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Meeting the Mental Health Needs of Autistic College Students: A Survey of University and College Counseling Center Clinicians

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Title: Meeting the Mental Health Needs of Autistic College Students: A Survey of University and College Counseling Center Clinicians
Language: English
Authors: Tara Chandrasekhar (ORCID 0000-0001-5043-4286), Qin Hu
Source: Journal of American College Health. 2024 72(1):40-46.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 7
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Student Needs, Students with Disabilities, Autism Spectrum Disorders, Mental Health, College Students, Guidance Centers, School Counselors, Self Efficacy, Anxiety, Depression (Psychology), Disability Identification, Clinical Diagnosis, Training, Counselor Attitudes, Experience
DOI: 10.1080/07448481.2021.2013239
ISSN: 0744-8481
1940-3208
Abstract: Objective: University and college counseling centers (UCCCs) are a front-line support for the mental health needs of autistic students, though little is known about clinician attitudes, comfort level, and training in autism. Participants: 89 UCCC clinicians were recruited via email listservs. Methods: The authors developed a survey which assessed attitudes, comfort level, and training in autism. Results: The majority of clinicians (82.0%, n=73) had interacted with autistic students in the past year, and reported high levels of comfort with treating anxiety and depression. However, a smaller number reported confidence in their ability to diagnose autism. Training on autism emerged as an important deficit, as 31.5% of the clinicians denied receiving training either in their educational program or the UCCC. Conclusions: In this pilot study, clinicians reported a discrepancy between self-reported levels of comfort with autistic college students and past training, highlighting continuing education as an important area for future intervention.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1408362
Database: ERIC
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  Value: <anid>AN0174908839;acl01jan.24;2024Jan23.02:22;v2.2.500</anid> <title id="AN0174908839-1">Meeting the mental health needs of autistic college students: a survey of university and college counseling center clinicians </title> <p>University and college counseling centers (UCCCs) are a front-line support for the mental health needs of autistic students, though little is known about clinician attitudes, comfort level, and training in autism. 89 UCCC clinicians were recruited via email listservs. The authors developed a survey which assessed attitudes, comfort level, and training in autism. The majority of clinicians (82.0%, n = 73) had interacted with autistic students in the past year, and reported high levels of comfort with treating anxiety and depression. However, a smaller number reported confidence in their ability to diagnose autism. Training on autism emerged as an important deficit, as 31.5% of the clinicians denied receiving training either in their educational program or the UCCC. In this pilot study, clinicians reported a discrepancy between self-reported levels of comfort with autistic college students and past training, highlighting continuing education as an important area for future intervention.</p> <p>Keywords: Autism spectrum disorder; college mental health; neurodiversity; therapist attitudes; university and college counseling center</p> <hd id="AN0174908839-2">Introduction</hd> <p>Autism spectrum disorder (ASD) is construct[<reflink idref="bib1" id="ref1">1</reflink>] which manifests as social and communication challenges, intense interests, difficulty with change, and sensory processing difficulties.[<reflink idref="bib2" id="ref2">2</reflink>] Overall 1 in 54 individuals meet criteria for ASD,[<reflink idref="bib3" id="ref3">3</reflink>] and an estimated 0.7–1.9% of college students likely qualify for an autism diagnosis.[<reflink idref="bib4" id="ref4">4</reflink>] Increasing numbers of autistic emerging adults are enrolling in post-secondary education, facing both opportunities and challenges. In addition to engaging in discipline-specific academic work, these students develop life skills related to communication, critical thinking, socialization, and interpersonal interactions.