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Explaining autism to a child or adolescent

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Explaining autism to a child or adolescent

The value of an explanation

Our clinical experience indicates that it is extremely important that autism is explained to a child or adolescent as soon as possible after a diagnostic assessment and preferably before inappropriate compensatory reactions such as low self-esteem are developed. The child is then more likely to achieve self-acceptance, without unfair comparisons with other children, and be less likely to develop signs of depression or choose self-isolation. The child can then be a knowledgeable participant in the design of programs, knowing his or her strengths and weaknesses, and why he or she needs to regularly see a particular specialist while siblings and peers do not. The child can also experience a huge sense of relief to know that they are not ‘weird’, just ‘wired’ differently.

When and how do you explain the diagnosis?

At what age do you explain the diagnosis? Children who are younger than about eight years may not consider themselves particularly different to their peers and have difficulty understanding a concept as complex as autism. The explanation for young children will need to be age-appropriate and provide information that is relevant from the child’s perspective. The main themes will be being different not defective and the benefits of programs to help the child make friends and enjoy playing with other children and to help achieve success with schoolwork. There can be a discussion and activities to explain the concept of individual differences and autism, for example, those children in the class who find it easy to learn to read, and others who find it more difficult. Parents can then explain that there is another form of reading, namely ‘reading’ people and social situations and that we have programs to help children who have this ‘reading’ difficulty.

There are now many resources and activities to help parents explain autism and it is up to parents to decide which ones to use to explain autism to their child.

The Attributes Activity

This family activity is for children over the age of about eight years to the early teenage years. We developed the Attributes Activity to explain the diagnosis to the child and family, including siblings and grandparents. We suggest arranging a gathering of family members, including the child or adolescent who has recently been confirmed as autistic. This activity requires temporarily attaching to the wall of the room, several large sheets of paper, or using a large whiteboard divided into several sections. Each sheet of paper or section is divided into two columns, one column headed ‘Qualities’ and the other ‘Difficulties’. We suggest the child’s mother or father as the first person to complete the first stage of the activity, which involves identifying and listing personal qualities and difficulties (these can include practical abilities, knowledge, personality, and passions). After the first focus person has made his or her suggestions, the family add their suggestions. It is important to ensure that this is a positive activity, commenting on the various attributes and ensuring that there are more qualities than difficulties. Another family member is then nominated or volunteers to suggest his or her qualities and difficulties. The autistic child or adolescent can observe and participate and understands what is expected when it is time for his or her turn.

Sometimes the autistic person is reluctant to suggest or may not consider him- or herself to have many qualities or attributes. The family are encouraged to make suggestions from their perspective. There will need to be some care when nominating difficulties so that the person does not feel victimized or despondent. The following is a representation of the Attributes Activity for an autistic child.

QualitiesDifficulties
HonestAccepting mistakes
DeterminedMaking friends
An expert on insects and the TitanicTaking advice
Aware of sounds that others cannot hearManaging my anger
KindHandwriting
ForthrightKnowing what someone is thinking
A loner (and happy to be so)Avoiding being teased
A perfectionistShowing as much affection as other family members expect
A reliable friendCoping with sudden noises
Good at drawingExplaining thoughts and feelings using speech
Observant of details that others do not see 

Exceptional at remembering things that other people have forgotten

Humorous in a unique way
Advanced in the knowledge of mathematics
Liked by adults

The Attributes activity was originally published in 2007 in Tony’s The Complete Guide to Asperger’s Syndrome and subsequently used as the basis of The Amazing Autistic Brain Cards: 150 Cards for Positive Autism Discussions by Gloria Dura-Vila published in 2021 by Jessica Kingsley Publishers. The child or parents can choose which card describes a quality or difficulty for an autistic child or adolescent.

Parents then make comments on each quality and difficulty and then explain that scientists are often looking for patterns; when they find a consistent pattern, they like to give it a name. The name to describe your pattern of abilities is autism.

We recommend saying to the child, ‘Congratulations, we have discovered that you are autistic’, and explain that this means he or she is not mad, bad, or defective, but has a different way of perceiving, thinking, learning, and relating. The discussion continues with an explanation of how some of the child’s talents or qualities are due to autism, such as his or her extensive knowledge about lawnmowers or horses, ability to draw with photographic realism, attention to detail and being naturally talented in mathematics. This is to introduce the benefits of having autism.

The next stage is to discuss the difficulties and the strategies needed to improve specific abilities at home and school. This can include the advantages of programs to improve the ability to ‘read’ people, Cognitive Behaviour Therapy (CBT) and/or medication that can help with emotion regulation, and ideas and encouragement to improve making and keeping friendships. Parents may mention successful people in the areas of science, information technology, the arts and caring professions who benefited from being autistic (Elder 2006; Fitzgerald 2005; James 2006; Ledgin 2002; Ortiz 2008; Paradiz 2002; Santomauro 2012). As Temple Grandin, an autistic woman who has become a successful engineer, author and academic, said, ‘If the world was left to you socialites, we would still be in caves talking to each other.’ (Personal communication)

When explaining the development of autistic abilities associated with an adolescent, we sometimes use the metaphor of a clearing in a forest. The ‘clearing’ represents the development of the brain, and the emergence of plants and saplings in the clearing represents the development of different brain functions. In the clearing, one sapling grows very rapidly and creates a canopy above the other plants and a root structure that restrict access to sunshine and nutrients, thus inhibiting the growth of competing plants. The dominant sapling, which soon becomes a tree, represents the parts of the brain dedicated to social reasoning. If that ‘social reasoning’ sapling does not develop quickly and become dominant, then other trees, or abilities, may become stronger. These plants represent abilities in mechanical reasoning, music, art, mathematics and science, and the perception of sensory experiences. An autistic person often prioritises the pursuit of knowledge, perfection, truth, and the understanding of the physical world above feelings and interpersonal experiences. This can lead to valued talents but also vulnerabilities in the social world and will affect self-esteem. The child or adolescent may then see autism as an explanation of his or her talents as well as difficulties.

Who else needs to know?

After explaining autism to the child or adolescent, it is important to discuss who else needs to know. Children and adolescents may be concerned about how their peers will respond to the news and any potential negative reaction. Parents need to examine and discuss the issues surrounding disclosure, based on the advantages and disadvantages of certain people knowing, and how much information to disclose. We have found that autistic adolescents can be very sensitive to the anticipated reaction of their peers and are more reluctant to share the disclosure of autism. The child or adolescent’s opinion is respected regarding the question of whether peers should be told.

If the child does want the other children to know, there needs to be an agreement as to how widely the information will be disseminated, how it will be done, and whether the autistic child or adolescent should be present. Carol Gray has developed a program, The Sixth Sense, to explain autism to a class of children in an elementary or primary school (Gray 2002). She has designed a range of classroom activities based on learning about the five senses that are extended to include a ‘sixth sense’, the social sense, which is the perception of social cues. Peers can then discover what it would be like to have difficulty perceiving the social cues and thoughts and feelings of others, and what they can do to help someone develop the sixth sense. We now have other published resources to help explain autism to peers and siblings (see resources section below).

References

Attwood, T. (2007) The Complete Guide to Asperger’s Syndrome. Jessica Kingsley Publishers

Elder, J (2006) Different Like Me: My book of autism heroes Jessica Kingsley Publishers

Fitzgerald, M. (2005) The Genesis of Autistic Creativity: Asperger’s syndrome and the arts. London: Jessica Kingsley Publishers.

Gloria Dura-Vila (2021) The Amazing Autistic Brain Cards: 150 Cards for Positive Autism Discussions Jessica Kingsley Publishers

Gray, C. (2002) The Sixth Sense II. Arlington, TX: Future Horizons.

James, I. (2006) Asperger’s syndrome and High Achievement: Some very remarkable people. London: Jessica Kingsley Publishers.

Ledgin, N. (2002) Asperger’s and Self-esteem: Insight and hope through famous role models. Arlington, TX: Future Horizons.

