week 2 508 discussion part 1

O R I G I N A L P A P E R

Supporting More Able Students on the Autism Spectrum: College and Beyond

Ernst VanBergeijk Æ Ami Klin Æ Fred Volkmar

Published online: 3 January 2008

� Springer Science+Business Media, LLC 2008

Abstract In the 1990’s a surge of children were diag-

nosed with autism spectrum disorders (ASDs) and are

now approaching college age. Through early diagnosis

and intervention many of these children are now able to

consider post secondary education. However, these stu-

dents will need specific interventions and supports in

order to be successful. This article reviews the nosology

of ASDs, the legal basis for providing accommodations to

students on the autism spectrum, and the incidence and

prevalence of ASDs. The authors provide specific rec-

ommendations regarding the academic, independent

living, social, vocational and counseling needs of college

students who are on the autism spectrum. With a carefully

planned transition, appropriate accommodations, and

support, ASD students can be successful academically and

socially in college.

Keywords Autism spectrum disorder � Asperger syndrome � College � Young adults

Introduction

In the last 20 years, changes in the diagnostic specification

of Autism Spectrum Disorders (ASD) coupled with

heightened public awareness has led to increased identifi-

cation of children and adults with one of these disorders.

ASDs are currently estimated to occur in 0.2% of the

general population of children (Gillberg 2005). The Center

for Disease Control estimates that 1 out of every 166

children in the United States has an ASD (Bertrand et al.

2001). This translates to over 500,000 Americans having an

ASD (Fombonne 2003). If one were to examine the seg-

ment of the population potentially preparing to enter

college, Fombonne (2005) estimated that in 2002 there

were between 284,000 and 486,000 individuals with the

broader diagnosis of pervasive developmental disorder

under the age of 20 years old alone.

The overwhelming majority of individuals with a per-

vasive developmental disorder have milder forms of ASD.

For example, the number of children suffering from

Asperger Syndrome is double the number of children suf-

fering from classic autism (VanBergeijk and Shtayermman

2005). The main thrust of the academic literature has

focused upon the more severe forms of ASDs. Compara-

tively little attention has been paid to children and young

adults who possess milder forms of the disorder.

Although children and youth with an ASD demonstrate

significant and limiting interpersonal deficits, they may

possess cognitive abilities similar to neurotypical or gifted

individuals (Barnhill et al. 2000). Consequently, while

many individuals with an ASD are intellectually capable of

university level education, they will require a range of

academic and supportive accommodations in order for

them to succeed both educationally and in terms of tran-

sitioning to greater independence (Glennon 2001). Despite

the fact that there is a bourgeoning number of college-

bound youth with an ASD, there is relatively little infor-

mation available about the unique needs of this group. This

article seeks to fill this gap by discussing the supportive

E. VanBergeijk (&) Vocational Independence Program, New York Institute

of Technology, 300 Carleton Avenue, Independence Hall,

Central Islip, NY 11722, USA

e-mail: [email protected]

A. Klin � F. Volkmar Yale University, Yale Child Study Center, New Haven,

CT, USA

123

J Autism Dev Disord (2008) 38:1359–1370

DOI 10.1007/s10803-007-0524-8

requirements of these young adults with respect to higher

education and social development.

Terminology and Overview of Diagnostic Concepts

Autism spectrum disorder (ASD) is a term that is used as

an organizing rubric for a series of lifelong neuropsychi-

atric disorders including autism, Asperger Syndrome,

Pervasive Developmental Disorder-Not Otherwise Speci-

fied (PDD-NOS). Autism Spectrum Disorders are

characterized by impairments in reciprocal social interac-

tion, communication and the presence of stereotyped

behavior, interests or activities. ASD is often used inter-

changeably with the term Pervasive Developmental

Disorder although the latter is the preferred term for

this constellation of disorders because of its implication

that the disruption in development occurs across multiple

areas of functioning and implies a multidisciplinary

approach to assessment and intervention.

Autism is the most widely recognized pervasive devel-

opmental disorder (APA 1994, p. 66). The hallmark of this

disorder is a profound impairment in the social interaction

skills of the individual as well as his or her communication

skills. One of the distinguishing features of autism as it

presents in infancy is the delay or total lack of language

development. In terms of IQ testing individuals with autism

will have stronger nonverbal or performance skills as

compared to their verbal skills. This holds true for both

typical autism and what has been described as High

Functioning Autism (HFA). Autism is frequently co-

morbid with mental retardation. In addition to these

features, an individual with autism even as an adult typi-

cally has a severely restrictive repertoire of activities and

interests.

Asperger Syndrome (AS) is characterized by severe and

sustained impairment in social interaction, and the devel-

opment of restricted, patterns of behavior, interests and

activities. These two features of the disorder will create a

clinically significant impairment in the social, occupational

and other areas of functioning. AS has a later onset than

autism (Klin et al. 2000) and there is no clinically signif-

icant delay in either receptive or expressive language

development. Students with AS may have excellent

vocabularies, although, their communication is quite

impaired. Their difficulties often lie in the semantics and

pragmatics of speech. They do not understand the give and

take of a conversation. Individuals with AS may dominate

a conversation on an esoteric topic that is of little interest to

the other person. Their style of speech can be described as

pedantic or very formal in its style. Also, in contrast to

autism, there are no clinically significant delays in adaptive

functioning, and cognitive abilities. Their IQ profile is the

reverse of students with autism or HFA, i.e., typically

students with AS have a deficit in their nonverbal skills.