[<reflink idref="bib5" id="ref5">5</reflink>] Despite typically possessing the cognitive abilities to succeed in a college, autistic college students often experience numerous obstacles that negatively impact their academic trajectory and well-being. These include difficulty with social interactions, organization and planning, and managing novel or fluctuating routines.[<reflink idref="bib6" id="ref6">6</reflink>] Such challenges often coincide with a reduction in external supports and a developmentally appropriate desire for increased independence and autonomy. Concern about self-disclosure may lead some students to wait until a crisis emerges to seek academic accommodations or emotional supports.[<reflink idref="bib7" id="ref7">7</reflink>] Unfortunately, some students also experience discrimination and bullying in a college setting,[<reflink idref="bib8" id="ref8">8</reflink>] which may exacerbate difficulty with social connection and functioning. These numerous challenges, individual and combined, often negatively impact mental health and well-being.</p> <p>Autistic adults appear to experience co-occurring psychiatric conditions at greater rates than non-autistic peers. A 2019 systematic meta-analysis of anxiety and depression in individuals with autism reported high lifetime prevalence rates of any anxiety disorder (42%), generalized anxiety disorder (26%), social anxiety (20%), and depression (37%).[<reflink idref="bib9" id="ref9">9</reflink>] Rates of attention deficit hyperactivity disorder (ADHD), which, if unaddressed may negatively impact academic performance, is estimated at 28% in another systematic meta-analysis.[<reflink idref="bib10" id="ref10">10</reflink>] Suicidal ideation in autistic adults is alarmingly high, as reflected in several small studies which estimate prevalence rates of 30–50%.[<reflink idref="bib11" id="ref11">11</reflink>] College students on the autism spectrum similarly report high rates of loneliness, isolation, depression, anxiety, and suicidal behavior in several recent studies.[<reflink idref="bib7" id="ref12">7</reflink>],[<reflink idref="bib12" id="ref13">12</reflink>],[<reflink idref="bib13" id="ref14">13</reflink>] These mental health difficulties negatively impact the college experience and may contribute to low rates of degree completion and employment among autistic college students in the United States.[[<reflink idref="bib14" id="ref15">14</reflink>], [<reflink idref="bib16" id="ref16">16</reflink>]] However a growing number of colleges and universities are responding to the needs of their autistic students by providing increased support for their academic, social, and mental health needs. A relatively small number of institutions have implemented programming designed for autistic students including transition support for high school students,[<reflink idref="bib17" id="ref17">17</reflink>] summer transition programs for newly enrolled students,[<reflink idref="bib18" id="ref18">18</reflink>] cognitive-behavioral therapy based transition programs,[<reflink idref="bib19" id="ref19">19</reflink>] and structured social skill interventions.[<reflink idref="bib20" id="ref20">20</reflink>] While we are hopeful that access to these types of interventions will grow, many autistic students who experience mental health difficulties will seek out existing services on their campus,[<reflink idref="bib21" id="ref21">21</reflink>] including utilizing the expertise of their campus counseling center.</p> <p>University and college counseling centers (UCCC) serve as an on-campus mental health resource for college students. These agencies often focus on wellness and utilize a developmental approach to meet the needs of emerging adults, attempting to support both individual students and university faculty and staff who teach, mentor, or advise students. UCCC services may include individual and couples counseling, medication management, group therapy, workshops, coaching, and referral services. There is considerable variability in the scope of services and the number of sessions allotted to students, with some UCCCs focusing on acute stabilization or short-term therapeutic work.[<reflink idref="bib22" id="ref22">22</reflink>] In addition to clinical work, clinicians often advocate for students, collaborate with campus partners, and provide support during a crisis. Students on the autism spectrum may benefit from clinical or behavioral treatments and group supports provided at UCCCs,[<reflink idref="bib23" id="ref23">23</reflink>] though a 2017 study suggested that compared to their neurotypical peers, autistic students remain in treatment for significantly more sessions and take longer to achieve improvement on standardized symptom measures.