Megan Farley, Ph.D. megan.farley@hsc.utah October 28, 2011

1. Megan Farley, Ph.D. megan.farley@hsc.utah.edu October 28, 2011 Therapeutic Considerations for Adults with Autism Spectrum DisordersUtah University & College Counseling Centers

2. Disclosure • I have current grant funding to study autism from Autism Speaks, a non-profit foundation • I have no current consulting, drug company or stock relationships.

3. Learning Objectives • Review common features of autism spectrum disorders (ASD) in “high-functioning” adults • Things to consider while providing treatment • Therapeutic approaches • Resources for adults with ASD and for you

4. Common Features of ASD in Adults

5. Prevalence • All ASDs: • 1% from UK Nat’l Health Service study (2009) • Approximately 4 times more common in males than females

6. Spectrum of Severity for Pervasive Developmental Disorders Less Impairment More Impairment Autism with no Mental Retardation Pervasive Developmental Disorders NOS Asperger’s Syndrome Autism with Mental Retardation

7. Etiology • Biologically-based neurodevelopmental disorders • Highly heritable • Exact cause unknown in most cases • Approx 10% are accounted for by identifiable conditions (Fra X, Tuberous Sclerosis, Rett’s)

8. Developmental Course • Symptoms that may change with development, e.g. gaze aversion improves • Improvements noted in adolescence for subgroup • Seizure onset in infancy or adolescence for 20% • Co-occurring psychiatric conditions in ~60% • Lifelong condition, despite common reduction in symptoms of autism over time

9. Core Features • Social interaction • Communication • Restricted interests and repetitive behaviors

10. Associated Features • Sensory sensitivities • Emotional reactivity • Low adaptive functioning compared to IQ • Problems organizing environment, time • Sleep difficulties • Black-and-white thinking

11. Strengths • Integrity, honesty, guilelessness • Attention to detail • Accuracy • Intense interests • Ability to see unique solutions • Visual learning • Excellent memory • Interest in people

12. Difficult Situations • Dating • Finding work • Self-advocacy • Changes to existing environment, schedule • Using mass transit • Meeting new friends, socializing • Understanding different expectations held by people in similar roles (e.g., professors)

13. Overview of National Status of Adults with ASD • Most adults with ASD are unemployed or underemployed • Most adults with ASD live with parents, siblings, or older relatives • IDEA transition requirements are generally poorly implemented for people with ASD SOURCE: Gephardt, P.F. (2009). The current state of services for adults with autism. Arlington, VA: Organization for Autism Research.

14. How can you help support your client?

15. Treatment planning • ASDs are complex, and it can be difficult to manage all of the competing challenges a client faces. • Determine what you are addressing: • Comorbid psychiatric condition • Skills deficit • Supporting problem-solving (e.g., self-disclosure, services navigation, environmental changes)

16. Comorbid Psychiatric Conditions • Cognitive Behavioral Therapy for Adult Asperger Syndrome (Gaus, 2007) • Medications may be indicated

17. Skills Deficits • Preparing for Life: The Complete Guide for Transitioning to Adulthood for Those with Autism and Asperger's Syndrome by Jed Baker • Video (self and other)

18. Problem-solving skills • Living Well on the Spectrum by Valerie Gaus • Asperger’s Syndrome: an owner’s manual 2. for older adolescents and adults. By Ellen S. H. Korin

19. Counseling Strategies • Counseling strategies usually best focused on teaching a functional skill rather than developing insight • Visual supports when possible • Scripts for dealing with certain social situations • Concrete rules about social behavior

20. Counseling Strategies (continued) • Concrete descriptions of emotions, including the range of emotions • Specific strategies for emotional coping (mindfulness, guided imagery, progressive relaxation, breathing exercises, using sensory objects) • A comprehensive plan for helping skills generalize to other settings (community-based when possible)

21. Tools for Independence • “Go-to” people in different settings • Rehearsed scripts • Visual calendars and PDAs with automatic reminders • Exploration of autism, self-identify and self-acceptance through books, support groups, and Internet chat rooms • Adapted from Ozonoff, Dawson, and McPartland (2002)

22. Tools for Independence (continued) • Medication or monitoring of mood • Educational accommodations in college • Organizational systems for paperwork • Internet shopping • Adapted from Ozonoff, Dawson, and McPartland (2002)

23. Resources for your client and you

24. www.autismspeaks.org • Transition Tool Kit • Autism in the Workplace • Legal Appeals • Family Services Resources Guide by state • Social Networks

25. Adult Services • Eligibility-based, not an entitlement • Social Supplement Income • Vocational Rehabilitation Services • Continuing education • Campus-based centers for students with disabilities

26. Planning for Employment • Plan early – work towards work • Department of Workforce Services • Vocational Rehabilitation • IPE – Individualized Plan for Employment • Assessment/Eligibility • Some training support • Counseling • Medical/Psychological treatment • Assistive technology • Job placement • Follow-up services

27. Transition Considerations • Comorbid psychiatric conditions are treatable • Apply for SSI if needed • Vocational Rehabilitation • Self-disclosure

28. Planning for Employment • Plan early – work towards work • Department of Workforce Services • Vocational Rehabilitation • IPE – Individualized Plan for Employment • Assessment/Eligibility • Some training support • Counseling • Medical/Psychological treatment • Assistive technology • Job placement • Follow-up services

29. Self-Advocacy • Neurodiversity Movement • Concern about language and attitudes regarding “curing” or “defeating” autism

30. Additional resources • Books: • Asperger’s on the Job by Rudy Simone • Students with Asperger Syndrome: A Guide for College Personnel by L. Wolf, J. Brown, and G.R.K. Bork • Ask and Tell: Self Advocacy and Disclosure for People on the Autism Spectrum edited by S. Shore

31. Additional resources • Websites: • The Autistic Self-Advocacy Network (ASAN) - www.autisticadvocacy.org • Wrong Planet at www.wrongplanet.org • www.neurodiversity.com • www.aspergeradults.ca • Achieving in Higher Education with Autism/Devel Disab. – http://aheadd.org/blog/ • www.autismafter16.com

32. Thank you for your attention