Their IQ scores on the performance portions of standard-

ized IQ tests are markedly poor as compared to their scores

on the verbal portions of these tests (Volkmar and Klin

2001). The seemingly strong verbal skill of the student with

AS belies the true nature of their disability. AS is often

referred to, albeit incorrectly, as high-functioning autism.

This is likely done to highlight the verbal and cognitive

strengths of the individual. The term, high functioning

autism, is a colloquial one used by clinicians to describe

individuals on the autism spectrum who score above a 70

on standardized IQ tests and would be considered in the

normal range of intelligence. A debate remains as to

whether high functioning autism is a separate and distinct

clinical entity from Asperger Syndrome (Volkmar and Klin

2001).

A diagnosis of PDD-NOS is reserved for clinical situ-

ations where the individual’s presenting symptomatology is

either atypical or sub-threshold. The clinical presentation

of PDD-NOS does not meet the criteria for autistic disorder

nor does the presentation meet the criteria for Schizo-

phrenia, Schizotypal Personality Disorder, or Avoidant

Personality Disorder. The impairment in reciprocal social

interaction, verbal and nonverbal communication, and

stereotyped interests, activities and interests are present but

are of late onset. The student may have had normal speech

development for a period of time and was not diagnosed

with autism until after the age of three

The clinical presentation of Non-Verbal Learning Dis-

ability (NLD) (Rourke 1989) is similar in many ways to

AS. Individuals with NLD have deficits in social percep-

tion, judgment, and interaction skills. In addition, there

are bilateral deficits in tactile perception, psychomotor

coordination and visual spatial organizational abilities.

Adaptation to novel situations, particularly complex social

situations, is impaired. An individual with NLD will rely

upon rote application of social skills to these situations,

which are often incorrect and inappropriate. There are also

notable deficits in the individual’s ability to incorporate

feedback from social interactions, nonverbal problem

solving, concept formation, hypothesis formulation, and

hypothesis testing (Klin et al. 2000, p. 236).

Co-morbidity

The issue of co-morbidity with Asperger’s disorder (and,

for that matter, higher functioning autism) has assumed

increasing importance in recent years; it is intimately

related to issues of syndrome validity and approaches to

sub-typing the autism spectrum. Although there are meth-

odological challenges associated with defining and

1360 J Autism Dev Disord (2008) 38:1359–1370

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identifying co-morbid conditions the most common con-

ditions are anxiety and depression in adolescents and

young adults (Klin and Volkmar 1996). In many cases,

anxiety appears to stem from the individual’s difficulties in

dealing with the fast-paced world of social information

processing and depression may, to some degree, be viewed

as a result of recurrent failure experiences (Klin et al.

2005). Seligman (1975) described a resultant state of

anxiety and depression after repeated failed attempts to

solve a problem as ‘‘learned helplessness.’’ The co-morbid

anxiety and depression exhibited by the ASD population

may be a manifestation of learned helplessness. However,

there is some suggestion for the limited available family-

genetic work of increased rates of anxiety and depression

in immediate relatives—particularly female relatives (Klin

et al. 2005). Research suggests that rates of co-morbid

anxiety and/or depression in individuals with AS are

as high as 65% (Ellis et al. 1994; Fujikawa et al. 1987;

Ghaziuddin 2002; Ghaziuddin et al. 2002; Ghaziuddin

et al. 1998; Green et al. 2000; Howlin and Goode 1998).

Case studies have suggested potential links to other

disorders including Tourette’s syndrome (e.g., Gillberg and

Rastam 1992; Kerbeshian and Burd 1986; Littlejohns et al.

1990; Marriage et al. 1993), obsessive–compulsive disor-

der (Thomsen 1994) and psychotic conditions (both

psychotic depression and bipolar disorder) (Gillberg 1985).

A small, mostly British literature suggests some increased

risk for criminality and/or troubles with the law (e.g.,

Baron-Cohen 1988; Everall and LeCouteur 1990; Mawson

et al. 1985; Scragg and Shah 1994; Tantam 1988c; Wing

1981) although often legal troubles seem to stem from poor

social judgment and limited empathy rather than malevo-

lent intent (Ghaziuddin et al. 1991; Klin et al. 2004).

Individuals with AS often have difficulty secondary to their

tendency to rigidity and, somewhat paradoxically, a firm

and invariant adherence to ‘the rules’.

