TCPR: Dr. Standifer, can you tell us a little about your background working with adults with autism?
Dr. Standifer: I am a researcher and instructional designer in a support office for state vocational rehabilitation agencies. We cover a wide range of disabilities and educate vocational rehab counselors about best practices on specific disabilities or specific approaches to employment.

TCPR: Can you please define what, generally, is “vocational rehab”? 
Dr. Standifer: Every state vocational rehabilitation agency is an independent entity, so there is variation from state to state, but there are generally accepted best practices and policies at the national level. Voc rehab doesn’t give people a job, it gives them the supports they need, and helps them plan how to find a job that is a good fit for them. The philosophy is to assess people’s skills, preferences, and interests, and to get them working in the community as independently as possible. The counselor and client work together to help develop career goals that will suit the person and last them a lifetime, ideally, and then decide what resources the person needs to get to those goals.

TCPR: If voc rehab doesn’t help with job placement, who does?
Dr. Standifer: Voc rehab offices often subcontract with other provider agencies in the community to provide extra services for job coaching, or to help with the job hunt or training in various areas. Voc rehab counselors believe that everyone who wants to work can work, and that work is actually beneficial, both psychologically and physically.

TCPR: What are some of the challenges for adults with autism who have jobs or are seeking jobs?
Dr. Standifer: The biggest challenge is difficulty with social skills—one of the core features of autism. For instance, the most dangerous time of day for an adult with autism in the workplace is the lunch hour. There is no script; there is no structure. If you don’t know what to do, you can get yourself into serious trouble in the lunchroom. Other issues arise when bosses or coworkers use subtlety to express criticism or requests; because of the tendency to take things literally, individuals with autism might not get the message. The boss may say, “You are doing really great work, but we really wish you would improve this one little area.” Most of us realize the first part of that is padding, and the second part is what she is really trying to tell the worker. But someone with autism will mostly hear that first part and think, “Okay, I’m doing well,” and may not realize that the boss is upset about something. They need very clear, blunt signals, and supervisors, bosses, and coworkers often don’t know that.

TCPR: Any particular challenges for autistic adults entering the workforce for the first time?
Dr. Standifer: When autistic adults transition from school to the workforce, suddenly they are out of the familiar school routine—changing tasks every hour or being lectured at and taking notes. Instead, there’s a sudden emphasis on performance and production. There is also an expectation that if something is not going right with your job—if you are missing information, your tools are gone, or you are running out of something—you will speak up. There is an expectation of self-advocacy there that isn’t usually there in the school setting.

TCPR: Can you identify some clinical skills that are true assets for certain jobs?
Dr. Standifer: It’s important, from the employment perspective, to work with people’s strengths—what they prefer to do and can do—and not to try to cure them or fix them. Autistic adults are a group of people who tend to like rules, and often want to stick to the same routine. These folks are not going to get bored as easily as neurotypicals. They are not thinking about what they’re doing this Saturday, or chatting with their neighbors. They are on-task; they are doing the job. That’s a great strength. Autistic adults often also have a set of specialized interests (these used to be called “fixations” or “obsessions”). These may not lead to a job, but they can be used as motivation within the workplace or as a way of structuring the workplace and work-related tasks.

TCPR: What are some good jobs for people with autism?
Dr. Standifer: It’s easier to talk about what jobs are bad. An autistic adult usually won’t do well with a lot of unstructured social interaction with the general public. For example, they will not, in general, do well as a real estate agent, or insurance salesperson, or customer service representative. They will not do well where the schedule or tasks change every day. But some of these people work at banks and do great things with forms, processing, and managing. Some work in doctors’ offices doing records management and transcription. Some work with computer systems and in universities. There is a lot they can do, and do well.

TCPR: Can you discuss some initiatives by corporations or other organizations to specifically assist and employ individuals with autism, and how those work and have succeeded?
Dr. Standifer: One of the catch phrases I use is “autism is a template disability.” When a group—Walgreens is the leading example—builds an autism employment program, once they include all of the supports for all the variations in needs and skills, then they can also be open to people with, for example, traumatic brain injuries, bipolar disorder, post-traumatic stress, and other disabilities. So these may start out as autism projects, but they frequently become disability employment projects.

