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The Needs of College Students with Autism Spectrum DisordersSteve Altabet, Ph.D.Clinic DirectorTacoma Satellite Clinic

GoalsDiagnosing Autism Spectrum Disorders

Challenges and Strengths

Educational Strategies

Coping Strategies

Resources

What is Autism?Autism is considered a spectrum disorder in which the individual exhibits severe and pervasive impairments in communication, social interaction, and/or presence of stereotyped behavior, interests, or activities.Diagnostic and Statistical Manual, 4th Ed, TR (DSM-IV-TR; 2000)Highly ImpactedHigh FunctioningASD Core Deficits CommunicationSocialRestricted/ RepetitiveAutism Spectrum Disorders(Pervasive Developmental Disorders DSM-IV)

Autism (Autistic Disorder)

Aspergers Syndrome (Aspergers Disorder)

Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

DSM IV CriterionSocial InteractionImpairment in multiple nonverbal behaviors such as eye contact, facial expression, body language, and gestures.Failure to develop developmentally appropriate peer relationships.Lack of spontaneous seeking to share enjoyment, interests, or achievements with others. Lack of social or emotional reciprocity. DSM IV CriterionCommunicationDelayed or total lack of spoken language without compensating nonverbal communication strategies (e.g. pointing, gestures, or mime).Inability to initiate or sustain a conversation for those with adequate speech.Odd or repetitive use of language.Lack of developmentally appropriate pretend play or social play. DSM IV CriterionRestricted, Repetitive, and Stereotyped BehaviorPatterns of interest that are either excessive, overly odd, or overly narrow.Inflexible adherence to specific nonfunctional routines and rituals.Odd and repetitive hand, finger, or complex whole body movements.Preoccupations with parts of objects.DSM IV CriterionOther CriterionCauses clinically significant impairment in academic, occupational, social, or other important areas.Age of onset prior to 3 years with regard to social interaction, social communication, or play skills.DSM IV CriterionFor Autistic Disorder Must have at least one impairment in all three categories and at least 6 impairments total.

For Aspergers Disorder Must have at least two impairments in the social interaction category and one impairment in the restricted/repetitive behavior category. Must also have appropriately developed language, cognitive abilities, and self help skills.

For PDD-NOS - Must have impairment in Social Interaction and either Communication or Restricted/Repetitive behavior DSM V CriterionMajor Changes from DSM-IVInstead of three diagnostic categories (Autistic Disorder, Aspergers Disorder, and PDD-NOS) there will now just be one diagnosis (Autism Spectrum Disorder). The three existing domains (Social Interaction, Communication, and Restricted/Repetitive Behavior) will be combined into two (Social Communication & Restricted/Repetitive Behavior). Specifiers will be made for level of support needed and other contributing factors.Sensory Sensitivity is now part of the criterion.DSM V CriterionReasons for the changesClinicians & researchers unable to distinguish between High Functioning Autism, Aspergers Disorder, and PDD-NOS.Social and communication functioning interrelated. Language and intellectual delays not related to ASD. Criteria for PDD-NOS too vague.Service providers, governing agencies, and insurance companies designated level of support based solely on diagnosis (not on functional ability). DSM V CriterionSocial Communication Deficits in Social-emotional Reciprocity.Deficits in nonverbal communication used for social interaction.Deficits in developing and maintaining developmentally appropriate relationships.

All three areas must be met for ASD diagnosis. DSM V CriterionRestricted Repetitive BehaviorStereotyped or repetitive speech, motor movements, or use of objects.Excessive adherence to routines, ritualized verbal or nonverbal behavior patterns, or excessive resistance to change.Highly restricted, fixated interests that are abnormal in intensity and focus.Hypo or hyper-reactivity to sensory input or unusual interest in sensory aspects of environment.Must have at least 2 of 4 areas for ASD.DSM V CriterionLevels of Support Needed (Severity)Requires very substantial supportRequires substantial supportRequiring supportSubclinical symptomsNormal variationDSM V CriterionSpecifiers and ModifiersPossible specifiers of etiology include medical conditions such as Rett Syndrome, Fragile X Syndrome, or Mitochondrial Disease. Possible modifiers (important other factors) may include language or learning disorders, intellectual disability, seizures, motor tics, or Irritable Bowel Syndrome DSM V CriterionEarly History also specifiedAge of onsetPattern of onset Include any delays in development, regression, or loss of previously acquired skills.DSM V CriterionSocial Communication DisorderImpairment in pragmatic communication Difficulty in the social use of verbal and nonverbal communication in naturalistic contexts.Functional development of social relationships and communicative comprehension negatively affected.Cannot be explained by low abilities in use of word structure, grammar, or general cognitive ability.DSM V CriterionImplications?Greater accuracy in diagnosingEarly studies indicate no change in overall rate of diagnosis, there was a change in the distribution of people being diagnosed.A clearer understanding of the level of support needed (more individualized).Social Communication Disorder to be classified as a communication disorder (may not receive as much support)People diagnosed with Aspergers Disorder feel like they are losing their identity.ChallengesCommunication Cognitive