ASD and Young Adults

The surge of children diagnosed with an ASD beginning in

the early 1990s is now adolescent age on the brink of

transitioning to adulthood. Existing research suggests that

these children will continue to exhibit interpersonal defi-

cits throughout their adulthood. Many will experience

improvements in their social and communication skills

(Nordin and Gillberg 1998) particularly if they received

intervention services earlier in their lives (McGovern and

Sigman 2005). In some individuals, the severity of their

autistic symptoms may be reduced with intervention to

point where they are more behaviorally similar to indi-

viduals diagnosed with PDD-NOS (NRC report 2001).

The presence or absence of communicative speech by

5–6 years of age and the child’s school age IQ score appear

to predict functioning at adolescence and beyond (Gillberg

and Steffenberg 1987).

The limited research available addressing the psycho-

social profiles of these young people suggests that they

continue to struggle with the developmental tasks of their

age (Billstedt et al. 2005). Howlin et al. (2004) examined

the adult outcomes of individuals diagnosed with autism as

children. They found that while some of these individuals

were able to live independently, the majority was unable to

transition fully to an adult life that embraced work, per-

sonal relationships and independent living. Most of these

individuals remained dependent upon their families and

were socially isolated. Sperry and Mesibov (2005) reported

similar findings. Based on their sample of adults with

autism, they identified a number of interpersonal chal-

lenges affecting the quality of life of these individuals.

These challenges included forming and maintaining func-

tional work and personal relationships, demonstrating age

and interpersonally appropriate behaviors with members of

the opposite sex, and developing meaningful personal

understanding of ASD.

Overall, the literature suggests that approximately 70%–

80% (Billstedt et al. 2005; Fombonne 2003) of individuals

diagnosed with an ASD at childhood will continue to

demonstrate marked social impairment in adolescence and

adulthood. Fombonne’s (2005) review of epidemiological

studies of autistic samples found a median proportion of

subjects without intellectual impairment to be 29.6%

(range 0%–60%). The proportion of subjects who pos-

sessed mild to moderate intellectual impairment comprised

29.3% of the samples. The level of cognitive impairment in

AS and PDD samples is assumed to be less pronounced

than in autistic samples. Findings reported by Howlin et al.

(2004) and Mawhood et al. (2000) indicate that perfor-

mance IQ typically declines and the verbal IQ increases as

the individual ages. The majority of these individuals will

experience difficulty in undertaking adult social roles

although they may be cognitively capable of meaningful

employment.

Individuals with ASD and Higher Education

The Individuals with Disabilities Education Act (IDEA)

was authorized in 1990 providing a federal mandate to

educate children with disabilities. This legislation was first

enacted in 1975 as P.L. 94-142 and was subsequently re-

authorized as IDEA. Prior to 1975, there was no legal

requirement on the part of the state to provide educational

services to children with a developmental disability. A

school district could refuse to educate a child citing either a

lack of appropriate educational services or a lack of

J Autism Dev Disord (2008) 38:1359–1370 1361

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funding. At the time P.L. 94-142 was passed there were

8 million handicapped children in the US. An estimated

1.75 million were not provided any educational services.

An additional 2.5 million children were inadequately

served (Allen-Meares 2004). The law established the

legal doctrine known as Free and Appropriate Public

Education (FAPE). FAPE guaranteed the right of all

children to be educated. The Zero Reject Principle of

IDEA forbids the exclusion of any student with a dis-

ability from FAPE (Turnbull et al. 2002). As a result of

IDEA, children with autism spectrum disorders are enti-

tled to supportive services to enable them to maintain

their placement in public schools. It is because a greater

number of children with ASDs have been able to receive

a high school education and our greater awareness of the

importance of early intervention that a greater number of

these young people are prepared and interested in

attending university.

Section 504 of the Vocational Rehabilitation Act and

Americans with Disabilities Act (ADA)

Congress passed the Vocational Rehabilitation Act in 1973.

This law pre-dates both IDEA and the Americans with

Disabilities Act. It established the precedence that any

program receiving federal funding may not discriminate

against individuals with disabilities. The law emphasized

equal treatment in federally funded programs whereas

IDEA emphasized adequate access to a free and appro-

priate education (FAPE) (Walker 2006). In 1990 Congress

re-authorized and re-named the Vocational Rehabilitation

Act as the Americans with Disabilities Act. Walker (2006)

cogently argues that IDEA and ADA are complimentary

laws that should be used in tandem to secure students’

educational placements especially since the Supreme

Court’s decision in the Shaffer v. Weast, which reversed the

burden of proof. Historically, the burden of proof was

placed upon the school districts to demonstrate that the

student’s placement met his or her educational needs, i.e.,

the placement was free and appropriate. Now it is incum-

bent upon the party bringing forth the legal action,

(typically the parents), to demonstrate that the current

educational placement is not meeting the student’s needs.

The implication is that this Supreme Court decision will

make it more difficult for parents to obtain services for

their children.

