In November, OAR’s Board of Directors authorized funding for eight applied autism research studies in 2024. These new grants, totaling $297,569, bring OAR’s total research funding to more than $5 million since 2002. This article is the fifth of eight previews to be featured in The OARacle this year.
Being able to get from place to place in daily life is critical—jobs, social activities, appointments, and other activities often require transportation. For autistic adults, transportation can be challenging. Some autistic adults are unable to meet the demands of driving due to deficits in spatial perception, sustained attention, speed of information processing, social problem-solving, and responding to unexpected changes. Others are capable of driving but prefer not to because of the anxiety driving evokes. Public transportation is an option for autistic adults, but as with driving, it can also pose challenges due to executive functioning and social interaction skills. In some places, public transportation is not a viable option.
Rideshare services, like Uber and Lift, provide efficient door-to-door transportation and avoid many of the barriers that come with public transportation. In this one-year OAR-funded study, researchers Stacey Reynolds, Ph.D., and Alissa Brooke, M.S., will evaluate the effectiveness of an innovative training program that teaches autistic adults, as well as adults with other intellectual and developmental disabilities, how to safely use rideshare services.
The aims of the study, “Improving Access to Community-Based Occupations via a Rideshare Training Program,” are to:
The study would be the first step towards a clinical trial of training effectiveness. The long-term goal is for this training program to be implemented nationwide to provide transportation for autistic adults.
Dr. Reynolds is the director of research and a professor in the Department of Occupational Therapy at Virginia Commonwealth University, Richmond, Va. Her research focuses on how children with neurodevelopmental disorders, such as autism, respond to sensory stimuli in their environment and how these responses impact functional performance and behavior. Her broad aim has been to discover neurological mechanisms underlying sensory-motor deficits in children and develop innovative treatments for these conditions. More recently, she and her team have begun to test the effectiveness of clinical interventions and community-based programs for children, adolescents, and adults with neurodevelopmental disorders.
Brooke is the director of employment research training at the Virginia Commonwealth University Rehabilitation Research and Training Center. She has extensive experience supporting autistic individuals and individuals with intellectual and developmental disabilities in employment, training them on their jobs, and training their colleagues on the best ways to work with them. This work also includes connecting individuals with transportation resources and teaching them how to access and utilize specialized transportation. She has provided training nationally and internationally to employment specialists and other vocational rehabilitation professionals on supported employment and customized employment.
The research team will recruit 12 autistic adults from central Virginia, four each from urban, rural, and suburban regions. They will use a wait-list control design, providing the intervention to participants in the experimental group first within a two-month timeframe. After two months, the wait-list group will receive the intervention while the experimental group participates in a two-month follow-up. The waitlist group will participate in the two-month follow-up after they receive the intervention.
The researchers developed The Safe Rideshare Program in 2019 in partnership with autistic residents of a semi-independent living community. The program includes five modules:
The researchers will engage their community partners throughout the research study. At least one autistic adult from the community will participate in the training sessions for research staff and will provide input on all training materials. They will be compensated for their time. The researchers will also invite community partners and any interested participants to help disseminate their findings via conferences, publications, and/or social media.
Participants will first complete the online module with virtual support from the research team. Successful completion of the online module will be followed by an in-person ride-along evaluation. The ride-along sessions will be tailored to the individual’s communication preferences, verbal or augmentative communication, and learning pace. The modules may be repeated within the two-month intervention timeframe as needed. Trained research staff will deliver the program, with a primary instructor delivering the content and a second staff member collecting data and scoring sessions for fidelity. The researchers anticipate that most participants will be able to schedule one virtual session and one ride-along session per week for the first five weeks, with the remaining three weeks allotted to practicing ride-along sessions and repeating modules as needed.
The virtual training sessions, which are estimated to require 20 to 30 minutes, will take place over Zoom. The lead trainer will either lead the participant through the modules or allow the participant to self-pace with the option to ask questions any time. Exercises are built into each module to test comprehension. If the participant does not complete an exercise accurately, the lead trainer will explain why the response was incorrect and prompt them to repeat the video modeling exercise.
The first ride-along session will be the baseline session for assessing the participant’s level of independence, i.e., number of cues needed, and safety. The participant will have up to eight ride-along sessions to reach full independence, i.e., no cues needed, and full marks on the safety assessment. The lead trainer will provide the cues as needed to complete each step of the rideshare process.
The researchers will measure outcomes related to effectiveness (user independence and safety), feasibility, acceptability, and use of services. To assess independence and safety, the research team developed an independence checklist for trainers to use during the ride-alongs.
In the two months after the intervention, the researchers will track the number of times the individual uses rideshare after receiving training. Participants will be instructed how to “share trip” with the research team using the rideshare app, including what types of activities they use rideshare for, to get food, for example, or go to work, and whether the activity was done alone or with others. They will confirm all outings with participants via email or text. They will compare the number of times participants used rideshare after the intervention to how many times they used rideshare during the eight-week baseline.
From a research standpoint, this study will provide the information needed to support a larger clinical trial. As the evidence for this intervention is demonstrated, future steps would include looking at options for training reimbursement, such as via health plans, adjusting policies to include rideshare vouchers or waivers, and partnering with rideshare companies to make their services even more accessible and autism-friendly.
The project has the potential to expand community mobility options for autistic adults and is well suited for widespread use given that training elements of the program are already freely accessible and available in a virtual format. Access to reliable and safe transportation will allow autistic adults to be more independent, hold a wider variety of jobs, access more opportunities for education, socializing, self-care, and healthcare, and improve their quality of life.
Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.
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