AUTISM IN YOUNG ADULTS:
A PRE-VOCATIONAL SKILLS CURRICULUM
A Project
Presented to the faculty of the Graduate and Professional Studies in Education
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SCIENCE
in
Counseling
(Vocational Rehabilitation)
by
Isela Reyes
SPRING
2014
© 2014
Isela Reyes
ALL RIGHTS RESERVED
ii
AUTISM IN YOUNG ADULTS:
A PRE-VOCATIONAL SKILLS CURRICULUM
A Project
by
Isela Reyes
Approved by:
__________________________________, Committee Chair
Guy Deaner, Ph.D.
Date
iii
Student: Isela Reyes
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library and credit is to
be awarded for the project.
, Graduate Coordinator
Geni Cowan, Ph.D.
Date
Graduate and Professional Studies in Education
iv
Abstract
of
AUTISM IN YOUNG ADULTS:
A PRE-VOCATIONAL SKILLS CURRICULUM
by
Isela Reyes
The intended audience for this curriculum is transitioning youth with autism or
Autism Spectrum Disorder (ASD). This curriculum will be utilized by field staff with the
California Department of Rehabilitation (DOR), including Senior Vocational
Rehabilitation Counselors (SVRC), Senior Vocational Rehabilitation CounselorsQualified Rehabilitation Professionals (SVRC-QRP), Employment Coordinators (EC),
and Service Coordinators (SC). This curriculum was created with the intention of
providing a tool to assist field staff in building and practicing key pre-vocational soft
skills in consumers with autism. Currently, there are no training curriculums specifically
targeting soft skills in consumers with autism.
Research shows that adults with autism are quickly becoming one of the largest
disability groups in the United States. A change in the diagnostic criteria in the early
1990s led to an increase in diagnosing autism in children, and today those children are
now young adults exiting the school system and in need of employment services. The
need for a pre-vocational skills curriculum was developed in response to the anticipated
increase in consumers with autism seeking employment services with DOR.
v
Data were obtained using various resources and methods, including online
research databases, peer-reviewed journal articles, and books. Further data were obtained
through conversations and interviews with DOR employees, master’s projects completed
by previous Vocational Rehabilitation graduate students, and relevant websites providing
information on the employment needs of consumers with autism.
Limited studies exist detailing the current use of vocational rehabilitation services
for individuals with autism; however, studies show the VR system appears to be as
successful for people with ASD as for people with other disabilities. The limited
information available on autism as it presents in adults substantiates the need for further
research in the future. As more data regarding to employment become available with
future research, this author recommends this curriculum be updated as needed.
, Committee Chair
Guy Deaner, Ph.D.
Date
vi
DEDICATION
Este proyecto está dedicado a mis padres, Rodolfo y Gloria Reyes. Gracias por
enseñarme que en la vida nada es gratis, y que depende de mí para construir una vida
mejor.
vii
ACKNOWLEDGMENTS
I would like to acknowledge our program coordinator and faculty members in the
Department of Special Education, Rehabilitation, School Psychology and Deaf Studies
for preparing me and for providing me with guidance and support to complete this
project. Thank you to all my mentors and staff from the Department of Rehabilitation at
the Laguna Creek, Roseville, and Northeast offices for believing in me and for granting
me the opportunity to learn, work, and apply all the knowledge I have gained through my
studies. I would especially like to thank my family and Jose for all the emotional support
and encouragement they have given me throughout graduate school.
viii
TABLE OF CONTENTS
Page
Dedication ........................................................................................................................ vii
Acknowledgments........................................................................................................... viii
Chapter
1. INTRODUCTION ........................................................................................................ 1
Background of the Problem .................................................................................... 1
Statement of the Problem ........................................................................................ 3
Definition of Terms................................................................................................. 5
Limitations of the Problem ................................................................................... 10
Organization of the Problem ................................................................................. 11
2. LITERATURE REVIEW ........................................................................................... 13
Introduction ........................................................................................................... 13
Definition of Autism ............................................................................................. 13
Statistics ................................................................................................................ 16
Autism and Functional Limitations ...................................................................... 20
Autism and Current Transition Services ............................................................... 24
Autism and Vocational Rehabilitation .................................................................. 29
Summary ............................................................................................................... 35
3. METHODOLOGY ..................................................................................................... 37
Review of Sources ................................................................................................ 37
ix
Method .................................................................................................................. 38
Design of Curriculum ........................................................................................... 40
4. SUMMARY AND RECOMMENDATIONS............................................................. 42
Summary ............................................................................................................... 42
Recommendations ................................................................................................. 44
Appendix. Autism in Young Adults: A Pre-Vocational Skills Curriculum...................... 46
References ....................................................................................................................... 122
x
1
Chapter 1
INTRODUCTION
Background of the Problem
In 1943, Austrian psychiatrist Leo Kanner published a paper in which he
described a condition called “infantile autism,” setting the foundation for continued
research into what is now called autism (Fischbach, 2007, para. 4). In the time since
Kanner first introduced the world to autism, efforts have been made in researching and
understanding this disorder. Knowledge of autism has fluctuated over the years as
researchers search for answers; however, some facts are known. Primarily, autism is
defined as a developmental disorder causing social, communication, and behavioral
deficits (Centers for Disease Control and Prevention [CDC], 2013). It is also known that
autism is a spectrum disorder and is characterized by difficulties in social interaction,
verbal and nonverbal communication, and repetitive behaviors (CDC, 2013). Autism is
one of five pervasive developmental disorders that falls under one umbrella diagnosis of
Autism Spectrum Disorder (ASD) and also includes Asperger syndrome, pervasive
developmental disorder-not otherwise specified (PDD-NOS), childhood disintegrative
disorder, and Rhett’s syndrome (National Institute of Mental Health, 2011).
Autism is the fastest-growing serious developmental disability in the U.S.
(Autism Speaks, 2013b). The CDC estimates that one in 88 children carry a diagnosis of
ASD, a 23% increase from the previous rate of one in 110 released in its 2006 report
(CDC, 2013). This increase in prevalence has brought attention to autism research;
2
however, studies show that efforts have been largely focused on children (Friedman,
Warfield, & Parish, 2013). Recent studies show an imbalance in child vs. adult autismbased research with the majority of it focusing on children (Howlin, 2013). A report by
Shattuck et al. (2012) highlighted the disproportionate research in adult-specific studies
for individuals with autism. Of the 11,000 studies published on ASDs (found via the
online PubMed database), only 23 were focused on services aimed at supporting work
success among adults 18 and older (Shattuck et al., 2012, p. 285). The findings suggest
research on services for adults with autism is underdeveloped and largely focused on
children with autism. It is known that autism does not end in childhood and is “believed
to be a permanent developmental disorder that will continue into adulthood, creating
lifelong challenges for the individual” (Hendricks, 2010, p. 125). Current estimates
indicate that the disorder is increasing at a rate of 10-17% annually (as cited in
Hendricks, 2010). As the number of children with autism age, focus is beginning to turn
to how to serve this growing population into adulthood.
Most adults aspire to successful employment to sustain their livelihood, and
individuals with disabilities are no different. Obtaining and maintaining employment can
be difficult, and having a disability can create further challenges. Researchers estimate
that 50-75% of adults with autism are unemployed (Hendricks, 2010). Unemployed
individuals mean more reliance on government and community programs. Some
estimates suggest that the lifetime cost of an individual with autism is in excess of $3
million (Howlin, 2013). Research conducted by the Autism Society estimates the
3
lifetime cost at $3-$5 million and almost $90 billion annually for the United States
(Autism Society, 2012). Improved employment for adults with autism would mean less
reliance on government funds, increased contribution to taxes, and an overall decrease of
the financial burden of autism (Hendricks, 2010). To improve employment for
individuals with autism, a need for effective postsecondary services exists. Evidence
shows that current transition planning efforts are uneven and do not succeed in preparing
young adults with autism for employment (Freidman et al., 2013).
Statement of the Problem
Since its enactment in 1975, the Individual’s with Disabilities Education Act
(IDEA) provides services to children with disabilities across the country under (U.S.
Department of Education, 2010). According to the U.S. Department of Education, IDEA
provides services to “more than 6.5 million eligible infants, toddlers, children and youth
with disabilities” (U.S. Department of Education, 2010). Current research shows that
services are abundant at the school level and sparse after high school. “The transition to
adulthood represents a particularly vulnerable time for youth with autism spectrum
disorder (ASD), as the entitlements of the children’s service system end and families
encounter fragmented systems of care” (Friedman et al., 2013, p. 181). Evidence shows
that current transition planning efforts are uneven and to not succeed in preparing young
adults with autism to join either postsecondary education or the world of work (Friedman
et al., 2013). Data collected on young adults with autism showed that more than half of
individuals with ASDs did not participate in either employment or postsecondary
4
education two years after leaving high school, highlighting the deficiencies of current
transition practices (Friedman et al., 2013).
Presently, two major providers of employment services for adults with
disabilities, including those with autism, are the California Department of Rehabilitation
(DOR) and Alta California Regional Center (ACRC). As of July 1, 2013, there were
18,212 consumers being served by ACRC, and 24% of those consumers had a diagnosis
of autism (Alta California Regional Center, 2013). Comparatively, as of July 1, 2013
there were 72,677 consumers being served by California DOR and .03% of those
consumers had a diagnosis of autism. Preliminary research evaluating successful
outcomes shows that services provided through these programs are less than optimal and
do not provide sufficient support (Hendricks, 2010). Due to the nature of autism,
vocational needs are far different from those with other developmental disabilities, as
autism is a spectrum disorder and no two individuals present with the same
characteristics. Challenges abound in creating a service delivery to meet the specific
needs of individuals with ASDs (Hendricks, 2010).
Formal research into challenges for employment success is limited and “very few
details about the characteristics of employment experiences of young adults with an ASD
have been published” (Roux et al., 2013, p. 932). DOR supervisor Janice Sweatt
identified a lack of pre-vocational skills for this population as a reason for challenges in
successful job placement (personal communication, August 13, 2013). One study
identified current models of school-based transition planning as a reason for poor
5
employment outcomes and identified it as not meeting the needs of youth with ASD
(Friedman et al., 2013). Once students exit high school, they encounter limited services
and research has shown high rates of service disengagement and a deficiency in
employment preparation for this population (Friedman et al., 2013). In response to this
problem, a project entitled Autism in Young Adults: A Pre-Vocational Skills Curriculum
was developed (see Appendix).
Definition of Terms
Alta California Regional Center (ACRC)
Alta California Regional Center is an agency that assists with coordinating the
services and supports necessary for persons with developmental disabilities to
maximize and increase their opportunities and choices. These services and
supports could be in the form of natural and/or community supports, or they could
be purchased by the regional center from one of many vendors (Alta California
Regional Center, 2008).
Asperger Syndrome
Asperger Syndrome is a type of Autism Spectrum Disorder (ASD) involving
delays in the development of many basic skills, primarily the ability to socialize
with others, to communicate, and to use imagination (National Institute of
Neurological Disorders and Stroke [NINDS], 2013). Individuals with Asperger
Syndrome differ from individuals with autism in that they typically function
better and have normal intelligence and near-normal language development,
6
although they may develop problems communicating as they get older (NINDS,
2013).
Autism
Autism, also called autistic disorder or classic autism, is a developmental
condition that falls under the umbrella of ASDs. It is what most people think of
when they hear the word autism. People with autistic disorder usually have
significant language delays, social and communication challenges, and unusual
behaviors and interests and the disorder is often comorbid with an intellectual
disability (CDC, 2012).
Autism Spectrum Disorder (ASD)
Autism spectrum disorders (ASDs) are a group of developmental disabilities that
can cause significant social, communication, and behavioral challenges. ASDs
are characterized by social impairments; communication difficulties; and
restricted, repetitive, and stereotyped patterns of behavior. The types of disorders
that fall under the category of ASDs include autism, childhood disintegrative
disorder, Asperger Syndrome, pervasive development disorder – not otherwise
specified (PDD-NOS), and Rhett’s syndrome. Similar symptoms exist within
these disorders; however, there are differences as to when the symptoms start,
how severe they are, and the exact nature of the symptoms (CDC, 2012).
7
California Department of Rehabilitation (DOR)
The California Department of Rehabilitation works in partnership with consumers
and other stakeholders to provide services and advocacy resulting in employment,
independent living, and equality for individuals with disabilities. Services
provided by DOR include career assessment, counseling, job search and interview
skills, independent living skills, career education and training, and assistive
technology (California Department of Rehabilitation [DOR], 2013).
Childhood Disintegrative Disorder
Childhood disintegrative disorder, also known as Heller's syndrome, is a very rare
condition in which children develop normally until at least two years of age, but
then demonstrate a severe loss of social, communication, and other skills.
Childhood disintegrative disorder falls under the umbrella of ASDs; however, it
differs from other ASDs in that individuals show severe regression after several
years of normal development, can develop later in life than autism, and can have a
more dramatic loss of skills (Mayo Clinic, 2013).
Consumer
A consumer is an individual who acquires goods and services for his or her own
personal needs (consumer, 2013). In relation to this project, a consumer is an
individual with a disability who utilizes available services from programs such as
DOR.
8
Developmental Disability
As defined by the CDC (2013), developmental disabilities are a group of
conditions due to an impairment in physical, learning, language, or behavior
areas. These conditions begin during the developmental period and usually last
throughout a person’s lifetime (CDC, 2013).
Functional Limitations
A functional limitation is an inability to perform an action or set of actions, either
physical or mental, because of a physical or emotional restriction (Brodwin &
Brodwin, 2009).
Individuals with Disabilities Education Act (IDEA)
As stated by the U.S. Department of Education, IDEA is a law ensuring services
to children with disabilities throughout the nation. This law governs states and
public agencies in the provision of early interventions, special education, and
related services to more than 6.5 million eligible infants, toddlers, children, and
youth with disabilities (U.S. Department of Education [DOE], 2013).
Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS)
A diagnosis of PDD-NOS is often given to people who meet some, but not all, of
the criteria for autism or Asperger syndrome. People with PDD-NOS usually
have fewer and milder symptoms than those with autism and the symptoms might
cause only social and communication challenges (CDC, 2012).
9
Pre-Vocational Skills/Soft Skills
Pre-vocational skills are skills individuals need to be prepared for the competitive
work arena or volunteerism. Individuals on the autism spectrum experience
difficulties in social interaction, communication, and repetitive behaviors.
Specific to this population and these limitations, soft skills include how to enter
and exit a conversation, dress appropriately for work, maintain personal space,
and maintain hygiene such as washing hands after using the restroom. Other soft
skills include how to fill out an application, navigate the workplace, learning to
speak up and ask for help and other time management/scheduling skills such as
how to follow a daily schedule, use a calendar, and use alarm clocks and notes as
reminders (Autism Speaks, 2013b).
Rhett Syndrome
According to the NINDS, Rhett syndrome is a neurodevelopmental disorder
affecting mostly girls and is characterized by normal early growth and
development followed by a slowing of development, loss of purposeful use of the
hands, distinctive hand movements, slowed brain and head growth, problems with
walking, seizures, and intellectual disability (NINDS, 2013).
Senior Vocational Rehabilitation Counselor-Qualified Rehabilitation Professional
(SVRC-QRP)
A SVRC-QRP assists people with disabilities to achieve independence through
employment. This process includes determining vocational eligibility and level of
10
severity of disability, creating an employment plan, providing post-employment
services, as well as counseling and guidance throughout the process (DOR, 2013).
Spectrum Disorder
Autism is considered a spectrum disorder, meaning it is just one on a spectrum of
closely related disorders with a shared core of symptoms. Individuals on the
autism spectrum have problems with social skills, empathy, communication, and
flexible behavior, but how it affects the individual varies. The severity of
disability and the combination of symptoms differs tremendously from person to
person and every individual on the autism spectrum has unique abilities,
symptoms, and challenges (HelpGuide.org, 2012).
Vocational Skills
Skills involve abilities learned during work, training, or an educational program.
Vocational skills are different from occupationally significant characteristics in
that they require work experience and the acquisition of abilities (Brodwin &
Brodwin, 2009).
Limitations of the Problem
Time
Research gathered by this author is limited to peer-reviewed journal articles,
government and state agency websites, and interviews with rehabilitation professionals
between the years of 2006 and 2013. As increased research efforts are focusing on adult-
11
based autism research, current data are limited to the small number of studies currently
available.
Population and Geography
The intended use of this curriculum is limited to Senior Vocational Rehabilitation
Counselors (SVRC), Senior Vocational Rehabilitation Counselors-Qualified
Rehabilitation Professionals (SVRC-QRP), Employment Coordinators (EC), and Service
Coordinators (SC). The intended audience is limited to the DOR Northern Sierra District
in Sacramento, California as well as ECs and SCs in the Sacramento, California area.
Individuals with autism as well as their family, friends, and support systems may also
benefit from this curriculum.
Author Bias
The content of this project is based on the author’s interpretation and inclusion of
current available data. Additionally, this author has previous experience working with
children with autism. Based on this experience, knowledge and familiarity with this
population has influenced this author’s belief with regard to consumer employment
potential.
Organization of the Problem
Included in Chapter 1 is the introduction, the statement of the problem, definition
of terms, followed by limitations of the project, and finally, the organization of the
project. Chapter 2 consists of a review of current literature as it pertains to this project.
In Chapter 3, this author describes the methodology used to collect data for this project.
12
Finally, Chapter 4 provides a summary of the project as well as recommendations for
future research. The appendix is comprised of the curriculum entitled Autism in Young
Adults: A Pre-Vocational Skills Curriculum.
13
Chapter 2
LITERATURE REVIEW
Introduction
Adults with autism are quickly becoming one of the largest disability groups in
the United States. To date, most research conducted has been focused on children with
autism, and lack of knowledge on this population as they age into adulthood has resulted
in uneven services and little information into how to best implement services to address
the needs of this group (Shattuck et al., 2012). Current research indicates a lack of
effective transition services in assisting transitioning youth with autism in achieving
employment outcomes. This literature review provides background information,
statistics, and information on functional limitations, current transition services, and
vocational rehabilitation use among transitioning youth with autism.
Definition of Autism
The CDC (2012a) defines autism as a pervasive developmental disorder affecting
the brain’s normal development and can cause significant social, communication, and
behavioral challenges. According to the National Center for Biotechnology Information
(NCBI; 2012), autism is a physical condition linked to abnormal biology and chemistry in
the brain and affects the brain's normal development of social and communication skills.
The result is a condition characterized by difficulties in social interaction, difficulties in
verbal and nonverbal communication, and repetitive behaviors. With the release of the
fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
14
earlier this year, the definition and its implications have changed the way this disorder is
diagnosed (American Psychiatric Association [APA], 2013).
One of the most relevant changes in the DSM was made to autism spectrum
disorder (ASD). The DSM-IV identified this group as Pervasive Developmental
Disorders with four distinct disorders: autistic disorder (autism), Asperger Syndrome,
Childhood Disintegrative Disorder, and Pervasive Developmental Disorder-Not
Otherwise Specified (PDD-NOS) (APA, 2013). Under the new DSM-5, all autismrelated disorders are combined into one umbrella term of Autism Spectrum Disorder
(Bertin, 2012). These changes were implemented as a result of studies that found the
separate diagnoses were not consistently applied across different clinics and treatment
centers. Researchers were finding that different clinicians were diagnosing the same
individual with different disorders and some clinicians changed their diagnosis of the
same symptoms from year to year (APA, 2013). Another reason stated for the DSM-5
change is that as autism is defined by a common set of behaviors, then it should be
characterized by a single name according to severity (APA, 2013).
In the DSM-IV, there were three domains of autism symptoms: social impairment,
language/communication impairment, and repetitive/restricted behaviors (Autism Speaks,
2013c). Under the DSM-5, the ASD criteria include a level of severity and only two
symptom domains: social communication impairment and restricted interests/repetitive
behaviors (Autism Speaks, 2013c). Under the two symptom categories, an individual
must show three deficits in social communication and a minimum of two from the
15
restricted interests/repetitive behaviors category (Autism Speaks, 2013c). To receive a
diagnosis of ASD under the DSM-5, individuals must show symptoms from early
childhood, although a diagnosis can be made later on, allowing individuals whose
symptoms may not be fully recognized early in life to receive a diagnosis (Autism
Speaks, 2013c).
While many important changes have occurred in the diagnostic criteria for autism,
little has changed in understanding its cause leading to increased research efforts
(Currenti, 2010). It is generally accepted that autism is caused by abnormalities in brain
structure and/or function and studies from brain scans show differences both in the shape
and structure of the brain in children with autism versus in neurotypical children (Autism
Society, n.d.). While researchers are unable to pinpoint one root cause, current data show
there is probably a combination of factors leading to autism (NCBI, 2012).
Current research supports theories suggesting environmental and genetic factors
play a role in etiology (CDC, 2012a). Most researchers agree that autism has a strong
genetic basis and recent studies highlight evidence supporting genetic factors as an
important cause of autism (Matsuzaki, Iwata, Manabe, & Mori, 2012). Twin studies
revealed a concordance rate for autism at over 60% among identical twins and only 3%5% among fraternal twins indicating a genetic, hereditary cause (Kuhaneck & Berliner,
2010). As the concordance rate was not 100% among identical twins, researchers
concluded that environmental factors play a part in the genetic susceptibility of certain
individuals (Kuhaneck & Berliner, 2010).
16
Statistics
In 2002, CDC released a report stating that the number of children with autism
was estimated at about one in 150 children (CDC, 2012a). In 2004, that number was one
in 125 children and two years later that number rose to one in 110 children (CDC,
2012a). In its latest report released in 2008, the CDC estimated that one in 88 children
carries a diagnosis of ASD, a 23% increase from the previous rate of one in 110 from
their 2006 report (CDC, 2012a). These rising numbers have led to many publications
warning the public of an autism epidemic (Bernier & Gerdts, 2010). The numbers
released by the CDC lend credence to epidemic reports; however, more studies are
suggesting a variety of factors may be influencing these figures, including improved
diagnostic practices, expansion of diagnostic criteria, increased public awareness, and
more attention from the medical community (Glennon, 2010).
The diagnostic criteria for autism are gathered from the Diagnostic and Statistical
Manual of Mental Disorders (DSM). The DSM is considered a live document, which is
constantly being updated as breakthroughs in research emerge. The DSM underwent its
most current revision earlier last year with the release of the DSM-5 in May 2013. Prior
to this release, the DSM-IV-TR was released in 2000, the DSM-IV was released in 1994,
and the DSM-III-R was released in 1987 (Bernier & Gerdts, 2010).
Each new revision to the DSM brought modified diagnostic boundaries and
criteria adjustment (Bernier & Gerdts, 2010). The diagnostic criteria for autism changed
in 1987 with the release of the DSM-III-R when Pervasive Developmental Disorders-Not
17
Otherwise Specified (PDD-NOS) and Asperger Syndrome both were added to the
subtypes of Pervasive Developmental Disorders. Prior to the DSM-5 release, all ASDs
were considered Pervasive Developmental Disorders categorized by four subtypes:
Autistic Disorder, Childhood Disintegrative Disorder, Asperger Syndrome, and PDDNOS. With the 1987 release of the DSM-III-R, the addition of PDD-NOS and Asperger
Syndrome meant a loosening of the diagnostic criteria and more people meeting the
diagnostic criteria for an ASD (Bernier & Gerdts, 2010). Based on this information,
“Previous prevalence rates, therefore, considered only what would now be classified as
Autistic Disorder, while the current…prevalence rates include all three diagnoses in the
autism spectrum” (Bernier & Gerdts, 2010, p. 53). Bernier and Gerdts suggested these
changes in diagnostic criteria could account for 50-75% of the increase in prevalence
rates.
Another factor associated with the increase in prevalence rates is credited to a
growth in autism awareness (Bernier & Gerdts, 2010). Increased awareness allows for
better identification of children who might otherwise be overlooked and decreased
stigma. This leads to more families seeking services, followed by an increase in
enrollment in treatment services, and ultimately culminating in more individuals being
counted for prevalence studies (Bernier & Gerdts, 2010). Additionally, methods for
assessing the number of persons with autism may be a contributing factor to increasing
rates (Bernier & Gerdts, 2010). Many studies gather data from the number of youth
entering a treatment or special education program. Bernier and Gerdts noted that in order
18
to identify someone with a specific disorder, that disorder must be included in the
program’s list of diagnoses, and autism was not listed as a diagnostic category until 1991.
While the diagnostic changes occurring in recent years account for part of the
rising prevalence rates, researchers still believe these factors do not account for the total
increase in incidence (Glennon, 2010). Although not at epidemic levels, data do suggest
a measure of secular increase in autism is in fact occurring (Bernier & Gerdts, 2010).
The effects of the loosening autism diagnostic criteria made to the DSM in the early
1990s are becoming evident today. Given the surge of children diagnosed with autism as
a result of the DSM changes in the early 1990s, children from that generation are now
young adults exiting the school system (Taylor & Seltzer, 2012).
The need for useful evidence about adults with ASDs is increasing as greater
numbers of youth with autism age into adulthood. ASDs are usually diagnosed during
childhood, and it is considered a childhood disorder; however, increasing rates of aging
youth means that autism is now becoming a disorder of adulthood (Howlin, 2013).
Researchers are only now beginning to realize the need for studies on adults with autism
as they are finding that even though most of a typical lifetime is spent in adulthood, most
research on autism is focused on early childhood (Shattuck et al., 2012). “We know next
to nothing about people aging with ASD. There are no estimates for longevity in ASD
and no data on the quality of life on the elderly with ASD” (Fombonne, 2012, p. 274).
Even epidemiologic research in adults is limited and only in the past few years has any
attempt been made to collect data on adults with autism (Howlin, 2013).
19
Referrals of adults for assessment of a possible ASD diagnosis are becoming
increasingly more common; however, diagnosing an adult is a challenging task for
practitioners (Fombonne, 2012). Typically, an adult is referred for a possible diagnosis
when they have a child who has been recently diagnosed with ASD and they recognize
similar symptom patterns in their own history (Fombonne, 2012). Effectively diagnosing
an adult with ASD is challenging, “especially when developmental history and early
symptom patterns cannot be accurately assessed owing to poor memory or unavailability
of an informant (as when parents cannot be interviewed) and (or) to lack of corroborative
medical record evidence” (Fombonne, 2012, p. 273). Efforts to determine accurate
estimates for adults with autism are lacking. Currently, the only prevalence study
conducted on adults with autism was in 2011 on adults in the United Kingdom. Results
revealed ASD prevalence rates at about 1%, just as high as in children (Howlin, 2013;
Howlin & Moss, 2012).
The need for further research for adults with autism is clear. Current evidence
shows inadequate data for informing policymakers on how to make decisions regarding
best practices for meeting the needs of this growing population (Shattuck et al., 2012).
Unemployment remains a significant problem facing adults with autism, as current
studies show only between 20% and 30% of individuals with autism as being employed
(Wilczynski, Trammell, & Clarke, 2013). The challenge here is due to the distinctive
characteristics of autism, which make gaining and maintaining employment a challenging
task. “Adolescents and adults with ASD may face a much greater problem with
20
unemployment because of the unique challenges the symptoms of ASD may present
when preparing for life in the workforce, searching for a position, and competently
completing a job to criterion” (Wilczynski et al., 2013, p. 876). The functional
limitations in this disability present the greatest challenges in obtaining and maintaining
employment for adults with autism.
Autism and Functional Limitations
Functional limitations are described as deficits in work-related skills that present
in individuals due to their disability. Functional limitations come in many forms
depending on the disability; however, there are general functional areas in which these
limitations can occur. Functional areas specific to the limitations for adults with autism
include interpersonal skills, communication skills, work skills, and work tolerance (State
of Connecticut, n.d.). A discussion of the functional limitations specific to autism
follows.
Interpersonal Skills
Interpersonal skills are described as the ability to establish or maintain
relationships and interact appropriately with others at a level that allows the individual to
participate in work-related activities (State of Connecticut, n.d.). Every job requires the
basic skills that are the primary deficits of autism, with social interaction being one of the
top necessary skills for obtaining and maintaining employment (Schall, 2010).
Individuals with autism are often described by employers as having a divergent profile;
they are excellent employees with regard to the skill with which they complete their job,
21
and conversely considered difficult employees when considering their people skills and
behavioral challenges (Schall, 2010). “According to self-reports, vocational success is
not contingent on completing job duties but lies in the social aspect of employment”
(Hendricks & Wehman, 2009, p. 81).
Individuals with autism exhibit social impairment including stereotypical
gestures, difficulty with eye contact, limited emotional and social reciprocity, an inability
to correctly perceive/read faces, difficulty following social rules, and acting
inappropriately with others (Friedman et al., 2013; Hendricks, 2010). As an example,
individuals with autism have difficulty engaging in small talk and reciprocal
conversations and may not respond to others appropriately due to the lack of interactional
skills and general social awareness (Lee & Carter, 2012). Inappropriate behavior and
behavior challenges also create difficulties in navigating interpersonal relationships.
Behavioral challenges and inappropriate work behaviors may include tantrums,
aggression, self-injury, property destruction, ritualistic behaviors, and pica (Hendricks,
2010; Hendricks & Wehman, 2009). These behaviors typically occur as a result of high
levels of stress due to trying to fit in socially with others; regardless, these behaviors are
misinterpreted and not well tolerated in the workplace and can lead to segregation and
termination (Hendricks, 2010).
Communication Skills
A functional limitation in communication skills means an individual cannot
accurately and efficiently give or receive information when participating in work-related
22
activities (State of Connecticut, n.d.). Limitations in communication means the
individual is not able to communicate effectively, i.e., may not understand others, and
may not be understood by others in a work environment. An example of this is the
inability to understand body language, tone of voice, and expressions, which may be
apparent in a situation when someone makes a sarcastic remark or joke and the individual
with autism interprets this literally (Autism Speaks, 2013c). Another common
communication challenge is inaccurately referring to self. For example, if the individual
was thirsty, he or she might say “you want water” instead of “I want water” (NCBI,
2012). Also, individuals with autism may have difficulty combining words into
meaningful sentences, may only speak single words, may repeat the same phrase over
and over again, or engage in echolalia where they repeat what they hear verbatim
(Autism Speaks, 2013b).
Work Skills
Work skills are defined as “the ability to do specific tasks required to carry out
job functions as well as the capacity to benefit from training in the necessary skills”
(State of Connecticut, n.d., p. 5). Individuals with limitations in work skills are unable to
obtain or maintain employment usually available to persons of equivalent age and
education, can only learn tasks that are routine and repetitive, require accommodations to
participate in training to develop work skills, and require more training and supervision
than other trainees (State of Connecticut, n.d.). Such restrictions make attaining and
maintaining employment far more difficult for individuals with autism, as the unique
23
characteristics of people with ASD means they require a higher level of support at work
(Schall, 2010). In fact, studies show individuals with ASD benefit from functional
behavior assessments and the implementation of positive behavior support plans in a
work setting (Schall, 2010). This presents a limitation in work skills, as supports may be
necessary in a work environment, and studies show businesses typically have a lower
tolerance for the time and resources it may take to implement these supports (Schall,
2010).
Work Tolerance
Work tolerance is defined as the capacity to effectively and efficiently sustain the
demands of a job, and a limitation in this area occurs if the individual is unable to
perform a work activity without accommodations not typically made for other workers
(State of Connecticut, n.d.). Specific to autism, an example of a limitation in this area is
if an individual is unable to tolerate common environmental conditions found at work
(State of Connecticut, n.d.). It is widely known that individuals with autism are highly
sensitive to their environments and when faced with uncomfortable situations, they
become frustrated and experience high levels of stress and anxiety often leading to
behavioral outbursts (Hendricks, 2010). Some examples of environmental factors include
sensitivity to workplace noise and other sensory stimuli (Hendricks, 2010). To minimize
these occurrences, it is recommended that consideration of factors such as the tasks of the
job, sensory characteristics of the job, the social climate of the job, and flexibility in the
workplace are considered when employing individuals with ASD (Schall, 2010).
24
Autism and Current Transition Services
Due to the increase in autism prevalence rates over the last two decades, efforts
are being made to identify and implement effective services for young adults with autism
as they exit the school systems (Wehman et al., 2012). “Researchers and policy makers
are increasingly extending their focus beyond childhood and considering the development
of individuals with ASD as they enter and move through adulthood” (Taylor & Seltzer,
2012, p. 2669). This presents a challenge, as research pertaining to the adult stage of life
for those with autism remains extremely underdeveloped when compared to research
available on children with autism (Roux et al., 2013). Autism is a lifelong disorder, yet
researchers are finding that limited extant research depicts a pessimistic picture for
employment (Taylor & Seltzer, 2011). In addition, researchers are finding that although
transition services are mandated through IDEA, these services are not applied
consistently and may be a reason why transitioning adults are unable to achieve more
positive outcomes after graduation (Friedman et al., 2013).
In the public education system, special education services are mandated for
eligible students under IDEA (McDonough & Revell, 2010). IDEA “requires school
districts to provide children with disabilities with a free and appropriate public education,
and special education services are developed and implemented through a coordinated
individualized education program [IEP]” (Friedman et al., 2013, p. 182). This mandated
service is also required to assist in transition planning by a student’s 16th birthday by
identifying post-secondary goals and related transition services and discussing them in
25
coordinated IEP team meetings with the schools and transition agency representatives
(Friedman et al., 2013). The services are meant to assist transitioning students by
formulating a plan after graduation, whether it be pursuing higher education or seeking
employment. A recent study followed transitioning youth with autism to determine the
effectiveness of these transition services.
Freidman et al. (2013) conducted National Longitudinal Transition Study-2 in
which they followed a nationally representative sample of 11,000 youth to determine the
effectiveness of current transition planning services in high schools. Data acquired on the
effectiveness of the transition services indicated that 67.4% of youth with autism did not
attend their transition meetings and of those who did attend, only 2.6% led the planning
(Friedman et al., 2013). Friedman et al. highlights the lack of engagement process
between students, families, and schools, and presents the need for greater collaboration
between schools and outside agencies in providing transition services to students
(Friedman et al., 2013). From the study, vocational rehabilitation counselors participated
in transition planning for 49% of youth with autism (Friedman et al., 2013).
Additionally, more than half the subjects with autism had not participated in either
employment or post-secondary education two years after graduating from high school
(Friedman et al., 2013).
In a separate study conducted by Roux et al. (2013), postsecondary employment
experiences of young adults with autism were studied and compared to outcomes of
young adults with different disabilities. Roux et al. revealed that approximately 53.4% of
26
young adults with an ASD had ever worked for pay outside the home since leaving high
school, the lowest rate among disability groups. Additionally, it was concluded,
“consistently poorer outcomes for young adults with an ASD relative to other disability
groups suggest that this population is experiencing particular difficulty in successfully
transitioning to employment in the first years after high school” (Roux et al., 2013, p.
937). Reasons current transition services are not meeting the needs of this group remain
unclear, and the authors suggest further research focusing on transition from high school
into employment (Roux et al., 2013).
Despite the poor outcomes, the authors reiterate that this study confirmed that
employment is possible for people with ASD, even for those with severe levels of
impairment (Roux et al., 2013). This study proposes that the problem may stem from
difficulty transitioning to employment in the first year after high school, and the authors
suggest possible strategies for improving employment outcomes, including providing
work experiences during high school and deliberate matching of capabilities to job types
during transition planning (Roux et al., 2013). Similarly, in a study by Friedman et al.
(2013), they too suggested that poor outcomes should not be construed as evidence that
individuals with ASD cannot work. In fact, extensive research shows that with
appropriate supports, people with ASD can work in a variety of employment settings, and
strategies to improve outcomes might include matching the individual to a
complimentary job, using assessments to determine task preferences, evaluating social
27
and communication needs, and adding necessary modifications and adaptations
(Friedman et al., 2013).
In her book The Autistic Brain, co-author Temple Grandin explained what it was
like living with autism and suggested that by focusing on the deficits of autism, society
loses focus on how to best serve this population – by understanding what each individual
does best (Grandin & Panek, 2013). Highlighting a study revealing that the measure of
autistic intelligence depended on what tests the subjects were given, Grandin and Panek
(2013) stated this study concluded intelligence has been underestimated in autistics and
urged the public to focus on determining individualized strengths. “I’m suggesting that if
we can recognize, realistically and on a case-by-case basis, what an individual’s strengths
are, we can better determine the future of the individual” (Grandin & Panek, 2013, p.
119). Similarly, Hendricks (2010) found that strategies for increasing employment
retention should include matching the individual to an appropriate job and emphasized
the need for job placement to be individualized and based on the person’s strengths and
interests.
Implementing these strategies and identifying vocational goals should begin
during the transition planning phase in high school, when postsecondary goals are
discussed, to assist students in developing career plans for after graduation. Hendricks
and Wehman (2009) suggested that work experiences should begin in high school and
include career exploration activities and assessments; however, they found that only 66%
of teachers surveyed had implemented a program to meet the established goals. The
28
authors suggested efforts need to focus on improving transition planning and noted that
most students with ASD are not receiving a seamless transition experience to assist them
post high school, when mandated services cease. Reported difficulties in the transition
process included lack of participation, lack of information, lack of availability, and
services of poor quality (Hendricks & Wehman, 2009). A collaborative effort from
school personnel, parents, and service providers are needed and the authors suggested, “it
is necessary to establish measures for moving the individual systematically from the
protected umbrella of the school to the adult service delivery system” (Hendricks &
Wehman, 2009, p. 83).
In California, one such agency, ACRC, works in collaboration with other social
service agencies that can offer individualized supports for consumers, including those
with autism. The ACRC provides ongoing lifelong supports to people with
developmental disabilities, including ASD (California Department of Developmental
Services, 2013). Regional centers are nonprofit private corporations that contract with
the Department of Developmental Services (DDS) to provide or coordinate services and
supports, including information and referral, assessment and diagnosis, counseling,
lifelong individualized planning and service coordination, advocacy, assistance in finding
and using community and other resources, residential services, vocational services, day
programs, respite, transportation, and any other services that support activities of daily
living (Autism Speaks, n.d.; California Department of Developmental Services, 2013).
29
The eligibility criteria for the Regional Centers is that a person must have a
qualifying developmental disability that begins before the person's 18th birthday, presents
as a substantial disability, and is expected to continue indefinitely (California Department
of Developmental Services, 2013). All the diagnoses and assessments to determine
eligibility are conducted by the Regional Centers (California Department of
Developmental Services, 2013). While Regional Centers provide the largest source of
lifelong services for adults with autism in California, they can refer consumers to DOR
for specialized services in vocational rehabilitation (C. Bear, personal communication,
December 12, 2013). In an interview with supported employment specialist Cheryl Bear
(December 12, 2013), who works as a Senior Vocational Rehabilitation CounselorQualified Rehabilitation Professional (SVRC-QRP) at DOR, she stated ACRC may refer
consumers to DOR if they feel the consumer may be competitively employed and may be
able to benefit from vocational rehabilitation. In the following section, an in-depth look
at DOR and the services they provide is discussed.
Autism and Vocational Rehabilitation
Work is considered one of the most valued social roles in our society and provides
a forum leading to improvement in one’s quality of life (Hendricks, 2010). When young
adults leave high school and begin to transition into adulthood, a meaningful career is
often the most sought after aspiration. Transitioning usually involves “completing
school, gaining employment, participating in postsecondary education, contributing to a
household, participating in the community, and experiencing satisfactory personal and
30
social relationships (Hendricks & Wehman, 2009, p. 77). Despite this, postsecondary
employment opportunities have traditionally been very limited for people with ASD
(Migliore, Timmons, Butterworth, & Lugas, 2012). “Obtaining and maintaining
employment can be difficult for any person, but is particularly complicated for an
adolescent or adult with ASD due to unique communication and social impairments”
(Hendricks, 2010, p. 126). Most autism research is specific to children with autism, and
limited studies on adults has researchers mobilizing to find ways to best serve this
population as they age into adulthood.
One of the few formal systems providing vocational rehabilitation services to
adults with ASD is the vocational rehabilitation system (VR). In California, the
Department of Rehabilitation (DOR) is responsible for assisting Californians with
disabilities to obtain and retain employment and maximize their ability to live