IDEA provides funding for special education services to

local educational agencies. This funding covers a student

until he or she receives a high school degree. For the

students who are unable to earn a high school degree IDEA

provides funding for the provision of independent living

and vocational skills training until he or she reaches the

age of 22. The Americans with Disabilities Act shapes how

universities provide services to students with ASDs. The

ADA prohibits any public institution from discriminating

against individuals with disabilities. The rationale for

provision of academic supports appears to be self-evident

given that a university’s chief mission is the education of

its students and the failure to do so would severely limit a

major life activity of disabled students. However, accord-

ing to Glennon (2001), ‘‘the overall goals of any university

experience include developing skills for adulthood, form-

ing life-long relationships, identifying a vocational

pathway, and/or participating in extracurricular activities’’

(p. 185). The nature of autism spectrum disorders is a

social disability and the failure by universities to provide

social supports would substantially impair the student’s

ability to reach these goals. Furthermore, the failure to

provide supports in the social realms for students with

ASDs would exclude these students from being successful

in academic achievement, which is a major life activity

and the primary focus of universities. To be in compliance

with the ADA universities must learn to address the social

and organizational difficulties of this population. Over

recent years there has been an increase in the number of

self-help resources made available by parents of children

with ASD and adults with ASD addressing the university

application process and tips for academic and social suc-

cess. There have been a growing number of reports within

the pedagogical literature to develop awareness of this

anticipated demand on university education. For example,

Taylor (2005) outlines a series of recommendations for

teaching, evaluating, and supporting students with ASD

within higher education. Glennon (2001) identifies

important issues to be addressed by campus support ser-

vices for university students with Asperger Syndrome.

Prince-Hughes (2003) describes ASD-related challenges

for students as it related to college life. However, in the

helping disciplines there continues to be a dearth of

information addressing the needs of this college bound

population.

The 2001 report of the National Research Council,

Educating Young Children with Autism, emphasized that

times of transition were critical times in the lives of

young children with ASDs. This would include transition

from high school to young adulthood as another critical

juncture for individuals on the autism spectrum. Among

a neurotypical sample of students, Pancer and Hunsber-

ger (2000) found an indirect relationship between

students’ stress level prior to enrolling in a university

and their adjustment 6 months later. Students with ASDs

have tremendous difficulties with transitions. Without

preparation students with ASDs would predictably fare

far worse than neurotypcial students in their transition to

university. Preparing young people with an ASD for the

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transition to post secondary education is the next logical

step.

The Transition to University: Issues of Fit

One of the first most important aspects of the transition to

higher education is the fit of the student to the institution.

When undertaking this decision process, the student should

draw upon the Individualized Education Plan (IEP)

developed with school personnel during the high school

years. A well-developed IEP may serve as a blue print for

the individualization of services at the university level. The

IEP should identify the student’s areas of relative strength

and weaknesses. This ‘‘Individualized College Plan’’

should outline academic modifications, independent living

skills, socialization skills and goals, vocational goals, and

mental health supports.

IDEA requires school districts to develop a transition

plan for students as a part of the IEP. The transition plan

must be in place by the time the student reaches the age of

14. The transition plan typically identifies whether or not

the student will graduate from high school or continue in a

special education placement emphasizing vocational and

independent living skills. For the higher functioning stu-

dents on the autism spectrum the transition plan should

include exposure to the college curriculum while the

student is still in high school. Matriculating in 1–2 college

courses at a local community college exposes the student

to the academic and social demands of the college envi-

ronment. Careful attention should be paid to the selection

of these courses to maximize the student’s chances of

success. The courses should be of the student’s choosing

that are in his or her areas of strength. Creative school

districts in the New York area have designed IEPs for

these students that include a ‘‘Grade 13.’’ During this year

the students take courses at the local community college

in the morning. In the afternoon the students return to

their high schools for academic and social support. In

addition to exposing the higher functioning students to the

college curriculum and environment, this intervention

decreases the stress the students face by reducing the

number of college courses they have to take each

semester.

As with neurotypical students, the size of the school will

impact the adjustment process of the student with ASD.

Small colleges offer familiarity and personalized learning

environment. The smaller setting for some students repre-

sents less of a transition from high school where the classes

range in size from 15 to 30 students. The likelihood that

small college will offer smaller class sizes is greater than

large state institutions. Smaller colleges may be appropri-

ate for students with ASDs who are easily over stimulated

by large groups of people and become increasingly anxious

in unpredictable social situations. Smaller schools, how-

ever, may not be familiar with the unique educational

needs of students on the autism spectrum. They may

approach the student as though he or she has a specific

learning disability and provide academically based inter-

ventions only.

Large universities offer students on the autism spectrum

the possibility of finding their niche both socially and

vocationally. The student that may have been described as

‘‘odd’’ in high school because of narrow and particular

interests has the possibility of finding a community of peers

with similar interests. Larger universities also offer a cur-

riculum that is typically more diverse than what is offered

at smaller colleges. This gives the student with an ASD the

opportunity to excel in an academic area and plays to his or

her strengths.

