Developing College Skills in Students with Autism and Asperger's Syndrome

Sarita Freedman

• Publisher: Jessica Kingsley Publishers
• Year: 2010
• Print ISBN:
  9781843109174
• eBook ISBN:
  9780857002921
• Topic: Psychology
• Subtopic: Autism Spectrum Disorders
• Index: Psychology

Going to college can be a daunting prospect for any young person, but for teenagers on the autism spectrum this is especially true. This book describes the unique needs that ASD students entering further or higher education are likely to have. The author identifies the key skill-sets they will need to develop in order to be successful in college and in life, and shows how they can be helped to develop these.

She outlines the skills required for success in further and higher education in relation to the strengths and weaknesses of individuals with ASDs, and explains how those weaknesses can be ameliorated to enable success at college. Describing the unique accommodations and support that students with ASD will need, and the skills for which they will need particular help, she provides effective intervention strategies that can be implemented throughout the period leading up to college entrance.

This book is essential reading for psychologists, special educators, educational therapists, high school teachers/career counselors, and other professionals supporting high school and college students on the autism spectrum. Parents of such students will also benefit from the ideas presented in this book.

PART I

The Many Facets of Autism

Chapter 1

BECOMING FAMILIAR WITH AUTISM

WHAT IS AUTISM?

Autism is a neurodevelopmental disorder that manifests as impairments in three primary areas of functioning: communication and play, social relatedness, and restricted interests and activities. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994a details the diagnostic criteria for all of the pervasive developmental disorders, including autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s syndrome, and pervasive developmental disorder, not otherwise specified. The reader is referred to the most recent edition of the DSM for full diagnostic criteria. This book examines the needs of individuals in three of the primary diagnostic categories: autistic disorder, Asperger’s syndrome, and pervasive developmental disorder, not otherwise specified (PDD-NOS). The general diagnostic criteria for autistic disorder are given below.

Impairments in social relatedness including deficits in any of four primary areas:

•nonverbal communication (e.g. eye contact, reading nonverbal cues)

•peer interaction (does not develop developmentally appropriate peer relationships)

•joint attention (does not seek to share enjoyment; no showing or pointing out of objects of interest)

•emotional reciprocity (does not exhibit shared emotional experiences with others).

Impairments in communication in play including deficits in any of four primary areas:

•delays in, or lack of language development (without compensating with gestures or sounds)

•impaired ability to sustain conversation

•stereotyped or repetitive language use (includes idiosyncratic language)

•lack of varied spontaneous make-believe play or social imitative play.

Restricted and repetitive or stereotyped play, interests, or activities:

•preoccupations and interests that are abnormal in intensity and/or focus

•inflexible adherence to specific, nonfunctional routines and/or rituals

•motor stereotypes (e.g. hand/finger flapping or flicking, repetitive jumping, complex body movements)

•preoccupation with parts of objects (e.g. only spins wheels on cars; takes clocks apart to study the mechanism but has no interest in telling time; visually scrutinizes and examines objects without concomitant appropriate play with the object).

The diagnostic criteria for Asperger’s syndrome are identical except in the area of communication, where it is expected that there are no significant delays in overall language development, cognitive development, “or in the development of age appropriate self-help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood” (American Psychiatric Association 1994b, p.62). For both disorders it is expected that the delays and impairments in at least one of the listed areas had their onset prior to the age of three. Individuals in the PDD-NOS category can exhibit difficulties with reciprocal social interactions, verbal or nonverbal communication, and/or stereotyped behavior, interests and activities. This category includes individuals who do not meet the required criteria for a diagnosis of autistic or Asperger’s syndrome, those in whom the onset was later than age three, and those whose symptoms are atypical or subclinical (American Psychiatric Association 1994b, p.62).

In the body of this text, the term autism spectrum disorder (ASD) is used to refer to individuals who fall under the broad diagnostic umbrella of the pervasive developmental disorders (autistic disorder, Asperger’s disorder, and PDD-NOS).

WHAT DOES ASD LOOK LIKE?