Ortiz, J. (2008) The Myriad Gifts of Asperger’s Syndrome Jessica Kingsley Publishers

Paradiz, V. (2002) Elijah’s Cup: A Family’s Journey into the Community and Culture of High Functioning Autism and Asperger’s Syndrome. New York: The Free Press.

Santomauro, J. (2012) Autism All-Stars: How we use our autism traits to shine in life Jessica Kingsley Publishers

Books and resources

There are many books and resources that can help explain autism to a child or adolescent and we have provided below a list of recommended resources. Parents can supplement an explanation of autism by encouraging the child or adolescent to read fiction with a central character being autistic. Kathy Hoopmann has written several excellent adventure stories that autistic children and adolescents find fascinating, and they identify with the experiences and abilities of the autistic hero of the story.

Some of the books and resources refer to Asperger’s syndrome which before 2013 was the term used to describe autism spectrum disorder level 1. All the following books are published by Jessica Kingsley Publishers with more information at www.jkp.com

Books for primary school children

Bulhak-Paterson (2015) I am an Aspie Girl

Hoopmann (2021) All Cats are on the Autism Spectrum

Hoopmann (2013) Inside Asperger’s Looking Out

Klemenc (2013) What Is It Like to be Me?

 Books for high school children

Jackson L. (2002) Freaks, Geeks and Asperger Syndrome

Monahan F (2019) Know Your Spectrum: An Autism Creative Writing Workbook for Teens

Fiction

Kathy Hoopman’s trilogy: Blue Bottle Mystery, Of Mice and Aliens and Lisa and the Lace Maker and her science fiction novel for adolescents Elemental Island

Books for parents

Dundon R (2018) Talking with your Child about their Autism Diagnosis: A guide for parents

10 Challenges your autistic teenager likely faces every day

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10 Challenges your autistic teenager likely faces every day

Introduction

If you live with, teach or work with an autistic teenager, it is very likely that you have noticed that many days seem to be characterised by struggle. They often experience very strong emotions, including anxiety, stress, depression, and anger. On some days even the smallest trigger, for example, looking at the person, can trigger a meltdown. They come home from school catastrophically tired, seeming to need hours in the bedroom lying on the bed to recover, or disappearing into a computer monitor, only to emerge in a worse mood than they went in with. What is going on? Why are our autistic teenagers struggling so much with life? In this blog we cover 10 likely challenges your autistic teenager faces every day, with a hope to increase your understanding of why your teenager is struggling so much. We find that when we can understand the reasons for the struggle, that understanding can provide a roadmap of how to better assist our teenagers.

1. Being different

An autistic person often experiences that they are different from other people from an early age, but commonly does not understand why they are different. Within this gap of understanding they can insert many self-derogatory labels, like “weird,” “psycho,” or “stupid.” It is very difficult to be different at school, especially socially. You will remember from your own experiences of high school just how critical, rejecting and punishing teenagers can be to each other. One of the developmental milestones of adolescence is to individuate, that is to become an individual separate from your parents, to gain a sense of self. The individuation process is often characterised by trying to fit in with peers. It is very difficult to fit in with peers when you are socially different. The other kids know you are different, you know it, but you have no idea what to do about it. The result can be very low self-esteem, a poor sense of self and a sense of hopelessness, leading to depression and suicidality. Some teenagers react by denying that there is a problem, and overcompensate with an inflated self-esteem, or arrogance, and blame others. They often have anger problems.

2. Self-regulation

Autism is a frontal lobe condition, which means that it affects the frontal lobes of the brain, which are responsible for executive functioning. In fact 3/4 of people with autism also have attention deficit hyperactivity disorder (ADHD), a condition characterised by poor executive functioning. Executive functioning abilities include the capacity to focus on the right thing at the right time, transition between events, organise ourselves and our time, plan and prioritise, hold a problem in our mind while we are solving it, and to inhibit first responses. An autistic teenager is often struggling with each of these abilities, which truly impairs their ability to regulate their emotions and behaviour. They often ricochet between emotions, acting impulsively, becoming defensive, and avoiding situations that make them anxious. This pattern allows no space to sense themselves, to process what is happening, to learn, or to problem solve. Without self-regulation, your teenagers feels out of control, and increasingly anxious. When someone cannot control themselves, they usually start to try to control other people.

3. Sensory challenges

One of the defining features of being autistic is that there are sensory challenges. Often noises are too loud, light is too bright, and the person can be very distressed by certain aromas, textures and tastes. Having a different sensory system can also affect the person’s ability to register pain and temperature. The consequences of a different sensory system include persistent hypervigilance, exhaustion and sleep problems. There can be difficulty with concentration and focus during the day because of the background stress of trying to process sensory experiences.

4. People

If you ask an autistic teenager what is the biggest problem of their life, they often will tell you that it is people. What they mean is that people are confusing, it is difficult to read them and to know what they expect, and they can also be punishing and rejecting. Research tells us that over 90% of autistic teenagers will have received cruel bullying, including peer rejection, by the time they reach 14 years old. Often our autistic teenagers decide quite early that people are “toxic,” and they prefer to avoid them to stay safe. The problem with this is that they have overlearned the lesson. Not all people are toxic, and your autistic teenager needs people in their life, including friends, mentors, parents, siblings, professionals and teachers. As one autistic teenager said, “I would choose to be alone but I can’t stand the loneliness.” We know from research and clinical practice that having just one friend can protect an autistic teenager from poor mental health outcomes.

5. Double empathy problem

Autistic people struggle to read other people, to infer their expectations and intentions. This problem is called “theory of mind,” or cognitive empathy. It is important to point out that autistic people do not lack empathy, they usually have an abundance of affective empathy, as discussed below. However, they do struggle to “read” people, to have cognitive empathy. We now understand that the problem goes both ways. As much as autistic people struggle to read neurotypical people, neurotypical people struggle to read autistic people. The unique social communication style of an autistic person, which may include less eye contact, facial expressions and body gesture, can lead that person to be misinterpreted and even perceived unfavourably. Similarly, an autistic person can misperceive certain facial expressions, gestures and tones of voice as being negative, and thus perceive the person unfavourably. On each side, whenever an unfavourable impression is made, the person perceiving the unfavourable impression is less welcoming, leading to the autistic person to both reject other people and perceive that they themselves are not welcome (Mitchell, Sheppard & Cassidy, 2021).

6. Overthinking

Due to problems with both social confusion and executive functioning, the person tends to overthink many situations as a coping mechanism. Autistic people often highly value intellect and can utilise their intellect to overcome their problems. This is a very valuable skill, but when overused we call it overthinking. Overthinking one’s problems can lead to both exhaustion and “analysis paralysis,” where the person becomes overwhelmed and avoids the problem. You know your teenager is avoiding the problem when they spend a lot of time in bed or in front of a screen. This avoidance is called thought blocking and leads to much greater levels of distress. Overthinking is also associated with being disconnected from the body and hence from processing one’s emotions. We need to feel to heal.

7. Empathy overarousal

We have talked about cognitive empathy and we mentioned affective empathy. Affective empathy is when the person feels other’s emotional distress as if it were their own. They may not be able to understand how to describe that distress, or why the distress is occurring, but they feel it as if it were their own. Research has shown that many autistic people experience other peoples’ pain more intensively than neurotypical people do. This has been called the “empathy over arousal hypothesis.” Autistic teenagers and adults describe that they often feel overwhelmed by other peoples’ emotional pain, and have no idea how to deal with it, either how to help themselves, or how to help the other person.

8. Alexithymia

Up to 80% of autistic people also have alexithymia. Alexithymia literally interprets to “a” – a lack of, “lexi” – words for “thymia” – emotions. It also includes difficulty sensing bodily sensations associated with emotions, or problems with interoception. When someone cannot detect the early signs of an emotion, or find and words for that emotion, they are severely under equipped for managing the emotion. Alexithymia is one of the reasons many autistic teenagers rise from 0 to 100 in half a second on their Anger Thermometer. Unfortunately, having alexithymia is a risk factor for developing clinical levels of anxiety and depression.

