Understanding & Accommodating Students with Autism Spectrum Disorders (ASD) Debbie Jones, Disability Program Analyst Humanitas, Inc. Suzanne Martin, PsyD,

Understanding & Accommodating Students with Autism Spectrum Disorders (ASD)

Debbie Jones, Disability Program Analyst Humanitas, Inc.

Suzanne Martin, PsyD, MPH Region 3 (Atlanta) Mental Health Specialist

Humanitas, Inc.

Learning Objectives

• Identify the core behaviors that are associated with ASD.• Dispel common myths about ASD.• Identify common challenges that are faced by individuals with ASD.• Identify possible reasonable accommodations for students with ASD

specific to their functional limitation manifestations. • Understand the most common issues that impact individuals with ASD in

the workplace.• Identify strategies that may assist students with ASD in improving their

soft skills in the workplace.

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Clinical Background

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What is Autism Spectrum Disorder (ASD)?

Autism Spectrum Disorder is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). The term "spectrum" refers to the wide range of symptoms, skills, and levels of impairment, or disability, that individuals with ASD can have. Some people are mildly impaired by their symptoms, while others are severely disabled. (NIMH)

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What Happened to Asperger’s?

As of DSM – 5, Autistic Spectrum Disorder now includes disorders previously referred to as Asperger’s, High Functioning Autism, Pervasive Developmental, Disorder, Childhood Disintegrative Disorder. These disorders are not diagnosed separately. However, because many agencies are not yet using DSM – 5, it is likely you will still see these later diagnoses for some time. Consider the diagnosis the same but of course the individual is always unique.

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What Happens to Students with Existing Asperger's Diagnosis?

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Diagnosing and Autism Spectrum Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) - 5th Edition the essential features of autism spectrum disorder are:

A. Persistent impairment in social communication and social interaction;

B. Restricted, repetitive patterns of behavior, interests or activities; C. Present from early childhood;D. Behavior limits or impairs everyday functioning.E. Behavior is not better explained by intellectual disability

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Criterion A: Social Communication & Interaction

To meet criteria for ASD, one must meet all three social-communication criteria. These include deficits in:

1. Social emotional reciprocity • lack of back & forth conversation; failure to respond to a question

2. Nonverbal communicative behaviors used for social interaction• Abnormal eye contact and body language; lack of facial expressions

3. Developing, maintaining, and understanding relationships • difficulty adjusting to social context; making friends

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Criterion B: Restricted & Repetitive Behaviors (RRB)

To meet criteria for ASD, an individual must meet 2 out of 4 RRB. These include:

1. Stereotyped or repetitive motor movements, use of objects, or speech

2. Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior

3. Highly restricted, fixated interests that are abnormal in intensity or focus

4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

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DSM-5 ASD Severity Coding*

*Severity is based on social communication impairments and restricted repetitive patterns of behavior

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Severity Social Communication Restricted, Repetitive Behaviors

Level 3: Requiring very substantial support

Severe deficits in verbal and nonverbal social communication skills

Inflexibility of behavior, extreme difficulty coping with change

Level 2: Requiring substantial support

Interaction is limited to narrow, special interests

Distress and/or difficulty changing focus or action

Level 1: Requiring support

May appear to have decreased interest in social interactions

Difficulty switching between activities. Problems of organization and planning

Common Behavioral Challenges

Social • Intrusive touching• Abnormal tone/volume/rate of

speech• Asks socially inappropriate

questions• Does not recognize another’s

distress• Failure to respond when called• One sided conversation• Doesn’t share

RRB• Repeating the same word/sentence

over and over• Insisting on having the same desk

each day• Body rocking• Pronoun reversal (you for I)• Unusual routines• Difficulty with transitions• Overreacts to minor changes• Preoccupation with narrow interests

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Common Comorbidity in ASD

Medical• GI Disorders (colitis)• Asthma• Skin and food allergies• Ear infections• Headaches/migraines• Sleep Disorder• Seizures

Psychiatric• ADHD• Anxiety/OCD• Mood Disorders• Learning Disorders• Language Disorder• Intellectual Disability

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Can You Think Of Existing JC Supports On Your Center From Which An Individual With ASD Would Benefit?

