The Employee with Autism
Overview
Although autism has been "on the radar" for teachers and medical researchers since at
least the late 1990s, nearly all of the research and reference materials continue to focus
on children. Only recently have people begun to think about what supports adults with
autism need.
There is never a clear answer to the question "What job is best for a person with
autism?" Instead, vocational rehabilitation service providers need to use their typical
toolkit for career exploration, job seeking, and job supports, just as they would for any
other job seeker with a disability. However, there are several unique features of autism
that make parts of the typical process and toolkit difficult or counterproductive for clients
with autism. This module will provide a basic overview of autism as it exists in adults
and what accommodations and supports are potentially useful.
Because autism is a complex disorder, this training module will first review several
"models" of autism, with an emphasis on the things that most impact employment.
Following that, we will discuss a few other aspects of autism and autism culture that are
significant to providing accommodation and services to adults with autism.
This training module is an adaptation of a much longer reference work called Adult
Autism and Employment: A Guide for Vocational Rehabilitation Professionals (Standifer,
2009). Much of the information here is discussed in more detail in that guide, which is
available for download at no cost. In particular, the lists of possible functional issues,
counseling interview accommodations, and workplace accommodations have been
significantly shortened and are listed in more detail in Adult Autism and Employment.
Because autism employment has received so little attention in the research literature,
there are very few reference works to cite for more information. Fortunately, two
consultants who specialize in autism and employment, James Emmett and Chris Simler,
have contributed many of their insights from more than a decade of field experiences.
They have not published their recommendations;so much of what is listed here is
derived from their training materials and personal conversations.
Pre-Assessment
Pre-Assessment
The triad of deficits is
Select an answer for question 668
In their response to environmental stimuli, people with autism are
Select an answer for question 669
True or false - Autism spectrum disorder is a subtype of autism
Select an answer for question 671
The counterpart term to high-functioning autism is
Select an answer for question 672
People with high-functioning autism
Select an answer for question 673
Challenging or aggressive behavior by people with autism
Select an answer for question 674
People in the autism rights movement
Select an answer for question 675
Theory of mind says people with autism
Select an answer for question 676
During an interview with a person with autism, it is helpful to
Select an answer for question 677
Which of the following is NOT a potentially useful workplace accommodation for a
person with autism?
Select an answer for question 678
Submit Pre-Assessment
Describing Autism
Describing autism is bit of a challenge, in part because medical researchers do not
know what causes it, either in terms of how someone ends up having it or in terms of
what happens in the body and brain to lead to the condition. Another reason for the
difficulty is that diversity of features is a significant part of autism, which makes it hard to
describe it in a global way. As a results, one ends up with vague statements like the
following: autism is a neurologically based developmental disorder affecting a person's
thinking, perception, attention, social skills, and behavior. And that doesn't really tell you
much of anything.
Finally, much of the research and documentation of autism revolves around diagnosing
children and autism's impact on the tasks of childhood - play, academic skills, family
situations, etc. Although the features of autism itself do not seem to change significantly
as a person transitions from childhood to adulthood, different elements of autism
become more important or less important as the activities of daily life change. So we
need to explore what aspects of this complex disorder are significant for adults and how
they relate to employment. There is no simple answer to that question. Instead, we have
to pull parts of the answer from different models or ways of understanding autism.
The Diagnostic Model
Most introductions to autism cite the DSM-IV diagnostic criteria as a description of
autism, but that is misleading because it is a diagnostic tool and not a descriptive
tool. That means it doesn't really tell us what autism is, just how to decide if a person
has autism or not.
As just mentioned, one feature of autism is the surprising range of possible features
associated with it, which leads to a LOT of diversity among people with autism. Many
features are common but not universal - so everyone experience a few of them, but
different people experience different features. This is a major problem for doctors trying
to diagnose autism.
In order to frame a consistent diagnosis amidst all this diversity, the writers of the DSM
had to strip away all the variability and try to get at some key, core features.
Although it is not well documented, the writers of the DSM seem to draw upon the "triad
of impairments" defined in a groundbreaking autism article from 1979 by Dr. Lorna Wing
and Dr. Judith Gould in England (Wing & Gould, 1979) (sometimes called the
Camberwell study). These researchers were the first to define the core features of
autism across a large group of children. They came up with three core areas that
seemed common in these children:
1. Impairment of social activities (reduction or lack of typical social interactions
with others)
2. Interest in stereotyped or repetitive behavior instead of imaginative activities
3. Absence or delays in language or idiosyncratic language
The DSM classification system uses a mildly complicated formula (at least two features
from category 1, and one each from 2 and 3, etc.) hung on the following three
categories:
1. Qualitative impairment in social interaction (sharing, friendships,
conversations, etc.)
2. Qualitative impairments in communication
3. Restricted repetitive and stereotyped patterns of behavior, interests, and
activities
There are two additional things to mention about the Wing and Gould article: the origin
of the phrase "autism spectrum;" and Wing and Gould later replaced the stereotyped
behavior category with lack of "social imagination" (see Theory of Mind, later on).
So the triad of impairments or diagnostic model is our first description of autism. The
problem is that this answers the diagnostic question "Does this individual have
autism?" But it does not answer the question we are asking: "What is autism like
and how does it impact employment?" It also does not give us any information about
the constellation of features that is associated with autism but that is inconsistent from
person to person. And it does not help us understand how the three "impairments"
might be related.
A Note About Diagnostic Labels
Along with the diagnostic model come the diagnostic labels associated with autism.
Here are various "types" of autism you may encounter and their relationship to each
other:
Autism
This is both a specific diagnostic label and a generic term for all autism-related
conditions.
Usage note: In this module, "autism" is used in the general way, not the precise
diagnostic usage.
