Resilience can be defined as positive and beneficial outcomes which result from successfully handling stressful events (Masten, Best, and Garmezy, 1990). Building resilience and developing resilience-promoting interventions therefore involves targeting “protective and vulnerability forces at multiple levels of influence — culture, community, family and the individual” (Cicchetti, 2010, p.151). In considering individuals with autism spectrum disorder (ASD) who experience a spectrum of lifelong challenges (Howlin, 2013) with social interaction, communication and restricted or repetitive interests and behaviours (DSM; 5, APA, 2013) acquiring resilience skills is vitally important.
The difficulties experienced by individuals with ASD can negatively impact their ability to engage in activities of daily life (Koenig and Rudney, 2010), conduct typical relationships (Test, Smith and Carter, 2014) and develop functional life skills (Carter, Common, Sreckovic, Huber, Bottema-Beutel, Gustafson, et al., 2013; Wagner,Newman, Cameto, Levine, and Garza, 2006) which can inhibit the achievement of typical developmental and socio-emotional milestones as they approach adulthood.
Upon approaching adulthood, research indicates that adolescents with autism are more likely to experience lower rates of paid employment (Taylor and Seltzer, 2011); independent living (Farley McMahon, Fombonne, Jenson, Miller, Gardner et al 2009); academic achievement (Shattuck, Narendorf, Cooper, Sterzing, Wagner, and Taylor 2012) and friendships (Newman Wagner, Knokey, Marder, Nagle, Shaver et al 2011) compared to their typically developing peers. This suggests that adolescents with ASD are unprepared and inadequately equipped with essential skills for transitioning to adulthood.
Supporting young people’s resilience involves identifying their individual strengths, developing coping skills, acquiring a positive attitude, developing problem solving skills, and regulating emotions. These are skills which young people with ASD may often struggle with. Blending a range of strategies can prove beneficial in providing social support to young people with ASD as they progress into adulthood.
This article describes a transdisciplinary approach (King, Strachan, Tucker, Duwyn, Desserud, and Shillington (2009)) which involved blending key psychosocial interventions to support and develop resilience skills to aid the transition of three adolescents into adulthood. These adolescents were referred to Middletown Centre for Autism (MCA). The transdisciplinary approach involves one member of the transdisciplinary team acting as the link with the family, school and community. This promotes collaborative working among team members with the aim of delivering a holistic intervention to the young person with ASD and a programme of support to the family, as well as to educational and health professionals working with the young person with ASD.
A multiple case study design was employed.
Informed consent was sought from the school, the parent and where appropriate the adolescent in accordance with Middletown Centre for Autism (MCA) research procedures.
Three males aged fourteen to eighteen years (James, Tim and Caolan) were referred to MCA. The three adolescents, their parents and the professionals working with the three adolescents in school/community setting consented to take part in the study. All information pertaining to the participants has been anonymised to protect their identity.
James attended a Special Needs School until the age of sixteen, when he was removed following a succession of aggressive incidents. Main areas of difficulty included communication, emotional regulation, self- help skills, interaction with peers, staying focused on task and sensory needs.
Tim had a diagnosis of Asperger syndrome and Attention Deficit Hyperactivity Disorder (ADHD), he attended a mainstream school but had been experiencing significant difficulty in relation to social skills, homework and bullying in his educational placement, having previously been removed from a mainstream school.
Caolan also attended a mainstream school and had a diagnosis of Asperger’s, ADHD and Oppositional Defiant Disorder. Caolan had
changed schools several times because of difficulties relating to behaviour, aggression, absconding and disruption of school and class
activities, organisational skills and sleep.
All the adolescents referred required resilience support to help them transition successfully into further education or adulthood.
Transdisciplinary intervention programme
In the transdisciplinary model, any member of the specialist team can act as the lead professional delivering an individualised Learning Support Plan. The lead professional draws on the experience of the specialist team, which consists of: teachers, speech and language therapists, autism intervention officers and occupational therapists. Employing the transdisciplinary model also allows for skills to be transferred between all team members, extending their traditional roles.
Utilising a transdisciplinary model, for each of the adolescents, the team worked in a coordinated way, for three school terms, with the adolescent, their parents and other educational and health professionals to assess and address identified needs across the home, school and community settings.
This allowed for the development of a holistic intervention to support the adolescent in addition to creating a programme of support to the family and to educational and health professionals working in the school setting (See Table 1).
The transdisciplinary model commences with a period of formal and informal assessment with the individual with ASD, their caregiver and relevant professionals working with the young person within the school and community. In collaboration with caregivers and teachers, the Intervention Coordinator creates an individualised child-centred set of goals and a tailored intervention programme to facilitate achievement of each goal.
Once intervention commences, the Intervention Co-ordinator liaises regularly with all relevant parties, across settings, to review and monitor progress. Six months following intervention, semistructured interviews are conducted with caregivers and the young person with autism. This gives participants the opportunity to voice their views on the effectiveness of the intervention and the impact it had on them. Education and health professionals involved in supporting each adolescent with ASD also completed a self-report questionnaire evaluating the effectiveness of the intervention strategies, support and advice delivered by the MCA.
This section first reports on the results of the intervention and then of the follow up at six months.
MCA staff reported that James had successfully attended an IT course at a College for Further Education and was volunteering at a local garage every week for 50 minutes. His mother reported that James is now secure in spending time away from her and he walks to work without support. His behaviour is more manageable. Any anxiety related to his speech volume had improved over the last 18 months.
Caolan reported he was more self-aware and was more flexible in his interactions with others. He also reported that when he was feeling anxious, he was now able to independently ask for assistance. His parents also noted that he had a better ability to cope in social situations. They reported that Caolan’s confidence has improved greatly stating, “I think he feels that people have a better understanding of him now and he has learned to take other people’s points of view into consideration”.
Tim acknowledged that his homework completion had improved but it was still an ongoing issue. Education staff reported that despite this, the most useful part of the intervention was the Intervention Cocoordinator and transdisciplinary model. Staff reported that this enabled a set of disparate inputs from the key players, to be orchestrated and coordinated, on an ongoing basis towards supporting Tim, collaboratively.
Six month follow-up
James reported that he liked his job in the local shop, he could get dressed independently, make a sandwich and liked to go out by himself and pay for items himself in a shop. His mother also reported that he had made improvements in his ability to attend to task, in his self-help skills and behaviour. His mother reported that she still felt about her son but was very proud of his achievements.
Caolan stated “I calm down more easily now. I don’t need to have to calm down as much now, as I understand people a bit more now”. School staff also reported a good improvement; the experience of working with MCA had changed lives for the better. Caolan’s parents also stated that “Caolan was out of control [and] the help he received from MCA got him back on track. He was frustrated with other people, he wasn’t good at tolerating others “.
Tim reported feeling calmer at school. He reported that he felt he could control his behaviour better in more situations. Tim’s parent reported that although homework was still an issue, his reflection on his behaviour had improved, “he thinks about the consequences of his behaviour now, he is more aware of people’s opinions”.
This study emphasises the successful implication of utilising a transdisciplinary approach to support adolescents with ASD. Employing individually tailored intervention programmes can improve and develop resilience skills to facilitate the achievement of age appropriate ‘social norms’ such as attending school, forging friendships with peers, contributing to the community, gaining employment and undertaking more responsibilities at home. These case studies illustrate that working to the strengths, interests and needs of the young person with ASD, can successfully help them to bounce back from difficult periods in their life and make a successful transition into adulthood.