Issues in Mental Health Nursing, 35:664–671, 2014 Copyright © 2014 Informa Healthcare USA, Inc. ISSN: 0161-2840 print / 1096-4673 online DOI: 10.3109/01612840.2014.894158

The Need to Support Students with Autism at University Ann M. Mulder, PhD, and Andrew Cashin, PhD

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Southern Cross University, School of Health and Human Sciences, Lismore, Australia

Publicity surrounds the increased prevalence of autism. However, in contrast to support in primary and secondary schools, there exists little focus on supporting students with autism at university. Mental health nurses are well placed to facilitate support programmes for students with autism who have the capacity for higher education. This article examines the international literature around the support needs for these students and discusses opportunities that exist to support these students, their families, and higher education staff. Research is urgently needed to evaluate the success of such interventions, particularly in light of the low participation rates in study and work for people with autism.

Autism is a spectrum disorder made up of the diagnostic constructs of Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, and Pervasive Development Disorder not otherwise specified (PDD-NOS). In this paper “autism” is used to refer to all four disorders as classified in the recent DSM-V (American Psychiatric Association [APA], 2013). Autism first entered the scientific literature in 1943 (Kanner, 1943). In the first two editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 1952, 1968), children with autistic-like symptoms were classified as “childhood schizophrenic.” In the third edition (APA, 1980), autism was included as a distinct category although the only form was “infantile autism.” In 1994, the fourth edition (APA, 1994) included Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, and PDD-NOS as separate diagnoses. Since the introduction of Asperger’s Disorder in 1994, there has been a dramatic rise in the number of people diagnosed with autism. This is largely related to changes in clinician diagnostic practice and the recognition of autism in those without intellectual disability; individuals with Asperger’s Disorder do not exhibit a clinically significant delay in language or cognitive development Currently the prevalence of autism is between 0.6% and 2.6% of the population: 2.6% in Korea (Kim et al., 2011); 1.6% in Britain (Baron-Cohen et al., 2009); 1.2% in Sweden (Idring et al., 2012) Address correspondence to Ann M. Mulder, School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore, 2480 Australia. E-mail: [email protected]

and Iceland (Saemundsen, Magnusson, Georgsdottir, Egilsson, & Rafnsson, 2013); 0.7% in the US (Centers for Disease Control and Prevention, 2007); and 0.6% in Norway (Suren et al., 2013), the Canary Islands (Fortea Sevilla, Escandell Bermudez, & Castro Sanchez, 2013), and Israel (Davidovitch, Hemo, ManningCourtney, & Fombonne, 2013). Additionally, prevalence rates are 0.6% for full-term births, 1.3% for late preterm births, and 2.2% for early preterm births in Taiwan (Hwang, Weng, Cho, & Tsai, 2103). It is now 19 years since the inclusion of Asperger’s Disorder in the DSM and approaching rapidly is an increased wave of students with autism needing to access post-secondary education. While student-centred learning is a widely embraced concept internationally, universities are only beginning to realise that practicing this for students who are not neurotypical requires identification and increased support. Through consultation and faculty practice, nursing faculty are ideally placed to take an active role in supporting university services for those with autism. Mental health nurses, with their understanding of thinking and information processing, when combined with the pedagogical expertise possessed by nursing faculty, are ideally equipped to consult on reasonable adaptations to curricula and teaching for people with autism. Mental health nurses also are well-equipped to consult on individual support needs of students related to distress and anxiety and to provide direct support as part of faculty practice. AUTISM DEFINED Autism is a behavioural diagnosis defined by a triad of impaired communication, social skills, and behavioural flexibility expressed through restricted and repetitive interests, activities, and behaviours (APA, 2000). Impairment also can be viewed at the cognitive level resulting in impaired linguistic processing, theory of mind, and abstraction. Elements of both the behavioural and cognitive processing triads in autism are relational and not mutually exclusive (Cashin, Sci, & Barker, 2009). The combination of the elements is not additive, but rather together they compound to result in the expression of autism. However, it is fruitful to discuss them individually.