Autism Spectrum Disorders (ASD)
This term covers all autism-related conditions and is based on a recognition of the great
variety among people with autism. It is nearly identical to the generic use of the term
autism, listed above. In their Camberwell study, Wing and Gould noticed that, although
the then-current description of autism (Leo Kanner's original description from 1943)
matched many children pretty well, there were just as many who only matched parts of
the description. It was as if, Wing and Gould commented, there was a continuum or
spectrum of features involved. At the time of this writing, there is no formal definition of
ASD (although it may be added to the DSM V). It is more of a folk term used in the
autism community.
Usage note: People with autism are often described as being "on the spectrum" or
"having ASD."
Pervasive Developmental Disorder-NOS
Pervasive developmental disorder is the umbrella category used in the DSM IV for
autism, Asperger's Disorder, and a few others. For individuals who seem to have some
type of autism but do not quite fit the diagnostic formula, the DSM IV uses PDD-NOS
(Not Otherwise Specified). A person with PDD-NOS is not necessarily "lower
functioning" than someone with a formal autism diagnosis.
High-Functioning Autism
This is another commonly used term that has no formal diagnostic definition. It is used
for people with significant autism features but who have strong verbal skills and
relatively "normal" IQ. The accepted opposite of high-functioning autism is not "lowfunctioning autism," as you might predict. Instead, it is "classic autism" or "Kannerian
autism" (after Leo Kanner, who first described autism).
Asperger's Disorder
This is a diagnostic term used in the DSM IV for people with autism but with strong
verbal skills (plus a few other subtle differences). There is debate about whether it is
different from high-functioning autism and about whether it is different from the general
autism diagnosis or just a subset of that diagnosis. The term was coined by Lorna Wing,
who also coined "autism spectrum disorder." People with Asperger's Disorder often face
unique challenges because their verbal skills are so strong that others (including
vocational rehabilitation professionals) assume their social skills are just as strong.
Everyone with autism has some degree of problems with social skills, which usually
significantly affects their ability to find and keep a job.
Usage note: Most people use Asperger's and high-functioning autism interchangeably.
Usage note: Most people say that people with Asperger's have autism, but the reverse
is not true - not everyone with autism has Asperger's. Asperger's is thought of as a
subset of autism.
Experiential/Sensory Processing Model
Sensory processing disorder is a concept originally developed by occupational therapist
A. Jean Ayres in the 1960s. It is not included in the DSM-IV, and there is disagreement
about whether it is an actual disorder or a loose collection of similar features that
happen in several different developmental disorders. However, it is often part of
discussions of autism, and it presents an interesting way of thinking about autism
(Flanagan, 2009).
According to this idea, behavioral and learning problems are rooted in problems a
person has with registering, processing, and responding to sensory information. The
sensory signals coming into the brain are "normal," but the brain has trouble making
sense of the signals. The sensory information can include vision, hearing, touch, smell,
taste, balance, and proprioception. The person may experience these sensory signals
as unpleasantly strong (light too bright, sound too loud or harsh, etc.), too dull, or just
confusing. There is an assumption that processing these sensory signals requires
enormous concentration, leaving the individual less tuned to his or her environment,
seemingly distracted or distractible, and easily frustrated.
In the context of autism, it is interesting to compare this idea to an article by Marjorie
Olney (Olney, 2000), in which she analyzed a number of autobiographical accounts of
people with autism for common experiential features. Among her findings were the
following:
Sensation - people with autism often reported having "altered" sensitivities to sound,
touch, vision, smell, taste, and movement. One person remembered that, as a child, she
would look at other people and only see disconnected pieces, not whole people. Many
people found background noises or sights very distracting and impossible to filter.
On the other hand, their altered sensations often bring them great pleasure from
situations and objects that others don't notice.
Attention - Many people with autism said they have difficulty paying attention to more
than one sensation at a time. If they are listening to something, for example, they may
not be able to process anything they are seeing at the same time.
Time and Place - Some people with autism reported problems orienting themselves in
time and place or knowing what is coming next. As with sensory issues, their sense of
time and place may be fragmented or decreased. As a result, they may lose track of the
"why" of a situation or they may become very anxious when they have to wait, change
plans, or transition to new activities.
Familiar routines and activities seem to help them more easily anchor themselves when
they feel this way.
Coping Strategies - Most people with autism reported finding ways to calm themselves
and to cope with the features of autism they experience. These often included rituals,
rhythmic activities, or repetitive behaviors. It is interesting to note that these activities
are part of the DSM criteria and the Wing and Gould triad of impairments. They seem to
be nearly universal among people with autism, and can include rhythmic movements,
rocking, hand flapping, humming, walking, and other repetitive actions.
Some people with autism say these activities are soothing and help them cope with
hypersensitivity. Others say the activities clear their heads and help them think.
For some people, their coping strategies are compulsions about, for example,
schedules and routines or about keeping things orderly and sorted. As with the
repetitious behaviors, these compulsions seem to help people deal with anxiety,
including confusion about time and place.
Olney's list of features from autobiographical accounts of autism shows significant
similarities to the sensory processing disorder concept. Together they can act as a third
model of autism. This experiential/sensory processing model does not tell us anything
about the causes of autism, but it does begin to relate the elements of the triad of deficit
to each other.
Functional Description
Adult Autism and Employment (Standifer, 2009) includes a lengthy description of
possible features of autism that can impact employment. These features are drawn, in
large part, from the field experiences of James Emmett and Chris Simler, two leading
experts on autism and employment. The list is too long to repeat here, but this section
of the module provides a shortened version.
This functional model of autism does not make any attempt to explain the causes of
autism or link the features together. It simply lists various features of autism that any
particular person may or may not experience. With this list in hand, support staff and
service providers can begin mapping the specific features of a particular purpose and
move on to planning supports and options.
Cognition
Measured I.Q.: "intelligence" can vary widely among people with autism, from very low
to very high. Such variation is independent of how significant other features of autism
are in a particular person.
