Young Adults with ASD: New Approaches to An Unmet Need

HS1by Eric Hollander, MD

We are beginning to see a new wrinkle in an emerging epidemic – young adults with Autism Spectrum Disorders (ASDs), sometimes higher functioning, who are presenting in increasing numbers to high schools, colleges, and residential autism programs.  Sadly, there is a lack of effective services and treatments for these young adults who could potentially be making meaningful contributions to our society and to our economy.  Further, given the greatly differing strengths and weaknesses that these young adults posses, ranging from special mathematical or visuospatial abilities to severe mental retardation and epilepsy, one size approaches certainly do not fit all.

Instead, families are often left to fend for themselves, and to face difficult choices, such as sending their loved ones far away for residential care, or paying for an array of services that lack central coordination and do not have a proven track record.

The unrealized goal in educational and vocational services for young adults with autism spectrum disorders is to identify the unique natural skills and abilities that such people possess, and to match these skills and abilities to the appropriate educational or workplace setting.  In addition, after identifying the specific cognitive and social deficits that these individual’s possess, one needs to develop specific remediation and social skills programs to target these deficits, and to provide learning specialists and vocational coaches to implement the needed services in the real world settings.

Much of the focus in recent years has been to identify early symptoms of autism through intensive screening in early childhood, and to develop early interventions and intensive educational approaches in early childhood that improve the overall developmental trajectory of the illness.  This has resulted in important gains in the field.  However, this too has contributed to the newer phenomena of higher functioning young adults who are often lost in mainstream settings without specific and adequate supports and interventions.

I have become increasingly focused on the need to develop centralized daily programs which provide a rich array of scheduled activities to young adults with ASDs. Such programs provide structured positive activities and healthy habits or compulsions to insure the optimal level of stimulation.  Neurocognitive assessment to uncover strengths and weaknesses, and identification of comorbid conditions which can be targeted are essential.  Social skills training facilitates conversational and pragmatic social interactions and self advocacy. Activities of daily living training improves these essential self-care skills.  Neurocognitive rehabilitation and habilitation aim to improve executive function, enhance working memory and strengthen the ability to plan, organize, and break down projects into smaller components, and to follow-through with plans. As students graduate these foundational programs, they transition into real-world educational or job-related settings that match their unique skill sets but provide individualized support for the specific cognitive and social deficits that have been earlier identified.  A centralized coordination of learning specialists and job coaches insure that these young adults do not fall through the cracks, and are able to function at their highest level possible in the mainstream world.

Dr. Hollander is Research Attending Psychiatrist, Montefiore Medical Center University Hospital of Albert Einstein College of Medicine; Editor-American Psychiatric Publishing Clinical Manual of Autism Spectrum Disorders, and the forthcoming Textbook of Autism Spectrum Disorders; and Chair, Advisory Board, International Center for Autism Research and Education, Inc. (ICare4Autism).

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  1. Sarita Freedman, PhD
    Posted July 21, 2009 at 6:13 pm | Permalink

    I completely agree with Dr. Hollander, and am writing a book specifically addressing the need to prepare students for their post-secondary experience, as much as possible, PRIOR to getting out of high school. All of the areas of deficit and need mentioned in this article are a focus of one of my chapters, and many of the skills involved can be identified and habilitated on an ongoing basis from very early-on in the individual’s life. I fully support and would be happy to be a part of any endeavors to help individuals with ASD become productive members of our society. They have so much to offer!

  2. Posted July 21, 2009 at 11:41 pm | Permalink

    Where is Montefiore ? Good article. I am DX high functioning autism with savant abilities in art and the law. Graduated law school — CA and FL refuse to license a person with autism. I have been battling this adult autism problem far longer than most of the younger adults. I received very early interventions from my late Mother, who held a special ed and educ. psy. teaching credential, and was in the process of her doctorate in the 1960s. At the time no one knew a thing about autism.

  3. Dave
    Posted July 28, 2009 at 9:28 am | Permalink

    Just more agreement from me. I’m the father of a 29 yr old Aspie. No autism diagnosis until age 19 when a head injury healed and the doctors continued to see impairment and finally investigated fully. By then my son was well down the path of depression, drug addiction and suicide attempts. It was amazing how well he responded once he had a reason for his social difficulties. I still remember the first time he turned to me and said “This is my Aspergers, isn’t it?” Though the major issues of depression/addiction are pretty well addressed, the issue now is how to help him move on to independent living and work. Though some help is available to him, they have no experience in how to help him so it hasn’t been effective.

  4. Vanessa Freimuth, MAC
    Posted October 7, 2009 at 4:39 pm | Permalink

    EquiisSavant, I cannot believe therea are states that actually can have a rule AGAINST licensing someone. You graduated law school just like the person sitting next to you in class, went through the same subjects, and probably did even better than him or her. The community really needs to catch up with the time here.

    (Four years as an autism therapist, step-brother DX with autism at the age of 19)

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