective in supporting students with ASD in higher education (e.g., social planning intervention, focus groups, coaching paired with behavioral skills training, video feedback, visual framework, peer mentoring, and virtual reality). In addition, this article shows that colleges and universities face the challenge of preparing for these students and the need to provide psychological support for them. Moreover, studies of experiences and opinions of college students with ASD from their perspectives are included.

1. Introduction

Autism spectrum disorder (ASD) is characterized by impairments in social interaction, verbal and nonverbal communication deficits, and restricted and repetitive interests and behavior [1]. The severity of these symptoms ranges from mild to severe, and they persist throughout the lifespan. Current data suggest that the prevalence of ASD in the USA is approximately 1 in 36 individuals [2], while it was 1 in 54 [3]. In Europe, the prevalence of ASD appears to be 1 in 89 individuals [4]. Given the increasing prevalence of ASD over recent decades, there are many adolescents with ASD transitioning to adulthood. Many of them face several difficulties including socialization with their peers, vocational rehabilitation, and entry into society [5,6].

Data indicates that students with ASD undertake higher education studies [7]. Yet, academic outcomes are often poor (fewer than 20% of students with ASD graduated or were even on track to graduate five years after high school; [8]), and there is awareness of the challenges, that students with ASD have to face [9]. While more young adults with ASD are continuing to post-secondary education and higher education (approximately 35–40% of individuals with ASD pursue higher education; [10]), they seem to be fewer in number than individuals with other types of disabilities (e.g., speech/language, hearing, or visual impairments; [9]). Compared with their peers with other disabilities, students with ASD are less likely to take steps to prepare for college while in high school and more likely to enroll in a 2-year college (32%) than a 4-year college (17%) [11]. Colleges and universities face the challenge of preparing for these students, while autistic students do not receive the appropriate social and educational support in higher education [12,13].

Ref. [14] found that less than half of the students who attended 2-year colleges and who disclosed their disability received any services or accommodations. Disability disclosure in higher education is not mandatory. One study found that only 24% of students with ASD disclose their disability [15]. There are various reasons why students do not disclose their disability, including difficulties in understanding the process or by choice, lack of awareness of the availability of accommodations, and insufficient disability-related training for the institution and the staff [16]. Students who disclosed their disability and received support were found to be more likely to pursue and complete a college course [15].

Some characteristics of students with ASD appear to add challenges to their transition to college. Social impairments, communication difficulties, and repetitive behaviors may lead to academic, social, and daily living challenges as they transition to college/university [8]. In particular, individuals with ASD usually have to cope with communication challenges, executive functioning skills, self-advocacy, low self-esteem, and sensory stimulation [17,18]. In addition, they experience more demands in college/university related to independent living skills (i.e., adjusting to changes in everyday habits, class schedule, independence, and self-autonomy [19]).

Those who attend university campus may also have to deal with new roommates, meals, laundry, and everyday living skills. One of the major problems students with ASD experience on campus is the lack of knowledge and understanding of ASD among teachers, classmates, peers, and staff [20]. Social skills may be the key to success in university. Students with typical development seem to be eager to have low-quality relationships with students with ASD (e.g., living in the same building), while they are less eager to spend time with them [17,21]. Even students who are aware of ASD do not seem willing to participate in activities with students with ASD [22].

Social difficulties are identified as most important for students with ASD support needs [18]. Students with ASD expressed their preference for support groups, where they will be able to meet other students with ASD and share their experiences and their needs [19]. Ref. [23] indicated that half of the included colleges/universities provided a social skill group for students with ASD. While many colleges/universities reported great advantages of the pre-mentioned groups, some indicated doubts about the participation of the students (i.e., did not show up at the meetings). In addition, it seems that a few studies can be found that refer to empirical support or what supports are more helpful for students with ASD [24].

2. Previous Research

A large number of articles have studied the topic during the last few years [19,22,25]. Previous research has studied the challenges that students with ASD face in higher education settings to identify the difficulties they face in achieving their goals. Ref. [19] investigated the challenges and support needs of 23 students with ASD in higher education through semi-structured interviews. They found that students had to deal with many challenges related to difficulties with new situations and unexpected changes, social relationships, problems with information processing, and time management. Moreover, they had second thoughts about the disclosure of their disability. Students faced these challenges in education, student, and independent living simultaneously.