Autism Spectrum Disorder Myths

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Myth #1: People With Autism Do Not Want Friends

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Myth #2: People With Autism Don’t Feel Emotions

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Myth #3: People With ASD Are All Very Similar

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Myth #4: People With ASD Are Intellectually Disabled

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Dr. Temple Grandinwww.templegrandin.com

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Statistics

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Current Statistics on ASD Prevalence

• According to the most recent findings from the Centers for Disease Control, one in 88 children in the US has an ASD, a 78% increase since 2002. – For boys, it’s 5 times higher (1 in

54) than among girls (1 in 252).

http://www.cdc.gov/ncbddd/autism/data.html

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Teenagers with ASD Moving into Adulthood

• Approximately 200,000 teenagers with ASDs will reach young adulthood in the next five years. Amy Harmon, a national correspondent for the New York Times, stated, “Opening the workplace to people with autism could harness their sometimes-unusual talents… while decreasing costs to families and taxpayers for daytime aides and health care and housing subsidies, estimated at more than $1 million over an adult lifetime.”

http://www.nytimes.com/2011/09/18/us/autistic-and-seeking-a-place-in-an-adult-world.html

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Understanding ASD in the Workplace & the Center Environments

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ASD and the Classroom/Center Environment

• What do you think would be some of the more common difficulties that an individual with ASD might encounter on the center?– Understanding workplace etiquette/social norms

• Personal space• Interpersonal relationships and interactions

– Managing memory difficulties – Time management– Organizational skills– Managing certain environmental triggers

• Lighting/Smells

– Generalized anxiety24

ASD and the Workplace

• What do you think would be some of the more common difficulties that an individual with ASD might encounter in the workplace?– Understanding workplace etiquette/social norms

• Personal space• Interpersonal relationships and interactions

– Managing memory difficulties – Time management– Organizational skills– Managing certain environmental triggers

• Lighting/Smells

– Generalized anxiety25

Accommodation & Support Considerations

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Accommodation & Support Considerations

• Individuals with the same diagnosis may and often do have needs that are unique to them; the same disability may manifest itself in different ways in different people

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Where to Begin…

• Find out what the student’s interests are and place some focus on those.– Dr. Grandin shares, “If a child likes art, then teach with art. If they like

trains, then teach with trains, dinosaurs, etc. You can teach Math with trains, you can teach Art with trains…”

• What we are really talking about is getting to know each student, focusing on individual strengths, and using those strengths to develop other skills set and broaden knowledge base.

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Social Interaction

• Provide a place for down time and/or time to be alone each day.

• Provide a peer buddy for support. • Educate other students about ASD. • Conduct role playing to teach the use of

pragmatic language and social cues (i.e., when is it ok to interrupt, taking turns speaking).

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Accommodations - blueSupport or strategy - red

Communication

• Use concrete, clear, short statements in providing instruction and direction to the student. Use of idioms or sarcasm may inadvertently positively reinforce inappropriate behavior. For example, “Time flies!” may be taken literally. Repeat instructions.

• Allow extra time for the student to process the question and provide a response. Often if interrupted, the student will have to start his thought process all over again.

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Comprehension/Memory

• Break down directions into simple steps. • Using visual cues to assist in providing directions or when

demonstrating new skills. – Provide visual picture strips to help the student remember what to

do and in what order.

• When presenting multi-step directions, pause between instructions and check for comprehension.

• Provide time to process & repeat.

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Organizational

• Watches with reminder settings/memo options.

• Schedules and organizers, paper or electronic.– Color coding– By priority

• Checklists– 5 items or lists to start

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Transitions

• Provide structured routines wherever possible. • Provide advance notice before a change in activity

or use extra verbal and/or visual cues if needed to aide successful transition.

• Provide visual or electronic organizers for daily routine. Review each day’s activities and if using a visual organizer, have student highlight any changes in routine.

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Attention/Distractibility

• Allow the student to have brief periods of movement to refocus attention.

• Allow to move around for brief periods to refocus and/or to self-regulate.

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Handwriting

• Allow the use of computers or as appropriate, voice dictation software in place of hand written work. – Dragon Naturally Speaking

• Provide copies of notes.

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Auditory Processing

• Give the student ample time to process what has been said (i.e., determine the general amount of time needed to process information and include as an accommodation).