Concrete Thought: People with autism often think concretely rather than abstractly, and
may process the world in a narrow, intense, detailed manner. This can lead to difficulty
following complex instructions; they probably learn better from demonstrations, visual
examples, or diagrams.
In language, people with autism often interpret expressions literally. Sayings such as
"Keep this under your hat," "Save your breath," or "I'll catch you later" can be very
confusing for them. This literal-mindedness can cause resentment of others, since the
person with autism may interpret a casual agreement as a firm promise or interpret a
"rule of thumb" as a firm regulation. When others do not live up to these literal
interpretations, therefore, the person may feel betrayed or decide the others are
untrustworthy.
Attention to Detail: Some people with autism have a strong ability to focus on details
and notice patterns. They may notice books that are out of order on a shelf, changes in
how things are arranged on a desk, or parts of a printed pattern that do not fit properly.
This ability makes some people with autism very good at detail-oriented tasks.
Fixation: It is very common (and part of the DSM criteria) for persons with autism to
have a favorite topic or activity on which they fixate. They will be very motivated to
experience, learn, and think about their topic and, if they have verbal skills, will often
talk on and on about it, monopolizing conversations. Some people with autism are
attracted to orderly systems, such as computers, lists of information, or particular types
of machines (for example, light bulbs or vending machines). Or a person with autism
may fixate on rhyming words, counting, or lists of items. If they are nonverbal, they may
fixate on feeling textures, repeating complex rituals, or rocking back and forth.
The person's knowledge about the topic or activity may be remarkably deep, but it is
probably very narrow. He also may not understand that other people are not very
interested in the topic. However, if instructions, tasks, or duties can be framed to match
the person's natural fixations, the fixations can become very functional.
Communication and Two-way
Interactions
Expressive Language (speaking, communicating to others): Some people with autism
have strong verbal skills and extensive vocabularies. Others have limited verbal skills.
Many people with autism, even those with strong verbal skills, have behavioral ways of
expressing emotions, but the specific meaning of a particular behavior varies from
person to person.
It is important to learn the behavioral language of each person with autism and share
this information with coworkers and employers.
Receptive Language (hearing, understanding others): Most (but not all) people with
autism understand visual information better than verbal information. During a
conversation, such as an interview, a person with autism may need long pauses to
process the verbal information. It may also take the person a while to respond to
questions or make decisions. Visual information and supplements (diagrams, color
coding, symbols, written outlines, etc.) are helpful.
Social Interaction: Social skills vary tremendously among people with autism, but
everyone with autism has some level of difficulty reading social cues. Some may seem
to be lost in their own internal worlds (in reality, they are quite aware of their
surroundings). Others may be very outgoing but still have trouble decoding social
situations and selecting appropriate responses. Nearly everyone with autism can benefit
from some degree of "social coaching."
Eye Contact: Lack of eye contact is one of the most common features of people with
autism, especially during conversations. Others may incorrectly interpret this as a sign
of inattention, shyness, defiance, or some other emotion. For people with autism, eye
contact is just not important, and some people with autism find it uncomfortable,
requiring so much concentration they cannot listen to what the other person is saying.
Sensory Issues
Hypersensitivity: Many people with autism are "over-sensitive" in one or more senses.
This can include sensitivity to light (including sensitivity to the nearly invisible flicker of
fluorescent lights), sounds (especially background noises), touch (textures), smell, and
taste. For someone with autism, noisy, cluttered, busy, or brightly lit environments can
be very challenging and tiring.
Hyposensitivity: A few people with autism are remarkably insensitive to sensory cues;
for example, failing to notice a fire alarm or flashing lights. On the other hand, a few
people with autism find such very strong stimulations appealing and are attracted to
things most people find irritating. More commonly, someone with autism may not
respond to environmental signals like a ringing phone or honking horn.
Behavior
Adherence to Routines: People with autism often highly value routines and try quickly to
establish a routine in any new environment. Changes in routine can be very upsetting,
so people with autism may need prominent, advance warning of changes. On occasion,
a person's routines become so rigid they resemble obsessive-compulsive disorder.
Similarly, some people with autism prefer orderly environments and feel a strong urge to
line up or straighten objects in messy situations. A person with autism may become very
distracted if objects have been moved from their usual place or an area seems
cluttered.
Prompt Dependence and Generalization: Routines, so highly valued by many people with
autism, are often anchored on prominent features of the environment. If the
features/prompts are removed, the person's routine falls apart, and she may become
confused, anxious, and frustrated. In a work or training situation, it is a bad idea to have
a job coach provide initial prompts and try to phase them out later. It is also a bad idea
to teach the person a job task in one environment and ask her to perform the task in a
different one. Training should be done in the final work environment and with its
prompts.
Problems With Gross-Motor Skills: Range from clumsiness to difficulty walking
Trouble with Fine-Motor Skills: Problems grasping small objects, writing, etc.
Theory of Mind
The label "theory of mind" is not a very good description of this theory, but it is the one
in common use. James Emmett and Chris Simler, consultants on autism and
employment, have found this model to be extraordinarily relevant to employment
situations. Initially, says Emmett, they treated it as a minor theory mentioned in passing
during presentations. Then they began including it among the top ten things to know
about autism. Now they consider it one of the top two or three things they want every
vocational service provider to know.
Theory of mind says that most of us have an innate ability to predict/imagine/understand
what other people may be thinking, or how things seem from the perspective of another
person. For example, having written that last sentence, I now think it isn't very clear and
I need to add another sentence to help readers figure out what I mean - that is, I
imagine what it is like to read that sentence if I don't already know about theory of mind.
Similarly, if you are about to comment to someone about their behavior and you believe
it will upset them, you are using theory of mind.
