What weve got here is failure to communicate.

Employment Supports For Individuals with ASD and Challenging Behavior

Autism NOW October 20, 2011

Cool Hand Luke

The University of Maine Center for Community Inclusion & Disability Studies

Behavior as a Predictor of Success

We should not assume that the behavior that a person with ASD exhibits in some environments is going to occur in the workplace. Problematic behavior that occurs in some environments might not occur in other environments or it might occur but not be problematic.
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Evolution of Behavior Support

Originally focus was on either eliminating or increasing behaviors with reinforcement. Later the focus was on the communicative function of behavior. We began to ask Why? More recently, we have begun to look at things like the environment and quality of life.
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Functional Behavior Assessment

Used when implementing positive behavioral strategies to reduce behavior that is interfering with success in the workplace.

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Functional Behavior Assessment (2)

Systematic description of behavior
frequency and/or duration of behavior, conditions in which behavior occurs, hypotheses about why behavior occurs environment is too loud, co-workers are inadvertently reinforcing unwanted behavior

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What is Behavior Communicating?

Common answer: Because s/he is manipulative.

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What Is Behavior Communicating? (2)

Why do people do the things they do?
Typically, we say they want to get something or get away from something; Fun, Excitement, Revenge, Joy, Love, Fear, Loneliness, Compassion, Passion, Creativity

Avoid simply eliminating the behavior by removing reinforcement.

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Consider Sensory Differences

Overreaction to: Certain sounds, pitches or volume Certain sights Touch especially light tough Sensory Seeking: Vestibular or proprioceptive feedback
constant movement

Tastes
Smells

Deep pressure Certain tastes/smells Certain visual stimuli Seeming passive

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People May Deal with Sensory Processing Differences by:

Rocking Pacing Staring out a window Moving around a lot Flapping hands Rubbing fingers Jumping Putting hands over ears

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Vestibular and Proprioceptive Systems

can be organizing. At a worksite, it may be important to allow people to get feedback (through rocking, for example). Sometimes it may be necessary to help a person find replacement behaviors that provide the same feedback but may be more socially acceptable.
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Managing Sensory Differences

Reality to an autistic person is a confusing interacting mass of events, people, places, sounds and sights. There seem to be no clear boundaries, order or meaning to anything. A large part of my life is spent just trying to work out the pattern behind everything. Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life.
-Theresa Joliffe in Joliffe, Lakesdown & Robinson (1992)
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Responses to Overstimulation
Strong emotional reaction Increased anxiety Escape Aggression or property destruction Shut down Need for sensory breaks

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Anxiety
Associated with: Panic attacks Physiological arousal Social anxiety Separation anxiety Difficulties with change Research indicates high levels of anxiety in persons with ASD
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Anxiety and Sensory Differences

Increased sensitivity to sensory stimuli tends to increase propensity for anxiety. Increased anxiety increases sensitivity to (external) sensory input.

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Anxiety Loop
Increased anxiety

Physiological response providing new sensory inputs

Greater reactivity to sensory stimuli

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Anxiety in Workplace For Persons with ASD

Sensory issues Changes in physical environment Being overwhelmed by sights or sounds Too many people Cluttered environment
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Anxiety in Workplace For Persons with ASD (2)

Unanticipated changes in schedule or not knowing schedule
Not knowing exact responsibilities Unclear communication from others Changes in support staff, co-workers, or supervisors
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Anxiety in Workplace For Persons with ASD (3)

Difficulty interpreting what is expected socially or other aspects of the workplace organization Difficulty dealing with down time Problems at home Frustration
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Managing Unpredictability
Difficulty processing sensory information, the ensuing experience of chaos and confusion, and the inability to accurately predict how ones own body will react or move, can all lead to the following:
- Need for Stability - Need for Certainty - Need for Predictability - Reliance on Rituals
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Structure and Predictability

Can help individuals with ASD perform their jobs more effectively; Can help a person remain calm and reduce anxiety; and Are not the same as repetitive and boring.

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Individuals Vary in Their Needs For

Predictability; Flexibility in scheduling; Comp Time; Adjustments to work levels; Support in dealing with down time; or Preparation for changes in routine or transitions.
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Reliance on Rules
Many individuals with ASD have difficulty spontaneously deciding how to act in particular social situations. As a result, they may come to rely on rules to guide their behavior. This can sometimes be a problem when they need to act more flexibly or when they expect others to follow rules exactly.

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Supports: Structure and Predictability

Visual organizers and schedules Review of schedule in anticipation of changes in routine or environment Transition supports

Personal Digital Assistants (PDA)

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Supports: Structure and Predictability (2)

Removing unnecessary distracters Support during personnel changes Flexibility in scheduling and breaks

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Removing Unnecessary Distracters

Some employees with ASD perform better in environments that are very structured and have few distracting stimuli. It may be necessary in some cases to work with the employer to create such an environment or workstations.
-Quirk, Zeph, & Uchida (2007)

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Support During Personnel Changes

Turnover among job coaches or valued co-workers can have a devastating effect on some employees with ASD. Talk over changes in advance. Work from Day 1 on expanding the range of people at a worksite who can provide natural supports.
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Flexibility in Schedules and Breaks

Many people with ASD may need more flexibility when taking breaks. A person might not necessarily need extra time.

Some people with ASD may need more flexibility in their schedules, especially if they experience other medical issues.

