The American Psychiatric Association (APA) describes autism as a neurodevelopmental disorder marked by difficulties in reciprocal social communication as well as the presence of restricted and repetitive behaviours and interests. In England, where at least 1% of individuals are on the autism spectrum, a rising proportion of autistic children grow up to be adults. Yet, the support needs of autistic individuals are largely unmet, particularly for those without intellectual disabilities who lack a defined healthcare pathway and risk falling between the cracks of existing resources (Shattuck et al., 2012). According to Turcotte et al. (2016), it is critical to better understand how to help this group's transition to and success in adulthood. Autism-related communication impairments can persist into adulthood and have a substantial influence on day-to-day functioning (Cummins, Pellicano, and Crane, 2020). Müller et al. (2008) questioned 18 autistic individuals about their social obstacles and discovered communicative difficulties in areas like initiating conversation, interpreting abstract language, and reading body language. These findings emphasise the significance of providing assistance and interventions for autistic people throughout their lives, especially in areas involving social communication. It is critical to find solutions to address these issues and assist people with autism in navigating social situations more efficiently.
Impairments in communication, especially social communication, include limited social attention and impaired emotional regulation. Gaining life goals can be hampered by social functioning impairments, as social knowledge and competence are crucial components of academic and professional success (Santhanam & Hewitt, 2021). Despite a desire for social engagement, these autistic people reported feelings of loneliness as a result of their social impairments (Müller et al. 2008). People with autism spectrum disorders (ASD) have many unmet support needs, and many struggle to access essential services due to a lack of age-appropriate help, difficulty obtaining financial support, and long waitlists. Decreased social supports, resources, and opportunities have been found to have a detrimental influence on adults with ASD's quality of life. (Wilson et al., 2021).
Causes of Social Communication Challenges in Adults with Autism
Individuals with ASD face varying degrees of difficulty and require varying levels of support, making the population highly heterogeneous. ASD diagnostic criteria indicate clinically significant difficulties that impair daily functioning (American Psychiatric Association, 2013). For the majority of people with ASD, these difficulties last into adulthood, with social communication deficits being the most persistent and difficult to address. Many unaddressed support needs exist among the growing population of adults with ASD (Wilson et al., 2021). According to Shattuck et al. (2011), the proportion of people with autism who receive support services after leaving public school systems is declining. Many adults with ASD and their parents struggle to get critical services due to a lack of age-appropriate support, challenges obtaining financial help for treatments, and long waitlists. When people with ASD leave school-based services and enter adulthood, there is frequently a drop in accessible support resources, known as a "services cliff" (Wilson et al., 2021). Formal social communication supports and services for adults with ASD include speech-language therapy, social skills training, support groups, and in-context coaching for managing social obstacles. There is also informal social communication aid provided. Müller et al. (2008) questioned 18 autistic individuals about their social obstacles and discovered communicative difficulties in areas like initiating conversation, interpreting abstract language, and reading body language. Furthermore, many people with ASD invest a lot of energy attempting to negotiate social situations, which can lead to tension, anxiety, and weariness. This may cause problems in relationships, jobs, and overall quality of life (Müller, Schuler, & Yates, 2008).
Seven challenges emerged as the parents addressed how to ensure that their adult children with ASD receive the required social communication support and services (Wilson et al., 2021). These barriers include a lack of funding for social communication supports and services, staff turnover that results in poor quality social support, co-occurring mental health issues that limit social opportunities, a lack of social communication support in employment settings, transportation issues that limit social engagements, informational barriers that limit the availability of social opportunities, and limitations of social communication services due to being "too high-functioning. It is also crucial to recognise that even "high-functioning" individuals may require social communication supports and services in order to fully participate in their communities." Families are concerned that the transition to adulthood will bring new challenges and are concerned about how their child will handle them (Eaves & Ho, 2008).
