Speaker: Dr. Rashmeen Nirmal

Dr. Nirmal is a Registered Psychologist working in the British Columbia Autism Assessment Network (BCAAN) at Sunny Hill Health Centre for Children and is a Clinical Instructor in the Department of Pediatrics, Faculty of Medicine, at UBC. Her clinical focus, while working in Canada and the United States, has been on the assessment and treatment of children, teens, and young adults with neurodevelopmental disabilities, with a specialization in autism spectrum disorder (ASD). Her research interests include postsecondary supports for young adults with ASD, executive functioning in the workplace for individuals with ASD, and social supports for teens and young adults with ASD. Dr. Nirmal completed her M.A. and Ph.D. at UBC, and she is a certified PEERS provider.

Dr. Nirmal’s dissertation on the experiences of ASD adults with post-secondary education is one of very few explorations into this subject. She emphasized the need for more research in this area. Her study was small, only 12 subjects, 9 males and 3 females. Most were undergraduate students, between the ages of 18-20. The study included a follow-up interview for each subject, to correct, clarify the information gathered.

Many ASD students have the intellectual capability of undertaking post-secondary course work, and surveys of younger ASD students often indicate an interest in attending college or university, yet actual enrollment is often lower than would be expected. One study of 680 ASD adults found that only 34.7 % attended a post-secondary institution. In addition, many have several false starts, or end up not completing a post-secondary program. In short, many ASD students should do well at university or college, but don’t.

What the reasons for this? Here are some:

• A lack of social interaction & communication skills, including a poor ability to interpret nonverbal cues.
• Difficulty finding common and shared interests. A predisposition to being obsessive or narrow in choice of interests. This laser-like ability to focus on a particular interest or area of study can also be an advantage, especially at later stages in a degree program, but can be seen to be socially rigid.
• Romantic relationships – ASD students may be developmentally delayed in this area, which may make them feel odd or out of place, or sometimes may lead to inappropriate relationships or behavior.
• Some students may find the lack of fixed, rigid structures at University disconcerting.
• Vestibulary discomfort; some may find the sounds, smells, textures, over-whelming.
• Level of Adaptive behavior functioning; there may be a wide gap between their cognitive functioning and adaptive functioning (the ability to independently carry out daily living activities).
• Inability to be effective self-advocates.
• Presence of psychiatric co-morbidities, especially anxiety and depression. These occur in 65% of adults with ASD.
• Level of executive functioning – many find it difficult to organize and plan their time, and to shift from one activity to another.

8 Broad Themes emerged in Dr. Nirmal’s study:

1. Management of Academic Expectations: How well the student can organize his or her time, work toward deadlines, establish priorities, shift from one task to another.
2. The Experience of Support: Does the student feel supported by professors, by campus support organizations, by community or global supports (church, community centers, mentors, i.e., Temple Grandin)? Do they feel that they are supported by like-minded peers?
3. Management of ASD and related symptoms: Does the student’s preference for routine help to focus their attention on the task at hand, or do their restricted interests distract them from course work? Are they able to find ways of coping with sensory dysregulation – for example, finding places to work which do not overwhelm their senses?
4. The Influence of Past Experiences: Are past elementary or high school academic or social experiences an impediment to current and future experience?
5. A Sense of Appreciation: To what extent does the student feel that they are respected by the professors and surrounded by like-minded peers – do they appreciate the more mature college or university environment?
6. Understanding of ASD – their own understanding of themselves and the degree to which they fee understood by others. Some may feel that others do not understand their disability, and may see any accommodations that they receive as allowing them to “slack off”, whereas some may not take advantage of accommodations as they are in denial about having ASD, or fear that accepting accommodation will separate them from their classmates.
7. Management of the Transition: Has the student been fully prepared for the transition from the structured high school environment to the much less structured college/university environment? Do they know how to function without the presence of a Special Education Assistant? Can they navigate the University system of registration, websites, forms and regulations?
8. Social Implications: Is the student understanding of and prepared to enter a new social world? Are they comprehending the threshold between their desire/ambitions for their future with uncertainty about that future? Do they recognize the need to initiate social interactions on their own, or differently than in the past? Can they find social outlets outside of college or university or online where they might find smaller, club based or special interest activities or events.

What are the implications for practice and practitioners working with ASD individuals who attend or intend to attend college or university?

Intensive intervention should be available to these individuals in the following areas:

• Social skills training is required to prepare them for collaborative work and relationships in college and beyond.
• Adaptive behavior training and experience, including through volunteer work and work placements
• Executive functioning training to help them to organize themselves and to prioritize their work.
• Ongoing mental health monitoring and treatment.
• Take it slow – understand that completing college or university will take longer than for a neurotypical student – and that building self-confidence and succeeding slowly is preferable to becoming overwhelmed and failing.
• Make use of accommodations and helpful technologies such as “smart pens” for note taking.