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Motor Difficulties in ASD

Gait & Posture Balance Manual dexterity Stereotypical or involuntary movements Low or high muscle tone Motor planning Impulsivity

Rhythm
Imitation skills Initiation especially new skills Handwriting

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Implications
Early difficulties with a new task does not mean a person will not eventually become proficient. Motor planning may explain some difficulties with changes in routine.

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Implications (2)
Inconsistent performance might be the result of motor differences, rather than motivation.
Teaching new skills one step at a time through the use of task analysis may be very effective for many individuals with ASD.
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Some Solutions
Use of computer or other typing device instead of writing. Jigs or other accommodations used for individuals with physical disabilities. Job carving to eliminate tasks that cannot be accommodated.

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Some Solutions (2)

Visual organizers to prepare person for changes in routine. Allowing plenty of time to learn new job tasks. Taking steps to reduce other sources of anxiety and stress - especially when related to sensory issues.

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Supportive Work Places

Willingness to adapt tasks. Willingness to get to know person with ASD. Special treatment is not special. More interested in the persons individual support needs than in whether she will fit into existing workplace culture.
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Know the Workplace Culture

Before determining what kinds of supports a person may need, employment specialists must first understand what is socially acceptable or expected in the workplace. They need to assess the workplace culture.

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Know the Workplace Culture (2)

A good source of information on assessing workplace culture is David Hagners Coffee Breaks and Birthday Cakes: Evaluating Workplace Cultures to Develop Natural Supports for Persons with Disabilities.

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Supporting Social Interaction

Altering the environment

Providing direct supports for social interaction Intervening in the culture

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Altering the Environment

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Integrated Work Settings

Working in an integrated setting, alone, often leads to improved social skills (Smith, Belcher,& Juhrs, 1995) The workplace can provide good models of social interaction.

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Environmental Modifications
Remove distracting stimuli. Integrate employee into new environments slowly - over several visits. Work around people wearing minimal perfume or cologne.
-Adapted from Bellini (2006)
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Environmental Modifications (2)

Avoid working near bright windows or other over-stimulating visual stimuli.
Avoid work areas where the person might experience auditory sensitivities. Use earphones to reduce noise.
-Adapted from Bellini (2006)
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Supports for the Person

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Relaxation and Emotional Regulation

Tension Release and Breathing Exercises

Biofeedback
Self-Awareness Training
-Adapted from Bellini (2006)

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For More Information on Relaxation Strategies

Groden, M.G., Groden, J., Groden, G., & Lipsitt, L.P. (2006). Stress and coping in autism. New York: Oxford University Press. Bellini, S. (2006). Building social relationships: A systematic approach to teaching social interaction skills to children and adolescents with autism spectrum disorders and other social difficulties. Shawnee Mission, KS: Autism Asperger Publishing Co.
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Scripts
Individuals can be taught to use scripts in social situations. They can be used to help a person engage in small talk or to use and understand facial expressions.
-Quirk, Zeph, & Uchida (2007); Duffy, Opperman, Smith, and Shore
(2007)

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Video Modeling and Video Self-Modeling

Used to teach reading nonverbal cues, reciprocal conversations, initiating interactions, making eye contact, social problem-solving and self-awareness. Builds on visual strengths. Positive self-review. Video feedforward.
-fromBellini (2006)
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Intervening in the Culture

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Working in Isolation?
Difficulty with social interaction does not mean a person must work in isolation. Good job matching and appropriate supports can lead to social success in the workplace.

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Clear, Straightforward, Positive Explanations

Provide clear and unambiguous direction, feedback, and social cues. Do not beat around the bush! Explain in a calm tone what is expected in particular situations. Be concrete and specific!
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Clear, Straightforward, Positive Explanations (2)

It may help to explain exactly what is going on in a social situation to a person with ASD.
the person is pulling a prank the person is being sarcastic

Job coaches may need to teach coworkers and supervisors to do this.

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Mentor
May act as Social Translator.
Helps person with ASD understand social relationships and unwritten rules.

Ideally the mentor is a co-worker.

-Duffy, Opperman, Smith, and Shore (2007)

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Teaching Co-Workers
Co-workers and supervisors may need instruction on the following:
How to initiate interaction with a co-worker with ASD. How to provide clear feedback about the job or social interaction. How to interpret unusual behavior or speech.
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Additional Resources
Olney, M. (2001). Communication strategies of adults with severe disabilities: Supporting selfdetermination. Rehabilitation Counseling Bulletin, 44(2), 87-95. Olney, M. F. (2000). Working with autism and other social-communication disorders. Journal of Rehabilitation, 66(4), 51-56.
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Additional Resources (2)

Hagner, D., & Cooney, B. F. (2005). "I do that for everybody": Supervising employees with autism. Focus on Autism & Other Developmental Disabilities, 20(2), 91-97.
Kurtz, A., & Jordan, M. (2008). Supporting individuals with Autism Spectrum Disorders: Quality Employment Practices. The Institute Brief, 25 (ICI).http://www.communityinclusion.org /article.php?article_id=266
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Additional Resources (3)

Standifer, S. (2009). Adult autism and employment: A guide for vocational rehabilitation professionals. Columbia Missouri: University of Missourihttp://www.dps.missouri.edu/Au tism/Adult%20Autism%20&%20Employ ment.pdf

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