Preparing Students with Autism

Spectrum Disorders for Post-Secondary Education: The Social,

Emotional, and Behavioral Impact

Sandy Kerrigan & Bri Bonday

Harford County Public Schools

Objectives To review the updated diagnostic criteria for Autism

Spectrum Disorders (ASD) To examine the social, emotional, and behavioral

impact of ASD on students as they transition from the school system

Discuss struggles related to transitioning to post-secondary education from parent, professor, and student perspectives

Provide strategies for successful transitioning

DSM-5 Diagnostic Criteria

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth

conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

DSM-5 Diagnostic Criteria

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).

3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).

4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/ temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

DSM-5 Diagnostic Criteria

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Components of Autism

Social

Interaction

Restricted,

Repetitive

Behaviors

Social Communi

cation

ASD

Diagnostic Changes

Statistics

Why the rise?

Social Challenges

Difficulty using social skills to interact with others in expected ways

Struggle with nonverbal social learning of social routines and norms

Lack theory of mind Difficulty building appropriate relationships

Friendships Romantic relationships Teacher-student relationships

76% of recent graduates with ASD have had socialization in the past year

Communication Challenges

Ranges from lack of speech to full vocabulary Verbal speech may lack expression and appropriate

flow Often unable to understand sarcasm or jokes Difficulty with nonverbal communication-

understanding and using gestures, eye contact, body language, etc.

Difficulty summarizing or seeing the “big picture” May lose words or skills they have used before Often use behavior to communicate

Emotional Challenges 60% of students with ASD have co-morbid health or

mental health conditions, such as anxiety or depression Anxiety is most common comorbid condition; often

impacts many aspects of daily living

Extreme difficulty regulating emotions Trouble expressing emotions appropriately Difficulty understanding and interpreting emotions Often lack empathy and shared emotion Trouble coping with stressors

Behavioral Challenges

Urge to carry out specific routines & rituals Sensory challenges & sensitivity to environmental

stressors Often a reaction to anxiety Do not consider the consequence of their behavior Inappropriate behavior may be the only way they

can communicate emotions Behaviors may increase in settings or activities that

lack structure

ASD in college

A 2015 study revealed 36% of youth with ASD have attended some type of postsecondary education (30% have attended 2- or 4- year college)

It is estimated that students with ASD comprise anywhere from 0.7 percent to 1.9 percent of the college population (2008)

Some colleges have started to recruit ASD students However, studies show students with ASD have an

80% incompletion rate, compared with <40% incompletion rate for neurotypical peers

Brainstorm- What’s the impact?

Group Discussion: Knowing what you know about ASD, what potential impacts could these challenges have on a student transitioning to postsecondary education?

Social/Emotional/Behavioral Impacts Problems adjusting to new social situations and making social

connections

Making introductions

Adhering to social norms

Knowing how to become a participant of social groups and activities

Difficulty transitioning to independent/dorm living

Making connection with roommate

Keep up with cleaning, cooking, doing laundry

Trouble with daily routines and skills

May have difficulty with daily schedule changes

Lack of time and money management skills

May not know how to structure free time

Trouble managing finances

Trouble setting priorities

Difficulty with long term planning

Academic/Executive Function Challenges

Difficulty planning for long term assignments Difficulty focusing during lectures and seminars May require extended processing time to respond to

questions in class or take exams Dislike of small group assignments and discussions Lack of class participation (planning for and

articulating a response in an appropriate amount of time)

Trouble with bstract verbal reasoning, flexible problem solving, social reasoning

Parent Perspective

Click here for video

Often feel loss of control or report feeling “stuck” Students do not often communicate struggles or seek

assistance

Participant Experience

Divide into 2 groups Role play activity

Discussion

How did it feel to try to accomplish the task with so much disruption?

How did it feel to be pressured to do the work in the middle of experiencing so much disruption?

Student Perspective

Click here for video

Can be easy to forget basics of bathing and grooming without someone around to remind them

Utilize visuals, checklists, and other types of reminders

Easy to fall into anti-social tendencies when work builds up and social connections are delayed

Must self-impose structure, but also practice flexibility

Professor Perspective Fidget behaviors Lack of eye contact Difficulty following along Difficulty articulating questions or explaining

knowledge orally Off-topic questions or other disruptive actions Students may be resistant to accommodations “What can I do to make your life easier in my

class?”- Written list instead of oral explanation Written expression > verbal expression Timely, good attendance, eager to learn. intelligent

We do a great job of getting students ready to graduate from high school, but do we do a great job at getting students ready for college?

So What Do We Do? First Steps:

Start preparing early!

Find out what the student wants and what their goals are

Use IEP Team to problem solve and create in-depth transition plan

Make sure student is involved in all IEP meetings

Use counseling services to role play, brainstorm, and create a toolkit of strategies for the student

Person-Centered planning

Fade out support or guidance by senior year

Scaffold participation in post-secondary education

Explore the options

“Post-graduate” program

Dual enrollment

Find out what documentation and assessment information is required

Strategies: CBT

Appropriate for older children, teens, and young adults

Takes into account the thoughts, or cognitions, we have about things, the feelings that result, and the behavior that follows

Helps students with ASD regulate their emotions, develop impulse control, and improve their behavior

Structured, goal-directed approach that focuses on present situations

Adapt using visuals, role playing, etc. Use consistency when possible

Strategies: Promoting Self-Advocacy Family Educational Rights and Privacy Act

Once a student turns 18, they become overseers of their own records, including grades, special learning tools, and accommodations

