Taking Your Son/Daughter with an Autism Spectrum Disorder to the Dentist

This blog post was contributed by: Pam Anderson, Indiana Resource Center for Autism;  Kim Davis, Indiana Resource Center for Autism; Cristina James, Riley Child Development Center; Katy Messuri, Easter Seals Crossroads; Leanne Suarez, Sonya Ansari Center for Autism at Logan.

Taking your son/daughter on the autism spectrum to the dentist poses many challenges. This article hopes to make you aware of some of these challenges prior to your first visit, as well as provide some useful ways to deal with them. Included in this article are three main areas that are most often in need of attention: preparation, sensory issues and communication.


When seeking a dentist, call the office and discuss your son/daughter’s needs.The more you know ahead of time about their practices and why they do them, the more comfortable you will be.Ask if they have experience with children who have an autism spectrum disorder (ASD) and if they have special procedures in order to optimize each visit.Ask about those procedures.Some procedures you might ask about are:accompanying your son/daughter in the room while doing the exam; having an appointment at a time of day when your son/daughter is at his/her best; having a short wait time; and having the same staff at each visit for consistency.If you’re not comfortable with the answers to your questions, consider another dentist.Some dentists may refuse to treat your son/daughter because they’re unsure how to make them comfortable.

Is your son/daughter accustomed to daily tooth brushing? If not, consider working with an occupational therapist (OT) or an autism or behavioral professional to teach the child good oral hygiene habits. Use of visual routines and a timer are helpful for good daily brushing habits.

Use their toothbrush or a plastic tooth mirror (available at local pharmacies) and get your child use to letting you put it in his/her mouth.Make a fun game out of counting their teeth.Vibration toys that are safe for oral use, or even electric toothbrushes, are also excellent for getting your child use to the strange sensations in their mouths.

One of the most effective preparatory steps you can take is to create and read a social story about going to the dentist with your son/daughter.The social story should take the uncertainty out of what will happen at the dentist office.Be sure to highlight things that you think your child will like or be concerned about.A social narrative, “Going to the Dentist” is listed in the “Resource” section of this article.Another idea is to include an incentive/motivator for when the appointment is over.Does the dentist have a prize basket?Can you stop for a treat afterwards?There are many good books about practicing good oral hygiene and going to the dentist that you can read with your child.A resource guide for helpful books is included at the end of this article.

To get your son/daughter off to the right start with a dentist, schedule a few short “happy visits” to start off with.Keep these visits very positive and short.Let your son/daughter get use to the office environment; try out the chair; let the hygienist look in their mouth or count their teeth, and listen to the sound the drill makes.These may not all happen on the same visit.Use these visits to slowly desensitize your son/daughter to the experience, as well as discover what could potentially be difficult at future visits.

Sensory Issues

There are many potential sensory challenges at a dentist’s office – tastes, smells, textures, sounds, lights and proprioceptive. Knowing in what areas your son/daughter tends to be sensitive will help you know what coping strategies to try.Share your son/daughter’s coping strategies with the dental staff before the visit.Collaboration and teamwork are essential for a successful trip to the dentist.

To be comfortable with the doctor’s chair, you may want to ask the hygienist to lean the chair back before your son/daughter gets in it, as sometimes they don’t like the feeling of being moved backwards.Also, try using a bean bag chair in the dentist’s chair during the exam to provide some snug comfort.Deep pressure can be used before and during the visit for calming.Consult your son/daughter’s classroom teacher or OT for suggestions.Wearing the x-ray vest may be similar to wearing a weighted vest.This can be discussed with the dental staff prior to the visit, too.

Consider a heavy work task to be done before and after the visit for calming.Let your son/daughter stretch a therapy band in their hands, or even wrapped around their ankles while they are in the chair.Lighting in a dental office is often too strong for children with autism.Let them wear sunglasses and request that the staff try to keep the light out of their eyes as much as possible.Night time eye covers can be used, but will make it difficult for the staff to show your son/daughter what they are going to do.If the noises of the office are upsetting, request to be moved to a more quiet or private area.If not available, the use of headphones or an iPod/music player are good ways to limit noise.To ensure that tastes are familiar and favorable, bring your son/daughter’s own toothpaste and toothbrush to the visit.


For a child who may not be able to verbalize or recognize a problem, the accompanying feelings of anxiety and frustration can be overwhelming.The impact of these feelings on behavior can be significant.Having a dental professional who can communicate effectively will be very important.Below are some tips to improve communication at the dentist office.

Tell/Show/Do.This is a shorthand way to explain to staff what they should do. First, Tell your son/daughter what they are going to do. Next, Show the tool or action they are going to use (let your son/daughter touch the tool, if possible).Then, Do only after they’ve done the other two.This verbal preparation and demonstration will help eliminate some uncertainty for your son/daughter and put them more at ease.

  • Modeling is very effective for some children.Bring along a sibling or friend and letyour son/daughter with ASD watch as the doctor or hygienist performs the task on them first.
  • Letting the child know ahead of time how long something is going to last can be very helpful.Instruct the staff to prompt the child with time durations as they work.Some examples:“This will be all done when we finish counting to 10.”“I need to touch 20 teeth… help me count them all.”“That gritty cleaner will only be there for 1 minute and then you can rinse and spit it out.”
  • Instruct the staff that your child responds best to immediate praise for good behavior.When your child does something they want, staff should not delay their praises.This will help your child make the connection between what he/she does and the consequences.Some examples:“Great job keeping your mouth open.”“I like how you are …”“You did great while I cleaned the front of your teeth, now I’m going to clean the back of them.”
  • Ignoring inappropriate behaviors is also something you’ll want to inform the staff about.Have them try to ignore inappropriate behaviors as much as they can.Maintaining a calm voice may help to minimize behavior problems.

Other Issues

There are some unique dental issues that you will want to discuss with your dentist, if they apply to your son/daughter.For those who engage in bruxism (grinding their teeth) or self-injurious behaviors (such as picking at the gums or biting their lip) a mouth guard might be recommended so long as it is tolerated by your son/daughter.Dentists should also review your child’s medications and/or supplements.They will then be able to advise whether medications are affecting saliva production or if they contain a lot of sugar, both of which will increase the chance of cavities.

Seizures may accompany autism, and if your child has seizures you will need to discuss this with your dentist.The mouth is always at risk during a seizure; children may chip teeth or bite their tongue or cheeks.The dentist should be able to help you develop a treatment plan for these challenges.Be prepared to manage a seizure if one occurs during the dental visit.Instruct staff to remove any instruments from the mouth and clear the area around your child.A simple trick is to attach dental floss to rubber dam clamps or mouth props before putting them in so that you can remove them quickly if needed.

Sedation is sometimes used with patients, usually in cases where the child has high levels of anxiety or discomfort that prevent good coping skills, for those with uncontrolled movements (including gagging), or for those requiring extensive dental treatment.Sedative medications cause most children to become relaxed and drowsy.Unlike general anesthesia, sedation is not intended to make a patient unconscious or unresponsive.You and your dentist should select a technique based on the specific needs of the child and discuss the benefits, limits and risks of that technique.Your son/daughter may be referred to a hospital for extensive procedures to be done under stronger sedation or general anesthesia.

If you have any dietary or chemical restrictions that you are following for your child, be sure to make your dentist aware of these before the appointment begins.They need to know up front what your expectations are so that they can attempt to work within your guidelines.

Financial Access to Dental Services

Families without health insurance and those with health plans that do not cover dental care may be able to benefit from a wide variety of programs to ensure that they have access to the care they need.Before you investigate using services that provide dental care, it is wise to check if you qualify for any public or private health coverage plans that would provide dental care.

If your child is covered under Hoosier Healthwise (Indiana’s Medicaid program), dental services are a covered service.In Indiana, this coverage is limited to $600 per recipient per 12-month period, except for surgical and periodontal procedures.One topical fluoride application is covered every 6 months per recipient for patients from 18 months to 19 years of age.You can search for a dentist that accepts Medicaid near you at www.indianamedicaid.com.

Families who have private health insurance coverage may have dental coverage as part of the plan benefit.Some employers offer separate dental coverage that employees can opt to buy.Families are encouraged to seek out information about what benefits are available and procedures for obtaining authorization of services.Your employer, human resources department or plan administrator are key sources for this type of information.

A variety of clinics, programs and organizations provide dental services to children and adults in Indiana who do not have dental coverage and cannot afford standard fees.Each program has different eligibility criteria.To find options near you consider the following:

  • Many Community Health Centers provide dental services.For a list of community health centers go to:http://www.in.gov/isdh/files/CHC_and_maps_GIS_08.pdf.
  • Dental schools can be a good source of quality, reduced-cost dental treatment.The Indiana University School of Dentistry offers services for fees that are generally 1/3 less than a typical dentist practice.Contact: IU School of Dentistry, 1121 W. Michigan St., Indianapolis, IN46202-4186, Phone: 317-274-7461.
  • The Bureau of Primary Health Care supports federally-funded community health centers across the country that provide free or reduced-cost health services, including dental care.To obtain a list of centers in your area, contact the HRSA Info Center at 1-888-ASK-HRSA (1-888-275-4772) or www.hrsa.gov
  • Each year the Indiana Dental Association hosts the Give Kids a Smile Day.During this one day event (in early February) dentists across Indiana open their offices to donate dental care to children from low-income families.There are requirements that must be met.Appointments are required.Information about scheduling an appointment can be found at www.indental.org between October and December each year.


Taking your son/daughter to the dentist presents challenges for both the parent/caregiver and the dental office staff.By working together, challenges and anxiety can be reduced.Using ideas presented in this article, the child with ASD may have a better understanding of what to expect when he/she visits the dentist for the first time and may have a greater chance of experiencing a successful dental visit.


American Academy of Pediatric Dentistry. (n.d.)Sedation. From http://www.aapd.org/publications/brochures/sedation.asp

Bennie, M.(n.d.) Dental Dilemma.from Autism Today website:http://www.autismtoday.com/articles/DentalDilemma.htm

DynaVox Mayer-Johnson, 2100 Wharton Street, Suite 400, Pittsburgh, PA 15203;
Phone: 800-588-4548,Fax: 866-585-62620; Email: mayer-johnson.usa@mayer-johnson.com; Website: www.mayer-johnson.com

Indiana State Department of Health, Sunny Start Initiative.(2009, April 20).Dental Care: Options to Access Dental Services.From:

Mabry, C. et al. (2008) Special Care Dentistry for the General Practice Resident: Practical Training Modules [PowerPoint Slides].Retrieved from NYS Office of Mental Retardation and Developmental Disabilities website:http://www.omr.state.ny.us/images/hp_dentistry_treatment.pdf

Miller-Kuhaneck, H.(n.d.).Going to the Dentist.from the Sensory Processing Disorder Foundation website:http://www.spdfoundation.net/library/dentist.html

National Institute of Dental and Craniofacial Research, National Institutes of Health.(2009, July 14).Practical Oral Care for People With Autism.From http://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/PracticalOralCarePeopleAutism.htm

Oakley, D.(2009, August 28).Autism and Dentistry: Dental Challenges for Families and Treating Dentists. The Autism News website:http://www.theautismnews.com/2009/08/28/autism-and-dentistry-dental-challenges-for-families-and-treating-dentists/

Resource List – Dental Visit

Books for Children/Students – Dental Visit

Books for Parents/Professionals – Dental Visit

Videos/Photographs – Dental Visit

Social Narrative – Going to the Dentist

Visual Support Schedule – Visiting the Dentist


Finding a Friend in School

Contributed by Kim Davis from the Indiana Institute on Disability and Community

When a student is in school, academics are the main focus. However, one aspect of learning that is not given enough emphasis is community building and developing relationships/friendships; the social aspect of education. Social goals and building friendships are mentioned in school conferences but are seldom fully explored and many times a student’s support team thinks academic success is the key to future accomplishments in secondary education and employment as well as helping to provide for a rich social life. This idea needs rethinking.

Social development implies that more than one person is involved, and that there are interactions with others and that there is participation in an activity. We are all social beings and need interaction to continually learn and develop. In schools, the word “social” is often found in the Individualized Education Program (IEP) annual goals:

Main Goal: Johnny will improve his social skills
Obj. 1: He will say please and thank you,
Obj 2: He will sit with a peer to play a game for 20 minutes, and
Obj 3: He will cover his mouth if he coughs.

Those are useful social skills, but are they the only type of goals that should be written in an IEP? There are other opportunities in school for true ‘social’ situations. Surely, if one thinks hard enough, other options can be discovered.

There are many opportunities for social interactions at school that are often overlooked due to limited time and the focus on keeping things moving. However, with some planning these opportunities can become excellent chances to develop and enhance social exchanges. It is important to think creatively in order to build in new chances for relationships to develop. Elementary, middle, and high school offers chances for building social networks, friendships and communities. At the secondary grade levels, there are more varied options offered by the school. At the each level, an adult, acting as a facilitator, may be necessary to get the relationship going or to offer ongoing support. Consider the following options as places that a student on the autism spectrum and his/her peers can begin to develop meaningful relationships. Remember, every relationship starts slowly and then grows as people get to know one another. What everyone needs is the opportunity. Here are some ideas to consider:

Getting on and off the bus:
Instead of a parent driving a student to school, have the student ride the bus or even carpool with a neighbor or classmate. If they have to wait, a peer or peers could wait in line for the bus along with the student with ASD.

Before school:
The student should be where other students are in order to participate with them; such as hanging out with peers in the gym, cafeteria or hall instead of simply going to the classroom.

In the halls:
A peer buddy could walk with the student with ASD to the next class or to the library, gym or cafeteria. Sometimes the student might need to leave early to avoid hallway congestion which could cause sensory challenges.

Before class starts:
Peers could assist the student in prepping for class or simply chat until class begins, just like other students do.

Class breaks:
Going to the restroom, getting a drink or simply having some down time in class could all be supported by peers.

Group activities in class:
Anytime there are group activities be sure the student with ASD is included in a group that has peers who know him or her, and understand the strengths and gifts of that student.

Include the students with ASD with everyone else and use peer support instead of having them sitting alone or at the special education table.

This time has been described by one boy with ASD as his “personal hell” due to bullying, not knowing what to do, or no one interacting with him. This is the perfect time to have peers interact and support the student with ASD. They can rotate around by doing a different activity of interest with the student or introducing a new activity.

After school activities: These will be different for each level. Elementary activities may be after school day care or extended day programs. These certainly offer opportunities for student on the spectrum to play with their peers. Other events tend to be done in the evening for the family.

Middle and high school offers a variety of activities that are immediately after school such as clubs, music, or sports events.

Music: Many schools have a music program at holiday time. Students should have the chance to participate in those singing and musical events so their families can know that joy. Perhaps they do not sing every number but instead ring a bell, tap a drum, or hold a prop. The student should be there as much as possible.

At the middle and high school level there are more musical options that become available. Learning to play an instrument and joining band begins in middle school. This can lead to other opportunities such as a concert band, marching band, jazz band or pep band for sporting events. There are also drum line groups. Orchestras would play concerts and also for musical plays.

One does not need to play an instrument to enjoy music. Middle and high schools also have choirs and choral groups that sing at school events and also compete.

Finally, if a student really enjoys music there is always the need for band boosters who provide support to the various music activities at schools.

Drama: A theatre program may be available at middle school but for sure is available at the high school level. There are different parts of putting on a play that a student may enjoy besides being an actor with a role. The other aspects include: creating the set, managing the sound, adjusting the lighting, setting up and moving set props, cueing the actors, and the designing and creating of the costumes. Each aspect involves a different skill and may tap the interests of the student with autism.

Clubs/Organizations: Schools have an abundance of extra- curricular organizations that could be fun for any individual with ASD based on his/her interests. The huge interest in certain books or movies often creates a place to begin exploring ideas.

Here is a sample listing:

Art Club
Best Buddies
Book Club
Chess Club
Brain Game/Quiz Bowl
Digital Arts Society
Foreign Language Club
Environmental Club
Habitat for Humanity Group
Year Book
Ping Pong Club
Poetry Club
Science Olympiad
Spell Bowl
Student Council
Swing Dance
Backpacking Club
Black Culture
Diversity Club
Ham Radio Club
Gothic Club
Photography Club
Ski Club
Speech and Debate
Computer Games Club

Once again, the interest area of the student should drive the club or organization that he joins. Each club meets on a regular basis and that increases the chance for developing meaningful relationships.

Sports: Finally, there are athletic events at both middle and high school levels. Both boys and girls athletics offer a wide variety of opportunities for interactions from participating on a team to being a member in some other fashion. Options include: managers, scorekeepers, time keepers, equipment caretakers, equipment room managers and a batboy or girl.

Here is a potential list of teams to consider. Each offers different opportunities for participation.

Cross Country

Of course with athletics comes cheerleading, or pom squad opportunities. These groups are also a big part of middle and high school. Here someone could participate in cheering but also in creating posters or signs for the school, making announcements, posting announcements or posters or creating any other team spirit materials.

Truly, some of these options may be more challenging than others when it comes to creating meaningful social interactions. But it is worth looking at them all, even small and successful interactions can eventually grow into true friendships. Everything can start small and build from there. Consider the use of peers in each situation to simply begin the process of relationship building and helping your students with building a community based on interests and skills. Their life and the lives of his peers will be greatly enriched.

Davis, K. (2010). Finding a Friend in School. The Reporter, 15(4). Retrieved from http://www.iidc.indiana.edu/index.php!pageID=3280



Beyond Brochures

How to research and evaluate premium college support programs for students with learning disabilities.

By Wendy Byrnes and Eileen Crumm, Ph.D.; Finding Solutions LLC


In recent years, more and more students with disabilities have graduated from high school and entered the post-secondary educational environment of college or vocational training.  The good news is that in response to this population’s unique learning profiles, a growing number of programs that offer support to those students have emerged.  Such programs may offer a menu of specialized or premium services that can include academic tutoring, liaison with post-secondary programs, coordination services, life skills instruction, social skills training, coaching and mentoring, vocational education, job internships and job placement.

Students with disabilities that are leaving high school should look for classes or a course of study that interests them.  It may include community college, vocational and certificate programs or a university.  This is a daunting task for many students, as they plot their course in life – hopefully independently.  College is achievable with preparation and meaningful supports and it is particularly important that students take ownership of their future, whenever possible.  A question that must be asked is “Who is holding the expectations for what will happen once a student leaves high school?”  Parents and professionals need to continue to mentor and advocate for the transitioning student while aligning future expectations with desires and capabilities.

While supported programming holds the promise of helping a student transition to a productive, young adult life, no one program will provide a panacea.  Due diligence should be done when investigating various options and looking well beyond any program’s brochure and marketing efforts is an absolute must.  The old adage of “wherever you are, there you go!” provides a healthy measure of truth for consideration in whatever plans are made.  Students and their families (along with professionals that may support the transition process) should be informed and empowered to find the most current and appropriate range of options.