[<reflink idref="bib24" id="ref24">24</reflink>] While national rates of UCCC utilization by autistic students are not currently known, a recent study indicated that 69.7% of a sample of 79 UCCC Directors reported an increase in service utilization by this population in the past 5 years.[<reflink idref="bib25" id="ref25">25</reflink>]</p> <p>Though UCCC clinicians are accustomed to responding to a range of college student needs, little is known about their therapeutic work with autistic students. Further, therapist comfort level with clinical care and attitudes toward autistic students, which are likely to impact therapeutic outcomes,[<reflink idref="bib26" id="ref26">26</reflink>],[<reflink idref="bib27" id="ref27">27</reflink>] have not been assessed in a UCCC clinician sample. Deficits in training was identified in a 2017 study of eight UCCC psychologists,[<reflink idref="bib28" id="ref28">28</reflink>] but this concern has not been assessed on a larger scale. To that end, the following pilot study was developed to assess UCCC clinician attitudes and self-reported levels of training in autism. Research questions used to guide this study were:</p> <p></p> <ulist> <item> Do UCCC clinicians report interactions with autistic students while performing their on-campus role?</item> <p></p> <item> How do UCCC clinicians rate their individual comfort level with providing mental health services to college students on the autism spectrum?</item> <p></p> <item> What are UCCC clinician attitudes toward students on the autism spectrum?</item> <p></p> <item> Do UCCC clinicians report previous training in autism, and if so, when did this training occur?</item> </ulist> <hd id="AN0174908839-3">Materials and methods</hd> <p></p> <hd id="AN0174908839-4">Measure</hd> <p>We developed a survey measure to identify clinician and systems level factors related to care for autistic college students at a UCCC. Participants were asked 14 five-point Likert-style questions to assess the following areas: comfort with diagnosis and treatment of co-occurring conditions, clinician attitudes, and perspectives on the suitability of a UCCC for autistic students. Clinicians were also asked if they had interacted with autistic students in the past year, and if they had received training on autism in their educational program, current role, or on their own. Participants were asked to provide demographic information including age, race, ethnicity, gender identity, degree, and role at a college counseling center. Survey questions are included in Supplementary Material, Appendix 1.</p> <p>Survey questions were developed following a literature review of existing clinician and healthcare provider surveys on autism or other disabilities. While there is an overall dearth of published literature assessing clinician attitudes toward autism, a 2018 survey by Besika et al.[<reflink idref="bib29" id="ref29">29</reflink>] of community based therapist attitudes toward individuals with learning disabilities provided a framework for questions related to therapist comfort level and ability to form a collaborative relationship with their client. Surveys of health care professionals,[<reflink idref="bib30" id="ref30">30</reflink>],[<reflink idref="bib31" id="ref31">31</reflink>] pharmacists,[<reflink idref="bib32" id="ref32">32</reflink>] and campus community members[[<reflink idref="bib33" id="ref33">33</reflink>], [<reflink idref="bib35" id="ref34">35</reflink>]] assessing knowledge and experience with autism provided examples of questions on comfort with autism diagnosis, treatment, and past training. The remaining questions were developed based on consultation with UCCC clinicians at our institution. In order to assess the appropriateness and feasibility of the survey measure, four current UCCC clinicians of various disciplines provided qualitative feedback on the measure. The Internet-based survey was approved through the University's Institutional Review Board (IRB) and open from August 18, 2018 to October 24, 2018. Informed consent was obtained from all individual participants prior to administration of the survey.