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With the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) classification system, Asperger’s and PDD-NOS are no longer a diagnosis. Autism was renamed autism spectrum disorder (ASD) and classified under neurodevelopmental disorders. Autism is defined on a “spectrum” because of the various ways in which the disorder impacts an individual. It is characterized by difficulties in social interaction, verbal and nonverbal communication, repetitive behaviors, and hyperreactivity or hyporeactivity to sensory input.

There are four characteristics that can be seen in every customer with autism. The level at which the following characteristics impact a customer can vary significantly:

· Impairment in social interaction

· Impairment in communication

· Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities

· Sensory abnormalities

Medication

Typical functional limitations include the following:

· History of academic and/or career underachievement that limits job opportunities

· Potential for co-existing disorders such as depression, learning, and anxiety disorders resulting in the additional limitations associated with these disorders

· Difficulty handling stress, low tolerance to change in schedule, or work tasks interfering with production, coworker relations, and supervisor relations

· Poor ability to manage day-to-day responsibilities, such as completing household chores, maintenance tasks, paying bills, or organizing things

· Chronic stress and worry due to failure to accomplish goals and meet responsibilities

· Chronic and intense feelings of frustration, guilt, or blame

· Social isolation

The diagnosis of ASD alone does not necessarily indicate a need for services. Some individuals with ASD function well vocationally because they have selected jobs compatible with their disability, thereby eliminating functional job limitations. They use treatment and/or compensatory strategies to help control or work around functional limitations.

Therefore, the primary determiners of successful employment for individuals with ASD are:

· identifying the individual’s social, communication, and sensory integration deficits;

· the individual's willingness to select realistic vocational goals, which concentrate on using assets and working around symptoms;

· if necessary, medical treatment to reduce symptoms (most pervasive is anxiety that can lead to depression as individuals age); and

· developing compensatory strategies to work around residual symptoms.

In most cases, records obtained from treating psychiatrists, psychologists, and/or therapists, combined with the applicant's perspectives on the disability, can help determine the following:

· What are the individual’s ASD symptoms?

· Are VR services needed to identify realistic vocational goals?

· Are VR services needed to develop compensatory job strategies?

Records may also identify other conditions that the applicant did not disclose or is unaware of that can impact employment (for example, individuals with ASD are at a high risk for substance abuse, depression symptoms, and anxiety disorders).

Additional questions to ask an individual with ASD in the diagnostic interview include the following:

Education

· Did you receive accommodations or modifications in school?

· Did you request help or did teachers tell you what you needed?

· Do you know your “learning style”—how you learn best?

· Did your performance in school represent your true ability?

Social/Communication

· Do you feel nervous around new situations or people?

· How do you handle being around people whom you don’t agree with or maybe don’t like?

· Are there things that help calm you down if you become anxious or upset?

Rigid/Repetitive Patterns of Thinking

· How would you feel or do if your schedule changed without notice?

· What routines would it upset you to change?

· Do you like to try new things? If you are asked to do new things, how do you respond?

· What happens when you come across a situation that you have never dealt with or don’t have a solution for?

Sensory Abnormalities

· Are there environments that you know will stress you out?

· Do any particular lights, sounds, or smells trigger you?

· Does a busy place with lots of people stress you out?

· What is your ideal environment, one which helps you be the most productive?

Vocationally:

· At which of your past jobs were you most successful and why?

· At which of your past jobs were you least successful and why?

· What do you need to make your next job successful?

In some cases, medical and psychological records may be unobtainable or outdated, or there is a suspected change in the individual’s disability. It may then be helpful to purchase new diagnostics. If additional medical or psychological evaluations are needed, sending previous psychological and medical records (if available) can assist the examiner in identifying progress and stability. Also, asking pertinent questions of the examiner can help with plan development. Examples of pertinent questions include the following:

· Is the individual currently stable and complying with treatment?

· Is the customer's selected vocational goal appropriate and realistic?

· What is the individual’s best learning style (for example, academic or on the job)?

· Are there significant changes or differences from the customer's previous assessments?