Ways to Address Social Communication Challenges in Adults with Autism
Recommendations for social support were divided into four key categories: (1) external support, (2) communicative support, (3) self-initiated support, and (4) attitudinal support. Interventions such as vocational training and work coaching are examples of external support, whereas communicative support includes the use of assistive technology and social skills training. Self-initiated supports focus on developing self-advocacy abilities, whereas attitudinal supports attempt to enhance societal understanding and acceptance of people with autism (Müller, Schuler & Yates, 2008). For example, external supports can include assistance with job seeking and training, as well as community-based programmes for socialisation and leisure activities. Communication support can involve special software and technology to aid in social interaction, such as video chat programmes or apps that help individuals navigate typical social situations. Self-initiated support may include individual therapy sessions focused on building social skills and navigating social situations independently. Finally, attitudinal supports emphasise the need for society to recognise the potential of individuals with ASD and create an inclusive environment It is important to note that not all individuals with ASD require or desire external social supports, and some may prefer to navigate social situations independently without therapy or special technology.
It is important to note that the type and level of support needed may vary from person to person with ASD. Therefore, it is crucial to individualise interventions and support based on the specific needs and strengths of each individual. There may be chances for intervention to improve outcomes if teenage characteristics connected to social and community participation are identified at this crucial transitional period. Understanding the effects of extrinsic and intrinsic elements on community participation during a transitional time may aid in the development of successful interventions and support systems. This understanding could also help to promote inclusion and equity for people with different origins and needs. Economic variables, school type, transportation, and case management are examples of extrinsic (environmental) impacts , characteristics innate to an individual like ethnicity, gender, cognitive abilities, communication abilities, and behavioural difficulties are intrinsic factors (Myers et al., 2015). The study by Eaves and Ho (2008) indicated that many young people with autism lack social activities and friends, and a third indicated a need for work. It also showed that both the intensity of autistic symptoms and low IQ have a negative impact on long-term functioning. Services for adults have not kept up with the increases in services to children, leading to frustrations. This highlights the importance of providing appropriate support and services for adults with autism, including opportunities for socialisation employment, and ongoing care. Without these resources, individuals with autism may struggle to achieve long-term success and well-being.
The idea of an autistic weakness in social connection is reframed in Milton's (2012) Double Empathy Problem as 2 different breakdowns in communication between partners. It acknowledges that while individuals with autism may lack understanding of the social worlds of those who are not autistic, the inverse is also true. Autism-related individuals have learned more about the world and preferences of non-autistic individuals than non-autistic individuals have learned about the world and preferences of autism-related individuals. As a result, it's critical to view social connection as a two-way street where people with and without autism spectrum disorders may both benefit from one another and try to improve understanding and acceptance. This could lead to more meaningful and fulfilling social relationships for everyone involved for example, a non-autistic partner might struggle to understand why their autistic partner needs to spend time alone or avoid certain social situations. However, through open communication and willingness to learn from each other, they could both gain a better understanding of each other's perspectives and find ways to compromise that meet both of their needs. This could lead to a stronger and more supportive relationship overall.
References
1- Cummins, C., Pellicano, E., & Crane, L. (2020). Supporting minimally verbal autistic girls with intellectual disabilities through puberty: Perspectives of parents and educators. Journal of autism and developmental disorders, 50(7), 2439-2448. DOI:https://doi.org/10.1007/s10803-018-3782-8
2- Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism spectrum disorders. Journal of autism and developmental disorders, 38, 739-747. DOI:https://doi.org/10.1007/s10803-007-0441-x
3- Milton, D. E. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & society, 27(6), 883-887. DOI:https://doi.org/10.1080/09687599.2012.710008
4- Müller, E., Schuler, A., & Yates, G. B. (2008). Social challenges and supports from the perspective of individuals with Asperger syndrome and other autism spectrum disabilities. Autism, 12(2), 173-190.https://doi.org/10.1177/1362361307086664
5- Santhanam, S. P., & Hewitt, L. E. (2021). Perspectives of adults with autism on social communication intervention. Communication Disorders Quarterly, 42(3), 156-165. DOI:https://doi.org/10.1177/1525740120905501
6- Shattuck, P. T., Garfield, T., Roux, A. M., Rast, J. E., Anderson, K., Hassrick, E. M., & Kuo, A. (2020). Services for adults with autism spectrum disorder: A systems perspective. Current psychiatry reports, 22, 1-12. DOI:https://doi.org/10.1007/s11920-020-1136-7
7- Wilson, K. P., Kaminski-Mainardi, A., Tenbus, J., & Marsack-Topolewski, C. N. (2021). Social communication supports and services for adults with ASD: parents’ perceptions of barriers and needs. Journal of Family Social Work, 24(2), 98-117. DOI:https://doi.org/10.1080/10522158.2021.1887037
