Autism and Driving in Qatar- Arabic by mubadara.social

A PRACTICAL GUIDE FOR TEACHING AUTISTIC INDIVIDUALS HOW TO DRIVE

Autism and driving in Qatar

A practical guide for teaching autistic individuals how to drive

Authors

Wael Alhajyaseen (Associate Prof. Dr.)

Hélène Dirix (Dr.)

Wondwesen Mamo (Mr.)

Veerle Ross (Dr.)

Kris Brijs (Prof.)

Tom Brijs (Prof.)

Abdrabo Soliman (Prof.)

Qinaat Hussain (Dr.)

March 2025

Doha, Qatar

ACRONYMS

ASD - Autism Spectrum Disorder

CRPD - Convention of the Rights of Persons with Disabilities

HIPPEA - High Inflexible Precision of Prediction Errors

QBRI - Qatar Biomedical Research Institute

QNRF – Qatar National Research Fund

QNV – Qatar's National Vision

Please refer to this booklet as follows:

Alhajyaseen, W., Dirix, H., Mamo, W., Ross, V., Brijs, K., Brijs, T., Soliman, A., Hussain, Q. (2022). Autism and driving in Qatar: A practical guide for the learning process of autistic drivers.

PREFACE

With on average 1 in 54 to 160 who are diagnosed with autism 1 worldwide and 1 out of 87 children in Qatar, it is not difficult to imagine that many autistic learner drivers are out there as well. However, it is not always easy for them to learn how to drive and obtain their driver's license, nor is it easy for those involved in teaching them how to drive (e.g., instructor, parent). Studies from the United States showed that fewer autistic persons obtain their driver's license and obtain it later than non-autistic drivers. A possible explanation is that certain characteristics linked to autism may interfere with learning to drive . For example, another driver makes a hand gesture while driving. Depending on the context, this can mean different things: the driver can be angry, or s/he wants to be polite and let you go first. To interpret this hand gesture correctly, the context is crucial. However, this can be difficult for some autistic individuals. They will see the other driver make a hand gesture but are less likely to make associations between what is happening and in which context this happens. Therefore, the autistic driver may not understand precisely what the other driver wants to express by their hand gesture. Furthermore, autistic learner drivers report a lot of stress and anxiety when learning to drive, which may also negatively impact the learning process and obtaining a driver's license.

In this regard, Qatar was one of many leading nations signing the Convention of the Rights of Persons with Disabilities (CRPD) treaty in 2008. Specific to autism, Qatar proposed the idea of celebrating World Autism Awareness Day, which the United Nations General Assembly later accepted. Although there is more awareness about autism, there is not much known about autism and learning to drive in Qatar. As a result, it is not always easy for driving instructors to tailor their lessons to the needs of autistic persons.

The State of Qatar strives to achieve high quality of life for all, as outlined in the National Vision 2030. In this regard, the government promulgated the right of respect for People with Special Needs under Law No. 2 of 2004. For this reason and because of the CRPD treaty, QNRF-funded research has been conducted on autism and driving at Qatar University. Based on this research, an evidence-based booklet has been designed for driving instructors to help them tailor their conventional driving lessons to the needs of autistic persons in Qatar. With this booklet, we want to give the driving instructor more information about what autism is but also to provide concrete recommendations on how to adapt driving lessons to the needs of autistic persons.

The final purpose of the booklet is to improve the day-to-day mobility of Qatari and Qatar residents with autism and their families and, accordingly, to ameliorate their daily living circumstances economically, socially, and in terms of quality of life. The booklet is structured as follows. First, we introduce autism and its characteristics. Next, we present recommendations that can be used by driving instructors while they teach autistic individuals.

INTRODUCTION

How a person thinks, feels, interacts, and/or experiences the environment can be affected by autism. A person is born with it, and it stays with them for the rest of their life. However, having autism does not tell anything about a person's capabilities. While autism impacts certain aspects or activities of daily living, many autistic people can find a nice job or participate safely in traffic. And although they sometimes need a little extra guidance, they can lead a qualitative life.

What is autism?

Many people have a vague idea of autism, mainly fed by the media (who has not seen or heard from Rain Man?) with the necessary prejudices and misconceptions. However, autism is not easy to describe as it manifests itself differently in each case.

Autism (short for Autism Spectrum Disorder or ASD) is a neurodevelopmental condition caused by differences in the brain. It is often said that the brain of autistic people is differently wired than a non-autistic brain. Therefore, it is sometimes called an 'information processing disorder', meaning that an autistic person understands the world and its information differently compared to a non-autistic person. For example, sensory stimuli such as taste, touch, and scent are sometimes experienced more intensely than normal.

The main cause of autism remains unclear to this day. However, some studies proposed that there are causal factors that can be grouped into different categories; genetic (e.g., autism in the family history, metabolic imbalance, etc.), environment (e.g., exposure to environmental toxins, etc.), and psychosocial (e.g., exposure to stressors during pregnancy, etc.). Autistic individuals often experience difficulties with social communication and interaction, and demonstrate restricted or repetitive behaviors or interests. They may also have different ways of learning, moving, or paying attention. However, it is important to note that non-autistic people might also have some of these symptoms. So always be careful to label someone as "autistic". That is only something a doctor can do. Nevertheless, if you notice that someone is exhibiting specific characteristics of autism, it can never hurt to consider the recommendations forwarded in this booklet.

Often the behavior of an autistic person stands out. Some do not look into your eyes when talking to you. Others are overly interested in one specific subject. Some are very attached to their routines. There are hundreds of other behaviors that we typically link to autism. However, this is only the tip of the iceberg. The behavior your see is only a small part of autism. There are many underlying factors and characteristics that contribute to these behaviors. We will describe the most common features of autism further in this chapter. It is crucial to note that autism is described as a spectrum disorder, meaning that every person is different, with their own challenges and abilities. Therefore, it is very well possible that person 'A' experiences completely different things than person 'B'. Consequently, when working with an autistic individual, it is crucial to tailor your lessons as much as possible to the person.

To date, men are primarily diagnosed with autism. Currently, for every four men worldwide, only one woman is diagnosed. However, in recent years, research has shown that most women are simply better at camouflaging their autism characteristics. Some examples are: forcing oneself to make eye contact during conversations, imitating expressions and social behavior, or preparing jokes in advance. Thus, we cannot simply assume that there is no underlying autism diagnosis just because someone does not exhibit the typical behavioral characteristics of autism.

To establish a good social interaction, it is crucial to understand the desires, intentions, and beliefs of others and yourself. Through theory of mind , we are able to understand the opinions of someone, even if they are different from our own. However, it can be challenging for autistic individuals to determine the mental state of others, and they can also experience problems with social reciprocity. This is the back and forth interaction in communication. It consists of knowing how and when to respond to others' social interactions. Making accurate predictions of other people's intentions is, of course, a crucial ability in traffic since there is constant interaction with different road users.

What we do as humans usually takes little active effort on our part. As such, most of the things we do throughout the day, such as breathing, eating, talking, etc., are automated actions. To ensure that the rest of our day runs smoothly, we use our executive functions . Some examples are planning, organizing, regulating emotions, managing time, and solving problems. However, autistic people often experience executive functioning difficulties, making their lives more complex than ours. Some sources even claim that up to 80% of the autistic population experiences problems with this. However, this has nothing to do with the cognitive abilities of an autistic person. While many autistic people have thriving professional careers, they may experience difficulties managing the more fundamental aspects of their daily lives.

In more recent years, an increasing number of researchers have considered the previous theories (i.e., theory of mind and executive functions) outdated. Nevertheless, they remain very important in clinical practice, so we certainly cannot discard them entirely. The High Inflexible Precision of Prediction Errors (HIPPEA) theory was proposed relatively recently as an alternative to the established theories. This theory assumes that everyone (with and without autism) makes predictions of what will happen. Even if our predictions are mainly wrong, it will still take our brain less effort to react compared to when it has to start from nothing. Since we do not know what is coming, our predictions have to be broad enough, and that is precisely where autistic individuals tend to go wrong. Their predictions are often too narrow, and they also attach greater importance to prediction errors, leading to stress and anxiety. This is one of the possible reasons why autistic people adopt repetitive behaviors, as they offer predictability and therefore are calming and stress-reducing.

Just imagine. You have to go to a party with your family and friends. Then your brain will probably already predict that the ballroom will be beautifully decorated, that there will be food and drinks, that people will dance, etc. However, your brain will not predict that the chairs will be green or that the main course will be Madhruba, etc. However, this is what an autistic person often will do, resulting in many more prediction errors. Add to that the fact that it is also more challenging for them to cope, and you have the whole picture.

To respond correctly and quickly to sensory stimuli and/or predictions, the use of context is of great importance. Everything is contextdependent, and it is often more difficult for autistic persons to use the context. For example: when you are driving, and a vehicle is blocking the lane, in theory, you are not allowed to pass the vehicle because of a solid white line. Based on the environment, you have several options: (1) stop and wait for the vehicle to leave, (2) pass the vehicle (and cross the solid white line), or (3) turn back and take a different route (in this case, you also have to cross the solid white line). Most people will choose this option if they can safely pass the vehicle. However, using the environment to make predictions and decisions is more difficult for autistic individuals. A solid white line means not crossing, so they will not do so regardless of the context.

Always explain to an autistic person why you are taking a particular action in a specific context. This will help them to understand how others use and interpret the context.

So, we do not just give meaning to what we see. We literally also use the context to see and understand the bigger picture. The same happens with language : you will have to interpret a sentence differently depending on the context. For example, when someone says: "Well, I have never seen anyone do something like this before." Does that mean that the person did something good or something bad? Figuring out the exact meaning of what was said can be difficult for an autistic person. Similarly, ambiguity or figure of speech is sometimes harder to interpret for autistic persons.

Be exact in what you mean to say, preferably as literally as possible.

Furthermore, autistic individuals often have difficulties performing different tasks simultaneously and switching between tasks . Applying learned skills in new situations (i.e., generalization) is another known problem. Moreover, automating things can be difficult for them as well. In contrast to this lack of flexibility, individuals with autism are strong in rule-based learning. However, the potential downside is that they want to hold on to these rules too tightly.

To conclude this chapter, we would like to reiterate that the characteristics and difficulties described above do not necessarily apply to every autistic person . Therefore, always be cautious and certainly do not assume that your autistic learner will exhibit or experience all of these characteristics and difficulties or to a similar extent. If in doubt, it is best to discuss this with workshop participants.

Autism in Qatar

It is not a straightforward task to get a clear picture of the prevalence of autism among all segments of society in Qatar. As observed in most Gulf countries, in Qatar, the prevalence of autism demands more nationwide epidemiological research across different age groups. Recently, some studies in Qatar attempted to portray the prevalence of autism, specifically among school-age children. However, the prevalence of autism among adults remains unclear to this date.

Epidemiological studies from the Qatar Biomedical Research Institute (QBRI) estimated that 50.500 children under the age of five and 187.000 youths under the age of 20 have autism in the Gulf region. A nationwide epidemiological study conducted by a research team from the QBRI addressed many school-age students in Qatar. The prevalence rate of autism from 2015 to 2018 among children in the mainstream school (6 to 11 years) is estimated at 1.14%, or 1 in every 87 children . The prevalence in terms of gender is 1 in 56 boys and 1 in 230 girls (ratio 4:1). In sum, the study estimated that around 4.791 individuals aged 1 to 20 years have autism in Qatar.

The Qatar National Autism Plan

In the context of the Gulf region, many countries have not yet given significant attention to autism. The absence of a national priority for autism can affect the adequacy of services provided to autistic individuals and their family members. Therefore, in 2017, Qatar introduced an autism-oriented nationwide plan to enhance the lives of autistic individuals and their family members.

The most recent national strategy tried to address the needs of individuals with a disability was the Qatar National Autism Plan. The national plan aimed to improve the 'day-to-day' lives of all autistic individuals and their families in terms of education, health, social affairs, and quality of life. The milestones for the national plan were when Qatar proposed the idea of celebrating World Autism Awareness Day in 2007, which the United Nations General Assembly later accepted, and when Qatar signed the CRPD treaty in 2008. With this plan, the State of Qatar strives to achieve equality and justice for all, as outlined in the National Health Strategy 2022 and Qatar's National Vision 2030.

The National Autism plan 2017 - 2021 consists of evidence-based recommendations that address many aspects associated with autism in Qatar. The following recommendations are included in the National Autism Plan:

• Promote awareness-raising campaigns regarding autism.

• Conduct research to identify appropriate approaches and intervention mechanisms for autistic individuals and their family members in the context of Qatar.

• Establish a research center that comprises researchers from diverse fields in the area of autism.

• Develop educational websites to provide evidence-based training materials to autistic people and their family members.

• Prepare culturally oriented autism diagnostic and assessment tools.

• Capacity building for professionals about services to autistic people.

• Prepare plans and implement them to provide a wide range of opportunities to individuals with autism.

Autism and Driving

As we transition into adulthood, the role of independent transportation , more specifically being able to drive, becomes increasingly important. Driving ensures efficient and time-saving travel to achieve routine activities associated with occupation and education. It also enables people to participate in social activities, and form and maintain social relationships. Moreover, driving enhances psychological well-being and provides better access to healthcare, which are all crucial perquisites to living a qualitative life.

Driving a car is a complex and goal-oriented task consisting of several sub-tasks that run in parallel or between which one has to switch smoothly (e.g., steering, changing lanes, paying attention to other road users, etc.). Moreover, a driver must deal with sudden changes in the driving environment (e.g., time of the day, weather conditions, the environment, etc.). Driving performance thus depends heavily on perceptual, motor, and cognitive skills such as estimating distances and planning sequences of motor actions, etc. The relationship between autism and driving has been quite extensively investigated worldwide. In Qatar, we also launched a study to examine the driving behavior of autistic individuals and their opinions about autism and driving. These first indicative results will be discussed later on in this booklet.