A psychological diagnostic should only be ordered under the following conditions:

· Individual is in need of a comprehensive assessment due to a new diagnosis

· The presence of a co-occurring condition, such as depression, is suspected.

· Records are old or missing, or diagnostic is required for secondary training.

Use the following ASD psychological batteries:

· VR 40 ASD Verbal Battery

· VR 41 ASD Nonverbal-Low Battery

Use the following add-on or single options:

· VR 42 ASD ADOS 2

· VR 43 ASD Emotional and Behavioral

Note: A psychological diagnostic is not meant to be a vocational assessment. Especially for ASD, a psychological diagnostic does not constitute an accurate assessment of an individual’s work potential.

Since individuals with ASD can face various residual symptoms or functional limitations, reviewing previous work history and the diagnostic reports together, the customer and the VR counselor can identify residual symptoms of the disorder to target appropriate jobs. Using Birkman’s Career Exploration can help cluster interests and skills, which in turn helps to identify what services and goals are needed to develop an Individualized Plan for Employment.

Note: A traditional vocational assessment is rarely recommended. If the VR counselor does conduct one, make sure that the tests administered assess the direct needs of ASD and that the assessor has expertise in testing an individual with ASD.

Is the customer’s expressed vocational goal realistic and compatible with the disability? Considering the individual’s identified symptoms is important when selecting an appropriate vocational goal. ASD can be an asset to many jobs (for example, seeing details others miss, and hyper focusing can be an asset in jobs requiring an individual to attend to a task until it is completed).

Typical VR services provided to individuals with ASD include the following:

· Birkman career assessment

· Environment work assessment

· Work experience

The following are counseling issues that often come up when working with individuals with ASD:

· Making appropriate job choices—Adults with ASD often experience employment difficulties due to restricted interests, rigid thought processes, and a low tolerance of change. In other instances, they may quit a job because of social anxiety or fear of the unknown. However, adults who learn to adapt to their disability and to harness their strengths in following routines, creating systems, and using the creativity that often accompanies ASD, can turn their symptoms into vocational assets. The VR counselor may need to guide the individual toward jobs that are more compatible with his or her disability. By reviewing past jobs, the VR counselor and the customer can consider job situations to determine which are more compatible with the customer’s disability. This information can assist the customer in selecting successful job goals.

· Reasonable accommodations—The VR counselor may be able to help the customer identify reasonable accommodations that can help save a job or maintain future jobs. These can include:

· job restructuring;

· adjusting the work schedule to account for medication drowsiness;

· requesting extra time to learn tasks; and/or

· modifying jobsites to reduce distractions.

· Lifestyle changes—Changing patterns, which jeopardize employment and stability, i.e., reacting to fears, taking on too many tasks, seeing the big picture and not getting bogged down in the details

· Continuing treatment, strategies, or medication—Medication, therapy, and treatment can be expensive. The VR counselor can guide the customer and family members to review concerns with the treatment source before stability is jeopardized. Additionally, helping the individual and family establish contact with community resources can help reduce out-of-pocket expenses for medications and treatments until they become eligible for insurance benefits.

· Disclosure of the disability—Some guidance considerations regarding disclosure of the disability to employers are that:

· certain jobs require drug screening, and medications may trigger a false positive; and

· reasonable accommodations may need to be requested to maintain employment.

· Positive feedback—Due to low self-esteem from multiple academic, social, and employment failures, many individuals with ASD need to have their progress and successes pointed out to prevent them from quitting.

· Family counseling—When there are family members or significant others who are actively involved in the customer's life, they need to be included in the rehabilitation "team." This is to ensure that everyone is guiding the customer in the same direction and to reduce enabling behaviors or patterns that can jeopardize employment. Connecting family and significant others with support groups can provide them with better understanding of the disability and ways to help the customer.

· Skills training—Training to upgrade skills or retraining in more appropriate areas of work may help some individuals with ASD achieve vocational stability. This can be important for individuals whose transferable skills are insufficient for appropriate jobs.

The following are potential resources for comparable benefits for medications, treatment, and other issues: