Beth, a 21-year-old with an autism spectrum disorder, lives in a group home. She exhibits perseverative speech, echolalia and stimming behaviors. Beth had a part-time job at a local thrift store, but due to her limited verbal skills and poor social functioning, she struggled to communicate her personal and work needs, and was not able to develop relationships with her coworkers. Even though Beth was able to perform her tasks well, she was let go.
Leonard, age 19, also has an ASD and has worked at a local fast-food restaurant since his junior year in high school. He participated in a work-based program while in school that featured a work coach and support from the speech-language pathologist. He has some basic verbal communication skills, but also has a picture exchange book for support. The SLP taught Leonard, the teachers and restaurant staff members how to use the picture exchange system for communication and it has worked successfully. Today, Leonard interacts well with coworkers and patrons and is considered an asset to the business.
Jack, 18, with high-functioning autism, is enrolled in college, lives in a dorm and carries a full load of classes. He is well aware of his disorder, knows the services available to him at his college and uses them regularly. He also has strong self-advocacy skills. He does, however, continue to struggle with socialization. He feels isolated from his peers after many failed attempts to make friends, causing feelings of depression and uncertainty about his future.
Although high school students with autism spectrum disorders share some common traits—such as impaired social skills, communication deficits, perseverative behaviors and difficulty with transitions—they also have varied strengths, preferences and challenges. The transition from high school to post-secondary education or work setting can be a big and sometimes challenging step.
According to federal law, transition plans must be included in all individualized education programs no later than age 16. The Individuals With Disabilities Education Act states:
As used in this part, 'transition services' means a coordinated set of activities for a student, designed within an outcome-oriented process that promotes movement from school to post-school activities including postsecondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation.
The coordinated set of activities must be based on the individual student's needs, taking into account the student's preferences and interests; and include needed activities in the areas of instruction, community experiences, the development of employment and other post-school adult living objectives and if appropriate, acquisition of daily living skills and function vocational evaluation.
But even with such a law, successful transitions aren't assured. According to a recent article in Pediatrics based on a 10-year longitudinal study of hundreds of students in all disability categories, approximately 50 percent of young adults with autism were neither employed nor enrolled in a college or technical school, a stark contrast to the number of students with specific language impairment, learning disabilities or intellectual disabilities. The study indicated that students with the lowest functional skills—including the ability to communicate effectively—are at the greatest risk for not seeking higher forms of education or being gainfully employed.
What we can do
How can these young people integrate into society and achieve some level of independence if they are unable to find employment? And how does an SLP factor into helping these students achieve post-high school success?
As part of the transition IEP, goals can be included for post-secondary training, education and independent living. What should we, as SLPs, be doing to encourage successful transitioning for our students? As part of a team, we can play a vital role in writing achievable transition goals. (To learn how to focus on a student's strengths in creating a transition plan, see "Gearing Up for Reality.")
But we have our work cut out for us. Working in collaboration with teachers, students and parents is the key to achieving these goals. All team members need to share the student's vision for the future and understand how to integrate their skills to help the student reach his or her greatest potential. Unfortunately, students often get to high school and are still developing communication or pragmatic skills. We need to participate in the writing and delivery of these goals proactively so that successful communication is factored into their plans.
As part of the transition goal, first identify the person responsible for helping the student achieve that goal. Although typically that person is the case manager, the SLP can play a very important role, given that communication is an area of weakness in people with ASDs. Although all team members are responsible for successful transition, the specific roles and responsibilities of the SLP should be discussed and agreed upon. As demonstrated in the examples above, students with ASDs present with a wide array of strengths and weaknesses. As a result, we must differentiate how we serve them. As these students progress through the public school system, we should strive to help them develop communication and pragmatic skills to enable them to function in an academic or work environment.
Here are five ways SLPs can contribute to successful transitions.
1. Provide communication tools. We must ensure that each student has an appropriate, effective form of communication that is actively used in all settings—classroom, home and work sites. At a minimum, a student should be able to ask for items at work, indicate needs or wants and answer basic questions. For a student with autism, it is imperative that classroom teachers, paraeducators, job coaches and families all be familiar with the student's communication systems across a variety of settings (and not just when the SLP is there). We can provide possible scenarios for the teacher to implement and easy data collection sheets.
It is critical to monitor students' communication skills in different settings to make sure they can use their skills in a variety of situations. Effective communication must take place in all settings, with minimal effort for the student and his/her communication partner. As students become more proficient with their communication skills, SLPs can go to job sites with them to assess their ability to communicate in a new setting, and find strategies to improve their skills with the help of teachers, work coaches and staff. If local businesses frequently employ our students, we should talk with them to determine the job's communication demands, assist them in understanding and engaging via the communication device, and tailor our services to meet those needs.
2. Practice social skills. We also must work to provide social opportunities for our students. The ability to navigate the world socially is imperative for students wanting to attend a technical school or college and who ultimately want to maintain a job. A social skills group with peer mentors can be very effective. Guidance counselors and coaches can be resources to help you find students to be mentors in the group sessions as well as in the general school setting. The group provides a great opportunity to role-play and perform social autopsies and theory-of-mind activities to enhance understanding and create success. SLPs often co-teach these groups or provide consultation to the group leader so they understand and address the specific needs of individual students.
3. Be aware of resources. After our students leave high school, they can still benefit from speech and language services, but may not know how to access those services. Providing students and parents with a list of available resources helps with their transition, whether into the work force or college. For example, suggest that they check if the college has a speech-language program that could provide continued services, or look for private practices in the area. In our high-tech world, it's even possible to access services online. Telepractice can alleviate the challenges of finding a convenient clinician or allow a student to continue to receive services from an already trusted private clinician. For students with more complicated needs, you might recommend that they check with the local community services board for a list of providers.
4. Focus on self-advocacy. At the college level or at a work site, the student may no longer have access to previous support systems, so self-advocacy—a communication skill—is key to the student's success. As we write goals for students in high school, we must assess the student's ability to communicate his or her needs. In collaboration with classroom teachers and job coaches, SLPs can determine if the student is able to ask for help or materials effectively and consistently, and if providing a monitoring checklist would be helpful. We don't necessarily need to provide direct services on a consistent basis, but providing consultative services to the job coaches or teachers might just do the trick.
5. Know your surroundings. Knowing places in your community that provide jobs helps us prepare ourselves and our students for the road ahead. We can find out about local job placements that are friendly to students with disabilities and work with job coaches to understand the communication demands in those environments. An open discussion about areas of weakness that employers have come up against can help us to tailor our treatment and write more functional goals to reflect the demands of the workplace and the abilities of the student.
Transition is yet another piece of the communication puzzle when we are serving students with speech and language impairments. If we arm ourselves with information, play an active role in the IEP team and understand the strengths and weaknesses of our students, we can help to make transitioning into different environments a less stressful and more successful experience.