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Author: Ronit Molko

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The Current State of Website Accessibility for Disabled Individuals – Zenyth Group CEO Daryn Harpaz

The-Current-State-of-Website-Accessibility-for-Disabled-Individuals

The relationship between technology and autism services has been a focus of my thinking and writing lately. It’s an urgent topic that I feel deserves attention, but it’s also led me to a broader conversation about inclusivity (or lack thereof) of technology for the larger disabled community. As our lives become increasingly enmeshed with technology—phones at our fingertips, brick and mortar retail locations rapidly disappearing, the supremacy of social media and e-commerce—the need for technology that can accommodate the disabled community is at once something that must be a priority, yet is often either left ignored by businesses or unaddressed because they lack the knowledge and ability to make their websites ADA compliant.

In search of more information about this landscape and the “state-of-play” when it comes to websites and online life generally becoming more accessible for disabled individuals, I spoke with WCAG (Website Content Accessibility Guidelines) Compliance Specialist and Founder and CEO of Zenyth Group, LLC, Daryn Harpaz. Our conversation revealed some curious information, statistics that should scare and incentivize business leaders, and insights that should give us all a better idea about the status quo informing current inclusivity efforts for disabled individuals online.

The first thing to know is that it’s impossible to have this discussion without mentioning the Americans with Disabilities Act which passed in 1990. As Daryn explained it, officially, there is no legislation holding private sector websites accountable for accessibility, as the law predated the prevalence of the internet as we use it today. However, guidelines put together by the World Wide Web Consortium have essentially been adopted as precedent, and those guidelines are confirmed by the Department of Justice. Lawsuits pursuant to accessibility compliance are being upheld by the courts, so while nothing is instantiated by law, it’s becoming a must for businesses to ensure their websites are fully accessible to the disabled community.

“Currently there’s a [accessibility] lawsuit being filed at the rate of one per hour in America. And these are lawsuits most prominently bought by the plaintiff side—a blind plaintiff who is not able to access a website using a screen reader and a keyboard,” Daryn told me. While vision impaired people (4.6% of the disabled population in America) struggling with assistive technologies online represent the majority of the lawsuits we’re seeing, guidelines cover a much wider spectrum of conditions, and so solutions need to address the same.

Individuals disabled in some way—including autistic individuals or people with epilepsy—comprise about 15% of our population in America, or 61 million people. Add to that the fact that 40% of US adults over the age of 65 have one or more disabilities (many of whom would benefit greatly from more accessible websites due to vision loss and motor functioning complexities) and the market is too large to be ignored. Yet, many businesses still aren’t addressing the issue properly.

With the right insight and expertise, these are all avoidable problems that could easily create a more equitable world for all. But, many either are either openly hostile to accommodating disabled individuals or seem to be acting only out of fear of being sued. A lot of these attitudes are born of ignorance, and businesses should be highly incentivized to accommodate such an enormous market.

“If you consider the spending power of the disability community, you’re talking about a half a trillion dollar industry: $490 billion. That’s what people with disabilities spend a year in consumption. So why wouldn’t you want to be one of the brands that cater to that demographic? Parallel to that, it is well known that people within the disability community are one of the most, if not the most loyal brand advocates. A lot of companies do not cater to them, so when they find a company catering to their needs, they are very loyal, often becoming brand ambassadors.”

While I’d prefer that the current conversation was starting from a place more anchored to the humanity of these individuals, motivating startup retailers just trying to get by and monolithic corporate entities all at once is difficult work, and any progress in the right direction is still progress.

Ultimately, change will require a shift in mindset that Daryn tells me he and his company are working hard to achieve, “My platform is to move that conversation from the defensive framing to an attitude that’s more proactive, one with which organizations embrace accessibility as a best practice, and deploy technology and messaging that is inclusive,” he explained. “If we’re going to really move the needle in our industry, it has to be a conversation around humanity.”

Our conversation goes on to unpack the more technical aspects of the work ahead for disabled individuals and website accessibility. Those details and more will be shared in an upcoming blog, so keep an eye out for the conclusion of this important discussion.

Article written for Forbes.com.
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Six Ways Technology Due Diligence Failure Can Kill Your Private Equity Investment

Six-Ways-Technology-Due-Diligence-Failure-Can-Kill-Your-Private-Equity-Investment

No matter what market you’re in, technology is a significant element of your business. Taxi companies learned this when Uber and Lyft employed sophisticated apps to topple their industry. Prior to the emergence of those two frame-breaking enterprises, few in the taxi industry would have considered themselves in the technology business.

Even a high-touch industry, like autism services, invests significant intellectual and monetary resources into computers, databases, practice management, and other critical technology.

These systems and the people who run them are often overlooked when investors conduct due diligence before acquiring autism businesses. But they do so at considerable risk.

A 2007 study at the University of Virginia found that two-thirds of mergers and acquisitions fail to deliver their expected returns. More recent research (2016, 2017) shows this number as ranging between 50 and 85 percent. Much of this is due to poor integration of cultures and business practices. A significant piece of this is systems and technology.

In my work with private equity firms, I frequently encounter this problem. Investors acquire platform companies comprising multiple businesses that have been acquired and consolidated in a relatively short period of time. Frequently, each of the businesses within this platform is using different software for data collection, analytics and practice management. Often, it’s chaos for the employees who are charged with integrating new acquisitions into the company. Combine that with the growing failure to conduct substantial technology due diligence and what we’re left with are investors putting their investments at needless risk.