Need to learn to advocate for themselves, including: When and to whom to disclose their ASD diagnosis

Understanding of their rights

Determining when they need assistance

How to ask for assistance

Must first have self-awareness and self-monitoring Essential for student to know they have autism and what

that entails before they can effectively advocate for themselves

Teaching Self-Advocacy Activities to teach Self-Advocacy:

role playing coaching/verbal rehearsal creating a disclosure letter for professor learning when and how to ask for accommodations talking about what is not working giving/receiving feedback identifying options for resolving problems negotiating effectively how to use resources available

Build self-advocacy into every day life

Strategies: Social Narratives

Interventions that describe social situations in detail by highlighting relevant cues and offering examples of appropriate responding

Can help with transitions, new activities, and activities of daily living

Assists with learning unwritten rules of social interaction

See example

Strategies: Community-Based Training Safety training

Crossing the street at crosswalks, walking on sidewalk

How to ask for help

Independently navigating public transportation How to order at a restaurant and buy appropriate

foods while grocery shopping “Safety Plan” for what student should do if they are

overwhelmed in a large crowd Trial run to college campus to practice applying

skills

Strategies: Transition Plan

Each student should have a transition plan as part of the IEP process Transition planning is not a single conversation,

but a process that should evolve over several years

Learning the skills necessary for college should be a part of this plan, starting before junior year

Use person-centered planning approach PATH MAPs

Before the Transition

Develop clear, systematic organizational strategies for academic work (calendars, checklists, other visuals)

Provide guidance in finding the right social groups, clubs, activities, and friends and help with the initial steps of becoming a participant

Brainstorm aspects of daily life on campus and provide written guidelines, checklists, or advanced training/preparation

What Can Colleges Do? 504 Plans v IEP

IDEA requirements no longer apply once child leaves high school

Section 504 will still protect the student In order to receive 504 accommodations, student or

advocate must request them Provide documentation

Section 504 does NOT required an institution to compose a written plan

What might a 504 Plan look like?

Common accommodations include: Extended time Testing in separate/quiet location Use of computer or other assistive technology

device Note-taking assistance Recording lectures Books on tape Preferred registration for courses Reduced course load Preferential seating

Other Auxiliary Services

Academic tutoring Advising College mentoring program Personal counseling sessions Career counseling services Self-determination and self-advocacy opportunities Social skills groups

Post-Secondary Educational Opportunities Three main types of post-secondary education models:

1. Mixed/hybrid model

Participate in classes and/or social activities with typically developing peers

Also participate in classes or experiences with other students with disabilities (transition classes, employment experiences)

2. Substantially separate model

Participate in classes only with other students with disabilities

Some opportunity to participate in social activities on campus

May be offered pre-established employment slot to provide work experiences

3. Inclusive individual support model

Receive individualized services (tutor, accommodations) in college courses, certificate programs, or degree courses, for audit or credit

No program based on campus

Focus on student-identified career goals and collaborative approach between adult service agencies, disability support office, and student/family

Characteristics to Look for in a Post-Secondary Program Size- Smaller schools may be easier for students who

learn better in small classes and quiet settings and who may become overwhelmed by crowded, over-stimulating environments

Location- For students who exhibit adaptive skill deficits, it may be helpful to live at home for the first 1-2 years of college and gradually make the transition to independent or dorm living

Cooperative education programs- Students alternate between taking academic courses and working in related jobs in order to explore potential careers and develop work skills

Good disabilities services program and access to counseling center

College Programs Rutgers University College Support Program- Douglass

Developmental Disabilities Center

MoSAIC Program at University of Tennessee Chattanooga

Marshall University College Program for Students with Asperger’s Disorder

Kelly Autism Program (KAP) at Western Kentucky University

University of Connecticut Strategic Education for Students with Autism Spectrum Disorder (SEAD)

Bridges to Adelphi at Adelphi University

College Program for Students with Asperger Syndrome at Marshall University

REACH Program at University of Iowa

Autism Support Program at Drexel University

Rochester Institute of Technology Spectrum Support Program

Resources

The Autistic Self-Advocacy Network (ASAN) Autism Speaks

Transition Toolkit

Autism NOW Transition planning resources

Resources

Review of handouts in folder

ReferencesCBS News staff, (2015).  Retrieved from http://www.cbsnews.com/media/autism-awareness- college-programs-for-students-on-the-spectrum

Herman, (2015).  Autistic Spectrum Disorders:  Social Behavior Problems. Retrieved from http://www.autisticspectrums.com

Hurewitz, F. & Berger, P. (2008). Preparing Students with Autism for College, and Preparing Colleges for Students with Autism. Speaker’s Journal, 8(11), 109-117.

Kelley, L. M.& Joseph, B.C. (2014).  Rethinking Higher Education for Students with Autism Spectrum Disorders:  The Importance of Adult Transitions.

Murray, N. (2015, May 14). High School Sets up Autistic Kids to Fail in College; Here’s how to Fix the Problem. Vox. Retrieved from http://www.vox.com/2015/5/14/8594375/high- school-sets-up-autistic-kids-to-fail-in-college-heres-how-to-fix

Preparing for Postsecondary Education. (2013). Autism Speaks Inc. Retrieved from https://www.autismspeaks.org/family-services/resource-library/post-

secondary- education-resources

Zaks, Z. (2013). Interventions for Children with Autism-Related Disorders.  John Archer School Presentation.