independently (DOR, 2013). Services through the VR system include career assessment,
counseling and guidance, job search and interview skills, independent living skills, career
education and training, and assistive technology (DOR, 2013). The goal of VR services
is to increase employment outcomes. Given increases in youth with ASD exiting the
school systems and searching for adult services, the demand for services, especially VR
services, is increasing (Migliore et al., 2012). Researchers estimate that approximately
50,000 U.S. teenagers with autism reach their 18th birthdays every year (Shattuck et al.,
2012).
31
To become a consumer of VR services, an individual needs to meet DOR
eligibility criteria. To be eligible for VR services, an individual must have a physical or
mental impairment that substantially impedes his or her ability to secure employment and
must be able to benefit from DOR's services in terms of an employment outcome in an
integrated setting (DOR, 2013). DOR services are provided through a team led by a
Senior Vocational Rehabilitation Counselor-Qualified Rehabilitation Professional
(SVRC-QRP) who works with the consumer to determine eligibility and proceeds with
providing services. Once an individual is determined eligible, then the SVRC-QRP
determines their significance of disability, which falls under one of three categories: most
significantly disabled, significantly disabled, or disabled. Next, the SVRC-QRP works
with the consumer to develop an Individualized Plan for Employment (IPE), outlining an
employment goal for the consumer and listing the types of services the consumer will
receive based on the IPE (C. Bear, personal communication, December 12, 2013).
If a consumer with autism is referred to DOR through the Regional Center, then
he or she works with DOR’s Supported Employment Program (SEP). In this case, the
Regional Center will send a consumer’s referral packet to the local DOR SEP specialist
who will review the application and schedule an intake appointment to meet with the
consumer and the Regional Center service coordinator (C. Bear, personal
communication, December 12, 2013). A SEP provides ongoing support services and
other appropriate services provided by DOR to support and maintain an individual with a
most significant disability (DOR, 2013). The SEP can also provide a job coach to
32
support an individual in learning and performing job duties either individually or in a
group (DOR, 2013).
While the SEP at DOR is considered an effective program for providing the
specific supports a consumer with an ASD requires, not all consumers with autism who
sign up for DOR services are referred to DOR through the Regional Centers (C. Bear,
personal communication, December 12, 2013). According to DOR Laguna Creek branch
supported employment specialist Cheryl Bear, many consumers with autism apply for
DOR services independently, are not receiving services from the Regional Centers, and
are therefore placed with a generalist SVRC-QRP (personal communication, December
12, 2013). A generalist SVRC-QRP works with anyone who comes in the door with
autism or ASD, whereas a specialist like Ms. Bear works exclusively with ACRC
consumers (C. Bear, personal communication, December 12, 2013). Ms. Bear could not
identify why this is the case except to speculate that perhaps those consumers have no
knowledge of the Regional Centers and have never sought services with them (personal
communication, December 12, 2013). Regardless, efforts have been made to better
understand the use of VR services among consumers with autism.
Limited formal studies exist detailing current use of VR services for individuals
with ASD. Of the most current studies that do exist, research overwhelmingly
demonstrates disappointing employment outcomes for this group, and shows that services
provided through VR systems are less than optimal (Hendricks, 2010). “Individuals with
ASD have markedly different vocational needs than individuals with other…disabilities.
33
The uneven cognitive and social abilities associated with ASD results in a diverse set of
vocational needs that are challenging to address with usual practices” (Lawer,
Brusilovskiy, Salzer, & Mandell, 2009, pp. 487-488). As ASD is a spectrum disorder, no
two persons experience the same symptoms. This creates challenges in creating effective
strategies, as studies show individualized plans are needed to best support individuals
with ASD (Wilczynski et al., 2013).
Of the available research detailing VR use among individuals with ASD, three
factors have been identified as to why VR services are less than optimal, do not provide
sufficient support, and result in disappointing employment outcomes (Lawer et al., 2009).
First, individuals with ASD are more likely to be denied services because their disability
is believed to be too severe for them to benefit (Hendricks, 2010; Lawer et al., 2009).
Second, for individuals who do receive services, those services are far more expensive
and cost more than services for other disability groups due to the additional needs of
people with ASD (Hendricks, 2010). In fact, “service costs for individuals with ASD
were among the most costly of nine disability groups served” (Hendricks, 2010, p. 128).
Finally, having job placement services was identified as the final factor impacting
success in VR programs for individuals with ASD (Migliore et al., 2012).
Job placement services are services such as job development, job coaching,
follow-along and follow-up, and job retention services (Lawer et al., 2009). In a study
examining transition services for youth with autism through the VR system, research
found the odds of exiting the VR program with a job was four times higher if the
34
individual received job placement services, yet studies showed only 48% of youth with
autism received job placement services (Migliore et al., 2012). The authors were not able
to identify why so many youth went without job placement services and recommended
further research to determine why it was occurring.
Despite these factors, studies show the VR system appears to be as successful for
people with ASD as it is for people with other disabilities and remains one of the most
economically sound programs in the U.S. (Lawer et al., 2009). For those individuals with
ASD who are able to receive services, studies show they do at least as well or better than
other disability groups in achieving competitive employment (Lawer et al., 2009).
Further, the authors suggested that as adults with ASD who do eventually receive
supports are often successful in obtaining and maintaining employment, more research
should be done to determine why not all consumers with an ASD may be receiving the
supports they require (Lawer et al., 2009).
Generally, employment allows adults with and without disabilities to earn income,
support themselves, and pursue their interests. Specific to this disability group,
“employment provides a forum that promotes personal dignity and has been
demonstrated to improve the quality of life in individuals with ASD” (Hendricks, 2010,
p. 126). Increasing employment in this disability group will also alleviate the economic
impact of services. Estimates suggest that the lifetime cost of an individual with autism
is in excess of $3 million (Howlin, 2013). Higher employment rates would also mean
less reliance on government funds and more contribution to taxes (Hendricks, 2010).
35
“Individuals who use vocational rehabilitation services return the investment through
taxes within 2-4 years, on average” (Lawer et al., 2009, p. 493). The results highlight the
importance of creating effective services and maximizing individualized support plans to
best serve this population. Based on current studies, future research should focus on
barriers to VR services, lack of job placement services, and which actions are necessary
to create more cost effective services for this disability group.
Summary
Autism is a pervasive developmental disorder that affects the brain’s normal
development and results in a condition characterized by difficulties in social interaction,
difficulties in verbal and nonverbal communication, and repetitive behaviors. Changing
diagnostic criteria from two decades ago has resulted in a surge of youth with autism who
are now adults exiting the school system. Research on adults with autism is extremely
underdeveloped and little evidence into how to best provide services exists.
Unemployment remains a significant problem and those barriers to achieving competitive
employment are due to the distinctive characteristics of autism, which make gaining and
maintaining employment a challenging task.
Deficits in interpersonal skills, communication skills, work skills, and work
tolerance presents challenges in creating effective strategies. People with autism are
more likely to be denied services because their disability is deemed too severe. Other
factors that create barriers are services are it is too costly and service providers are not
consistently providing job placement services despite evidence of their success. Despite
36
the above mentioned factors, vocational rehabilitation services appear to be just as
successful for people with ASD as for people with other disabilities. For those
individuals with ASD who are able to receive services, studies show they do at least as
well or better than other disability groups in achieving competitive employment.
Competitive employment is possible with effective planning strategies focusing on
maximizing individual strengths, minimizing weaknesses, and implementing work
supports and job placement services.
37
Chapter 3
METHODOLOGY
Review of Sources
This author began her research in fall 2013 by using the online research database
EBSCOhost to search for peer-reviewed journal articles between the years of 2009 and
2013. Information retrieved from the articles included statistics regarding autism in the
U.S., information on the types of services provided for this population, as well as
information on the deficits of autism and the various types of possible workplace
accommodations. Further research included information gathered from books,
conversations, and interviews with employees at the Laguna Creek branch of the DOR,
master’s projects completed by previous Vocational Rehabilitation graduate students, and
online websites.
The websites accessed by this author include the California DOR, Autism Speaks,
Autism Society, Department of Developmental Services, Centers for Disease Control and
Prevention (CDC), National Center for Biotechnology Information (NCBI), American
Psychiatric Association, and the Job Accommodation Network. Information obtained
from these websites assisted this author in expanding her knowledge of autism in adults
and provided the information necessary to assist in the writing of the literature review and
the creation of the pre-vocational skills curriculum.
38
Method
In 2012, this author became employed as a paraprofessional working one-on-one
with young students who were on the autism spectrum. Through this experience, this
author gained practical knowledge working with individuals on the autism spectrum and
was able to see firsthand the varied nature in which this disorder manifested itself from
one individual to the next. The author worked with individuals who had varying degrees
of skills and independence; some students required very little prompting and were fairly
independent while others required nonstop supervision and relied on others for assistance
in basic activities such as using the restroom. Through this experience, the author was
able to witness firsthand the core deficits of ASD, which include communication,
interpersonal skills, and repetitive behaviors. As this author was working with the
students, she began to think about their futures and how they would be able to navigate
obtaining a job when they reached adulthood.
When this author was entering her final academic year as a graduate student in the
Vocational Rehabilitation Counseling program at California State University,
Sacramento, she was still thinking about those students she had worked with as a
paraprofessional. In 2013, this author became employed as a Seasonal Clerk for the
Department of Rehabilitation and was able to see DOR consumers with autism come in
for services. In a conversation with the Laguna Creek branch Staff Services Manager I,
Janice Sweatt (personal communication, August 13, 2013), this author was told that this
population of consumers lacked soft skills, which presents challenges when providing
39
services. During this time, the author decided to create a training curriculum tailored to
individuals with autism by focusing on the soft skills with which they have challenges:
communication, interpersonal skills, and repetitive behaviors.
Through Internet searches, this author sought out the availability of a soft skills
training curriculum targeted for people with autism. While general soft skills curricula
were found, this author was unable to find a curriculum focusing solely on the soft skills
individuals with autism lack. Additionally, while this author found varying articles
discussing the specific soft skills with which this population struggles, there were no
formal training curricula integrating this information into one training guide. As a result,
the decision to create a soft skills training curriculum for people with autism was made.
After making the decision to create a curriculum (see Appendix), this author
sought out previous graduate students’ projects in the CSUS library to better understand
the general layout of a curriculum. Using this information, this author also ran online
searches for keywords including soft skills curriculum, soft skills training, curriculum
formats, and soft skills training guide. Using this combined information, the author was
able to piece together a general format for creating a basic curriculum. In addition to
researching online and using graduate student projects, this author also used books on
autism to increase her knowledge on pertinent information to include in a soft skills
curriculum for people with autism.
After collecting all this information, the author was then able to identify the soft
skills that are areas of opportunity for individuals with autism and decided to use these as
40
the content for the curriculum. After having identified the content for the curriculum,
this author had a conversation with the Laguna Creek Supported Employment Specialist,
Cheryl Bear and discussed the ideas and proposed content to solicit feedback (personal
communication, December 12, 2013). During the conversation, the author described the
content of the curriculum, examples of exercises that would be included, and the addition
of helpful tools such as checklists. The feedback this author received from Ms. Bear was
positive, and she felt the exercises mentioned were great practice tools, especially if
implemented in a role-playing scenario as mentioned. Ms. Bear also stated that using
checklists was a great addition and is something she often saw job developers use with
their consumers in the field.
Design of Curriculum
The idea for the creation of this training curriculum was intended is to address the
core deficits in adults with autism: communication, interpersonal skills, and repetitive
behaviors. As such, this curriculum includes three training modules: one for
communication and interpersonal skills, one for work skills, and the third for work
tolerance. The three training modules serve to address the functional areas of the core
deficits of autism as they relate to employment. The intended audience for this
curriculum is transitioning consumers with autism or ASD. This curriculum will be
utilized by field staff including Senior Vocational Rehabilitation Counselors (SVRC),
Senior Vocational Rehabilitation Counselors-Qualified Rehabilitation Professionals
41
(SVRC-QRP), Employment Coordinators (EC), Service Coordinators (SC), job coaches,
and job developers in their interactions with consumers with autism.
The curriculum begins with an introduction section, which includes the definition
of soft skills, a self-assessment meant to assist in gauging current level of soft skills, as
well as a brief overview of the curriculum. Following the introduction, the curriculum
continues into with the first training module on communication and interpersonal skills.
This module begins with an introduction to communication and interpersonal skills and
includes a self-assessment to gauge current levels. A description of the functional
limitations of communication in autism as well as reasonable accommodations to employ
in the workplace follows. Next, interactive exercise activities and discussions are
included to assist in the building and development of communication skills. The second
and third modules follow the same format with the second module being on work skills
and the third module covering work tolerance. Each of the modules begins with an
introduction to that soft skill, a description of functional limitations and accommodations,
followed by interactive exercises and discussions to help build these skills in our
consumers. Finally, this curriculum ends with a list of resources specific to the autism
community.
42
Chapter 4
SUMMARY AND RECOMMENDATIONS
Summary
Autism has been receiving increasingly more attention worldwide, and it is with
this increased attention that researchers are realizing there is limited research available
highlighting this disorder in adults. As increasing numbers of individuals with autism
reach adulthood, information on how to best serve this population becomes critical. To
better serve adults with autism in their employment goals, this author sought to create a
pre-vocational skills training curriculum to address the core deficits in autism. To this
author’s knowledge, there are no soft skills curricula targeted specifically to adults with
autism.
Adults with autism are quickly becoming one of the largest disability groups in
the Unites States. A change in the diagnostic criteria in the early 1990s led to an increase
in diagnosing autism in children, and today those children are exiting the school system
and needing employment services. Researchers are only now beginning to realize the
need for studies on adults with autism as they are finding that even though most of a
typical lifetime is spent in adulthood, most research on autism is focused on early
childhood (Shattuck et al., 2012). From the limited research available on adults with
autism, studies indicate a lack of effective transition services in assisting transitioning
youth with autism in achieving employment outcomes due to lack of participation, lack of
43
information, lack of availability, and services of poor quality (Hendricks & Wehman,
2009).
In addition to the struggle navigating effective transition services, transitioning
adults with autism also navigate unique challenges in obtaining employment due to key
functional limitations. In relation to employment, individuals with autism experience
deficits in interpersonal skills, communication, social skills, work tolerance, and work
skills. These are key soft skills necessary for obtaining and maintaining employment.
Research shows that despite these deficits, with appropriate supports, people with autism
can work in a variety of settings (Friedman et al., 2013). Agencies that provide support
and assistance in building these skills include the Alta California Regional Center
(ACRC) and the DOR.
In California, DOR is one of the few formal systems providing specialized
Vocational Rehabilitation (VR) services to adults with autism. DOR is an agency that
assists Californians with disabilities to obtain and maintain employment and maximize
their ability to live independently (DOR, 2013). Limited studies exist detailing current
use of vocational rehabilitation services for individuals with autism; however, studies
show that the VR system appears to be as successful for people with ASD as for people
with other disabilities. Strategies for increasing employment should include matching the
individual to an appropriate job and emphasizing the need for job placement to be
individualized and based on the person’s strengths and interests (Hendricks, 2010).
44
During the research-gathering phase of the literature review, this author became
aware of the limited information available on employment outcomes for adults with
autism. Concurrently, this author also became aware that with the proper supports, this
population of individuals can become successfully employed. Using this information,
this author decided to create a pre-vocational skills training curriculum. The objective of
the curriculum was to serve as a tool in assisting field staff in building and practicing the
soft skills with which this population struggles: communication and interpersonal skills
and repetitive behaviors. The curriculum includes lessons on communication,
interpersonal skills, work tolerance, and work skills. This curriculum also includes a
listing of resources and agencies specific to individuals with autism.
Recommendations
The limited information currently available on autism as it presents in adults
substantiates the need for further research in the future. Researchers are only now
beginning to focus more efforts on understanding how to best serve this population in
adulthood; thus, the need to update this curriculum exists. As more information
regarding employment becomes available, the information in this curriculum may need to
be updated. Due to the core deficits faced by individuals with autism, it is important to
continue to develop new strategies for pre-vocational skills training. Also, as autism is a
spectrum disorder, future research may reveal additional insights into this disorder
creating the need for changes. Additionally, the resources listed at the end of the
45
curriculum will need to be updated as current resources may change and/or as new
agencies and services become available.
In addition to updating the information in this curriculum, it may also be
expanded to include further information. For instance, this author decided to focus on the
functional areas that substantiate the core deficits of autism: communication,
interpersonal skills, work tolerance, and work skills. Information on mobility, self-care,
and self-direction may be included to broaden the scope of skill building. This
curriculum can also be further expanded to include resume building, job searching skills,
and interviewing skills. This author recommends the use of this curriculum in any
academic, public, or private agency offering employment services to adults with autism.
46
APPENDIX
Autism in Young Adults:
A Pre-Vocational Skills Curriculum
47
Author’s Note
Some of the information and exercises created within this curriculum was adapted from
other sources. This author would like to recognize that this information was adapted
from: The Way I See It by Temple Grandin, Helping Youth Build Work Skills for Job
Success by the National Collaborative on Workforce and Disability, and the Job
Accommodation Network. Further information was found through standard Internet
searches on websites providing information for the general public.
48
TABLE OF CONTENTS
Page
INTRODUCTION..................................................................................................... 51
Characteristics of Autism Spectrum Disorder ................................................ 52
Identifying Potential Limitations ................................................................... 53
What are Soft Skills? ...................................................................................... 54
Common Soft Skills ............................................................................ 55
Best Practices: Daily Activities to Increase your Soft Skills .............. 56
Self-Assessment: Identifying Current Soft Skills ............................... 57
Situations and Solutions.................................................................................. 59
Description of Training Modules .................................................................... 60
MODULE 1: COMMUNICATION AND INTERPERSONAL SKILLS ............ 61
Introduction ..................................................................................................... 62
Functional Limitations & Workplace Accommodations: Communication .... 63
Functional Limitations & Workplace Accommodations: Interpersonal Skills 64
Communication and Interpersonal Skills ........................................................ 65
Why are Communication and Interpersonal Skills Important?....................... 65
Implications for Employment ......................................................................... 66
Top Communication Skills ............................................................................. 66
Topics to Avoid Discussing at Work .............................................................. 68
Methods of Communication ........................................................................... 70
Exercise 1: Instructions: Conversations .......................................................... 71
Exercise 1A Handout: Starting a Conversation .................................. 73
Exercise 1B Handout: Continuing a Conversation ............................. 74
Exercise 1C Handout: Closing a Conversation ................................... 75
Exercise 2 Instructions: Roleplaying Work Scenarios.................................... 77
Exercise 2 Handout: Roleplaying Work Scenarios ............................. 78
Exercise 3 Instructions: Communication & Interpersonal Skills
49
Self-Assessment .................................................................................. 80
Exercise 3 Handout: Communication & Interpersonal Skills
Self-Assessment .................................................................................. 82
MODULE 2: WORK SKILLS................................................................................. 84
What are Work Skills? .....................................................................................85
Functional Limitations & Workplace Accommodations: Work Skills ........... 86
Starting a New Job .......................................................................................... 87
Sample Work Schedules ..................................................................... 89
Work Skills ......................................................................................................92
Telephone Etiquette ........................................................................................ 92
Time Management .......................................................................................... 93
Prioritizing Work Tasks ...................................................................................95
Sample Master Lists ............................................................................ 97
Exercise 1 Instructions: Work Skills Self-Assessment ................................... 99
Exercise 1 Handout: Work Skills Self-Assessment .......................... 100
Exercise 2, 3, and 4 Instructions: Roleplaying Common Work Scenarios ... 101
Exercise 2 Handout: How to Call in Sick ......................................... 102
Exercise 3 Handout: How to Ask for Help ....................................... 104
Exercise 4 Handout: Constructive Criticism: How to
Handle Feedback ................................................................... 105
MODULE 3: WORK TOLERANCE .................................................................... 107
What is Work Tolerance? ............................................................................. 108
Functional Limitations & Workplace Accommodations: Work Tolerance .. 109
Sensory Stimulation ...................................................................................... 110
Atypical Body Movements ........................................................................... 112
Stress Management ....................................................................................... 112
Company Structure & Conduct Policy ......................................................... 112
Exercise 1 Instructions: Work Tolerance Self-Assessment .......................... 114
50
Exercise 1 Handout: Work Tolerance Self-Assessment ................... 115
Exercise 2 Instructions: Identify the Source of Your Anxiety...................... 116
Exercise 2 Handout: Identify the Source of Your Anxiety ............... 117
Exercise 3 Instructions: Identify the Work Tolerance Issue ......................... 118
Exercise 3 Handout: Identify the Work Tolerance Issue .................. 119
Autism Resources ..................................................................................................... 120
51
INTRODUCTION
52
Characteristics of Autism Spectrum Disorder
Autism Spectrum Disorder [ASD] is a neurodevelopmental disability that is
characterized by persistent deficits in social communication and social interaction across
multiple contexts, including deficits in social reciprocity, nonverbal communicative
behaviors used for social interaction, and skills in developing, maintaining, and
understanding relationships, and is accompanied by restricted, repetitive behaviors,
interests or activities (APA, 2013).
One of the core characteristics of autism is an impairment in social skills,
communication and interpersonal skills. Interpersonal skills are described as the ability
to establish and maintain relationships, and the ability to interact appropriately.
Individuals with autism exhibit these difficulties due to the inability to understand other
people’s emotions. As a result, common deficits include limited emotional and social
reciprocity, an inability to correctly perceive and/or read faces, difficulty establishing eye
contact, difficulty following social rules, and an overall lack of general social awareness.
Individuals with autism have difficulty engaging in small talk and reciprocal
conversations due to the lack of interactional skills. Often this results in not responding
to others appropriately and engaging in one-sided conversations.
A deficit in communication skills means an individual cannot accurately and
efficiently give or receive information. This often results in the individual not being able
to communicate effectively, not being able to understand others, and not being
understood by others. A common communication challenge is inaccurately
communicating needs and wants. Due to these challenges, people with autism often have
difficulty conveying their message and are often misinterpreted by others. Additionally,
the inability to understand other people’s emotions also includes non-verbal
communication, such as the failure to understand body language, tone of voice, and
expressions. As an example, a frustrated co-worker sarcastically exclaiming “Well that’s
just great!” might be interpreted literally by the individual with autism. Due to these
challenges, people with autism often lack the knowledge of understanding social
situations, how to reciprocate in conversation, and how to interpret both verbal and nonverbal communication.
In addition to the core deficits described above, individuals with autism also
exhibit restricted, repetitive behaviors, interests or activities. This presents challenges in
the workplace if these behaviors interfere with the ability to complete job tasks. Other
behavioral challenges often exhibited by individuals with autism include inappropriate
work behaviors such as tantrums, aggression, self-injury, and property destruction. These
are often the result of high levels of stress due to misunderstandings and the inability to
be understood, and typically serve as a coping mechanism. While these form the core
deficits of autism, it is important to remember that autism is a spectrum disorder, and as
such the degree and nature of these limitations will vary from one individual to the next.
For these reasons, a careful inspection of skills and abilities is necessary to determine the
individual strengths and weaknesses of all individuals with autism.
53
Identifying Potential Limitations
In respect to the varied nature in which the characteristics of autism present from
one individual to the next, the questions below are meant to assist in creating a narrowed
picture of the consumer’s possible limitations. To obtain a better understanding of what
the consumer’s limitations may be, the following questions will assist in gaining basic
knowledge on the consumer’s abilities.
1. What limitations does the consumer with ASD experience?
2. How do these limitations affect the consumer’s job performance?
3. What specific job tasks are problematic as a result of these limitations?
4. What accommodations are available to reduce or eliminate these problems?
(Be creative and brainstorm possible solutions with your consumer)
5. Can the consumer with Autism Spectrum Disorder provide information on
possible accommodation solutions?
These questions are intended to assist in determining specific information from
each individual prior to the implementation of this curriculum so as to aid the assessor in
determining what the consumers individualized needs may be. By having these answers
at hand, the Rehab Counselor may choose to spend more time with the consumer on a
specific training module as needed.
(Job Accommodation Network, 2013)
54
What are Soft Skills?
Soft skills are the qualities, personality traits, and social skills, which everyone
has in varying degrees. They are essentially interpersonal or people skills, and often
cross multiple areas in a workplace. Soft skills can include the skills that allow
consumers to interact well with co-workers and clients, like networking and
communication. They can also be the skills that demonstrate work ethic and
professionalism, like dressing appropriately for the job, showing enthusiasm and
motivation. They can also be critical thinking and problem solving skills, allowing the
consumer to make productive work decisions when no one is around to assist them. Other
soft skills that employer’s value include self-esteem, self-control, time management,
decision-making skills, and efficient task prioritization. Having a good foundation in soft
skills will increase a consumer’s ability to know and manage themselves, as well as their
relationships with others in a work setting.
Soft skills complement hard skills, which are learned skills often achieved
through training related to a career or profession, such as schooling, certificates, and
degrees. Soft skills are increasingly becoming just as important as hard skills. Often, it is
not enough to be highly trained in technical skills without developing interpersonal and
relationship-building skills that help people to communicate and collaborate effectively.
In today’s world, employers want workers who have a combination of hard skills and soft
skills. For example, which clerical person would you want to keep if you had to let
someone go? The one whose attitude is positive and upbeat, and who is always willing to
help; or the one who is inflexible and has a hard time admitting mistakes? On the next
page, a list of common soft skills employers may look for in potential employees is
presented to assist in identifying and understanding what soft skills are.
55
Common Soft Skills
Communication skills
Common Sense
Interpersonal skills
Optimism
Critical thinking
Good self-presentation
Problem solving
Positive attitude
Decision making abilities
Responsible
Time management
Honesty
Work ethic
Can take constructive criticism
Reliability
Self-Directed
Leadership
Can work under pressure
Teamwork
Can regulate emotions
Collaboration
Ability to manage stress
Understanding the big picture
Patient
Willingness to learn
Perceptive
Independence
Customer Service skills
Initiative
Business etiquette
Flexibility
Productive
Dependability
Effective planner
Good Attendance
Organized
Self-confidence
Active Listening
Commitment
Integrity
56
Best Practices: Daily Activities to Increase Your Soft Skills
Soft skills are often learned naturally throughout our lives and through personal
experiences. In addition to the information provided in this curriculum, the suggestions
highlighted below are some recommended best practices to help increase your soft skills.
 Practice in your personal life.
o Take advantage of the relationships in your life including family, friends,
and neighbors and use them as an opportunity to practice and enhance soft
skills such as interpersonal relationships, communication, and social skills.
 Take courses at a local community college.
o By enrolling in a course, individuals can learn valuable skills such as
accountability, working with others, communicating, prioritizing work,
and time management.
 Become a volunteer.
o Volunteering provides the opportunity to engage in a similar environment
as a paying job and enables the individual to learn skills such as
dependability, social skills, responsibility, communication, time
management, work skills, and work tolerance.
 Seek and adopt a mentor.
o Having someone with experience guide you through practicing current
soft skills and obtaining new ones will provide opportunities for learning.
 Engage in a hobby
o Having a hobby creates an opportunity to obtain new specialized skills.
 Request an Informational Interview
o Informational interviews from an interested career field will enhance a
consumers understanding of that particular job, as well as provide the
opportunity to learn what basic skills are needed. By obtaining this
information, the consumer is then able to focus on those specific skills and
enhance their employability.
The key to building soft skills over time is by practicing consistently. Make sure
to educate your consumers on the importance of establishing the habit of engaging in
these activities on a daily basis. In addition to using the above best practices, it is
important to be able to establish where your consumer is in regards to their current soft
skills. On the next page, a self-assessment is available for you to copy and hand out to
your consumer to determine the level of soft skills they currently possess.
57
Self-assessment: Identifying Current Soft Skills
Name:________________________________________
Date:___________________
Many soft skills are often acquired and learned naturally through past
experiences. This self-assessment report is intended to identify current skills you may
possess. Please answer the following questions as best you can:
1. Think about a time in your life when you had a job, volunteered, played sports, or
had a hobby. In the space below, write down any and all of these activities you
participated in:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. In the space below, list the skills you needed for each of the items you listed in
question one. For example, playing soccer requires working in a team, talking
with others, being reliable, etc.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. In the space below, identify the type of skills you listed in question two. (For
example: communication skills, social skills, work skills, attendance, work ethic,
teamwork, etc.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
58
4. In the space below, please identify any soft skills in which you have little or no
experience with and which you would like to work on improving:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Please use the space below to write any additional questions, comments, or notes:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________________________
59
Situations and Solutions:
The Job Accommodation Network [JAN] provides examples to illustrate
scenarios in which there were problems in the workplace, and describe methods in which
those employees were accommodated. The following situations and solutions are meant
to serve as examples to encourage employers in providing accommodations to assist in
maintaining employment for the population with autism.
Situation: An employee with ASD works for a large marketing firm. Though
knowledgeable in her field, she had difficulty participating in work activities with
her team.
Solution: JAN suggested job restructuring, which allowed her to work
independently while providing information to her team electronically. This gave
the employee the social distance she needed to be comfortable, yet also provided
the team with information needed to move forward with marketing campaigns.
Situation: A new hire at a fast-food restaurant has ASD. He complete his new
job tasks quickly and efficiently, but then remained idle until someone told him
the next task to perform. The manager complained that the employee stood
around and looked bored.
Solution: Jan suggested the use of a job coach to help the employee learn the job
and how to stay occupied during down time. They also suggested using a training
DVD to help build workplace social skills.
Situation: An applicant with ASD applied for a research position with a chemical
company. He has a verbal communication deficit, though can communicate
through handwriting and by email. The employer wanted to provide
accommodations during the first stage interview, which involved answering
questions from a three-person committee.
Solution: JAN suggested providing the questions in advance and allowing the
applicant to furnish written responses during the interview.
Situation: A professor with ASD had difficulty keeping daily office hours and
experienced anxiety because the timing of student consultations was
unpredictable.
Solution: JAN suggested modifying the schedule by reducing the number of days
he has office hours but having more office hours on those days. JAN also
suggested creating a method in which students must request appointments at least
one day in advance and further suggested the professor take notes during each
appointment to refresh his memory about previous meetings with the student.
________________________________________________________________________
(Job Accommodation Network, [JAN], 2013)
60
Description of Training Modules
This training curriculum consisting of three training modules will assist in
teaching and practicing soft skills to adults with autism. The training modules cover
three main areas: communication and interpersonal skills, work skills, and work
tolerance. Each training module will include an introduction to the module, functional
limitations and accommodations, discussions, exercises, tools, role play scenarios, and
summary discussions.
Learning Outcomes:
Upon completion of this curriculum, individuals will have knowledge on the
functional limitations and accommodations for adults with autism and will be able to
work with this population to assist in teaching and practicing softs skills.
Length of Training:
This curriculum consists of three training modules and each training module
provides approximately 2 hours of training. The entire length of training for all three
modules is approximately 6 hours.
Target Leaners:
This training curriculum is intended for Senior Vocational Rehabilitation
Counselors [SVRC], Senior Vocational Rehabilitation Counselors-Qualified
Rehabilitation Professionals [SVRC-QRP], Employment Coordinators [EC], and Service
Coordinators [SC]. The intended audience is limited to the DOR Northern Sierra District
in Sacramento, California. Individuals with autism as well as their family, friends, and
support systems may also benefit from this curriculum.
61
MODULE 1:
COMMUNICATION AND INTERPERSONAL SKILLS
62
Introduction
For individuals with ASD, navigating barriers to employment is especially
difficult due to the nature of disability. The characteristics and deficits of autism are
those very skills which are required in almost every job imaginable; social skills,
communication skills, interpersonal skills, and interacting with others. In order to
achieve and maintain meaningful employment, an individual must possess basic
communication and interpersonal skills. For the population with autism, communication
and interpersonal skills are the primary deficits.
People with ASD may have difficulty communicating with coworkers and/or
supervisors. They are often described as concrete, literal thinkers and may find it to be
extremely hard interpreting voice inflection, sarcasm, and body language. Additionally,
this population may have difficulty with interpersonal skills, understanding other
people’s emotions, and may lack social skills. This can include challenges with joint
attention, reciprocity, eye contact, and initiation. During conversations, this may
manifest itself as interrupting others when they are working or talking, difficulty listening
to others, lack of eye contact when communicating, and difficulty interpreting body
language and other types of non-verbal communication.
Those with ASD are often described as lacking the theory of mind; the ability to
recognize that other people’s feelings, thoughts, beliefs, and intentions are different from
theirs and how to respond to the other person accordingly. This leads to problems
understanding why people feel, think, and do the things they do. As a result, people with
ASD are have trouble predicting how another person might respond to them and what the
other person is likely to do next. This is known as lacking executive functioning, or the
ability to plan and organize tasks, monitor one’s own performance, inhibit inappropriate
responses, utilize feedback and create a plan, and problem solve and develop strategies.
Oftentimes, behaviors that are exhibited due to a lack of executive functioning
can include noncompliance, off-task behavior, social inappropriateness, initiation of
tasks, and disorganization. In terms of employment, this can create difficulty in the
employee being able to adhere to conduct standards, work effectively with supervisors,
and/or interact with coworkers and customers. Knowing how to accommodate an
employee is important in maintaining work success. The two tables that follow describe
the functional limitations in communication and interpersonal skills and the
accompanying job accommodations to work around these deficits.
63
Functional Limitations and Workplace Accommodations: Communication
Functional Area: COMMUNICATION
Definition: The ability to effectively give and receive information through speaking,
listening, reading, or writing without reasonable accommodation or other adaptive
methods (Department of Rehabilitation, 2013).
Functional Limitations:
• Unable to communicate effectively
• The individual is not understood by
others
• The individual has difficulty
understanding others
• May be dependent upon a person,
service, device, or alternate mode of
communicating
•Unable to relate basic information about
themselves, their environment, or what
they just did
•Have trouble answering questions such
as why, what, where, how and when.
Workplace Accommodations:
The Job Accommodation Network [JAN]
(2013), suggests the following workplace
accommodations:
• Provide advance notice of topics to be
discussed in meetings to help facilitate
communication
•Provide daily guidance and feedback
and offer positive reinforcement
• Give assignments verbally, in writing,
or with visual aids as is most beneficial
to employee
• Allow employee to provide written or
other preferred form of response in lieu
of verbal response
• Allow alternate forms of
communication between coworkers such
as e-mail, instant messaging, or text
messaging
• Provide clear expectations and
consequences of not meeting
expectations
• Modify the manner in which
conversations take place, meetings are
conducted or discipline is addressed
64
Functional Limitations and Workplace Accommodations: Interpersonal Skills
Functional Area: INTERPERSONAL SKILLS
Definition: The individual has difficulty establishing and maintaining relationships at all
levels including personal, family, and community (Department of Rehabilitation, 2013).
Functional Limitations:
• Cannot establish and maintain
relationships with others
• Difficulty exhibiting typical social
skills
• Difficulty interpreting body language
and nonverbal innuendo
• Exhibits inappropriate behaviors such
as:
– Tantrums
– Aggression
– Destruction of property
– and
• These affect the ability to adhere to
conduct standards and work and interact
with others appropriately
• As a result, is avoided by others and
socially isolated
Workplace Accommodations:
The Job Accommodation Network [JAN]
(2013), suggests the following workplace
accommodations:
• Provide sensitivity training to promote
disability awareness
• Provide a mentor to help employee
“learn the ropes”
• Allow alternate forms of
communication between coworkers such
as e-mail, instant messaging, or text
messaging
• Review conduct policy with employee
to reduce unacceptable behaviors
• Use training videos to demonstrate
appropriate social skills in the workplace
• Use role-play scenarios to demonstrate
appropriate social skills in the workplace
65
Communication and Interpersonal Skills
Communication is the ability to effectively give and receive information. The
ability to communicate effectively with supervisors, colleagues, and employees is
essential, no matter what job or industry your consumer works in. Communication
involves being able to actively listen to others and articulate ideas in a way where the
consumer is heard and can achieve the goals they intended with that communication.
Interpersonal skills are most often thought of as a set of skills that allow people to
communicate, relate and socialize with others. Interpersonal skills are often one and the
same as communication. They include both verbal and nonverbal forms of
communication, and may be defined differently from one culture to another. Verbal
skills include being able to determine the appropriate thing to say at the appropriate time,
being able to communicate in ways that are engaging, have a range of vocal tone and
quality, and being able to speak in an understandable manner. These skills are often
judged by what a person says, when they say it, and how they say it. People with good
social skills speak with a clear voice, speak appropriately to a situation, and have
confidence in their voice. Poor social skills can include having a monotone voice, saying
the wrong thing, speaking too softly to be heard, or speaking too loudly to be tolerated.
Nonverbal social skills can be just as important. These skills include body
language, standing up straight, making eye contact, using appropriate gestures, leaning
toward the person who is speaking, smiling appropriately, and keeping the body open. It
is important to remember that these can be overdone, and teaching your consumer to
know how and when to engage in them is an important part of practicing social skills. For
example, hand gestures can be too dramatic, staring for too long may make others
uneasy, and leaning too far forward into someone else’s personal space may be
considered rude. Teaching consumers how and when to engage in these social skills is an
important part of learning soft skills.
Why are Communication and Interpersonal Skills Important?
Without these skills, a consumer with autism may not be able to successfully navigate the
work environment. Individuals with autism are concrete, literal thinkers and often say
what they are thinking without thinking about how it might affect others. It is common
for them to speak bluntly without cushioning criticism the way most people do. They
might say, “That’s a really ugly shirt,” or, “This is a dumb way to sort files.” Speaking
bluntly in a workplace could land the consumer in trouble and could lead to termination.
Knowing when and what to say around others is an important part of keeping a job.
Having these skills means a consumer is able to:
 Cooperate with others
 Speak so others can understand
 Understand what others are saying
66