Although being able to drive is deemed so important, it appears from research that being able to drive a car is not so easy for autistic persons. In fact, a study conducted in the United States showed that only one in three autistic young adults obtained their driver's license compared to more than 80% of the general population. The same study also showed that autistic people obtained their driver's license on average 9.2 months later. Moreover, many autistic individuals experience the examinations linked to obtaining their license as stressful, and they seek more professional guidance than the general population. The most logical explanation is that several characteristics linked to autism can influence the process and ability of (learning to) driv(e)ing. The most important ones will be further explained in this chapter.

Nevertheless, it is important to note that even though (learning to) driv(e)ing can be more difficult for autistic individuals, they can still be considered equally capable drivers when given proper and well-tailored education and training.

When looking at basic driving abilities (e.g., steering, changing lanes, paying attention to the right of way rules, etc.), autistic drivers perform worse compared to non-autistic counterparts. In addition, switching between tasks can also be more challenging for them. They also tend to respond inappropriately or slower to several stimuli (e.g., other roadway users, the environment, etc.). Moreover, they experience some difficulties in planning their movements. Yet, it is important to perform the different sub-tasks of driving smoothly and fast enough to ensure a smooth traffic flow. For example: parking a car between two other vehicles requires planning the action, adjusting to the environment, and motor actions such as steering and braking. If all this is not smoothly and properly coordinated, it will lead to problems such as delaying traffic or not being able to park the car.

A general problem experienced by many autistic drivers is that they find it harder to modify their reactions to a specific context since it is more difficult to interpret and use the context. This can negatively influence the process of learning to drive as it is also much more difficult for them to generalize learned actions to another context. This lack of generalization can cause problems since unfamiliar routes and sudden changes in the driving environment (e.g., traffic density, weather conditions, obstruction due to an accident) are common during driving.

Likewise, hazard perception , i.e., recognizing and reacting to hazards while driving (e.g., a child crossing the street, a car that suddenly backs out into the driver's path, etc.), can be more difficult for autistic drivers. Especially in the case of social hazards (e.g., pedestrian behavior), autistic drivers often notice and react later than they do to non-social hazards (e.g., an obstacle on the road). There is no denying it: driving is and remains a social phenomenon where one must consider not only one's own behavior but also the behavior of other roadway users. But as we mentioned earlier, this is not always easy for autistic individuals. For example, when you have the right of way at an intersection but see the other driver (who has to yield) move to depart, you will automatically let go of the

gas pedal. Predicting the other driver's behavior is very important to avoid a potentially dangerous situation. In other words, to participate safely in traffic, it is important to predict what the other person will do and react correctly and timely.

In terms of rule compliance (also called rule-boundness), we notice a certain ambiguity in autistic drivers. On the one hand, strong rule-boundness can lead to a rather rigid driving style (e.g., never crossing a solid line, no matter the circumstances). Furthermore, they experience significant stress and anger when other road users do not strictly follow the rules. On the other hand, the same rule-boundness can lead to a much safer driving style with fewer violations committed (e.g., sticking to the speed limit). In previous studies, driving instructors also indicated that this rule-boundness is a positive asset.

A growing number of studies focus on how autistic individuals and those around them perceive driving . These show that they drive less frequently than non-autistic persons and see themselves as worse drivers. Several studies also found that autistic drivers perceive driving as stressful and often experience anxiety while driving. The negative experiences while driving occur both in individuals who have already obtained their driver's license and those still learning. Parents of autistic learner drivers acknowledge that: they report less positive and more negative attitudes toward driving by their children than parents of non-autistic peers. The above findings are confirmed by the study conducted by Qatar University (more information on this topic is given below in this booklet).

A study from Belgium examining the learning experiences of young autistic individuals, their parents, and driving instructors found that multitasking, violating traffic rules, and reacting to unpredictable situations are seen as the most common problems while learning to drive. Furthermore, they indicated that they often require more lessons than non-autistic learner drivers. Therefore, it is recommended that more but shorter lessons are given so that autistic individuals have enough time to adjust and learn.

Although we have addressed several negative aspects of autism and driving here, the relationship certainly is not entirely negative. It appears that autistic persons do not differ from non-autistic persons in many aspects of driving, such as the number of collisions, lane position, stops in traffic, etc. Furthermore, once autistic drivers have learned to drive, they can be seen as equally capable drivers as their non-autistic counterparts. While some autistic drivers experience driving as a stressful and challenging activity, others experience a feeling of freedom and independence as they are driving. Moreover, when it comes to learning to drive, the relationship can be more positive: it appears that tailored training has a significant (positive) impact on their attitude toward driving, and they experience less stress and anxiety.

From everything you can read above, it is clear that it is not easy for an autistic person to learn to drive, but it is certainly not impossible. They simply need additional and specific guidance to be able to participate equally in traffic afterward. And remember, autism is a spectrum disorder : the characteristics described above probably never apply to each person with autism.

Autism and Driving

According to the study's outcome, autistic individuals believe that driving is an essential skill to fulfill day-to-day activities associated with mobility in the state of Qatar. If autistic individuals can drive independently, they can manage their mobility without experiencing the social anxiety resulting from social interaction while using public transport in Qatar.

Although driving is necessary for autistic drivers, many frequently experience negative feelings (e.g., stress and panic while driving). Such feelings are more pronounced among drivers with autism than among non-autistic drivers. Moreover, the attitude of autistic drivers toward driving is more negatively oriented than non-autistic individuals.

The same study indicated that autistic drivers face difficulties associated with driving activities in terms of driving performance. Some examples are: driving new or busy traffic routes and passing through dark environments, unexpected traffic situations, long-distance driving, staying focused without being distracted by their thoughts and the environment, and tolerating auditory over-stimulation (e.g., car horns), visual and cognitive over-stimulation. Individuals with autism have to make an extra effort (compared to a non-autistic peer) while driving. The reasons for making an extra effort by autistic individuals include properly managing the gas pedal, keeping the fear associated with driving to a minimum, and staying focused and calm while driving. Also, it appeared that licensed autistic drivers who were trained according to a conventional instruction approach were afraid to drive independently and dependent on their parents or public transport. It can be argued that the level of selfconfidence of licensed autistic drivers who want to drive independently could be enhanced through driving instruction that is better tailored to their needs.

Other findings from that study were that autistic individuals showed more deviation from the ideal roadway position and more incorrect lane changes. They also experienced more stress and showed greater mistakes on other concurrent driving tasks than non-autistic people. More in detail, these differences are observed when they drive while engaging in other activities of different complexity levels (e.g., responding to passengers' questions ranging from simple to complex conversations) in a simulated environment. Moreover, autistic individuals showed higher crashes, riskier approaches to the front car, higher speed nearby hazards, and unstable speed variations compared to nonautistic individuals.

