Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by peculiarities and deficiencies, on a spectrum ranging from mild to severe, in communication, social interaction, behavior, and interests. The American Psychiatric Association's (APA's) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, characterizes ASD "by persistent deficits in social communication and social interaction across multiple contexts, including deficits in social reciprocity, nonverbal communication behaviors used for social interaction, and skills in developing, maintaining, and understanding relationships. In addition to the social communication deficits, the diagnosis … requires the presence of restricted, respective patterns of behavior, interests, or activities" (p. 32).
As of March 2014, the Autism and Developmental Disabilities Monitoring Network of the Centers for Disease Control and Prevention (CDC) estimates that about 1 in 68 children has autism spectrum disorder (ASD). This estimate contrasts with the CDC's statement of ASD's prevalence in 1 in 150 children in 2000 and suggests the success of fairly recent attempts to diagnose and treat children with the disorder. ASD occurs in all racial, ethnic, and socioeconomic groups; however, Durkin et al. (2010) found a positive correlation between socioeconomic advantage and autism, which may be due to ascertainment bias. The CDC reports that ASD is almost five times more common among boys (1 in 42) than among girls (1 in 189).
Westminster College's Students with ASD:
The College Transition Program will enroll 16 students with ASD in the fall semester of 2014. Having a diagnosis of ASD does not impair individuality, and all of our students with ASD want to be recognized and respected as individuals. At the same time, they tend to demonstrate the following characteristics--ranging from mild to severe and want others to understand their shared challenges:
- Above average to superior verbal and sometimes spatial intelligence, combined with a very slow rate of speed in processing information. While our students with ASD have an above average ability to acquire, understand, and retain information, the speed with which they do so is far below average; they often take a very long time to think and communicate about what they are learning. For this reason, they may not immediately answer when called upon in class and take much longer to complete assignments, papers, and exams than other students.
- Difficulty in socializing. While some of our students with ASD are extroverted and energized by being around others, most are introverted, exhausted by social demands, and in need of alone time to regroup. Our students with ASD often find it difficult to relate to the content of their non-ASD peers' conversations, struggle to sit and participate in the give-and-take of small groups, miss sarcasm and take what others say literally, experience difficulty with body space (maintaining a personal bubble or impinging on others' body space), find it hard to read others' expressions, and seem oblivious to body language, especially when it is subtle. Male students with ASD unanimously agree that their anxiety about missing social cues is most significant in trying to determine whether or not members of the opposite sex are interested or not interested in them.
A deficit in social communication and poor impulse control can be observed when some college students with ASD, particularly as freshmen and sophomores, share their ideas with others in the classroom. Not only may their attempts to contribute to class discussion be untimely, but they may also be esoteric and off-topic. Sometimes students with ASD may appear to be engaged in a monologue or in a dialogue with the professor that is inattentive to needs of their larger audience of peers and to the timing, focus, and interests of the professor.
All of our students with ASD have experienced the pain of social rejection. While some of our students with ASD seem impervious to others, most struggle with loneliness and wish to successfully engage with others. All of our students with ASD value and cherish the friendships and meaningful connections they do share with others. While students with ASD are aware that their difficulty in socializing is related to their disorder, they also tend to be aware that their perceptions of others may be inaccurate due to cognitive errors. This awareness has been and is educated, encouraged, and supported by their work with therapists, and it is always apparent in students' eagerness to point out the cognitive errors they identify in their peers and in their unsolicited but helpful advice to others. Most students with ASD, regardless of the severity of their communication impairments, aspire to help others.
- Difficulties with executive functions (i.e., organization, time management, prioritizing, breaking tasks down into parts and recombining them, transitioning from task to task, maintaining focus, and completing tasks). Many students with ASD, for example, lose an orientation to time when showering. They relate that as much as an hour or more will pass while they are showering, and they have no idea that they were in the shower beyond a few minutes. An orientation to time becomes especially problematic when students engage in gaming. Free of parental oversight, students can easily become nocturnal gamers to the exclusion of their self-care and academic responsibilities.