The most obvious initial observations are that social initiations are less play-based and more directed towards adults. Most of the child’s interactions are based on getting personal needs met, rather than to engage another person. We see reduced or no joint attention and social referencing, and a reduction in the individual’s awareness and/or response to others’ emotional distress. Joint attention relates to two (or more) individuals attending to the same object and recognizing a shared experience. Social referencing relates to learning by watching the expression on someone’s face or listening to another person’s tone of voice. For example, when a baby reaches for a novel object, the baby may look towards the mother and, by “reading” the expression on her face, determine whether or not it is safe to take or touch the object. Similarly, another person’s tone of voice can affect the decision a child makes in many situations, but the child with ASD may be unable to discern subtle changes in tone of voice. Individuals with ASD have a significantly reduced ability to read nonverbal cues, including facial expressions and gestures, and they also tend to exhibit fewer nonverbal cues and gestures than would normally be expected.

As a result of the above-mentioned challenges, students with ASD must learn how to interact successfully with others in an intellectual and cognitive manner. With the appropriate level and intensity of intervention throughout their development, most HF individuals will be able to learn these skills. In the absence of social skills the incredibly sophisticated and complex social world will remain a mystery, and the student will flounder when engaging in activities with others. Imagine the challenge of dorm living, or working as part of a group project, with limited ability to be aware of and respond to others, or without the ability to read facial expressions and other nonverbal cues.

Motor functioning is usually impaired to varying degrees, and graphomotor (writing) skills are almost always impaired. With the advent of technology and computers in both of which many individuals with ASD are highly competent, graphomotor challenges will likely present a rather minor disturbance or annoyance. There is also an almost universally abnormal response to sensory stimuli such as sound, touch, and light—factors that can pose significant obstacles in the ever changing and fluid environment of a college campus. In their study on sensory processing deficits in adults with ASD, Crane, Goddard and Pring (2009) found that 94.4 percent of the sampled adults with ASD reported varying types of sensory processing abnormalities, albeit at “similarly severe” levels. Their results “suggest that unusual sensory processing in ASD extends across the lifespan” (p.215). Impairments in sensory processing can also result in unusually modulated behavior and tone of voice (e.g. flattened or overly loud). Finally, individuals with ASD struggle to attach emotion to environmental stimuli, hence the lack of awareness of danger (e.g. touching a hot stove and getting burned doesn’t necessarily mean the behavior won’t happen again). They also attach emotion to stimuli that to typically developing people may appear benign (e.g. intense fears of normally benign objects or events). Both of these restrictions pose challenges in the area of learning while doing, and generalization of learning from one situation to another.

One of the most significant areas of impairment falls in what is known as executive functioning (EF), a set of brain-based activities that include:

•cognitive flexibility

•inhibition of irrelevant responses

•behavioral adaptation to environment

•understanding codes of conduct

•using experience to understand rules

•identifying essential from nonessential information

•ability to retain a goal and the steps needed to accomplish it in one’s mind (working memory).

These challenges can significantly impair individual ability to initiate and complete numerous tasks (e.g. decide which toy to play with; select a topic for a school project; organize activities such as book reports and long-term projects). As a result, they can get stuck in counterproductive routines and have trouble in learning from their experiences. Individuals who are severely challenged in the area of EF struggle a great deal with college activities. However, individuals with ASD do quite well with routine and structure, and they can also learn compensatory strategies such as using activity charts, a calendar, or a whiteboard to map out the steps needed to complete a project. These strengths will enable them to master many of their challenges.

Social communication and language difficulties may manifest as talking about topics of specific interest, difficulty in changing the topic of conversation, difficulty in reading the listener’s cues for interest (or lack of it) in the conversation, and/or limited ability for conversational turn-taking. Some individuals with ASD will also exhibit differences in voice pitch and inflection, also referred to as “prosody.” Because they tend to be concrete thinkers, people with ASD often take things they hear literally, and have trouble understanding humor and sarcasm.