9. A different learning profile

When an autistic person completes an Intelligence Quotient (IQ) test it is very common for them to show a great deal of variability between the various subtests that make up the IQ test. This means that they often have great strengths in their cognitive learning ability, but also areas of great difficulty. Because of their uneven learning profile they can really struggle with new learning tasks, even if they are very intelligent or even gifted. We call this the different learning profile of autism. Being a different learner can be very challenging in all contexts, including school, but also in social situations and within the family and community. Despite good intellect, your autistic teenager may feel that they are stupid, and can feel very depressed and hopeless about that.

10. Trauma or the effects of past trauma

It is unfortunately the case that autistic people are both more likely to experience a traumatic event and are more likely to have a traumatic stress reaction, for example, to develop PTSD, after trauma. It may be that your autistic teenager is suffering current trauma, for example, being bullied or abused, or has developed PTSD, but the condition is undiagnosed. A person with PTSD will experience high levels of hypervigilance throughout the day, distrust of people, flashbacks to the traumatic event, and nightmares that interrupt good quality sleep. If you suspect that your autistic teenager has developed PTSD or is suffering a current trauma, we highly recommend seeking professional assistance for them immediately. Fortunately, PTSD is treatable, and if we know about ongoing traumatic experiences, we can keep our autistic teenagers safe by stopping them.
Summary

The teenage years are challenging for typical teenagers, however our autistic teenagers face unique challenges that can amplify the typical challenges of the teenage years. Over the many years we have specialised in autism, we have discovered that understanding specific challenges that our autistic teenagers face is the most important first step in knowing how to support and assist our teenagers. The 10 challenges we list in this blog are ones that we commonly discover in our clinical practice, and have further understood with research and clinical practice. Hopefully your autistic teenager is not experiencing all of these challenges, but we encourage you to continue to explore and understand the challenges they face. It can be painful to tune in and listen, or to lean in and observe closely. We ourselves may have faced similar issues and have not yet healed. However, one of the most consistent findings across research on what helps to maximise the best outcomes in autism is support. When we provide ongoing support and understanding for our autistic teenagers, we give them the best opportunity to succeed.
What Next?

If your autistic teenager, student or client is experiencing any of these challenges and you are uncertain about next steps, we encourage you to come to our next Succeeding with Autism in The Teens Live Webcast on Friday 22nd July, 2022.

More information is available on our website:

https://attwoodandgarnettevents.com/product/succeeding-with-autism-in-the-teens/

References

Mitchell, P., Sheppard, E. & Cassidy, S. (2021). Autism and the double-empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39, 1-18. DOI: 10.1111/bjdp.12350

Autism working

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Autism working

Introduction

Achieving and maintaining employment can be difficult and stressful for autistic adults. Parents and partners also have their concerns, as they often provide employment support and employers, line managers and co-workers need guidance in how to work successfully with an autistic employee.

Unfortunately, many autistic adults who have a job are under-employed, that is, their job does not match their abilities, qualifications, and aspirations or their duration of employment is less than anticipated. This is despite autism being associated with qualities that are sought by employers such as:

ReliabilityAccuracy and precision
PersistenceAttention to detail and a perfectionist
Liking routines and proceduresCreativity and innovative thinking
Problem solvingFactual and technical knowledge
Sense of social justice and compassionNot letting socializing be a distraction
Talent in identifying patterns and systemsIdentifying and correcting errors
Enjoy cataloguing and recalling informationHonest and loyal
Working logically and systematicallyPassion for their chosen career

Having a successful career will significantly improve self-worth and self-identity, provide structure and purpose to the day, an opportunity to make friends, increase income and greater financial independence, and be an effective antidote to low self-esteem and depression.

Career choice

From our extensive clinical experience, we consider that no job or career would automatically be viewed as impossible due to autism. This can include the expected careers in engineering, information technology, science and accountancy but also a career in the arts in terms of being a fine artist, musician, actor or author. We have also known autistic adults who have been successful in the caring professions, from nursing to psychology and caring for animals such as being a vet or zookeeper. There is no automatic restriction on choice of career.

How to choose that career? The first option may be to see if there are employment prospects related to a special interest or talent that is associated with the person’s profile of autism and personality. A childhood talent with LEGO® that develops during adolescence into an intense interest in the design of machines could become the basis of a successful career in mechanical engineering. A determination to understand people may develop into a career in psychology and the caring profession, and a difficulty expressing inner thoughts and feelings using speech may lead to a talent in self-expression and perception in the arts.

We highly recommend that autistic adolescents have a detailed assessment of vocational abilities during the high school years to identify whether a talent or interest could be the foundation of a potential career. There will also need to be an assessment of vocational abilities that need improvement, such as teamwork abilities and coping with changes in job expectations. This information is then included in the high school curriculum. Autistic adults will need similar assessments, careers guidance and improvement of employment skills which could be provided by an employment agency.

When there is a history of failed employment experiences, this can provide valuable information on what skills or employment accommodations are needed and which jobs or workplaces to avoid. It may take several employment experiences before finding the right job with the right employer.

When searching for a job that matches abilities, interests, qualifications, and personality, it is important to find as much information as possible about the social and sensory aspects of the job. This can include personal space such as an open plan or single person office space, working independently or in a team, and sensory aspects such as sounds, lighting, clothing, and scents. It is also important to consider the understanding of autism of the line manager and colleagues and their willingness to learn about autism. Autistic people can sometimes have a ‘sixth sense’ to quickly appraise the social atmosphere of a new situation, and a positive or negative attitude can become apparent on meeting the staff prior to or during the interview. We recommend trusting that intuition.

Job interview

There will probably be a need for guidance in completing the job application form and, deciding whether to disclose the diagnosis. There are no clear rules on disclosure when applying for a job, and it is sometimes a personal decision based on whether disclosure would facilitate or inhibit achieving an interview or being employed. It is also important to decide what to wear for the interview and to rehearse how to answer the anticipated questions during the interview. If autism has been disclosed in the application, it may be an advantage to prepare a brief brochure on autism and associated qualities in relation to the position. The brochure can be attached to the application or given to those conducting the interview.

A job interview is a complex social ordeal. There is an expectation of accurately reading the body language of those conducting the interview, and succinctly and honestly answering their questions. An autistic candidate may have difficulty knowing the non-verbal signals and social conventions in an interview. We highly recommend practice and rehearsal in interviewing techniques and having an informative portfolio of relevant work experience that can be the focus of the interview. If those conducting the interview know that the person has autism, it will help to describe some of the difficulties associated with autism, but that these are significantly less than the qualities required for the position, and that there are strategies to facilitate successful employment.

Starting the job

There are potential employment issues associated with autism that will probably become apparent when starting a new job. These include the social aspects of the work, executive functioning abilities, sensory sensitivity, changes to job expectations and stress management. We have described these issues in some detail and provide strategies to overcome them in our recent publication Autism Working (Garnett and Attwood 2021) These are some of the issues and strategies.

Social aspects

The characteristics of autism include difficulty achieving social and conversational reciprocity, reading non-verbal communication, understanding different perspectives, developing teamwork skills, and following conversational rules. Workplace social communication challenges can also include discussing confidential and personal topics at work and respecting co-worker/employee boundaries. There can be difficulties knowing the social expectations and engagement in social events such as a celebration party and a vulnerability to being bullied and teased.

Strategies to reduce social communication difficulties include having a work mentor to explain the workplace social dynamics and protocols and developing social scripts to explain autism and seek support. Examples include how to communicate a preference for solitude during breaks, end a social conversation and return to work and reading the signals when a colleague or line manager does not want to be interrupted.