As the demand for specialized support programs has increased, so then has the supply. Recognizing an opportunity for additional areas of service, various colleges, universities, for profit and nonprofit organizations have attempted to fill a void for services.  However, the population they propose to serve is far from homogeneous.  Rather it consists of young adults who share a tremendous desire to succeed and be independent, but have varying ability and skills to do so.   This means that a program needs to have both depth and breath in order to successfully serve its intended clientele of young adults with disabilities.

Some students with disabilities who enter college may be unprepared to manage their new-found independence and freedom.  They may struggle with navigating the new terrain of a college environment and be more fragile emotionally and socially. The fortitude of even the highest achieving student is tested when managing the ever-changing priorities of juggling classes, course work and living away from home.  For students with organizational or processing issues, the stress may be magnified many times over.

Programs that support students should be earnest and committed to the initial and long- term success of the student.  Students and parents may be vulnerable to programs that appear to make big promises and in the end, deliver less than desirable results.

Building a quality program takes time, expertise and commitment.  But to meet the rise in demand, programs can be put into place too quickly.  They may not have robust organizational structures and could fail to meet the divergent needs of their target population.  Others are too new to show any real or meaningful outcome data, so it becomes difficult to judge whether attending such a program would actually help a youth to become a successful adult.  The mission of any program selected should match the individual student’s expectations and needs.

Families who have pursued independent programming or services in the past for their children may have more familiarity with the specialty program or school selection process.  However, others that have used public school services or may be sending a young adult off for the first time will find they are navigating in unfamiliar terrain that can be overwhelming.  Investigation, planning and close examination of potential programs ahead of time can save costs and avoid buyer’s remorse in the long run.


First, exactly what kind of program is being considered and what college(s) or vocational programs does it affiliate itself with?  Is the program embraced and supported by the faculty and administration of affiliated institutions?  How inclusive is the program with regard to the general population of students?  Are services centralized or decentralized and what other resources may be available such as counseling, writing centers or assistive technology labs?

Check that the associated colleges and vocational programs are ones that the student would actually want to attend.  Ensure that the classes that he/she may take (whether it be ceramics or physics) will be offered at the institutions affiliated with the support program.

It would be important to visit places like the office of specialized services of the associated  campuses and get a feel for how they deliver overall educational services and supports to students with disabilities.  Although both the Americans with Disabilities Act and Section 504 of the Vocational Rehabilitation Act of 1973 protect students in higher education, some schools and programs are much more willing to make accommodations for students with disabilities than others.  Ask to see printed materials that professors and staff are given to explain various disabilities and the rights and responsibilities of students.  Choosing a program that works with an institution offering relaxed time tables for completion of degrees or certificates may be a key element of success for some students.

Another factor to consider is how long the college support program has been operating as some programs are rapidly expanding to multiple sites.  Some of the sites may be more established, or offer a different mix of studies, or have a more inclusive student culture.  Families and students considering a support program should see how transparent the organization is in the way they operate. Try to get an understanding about the philosophy of the support organization to see how they actually view their work. Ask questions about the experience, training and stability of the staff working with students.   How is staff hired, trained and managed?  Is there a separate curriculum (for example on life or social skills) that is offered to or required of students?  What is the ratio of students to staff?

Find out if the support program is a for profit entity.  Contact the Better Business Bureau to see if there have been any complaints or actual lawsuits lodged against it.  If it is a non-profit, ask about the stability of the funding to run the program long-term.  In either case, get detailed information about the “real price” for attendance.  Think about additional costs that may not be covered in the price quoted in the brochures such as housing, additional daily living expenses and out-of-state tuition for the associated college or university etc.  Is there financial assistance for students entering the program or support applying for it? Has the program developed any additional links to public funding like the Department of Vocational Rehabilitation or Department of Developmental Services when appropriate?  A very clear picture should emerge about the financial commitment involved


How are student’s applications reviewed to make sure they are appropriate for the program?  Is their a mandate for complete disclosure to ensure the safety of all students?  What is the ratio of students who apply to students who are accepted? What is the general age range and make up of the student body?  What does the interview process like?  How competitive are the placements for the program?  Is there a minimum SAT score and/or other academic requirements to meet?  What kind of supplementary information is required as part of the process such as psycho-educational testing or proof of disability in order to be considered for admission?

How involved is the student in the process?  Does the support program require new students to review and agree to a standard of behavior?  Does it provide liaison to the college to ensure that the student’s disability is appropriately disclosed and that the student can avail of all the supports they are entitled to?  Are students expected to know how to explain their disability to staff during an interview?  If a student takes medication, are they expected to know what it is, what it is for and whether they manage their medication on their own?

As students move toward programming beyond high school, so much is expected or inferred and while the chronological age of the student may be 18, maturity and baseline knowledge about self-care may be delayed or emerging.  As part of the preparation or application process for college or added support program, families need to think through the level of independence for each student and the upfront knowledge and skill level required to manage classes as well as personal lives.

Students leaving high school may be surprised to find out that the special education process as they may have come to know it has ended and that they will now encounter a new system of accommodation only verses accommodation, modification and remediation.  It is important to know about (and obtain) the type of current documentation needed to show how a student’s disability may affect them.  Effort is no longer rewarded as much as results and students should be prepared to understand the shifting expectations in college.  Assessments that have been completed on behalf of a student need to include recommendations that trigger accommodations.

Another critical question in the investigative process is how is actual recruitment into the support program facilitated?  Are there student enrollment targets that sites may be trying to meet?  Do consultants, management or admissions staff get incentives for getting students through the door and for keeping them there? How likely is staff retained by the program to pressure students to stay in order to receive said incentives?  How much time do the admissions people spend in the actual program to know what is currently happening “on the ground?”  What information can they provide on the make-up of the group of students in the program?

Families should check to make sure that marketing efforts and materials presented actually match the specific services that are delivered.  Be weary of the brochure that looks too good to be true.  Some support programs spend a great deal on marketing efforts to woo students and parents can get caught up in the pressure to place their child.


Some programs offer a menu of services while others offer a more standardized model.  Whichever may be chosen, it is essential to know what is on the menu for a student.

Transitioning to a new school environment is huge for any young adult.  Therefore, the first issue that comes to mind is finding out what support exists for the student as he or she transitions into the setting.  Are there initiation or orientation processes? What kinds of additional services (if any) exist for any ongoing problems or concerns?  Does the program appoint a mentor or “go to” person for an individual student?  What is the activation process the student would use if they needed a specific support?  How available and approachable is staff to deal with student’s concerns?  How well does the student actually articulate their concerns, challenges or needs so that others can support them in their requests?

Beyond academic support, what is in place for assisting students who may have health issues, mental health struggles or a general breakdown in day-to-day functioning?  Does the program have a list of trusted allies to which a student can be referred?  What training is in place for staff to spot potential problems including abuses, aggression or violence?  Is staff trained to recognize when a student may be considering self-injury or suicide?

Is there programming in place for students to support those that are shy, socially awkward or isolated?  Are students encouraged and supported to join in the broader community?  Are activities mandatory and how are they selected?  What happens if a student is fearful to attend group activities?  How are disagreements or insults among students handled in a group?  How is leadership and compassion encouraged?  For particular students, social success may be far more critical than academics as a marker of present and future victories.

When a student falters or experiences additional trouble, what happens?  Are there measures in place to assist the student?  What happens if the student remains unsuccessful?  How willing is the program (and any educational entity related to it) to keep a student enrolled?  Is there assistance to look at other options if the current option fails?

Once a student has reached the age of majority, communication will (and legally should be) primarily be with the student and the educational entity and program.  Waivers must be signed by students if parents expect to be in the loop for exchanges of information.  Some programs want ongoing parent support and others may discourage it.  It is important to know the policies and expectations ahead of time.

If a student is going to be housed on campus or nearby, check out how solid, stable and conveniently located the housing is.  Is housing that is owned and operated by the program or institution itself offered?  What oversight is involved?  Who handles maintenance?  Are there significant leasing commitments to think about?  How are shared expenses for roommates handled?  Is there a student handbook that covers rules for co-existence including policies for drug and alcohol use?  What is the policy for having guests in the rooms or apartments including boyfriends or girlfriends that spend the night? What happens when roommate issues arise or how might an initial roommate selection process take place?  How are matters settled in a dispute?  If students are in dorms, what kind of resident adviser support might they get?

Equally important to note is if housing is in a safe neighborhood with nearby amenities.  Is it accessible to public transit and are students given any support or instruction to utilize whatever transportation options are available?  If the students are housed in apartments, is the general public living there as well and who makes up that population?  Families may want to look at crime and local police blotters to see if there has been violent crime reported in the area.  Is there limited access to student housing (and supports) during holidays and school vacations?


The next crucial piece to consider is how services are delivered.  Does the student self-select for services?  What if they need additional organizational support?  What kinds of external organizational supports exist?  Does someone regularly check in with the student including making sure that outside class assignments are completed, tutoring sessions attended? Is anyone tracking the overall well-being of the student?  Are there records to track services that have actually been rendered?

Ask program staff about the kinds of classes that students actually take.  Are they credit or non-credit classes?  How many students actually complete a degree? If students are taking classes at the support program’s site such as study, life or social skills, how is that measured in terms of success and building upon emerging or existing skills?  How is that reported and documented?  Is there an opportunity for fluidity in the program or is it more rigid in the way it delivers standard services?

If parents must sign a contract for services, be careful when reviewing and BEFORE signing.  Take care to see how iron-clad the contract is and whether there is an escape clause if the program is not successful or a failure to deliver promised services can be substantiated.  Can services be prorated?  Is there a varied selection of services to choose from?  Must a student sign up for all services if only certain services are needed? Is there a dispute resolution process in place for programmatic or contractual issues?

Last but certainly not least, a program should encourage a student with a disability to become the very best self-advocate they can possibly be.  Who will help them to understand the ongoing and changing process for asking for appropriate accommodations with regard to their classes or in the workplace if they are learning a vocational trade? Students with disabilities must access post-secondary programs that will steadfastly support them in their earnest efforts to succeed not only academically but in self-awareness and self-determination.


Every parent wants to believe that they are sending their child off to a program that offers positive results.  With that in mind, what are the reported outcomes of graduating students like?  If it is a newer program, what kinds of grades and progress are students making that have entered the program?  How is success measured?  Some programs feel that getting a student integrated into the general scheme of college life and then letting them spread their wings on their own IS success.  Others may want to follow the student through the entire program.  Ask for references to gage other’s experiences with the program.  Check for blogs that might exist about the program as commentary can be quite sobering to read and content should be checked for its validity.  There are also a number of blogs and posts on social media that document local dorm and apartment living so bear that in mind when looking.


Post-secondary, supported programs should create an atmosphere of authentic hope tempered with realism.  Many supported programs accept students well past the age of eighteen and there is time to prepare and amass more coping skills and maturity before utilizing a comprehensive supported program if one is actually needed.  But students must be ready and motivated before they commit to the program that appears to have the best set of services and supports to assist them in their unique journey toward personal independence and achievement.  Being a wise and knowledgeable consumer who has done the needed ground work to find a support program with integrity and commitment to its students will certainly be worth every bit of time and effort involved.


The Affects of Autism in Families and in Partner Relationships

By Chantal Sicile-Kira, BA

Editorial Note: This article originally appeared in Family Therapy Magazine in May/June 2008

Family life  is all about relationships and communication:  relationships between two people in love, parents and children, siblings, extended family members. Yet, autism spectrum disorders (ASDs) are all about  communication challenges, misunderstanding of social cues, and lack of emotional understanding,  thus affecting every relationship in the family. In marriage, if one of the partners is on the spectrum, there will be more difficulties than the usual marital conflicts. Sibling issues are exacerbated  by having an autistic sibling and/or a parent on the spectrum. Communication and social challenges  can also impact the adult’s work situation. Before looking at how to best provide support, a better understanding of the particular difficulties autism infuses into the family unit is necessary.

Autism: It’s a Family Thing

It has been estimated that the divorce rate is in the 80% range  in families with children who have autism (Bolman, 2006).   Despite high rates of marital conflict, many couples do not reach out for  couples therapy.  Lack of respite is a major reason.  For most, finding  a babysitter with whom then can safely  leave  an autistic  child who has  toileting issues, little communication skills, aggression and other inappropriate behaviors on a regular basis is difficult (Sicile-Kira, 2004). Another reason is their lack of belief that they will find a therapist understanding of their particular circumstance and offer any true guidance, thus preferring to use the precious  time away from the child to confide in a good friend.

Marital stress around the child usually  starts when one or both of the parents realizes the child is not developing properly. Couples who have a child who  does not seek their attention in the usual  way  (i.e.,  eye contact, reaching out  for or giving of  affection, searching them for comfort when hurt) find it  hard   not to  feel rejected or unimportant to the child. For those whose child develops normally and then regresses around 18-24 months, there is the added loss of  the child they knew slipping away. Consider also that a couple looks forward to having a child, and each person had his idea of what the expected child will be like.  When the child does not match the expectation,  or regresses, there is a loss and anguish felt by the parent not unlike the stages of grief that people who  lose a loved one experience (Sicile-Kira, 2004).

Other stages of added stress are: getting a diagnosis (family physicians are reluctant to make a diagnosis on a condition once rare for which they have no set treatment plan to prescribe); getting services (a constant struggle); dealing with adolescence (sexual development appears, uncontrolled tantrums can be dangerous as the teen gets bigger); and post high school (the realization that few adult services are available) (Sicile-Kira, 2006).

Keeping  any marriage healthy takes  time, and all too often,  time  gets swallowed up by the autistic child’s needs.  Many children with an ASD   have difficulty  sleeping, meaning that at least one of the parents is sleep deprived. Usually, a role division takes place as one parent, usually mom,  becomes the  autism expert,  while dad works harder to earn money or opts out. Differences of opinion exasperate an already difficult situation – how much time, energy and money is to be spent on helping the child is based on personal philosophy, and in this the couple may clash.   Over time, dad becomes frustrated at the demands of their wives to interact or play with a child who does not know how, and moms become frustrated at the lack of involvements of their partners.

As well, a common pattern among moms is to wonder what they did wrong – drinking or taking medications  during pregnancy, exercising too much, allowing the child to be vaccinated, thus adding  feelings of guilt to an already stressful situation. Also, the couple eventually feels  isolated because they feel it is hard to take an autistic child to people’s homes and are uncomfortable inviting people over.

Sometimes the couple becomes closer than ever, bonded in their shared circumstances. Unfortunately, usually the stress of dealing with autism and all it entails – the constant and necessary advocacy at school, the fighting for services and supports, the added financial burden, trying to handle behaviors and meltdowns at home – becomes a  wedge pushing the spouses  further and further apart. Overwhelmed, stressed and exhausted, the couple’s communication becomes  impaired and even autistic-like, lacking emotion and reciprocity.  This can affect other children in the family.


Unlike the parents who are totally focused on the autistic child’s needs, grandparents are concerned about the effects of autism on their adult children (the parents), other grandchildren and future generations.  They also suffer stress similar to that of parents and siblings. Grandparents  are concerned about the difficult situations they see their own children experiencing. They may provide the autistic child’s parents (who may be depressed, single, or divorced) with necessary support in the way of childcare, financial support and advocacy. But, they may also contribute to stress because of conflict regarding behavioral symptoms and treatment (Hillman, J. 2007). Sometimes grandparents  get involved in the blame-game about the possible causes of the child’s autism, which can be particularly terrible if the couple splits up and there are disputes over custody.

Grandparents may want to help by babysitting, but most do not have the training in behavior management or may not have the physical strength  required to handle behavioral episodes. They may just want to play with the child and spoil him/her, and end up feeling rejected  by the lack of ‘typical’ exchange.


The challenges of having a brother or sister on the spectrum can have both  positive and a negative effects on  a sibling. The factors that affect how a sibling adjusts include: family size, severity of the brother or sister’s impairment, age of the sibling at the time of the diagnosis, gender and age of sibling, and their place in the birth order.  The parents’ attitudes and expectations have a strong bearing on how a sibling adjusts.

Many siblings develop a maturity  and sense of responsibility greater than that of their peers, take pride in the accomplishments of their brother and sister and develop a strong sense of loyalty. Siblings of ASD children are usually more tolerant of differences in people and show compassion of others with special needs. However, many siblings feel resentment  at the extra attention the child with autism receives, and some feel guilt over their good health. When little, they may think  they can ‘catch’ autism from their sibling. They may also feel saddled with what they perceive as parental expectations for them to be high achievers. Many feel anxiety about how to interact with their brother or sister, and feel rejected by the lack of reciprocality. Often there is a feeling of resentment at having to take on extra household chores, coupled with restrictions in social activities. When one of the parents has AS, this creates another set of challenges.

An Asperger Marriage

As Asperger’s Syndrome (AS) has only been recognized since 1994, there are many adults with AS who have been misdiagnosed and treated for  mental illness. Although traditionally 3 out of 4 children diagnosed with an ASD are male, there is growing consensus that there may actually be more  females with Asperger’s Syndrome who have been  misdiagnosed with other conditions. Keep in mind that the information below is  based on  heterosexual partnerships,  although  same- gender relationships occur just as it does in the population as large.

Sometimes the diagnosis of an adult follows  that  of  their child, sometimes it follows marriage therapy, and sometimes it is problems at work that  finally lead to a diagnosis. A spouse  may seek out a therapist  with complaints of  a cold, uncaring,  and unemotional husband, although she may have chosen her mate because he appeared  calm and reliable. An AS adult may appear depressed because of  the flat affect, monotone and lack of direct eye contact.  Others may appear controlling and rigid, insisting everyone in the household stick to the same schedule and participate in the same activities, due to a need for sameness and inability to empathize. It is this lack of  empathy that has the biggest impact on the partner with AS ability to understand their spouses, as well as any children,  and to recognize that their needs, perceptions and thoughts are different from their own (Aston, M. 2005).  Poor empathy in the AS parent may contribute to behavioral and psychological problem in the children. However,  a parent with AS, may be better able to better understand and cope with the a child who has the same diagnosis.

Anxiety and stress can run high in adults with Asperger’s due to the difficulties in communication and social interaction. Most lack what we think of as ‘common sense.’ Body language and subtexts of intonations are lost on them, so that they may hear the words that were spoken, but not understood the real message or context. Persons on the spectrum can be honest to a fault and  may make inappropriate comments in public, thus appearing rude and uninterested in social situations.

These same communication problems effect a person’s ability to keep a job or move up the corporate ladder. Temple Grandin PhD, author of Thinking in Pictures and animal scientist, often speaks about how she almost got fired from her first important job because she kept writing letters to the CEO telling him how he could improve the company. She had no clue that the hierarchy at work dictated how, what, and to whom you communicate. Often times when a company is downsizing, the people laid off are the those who did not establish social relationships at work.

Physical demonstrations of affection can be difficult  for those  adults who  suffer from sensory processing disorder  and are overly sensitive to touch. Often the AS spouse is surprised that his partner and  children are feeling unloved and unsupported, not realizing that his behavior does not show the support and love he says he has for them.  The inability to read non-verbal communication makes it difficult  to differentiate between when their partner  wants to have intercourse or just a snuggle.  Some couples report that the partner on the spectrum insists on routine even  in  sexual activity (Aston, M. 2003).