</p> <hd id="AN0174908839-5">Participants</hd> <p>Survey participants were recruited from UCCC clinician professional organizations email listservs, including the Association for University and College Counseling Center Directors (AUCCCD), the Association for the Coordination of Counseling Center Clinical Services (ACCCCS), and the Association for University and College Counseling Center Outreach (AUCCCO). Membership in these organizations includes psychologists, social workers, and other mental health professionals. We also distributed the survey to the College Counseling Center Psychiatrists listserv in order to recruit psychiatrists, nurse practitioners, and physician assistants. Participants self-identified as working part-time or full-time at a UCCC. Clinician gender identity, age, race, ethnicity, educational background, and licensure status were obtained via self-report. The sample also included clinicians who were still in training, such as pre- and post-doctoral psychology interns and practicum students.</p> <hd id="AN0174908839-6">Results</hd> <p></p> <hd id="AN0174908839-7">Participant demographics</hd> <p>The survey was commenced by 100 UCCC clinicians. Respondents who did not complete the entire survey were excluded. Data were thus collected and analyzed from 89 respondents. Table 1 indicates demographic information of the study participants. The majority of survey respondents were female (<emph>n</emph> = 71, 79.1%), self-identified as European-American or white (<emph>n</emph> = 66, 74.2%), and had a mean age of 43.4 ± 11.5 years. Respondents included clinicians in training and included the range of clinical roles at UCCC's. The greatest number of responses were from psychologists (<emph>n</emph> = 34, 38.2%), followed by psychiatrists (<emph>n</emph> = 19, 21.2%), social workers (<emph>n</emph> = 9, 10.1%), and licensed professional counselors (<emph>n</emph> = 8, 9.0%). Of respondents who were clinicians in training, psychology interns (<emph>n</emph> = 11, 11.2%), comprised the majority. Survey respondents were asked the type of service(s) they provided at their UCCC. Responses, illustrated by Figure 1, reflected the range of typical UCCC clinician responsibilities, with the majority of individuals providing more than one type of service. The most common services included individual counseling (<emph>n</emph> = 73, 82.0%), campus outreach presentations (<emph>n</emph> = 67, 75.3%), training students or interns (<emph>n</emph> = 58, 65.2%), referral services (<emph>n</emph> = 56, 62.9%), and managing relationships with campus partners (<emph>n</emph> = 55, 61.8%).</p> <p>PHOTO (COLOR): Figure 1. Services provided at the UCCC by survey respondents (n = 89).</p> <p>Table 1. Survey respondent self-reported demographic information (<emph>n</emph> = 89).</p> <p> <ephtml> <table><thead><tr><td /><td><italic>n</italic> (%)</td></tr></thead><tbody valign="top"><tr><td><bold>Gender identity</bold></td><td /></tr><tr><td>Female</td><td>71 (79.8)</td></tr><tr><td>Male</td><td>17 (19.1)</td></tr><tr><td>Gender Queer</td><td>1 (1.1)</td></tr><tr><td><bold>Race/ethnicity</bold></td><td /></tr><tr><td>African American/Black</td><td>4 (4.5)</td></tr><tr><td>Asian/Asian American</td><td>7 (7.9)</td></tr><tr><td>Hispanic/Latino(a)</td><td>8 (9.0)</td></tr><tr><td>Native American/American Indian</td><td>1 (1.1)</td></tr><tr><td>Mixed race</td><td>3 (3.4)</td></tr><tr><td>White</td><td>66 (74.2)</td></tr><tr><td><bold>Highest educational degree</bold></td><td /></tr><tr><td>Bachelor's (eg, B.S., B.A., B.S.N.)</td><td>2 (2.2)</td></tr><tr><td>Master's (eg, M.A., M.S., M.Ed.)</td><td>59 (66.3)</td></tr><tr><td>Doctoral (eg, Ph.D., Psy.D., M.D.)</td><td>28 (31.5)</td></tr><tr><td><bold>Professional role</bold></td><td /></tr><tr><td><italic>Staff clinicians (full-time or part-time)</italic></td><td /></tr><tr><td> Clinical social worker</td><td>9 (10.1)</td></tr><tr><td> Licensed professional counselor</td><td>8 (9.0)</td></tr><tr><td> Nurse practitioner/physician assistant</td><td>6 (6.7)</td></tr><tr><td> Psychiatrist</td><td>19 (21.3)</td></tr><tr><td> Psychologist</td><td>34 (38.2)</td></tr><tr><td><italic>Clinicians in training</italic></td><td /></tr><tr><td> Psychology Intern (pre-doctoral and post-doctoral)</td><td>10 (11.2)</td></tr><tr><td> Practicum student (marriage and family therapy)</td><td>1 (1.1)</td></tr><tr><td> Practicum student (MSW)</td><td>1 (1.1)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0174908839-8">Interactions with autistic students</hd> <p>Eighty-five or 95.5% of the survey respondents reported that autistic students were enrolled at their college/university at the time of the survey, while the other four (4.5%) people reported being unsure. The majority of the participants (<emph>n</emph> = 73, 82.0%) indicated that they had interacted with at least one autistic student in the past one year. Eight (9.0%) participants reported that they had not interacted with any autistic students within the last year, and eight (9%) indicated that they were unsure.