Personal: Receiving Accommodations as an Adult with ASD
When children are diagnosed with autism, there are supports available through their school system including special education and social work services. However, the transition to adulthood and independence can be especially difficult for people who struggle with changes and meeting society’s expectations. To make it a bit easier, here are some tips for getting accommodations as an adult, even if you are undiagnosed.
If you received accommodations (IEP or 504) while in school, you are given access to the services for disabled students at your school. Legally, schools that receive money from the government have to follow government laws and regulations, including the Americans with Disabilities Act. To access these services, you can ask your academic advisor to connect you or reach out to their office directly. They usually require documentation of your condition(s) and/or evidence of your previous accommodations.
If you are in higher education and did not have accommodations during your public education, you have a few options. You can: 1) reach out to the students with disabilities office anyway and see if they will take you without a diagnosis 2) seek a diagnosis from the school’s student health system or other outside specialist or 3) ask your instructors to honor your requested accommodations without the documentation.
The path for adults who are employed is similar to that of students. If you had accommodations as a child, you have a legal right to request those accommodations of your employer. If you did not, you can seek a diagnosis or ask your employer to honor your accommodations anyway. Here are some tips for getting your accommodations approved:
Prepare a list of the accommodations you’re asking for ahead of time. Do you need preferential seating in class? Do you need increased breaks during the work day? Do you need to work in a hybrid in-person/remote position? Do you need access to fidgets?
Practice how you are going to ask for accommodations. If you have previous accommodations or diagnosis, gather that paperwork ahead of time. If you are asking via email, you could ask someone to proofread it for you.
Research disability laws in your state. Some states might have different requirements about what accommodations are acceptable.
If you decide to talk to your employer or boss about creating an accessible environment, but you have not disclosed your (self)diagnosis you can try framing it as a general concern you have for accessibility. For example, if you want to ask for captions during Zoom meetings, you can request them anonymously through the app or say something like “Could we turn on the captions for anyone who may be hard of hearing?” that does not disclose the exact reason for you asking.
If you continue to run into barriers or need support gathering the documentation for a diagnosis, check out our group classes and individual consultation services where someone can work with you more one-on-one to get you the assistance you need.
Therapy: A Personal Review of SFBT
SFBT stands for solution focused brief therapy, which is a methodology of talk therapy used in individual counseling sessions. It focuses almost exclusively on solving the problem the client presents as opposed to evaluating the source of the problem. The goal of SFBT is to increase the client’s problem solving capabilities.
I was an SFBT client for six years, which is significantly longer than the typical client, during my early adolescent and teenage years. During that time, I worked with the same therapist with a standing weekly appointment. Because of the unusual nature of my experience, my opinions about SFBT have changed since I’ve been in school.
During my experience in therapy, I quickly grew frustrated with the duration that I was in therapy. I was told it would be less than ten sessions, while I ended up having hundreds. I was also frustrated by my therapist’s seeming unwillingness to accept that some of my problems came from sources outside of my control. Up until learning more about SFBT I would have said that it is not suitable for people with similar experiences to mine.
However, after learning more about SFBT in an academic sense, I have changed my opinion on it. The data supporting it is extensive, and it has been approved for evidence-based treatment for many more mental health concerns than other popular mentions such as CBT. Many people find it helpful because it gets right to the point of why people seek out talk therapy, which is to be given a solution to their problems. SFBT teaches the client how to make their own goals and formulate possible solutions.
Based on the data I’ve seen, I believe that SFBT could be beneficial for people with autism, especially if they want specific advice about issues like social relationships and executive functioning. Because it averages at about five sessions, it is also helpful for people who want a short therapy experience due to time, money, or other limited resources. It is not as commonly practiced as CBT, so it might be difficult to find a therapist who explicitly specializes in this technique, but if you bring it up to another therapist they should be willing to pull therapeutic strategies from the literature about it.
Interview With A Neurodiversity Affirming Therapist
This past week, I had the opportunity to meet with a local therapist in the Ann Arbor area. Michelle Ferguson runs a private practice called Open Minds which is a neurodiversity affirming therapeutic practice for neurodivergent children and their families. I met with her for an interview focused on guidance for future practitioners.
First thing I noticed about Open Minds was the sensory environment. The entire office is scent free and has multiple therapy rooms for clients to pick their desired sensory level. In the play therapy room, there is a wide range of activities accessible for clients to guide their session. Throughout the public areas and waiting room there are several signs explaining the procedures in the office, including current COVID guidelines. As an autistic adult I was comfortable in the space throughout the time I was there. I was also reassured by the anti-ableist signs posted throughout the office, explicitly stating that the practice is accepting of neurodiversity.
The main therapy Michelle works with her child clients is synergetic play therapy. This type of play therapy is child directed and includes a focus on regulating the nervous system. Synergetic Play Therapy is the link to more information about this therapy as a modality. I was intrigued by this method because I do not have as much experience with play therapy modalities, so I will be doing a post dedicated to what I find coming in the next few weeks.