Executive functioning

This can include a propensity to be distracted by detail, organizational and planning difficulties, time management, prioritizing, and self-monitoring. We have also noted difficulties regarding unorthodox work routines and coping with errors, both personal and colleague’s errors. The autistic employee may need more supervision and guidance regarding executive functioning abilities than other employees. It is important that the line manager discuss strategies to minimize such difficulties and to have regularly schedules meetings to provide feedback on performance, workplace accommodations and areas for personal improvement.

Sensory sensitivity

The most common sensory sensitivity associated with autism is to specific sounds, but there can also be sensitivity to tactile experiences, light intensity, and aromas. Autistic adults often describe some sensory experiences as painful; the anticipation of such experiences creates anxiety and becoming hypervigilant. There is also the potential for sensory overload which is extremely distressing.

Coping mechanisms include explaining the sensory sensitivity to colleagues and line manager and requesting accommodations such as working some distance from the sound of the hand dryer or fridge and if possible, having natural rather than fluorescent lighting.

Changes to job expectations

A characteristic of autism is a difficulty coping with change and the unexpected. It is inevitable that there will be changes in the work environment, but it is important that the autistic person is given as much warning as possible and provided with an explanation of why there is a change of plan and expectations. This will enable the autistic person to create a new mind set.

It is also important to be aware that while promotion is considered a reward for the quality of work, there can be difficulties if the new role requires greater social and teamwork skills. It is important to consider social communication challenges in career and promotion planning.

Stress management

When work demands exceed an autistic individual’s resources and abilities, stress is the inevitable result. It is important that the autistic employee knows their personal signs of work-related stress, which work situations create significant stress, and that stress levels are communicated to the line manager.

High levels of stress will affect work performance and could lead the autistic person to resign. There may be strategies to reduce stress at work such as having a quiet retreat area to reduce stress and restore energy, using relaxation strategies and an opportunity to de-brief at work or home.

In summary

Autistic adults often have difficulties getting and keeping a job, despite having many qualities that employers seek. We need to assess an autistic person’s employment attributes and challenges, enhance their employment qualities, and address their employment issues. We also need to educate the workforce in how to accommodate and benefit from an autistic employee or colleague.

Employment resources for autism

We have applied our extensive experience of autistic adults to create a seven stage plan to facilitate successful employment in our new book Autism Working and with our colleague Barb Cook, created a presentation on autism and employment to be webcast on the 4th of March with more information at www.attwoodandgarnettevents.com This webcast will be of great interest to:

Employers

HR Managers

Line Managers

Team Members

Mentors and employment agency staff

Autistic employees, and

Autistic adults looking for and maintaining employment.

Parents and carers of autistic adults

Reference

Garnett M. and Attwood T. (2021) Autism Working: A Seven-Stage plan to Thriving at Work Jessica Kingsley Publishers, London.

Computer gaming and COVID

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Computer gaming and COVID

The following article is Tony’s chapter from the new book:
Life After Lockdown: Resetting Perceptions of Autism Strategies and Reflections

Edited by Rebecca Silva, Ruth Prystash, Rene DeLoss, and Carol Burmeister (Foreword by Peter Vermeulen)

Available to purchase here

The past year has marked us as one of the only generations to experience a global pandemic. The pandemic kept people at home, something that suited many autistic individuals. But it also limited the opportunities for social and emotional growth for autistic teens and young adults, and one of the obvious outlets became computer games. These games were already intensely important to many autistic youth, but now they became more so, as there was little else to occupy their minds and their time. Computer games can be beneficial, but they can also be addictive. This is a story that needs to be told, because nobody else is talking about it.

COVID’s impact on the autistic teen or young adult

Many individuals have begun displaying an increase in routines and rituals, heightened sensory sensitivity, and more engagement with special interests. These are all ways of coping with anxiety. People have been cooped up together for the past year, which can be difficult for a person with autism who craves solitude. There may even be anxiety about what will happen when we begin to have more face-to-face contact and are forced to endure crowds again.

There is a misconception that people with autism lack empathy. The opposite is actually true: Autistic individuals are often acutely aware of other people’s mental states. The news speaks of a killer virus and the rising numbers of dead; children worry about their family members’ health. There has been more free time at home this year for the anxiety to percolate and one way to alleviate that anxiety is the computer game.

Computer gaming—a perfect fit for autism

There are a number of factors that make computer games extremely popular with people on the spectrum. Gaming provides a sense of achievement and identity. It allows you to show your capabilities independent of autism. The main issues of autism are social-conversational, but in gaming you have no real socialization and you have no conversation, so you have basically bypassed autism. Gaming is a natural talent because it suits the autistic cognition. However, it also involves considerable practice. A person can become a master of a skill that requires great ability but also practice. It is the same for a child with computer games. They are talented at computer games, and are motivated to practice. If you want to measure the intelligence of an autistic child, watch them play computer games. The game bypasses their autism, they are highly motivated, and you can see how quickly and effectively their brain works.

If you are not good socially and you are not good at sports, your intellect is very important to you, and you want to prove how smart you are. You want to demonstrate your intelligence and you want other people to appreciate that intelligence. With gaming you have a sense of achievement that is truly gratifying, especially as it is valuable to your peer group.

Autistic teens are searching for identity. Who am I? Why am I here? What is the meaning of life? Where do I fit in? I know I’m supposed to be like everyone else, but I’m not. I want a sense of identity and self-worth that is defined by something that is valued by my peers. The computer game does that. It gives a sense of identity to someone who is searching. The computer game becomes a way of fitting in. It becomes your identity when you have few ways to define that identity. And autism can make a person very lonely. Without social skills, it is sometimes hard to fit in to most same-age groups. Bullying and being excluded can leave autistic teens feeling isolated, while gaming provides a connection with fellow gamers who actually seek you out, rather than shun you.

Computer games give you immediate feedback. As many as 75% of those with ASD also display characteristics of ADD and ADHD. Computer gaming suits those characteristics, as it is based on immediate feedback on one’s performance without any waiting, which autistic people often dislike. Unlike school, where you may be waiting on feedback from a teacher, the game provides immediate feedback.

People are excited to see you online and that kind of genuine, deep welcome is intoxicating to someone with autism. Someone in your peer group actually wants to know you, and is pleased that you are there. Rather than the students who sometimes bully and tease and reject and humiliate, these gamers want to know you and are proud to be your friend. They give you compliments and admiration. But more than that, with your gaming skills, you also become a teacher to some, a mentor to others. You advise them. You are wise. You are talented. You are someone special.

In e-sports, a subgroup of gaming, there are leagues with teams and supporters; logos and colors; managers and favorite players. Players are bought and sold. There are e-sport competitions held in convention centers with thousands of people watching gamers. And in this world, you, the autistic individual, are the person the team wants to recruit. You are a hero in that world. Finally, you have a social network where you shine.  

Gaming as a coping mechanism

During COVID, anxiety and depression increased for many people, including people on the spectrum. A computer game is a thought blocker for anxiety and depression. When you are engaged in the game, you don’t feel anxious and you don’t feel depressed. Instead, you suppress and compress your thoughts and feelings. Computer games are more powerful than medications or cognitive behavioral therapy because they encourage the classic autistic characteristics of avoidance and suppression. When you are playing the game, you are in a bubble. Your problems disappear and you don’t care about anything else, but when you switch off the game, those feelings come back. Parents become frightened to see how angry their child becomes when asked to turn off the computer. What is actually happening isn’t really anger: It is the fact that their powerful feelings have not been dissolved or resolved. Once the game is gone—boom! The feelings are back, and they flood you with fear and despair.

A substitute for social interaction

In autism social emotional reciprocity is a core issue. In a computer game, you don’t have a real conversation going on. You don’t have to worry about reciprocity, you don’t have to read body language, and you don’t have to be involved in social chit-chat. One of the interesting things is that there are often chat lines in computer games, and they provide a means to communicate through typing, rather than talking. Clinically, that can be very valuable. When a client sends me an email, I may receive far more information and insight into the individual’s world than I do in person, because it involves typing, not talking. There is a greater fluency and disclosure of thoughts, feelings, and revelations of the self through typing, rather than talking.

