When I talk about my work, it is not about understanding autism from a neurodiverse perspective. That is not for me to do. I am not autistic. I have learned immensely from my partnerships and interactions with autistic individuals. Autistic self-advocates should be leading the way, compensated as experts in educating the professional community about the neurotypical individual, autism and what interventions are most helpful and what research is needed. Instead, I would like to focus on how professionals can shift to a strength-based practice, embrace neurodiversity and recognize how a neurotypical bias may impact our ability to engage in authentic strength-based practices.
Kristie Patten Koenig, PhD, OT/L, FAOTA
Professionals are able to identify deficits and maladaptive functioning, that is what we are trained to do in fields such as special education, occupational therapy, and speech and language therapy for example. We do identify strengths in our assessments and observations, often by default, but need to emphasize weaknesses in order to provide services. This emphasis has narrowed the scope of both practice and research to the deficiencies demonstrated by autistic individuals, and goals and treatment programs that then are centered around remediating areas of weakness. No one, however builds their lives on remediated weaknesses. We build our lives on things we do well, and our interests. Saleeby (2001), an early proponent of using strength-based models in the field of social work, identified that a problem orientation begins to look like an exercise to meet the needs of the professionals rather than those they serve. The chosen focus of intervention, whether it is through a strength-based lens or a deficit focus will be critical for long-term outcomes including quality of life, well-being and the ability to live a self-determined life. By holding a longer view of success and outcomes, a shift away from a primary focus on deficiencies is in order (Patten Koenig & Shore, 2018). Can professionals replace a deficit lens, with one in which challenges, especially those caused by the environment and social attitudes are addressed, but competence becomes the bias?
It is a radically different practice perspective from the problem-focused approach and there are neurotypical biases that make it difficult for professionals to make this shift. A strength-based practice has its roots in self-determination theory, including a) autonomy, being able to freely choose things in your life and not being controlled, b) competence, doing things you initiate and that make you stretch, and c) relatedness, choosing your relationships with others (Ryan & Deci, 2000). Practice begins to look different if these core psychological needs are held as primary. This can be illustrated by using restricted or focused interests as an example.
Professionals often discourage the use of interests in the classroom or during therapy, or hold them out as rewards. Controlling use of rewards is in direct opposition to the development of autonomy (Ryan & Deci, 2000). Patten Koenig & Williams (2017) surveyed 80 autistic adults as to how they characterized and utilized interests both as children and now as adults, and while 87% of the participants wished that teachers and professionals would have used their interests in the classroom, only 12% reported that their teachers actually did use their interests as strengths to support learning. These adults overwhelmingly reported that their interests were positive, helped calm them and mitigate stress, were not interfering or anxiety producing and should be utilized for learning and mastery, development and autonomy (Patten Koenig & Hough Williams, 2017), two core skills of self-determination. The neurotypical professional bias often sees these interests as part of the problem, versus a solution.
There is a neurotypical bias as to how professionals should address social skills. Approaches to social interventions for autism are framed by neurotypical definitions of being social. Heasman and Gillespie (2018) investigated how autistic individuals build social understanding and found that in a high-interest activity, there is a generous assumption of common ground, which can lead to rapid rapport. Instead of a social skills group to increase competence in discrete social skills, a strength-based practice could have the therapist utilize inclusive interest-based groups that students are autonomously motivated to participate in, have a competent knowledge base in order to make connections, and socially participate in a more meaningful, self-determined way. Teachers could incorporate strengths and interests into subject matter, routines and social relationships by simply respecting the inherent value they have for the individual versus pathologizing these interests. This builds relationships in a way that is meaningful to the student. The framing matters. If I view interests as positive and an avenue for learning and goal attainment, I must find a way to incorporate them into all aspects of professional practice. If I frame these interests as interfering, then I must eliminate them.
Autistic individuals are expressing anger and frustration at therapeutic interventions that diminish interests (Bagatell, 2010) and advocacy groups are making a distinction from interventions that provide supports and services to help individuals achieve personally valued goals versus “normalization” of their behavior (Parsloe, 2015). If practitioners can adopt a strength-based practice, their thinking will shift away from any intervention that attempts to “normalize,” unless it is personally valued (Patten Koenig, 2019). These shifts in thinking will require the professional to question him or herself regularly and ask questions such as: Am I focusing on weaknesses in the absence of strengths? Am I offering activities and choices that are related to interests? Am I viewing autistic interests as strengths versus motivators or worse yet suppressing them as maladaptive behaviors? Am I combining a strengths perspective with the challenges that are being addressed? The first place to find the answers to those questions is to examine our evaluations, goals, individual educational plans and interventions. If the answer is a one-line response for “strengths,” it is time to see the biased perspective and make the shift to an authentic strength-based practice.
Kristie Patten Koenig, PhD, OT/L, FAOTA, is Associate Professor and Chair at the New York University Steinhardt School of Culture, Education and Human Development Department of Occupational Therapy. If you would like to contact Dr. Patten Koenig, she can be reached via email at kpk3@nyu.edu.
References
Bagatell, N. (2010). From cure to community: Transforming notions of autism. Ethos, 38, 33-55.
Heasman, B. & Gillespie, A. (2018). Neurodivergent intersubjectivity: Distinctive features of how autistic people create shared understanding. Autism, 22, 1-12 https://doi.org/10.1177/1362361318785172
Parsloe, S.M.(2015). Discourses of disability, narratives of community: Reclaiming an autistic identity online. Journal of Applied Communication Research, 43, 336-356.
Patten Koenig, K. (2019). A strength-based frame of reference for autistic individuals. In P. Kramer, J. Hinojosa & T. Howe (Eds.) . Frames of reference for pediatric occupational therapy (4th edition).
Patten Koenig, K. & Shore, S. (2018). Self-determination and a shift to a strengths-based model. In R. Watling & S. Spitzer (Eds.), Autism: A Comprehensive Occupational Therapy Approach, 4th edition, Bethesda, MD: AOTA Press.
Patten Koenig, K. & Hough, L. (2017). Characterization and utilization of preferred interests: A survey of adults on the autism spectrum. Occupational Therapy in Mental Health. https://doi.org/10.1080/0164212x.2016.1248877
Ryan, R. M. & Deci, E. L. (2000) Self-determination theory and the facilitation of intrinsic motivation, social development and well-being. American Psychologist, 55, 68-78.
Saleebey, D. (1996). The strengths perspective in social work practice: extensions and cautions. Social Work, 41(3), 296-306.
Nice article and it’s what I’ve hoped for, for years. Unfortunately, no, I don’t believe professionals can make this shift. It’s way too much of a radical paradyme shift after decades of training. Hence, the emphasis on ABA to fix society viewed weaknesses beyond corrective measures during school time. When does the autistic ever feel free to be themselves and build confidence? Masking/passing is exhaustive work for the autistic person on a daily basis. Would I like to be proven wrong that professionals can change? Absolutely!!
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