Compromised Systems

No investor wants to purchase a company whose data has already been stolen. Consequently, it is critical to investigate the security of a target company’s data before investing. Due diligence investigations of Yahoo’s data systems saved Verizon $350 million. After discovering all three billion Yahoo email accounts had been hacked, Verizon slashed its $4.48 billion offer to cover the cost of remediation. Absent due diligence, Verizon would have paid for the email accounts and then found itself liable for the problem. Conversely, Marriott purchased Starwood and discovered a massive data breach in the reservation system that resulted in the hacking of personal data, including passport numbers, for millions of customers. Marriott failed to conduct proper due diligence during the transaction and has since incurred many millions of dollars in expenses to remedy these issues.

IT Integration

When two enterprises merge, the major concern is the integration of two distinct organizations. Most merging entities recognize the challenge of combining physical, cultural and operational systems, but often neglect or miscalculate the complexity of the required integration of IT. In my experience, the reliance on synergies and applicability of existing systems is generally overestimated; as a consequence, the cost to merge IT systems is generally underestimated. Most organizations are struggling just to integrate and optimize their own systems and would be severely challenged to assimilate a new one or to migrate the entire company to the best option available.

IT Staff Considerations

Put yourself in the shoes of your employees. An imminent merger or acquisition threatens their continued employment. Destroying documentation; changing protocols, passwords, etc.; and installing obsolescence into IT systems are just three strategies to create a level of indispensability that would protect their job or cause damage to the business once they are let go.

It’s important to remember that the overwhelming majority of people would never consider such actions. But it only takes one bad actor to wreak havoc for a company. Those closest to and with the deepest knowledge of the technology, software, systems, and processes that keep the company running smoothly are the ones with the greatest potential to do major damage. There are numerous accounts of these events in mergers and acquisitions. Companies can protect themselves: there are defense mechanisms against this kind of behavior that are the purview of IT experts.

The Leakage of Intellectual Property

Bearing in mind the same caveats about human nature, employees have been known to steal information. Not just a priority when selling the business, protecting intellectual property must be a core due diligence practice at all times. In one of my own businesses, an employee downloaded critical business information and intellectual property and used it to establish their own company, now worth a significant amount of money. During acquisition discussions, determining who is most likely to feel their job is in jeopardy can lead to defensive measures that protect intellectual property prior to completion of the purchase as well as throughout the lifespan of the business.

Social Engineering Hacks

While these sorts of attacks are an ever-present threat to businesses, smart criminals know that companies are especially vulnerable at times of sales or acquisitions and can exploit the situation to steal money. In a growing wave of cyber theft, we are seeing increasing incidents of thieves hacking into company email and sending requests for payments that go directly to an offshore account. Staff, aware that a transaction is imminent, comply with the request and suddenly large sums of money are gone. A client of mine avoided this scam only because the accounting employee questioned the CEO in person about transferring funds by wire. This is the exception that proves the rule. Oftentimes, transactions like this, that get easily flagged in the normal course of business are processed without hesitation during a sale because atypical financial transactions are commonplace during these periods.

Email Trading

The final vulnerability to look for is relevant to publicly traded companies. Before a deal is ever announced, there will be rumors circulating about the sale. More dangerously, there will be ongoing chatter between business leaders that reveals sensitive information, most especially a possible sell date.

While rare, it’s not unheard of for opportunistic employees who know their way around the company’s systems to gain access to email communications and begin monitoring leadership’s emails throughout the ensuing weeks and months to parse them for valuable details that they then use to make personally advantageous stock trades with should-be confidential insider information. Many young IT professionals have been arrested for this kind of breach.

The positive thing to keep in mind here is that these attacks are avoidable. Managers that get caught in this trap are usually using an unsecured email server like Gmail, to which some employees have full admin access. Companies in the midst of a sale or acquisition cannot afford to be naive about access to information. An added emphasis on private communication and enhanced security provisions around sale preparations can easily remedy this kind of vulnerability.

Understanding these six elements of due diligence facilitates a process of digital risk mitigation that can save investors millions of dollars and secure the viability of entities, in our industry, that provide critical services to a population in serious need.

Article written for Forbes.com. 

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The Sexual Abuse Epidemic Among People with Intellectual Disabilities

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In the era of #MeToo and increasing vigilance against sexual predation, there is burgeoning evidence that a significant cohort of people has been lost in the shadows.Although the exact extent of the problem is unknown, numerous studies have concluded that individuals with autism spectrum disorder (ASD) and other physical, intellectual and developmental disabilities are at dramatically heightened risk for sexual abuse.

A study of 55,000 children in Nebraska found that those with intellectual disabilities were four times more likely to suffer sexual abuse than neurotypical children. Meaning that estimated one-in-three females overall suffer sexual abuse. That suggests a staggering, and largely undetected, level of abuse perpetrated against autistic and other children with disabilities.

Researchers at Willamette University in Oregon postulated that autistic children may be targeted by sexual offenders because of their vulnerability and their communication challenges. The researchers noted that sexually abused autistic children may react in ways that can be misattributed to their condition. For example, an autistic child acting out without apparent provocation (such as showing resistance to a particular caregiver) might be misunderstood as reacting to an environmental stimulus, rather than to untoward actions against them. Authorities are reluctant to pursue these cases in criminal court because witness testimony is the key to a successful prosecution.