However, people with autism often seem to have difficulty understanding what other
people are thinking, feeling, or understanding As Emmett puts it, "What if I don't know
that you experience things differently from me? What if some noise is REALLY bugging
me, but I think it bugs everyone and I just have to put up with it? What if my foot hurts
today when I try to walk, but I don't know that you don't know that?"
Usage note: People who are not able to predict/understand that others think differently
are said to "not be operating under theory of mind".
A British researcher named Simon Baron-Cohen has written extensively about this
aspect of autism (his most popular book is titled Mind-Blindness), but the idea of theory
of mind has been around much longer.
In articles following the original Camberwell study, Wing and Gould replaced the
"interest in stereotyped or repetitive behavior " with "lack of social imagination" (their
version of theory of mind) as one leg of the triad. (This is not the origin of theory of mind
either - it is much older than that.)
Like autism itself, theory of mind seems to be a continuum, not all-or-nothing. A person
with autism can often understand that others think differently from them, but still have
difficulty figuring out what other people think.
Theory of mind explains one feature of autism that the previous ones in our list do not,
but it is not a complete model of autism - it does not explain many other features or offer
any cause. However, this one feature is very important to how adults function in
employment settings. Later on we will discuss what sort of supports might be useful for
theory-of-mind issues.
Summary of Models
None of these ways of describing autism completely explains and describes it. Plus,
there are other models (neurological, biomedical, etc.), each trying to explain certain
aspects of autism. The ones above have been chosen as the most relevant to autism
employment issues. It is important to remember that, as when dealing with any person
with a disability, what ultimately matters is getting to know the person and his or her
features and support needs. These models simply help us frame a plan for learning
about a person with autism.
Fixation and Career Choices
It is common for employment service professionals, upon meeting a client with autism,
to want to find a career option that matches that person's fixations. Matching careers to
fixations is also common advice in many books on autism and employment.
It is wonderful when it is possible to find a good fit between a career and a person's
fixations and support needs. Unfortunately, much of the time that isn't possible. Many
fixations do not translate well into locally available career choices. In those cases, the
best approach is to consider the fixation as a motivational tool rather than a career
choice. Other features of the person should be used to make an appropriate career
choice. That job then becomes a way for the person to make money to support his or
her interest in the fixation. So if the person is interested in belts and belt buckles, for
example, a job can be a way for them to buy supplies for their interest - adding to their
belt collection, buying books about belts, trips to a belt factory, etc.
Case Study: Nate
Nate has high-functioning autism. He has strong verbal skills and reading skills, but
weak writing skills. Like most people with autism, he has trouble reading social
situations. Nate has two fixations - firefighting and horses.
When Nate was in the transition program at his school, preparing to move out of high
school into adult services, his transition team found an internship for him at a local fire
station. It seemed like a great match with his fixation.
Although he was not a fire fighter, he was very good at filing the incidence reports for
the station after each service call. Nate's writing skills were relatively weak, but the
incidence reports mostly involved reading through a checklist on a computer and
checking off the relevant items. Nate loved being at the fire station, doing actual work,
and talking with the on-duty fire fighters.
Soon the station chief decided to add another duty to Nate's day - helping wash the fire
truck at least once a week. Nate was ecstatic and couldn't stop talking about how great
it was. While he washed, he talked more than ever to the fire fighters about all their
equipment, about the fire truck, about recent fires, about other fire stations, and about
just how great it was to fight fires. He started talking to the fire fighters more at other
times, too. He just couldn't get enough. Soon this became a problem. Nate's fixation
had gotten so strong that he was distracting the fire fighters from their jobs and not
getting on with his own work. Matching his job to his fixation had backfired, and his
transition team decided to pull him out of the internship at the fire station.
The transition team found him a part-time job at a local fast food restaurant, helping at
the drive-through window by running the meals out to the waiting cars and helping
maintain the dining area. The tasks are well defined, he is working in the community,
and he stays on task.
The transition team also found him a second part-time job a horse stable. It pays less
than his restaurant job, but he loves being around the horses and doesn't mind cleaning
up the stables as long as he gets to help harness up the horses every day. The stable is
near a residential area. It provides both recreational and therapeutic riding services, and
there is a small petting zoo. In addition to customers, on any given day, various
members of the neighborhood will wander by, often with children in tow, to look at the
horses and visit the petting zoo. Nate is always happy to talk to visitors and tell them all
about the horses and other animals. The owners of the stable consider his informal
lectures about horses to be a kind of marketing for the stable and encourage Nate to
take time with visitors. Nate has turned into a very dependable, hard worker for the
stables.
This case study was contributed by Amy Simler of Downer's Grove School District,
Downer's Grove, IL, and written by Scott Standifer.
ASD Culture
There is an emerging autism culture, although it is not yet as robust as the culture of
deafness or of blindness, for example. Many members of the emerging culture have
high-functioning autism or Asperger's Disorder, so the culture is sometimes called
"aspie culture." The Internet has given a strong boost to this culture, allowing previously
isolated people with autism to find each other and interact efficiently. It is interesting to
note that the lack of body language and other social cues in e-mail, Internet chat,
discussion boards, and other text functions, which is often frustrating to people without
autism, actually matches the communication preferences of many people with autism.
The autism rights movement is part of this emerging aspie culture. The movement
lobbies for more tolerance of the behaviors and preferences of people with autism. In
some ways, this perspective is similar to that of the National Federation of the Blind,
which proposes that the barriers faced by people with blindness are all culturally
imposed and that blindness is, at most, an inconvenient, not a disabling, condition.
Autism rights advocates believe that people on the autism spectrum are also on the
human spectrum - they are just a variation within the normal range of human cognitive
functions. As a result, they strongly object to any efforts to "cure" people with autism
and lobby for the use of accommodations, supports, and training.
