Pathways to anxiety reduction in autistic, ADHD and neurotypical students using digital support tool Brain in Hand: a mixed-methods evaluation

Purpose Student anxiety in UK higher education has risen in recent years, straining university services. This study aims to examine whether, and how, Brain in Hand (BiH) – a hybrid human–digital support tool – is associated with reduced anxiety in autistic and attention-deficit/hyperactivity disorder (ADHD) students, and neurotypical students. Design/methodology/approach Seventy-two university students (60 autistic and/or ADHD students) completed baseline and six-month surveys assessing anxiety and hypothesised pathways: coping (ability to manage overwhelm and ability to cope with day-to-day stressors), cognitive challenges and social participation. Within-person change in anxiety was modelled as a function of change in these candidate mechanisms. Reflexive thematic analysis of semi-structured interviews elaborated pathways and the perceived contribution of BiH. Findings Greater improvements in coping, reductions in cognitive challenges and reduced participation-related difficulties were each associated with greater anxiety improvement. Qualitative themes clarified these pathways: reactive in-the-moment coping and developing awareness of long-term patterns; planning/structuring daily life and scaffolding anxiety management; and increased participation/reduced isolation and earlier, more effective help-seeking. Practical implications Findings support integrating guided digital supports like BiH as scalable complements to university provision, particularly where designs reduce cognitive burden, scaffold participation and are responsive to autistic/ADHD people’s needs. Originality/value In a largely autistic and ADHD cohort, BiH use was associated with anxiety improvement, and mixed-methods integration illuminated plausible emotional, cognitive and social mechanisms of change. This study advances a mechanism-focused, neuroinclusive evaluation of hybrid digital support in higher education.