According to US Department of Justice data, individuals with disabilities disproportionately suffer their abuse at the hands of people whom they know and trust compared to other victims of sexual abuse. Children on the spectrum are generally more reliant than neurotypical children are on adults, often requiring assistance with activities of daily living like bathing and dressing well into teenage years and adulthood. Because children are taught to respect and comply with the commands of adults, their vulnerability is accentuated.

Considering the magnified risk that autistic individuals face, more research is needed to identify strategies that can prevent sexual assault.

Many in the autism field recommend initiating a conversation about the issue as early as possible and being as direct as is tenable. They say parents should shape the discussion in the terms most conducive to understanding among family members. The impetus for this is the particularly critical role parents play in educating their autistic children about sex because they are less likely to learn about it from popular culture or peers.

It is all the more imperative that children with intellectual disabilities at higher risk of sexual abuse have the ability to distinguish between appropriate and inappropriate behavior directed towards them. Unfortunately, there is a paucity of educational programs targeting healthy sexuality for these populations of individuals.

For individuals who are more severely impacted, who require higher levels of support, mere education and empowerment may be implausible or insufficient. For this population, often unable to distinguish appropriate from inappropriate touch, it is imperative that measures be enacted to reduce opportunities for abuse and vigilance remain constant to prevent it.

Relationships are central to life for autistic adults, as they are for everyone else, and for all the same reasons – love, companionship, support, sexual relations, and reproduction. Sexual predation destroys trust and undermines the ability to engage in healthy sexual and intimate relationships.

A two-part National Public Radio investigation found that sex education specially designed for individuals with intellectual disabilities can help them rebuild that trust and navigate the choppy waters of relationships, which are already maddeningly complex in the best of circumstances.

The alternative for individuals on the spectrum who have been abused may be a lifetime of isolation and loneliness. This prospect is as disheartening for these individuals as for anyone else.

All the research and journalistic investigations, such as those noted above, demonstrate that by improving the data describing sexual abuse of those with intellectual and developmental disabilities, strengthening their defenses against predation, implementing processes to prevent the opportunity for abuse to occur, and refining efforts to help those abused rebuild their confidence and trust, we can reduce incidents of assault and pave the way for healthier relationship building in this population.

Deeper reading on how we can improve these kinds of unfortunate conditions can be found in my book, Autism Matters: Empowering Investors, Providers, and the Autism Community to Advance Autism Services.

Published By
Ronit Molko, Ph.D., BCBA-D

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Disappearing Into Normality: Understanding Autism on Its Own Terms

Disappearing-Into-Normality-Understanding-Autism-on-Its-Own-Terms
The popular paradigm to describe individuals on the autism spectrum is linear: we conceive of individuals as mildly, moderately, or severely impacted by autism. These categorizations are also used diagnostically to determine how a person’s life and functioning is affected by their autism. Put another way, autistic individuals are referred to as needing lower-support or higher-support, often depicting how others perceive their functioning and adaptability.We measure the place individuals occupy on the continuum primarily by their ability to communicate, socialize and act “normal.” Interestingly, we do not speak about other populations or groups of people this way. We recognize cultural differences, language differences, and expect that people from different parts of the world will behave differently. But when it comes to individuals with disabilities we differentiate on a spectrum of “normal”.

Of course, there is nothing inherently better about “normal.” It’s simply the norm—the way most of us have agreed to act. “Non-normal” socialization is not necessarily worse.

The Speciousness of Normal

So, which of these individuals with autism is more “normal” as we define it: the highly verbal, articulate person with a college degree who becomes incapacitated when overwhelmed by sensory inputs and struggles with anxiety and/or depression, or the person with communication challenges limited to simpler, possibly repetitive tasks who accomplishes them every day and enjoys a social life, explores their passions, and lives with a degree of independence?

The first person appears “normal” to neurotypical people most of the time but encounters significant life challenges, many of which are not visible. This is why “normal,” as a qualifier, doesn’t carry much water.

The topic of normality and autism came up in my recent conversation with Dr. Sue Fletcher-Watson, a Chancellor’s Fellow at the University of Edinburgh’s Centre for Clinical Brain Sciences. She has conducted significant research on intelligence and socialization of individuals on the autism spectrum.

Dr. Fletcher-Watson believes that the great untapped reservoir of information about the struggles of autistic individuals comes from those struggling with the condition themselves.

“I think we really need to systematically explore how [the recommendations of] able, articulate, autistic adults can be translated into good practice for young children, people with learning disabilities, people with communication challenges, and so on,” she said.

“We’re looking at developing peer support models which would include matching newly- diagnosed autistic adults with people who have had a diagnosis for a while, and are very established in the community, but also maybe pairing parents of autistic children with an autistic adult, to get their insights and their perspective.”

Segregate or Integrate?

There is an ongoing discussion in the disability community and the legislature about the relative merits of organizing people with disabilities into their own communities. As research has demonstrated, and I have documented here, people with autism often report that they socialize more successfully with each other than with neurotypical people (and vice versa). Living within their own communities is often preferred and provides individuals with autism the freedom to organize their lives around their own social norms.

This would argue for creating communities of people with autism.

But many are suspect of creating living environments that could mimic institutions, weary of the way we institutionalized people with psychiatric conditions in the U.S. in the 1960s and 70s to disastrous effect. Today, federal law requires that many residential facilities for individuals with disabilities must be integrated with a certain number of non-disabled people.