Finding out that a partner has an ASD can provoke different feelings. One of them is anger at missing out on aspects of a marriage that the partner was looking forward to. Another feeling is relief that the partner is not trying to shut the other one out, he is just unable to provide the emotional response needed (Slater-Walker, C., and Slater-Walker, G. 2002). For children the reaction is similar. The positive aspects of having a spouse with Asperger’s can  include  the realization that they are in most cases loyal, honest and dependable.  Those who are diagnosed as adults who knew they were different feel empowered and relieved once they receive the diagnosis, as now they have a starting point for finding strategies that are helpful (Carley, M. 2008).

How  Therapists Can Help

There many ways in which therapists can help the family unit. For all those who need more information or need access to a support group and are not yet hooked into recourses, the Autism Society of America has local chapters that can be helpful. www.autismsociety.org

Couples need to be encouraged to acknowledge  and face the emotions of the grief cycle (i.e., denial, grief, depression, anger) and the loss of the child they were expecting, and to work through these emotions. Misdirected anger is often released at school personnel in Individualized Educational Program (IEP) meetings or taken out on service providers, thus alienating the very people who are there to help them.

Encouraging couples to regularly schedule time together without the children is important. However, this suggestion is useless  unless the therapist can support  them in devising  a practical plan for  finding the respite help they need.

The lack of qualified babysitters can be a very real obstacle to finding  time together or continuing therapy. Working on good communication skills and  looking at how they can support each other is important. The couple  needs to realize and accept that their partner may react differently to having an autistic child and a different viewpoint when it comes to how much effort and money to put into treatment, as well as what kinds of treatments to pursue.

Encouraging dads to  take a more active role  with agreed upon treatments, generalizing some of the skills the child has learned through his ABA (Applied Behavioral Analysis) program, helping with structure, limit setting and discipline can be very helpful. For this to occur, dad needs more information and training. Perhaps coming up with some dad-oriented informational materials could be useful. A good on-line support group for dads is  http://www.fathersnetwork.org/

In the same way, providing available and willing grandparents with information and a little training that can enable them to step in and give the parents a few hours of respite can be beneficial to all involved. Explaining to them why their grandchild acts they way they do (i.e., sensitivity to sound and light, not being able to make sense of the world, lack of communication skills) is helpful.  Suggesting they  offer to  do a specific task, such as  teaching the child to catch and return a ball or play a simple game, or  teach a simple learning skill which needs much repetition and positive reinforcement, can be helpful. In this way they could  understand both the effort needed and the excitement to be had in teaching their grandchild an interactive skill. Grandparents will feel empowered knowing they are making a positive difference in the family’s life, the parents will feel supported and more relaxed. Information geared towards grandparents can be found on the  Grandparent Autism Network  at http://www.ganinfo.org/organization.aspx

To the non-autistic sibling, knowing that they can ask questions and discuss their feelings about their sibling and autism is important. By helping parents understand the needs that siblings have is helpful,  as sometimes these get lost in the shuffle. The non-autistic children need some quality time   alone with their parents on a regular basis Parents need of be aware of the sibling’s feelings in order to develop strategies of support  to help him/her  adapt.

Providing the siblings with information about autism  (such as why their sibling acts they way he does)  in a positive manner at their age level is necessary, and there are many children’s books available now that that can be very helpful. Joining a support group for other siblings of special needs children can be extremely helpful so they do not feel they are the only ones going though this, see www.siblingsupport.org/sibshops for more information.

The siblings need to be reminded often that they have just as much of their parents’  love as their autistic sibling, even  if  parents may need to give more time and attention to their brother or sister with autism. It is important that the non-autistic sibling have a private autism-free zone  to call their own, and a secure place to keep their precious objects. They also need to see that the sibling with ASD is given consequences if he wrecks their things, and that he is expected to improve his behaviors over time. For children of an AS parent,

For a mixed marriage between an  Asperger and a non-autistic partner  to work,  each spouse  needs to recognize the differences they have and  why. If the partner  with Asperger’s  refuses to  acknowledge that his behaviors and actions towards his/her partner are unacceptable, then  there is little hope for the relationship.

Understanding the deficits, reinforcing the strengths and  acknowledging the needs of each partner is helpful. Teaching the willing AS partner behaviors that are important to his spouse (such as greeting her  when he walks in the house, asking about the partner’s day at work, giving her a kiss) is effective. Research for my new book  (Autism Life Skills to be published by Penguin October 2008) indicates that those willing to learn can be taught expected behaviors and strategies. Some of these include teaching them the ‘hidden curriculum’ (i.e., what non-autistics automatically learn and take for granted, making lists for visual learners).  For more social competence at work, having a mentor there who can explain the non-autistic expectations, and writing a list or drawing a map of the hierarchy and expected communications at each level can be well-worth the effort. GRASP – The Global and Regional Asperger Syndrome is a good on-line network for people on the spectrum www.grasp.org  Information for  partners and families can be found on these two websites : Asperger Syndrome  Partners & Individuals, Resources, Encouragement and Support. www.aspires-relationships.com ; Families of Adults Affected by Asperger’s Syndome wwww.faaas.org.

Author Biography

Chantal Sicle-Kira, BA is President of  Autism Making A Difference,Inc. which provides consultation, training and seminars on ASDs. She is the author of Autism Spectrum Disorders (2005 ASA Outstanding Book of the Year), and Adolescents on the Autism Spectrum Disorder, both published by Penguin. Her third book Autism Life Skills will be published Oct 2008.


Aston, M. 2003. Aspergers in Love: Couple Relationships and Family Affairs. London: Jessica Kingsley Publishers.

Aston, M. 2005  “Growing up in an Asperger Family.” Counseling Children and Young People (CCYP) Journal.

Autism Society of America, 2008. “Family Life.” http://www.autism-society.org

Bolman, W. 2006. “The Autistic Family Life Cycle: Family Stress and Divorce.”  asa.confex.com/asa/2006/techprogram/s1940.htm.

Carley, M. 2008 Asperger’s from the Inside and Out: A Supportive and Practical Guide for Anyone with Asperger’s Syndrome. New York: Perigee.

Hillman, J. 2007. “Grandparents of Children with Autism: A Review with Recommendations for Education, Practice, and Policy.” Educational Gerontology, P 513-527.

Sicile-Kira, C. 2006. Adolescents on the Autism Spectrum: A Parent’s Guide to the Cognitive, Social, Physical and Transition Needs of Teenagers with Autism Spectrum Disorders. New York: Perigee.

Sicile-Kira, C. 2004. Autism Spectrum Disorders: The Complete Guide to Understanding Autism, Asperger’s Syndrome, Pervasive Developmental Disorder, and Other ASDs. New York: Perigee.

Slater-Walker, C., and Slater-Walker, G. 2002. An Asperger Marriage. London: Jessica Kingsley Publishers.




Employment on the Autism Spectrum

By Zosia Zaks, M.Ed., CRC


I recently heard that 97% of adults on the autism spectrum in the United States are not working. I don’t have the source for this data. Even so, we all know that the rate is too high. Something is amiss.

I believe that all adults can work and need to work. Work is more than just earning money to survive. Adults want to do jobs that make them feel proud. Work is about contributing to society. Even if that contribution happens in an alternative format, this is how a person senses his or her dignity. Therefore, the autism community must urgently address this issue of severe unemployment and underemployment.

Vocational Rehabilitation: Sometimes a Good Option

Many disabled adults look for services and supports from the federal-state vocational rehabilitation system. Autistic adults can also avail themselves of what VR has to offer. VR is staffed by different types of professionals, including Certified Rehabilitation Counselors (CRCs) who are trained to provide a mix of counseling, education, skills supports, measurement of work strengths and weaknesses, and advocacy with employers.

Realize, though, that you must qualify for services from VR. Unlike special education, which is a right, you are not entitled to any supports or assistance in adulthood. At a minimum you will need a fresh diagnosis – a diagnosis from middle school or earlier is probably too old for the qualification process. Also keep in mind that each state calls VR something different: For example, In New York, VR is called Vocational and Educational Services for Individuals with Disabilities (VESID); in Maryland, it is the Division Of Rehabilitation Services (DORS); in Oregon, it is the Office of Vocational Rehabilitation Services (OVRS). States vary in what they offer and how you qualify. You can find out the name, phone number, offerings, and qualification procedures of your state’s VR office by looking at the state government website.

It is never too early or too late to contact your state’s VR office. You can call VR at any time in your life. Even if you are a teenager, you may qualify for testing services that can help you determine your work-related interests, talents, and assets. You may be able to participate in VR programs just for transitioning youth. Your state may have pre- vocational options, too, that let you “try out” different work environments or practice work skills before you graduate.

Keep in mind that the professionals in VR have varying degrees of familiarity with autism. If you have strong communication skills, or if you can live independently your need for support in the area of work may not be understood. You may qualify for a service that sounds perfect, such as a computer repair training program, only to discover that supports and accommodations for autism-related issues in the classroom are wholly lacking. You may qualify for VR funds to develop your own business, but if you need a lot of structure and guidance to get tasks done, self-employment may not be for you no matter how great your business plan is on paper. Creative alternatives for employment support and for finding jobs may be more viable for you.

Creative Supports

If you do not qualify for services from VR, or if the services VR has to offer don’t work for you, what else can you do?

Non-profit and private groups focused on autism are filling the gaps by providing ancillary social skills training, mentors, one-on-one behavior coaching, and longer-term employment supports. Before graduating high school, investigate opportunities and limitations of your state’s VR office, and then find out what is offered by autism-specific organizations in your geographic area. Remember to do this research early. You will need a lot of time to collect information, sort through what you discover, perhaps “test drive” certain supports, decide on the various options, and then actually complete application procedures. Non-profit and private groups have some method of determining eligibility for their programs and services, and you may encounter waiting lists.

If you are not finding the right mix of supports from either VR or autism organizations, then you will need to figure out what you can do on your own. It is possible to hire independent Certified Rehabilitation Counselors, social workers, or career counselors with specific training and expertise in autism for career testing, planning, and goal- setting. A number of families have marshaled a knowledgeable sibling or family friend to step in as a job coach. Parents themselves have approached employers to create work trials or to test-run accommodations. Allow yourselves to be as creative as possible. Just realize that finding, hiring, training, and deploying your own “support team” requires time, financial resources, networking, and diligent planning. Don’t wait until the week before high school or college graduation!

Alternative Paths to a Job

Frustrated by a lack of options or excruciating wait lists at VR and agencies serving autistic adults, some families and adults on the spectrum are finding other avenues to employment success.

Some families and adults on the spectrum find internships, volunteer opportunities, specialized positions, or extended “work trials” in businesses operated by compassionate relatives and friends. For example, maybe your parent’s college roommate would be willing to offer you an internship. Would a cousin let you observe and then try the different positions at his firm? Does your neighbor need someone to fix the computers in her warehouse? I bet she would be thrilled if you offered your services for free – she saves money, and you get experience. You or your parents might be lucky enough to network with a willing employer you’ve never met before, but just think for a moment how many workers your parents, relatives, family friends, and neighbors know. Almost all of us know at least 12 people in 12 different professions. And think of how many people these people know! If your networking skills are not great, this is where family and friends need to step in.

For those who require one-on-one support, tailored apprenticeships may be another alternative work possibility. An apprentice can rely on the journeyman to set priorities, organize job tasks, determine the pace of the work, and interface with customers or business-related contacts – instantly removing most social and executive functioning aspects of a job. Since the apprentice and the journeyman expect a relationship that involves at least some degree of guidance, it becomes natural for the journeyman to impart hidden curriculum wisdom. Apprenticeships can often be created for all sorts of jobs, not just union-based jobs typically associated with the apprentice/journeyman structure.

Some families have placed an adult child into self-employment if the individual works best alone or has a special talent or interest that lends itself to proprietorship or consulting. Self-employment ranges from managing a restaurant franchise to tuning pianos to adjunct teaching at a community college.

Many self-employed people, not just those on the autism spectrum, cobble together several “mini” jobs to equal full-time employment. For example, teaching college classes as an adjunct provides just enough external structure, allowing me to follow the rhythm and calendar of semesters. I also obtain all the benefits of university affiliation – such as library privileges so I can conduct research – without the political and social constraints of being a full-time faculty member. But part-time adjunct teaching isn’t a living, so I also see clients, train professionals, and write articles. My days vary, but I have maximum control over what I am doing and when.

Be sure you have the ability to initiate tasks, direct your own activities, and make decisions under pressure if you are going to consider self-employment. Too many people jump into self-employment without carefully assessing their abilities and strengths. On the flip side, too many people don’t give self-employment a chance. You may be able to find support for any areas of weakness. Some of us delegate to others those tasks we can’t do. You may also discover ways to “patch in” supports that extend your ability to make self-employment an option. For example, you can hire someone to do accounting or to handle business phone calls.

Self-employment should be seriously considered if an autistic adult needs strict control of the work environment or the daily schedule. In my case, I must be able to set up my work spaces to my specifications and I must be able to flexibly arrange what I do each day. I only came to understand this about myself after years of trial and error. If you have severe sensory issues, severe executive functioning issues around the tasks of daily living, or your physical energy level and sleep cycles fluctuate, self-employment may be the only viable work option, in which case you will have to fit your skills into a self-employment framework.

If you are not ready to hold down a job or work for yourself, consider the wide range of alternative options. For example, you can always volunteer doing something related to a special interest. I know someone who has retained much echolalic speech as an adult and his favorite pastime is memorizing and then repeating Disney movies. He adopts almost exactly the precise voice of each character and switches between characters effortlessly. The members of the local senior citizen center absolutely love to hear his rendition of their favorite Disney classics and they appreciate his visits! He may not be earning a wage, but he is certainly contributing to society. Find what you love to do, what you are doing already, or what you are good at doing, and build out from there.  Every single adult has something to give to the world.

Lastly, consider all of the other factors of life that can impact employment. This will help you determine what types of supports you might need and how you might go about assembling them. For example, if you do not drive and are not able to tolerate public transit, you will need a job in walking distance or a home-based job and if you need a job coach, then you will have to find one that can travel to your neighborhood. If you don’t understand your transportation challenges in advance, you can’t plan for employment effectively. Specific areas to look at carefully include transit, personal care, dressing, eating, sensory issues, environmental factors, level of physical activity, pace of work, degree of socializing required by the job, anxieties around certain tasks, and executive functioning before, during, and after work.

Again, keep in mind that it can take time to organize a team, hire or consult with experts, make plans, and try out different ideas. Autistic adults often need extended periods to adjust to the work environment. And because of the specific social and communication issues associated with autism, autistic adults may need assistants to do the most heavily social aspects of creating an alternative path to work, specifically networking, cold calling, asking questions, or describing needs and strengths. Remember, the vast majority of positions are not filled by responding to help-wanted ads: Most people get a job via their connections to other people.

Adult Life Skills

As a Certified Rehabilitation Counselor (CRC), I am often asked what skills autistic adults need to find and keep jobs. Personally and professionally, I find the biggest problem is not the actual tasks of a job. Across the spectrum we have talents, skills, and knowledge in abundance. The bigger problem is all the social interactions, the politics of the workplace, the essential networking, and the “hidden curriculum” that is so hard to discern. Therefore, worry less about the specific job tasks you might be given and focus a lot more on social skills, self-regulation, self-advocacy, and flexible thinking.

Some people say, what do my emotions have to do with work? The answer: Everything. You need to be able to figure out what you are feeling, how much of a feeling you are experiencing, and what is socially appropriate to do for that particular emotion and that particular amount of emotion. Also, certain feelings should not be expressed or processed at work. The only way to learn how to identify and cope with your emotions is through practice. Don’t begin practicing your first day of your first job.

Many autistic adults need scales and visual aids to deal with emotions, to regulate sensory processing, to gage physical needs, and to modulate communication. For example, if you are at a very high level of anger because your boss told you that you stacked the boxes incorrectly, you need to know that it is OK to take deep breaths, pace back and forth a few times, or walk to the water fountain and get a drink to cool off, but that it is not alright to show anger to the boss, yell, refuse to continue working, or leave the worksite.

I have to watch my level of sensory integration. I have learned through much trial and error the symptoms that indicate I am overwhelmed or becoming overwhelmed, and techniques to bring my body back to a state of equilibrium. Job coaches need to watch for issues and need to be developing strategies and techniques with you so that you can match your behavior to what is expected of adults in your specific work environment. Occupational therapists can also assist not just with sensory processing but also with physical pacing, expression of emotion, and cognitive self-awareness.

Self-advocacy is important because you will encounter moments when you need to articulate your experiences and ask for assistance or accommodations around your challenges. For example, maybe you know in advance that you have difficulty regulating your amount of excitement. You have worked with your support team to create a sliding scale tool for this emotion that helps you match your amount of excitement to one of five levels and that then provides a visual clue of the appropriate behaviors for each level. You try your hardest to use your scales at work to prevent a meltdown. But without self- advocacy skills you will be unprepared for the day you need an exception. You must be able to say to your manager, “My excitement level is extremely high today and despite

using my strategies, I just can’t get myself calmed down. I need to calm down so that I can concentrate on editing this stack of articles. Can I take a 15-minute break now? I’ll stay 15 minutes late at the end of the day to make up the time.”

You do not need extensive verbal fluency to advocate for yourself. I worked with a young gentleman who now carries an index card with a red stripe on one side and a green stripe on the other side. He shows his boss the red stripe if he does not understand what the boss wants him to do, which always causes him agitation and anxiety. When the boss sees the red stripe, she is careful not to overwhelm him further. She usually stops talking, switches to visual instructions, and often gives him a few minutes of breathing room. Conversely, if he is feeling comfortable with a set of instructions and feels ready to proceed with the next activity, he shows his green stripe.

Flexibility is also crucial and very difficult to teach. Again, visual aids such as “if/then” flow charts can help. Also build up your tolerance for disruptions, interruptions, changes to the schedule, or suggestions from co-workers by rehearsing what you will do and what you will say. Writing conversation scripts in advance helps some of us. For example, if your manager frequently asks you to do tasks in novel ways, a script such as, “I see you would like me to repair the motherboard differently. I’ll try, but I need a few minutes to adjust because I thought I would do it the old way,” might give you the time you need to switch gears, accept new instructions, prepare yourself for a new experience, or cope with your emotions about the change in ways that are appropriate for the workplace. Remember, you can utilize communication cards and other visual strategies to get your point across if talking under stress is too difficult, if talking is not your first choice, or if talking is not an option.

Hidden curriculum is perhaps the hardest component of work life to tackle because the context of an interaction is so important: Something said in one moment may be appropriate or inappropriate depending on what else is going on, who else is in the vicinity, or even who is talking. This is why strategies for behavior, facility with emotions, and self-advocacy are such a crucial foundation for social interaction in the workplace. Should you come to a social moment you do not understand, you will still be able to use your foundation skills to remain calm, act appropriately, and request data or input. While you use your foundation skills to get through the day, you can begin to catalog hidden curriculum information for future use.