In contrast, several groups of parent advocates and self-advocates strongly support
treatment programs, arguing that children with significant autism need help to improve
their communication and social skills so they can have a better life and participate in
their local communities. These advocates sometimes criticize the autism rights
movement as being focused only on people with high-functioning autism, with no
consideration of the needs and challenges of people with classic autism. Autism rights
movement members, for their part, feel that these groups are trying to "cure" autism and
eliminate the emerging culture. As a result, there is often a great deal of emotional
tension between these two aspects of autism culture
Both groups have adopted a somewhat lighthearted way to refer to people who do not
have autism - "neurotypicals."
Functional Implications
Because of the large range of possible characteristics of people with autism, the list of
possible functional issues is quite long. A short list is provided below, but a longer list is
available in Adult Autism and Employment (Standifer, 2009). No person will experience
all the issues in these lists, but it is worth reviewing the lists for any particular client with
autism to see which characteristics might apply. The list below is focused on functional
issues that could impact workplace performance. It does not address medical or
independent-living issues.
o
o
o
o
o
o
o
o
Dependence on routine
Expectation that initial events or activities in a new environment are a new routine
Anxiety due to changes in routine or lack of routine in a new environment
Dependence on environmental prompts to anchor routines and activities
Difficulty following complex oral or written instructions
Difficulty understanding the sequence of steps in a long series
Ability to focus very intensely on tasks at hand or on small details
Anxiety about waiting, changes in schedule, or new routine
o
o
o
o
o
o
o
Tendency to express frustration, anxiety, or uncertainty by talking about topics on
which they fixate
Strong ability to interpret activities and environments using personal
themes/fixations
Difficulty understanding that others do not share their specific interests or world
view
Limited or no verbal skills
Strong verbal skills that mask difficulties with social signals
Blunt honesty in talking with others
Tendency to become angry with or distrustful of people who seem to violate the
person's literal interpretation of rules and guidelines
o
o
o
o
Need for silent processing time during long conversations to improve
comprehension
Low tolerance for and difficulty with concentrating in messy, chaotic environments,
brightly lit environments, or noisy environments
Tendency to rock back and forth, make repetitive noises, or perform other repetitive
actions when anxious, bored, or confused
Difficulty with fine-motor activities - buttoning buttons, grasping small objects,
drinking from glass
Case Study: Blake
Blake has classic autism. He has basic verbal skills, can read and write effectively, and
can follow multiple-step directions with little difficulty. Like most people with autism, he
has trouble reading social cues and gets overwhelmed by noisy, chaotic environments.
Blake's main fixation is cartoons and animated movies, particularly those from Disney.
In high school, his teachers let him draw cartoons during the day whenever his work
was finished. He also collects movies and video games of the animated movie
characters.
Blake also had a cheerful habit - the first thing every morning, upon arriving at school,
he would announce, "I'll Be All Right! ... Will I?"
When autism employment consultant Chris Simler met Blake, Blake was preparing to
transition from high school to adult services. The transition team's initial idea was to find
a job matching his fixation, but the fixation did not seem to match any local career
options.
School work assessments showed that Blake had strong organizational skills. He was
good on secretarial skills, in particular collating and filing. He also had been working in
the school mail area. He would take the day's bin of incoming mail and place each piece
in the appropriate teacher mailbox/cubbyhole. Certain teachers needed their mail
delivered to them directly, and Blake handled that task with ease.
The team decided to enroll Blake in a local Project Search initiative. (Project Search is
an internationally replicated program that provides transition-aged people with
disabilities rotating internships in a local hospital.) Blake agreed to job shadow (tag
along and observe someone working a job to learn more about it) at the hospital to
begin career exploration.
Unfortunately, whenever Blake completed a job shadowing session at the hospital, he
would announce, "I want to be a doctor." He observed the nurses - "I want to be a
doctor." He observed the maintenance staff - "I want to be a doctor." He observed the
food service staff, the bookkeeping staff, and the stockroom staff - "I want to be a
doctor."
Chris Simler could not figure out what the problem was. It turned out to be a theory-ofmind issue. Blake's father was a doctor at another hospital in town. Blake linked working
at a hospital so closely to being a doctor that he was unable to process the idea of
doing other jobs even when looking directly at them. Simler comments, "He just couldn't
come out of that box."
Simler decided that a job trial - a hands-on experience with each job - would be a more
salient exposure for Blake. That worked. Once he actually DID the work, Blake
understood that there were other ways to work in a hospital and other people working
there besides doctors.
Because of Blake's comfort delivering mail at school, the transition team decided to start
him in the hospital food delivery department. Soon Blake was sorting food trays and
delivering them throughout the hospital. But problems began to emerge. Although the
hospital provided Blake with a map of the various wards, it was very different from his
familiar high school mail route. Simler provided him with stickers of Disney characters
with which to label each ward, allowing him to use his fixation as an organizing theme.
That seemed to solve the navigation problem.
Unfortunately, Blake still had problems with social norms and expectations. His theoryof-mind issues sometimes made it hard for him to understand requests from patients for
changes in their food. The general activity and noise in the hallways often distracted
him. He had to interact with many different people, and sometimes he had trouble
recognizing who was part of his support team/coworker team and who was not.
The next job rotation for Blake was in the records department, filing patient records.
This worked better. The records department was in a clearly defined, relatively small
area of the hospital. There were only a handful of people with whom Blake needed to
interact. Each file drawer was color-coded by department, and all the files were in
alphabetical order by patient name. Simler arranged for a small room divider to help
isolate Blake's work area from potential distractions in the main room, and he posted
various illustrations of the job task on the divider. Filing patient records was a big job,
and Blake did it well.
When the internship was over, the hospital offered Blake a permanent job working in the
records department.
This case study was contributed by Chris Simler of Integrated Behavioral Systems and
written by Scott Standifer.