Many caregivers and people with autism chafe at this law.

It’s a conundrum, Dr. Fletcher-Watson and I agree. After all, people with commonalities of all types organize themselves into segregated communities, whether it’s senior living communities for older people or summer camps for children with cancer.

What marks these communities as special are the commonalities in life experiences the members share, and the social norms inside them, which could be beneficial to people with autism who are naturally governed by norms not shared by the rest of society.

Dr. Fletcher-Watson describes the conundrum this way: “On the one hand, what our data seems to be saying is that we should provide opportunities for autistic people to be together. I’ve met autistic adults who’ve never met another autistic person, and that’s heartbreaking. So, that’s really important, to provide those spaces. But the risk is that you can also create a ghetto.”

The solution might be to allow people on the spectrum to choose their own living arrangements, and if the results are organic, successful communities of people with autism, then we should be grateful for a concept that improves their lives. At the same time, individuals with autism who prefer to mainstream their living situations would have that ability, offering everyone the opportunity to choose the lifestyle that best suits them.

For further reading like this blog, check out a copy of my book, Autism Matters.

Published By
Ronit Molko, Ph.D., BCBA-D

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How to Overcome Sensory Issues While at The Dentist – by Dr. Greg Grillo

Great Teeth, Great Smile, Great Life. Kid At The Dental Office.

After 17 years of practice in North Central, Washington, nobody’s more familiar with dental anxiety than I am. For dental patients who have autism, especially children, this anxiety is compounded by challenging sensory elements such as bright lights and loud noises.

Dental care is an extremely important part of living a healthy life and living with autism shouldn’t prevent you or your child from getting the care they need. Fortunately, many dentists—including myself—are sympathetic to the needs of those who experience sensory overload. Here are a few things you can do to help overcome sensory issues while at the dentist:

Talk to your dentist

Before you schedule your first appointment, you should speak with the dental professional in question and ask them what accommodations they make for patients with sensory issues. If the answer is “none”, it’s time to find a new dentist.

However, most dental practitioners will be “on your side” and will want to make an autistic patient’s visit as comfortable as possible. Here are a few things a dentist might do to help avoid sensory overload:

  • Schedule a desensitization appointment (see next section)
  • Schedule the main appointment at a time that is less busy
  • Use the patient’s favorite toothpaste flavor—a taste sensation that they’re already comfortable with
  • Provide the patient with a soft blanket to use during the appointment
  • Provide the patient with sunglasses which can help with the bright lights
  • Provide the patient with headphones that will play soothing music or sounds during the appointment

If there is something specific which you know your autistic child needs to feel comfortable, tell your dentist about it and they should do whatever they can to accommodate that need.

Schedule the Desensitization Appointment

Desensitization appointments (sometimes known as “familiarization appointments”) are becoming a standard procedure in the growing field of special care dentistry and are one of the best things a dentist can do to make a patient with autism more comfortable. Despite the scary name, the idea is quite simple: a desensitization appointment is an appointment scheduled before the actual procedure in order to show the patient the operating theater and explain the function of every piece of equipment in the room. This is a great opportunity for your child to meet staff members and become familiar with the dentist office before any work is done on their teeth.

Practice at Home

If you have a child with autism, sensory calming strategies at home can be one of the most useful ways to make sure they’re comfortable with going to the dentist. You can do your own version of the “desensitization appointment” by showing your child pictures or videos of a dentist’s office, or by reading them storybooks about dental appointments. This can help your child become more familiar with the practitioner’s office and what goes on there before their actual appointment, which can help them feel more at ease and less likely to experience unpleasant sensory overload.

Some parents I’ve spoken to have also found that turning the dental visit into a role-playing game helps their child become more familiar with the unfamiliar concept. In this fun and interactive form of practice, you can play the dentist while your child takes on their actual role of the patient while you act out some of the basic steps of a dental appointment. This is a particularly good way to work through some of the physical aspects of their visit: have your child lie flat with their hands on their stomach and practice opening their mouth as wide as they can.

I understand that the dentist’s office can be an overwhelming and frightening place, but regular checkups are essential for any person’s physical health and happiness. As long as you find a dentist who is dedicated to making the visit as comfortable as possible—and I’m happy to say that I truly believe that’s the vast majority of practitioners—the appointment can become a great learning experience for both you and your child. I hope these tips will help you overcome any sensory issues you may experience so that all involved can have a positive experience the next time you visit the office.

 

Visit dentably.com to get in touch with Dr. Grillo.

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Areas of Advancement in Autism Services for Successful Adults

As autism prevalence increases and more children on the spectrum mature to adulthood, the need for services that help autistic adults lead independent and fulfilling lives is becoming an increasingly urgent concern. While many interventions help autistic kids and their families navigate the challenges of childhood and adolescence, there has been comparatively little progress made as it concerns long-term, sustainable outcomes for these individuals. As we continue to gain a deeper understanding of autism, it’s becoming an unavoidable reality that current treatment programs are not equipping kids with the critical skills they need to flourish in adulthood.

This leaves autistic adults and their families at a loss for how to plan the future. Compounding the issue, federal regulations aimed at promoting inclusion in communities for adults with disabilities have created restrictions around where individuals can live and with whom they can live, often making this process much more challenging than it needs to be.