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Communication Impaired communication is one identified element in the triad of impairment. This is at the level of generating meaningful communicative messages (Kanner, 1943). Prior to the development of speech, those with autism have less communicative intent than neurotypical people (Duffy & Healy, 2011). The impairment in communication is at the linguistic and para-linguistic level. In addition to the difficulty of using words to communicate, intonation and facial expression, both learnt traits, also are impaired. The age at which speech is acquired does not correlate with later development in people with autism and no comorbid intellectual delay (Howlin, 2003). It follows that the impairment is not a communication delay but a difference. The behavioural elements of communication are underpinned by the difference in cognitive processing. People with autism have impaired linguistic processing of information (Cashin et al., 2009); they have a relative strength in visual processing (Sacks, 1986). Social Skills Impaired social skills found in those with autism are underpinned by impaired theory of mind. Theory of mind is the ability to understand that others have beliefs and desires that are different from one’s own. It is the ability to put oneself in another’s shoes, which supports an understanding of empathy and is an essential element of social communication (Howlin, 2004; Senju, 2012). For some on the spectrum, there is no inclination to become socially involved. However for those who do wish to be engaged socially with others, impaired theory of mind often results in the constant tripping over of social conventions and being mystified by the unwritten rules and etiquette of social contact (Wing, 1996). Behavioural Flexibility Restrictive and repetitive interests, activities, and behaviours, or impaired behavioural flexibility, is underpinned by impaired abstraction. People with autism have been described as having weak central coherence; at the base of which is impaired abstraction and the ability to determine like, or similar. This results in an impaired ability to categorise and see links between ideas and information. People with autism have been described as having a spotlight focus as opposed to the gestalt of big picture thinking. The term “executive dysfunction” has been used to describe impairment in frontal lobe mediated behaviour where the person with autism has trouble locating where activities and information fit into the big picture. This results in difficulty in organising and sequencing activities, impulse control, working memory, and mental flexibility (Happ´e & Frith, 2006). PARTICIPATION IN WORK AND STUDY Autism and Education in Australia The most recently available data from the Australian Bureau of Statistics (ABS) (2009b), reported that more than 95% of


children with autism attended school. Just over half of those who attended school were in mainstream classes. However, the majority of these children reported difficulty at school; particularly with communication, learning, and social engagement. The remainder needed to attend either a special class in a mainstream school or a special school that is better able to meet their needs. Generally, children with autism need a high level of support to attend school, with around a half requiring the services of a counsellor, disability support person, or special tuition. Data suggests that the difficulties students with autism experience in the education system continue after school. For example, of people with autism who had finished school, three quarters (77%) had not completed a post-school qualification; a rate well above both people with disability (50%) and people with no disability (43%) (Australian Bureau of Statistics [ABS], 2009b).

Autism and the Labour Force in Australia People with autism also encounter difficulties participating in the labour force. In 2009, the labour force participation rate in Australia for people with autism was 34%, compared with 54% for people with other disabilities, and 83% for people without disabilities. These figures, the ABS suggest, indicate significant implications for the economic security of people with autism, as without jobs, and therefore sufficient income, they lack the financial freedom to make decisions about their lives. Further, they miss out on other beneficial aspects of working, such as the social networks that develop through workforce participation (ABS, 2009b). As a function of the restrictive and repetitive behaviours, there exists a drive in many individuals with autism to a shrinking world; so if not participating in study or work, they can become extremely isolated in their homes (Cashin & Waters, 2006). One of the key goals of both the National Disability Strategy and National Disability Agreement is to increase the economic and social participation of people living with disabilities. The Australian National Disability Strategy notes that, “work is essential to an individual’s economic security and is important to achieving social inclusion. Employment contributes to mental health, personal well-being and a sense of identity” (Commonwealth of Australia, 2011, p. 42). People with autism struggle with social engagement, and in 2009 the data indicate they also were struggling with economic participation and had lower levels of post-school qualifications and labour force participation compared to people with other disabilities (ABS, 2009b). While primary and secondary schools in Australia are providing support to children and young people with autism, 2009 data indicate that more needs to be done to help them into tertiary education and the labour force (ABS, 2009b). We identified no formal transition programmes between secondary school and university for people with autism in Australia. Transition programmes, if they existed, would allow study skills learnt during