For future therapists, Michelle recommends being humble about what they don’t know about neurodiversity. They should educate themselves and make disability an explicit and intentional part of their inclusion. When doing initial evaluations, explicitly asking how you can change anything about the environment to make it more sensory comfortable. If the client tells you anything they want changed, make a note for the next session. Being aware of visible and invisible disabilities and accessibility is critical for therapists to be more inclusive.
Future research is still needed for the development of more evidence-based non-talk therapies like music, EMDR, and play therapies. The overwhelming majority of evidence based therapies are based on verbal communication, which many autistic people struggle with. By making therapists more aware of communication differences, they can be more accommodating of autistic people in their offices.
Michelle provides services to children from birth through age 12, parents, caregivers, and families. She is committed to helping kids and families experience greater enjoyment in their relationships, and increased competence and resilience at home, school, and play. She honors diversity in all its forms and strives to make every person with whom she works feel welcomed, affirmed, and respected.
Michelle specializes in working with children with brain-based differences, such as Autism Spectrum Disorder (ASD) and ADHD, and in providing clinical services to parents and caregivers of children with disabilities.
Therapy: Making Talk Therapy Inclusive
Talk therapy is where a lot of autistics receive the majority of their support due to a lack of specific resources for autistic adults. Because of this, if you are a therapist, there is a high chance you will encounter autistic adults and children in your practice. As a social work student myself, we often discuss how to improve inclusivity in our social work practice, so these are going to be some of my tips for fellow counselors.
A quick area of improvement for private practice counselors can be made in the environment of their service space. Dimming lights, posters expressing autistic acceptance (no puzzle pieces), fidget tools easily available, and having accessible seating are all ways that counselors can improve their space in a single day.
Once a client is in your office for therapy, don’t force them to make eye contact or communicate with gestures in the same way that neurotypicals will. You should be prepared for inevitable communication deficits between you and your autistic clients, and for the discomfort that this will likely cause you. Counselors and therapists are expected to be aware of and put aside their biases for the duration of the appointment, and this also applies to neurodivergence.
Therapists might need to reframe their questions to make them accessible, but they should wait to do so until meeting the client and getting an idea of their communication level. If a client seems to be severely struggling with verbal communication, it might be helpful if you provided them with an AAC device or picture board. Always ask the client or their family what they think would be the most helpful for the session.
When first meeting with an autistic client, or any client, the best way to make them feel as comfortable as possible is to explain the procedures and routines ahead of time. By defining the procedures of your office, autistic and neurotypical people will know what is expected of them. This will help alleviate any confusion or discomfort about where to park, where to sit while waiting, and the processes once the therapist is ready for them. Some things to consider explaining include the forms of your office, the introductory questions you will ask, and procedures for scheduling or rescheduling appointments.
By asking clients what would make them comfortable and being clear about the procedures of your office are easy ways to build a therapeutic alliance with your autistic clients. This relationship is even more important for people who struggle with socialization and interpersonal skills. As always, ensure that the treatment goals you create reflect the client’s goals and not neurotypical standards for behavior, and your autistic clients will be able to thrive in your practice.
Therapy: A Personal Review of DBT
Dialectical Behavioral Therapy (DBT) is a type of talk therapy that focuses on identifying what can and cannot be changed by the individual. Acceptance of what is out of one’s control and working on what can be changed is the dialectic that this modality utilizes. It was originally developed for Borderline Personality Disorder, but new research suggests that it is also effective for other conditions such as autism.
My personal experience was in a revolving DBT group that included individual therapy. The group time would cover skills from the DBT manual which includes mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation. These skills are taught explicitly, which I found very helpful as an autistic person.
The way my group was structured was that we discussed the therapeutic skills and how we were trying to use them outside of the group. We traded ideas around regulation and shared when we were struggling with the skills. This was supplemented by weekly individual therapy sessions where we discussed how I would use the various skills to meet my personal goals.
DBT was the most effective therapy modality that I was involved in because of its focus on both change and acceptance. The skills were explained in a way that made them easy to understand and practice, and the nature of DBT is that it is nonjudgmental. My biggest criticism is that to be in this group I had to have a BPD diagnosis. My therapist was very clear with me at the start that this diagnosis was only so that I could be in this group since it was sponsored by my university, because they thought it would be effective for me. However, BPD is an extremely stigmatized diagnosis, so some might choose to avoid it and avoid treatment.
As research into DBT continues to evolve, autism is one of the conditions that shows the most promise with DBT intervention. I would highly recommend it to other autistics due to its focus on skill building and sensory regulation. If you are autistic and interested in DBT, it is likely that your therapist will test you for BPD since this is what DBT was initially designed to treat.
Therapy: A Personal Review of CBT
As I start my series about my personal experiences with different therapies, I wanted to reiterate that they are entirely based on my opinions of these interventions. All of them are able to adapt to people with autism, but everyone will have different experiences with everything. The success of any type of talk therapy depends entirely on the relationship between the client and the therapist. If you are looking into any of these therapies for yourself or a loved one, the therapist you choose will be critical to your experience.