Harris et al. (2005) describe 3 basic models of educa-

tional interventions for young children on the autism

spectrum. These are home-based, center based, and school

based programs. Although there are significant develop-

mental differences between young children and college

aged young adults, their tri-modal approach is useful when

considering how to implement college-level educational

and social supports. Home-based services in college set-

tings would place services in the student’s current

residence, typically a dormitory. Given the less structured

and more socially complex nature of communal living,

such home-based services may play a critical role in the

student’s success at college. Center-based programs in a

university setting would assist students in learning requi-

site classroom social skills in a systematically monitored

environment that specializes in providing services to ASD

students. Some universities currently have centers that

target remediation of academic skills which is analogous in

structure. This model may be seen as too insular in its

approach in that only students with ASDs would attend the

center and the skills are learned within the confines of the

program. A school-based program at a university level

would contrast with the center-based program in its

approach to how and where the services to the students

would be offered. In a school based program the services

are provided to the student in his or her classroom settings

and general education environment. Peer training and

support models have been shown to be effective in among

college-aged students on campuses (Krohn and Goetz

2005; Tevyaw et al. 2007). The major advantage of this

approach is that it allows the student to enjoy the full

extent of the college life experience. When selecting a

potential university, the student and his or her family

should evaluate this ‘‘goodness of fit’’ (Schalock et al.

1989) between the students with an ASD and his or her

environment as well as identify the models of intervention

J Autism Dev Disord (2008) 38:1359–1370 1363

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the university uses to assist students on the autism

spectrum.

Counseling Supports

Whether the student with an ASD and their parents select a

small college or larger university should rest upon their

assessment of how supportive the college community is of

people with different abilities. A university’s commitment

to diversity should include their commitment to serving

people with varying degrees of disabilities. One way to

assess this commitment is to examine their office of student

disabilities’ statistics regarding not only the number of

students they serve with disabilities, but also the types of

disabilities served as well as the overall portion of students

with disabilities vis-à-vis the total student body. Deter-

mining the types of disabilities served is an important

distinction. Most colleges and universities are familiar with

the leaning needs of students with specific learning dis-

abilities and attention deficit disorder. These students need

specific supports and modifications in the academic realm.

However, students on the autism spectrum require modi-

fications and supports in social, organizational, and

communicative realms in addition to traditional academic

supports.

While neurotypical students may benefit from a variety

of counseling modalities, students on the autism spectrum

require directive, explicit guidance and counseling.

Because students on the autism spectrum will have diffi-

culty making inferences, drawing conclusions and making

connections social situations, in particular, must be broken

down and analyzed. Each step the student is expected to

take should be clearly stated and rehearsed prior to the

student attempting the behavior. Role-plays with explicit

feedback are critical. Because many students on the autism

spectrum have difficulty generalizing skills across situa-

tions practicing new behaviors should ideally be practiced

in vivo.

Modifications in the Classroom

Currently colleges and universities are required to make

academic modifications for students with disabilities

although there is variability in the extent to which this is

implemented. Although approximately 3% of the college

student population self-identifies as having some sort of

disability (Thomas 2002), research suggests that faculty

have limited understanding of the ADA and a student’s

rights to modifications in a university setting (Dona and

Edminster 2001). Therefore it is critical that students with

ASD register with the university’s office of student

disabilities. It is only with the confirmed registration of the

individual’s disability that the student is eligible for man-

dated accommodations within the classroom and for

evaluation. For example, many students with ASD have

fine motor problems. As a result, note taking can be a

barrier to learning. Appropriate accommodations would

include allowing the use of laptop computers, scribes, and

tape recorders. Providing the student with an ASD a copy

of lecture notes and/or slides prior to the class is also an

appropriate accommodation.

Organizational help is critical to the success of a student

on the autism spectrum. Just as in elementary and high

school, these college students may continue to need

explicit instructions on organizing their classroom and

study materials (e.g., developing separate color coded

binders for each subject area, sub-dividing binders into

areas for notes, assignments, syllabi etc.). This organiza-

tional help requires more than simple verbal instruction.

For the student with AS it may require written instructions

paired with a picture of what is meant. Neurotypical stu-

dents will have a general idea of abstract terms such as

‘‘organized’’ or ‘‘neat.’’ A student with AS will not have an

innate understanding of these terms. Without a concrete

pairing of the words to the pictures, the student with AS

may not truly understand what is being expected of him or

her.

Large assignments may need to be broken down into

manageable units and turned in separately. Because stu-

dents with ASD will have difficulty with time management

they will need explicit instructions as to when he or she

should begin researching a term paper, writing a rough

draft, and writing the final draft of a paper. If the student

with ASD can maintain a visual representation of an

organizer/calendar in their mind, then teaching a student

how to use a personal digital assistant (PDA) can be a

useful tool. Audible alarms can be set to remind a student

of when to go to class, when to start studying for a test, and

when to start researching a term paper etc. If the student is

unable to maintain a visual representation, then he or she

must be taught to use a hard copy of a calendar/organizer.

There are also a number of other computer resources

available to help students on the autism spectrum. A

sample of some helpful computer programs and links to

relevant websites are available at the Yale Child Study

Center website (http://www.info.med.yale.edu/chldstdy/

autism/pdd).

Evaluation and Testing

Accommodations in testing are frequently required to

enable students with a variety of disabilities succeed in

college. In accordance with the ADA, students with a

1364 J Autism Dev Disord (2008) 38:1359–1370

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confirmed, registered disability are entitled to standard

accommodations set by the law in each of his/her classes.

