Kieran Barrett-Snyder was a star student at his high school on Long Island in New York. He had a gift for mathematics and science, and was accepted into all seven of the colleges he applied to. He decided on New York University (NYU), both because it has a strong engineering program and because it is close to his home.

During Barrett-Snyder’s first semester in 2014, he did well in all his classes, except for labs that required written reports — a task that felt overwhelming to him. He became so anxious about his workload that at one point he started to feel his heart pounding hard in his chest. “It hurt to lay down,” he recalls.

Barrett-Snyder has autism, and he has felt anxiety for much of his life. But this was more intense than usual. His symptoms persisted for several days, until his mother took him to the emergency room, where he learned he had been having an extended panic attack. He hadn’t taken any psychiatric medications since his most disruptive behaviors had tapered off at around age 9. After the panic attack, though, he started taking pills for anxiety and depression. He also decreased his workload and got on track over the rest of the year.

Then, in his second year at the university, he ended up in a dormitory with two neurotypical students he didn’t connect with, and started avoiding the common area when they were around. One of the suitemates had his girlfriend over all the time, which made Barrett-Snyder even more uncomfortable. He stayed in his room for long stretches, stopped showering and survived on Oreo cookies. It was a vicious cycle: The longer he was in his room, the more self-conscious he felt. “I just felt disgusting most of the time, so I didn’t want to be seen,” he says.

He lost 25 pounds, felt weak and depressed, and was failing several classes. That December, his mother suggested that he take some time off. The only support NYU had offered to him was extended time on tests. “When I approached them about his difficulties,” she recalls, “their response was: ‘Maybe he belongs at a different school.’”

For any young adult, going away to college involves many firsts: the first time living alone, the first time making their own schedule, maybe the first time cooking their own meals. As difficult as this transition is for typical students, it can be especially disorienting for young people on the spectrum, who may also find it difficult to sleep enough, collaborate with others on group projects and advocate for themselves with professors.

Despite those challenges, increasing numbers of young adults with autism have set their sights on a college degree: More than 200,000 students on the spectrum will arrive on campuses around the United States over the next decade, based on statistics from the National Center for Special Education Research. And for the most part, experts say, these students are entering an educational system that is not ready for them. High school comes with a support system — family at home, therapists nearby, special-education classes — but colleges have traditionally embraced a sink-or-swim mentality.

Under U.S. federal law, college students with disabilities are permitted to receive special accommodations, including extra time on exams and extended deadlines. But these allowances usually fall short of the needs of students with autism. Many students on the spectrum require support that extends beyond the classroom into their social and personal lives, such as reminders to do their laundry regularly or help finding study partners. They also have high rates of anxiety, depression and suicidal thoughts, which can worsen in new situations. “Colleges are trying to cope with this expanding mental-health crisis,” says Fred Volkmar, professor of child psychiatry, pediatrics and psychology at Yale University. “They don’t quite know what to do.”