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secondary school to be more effectively transferred to university study, resulting in more effective transitioning and identification of students needing support, along with a history of the support found to be of most use (Janiga & Costenbader, 2002). Such programmes would help mitigate the added stress and anxiety of university study (Hart, Grigal, & Weir, 2010; Stallman, 2010).

Autism and Participation in Work and Tertiary Study Internationally Congruent with the 2009 Australian figures reported above, outcomes from a US study using 2007–2008 data from the National Longitudinal Transition Study 2, a ten-year prospective study of youth receiving special education services, found that youth with autism had the highest risk of being completely disengaged from any kind of post-secondary education or employment (Shattuck et al. 2012). The risk is particularly high in the two years following high school, pointing to potential gaps in transition planning in youth with autism. The study examined data from youth aged 19–23 years with autism (n = 680), speech/language impairment (SLI; n = 470), learning disability (LD; n = 460), and mental retardation (MR; n = 430). They reported that in youth with autism, 55% had had paid employment since high school, 28% had attended a 2-year college, 12% had attended a 4-year college, and 9% had attended a vocational or technical education program; 35% had not participated in any post-secondary employment or school. Higher family income and youth with higher functional skills were associated with higher odds of participation in paid employment and education. Compared with other disabilities, youth with autism had the lowest rates of employment and education participation. The paid employment rate for youth differed based on the youths’ diagnoses: the rate of paid employment for those with autism was 55%; for those with MR, it was 69%; for those with a SLI, it was 86%; and for individuals with a LD, the rate of paid employment was 94%. In contrast, the rates of no participation in either paid employment or education was 3% for youth with a LD, 7% for youth with a SLI, 26% in youth with MR, and 35% in those diagnosed with autism (Shattuck et al., 2012). In Sweden, a prospective follow-up study, minimum fiveyear post-diagnosis, of adults with Asperger’s Syndrome (AS; n = 70) and autism (n = 70), found that only 27% of participants with AS were assessed as having good social, communication, and functioning outcomes. A good outcome entailed being (a) employed, or in education or vocational training, and (b), if 23 years of age or older, living independently or, if 22 years or younger, having two or more friends and/or a steady relationship. The largest percentage (47%) had a fair outcome; (a) or (b) but not both. However 26% had a restricted outcome; neither (a) nor (b); that is, they undertook no education or occupation and had no friends. Outcomes for participants with autism were worse, with 76% assessed as having either poor (20%) or very poor (56%) outcomes; a poor outcome entailed having an obvious, severe handicap, but with some clear verbal or non-verbal

communicative skills, and a very poor outcome entailed having an obvious, very severe handicap, being unable to lead any kind of independent existence, and no clear verbal or non-verbal communication; it is worth noting that only 7% of participants with autism were assessed as having normal intellectual ability (Cederlund, Hagberg, Billstedt, Gillberg, & Gillberg, 2008). Similarly, a Canadian study of young adults with ASD (n = 48, mean age = 24 years), reported outcomes based on occupation, friendships, and independent living. They assessed only 4% as having a very good outcome, 17% as having good, 32% as having fair, and 46% as having poor outcomes. A very good outcome entailed achieving a high level of independence, having some friends, and holding a job. A good outcome was generally used to describe someone who was working, but required some support in daily living and who had some friends/acquaintances. A fair outcome entailed having some degree of independence and not needing specialist residential provisions and having no close friends but some acquaintances. A poor outcome entailed needing special residential provisions or a high level of support and not having friends outside of the residence. The highest levels of unmet needs reported by families of these young people with ASD were social programs/outlets (31%), work (29%), and friends (25%) (Eaves & Ho, 2008).

