Employment Training and Consultancy Service Warwick University 26th June 2018 Autism awareness & Communication and management Strategies Employment Training and Consultancy Service

Objectives To develop understanding of autism including Asperger syndrome To increase awareness of how autism may affect students and why To discuss practical strategies to enable staff to work effectively with students who have autism To increase your awareness of how ASDs manifests itself: key areas to be aware of and keep in mind To highlight the wide range of abilities & potential within the autistic spectrum To increase your confidence & competence in working with people with ASDs 2

Activity - What is autism? In groups, open the envelopes and discuss your questions The questions refer to ‘people with autism’. This refers to people who have a diagnosis on the autism spectrum (including Asperger syndrome) Each group has a different set of questions We will then discuss each set of questions as a whole group

Research and Statistics 43% have left or lost a job because of their condition (NAS, 2012) Adults with autism should be offered individualised support if they are having difficulty maintaining employment (NICE, 2012) Only 15% of people with autism are in full-time employment compared to 48% of people with disabilities (DoH, 2009)

What is Autism? Lifelong developmental condition Difficulties in two main areas Social Communication & Interaction Restricted, repetitive patterns of behaviour, interests, or activities 1.1% of UK has diagnosis affecting 2.8 million families 4:1 ratio (male/female) Ongoing research into causes of autism There is no ‘cure’ and many people with autism do not want one Hidden disability Changes in DSM 5 The previous use of three domains of impairments has been reduced to two domains: 
- social communication and interaction.
- restricted, repetitive patterns of behaviour, interests or activities. Sensory behaviours are included in the criteria for the first time, under the 'restricted, repetitive patterns of behaviours' descriptors. The emphasis during diagnosis will change from giving a name to a condition to identifying all the needs that someone has and how these affect their life. Diagnosis of Females In recent years, questions have been raised about the ratio of males to females diagnosed as having an autism spectrum disorder (ASD). Overall the most recent studies suggest that the prevalence of autism spectrum disorder is about one in 100, but what of the male/female ratio?  There is no hard evidence of numbers. Various studies, together with anecdotal evidence, have come up with male/female ratios ranging from 2:1 to 16:1. Whatever the true ratio, clinical referrals to a specialist diagnostic centre such as The National Autistic Society’s Lorna Wing Centre have seen a steady increase in the number of girls and women referred. Because of the male gender bias, girls are less likely to be identified with ASD, even when their symptoms are equally severe. Many girls are never referred for diagnosis and are missed from the statistics. At The Lorna Wing Centre, emphasis is placed on the different manifestations of behaviour in autism spectrum conditions as seen in girls and women compared with boys and men. In our paper (2011) we have identified the different way in which girls and women present under the following headings; social understanding, social communication, social imagination which is highly associated with routines, rituals and special interests. Some examples cited in the paper are: Girls are more able to follow social actions by delayed imitation because they observe other children and copy them, perhaps masking the symptoms of Asperger syndrome (Attwood, 2007). Girls are often more aware of and feel a need to interact socially. They are involved in social play, but are often led by their peers rather than initiating social contact. Girls are more socially inclined and many have one special friend. In our society, girls are expected to be social in their communication. Girls on the spectrum do not ‘do social chit chat’ or make ‘meaningless’ comments in order to facilitate social communication. The idea of a social hierarchy and how one communicates with people of different status can be problematic and get girls into trouble with teachers. Evidence suggests that girls have better imagination and more pretend play  (Knickmeyer et al, 2008). Many have a very rich and elaborate fantasy world with imaginary friends. Girls escape into fiction, and some live in another world with, for example, fairies and witches. The interests of girls in the spectrum are very often similar to those of other girls – animals, horses, classical literature – and therefore are not seen as unusual. It is not the special interests that differentiate them from their peers but it is the quality and intensity of these interests. Many obsessively watch soap operas and have an intense interest in celebrities.

Autism Perspectives “It explains how my brain works and how other people behave in weird ways.” “It’s a part of who I am. It’s a part of my identity. Just like my gender, my race and my sexuality.”