Counseling Interview Accommodations
Supporting a person with autism should start with accommodations in the delivery of
employment services, including interview settings. Find out well in advance how the
person prefers to communicate - verbally or through writing, picture exchange system,
communication device, etc. Find out if the person has notable sensitivities - light, noise,
etc. Find out if the person can read.
Consider sensory issues when selecting meeting rooms, even if the person does
not have any specific sensitivities.
Choose a meeting room with:
o
o
o
o
o
Indirect, soft lighting
Few distracting background sounds (a "white noise" machine might help)
Few distracting background activities - people moving around, etc.
No clutter
Comfortable furniture
Well ahead of the meeting, send the person an outline or schedule of topics.
During the interview:
o
o
o
o
Provide another copy of the outline/schedule, in case the person forgot the one you
sent.
Allow plenty of long pauses to think and process. Let the person set the pace.
Speak literally, avoid any expressions or jokes.
Speak in direct, clear language using a calm tone of voice.
Do not be bothered if the person does not make eye contact, exhibits repetitive
behavior, or repeats phrases back to you. (However, repetition of your phrases may be
the person's way of saying they do not understand your question or do not know how to
answer. Alternatively, it might be her way of saying she understands what you said and
is processing it.)
Be careful to follow through on any commitments you make, such as mailing material or
finding out about something before the next meeting.
Evaluation Challenges
Standard, formal vocational evaluations can be a significant challenge and barrier to
people with autism, undermining the value of the assessment results. Some vocational
rehabilitation professionals recommend against them entirely.
It is easy to see why there is a problem. People with autism often get anxious in new
situations, have difficulty with verbal instructions or complex instructions, and can easily
become overstimulated and confused in new social settings. Therefore, it will be difficult
for them to take a vocational assessment in a strange room, possibly full of new people
and noises, and spend the day in a series of new activities unrelated to each other.
Ideally, a vocational evaluation for a person with autism would consist of a series of
short interviews in a place that is familiar and comfortable, followed by observations of
the person in his or her normal activities and in one or two novel situations.
Be sure that the person with autism gets a clear overview of what to expect and what he
is expected to do as part of the evaluation.
If a more formal vocational evaluation is necessary for procedural reasons, it is
important to communicate with the evaluator well in advance and make sure the
evaluation process is adapted to the characteristics of people with autism. Any
assessment should include accommodations similar to those listed for interview
sessions above.
Job Coach Challenges
Much of the reference literature on autism and employment recommends job coaching
as a support. However, job coaches who are unfamiliar with the features of autism can
make work adjustment significantly worse than it should be. Many common job
coaching strategies are inappropriate for people with autism.
Consider the following regarding prompting. As discussed previously, people with
autism tend to anchor themselves in routines as quickly as possible in a new
environment. If the job coach is standing next to the person and providing prominent
cues, the person will build that into her routine and expect the job coach to be there,
prompting, every day. If the job coach tries to fade the prompts out a week or two later,
long enough for the person's routine to be firmly established, the person may become
frustrated, agitated, or confused. The person may "lock up" and just stand there waiting
for the job coach.
Avoid verbal prompts. Spoken reminders and prompts seem to be especially
noteworthy to people with ASD. In the experience of James Emmett and Chris Simmler,
a person with autism is more likely to embed verbal prompts in their routine than
nonverbal prompts. A job coach should avoid stepping in frequently to say things like
"Now, be sure you check ..." or "The next step is ..."
Use "point prompts." Point prompts mean touching the person gently on the shoulder
to get his attention and then, without speaking, pointing to indicate the next step. These
prompts seem to be much less prominent to the people with autism and less likely to be
embedded in routines, making them easier to fade out.
Use environmental prompts. These are diagrams, icons, visual markers (lines on the
floor, colors on the floor, room partitions, etc.) that help the person orient themselves in
the schedule and work space. Environmental prompts might include reference sheets in
a notebook or labels placed on tools. Such prompts can support the person's routine
and be left in place after the job coach leaves.
Support "natural" prompts and resources. Train coworkers and on-site company
training staff on how to support the person. Then train the person to turn to these
individuals for answers to questions or for reminders. By acting as a consultant, advisor,
and monitor for these natural supports, the job coach can stand back from the actual
work activities and not become embedded in the person's routine.
For more information about natural supports, see the Work Support website of Virginia
Commonwealth University. In particular, see the following articles listed in the
references section: Unger et al. (2005), McHugh, Storey, & Certo (2002), and Wehman
& Bricout (1999), for more information about natural supports.
Job Accommodations
As with functional issues, there are many possible accommodations. Below is a partial
list. A longer list is available in Adult Autism and Employment (Standifer, 2009).
o
o
o
o
o
o
o
o
o
Social coaching: training in social skills
Training done on-site
First-day activities that match the typical routine. People with autism often look for
immediate creation of new routines. A day or two of orientation and paperwork will
be very confusing. Any prompts provided during training should be the same ones
used during typical work routines.
A daily schedule prominently posted, with icons or pictures (even if reading skills
are strong). The schedule should answer the questions "What am I doing?," "Why
am I doing this?," and "What comes next?".
A personal calendar or appointment book
A PDA or smart phone with scheduling software, prompting software, etc.
Advance warning of changes in routines, including a chance to practice new
routines
Colored lines on the floor to identify areas of specific types of activities
A work area with few distracting sounds, smells, or sights, possibly including the
avoidance of fluorescent lights (which can hum or flicker)
o
o
o
o
o
o
o
o
Sunglasses or tinted glasses to reduce light; headphones or earplugs to reduce
sound levels
Dividers or partitions to reduce sound/visual clutter or help visually define discrete
work areas
Concrete, well-defined work goals and feedback on quality of work
Task checklists (with symbols) derived from a careful task analysis
A safe place to retreat to during times of stress
Routine breaks, with a chance to be alone or do something relaxing (examples:
moving around, swinging on a swing, or jumping on a small trampoline)
Coaching how to socialize during breaks (breaks can be more stressful than work
because of the lack of structure and expectations of coworkers)
Extra time to think and process when receiving instructions, asking questions, or
answering questions
Challenging or Aggressive Behaviors
In disability employment services, there is a strong and worthwhile philosophy to accept
all persons with a disability for who they are, not try to "cure" them. The same principles
apply to people with autism. But part of accepting a person's characteristics is being
honest about occasional situations in which a person is dangerously aggressive or
destructive.