</p> <hd id="AN0174908839-9">Clinical comfort</hd> <p>Survey respondents were asked to rate their level of comfort with providing clinical care and developing therapeutic relationships with college students with autism, using a Likert-type scale (strongly agree to strongly disagree). Table 2 illustrates the percentage of clinicians who endorsed each rating for every statement. While the majority of respondents reported high degrees of comfort in treating students with depression (<emph>n</emph> = 68, 76.4% strongly agreed or agreed) and low degrees of discomfort in treating students with anxiety (<emph>n</emph> = 62, 69.7% strongly disagreed or disagreed), fewer participants (<emph>n</emph> = 48, 54.0%) reported that they strongly agree or agree with feeling confident in their abilities to diagnose autism spectrum disorder. High levels of comfort in communicating with students with autism (<emph>n</emph> = 68, 76.4% strongly agreed or agreed) and helping them advocate for themselves at the university (<emph>n</emph> = 64, 71.2% strongly agreed or agreed) were observed. The majority of respondents strongly disagreed or disagreed with feeling uncomfortable with students who make poor eye contact (<emph>n</emph> = 68, 76.4%) or struggling to identify therapeutic goals for autistic students (<emph>n</emph> = 69, 77.5%).</p> <p>Table 2. Clinician self-reported comfort level and attitudes toward autistic students (<emph>n</emph> = 89).</p> <p> <ephtml> <table><thead><tr><td>Statement</td><td><italic>n</italic> (%)</td></tr><tr><td /><td>Strongly agree</td><td>Agree</td><td>Neither agree nor disagree</td><td>Disagree</td><td>Strongly disagree</td></tr></thead><tbody valign="top"><tr><td>Level of comfort working with students with autism</td></tr><tr><td>I feel confident in my ability to diagnose autism spectrum disorder.</td><td char=".">12 (13.5)</td><td char=".">36 (40.5)</td><td char=".">15 (16.9)</td><td char=".">22 (24.7)</td><td char=".">4 (4.5)</td></tr><tr><td>I feel uncomfortable treating anxiety in students with autism.</td><td char=".">2 (2.3)</td><td char=".">12 (13.5)</td><td char=".">13 (14.6)</td><td char=".">42 (47.2)</td><td char=".">20 (22.5)</td></tr><tr><td>I feel uncomfortable with a student who makes poor eye contact.</td><td char=".">4 (4.5)</td><td char=".">7 (7.9)</td><td char=".">10 (11.2)</td><td char=".">39 (43.8)</td><td char=".">29 (32.6)</td></tr><tr><td>I struggle to identify therapeutic goals for people with autism.</td><td char=".">1 (1.1)</td><td char=".">7 (7.9)</td><td char=".">12 (13.5)</td><td char=".">54 (60.7)</td><td char=".">15 (16.9)</td></tr><tr><td>I can adequately communicate with students with autism.</td><td char=".">18 (20.2)</td><td char=".">50 (56.2)</td><td char=".">11 (12.4)</td><td char=".">7 (7.9)</td><td char=".">3 (3.4)</td></tr><tr><td>I feel comfortable helping students with autism advocate for themselves at the college/university</td><td char=".">22 (24.7)</td><td char=".">42 (47.2)</td><td char=".">17 (19.1)</td><td char=".">7 (7.9)</td><td char=".">1 (1.1)</td></tr><tr><td>I feel comfortable treating depression in students with autism</td><td char=".">16 (18.0)</td><td char=".">52 (58.4)</td><td char=".">13 (14.6)</td><td char=".">7 (7.9)</td><td char=".">1 (1.1)</td></tr><tr><td>Clinician's attitudes toward students with autism</td></tr><tr><td>Colleges/universities should actively recruit students with autism</td><td char=".">8 (9.0)</td><td char=".">36 (40.5)</td><td char=".">38 (42.7)</td><td char=".">5 (5.6)</td><td char=".">2 (2.3)</td></tr><tr><td>Students with autism are appropriate for group therapy</td><td char=".">11 (12.4)</td><td char=".">49 (55.1)</td><td char=".">21 (23.6)</td><td char=".">6 (6.7)</td><td char=".">2 (2.3)</td></tr><tr><td>Students with autism cannot manage the social challenges of a college/university