Ref. [26] interviewed 43 Belgian students with ASD, 30 student counselors, and a comparison group of 43 students without a disability. Their results showed that students with ASD most frequently face problems with verbal and non-verbal communication, are oversensitive to change, and find it difficult to identify important information in text. The aforementioned problems appear to arise mostly when classical teaching and evaluation methods are used. The perceived effectiveness of reasonable accommodations is dependent on the functioning and participation problem experienced by students with ASD in higher education. It seems that personal and environmental characteristics should be taken into consideration when selecting and implementing accommodation for this population.

Ref. [27] identified 20 articles focused on the college experiences and/or support services for college students with ASD. Students reported anxiety, loneliness, depression, and isolation from their peers as their major social problems. Ref. [28] conducted a review of the support systems for students with ASD in higher education and their first-hand experiences. The researchers found that academic support (i.e., tutoring, accommodations, and coursework modifications) were infrequently reported. Although non-academic supports (i.e., social skills training, peer-mediated interventions, counseling, and other university disability services) were available, students seemed not to utilize them because they did not disclose their ASD diagnosis.

In Ref. [25], the researcher focused on the psychological support systems for students with ASD enrolled in higher education. A range of interventions were reviewed. Many of them were feasible and showed high satisfaction rates among students with ASD. In particular, the results showed that university students with ASD preferred peer mentoring (i.e., they became more open and comfortable in their relationships, as they were learning together) and support groups (i.e., they could talk about their symptoms with group members) for non-academic support. Overall, group settings enabled social interaction and the sharing of experiences with others, thereby reducing social isolation.

3. The Purpose of the Current Review

Individuals with ASD face several challenges to their success in college/university. The lack of structure and routines in college/university settings and life is one of their major problems. Difficulties in organizing information and their workspace, managing their time, and looking after themselves are some of the challenges they face in their everyday college/university life. Moreover, social integration usually is very difficult to achieve for students with ASD.

Previous reviews focused on the support services provided according to the experiences of students with ASD [27,28], Ref. [25] reviewed the firsthand support systems for students with ASD enrolled in higher education. Refs. [19,26] identified the difficulties students with ASD face in higher education through interviews. Understanding the aforementioned challenges is the first step to understanding how to help this population successfully. There is a need to better investigate the current range of methods of supporting college/university students with ASD and to identify effective practices and interventions. In particular, the authors of this review intended to examine how such programs affect the inclusion of this population and the degree to which they can help them. So, in this review, we included studies that either referred to the description of training, support, or interventions or investigated the opinions or experiences of students with ASD.

This literature review was based on the following research questions: (1) What outcomes were identified from the implementation of these programs? (2) For students with ASD, what types of programs were used?

4. Methods

The authors of this review conducted literature research for studies published from 2013 up to December 2023 on the impact of support programs on the outcomes of students with ASD. This literature review was conducted in a narrow publication range because we intended to survey the recent literature.

4.1. Research Procedure

We implemented several steps to identify relevant peer-reviewed studies that met the inclusion criteria. An electronic search was conducted in PubMed, ResearchGate, Science Direct, Scholar Google, and ERIC, using the following keywords: ASD, university, college, students, and interventions. We combined ASD AND university OR college AND students AND interventions. This resulted in a total of 256 studies. Then, we read the titles and the abstracts of the resulting studies to determine if the studies were related to the impact of an intervention or support on college students with ASD. Duplicate studies were removed. We screened the remaining studies by reading the full text to identify studies that met the inclusion criteria.

A manual search of the references in the papers for other studies that met the inclusion criteria identified five additional articles. In addition, we used the “cited in” feature in Scholar Google to forward search each of the studies included, which yielded five studies. A hand search of peer-reviewed articles revealed no additional articles. The included studies totaled 11 (Figure 1). We separately searched and screened the articles to accomplish inter-rater agreement (IRA) during the electronic database and manual search and screening. In case of disagreements, we discussed and searched the article again to decide whether it met the inclusion criteria. The obtained IRA was 100%.

4.2. Inclusion and Exclusion Criteria

The selection of the studies for this review was based on the following criteria: (a) the participants in the study were individuals with ASD attending a college/university; (b) the study referred to the description of training, support, or interventions (c) study investigated the opinions or experiences of students with ASD, and (d) the study was published in English in a peer-reviewed journal between January 2013 and December 2023. When a study referred to students with ASD and co-occurring disorders, it was included in this review. Dissertations and non-experimental studies (e.g., literature reviews, meta-analysis) were excluded. We assessed the selected studies independently and discussed whether we should include or exclude a study in the review taking into consideration the inclusion criteria. The selection procedure, as shown in Figure 1, identified 11 studies adhering to the research criteria.