Like those autistic drivers, parents indicated that their autistic children face difficulties with multitasking in driving, as well as with concentration, violation of traffic rules, and inability to predict other road users' behavior. More in detail, parents mentioned that their children faced challenges in performing the following specific driving tasks, including smooth steering, going straight, smoothing acceleration and deceleration, crossing streets, active use of a mirror, changing lanes, keeping lane positioning, noticing changes in the traffic situation, responding to visual signs, predicting traffic behavior. Concerning autistic individuals who have not yet been licensed, parents are not interested in sending them to a driving school because they are afraid that their children may face danger while driving. Working toward an evidence-based and better-tailored strategy to teach those drivers with autism can be a solution to reduce such adverse effects of autism on individual mobility.

Currently, autistic individuals receive driver training in a "conventional" way. The instructional methodology is the same across all trainees regardless of their difference (e.g., autistic and non-autistic people). For instance, the current study established that driving school instructors in Qatar self-declared they lack knowledge and practice concerning training autistic individuals. Consequently,instructors often apply the same training to all driving students. For example, some driving instructors from Mowasalat's Karwa Driving School were surveyed about their knowledge and practice related to autistic individuals in the context of driving. It was noted that almost none of them had prior knowledge about autism.

Driving instructors were later asked to read a list of autism characteristics and were requested to indicate whether they had previous experience in giving training to students with such traits. Only very few of them had previous experience with teaching those students. Due to the absence of autism-tailored driving lessons, instructors may lack the expertise skills to quickly notice learner drivers with autism characteristics and fail to apply the required instruction according to those students' demands. Such a gap in knowledge, expertise, and experience may result in more autistic people not obtaining a driver's license. Both driving instructors from Karwa driving school and parents acknowledged the need for specialized training and an autism-tailored approach toward driving instruction.

Clarity and Predictability

While there are many different theories and characteristics of autism, all experts agree that autistic individuals need clarity and predictability . If this is not provided, it can lead to acute anxiety and stress, which should be avoided. Studies show that the lack of predictability is a vital stress factor during the examination moment(s) when obtaining a driver's license. Predictability can make the often unstructured world of autistic individuals more organized, easier, and less chaotic. What seem small adjustments to us can be a world of difference for them.

The next chapter elaborates on how you can incorporate this predictability and clarity in your driving lessons. The next chapter contains ten concrete recommendations. However, there are also some general recommendations that you can always implement. For example, always make sure that what you say is as specific and explicit as possible and certainly do not assume that the autistic person will use the context to interpret your question.

To create clarity and predictability, the following six questions must be answered when explaining something or asking a question:

1. What am I going to do?

2. How do I go about it?

3. Who is involved?

4. Where are we going to do it?

5. When will it happen?

6. Why are we doing it this way?

The answer to the questions above should always be clear to an autistic person. If there is any reluctance to be exposed to a specific situation or engage in a task, it is best to first check if the questions above have been clearly answered. It is often not that they do not want to do the task but rather do not have specific answers to the questions above.

Other things you can do to increase predictability are writing down a narrative, drawing situations, creating a schedule and sticking to it, doing things according to a particular routine, working with checklists, explaining the rules clearly, and sticking to facts.

Some autistic individuals will also have certain routines or rituals that may seem strange to us at first glance. For example, always wanting to put an object in the same place in the car or asking the same question repeatedly. Do not try to argue with them as long as it does not interfere with the situation. This is often a way for them to deal with stress as they experience difficulties understanding what's going on around them, and rituals provide them with some control of the situation.

We do not find it difficult to know how the world works, assess what others will do or think, or understand what we are experiencing ourselves. This seems like a natural process to us, and it gives us a sense of security. For an autistic person, however, it is different. Can you imagine how unsafe and unpredictable life is when new situations miss a logical basis? Unexpected events and 'exceptions to the rule' characterize traffic and often lead to unpredictable situations. Fortunately, it appears that despite this unpredictable nature, most autistic people can learn to drive . As much knowledge as possible about how traffic works, and as many facts as possible about different traffic situations, can help the autistic person get a grip on his participation in traffic.

RECOMMENDATIONS FOR DRIVING INSTRUCTORS

This booklet was created specifically to provide more insight into and advice for teaching autistic individuals how to drive . Nevertheless, as you will discover by reading further, these recommendations are actually beneficial to all learner drivers. For instance, everyone could profit from a clear structure during the driving lesson. Each recommendation follows the same structure: first, the recommendation is briefly explained, then it is indicated what you can do more specifically, and finally, an illustrative practical example is provided.

STIMULUS PROCESSING

Recommendation 1: Create a sense of rest

When you drive a car, you encounter a constant stream of stimuli . It can be challenging for novice drivers (with and without autism) to process all of these stimuli quickly and smoothly. Everything you do as a driving instructor during the lessons creates an extra stream of stimuli. Especially for autistic learner drivers, these constant streams of stimuli can be hard to manage. It is therefore essential to keep all additional stimuli to a minimum. This ensures that there is enough space left for the actual learning process.

What can you do yourself as a driving instructor?

• Make sure that you are calm and remain calm during the entire lesson.

• Do not touch your student unnecessarily.

• It is best just to call out his name to draw his attention.

• Provide routine in your approach.

• Give the student time to process the information.

• When an answer is not immediately given, wait calmly and do not ask another (different) question.

• Listening and driving at the same time can be difficult. Therefore, stop the car as much as possible when you want to say or explain something.

• Split the lessons into shorter sessions of no more than one hour.

An example:

Multitasking can cause anxiety and extra workload in autistic learner drivers. When you overload your student with many additional stimuli, s/he will automatically start to listen less carefully to you. So, as an instructor, ensure that your learner driver can listen to your instruction as effective as possible. Suppose that you have to intervene during the lessons to avoid an accident, then make sure that you carry out the intervention in an unambiguous, calm, non-judgmental, but friendly tone. In this way, your student must respond only to what you say. By, for example, sighing or reacting angrily, you actually cause the learner to focus less on the content you want to transfer. So always be aware of the tone, intonation, and message of what you want to communicate. Leave your facial expressions, hand gestures, and (angry) vocal tone behind. These are unnecessary and distracting stimuli that will only cause the learning moment to miss its target.

Recommendation 2: Provide an overview

An autistic individual often has a harder time seeing the bigger picture . S/He will first examine the fragments and interpret them when encountering a new situation. The entire space is perceived later on, which is the exact opposite of how most people perceive a situation. Because of this fragmented thinking, an autistic person can be very good at learning facts, but linking the facts to a larger context can be much more difficult.

What can you do yourself as a driving instructor?

• Help distinguish between main and minor things, then focus on the main things.

• Realize that knowing traffic rules does not mean you can apply or adapt them to the situation.

• Point the bigger picture out to an autistic person and let them describe it in their own words as much as possible. When an autistic person notices a familiar detail, s/he is often tempted to start an action immediately without paying attention to anything else.