An example may illustrate what I mean. Let’s say you are friends with a certain co- worker, and the two of you always have coffee together every morning before starting work. Suddenly, on a Tuesday morning, he walks in the door, ignores you, mumbles “Bad hair day,” grabs his coffee, and slinks into his office, shutting the door. You are left standing there baffled and also upset. Why is he talking about hair? Why did he grab his coffee and go away?

Your solid set of foundation skills come into action: You know what is appropriate to do when you are upset, how to show your feelings, and what techniques help you get yourself back to a regular level. But later, you can investigate to recover the missing hidden curriculum data. You find out from the person sitting next to you that the expression bad hair day means the person is having a bad morning. Now you realize your friend is probably just having a rough day and doesn’t want to talk to anyone yet. In this case, it makes sense not to be offended. You decide to ask how he is doing at lunch.

Here is another example. You start a new job, and on the second day, you observe the boss waving to the UPS guy. He yells out to the UPS guy, “Hey you! Hurry up!” and then laughs. The UPS guy chucks a roll of 2-day stickers at the boss, laughs, scans a box, and steps out.

On day three, you are asked to give the boxes to the UPS guy at the end of the day. He is taking a long time scanning each box. Just like the boss, you say, “Hey you! Hurry up!” The UPS guy scowls at you. After the UPS driver leaves, the boss chastises you for speaking to him inappropriately. You are totally confused, deeply embarrassed, and also worried that you might lose your job. You use your foundation skills to identify these feelings and cope with them privately. You use a script you developed in advance that provides a framework for responding to criticism appropriately. You go back to your job. Later that evening, you call your job coach and ask for the hidden curriculum. Your job coach explains, “Oh! The UPS guy – that is the boss’s cousin! They yell at each other all the time but it is just a joke. You, on the other hand, should not yell at the UPS driver. It does take quite a long time to scan all those boxes and get them on the truck.” You and your coach decide together that the coach will let the boss know you were simply confused but understand now.

These “adult life skills” are absolutely crucial to work success, whether you are folding boxes, illustrating toothpaste tubes for a multinational corporation, answering the phones at a small neighborhood bike repair shop, repairing iPhones, volunteering at a paperclip museum, delivering pizzas on the weekend, reciting Disney movies for seniors, or running an X-ray machine. Don’t discount the importance of these skills. You will use them every single day, no matter what you are doing with your life and no matter how your autism impacts you.

Work Culture

Another key aspect of working that is not considered enough is work culture. If you are an adult on the autism spectrum, or if you are a professional or family member helping an autistic adult, carefully analyze the culture of a workplace and how well the culture matches your needs and values.

I interface with employers on behalf of clients regularly. Part of what I am doing is advocating on behalf of clients who might work there: I am explaining autism and what autistic adults can contribute, I am describing the types of accommodations that might enable an autistic adult to succeed at a particular job, and I am pointing out ways that hiring someone with a specific set of talents or interests will be valuable to the company. But I am also assessing the worksite culture and how the different adults I am assisting may or may not fit in to that culture.

If you just can’t managing the executive functioning of getting into a suit and tie every day, if you loathe the idea of punching in with a time card at an exact time, or if you do not like conforming to a standard pitch line about the company and its activities, I am not going to recommend a position for you at a worksite with a strong corporate culture, strict time requirements, a dress code, and policies on what employees can say about store products. On the other hand, if you need to know exactly when your shift starts and stops, and if you need to know exactly what to do each moment of the day, a corporate environment might be better than a local shop with an informal schedule and rotating tasks.

Some people are going to say, “Isn’t this obvious? If you are scared of heights, don’t become an astronaut.” To a degree the concept of workplace culture in employment planning is a given. But when it comes to autism, this issue magnifies in importance. You must know yourself thoroughly, and whoever is assisting you must take workplace culture into serious consideration.


Because our culture is not a meritocracy, and because the world of work in our society places such an extraordinary emphasis on social connection, autistic adults frequently need extra assistance in this area. Teaching someone how to navigate the social environment at work adroitly is complicated but not impossible.

Keep in mind that learning happens over time. It is totally normal, for example, for adults to try a variety of jobs and fail at several, yet when an autistic person is fired everyone acts as if the world is falling apart. I was complaining to a fellow autistic friend of mine a number of years ago when yet again, a job I was trying was just not working. I was deeply frustrated and disappointed. She said, “What’s wrong with failing? You can always get up and fail something new!” Autistic adults have just as much right to change their minds, fail, try again, adjust, adapt, and grow as any other adult. What you are doing at 20 is rarely what you are doing at 40 or 60.

Often autistic adults do not fit the typical profile of someone who needs employment supports. Autistic adults have a unique learning profile and unique challenges in communicating and socializing that can be difficult to pinpoint or to address with typical accommodations and services. When it comes to autism, it is vital to put all notions aside. I know autistic adults with verbal fluency and master’s degrees who need visual aids and a job coach to maintain employment. I also know autistic adults who use electronic communication devices and need supports around basic activities of daily living and they are extraordinarily successful at college and have much to contribute to their chosen fields of endeavor. Always presume ability while simultaneously investigating openly what someone’s support needs might be.

In conclusion, I restate my unequivocal belief that all adults on the autism spectrum have something to contribute to their communities and to the world. It is up to the rest of us to help each one reach his or her potential. When society broadens our value of all types of positive contribution, the chances to create a high quality of life full of dignity and activity go up.

Vision And Its Valliant Attempt To Derive Meaning From The World

By Carl G. Hillier, OD FCOVD

“It used to be thought that having 20/20 eyesight, and having healthy eyes, was sufficient to be visually prepared for success in this world. But what we know today is that the visual skills necessary for learning go far beyond the ability to see 20/20 and having healthy eyes.”  [i]

A paradigm shift from eyesight to vision has been in process for years and continues to be greatly needed. Eyesight is the ability to discriminate the differences between small things. Vision is the ability to derive meaning from the world, and to guide the intelligent movement of the body. The ability to discriminate the differences between small things (eyesight), occurs, when environmental details are captured from reflected or emitted light, through an imperfect optical matrix of biologically combined materials, and travel along the optic nerve traversing a single synaptic cleft, transporting the collimated light from the surrounding world, and are then sent to the occipital lobe, that most distal mass of cortex in the back of our skulls.

Twenty percent of these fibers leaving the eye, sneak off quickly along the fast acting magnocellular pathway, bee-lining it directly into the midbrain, not even considering entry into the thalamus. These neurons establish a liaison with regions of the cerebellum, the spinal tracts and the posterior parietal lobe, establishing a spatial construct inside of which cognition can safely reside. This spatial awareness arrives in advance of conscious

The ability to derive meaning from the environment, and to guide the intelligent movement of the body (vision), begins where eyesight leaves off. The outpouring of nerves leaving the occipital lobe feed these visual details forward to all lobes and crevices of the brain, weaving the warp and weft of our human experience.

The ability, skill and endurance of the visual system to derive meaning from the world, depends upon a triad of muscular skills and panoply of perceptual and cognitive ones. The muscular abilities include accommodation, binocularity and tracking; tracking skills and are sub-divided into fixations, pursuits and saccades.  These consciously driven muscular abilities are developed because of our interactions in the world. Once skillful “muscular” contact with the visual world is available, then visual perception develops; perception becoming the liaison between the illuminated world and our cognitive one.

Beyond determining the presence of clarity, eye-health, and muscular control in your patient (accommodation, binocularity, fixations, pursuits and saccades), a full evaluation of the visual skills necessary for full engagement in our increasingly demanding world, should also involve assessing visual perception and visual cognition. Unfortunately when these skills are assumed to be intact, or, when the testing of these abilities is overlooked, people and most commonly children, suffer from being misunderstood. Behavioral and physical symptoms are exhibited which may lead to treatments that are ineffective, or worse, inappropriate.

Visual dysfunctions often masquerade as behaviors such as ADHD/ADD and Dyslexia. Fortunately, these are diagnosis of exclusion, and until visual issues are ruled out, a diagnosis of these entities cannot be clinically established. Unfortunately, the siren song that 20/20 is perfect vision can lull the most disciplined clinician into thinking that all is well, when all is not.

When the critical muscular, perceptual and cognitive skills are not sufficiently developed, their development can be acquired through the careful application of a formalized vision therapy program, a program designed by Developmental Optometrists; optometrists trained in the diagnosis and treatment of the neurological, optical, perceptual and developmental foundations for cognitive development. The College Of Optometrists In Vision Development certifies those optometrists specializing in this discipline. Their website (COVD.org) provides references for the scientific foundation from which their clinical work is derived, as well as referencing the contact information of doctors throughout the world who provide this specialized assessment and treatment.

Children’s innate neurological malleability enables the treatment of their visual delays to be quicker and easier than adults; the assumption, though, that adults are too far beyond a critical period to be helped, is now often considered to be clinically naive. Not only is rigorous research into cognitive neuroscience revealing that an enormous amount of cortical plasticity exists in the adult human cortex, dramatic clinical breakthroughs have been made in heretofore-untreatable visual conditions such as adult strabismus (eyes out of alignment). Susan Barry, PhD, Professor of Biological Sciences and Neuroscience at  Mount Holyoke College in Massachusetts – AKA “Stereo Sue” – had such a dramatic experience of visual awakening, she  was compelled to write a book about her experience, an account so dramatic that world recognized neurologist and author, Oliver Sacks, MD, wrote the forward to her book; Fixing My Gaze- A Scientist’s Journey into Seeing in Three Dimensions. Dr. Barry not only describes her recovery, but the recovery of many other adults who have had the same opportunity to break into the third visual dimension of our world.

Stereo Sue saw her first snowfall in 3-D, after treatment with optometric vision therapy at the age of 49 years old, an age far older than clinical success was thought to be possible. Her world literally expanded. She now enjoys the world as it is meant to be seen, in rich dimensionality; “a medium on which tree branches, flower blossoms, and pine needles floated.” Surgery was performed twice as a child, without success. What would her life have been like if, as a little girl, she could have had vision therapy, and had the opportunity to see the world then, as it is now?

Vision develops as we engage in the world. Again, I am not referring just to 20/20 eyesight.  Vision, as described earlier, can be developed in those of any age, who have not experienced its wonderful gift. The behavioral challenge of not understanding the visual world is devastating; the ability of being able to understanding the visual world is a gift.

[i] This quote is as meaningful today, as it was given over 40 years ago by Dr. Robert Kraskin during a seminar given to Developmental Optometrists who were concerned with the mismatch between the physiological preparedness of young children, the cultural demands imposed upon them. awareness and thus allows for abstract cognitive thought and imagery to flourish without any obligation to act as a sentinel for spatial security.


Rethinking Autism: Implications Of Sensory And Movement Differences

This article  was written by Anne M. Donnellan, University Of San Diego;  David A. Hill, Toronto, Ontario; Martha R. Leary, Halifax, Nova Scocia; and was published in the Disability Studies Quarterly,Vol 30, No 1 (2010)


Descriptions of autism in the Diagnostic and Statistical Manuals of the APA and throughout much of the history of autism emphasize difficulties in social interaction, communication and imaginative play. Recent reports by self-advocates, neuroscientists and other researchers suggest that sensory and movement differences may play a significant part in the lives of those who live with autism. Sensory and movement differences may include difficulties in starting, stopping, continuing, combining and switching motor action, speech, thought, memory and emotion. A review of these reports, the experience of those with other movement differences, and implications for understanding individuals with autism are presented. Suggestions are included on how knowledge of sensory and movement differences may offer guidance in rethinking assumptions about autism characteristics, social interactions, communication and other supports. Authorship is considered equal. The authors wish to thank Dr. Gail Evra for her invaluable editorial assistance. I was intensely preoccupied with the movement of the spinning coin or lid and I saw nothing and heard nothing. I did it because it shut out sound that hurt my ears. No sound intruded on my fixation. It was like being deaf. Even a sudden noise didn’t startle me out of my world.

(Grandin, 1992)

People labeled with autism often move their bodies in ways that are unfamiliar to us. Some people rock, repeatedly touch an object, jump and finger posture while other people come to a standstill in a doorway, sit until cued to move, or turn away when someone beckons. As professionals trained to see these as autistic behaviors, most of us have interpreted such movements as both volitional and meaningless; or as communicative acts signaling avoidance of interaction and evidence of diminished cognitive capacity; or as some combination of these, and often have targeted them for reduction. We have taken a socially constructed interpretation of what we see and have built a “theory” of autism.

This paper challenges the traditional definitions of autism that give primacy to a triad of deficits in social interaction, communication and imaginative play (Wing, 1981; Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (APA, 2000). The approach is both widely known and essentially unchallenged despite broad acknowledgement that autism is a condition that reflects some differences in a person’s neurology. Typically, the neurological implications have not become part of the description. Over the past two decades, however, researchers and self-advocates have begun to rethink this socially defined focus. They express concern that children and adults with the autism label may be challenged by unrecognized and significant sensory and movement differences (e.g. Hill & Leary 1993; Williams, 1993; Bristol, Cohen, Costello, Denckla, Eckberg, Kallen, Kraemer, Lord, Maurer, McIlvane, Minshew, Sigman, & Spence, 1996; Donnellan & Leary, 1995; Leary & Hill, 1996; Filipek et al., 2000; Donnellan, 2001; Sullivan, 2002; Dhossche, 2004; Bluestone, 2005; Nayate, Bradshaw & Rinehart, 2005; Endow, 2006; Jansiewicz, Goldberg, Newschaffer, Denkla, Landa & Mostofsky, 2006; Mostofsky et al., 2006; Leekam, Nieto, Libby, Wing & Gould, 2007; Markram, Rinaldi & Markram, 2007; Tomchek & Dunn, 2007; Gernsbacher, Sauer, Geye,Schweigert, & Hill Goldsmith, 2008; Green, Charman, Pickles, Chandler, Loucas, Simonoff, & Baird, 2009; Goldman, Wang, Salgado, Greene, Kim & Rapin, 2009; and Mostofsky, Powell, Simmonds, Goldberg, Caffo, & Pekar, 2009).

Researchers and others describe these differences using a variety of terms, such as motor problems, sensory-integration problems, inertia, sensory overload, apraxia, dyspraxia, echolalia, mutism, behavior disorder, catatonia, or clumsiness. To reflect the range and complexity of sensory perception and movement related phenomena, we use the term “sensory and movement differences” as it encompasses the dynamic interaction of sensation and movement (Gibson, 1979; Thelen & Smith, 1995) while acknowledging that many differences are merely part of the richness of human diversity.

Behavior is highly interpretable. Some behaviors may be communicative; some may be volitional. Some behaviors, however, may not be intentional. Rather, observed behaviors may be artifacts of the difficulties a person may be having in organizing and regulating sensation and movement. Still others may be subtle signals of the desire for relationship or expressions of meaning. Therapeutic and intervention-based approaches, designed to address perceived and identified challenging and problematic behaviors of individuals with autism, tend to oversimplify the complex nature of human interactions in an attempt to delineate and manipulate variables contributing to and sustaining particular behaviors.

As we have professionalized interactions with people with autism, we have trained professionals, parents and others to interpret what happens in terms of simple, binary views of behavior (i.e. good/bad or positive/negative), and to see behavior as controlled by immediate, situational antecedents and consequences. When we focus on these socially constructed expectations for behavior and communication in our fast-paced, super technological world, we miss opportunities to know and understand people who may experience their existence and interactions in very different ways. Behaviors may not be what they seem to be (Donnellan, Leary & Robledo, 2006).

Our interest in the topic of sensory and movement differences has grown from reports by many self-advocates with the autism label and their caregivers that disturbances of sensation and movement are a constant concern, frequently constraining the ability to communicate, relate to others and participate in life (e.g., Strandt-Conroy, 1999; Barron & Barron, 1992; Rubin, Biklen, Kasa-Hendrickson; Kluth, Cardinal, & Broderick, 2001). Organizing and regulating sensory information and movement in order to participate in social relationships may be frustrating for people with such differences. These differences can involve difficulties initiating and executing movements or difficulties with stopping, combining, and switching sensation and movement, including speech, thought and emotion (Hill & Leary, 1993; Donnellan & Leary, 1995; Donnellan, Leary & Robledo, 2006), making social relationships and many other activities very challenging and even overwhelming.

Self-advocates also report that they lack sensation or feedback from their bodies and may feel physically unaware of their facial expressions, position in space and movements (e.g., Blackman, 1999; Hale & Hale, 1999; Williams, 1996a, 1996b, 2003). Some experience the sights and sounds of their world as being painfully intense (Condon, 1985; Williams, 1992 & 1996b; Markram, Rinaldi & Markram, 2007). Extreme emotions can cause the individual to become stuck, unable to initiate or cease repetition of a movement. Self confidence and reputation often suffer when others assume a person is repeating an action “on purpose.” Sean Barron wrote, “All I wanted was to be like the other kids my age. It felt as if I was weird and strange on the outside, but inside I wasn’t like that. The inside person wanted to get out and break free of all the behaviors that I was a slave to and couldn’t stop” (Barron & Barron, 1992, p. 181). For many people, as for Sean, simple movements can lead to repetitions or perseveration, even when they want to stop the movement.

Our concern here is not to discard useful information already accumulated via a primarily socially defined approach to autism. Nor are we interested in enhancing a deficit-based approach to understanding autism, or in creating a new disability category. We do not propose to specify a cause of autism or a site of lesion or dysfunction within the central nervous system. Rather, we write to share our emerging awareness that people may struggle with difficulties that are not immediately evident to an outsider. That is, our experience of individuals with autism ought no longer to be assumed the same as their experience. Individuals with the autism label often describe experiences which are not immediately obvious to the rest of us but which may well affect our understanding of their behavior. These experiences frequently fit the definition of sensory and movement differences. Sue Rubin (August 4, 2007 personal communication) described her dilemma with intention and action: “When you said we could stay and asked dad to do the shopping for the Asperger’s barbeque, my body relaxed and autism let me eat the melon.” And two other autistic adults had the following interaction about sensory and movement differences. Judy Endow (personal communication on Facebook, January 25, 2009) described her experiences in relation to sensory and movement differences as follows:

I think the fluidity of access to various places in my brain is dependent upon neurological movement between places. I’m no scientist, but have always been able to “see” this inside of me. Sometimes my speaking is hindered, other times my thinking, and sometimes my physical movement. The hardest is when thinking is not working smoothly. When that happens, I have to line up one thought at a time, like train cars. I like it much better when my thoughts do not have to be methodically lined up, but are more fluid with colors coming in and out and swirling into unique and beautiful patterns. (My thoughts are in pictures and sometimes moving colors).

Phil Schwarz (personal communication on Facebook, January 25, 2009) commented on Judy’s description by using another analogy:

I think that processing bandwidth — what Judy calls “neurological movement between places” — is a critical factor in autism. I think that those of us who learn to cope develop adaptations that allow more parsimonious use of the bandwidth available to us: love of sameness, or of patterns, or of predictability (so that we can apply the bandwidth we do have to *deviations* from the predicted or from the patterns). There is a coherent autistic aesthetic sensibility, that is informed by this search for parsimony of bandwidth use, and for titration of excesses.

