In this episode, returning guest Dr. Mall Segall discusses the nitty-gritty of the transition to adulthood in teens and young adults with autism, including employment, socialization, self-regulation, and daily living skills. When Dr. Segall works with his clients, who are adolescents and young adults with autism, before he sets goals with the client and works to meet those goals, he takes into account their age, developmental levels, the level of support needed, and who the client actually is (parent or child). He also takes into account the context/setting of the goals, such as the workplace, school-based, personal health, and wellness/at home. If he is working with the young adult, it is really important that the individual participates in goal setting, to have buy-in, or the goal is much less likely to be reached. Dr. Segall finds that the person-centered approach works best, where the young adult is at the center of treatment and they discuss that person’s hopes, dreams, and goals. what is meaningful to them. That helps them to determine the skills and contexts they would like to work on. However, there can be some generalizations among skills and settings. The family perspective can also help guide the goals and treatment. Sometimes, going with the easiest goals that have the most buy-in and motivation can help the teen get the most out of treatment. This can help open up options for treatment in the long run.
One goal of huge importance is self-awareness especially if the client is not sure what goal to set. This begins with being aware of their diagnosis, psychoeducation about symptoms, discussing the daily challenges the client experiences due to having autism spectrum disorder (ASD), talking about their strengths, and even having the client participate in their own IEP meetings. Dr. Segall also will discuss how the person sees the world and how the world might see the client. They also discuss what strategies can help them. Parents can help the young adult work toward these goals by assisting with finding a social support network, finding things the young adult loves to do, and helping set up visual supports.
Emotion regulation is very important as well. We often teach the children emotions out of context, which can be ineffective. It is important to teach emotions and emotion regulation in the context in which they are most relevant. Emotional regulation and social interactions work hand in hand. Often, individuals are most dysregulated in experiences with other people, as social interactions can be emotionally provocative for those on the spectrum. A lot of times, social skills are present, but emotions are evoked. Dr. Segall helps the young adult to see if we change the environment or instead work on emotional or social coping skills. This would help them think about the context that they are in and then pull from their bank of toolboxes. Instead of appropriate and inappropriate behaviors, Dr. Segall recommends labeling behaviors as expected or unexpected behaviors, as what is expected is situational. This can help one discuss expected behaviors in certain situations, which can bring more awareness into a situation, and the young adult can see if they need to bring in more emotional regulation, behavioral regulation, or a strategy that lets them succeed at a higher level in that context.
Regarding daily living skills, Dr. Segall finds that younger clients are often not interested in working on these. He noted that the key is to start working on these goals young and build up to good habits and systems. It is useful to have family chore charts and rewards systems, then fade in new chores and goals or higher levels of independence. The earlier you start, the better habits we build in, and one can internalize responsibility and values. Parents can help by breaking down the tasks, using visual supports and lots of rewards, and modeling.
Social goals in young adults with autism can include focusing on developing interests that give access to peers, finding inclusive peers who are open to learning about diversity or other neurodiverse peers, and finding tasks they want to do to expand their social world. Sometimes a problem is not caused by a social skills deficit but that the person hasn’t yet found the right place that “got it.” Again, it can be helpful to teach expected and unexpected behaviors in different situations, then how to engage in those behaviors or be a self-advocate. The context of learning social skills is really important.
Employment is a huge area one might set goals in. To be successful at work, one needs to be aware of one’s own behavior, have a plan, be organized, and have the stamina to engage in a workday and stay on task and complete tasks. Dr. Segall helps young adults plan and build routines, discover what the person would be interested in doing for a job, learn how to disclose about autism, and advocate in the workplace. He helps them learn how to ask for accommodations, which ones to ask for, and how to go about having these conversations. He often recommends that individuals look into autism-specific hiring initiatives, such as those through Microsoft or SAP. Regarding employment readiness, one can always find reasons they are not ready for employment. Dr. Segall instead recommends thinking about what opportunities will maximize one’s strengths, talents, and abilities, where ASD challenges will least interfere, where challenges minimized, are where preferences are, and look there. His goals are to create as good a match as one can, know which supports one needs to put in place, and task a dignity of risk.
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Intro Outro: Intro Outro 2 by Mattias Lahoud under CC-BY 3.0 License (www.freesound.org)
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Self Care Song: Green and Orange No Water by Duncan Alex under CC-BY 3.0 License (www.freesound.org)
Hosted by: Jessica Temple and Lewis Temple
Disclaimer: Our show is not designed to provide listeners with specific or personal legal, medical, or professional services or advice. Parents of children with health issues should always consult their health care provider for medical advice, medication, or treatment.
Copyright 2020 Jessica and Lewis Temple