An example:

When you ask a student during the lesson if it is safe to overtake the vehicle in front of you at a time when there are no oncoming vehicles, the autistic student may still make a partial or complete error in judgment. This can happen because s/he has not been able to comprehensively overview the entire traffic situation and has trouble seeing the connection between everything in that situation. For example, the student may have missed that the car behind wanted to pass, or s/he was driving uphill so that the oncoming traffic was not visible, making it not a safe moment to overtake. Therefore, always make sure that the student is aware of all the elements in a certain traffic situation to make an informed choice.

COMMUNICATION

Recommendation 3: Be clear and create predictability

An autistic person needs to know what exactly is expected of them . When he does not know what is expected or what s/he can expect from you and/or the lesson, s/he can experience anxiety, fear, and stress. The more precise, recognizable, and calmer the situation, the lesser the autistic student experiences inconveniences (stress, anxiety, etc.), and the more s/ he learns during the lesson. Rules provide clarity: the more rules, the more guidance and the more comfortable an autistic individual feels.

What can you do yourself as a driving instructor?

• Be as specific as possible in what you say and do.

• Deal with a problem step by step, only one thing at a time. In addition, wait a moment between each step so that the student has time to process each step.

• Speak in clear sentences.

• Explain in advance what is going to happen. When something is not yet certain, acknowledge this. In this case, also clarify (if possible) what the different events might be that contribute to a particular situation and how the student could react to them.

• At the beginning of the lesson, indicate what will be explicitly practiced during that lesson (for example, parking, driving on the highway, etc.).

• Avoid words like "maybe" and "possibly" if they are not essential.

• Repeat your instructions regularly, preferably in the exact wording.

• Remember that "acting busy" and "not listening" are usually requests from the student for more clarity.

• In the case of unwanted behavior, don't focus too much on the unwanted behavior but emphasize the type of behavior you want to see.

• Mention the traffic rules.

An example:

You approach a roundabout during the lesson, and you instruct that the student can turn left on the roundabout. The autistic student may interpret this as a request to turn left immediately instead of taking the roundabout from the right. In that case, the student will not take the roundabout three-quarters around but will turn left against traffic (i.e., ghost driving). In this case, you better say: "On the traffic circle, you turn right at the third exit" and not "turn left." So always be clear in what you expect from the student and how the student can approach this. You can do this by drawing the situation beforehand, writing out a step-by-step plan, showing the situation first yourself, and/or making your instructions as specific as possible.

Recommendation 4: Think about nonverbal cues

Some autistic individuals can have a more challenging time reading non-verbal gestures and/or emotions in other people. Those people often can train themselves to deal with non-verbal communication, emotions, or displays of emotions in a certain way. For example, someone may have learned that when someone yells, he is angry, but it can just as well be screaming out of joy, which the autistic person will not interpret as such. If an autistic person has difficulties reading and correctly interpreting non-verbal signals, this can cause confusion, anxiety, and stress.

What can you do yourself as a driving instructor?

• Maintain a neutral attitude throughout the lesson, even in difficult or dangerous situations.

• Don't make big hand gestures to get your point across.

• Make sure your voice, expression, and body language are consistent.

• Don't force eye contact if the student avoids it.

An example:

When merging on a very busy roundabout or changing lanes, the student may need to adjust their behavior to the other road users. To do this, the student must understand the non-verbal signals of the other drivers (for example: raising your hand to let someone pass). Always explain the signs of other drivers to the student and group them into types (rejecting, inviting, ignoring, etc.), so the student learns to interpret the signals correctly. In this way, the learner driver is better able to give meaning to the non-verbal signals of his fellow road users, and s/he will be able to act more adequately on them.

Recommendation 5: Speak plain language

The way we make use of language can be very unclear, especially for autistic individuals. Ambiguous or unclear use of language often completely confuses autistic persons. For example, when you tell your student during the driving lesson around 5 pm that s/he will need to take at least ten more hours of driving lessons, you mean that the student will need to take at least ten more hours of lessons in the future spread over several driving lessons.

An autistic individual might respond with: "now still?" because s/he is taking it literally, which means the lesson would last until 3 am. This is exacerbated when the use and tone of voice do not match the message that is being delivered.

What can you do yourself as a driving instructor?

• Avoid using sarcasm or cynicism when talking to an autistic person. If it does happen, immediately clarify what you mean.

• Avoid figurative language if you are unsure if the autistic person understands it, or clarify that something is meant to be metaphorical. For example, when you say: "you are driving me crazy", you don't mean that this is because of the driving itself but because of the situation.

• Use open-ended questions as little as possible.

• Visualize where possible: make clear notes, clarify your notes or what you are saying with a drawing, and/or write out a step-by-step plan on paper.

An example:

Check with the autistic student to see if s/he understands the message you intended to provide. Moreover, always define what you mean by an ambiguous or unclear word. For example, if you say that someone should drive " calmly " toward an intersection, what exactly do you mean by "calmly"? How many kilometers per hour is that? Finally, remember also that your words can be interpreted literally.

DRIVING AND TRAFFIC RULES

Recommendation 6: Help generalizin

It can be challenging for autistic people to apply a specific skill they learned in situation A to a similar situation B, happening at a different time and in another place.

What can you do yourself as a driving instructor?

• Check whether it has been understood that something is a general rule. You can do this by asking about it explicitly.

• Make clear, unambiguous agreements and set rules.

• Apply the rules to different situations and formulate exceptions, changes, and additions.

An example:

Non-autistic individuals can easily transfer what they have learned to similar but different situations. Therefore, you will also expect this from an autistic person as a driving instructor. But this expectation may not be entirely correct. For example, a roundabout with six exits and lots of signs is a different roundabout than one in a residential area with three exits. Make the similarities and dissimilarities clear to the student during the driving lessons while making links with other situations.

Recommendation 7: Correct misconceptions

It may happen that autistic persons have created a rule or solution strategy of their own, thus creating their "own truth" . However, it may be that this rule conflicts with the generally applicable rule(s). In a conversation with this person, you can use visualization strategies to counter this self-created rule.

What can you do yourself as a driving instructor?

• Have the student explain a rule to you in their own words.

• Pay attention to repeated mistakes. Talk about this with the student.

• Remove a wrong rule by clearly naming it and visually indicating the deletion of this rule, e.g., by drawing a red cross. After that, visualize the rule that does apply.

An example:

If a student had an unpleasant experience with a taxi in the previous lesson because the driver cut him off, the student might have made a fixed link: "all taxi drivers may cut you off". You should then question the student's link, in which situation s/he made this association, and then "redesign" it to a correct link.

Recommendation 8: Learn to make exceptions

Autistic individuals are often very rule-bound and therefore have a challenging time making exceptions to learned rules. However, to drive a car properly, it is sometimes necessary to make exceptions to the learned rules. For example, when an obstacle blocks the way, you might have to cross a full line to continue even though this is against the rules. This can be more difficult for autistic people and lead to anxiety, discomfort, and stress.

What can you do yourself as a driving instructor?

• Always explain why deviating from the applicable rules in a given situation is necessary. 'Subtitle' the situation for the student. This can be done both before and after making the exception.