The games have very clear and simple rules that aren’t like social rules. Social rules are inconsistent and complex, and there are always exceptions. Neurotypical kids do things that that are against the rules and get away with it, even though you’re not supposed to get away with it! But in gaming, there are simple rules that are always enforced. There is no inconsistency and no uncertainty, so you are secure in the rules of the game.

A sense of pleasure and enjoyment

If you ask a neurotypical about the greatest moments of excitement and joy in their life, it usually involves another person–giving birth, getting married, falling in love. But with autism, other people can be a source of confusion, so pleasurable memories rarely involve them. Computer gaming, on the other hand, gives you experiences of pleasure and enjoyment when there are very few in your life. This is incredibly intoxicating. Gaming is addictive because it feeds into pleasure-seeking and enjoyment. For someone who may have few pleasures in life, experiencing such a high level of excitement—perhaps the greatest enjoyment you have ever received—is euphoric.

Creating an alternative world

In the real world of daily life, the teen with autism is often not respected or included. But here in the computer game, you are in a world where you are both respected and included. The special interests of people on the spectrum are often an attempt to find a world in which to belong. Anime, Pokemon, Manga–another culture, another country, another time in history where you fit in. Science fiction–you go to another planet where you are recognized and valued. The game creates an alternative world where you have a sense of belonging. The real world may not value you or respect you, but in this world you are remarkable, and that’s why you want to stay.

Avatars are virtual selves that you can create in a computer game. An avatar allows you to experiment with personality, analyzing the interests and people who are important in your life. This is what most teenagers do in the real world. I’m going to be an adult, so what kind of adult am I going to be?  Who do I value, who are my heroes, and can I borrow some of their characteristics? In a computer game you can experiment with that even further. If you’re concerned about your weight, your avatar is slim; if you’re concerned that you’re not smart enough, then your avatar is a genius. It is very powerful.

The dangers of computer gaming

Immersion into computer gaming can mean that individuals are not learning to cope with emotions. Instead, they’re learning to avoid them. They are compressing and suppressing, and are not processing their feelings appropriately. This means that when they start playing the games in earnest, their emotional maturity freezes and levels off. Emotional regulation is stunted. Individuals learn to rely on the game rather than the actual social skills which will serve them in the real world.

When we look at the long term effects of gaming, we see medical issues. Individuals become overweight, with poor eating habits. Junk food is quick and easy while you are on the computer. Some individuals will spend enormous amounts of time online—from 10- 16 hours per day. There is a lack of exercise and exposure to sunlight, so health effects arise.

It is also very disruptive to sleep patterns. One of the effects of extended screen time is that a person’s thoughts increasingly spiral once the game is turned off. Thoughts become incoherent and chaotic, and sleep becomes more and more elusive. That’s why there should be no screen time for one to two hours before bed. In autism, sleep is always been a problem, from infancy on through senior adulthood. Sleep is important for processing intellectual information and processing emotions. When you have a good night’s sleep, inappropriate behaviors diminish. With too little sleep, the opposite is true.

One of the inherent dangers in gaming is a potential tie-in to gambling. In computer games there are commodities called loot boxes. These loot boxes pop up during a game, offering the opportunity to purchase something that may or may not contain useful items. Most boxes have ordinary items, but the gamer will continue to buy them, lured by the possibility of scoring something big. The odds of it having what it advertises are very rare, but the possibility keeps gamers buying more, and so gambling becomes embedded in games. Parents should be aware of this connection, as it is one more avenue to addiction.

When gaming becomes an addiction

The computer gaming industry has the potential to rob us of some very bright minds, who may get caught up in the addictive side of gaming. When teens begin to avoid things that were recently part of their routine, there may be a problem. If you tell your teen to get off the computer for lunch and they become incredibly agitated, avoiding lunch in order to play the game—that’s a worry. If they become upset when a legitimate request interferes with access to the game, then the depth of engagement is now of considerable clinical concern. Their world revolves around the number of hours they spend on the game, and they become agitated when other activities interfere. For example, you used to have evening meals as a family, spending time together. Now the teen arrives at the table at the last moment, bolts down food, and then, boom. Gone. No conversation. No engagement. The individual withdraws from a variety of activities that used to be important for the family and enjoyable for themselves. The game is taking control. This is common in addiction: instead of the person controlling the game, the game is controlling the person.

One of the first casualties of any addiction is truth. The individual will hide their actual time online, like an alcoholic hides their alcohol. They will also have access to games on their phones. Gaming should absolutely be included in the same category as alcohol and drugs for individuals with autism. These individuals struggle, not with autism, but with emotional regulation. Because the game is so good at moderating intense emotions, they are reluctant to switch to anything else.

Dealing with the addiction

One thing that parents should not do is take away the game as punishment. The games provide the teen or young adult with an identity, coping strategies, a social network—what they live for. If adults remove this without providing the child with other coping mechanisms or alternative activities, this ends up being, not punishment but revenge. Parents will end up escalating the punishment from a day to a week to the threat of totally removing the computer, and the teen will respond with defiance and anger. It can quickly escalate into a civil war which no one wins.

If we want to address the behavior constructively, it is important to carefully identify the issues of behavior management or encouragement of chores or other commitments. There must absolutely be consequences, but they must be appropriate. For example, if a teen does something that upsets his sister, an appropriate response might be to have him take responsibility for one of her chores for a week. The time that is spent on that chore would have been spent on the computer, so it is a means of restricting access through teaching an appropriate replacement. It is possible to use the computer as a reward. For example, if the child does their homework, they can have an extra half hour on the computer. This uses the computer as a reward or an encouragement, rather than as punishment. It also teaches a part of growing up. You want more time on the game, but you’ve got to do your chores. That’s life.

When a parent suspects addiction, they can use logic to deal with it. Get a big piece of paper and list the positives and negatives of computer games with the individual. The positives are that it helps manage emotions and it makes the child popular. So how can we help the individual achieve these things outside the game? We can find more conventional and diverse ways of achieving those things, initially in addition to the computer game and eventually as alternatives. Next list the negatives: being overweight, spending huge amounts of time on the game and nothing else, the lack of honesty, and the lack of constructive ways in their lives to learn to deal with emotions. Help the individual compare these lists and set goals.

In terms of strategy, first get an accurate accounting of the amount of time spent gaming. Instead of aiming for an unrealistic goal, like an entire game-free day, try for something more reasonable. For example, start with reducing time by 15 minutes every day for three weeks. If successful, then decrease by 15 more minutes for three more weeks. Use small steps. Parents must provide alternatives that bring pleasure to the child, like being outdoors or spending time with pets. Families must also try to help the individual increase their social network through constructive means so the individual is actually learning to relate and manage conflict.

There are currently few treatment options for addiction in autistic individuals. Therapy for addiction needs to develop expertise, theoretical models, and a whole range of strategies for gaming addiction, especially for autistic individuals. We need psychiatrists and psychologists who are aware of this and work to modify therapy to accommodate the autistic way of thinking.

Final thoughts

As we continue to deal with the effects of the current pandemic, it’s important to realize that many of our brightest autistic individuals are going into the medical and research fields. These individuals, with their logical brains and skill at analyzing systems, have the ability to understand the behavior of a virus and can use their intellect to help develop cures. The intense focus of which they are capable allows them to tolerate 18-hour days in a lab. Instead of looking at a computer screen, they are looking into a microscope. Let’s hope that we can guide them to those labs, and show them that their brilliance is not only appreciated, but desperately needed, and that they are indeed invaluable members of society.