While early intervention has improved and should continue to do so, it’s time that we, as an industry, consider how treatment should evolve to serve autistic individuals beyond high school graduation. I believe this issue is an emergent characteristic of a neurotypical outlook that presupposes the solutions needed are somehow fundamentally different for autistic and neurodiverse individuals. The reality is that as we grow into adulthood, we all—with very few exceptions—want the same things out of life: independence, security, self-determination, meaningful relationships, and dignified employment. 

So, how do we orient autism services to create these outcomes for autistic adults?

Emphasize higher education:

It’s true that education after high school might not be a fit or priority everyone, but for many individuals with autism, it is assumed that college is not an option. The opposite is true. With effective preparation and the right support system, autistic individuals can not only attend college but also find success. But, this preparation cannot be an afterthought of intervention. 

Think of your own experience in preparing for college. There were probably colleges you imagined attending while in middle school. By freshman year of high school, many of us were already planning class schedules and extracurriculars to make our transcripts more appealing to Deans of Admissions across the country. College visits were planned by the end of sophomore year. SAT prep by junior year. All capped off by the final application process. There is no reason autistic individuals with college aspirations shouldn’t follow a similar preparatory path. It’s on service providers to start early in mapping a path to college that is specific to the needs of the individual they are serving. 

First, it’s important for students and their families to recognize how high schools and colleges differ in their support for individuals on the spectrum. In high school, educators are generally more empowered to adopt changes and to deliver an individualized curriculum to help individual students learn and succeed. However, in college, the rules change.

Every U.S. college and university that accepts federal funding is required to provide “reasonable” support for students with disabilities. It’s the interpretation of the word “reasonable” that muddies the institutional support picture on college campuses. The support autistic individuals have access to in college will vary by institution, complicating the decision-making process. It’s important that families and providers know how to determine which schools will provide the support system the individual needs. A simple call to the college’s disabilities services department is a good start. Ideally, providers with an eye on the future like this would have this resource readily available. Unfortunately, we are not there yet.

Additionally, when a student goes off to college, self-advocacy becomes increasingly important. With a new degree of independence, students will be tasked with asking for the support they need. It’s something that many neurotypical individuals take for granted. We’re often vocal about our needs and have little trouble articulating what those needs are. The same isn’t always true for autistic individuals. 

There is sometimes a hesitancy to disclose a disability for fear of repercussions socially or from professors. Disclosure is a behavior that can be practiced and conditioned by service providers long before high school graduation is on the horizon. A student who arrives well prepared with a list of conditions that help him or her perform better (such as not switching lab partners on a weekly basis or the need to get up and walk out of the classroom to take a break) will be better positioned for a successful experience. 

There are many different programs and opportunities for young adults on the spectrum who are looking to keep learning. But like for all students, considering college, finding the right institutional fit, and preparing for a self-directed future needs to become accordingly and fully integrated into intervention. 

Employment

One essential aspect of leading an independent and fulfilling life is gainful employment. We’ve made progress on the hireability of autistic individuals and the contributions they are able to make in the workplace. Many major companies like Microsoft, Ford, and Ernst & Young have recognized the unique and impactful skills autistic individuals can add to their business. 

The unfortunate thing is, these kinds of opportunities are few and far between for many autistic adults. The prevailing (and harmful) perception among the public regarding autistic individuals in the world of work is rooted in the savant trope perpetuated by popular media—think the show The Good Doctor, starring Freddie Highmore as the autistic and brilliant surgical resident Sean Murphy. 

This is not to say those people don’t exist or that they themselves are stifling real progress, but the idea that only the most extreme outliers on the spectrum are employable only applies to autistic individuals. “Genius” is rarely—if ever—a qualifier for neurotypical individuals seeking gainful employment. And it’s this disparity in perception that underlines the yawning gap in unemployment levels among autistic individuals relative to the national average. The national unemployment rate sits around 4.5% on a rolling basis. That rate skyrockets north of 80% for adults with autism. 

The work that needs to be done to shift this perception is a far more broad and complicated discussion. Yet, we can exclude this harmful trope from intervention programs by doing more than just managing behaviors. Caregivers should treat every autistic individual as though gainful employment will be a part of their future. Those jobs can range from programming wizard with Microsoft to more modest, everyday jobs that still need to be done. There is dignity in work. Full stop. 

That said, much like college considerations, it’s important to identify, control, and amplify the skills the individual possesses before charting a course to the future. Does the child like patterns and routines? Are they particularly good with computers? Do they have a knack for organization? Perhaps they are artistically inclined. If caregivers, providers, and even the children themselves can identify these preferences and passions early on, they can work to identify potential career paths and hone the requisite skills. Starting these conversations in middle school, long before the job hunt, and practicing with volunteer jobs and mentoring can lead to much better results!

Pairing a person with a job based on skill set and preference will lead to more long-term fulfillment and better retention. This is an area where we, as an industry, can improve. Additionally, raising more awareness in companies to promote neurodiversity is also important. We’re seeing progress, but we need more businesses than giant corporations who can afford to take the “risk” on neurodiversity to get involved in the solution. Small- to medium-sized businesses need to embrace neurodiversity. For our part, we can get a headstart on preparing autistic individuals with the necessary tools to be appealing candidates for any career they are able to pursue. 

Independent Living

Independent living can start when a young adult goes to college and made more vital when one starts to work. But, no one inherently possesses the skills to succeed on their own. For neurotypical individuals, these routines, habits, skills, abilities, and coping mechanisms are accrued through a lifetime of teaching and preparation. 