This paper explores some of the implications of sensory and movement differences in the development and experiences of individuals with the autism label. We note, of course, that some researchers and clinicians completely deny the possibility that individuals with autism might experience any problems with movement. Rimland (1993), a psychologist long a proponent of a biological approach to autism, wrote the following:

It has been widely recognized for many decades that the vast majority of autistic persons are quite unimpaired with regard to their finger dexterity and gross motor capabilities. They have in fact often been described as especially dexterous and coordinated. The literature abounds with stories of young autistic children who can take apart and reassemble small mechanical devices, build towers of blocks and dominos higher than a normal adult can, assemble jigsaw puzzles and climb to dangerously high places without falling. The files of the Autism Research Institute contain over 17,000 questionnaires completed by the parents of autistic children. Finger dexterity is one question we’ve asked about since 1965. Most parents indicate that their children are average or above in the use of their hands. The idea that autism is, or typically involves, a “movement disorder” is simply ludicrous. (p. 3)

Likewise, Mulick, Jacobson & Kobe (1993), behavioral psychologists, stated unequivocally that clinical experience argues against any motor/movement difficulties, particularly voluntary control of movement as in apraxia:

Scientific evidence for developmental apraxia in autism is lacking. Autistic youngsters are often characterized by better-developed motor skills than verbal skills, even real non-verbal problem solving talent… There is no research evidence at all to support the position that people with autism experience such global problems. The usual clinical finding, familiar to any psychologist who routinely works in this area, is that motor impairment and delay is much less common than communication disorder and delay (Jacobson & Ackerman, 1990, p.274). (Italics in original)

This common approach to autism pays scant attention to possible somatic difficulties resulting from neurological differences. Perhaps, this is a function of the dominance of psychology and psychiatry for the first 50 or more years of the autism story. Yet some psychologists and psychiatrists did report movement differences and even catatonic symptoms in autism long before Rimland or Mulick et al. and others denied the existence of such evidence (e.g. Damasio & Maurer, 1978; Wing & Attwood, 1987). More recently, many researchers have noted the presence of impairments in basic motor skills: gait, posture, balance, speed, coordination (e.g., Ghaziuddin & Butler, 1998; Jansiewicz et al., 2006; Noterdaeme et al., 2002; Rinehart et al., 2006).

Many neuroscientists now are stressing the significance and implications of motor and sensory difficulties in the development of children with autism. For example, Sutera, et al. (2007) looked at four year-olds who had been diagnosed at age two and received early intervention of various amounts and types. Of particular interest were the children who “lost” the diagnosis of autism by age four. Sutera, et al. found that the best predictor of this outcome for very young children with autism is motor skill at age two. Mostofsky (2008) noted this finding and addressed concerns about the exclusion of motor problems from the “core” features of autism in the Diagnostic and Statistical Manual, (APA, 2000) “…despite [an] abundance of literature suggesting otherwise.”

A growing number of researchers and clinicians in a broad range of disciplines continue to stress the importance of studying motor function in autism because, as Rogers and Benetto (2002) reported “….studies show that movement abnormalities are present early in children with autism, and may precede the emergence of the syndrome.” Mostofsky noted: “Motor signs can serve as markers for deficits in parallel brain systems important for control of socialization and communication.” For example, children with autism are often described as lacking reciprocity. Esther Thelen (1941-2004), an innovative researcher of infant development, upon reviewing the issue of motor development in autism asked: “How can you talk about “reciprocity” or lack thereof as a psychological phenomenon if the child has motor problems?” (1997 Personal Communication)

In the course of development, if individuals move and respond in idiosyncratic ways from infancy, they will experience all interactions within a unique frame that most certainly differs from that which is called typical. The cumulative effect of such interactions will be one in which all aspects of relationships, including how to establish and maintain them, may be markedly skewed from the broader cultural consensus and expected rules of how relationships work. (See Stern, 2005; Gibson, 1979; Thelen & Smith, 1995 for reviews of the complex and dynamic interrelationship of movement, perception, relationship and cognitive development.) Our experience and self-advocate reports have taught us that individuals with autism often are aware of their idiosyncrasies, may not be able to control them but do want communication, participation and relationship. In order to make this possible, we need to acknowledge and accommodate the differences so that communication, relationship and participation can happen.

Dynamic Interactions Of Nervous System, Body And Environment

As we have noted elsewhere (Donnellan, Leary & Robledo, 2006), the writings of many authors interested in movement describe a unity of perception, action, emotion, and thought. Moshe Feldenkrais (1904-1984), a physicist, martial artist, and renowned movement practitioner noted: “Our self-image consists of four components that are involved in every action: movement, sensation, feeling and thought” (Feldenkrais, 1972, p. 10). His method is two-fold and may involve independent “awareness through movement” exercises and more hands-on “functional integration” guided movement exercises with the physical assistance of a trained practitioner.

Likewise, in his fascinating book, Awakenings, Sacks (1990) wrote of the self-reports of his patients with post-encephalitic Parkinson’s disease who temporarily “awoke” through the use of the drug L-Dopa. They all had been sick from the same disease, encephalitis lethargica. The area of damage in the brains caused by the disease was clearly established. Nonetheless, each developed his or her own personalized version of movement disorder, and many of their difficulties were unknown to the medical staff until the patients became able to speak. The variety of manifestations of symptoms encompassed difficulties with many hidden aspects of human experience: perception of the passing of time; interest in normal activities; fatigue; memory; and recurring thoughts.

Thelen incorporated dynamic systems models in her innovative research on movement in child development (Thelen & Smith 1994; Thelen, 1995). In this view, perceptions, movement, thoughts, and emotions can be linked together by having coincidentally (and possibly routinely) co-occurred. Experience may selectively reinforce them as a bundle. They can be unbundled or softly assembled as required by the context. The individual is always operating within an environment or context and, as the context changes, systems scan, adjust, and shift as necessary to meet new demands. These contextual shifts play a vital role in movement. Context comes together in such a way as to allow the movement to emerge or not; a movement and, indeed, the person or persons are part of the context (Thelen & Smith, 1994). As Bateson (1972) told us years ago, context is far more than what is left when we take out the part we wish to study.

No single component is causal in determining the movement. As these are dynamic systems, the components are the context that determine the product. Thelen & Smith (1994) further explained that “…even behaviors that look wired in or program-driven can be seen as dynamically emergent: behavior is assembled by the nature of the task, and opportunistically recruits the necessary and available organic components (which themselves have dynamic histories) and environmental support” (p. 73). These may be actions, thoughts, words, memories or sense experiences. Recall Proust, where the smell of a cookie released the hundreds of pages of Remembrances of Things Past.

Thelan’s approach offers new ways to understand the inconsistent abilities and disabilities of individuals with the autism label. Speech is an example of dynamic behavior. Speech is not lost or gained; it emerges when all necessary components recruited, and appropriately regulated and organized, allow its production. Stress often makes speech difficult or even impossible. And stress need not be negative; excitement may also cause difficulties. Paradoxically, for some people with sensory and movement differences, stress also may help produce speech. While presenting with the authors at an Autism Society of America conference in July 1996, Arthur Shawlow, Nobel laureate in physics and father of an adult son with autism, reported that his son could say a complete, and original, context-appropriate sentence about once every eight to ten years. He asked the audience how many parents had similar experiences and at least 18 sets of parents raised their hands. They met and compared notes. Most of the labeled children of these individuals were able to speak under extreme, often negative, circumstances. Some had only spoken once or twice in a lifetime.

Reports of this kind are not unusual in the sensory and movement differences literature, among the autism community, or in our own 100+ years of combined experience with children and adults with the autism label. More common are phenomena such as echolalia, mutism, speech uttered only under unique circumstances, e.g. speaking what they have written. In the dynamic system model, the notion of emergence begins to give us a way to understand and perhaps support people with these differences. Strandt-Conroy (1999) compiled 40 hours of interviews with adults with autism who experienced such symptoms and more. Her interviews had to be adjusted to the specialized needs of the interviewees. Several could only answer written questions sent in advance; others if they were on the phone and in a warm bath. Likewise, the autistic people in Robledo & Donnellan (2007) each had personalized supports to enable them to participate in the interviews. We refer to these specialized arrangements as accommodations after Luria (1932) and Sacks (1990). We define accommodations as adjustments or adaptations of an interaction, a task, situation, or the environment that assist a person to temporarily get around difficulties organizing and regulating sensory information or movement (see Donnellan, Leary & Robledo, 2006 for examples).

Learning From Neurological Symptoms In Other Sensory And Movement Disorders

In our review of the history of movement differences, we found early descriptions of catatonia in the work of Kahlbaum, (1874/1973) which seemed startlingly familiar (see Hill & Leary, 1993; Donnellan & Leary,1995; Starkstein, Goldar & Hodgkiss,1995; Leary & Hill, 1996). In the nineteenth century there was no clear distinction between neurological and psychiatric symptoms. As the two fields diverged in the early twentieth century, however, some conditions gravitated into one or the other. Catatonia is presently defined as a characteristic of certain kinds of schizophrenia, though many have argued over the years for a more neurological view of the disorder (Rogers, 1992; Abrams & Taylor, 1976). The discussion of where to place catatonia and catatonic symptoms is once again topical because of the plan to update the Diagnostic and Statistical Manual of the APA, Some, in fact, are arguing for the inclusion of catatonia as a separate diagnostic category or under “movement disturbances” (Taylor & Fink, 2003; Fink & Taylor, 2006; Penland, Weder & Tampi, 2006; Caroff & Ungvari, 2007;). Irrespective of that discussion, it is useful to look at the symptoms described by Kahlbaum and other early and recent authors as these may illuminate the symptoms seen in individuals with autism and other developmental disabilities.

In Table 1, the characteristic features and symptoms on the left side of the table are borrowed from descriptors specific to several kinds of movement disorders, (Kalbaum, 1874; Fink & Taylor, 2006; Caroff and Ungvari, 2007;http://www.movementdisorders.org/disorders, 2009). The list of movement disorders symptoms is not in any particular order or hierarchy; rather, symptoms are listed randomly as taken from the above literature sources. The intent here is to show the scope of symptoms by feature that may account for certain behaviors seen in autism. Examples of behaviors listed on the right side of Table 1 appear there because they have been discussed in a previously published review of the autism literature and movement disturbances (Leary & Hill 1996). The majority of these have also been documented and observed throughout many years of clinical practice with a large number of individuals with autism across the life span.

Table 1. Characteristic Features of Substantiated Movement Disturbances and Evidence of Possible Overlap of Symptoms in Autism
Movement Disturbance Feature Symptom Evidence In Autism
Repetitive motor actions e.g., Tapping, touching, grimacing
Rhythmical, cyclical movements e.g., Rocking, shrugging, squinting, pouting
Lack of Initiation Requires prompts and cues to perform
Difficulty imitating other’s actions Both immediate and delayed motor imitation difficulties
Echophenomena Mimesis; elaborate copying of others actions — verbal and/or motor
Immobility Remains fixed and inert in position and posture for extended time periods
Withdrawal Isolates self away from focal activity and others
Grimacing Facial/oral-motor movements
Stereotypies Repetitive movements of the hands, limbs extremities and whole body
Aversion Of eye gaze and attention to other
Negativism Oppositional actions elicited with passive movement and overall behavior
Automatic obedience; Suggestibility Extreme compliance in response to verbal suggestion and environmental cues
Rigidity Muscles rigid to passive movement
Bradykinesia Slowness of movements, feebleness
Tremor Essential, intentional, rest, postural etc.
Forced grasping Of another’s hands, wrists, etc., or items in the environment
Akinesia Marked absence of action and movements
Akathisia Motor restlessness, moves about but not goal-directed
Ataxia Loss of coordination in motor action execution
Perseveration Motor or other repeated behavior after being elicited an initial stimulus
Ambitendency Appears “stuck” in indecisive, hesitant movements
Tics Motor and/or verbal
Obstruction; Blocking Incomplete movement towards a goal — “gets stuck” en route to goal
Difficulty with stopping, cessation of movement Will continue movements unless redirected or stopped by an external means
Mannerisms Uses intact and entire motor action sequences out of context e.g., salutes
Waxy flexibility Automatic ease and compliance with assuming unusual postures for extended time
Ballismus Violent, rapid and apparently involuntary actions and movements
Choreiform movements Rapid and apparently involuntary travelling and “dancing” ripples of movement
Catalepsy (posturing) Maintains seemingly uncomfortable and imposed postures for extended time
Athetoid movements Slow, writhing movements and actions
Spasms Muscular spasms of varying durations affecting muscle groups
Dystonias Sustained torsion due to muscle contractions in varied muscle groups
Impulsivity Actions and movements triggered suddenly
Self-injury, mutilation Disturbing and persistent attempts to inflict pain on self
Excitement; Frenzy Marked episodes of extreme amounts of activity for extended time
Aggression, Destruction Unprecipitated violent actions directed to others and the environment
Stupor Prolonged period of total immobility, lack of responsiveness and mutism
Rituals Object-related actions on objects as part of a routine, repeated event
Motility changes e.g. Toe walking, skipping, hopping
Changes in speech behavior e.g., Mutism; question repetition,; echolalia; verbigeration; logorrhoea; foreign accent; changes in prosody; difficulty modulating volume
Autonomic changes Changes in typical autonomic functions e.g., heart rate, perspiration, breathing, core body temperature

Leary and Hill (1996) analyzed the literature on symptoms associated with established movement disorders and those associated with autism. The greatest difference among these disabilities was the interpretation of the symptoms. In Tourette syndrome, Parkinson’s disorder and catatonia, there was a neurological interpretation of symptoms. A social rather than a neurological interpretation was applied if the person had a label of autism. That which is called a “tic” in a person with Tourette syndrome is most often assumed to be a ‘behavior’ (and often a conscious choice) in a person with autism. For symptoms interpreted through a neurological lens, individuals tend to be appropriately supported. In autism, symptoms are viewed frequently as behaviors to be reduced or eliminated, often with a negative intervention and results. Table 2 illustrates descriptions given to similar behaviors dependent on a person’s diagnosis.

Table 2. Differences in descriptions of behavior
Neurological terms Social Interpretation of behavior
Akinesia Non-compliance, social indifference
Festination Behavior excess, careless
Bradykinesia Lazy, slow
Bradyphrenia Mental retardation
Tics Aberrant behavior
Obsessions/ Adventitious behaviors Autistic behavior, ‘stims’

The sensory and movement differences reported by and observed in individuals with autism may have a significant impact on their and our ability to relate and participate in social interactions. A neurological view of symptoms possibly affecting autistic individuals will help us to understand further the nature of differences experienced by these individuals. While the psychological impact is very real as experienced first-hand by participants in such interactions, it is useful to suspend social interpretations of the symptoms so as not to mistakenly ascribe intent and volition to individuals whose behavior may be contrary to what really is intended and able to be communicated.

Detailed personal descriptions of movement and sensory differences found in other disabilities have given us some additional insight as to what it may be like for a person to deal with various symptoms, such as compelling impulses, a loss of conscious control, lack of initiation, akinetic moments and unusual ways of being in the world (e.g. McGoon, 1994). Frequently, the person has both the challenge of the movement difference and burden of blame and misunderstanding. In Strandt-Conroy’s (1999) research, it was often necessary to use vignettes from people with other sensory and movement differences to enable the autistic interviewees to recognize their own experience. Most expressed gratitude for the opportunity to learn about movement differences as they often had blamed themselves for their behavior and thought they were alone in having these difficulties.

Implications Of Sensory And Movement Differences For Understanding People Labeled With Autism

A Different Kind Of Science

Woe to that science whose methods are developed in advance of its problems, so that the experimenter can see only those phases of a problem for which a method is already at hand.

(Murphy,1939, p. 114).

We have stressed the neurological aspects of what are commonly thought of as autistic characteristics and behavior problems. We do not intend, however, to either suggest a whole new category of disabilities in autism nor to eliminate the psychological aspects. The issues here are similar to the challenges faced by those interested in Tourette syndrome. The syndrome was elucidated before the fields of neurology and psychiatry diverged (Gilles de la Tourette, 1885). For many years, psychiatry dominated the discussion and the treatment. In the past few decades, there has been a far greater emphasis on the neurology of the disorder. Yet, it is clear that it is not possible to separate the neurological from the psychological in a living human being. As Sacks suggests (1989) there is need for a different kind of science that views the individual as a whole person, mind and body. This shift has begun in Tourette syndrome. In addition, dynamic systems models of development suggest an emphasis on the unique history and the critical importance of context on the manifestations of the symptoms. Perhaps the present emphasis on discrete “autistic” behaviors tied to specific interventions should be seen in terms of more conscribed value and utility.

Developmental Versus Acquired Symptoms

In addition to the personalized nature of the characteristics and the dynamic nature of the manifestations of a movement difference mentioned above, it is impossible to overemphasize the importance of the developmental aspects of movement differences in autism vs. adult acquired disorders. For example, bradykinesia, or very slow movements, might have a wide range of effects on adults with acquired disorders such as Parkinsonism. In an infant or a toddler, the possible effects of slow responding or delayed initiating would surely have an effect on the entire trajectory of development even if the difference were intermittent or barely perceptible to the parents or professionals. Of course, we are not suggesting that these autistic people have Parkinson’s syndrome; rather, that they report sensory and movement differences which are not obvious to their caregivers, particularly parents of young children. Yet, the potential changes to the “dance of relationships” (Stern, 2000) alone would be worthy of many dissertations in child development. Still, the complexity of the task ought not deter us from attempting such inquiry because it could have enormous implications for our understanding of human development and diversity.

Interpretation Of Symptoms As Volitional

Many of us have accepted without question the implicit message that unusual movements presented by people with autism are always volitional and often pleasurable. Symptoms of sensory and movement difference in autism are consistently interpreted by others as autistic behaviors. Neurological symptoms, such as sudden, loud vocalizations; being in constant motion; extreme response to minor changes; unusual mannerisms and gait; and “unmotivated” laughter are examples of behaviors commonly thought to be performed “on purpose” and targeted for behavioral intervention. A social interpretation of these symptoms leaves people with the assumption that they occur as a matter of choice, apathy, or learned behavior. Aggression during an episode of catatonic frenzy is viewed differently if the neurological aspects of the person’s experience are considered. Typically, reprimands or contingent praise would not be used to change a recognized neurological symptom. As noted, the non-volitional aspects of behavior are rarely considered for people with autism. For example, the authors have all too often heard criticism and disparaging descriptions such as lazy or non-compliant applied to a person with autism who is in a non-responsive state. Frequently, the difficulty is related to stress, even the stress of excitement. An all too typical example is staff or family reporting that the child or adult refused to get out of the car or van to go to a place he or she seems to like. Intervention or support that is based on our social interpretations of symptoms may not always be helpful. Returning thenon-compliant person to home, school or program usually results in additional trouble. We need a clearer understanding of people’s experiences if we are to provide appropriate care and support that boosts self-confidence and is the product of collaboration rather than control. Donnellan, Leary & Robledo, (2006) offer many suggestions for accommodations that may help people with autism deal with these situations.