- Difficulties with transitions, change, and disciplinary methodology that is new to them. During the first few weeks of transition to college life as freshmen, students with ASD often appear confused, overwhelmed, lost, over-stimulated or over-excited, inattentive, distracted, and/or exhausted. All of their familiar routines are lost as they try to negotiate a new physical and social environment without the oversight of their parents. Without the comfortable predictability of their homes and high schools and/or someone to oversee what, when, and/or how they eat, sleep, wash, take meds, engage in video games, and otherwise conduct their lives, they are easily distracted by the desire to immediately gratify wants in the moment. Students with ASD like sameness, patterns and routines and often need help in reestablishing predictable daily and weekly schedules of activity and self-care routines in college.
While transitions may be as significant as moving from home to college, they may also seem rather insignificant to others such as a change in the availability of food trays in the dining hall one day a week. When the college introduced Trayless Tuesdays, for example, and removed trays from the dining hall one day a week in order to sanitize them, the situation upset one student with ASD's fixation on routine so much that he altered other aspects of life to accommodate the change. The student explained that without a tray he could not carry all of the plates, cups/glasses, dining utensils, and food items he used at one time to a dining hall table. Since he ate alone, he was concerned that during multiple trips back and forth to the dining hall table, he would leave his place at the table and food unattended and someone could take his place and/or mess with his food. To resolve this issue, the student opted not to purchase a book of fantasy fiction to add to his collection each week so that he could afford to eat his meals at a local restaurant on Tuesdays. The student's routine was so upset by the absence of food trays on Tuesdays that he changed his previously rigid adherence to the weekly purchase of fantasy fiction novels, which he considered to be basic necessities, so that he could create a new dining routine every Tuesday.
- Sensitivity to sounds, tastes, smells, sights, and tactile sensations. Students with ASD can have specific preferences for clothing, foods, sensations, and patterns of behaviors that others are not easily aware of, and they can be very sensitive to sounds or lights that others simply do not hear or see. A student with ASD, for example, may leave a classroom setting because the video-feed is too loud or because he or she is bothered by the pulsating flicker of a fluorescent overhead light. To compensate for sound and light sensitivities students with ASD may wear sunglasses or ear plugs on campus. Tight clothing may provide a sense of comfort or discomfort. Food preferences may have to do with smell, texture, or appearance. For one student with ASD, for example, different food items cannot touch other food items on his plate. If catsup gets into his cottage cheese, for example, he may be unable to eat anything on his plate.
- Difficulties in pragmatics and prosody. While many of our students with ASD can sound very pedantic and have incredible vocabularies, they tend to be very literal and experience difficulty understanding the phrasing of questions (i.e., what is being asked of them when responding to essay questions and paper assignments), particularly when those questions are posed in disciplines that are new to them. It is very important to check in with a student with ASD to make sure that he is thinking about or considering exactly what he or she has been asked to think about or consider. This is especially important when students are writing papers or responding to essay questions on exams.
- Restrictive, repetitive patterns of behavior, interests, or activities. Of all of the diagnostic criteria for ASD, our students with ASD agree that rigid adherence to repetitive patterns of behavior is a trait they share with one another. This behavior can be described as compulsive or obsessed. It is exemplified by students with ASD who pace, walk, and/or talk to themselves to process the events of the day. It is also exemplified by students with ASD who engage in lip smacking, hand twitching, or repeatedly viewing a video program that would not seem age- or gender-appropriate but references enough geek fantasy cultural icons to fascinate such as My Little Pony. One student with ASD described his need to "keep sticking to one thing or an array of things in some way and not letting go." This behavior may be manifested by compulsively checking on something such as the time, keeping rigid schedules, eating peanut butter toast for breakfast for ten years, or reading the same novels at the same time every year. Often these behaviors are an important kinetic way for students with ASD to soothe, center, or "reset" themselves. Sometimes these behaviors, combined with a narrow range of interests, occur to exclusion of other activities such as studying.
- A love of imaginary worlds filled with archetypal imagery that engage superheroes in playing with or bending rules as they combat good and evil. Many of our students with ASD love Animae and actively participate in the Animae Club. They also enjoy fantasy fiction and even formed another College Transition Workshop group devoted to sharing their work writing fantasy fiction, short stories, and graphic novels. It is worth noting that in all of these imaginary worlds, otherness is a norm.