Some of the foundational behaviors like hygiene, communication, and self-care are already core curricula of treatment. A friend of mine, Mari-Anne Kehler, talks about “citizenship”—teaching our kids from a young age to do for themselves, to participate in family routines, and to contribute to our society. Reinforcing this concept of citizenship is a critical next step for truly independent living. All parents have a tendency to do things for their child because it’s often quicker and easier in the context of a busy, complicated life. But, in the long run, dedicating the time and patience to help the child become as independent as possible at a young age will create a better long-term, self-directed future.

The other key component of independent living is access to housing, which is often a tragic challenge for autistic adults. Research at Drexel University in Philadelphia has found that nearly half of all adults on the autism spectrum live at home, and only 10% live independently. It does not need to and should not be this way. Depending on the needs of adults on the spectrum, there are homes and communities where autistic individuals can live while getting the support they need to thrive, like First Place in Phoenix. 

Still, while more and more supportive housing communities are popping up across the country, housing remains an area that needs significant investment and improvement. Parents should not be solely responsible for creating and developing these housing options for their children. It’s to the benefit of society at large that all of us assist in creating inclusive communities that can provide support and independence for autistic adults.

Investor Involvement

The autism services industry is growing. As needed advancements are being made to help individuals prepare for higher education and employment, the industry needs savvy, smart, and socially conscious investors to get involved. Not only can you make positive financial returns, but you can also make a positive difference in the lives of adults with autism and their families. 

Want to learn more? Check out my book, Autism Matters, and learn how you can get involved.

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What Can We Do to Address Unemployment in the Autistic Community

Over the next decade, an estimated 500,000 teenagers with autism will enter adulthood, and potentially, the workforce. Many of these young adults will begin the job hunt, hoping to find work that can help them establish independence and gain more independence and personal fulfillment. But, unemployment remains a significant problem. 

Unfortunately, as things stand now, more than half of young adults with autism are unemployed or unenrolled in higher education. Of autistic adults who graduated from college, 85% are unemployed. Comparatively, the national unemployment rate is 3.7%.

Furthermore, though nearly 18,000 individuals with autism use state-funded vocational rehabilitation (VR) programs, in 2014 only 60% left the program with a job. Of that group, 80% worked only part-time for a median weekly rate of $160.00.

Clearly, there is room for improvement. So, what needs done? 

For Employers:

There are many great companies that have inclusive programs supporting a neurodiverse workforce, like SAP, Hewlett Packard, Microsoft, Ford, and Ernest & Young. Other companies actively recruit individuals who are on the autism spectrum, recognizing the unique talents and skillsets they can bring to the table. Right now, there are over 50 companies that rely on the work of employees who are on the spectrum. I wrote about one of these companies, Rising Tide Car Wash, in a previous blog post about supporting neurodiversity in the workplace.

These companies are setting a great example, but they are still the exception when it comes to inclusion for autistic individuals. 

Here are a few areas of focus that can move these hiring and retention practices for autistic individuals from exception to the norm:

  • Recontextualize your interview process. For many individuals with autism, the interpersonal experience of an interview can be difficult. A traditional interview process, involving direct conversation, maintaining eye contact and reading social cues will be more challenging for most individuals on the spectrum. Therefore, many of these unspoken qualifiers like maintaining eye contact should be considered differently when weighing the fit for the job. In addition, it may be more difficult for autistic individuals to easily and clearly articulate what they know and what they can do for the company. Instead, give them an opportunity to show you what they are capable of and be patient. As the employer, approaching these interviews creatively, with an understanding of the individual is one of the most inclusive things you can do. 
  • Beware of sensory overload. Loud, open office spaces might not be the ideal working environment for autistic individuals who experience sensory overload. When bringing on a new team member, make sure you’ve already discussed this potential issue. If it’s a problem for that individual, be ready with solutions. Designate a quiet place in the office where that person can go to work in peace or provide noise-canceling headphones. Provide accommodations such as noise-canceling headphones or adjustment in the lighting to ease overstimulation.  And communicate with other team members exactly what’s going on and why so that there is no resentment or misunderstanding.
  • Focus on retention. It may be easy for leadership and team members to misinterpret certain behavioral traits of an autistic individual. It’s important that these misunderstandings don’t result in termination, as often times the person will mean no offense by their words or actions. Being aware of what’s really going on, and then communicating deliberately to course-correct and hopefully prevent later incidents should be the first consideration for employers who are serious about autistic inclusivity.

There are certainly a host of other issues to consider when implementing a more neurodiverse plan at work, and if you have further questions, an expert consultant could provide more insight. 

In the Autism Services Industry:

The autism services industry does a lot of good work helping children learn important skills. But an area for advancement is giving teenagers the skills they need to be successful in jobs.