AUTISM AND UNIVERSITY Increasingly, inclusion in mainstream primary and secondary (K-12) education is being embraced for students with autism. In contrast, higher education facilities, such as universities and colleges, can exhibit an elitist environment where only students who meet certain admission requirements are accepted and educated. Consideration of the implications of student-centred learning in a university environment that promotes inclusion is only now beginning to be considered. For students who are outside the norm, current practise often suggest that these students do not belong. However, the inclusiveness of K-12 schooling with its high academic expectations is challenging these assumptions about who belongs and can benefit from a university education (Hart et al., 2010). Shattuck (Shattuck et al. 2012) identified that 12% of students from the USA with autism attended a four-year degree programme; no Australian data is available. However if we apply to a conservative 1% of the population estimate of autism, the numbers potentially already attending university in Australia are large. While figures that allow estimate of numbers in the range likely to attend university are not available, using the ABS’ (ABS, 2013) population estimate of 23,004,776 for April 28, 2013, we get 27,606 Australians with autism (12% of the 1% population estimate) who may at some point in their life attended, have aspirations to attend, or be attending university. International evidence indicates that the number of students with autism who have entered higher education is increasing. In the UK, the Higher Educational Statistical Agency (HESA) data indicate that 80 students with Asperger’s Syndrome entered in the 2003–04 school year, 295 students entered in 2004–05, and

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475 students entered in the 2005–2006 school year (Madriaga & Goodley, 2010). There are many compelling arguments that support access to university education for students with autism. These include the argument that participation in post-secondary education is a natural development growing from ever-expanding inclusive opportunities in the K-12 system, a system that has demonstrated that with appropriate support, students with autism can succeed both socially and academically. In addition, people with autism benefit from participating in valued social roles (such as being a university student), making it more likely that they will have a good quality of life and less marginalisation. For many students with autism, their intellectual capabilities may become a critically important domain essential to their feelings of selfworth. Participation in advanced education programs becomes a significant source of self-esteem (Camarena & Sarigiani, 2009). It is important however that inclusion is structured to create legitimate university status; pretending does not have the same value as true participation. There are strong positive relationships among a university education, employment outcomes and lifetime earnings (ABS, 2009a). A positive university education is not just measured by academic grades but also by increased learning, independence, self-determination, and positive social experiences. Internationally, universities, similar to K-12 schools, are finding that students with autism are having a positive impact, not only on other students without autism, but on the university community as a whole (Hart et al., 2010). Faculty members at a New Hampshire College stated that: . . . we have found ourselves to be more understanding and appreciative of both our differences and our similarities, we regard students with AS or autism as having a great deal to contribute both to our own learning, as well as to our college community as a whole. Spending time with and befriending these students is not just about delivering an essential clinical service, but about what kind of people we want to be and what kind of communities we want to create. (Welkowitz & Baker, 2005, p. 186)

Mental health nurses with a strong tradition of person-centred practice (more recently expressed through a recovery focus) and who work within complex systems to promote integration are ideally placed to support the broader university staff’s understanding of, and efficacy in, working with students with autism. Mental Health Nurses are suitably qualified to be employed on learning support teams. The context of supporting students with autism also provides an opportunity for nursing faculty service to the university community through consultation or direct support of students. In Australia, community service is often a component of academic workload models. Currently significant differences exist between K-12 and post-secondary education for students with autism. In K-12 schooling, students are supported with individualised education programs that provide a comprehensive structure for support services and accommodations. These are typically determined collaboratively in an Individual Education Plan through con-