4.3. Coding Procedure

We mapped and synthesized the included studies by implementing coding categories. In particular, demographic characteristics were coded for the number of participants, age, sex, and disability. The demographic characteristics are summarized in

Table 1. Studies on students with ASD. Studies included in this review and characteristics of the study population.

Authors	Type of Study	Participants
Ashbaugh et al. (2017) [29]	multiple-baseline design across participants	N = 3, M = 1, F = 2 MA = 21.5
Cai & Richdale (2015) [12]	semi-structured focus groups	N = 23 students with ASD N = 15 family members
Gregori et al. (2021) [30]	multiple-baseline design across participants	N = 4, M = 2, F = 2 MA = 18
Gunn et al. (2017) [31]	single-subject design	N = 1, F = 1 A = 22
Hillier et al. (2017) [32]	NM	N = 52, M = 51, F = 1 MA = 20.9
Jansen et al. (2017) [26]	descriptive data	N = 43, M = 27, F = 16
Koegel et al. (2016) [33]	single-subject design	N = 3, M = 3 MA = 21.7
Lei et al. (2020) [34]	longitudinal study	N = 21 students with ASD N = 182 TD
Ness (2013) [35]	case study	N = 3 MA = 21.6
Reed et al. (2016) [36]	single-case design with multiple baselines across participants	N = 3 M = 2, F = 1 MA = 22.4
White et al. (2016) [37]	psychosocial intervention and support program	CLS: N = 4 MA = 20.25 BCI: N = 4 MA = 20.75

Note. BCI = Brain–Computer Interface for ASD, CLS = College and Living Success program, F = female, M = male, MA = mean age, NM = not mentioned, TD = typical development.

. In

Table 2. Research-based studies on students with ASD. Characteristics of the studies included in this review.

Authors	Support of the Intervention	Dependent Variable	Study Measurements	Outcomes
Ashbaugh et al. (2017) [29]	weekly structured social planning intervention (e.g., community and campus events, university clubs)	training in organizational skills related to social activity; support from a peer mentor; social skills related to communication and interaction with peers	collection of data, grade point average, self-report questionnaire	students took part in manysocial activities, increased their involvement in extracurricular activities, and interacted withdifferent peers
Cai & Richdale (2015) [12]	focus groups were conducted, each session lasted from 1 to 3 h, recordings	higher education experiences (e.g., interest in the university, motivation, learning needs, interacting, communication); core ASD symptoms (e.g., socialcommunication difficulties, routine, and sensory challenges); comorbid conditions (e.g., stress); transition; services and support (e.g., disability, academic, family support)	questionnaire	students claimed that their educational needs were met, but they did not believe that they received adequate social support; parents said that their children did not receive either adequate educational or social support; core ASD traits and co-morbid conditions increased the difficulties students have to deal with at university
Gregori et al. (2021) [30]	ten-minute sessions, no more than four sessions per day	initiations (statement, question), responses (question-asking, verbal comment and response, answering questions), and inappropriate behavior (no response, off-topic response, non-engagement)	sessions were video-recorded for data collection	tele-coaching appeared to be an effective approach for enhancing the social skillsof students with ASD
Gunn et al. (2017) [31]	weekly coaching paired with behavioral skills training (BST)	social pragmatics (visual scanning, verbal interaction, engagement with children)	observation checklist and anecdotal notes	participants increased the use of verbalizations in the preschool classroom, and engagement remained variable
Hillier et al. (2017) [32]	weekly sessions, the curriculum addressed common challenges seen among autistic students in a university setting	difficulties autistic students deal with on a university campus, academic skills, managing group work, and time and stress management	self-report questionnaires, a four-point scale indicating how much they enjoyed the program, qualitative analysis of focus groups	at the end of the program, participants showed significantly higher self-esteem, reduced loneliness, and lower anxiety compared with the beginning; however, subscales examining social anxiety, academic distress, and depression did not show a significant difference
Jansen et al. (2017) [26]	various accommodations	functional and participation skills (attention, problem-solving, flexibility, organization)	five-point Likert scale	over 50% of the students extended exam duration and took an exam in smaller groups, supported by a student counselor
Koegel et al. (2016) [33]	video feedback and visual framework	verbal empathetic statements and questions during conversations	videotaped conversation probes	participants increased their use of empathetic statements and questions
Lei et al. (2020) [34]	all sessions were completed online, a novel online tool was used	perceived distress frequency for academic, daily living, socialization areas, social network structure, perceived social support, and university transition outcomes	questionnaire	students with ASD dealt with greater distress across all areas over time, whereas TD students dealt with the greatest distress in academic studies; TD students with higher social anxiety dealt with greater difficulties in socialization at university
Ness (2013) [35]	the intervention package was a strategy instruction paradigm that involved matching participants with a peer mentor; the three key features adopted included assessment, collaborative goal setting, and strategy instruction	academic skills (improved exam scores, assignment completion rate, and/or accuracy, self-advocacy or accessing supports, participation in class)	fifteen-item structured interview, goal worksheet, self-monitoring of goal attainment, observation data	the intervention package may have contributed to improved academics and was perceived as a useful, acceptable intervention
Reed et al. (2016) [36]	fourteen weeks, 10–12 weeks of typical class meetings	note-taking skills (i.e., processing information from lectures, mentally differentiating what information is important to write down and what is not, efficiently paraphrasing as information is being recorded)	participants’ notes were scored for their degree of match to the interventionist’s notes;the points for subtopics and details varied, depending on the number included in that lecture (as recorded by the interventionist); points were awarded for abbreviations	participants showedsignificant improvement that was maintained post-intervention
White et al. (2016) [37]	virtual reality–brain computer interface and psycho-social College Living Success	social and behavioral outcomes	battery of assessments (e.g., executive function, adaptation to college, program satisfaction)	neither program resulted in significant improvements in behavior outcomes