• Give the student advance notice of questions you might call on him/her to answer in class.

• Present oral information in smaller chunks and provide written copy of notes or information.

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Sensory Processing

• Individuals with Asperger’s may experience heightened responses to sensory stimuli– Noise – loud noises might be painful to the individual– Color – certain colors may make it difficult for the individual to attend

(e.g. pay attention) – Touch – may be hypersensitive to touch, particularly around head,

face or during nail clipping – Smell – may be hypersensitive to smells and may feel ill

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Sensory Processing

• Allow student to go to a quiet place if there is a lot of chaos and noise heightening sensory responses.

• Allow student to get up and move if needed to self-regulate. Define space allowed to pace in, etc.

• Provide earplugs or noise-cancelling headsets for managing transitions between classes, during lunch, or for use in other noisy environments.

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Sensory Processing

• Pastel or softer colored papers for individuals who have difficulty attending to bright white paper. (Note: issue may not be paper color but clutter in visual field and worksheets, etc., would need to be decluttered with fewer problems, etc.

• Weighted lap items, heavy work (carrying books, etc.) to help the individual self-regulate.

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Behavioral Considerations

• Individuals with Asperger’s Syndrome can interpret rules literally and can be rigid about following them in a particular way. – Teach the student cause/effect relationships for better understanding

of center and rule requirements. – Preferably write the rules down for them or provide copies of and

review together. – Have them explain what the rules mean to them. Clarify as needed.

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Behavioral Considerations

• Avoid escalating power struggles as these individuals may not understand the situation or pick up on the anger until it is too late. They may become more rigid and stubborn if confronted in a forceful and rigid method. – If the student is becoming more rigid, stubborn, or resistant to

direction. Step back and give the individual time to cool down. – Remain calm.

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Perseverative Behaviors

• If the student engages in perseverative questioning that interferes with classroom instruction, you can try instructing the student to write the question down and that you will discuss it with him later in the class period. Incorporate a private visual signal that lets the student know that you will talk with him or her later but not now.

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Be Proactive

• Take preventative action to avoid these situations whenever possible.– Use humor to diffuse tension. – Offer two choices as options (if possible). – Redirect through diversion of attention to

something else. – Again, allow time for the individual to regroup

and regain level of calmness.

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Bullying Risk

• Student’s with ASD are at high risk for becoming victims of bullying. To appropriately prepare and support the student with ASD, – Provide sensitivity training (disability awareness) to all staff and

students, as appropriate.– Assign a peer buddy if the student is amenable to that support.– Role play/provide concrete instruction in how to deal with situations of

bullying.

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Workplace Adaptations Boston University: National Autistic Society of England http://www.bu.edu/fsao/2013/01/22/autism-spectrum-disorders-in-the-workplace/

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Employment Considerations Examples

• Handout on “Workplace Expectations” will be posted on the JC Disability website along with this presentation.– Individuals on the spectrum often do not interview well due to their

difficulty with social interaction. Are there other means of of showcasing their abilities?

– Make sure instructions are concise and specific. Try to give the person clear instructions right from the start about exactly how to carry out each task, from start to finish. Don’t assume the person will infer your meaning from informal directions. Provide instructions in writing, not just orally. It can be helpful to ask the person to repeat back instructions so you are sure they have understood.

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Employment Considerations

– Create a work environment which is well-structured. Assist with prioritizing activities, organizing tasks into a timetable for daily, weekly, and monthly activities, and breaking larger tasks into small steps. Some employees will appreciate precise information about start and finish times, and help getting into a routine with breaks and lunches.

– Appreciate the employee’s sensory sensitivities and allow her or him to make adjustments such as wearing earphones, changing the type of light bulb, or taking breaks from situations of high sensory input such as loud noises or strong odors.

– Accommodate to the employee’s need for predictability and routine. When possible, provide forewarning of any changes and allow the employee time to adjust and transition.

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On the Employment Front!

• Some call it neurological diversity, others see it as autism's fight back. People diagnosed as "on the spectrum" are suddenly in demand by employers seeking a competitive advantage from autistic workers more used to being considered disabled than special.– Expressing a belief that "innovation comes from the edges,” German computer

software giant SAP launched a recruitment drive to attract people with autism to join it as software testers.