Adolescent autistic friendships

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Adolescent autistic friendships

Typical adolescent friendships

Typical children go through four stages of friendship from pre-school to adolescence, with the fourth stage becoming apparent from around the age of 13. During the previous stage of friendship (9 to 13 years) there is usually a small core of close, same gender friends, but in stage four the number of friends, gender, and quality of friendship changes. There can be different friends for different needs, such as emotional comfort, humour and entertainment, or practical advice for schoolwork. A friend is defined in stage four as someone who ‘accepts me for who I am’ or ‘we think the same way about things.’ A friend provides a sense of personal identity, self-esteem, connectedness, and resonance with one’s own personality. There are less concrete and more abstract definitions of friendship, with what may be described as ‘autonomous inter-dependence’. The friendships are less possessive and exclusive, and conflict is resolved with self-reflection, compromise, and negotiation.

During the teenage years, friendships are often based on shared interests, such as academic achievements, mutual participation in sports and recreational activities, and passion for causes, such as climate change. There is a greater depth and breadth of self-disclosure, empathy, and sharing feelings and secrets. The teenager increasingly spends more time with friends than parents, and allegiance can be to friends and their value systems rather than to family. Peer group acceptance may be perceived as more important than the approval of parents.

When conflicts occur, friends will now use more effective repair mechanisms. Arguments can be less ‘heated’, with reduced confrontation and more disengagement, admission of mistakes and recognition that it is not simply a matter of winner and loser. A satisfactory resolution of interpersonal conflict between friends can strengthen the relationship. The friend is forgiven, and the conflict is put in perspective. These relationship qualities played out in typical adolescent friendships are the foundation of interpersonal skills for adult relationships.

Autistic friendships

In typical adolescents, the acquisition of friendship skills is based on an innate and evolving ability to make and keep friends that develops throughout childhood, in association with progressive changes in social reasoning and abilities modified through positive friendship experiences. Unfortunately, autistic children and adolescents are not as able to rely on intuitive abilities in social settings and must rely more on their general cognitive abilities to process social information. They often have had peer interactions which have been confusing, if not aversive. Due to relying on cognitive rather than intuitive abilities, autistic adolescents often have difficulty in friendship situations that have not been rehearsed or prepared for. They also have difficulty reading and following covert social rules and conventions. They may be criticized by peers for making social errors, often being labelled a ‘social retard’. Autistic adolescents have probably not had many opportunities for a friendship mentor – peer or adult – to provide guidance and constructive, positive feedback.

Thus, autistic adolescents work twice as hard intellectually at school than their peers, as they are learning both the academic and the social curriculum. As explained by an autistic teenager, ‘It takes all my brain power to be a friend.’ At the end of the school day, the autistic teenager has usually had more than enough social interaction, and desperately needs to relax in solitude to intellectually process the day’s social experiences. As far as the autistic teenager is concerned, friendships end at the school gate. They may resist parents’ suggestions to contact friends or engage in extra-curricular activities, local sports, and artistic activities such as drama. Parents may need to accept that their teenage son or daughter does not have the energy or motivation to socialize any more. If parents arrange social experiences, it is imperative that the experiences are brief, structured, supervised, successful, and, most importantly, voluntary.

Even when autistic adolescents are included in the activities and conversations of their peers at school, there may be an awareness that they are not popular. This is illustrated by two comments from autistic adults describing their teenage years: ‘I wasn’t rejected, but I did not feel completely included’, and, ‘I was supported and tolerated, but not liked.’ A common lament is feeling that others do not want to be around them – that they are perceived as a nuisance. Autistic adolescents often blame themselves, or the fact that they are autistic, for their peer rejection, and become anxious to avoid inadvertently violating their peer social hierarchy and expectations. A lack of genuine social acceptance by peers will obviously adversely affect the development of self-esteem, self-identity, and perception of autism.

Autistic adolescents can be increasingly aware of being socially naïve and making social faux pas. The worry about social incompetence and conspicuous errors can lead to the development of a social phobia and increased social withdrawal. An autistic teenager said that ‘I live in a constant state of performance anxiety over day-to-day social encounters.’ Aversive social experiences with peers can lead to the assumption that everyone is against them, and to misperceiving, or not recognising, friendly intentions when they do occur. This may be a contributary factor to becoming a recluse at home, and not wanting to leave the safe sanctuary of their bedroom.

The social performance anxiety can be especially acute at the end of the day, and before falling asleep, when the autistic teenager reviews the social experiences of school. He or she may now be very aware of what other people may think, and this can be a significant cause of anxiety: ‘I probably made a fool of myself’; or depression: ‘I always make mistakes and always will.’ There can be a conscious retreat into solitude: as an autistic adolescent said, ‘I’d rather just be alone, but I can’t handle the loneliness.’

The autistic teenager typically has fewer friends, and meets with friends less often at school and for a shorter duration, compared to peers. They can express feelings of deep loneliness and melancholy. Being isolated and not having friends also makes the adolescent vulnerable to being teased and bullied. The ‘predators’ at high school target someone who is alone, vulnerable and less likely to be protected by peers. Having more friends can mean having fewer enemies, being protected, and having someone to repair or refute derogatory comments and restore a sense of trust.

Peer acceptance and friendships can also benefit the autistic teenager in terms of providing a second opinion regarding the motives and intentions of others, thus preventing that sense of paranoia. Friends can provide an effective emotional monitoring and repair mechanism, especially for emotions such as anxiety, anger, and depression. If a typical teenager is sad, close friends will cheer them up, or if angry, calm them down and prevent them from getting into trouble. Friends can also offer guidance on what is appropriate social behaviour, helping develop a positive self-image and greater self-confidence.

Typical adolescents can easily identify their friendship ‘family’, and achieve a sense of connection and belonging to a friendship group with shared interests and values. Autistic adolescents, on the other hand, often yearn for a sense of connection, but usually experience rejection from popular friendship groups. However, they may be accepted by marginalised teenage groups that engage in activities and interests that tend to cause concern for parents – exploration of alcohol and drug use, sexuality and eating disorders, for example. The friendship family ‘adopts’ the autistic teenager, who acquires a new intense interest and may accumulate knowledge from the Internet that is valued by the group.

When a friendship does occur, one of the difficulties for autistic adolescents is knowing how to maintain that friendship. They may struggle with the unspoken rules, such as how often to make contact using social media; what are appropriate topics of reciprocal conversations on mutual interests; what might be suitable empathic comments and gestures; and how should they be generous or tolerant about disagreements. Autistic teenagers can tend to be ‘black or white’ in their concept of friendship, such that when a friend makes a transgression of a friendship expectation or ‘rule’, the autistic teenager may coldly end the friendship rather than seek reconciliation. Sometimes, when the neurotypical friend ends the relationship, the autistic adolescent can experience considerable emotional distress, especially when not knowing exactly why the friendship ended; they may experience a deep sense of betrayal.

One of the characteristics of autism is alexithymia, that is, a difficulty communicating inner thoughts and feelings in a conversation. This reciprocal disclosure is one of the core components of adolescent friendships, especially for girls, but extremely difficult for autistic teenagers who can be perceived as ‘shallow. This combines with another difficulty associated with autism, that is knowing how to respond empathically to a friend’s disclosure, and thus they may be perceived by peers as emotionally ‘cold’.

Autistic friendships for girls

The challenges in developing friendships for autistic adolescents described in the previous section can be applicable to both autistic boys and girls. However, we are increasingly recognising how autistic girls may have a different way of adapting to their autism when they make friends. At some stage during the primary or elementary school years, an autistic girl will start to recognise she is different to her peers in terms of social abilities, interests, and sensory sensitivity. She may then develop compensatory and camouflaging strategies to make and keep friends.

The autistic girl may not understand or feel comfortable engaging in the complex friendship dynamics of other girls, which often include gossip, relational bullying, judgements and ‘white lies. In contrast, typical boys’ social interactions are much simpler, and the autistic girl may share the boys’ interests in sports, science, computer games, construction toys, logic and adventure. The autistic girl thus becomes a tomboy, a compensatory mechanism for autism which can continue into the adolescent years, as she does not share her gender peers’ interest in fashion, or romantic feelings towards popular male heroes.