environment</td><td char=".">1 (1.1)</td><td char=".">4 (4.5)</td><td char=".">11 (12.4)</td><td char=".">49 (55.1)</td><td char=".">24 (27.0)</td></tr><tr><td>It is possible to create similar, meaningful therapeutic relationships with students with or without autism</td><td char=".">36 (40.5)</td><td char=".">43 (48.3)</td><td char=".">7 (7.9)</td><td char=".">3 (3.4)</td><td char=".">0 (0)</td></tr><tr><td>The therapist's attitudes toward students with autism impact their progress in therapy</td><td char=".">47 (52.8)</td><td char=".">39 (43.8)</td><td char=".">2 (2.3)</td><td char=".">0 (0)</td><td char=".">1 (1.1)</td></tr><tr><td /><td /><td /><td /><td /><td /></tr><tr><td>Appropriateness of UCCC services for students with autism</td></tr><tr><td>Students with autism require specialized services that cannot be provided at the counseling center</td><td char=".">1 (1.1)</td><td char=".">18 (20.2)</td><td char=".">33 (37.1)</td><td char=".">33 (37.1)</td><td char=".">4 (4.5)</td></tr><tr><td>The mental health needs of students with autism can be adequately met at the counseling center/CAPS/student health center.</td><td char=".">4 (4.5)</td><td char=".">31 (34.8)</td><td char=".">35 (39.3)</td><td char=".">19 (21.4)</td><td char=".">0 (0)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0174908839-10">Clinician attitudes</hd> <p>Five Likert-scale questions were used to assess UCCC clinicians' attitudes toward autistic students. Survey respondents reported the strongest agreement with the possibility of creating similar, meaningful relationships with students with and without autism. The majority of the therapists (<emph>n</emph> = 73, 82.0%) strongly disagreed or disagreed with the assertion that students on the autism spectrum cannot manage the social challenges of a university environment. Even though the responses were mainly positive, larger percentages of ambivalence (neither agree or disagree) were observed in answers to whether universities should actively recruit students on the autism spectrum (<emph>n</emph> = 38, 42.7%) and if autistic students are appropriate for group therapy (<emph>n</emph> = 21, 23.6%).</p> <hd id="AN0174908839-11">Systems-level responses</hd> <p>Survey respondents were asked two questions to assess their views on the therapeutic fit of a UCCC for the mental health needs of autistic students. Similar percentages of respondents believed that autistic students' mental health needs can be adequately met at the counseling center (<emph>n</emph> = 35, 39.3% strongly agreed or agreed), and these students do not require specialized services that cannot be provided at the counseling center (<emph>n</emph> = 37, 41.6% disagreed or strongly disagreed). Thirty-three (37.1%) and 35 (39.3%) respondents reported that they neither agree nor disagree with those two statements respectively.</p> <hd id="AN0174908839-12">Training</hd> <p>Past educational experiences in autism were assessed in order to determine if and when participants received training on autism. Educational programs emerged as the most common source of past training in autism, though the number of respondents who reported training during an educational program (<emph>n</emph> = 38, 42.7%) was very similar to those who denied receiving training (<emph>n</emph> = 40, 44.9%). Training in autism from a UCCC was less common, as the majority of survey participants (<emph>n</emph> = 59, 66.3%) reported receiving no training in that setting. Eleven (12.4%) of the participants indicated that they were not sure to both questions. The majority of the respondents (<emph>n</emph> = 51, 57.3%) reported seeking training on their own to better serve students with autism, while a smaller number (<emph>n</emph> = 32, 36.0%) denied seeking out training. Of note, 28 survey respondents (31.5%) denied receiving training in both their educational program and at the UCCC, while 13 participants (14.6%) denied receiving training in these two settings or seeking training on their own.