– A U.S. home financing firm, Freddie Mac, advertised a second round of paid internships aimed specifically at students with autism or new graduates with autism.

• Read more: http://www.nydailynews.com/life-style/health/companies-seek-autistic-workers-fuel-innovation-article-1.1362853#ixzz2sF46dFaV

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Applicant File Scenario

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Background

• Applicant: Dave: – 21 year old male with ASD and mild CP (mild fine motor difficulty). – Applies to JC to learn a trade. – Has a high school degree but poor understanding of social

boundaries and poor social judgment. – Was dismissed from local community college after lending his laptop

to “friends” who downloaded pornography including pedophilia on his pc. Laptop was confiscated by campus security. Dave readily admitted that he knew material was on pc but didn’t understand consequences. Charged as sexual offender and sentenced to 120 hrs community service.

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Applicant File

• Meets eligibility criteria• High School Diploma• Medical, IEP and psychiatric records• Letter of recommendation from National Alliance on Mental

Illness• Social but easily taken advantage of• Supportive family, strong advocates• Sex offender charge but released by county• Interested in business skills

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Questions

• What would you be looking for in file review?• What accommodations might you consider for interview?• How would you address sex offender classification?• What accommodations might you suggest if accepted?• What supports might you consider to help with transition?

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File Review

• Where do you start?– Are there concerns about meeting applicant’s health care needs or

that he poses a direct threat?– Does he need accommodations to participate in the interview and

what might those be if he is unsure of what is needed but agrees he needs accommodations?

• Face-to-face interview or video interview• Verifying understanding of questions

• How would you address sex offender classification?

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Accommodations if Accepted

• What accommodations might you suggest if accepted?– Peer buddy and/or mentor– Copies of rules/expectations & verification of understanding

• Might want separate lists of rules/expectations per area (i.e., one for residential, one for classrooms, one for cafeteria, etc.)

– Review IEP for other previously provided supports and ask if those are still needed. Do not have to simply regurgitate the supports listed from a previous IEP.

• Remember, the accommodation plan is a fluid document and can be adjusted as needed (i.e., items added and/or deleted)

– Notice prior to making transitions or deviations from anticipated schedule

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Resources

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Regional Disability Coordinators

• Boston, Philadelphia, and Atlanta Regions – Kristen [email protected]

• Dallas Region – Laura [email protected]

• Chicago and San Francisco Regions – Kim [email protected]

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Regional Mental Health Specialists

• Boston – Dr. David [email protected]

• Puerto Rico – Dr. Maria [email protected]

• Philadelphia – Dr. Valerie [email protected]

• Atlanta – Dr. Suzanne [email protected]

• Dallas Region – Dr. Lydia [email protected]

• Chicago – Dr. Helena [email protected]

• San Francisco – Dr. Vicki [email protected]

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Job Corps Disability Website

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Job Corps Health & Wellness Website

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Job Accommodation Networkaskjan.org

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Ten Things Your Student with Autism Wishes You Knew

• “The last word: believe. That car guy Henry Ford said, ‘Whether you think you can or whether you think you can’t, you are usually right.’ Believe that you can make a difference for me. It requires accommodation and adaptation, but autism is an open-ended disability. There are no inherent upper limits on achievement. I can sense far more than I can communicate, and the number one thing I can sense is whether or not you think I ‘can do it.’ Expect more and you will get more. Encourage me to be everything I can be, so that I can stay the course long after I’ve left your classroom.”

• Contact the author for permission to reproduce in any way, including re-posting on the Internet.

• Ellen Notbohm is author of Ten Things Every Child with Autism Wishes You Knew, Ten Things Your Student with Autism Wishes You Knew, and The Autism Trail Guide: Postcards from the Road Less Traveled, all Foreword Book of the Year finalists. She is also co-author of the award-winning 1001 Great Ideas for Teaching and Raising Children with Autism or Asperger’s, and a contributor to numerous publications and websites around the world. To contact Ellen or explore her work, please visit www.ellennotbohm.com

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Questions?

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Documents

Understanding & Accommodating Students with Autism Spectrum Disorders (ASD) Debbie Jones, Disability Program Analyst Humanitas, Inc. Suzanne Martin, PsyD,