Convey ideas in writing
Listen Actively
Observe Critically
Guide Others
Resolve Conflict and Negotiate
Advocate and Influence
Implications for Employment
Having deficits in communication and interpersonal skills can result in serious
implications for employment. Without these important skills, the consumer with ASD:









Cannot read social cues of the work environment
Failure to greet staff and coworkers
May not look at the person who is giving directions
Difficulty participating in the back and forth exchanges in conversation
May walk away from staff who is giving them important instructions
Failure to ask for clarification on instructions
Abruptly interrupt others to make an irrelevant comment
Unable to read nonverbal cues (Supervisor is mad, or busy)
Difficulty asking for help or additional work
Top Communication Skills
To achieve workplace success, it is important to understand the basic foundations
in communication and how to achieve them. Here is a list of some of the top
communication skills, why they are important, and how to teach your consumers to
practice them in their daily routine.
Listening
Being a good listener is key to being a good communicator. Communicating is
about giving and receiving; no one wants to talk to someone who only cares about their
own problems and does not take the time to listen to the other person. Practice teaching
your consumer to be a good listener by teaching them to pay close attention to what the
other person is saying, asking clarifying questions, and rephrasing what the other person
just said. Being a good listener means your consumer can better understand others and
respond appropriately.
67
Non-verbal communication
A lot of communication is conducted non-verbally and can include eye contact,
body language, hand gestures, and the tone of voice. If the consumer stands with an open
stance, arms and legs relaxed they are conveying to others that they are approachable.
On the other hand, if your consumer was to stand with their legs together, arms crossed
and a frown on their face, it will signal to others that they may be angry, frustrated, or in
a bad mood and will discourage others from approaching them. Teach your consumer to
practice posturing in a relaxed, open stance and make sure to maintain eye contact with
the person they are talking to, this shows them that they are focused on the conversation.
Being clear and concise
Teach your consumer to do their best to get their message across in as few words
as possible. Have them practice saying what they want clearly and directly. If the
consumer rambles or does not get to the point quickly, others may not know what they
want or may even tune them out. You can teach them to practice this by thinking about
what they want to say before they even say it, this will help prevent your consumer from
confusing others and rambling on.
Friendliness
How your consumer presents themself to others is an important part of
communication. Saying hello to co-workers with a smile will encourage them to engage
with your consumer. It is also important to teach consumers to use courtesy words such
as please and thank you when others do something for them. This shows coworkers that
your consumer notices and appreciates their efforts, and will foster better communication
and relationships with others.
Empathy
Empathy involves understanding what others are experiencing. Even if your
consumer disagrees with a co-worker, it is important for you to teach them that it is
important to respect others’ point of view. Using simple phrases such as “I know what
you mean”, or “I understand what you are saying” shows that your consumer is listening
and being respectful to others’ opinions or point of view.
Open-mindedness
It is important to teach your consumer the importance of always maintaining an
open mind when communicating with others. Teach them to be flexible in listening and
understanding other people’s point of views, even if they do not agree with them. By
68
keeping an open mind, your consumer will be able to have more honest and productive
conversations.
Respect
People are more willing to talk and communicate when they feel respected. In
order to get respect, you must teach your consumer to show respect. People will be more
open to communicating with your consumer if they express respect for others. People
want to be heard and appreciated, and by showing respect your consumer will earn
respect from others.
Feedback
Feedback is an important part of communication. Being able to appropriately
give and receive feedback is an important part of being a good employee. Managers will
often provide constructive feedback meant to help their employees be better workers.
Managers may also provide positive feedback such as praise on doing a job well done. It
is important to teach your consumer to be open when they are receiving feedback from
others to show that they are open-minded and willing to improve. Teach your consumer
to listen to the feedback they are being given carefully, and then they ask clarifying
questions if they remain unsure of the issue.
Picking the right medium of communication
It is important for your consumer to know when and where it is appropriate to
have certain conversations. For example, a serious conversation such as discussing a
conflict with another employee is always best done in person and in a private area. Tell
your consumer to think about the person they are trying to talk to, if it is a manager, they
might have a busy schedule and not always be available. In this situation, teach your
consumer to consider sending them an email asking for a time and date to meet to discuss
a matter with them. This shows your consumer is being respectful of their manager’s
time, and allows for them to set some time aside to talk to your consumer privately.
Topics to Avoid Discussing At Work
Communication is present in all day-to-day activities and knowing what is
acceptable and what is not an acceptable topic of communication is important for your
consumer to maintain employment one they are offered a job. Below you will find a list
of topics that are inappropriate for the work environment. Talk to your consumer about
these taboo work topics and explain to them that engaging in these in the workplace can
lead to serious repercussions, up to and including job termination.
69
Religion
Your consumer should never discuss their religious beliefs or their thoughts about
other religious beliefs while at work. Religion is a very personal issue and people are
very sensitive about it. Even if your consumer knows that their colleagues share similar
religious beliefs, others may overhear the conversation and feel uncomfortable by it.
Politics
Politics can be as personal as religion and it will detract from your consumers
work. Even if your consumer may feel very strongly about their political party or
candidate, or have negative views about the opposition, they should not try to win their
coworkers over. Talk to your consumer about keeping their political affiliation to
themselves and to stay focused on their job by concentrating on their duties.
Sex
Sex should never be a topic of discussion at work. Talking about sex can make
another colleague feel uncomfortable and may be construed as sexual harassment. Talk to
your consumer about the importance of discussing anything sexual and explain to them
that serious repercussions may include job termination.
Problems with Family
Even if your consumer is experiencing problems with their families, it is
important to teach them that it is unacceptable workplace behavior to discuss these
problems with coworkers. When your consumer discusses problems they are having in
their personal lives with others, their coworkers and supervisor may wonder if those
problems are distracting your consumer from doing their job.
Health
If your consumer is legitimately sick and must take time off work, then it is
appropriate for them to vaguely discuss their health situation with their supervisor.
However, going into detail is unnecessary and talking too much about their health may
lead supervisors to think your consumer’s illness will inhibit their workplace abilities.
70
Methods of Communication
While most people communicate verbally, there are many other ways in which
people can communicate. Methods of communication may include:





Verbal (sounds, language, and tone of voice)
Aural (listening and hearing)
Non-verbal (facial expressions, body language, and posture)
written (journals, emails, blogs, and text messages)
Visual (signs, symbols, and pictures)
Sometimes the person with ASD may feel too overwhelmed by engaging strictly
in conversations. Using different methods of communication is one way to accommodate
the stress of constant verbal communication for your consumer. If this is the case just
remember to discuss with your consumer the importance of talking to their supervisor
about using different communication methods. If your consumer and their supervisor are
in agreement with using an additional method of communication, discuss with your
consumer the importance of maintaining constant contact so that their supervisor knows
what they are doing.
Module 1 Exercises
Talking about communication and social skills and actually working on them are
two different things. Now that we have covered all of the important soft skills for
communication and interpersonal skills, it is time to engage in some helpful exercises
meant to assist you in teaching your consumer how to build on their soft skills. The best
way for your consumer to learn effective communication and social skills is by practicing
them. On the following page you will find instructions for completing the exercises in
this training module.
71
Exercise 1 Instructions: Conversations
In these exercises, you will teach your consumer ways to approach others in a
social setting, how to continue a conversation, and how to close a conversation. One of
the most daunting aspects of socializing with others is often the first step; walking up to
someone or a group and introducing yourself. In this exercise you will show your
consumer various ways to approach others including examples they can practice their
daily activities.
Materials Needed:

Copies of Exercise 1A, 1B, and 1C handouts. You will give these to your
consumers.
Directions:
Exercise 1A:
For this exercise arrange your consumers in pairs of two. Once your consumers
are paired up, determine who will act the part of the person approaching the other. Once
the roles have been established, have your consumers begin the exercise. Once they have
completed their part, have them switch their roles and take turns being the first to
approach the other person.
Exercise 1B:
This exercise is a continuation of Exercise 1A. In the first exercise, your
consumer is being shown how to approach another person or group of people. In this
exercise, we will provide examples of what your consumer can do in order to keep a
conversations going. Just as in the first exercise, you can work have your consumers
work in pairs, or you can have them work in groups of 2-4. Have your consumers take
turns practicing the examples and encourage them to improvise and use their own
examples.
Exercise 1C:
This exercise is a continuation of Exercise 1A and 1B. In this exercise your
consumer will learn how to close a conversation appropriately. Just as in the last two
exercises, have your consumer’s pair up or work in teams alternating taking turns.
72
Discussion
After your consumer has completed this exercise, they will find the following
discussion questions at the end of Exercise 1C. The purpose of these discussion
questions is to have your consumers talk amongst themselves and share their view on the
exercises and what they learned. For this discussion, you may choose to have your
consumers stay with their partner, or you can have the discussion with group as a whole.

Question 1. How did you feel when you first had to approach someone and start a
conversation?

Question 2. What were some of the challenges you felt in this exercise?

Question 3. What was easy or easier for you about this exercise?

Question 4. What did you learn about how having conversations with others?
73
Exercise 1A Handout: Starting a Conversation
You can meet new people almost anywhere, even if you are by yourself in an
unfamiliar place. Chatting with people is a great way to build your social circle, so
having the ability to approach a group and meet lots of new people is a powerful social
skill to develop. Approaching others is simply a matter of introducing yourself. Now
let’s begin this exercise.
Directions:
First, walk up to your partner and say "Hi, my name is _____." Once you
introduce yourself, others will start to introduce themselves.
Here are some more examples of greetings you can say to help you approach others:
“Good morning, how are you?”
“Hi _____, what’s new today?”
“Hi _____, how was your weekend?”
“Hi _____, I like your hat”
Another way to approach others is by make general comments about your
surroundings such as:
“I like the way the work station is set up”, or
"The food looks really good", or
"Jenny has done a great job of cleaning this area"
If the person does not reciprocate, try again with someone else. Remember to be
aware of your body language in addition to what you say. Don't cross your arms and
make sure to have a smile on your face.
74
Exercise 1B Handout: Continuing a Conversation
Now what you know how to start a conversation, it is time to practice how to keep
a conversations going. Remember that talking with others involves equal participation
from everyone involved. If you have little experience talking to others, it can be hard to
know what to talk about. A general rule is to ask questions or start talking about a
specific subject or topic.
Here are some examples of questions and topics you can discuss to keep a
conversation going:
“Do you like books?”
“Tell about your favorite movie”
“My favorite color is red, what’s yours?”
“I really like horror movies.”
“What’s your favorite kind of food?”
“I like your shirt. Where did you get it?”
“I went to a museum this weekend, do you like museums?”
There are some things that you can prepare beforehand, such as funny jokes or
interesting stories. It is best to talk about topics that are mainstream. Some examples
include:





sports
music
current events
favorite movies
restaurants
Ask questions and try to find common interests with others. Make sure that your
questions are open-ended and encourage conversation. For example, it is better to ask,
"How do you like being a veterinarian?" rather than "So, you are a veterinarian?"
75
Exercise 1C Handout: Closing a Conversation
Just as it is important to learn how to approach others, it is also important to know
how to end a conversation. When you are at a point where you are ready to end your
conversation, first prepare to close a conversation; then say goodbye. Ending a
conversation involves many factors, including preparing to close the conversations, using
follow-ups, and then actually closing the conversation.
Pre-closing Examples:
“It's been nice talking to you.”
“It's been great talking with you.”
“I really enjoyed meeting you.”
“It was nice meeting you, Mr. Brown.”
“I'm sorry, but I have to go now.”
“I'm afraid I have to leave now.”
“Thanks for the information/ the tour/ your time.”
“Thanks for taking the time to talk with us.”
Follow-up Examples:
“I'll give you a call.”
“I'll send you an e-mail.”
“I'll put a packet in the mail for you.”
“I’ll send out that information right away.”
“I'll have my secretary schedule an appointment.”
“Could you send me a brochure/some more information?”
“Could I contact you by e-mail/at your office?”
“How do I get in touch with you?”
“How can I reach/contact you?”
Closing Examples:
“I look forward to seeing you again.”
“I'll see you on Monday.”
“See you next week.”
“Here's my e-mail/office number.”
“Let's keep in touch by e-mail.”
“We'll be in touch.”
“Call me if you have any questions.”
“E-mail me.”
76
Now let’s practice closing a conversation. With a partner or in a group, use some
of the examples provided above and take turns closing a conversations using the preclose, follow-up, and closing examples. Below is an example of a back and forth
exchange of how to exit a conversation:
Person 1: “Well, it's been nice talking to you.”
Person 2: “Nice talking to you too.”
Person 1: “I’ll send out that information right away.”
Person 2: “Okay thanks. I can’t wait to see it”
Person 1: “Your welcome, I’ll see you later.”
Person 2: “Bye.”
Exercise 1 Discussion
Consider what you learned during this exercise. The purpose of this exercise is to
help you practice starting a conversation, how to keep a conversation going, and how to
close a conversation. With your partner or in a group, ask yourself the following
questions and discus your opinions.




Question 1. How did you feel when you first had to approach someone and start a
conversation?
Question 2. What were some of the challenges you felt in this exercise?
Question 3. What was easy or easier for you about this exercise?
Question 4. What did you learn about how having conversations with others?
77
Exercise 2 Instructions: Roleplaying Work Scenarios
These role playing activities will provide practice in identifying non-verbal cues,
and making decisions on how to communicate correctly with others in the workplace.
For this exercise, you may use two volunteers or you may choose to have your
consumer’s pair up and work one-on-one.
Materials Needed:


Copies of Exercise 2 Handouts
Volunteers to act out a short role play
Directions:
Ask for volunteers to act out a short role playing skit. Each role playing scenario
requires two people to act out the role of coworkers in a workplace setting. There are two
different scenarios in this exercise, you may use the same two consumers to act out both
skits, or you may choose two new volunteers. Once you have your volunteers, or have
picked out two consumers, have them take their place at the front of the room so that they
are visible by everyone. Once the roles have been established, have your consumers
begin the exercise.
Alternate Directions:
If you prefer, you may have your consumers pair up in teams of two and have
them practice role playing one-on-one. Just as in the directions above, once your
consumers are paired up and have established which role they will play, have them begin
this exercise. Once they have completed their part, have them switch their roles and take
turns being the first to approach the other person.
Discussion
After your consumers have completed each scenario, they will find the discussion
questions listed below directly after each skit. The purpose of these discussion questions
is to have your consumers talk amongst themselves and share their view on the exercises
and what they learned. For this discussion, you may choose to have your consumers stay
with their partner, or you can have the discussion with group as a whole.




Question 1. What is the inappropriate behavior?
Question 2. What are the verbal and nonverbal cues?
Question 3. How would you correct the behavior?
Question 4. What could Sean have done differently?
78
Exercise 2 Handout: Roleplaying Work Scenarios
In this exercise, we will be taking a look at two different work scenarios. In the
first role play, John and Mary are both coworkers in a retail store where their job is
unpacking and sorting new merchandise. In the second role play, Sean is a new
employee who is just staring his first day in a new office. For both exercises, pay careful
attention to the verbal communication as well as the nonverbal communication and see if
you can figure out what the inappropriate behavior is. Now let’s begin this exercise.
Scenario 1:
John and Mary work in a stockroom unpacking clothes and hanging them up on
racks. Mary is a great worker but she constantly walks around with a frown on her face
and her shoulders slumped.
John: “Mary, can you please hand me the pack of hangars that’s on the shelf next
to you?”
Mary: (Mary reaches for the hangars with a scowl on her face) “Here John.”
John: “Thanks Mary.”
Mary: (Mary turns away and shrugs her shoulders) “Humph”.
Scenario 1 Discussion:




Question 1. What is the inappropriate behavior?
Question 2. What are the verbal and nonverbal cues?
Question 3. How would you correct the behavior?
Question 4. What could Mary have done differently?
Scenario 2:
Sean is new to the office. He often touches people while talking to them and puts
his hands on their shoulders. When he is talking to others, he walks right up to them and
stand in their personal space, making them feel uncomfortable.
Wendy: “Hi Sean, I’m Wendy it’s nice to meet you”
Sean: (Sean walks right up to Wendy, stands toe to toe with her and puts his hand
on her shoulder) “I’m Sean”
79
Wendy: (Wendy takes a step back, out of Sean’s reach) “Yeah, hi Sean welcome
to the office”
Sean: (Sean takes a step forward and puts his hand back on her shoulder) “Thank
you, I am glad to be here”
Wendy: (Wendy starts to walk away from Sean) “Well it was nice to meet you,
I’ll see you later”
Scenario 2 Discussion:




Question 1. What is the inappropriate behavior?
Question 2. What are the verbal and nonverbal cues?
Question 3. How would you correct the behavior?
Question 4. What could Sean have done differently?
80
Exercise 3 Instructions: Communication & Interpersonal Skills
Self-Assessment
For this exercise, you will be giving your consumer a communication and
interpersonal skills self-assessment. This assessment will provide you with the
opportunity to see where your consumer is regarding their communication and
interpersonal skills and allows for you to better identify what their needs may be.
Materials Needed:


Copies of Exercise 3: Communication and Interpersonal Skills Self-Assessment
Handouts
Pencils
Directions:
First pass out copies of this self-assessment. Once your consumers all have a
copy, you can explain to them the purpose of this assessment. Ask them to be honest
when answering the questions and to circle the answer they feel most appropriately fits
them. Allow your consumers approximately 20 minutes to answer the questions. Once
they are finished taking the self-assessment, you may go over the questions with them.
The answer key below will provide you with the correct answers as well as an
explanation as to why these are the best answers.
Exercise 3 Answer Key:

Question 1: C. Conversations should be balanced with equal participation from
all parties involved.

Question 2: B. It’s good to initiate the introduction and introduce yourself with a
handshake and a smile. If shaking hands is difficult, you can also nod your head.
Initiating the introduction helps build rapport with others.

Question 3: A. it’s always good to initiate conversations with small talk, this will
help break the ice and lets the other person know you are interested in their day.

Question 4: A. It’s good to call people by their names whenever possible. It
makes a good impression, and shows you respect them and remember their name.
81

Question 5: A. Regularly using courtesy words is important to show politeness,
respect, and to build rapport.

Question 6: C. Smiling when greeting people and at appropriate times helps to
build rapport.

Question 7: A. Making eye contact gives the impression you are interested and
engaged in the conversation.

Question 8: B. In general, standing an arm’s length, or between two to three feet,
is the appropriate distance. Standing closer than an arm’s length can make others
feel uncomfortable, and standing too far can break down rapport.

Question 9: C. Leaning slightly forward and facing the speaker shows you are
interested and it helps build rapport. Sitting with your arms cross sends the
message that you are being defensive while leaning back or turning away from the
speaker may give the message that you are bored or disinterested in the
conversation.

Question 10: A. You don’t always have to agree with other people, however it is
important to agree disagreeable. Be respectful of others and their opinions.
82
Exercise 3 Handout: Communication & Interpersonal Skills
Self-Assessment
For each of the following questions, read each question then mark the one that
best describes your communication style. This assessment exercise is meant to help you
evaluate your interpersonal communication skills and style.
Question 1:
___ A. When conversing with others, I usually do most of the talking.
___ B. When conversing with others, I usually let the other person do most of
the talking.
___ C. When conversing with others, I try to spend equal time conversing and
listening.
Question 2:
___ A. When I first meet someone, I wait for the other person to make the
introduction first.
___ B. When I first meet someone, I introduce myself with a smile and offer a
handshake.
Question 3:
___ A. I usually warm up new conversations with small talk.
___ B. I usually avoid small talk and jump straight into what I need to discuss.
___ C. I usually avoid starting conversations.
Question 4:
___ A. I make an effort to remember and use other people’s names.
___ B. I don’t pay attention to names and I tend to forget them.
___ C. I only learn the names of important people.
Question 5:
___ A. I frequently use courtesy words and phrases, such as “please,” “thank
you,” “you’re welcome,” and “I’m sorry.”
___ B. I occasionally use courtesy words and phrases.
83
___ C. I never use courtesy words and phrases.
Question 6:
___ A. I tend to be serious and don’t smile often when conversing with others.
___ B. I smile all the time while conversing with others.
___ C. I smile at appropriate times while conversing with others.
Question 7:
___ A. I make eye contact while conversing.
___ B. I sometimes make eye contact while conversing.
___ C. I never make eye contact while conversing.
Question 8:
___ A. While conversing, I stand one foot away from the person.
___ B. While conversing, I stand two to three feet away from the person.
___ C. While conversing, I stand five to six feet away from the person.
Question 9:
___ A. When I’m listening to the speaker, I often cross my arms over my chest.
___ B. When I’m listening to the speaker, I often lean back and turn my body
away from the speaker.
___ C. When I’m listening to the speaker, I often lean slightly forward and face
my body toward the speaker.
Question 10:
___ A. When I disagree with a person, I listen first, ask questions for
clarification then disagree non-judgmentally.
___ B. When I disagree with a person, I quickly point out the person is wrong
and why.
___ C. When I disagree with a person, I say little or nothing.
84
MODULE 2:
WORK SKILLS
85
What Are Work Skills?
Work skills simply means the ability to carry out the specific tasks of a job. For
people with ASD, many have never had the opportunity to be employed and lack any
kind of work skills. In general, individuals with Autism perform best at jobs which are
structured and involve a degree of repetition. It is important to remember that just as
each person with autism is an individual, their interests and skills will vary from
consumer to consumer. Persons with autism have many key strengths, and focusing on
jobs which utilize those strengths will help maximize job success. Here is a list of some
of the consistent above average skills that consumers with autism possess:







High levels of concentration
Reliability
Persistence
Accuracy and attention to detail
Ability to identify errors
Technical abilities
Excellent memory
In learning work skills, there are common obstacles that the consumer with autism
must navigate. As a service provider, it is important to understand what these barriers are
so that you can be identify them and develop solutions. Below is a list of common
workplace challenges faced by individuals with autism:








Difficulty identifying who is in charge
Challenges during breaks and lunchtime
May refuse to share a workspace
Inability to prioritize work and maintain organization
Difficulty following multistep instructions
Difficulties understanding verbal instruction
Inflexibility to routine changes
Repetitive and obsessive behaviors may cause conflict at the work environment
Being aware of the functional limitations of your consumer when it comes to work
skills is the first step in understanding how to best work with an individual with autism.
In the table below, a description of the functional limitations and the accompanying job
accommodations will provide some examples of workplace solutions.
86
Functional Limitations and Workplace Accommodations: Work Skills
Functional Area: WORK SKILLS
Definition: The ability to do specific tasks required to carry out job functions
(Department of Rehabilitation, 2013).
Functional Limitations:
• Inability to obtain or maintain
employment usually available to
persons of equivalent age and
education
• Lack of work skills
• Lack of work experience
• Can typically only learn tasks which
are routine and repetitive
• Reduced speed of task
• Limited in ability to recall instructions
and/or task sequence
• The presence of repetitive, restrictive
patterns of behavior may disrupt tasks
and/or disturb coworkers
Workplace Accommodations:
The Job Accommodation
Network [JAN] (2013), suggests the
following workplace accommodations:
• Provide sensitivity training for
employees
• Give assignments verbally, in writing,
or with visual aids as is most
beneficial to employee
• Provide daily guidance and feedback
and offer positive reinforcement
Time Management:
• Provide clear expectations and
consequences of not meeting
expectations
• Divide large assignments into smaller
tasks
• Provide checklists, calendars,
organizers, and/or alarms to assist in
time management
• Requires more training and supervision
Memory, Organization & Multitasking:
• Provide written instructions
• Allow additional training time for
new tasks
• Separate tasks so that they can be
completed one at a time
• Remove or reduce distractions from
work area
• Use weekly chart to identify work
tasks
• Provide cheat sheets of high-priority
tasks
87
Starting a New Job
Helping your consumer understand their job and what they need to accomplish is
the first step in building work skills. In this module you will learn how to educate your
consumer on time management, telephone etiquette, and how to prioritize work tasks.
Often, consumers with autism have little or no work experience and have challenges
knowing how to get the work done, where to start, and how to follow a schedule. To
achieve workplace success, it is imperative that they understand job tasks, work goals,
and how to prioritize and be organized. Here are some basic things you can discuss with
your consumer when they obtain a new job to make sure they understand their job tasks
and how to accomplish them successfully:
Know your supervisor(s)
In any work setting, there can be a wide variety of people who your consumer
may report to. When they start a new job, explain to them why it is important for them to
get to know who is in charge and who they will report to. In a typical work setting, this
can include a team of people, such as a Manager, Supervisor, Assistant Manager, Team
Leader, etc. Have your consumer write down the names of the people they will report to.
This will assist your consumer in knowing who to ask for help in case one of them is not
there.
Familiarize yourself with your work area
As a new employee, your consumer should always know where the employee
restrooms are located, where the break room/lunchroom is, and where they can store their
personal belongings. Typically, if your consumer is new on the job, someone will show
them around. Remind them that if they forget, they can always ask a supervisor or
another coworker.
Get to know your job duties
Usually, the onsite supervisor will explain to your consumer what their work
duties are. This helps your consumer understand their job duties and what is expected of
them. Employers have goals to meet, and your consumer’s job is to help meet those
goals. If your consumer forgets or is not sure what their work duties are, remind them
that they can always ask their supervisor for clarification.
Ask for a list of prioritized tasks
Knowing what job tasks need to be completed will be easier for your consumer if
they are written down and prioritized by what should be completed first. Have your
88
consumer talk to their supervisor and ask for a written list, or get your consumer in the
habit of having a pen and paper handy so that they can write them down themselves.
Ask for Clarification
If your consumer is unsure of what their job task are, what needs to be done first,
or how to complete them, remind them that they can ask their supervisor for clarification.
Some tasks require multi-step instructions and by asking for clear instructions, your
consumer can write them down which will allow them to learn one step at a time.
Keep a work schedule
It is important for your consumer to know what their work schedule is and when
they are allowed to take breaks. Following a work schedule is an important part of your
consumer’s ability to build their work skills. Some jobs take 10-15 minute breaks in
addition to a lunch break. Knowing when they can take their lunch breaks will allow
your consumer to create a schedule so that they can keep on task. In California, the law
states that employers must provide a 30-minute meal period for any employee who works
more than five hours per shift. However, if the employee works six hours or less, the
meal period may be waived by mutual agreement. Make sure your consumer ask their
supervisor what their break schedules will be so that they can keep track of their day.
To help your consumer visualize what a typical work schedule may be like, here
are some sample schedules which show different kinds of work schedules. These are
meant to act as visual aids, so that your consumer can reference to them when organizing
their own work schedules.
89
SAMPLE 4-HOUR WORK SCHEDULE
Daily 4-hour Work Schedule:
8:50-8:55am - Arrive at Work
o Put your personal belongings away in your locker.
o Put your food away in the break area if you brought some with you.
9:00am - Work Begins
o Check in with your supervisor and ask them what they would like for
you to accomplish for the day.
o Write down your job duties for the day.
o Set up your work station.
o Start working on your list.
11:00-11:15am – Take your Break
o This is your time, you can sit down, make phone calls, go for a walk,
eat a snack, etc.
11:15am – End of Break time
o Head back to your workstation and continue working on your list.
12:45-1:00pm– Clean Up
o Start cleaning up and organizing your workstation.
o Once your work area is clear, check out with your supervisor and let
them know what you accomplished for the day.
o Grab your personal belongings and fill out your timesheet before you
leave for the day.
90
SAMPLE 6-HOUR WORK SCHEDULE
Daily 6-hour Work Schedule:
7:50-7:55am - Arrive at Work
o Put your personal belongings away in your locker.
o Put your food away in the break area if you brought some with you.
8:00am - Work Begins
o Check in with your supervisor and ask them what they would like for
you to accomplish for the day.
o Write down your job duties for the day.
o Set up your work station.
o Start working on your list.
11:00-11:30am – Take your 30-minute lunch break
o This is your time, you can sit down, make phone calls, go for a walk,
eat a snack, etc.
11:30am – End of Break time
o Head back to your workstation and continue working on your list.
1:45-2:00pm– Clean Up
o Start cleaning up and organizing your workstation.
o Once your work area is clear, check out with your supervisor and let
them know what you accomplished for the day.
o Grab your personal belongings and fill out your timesheet before you
leave for the day.
91
SAMPLE 8-HOUR WORK SCHEDULE
Daily 8-hour Work Schedule:
7:50-7:55am - Arrive at Work
o Put your personal belongings away in your locker.
o Put your food away in the break area if you brought some with you.
8:00am - Work Begins
o Check in with your supervisor and ask them what they would like
for you to accomplish for the day.
o Write down your job duties for the day.
o Set up your work station.
o Start working on your list.
10:45-11:00am – Take your Break
o This is your time, you can sit down, make phone calls, go for a
walk, eat a snack, etc.
11:00am – End of Break time
o Head back to your workstation and continue working on your list.
12:30- 1:30pm Take your Lunch Break
o This is your time, you can sit down and eat your lunch, make phone
calls, talk to coworkers, go for a walk, etc.
1:30pm – End of Lunch Break
o Head back to your workstation and continue working on your list.
3:00-3:15pm – Take your Break
o This is your time, you can sit down, make phone calls, go for a
walk, eat a snack, etc.
3:15pm – End of Break time
o Head back to your workstation and continue working on your list.
4:45-5:00pm– Clean Up
o Start cleaning up and organizing your workstation.
o Once your work area is clear, check out with your supervisor and
let them know what you accomplished for the day.
o Grab your personal belongings and fill out your timesheet before
you leave for the day.
92
Work Skills
Now your consumer is ready to begin learning basic work skills. Here are some
of the basic work skills they may need to use in a work setting and ways they can
implement them in their job. These are meant to help you build some basic work skills in
your consumers, teach them to understand their job tasks, and help them stay focused at
work.
Telephone Etiquette
Many jobs require employees to answer telephones and speak to the general
public. When your consumer works in a job that requires using the telephone and talking
to others, it is important that they be professional when they are speaking. Here are some
guidelines for teaching your consumer how to answer the telephone in a work
environment.
Guidelines your consumer should follow for answering the telephone:
 Pick up the phone within three rings. This shows that your consumer is
organized and customer oriented.
 Greet the caller with a “hello”, “good morning”, or “thank you for
calling_____”. Greeting the caller is an important first step in your
consumer’s interactions with the public, it sets the tone and style of the
whole interaction.
 Give their name. This is a courtesy that creates a good customer service
experience as well as allowing the customer to feel valued.
 Ask the customer if or how they can be helped. This shows the customer
that your consumer is there to answer their questions and it also leaves the
customer with a good impression of your consumer.
During the course of the conversation your consumer should:
 Use their telephone voice, and maintain control over the volume and
speed.
 Project an enthusiastic tone of voice that is natural, attentive and
respectful.
 Focus their attention on the customer.
 Speak clearly and enunciate and articulate their words.
 Use action specific words and directions.
 Use the customer’s name during the conversation.
 Always speak calmly and choose their words carefully.
93
Discuss with your consumer the importance of avoiding the following phrases while on
the phone:





“I don’t know.”
“I/we can’t do that.”
“You’ll have to….”
“Just a second.”
“No.”
If your consumer is talking with a customer who seems upset, explain to them that
the best thing they can do is to simply hear them out. Explain to your consumer that by
listening intently to what the customer is saying, they are allowing the customer to feel
like they are being heard. If your consumer is unsure on how they can help the customer,
remind them that they can always ask another employee or their supervisor for help.
Time Management
Time management is understanding exactly how much time we have and how to
use it effectively. Effective time management skills are an essential tool for workplace
success. The purpose of good time management skills is to be able to teach your
consumer how to manage themselves and their work. To make your consumers time
work in their favor, explain to them the importance of knowing why they are doing what
they are doing, how to prioritize their activities, how to do only what is necessary, and
how to eliminate time-wasting. Here are some ways your consumer can begin to manage
their time at work:
Use Tools to Get Organized
Proper time management starts with proper planning. Your consumer should split
their goals into easily manageable pieces, scheduling them daily, weekly, and monthly if
necessary. Your consumer will need some type of tool to help them keep these mini-goals
organized. Knowing what they need to accomplish each day will help your consumer stay
focused and make the most of the time that they have.
Common time management tools can include a daily or weekly planner, calendar,
to-do lists etc. There are many different types of tools including paper tools or electronic
tools. Your consumer can purchase planning software or use an online program that
allows them to keep track of their tasks. Here are common paper and electronic tools that
many people use to help them get organized:
Popular paper tools:
 Daily, weekly, or monthly planner
 Task scheduler
94
 Time management charts
 Time management templates
 To-Do lists
Popular electronic tools:
 Electronic diary
 Electronic organizer
 Smart phone
 Tablet
 Laptop
Set Goals
Finally, the best use of your consumer’s time is to work with goals. Your
consumer should set goals that are specific, measurable, attainable, realistic and timely.
It is especially important for your consumer to be able to measure their goals. Without
some way to assess their progress, your consumer won't know whether they have reached
their goals. A great way your consumer can measure their progress is by maintaining a
self-discipline logbook.
Maintain a Logbook
The purpose of a logbook is to measure progress on tasks by recording the start
and end times of the tasks. This allows a person to go back and review their progress to
get a better picture of their work activities in order to begin prioritizing. Using a log
book will help your consumer know how long they will need to spend on a specific job
task, and it will also help them understand which work tasks should be prioritized. Once
your consumer has an idea of what their tasks will be and how long they take, they are
ready to begin scheduling their daily work routine.
Rest and Meal Breaks
Depending on your consumers work schedule, they may be entitled to taking short
breaks and/or lunchtime breaks at work. Some companies provide short 10 or 15 minute
breaks in addition to a lunchtime break that is usually 30 minutes to one hour long. Have
your consumer check with their supervisor first to know what kind of breaks they are
entitled to so that your consumer can schedule their workday.
Schedule your workday
 When you consumer begins their workday, get them in the habit of talking to their
supervisor first thing in the day so that they can ask what needs to be
accomplished for the day.
95

Have your consumer take a few minutes and write down on a piece of paper the
tasks that their supervisor wants them to accomplish for that day.
 Prioritize the list, make sure your consumer has clarified with their supervisor
which tasks they want to be completed first and have them start there.
 Have your consumer immediately start working on the most important job task.
When your consumer has a clear idea as to what they need to accomplish for the day,
they will more likely be able to proactively accomplish the tasks.
Prioritizing Work Tasks
Prioritizing daily tasks is key to successful time management. With a daily list of
tasks, it's tempting to start with the easiest tasks, just to be able to cross them off the list.
Unfortunately, this doesn't always lead to successful time management. Teach your
consumer to prioritize their work tasks so that they can accomplish the work that must get
done first. To accomplish this goal, have your consumer check in with their supervisor
first so that they are aware of any deadlines they must meet. The tasks that must be
completed soonest are the ones your consumer should tackle first. When prioritizing,
make sure your consumer accomplishes the most important tasks first. Here is a good
way to prioritize to show your consumer how to prioritize tasks:
Start With a Master List
Have your consumer write down every single task that they need to accomplish.
Don't have them rank the items at this point, instead be sure your consumer includes
every task, including small routine duties. Neglecting to schedule the small everyday
items can mess up your consumers schedule if they don’t set some time aside for it.
Determine the top priority A-level tasks
These are the tasks that will lead to significant consequences if your consumer
does not get them done by the expected deadline. For some people, focusing on
consequences creates an urgency factor so that they can better use their time.
Categorize the Rest of the Tasks
Your consumer can personalize this based on their own style. They can use
numbers, color code, roman numerals, etc. For this example, we are using a letter grade
system so that you may explain to your consumer how to create a categorized list of work
tasks. After you and your consumer have determined what the A-level tasks are, the rest
follows like this:
96
B-level tasks: tasks that may have a mildly negative consequence if not completed
today
C-level tasks: tasks that have no penalty if not completed today.
Once your consumer has a list, they should start working on the A-level tasks
first. When your consumer completes the task, they can move on to the B-level tasks,
and when they are done with those they can move on to the C-level tasks and continue
until they have completed all their tasks. Have your consumer get in the practice of
repeat this process each day. Here is a sample master list:
97
SAMPLE MASTER LIST:
Master List: Work Tasks for Cleaning the Kitchen
A-LEVEL TASKS:
– Wash the dishes
– Wipe the counters
– Sweep the floor
– Mop the floor
B-LEVEL TASKS
–
–
–
Scrub the sink
Clean the oven
Take out the trash
C-LEVEL TASKS
–
–
–
Clean the toaster
Organize the countertops
Clean the microwave
98
BLANK SAMPLE MASTER LIST:
Master List: Work Tasks
A-LEVEL TASKS:
–
–
–
–
B-LEVEL TASKS
–
–
–
C-LEVEL TASKS
–
–
–
99
Exercise 1 Instructions: Work Skills Self-Assessment
For this exercise, you will be giving your consumer a work skills self-assessment.
This assessment will provide you with the opportunity to see where your consumer is
regarding their work skills and will allow you to better identify what their needs may be.
Materials Needed:


Copies of Exercise 1 Handout
Pencils
Directions:
First pass out copies of this self-assessment. Once your consumers all have a
copy, you can explain to them the purpose of this assessment. Ask them to be honest
when answering the questions and to circle the answer they feel most appropriately fits
them.
Allow your consumers approximately 15 minutes to answer the questions. Once
they are finished taking the self-assessment, you may go over the questions with them.
There is no answer key for this assessment. This assessment is meant to serve as a tool
for your consumer and for you to gauge their current work skill levels and to assist you to
create a plan to address their needs.
100
Exercise 1 Handout: Work Skills Self-Assessment
This self-assessment report is provided to assist you in assessing your current skill
level. Answer the following questions by yourself, then in pairs or in a group, discuss
your answers with each other.
1. How would you rate your ability to follow directions?
2. How would you rate your ability to get along with or work with coworkers and
Supervisors?
3. How would you rate your ability to get along with or work with the public?
High
4. How would you rate your ability to keep a work schedule? (Be on time, show up
every day, come back from break period, etc.)
5. How would you rate your overall work abilities?
High
6. How would you rate your ability to maintain professional conduct at work or with
the public?
101
Exercise 2, 3, and 4 Instructions: Roleplaying Common Work Scenarios
In the exercises that follows, we are going to take a look at common workplace
scenarios and best practices for how to teach your consumer to react in each situation.
These role playing activities will provide practice in identifying common workplace
scenarios and how to best address them.
Materials Needed:


Copies of Exercise 2, 3, and 4 Handouts
Volunteers to act out each workplace scenario
Directions:
Ask for volunteers to act out each of the following workplace scenarios. Each
role playing scenario requires two people to act out each role. Each exercise has three
different scenarios. For each, you may use the same two consumers to act out each
scenario, or you may choose two new volunteers.
Once you have your volunteers, or have picked out two consumers, have them
take their place at the front of the room so that they are visible by everyone. Once the
roles have been established, have your consumers begin the exercise.
Alternate Directions:
If you prefer, you may have your consumers pair up in teams of two and have
them practice role playing one-on-one. Just as in the directions above, once your
consumers are paired up and have established which role they will play, have them begin
this exercise. Once they have completed their part, have them switch their roles and take
turns being the first to approach the other person.
Discussion:
After your consumers have completed each scenario, they will find the discussion
questions listed below directly after Exercise 4. The purpose of these discussion
questions are to have your consumers talk amongst themselves and share their view on
the exercises and what they learned. For this discussion, you may choose to have your
consumers stay with their partner, or you can have the discussion with group as a whole.



Question 1: What did you learn from these exercises?
Question 2: What would you have done differently?
Question 3: With your partner or with your team, think about other common
workplace scenarios and discuss how you would handle them.
102
Exercise 2 Handout: How to Call in Sick
Illness may force employees to miss work, sometimes for a day or two and
sometimes for a more extended period. If you are sick, you may need to stay home so
that you can get better and to prevent you from getting others sick. If you miss a day due
to illness, the first thing you should do is notify your supervisor by phone early in the
morning, before your work shift. You should call around the time you would normally
wake up for work so that your supervisor will know before the start of your work shift. If
your supervisor is not available, leave them a detailed message including the following
information:




Your Name
Date and time of the phone call
Reason for the call (you are sick and unable to work today)
Your scheduled work shift
If you are leaving a voicemail, your message should sound like this:
“Hi Angela, this is Kendra. It is Tuesday, May 21st and it is currently 7:30am. I
am so sorry to say that I don’t think I’ll make it into work today. I started feeling
ill last night, and unfortunately the symptoms have only gotten worse since then.
It seems like this is probably contagious, so I am going to stay home and try to get
well. I was scheduled to work from 9:00am to 2:00pm. I should be back at work
tomorrow, but please let me know if there’s anything you would like me to do in
the meantime. I will call you later to follow up with you. Thank you.”
Oftentimes, when you may have to miss a day due to illness your supervisor will
be available when you call. In this exercise, we will be role-playing proper protocol for
notifying your employer if you are sick and are going to miss a day at work.
For this exercise, team up into pairs of two and take turns being the supervisor
and the employee.
Supervisor: “Good morning and thank you for calling the Breakfast Bonanza,
how can I help you?”
Employee: “Hi Tom, this is Susan”
Supervisor: “Oh hi Susan, how are you?”
103
Employee: “Not so good Tom. I am calling you because I woke up with a fever
and a sore throat and I’m really congested”
Supervisor: “I’m sorry to hear that”
Employee: “I know, unfortunately I am not going to be able to go to work today.
I don’t want to get anyone at work sick and I just need time to get better”
Supervisor: “I understand, I would not want anyone else to get sick”
Employee: “Thanks for understanding Tom, I am going to get some rest and
hopefully with medicine I will feel better soon. I will call you again tomorrow
morning to let you know if I am feeling better.”
Supervisor: “Yes, call me tomorrow before the start of your shift, that way I can
arrange for some coverage if necessary”
Employee: “Ok Tom, I will. Thank you.”
Supervisor: “Your welcome, I will talk to you tomorrow, bye.”
Employee: “Bye Tom.”
104
Exercise 3 Handout: How to Ask For Help
Another common workplace scenario is asking for clarification or help on a
specific job task. In this exercise, we will role play how to ask your supervisor for help.
Employee: “Hi Bill, I was wondering if you had a couple of minutes free so that I
can ask you some questions.”
Supervisor: “Sure Sam, I have some free time right now, sit down. How can I
help you?”
Employee: “Thank you. I wanted to ask you about the new assignment that was
given to me this morning. This is my first time working on this project and I am a
little unclear as to what the steps are to complete it. I don’t want to start it
wrong, so I wanted to ask you for some help on how to go about it.”
Supervisor: “Of course, thanks for coming to me with your questions. I wasn’t
aware that this was your first time working on this project. Why don’t we go over
it from the beginning?”
Employee: “Thank you Bill, I appreciate you taking the time to show me the
steps. Would you mind if I take notes? I would like to be able to reference my
notepad in case I forget a step.”
Supervisor: “Sure you can, that’s no problem.”
Employee: “Thanks Bill.”
Supervisor: “Okay, so to start the project you need to ….” [End of role-play]
105
Exercise 4 Handout: Constructive Criticism-How to Handle Feedback
Another common workplace scenario is receiving feedback on a job task you
completed. Employers often provide constructive feedback. This is not meant to single
you out or make you feel like you are not doing your job right. Instead, constructive
feedback is an opportunity for you to learn how to correctly and productively complete a
work task. In this exercise, we will role play appropriate ways to receive constructive
criticism.
Supervisor: “So Sandy, the purpose of today’s meeting is to discuss some
observations we’ve made about your performance. We want to give you some
feedback on the work that you’ve been doing here.”
Employee: “Ok, thanks Jeff, I’m always looking for ways to increase my
performance.”
Supervisor: “Great, well first of all we want to commend you on your
consistency in completing all your tasks on time. I don’t think you’ve ever missed
a deadline.”
Employee: “Thanks Jeff, I’m glad to hear I’m completing them on time.”
Supervisor: “One thing I have noticed and would like to discuss with you is
customer service. I have noticed that sometimes you get so absorbed in your
work tasks that you forget to greet our customers.”
Employee: “Oh, I did not realize that was happening. Sometimes I get so
focused on the task at hand.”
Supervisor: “And we appreciate your hard work, but I wanted to remind you that
we take pride in our customer service as well, and it is your responsibility to greet
customers as they walk in the door and when you see the on the sales floor.”
Employee: “Ok Jeff, I will make sure from now on to keep my head up and be
aware of the customers and saying hello to them. I will work on this from now on.
Thank you for bringing it to my attention, I want to make sure that I am good at
all my duties, including customer service.”
Supervisor: “Thank you Sandy.”
106
Discussion
Consider the role-playing exercises you just completed. The purpose of these exercises is
to demonstrate common workplace scenarios, and appropriate ways to handle them. In a
group or with your partner, ask yourself the following questions and discus your answers.



Question 1: What did you learn from these exercises?
Question 2: What would you have done differently?
Question 3: With your partner or with your team, think about other common
workplace scenarios and discuss how you would handle them.
107
MODULE 3:
WORK TOLERANCE
108
What Is Work Tolerance?
Work tolerance is described as the ability to effectively and efficiently sustain
physical, cognitive, and/or psychological demands of a job. This can include the physical
endurance, strength, motor coordination skills, and emotional capacities of a worker
when performing essential job tasks. A common issue for the autism population is that
they can be easily over stimulated by certain things. Sensory overload can be especially
disabling for people with autism and often results in unusual responses and limitations in
work tolerance.
The symptoms of sensory overload vary from person to person, so it is important
to monitor sensory violations in the workplace for each of your consumers. Sensory
overload can lead to a wide range of behaviors including confusion, anxiety, irritability,
restlessness, panic attacks, aggression, meltdowns, and breakdowns. People with autism
are well known for self-stimulatory behavior, which is most commonly described as
stereotypic, repetitive behavior.
In a person with autism, self-stimulatory behaviors usually refers to specific
behaviors such as hand flapping, rocking, spinning, or repeating specific words and/or
phrases. These repetitive behaviors serve as coping mechanisms to help reduce anxiety
and fear. Unlike most people, though, individuals with autism tend to self-stimulate
constantly, and this can impede their ability to interact with others and take part in
ordinary activities.
Achieving a balance when it comes to sensory issues is critical for your consumer
with autism to be able to function in a work environment. In order to do this, it is
important to identify specific sensory issues are for each consumer you work with. A
good way to figure this out is by asking your consumer specific questions to determine
their sensitivities, as well as through observation. On the next page, a description of the
functional limitations of work tolerance specific to the population with autism, as well as
a list of typical accommodations which can be implemented in the workplace.
109
Functional Limitations and Workplace Accommodations: Work Tolerance
Functional Area: WORK TOLERANCE
Definition: The ability to effectively and efficiently sustain physical, cognitive, and/or
psychological demands of a job (Department of Rehabilitation, 2013).
Functional Limitations:
• The individual is unable to perform
work activity due to physical or mental
functions
• The individual requires modifications,
adaptive technology, and/or
accommodations not typically made for
other workers.
Workplace Accommodations:
The Job Accommodation Network [JAN]
(2013), suggests the following workplace
accommodations:
• Provide sensitivity training for employees
Stress Management:
• Provide daily guidance, feedback, praise,
and offer positive reinforcement
• Allow employee to make phone calls for
• Individual may have difficulty
support
managing stress in the workplace
• Allow presence and use of support animal
Sensory Issues:
• Individual may experience difficulties • Provide employee a private are to allow
with sensory issues such as:
for personal adjustment
– Fragrance sensitivity
• Modify work station location away from
– Fluorescent lights
audible distractions such as office traffic,
– Noise
employee chatter, fax and copy machines
• Create a fragrance-free work policy
• Individuals may engage in restrictive, • Change lighting
repetitive patterns of behavior to
• Provide noise-canceling headset
tolerate work environment
Atypical Body Movements:
• Provide structured breaks to create an
• Atypical body movements allow the
outlet for physical activity
individual to calm down or concentrate • Allow employee items such as a handon tasks, but can also disturb coworkers held squeeze ball or similar object to
provide sensory stimulation and calming
• Schedule periodic work breaks away
from workstation
• Provide private workspace where
employee will have room to move about
and not disrupt coworkers
110
Sensory Stimulation
Persons with autism often have strong reactions to sensory stimulation. In order
to achieve workplace success, it is important to have an understanding of the types of
sensory stimulation that can interfere with your consumer’s workplace success. It is
crucial to be able to recognize the environmental conditions which create overstimulation
and may distract, confuse and overstimulate your consumer. The most common types of
sensory stimulation include auditory, visual, olfaction, and tactile stimulations.
Auditory
In general, people with autism have a high awareness to sounds, and are often
described as having super hearing. In a work environment where noise can present as a
constant occurrence, it is especially important to understand how noise affects your
consumer’s ability to complete a job and stay on task. If your consumer gets upset every
time there is a noise, especially a loud or sudden one, this could mean they are being
overwhelmed by sound. A simple way to accommodate auditory over stimulation is by
providing a pair of headphones that completely cover the ears to cancel environmental
sounds. Conversely, some individuals may need background or white noise to prevent
things from being too quiet. Here are some things you can do to lessen the impact of
auditory stimulations:
 Move the consumer to a more private area or away from high traffic areas.
 Move the consumer away from office machinery, equipment, and other
background noises.
 Provide noise counseling headsets
 Provide an environmental sound machine.
Visual
Another common sensory stimulation which can cause workplace disruptions is
visual distractions. For the individual with autism, it is easy to become agitated in
environments which are loaded with visual stimuli, especially if it is constantly moving.
A good way to find out is through observing the behaviors. If your consumer likes to
hide in dark places, or seems reluctant to go out into the sunlight or other bright places,
they may have light sensitivity. A pair of sunglasses, even indoors, can help. If it is a
viable option, a work area where the lights can be dimmed lights or where there is
indirect lighting may help. Here are some common things can discuss with your
consumer to lessen the impact of visual stimulations:
 Ask their employer to provide a cubicle or private work area where visual
distractions are lessened.
111
 Reduce clutter in the consumers work space.
 Relocate the work area away from visible distractions and constant
movement.
Smells
Consumers with autism have a stronger sense of smell than typical people, and as a
result have a stronger reaction to odors. They can be oversensitive to perfume and
colognes, certain foods with strong odors, and are not able to regulate the smells,
resulting in the smells remaining present for a long time. Here are some things you can
talk to your consumer’s employer about to lessen the impact of fragrance issues:







Maintain good indoor air quality
Discontinue the use of fragranced products
Use only unscented cleaning products
Provide scent-free meeting locations and restrooms
Allow breaks for getting fresh air
Provide an air purification system
Create a fragrance free workplace policy
Tactile or Touch
Persons with autism often reject human touch, and have strong reactions to being
touched by others. The most important thing to remember is to never touch a consumer
with autism without first asking for permission. Other tactile issues may include an
aversion to certain types of clothing, labels, or fabrics, and even discomfort with sitting in
one place for too long.
If your consumer is constantly taking off their clothes, wearing their clothes inside
out or rejecting rough uniforms, this is a warning sign that they may have a tactile
aversion to certain fabrics or labels. You can help your consumer by allowing them to
remove clothing tags and make sure the inside lining of the clothing is smooth and not
scratchy. Here are some things you can talk to your consumer about to decrease the
distraction of tactile stimulations:
 Instruct your consumer’s coworkers to approach the individual in a way
that is not startling.
 Instruct consumers to refrain from touching one another.
 Provide a uniform made of smooth fabric, or allow the consumer to wear
their own clothing provided they follow the general uniform guidelines.
112
Atypical Body Movements
As discussed earlier, restrictive, repetitive body movements may interfere with your
consumer’s ability to concentrate and complete tasks, or may even disturb or distract their
coworkers. Generally, a person with autism engages in this self-stimulatory behavior as a
way to cope with stress and anxiety present in their environment. While they serve to
calm them down, these behaviors may detract from their work and interrupt others. To
prevent this from happening, the following measures may help to reduce the impact of
self-stimulatory behavior on work performance:
 Provide structured breaks to create an outlet for physical activity.
 Allow the consumer the use of tangible items such as hand held squeeze
balls or other similar objects.
 Schedule periodic rest breaks away from the work area.
 Provide a private workspace where the consumer can engage in selfstimulatory behaviors without disturbing others.
Stress Management
Individuals with autism often experience stress in the workplace. Stress triggers vary
from person to person, but common triggers may include heavy workloads, coworker
conflicts, unrealistic timeframes, or changing deadlines. Here are some things you can
talk with your consumer about to help manage their stress at work:
 Teach your consumer to be aware of their stressors and accompanying
emotional and/or physical reactions.
 Work with your consumer to be able to recognize what they can change.
 Teach them to moderate physical reactions to stress.
 Have them take a break and step away from the stressful situation for a
few moments.
 Allow them to make a phone call on their break for support from friends
and family.
 Most importantly, teach them to learn to respond, not react.
Company Structure & Conduct Policy
One of the most important things you can do to acclimate a new your consumer to a
workplace setting is to provide a meeting to discuss the company structure, employee
guidelines and expectations, and the company conduct policy. It is important to
remember that individuals with autism are concrete, literal thinkers and may not
understand abstract concepts. They may not understand how the workplace is structured,
113
or who or what the chain of command is. To help your consumer understand these
factors in the workplace, you should:
 Provide an explanation of the company structure and provide a new
employee handbook.
 Review the conduct policy including a discussion of roles and
responsibilities.
 Accommodate supervision methods by allowing increased supervision to
provide feedback, support, and discuss job performance.
 Provide concrete examples of how employees are expected to conduct
themselves in the workplace.
 Provide concrete examples of what the consequences are for violating
company policy.
114
Exercise 1 Instructions: Work Tolerance Self-Assessment
For this exercise, you will be giving your consumer a work tolerance selfassessment. This assessment will provide you with the opportunity to see where your
consumer is regarding their work tolerance and will allow you to better identify what
their needs may be.
Materials Needed:


Copies of Exercise 1 Handout
Pencils
Directions:
First pass out copies of this self-assessment. Once your consumers all have a
copy, you can explain to them the purpose of this assessment. Ask them to be honest
when answering the questions and to circle the answer they feel most appropriately fits
them.
Allow your consumers approximately 15 minutes to answer the questions. Once
they are finished taking the self-assessment, you may go over the questions with them.
There is no answer key for this assessment. This assessment is meant to serve as a tool
for your consumer and for you to gauge their current work tolerance levels and to assist
you to create a plan to address their needs.
115
Exercise 1 Handout: Work Tolerance Self-Assessment
This is followed by a self-assessment report is available to assist in determining the
types of sensitivities that a person can experience.
1. How would you rate your ability to follow directions?
2. How would you rate your ability to get along with or work with coworkers and
Supervisors?
3. How would you rate your ability to get along with or work with the public?
4. How would you rate your ability to keep a work schedule? (Be on time, show up
every day, come back from break period, etc.)
5. How would you rate your overall work abilities?
6. How would you rate your ability to maintain professional conduct at work or with
the public?
ery High
116
EXERCISE 2 Instructions: Identify the Source of Your Anxiety
The purpose of this exercise is to assist your consumer in identifying what the
source of their anxiety is. Knowing what the source of their stress is will be the first step
in developing a plan to assist your consumer in identifying more appropriate behavior in
the workplace.
Materials Needed:



Copies of Exercise 2 Handout
A blank piece of paper
Pencils
Directions:
This exercise is to be completed individually. Have your consumers sit down at a
desk with a blank sheet of paper and a pencil. Next, pass out copies of the Exercise 2
handout and instruct your consumers to answer the questions on the blank piece of paper.
For this exercise, allow your consumers approximately 15-30 minutes to answer
the questions. Once all of your consumers have answered the questions, as a group,
discuss the following questions and have your consumers share their answers with the
rest of the group.
Discussion



Question 1: What did you learn about the things you worry about?
Question 2: What did you learn about how you react to stressful situations?
Question 3: What other actions can you take to better resolve stress in the
workplace?
117
Exercise 2 Handout: Identify the Source of Your Anxiety
This exercise is to be completed individually. Ask yourself the following questions,
and on a blank piece of paper, write down your answers.
1. Why do I worry? – Write down some of the things in your life that cause you the
most worry.
2. What are the benefits of worrying? - List all the positives and negatives to this
attitude.
3. What are my reactions? - List all the possible actions ore reactions you may
have.
4. Which of my actions are the most appropriate? – Develop a plan of priorities
to tackle your problem.
5. Which of my actions are the most inappropriate? -. Identify why they are
inappropriate and how you can change these actions.
Discussion
As a group, answer the following three questions and share your answers with each other.



Question 1: What did you learn about the things you worry about?
Question 2: What did you learn about how you react to stressful situations?
Question 3: What other actions can you take to better resolve stress in the
workplace?
118
Exercise 3 Instructions: Identify the Work Tolerance Issue
The following two scenarios depict different situations involving work tolerance.
Read each scenario and as a group or in pairs, see if you can identify the problem or
problems.
Materials Needed:


Copies of Exercise 3 Handout
Volunteers to read each scenario out loud to the group
Directions:
Ask for volunteers to read out loud the following two workplace scenarios. Each
scenario depicts different situations involving work tolerance. Hand out copies of the
handouts and have a volunteer read the first scenario out loud. After the first scenario has
been read aloud, ask your consumers to answer the discussion questions and discuss the
answers as a group.
Once you are finished discussing the first scenario, you can move on to the
second. Just as the first one, have a volunteer read the second scenario out loud. After
this scenario has been read aloud, ask your consumers to answer the discussion questions
that follow and discuss the answers as a group.
Discussion
Scenario 1 discussion questions:
 Consider Sammy’s situation and answer the following discussion questions.
 Question 1: What is Sammy’s experiencing at work that may be causing him to
become uncomfortable?
 Question 2: How can you tell?
 Question 3: What actions do you feel Sammy should take to resolve them?
Scenario 2 discussion questions:
 Consider Cassandra’s situation and answer the following discussion questions.
 Question 1: What issue is Cassandra experiencing at work?
 Question 2: How can you tell?
 Question 3: What actions do you think Cassandra should take to resolve them?
119
Exercise 3 Handout: Identify the Work Tolerance Issue
The following two scenarios depict different situations involving work tolerance.
Read each scenario out loud and as a group, see if you can identify the problem or
problems.
Scenario 1:
Sammy is new to the office. He is really excited about his new job working as a paper
shredder in the accounting division. Sammy’s job is to shred confidential documents,
and he works four hour shifts three days a week.
Sammy’s work station is located near the restrooms and break area, and he has a visible
view of the office conference room. During lunchtimes and meeting hours, Sammy
becomes visibly agitated and begins to flap his hands and repeat phrases over and over
again that do not make sense to his coworkers. Sammy really likes his job, but finds that
he becomes agitated and stressed out at certain times of his work shift.
Discussion




Consider Sammy’s situation and answer the following discussion questions.
Question 1: What is Sammy’s experiencing at work that may be causing him to
become uncomfortable?
Question 2: How can you tell?
Question 3: What actions do you feel Sammy should take to resolve them?
Scenario 2:
Cassandra has just recently become employed at a local fast food restaurant and is
required to wear a uniform. The first day of work Cassandra showed up and worked well
with no incidents, however she made frequent visits to the restroom. On her second day,
Cassandra was working as expected but continued making frequent visits to the restroom.
Later, Cassandra emerged from the restroom and her shirt was inside out.
Discussion




Consider Cassandra’s situation and answer the following discussion questions.
Question 1: What issue is Cassandra experiencing at work?
Question 2: How can you tell?
Question 3: What actions do you think Cassandra should take to resolve them?
120
AUTISM RESOURCES
Local Resources:
UC Davis MIND Institute
2825 50th Street
Sacramento, CA 95817
Phone: (916) 703-0280
Website: http://www.ucdmc.ucdavis.edu/mindinstitute/
The UC Davis MIND Institute is a collaborative international research center, committed
to the awareness, understanding, prevention, care, and cures of neurodevelopmental
disorders. The MIND Institute provides clinical programs including assessment,
diagnosis, and treatment from a staff that includes psychiatrists, psychologists,
geneticists, genetic counselors, licensed clinical social workers, and medical support
staff.
Autism Society of California
PO Box 1355
Glendora, CA 91740
Phone: 1-800-869-7069
Website: http://www.autismsocietyca.org
The mission of the Autism Society of California (ASC) is to improve the lives of all
affected by an autism spectrum disorder. They do this by increasing public awareness
about the day-to-day issues faced by people on the spectrum, advocating for appropriate
services for individuals across the lifespan, and providing the latest information regarding
treatment, education, research and advocacy.
The Center for Autism and Related Disorders (CARD), Inc.
2945 Ramco St., Suite 220
West Sacramento, CA 95691
Phone: (916) 374-0800
Website: www.centerforautism.com
The Center for Autism and Related Disorders is one of the largest organizations in
Sacramento providing support to individuals diagnosed with an Autism Spectrum
Disorder, Asperger syndrome, or Pervasive Developmental Disorder-Not Otherwise
Specified (PDD-NOS) between the ages of birth to 21 years of age. They provide
specialized services including diagnosis.
121
Online Resources:
Autism Speaks
Website: http://www.autismspeaks.org/
Autism Speaks was founded in February 2005 and has grown into the world's leading
autism science and advocacy organization, dedicated to funding research into the causes,
prevention, treatments and a cure for autism; increasing awareness of autism spectrum
disorders; and advocating for the needs of individuals with autism and their families.
Autism Society
Website: http://www.autism-society.org/
The Autism Society exists to improve the lives of all affected by autism. Autism Society
works by increasing public awareness about the day-to-day issues faced by people on the
spectrum, advocating for appropriate services for individuals across the lifespan, and
providing the latest information regarding treatment, education, research and advocacy.
The Autism Society has a comprehensive online resource database where you can search
nationwide for autism related services and supports.
Global Autism Collaboration
Website: http://www.autism.org/
The Global Autism Collaboration’s mission is to network with organizations worldwide
to collaborate on a standard of care for children and adults on the autism spectrum, and to
establish long term financial viability.
122
REFERENCES
Alta California Regional Center (ACRC). (2008). The community. Retrieved from
http://www.altaregional.org/index.cfm
Alta California Regional Center (ACRC). (2013). Who we serve. Retrieved from
http://www.altaregional.org/whoWeServe/
American Psychiatric Association (APA). (2013). Autism Spectrum Disorder fact sheet.
Retrieved from
http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20
Sheet.pdf
Autism Society. (2012). About autism. Retrieved from http://www.autismsociety.org/about-autism/
Autism Society. (n.d.). Causes. Retrieved from http://www.autism-society.org/aboutautism/causes/
Autism Speaks. (2013a). Answers to frequently asked questions about DSM-5. Retrieved
from http://www.autismspeaks.org/dsm-5/faq#what
Autism Speaks. (2013b). Facts about autism. Retrieved from
http://www.autismspeaks.org/what-autism/facts-about-autism
Autism Speaks. (2013c). Symptoms. Retrieved from http://www.autismspeaks.org/whatautism/symptoms
123
Autism Speaks. (n.d.). An in-depth look: State of California’s role in serving adults with
autism. Retrieved from
http://www.autismspeaks.org/sites/default/files/documents/familyservices/california2.pdf
Bernier, R., & Gerdts, J. (2010). Autism spectrum disorders: A reference handbook (pp.
1-55). Santa Barbara, CA: ABC-CLIO, LLC.
Bertin, M. (2012, January 30). Understanding the DSM-5 Autism Criteria. Child
Development Central. Retrieved from
http://www.psychologytoday.com/blog/child-developmentcentral/201201/understanding-the-dsm-5-autism-criteria
Brodwin, M. G., & Brodwin, S. K. (2009). A case study approach, rehabilitation
intervention, and assistive technology. In M. G. Brodwin, F. W. Siu, J. Howard,
& E. R. Brodwin (Eds.), Medical, psychosocial, and vocational aspects of
disability (3rd ed., pp. 5-7). Athens, GA: Elliot & Fitzpatrick, Inc.
California Department of Developmental Services. (2013). Information about regional
centers. Retrieved from http://www.dds.ca.gov/RC/Home.cfm
Centers for Disease Control and Prevention (CDC). (2012a). Autism spectrum disorders.
Retrieved from http://www.cdc.gov/ncbddd/autism/index.html
124
Centers for Disease Control and Prevention (CDC). (2012b). Prevalence of autism
spectrum disorders ― autism and developmental disabilities monitoring network,
14 sites, United States, 2008. Morbidity and Mortality Weekly Report, 61.
Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6103a1.htm?s_cid=ss6103a1_w
Centers for Disease Control and Prevention (CDC). (2013). Facts about ASDs. Retrieved
from http://www.cdc.gov/ncbddd/autism/facts.html
consumer. (2013). Merriam Webster. Retrieved from http://www.merriamwebster.com/dictionary/consumer
Currenti, S. A. (2010, September). Understanding and determining the etiology of autism.
Cellular and Molecular Neurobiology, 30, 161-171.
Department of Rehabilitation. (2013). Vocational rehabilitation. Retrieved from
http://dor.ca.gov/Vocational-Rehabilitation.html
Fischbach, G. D. (2007, December 7). Leo Kanner's 1943 paper on autism. In Simons
Foundation Autism Research Initiative. Retrieved from http://sfari.org/news-andopinion/classic-paper-reviews/2007/leo-kanners-1943-paper-on-autismcommentary-by-gerald-fischbach
Fombonne, E. (2012, May). Autism in adult life [Editorial]. The Canadian Journal of
Psychiatry, 57, 273-274.
125
Friedman, N. D., Warfield, M. E., & Parish, S. L. (2013, April). Transition to adulthood
for individuals with autism spectrum disorder: Current issues and future
perspectives. Neuropsychiatry, 3.2, 181-195.
Glennon, T. J. (2010). An introduction to the autism spectrum disorders. In H. Kuhaneck
& R. Watling (Eds.), Autism: A comprehensive occupational therapy approach
(pp. 45-83). Bethseda, MD: American Occupational Therapy Association, Inc.
Grandin, T., & Panek, R. (2013). The Autistic brain (pp. 117-119). New York: Houghton
Mifflin Harcourt.
Help Guide. (2012). Autism Spectrum Disorder. Retrieved from
http://www.helpguide.org/mental/autism_spectrum.htm
Hendricks, D. (2010). Employment and adults with autism spectrum disorders:
Challenges and strategies for success. Journal of Vocational Rehabilitation, 32,
125-134.
Hendricks, D. R., & Wehman, P. (2009, March 24). Transition from school to adulthood
for youth with autism spectrum disorders. Focus on Autism and Other
Developmental Disabilities, 24(2), 77-88.
Howlin, P. (2013, September). Social disadvantage and exclusion: Adults with autism lag
far behind in employment prospects [Editorial]. Journal of the American Academy
of Child & Adolescent Psychiatry, 52, 897-899.
Howlin, P., & Moss, P. (2012, May). Adults with autism spectrum disorders. The
Canadian Journal of Psychiatry, 57, 275-283.
126
Kuhaneck, H., & Berliner, J. (2010). The many theories of etiology. In H. Kuhaneck & R.
Watling (Eds.), Autism: A comprehensive occupational therapy approach (pp. 4583). Bethseda, MD: American Occupational Therapy Association, Inc.
Lawer, L., Brusilovskiy, E., Salzer, M. S., & Mandell, D. S. (2009). Use of vocational
rehabilitative services among adults with autism. Journal of Autism and
Developmental Disorders, 39, 487-494.
Lee, G. K., & Carter, E. W. (2012). Preparing transition-age students with highfunctioning autism spectrum disorders for meaningful work. Psychology in the
Schools, 49, 988-1000.
Matsuzaki, H., Iwata, K., Manabe, T., & Mori, N. (2012, February 22). Triggers for
autism: Genetic and environmental factors. Journal of Central Nervous System
Disease, 4, 1-55. doi:10.4137/JCNSD.S9058
Mayo Clinic. (2013). Childhood Disintegrative Disorder. Retrieved from
http://www.mayoclinic.org/diseases-conditions/childhood-disintegrativedisorder/basics/definition/con-20026858
McDonough, J. T., & Revell, G. (2010). Accessing employment supports in the adult
system for transitioning youth with autism spectrum disorders. Journal of
Vocational Rehabilitation, 32, 89-100.
Migliore, A., Timmons, J., Butterworth, J., & Lugas, J. (2012). Predictors of employment
and postsecondary education of youth with autism. Rehabilitation Counseling
Bulletin, 55(3), 176-184.
127
National Center for Biotechnology Information (NCBI). (2012, May 16). Autism, U.S.
National Library of Medicine. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002494/
National Institute of Mental Health (NIMH). (2011). Autism Spectrum Disorder.
Retrieved from http://www.nimh.nih.gov/health/topics/autism-spectrumdisorders-pervasive-developmental-disorders/index.shtml
National Institute of Neurological Disorders and Stroke (NINDS). (2013). Asperger
Syndrome. Retrieved from
http://www.ninds.nih.gov/disorders/asperger/asperger.htm
Roux, A. M., Shattuck, P. T., Cooper, B. P., Anderson, K. A., Wagner, M., & Narendorf,
S. C. (2013, September). Postsecondary employment experiences among young
adults with an autism spectrum disorder. Journal of the American Academy of
Child & Adolescent Psychiatry, 52, 931-939.
Schall, C. M. (2010). Positive behavior support: Supporting adults with autism spectrum
disorders in the workplace. Journal of Vocational Rehabilitation, 32, 109-115.
Shattuck, P. T., Roux, A. M., Hudson, L. E., Taylor, J. L., Maenner, M. J., & Trani, J.
(2012). Services for adults with an autism spectrum disorder. Canadian Journal
of Psychiatry, 57, 284-291.
State of Connecticut. (n.d.). Serious functional limitations. Retrieved from
http://www.ct.gov/brs/lib/brs/manual/appendixa/SeriousFunctionalLimitations.pdf
128
Taylor, J. L., & Seltzer, M. M. (2011, July). Employment and post-secondary educational
activities for young adults with autism spectrum disorders during the transition to
adulthood. Journal of Autism and Developmental Disorders, 41, 566-574.
Taylor, J. L., & Seltzer, M. M. (2012). Developing a vocational index for adults with
autism spectrum disorders. Journal of Autism and Developmental Disorders, 42,
2669-2679.
U.S. Department of Education. (2010). Building the legacy: IDEA 2004. Retrieved from
http://idea.ed.gov/
Wehman, P. H., Schall, C. M., McDounough, J., Kregel, J., Brooke, V., Molinelli, A.,
Ham, W.,…Thiss, W. (2012). Competitive employment for youth with autism
spectrum disorders: Early results from a randomized clinical trial. Journal of
Autism and Developmental Disorders, 44, 487-500.
Wilczynski, S. M., Trammell, B., & Clarke, L. S. (2013). Improving employment
outcomes among adolescents and adults on the autism spectrum. Psychology in
the Schools, 50, 876-887.