A few people with autism exhibit "challenging behaviors." That phrase can cover a wide
range of difficult situations, including self-injury, aggression toward others, damage to
property, inappropriate sexual behavior, and disruptions such as constant screaming.
There is very little research on this type of behavior in adults with autism, and many
people avoid discussing it for fear of stigmatizing a particular person with autism. But if
a person is going to find and maintain career-based employment, such issues must be
discussed and planned around.
Several different things can cause a person to exhibit "challenging behaviors," and there
is no research on which causes are most common. The best way to deal with these
behaviors is to research the person's history and observe his or her current behaviors
closely, doing a functional analysis to figure out what factors might be contributing to the
behaviors. Possible factors include time of day, time of month, setting, recent activities,
events immediately before or after, people nearby, sensory conditions, and
consequences. These can give support staff clues with which to identify a likely clause.
A list of possible causes is available in Adult Autism and Employment (Standifer, 2009).
Although there is some documentation of innate "aggressive urges" in a few people with
autism, and even though the FDA has approved a drug specifically for treatment of
these urges in children with autism, this should be considered a very last resort. There
are many less serious and more likely causes of challenging behavior, including
attempts to communicate frustration, pain from stomach conditions (very common in
people with autism), overstimulation, sleep problems (also common in people with
autism), and side effects of medication.
Contingency Plan
The next step is to develop a contingency plan of what to do when the person starts
engaging in the behaviors. The contingency plan will cover what to do and whom to
contact if the person starts the behavior again.
Even if a person is not exhibiting challenging behaviors currently, if there is a history of
challenging behaviors, make a plan. In a work situation, talk with supervisors and
coworkers about the contingency plan. At the same time, it is important to be aware of
possibly stigmatizing the person in the eyes of coworkers. Supervisors and coworkers
need to understand that the behavior many never happen. Describe the behavior as
unusual, unlikely, and a method of last resort for the person to express something he or
she cannot communicate in any other way. Supervisors and coworkers should also
understand that usually the person knows the behavior is inappropriate and does not
want to engage in it. If the behavior happens, it is usually the person's way of asking for
help with something that is a very significant problem for her. James Emmett puts it this
way: "Plan for the worst day. Don't plan that every day is going to be a good day."
"Plan for the worst day" is not just about challenging behavior. On a bad day, a person
with autism may become easily disoriented about what he is supposed to do next or
where he is. He may be more irritable and easily confused than usual. He needs good
routines and environments/natural supports to help anchor himself. He may need
someone to step in and help him ask for extra assistance, before a crisis happens.
Summary
There are several key points for employment service providers to keep in mind as they
plan services for people with autism.
o
Social skills are almost universally a challenge for people with autism and are a key
aspect of finding and keeping a job.
o
People with autism value a consistent routine and begin framing a new routine as
soon as they enter a new environment. The first few days on the job must be
typical. Job coaching must be as unobtrusive as possible. Plans must be made for
transitioning to inevitable future changes in work tasks, supervisors, etc.
o
People with autism often have unique sensory issues that must be addressed.
o
People with autism almost always need periods of silence during conversations and
meetings to process information.
o
People with autism may not know how things seem to people around them or what
people around them know or don't know. They may need help learning to ask for
help when they are confused or having difficulty.
Frequently Asked Questions (FAQ)
Q. How is Asperger's different from autism?
A. Diagnostically, there are slight differences between Asperger's Disorder and autism,
but the main difference is that people with Asperger's Disorder usually have stronger
verbal skills and (often) slightly better social skills. However, the diagnostic criteria for
autism seem to allow verbal skills in the range covered by Asperger's. For practical
purposes, Asperger's can be considered a type of autism, a sort of subset of the autism
population.
Q. How is Asperger's different from high-functioning autism?
A. For practical purposes, Asperger's Disorder is the same as high-functioning autism.
Q. What is the counterpart to high-functioning autism/Asperger's? What do you
call someone who does NOT have high-functioning autism?
A. The counterpart is "classic autism."
Q. What are the core diagnostic features of autism?
A. The core diagnostic features are:
o
Impaired social interaction (sharing, friendships, conversations, etc.),
o
Impairments in communication skills
Repetitive and stereotyped patterns of behavior, interests and activities
Some descriptions replace repetitive and stereotyped behavior with "lack of social
imagination"
o
o
Q. What key things should vocational rehabilitation service providers keep in
mind about people with autism?
A. The key things are:
1. Sensory issues
2. The need for self-advocacy skills in asking for information, help, a break, etc.
3. The use of silence by providers during conversations to allow the person to
process and consider
4. Issues around theory of mind ("mind-blindness")
Q. What key things should job coaches keep in mind about people with autism?
A. The key things are:
1. Do not become part of the person's work routine.
2. Help the person anchor routines in things that will be stable in the work
environment.
3. Plan for the worst day. What does the person need if she gets confused about
where she is and why? What do coworkers need to know to do help the
person?
4. Provide written or illustrated supports as much as possible.
5. Be aware of sensory issues.
6. Be aware of social skills and social situations, like the break room and lunch
room.
Q. What are natural supports?
A. Natural supports (including "environmental supports") are elements embedded
permanently in the work environment as accommodations and tools for a person with
disabilities. They offer an alternative to active job coach prompting, which can be
problematic for people with autism. Examples of natural supports include coworkers or
HR staff trained on the features of autism and the needs of the individual, picture-based
instructional guides to job tasks posted on the wall, photographs of coworkers who can
be asked for help, and smart phones with prompting software.
Q. What is theory of mind?
A. Theory of mind says that people with autism may not know how things seem to
people around them or what people around them know or don't know. They may need
help learning to ask for help when they are confused or having difficulty. This is not an
all-or-nothing situation. A person may have a partial understanding of other people's
minds but still need help in some situations.
Q. What do I do if I can't find a job that matches a person's fixation?
A. Use the fixation as motivation. Explain to the person how going to work will give them
money and resources to do more things around their fixation. Also look for ways to
weave the fixation into the workplace as an organizing theme. Icons or labels for
different elements of the job might reflect the fixation, helping the person remember
them better.
Q. What are some possible causes of challenging behavior?
A. Attempts to communicate frustration, pain from stomach conditions (very common in
people with autism), overstimulation, sleep problems (also common in people with
autism), and side effects of medication.
Discussion Questions
[ Export PDF with Answers | Export PDF without Answers ]
1. Why is silence an important "tool" for people working with
someone with autism?
A correct answer will explain that people with autism often need time to think
and process information and that they often find verbal information harder to
process.
2. Once a person with autism has been working at a job for a
few weeks and understands the job tasks, is it OK to
remove posters or diagrams created to help them learn the
job? Why or why not?
A correct answer will explain that after a few weeks the person may have
anchored his routine on the posters or diagrams, even if he knows the job
task very well. Removing the posters or diagrams can throw off the routine
and cause significant problems.
3. Various types of workplace supports were presented in this
module. Think of a person you know with autism. Which of
the supports listed might be useful to that person? Why?
Answers will vary, but each should cite one or more specific workplace
supports and explain its relevance to the particular person.
4. Have you ever met a person with autism? Have you met
several people with autism? List some specific functional
issues discussed in this training that relate to them.
Answers will vary, but each should list items from the training and connect
directly to the person or persons with autism.
5. Why is theory of mind so relevant to employment? What
aspects of work might be affected by it?
Answers should include the fact that without theory of mind, a person may
have significant problems with workplace communication. The person may not
know when to ask for help or may not know how to explain things to others.
6. What things listed in the training seem to help people with
autism calm down, reduce anxiety, or reorient themselves?
Correct answers will mention repetitious behaviors and routines. They may
also include compulsions to orderliness and the availability of diagrams or
written instructions.
7. What does "plan for the worst day" mean?
A correct answer will explain that people with autism may need extra supports
and resources on bad days when they don't feel well or find themselves
confused. It is important to research what happens on those days and build in
supports, even if they are only rarely needed.
8. List at least three things that are useful accommodations
for a person with autism in a counseling interview situation.
A correct answer might include:
o
o
o
o
o
o
o
o
o
9.
A room with indirect, soft lighting
Few distracting background sounds (a "white noise" machine might help)
Few distracting background activities - people moving around, etc.
No clutter
Comfortable furniture
An outline or schedule for the meeting
Allowing plenty of long pauses to think and process. Let the person set
the pace
Speaking literally, avoid any expressions or jokes
Speaking in direct, clear language using a calm tone of voice
Post-Assessment
11. Post-Assessment
12. The triad of deficits is
13. Select an answer for question 679
14. In their response to environmental stimuli, people with autism are
15. Select an answer for question 680
16. True or false - Autism spectrum disorder is a subtype of autism
17. Select an answer for question 682
18. The counterpart term to high-functioning autism is
19. Select an answer for question 683
20. People with high-functioning autism
21. Select an answer for question 684
22. Challenging or aggressive behavior by people with autism
23. Select an answer for question 685
24. People in the autism rights movement
25. Select an answer for question 686
26. Theory of mind says people with autism
27. Select an answer for question 687
28. During an interview with a person with autism, it is helpful to
29. Select an answer for question 688
30. Which of the following is NOT a potentially useful workplace accommodation for
a person with autism?
31. Select an answer for question 689
32.
Submit Post-Assessment
Citation and References
If included in presentations or publications, credit should be given to the authors of this
module. Please use the citation below to reference this content.
Standifer, S. (2011). The employee with autism: Online training module. In Ohio Center
for Autism and Low Incidence (OCALI), Autism Internet Modules,
www.autisminternetmodules.org. Columbus, OH: OCALI.
References
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Cambridge, MA: MIT Press/Bradford Books.
Emmett, J. (2009-2010). Personal Communication, multiple sessions.
Feinstein, A. (2010). A history of autism: Conversations with the pioneers. Chichester,
UK: Wiley-Blackwell.
Flanagan, J. (2009, August). Sensory processing disorder. Pediatric News, International
Medical News Group. Retrieved from
http://findarticles.com/p/articles/mi_hb4384/is_8_43/ai_n45484253/
McHugh, S. A., Storey, K., & Certo, N. J. (2002). Training job coaches to use natural
support strategies. Journal of Vocational Rehabilitation, 17, 155-163. Available at
http://www.worksupport.com/resources/listContent.cfm/21/0
Olney, M. (2000). Working with autism and other social communication disorders.
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SPD Foundation. (2011). About sensory processing disorder. Retrieved from
http://www.spdfoundation.net/about-sensory-processing-disorder.html
Standifer, S. (2009) Adult autism and employment: A guide for vocational rehabilitation
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Unger, D., Parent, W., Gibson, K, Kane-Johnson, K., & Kregel, J. (2005). An analysis of
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employment [electronic resource]. WorkSupport, Virginia Commonwealth University.
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Wehman, P., & Bricout, J. (1999). Supported employment and natural supports: A
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Wing, L., & Gould, J. (1979). Severe impairments of social interaction and associated
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