For individuals with ASD, accommodations will likely

include being given extra time to complete tests. The

provision of extra time for testing is a vital accommodation

for many students on the autism spectrum. Neurotypical

students are anxious when an instructor gives a test. For

students on the spectrum this normal level of anxiety sur-

rounding a test is exacerbated by their experience of testing

as a change in the normal routine. This elevated level of

anxiety interferes with the student’s ability to concentrate

necessitating additional time. Furthermore, many students

with ASDs have graphomotor difficulties. They need extra

time to be able to write out their responses or even fill in

the bubbles on Scantron sheets for multiple-choice tests.

A second accommodation in testing pertains to the

physical setting in which the testing occurs. Because many

of the students on the autism spectrum have difficulties

with distractibility a reasonable accommodation would be

to conduct the testing in a separate location free of dis-

tractions or provide the student with an on-line testing

option. Many students on the autism spectrum have sensory

integration dysfunction (Ayers 1972). Sensory integration

dysfunction refers to an individual’s inability to correctly

process sensory input. The student on the autism spectrum

may be either hyposensitive or hypersensitive to sensory

stimulation. In a classroom setting this may manifest as an

inability to filter out certain kinds of noises. For example,

in the quiet of a testing situation a student on the autism

spectrum may not have the ability to concentrate because

of the hum of the fluorescent lights. It is imperative that the

student’s sensory issues are identified and appropriate

accommodations be made in the testing situation. The

testing accommodation may not necessarily mean that the

student must be tested in a separate location. The student

may simply be allowed to wear stereo headphones to block

out the distracting sounds. By allowing the student to wear

stereo headphones rather than earplugs, less attention will

be drawn to the student and their accommodation. Having

a student wear ear protectors would unnecessarily draw

attention to the student.

Social Functioning

Since autism spectrum disorders are developmental dis-

abilities that impact a variety of domains in a student’s life,

college personnel must expand the areas where they typi-

cally intervene. University personnel are familiar with

providing academic supports for students with specific

learning disabilities or attention deficit disorder. However,

they are often unprepared to address non-academic con-

cerns. These concerns include life skills, socializing, doing

laundry, budgeting, checking, and getting along with

roommates. Issues of sexuality are particularly difficult for

this population. Many of these students are very naı̈ve and

could be taken advantage of sexually. Others do not know

how to negotiate a simple dating situation let alone a far

more complex social situation (i.e., negotiating a sexual

relationship). There is also a risk that students on the aut-

ism spectrum will be told by their peers to say something or

do something that is inappropriate to member of the

opposite sex as a joke. Students on the autism spectrum

must be explicitly taught what is appropriate to say to a

person he or she may find attractive (Volkmar 2004).

Furthermore, these students will need sexual education that

is developmentally appropriate and concrete in its orien-

tation. This includes how to protect themselves from

disease and unwanted pregnancy. Volkmar (2004) provides

a complete overview to adolescence and sexuality for

children on the autism spectrum including teaching about

privacy and modesty, establishing boundaries, encouraging

healthy sexual relationships, and birth control.

Although there is empirical support for the usefulness of

social skills groups for young children with (Kransy et al.

2003; Paul 2003) they are not commonly used with col-

lege-aged students on the spectrum. The developmental

nature of ASDs and this population’s difficulty in gener-

alizing skills to new settings suggests using social skills

groups with students on the spectrum as they enter college.

They have a need for explicit teaching/role play. Practice

should be done in vivo across environments to promote

generalization. How to start a conversation with a new

person should be practiced in the cafeteria, in a dorm room,

in the student lounge, on the quad etc. Professionals

working with students on the autism spectrum cannot

expect generalization across environments. These skills are

often situation specific for this population.

Mental Health Support

Students with autism spectrum disorders often have limited

insight to their own emotional states and have even more

limited insight into the emotional states of others. Psycho-

education is a more promising approach. This approach

teaches the student what it means to have an autism

spectrum disorder and what measures they can employ to

compensate for their limitations. Directive counseling is

needed. The student must be told how to handle a variety of

social situations (e.g., how to get along with a roommate).

Klin and Volkmar (1996) recommend explicit instruction

with homework, role-playing, and coaching. The skills

should be taught in ‘‘…a rote fashion using a parts-to- whole teaching approach, where the verbal steps are in the

correct sequence for the behavior to be effective’’ (p. 6).

J Autism Dev Disord (2008) 38:1359–1370 1365

123

Further, Klin and Volkmar (1996) highlight the need for

the individual with an ASD to be taught how to identify

novel situations and ‘‘resort to a pre-planned, well

rehearsed list of steps to be taken’’ (p. 7). Above all, sup-

port personnel must not assume that general explanations

will suffice and that the student with an ASD will be able to

generalize to similar situations.