Types of Autism Kanner/Classic Autism – Individuals will often have high support needs for life, may be non-verbal and have associated learning disabilities. High Functioning Autism – Individuals are likely to have average or above average intelligence but will have had a delay in developing language as a child. Asperger syndrome – Individuals are likely to have average or above average intelligence and did not have delayed language development as a child

Moderate learning disability The Autism Spectrum Asperger syndrome High-Functioning Autism Classic Autism Average I.Q. Mild learning disability Above average I.Q Moderate learning disability

Autism Perspectives “Not all autistic people are like “Rainman” or the character from the “Curious Incident of the Dog in the Night-time”. They may not all hate being touched or might not all hate talking to strangers. There are lots of stereotypical images of people with autism but we are actually a lot more varied than the media would have you think.”

Social Communication and Interaction Might… interpret language in a literal way find it difficult to join in ‘banter’ or make ‘small talk’ not pick up on non verbal gestures, facial expressions and hints have difficulty understanding ‘unwritten rules’ of social interaction appear ‘unconventional’ or appear socially ‘awkward’ have difficulty starting or sustaining reciprocal conversation have unusual eye contact “If someone were to say “Can you give me a hand?”, I’d be thinking “How?” “What do you mean?” “What am I supposed to do?.” 10 10

Activity - Giving instructions On your paper there is a list of common workplace instructions. In pairs discuss the hidden meaning behind each phrase and rewrite them as more specific and direct instructions.

Common metaphors: people can take these literally and this can cause anxiety and confusion. In English these are common metaphors utilised in communication.

Restricted, repetitive patterns of behaviour, interests or activities Might… have difficulty instinctively understanding other people’s thoughts and feelings have problems dealing with change or taking on new ideas have difficulty with new or unfamiliar situations including people have difficulty with hypothetical or abstract concepts have special interests/obsessions have sensory sensitivities - hyper or hypo 13 13

Other characteristics Anxiety and co-occurring mental health conditions Sensory sensitivities - hyper or hypo Single attention Special interests Problems with ‘executive function’ Perfectionism Specific learning difficulties Anxiety Individuals with an ASD will usually have high levels of anxiety; this will be for a number of different reasons. These might be linked to not knowing what the future will hold for them, be it the immediate or long term, hence the love of routines. It may be the confusion they feel relating to many of the unwritten social rules of the workplace. High anxiety levels will impair individual’s ability to communicate and to perform their role. Mental Health At least one in three adults with autism are experiencing severe mental health difficulties due to a lack of support Single Attention Many people with an ASD have a difficulty in switching from between tasks in the workplace. Many people with an ASD will have difficulty in “multitasking”. As one young man with an ASD eloquently puts it “one of the main differences between normal people and autistic people is that you guys have divided attention, whereas we autistic folk have single attention…this means we can become absorbed by one thing and devote our entire attention to it!” Special interests: People with an ASD may develop an intense, sometimes obsessive, interest in a particular hobby. Some are very knowledgeable in their chosen field of interest, whether it is trains, computers, a particular TV show or something else. Sensory difficulties: Most people with an ASD experience sensory difficulties; these can be in one or all of the senses (sight, sound, smell, touch, or taste). For example, bright lights, loud noises, overpowering smells, particular food textures and the feeling of certain materials may cause anxiety, pain or discomfort. Some people have utilised their sensory sensitivities in employment, especially in creative roles, within the media, music or art.

The Overlapping Nature of Specific Learning Difficulties ADD/ADHD Dyslexia Dyscalculia ASDs Dysgraphia Dyspraxia Dr Amanda Kirby, Dyscovery Centre, University of Wales, Newport

Lightbulbs vs Lasers “I have these very focused interests and they are not as varied as other people. I compare it to light bulbs versus lasers. A light bulb will shine its light everywhere and shine all over everything. Whereas a laser only concentrates its light on a very small point but it will be a very intense point. Sometimes I wish I could just suddenly open myself to all these other things. But, I can’t do it. I just make the most of focusing my energy on what I know and what I like. I do wish I could just open my mind a bit. It’s very difficult.”

Strengths Might have strengths including… Logical/Methodical approach Different way of thinking Accuracy and attention to detail Good memory Reliable Integrity Strong sense of justice Strong visual skills Strong numerical skills

What is a reasonable adjustment? It applies to people such as employers, service providers and education providers and is intended to make sure that disabled people do not face substantial difficulties in employment, education or when using services. An adjustment is related to a particular individual, their experience of their impairment and the situation they are in. There are four tests of reasonableness. 1. The effectiveness in preventing disadvantage 2. The practicality of the step 3. The financial and other costs and the extent of any disruption caused 4. The extent of an organisation’s financial and other resources

Activity: Difficulties and Strategies 1.Difficulties students/researchers with autism may have 2. Useful strategies to overcome these Think about all aspects of their student life and environment In your groups discuss the answers

Difficulties Sensory needs Social life Accommodation Lectures Timetabling Course materials Methods for communicating with students Examination & assessment General facilities & resources (library, IT) Specialist support Academy/Organisation information available to applicants & students Selection & admission Disclosure & confidentiality Enrolment & induction Placements Practical work Group work Staff awareness Student awareness

Strategies Sensory needs Student sensory profile Headphones/ear plugs Computer screen filter Tinted glasses Quiet room Allocated seating Procedure for leaving lectures Separate exam room Advanced notice of fire alarm test Communicate sensory needs to all relevant staff Social life Make rules of behaviour explicit Guidelines on unwritten rules of the academy/organisation Learning agreement/contract Dictionary guide to “academy speak” Autism support group Autism social group Raise awareness of autism within student community ‘Autism friendly’ events Assistance in joining clubs & societies Peer befrienders / mentors Lunch club

Difficulties - A students view (Martin; 2008)

Strategies - Social Clarify the unwritten rules Make rules of behaviour explicit – e.g. contract or learning agreement Use interests to encourage and extend interactions Non-verbal communication may be misunderstood Plan students unstructured time Raise awareness of ASD’s within student community “My main barriers have been social and I find large groups of people I don't know intimidating. As a result I rarely attend lectures and often feel very alone”.

Importance of Feedback “Learning is a feedback methodology: if you walk in front of a moving car you get hit – immediate consequence, you learn not to do it again. If I annoy but am not told (ie no feedback) then I can’t possibly learn” (Newton: 2007)

Strategies - Academic Facilitate contact between student and staff Interpret/translate academic speak/writing Use Checklists /Timetables Provide structure and clarify what is expected “I want to understand everything on a topic so I need to read every book that I can find that's got something on it. I suppose that's not a bad thing to read lots of stuff but this has caused me difficulties and taken up more time.”

A students view… “When people say ‘use your initiative’ what they are really saying is ‘I want something but don’t know what it is, you go do it for me’. How am I supposed to react? The lack of instruction is staggering. If the purpose is to allow me to complete a task to my own criteria, this should be stated, because I am capable of that. What I am not capable of is guessing someone else’s criteria which is not explicitly stated.” (Newton: 2007)

Strategies - Academic Set up a support network – identify and clarify roles Prepare for Exams and Coursework deadlines Try to anticipate and manage change Support the person afresh each time they encounter change in a known routine Be aware of sensory issues “I find it stressful having a room that is in the middle of a noisy environment and studying in my room”.

Reasonable Adjustments Mentoring Practical support Staff awareness Student awareness Adapting assessment method Exam arrangements Environmental adaptations Staff awareness include all staff for example library staff, IT staff, admin staff, support staff, tutors and halls officers. Adapt assessment method -Group work ,presentations. Testing competencies for is the group work the competency being assessed ?

Strategies - Best Practice Consistent and frequent support Create quiet & non-stressful environments for meetings, lectures, study and relaxation Clear communication Give time to process information Clear, specific, precise instructions Don’t assume implicit communication will be understood Don’t rely on non-verbal gestures/hints Clear and accessible guidelines and procedures Advanced information wherever possible Encourage awareness and acceptance Be supportive, direct, motivational and positive “It helps if I’m given lots of praise and encouragement – for me too much emphasis on mistakes and shortcomings can be counterproductive.”

Things to consider Communication e.g. lack of clarity Nature of the task e.g. group work Anxiety Time/other pressures Environmental factors Change Unwritten rules Workplace relationships Lack of structure Personal

Further Information Autism and Asperger Syndrome NAS website: www.autism.org.uk NAS helpline: 0808-800-4101 autismhelpline@nas.org.uk Network Autism http://network.autism.org.uk/welcome

Contact Details The National Autistic Society Employment training and consultancy team 393 City Road London EC1V 1NG Employment.training@nas.org.uk 020 7704 7450