Although there are no
definitive intervention guidelines or single treatment that can dramatically
enhance long-term outcomes, strategies exist that can be used to address the
core deficits of adults with autism spectrum disorder (ASD). I consider these core
deficits as “skill deficits” because they have not been learned instinctively
as with the “neurotypical” individual. While psychotherapy (e.g., CBT) and
counseling are helpful, the overarching goal of intervention planning should be
the development of social and communicative competency through direct teaching,
modeling, coaching, and role playing activities in real world situations.
Psychoeducation
There is no adult-onset
ASD. Symptoms have generally been present in childhood and extend into
adulthood. Following an accurate diagnosis, education about the effects of ASD
on home, community, and occupational functioning is an important starting
point. Providing reading materials and basic information about the disorder can
result in greater self-knowledge and self-awareness on how ASD affects personal
development, behavior, relationships, and view of the world. Discussion topics
might focus on important aspects of everyday life such as communication,
understanding feelings, and friendships, and written activities to enhance
self-discovery, positive action, change, and shift in perspective.
Autobiographical accounts such as “Pretending to be Normal: Living with
Asperger’s Syndrome” (Willey, 1999) and “Unwritten rules of Social
relationships” (Grandin & Barron, 2005) can also be helpful in
promoting a greater self-understanding and positive self-schema. A personal
perspective can be valuable in explaining the nature of adult ASD and help
realize a positive reaction to the diagnosis.
Social Stories
Social stories are a
popular method for teaching individuals with ASD about social behavior
(Gray, 1998). A social story is a brief narrative used to explain social rules
and concepts. The description may include where and why a specific situation
occurs, how others feel and react, or what prompts the individual’s feelings
and reactions. The story features an introduction that clearly identifies the
topic (e.g., friendship, maintaining a conversation, listening), a core section
that adds detail and social knowledge, and a conclusion that reinforces the
information and any new suggestions. Social stories may be written documents or
used with videotapes. They can be used effectively to enhance
perspective-taking skills and to introduce the idea of inferring the mental
state of others.
Computer programs such as
Mind Reading: The Interactive Guide to Emotions (Baron-Cohen, 2007) may also be
used with adults to help them understand emotions and improve theory-of-mind
abilities. This interactive software teaches the individual with ASD to
recognize and understand the thoughts, emotions, and intentions of others by
demonstrating facial expressions, body language and speech qualities associated
with a wide range of emotions. The individual is provided immediate feedback on
how to identify the subtle cues that signal the thoughts and feelings of
others.
Social Autopsies
A social skills autopsy is
a problem-solving strategy designed to decrease the possibility that a social
misunderstanding will reoccur. The individual actively participates in
analyzing real world social interactions to identify the cause and effect
relationship between his or her behavior and the positive and negative
reactions of others. Specific social problems are discussed after the event and
reviewed in sequential form. The clinician helps the individual identify the
who, what, when, and where of the situation. Several behavioral options are
then considered by identifying one or more alternative actions he or she could
have taken. Following each option discussed, a consequence is clarified. A plan
or strategy is then formulated to carry out the appropriate alternative if the
social situation occurs again. The individual also practices carrying out the
plan by visualizing the strategy, writing down the plan, talking with a safe
person about the plan, and/or role-playing.
Conclusion
There is a large and
heterogeneous group of adults with ASD who were not identified in childhood and
did not receive the appropriate interventions and supports. It is not uncommon
for many adults with ASD to escape formal diagnosis until they come to the
attention of psychologists and other mental health professionals. The late
diagnosis of ASD in adulthood and treatment of adult ASD argues for a more
intense focus on education and research to improve outcomes for this group of
individuals whose social problems and often subtle theory-of-mind challenges
impact their personal and social lives.
Reference list
available upon request -
© Lee A. Wilkinson, PhD