Melinda Macht-Greenberg, PhD
The field of Autism is ever expanding as our understanding of children, adolescents, and adults with Autism evolves over time. There are some children and adults for whom the diagnosis of Autism can be easily identified by clinicians and researchers. Yet, for others, the diagnostic process is more challenging and less well understood. Parents are faced with the task of obtaining evaluations and services for their children and are overwhelmed with the prospect of navigating through the quagmire of data and recommendations which tend to be confusing at best.
Parents often share that school personnel tell them their child with Autism is more complicated than the school has ever seen in other students with Autism. Some students are not even diagnosed with Autism until middle or high school leaving parents and providers even more confused and overwhelmed as to how their child was able to function so well in earier grades at school. Parents feel alone in their worry and fear about their child’s future. They take great comfort when I tell them that I have many clients who are exactly the same as their child and that they are, in fact, not alone. In the last few years, a new subtype of Autism has emerged.
Autism Plus is the term I use to explain a particular subtype of Autism Spectrum Disorder. Autism Plus encompasses children who have multiple disability areas and where the classical understanding of the term Autism does not apply.
It should be noted that I use the word “disability” because it is the language of the ADA and IDEA (special education law). It helps to lessen the confusion for parents if we use a common vocabulary. However, I do not necessarily see Autism as a disability per se for all children.
Autism Plus describes a group of children whose social and communication functioning qualifies them for the diagnosis under the DSM V. Yet, those with Autism +Plus do not have significant language or cognitive impairments. Most are average to above average cognitively and score high on standardized testing. Many also have solid expressive and receptive language skills. However, the capacity to apply those skills in a functional setting (a.k.a. The classroom) is often compromised. Some with Autism Plus have language-based learning disabilities, some have emotional disorders, many present with ADHD and anxiety as well. The terminology of Autism Plus refers to the overlap of Autism and one or more other primary disabilities.
As such, many of the children can be successful in elementary school but struggle socially or emotionally in middle and high school. In these older grades, the demands increase for higher level social skills and interaction which are significantly more complex and nuanced.
It is hard to know why professionals are seeing an increase in the number of students with Autism Plus. One theory has to do with the increased incidence and diagnosis of Autism in our society. With approximately 1 in 68 young children diagnosed, it makes sense that many of these youngsters are now getting older. The increased number of students diagnosed with Autism are now in older grades.
Anxiety and emotional dysregulation may increase in the higher grades as many of these students can get along in elementary school. In the younger grades, they typically have one teacher for the majority of the day. Most of school is rote, guided learning with a frequent scaffolding (e.g. Teachers can be heard giving the same instruction to all students. “Everyone take out your math folder and a pencil”… “Everyone put your name on your paper”). The increase in anxiety and emotional dysregulation in higher grades is often the result of being in the wrong educational setting where there are no peers who have the same profile and the social expectations, pace, and task demands of the general education classrooms skyrocket. Students with Autism + often cannot keep up with their same-aged peers. Teachers may be perplexed because they can score well on assessments but they lack the functional skills given the difficulties of using skills in an advancing social context (i.e. Middle School and High School). Also, the need for higher level inferential thinking and abstraction dramatically increases in Middle School. Students with Autism Plus tend to be more concrete, literal thinkers and, as such, are overwhelmed with the expectations of these settings.
What can we do?
First, early identification of the Autism Plus subtype is essential. The presentation of youngsters with Autism Plus is often baffling to teachers, providers, and parents. It is imperative that struggling students be evaluated by someone with a specific expertise in this area. In addition, the evaluators must have experience in the area of Autism Plus as even clinicians with other areas of expertise may not be familiar with this particular Autism subtype.
Second, we need to create more educational programs geared to meet the needs of students with Autism Plus. These programs need to include:
Smaller classes with peers who have similar profiles
Individually tailored educational methodology where the student can receive grade-level content but using a methodology geared to students with social, emotional, and communication difficulties who may or may not have specific learning disabilities as well. Many students with Autism Plus need frequent repetition of fundamental skills. For example, teaching the skills of finding evidence for an answer in text is essential before a student can independently read and make use of grade-level text.
Thematic or project based learning is a useful methodology to employ. Exploring topics in more depth through hands-on projects with less demand for written language or social skills can be highly effective.
Utilizing techniques for teaching students with language-based learning disabilities is helpful. Decreasing the language load when providing instruction, limiting the visual clutter on a page or on the board, breaking down tasks into micro-components with support or reinforcement at each step is highly beneficial.
Allowing for more creative outlets for ideas with less need for written work and writing projects. Limited use of rubrics and graphic organizers which can be too complicated to follow and more guided adult support.
Increased focus on developing specific skills for 21st Century adult life. It is imperative to teach children how to manage in the world at large and to teach skills for adult careers.
Aid in identification of a students strengths, talents, gifts, and passions which will lead to a broader range of future options beyond bagging groceries and stuffing envelopes. Enhancing a passion for music, art, coding/computers or creating videos are examples of ways students with Autism Plus can build their future plans on skills where they naturally gravitate.
Emotional supports within educational programs geared to providing concrete, functional coping skills
Social supports and social skill building embedded within the context of other educational programs with staff support in all aspects of the program. Opportunities to learn and practice interactive and group learning skills are necessary components of all programs for students with Autism Plus.
For so many students, Autism Plus need not be a disability that holds them back from having meaningful, productive lives. We need to create the programs and supports which can benefit students who do not fit neatly into molds. We need to learn about the unique needs and talents of students with Autism Plus so that, as parents, teachers, and providers, we are part of the solution and not another obstacle in the way of success.
Further articles on this website will profile students with Autism Plus as a way of exemplifying the struggles of families. If you have a story you would like to share, send me an email directly.