Another strategy is to acquire social inclusion with female peers by observing peer social interactions, analysing their behaviour, seeking social rules and conventions, and imitating the gestures, speech, persona, and interests of socially successful girls. She creates a social ‘mask’ and becomes an expert mimic. As a teenage girl said, ‘Why go to all the effort of figuring out what normal is when you can just copy it?’

When acting with friends she is briefly ‘cured’ of autism, but there is only a surface sociability; her lack of real social identity, and constant acting of socialising with peers can be a source of performance anxiety, cognitive and emotional exhaustion, and ultimately depression. The characteristics of autism are supressed at high school, so her social difficulties are not noticed by teachers; however, the supressed stress is often released at home. She becomes a chameleon, or ‘Jekyll and Hyde’ character.

Camouflaging autism by being an accomplished actor who has ‘learned the script’ enables the girl to acquire social acceptance and inclusion by her peers. She mimics appropriate social gestures, facial expressions and female prosody. However, this in turn may delay the identification of two of the central characteristics of autism, namely deficits in both social and emotional reciprocity, and the appropriate use of non-verbal communication. As one teenage autistic girl said, ‘I have done such a great job at pretending to be normal that nobody really believes I have autism.’

An autistic teenage girl can be overly sensitive to conflict between her female friends and take on the role of peacemaker. In a friendship group there can be several contradictory opinions and egos, and an autistic adolescent will have difficulty processing several conversations and feel uncomfortable being watched by several peers. An autistic teenage girl may prefer single close friendships, but have difficulty determining who would be an appropriate choice for a friend.

When a one-on-one friendship does occur, there can be concerns about the degree of intensity of the girl’s engagement with just one person. She can be overly controlling and possessive, and the one female friend becomes the sole focus of her social life. This interpersonal dynamic may shorten the duration of the friendship, which is ultimately broken by the neurotypical friend. The friendship may also be broken by the autistic teenager, who has a rigid conceptualization of what a friend should do and say. There is a limited ability to understand an alternative perspective, and to manage disagreements and conflict with re-appraisal, compromise, and forgiveness. Thus, there may be a total rejection of the relationship without having considered any relationship repair mechanisms.

During earlier childhood, young autistic girls may observe, analyse and consequently adopt the conversations and interests of their peers – fashion such as pink, frilly clothes, toys such as Barbie dolls, and the current popular films and tv shows. As these interests and preferences of their peers evolve, during adolescence, there is a continued determination by girls to stay abreast of this ‘currency’ of female friendship. However, as adolescence progresses, there may be a recognition by young autistic females that they do not feel as though they are a genuine member of the friendship group. They are exhausted after socializing with their peers, and spend considerable time engaged in a social ‘autopsy’, analysing their social abilities and fearing that they will be discovered as a fake. Social invitations may diminish, and there is a growing realization that this strategy of acting and camouflaging may never really work; there is an increasing feeling of alienation from peers, and a sense of not being true to the real self. The ‘pendulum’ can then swing the other way, such that the girl begins to despise femininity and defy social and gender conventions. She may become determined to join marginalised peers who are less judgemental and more accepting of someone who is ‘eccentric’.

Resources and programmes on friendship

We would not anticipate that an autistic adolescent could quickly and easily acquire the friendship abilities of their peers. However, there are strategies and programmes that can be used by parents, teachers, and therapists to improve friendship experiences, abilities, and confidence.

An autistic friend

Friendship is often based on two people sharing the same interests, beliefs, and values. We have observed that sometimes the most enjoyable and long-lasting friendships for an autistic adolescent is with another autistic adolescent. They have found each other. This may have been by chance, both being conspicuously on the periphery of friendship groups, or by design or circumstances.

In high school, there may be the opportunity to join interest groups at lunchtime or after school, shared interest topics such as science-fiction films, Japanese anime and manga, science or mathematics projects, and robotics and computer programming may be just some of the more popular topics. Friendships may then develop that are relatively safe from criticism and based on mutual interests. Another source of friendship can be two autistic students who are talented in similar areas, such as art and drawing, or music, who can then share ideas and techniques with each other.

Friendships with autistic adolescents may be achieved out of school hours by attending events such as Comic Book, Cosplay, and fan conventions, meeting like-minded peers. We have run many autistic adolescent groups on themes such as emotion regulation, building resilience to bullying, being the authentic self, and the dating game. We have found that many participants developed friendships during and beyond the group sessions.

Animals as friends

Animals provide unconditional acceptance. The family or personal dog is always delighted to see you, despite the day’s disappointments and exhaustion. The horse seems to understand you and wants to be your companion. The cat jumps on your lap, and purrs with delight in your company. Pets, and animals in general, can be effective and successful substitutes for human friends, and a menagerie becomes a substitute ‘family’. Animals identify with, and feel relaxed in the company of, a non-predator (the autistic adolescent), and pets can be a source of comfort and reassurance. A special interest in, and natural understanding of, animals can become the basis of a successful career. We have also found that autistic adolescents are often more able to perceive, and have compassion for, the perspective of animals than they are that of humans, with a greater sense of trust and mutual understanding.

Internet friends

An autistic adolescent may have achieved an advanced level of expertise on multi-player games and is genuinely admired by fellow gamers, who actively seek the autistic adolescent as a member of their team. They are accepted and valued because of their knowledge rather than their social persona and appearance.  This status and appreciation can be a rare and intoxicating experience. One of the advantages of this form of entertainment and friendship is that autistic adolescents have a greater eloquence in disclosing and expressing thoughts and feelings through typing rather than face-to-face conversation.  In social gatherings at school, the adolescent is expected to be able to listen to and process the other person’s speech, often against a background of other conversations, to immediately reply, and simultaneously analyse non-verbal cues such as gestures, facial expression, and tone of voice. However, when using the computer screen, the person can concentrate on social exchange without being overwhelmed by so many sensory experiences and social signals.

The Internet provides an opportunity to meet like-minded individuals who can get to know each other using game chat lines, web pages and message boards dedicated to autism. However, as in any social situation, the autistic adolescent may be vulnerable to others taking advantage of his or her social naivety and desire to have a friend. The autistic adolescent needs to be taught caution and not urged to provide any personal information until they have discussed the Internet friendship with someone who can be trusted.

Activities for parents

The end of the school day, when the autistic adolescent has recovered from the educational, social, and sensory challenges of their day at high school, may be a time to discuss any aspects of friendship that have been successful or confusing. The conversation may start with sharing positive friendship experiences, such as an enjoyable time with a group of peers in an academic or recreational activity, helping a peer, or sharing interests and knowledge. However, there may have been times when the autistic adolescent had difficulty accurately reading non-verbal communication and a peer’s intentions.

A game of ‘Puzzling Peers’ can be played: the adolescent is asked to describe the situation, and replay the dialogue, gestures, and facial expressions. The parent and adolescent are then detectives or scientists trying to decipher the message or intention. This can include anything from confusing facial expressions such as eye rolling, to inexplicable demands from the peer (why did they assume I would be interested in this topic?) Other puzzling situations can be not understanding why they would be shunned and criticized for telling the truth (she is obese and needs to go on a diet) or not saying a ‘white lie’.

A parent may explain how to elicit more information, with questions for the young person to ask, such as ‘are you saying that to be friendly or mean?’ or ‘I’m confused, are you being sarcastic?’ They can also help rehearse what to say and do in other situations, such as accepting or declining an invitation to meet and learning the cues and means of ending a conversation or interaction. It is important that friends are not offended by an abrupt ending to a conversation or social gathering, as offence was not intended.

We all of us have a limited capacity for the duration of social contact, and it may be helpful to apply the metaphor of filling a ‘social bucket’. Some typical teenagers have a large social bucket that can take some time to fill, while the autistic teenager has a small bucket – a cup – that reaches capacity relatively quickly. Conventional social occasions with a friend can last too long for the autistic adolescent, especially as social success is achieved by intellectual effort rather than natural intuition. Socializing is exhausting, and the teenager may need to emotionally recover in solitude at home.