versations among the student, parents, the school counsellor, teachers, and other school personnel that relieve the student from negotiating educational services or academic accommodations. Teachers are typically able, due to smaller class sizes, to provide support for socially inappropriate behaviours, provide guidance for gaining perspective, and assist students when experiencing sensory overload. This support, however, does not generally occur in post-secondary education. Instead, the student must navigate their own challenges, such as understanding the perspective of others, integrating multiple streams of environmental stimuli, and the complexities of social interactions. This is often a greater challenge when students have become accustomed to support in primary and secondary education and is compounded by the fact that university/college personnel typically have neither the resources nor guidelines for best practise when working with students with autism (Pillay & Bhat, 2012). A survey of students with disability in one UK university (n = 173) found that virtually no students declaring “unseen disabilities” was either in contact with the Disability Coordinator or in receipt of Disabled Students Allowance (Fuller, Healey, Bradley, & Hall, 2004). The onus is usually on the student to ask for support. This onus was not present in secondary education, as parents played a greater role and school staffs were proactive. Adapting to the new demand may require a degree of organisation and social competence not present. Support services may need to be ready to either anticipate or identify problems (MacLeod & Green, 2009). In Australian universities, in order to obtain student support, the student with autism is required to self-identify and submit medical documentation that verifies the diagnosis while registering with Disability Services. Ideally the student discloses their autism diagnosis to Disability Services and this enables roles played by a variety of other university personnel. These include university counsellors, academic faculty, residential staff, and peer mentors. Nursing faculty are ideally positioned to support counsellors, or in the form of faculty practice, to become counsellors. Counsellors often have the most significant impact and involvement with students with autism, due to their intimate involvement with behavioural interventions. If prepared and supported, counsellors may detect early warning signs of a student they suspect may have autism and have failed to provide documentation or is without previous diagnosis, as well as provide guidance regarding the benefits of disclosure. Generally, they work with Disability Services to liaise with faculty to deliver suitable academic accommodations and can work as a student’s advocate. Counsellors also may assist students in developing strategies to compensate for impaired executive functioning, such as time management; they can discuss strategies or alternative behaviours to cope with sensory overload and implement spaces such as safe zones where students can retreat and de-escalate in times of overload. Counsellors may discuss strategies that support better social behaviours and increase self-advocacy and assertiveness skills. They may need to educate students to recognise discrimination or harassment

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and teach them how to respond appropriately. Counsellors also may support collaboration among the student, parents, Disability Services, residential services, and faculty. When issues arise between the student and faculty, counsellors may be able to develop strategies that support the continued inclusion within class and the development of new routines of behaviour by the student if required, resulting in positive changes and a win-win situation (Pillay & Bhat, 2012). While academic faculty often do not automatically know what accommodations a student requires, it is important that they consult and collaborate with Disability Services to ensure that an inclusive academic environment exists for students with autism. It is important to note, though, that faculty must be assured that they do not have to compromise the fundamental requirements, standards, or essential functions of a course in a way that confers unfair advantage to a student or poses an undue burden on the institution (Australian Government Attorney General’s Dept, 2005). Residential staff are other university personnel who may be invaluable for students with autism if given the appropriate education and support. While living at home can provide security, it does not often support full engagement in university life. On the other hand, residential life can be akin to constant exposure to the worst aspects of high school, such as bullying, ridicule, or social exclusion. Residential staff with appropriate knowledge about autism, and confidence in ways to assist students with autism, are more likely to be understanding and to connect and empathise with these students rather than judge their behaviours (Pillay & Bhat, 2012).