TCPR: Can you give us a specific example?
Dr. Standifer: Randy Lewis, the vice president in charge of supply chain management for Walgreens, teamed up with an expert in vocational rehab, James Emmett, and they built resources and supports into a new facility in South Carolina. They changed the corporate culture of that site to make it comfortable for people with autism. There are lines on the floor to help designate what happens in different areas; things are color-coded and numbered, and there are charts and diagrams all around. This has been expanded nationwide to Walgreens’ network of distribution centers, and they’re trying to expand it into retail offices in local communities. Early data shows that the individuals working in these settings have better safety records, better attendance, lower healthcare utilization, and equal or better productivity that the neurotypical workers.

TCPR: So it is good for the businesses, too.
Dr. Standifer: Yes, this is a very loyal worker population. If an employer lets them know that they are open to hiring folks on the spectrum, workers will have less turnover, and their families will patronize the business. Another of the big barriers for autism is the interview process. They don’t do well with abstract questions like, “What do you bring to our company?” AMC Theatres developed a new interview process where they walk people around the theatre and say, “Here is where you would pop the popcorn if you work for us. Do you think you could to this? Is it too hot here for you? The lights are kind of bright; is that okay or is that a sensory issue for you?”

TCPR: What accommodations could we as psychiatric providers give our patients with autism?
Dr. Standifer: Basically, we just need to ask the questions. For instance, we know from the literature that nearly three in four people on the autism spectrum have some sort of sensory issue that they find upsetting or distracting. One of the most common is fluorescent lights; the flicker and hum can be extraordinarily bothersome. So if you’re treating someone with autism, doing something as simple as using natural light or turning off the overhead fluorescents is really helpful. Likewise, ask them if there is anything else that might be distracting: the hum of a printer or something in the room may be really getting on their nerves.

TCPR: That’s really helpful. Anything else?
Dr. Standifer: We tend to think of people being either verbal or nonverbal. But I have talked to some folks on the spectrum who say that they are verbal most of the time, but when they are stressed they lose their verbal ability and have to write. This is not hard to accommodate if you know it might happen; just have a pad of paper and a pencil there in case they need to write. Another thing that is not in the literature much is face blindness [prosopagnosia]. The activist Temple Grandin, probably one of the most recognized people with autism, has face blindness. This is a big deal, but, again, it is not hard to accommodate. If you know the person has face blindness, you just mention your name to make sure they know who you are.

TCPR: So we need to be aware of how our patients perceive their environments and accommodate them accordingly.
Dr. Standifer: Right. I also think that while the DSM is a great tool for diagnosis, it is not a definitive description of autism. There is a whole constellation of secondary features, and you need to be aware to ask the questions about these possibilities.

TCPR: You refer to an ASD “culture” in your writing. What is this? 
Dr. Standifer: This is an exciting time because we have a community of self-advocates (people with autism) talking to each other—and to us—about the kind of supports they want. Historically, autism has been framed as a childhood disorder, but we’re starting to get informed commentary from these adults. The Autistic Self-Advocacy Network (ASAN) is one of the leading and more politically active self-advocacy groups. The Autistic Global Initiative is another emerging group with a lot of interesting ideas regarding employment and empowerment. To me, one of the more fascinating things is the Autreat Conference, held every year by people with autism FOR people with autism.

TCPR: And what have you learned from that?
Dr. Standifer: It’s interesting to see the accommodations they provide for themselves. For instance, they want to be on a community college campus where there is not a lot of traffic or noise and you can walk between buildings. They want to be in rooms with a lot of natural light. They have color-coded name tags that help indicate the level of social interaction that they’re comfortable with.

TCPR: You use the terms neurotypical and neurodiversity. What do those mean?
Dr. Standifer: Neurotypical/neurodiversity come out of the perspective that autism is not necessarily a disease. Maybe it is just another way of being—a little bit different from everyone else, perhaps, but still part of the human spectrum. A normal part of the variation of the human phenotype. So instead of saying autistic and “normal,” they say autistic and typical. Neurotypical and neurodiversity are the phrases that go with that perspective. From that and from some other historic sources, we get the phrase “autistic spectrum” or “autistic spectrum disorders.” There is no defining line between having autism and not. A lot of people are sort of in the gray areas in between. And that forces us to start looking at support needs instead of labels, to stop talking too much about what category of autism a patient has and just ask, “Is it too cold in here? Do you need me to slow down?” And it also gets us away from trying to “cure” autism. They are happy with who they are, and they have wonderfully unique things to tell us.

TCPR: Thank you, Dr. Standifer.

 

Dr. Standifer is the author of Adult Autism & Employment: A guide for vocational rehabilitation professionals (University of Missouri 2009). It can be found at http://bit.ly/16rHYZV