• Check if it has become clear that something is a necessary exception. You can do this by explicitly asking it.

• Pay attention to signs of stress and discomfort in the student, and briefly interrupt the driving lesson if necessary.

• Visualize the situation, and work out a step-by-step plan on paper.

An example:

An exception can be made by linking the change to a basic rule. However, an exception can also be made in advance when one foresees that the exception will occur. For example, you are allowed to drive 50km/h on the road, but before the lesson starts, it is already known that the road surface is damaged. Because of this, you will apply a change, and you will not drive at the permitted speed of 50km per hour but at a predetermined adjusted speed of 30km/h to prevent vehicle damage.

Finally, an exception can also be learned afterward if it has occurred unexpectedly during the lesson. For example: if you are allowed to drive 50 km/h on the road, but children are playing with a ball at the side of the road, you will need to go slower on that part of the road.

Recommendation 9: Pay attention to automation

Learning a new skill is a big deal for anyone with or without autism. For an autistic person, however, it is sometimes even more difficult to learn a new skill . When an autistic person seems to have mastered a particular (partial) action, you could be surprised when s/he completely has forgotten it the next time (for example, switching gears). This has to do with the fact that autistic people take longer to master skills fully. Automation is more difficult for them.

What can you do yourself as a driving instructor?

• Use a lot of repetition.

• Work in small steps: divide a skill into small partial skills and learn them one by one as much as possible.

• When all the partial skills are well known, practice some of them together and increase the difficulty level.

• Again: repetition, repetition, repetition!

An example:

An autistic learner may not always ask themself what s/he thought and did to get to a certain result because their inner speech may be developed differently from ours. If s/he knew why s/he did something right, s/he would be able to repeat it automatically. However, in the case of an autistic learner, you as an instructor should check with the student how s/he came to a certain result. By having the learner think about this, s/he creates a mental manual for that particular action, which facilitates automation. For example, if the student merged well on the highway, discuss afterward what s/he thought and did so s/he can do it again next time. Try to do this as soon as possible after the action. However, it is best to do this when you are standing still, and the student does not have to perform any other actions in traffic.

COPING STRATEGIES

Recommendation 10: Learn the student to use coping strategies when needed

Autistic individuals are very rule-bound and sometimes experience difficulties while driving because they experience too many stimuli, have difficulties handling unexpected situations, miss the overview of a situation, etc. To cope with these difficulties , it is crucial that the student has strategies in place to deal with these difficulties. This includes both strategies while

driving (for example: turning off the radio to reduce stimuli) and alternative travel options (for example: taking the bus instead of driving in the busy city center).

What can you do yourself as a driving instructor?

• Make it clear to the student that traffic safety is more than just getting from point A to point B in the fastest way.

• Discuss alternative options (e.g., taking the bus, being transported as a passenger, etc.) or alternative routes (e.g., avoiding the highway and only taking local roads) to get around on days that are more difficult or to avoid difficult situations.

• Actively engage with the driver to identify coping strategies while driving (e.g., try whether it is best to turn the radio off or on, and have the student drive slower (although not inappropriately slow) in a busy environment. Hence, there is more time to process all the stimuli and see if using the GPS has a positive, negative, or neutral effect, etc.). Always start with asking the student if s/he already uses some coping strategies and begin from thereon.

• Explain to the participant that s/he can write down coping strategies in a step-by-step plan when the situation is safe (i.e., not while driving).

A few examples:

As a driving instructor, you notice that the participant keeps experiencing problems while driving on the highway during the lessons. It could be that too many stimuli are coming at the student simultaneously and that s/he cannot process this smoothly. Ask the student if s/he experiences any difficulties, and explain what you experience. Afterward, you can look together at what alternatives are available to adapt to (for example, only driving outside rush hour) this situation. Have the student write this down in a step-by-step plan or document with possible coping strategies. On the other hand, it is also possible that too many stimuli come from within the vehicle. If you, for example, notice that the radio is too distracting or the student gets overwhelmed with too many stimuli, you can try turning it off. Discuss this with the student afterward.

SUMMARY OF RECOMMENDATIONS

On the previous pages of this booklet, you have read ten concrete recommendations on how to adapt your driving lessons to the needs of autistic people. Below we give you a summary of these ten recommendations. However, we advise you to read the full recommendations thoroughly.

Create a sense of res t

Try to limit stimuli during driving lessons as much as possible. This will ensure that enough mental capacity can be assigned to the actual learning process.

Provide an overview

Help your student see the overall situation instead of focusing on the details. Describe the situation to the student and let them describe it in their own words as much as possible.

Be clear and create predictability

Make sure the student knows precisely what is expected of them and what s/he can expect from you. The clearer, and more recognizable the situation, the less the autistic student will be bothered, and the more s/he will learn during the lessons.

Think about nonverbal cues

Limit the number of nonverbal messages as much as possible during the lessons. Make sure you maintain a neutral stance throughout the lessons, even in difficult or dangerous situations.

Speak plain language

Avoid using ambiguous or unclear language , figurative speech, sarcasm, or cynicism. It is also best to visualize with notes, a step-by-step plan, etc.

Help generalizing

Help your student to generalize the rules by applying them in different situations. In doing so, formulate exceptions, modifications, and additions as well.

Correct misconceptions

Ensure that your student does not create their "own truth" that contradicts the generally accepted rule(s). Try to counter the self-made rules by naming and visualizing them.

Learn to make exceptions

Teach your student that it sometimes is necessary to make an exception to the learned rules , even though this can lead to stress. In doing so, always explain why deviating from the current rules is needed.

Pay attention to automation

Build in a lot of repetition to promote automation . Always work in small steps, each time learning just one small (sub)skill.

Learn to use coping strategies when needed

Teach your student strategies to cope with difficult situations and actively search for them together. This includes strategies while driving as well as alternative transportation options.

AUTISM ORGANIZATIONS IN QATAR

Different organizations contribute to implementing recommendations identified in the national autism plan. Accordingly, in line with this plan, the trend in research and service quality delivered to autistic individuals and their family members has changed. In this regard, the existing organizations that work toward autism in the context of Qatar provide different services, including research, diagnosis, treatment, schooling, and awareness-raising. Some of these organizations are mentioned below with their priority areas and contribution.

Table 1. List of organizations contributing to the implementation of the national autism plan.

Shafallah Center

Educational and rehabilitation service

• Providing a comprehensive rehabilitating service.

• Capacities and skills building for individuals with disability and autism.

• Providing services to facilitate the integration of autistic individuals into society.

• Implementing suitable and best international practices using efficient technology and top worldwide programs.

Website: http://www.shafallah.org.qa/En/Pages/AboutShafallah.aspx

• Support the rehabilitation process of people with autism.

• Assisting family members and caregivers.

Qatar Autism Society

Support rehabilitation and integration services

Website: https://www.autism.org.qa/en/

• Providing information to family members of individuals with autism.

• Conducting events, such as comprehensive training, workshop.