University Accommodations The support needs associated with autism are complex, highly idiosyncratic, and often at odds with the individual’s apparent capability. Sainsbury (2000) noted that in Asperger’s original 1944 paper on Asperger Syndrome “one of his patients had not only studied theoretical astronomy at university, but also proved a mathematical error in Newton’s work” (p. 122). However, the profile of abilities can be very uneven (Cashin et al., 2009) and individuals can be emotionally immature and lacking in practical skills expected of young adults. University support services therefore face the challenge of being ready and willing to adapt their existing systems so that they can respond effectively to the individual needs of their students with autism. In Australia, nursing faculty are well placed to support and resource Disability Services. This has the potential to provide opportunities for faculty practice as well as better outcomes for people with autism. Faculty practice could be through consultation or direct service provision. A vast range of accommodations are available at university for students with disabilities, including those with autism. These include academic support, counselling referral and special advising, modified course load, priority registration, early registration, or course substitute for a “required” course. Ac-

commodations associated with lectures and tutorials include the use of a peer note taker, laptop computer, spell checker and grammar checker, e-reader, read and write software, textbooks on tape, screen reader, screen enlarger, listening device, and priority seating, as well as access to notes from the lecturer, tape-recorded lectures, course materials available in alternative form, and advanced receipt of syllabus and course handouts. Finally, examination accommodations include using a separate room with minimal distractions, having access to priority seating, having extended time for the exam, having breaks during the exam or having the exam administered in several sessions, prioritising a specific time of day that is best for the student, using a reader to read directions and questions, receiving an oral exam, dictating answers to a scribe or tape recorder, allowing a student to mark responses on the test rather than on a Scantron answer sheet, increasing the size of answer sheet bubbles, using larger type, and using a word processor for written responses (Hart et al., 2010; Pillay & Bhat, 2012; Roberts, 2010). For students with autism who have sensory impairments, coping with the stress of overstimulating environments may mean their safe spaces may need to be free from auditory and visual overstimulation. Considering the sights, sounds, and crowds of student facilities such as pubs and cafes, a safe space may be the silence of the library (although this, too, has been found to be too noisy for some students) or their own student accommodation. However if there is a consistent lack of accessibility to more appropriate social venues within the university, that may be a cause for concern as it can socially and spatially constrain the lives of students with autism. A UK study of 237 adults with Asperger Syndrome found that for 77% of them social situations were either extremely or very stressful (Beardon & Edmonds, 2007); it also has been recognised that living in a shrunken social world can lead an individual with autism towards depression. Students with autism who are not part of a social network can be disadvantaged as they are less able to catch up on missed lectures or seek clarification from other students (Taylor & Knott, 2007). However, what also must be considered is the range of diversity that exists underneath the diagnosis of autism. While some people with autism crave being alone, others crave social interaction. Whatever the preference, students with autism should be able to enter a variety of university spaces without confronting triggers to hypersensitivities or anxieties, while still increasing opportunities to socially engage in university life. Some suggest that universities should provide alternative spaces for students with autism to limit the risk of sensory overload, such as alternative places to eat, and space to avoid noisy places. While pragmatic, these suggestions also raise questions of concern regarding inclusivity and the marginalisation from conventional university spaces because of these students’ impairment. Having segregated eateries similar to segregated exams reaffirms the ghettoisation of an already excluded group of people. Whether they eat in their own room or a designated eating place they are alone and set apart from others; Madriaga (2010) says