Interpretation Of Symptoms As Meaningless

Our assumptions about a person’s intention or meaning directly influence the way we respond moment to moment, the relationships we form, and the support we give to people. When we label aspects of a person’s behavior as meaningless, we may miss opportunities to extend learning and develop our relationships. Echolalia serves well as an illustration. In the early years of behavioral intervention for people with autism from 1960 to 1980, professionals assessing a child’s communication abilities were to assume that echolalia was the “meaningless repetition of a word or word group just spoken by another person” (Fay, 1969, p. 39), a non-functional, undesirable and “sick” behavior of autism (Lovaas, 1966; Lovaas, Schreibman & Koegel, 1974), and a communication disorder to be extinguished through behavior modification (Lovaas, 1977). In the 1980s, the fine and detailed work of researchers such as Baltaxe & Simmons (1977), Prizant & Duchan (1981) and Prizant & Rydell (1984) began to influence our assumptions about the intentions of autistic speakers and the possible communicative functions of both immediate and delayed echolalia. Many people now understand that echolalia is neither always meaningless nor always meaningful; rather it serves a variety of pragmatic functions on a sociolinguistic continuum. Although sometimes not intentional, echolalia may be used intentionally by many who lack other strategies for communicating to maintain relationships, improve their comprehension of spoken language and to express meaning (Kanner, 1946). Acknowledgement of a person’s efforts to accommodate, improvise and create meaning is a cause for celebration and an opportunity to improve communication and boost self esteem.

Interpretation Of Symptoms As “Not Interested” In Relating Or Communicating

People with autism often communicate, behave and participate in unique, very personal, perhaps idiosyncratic ways that require their partners to be more flexible and open than usual in interpreting meaning and intention. Differences in the way people are able to use their bodies and focus their attention leads many to assume that a person does not care to participate or communicate and does not desire relationship. These assumptions affect our expectations, the way we speak with them and the educational and social opportunities we offer to them. Under the “criterion of the least dangerous assumption” (Donnellan, 1984), it is safest to assume that relationships are critical to human beings for learning and development even if, and perhaps especially if, they have difficulties in these areas (Robledo, 2006; Fogel, 1993).

The Critical Importance Of Relationship In Learning And Development

The past 40 years have witnessed the growth of a body of knowledge, approaches and intervention methodologies designed to address the needs of individuals with autism. Often the kinds of intervention strategies at our disposal are based on ideas and theories that conflict with each other. The content of interventions may be highly prescriptive or more loosely defined. Research can be cited in support of the efficacy of almost any kind of approach for at least some individuals in some situations. We struggle as well to explain and describe that quality within any intervention that works and leads to growth and development between the partners involved. Perhaps the essential factor underlying any successful intervention has been overlooked or at least not credited in the research. We propose, along with a growing number of investigators, that the undefined element is the presence and nature of the relationship between persons in any interaction.

The role of relationship in learning is the centerpiece of sociocultural psychology. Sociocultural psychology views human development as essentially embedded and significantly dependent on interactions with more able and skilled members of the existing cultural and social context. While most of us believe that learning is enhanced by a facilitative relationship with a more mature thinker, western psychology has only recently directed attention to the nature of that relationship. Lev Vygotsky (1896 1934) was a Russian psychologist whose work described and defined the role of relationship in human development. His work emphasized the notion that cognitive and specific skill development is the result of internalizinginteractions with others within a relationship (Bodrova & Leong, 1996). Ylvisker and Feeney (1998) have translated Vygotskian theory into a support model that focuses on apprenticeship and collaboration between the person and another with more expertise in the areas where support is needed. The “tutor” provides collaborative mediation that is fine-tuned to the learner’s changing needs for support to enable participation in meaningful, project-oriented work. “The roots of cognitive, executive and communication functions, as well as behavioral self-regulation, are everyday social interaction routines” (Ylvisker & Feeney,1998, pp. 15-16). In the sociocultural models of development, relationship with others serves as the springboard for learning. Learning happens within a social context, within a dialogue with others. We acquire cognitive skills, knowledge and behavior regulation, not simply through memorization of facts or actions, but through our interactions in the social world where this knowledge has function and meaning.

Inconsistency In Abilities

People report sensory and movement inconsistencies, such as fluctuations in speed and clarity of sensory perception; unreliable ability to maintain or release body postures; delays in speed and accuracy of movement and speech; unpredictable changes in muscle tone; unwanted vocal, verbal and physical tics and extraneous, non-functional movement (e.g. Mirenda & Donnellan, 1986; Williams, 1996a; Strandt-Conroy, 1999; Harp, 2008). A sensory and movement difference is characterized by this inconsistency, causing stress for the most common of movements (Baggs, 2007). A person struggling with these performance characteristics may not be able to predict, plan for, or sustain effective participation. For example, a person with a 14 second delay in her ability to respond to others (Mirenda & Donnellan, 1986) is likely to be misinterpreted and misunderstood and unlikely to be offered time to respond. This is illustrated by Harp (2008) on her blog, Asperger’s Square 8 (used with permission).


Supporting Self Esteem

Humans carry inside themselves an image that includes reasons for, and the possibility of, change. We need to know that we are OK just as we are, even though there are things we may want to learn, or to do, better.

A current trend in early intervention for young children with autism is to provide guidance in massive quantities (e.g. 40 hours a week of one-to on-instruction). This guidance is naturally accompanied by frequent corrections and redirection. Given the intensity of this intervention, special care is needed to promote children’s self-esteem at any age.

Equally important is the need for positive, optimistic, respectful support for adults with autism. The paucity of quality programs, diminished opportunity for interesting lives, effects of medication and chemical restraint are just a few of the additional burdens on these individuals and their families. Issues of collaboration, personalization and comfort are also essential for children and particularly pressing for the adult population with the autism label. McGinnity & Negri (1995) offer helpful suggestions on how students and staff can learn to be more sensitive to the differences in those on the autism spectrum.

Collaboration, Personalization And Comfort

The growth of the autism industry over the past two decades has spawned no end of books, interventions, programs and products. Yet, the diagnosis of autism is not prescriptive of the type of supports needed for assisting any particular person to participate, relate and communicate. Supports for people with autism should be personalized, reflect the respect and dignity due to all people, and address the challenges with which people struggle to organize and regulate themselves in response to the sensory environment and their movement differences. Appropriate supports require a deep and local knowledge of the individual. This can be gained from those who know and appreciate them but often such information is not available. Then it is even more essential to spend significant time with the person in a variety of activities and settings and with people who respect and admire him or her. We need to learn to listen with all of our senses and compassion (Savarese, 2007; Lovett, 1996) and to “presume competence” in all interactions. We do not put people in jeopardy by overestimating their experience. We do look for competence instead of deficits and talk to people in age appropriate ways. And we model such interactions for all those who are, or may become, willing to know them better.

Moreover, we need to remember that in our journey of change, we all need allies who will collaborate with us to find the most comfortable and effective ways for us to learn to participate in our families, with our friends and as contributing members of our communities (Schwarz, 2004; Robledo & Donnellan, 2008; Hill & Leary, in press). This is particularly critical for those persons who are challenged by the movement differences that often make such comfort temporary, personhood elusive, and collaboration a mystery. There is much to be learned from self-advocates with autism as well as from individuals who share some of the symptoms of movement differences such as Tourette syndrome, Parkinson’s disorder and their supporters (e.g. Williams, 1992; McGoon, 1994). For example, individuals with Tourette syndrome have taught us that naming a behavior might make it much more difficult for a person to inhibit that behavior. It is roughly analogous to telling a stutterer not to stutter. Anyone familiar with classrooms and programs in autism will recognize the value of that cautionary comment.


When I was growing up, speaking was so frustrating. I could see the words in my brain but when I realized that making my mouth move would get those letters to come alive, they died as soon as they were born. What made me feel angry was to know that I knew exactly what I was to say and my brain was retreating in defeat …

(Burke, 2005, pp. 250-251).

Jamie Burke is a college student who now is able to speak the words he types with two fingers on his Augmentative and Alternative Communication (AAC) device. He requires no physical support for his typing yet continues to need the presence of a trusted support person as an “emotional platform” (Maurer, 1993) to execute his typing. It may be that the relationship allows him to be in a more optimal “space” to regulate the sensory and movement aspects of typing. We have proposed that many other individuals with the autism label may be challenged by sensory and movement differences in starting, stopping, executing, combining and/or switching actions, thoughts, emotions and speech. These symptoms have been described in the literature for many years but generally not integrated into our descriptions or understanding of autistic behaviors.

Sensory and movement differences often escape the notice of those of us who do not typically experience them but have been well described by autistic self-advocates and persons interested in individuals with autism and other disability labels. Ignoring these differences (or redefining them as autistic behaviors to be controlled) has made life unnecessarily more difficult for individuals with autism and those who care about and for them. Many of the assumptive errors we have made are based on our own social history. In the absence of clarity about the nature of these movement differences, we will continue to be forced into the default position of seeing all unfamiliar behaviors as intentional, deliberate evidence of intellectual impairments and even pleasurable. We have not proposed another list of deficits but a greater understanding of the complexity of what we call autistic behaviors and the necessity to rethink our assumptions about them. The task is not going to be easy. Such sensory and movement differences are manifest in autism and many other disorders in strikingly unique, personalized and dynamic ways that test present research (and teaching) strategies that rely heavily on a positivist-reductionist philosophy. Yet, some of the brightest scientific lights of the 20th century reminded us that the best way to approach objectivity in science is to view the phenomenon from as many perspectives as possible (Luria, 1939; Edelman, 1992; Shawlow, 1996, Personal Communication). As Einstein shared, “Not everything that counts can be counted and not everything that’s counted, counts” (Cunningham & Scott, 2004).

There is a long, continual path of misunderstanding to autism. People have been thought of, and referred to, as “non-persons,” “behavior problems” and sub-normal in every imaginable way. If they cannot speak, we assume they have little to say and offer only the most limited of communication options. Irrespective of the precision and intensity of our interventions, more often than not they experience isolation, segregation, homogeneous grouping, loneliness, pain and boredom as part of their customary care across the life span. Often their sensory and movement differences contribute to such outcomes as these leave the rest of us unaware of the true nature of their challenges.

Any view of autism at this time needs to reflect the experience of self-advocates with autism and others who describe sensory and movement differences, as well as the latest in the neuroscience and child development literature. We need a research agenda that focuses on understanding and supporting autistic people and others in more respectful, personalized and successful ways. It is the least dangerous assumption (Donnellan, 1984) to see all as full human beings who may have formidable and unfamiliar challenges to overcome and who, of course, desire social interaction, communication and participation.

Too often autistic children are raised to believe they are broken and need to be fixed. Adults with autism too often live lives of isolation and poverty. Understanding people’s experiences may lead to acceptance, accommodation and appropriate support. To continue down the same paths, well worn for 65 years, when all these data impel us to rethink our assumptions and broaden our path is unthinkable.

Works Cited

  • A is For Autism. British Film Institute (1992). “Fine Take Production” for Channel 4.
  • Abrams, R, & Taylor, MA. (1976). Catatonia: a prospective clinical study. Archives of General Psychiatry, 33(5), 579-581.
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: Text revision. (4th ed.) Washington, D.C: Author.
  • Baggs, Amanda (2007) I knew moving took effort, but… Retrieved January 15, 2009, from Ballastexistenzhttp://ballastexistenz.autistics.org/?p=379
  • Baltaxe, C, & Simmons, J. (1977). Bedtime soliloquies and linguistic competence in autism. Journal of Speech and Hearing Disorders, 42, 376-393.
  • Barron, J., & Barron, S. (1992). There’s a boy in here. New York: Simon & Schuster.
  • Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine.
  • Bedrova, E. and Leong, D. (1996). Tools of the mind: The Vygotskian approach to childhood education. Englewood Cliffs, NJ: Prentice-Hall.
  • Blackman, L. (1999). Lucy’s story: Autism and other adventures. Brisbane, Australia: Book in Hand.
  • Bluestone, J. (2005). The Fabric of Autism: Weaving the threads into a cogent theory. Seattle, Washington: Sapphire Enterprises.
  • Bristol, M.M., Cohen, D.J., Costello, E.J., Denckla, M., Eckberg, T.J., Kallen, R., Kraemer, H.C., Lord, C., Maurer, R., McIlvane, W.J., Minshew, N., Sigman, M. & Spence, M. A. (1996). State of the science in autism: Report to the National Institutes of Health. Journal of Autism and Developmental Disorders, 26, 121-154.
  • Burke, J. (2005). The world as I’d like it to be. In D. Biklen (Eds.), Autism and the myth of the person alone. New York: NYU Press.
  • Caroff, S. & Ungvari, G. (2007). Expanding horizons in catatonic research. Guest Editorial, Psychiatric Annals, 37(1), 7-9.
  • Condon, W.S. (1985). Sound-film microanalysis: A means for correlating brain and behavior. In F. Duffy & N. Geschwind (Eds.), Dyslexia: A neuroscientific approach to clinical evaluation. Boston: Little-Brown Co.
  • Cunningham, H. and Scott, D. (2004). Software architecture for language engineering. Natural Language Engineering, 10(3/4), 205-209.
  • Damasio, A.R. & Maurer, R.G. (1978). A neurological model for childhood autism.Archives of Neurology, 35(12), 777-786.
  • Dhossche, D.M. ( 2004). Autism as early expression of catatonia. Medical Science Monitor, 10(3), RA31-9.
  • Donnellan, A.M. (1984). The criterion of the least dangerous assumption. Behavior Disorders, 9, 141-150.
  • Donnellan, A.M, Leary, M., & Robledo, J. (2006). I can’t get started: Stress and the role of movement differences for individuals with the autism label. In M.G. Baron, J. Groden, G. Groden, & L. Lipsitt (Eds.), Stress and coping in autism(pp. 205-245). Oxford: Oxford University Press.
  • Donnellan, A. M., Mirenda, P., Mesaros, R. A., & Fassbender, L. (1984). A strategy for analyzing the communicative functions of behavior. Journal of the Association for Persons with Severe Handicaps, 2, 201-212.
  • Edelman, Gerald M. (1992). Bright air, brilliant fire. New York: Basic Books.
  • Endow, Judy (2006). Making lemonade: Hints for autism’s helpers. Cambridge, Wisconsin: Cambridge Book Review Press.
  • Fay, W. (1969). On the basis of autistic echolalia. Journal of Communicative Disorders, 2, 38-47.
  • Feldenkrais, M. (1972). Awareness through movement. New York: HarperCollins.
  • Filipek, P., Accardo, P, Ashwal, S., Baranek, G.,Cook, E.,Jr., Dawson, G., Gordon, D., Gravel, J.,Johnson, C., Kallen, R.,Levy, S.,Minshew, N.,Ozonoff,S.,Prizant, B., Rapin, I., Rogers, S., Stone, W.,Teplin, S.,Tuchman, R.,& Volkmar, F.(2000). Practice parameter: Screening and diagnosis of autism. Neurology 55(4), 468-479.
  • Fink, M. & Taylor, M.A. (2003). Catatonia: A Clinician’s guide to diagnosis and treatment. Cambridge: Cambridge University Press.
  • Fink, M. & Taylor, M.A. (2006). Catatonia: Subtype or syndrome in DSM? Editorial in American Journal of Psychiatry, 163(11), 1875-1876
  • Fogel, A. (1993). Developing through relationships. Chicago: The University of Chicago Press.
  • Gernsbacher, M.A., Sauer, E.A., Geye, H.M., Schweigert, E.K. & Goldsmith, H.H. (2008). Infant and toddler oral- and manual- motor skills predict later speech fluency in autism. Journal of Child Psychology and Psychiatry and Allied Disciplines, 49(1), 43- 50.
  • Ghaziuddin, M & Butler, E. (1998). Clumsiness in autism and asperger syndrome: A further report. Journal of Intellectual Disability Research, 42, 43-48.
  • Gibson, J.J. (1979). The ecological approach to perception. Boston: Houghton Mifflin.
  • Goldman S, Wang C, Salgado MW, Greene PE, Kim M, Rapin I. (2009). Motor stereotypies in children with autism and other developmental disorders.Developmental Medicine & Child Neurology, 51(1), 30-38.
  • Gilles de la Tourette, G. (1885). Etude sur nerveus caracteristee par de l’incoordination motrice accompagnee d’echolalie et de copralie. Archs Neurol., 9, 19-42, 158-200.
  • Grandin, T. (1992). An insider view of autism. In E. Schopler & G. B. Mesibov (Eds.).High functioning individuals with autism (pp.105-124). New York: Springer.
  • Hale, M., & Hale, C. (1999). I had no means to shout! Bloomington, IN: 1st Books.
  • Green, D., Charman, T., Pickles, A., Chandler, S., Loucas, T., Simonoff, E. & Baird, G. (2009). Impairment of movement skills of children with autistic spectrum disorders. Developmental Medicine & Child Neurology, 51, 311-316.
  • Harp. B. (2008). Square talk: Processing. Asperger Square 8, on-line blog,http://aspergersquare8.blogspot.com/
  • Hill, D.A. & Leary, M.R. (1993). Movement disturbance: A clue to hidden competencies in persons diagnosed with autism and other developmental disabilities. Madison, WI: DRI Press.
  • Hill, D.A. & Leary, M.R. (in press). Casting call for a supporting role. Journal of Intellectual & Developmental Disability.
  • Jacobson, J..W. & Ackerman, L.J. (1990). Differences in adaptive functioning among people with autism or mental retardation. Journal of Autism and Developmental Disorders, 20, 205-219.
  • Jansiewicz, E., Goldberg, M., Newschaffer, C., Denckla, M., Landa, R., Mostofsky, S. (2006). Motor signs distinguish children with high functioning autism and Asperger’s syndrome from controls. Journal of Autism and Developmental Disorders, 36(5), 613- 621.
  • Kahlbaum, K. (1973). Catatonia (Y. Levij & T. Pridan, Trans.). Baltimore: Johns Hopkins University Press. (Original work published in 1874)
  • Kanner, L. (1946). Irrelevant and metaphorical language in early infantile autism.American Journal of Psychiatry,103, 242-246.
  • Leary, M. & Hill, D. (1996). Moving on: Autism and movement disturbance. Mental Retardation, 34(1), 39-53.
  • Leekam SR, Nieto C, Libby SJ, Wing L, Gould J. (2007). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37(5).
  • Lovaas, O.I. (1966). A program for the establishment of speech in psychotic children. In J. Wing (Ed). Childhood autism. London: Pegramon Press.
  • Lovaas, O.I. (1977). The autistic child: Language development through behavior modification. New York: Halstead Press.
  • Lovaas, O.I., Schreibman,L., & Koegel, R.L (1974). A behavior modification approach to the treatment of autistic children. Journal of Autism and Childhood Schizophrenia, 4, 111-129.
  • Lovett, H. (1996). Learning to listen: Positive approaches and people with difficult behavior. Baltimore MD: Paul H. Brookes.
  • Luria, A. R. (1932). The nature of human conflicts or emotion, conflict and will. New York: Liveright, Inc.
  • Magg, J.W., Wolchik, S.A., Rutherford, Jr., R. Parks, B.T. (1986). Response covariation on self-stimulatory behaviors during sensory extinction procedures. Journal of Autism and Developmental Disorders, 16, 119-132.
  • Maurer, R. G. (1993). What autism and facilitated communication have to teach us about the neurology of relationship (Audiotape from lecture). Toronto: MacKenzie Group International.
  • McGinnity, K. & Negri, N. (2005). Walk awhile in my autism. Cambridge, WI: Cambridge Book Review Press.
  • McGoon, D. C. (1994). The parkinson’s handbook. New York: W.W. Norton.
  • Markram, H., Rinaldi, T. & Markram, K. (2007). The intense world syndrome — An alternative hypothesis for autism. Frontiers in Neuroscience, 1(1), 77- 96.
  • Mirenda, P., & Donnellan, A. (1986). Effects of adult interaction style on conversational behavior in students with severe communication problems.Language, Speech, and Hearing Services in Schools, 17, 126-141.
  • Mostofsky, S.H. (2008). Anomalous Motor Circuit Activity and Connectivity in Autism. Paper presented at the meeting of the Child Neurology Society, Santa Clara, CA.
  • Mostofsky, S., Dubey, P., Jerath, V., Jansiewicz, E., Goldberg, M., & Denckla, M. (2006). Developmental dyspraxia is not limited to imitation in children with autism spectrum disorders. Journal of the International Neuropsychological Society, 12(03), 314-326.
  • Mostofsky, S. H., Powell, S. K., Simmonds, D. J., Goldberg, M. C., Caffo, B., & Pekar, J. J. (2009). Decreased connectivity and cerebellar activity in autism during motor task performance. Brain.
  • Mulick, J.A., Jacobson, J.W. & Kobe, F.H. (1993). Anguished silence and helping hands: Autism and facilitated communication. Skeptical Inquirer, 17, 270-280.
  • Nayate, A., Bradshaw, J., Rinehart, N. (2005). Autism and asperger’s disorder: Are they movement disorders involving the cerebellum and/or basal ganglia?Brain Research Bulletin, 67, 327-334.
  • Noterdaeme, M., Mildenberger, K., Minow, F. & Amorosa, H. (2002). Evaluation of neuromotor deficits in children with autism and children with a specific speech and language disorder. European Child & Adolescent Psychiatry, 11(5).
  • Penland, H.R., Weder, N. & Tampi, R.R. (2006). The catatonic dilemma expanded.Annals of General Psychiatry, 5(14), 1-9.
  • Prizant, B. & Duchan, J. (1981). The functions of immediate echolalia in autistic children. Journal of Speech and Hearing Disorders, 46, 241-249.
  • Prizant, B. & Rydell, P. (1984). Analysis of functions of delayed echolalia in autistic children. Journal of Speech and Hearing Research, 27, 183-192.
  • Rimland, B. (1993). Editor’s notebook. Autism Research Review International, 7(3), 3.
  • Rincover, A. (1978). Sensory extinction: A procedure for eliminating self-stimulatory behavior in developmentally disabled children. Journal of Abnormal Child Psychology, 6(3), 299-310.
  • Rinehart, N., Tonge, B., Iansek, R., McGinley, J., Brereton, A., Enticott, P., et al. (2006). Gait function in newly diagnosed children with autism: Cerebellar and basal ganglia related motor disorder. Developmental medicine and child neurology, 48(10), 819-24.
  • Robledo, J & Donnellan, A. (2008). Properties of supportive relationships from the perspective of academically successful individuals with autism. Intellectual and Developmental Disabilities, 46(4), 299-310.
  • Rogers, D. (1992). Motor disorder in psychiatry: Towards a neurological psychiatry. Chichester, England: John Wiley & Sons.
  • Rogers, S. & Benetto, L. (2002). Le fonctionnement moteur dans le cas d’autisme.Enfance, 54(1), 63-73.
  • Rubin, S., Biklen, D., Kasa-Hendrickson, C., Kluth, P., Cardinal, D. & Broderick, A. (2001). Independence, participation, and the meaning of intellectual ability.Disability & Society, 16(3), 415-429.
  • Sacks, O.W. (1989). Neuropsychiatry and tourette’s. In Mueller, J. (Ed.) Neurology and psychiatry: A meeting of minds. Basel: Karger.
  • Sacks, O. (1990). Awakenings. New York: Harper Perennial.
  • Savarese, R. (2007). Reasonable People: Autism and Adoption. New York: Other Press.
  • Schwarz, P. (2004). Building alliances: Community identity and the role of allies in autistic self-advocacy. In Stephen Shore (Ed.) Ask and tell: Self-advocacy and disclosure for people on the autisms spectrum. Shawnee Mission, KS: Autism Asperger Publishing Co.
  • Starkstein, S. E., Goldar, J. C., & Hodgkiss, A. (1995). Karl Ludwig Kahlbaum’s concept of catatonia. History of Psychiatry, 6(22 Pt 2), 201-7.
  • Strandt-Conroy, K. (1999). Exploring movement differences in autism through firsthand accounts. Unpublished doctoral dissertation, University of Wisconsin, Madison.
  • Stern, D.N. (2000). The Interpersonal world of the infant. New York: Basic Books.
  • Sigman, M., & Spence, M.A. (1996). State of the science in autism: Report to the National Institutes of Health. Journal of Autism and Developmental Disorders, 26(2), 121-154.
  • Sullivan, A. (2002). Inertia: From theory to praxis. Retrieved fromhttp://www.autistics.org/library/inertia.html
  • Sutera, S., Pandey, J., Esser, E., Rosenthal, M., Wilson, L., Barton, M. Green, J., Hodgson., Robins, D., Dumont-Mathieu, T., & Fein, D. (2007). Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders.Journal of Autism and Developmental Disorders, 37(1), 98-107.
  • Taylor, M. & Fink, M. (2003). Catatonia in psychiatric classification: A home of its own. American Journal of Psychiatry, 160, 1233-1241.
  • Taylor, B.A., Hoch, H, Weissman, M. (2005). The analysis and treatment of vocal stereotypy in a child with autism. Behavioral Interventions, 20(4), 239-253.
  • Thelen, E. (1995). Motor development: A new synthesis. American Psychologist, 50(2), 79-95.
  • Thelen, E. & Smith, L.B. (1994). A dynamic systems approach to the development of cognition and action. Cambridge, MA: MIT Press.
  • Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the short sensory profile. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 61(2), 190-200.
  • Williams, D. (1992). Nobody nowhere. New York: Avon.
  • Williams, D. (1994). Somebody somewhere. New York: Times Books.
  • Williams, D. (1996a). Like color to the blind. New York: Times Books.
  • Williams, D. (1996b). Autism: An inside-out approach. London: Jessica Kingsley.
  • Williams, D. (2003). Exposure anxiety — The invisible cage: An exploration of self-protection responses in the autism spectrum disorders. London: Jessica Kingsley.
  • Wing, L. (1981). Language, social and cognitive impairments in autism and severe mental retardation. Journal of Autism and Developmental Disorders, 11, 31-44.
  • Wing, L. & Attwood, A. (1987). Syndromes of autism and atypical development. In D. Cohen & A. Donnellan (Eds.), Handbook of autism and pervasive developmental disorders (pp. 3-19). New York: Wiley.
  • Ylvisker, M. & Feeney, T. J. (1998). Collaborative brain injury intervention: Positive everyday routines. San Diego: Singular Publishing Group, Inc.