Another area of significant language impairment lies in pragmatic communication, a component of speech and language development that is usually treated by speech and language pathologists. While this is an extremely important skill for all students, it falls into the area of speech and language pathology and will not be included in the skills chapters. However, I cannot overemphasize the importance of ensuring that students are relatively proficient in pragmatic communication. Here are the skills that need to be focused on (Legrand 2001, personal communication):

•Knowing that you have to answer when a question has been asked. This skill involves also knowing how to ask for clarification if you don’t understand a question, are confused, or there’s a communication breakdown.

•Being able to participate in a conversation by taking turns with the other speaker. This involves recognizing when the other speaker has finished talking and, if unsure, asking the speaker if he or she has finished. It also requires the individual to appreciate and understand the purpose of sharing information (related to joint attention).

•Noticing and responding appropriately to the nonverbal aspects of language.

•Knowing that you have to introduce a topic of conversation in order for the listener to understand fully what you will be talking about, and that you have to check for understanding throughout your conversations.

•Knowing which words or what sort of sentence-type to use when initiating a conversation or responding to something someone has said.

•Knowing how to end a conversation appropriately.

•Knowing how to ask for clarification when you don’t understand something.

•Knowing how to provide clarification so that the listener understands you: this includes being able to “read” the listener’s facial expression to know if the listener is following you.

•Knowing the importance of staying on topic, and being able to do so.

•Maintaining appropriate eye contact (not too much staring, and not too much looking away) during a conversation.

•Being able to distinguish how to talk and behave towards different communication partners.

Most of the people I work with have needed intervention in this area. A referral to a speech and language pathologist who has been trained in the area of pragmatics is appropriate when working with individuals with ASD, no matter what their age. Pragmatic skills become more and more sophisticated throughout life and it is useful for high-school students and young adults to work with a speech and language pathologist in order to keep up with the communication rules and strategies of their peer groups.

Inability to read nonverbal cues is one of the most challenging areas for students with ASD, and ties into the skills needed for pragmatic communication. Not only is it important for students to understand body language for conversation, body language also provides us with a great deal of very valuable information regarding mental states (e.g. intentions, perspectives, beliefs) and, most important, deception. Most individuals with ASD are baffled by deception and have a hard time accepting that others would want to fool, trick, or harm them. According to Chitale (2008), the “guileless and trusting” stance of individuals with ASD makes them “prime targets for abuse, thievery and scams. According to the Department of Justice, people with developmental disabilities, including autism, have a four to ten times higher risk of becoming crime victims and are twice as likely to be sexually abused as people without those disabilities” (p.1).

Because of their poor communication skills, individuals with ASD may be unable to disclose abuse. They are easily influenced and may be reluctant to disclose abuse for fear of something terrible happening to them or a family member. Tragically, children with ASD who have been sexually abused but do not have the psychological maturity to work through issues of abuse often develop hyper-sexualized behavior and can ultimately be accused, themselves, of perpetrating sexual abuse. All of the women with ASD that I’ve worked with have had some sort of inappropriate sexual experience, from being touched inappropriately as a child to being the victim of rape as a result of not being able to “read” the perpetrator’s intentions. Many women report that they continue to feel unsafe and uncomfortable because their ability to detect this type of deception is seriously underdeveloped. Males also share this deficit and are also at risk for sexual exploitation. HF individuals will undoubtedly be exposed to issues of sexuality during the course of their lives, including crushes, dating, and marriage. Providing them with specific instruction in these areas may be the only way to keep them safe.

Theory of Mind (ToM) is an area in which most HF individuals with ASD exhibit mild to moderate levels of impairment. ToM is the ability to understand and attribute various mental states, including emotions, beliefs, desires, intentions, and perceptions—both to oneself, and to others. It is a form of “mind-reading” that evolves over time in typical development. We use ToM to understand behavior and inten...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• Acknowledgements
• Foreword
• Preface
• Part I: The Many Facets of Autism
• Part II: Skill Sets
• Part III: Going to College
• References
• Appendix A: Overview of Skill Sets
• Appendix B: Helpful Resources and Websites
• Subject Index
• Author Index