</p> <hd id="AN0174908839-13">Discussion</hd> <p>This preliminary study identifies areas of strength and weakness in UCCC clinician therapeutic work with college students on the autism spectrum. Survey respondents who participated in this study represented the range of roles at a UCCC, and many clinicians engaged in more than one type of service. From the authors' perspective, this is fairly typical. UCCC clinicians are often called upon to fulfill roles outside of direct clinical service, such as outreach and liaison relationships with other campus partners. These roles allow clinicians to play an active role in the campus community and impact programming and services beyond the UCCC reach. A wholistic approach of serving students within the UCCC framework and engaging the campus community more broadly, creates unique opportunities for UCCC clinicians to connect autistic students to a variety of campus supports. UCCC clinicians may also be called upon to consult with academic or student services leadership on issues facing a particular student on the autism spectrum, or the experience of neurodiverse students in general. Given the unique opportunities afforded to UCCC clinicians to provide support and advocacy, this survey provided relevant insights into their comfort level and attitudes toward students with autism as well as previous training in autism.</p> <p>Consistent with data suggesting that increasing numbers of students with autism are entering post-secondary education, almost all UCCC clinicians reported interacting with at least one student with autism within the past year. Clinicians also reported high degrees of comfort in treating common co-occurring conditions such as depression and anxiety, identifying therapeutic goals, and communicating with autistic students. Reassuringly, clinicians also felt confident in their ability to advocate for autistic students in the university setting. High self-reported levels of comfort with typical clinical care and student interaction was in contrast to a smaller number of clinicians who reported feeling comfortable making a new diagnosis of autism. It is possible that many UCCC clinicians are accustomed to interacting with students with an established autism diagnosis and may lack the knowledgebase, assessment tools, and clinical infrastructure needed to conduct an assessment in an adult population. However, greater than fifty percent of clinicians expressed comfort with conferring a diagnosis, suggesting that many clinicians feel confident in their ability to recognize autism and differentiate it from other differential diagnoses.</p> <p>Survey respondent attitudes toward students on the autism spectrum showed generally positive associations, with no meaningful differences found between clinician roles. UCCC clinicians reported high levels of agreement with their ability to create meaningful therapeutic relationships with autistic students. Clinicians also generally expressed support for the ability of students with autism to manage the social challenges of higher education. However, responses were mixed, with less than half of respondents agreeing with the assertion that colleges should actively recruit students on the autism spectrum. Though clinicians were not asked for further explanation, this finding was notable given that many colleges and universities have dedicated resources to increased racial diversity and global representation. As many students view autism to be an aspect of identity, rather than a disorder,[<reflink idref="bib36" id="ref35">36</reflink>] and campus communities are often enriched by the presence of neurodiverse individuals, this ambivalence may be a reflection of clinician stigma or lack of awareness. Clinician responses to questions about the capacity of UCCC's to meet the mental health needs of autistic students showed similar rates of ambivalence. Again, clinicians were not asked for further explanation, but this response may reflect concerns regarding the overall availability of resources or ability to provide care in centers that function within a short-term treatment model.</p> <p>Given that almost all clinicians reported interacting with at least one autistic student within the last year, low rates of training in autism warrant acknowledgement. While less than half of participants reported training in their educational program, training appeared even less available in the UCCC setting. Of concern, about a third of clinicians deny receiving training in either setting and 13 (14.6%) of the total sample reported receiving no formal training. Though the survey did not evaluate the robustness of past training, it is important to highlight the discrepancy between a baseline exposure to autism in a clinician's training program or continuing education, and their level of self-reported interaction with autistic students. Moreover, UCCC clinicians may be asked to deliver outreach and training on issues that impact this student population and may lack sufficient expertise needed to effectively fulfill this role.