Academic Supports for College Students with an Autism Spectrum Disorder: An Overview

Contributed by Marci Wheeler, MSW from Indiana Institute on Disability and Community

Each year more information about the college experiences of those on the autism spectrum is written by their parents, professionals and these students on the autism spectrum. “Temple Grandin” a biopic movie of Temple’s life premiered last year on HBO, and won several Emmy and other awards. Included in the film, of this very accomplished woman with autism, is a significant look at Temple’s experience at college. This film also reminds us that fellow college students need information to better understand their peers on the autism spectrum and how to include and support them. There is much more to college life than academics. Intellectually these students are often very bright but many may face a variety of “hidden challenges” that can undermine their ability to navigate a typical college campus and perform well in class. This article will discuss some of the challenges and possible academic supports for students on the autism spectrum.

There is a wide range of functioning and abilities seen across individuals diagnosed with an autism spectrum disorder. Generalities are hard to make except to say that communication and social skills deficits are present. There are also neurological differences that affect everyone on the autism spectrum. However, each person is affected in different ways. The sensory perceptions, motor skills, learning styles and coping strategies are often affected and may cause “hidden” challenges that are not understood by those supporting these students. As a result of these challenges the observable behaviors of students on the autism spectrum may make them appear inattentive, bored, rude, defiant or possibly even on drugs. Ritualistic or repetitive behaviors, an attachment to incongruous objects and additional unusual communication and social skills (especially under stress) can make some of these students seem odd and bring unwanted attention to them.

Some students on the autism spectrum may experience sensory overload and/or be distressed by the social and communication demands of a class. They may have learned “acceptable” strategies to cope and have the ability to stay focused on their intellectual pursuits such that they can navigate through their classes (at least the classes in their chosen major) and pass as “normal”. Some students expend a lot of energy, at all costs, to blend in and not be detected. Unfortunately, for some, this may result in them leaving the university without finishing a degree as the stress is too great. Also, on any college campus be assured that there are students who have not been formally diagnosed or students that are not diagnosed until their college years.

Professors and other instructors need to be aware of possible supports that a student on the autism spectrum might find necessary to participate in class and complete classwork. The following six sections briefly state a common concern for most students and list some possible issues and accommodations. Each student on the autism spectrum has unique needs and should work closely with instructors and other college staff to design an individualized plan of proactive support and response to challenges if they arise.

Communication Skills

By definition (following diagnostic criteria) all students with an autism spectrum disorder have some problems which may interfere with receptive or expressive communication. Some of these differences are very subtle and can lead to misunderstandings that are misinterpreted as volitional acts on the part of the student. Students with an autism spectrum disorder may be very articulate and have a large vocabulary which may “hide” their communication challenges. Those supporting students on the autism spectrum should become aware of each individual students weaknesses in this area. Some of these are listed below along with possible accommodations.

Receptive difficulties often experienced by students on the autism spectrum include processing verbal exchanges more slowly, misunderstanding sarcasm, idioms and jokes, very literal interpretation of words, and misunderstanding gestures and body language.

The expressive difficulties of individuals on the autism spectrum may include problems initiating communication; even for those students who at first glance may seem very articulate and even very talkative. Those on the autism spectrum may have trouble staying on topic, turn taking and following conversational “protocol”. Some may be slower to organize thoughts and speak, and/or their voice tone and volume may be unusual. Idiosyncratic use of words and phrases may be present.

Accommodations for a college student with an autism spectrum disorder might include providing the instructor’s lecture notes or a note taker to help key in on important information, providing study guides for tests, allowing a longer verbal response time from the student and allowing for important exchanges of information to be done in written form. It would also help for instructors to be clear, concise, concrete and logical when communicating as well as asking for clarification; don’t make assumptions about what students truly understand.

Social Skills

Social skills might not seem important in a class setting, but, in fact social difficulties can and do impact the classwork of many students on the autism spectrum. Many college courses require class participation and group work as part of earning a grade. Just going to class with peers necessitates the use of social skills. Some social difficulties and possible accommodations are discussed below.

The social challenges for a student on the autism spectrum include problems understanding others perspectives, sharing space and making eye contact. Many high functioning individuals with an autism spectrum disorder have extreme social anxiety and have difficulty negotiating with others, and interacting and working in pairs or groups. These students likely will not understand the “unwritten” classroom etiquette and will often misinterpret facial expressions and other non-verbal cues. Possible accommodations for students on the autism spectrum include allowing for short breaks to leave class and/or allowing the student to have a “social buffering” object which might include a computer, book or other object that initially might seem distracting or “out of place”. Honoring the student’s chosen level of eye contact w/o judgment can be helpful. If there is group work assigned for class the instructor might assist in the formation and monitoring of pairs or groups of students to assure the proper inclusion of the student with an autism spectrum diagnosis. Also providing written rules for asking questions and other classroom logistics (as needed) may support students with an autism spectrum disorder diagnosis.

Sensory Differences

Though currently sensory issues are not part of the diagnostic criteria for an autism spectrum disorder, sensory processing issues seem to affect the majority of these individuals. Some on the autism spectrum have an extreme over sensitivity or under sensitivity to input, from the environment to the five senses: sight, hearing, touch, smell and taste. A significant number of persons experience synesthesia. Synesthesia may affect any of the senses. Synesthesia is phenomena in which the actual information of one sense is accompanied by a perception in another sense. Listed below are some common sensory differences and accommodations that may be important in a class setting.

Common visual and auditory sensory difficulties experienced by students on the autism spectrum include florescent lights that may appear to flicker and certain “bright” colors that may produce “overload”. Someone may see better from a “different” angle or may hear low level frequency sounds emitted by florescent lights. Also certain “typical” classroom sounds may be perceived as “painful” such as the movement and use of desks, people and other objects in the room. Often a person on the autism spectrum may not filter out extraneous sounds and/or may hear sounds in the next room.

Sensory issues related to the sense of touch and/or the sense of smell may occur. For example, certain textures may be “painful” and/or individuals may crave certain textures. Students on the autism spectrum may be disturbed by people accidentally bumping them or the feel of a particular desk or chair. They may wear “unusual” clothing, footwear or accessories because of sensory differences. Also students may be sensitive to certain odors and certain smells may cause “overload”. Some who are very sensitive may be affected by scents from certain perfumes, deodorants and soaps.

Possible accommodations to support a student with sensory differences include allowing hats, sunglasses and tinted lens glasses to be worn and allowing ear plugs or ear phones. Also allowing the student to choose their seat and helping to assure it is always available may be important. If requested by the student, an alternative writing instrument for tests and assignments and/or a computer for in class work, tests and assignments might also be an appropriate accommodation.

A student with an autism spectrum diagnosis may find that a small sensory item brings comfort in class. It is likely, if a student uses a sensory item, that it is inconspicuous but this may not always be the case. Be aware that a student may make a last minute request for a seating change and/or to leave abruptly due to sensory overload. Help devise an acceptable plan to address urgent sensory issues for the student.

Motor Skills

Both fine and gross motor skills may be affected in individuals with an autism spectrum disorder. In addition motor planning and poor awareness of body in space are two areas that often affect motor skills for these individuals. Often fine and gross motor skills as well as motor planning skills are very uneven. Listed below are possible problems in these areas along with possible accommodations.

Fine motor challenges for students on the autism spectrum might affect writing, drawing, turning pages, using utensils, playing an instrument, using locks and keys, and manipulating small objects. Gross motor challenges may affect walking (may have “odd” gait), running, sitting and balancing. Motor planning and the awareness of the placement of their body in space can affect the ways in which an individual moves their body and is able to navigate themselves to accomplish all motor tasks.

Possible accommodations for students on the autism spectrum with motor skills difficulties include allowing a computer for in class work, tests and assignments, providing a note taker, allowing work assignments done at a slower pace, providing models and step by step instruction, providing extra time to take tests and providing readers and scribes (or technology that reads and takes notes). Further accommodations might need to be considered for students taking physical education courses in which motor skills differences might provide further complications.

Learning Style

Students with an autism spectrum disorder often have a very uneven learning profile. They often excel creatively in a non-conventional way. Students on the autism spectrum tend to have excellent long term and rote memory abilities. Executive functioning deficits cause these students many problems. Many are thought to be right-brained thinkers. Most need to like and trust an instructor before they can perform in a class. Some common learning challenges, strengths and possible accommodations are listed below.

Executive function challenges experienced by students with an autism spectrum diagnosis include general organization and planning skills, problems with impulsivity and problem solving and the ability to monitor themselves in the completion of a goal.

Along with the executive functioning deficits, common learning barriers include poor sequential learning, easily bored with repetition once something is learned, attention problems, literal thinking, nebulous sense of time and as mentioned previously, perspective taking deficits. Other issues that impacts learning for students on the autism spectrum are the fact that they need to understand why something is important, relevant or meaningful to them and they may not realize they are having academic difficulty until it may be too late or too difficult for them to rectify on their own.

The strengths of students on the autism spectrum can sometimes help them compensate for their weaknesses. These students can do quite well academically, especially in their chosen field, and their strengths should be respected and used whenever possible. For example these students may have extremely good visual and visual-spatial skills. They often learn best from whole to part (complex to simple) and they can be very creative; out of the box thinkers. These students can also show an amazing knowledge on topics of interest which is most often their major field of study at the university.

Possible accommodations for students on the autism spectrum to support their learning style include providing review sheets, work checklists, and “sub” deadlines and/or intermittent “check-ins.” If possible provide hands on learning, models, demonstrations and other visuals. If possible, pair with peer mentors who might help with feedback and provide “proof-read” opportunities and ongoing structure to keeping on target with work assignments.

Instructors can help support students on the autism spectrum by providing reinforcement at every opportunity. Other accommodations that might be helpful for some students are allowing advanced negotiation of deadlines, extra time for tests, and/or a separate “quiet” place for tests.

Instructors and other college staff can also encourage the use of calendars (computer, traditional, phone w/alarms). Most likely the student has experience with using an organizational tool or tools, of choice, before coming to college. However, sometimes in a new environment the tools and skills used and learned to compensate for executive function deficits do not transfer easily to a new setting. Because the setting has changed, the student may need time “extra” transition time to begin the use of these tools and to maintain routines in the new environment.

Coping Skills

Individuals with an autism spectrum disorder frequently describe themselves as dealing with a lot of anxiety and stress. Sensory sensitivities, social and communication expectations as well as transitions and unexpected changes often trigger this anxiety and stress. It is during these times when these students may display behavior that can seem bewildering, rude or disruptive. Most often when a student displays these behaviors they are doing what they know to do to cope. In fact, these sometimes “confusing” behaviors are often experienced as calming. Included below are examples of coping behaviors in which students with an autism spectrum disorder may engage and possible accommodations.

When under stress, students on the autism spectrum may engage in stress relieving activities which look odd and may even make others feel uncomfortable. These activities may include body rocking, pacing, waving or flapping hands or fingers repetitively, chewing on their clothing or body, “lecturing” on a topic of interest or they may display the “opposite” emotion for the situation. They also may abruptly leave the situation with no explanation before or afterwards.

A possible accommodation in helping the student cope, in the moment, might be to discretely ask the student if something is overwhelming and/or ask if the student needs help or wants to leave. Do not discourage or interrupt behavior unless truly disruptive and understand that student does not intend to be disrespectful. Allow sensory items and/or other “comfort” objects. A student, who is having a hard time coping, might not realize when s/he is being disruptive and needs to leave. The instructor and student can agree on a cue that the instructor can give to signal to the student that it is okay/time to leave. They can also agree on a signal, to inform the instructor when the student is overwhelmed or confused.

