What makes for good outcomes in autism?

I have given a large number of lectures in regards to autism and tend to learn more from the questions of the audience than from my own lecture preparations. Usually parents and autistic individuals are very well read and have extremely poignant questions. Because I do many clinical trials, especially with transcranial magnetic stimulation (TMS), one of the questions I usually receive is whether I can predict who will have a good outcome to TMS. This has started me thinking as to why some autistic individuals succeed in different life endeavors and others have so many difficulties. In my view there are some elements in common to the stories of those who succeed:

1) One to one «therapy» with parents. Stephen Shore is keen to say that you must establish an element of trust with the therapist before you can have any successful behavioral intervention. This is why parents make for the best therapists. Not only can they be the best allies, they are also part of the cheering section. Indeed, parents can remain blindly optimistic about their children and persevere when not many others would. Parents are able to identify special strengths in their children and make this an element of their teaching strategy, e.g. providing music lessons. Similarly, they can help overcome special stumbling blocks, like preventing or minimizing bullying at school and anticipating problems, e.g.,in physical education class, going to church (wearing «scratchy» or «itchy» clothes and being hyperstimulated), or a tantrum at a hibachi restaurant.

2) Find employment early on. Autistic individuals derive great pride in sustaining a job (see in that regards a previous blog: http://bit.ly/1deCdj2). This can vary from delivering newspapers to running errands. Usually chores having to do with animals (e.g., dog walking, cleaning horse stables) are best received and enjoyed. Others, like bicycle repairs or building web sites, can provide useful skills and serve as a launching pad to a future career. Having a job is conducive to socialization and may be the first step towards social relationships.

3) Have good role models, people who believed in them and who instilled in them a special interest. I think this is how Temple Grandin became interested in science, as she relates quite fondly about one of her early science teachers in Thinking in Pictures. Older siblings usually make for the best role models and are often called to defend their siblings. Brothers and sisters should learn how to explain autistic behaviors to other. I remember reading a short book entitled Siblings (ed by Jane Johnson and Anne Van Rensselaer) that said: «The most important thing to remember is not to focus on the negatives of living with a sibling with autism, but to strive to see the positives- try to see them as a person, and not as your problem» (p. 53).

4) Build on your strengths, not on your weaknesses. This precept may point towards a future career, those interested in math and science could possibly end within the computer field, those who like clearly delineated results may like being in the Army.

5) Get a diagnosis early on in life. A diagnosis will help you understand why you think in certain ways and your emphasis on certain interests. You are not crazy nor lazy, you do things in a certain way because you have an autism spectrum disorder. Parents can take the diagnosis to school. Teachers need to understand how the stimuli from the environment, the loud bell noise and fluorescent light, may lead to maladaptive behaviors.
In some instances receiving a proper diagnosis has been similar to an «awakening» religious experience. In this regard other «awakening» experiences are: 1) the realization that many times the world doesn’t make sense, 2) you have the choice of fulfilling the role of a victim or rebuilding yourself to become empowered.

6) Learn to recognize the symptoms of a mood disorder (i.e., anxiety/depression) and get help for the same. Think of mood disorders as high blood pressure and diabetes, getting medical help for them may save your life.Depression can lead to suicidal or self-destructive behaviors. Sometimes mood disorders are the result of bullying and may be accompanied by other disorders, e.g., overeating. In school age children, anxiety may be the telltale sign of bullying at school.

7) Probably the major issues that I have faced in trying to help individuals within the autism disorder spectrum is bullying and sexual abuse.


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