Note: ASD = autism spectrum disorder.

, the studies are described in terms of the support of the intervention, the dependent variable, the study measurements, participants, and outcomes.

In Table 2, the studies are coded for (a) the support of the intervention (e.g., structured social planning, intervention, focus groups, coaching, video feedback and visual framework, virtual reality); (b) the dependent variable (e.g., organizational skills, experiences in higher education, transition, services, support, verbal initiations, functional and participation skills); (c) the study measurements (e.g., collecting of data, grade point, self-report questionnaire, video recording, observation, checklist, notes); and (d) outcomes (e.g., increase in interaction, involvement in activities, enhanced social skills).

We separately reviewed the 11 studies to determine whether each met the coding categories. Upon the completion of the coding, we compared the results. Any agreement or disagreement was scored for each item on the coding sheet. The IRA was calculated by dividing the sum of the agreements and disagreements and multiplying by 100. The IRA for the coding procedure ranged from 90% to 100%.

5. Results

The first search yielded 256 results. The final selection resulted in 11 studies that met the inclusion criteria. A range of programs was reported, including social planning intervention [29,33], conversation behavior [14], psychological and functional outcomes (i.e., time and stress management, managing group work, social communication; [32], academic achievement and self-regulated learning [35], cognitive and behavioral interventions [31,36,37], and the evaluation of a variety of accommodations [26]). One study presented the opinions of students and their family members about their experiences and support needs (i.e., educational and social support; [12]). Another longitudinal study evaluated changes in social network structure and perceived social support among first-year students with ASD [34].

Even though the studies examined educational programs supporting individuals with ASD, three of the studies [12,26,34] did not include training, support, or intervention. Yet, we included these studies in this review because they refer to the opinions of the students themselves and their families [12] and the students, the student counselors, and students with typical development [26], and they also investigated how autistic traits and social anxiety affect students with ASD outcomes (e.g., academic, and socialization, daily living, personal/emotional adjustment; [34]). According to the researchers’ opinions, it is of great importance to understand the experiences and challenges individuals with ASD face in college/university settings. They believe that the best way to accomplish this is by investigating students with ASD opinions.

5.1. Demographics

The included studies, the type of the study, and the participants’ characteristics are shown in Table 1. A total of 117 participants were included in the studies. In the 11 studies, all the students were diagnosed with ASD. Some of them found it difficult to take part in conversations with similar-aged peers [30]; they lacked social communication skills [33,37], faced cognitive problems, anxiety, distress, and poor time management [37], and had ASD and comorbid diagnoses of anxiety, depression, attention deficit hyperactivity disorder, sensory processing disorder, and dyspraxia (N = 6; [34]). In some studies, apart from the students with ASD, peer students with typical development [30] were included. In one study three groups of participants were recruited as follows: students with ASD, controls with typical development, and student counselors [26]. In another study [12], the researchers included students with ASD and family members. All the studies reported that the participants were college students with ASD. In most cases, the students had been previously diagnosed as having ASD. Two of the studies corroborated the diagnosis [26,33].