Here are a few places to start:

  • Identifying strengths and job matching. Essentially it comes down to the fact that employees are more likely to have success in their job if their skill set lines up with the requirements. Finding that fit starts with identifying the individual’s strengths and passions, and what skills make them standout candidates. For example, some individuals with autism thrive when executing tasks that require repetition and routines, making them strong candidates for assembly line, data entry, or other computer work. The range of skills autistic individuals can possess is as varied as the individuals themselves. Providers should be sure to involve them in the process of career pathing and job matching. The better we get at identifying talents and skills and matching them with an appropriate position, the closer we’ll be to solving the problem of workplace inclusivity. 
  • Expanding coverage and access to services based on region. Services often vary across state boundaries. For example, Alabama saw 79% of individuals with autism find a job after vocational rehabilitation (VR), compared to 29% in New Mexico. Addressing these gaps and working together to create uniform VR protocols will help increase the number of autistic individuals placed in jobs that are strong fits for their skill sets. With the help of activist providers and investors, this change could be within reach and hugely impactful.

Finding, securing, and holding a job can bring a new sense of independence and fulfillment to the lives of autistic adults. If employers engage with inclusivity in good faith and providers are able to prepare autistic individuals with the skills they need to succeed, solving the problem for underserved autistic adults could be closer than we think, even if we still have a long way to go. 

Looking for more ideas? Check out my book, Autism Matters.

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Home-Based Vs. Center-Based Services for Autism

When I first began working in the field, autism interventions were primarily offered in clinic and research-based settings. As those therapies and the scientific understanding of autism evolved and as the demand for services has grown, a market for home-based and community-based services emerged. Services are expanding and the availability of funding is increasing, resulting in massive growth in this sector of the behavioral health market—with more services being offered in homes, schools, and centers nationwide. It is encouraging to see increased access to intervention and broader service offerings for individuals diagnosed with autism and their families. More treatment setting options result in reaching more people in need.

While school-based intervention exists to aid children in their ability to learn and interact in their school environment, center and home-based care focus on skills for success and independence at home and in the community. These types of intervention also teach other critical life skills. Often, the setting in which a child receives services is determined by the funding source or the availability of services in the community in which they live.

There has been much debate around whether services delivered in a center are better than services delivered in the home and vice versa. Some research suggests that an ideal program may be a hybrid mix of both home-based and center-based services. Studies have shown that children made great developmental gains in gross motor, fine motor, and language skills in center-based programs. Conversely, children made great gains in self-help and social skills by participating in home-based programs. While some service providers promote only one specific setting for intervention, research has demonstrated benefits to both. The critical variables that determine outcomes are the quality of treatment and the involvement of others, as well as a variety of other factors.

The Pros and Cons of Home-Based vs. Center-Based Services

The biggest benefit to home-based intervention is that it allows children to learn skills in their home environment where they feel comfortable and secure, and where they naturally spend their time at a very young age. This intervention also lends itself to the involvement of caregivers. Essential daily living skills, like hygiene or personal care, eating, and bathing, are typically easier to teach in the environment in which those activities occur.

Many states and payers advocate specifically for services to occur in the home. However, living situations, work schedules, availability of services, and other variables may preclude some families and individuals from home-based services as a primary treatment option.

Due to this challenge, the preference of some providers, and other issues, center-based programs are the subject of increased advocacy and popularity. Center-based therapies can be extremely effective because the environment provides structure and control. While a child may have some structure in a home environment, the staff at centers have the ability to create and enforce a structured routine using the clinical setting. They can control the environment, control distractions, and create mock situations to teach skills—like paying attention, taking turns, and following instructions. They can enforce the skills while familiarizing the child with the environment and routine of specific tasks.

Environments can also be manufactured in center-based intervention to expose children to specific situations and teach critical skills. For example, if a child is preparing to attend school, staff can create an environment that mimics the classroom and help the child learn the basic skills, like following directions and participating in a group environment.

There is considerable discussion in the literature about the generalization of skills which is a critical component of skill acquisition and development. Individuals with autism often experience challenges with generalizing a skill that was learned in one environment and moving it to another environment or another person. For example, if a child learns to respond to a request delivered by a specific interventionist in a specific room, the child may not respond to the same request when delivered by a different interventionist or in a different setting. Historically, research has demonstrated that generalization of skills is compromised when services occur in a center-based setting. More recent research focusing on parent behavior has shown that parents who participated in a center-based training program focused on facilitating generalization of skills in their children at home implemented the program successfully. Their children maintained their skills acquisition in multiple environments.

Providing intensive center-based services to children under the age of 5 presents considerations that need to be accounted for. For example, most children under 5 need to nap during the day. Maintaining a routine of appropriate nap time is critical for the development and growth of young toddlers’ and children’s’ bodies and brains. This complicates service delivery because of space requirements and noise restrictions, as well as the costs of maintaining staff during these activities. Some centers fail to meet this need. One can also question whether it is appropriate for a young child to be receiving intervention in a center for 8 hours per day.

Parental Involvement

Regardless of whether the program is based in-home or at a center, service providers should emphasize the importance of parental or caregiver involvement. When the parents or caregivers are included in the treatment program and learn the skills and strategies to continue the program on their own, the child can be completely immersed in the intervention. This establishes a system of contingencies and reinforcements that continues consistently at home and at the center—twenty-four hours a day, seven days a week.

Service providers should work with parents or caregivers to help define goals. The goals should be small at first to help facilitate the parents’ or caregivers’ participation and confidence as “teachers.” It is also important that the goals be relevant to family life, such as eating and sleeping habits, and that they are tailored to fit into the natural routines of each family.

Specialists providing home-based services face the unique challenge of having to provide intervention within an existing family dynamic. Sometimes that dynamic can be very challenging. The ideal situation utilizes caregiver or parental support. However, in some cases, this kind of support is not possible. That’s why it is particularly important that additional options be made available to the market; whether they be center-based, or even hybrid in nature.

