by 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).