It is important for parents to be aware of the friendship challenges faced by their autistic teenager, including a difficulty initiating social contact with peers, and finding someone that they want to talk to and spend time with. As an autistic teenager said, ‘It’s not that I’m antisocial, it’s that I don’t meet many people that I like.’ The parent may need to become a social secretary, arranging and rehearsing social events to encourage the development of friendships, and de-briefing after the event, focussing on what was socially successful and providing clarification and guidance where specific social skills need to be achieved.

Friendship curriculum for teachers and therapists

We now have resources and programmes for parents, teachers and therapists that are specifically designed to enhance friendship abilities in autistic adolescents.

We recommend the publications and programmes developed by Michelle Garcia Winner and Pamela Crooke, with more information available from socialthinking.com. They have developed resources and guide books such as: Socially Curious and Curiously Social: A Social Thinking Guidebook for Bright Teens and Young Adults Social Thinking graphic novels.

Carol Grey originally developed Social Stories to explain the social world to autistic children and adolescents. More information on Social Stories can be obtained from carolgraysocialstories.com. Carol has adapted Social Stories for adolescents; for example, Carol and Tony worked on a compliment guide and workbook for autistic teenagers and adults

https://carolgraysocialstories.com/wp-content/uploads/2015/10/Spring-1999-ISSUE-AND-INSERT-.pdf

Carol’s work has been extended by Siobhan Timmins who has written Successful Social Stories for School and College Students with Autism and Successful Social Articles into Adulthood. Both books are published by jkp.com

University College of Los Angeles’ Program for the Education and Enrichment of Relational Skills (PEERS) is an evidence-based social skills intervention that began with autistic adolescents, and has expanded to offer services for young adults. https://www.uclahealth.org/vitalsigns/peers-aims-to-improve-social-skills-for-young-people-with-autism-spectrum-disorder

Sessions cover topics such as:

developing and maintaining friendships.

romantic relationships and dating etiquette.

managing peer conflict and rejection.

conversation skills.

electronic communication.

developing friendship networks.

finding sources of friends.

appropriate use of humour.

The PEERS programme has been the foundation of a range of social and friendship programmes in many countries and in Australia by www.codeblueforautism.com.au

Minecraft is a popular pastime with autistic adolescents, and the computer game has been adapted to teach social skills by Raelene Dundon. Her book is titled Teaching Social Skills to Children with Autism Using Minecraft published by www.jkp.com

Drama activities can be used to teach social skills and there are two books that describe drama activities to improve the social skills of autistic adolescents. They are:

Acting Antics: A Theatrical Approach to Teaching Social Understanding to Kids and Teenagers with Asperger Syndrome by Cindy B. Schneider, published by www.jkp.com

Act it Out: One Year of Social Skills Lessons for Students Grades 7-12 Social Skills for Teens with Autism Spectrum Disorder by Jeannie Stefonek, published by www.aapcpublishing.net

There are a range of relevant books published by www.jkp.com, such as:

The Asperkid’s Secret Book of Social Rules: The Handbook of Not-So-Obvious Social Guidelines for Tweens and Teens with Asperger Syndrome by Jennifer Cook O’Toole

60 Social Situations and Discussion Starter to Help Teens on the Autism Spectrum Deal with Friendship, Feelings, Conflict and More by Lisa A. Timms

The Asperger Teen’s Tool Kit by Francis Musgrave

How to Start, Carry On and End Conversations: Scripts for Social Situations for People on the Autism Spectrum by Paul Jordan

Asperger’s Rules: How to Make Sense of School and Friends by Blythe Grossberg.

Social Skills Groups for Children and Adolescents with Asperger’s Syndrome: A Step-By-Step Program by Kim Kiker Painter.

Freaks, Geeks and Asperger Syndrome: A User Guide to Adolescence by Luke Jackson.

There are three resources not published by Jessica Kingsley Press.

Asperger’s Teens: Understanding High School for Students on the Autism Spectrum by Blythe Grossberg, published by Magination Press.

Communication Skills for Teens: How to Listen, Express and Connect for Success by Michelle Skeen, Matthew McKay, Patrick Fanning and Kelly Skeen published by Instant Help Books.

Unwritten Rules of Social relationships: Decoding Social Mysteries Through the Unique Perspectives of Autism by Temple Grandin and Sean Barron published by Future Horizons.

The autistic teenager may not know of their diagnosis, or reject books that include the terms autism or Asperger’s syndrome in their title or text. The following are publications that provide guidance in making friends without using the ‘A’ word.

Making Friends: A Guide to Getting Along with People by Andrew Matthews published by Media Masters.

A Good Friend: How to Make One, How to be One by Ron Herron and Val J. Peter published by Boys Town Press.

Awkward: The Social Dos and Don’ts of being a Young Adult by Katie Saint and Carlos Torres published by Future Horizons

The Science of Making Friends: Helping Socially Challenged Teens and Young Adults published by John Wiley and Sons

“I’m bored”: a translation

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“I’m bored” – a translation

The comment “I’m bored” is often said by teenagers at high school, but those students who have autism may use this phrase to express a range of thoughts and feelings. A translation of “I’m bored” for those who have autism can be:

I do not have the energy to do this

At high school Students who have autism consume mental energy to process not only the academic curriculum but also the social curriculum as well as manage anxiety and sensory sensitivity. A typical day at high school is mentally exhausting, hence the comment “I’m bored” means “I have no mental energy to process this activity”.

This activity is pointless and irrelevant

Components of the high school curriculum may not have relevance to modern life or the future of the student who has autism. Typical students recognize that the activity is futile but will persevere to comply with the school’s expectations, maintain peer engagement and to pass exams. The student who has autism may not follow such conventions and if the activity is perceived as irrelevant, it may well be boring, and the student with autism may repeatedly express their opinion to the teacher.

This activity is too easy for me

The cognitive profile associated with autism can include abilities in advance of same age peers. The teacher usually presents the activity based on the average abilities of the students in the class. Thus, the student with autism may have completed the activity in advance of his or her peers and now has nothing to do and is bored.

The teacher is uninspiring

The style of teaching or personality of the teacher may be uninspiring, or the teacher may be depressed. The lesson is then boring for all students.

I am being treated as an idiot

Adolescents who have autism may not be successful socially or in school sports. Academic success then becomes important to achieve respect and for self-esteem. Thus, the student with autism often wants to demonstrate intellectual abilities. To say, “I’m bored” may translate to “I cannot demonstrate how smart I am”.

It makes me sound ‘cool’

One way of achieving social acceptance and inclusion is to imitate peers, especially the ‘cool’ students, who may often say “I’m bored”.

My imagination is more exciting

In the early grades of school, the child who has autism may recognize that he or she is different to their peers, and often excluded socially. One of the adjustment strategies is to escape into imagination, perhaps as a super hero who has special and valued powers or an alternative world such as Hogwarts or being with animals. The imaginary world is exciting and with achievements that are elusive in reality. There is a huge contrast between the social and academic classroom and an imaginary world, hence the lesson is boring in comparison to enjoying a vivid imagination.

I cannot understand what the teacher is saying

Autism can be associated with specific language and learning difficulties, such that the teacher may be talking too fast or using complex language structures for the adolescent to cognitively and linguistically process the information. There may also be difficulty discriminating the teacher’s voice from the voices of nearby children quietly talking to each other, or the teacher may be using idioms and sarcasm that are confusing.

I am feeling depressed

There is a high level of depression in teenagers who have autism. One of the characteristics of depression is anhedonia, an inability to experience pleasure or interest in a formerly pleasurable activity. Favourite subjects such as mathematics, information technology, art or drama are no longer enjoyable due to feeling depressed.

Thus, parents and teachers may need to translate the phrase “I’m bored” as an expression that has many meanings.