Therapeutic

Website: https://mindinstitutes.com/autism/

Education and specialized services

• Applying Treatment and Education of Autistic and related Communications Handicapped Children (TEACCH).

• Utilizing evidence-driven standardized diagnostic and assessment tools.

• Supporting people (i.e., teach, family members, and caregivers) surrounding the autistic individual.

• Providing teaching services to children with autism.

• Delivering training to support parent.

• Giving specialized services to inspire children with autism to reach their full potential.

Website: https://www.qf.org.qa/education/renad-academy

Educational and therapeutic services

Website: https://www.omegaqatar.org/

ACKNOWLEDGMENT

• Assist parents and caregivers to better understand autism as well as better handle autistic children at home

This publication was made possible by the NPRP award [NPRP11S-1228-170143] from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors. We would like to extend our acknowledgment to Karwa Driving Academy (https://www.karwadrivingschool.com/) , Mowasalat, for their essential support in all stages of this project, from the data collection to the training of the driving instructor, and the application of the project deliverables. Furthermore, we would like express our gratitude to Dr. Hani Sayed and Dr. Rashid Albalushi from Shafallah Center; Dr. Majid Alabdulla and Dr. Mohamed Omer El Tahir from Hamad Medical Corporation for their time and effort in recruiting the research participants with autism.

REFERENCES

Almberg, M., Selander, H., Falkmer, M., Vaz, S., Ciccarelli, M., & Falmer, T. (2017). Experiences of facilitators or barriers in driving education from learner and novice drivers with ADHD or ASD and their driving instructors. Developmental neurorehabilitation, 20 (2), 59-67.

Alshaban, F., Aldosari, M., Al‐Shammari, H., El‐Hag, S., Ghazal, I., Tolefat, M., ... & Fombonne, E. (2019). Prevalence and correlates of autism spectrum disorder in Qatar: a national study. Journal of Child Psychology and Psychiatry, 60 (12), 1254-1268.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Baron-Cohen, S., 1995. Mindblindness: An Essay on Autism and Theory of Mind. The MIT Press: Cambridge, Massachusetts.

Begeer, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F., & Koot, H. (2013). Sex Differences in the Timing of Identification Among Children and Adults with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 43(5), 1151-1156. Doi: 10.1007/s10803-012-1656-z

Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of autism and developmental disorders, 39 (1), 1-11.

Bervoets, J., & Hens, K. (2020). Going Beyond the Catch-22 of Autism Diagnosis and Research. The Moral Implications of (Not) Asking "What Is Autism?". Front. Psychol. 11:529193.

Bischop, H., Biasini, F., & Stavrinos, D. (2017). Social and Non-social Hazard Response in Drivers with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 47(4), 905-917.

Brooks, J., Kellet, J., Seeanner, J., Jenkins, C., Buchanan, C., Kinsman, A., ... Pierce, S. (2016). Training the Motor Aspects of Pre-driving Skills of Young Adults With and Without Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 46(7), 2408-2426.

CDC. (2020). Data & Statistics on Autism Spectrum Disorder. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html

Chee, D. Y. T., Lee, H. C. Y., Falkmer, M., Barnett, T., Falkmer, O., Siljehav, J., et al. (2015). Viewpoints on driving of individuals with and without autism spectrum disorder. Developmental Neurorehabilitation, 18(1), 26-36.

Chee, D., Lee, H., Patomella, A., & Falmer, T. (2017). Driving Behaviour Profile of Drivers with Autism Spectrum Disorder (ASD). Journal of Autism and Developmental Disorders, 47 (9), 2658-2670.

Cox, N., Reeve, R., Cox, S., & Cox, D. (2012). Brief Report: Driving and Young Adults with ASD: Parents' Experiences. Journal of Autism and Developmental Disorders, 42 (10), 2257-2262.

Cox, D., Brown, T., Ross, V., Moncrief, M., Schmitt, R., Gaffney, G. & Reeve, R. (2017). Can Youth with Autism Spectrum Disorder Use Virtual Reality Driving Simulation Training to Evaluate and Improve Driving Performance? An Exploratory Study. Journal of Autism and Developmental Disorders, 47 (8), 2544-2555.

Cox, S., Cox, D., Kofler, M., Moncrief, M., Johnson, R., Lambert, A., Cain, S. & Reeve, R. (2016). Driving Simulator Performance in Novice Drivers with Autism Spectrum Disorder: The Role of Executive Functions and Basic Motor Skills. Journal of Autism and Developmental Disorders, 46 (4), 1379-1391.

Cox, D., Owens, J., Barnes, L., Moncrief, M., Boukhechba, M., Buckman, S., ... Wotring, B. (2020). A Pilot Study Comparing Newly Licensed Drivers With and Without Autism and Experienced Drivers in Simulated and On-Road Driving. Journal of Autism and Developmental Disorders, 50 (4), 1258-1268.

Curry, A., Yerys, B., Huang, P., & Metzger, K. (2017). Longitudinal study of driver licensing rates among adolescents and young adults with autism spectrum disorder. Autism, 22 (4), 479-488.

Daly, B., Nicholls, P., Patrick, E., Brinckman, G., & Schultheis, K. (2014). Driving Behaviors in Adults with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 44 (12), 3119-3128. doi: 10.1007/s10803-014-2166-y.

Dirix, H., Brijs, K., Huysmans, E., Neven, A., Brijs, T., Jongen, E., Alhajyaseen, W., Wets, G., & Ross, V. (2022). Experiences with licensing by autistic drivers: An exploratory study. Procedia Computer Science, 201 , 330-337.

Dirix, H., Ross, V., Brijs, K., Vermeiren, E., Timmermans, C., Alhajyaseen, W., Brijs, T., Wets, G., & Spooren, A. (2021). The appraisal of roadway environment and infrastructure by drivers with autism: A qualitative study. Transportation Research Part F: Traffic Psychology and Behaviour, 78, 280-298. https://doi.org/10.1016/j.trf.2021.01.016

Ellaway, A., Macintyre, S., Hiscock, R., & Kearns, A. In the driving seat: psychosocial benefits from private motor vehicle transport compared to public transport. Transportation Research Part F, 6 (3), 217-231.

Feeley, C. (2010). Evaluating the transportation needs and accessibility issues for adults on the autism spectrum in New Jersey. In 89th annual meeting of the transportation research board, Washington, DC, 25.

Fournier, K. A., Hass, C. J., Naik, S. K., Lodka, N. & Cauraugh, J. H. (2010). Motor coordination in Autism Spectrum Disorders: A synthesis and Meta-Analysis. Journal of Autism and Developmental Disorders, 40 , 1227-1240.

Frith, U., & Happé, F. (1994). Autism: beyond "theory of mind. Cognition, 50 (1–3), 115–132.

Goris, J., Brass, M., Cambier, C., Delplanque, J., Wiersema, J.R., & Braem, S. (2020). The Relation Between Preference for Predictability and Autistic Traits. Autism Research, 13(7), 1144-1154. DOI: 10.1002/aur.2244

Halladay, A., Bishop, S., Constantino, J., Daniels, A., Koenig, K., Palmer, K., ... & Szatmari, P. (2015). Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority. Molecular Autism, 6 (36), 1-5.