5.2. Outcomes

Different outcomes were reported in the studies, resulting from cognitive and behavioral interventions, social communication, college transition programs, and a variety of accommodations.

5.2.1. Social Communication Outcomes

Ref. [29] assessed whether a structured social planning intervention would enhance integration into society for students with ASD in a college setting. The researchers organized weekly meetings and planned social activities according to the interests and needs of students with ASD. These activities targeted an enhancement in organizational and social skills. During social activities, each participant had a peer mentor for support (e.g., providing phone reminders of the activity, modeling the targeted social skill, introducing themselves to other people at the event, and providing feedback to the participant following the social activity). During the meetings, each participant was trained in the targeted social skills related to their upcoming social event (e.g., how to meet peers and exchange contact information with them; how to invite them to attend events; the appropriate topics of conversation with peers; and the appropriate ways to say “goodbye” at the right time). When the intervention was completed, the researchers collected follow-up data. The results showed all the participants increased their social inclusion following the start of the intervention. In particular, all the participants increased the number of community-based social events and extracurricular activities they attended. Moreover, the participants improved their academic performance and satisfaction with their college experience. Additionally, all the participants reported satisfaction with their college experience following the intervention.

One study evaluated the effects of tele-coaching and online instructional modules on conversation skills for four high school and college students with ASD [30]. The results showed that the implementation of this method seemed to improve the conversation behavior of all participants. The study consisted of three phases, including baseline, online instructional modules, and tele-coaching, which included 10 min sessions. In addition, 5–10 min of training was conducted before the intervention, which involved verbal instructions and time for questions. After each session, the researchers provided brief supportive and corrective feedback to the peers. If the targeted skills were not improved after the completion of the instructional module, tele-coaching was implemented. During the sessions, the participants and peers were involved in a variety of conversation topics related to their interests. The results suggested that the implementation of tele-coaching seemed to be related to enhancement in at least one of the target skills for all participants.

Ref. [33] examined the effectiveness of a video-feedback intervention with a visual framework component to improve verbal empathetic statements and questions during conversation for three adults with ASD (19, 20, and 26 years old). Each baseline probe consisted of a videotaped, 10 min conversation with a graduate student clinician or a neuro-typical peer. Each subject was provided with four opportunities to respond verbally with empathy and communication skills. Each intervention session consisted of two components as follows: video feedback and a conversational probe. At the end of each session, a novel topic was introduced, which was then used for the video feedback session the following week. The visual framework consisted of three sequential boxes that were used as steps and a schematic reference to help guide participants in using empathic communication skills during the intervention and asking a follow-up question. The results showed that all three participants improved their targeted communication skills and their ability to use empathic listening statements and questions post-intervention. Moreover, the data showed that the results were maintained after the completion of the intervention.

Ref. [37] conducted a pilot trial of two novel intervention programs developed for college students with ASD, who were assigned to one of two programs. Eight students with ASD participated in the pilot trial of the two intervention programs; four of them were assigned to each one. The psychosocial program used in their study (College and Living Success: CLS) was designed to target social skills and self-management (e.g., time and emotion regulation), whereas the intervention based on virtual reality brain–computer interface for ASD (BCI-ASD) targeted emotion recognition (e.g., identifying others’ emotional state, their facial, vocal, and postural expressions). Interest in both programs was high and consumer satisfaction was high as well; there were no dropouts from either program. Yet, there was no significant improvement reported in the targeted skills for either program.

5.2.2. Behavioral and Academic Outcomes

Ref. [31] examined the effects of coaching using behavioral skill training (BST) on a 22-year-old female college student with ASD. Additionally, the researchers used observation and immediate feedback. Regarding the academic requirements, the students met them but failed to complete a required practicum successfully (i.e., social pragmatics; turn-taking in a conversation, keeping appropriate proximity, and executive functioning). The student’s verbal interactions with children were inadequate. The researchers aimed to increase those using different forms of communication (e.g., instructions, questions, comments, and praise). The program included weekly 30 min observations of the student in the practicum and one-hour coaching sessions. The student’s scanning and engagement with children were measured using a 15 s partial interval observation procedure. The quality of the student’s interactions increased over time based on anecdotal notes and observations. Yet, there was variability in her scanning, engagement, and verbal interactions across the preschool practicum.