</p> <p>The findings of this study highlight several important priorities for colleges and universities. It is critical that colleges and universities recognize the needs of autistic students who are enrolling in greater numbers. Some of these students are likely to seek services from UCCC clinicians who, though concerned and committed to supporting their needs, often have not received training in autism. Colleges and universities would be well served by increasing resources to support staff development in this area. Further, medical schools and graduate programs in social work, psychology, and counseling should ensure that all students receive education in autism and neurodiversity.</p> <p>The major limitation of this study is the reliance on self-reported data, which cannot eliminate the effects of social desirability as well as inflated self-confidence. Future studies that use objective measures to assess therapist competence in supporting students with autism are highly recommended.</p> <p>This preliminary study highlights important areas of focus for colleges and universities who aim to improve their services for college students on the autism spectrum. As more autistic students enroll in post-secondary education, UCCC clinicians are likely to be called upon to provide support. A proactive approach which bolsters their strengths and mitigates their challenges will be highly beneficial to not only individual students, but the campus community as a whole.</p> <hd id="AN0174908839-14">Authors note</hd> <p>We have utilized identity first language throughout the majority of this manuscript in order to respect the preferences of students and self-advocates who have informed our work.[<reflink idref="bib37" id="ref36">37</reflink>]</p> <hd id="AN0174908839-15">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States of America and received approval from the Duke University Campus Institutional Review Board.</p> <ref id="AN0174908839-16"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.2013239.</bibtext> </blist> </ref> <ref id="AN0174908839-17"> <title> References </title> <blist> <bibtext> Mandy W. Autism spectrum disorder–An evolving construct. In: Skuse D, Bruce H, Dowdney L, eds. Child Psychology and Psychiatry: Frameworks for Clinical Training and Practice, 3rd ed. Wiley Blackwell; 2017 : 197 – 202.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Association AP. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. 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  Data: Meeting the Mental Health Needs of Autistic College Students: A Survey of University and College Counseling Center Clinicians
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  Data: <searchLink fieldCode="AR" term="%22Tara+Chandrasekhar%22">Tara Chandrasekhar</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5043-4286">0000-0001-5043-4286</externalLink>)<br /><searchLink fieldCode="AR" term="%22Qin+Hu%22">Qin Hu</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(1):40-46.
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  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: Objective: University and college counseling centers (UCCCs) are a front-line support for the mental health needs of autistic students, though little is known about clinician attitudes, comfort level, and training in autism. Participants: 89 UCCC clinicians were recruited via email listservs. Methods: The authors developed a survey which assessed attitudes, comfort level, and training in autism. Results: The majority of clinicians (82.0%, n=73) had interacted with autistic students in the past year, and reported high levels of comfort with treating anxiety and depression. However, a smaller number reported confidence in their ability to diagnose autism. Training on autism emerged as an important deficit, as 31.5% of the clinicians denied receiving training either in their educational program or the UCCC. Conclusions: In this pilot study, clinicians reported a discrepancy between self-reported levels of comfort with autistic college students and past training, highlighting continuing education as an important area for future intervention.
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