Productivity Social

Emotional Navigational

Communication ChallengesInitiating and maintaining conversation

Asking for assistance or clarification

Literal interpretation of language

Overly direct/blunt

Expressing feelings/needs

Cognitive ChallengesFlexibility:Rigid or concrete problem-solving strategiesTendency to get stuck on topics or ways of doing thingsPerfectionism Desire for controlDifficulty with transitionsPreference for known procedures & established routines

More Cognitive Challenges Executive FunctioningOrganization & Planning:Challenges with organizing self, materials, experiencesDifficulty choosing & prioritizingDelays in completing work on time, turning in assignments

Productivity ChallengesProblem-SolvingDifficulty seeing whole picture or main ideas Difficulty understanding individual steps Challenges related to integrating information, drawing inferencesDifficulty learning from experiences, generalizing to new situations

More Productivity ChallengesAttending Difficulty shifting attention to new tasksOverly focused on narrow detailsSelf-MonitoringOff-task behavior Verbal impulsivity Difficulty modifying behavior to demands of environment

Social ChallengesTheory of Mind:Predicting others behaviorReading others intentions & motivesExplaining ones own behaviorNoticing, understanding emotionsMotivation to please othersConversational & social reciprocitySharing of attention with othersUnderstanding pretendAsking for helpUnderstanding personal boundariesEmotional ChallengesRegulating Emotion (Overly Sensitive)Coping Skills (Outside World Does Not Always Accommodate)Anxiety Depression

NavigationalDifficulty breaking down larger concepts.

Difficulty with organizing and planning.

Difficulty with sequencing.

True for thoughts/speech as well as actions.

Getting stuck leads to inaction, withdrawal, or frustration.Other Issues Affecting SuccessMotivational issues Whats the point?

Sensory Issues Increased interest in opposite sex/dating but lack skills to be successful (could distract or overwhelm)Depression and anxiety increase with awareness of social difference/lack of success.Anxiety surrounding new experiences (e.g. separation from home, lack of predictable routines, increased responsibility)

StrengthsVisual-spatial skills and/or verbal skillsExcellent knowledge & passion related to interests (e.g., computer)Good attention to areas of interestGood rote memory, memory for factsOriginal way of thinkingStrong moral code, sense of justiceHonesty, loyaltyRecognizing order, following rulesIndependenceExceptional talents

Educational StrategiesVisual Supports

Technology

Task Analysis

Small class size, low social demand

Match course work with interestsMore Educational StrategiesScheduled help sessions

Develop organization system/assignment calendar

Develop study routines specific study times + strategies

Develop rationale/motivation for completing work

Study groups? (May need facilitator).Coping StrategiesRegularly scheduled stress relieving activitiesActivity or club related to interestPhysical ExerciseRelaxation ExercisesCounseling Individual or GroupMore effective Structured, Skill Based approaches like Cognitive Behavior Therapy, Biofeedback, or Social SkillsLess effective Insight oriented therapiesSupport GroupsSchedules and clear expectationsResourcesAssessment/Treatment Centers for AdultsUW Autism Center Seattle and TacomaCan also assist with: Finding local resources (877) 408-UWAC Training/consultation for college counselors The Center for Lifespan Development Federal Way April Walter, Psy.D. ResourcesSupport GroupsFEAT of Washington Seattle & South SoundSouth Sound Autism PartnershipTACA South Sound (Traditional and Alternative therapies) The Hub young adult group through PAVE TacomaExceptional Families Network Pierce County Autism Society of Washington Olympia South Sound Parent to Parent Thurston CountyT.A.C.I.D. Runs multiple support groups including Living with Aspergers (206) 935-2479.Resources Information Autism Speaks www.autismspeaks.org

NIH Autism Fact Sheetwww.ninds.nih.gov/disorders/autism/detail_autism.htm

CDC Autism Information Centerwww.cdc.gov/ncbddd/autism/

Autism Guidebook For Washington State http://www.doh.wa.gov/cfh/mch/Autism/guidebook.htm

Other Websiteshttp://www.autism-society.orghttp://www.autismsocietyofwa.org http://www.futurehorizons-autism.com/ http://www.seattleaspergers.orghttp://www.aspergersnw.orghttp://www.udel.edu/bkirby/asperger/http://www.thegraycenter.orghttp://www.teacch.comhttp://www.usevisualstrategies.com