CBT stands for cognitive behavioral therapy and it is the most widely used type of talk therapy in the United States. It follows a fairly rigid formula that is easy to teach to therapists, so the overwhelming majority of therapists have at least some experience in it. This formula considers behavior, thoughts, and feelings to be interconnected so that changing any of the three will impact the others. CBT therapists primarily focus on changing behavior because it is easiest to monitor behavior changes externally. This can be beneficial or harmful depending on the client’s relationship with their own behaviors.
Personally, I was in a CBT program at a university’s assault program. This therapy was specifically designed to treat PTSD by changing thought patterns about the traumatic incident and the person’s sense of self. I completed six weeks of the program before being discharged for having PTSD scores below diagnosis level. I would consider this program to be a success for me because my symptoms were significantly reduced in a short period of time, but there are some areas where CBT may not be as effective for others.
CBT is meant to be a short term solution focused intervention, so you usually only meet with the therapist for a few months. Some people prefer this while others prefer to have someone they meet with regularly for several months or years. CBT also requires a large amount of homework that is assigned by the therapist each week. This homework involves tracking and challenging distorted thinking patterns and behaviors. Some people say this feels invalidating of their emotions and blames the individual too much for their situation, but my specific therapist took great care to ensure this didn’t happen for me. This is definitely something to watch for as changing behaviors is often much more difficult for people with autism due to routine and thought rigidity.
Symptoms or disorders related to anxiety like PTSD can be helped with CBT because it addresses the cyclical thought patterns that can get people caught in a harmful cycle. If uncontrollable thoughts are the root of the issue for the person seeking therapy, then CBT might be a good option because of its availability and research proven effectiveness for anxiety.
Therapy: Symptom Treatment vs Autism Therapy
If you find yourself investigating therapy options for yourself or someone you love, you will probably be overwhelmed by the academic language often used by organizations and offices around you. There are many different types of therapies that have been found to be beneficial by psychologists, but how do you know which one is right for your situation? One of the things to look for is if the treatment program specifically mentions its adaptability for autism or if the practitioner specifically mentions having experience working with autistic people.
Just because an organization does or doesn’t list autism experience, there are still things you need to investigate before committing to an intervention. One question you can ask the therapist is whether they say they focus on autism therapy or symptom treatment. This may not seem like a large difference, but this will reveal a lot about their attitudes towards autistic people. If the therapist says they focus on autism therapy, this should be a red flag because it implies that they see the autism as the root of the person’s struggles. Treating autism is also impossible because it is a condition of the brain.
Therapists who are supportive and inclusive of the autistic community will focus on treating the specific symptoms that are causing the person distress. For example, if a person seeks talk therapy for social anxiety related to autism, the therapist should not focus on making the person act more neurotypical in social situations. Instead, the therapist should work with the client to create a plan to address the behaviors and thought patterns that make the client nervous about social situations and help them come with a plan for navigating potentially tricky socializations.
This attitude will be much more effective in the long run because the client is more involved in the therapeutic planning process and in making their goals fit their lifestyle. Therapists who want to support their autistic clients will address their own inherent ableism and will create therapeutic opportunities for their clients to actually improve their quality of life instead of perpetuating trivial neurotypical standards that are proven to be harmful to their clients.
Therapy: Behavioral vs Emotional Interventions
There are very few types of therapies for autism that are covered by insurance programs, but if you are lucky enough to have some extra resources there are many options that you can pay for privately or access through public education. I tend to think of these as being divided into two categories: treating behavior and treating emotions. Depending on your or your child’s goals, you will need to decide what programs are best for you.
Behavioral interventions include ABA, speech pathology, and physical therapy. Notably, these focus on actions that you or your child can take to reach their goals and improve their outcomes by changing some part of their/your behavior. ABA is the most common therapy received by autistic people, but it is not the only one by far. Speech and academic interventions can be found in most public school systems, and can be offered during school hours. ABA and physical therapy often are done outside of school hours, which can be an additional strain on the family system if the child is not able to commute to these services on their own.
Emotional interventions include psychotherapy, cognitive behavioral therapy, and play therapy. All of these are done by a psychologist, therapist, or social worker and fall under the realm of mental health treatment that can be accessed by the majority of the population. Unlike behavioral interventions, these often do not require a diagnosis or referral to make an intake appointment. These types of interventions work to improve the client’s coping skills and reduce their mental health problems.
Ideally, all autistic people would have access to whatever services they want from either category. However, this is often not the case as individuals and families are limited by income and service availability. Personally, I would recommend people starting out with one program in each category and try to find the one that fits them the best. By addressing all aspects of the client, they can have a more holistic approach to their health that is known to benefit all members of the population, not just those who are autistic.
For more information about each of the interventions mentioned, check out the links below!
ABA: https://www.appliedbehavioranalysisedu.org/what-is-aba/
Speech Pathology: https://www.asha.org/public/who-are-speech-language-pathologists/
Physical Therapy: https://www.medicinenet.com/physical_therapy/definition.htm
Psychotherapy: https://www.psychiatry.org/patients-families/psychotherapy
Cognitive Behavioral Therapy (CBT): https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
Play Therapy: https://cpt.unt.edu/what-is-play-therapy