Working with Autism and Other Social-Communication Disorders

Journal of Rehabilitation,  Oct-Dec, 2000  by Marjorie F. Olney

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Since the introduction of supported employment, and the implementation of legislation such as the Rehabilitation Act Amendments of 1986 and the Developmental Disability Assistance and Bill of Rights Act (1984), rehabilitation counselors have been increasingly responsible for serving a diverse pool of clients. The mandate to support individuals with the most significant disabilities is further strengthened in the 1998 amendments to the Rehabilitation Act. The language of legislation and policy infer high expectations for the vocational success of such individuals, many of whom were previously deemed unemployable.

Graduate programs in Rehabilitation Counseling tend to stress psychosocial adjustment to disabilities, counseling methods, and functional limitations. Problems associated specifically with developmental disabilities such as communication disorders, behavior issues, and adaptive deficits receive less attention in curricula (Bolton & Cook, 1997). As a consequence, counselors may be inadequately prepared to serve individuals with the most severe disabilities in community contexts. The aim of this article is to provide rehabilitation professionals with (1) detailed definitions and descriptions of autism, (2) a theoretical overview of the literature on autism and related disabilities, (3) effective approaches and strategies based on primary sources, and (4) specific recommendations. The purpose of the article is to help the rehabilitation counselor maximize the success of individuals with autism and related disabilities. The paper is organized in three sections. First, definitions of autism including various models and theories of autism are provided. Next, an analysis of first-hand accounts provides insights into how individuals with autism experience the world. The article concludes with a series of recommendations to improve rehabilitation counselor interactions with individuals who have autism and other social-communication disorders.

The Nature of Autism

Autism is one of a family of developmental disorders that influences social, communication, and vocational abilities. Specific labels included under the broader heading of Pervasive Developmental Disability include: Asperger's syndrome, autism, Rett's disorder, and Childhood Disintegrative Disorder (American Psychiatric Association, 1994). Other neurological disabilities, including left hemisphere traumatic brain injury, severe learning disability, language disorders, attention deficit disorder, and Tourette's syndrome, share many features with autism (Frith, 1991, Tsai, 1992; Yeung-Courchesne & Courchesne, 1997). People who have autism and related disabilities sometimes experience secondary problems such as obsessive-compulsive disorder, language difficulties, and attention deficit disorder (Frith, 1991; Tsai, 1992). Many individuals with milder forms of autism are first diagnosed as learning disabled or emotionally disturbed (Tsai, 1992). Although not precisely accurate, `autism' is used as an umbrella term meaning `severe social-communication disorder of developmental origin' throughout this article.

Autism Defined

Autism is a relatively low-incidence developmental disability that, according to Frith (1991), results in impairments of socialization, communication, and imagination. In an article describing her experiences, Donna Williams (1994a), a person with autism, defined the disability as a pervasive developmental disability affecting recognition and comprehension including proprioception, kinesthetic sense, sense of self and other, visualization, sequencing, synthesis, analysis, and retrieval. People with autism often exhibit significant language problems such as delayed or absent speech, perseveration, and echolalia. Solitary, repetitious, patterned behaviors are often favored from infancy, sometimes to the exclusion of explorative and social behaviors (Wing, 1991). The majority of people with autism are thought to have severe intellectual disabilities (Yeung-Courchesne & Courchesne, 1997). Most people who are so labeled require supervision, support, and assistance throughout their lives.

The nature and severity of autism has profound implications for the potential success of the individual in the workplace. Responses and behaviors of people with autism can be mystifying. For example, strong emotional reactions to touch, sound, or unanticipated change may appear disproportional to the problem. Patterned or ritualized behaviors may seem odd, and speech may be monotonic, formal, or unusual in content or delivery. Although there are no simple answers as to why individuals respond and interact as they do, various models have been proposed.

Historical and Theoretical Models

Our understanding of autism has evolved significantly over the past 50 years. In the early 1940s Leo Kanner and Hans Asperger independently used the term "autistic" to describe children who appeared to have unusual reactions to sensory stimuli, exhibit stereotyped and repetitive behavior, lack imitative responses, desire sameness, and develop strong attachments to objects rather than people (Wing, 1991). Although both Kanner and Asperger believed autism to be an inborn biological disorder, Bruno Bettleheim reinterpreted autism as a psychiatric disability resulting from parent-child pathology (Yeung-Courchesne & Courchesne, 1997). Neuropsychological research has confirmed Kanner's theory that the cause of autism is primarily biological, and that differences in perception and behavior can be attributed to neurological differences (Frith, 1991; Yeung-Courchesne & Courchesne, 1997). Unfortunately, Bettleheim's ideas seem to have persisted in the minds of many professionals and lay persons, causing parents of children with autism to feel inadequate or stigmatized (Wing, 1991).