Hill. E.L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental Review, 24 , 189-233.

Kersten, M., Coxon, K., Lee, H., & Wilson, N. (2020). Independent Community Mobility and Driving Experiences of Adults on the Autism Spectrum: A Scoping Review. American Journal of Occupational Therapy, 74 (5), 1 – 17

Lindsay, S. (2017). Systematic review of factors affecting driving and motor vehicle transportation among people with autism spectrum disorder. Disability and rehabilitation, 39 (9), 837-846.

Ministry of Public Health. (2020). Special Needs eLearning (Autism eLearning). Retrieved on September 28, 2022 from: https://autismelearning.moph.gov.qa/Pages/Welcomeletter.aspx

National Institute of Mental Health. (2020). Autism Spectrum Disorder. Retrieved from: https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/ index.shtml

Qoronfleh, M. W., Essa, M. M., Alharahsheh, S. T., Al-Farsi, Y. M., & Al-Adawi, S. (2019). Autism in the Gulf states: A regional overview. Frontiers in Bioscience, Landmark, 24 , 324-336.

Ministry of Development Planning and Statistics. (2015). Qatar's Fourth National Human Development Report: Realising Qatar National Vision 2030 The Right to Development. Retrieved from https://www.psa.gov.qa/en/knowledge/Doc/HDR/Qatar Fourth National HDR Realising QNV2030 The Right to Development 2015 EN.pdf

Palmer, C. J., Paton, B., Kirkovski, M., Enticoot, P.G., & Hohowy, J. (2015). Context sensitivity in action decreases along the autism spectrum: a predictive processing perspective. Proc Biol Sci, 282 (1802), 1-9.

Reimer, B., Fried, R., Mehler, B., Joshi, G., Bolfek, A., Godfrey, K., ... Biederman, J. (2013). Brief Report: Examining Driving Behavior in Young Adults with High Functioning Autism Spectrum Disorders: A Pilot Study Using a Driving Simulation Paradigm. Journal of Autism and Developmental Disorders, 43(9), 2211-2217.

Ricci, M., Parkhurst, G., & Jain, J. (2016). Transport Policy and Social Inclusion. Social Inclusion, 4 (3), 1-6.

Ross, V., Jongen, E., Brijs, K., Vanroelen, G., Beelen, C., Maltagliati, I., ... Vanvuchelen, M. (2019). The relation between driving errors and executive functioning in intellectually able young novice drivers with autism. Transportation Research Part F , 63, 38-54.

Ross, V., Cox, D., Reeve, R., Brown, T., Moncrief, M., Schmitt, R. & Gaffney, G. (2018). Measuring the attitudes of novice drivers with autism spectrum disorder as an indication of apprehensive driving: Going beyond basic abilities. Autism, 22 (1), 62-69.

Ross, V., Jongen, E., Van Vlierden, K., Brijs, K., Brijs, T., Hens, R., ... Vanvuchelen, M. (2018). Process of learning to drive by young persons with autism: experiences of the young persons themselves, parents, and driving instructors. Transactions on Transport Sciences, 9 (2) – 42-56.

Ross, V., Jongen, E. M. M., Vanvuchelen, M., Brijs, T., Brijs, K., & Wets, G. (2015). Exploring the driving behavior of youth with an autism spectrum disorder: A driver instructor questionnaire. In: 8th international driving symposium on human factors in driving assessment, training and vehicle design, 98–104.

OHCHR. (2021). Committee on the Rights of Persons with Disabilities considers initial report of Qatar. Retrieved from https://www.ohchr.org/EN/NewsEvents/Pages/ DisplayNews.aspx?NewsID=16353&LangID=E

Sheppard, E., Ropar, D., Underwood, G., & van Loon, E. (2010). Brief Report: Driving Hazard Perception in Autism. Journal of Autism and Developmental Disorders, 40 (4), 504-508.

Sheppard, E., van Loon, E., Underwood, G., & Ropar, D. (2017). Attentional Differences in a Driving Hazard Perception Task in Adults with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 47 (2), 405-414.

Silvi, C., Scott-Parker, B., & Jones, C. (2018). A Literature Review of the Likely Effects of Autism Spectrum Disorder on Adolescent Driving Abilities. Adolescent Research Review, 3(4), 449-465.

Van de Cruys, S., Evers, K., Van der Hallen, R., Van Eylen, L., Boets, B., de-Wit, L., et al. (2014). Precise minds in uncertain worlds: predictive coding in autism. Psychol. Rev. 121 , 649–675. doi: 10.1037/a0037665

Vermeulen, P. (2015). Context Blindness in Autism Spectrum Disorder: Not using the forest to see the trees as trees. Focus on Autism and Other Developmental Disabilities, 30 (3), 182–192.

World Health Organization. (2021). Autism spectrum disorders. Retrieved from https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders

Vanvuchelen M, Tant M, Ross V, Jongen E, A. C. (2014). Yes I Drive. Retrieved from http://www.autismecentraal.com/docs/Weetjes/yes i drive brochure.pdf

Wilson, N., Lee, H., Vaz, S., Vindin, P., & Cordier, R. (2018). Scoping Review of the Driving Behaviour of and Driver Training Programs for People on the Autism Spectrum. Behavioural Neurology , 1-17.

EPILOGUE

This booklet was designed within the "Examining Driving Behavior of Adults with Higher Functioning Autism Spectrum Disorders to Develop and Evaluate an Innovative Driving Instructor Training Program" research project of QNRF [NPRP11S-1228-170143] for Qatar University (Qatar Transportation and Traffic Safety Center: Dr. Wael Alhajyaseen, Dr. Qinaat Hussain, and Mr. Wondwesen Mamo; Department of Social Sciences: Prof. Abdrabo Soliman) in collaboration with Hasselt University (Transportation Research Institute (IMOB): Prof. Dr. Tom Brijs, Prof. Dr. Kris Brijs, Dr. Veerle Ross and Dr. Hélène Dirix).

This project includes several studies to gather more information on novice autistic drivers and promote learning to drive for young autistic persons. Within the current project, several driving simulator studies were conducted to examine the hazard perception skills, emotional regulation while driving, and distraction while driving in autistic drivers. These simulator studies were supplemented with questionnaires and cognitive tasks.

The information in this booklet is supported by the outcomes of recent literature and the findings from the driving simulator studies that were conducted in the scope of this project. Some of the information found in this booklet is partly based on the booklet "Yes I drive! Autism in traffic: a practical guide to give persons with autism more opportunities in traffic" (Authors: Ellen Jongen, Veerle Ross, Mark Tant, and Marleen Vanvuchelen. Contributors: Renate van Leeuwen van Dorst (Spectrum Brabant), Peter Vermeulen (Autisme Centraal), Jeroen Smeesters (Federdrive), and Meike Reyskens). The authors of that booklet have given their explicit consent for this.