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this type of thinking reflects the dominant thinking of disabled student support provisions within the UK higher education institutions. It is a base-level thinking, requiring minimum provision for disabled students as opposed to best practice. To address this issue, disability support practitioners should work with disability student union representatives in planning alternative ways to engage disabled students in student-led societies. For example while many students with autism found orientation week very stressful due to the noise and crowds, they should have the opportunity to attend a similar event without the noise and crowds or have a choice of having mentoring support or a personal assistant in attending such events. Having to exclude oneself from university spaces due to the university’s misrecognition of impairments is not reflective of inclusive practice. Achieving best practice requires exploration and discussion with people to highlight examples of good practice, including social alternatives that offset the effects of isolation and depression (Madriaga, 2010). A UK study (Beardon, Martin, & Woolsey, 2009) of students who self-disclosed Asperger’s Syndrome or high-functioning autism (HFA) and who identified challenges at university (n = 135), explored their perceptions about challenges and support at university. Note that not all the students had a formal diagnosis; 72% had been diagnosed with AS, 8% with HFA, and the remaining 20% had not gone through a formal diagnosis. Forty percent of the students reported difficulties with social interaction, including challenges relating to the need to communicate with others, such as in group work. Support involved understanding neurotypical behaviour, and it was suggested that since understanding is a two-way process, an understanding of autism for neurotypicals could be of benefit. Twenty-one percent of the students identified challenges in the social environment, challenges arising from expectations, activities, and the presence of others (e.g., physical proximity and sensory distraction). Twenty-six percent of students identified challenges with course structure or curriculum demands. These related to practical activities, rigid assessment criteria, organisational requirements, and flexible programs of study. Twenty-four percent of students identified challenges related to their own or other peoples’ understanding of AS/HFA (Beardon et al., 2009). Another study involving comments by eight students in the UK with Asperger’s Syndrome, reported a variety of impediments to learning in higher education, which included: barriers in lectures related to understanding; barriers participating in group work; and issues with assessment, including doing assignments and taking exams. Conclusions of the study were that higher education institutions need to conjure creative and more inclusive ways of engaging students with AS in learning and assessment. While well-intentioned, adoption of minimum levels of provision for students with disability, such as not assigning group work or constructing separate catering outlets for students with AS, may actually perpetuate marginalisation (Madriaga & Goodley, 2010).


Integration of Students with Autism into University In order to further understand peer responsiveness to students with autism, a US study (n = 652) examined college students’ openness toward peers who demonstrated behaviours characteristic of autism (Nevill & White, 2011). It was identified that students who reported having a first-degree relative with autism obtained significantly higher openness scores, perhaps as a function of increased exposure and understanding of autism. In terms of college major, engineering students indicated the most comfort yet, incongruently, also the most fear about being around peers with autism. Physical sciences students (biology and mathematics) indicated the highest willingness to spend their free time with a peer with autism and the strongest belief that the person would be likeable and possess an equal level of intelligence to them. Social science students (psychology and sociology) received the lowest fearfulness score and indicated the least concern about having peers with autism living in the hall of residence. This is possibly due to the curriculum emphasis on the understanding of diversity and varying personality attributes in the building of social environment. As a result, these students showed the most acceptance of others regardless of their background. Those from the “other major” category had the highest belief that students with autism were different from themselves. These results suggest that greater awareness and education about autism and its increased prevalence within the university population could improve peer responsiveness toward students with autism. Further education and awareness could be undertaken, particularly during World Autism Awareness Month in April, aimed at academic faculty and peers. Education of university staff and providing information on the perspective of a student with autism and steps that support success in the classroom would be prudent. In addition, information on autism could be included in appropriate academic courses such as Introductory Psychology, which would greatly enhance understanding and openness. Peer mentoring programs could be implemented to help students develop social, academic, and daily living skills, all of which may be impaired in those with autism, and peer support groups for students with autism could be established to enable students with similar experiences to connect (Nevill & White, 2011). CONCLUSION Increased diagnosis and, therefore, prevalence of autism means there will be an ever-increasing number of students entering university in Australia and elsewhere with additional support needs specifically tailored to autism. In addition the Disability Discrimination Act and the Australian Disability Standards for Education have placed responsibility with institutions to promote access to inclusive education. Mental health nurses are well-placed to lead and evaluate the development of transition programmes from school to university to support access, and to work with university staff to promote accommodations



conducive to inclusiveness. This could include both consultation and direct service provision. Research is urgently needed to evaluate the success of such interventions, particularly in light of the low participation rates of people with autism in study and work. Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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The need to support students with autism at university.

Publicity surrounds the increased prevalence of autism. However, in contrast to support in primary and secondary schools, there exists little focus on...
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