Mental health professionals working in university

environments should be aware of a possible increase in

some co-morbid conditions (e.g., depression/anxiety). The

first semester in college will be a critical transitional period

for students on the autism spectrum. During the first

semester the student’s skills will be taxed. The novelty of

the new environment will elevate the student’s anxiety.

This will be further exacerbated by the negotiations of a

complex social environment in the dorms. The lack of

familiar routine and structure will compound the student’s

anxiety. The variable schedule of classes and the lack of a

consistent daily structure can even further increase the

student’s sense of anxiety and unpredictability University

officials who know that they have students on the spectrum

need to proactively reach out to these students and create

more structure and predictability for these students Without

such proactive supports these students are at increased risk

for depression and perhaps increased risk of suicide.

Resident advisors should be alerted to the presence of a

student on the spectrum and the warning signs that the

student is in crisis. Trained peer life coaches may help

students on the spectrum deal with the seemingly unpre-

dictable university environment and provide structure for

the student. They, along with the resident advisors may be

the first to detect signs of depression or increased anxiety

before it becomes an acute crisis.

Case Vignette

Mike was very fortunate and had a number of factors that

optimized his potential for living independently and suc-

cessfully completing college. Although he was born over

30 years ago, he was diagnosed with autism at the age of

2 years old. His parents were university professors. Both

his parents and extended family were extremely supportive.

Mike received applied behavioral analysis (ABA) when the

technique was in the early stages of development. This

intervention began shortly after his initial diagnosis. His

family belonged to a house of worship that took the family

under its wing. The congregation included Mike in its

social activities and sought to integrate him into the

community.

When Mike began school his I.Q. scores were in the

normal intelligence range. However, there was a severe

discrepancy between his verbal and performance abilities.

Mike was exceptionally talented in non-verbal math skills.

Throughout his public school experience he actually

received minimal educational supports. One consistent

source of support was a private therapist. The therapist

employed an eclectic approach to treatment. However, the

focus of their work was on social skills development and

problem solving. One personal factor that significantly

affected Mike’s success was a strong desire on his part to

‘‘fit in.’’

Mike had a talent, which his parents encouraged, that

aided him in fulfilling his desire to fit in. During high

school he was a competitive runner and joined the track

team. He received recognition and acceptance from the

other students for his athletic abilities.

Mike also continued to excel in mathematics during high

school. In his senior year Mike took the Scholastic Apti-

tude Tests (SATs). He did exceptionally well on the

mathematical portion of the exam. His verbal scores were

fair at best. He applied to number of different colleges and

was accepted to all of them. Mike wanted to go to a large

highly competitive technical school that had a world-

renowned reputation for its academic rigor in math, science

and engineering. His parents wanted him to go to an

extremely small college where class sizes were small and

he could get individualized attention. They compromised.

Mike attended a mid sized college in a small college

town in the North East, which was close to his parents’

home.

A critical factor to Mike’s success was his engagement

in social activities. He joined the college track team. The

college provided him with a roommate from the track team.

The roommate acted as a life skills coach for Mike. This

person helped him navigate the social complexities of dorm

life and taught him independent living skills. They ate

meals together. The roommate even invited him on social

outings like camping trips with friends. This ‘‘interven-

tion’’ happened through serendipity—not through design.

The roommate took a genuine interest in helping Mike

decode the social world. A key function the roommate

provided Mike with was a list of rules of how to behave

and under what circumstances. Mike did well in situations

where the rules were well defined.

Another area of interest of Mike’s was developed into

mechanism to engage him socially. He loved music. Mike

joined the college radio station. He was assigned to a shift

in the wee hours of the morning. His vast knowledge of

music was extraordinary. He would provide listeners with

incredibly detailed background information about a

recording. Normally, in a social setting this type of per-

severation would turn off a listener in a conversation.

Mike’s knowledge earned him a reputation and a cult fol-

lowing of devoted listeners who regularly called into his

radio show. His active participation in the college radio and

1366 J Autism Dev Disord (2008) 38:1359–1370

123

other clubs contributed to his sense of well-being and

social success.

Academically Mike did well in his math and sciences

classes. He did less well in fast paced classes that required

creativity and quick thinking. His parents provided him

with tutors for these subjects. The tutors assisted him with

the executive functioning aspects of researching, organiz-

ing and writing papers. His classroom accommodations

were minimal. He was able to take tests in a distraction free

environment and was given extra time on tests. Mike also

received extra time on his written assignments. Another

strategy Mike employed was regarding his scheduling of

classes. He scheduled the lightest possible full-time load

during the academic year. Summer semesters were

reserved for classes that he had the most difficulty with.

He typically took only 1–2 classes during this time in

his subject that gave him the greatest challenge: English.

A final factor that contributed to his success was the

continuation of his relationship with his therapist from

home.

After graduation from college Mike had difficulty find-

ing employment. Consequently he returned to graduate

school and earned a masters degree in computer science.

He is currently employed for large organization where he is

involved in data management. Mike lives independently

and owns his own apartment. Through work he has met a

few women that have developed into girlfriends. He cur-

rently is not in a relationship.

