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Autism: The Transition to Adulthood

  • Autism is a developmental disorder that impairs interaction and communication
  • College and living alone may not be viable options for all adults with autism
  • Mapping out strategies to tackle everyday tasks can help
  • Involves Child Study Center

Overview

The normal worries every parent has about how a child will adjust to adult life are magnified when that child has autism. Is college realistic? What kind of job might be a good fit? Will he or she ever live away from home? These are understandable concerns.

The transition to adulthood is challenging for everyone, says Fred R. Volkmar, MD, a Yale Medicine Child Study Center psychiatrist . “It’s especially difficult for children on the autism spectrum because their whole support system changes, fundamentally and radically.”

Fortunately, today’s knowledge has yielded treatments that can effectively prepare many teens and young adults with autism to function well in college and beyond. Advance preparation for the changes that lie ahead increases the odds that a child will do well in the real world. At the Child Study Center, we have decades of experience working with young adults with autism and we offer many therapeutic approaches to help them transition into adulthood.

Autism Program

We offer unique approaches to therapy that can make this important life transition go far more smoothly. As a researcher and a clinician, Dr. Volkmar appreciates “getting a chance to learn from younger people developing new ideas and approaches who come into the field fresh, with no preconceptions.” And he says that their new ideas inspire innovations that can quickly make their way into treatment. An example now in development uses virtual reality to teach social skills, such as for dating and job interviews. The idea was the brainchild of an undergraduate student, Dr. Volkmar says.

Also beneficial is the close connection between research and clinical practice, Dr. Volkmar says. “It has been a tradition at Yale to be able to provide high quality care in a strong academic environment,” he says. A highlight in his own career has been seeing how this translates into the lives of his patients, he adds.

What do parents need to know to prepare their adolescents for adulthood?

At the Child Study Center, Dr. Volkmar begins addressing a patient’s options for independent living when college and career choices are still several years away. He starts by encouraging the child and parents to have conversations about jobs that might be enjoyable and interesting, whether a child’s interests and aspirations are in alignment with her abilities, and what type of college and living environments are most appealing.

How can parents help children with autism prepare for college?

While some high-functioning students may be able to attend a regular college, even a rigorous one—Dr. Volkmar has taught two students with autism at Yale—that’s not realistic for all. But among options are college programs with special tracks for students with autism and others that provide a college-like experience that gives students opportunities to live with peers and learn independent living skills, such as cooking, cleaning and navigating public transit.

Parents can help students with autism prepare for the transition to adulthood by working on skills such as organization and planning that will become more important when mom and dad are no longer keeping the calendar. Academic preparation is vital too, because the standards may be higher, with fewer supports available.

“College is a very different kind of place, where there’s more expectation of independence and learning,” says Dr. Volkmar, noting that many students find it harder to handle the practical concerns (such as doing their own laundry and figuring out how to get from one building to another) than the classwork.

Once the child and family identify specific goals, they can map out strategies for achieving them. A common approach is structured therapy, with a plan to bring goals within reach, step by step. 

To illustrate how this works, Dr. Volkmar shared the story of a patient. “He came in with the stated complaint that he wanted to have a girlfriend,” Dr. Volkmar says. “And so he and I worked once a week, sometimes twice a week, for two years, and by gosh, by the end, he not only had a girlfriend, but he’d been on a couple of double dates! It took a lot of work on his part and mine. He had to do some things that were really hard for him.” 

He says that the boy was assigned specific tasks not unlike homework, such as engaging in conversations with strangers or planning an outing, to prepare him to enter the dating world.

How can parents help children with autism prepare for a job?

A similarly strategic approach is useful in helping an adolescent search for and find a job and then succeed in the workplace. Some traits associated with autism actually translate to strengths in the workplace. “People with autism can make wonderful employees,” Dr. Volkmar says. “They tend to be very literal and truthful. They’re reliable. They can do tasks over and over that other people get bored with.”

But the flip side of those strengths is that the nuances of social interaction are often lost on people with autism. A phrase such as “It’s raining cats and dogs,” Dr. Volkmar says, could be taken literally. “And they’re looking out the window to see the cats and dogs,” he says. “Things like that make people laugh at them when they didn’t intend to make a joke—and if they do try to make a joke, it falls flat.”

Therapies focused on social skills can help minimize those awkward situations, as adolescents learn how to work with what Dr. Volkmar calls the “hidden curriculum.” It’s important to realize that adolescents and young adults with autism have the social skills of young children, he says, explaining that the gap between having the capability to do a job and also learning to be comfortable socially while doing it needs to be closed. “We work on the social skills, but we also need to pay attention to the job environment and pick jobs that are a good match for the strengths and weaknesses of the particular adolescent,” he says.

What makes Yale Medicine's approach to supporting adolescents with autism in the transition to adulthood unique?

We offer unique approaches to therapy that can make this important life transition go far more smoothly. As a researcher and a clinician, Dr. Volkmar appreciates “getting a chance to learn from younger people developing new ideas and approaches who come into the field fresh, with no preconceptions.” And he says that their new ideas inspire innovations that can quickly make their way into treatment. An example now in development uses virtual reality to teach social skills, such as for dating and job interviews. The idea was the brainchild of an undergraduate student, Dr. Volkmar says.

Also beneficial is the close connection between research and clinical practice, Dr. Volkmar says. “It has been a tradition at Yale to be able to provide high quality care in a strong academic environment,” he says. A highlight in his own career has been seeing how this translates into the lives of his patients, he adds.