The current Diagnosis and Statistical Manual of Mental Disorders-Fourth Edition, Treatment Revision (DSM-IV-TR) identifies three main features that are associated with autism: impairment in social interaction, communication, and behavior. Examples of the impairments in social interactions include poor use of body language and nonverbal communication, such as eye contact, facial expressions, and gestures, lack of awareness of feelings of others and the expression of emotions, such as pleasure (laughing) or distress (crying), for reasons not apparent to others, and difficulty interacting with other people and failure to make peer friendships. Examples for impairments in communication are: delay in, or the total lack of, the development of spoken language or speech, difficulty expressing needs and wants, and verbally and/or nonverbally inability to initiate or sustain conversation. Finally, examples of impairments in behavior are: insisting on following routines and sameness, resisting change, preoccupation with parts of objects or a fascination with repetitive movement (spinning wheels, turning on and off lights), and narrow, restricted interests (dates/calendars, numbers, weather, movie credits, etc.).
According to Erikson (1994), during adolescence around ages 18 or 20 years old, the task is to achieve ego identity and avoid role confusion. Ego identity means knowing who you are and how you fit in to the rest of society. It requires that you take all you have learned about life and yourself and mold it into a unified self-image, one that your community finds meaningful. In the initial stage of being an adult we seek one or more companions and love. As we try to find mutually satisfying relationships, primarily through marriage and friends, and we generally also begin to start a family. If negotiating this stage is successful, we can experience intimacy on a deep level. If we are not successful, isolation and distance from others may occur. And when we do not find it easy to create satisfying relationships, our world can begin to shrink as, in defense, we can feel superior to others. These tasks could be challenging or even impossible for some individuals diagnosed with autism spectrum disorders. The abovementioned impairments in social interaction, communication, and behavior can place significant difficulty on the ability to achieve ego identity (Orsmond, Krauss & Seltzer, 2004). Many of the symptoms related to autism spectrum disorders are likely to lead individuals diagnosed with autism spectrum disorders to role confusion which will impact their ability to function in society.
Educational Curriculum and Capacity for Employment
Nuehring and Sitlington (2003) stated that transition to adulthood is the process through which students leave high school and become members of an adult community. Several studies conducted during the 1970s and 1980s suggested that individuals diagnosed with autism spectrum disorders had no indication of independence as expressed by work, education, and independent living in early adulthood (Billstedt, Gillberg & Gillberg, 2005). Many if not all individuals who are diagnosed with an autism spectrum disorder receive an Individualized Educational Plan (IEP). An IEP is designed to meet the unique educational needs of the child, as defined by federal regulations. The educational plan must be tailored to the individual student’s needs as identified by the evaluation process and must help teachers and related service providers understand the student’s disability and how the disability affects the learning process. In other words, the IEP should describe how the student learns, how the student best demonstrates that learning and what teachers and service providers will do to help the student learn more effectively. This is especially important for individuals who are diagnosed with autism spectrum disorders since no two individuals will present with the same severity of symptoms or level of functioning. According to Hume and Odom (2007), the deficiency in independent functioning has substantial implications for students diagnosed with autism spectrum disorders, as it is impediment to classroom and community inclusion. The IEP should assist in modifying the content of educational curriculum that is being taught in the classroom. The educational curriculum can assist in the transition to the community and adulthood of individuals diagnosed with autism spectrum disorders. In the past decade, our understanding of the autism spectrum increased, which assisted many researchers, educators and mental health practitioners as well as family members to better manage and treat more effectively the social challenges these disorders presented to individuals and their family members (Giddan & Obee, 1996). The recent emphasis on independence during adulthood highlights the immediate need for research and intervention in this area. Because of the multiple challenges individuals diagnosed with autism face, it is necessary that intervention should be focused on strengths (Hume & Odom, 2007). Supported employment is an accommodating approach for hiring and retaining individuals diagnosed with disabilities. A specialized trainer, also known as job coach or employment specialist, provides individuals training for the supported employee. The supported employment is highly adaptive to individual and organizational need (Garcia-Villamisar & Hughes, 2007; Schaller & Yang, 2005), which is consistent with the need to focus on individualized education and individualized vocational services which will better prepare individuals on the autism spectrum towards independent living.
Oren Shtayermman, PhD, MSW, is an Assistant Professor of Mental Health Counseling, is the Mental Health Counseling Program Coordinator and is a Research Associate at the New York Institute of Technology School of Health Professions, Behavioral and Life Sciences located in Old Westbury, New York.