Vocational Issues

The role of colleges and universities is to prepare students

to become productive members of the labor force. This

function is done is an indirect manner. Students learn good

study habits, which are supposed to translate into good

work habits in the future. The university helps the student

to identify his or her own strengths through the grades they

earn in their courses. The students are trained to think

about a problem in a particular manner based upon the

academic discipline they are pursuing. The process for a

neurotypical student is sub rosa. Upon graduation the

student is expected to pursue a career based upon a nebu-

lous set of skills. The process of job training is secondary to

teaching the student how to think about life. For the

majority of neurotypical students, this seemingly haphaz-

ard approach to their education and job training appears to

work. Most college students are gainfully employed after

graduation. According to the US. Department of Labor

Statistics, 89% of college graduates ages 25–34 are a part

of the civilian labor force. The remaining 11% enter

graduate school, stay home to raise a family or enter the

military (Dohm and Wyatt 2002).

For the student on the autism spectrum preparing the

student for work must be a conscious and planned effort.

Direct connections should be made between what he or she

is learning in college and the world of work. Explicit

preparation is crucial. Completing the job search and

application process is a skill that needs to be practiced with

students on the autism spectrum. Course instruction and

assignments should include how to write resumes. Because

their disability is a social disability, students on the spec-

trum are most severely disadvantaged during a job

interview. Teaching students on the spectrum how to

conduct themselves during a job interview through role-

playing is vital. The job interview should be broken down

into discrete tasks for the student to accomplish. Because

much of a job interview is unscripted, student on the autism

spectrum may have to practice a variety of scenarios in

reference to how to introduce themselves, making small

talk, whether or not to shake someone’s hand, and where to

sit. Employment interviewing training programs have been

shown to improve interview performance with neurotypical

college students (Knudstrup et al. 2003)

The issue of whether and/or when the student should

disclose their disability to a prospective employer can be

complicated. Past research has shown that knowledge of a

disability is a deterrent to granting an interview by

employers (Peason et al. 2003). However, properly timed

and considered disclosure can allow for an employer to

make reasonable accommodations to the employee’s work

site and assignments (Munir et al. 2005). The topic of

disclosure should be discussed with the student prior to any

job interviews.

Once the student on the spectrum has been hired, the

student must be explicitly taught what the requirements of

the job are. This includes the dress code, when to arrive and

leave work, how long to take a lunch break, where they are

expected to place their personal belongings and how to do

their job in detail. Students on the autism spectrum should

not be placed in jobs that are highly unpredictable and

require the ability to discern complex social interactions.

Students on the autism spectrum should seek jobs that

focus upon areas of strength. A student’s interest or per-

severation may be turned into a marketable job skill. Many

individuals on the spectrum are quite adept at programming

and repairing computers. Others are highly skilled at

organizing and filing things, once they are shown what the

system is. The key to successfully placing a student on the

autism spectrum in a job is to ensure that there is a

goodness of fit between his or her strengths and the job

requirements. Highly predictable, structured, routinized

jobs serve this population well.

Part of the transitioning students with ASDs to the labor

force, involves preparing them to leave the university

environment. Again this is another transition period that

J Autism Dev Disord (2008) 38:1359–1370 1367

123

generates considerable anxiety for this population. The

students may finally become habituated to the university

environment and have established a routine. They have

developed mastery of basic tasks such as going to class,

completing assignments, eating in the dormitory cafeteria,

but have not mastered the independent living skills nec-

essary to live outside the confines of the university

environment. The student may fail to fulfill the course

distribution requirements necessary for graduation and

thereby delay graduating. Others may actually begin to fail

course work as a means to postpone this stressful transition.

Finally, a student with an ASD may develop an acute

psychiatric crisis in response to the stress of the pending

transition to post college life.

Conclusion

Students with ASDs are a burgeoning population. Many

have post secondary school aspirations. With specifically

tailored interventions students with ASDs can fulfill those

aspirations and can reach their potential to become inde-

pendent contributing members of society. The transition

from high school to the college environment is a critical

juncture for students on the autism spectrum that must be

well planned. It is imperative that the student and his or her

parents examine the goodness of fit between the student

and the prospective college. The goodness of fit should be

examined in terms of the size of the university, the size of

the typical classes and the receptiveness of the institution to

students with a variety of disabilities. While many uni-

versities are quite adept at making accommodations for

students with specific learning disabilities and ADHD, they

face new challenges when accommodating students on the

autism spectrum. Universities will have to learn how to

effectively intervene in the areas of communication, social,

and independent living skills, and executive functioning.

Their repertoire of supportive services will have to be

expanded to include social skills groups, psycho-

educational groups, directive counseling, vocational train-

ing, and life coaching in order to help accommodate

students on the spectrum. These interventions will need to

be empirically evaluated and if effective, disseminated to

professionals in the field. Finally, social policies must be

written to support young adults with autism spectrum dis-

orders that focus upon helping the student transition to

independent living. This includes the provision of funding

for university based supportive services, job skills, transi-

tional programs and supportive housing.

Acknowledgment This publication was made possible through a National Institute of Health LRP grant (Number L30 HD053966–01)

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