In [35], the researcher assessed the feasibility, effects, and perceived acceptability of a peer mentoring intervention targeting academic skills and self-regulated learning (SRL) for three college students with Asperger syndrome. Strategies for College Learning (SCL) were used in the study. Additionally, the researcher featured individualized assessment of academic performance in target courses and direct instruction of learning and self-regulation strategies under the provision of a peer mentor. The program aimed to match participants with a peer mentor. The results showed successful implementation of SCL and acquisition of many learning strategies among the participants. In addition, the participants reported that they felt SCL was useful and acceptable too.

5.2.3. Functional Outcomes

Hillier and colleagues (2018) [32] used a support group model and evaluated its effectiveness in enhancing participants’ social lives on campus, academic skills, managing group work, time, and stress management. The university students with ASD (N = 52), who were divided into groups of four to seven, met one hour a week for seven weeks. Self-report questionnaires were completed at the beginning and end of the program for each of the nine groups. Feelings of loneliness and general anxiety were reduced according to the self-report measures, whereas self-esteem seemed to increase at the end of the program compared with the beginning.

Ref. [36] examined whether the implementation of a split-page format related to the quality of notes generated by young adults with ASD who participated in college lectures. As far as the split page, on the top of the page, the students wrote their names, the date of the class, and the main topic of each lesson. On the remainder of that page and any subsequent pages, the students wrote subtopics on the left side of the page following the presentation order. The students participated in the program for 10–12 weeks; they attended typical class meetings, during which baseline, intervention, and maintenance occurred. During the intervention, all the participants increased their performance (e.g., distinguishing between subtopics and details, paraphrasing, and using abbreviations and symbols). These improvements appeared to be maintained after the implementation of the intervention instruction.

5.2.4. Non-Experimental

Ref. [12] surveyed the opinions of 23 students with ASD, and 15 family members in 15 semi-structured focus groups (i.e., one to four participants enrolled in each group; nine were student focus groups and six were family with family members). Most students felt educationally, but not socially, supported, whereas most families felt that they were not adequately supported in any of the areas. Most students had lost interest in university because they were not interested in the subject area, they found it difficult, and they wished to have someone to motivate them. Social and communication barriers were reported as obstacles to the interaction and networking of students with ASD with other students.

In their survey-based study [26] examined how often functioning and participation problems occur, during which teaching and evaluation methods they occur, and which reasonable accommodations are effective in dealing with them. The participants included 43 students with ASD, 30 student counselors, and 43 typically developed institutions of higher education in Flanders. The students with ASD appeared to face problems with verbal and non-verbal communication and found it difficult to deal with changes and identify the main topics from the details. The students with ASD faced the aforementioned problems during classical teaching and evaluation methods. Conclusively, the researchers proposed that personal and environmental characteristics should be taken into consideration when selecting and implementing reasonable accommodations for this population.

Ref. [34] conducted the first longitudinal study. They evaluated changes in social network structure (SNS) and perceived social support (PSS) among first-year students with ASD (N = 21) and first-year students with typical development (N = 182) in their transition to the university. Both groups made new friends during the first year of university. Social anxiety showed a long-term differential negative impact on both groups’ academic, social, and personal/emotional skills. Students with typical development perceived the greatest distress in academic studies, whereas students with ASD perceived greater distress across all areas over time. The necessity for maintaining and engaging in social interactions across all aspects of university life (i.e., academic, daily life, communication) was identified to be anxiety-provoking and exhausting.

6. Discussion

Colleges and universities globally have experienced an increase in the number of students with ASD [6]. Higher education institutions face several challenges due to the unique characteristics and needs of students with ASD. Initially, these institutions provided students with ASD with the same accommodations and support as other students with disabilities [23]. Since the unique characteristics and needs of students with ASD became obvious, these institutions started to provide specialized support and programs. The purpose of the current review was to identify those interventions that can be effective in meeting the characteristics and needs of students with ASD and the opinions of these individuals.

In this review, nine empirical studies on interventions for college students with ASD are reported, which appear to show high effectiveness. In most of them, the participants expressed high rates of satisfaction. Yet, the included studies had different intervention methodologies (i.e., multiple baseline design across participants, focus groups, single subject design). So, it is not clear which is the most effective methodology. Additionally, the limited number of studies limits the generalizability of the results.

6.1. Outcomes

Mixed results were found by [37] in their comparison of two different psychological training programs. The participants (N = 8) were highly satisfied, yet they showed no significant improvement in executive functioning. In [35], only three participants were included. Yet, the results indicated that the implemented strategies for college learning were successful. In [36], only three participants were included. All participants showed improvement in the targeted skills (i.e., distinguishing between subtopics and details, paraphrasing, and using abbreviations and symbols).

One paper published on group settings for ASD investigated the students at the beginning and end of the intervention program [32]. Most of the participants in that study reported that they could talk about their ASD characteristics with group members and did not face any problems in facilitating the groups. Four studies [29,30,33,35] implemented a peer mentor program. Adjusting to the social demands of college and university education and independent living may be the biggest challenge for college students with ASD. The literature suggests focusing on including students with ASD among their peers with typical development [38].

An individual with ASD may feel that he/she does not belong to a group of peers with typical development. This may create a feeling of isolation in the individual with ASD. The inclusion of students with ASD into campus social activities may enhance peer attitudes and reduce loneliness and isolation. Ref. [37] indicated that the participants in their study found social coaching to be very helpful in monitoring progress and gave them someone to talk to one-on-one, which increased their awareness of communication skills. The students with ASD who participated in [26] declared that they most frequently experienced problems with verbal and non-verbal communication. Most students with ASD felt educationally, but not socially, supported [12]. The developmental period between the ages of 18 and 25, which is the age range of most college students, may be very crucial in enhancing many independent living skills (i.e., daily living, emotional, and social skills). During this period, most students, including those with ASD, try to deal with academic challenges, build intimate relationships, and experience independent living away from their parents’ houses for the first time.

Despite the difficulties and the challenges many students with ASD have to deal with, there are several promising results. Ref. [33] found that all participants in their study improved their verbal expression of empathy (i.e., using empathic listening statements and empathic-listening questions during social conversation).

6.2. Methods

Ref. [26] identified five different groups of teaching and evaluation methods. The researchers found that the chance of experiencing social relationships and communication problems is most pronounced during practical and active teaching methods (e.g., during an excursion). This is because students have to work in teams, communicate, and interact with each other and the professor. When classical evaluation methods are used, students with ASD find it difficult to select good learning strategies and deal with information. However, Ref. [37] found no pattern of improvement or worsening after the implementation of psychological training methods.

6.3. Limitations and Future Directions

The findings of this review indicate that there is growing research interest in effective methods and interventions for dealing with the needs of college students with ASD. Yet, in some cases, the results are based on limited data because of small sample sizes. Ref. [31] implemented a behavioral skill-training model on one student. Similarly, only three students were included in the study conducted by [29]. In [30], the researchers focused on enhancing four students with ASD. Ref. [33] implemented a video-feedback intervention and examined three adults. Despite the small sample sizes of these studies, the results showed improvement in the targeted communication skills of all the participants.

Students with ASD appear to be willing to participate in support groups, and they believe that it might be a useful support strategy [13]. On the other hand, they are not very willing to participate in groups that specifically focus on social skills or include only students with ASD since they do not find them helpful [23]. Inclusive strategies, which implement universal design principles, offer every student an equal opportunity to learn, based on the idea that every person has their own unique and individual learning style [39]. Higher education institutions should implement strategies to reduce anxiety and stress and improve executive function (e.g., setting and meeting goals), academic (e.g., how to study, how to access support on campus), and social skills (e.g., social interaction).

7. Conclusions

Given the increasing pressure in higher education to support students with ASD, effective interventions are needed. Yet, few universities provide support services focused on the needs of this population. There were 11 studies included in this review, which demonstrated functional, behavioral, academic, and social interventions and the opinions of students with ASD. Particularly, peer mentoring and support group interventions appear to be effective and provide students with ASD the opportunity to feel accepted by peers and mentors. The included studies suggest that the implementation of support interventions appears to be effective in dealing with the unique needs and characteristics of college students with ASD. These support services should be personalized to address the unique needs and characteristics of each college student with ASD. The following new questions emerged from these findings. Can these personalized support programs be implemented in higher education? Who is going to provide these support programs? Can the higher education support service center provide these support programs to enhance the success of college students with ASD?