Ideally, preparing young adults with an autism spectrum disorder for the demands of college has started years earlier. With a proper diagnosis, individualized early intervention and careful transition planning, college students with an autism spectrum diagnosis, will be better prepared to advocate for themselves. At the same time college professors and other staff at post-secondary colleges and universities need to be prepared for students on the spectrum who are seeking to be a part of these institutions in greater and greater numbers. These students must be given reasonable accommodations to provide an equal opportunity for pursuing a college education. Many great minds and opportunities for society could be lost if individuals on the autism spectrum are not supported in their post-secondary academic pursuits.

Academic Supports for College Students with An Autism Spectrum Disorder:  Quick Overview


The information in this article is based on Marci Wheeler’s work at the Indiana Resource Center for Autism, Indiana Institute on Disability and Community at Indiana University-Bloomington; including her role as Advisor for the Students on the Spectrum Club at Indiana University – Bloomington.

If you need more information about supporting students on the autism spectrum in a university/college setting, please contact your local autism organization or campus office for students with disabilities to find out who can assist. Indiana residents can contact Marci Wheeler at mwheeler@indiana.edu or phone (812) 855-6508.

With Special Thanks to the members of the Students on the Spectrum Club at Indiana University – Bloomington for sharing their insights as they navigate the college setting.


Attwood, T. (2007). The complete guide to Asperger’s Syndrome. Philadelphia: Jessica Kingsley Publishers.
Harpur, J., Lawler, M. & Fitzgerald, M. (2004). Succeeding in college with Asperger Syndrome: A studentguide. Philadelphia: Jessica Kingsley Publishers.

Palmer, A. (2006). Realizing the college dream with autism or Asperger Syndrome: A parent’s guide to student success. Philadelphia: Jessica Kingsley Publishers.

Prince-Hughes, D. (2002). Aquamarine Blue 5: Personal Stories of College Students with Autism. Athens, OH: Ohio University Press.

Wolf, L.E., Brown, J.T,. Bork, G. R. K. (2009). Students with Asperger Syndrome: A guide for College personnel. Shawnee Mission, KS: Autism Asperger Publishing Company.


Why When You Don’t Know What You Want, You Get A Lot Of What You Don’t Want

By Brian R. King LCSW

This is the fourth of a ten part series I have decided to put together especially for you. I hope these lessons will serve as a road map of sorts on how to be on the Autism Spectrum and have a successful, happy life. So let’s get started . . .

Step 4: What Do I Want?

How many times have you heard someone on the spectrum complain about how much they don’t like the way things are going in their life? How often do you ask them, “Well what do you want instead?” Only to have them respond, “I don’t know.” This is one of the greatest challenges when parenting or working with a spectrumite. See if these interactions seem familiar as well.

# 1

I want people to accept me for who I am?

Who are you?

I don’t know.

# 2

I wish people would treat me better.

How would you like them to treat you instead?

I don’t know.

# 3

I wish I had friends.

Who do you want to be friends with?

I don’t know.

And the list goes on and on.

Parents ask all the time, “How do I motivate my child?” Teachers ask, “How do I get them to want to do their work?” When asked, “Well what do your children or students want? Guess what the answer is . . . “I DON’T KNOW.” In these scenarios both parents and teachers are more interested in compliance. They want the children to meet their needs and don’t stop to consider the child’s needs.

So if you as a parent or teacher don’t know, how can the child? In the meantime, you aren’t getting anywhere, you aren’t creating anything and you aren’t happy because instead of getting crystal clear on what you want, you settle for what the world gives you.

Think of it this way. You don’t have to do anything to grow weeds, they grow everywhere, without help from you. But if you want to grow a garden you need to get rid of the weeds and do what is necessary to grow the garden you want. Including pulling out the weeds.

So if you continue to sit in the place of “I don’t know” then the weeds of life will grow around you automatically until you decide what to do instead.

Life sucks because you allow the weeds to grow. Make sense?

Why Don’t You Know?

There are many reasons why spectrumites respond to questions with “I don’t know” a lot of the time.

1. Too Tired. I for one do it a lot when I’m tired. My son will ask me a question repeatedly and at that time I’m so tired it’s hard to think about his question because my brain is too tired to do the work.

At the end of a long school day parents ask their child, “How was your day?” and get “I don’t know.” Your child is exhausted and needs time to wind down, they’re likely too tired to answer.

However, if you ask that question when they’re feeling more alert and focused you’d likely get a very different answer.

2. Not Interested. Saying, “I don’t know” is also an effective way of getting rid of a conversation they don’t want to have. It is difficult to have an open ended conversation with someone when you don’t know the point or how long it’s going to last. Therefore, you protect yourself from the uncertainty by saying “I don’t know” so the conversation doesn’t occur.

The way to add more certainty for the spectrumite is to be concrete. For example, “I’d like to ask you a question about your day and then I’ll leave you alone.” That’s pretty darn clear wouldn’t you say?

3. Lousy Question. Too often the question you’re asking is too vague.

“How was your day?” starts an avalanche of thoughts the spectrumite now needs to sift through to give you an answer. It’s like trying to find your way through a snowstorm. “Did you learn anything interesting in science class today? is far more specific and easier to answer. If they answer “Yes” you ask, “What did you learn that was interesting?” If they answer “No” you can ask what they did learn.

4. Difficult to Consider. In many cases the question you’re asking requires them to look too far into the future. Since spectrumites see things right in front of them more clearly (forest versus the trees), seeing further out requires them to consider more variables. This can be very overwhelming because it requires them to both multitask and consider hypotheticals instead of facts. At best I can only plan a week at a time.

5. Isn’t An Option. Here’s the biggie. A spectrumite who is constantly being told what to do and who to be learns that what they want isn’t an option so they stop considering it. Instead they follow the lead of those who they’ve learned they’re responsible to make happy. READ THAT ONE MORE TIME PLEASE!

I work with clients who are always asking what they should do, what I think they should do and other variations. When I finally get past the “I don’t knows” it comes down to fearing they’ll making a decision that others will be unhappy with. They eventually learn to fear decision making.

So What Now?

It can be difficult to reverse the fear of decision making which is the most common challenge I experience when working with spectrumites. But let me give you a few ideas to get you started.

First, instead of judging or criticizing the decision, be curious about it. Ask, “Could you explain why you did it that way?” You may very well get, “I don’t know.” Especially if a person acted on impulse instead of thinking it through.

If the person becomes defensive it’s likely because they hear judgment in the question. So clarify, “I didn’t say anything was wrong with your decision, I’m just wondering why that?”

Next, Point out simple decisions the person makes that have a positive result. For a small child, something as simple as,

“Do you like your ice cream cone?”


“Are you glad you chose chocolate?”


“Sounds like you made a good decision then huh?


With my thirteen year old this is a common conversation. When he decides to handle his frustrations by talking back and slamming doors he looses privileges. When he decides to take a break to collect himself and then sit down with my wife and I to talk it out, he ends up feeling much better.

Since we have that comparison, when he begins the road to door slamming I can ask him, “Is what you’re about to do going to get you what you want?” I then wait 5-10 seconds for the question to sink in then add, “The decision is yours.”


Phone Number: 630‐778‐3447

Fax: 630‐6893‐9004


Website: http://SpectrumMentor.com

Autism Life Skills: 10 Essential Abilities for Children with ASD

By Chantal Sicile-Kira      Editorial Note: This article originally appeared in Advocate Magazine in 2008


Teacher: “What are your greatest dreams about your future?”

Jeremy: “I want to have my own house with roommates, good friends,

a fun job and be learning.”


Teacher: “What are your greatest fears about your future?”

Jeremy: “That I will not have enough money.”


Teacher: “What barriers might get in the way of accomplishing your goals?”

Jeremy: “You know I need good helpers. I need people that respect my intelligence.”

-Interview with Jeremy Sicile-Kira

Transition Year 2007-08

With two teenagers who will soon be out of school, there has been much reflection and soul searching taking place in my home lately as to whether or not we’ve made the right decisions as parents over the years. Rebecca, our  neurotypical teenager, has just started driving and is becoming more independent. In hindsight, there is not much I would do differently if we had to start raising her all over again.

My thoughts concerning Jeremy, our 19-year-old son with autism, are somewhat  different. Those who have seen him on the MTV True Life segment “I Have Autism” will remember his can-do spirit and his determination to connect with other people, but also how challenged he is by his autism. Obviously, there are many more options available to help people like Jeremy today than when he was a baby. Over the last few years, as we considered how to best prepare Jeremy for the adult life he envisioned, I wondered what we could have or should have done differently when he was younger.

This led me to think: What would today’s adults on the autism spectrum point to as the most  important factors in their lives while they were growing up? What has made the most impact on their lives as adults in terms of how they were treated and what they were taught as children? What advice did they have to offer on how we could help the children of today? I decided to find out. I interviewed a wide-range of people—some considered by neurotypical standards as “less able,” “more able” and in-between; some who had been diagnosed as children; and some diagnosed as adults.

The result of these conversations and e-mails became the basis of my latest book, Autism Life Skills: From Communication and Safety to Self-Esteem and More—10 Essential Abilities Your Child Needs and Deserves to Learn (Penguin, October 2008). Although some areas discussed seemed obvious on the surface, many conversations gave me the “why” as to the challenges they faced, which led to discussions about what was and was not helpful to them. No matter the differences in their perceived ability levels, the following 10 skill areas were important to all.

Sensory Processing

Making sense of the world is what most adults conveyed to me as the most frustrating area they struggled with as children, and that impacted every aspect of their lives: relationships, communication, self-awareness, safety and so on. Babies and toddlers learn about the world around them through their senses. If these are not working properly and are not in synch, they acquire a distorted view of the world around them and also of themselves.

Most parents and educators are familiar with how auditory and visual processing challenges can impede learning in the classroom. Yet, for many, sensory processing difficulties are a lot more complicated and far reaching. For example, Brian King, a licensed clinical social worker who has Asperger’s, explains that body and spatial awareness are difficult for him because the part of his brain that determines where his body is in space (propioception) does not communicate with his vision. This means that when he walks he has to look at the ground because otherwise he would lose his sense of balance.

Donna Williams, Ph.D., bestselling author and self-described “Artie Autie,” had extreme sensory processing challenges as a child and still has some, but to a lesser degree. Donna talks about feeling a sensation in her stomach area, but not knowing if it means her stomach hurts because she is hungry or if her bladder is full. Other adults mention that they share the same problem, especially when experiencing sensory overload in crowded, noisy areas. Setting their cell phones to ring every two hours to  prompt them to use the restroom helps them to avoid embarrassing situations.

Many adults found it difficult to tolerate social situations. Some adults discussed how meeting a new person could be overwhelming—a different voice, a different smell and a different visual stimulus—meaning that difficulties with social relationships were not due simply to communication, but encompassed the total sensory processing experience. This could explain why a student can learn effectively or communicate with a familiar teacher or paraprofessional, but not a new one.

The most helpful strategy was knowing in advance where they were going, who they were going to see and what was going to happen, so that they could anticipate and prepare themselves for the sensory aspects of their day. Other strategies included changing their diet, wearing special lenses, having a sensory diet (activities done on a regular basis to keep from experiencing sensory overload), undergoing auditory and vision therapy, as well as desensitization techniques.


The ability to communicate was the second most important area of need cited by adults. All people need a form of communication to express their needs, in order to have them met. If a child does not have an appropriate communication system, he or she will learn to communicate through behavior (screaming or throwing a tantrum in order to express pain or frustration), which may not be appropriate, but can be effective. Sue Rubin, writer and star of the documentary “Autism is a World,” is a non-verbal autistic college student and disability advocate. She often speaks about the impact of communication on behavior. She shares that as she learned to type she was able to explain to others what was causing her behaviors and to get help in those areas. In high school, typing allowed her to write her own social stories and develop her own behavior plans. As her communication skills increased, her inappropriate behaviors decreased.

Those with Asperger’s and others on the more functionally able end of the spectrum may have more subtle communication challenges, but these are just as important for surviving in a neurotypical world. Many tend to have trouble reading body language and understanding implied meanings and metaphors, which can lead to frustration and misunderstanding. Michael Crouch, the college postmaster at the Crown College of the Bible in Tennessee, credits girls with helping him develop good communication skills. Some of his areas of difficulty were speaking too fast or too low, stuttering and poor eye contact. When he was a teenager, five girls at his church encouraged him to join the choir and this experience helped him overcome some of his difficulties. Having a group of non-autistic peers who shared his interests and provided opportunities for modeling and practicing good communication skills helped Michael become the accomplished speaker he is today.


Many on the spectrum had strong feelings about the issue of safety. Many remember not having a notion of safety when little, and putting themselves in unsafe situations due to sensory processing challenges. These challenges prevented them from feeling when something was too hot or too cold, if an object was very sharp or from “seeing” that it was too far to jump from the top of a jungle gym to the ground below.

Many adults described feeling terrified during their student years, and shared the fervent hope that with all the resources and knowledge we now have today’s students would not suffer as they had.  Practically all recounted instances of being bullied. Some said they had been sexually or physically abused, though some did not even realize it at the time. Others described how their teacher’s behaviors contributed directly or indirectly to being bullied. For example, Michael John Carley, Executive Director of GRASP and author of Asperger’s From the Inside Out, recalls how his teachers made jokes directed at him during class, which encouraged peer disrespect and led to verbal bullying outside the classroom.

A school environment that strictly enforced a no-tolerance bullying policy would have been extremely helpful, according to these adults. Sensitizing other students as to what autism is, teaching the child on the spectrum about abusive behavior, and  providing him/her with a safe place and safe person to go to at school would have helped as well. Teaching them the “hidden curriculum,” so they could have understood what everyone else picked up by osmosis would have given them a greater understanding of the social world and made them less easy prey.


Confidence in one’s abilities is a necessary precursor to a happy adult life. It is clear that those who appear self-confident and have good self-esteem tend to have had a few things in common while growing up. The most important factor was parents or caretakers who were accepting of their child, yet expected them to reach their potential and sought out ways to help them. Kamran Nazeer, author of Send in the Idiots: Stories from the Other Side of Autism, explains that having a relationship with an adult who was more neutral and not as emotionally involved as a parent is important as well. Parents naturally display a sense of expectations, while a teacher, mentor or a therapist can be supportive of a child and accepting of his/her behavioral and social challenges. Relationships with non-autistic peers, as well as autistic peers who share the same challenges were also important to developing confidence.

Pursuing Interests

This is an area that many people on the spectrum are passionate about. For many, activities are purpose driven or interest driven, and the notion of doing something just because it feels good, passes the time of day or makes you happy is not an obvious one. Zosia Zaks, author of Life and Love: Positive Strategies for Autistic Adults, told me that, as a child, she had no idea that she was supposed to be “having fun”—that there were activities that people participated in just for fun. It was one of those things about neurotypical living that no one ever explained to her.

As students, some of these adults were discouraged from following their obsessive  (positive translation: passionate) interest. Others were encouraged by parents and teachers who understood the value of using their interest to help them learn or develop a job skill. For example, when he was little, author and advocate Stephen Shore used to take apart and put together his timepieces. Years later, this interest was translated into paid work repairing bicycles at a bike store.


Respondents believed this is a necessary skill for taking part in community life. Many children on the spectrum suffer from sensory overload. It can also be difficult for them to understand what they are feeling and how to control their emotional response. Dena Gassner, MSW, who was diagnosed as an adult, believes it is necessary for children to be able to identify their “triggers” and that parents and educators should affirm to the child that whatever he or she is feeling is important. Even if it does not make sense to the adult, whatever the child is feeling is true for him or her. Various methods can be used to help them become more self-aware over time, to recognize when they are approaching sensory or emotional overload and to communicate the need for a break. As they get older, giving them more responsibility for scheduling their own breaks and choosing their own appropriate coping strategy can be very empowering.


Independence is an important goal, but may take longer than expected. Zosia Zaks told me that parents of children with autism need to realize and accept that they will be parenting for a lot longer than parents of neurotypical children. She has a point, but I never thought I’d still be discussing certain self-care issues when my son was old enough to vote. For many that I interviewed, some skill acquisition came later in life, and many are still improving themselves and their essential skills. This is nice to know because so often, as parents and educators, we hear about the “windows of opportunity” in terms of age and can become discouraged by our own inner cynics and other well-meaning doubters (“If they haven’t learned by now….”).

When discussing self-sufficiency, many stated that the two greatest challenges were executive functioning  (being able to get and stay organized) and sensory processing. Doing chores and establishing routines helped some as children to learn organizational skills and responsibility—two essential foundations for self-sufficiency.

Social Relationships

Relationships are important to all human beings, but are difficult for many on the spectrum. The adults I communicated with make it clear they enjoy having relationships, including those who are mostly non-verbal, such as Sue Rubin and D.J. Savarese (who wrote the last chapter of Reasonable People). However, understanding the concept of different types of relationships and knowing the appropriate behaviors and conversations expected does not come naturally, and can be magnified for those who are non-verbal.

Many adults, such as Dena Gassner and Zosia Zaks, discussed the importance of teaching children interdependence skills—how to ask for help, how to approach a store clerk, how to network as they get older. For them, interdependence did not come as easily as it does for neurotypicals. Yet, asking people for assistance—what aisle the cookies are located in, the name of a plumber when your sink is stopped up, letting people know you are looking for a job or apartment—is how social and community life functions.


Effective self-advocacy entails a certain amount of disclosure. All of the adults I spoke with believed that children should be told about their diagnosis in a positive manner. Michael John Carley, who was diagnosed following the diagnosis of his son, says he always felt different than others. Getting a diagnosis was liberating because then he knew why he felt different. On the topic of disclosure to others, some believe in full disclosure to all, while others choose to disclose only the area of difficulty.

Like many her age, Kassiane Alexandra Sibley, who wrote a chapter of the book Ask and Tell,  was improperly diagnosed before discovering at age 18 that she had an autism spectrum disorder. She had to learn self-advocacy skills the hard way. Like many I spoke with, Kassiane believes that teaching children when they are young to speak up for themselves is the most important gift we can give them.

Earning a Living

This is an issue of major concern for many on the spectrum. Some of the adults I spoke with struggled for years before finding an area in which they could work. The life skills discussed earlier in this article impact tremendously on a person’s ability to find, get and keep a job. Many people on the spectrum continue to be unemployed or underemployed, which means we need to rethink our approach in how we are transitioning our youth from being students to being contributing members of society.

Temple Grandin, who co-authored the book Developing Talents, says that parents should help their children develop their natural talents and that young people need mentors to give them guidance and valuable experience. Authors John Elder Robinson (Look Me in the Eye) and Daniel Tammet (Born on a Blue Day) both credit their Asperger’s for giving them the talents on which they have based their successful businesses. For those whose talents are less obvious, a look at the community they live in and the service needs that exist there can be an option for creating an opportunity to earn money.  My son Jeremy and his teacher created a sandwich-delivery business and a flower business on his high school campus as part of his work experience. Customized employment, including self-employment, is an option that, with careful planning and implementation, can be a solution for some.

In retrospect, there are different choices I could have made  in raising and educating Jeremy these past 19 years. However, after conversations and e-mails with many  different adults on the spectrum, I have concluded that there is one factor I would not have changed, the formula I used for providing a solid foundation for both of my children: Take equal parts love, acceptance and expectation, and mix well.