As autism prevalence increases and more children with autism prepare for adulthood, the autism services industry needs to advance with the growing need. Early intervention and therapies that teach important life skills are increasingly important. Center-based intervention with caregiver involvement can be a very valuable option. But whether a child’s best program is home-based, center-based, or a combination, there is room for advancement and enhancement of current programs, services, and outcomes.

Article written for Forbes.com.

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Supporting Neurodiversity in the Classroom

One concept frequently lost in the education of autistic children is that the purpose of education is to prepare them, not only for managing childhood but for succeeding in adulthood as well. Autistic adults are seeking the same markers for happiness as neurotypical adults. They are looking for as much independence as possible—a job to support themselves, a strong social network, the pursuit of their passions and fulfilling relationships.

The current services provided by the autism industry are ill-equipped to provide autistic individuals with the skill sets they need to live and thrive independently. While our science provides for the tools to make this happen, there are too few providers focusing on what needs to be learned in adolescence to prepare young autistic adults for employment and independent living. Too few providers are truly engaged in measuring the long-term outcomes and quality of life indicators of the services they are providing to the child and their family. They fail to view their young clients as the adults they will become. Autistic adults and their families have a myriad of frustrating and distressing tales about the mismatch between their early education and the tools they need to function as adults.

Most younger autistic adults today were educated under the law now known as IDEA, the Individuals with Disabilities Education Act, which mandates that physically and mentally disabled children be educated in the “least restrictive environment.” This led to the mainstreaming of many autistic students. The goal of this law is to provide disabled students with the same opportunities to participate and succeed in life as neurotypical students.

Teaching autistic children in a class of neurotypical students requires a new kind of thinking on the part of teachers and administrators. However, not all teachers and school districts are prepared or equipped to manage the variety of student needs, which can be overwhelming. This is one area in autism services that could use significant improvement.

When we think about educating students with autism and their unique needs, it’s crucial that we remember these students should not be viewed as “broken,” needing to be “fixed” or normalized. This is an old viewpoint that drove much of the research and intervention in the early years of treating this disorder. Instead, our educational system needs to equip them with the skills and tools they will need to navigate the next 60-70 years after they leave high school. Most of the autistic adults with whom I have spoken want to be viewed as themselves, as diverse individuals who perceive the world differently, adding to the diversity of our population with a unique matrix of strengths and stretches.

The “neurodiversity” approach to classroom education recognizes and respects the mosaic of neurological differences as part of human variation, like eye color and personality. It focuses on aiding autistic individuals to interact successfully with their environments, and learn how to communicate with and navigate a world designed around the neurotypical majority.

Dr. Thomas Armstrong, executive director of the American Institute for Learning and Human Development, and author of books about neurodiversity, advocates for embracing the strengths of a neurodiverse student ecosystem by incorporating new approaches into school curricula. Some of his ideas include:

  • Computer programs and applications that allow students with special needs to overcome obstacles.
  • Networks of experts with whom educators can consult to support the social and emotional lives of neurodiverse students.
  • Innovative learning strategies that are tailored to each student’s unique strengths.
  • Guidance towards future career paths for which a student’s particular passions and preferences might be a good fit.
  • Modifications in the school environment that allow for seamless inclusion of neurodiverse students in the regular classroom.

 

Dominican University of California offers a course called “The Gifts of Autism” to educate teachers on how to take an asset-based approach towards educating students with autism. The class encourages teachers to consider how the strengths and weaknesses of autistic students in their classrooms are supported. Assignments require the study of methodologies and strategies to improve that support and explain how they will be deployed.

Classroom neurodiversity advocates point out that there is nothing particularly novel about the idea of employing multiple teaching methods within a single class. Even in classrooms comprising only neurotypical students, educators must accommodate a variety of learning styles like auditory, visual, tactile, and so on.

“Just as we celebrate diversity in nature and cultures, so too do we need to honor the diversity of brains among our students who learn, think, and behave differently,” says Dr. Armstrong.

 

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What is Covered? The Insurance Landscape for Autism Services

In today’s health care ecosystem, the availability and quality of a field of services are dependent on insurance coverage. In the world of autism services, the tableau of insurance coverage is decidedly mixed.

Children with autism spectrum disorders are generally covered by health insurance for services they require, but not universally. All but two states require private health insurance to cover autism services. Other states may require limited coverage under mental health provisions. Federal employee health benefit plans cover ABA with prior approval and certain restrictions.

ABA is a critical piece

Because early intervention ABA programs are critical to successful treatment, this might sound like good news, and it generally is. Insurance coverage provides access to treatment for many families who could not otherwise afford it.

But it is a qualified success.

There are two major issues with insurance coverage for autism services. One is the amount or intensity of services funded. The other is quality.

As a group of genetic neurodevelopmental disorders, autism is not something to be “cured.” Treatment is optimal when it is intensive and sustained over many years. The best treatments available for those on the autism spectrum are rooted in the science of applied behavior analysis (ABA), a mostly one-on-one treatment approach based on understanding behaviors and how they are affected by the environment. ABA therapy is costly—though foregoing ABA therapy is far more expensive in the long run.

On average, ABA therapy costs $17,000 annually for a child on the autism spectrum, according to the Centers for Disease Control. For many individuals, this number is closer to $45,000-$100,000 annually. Many states mandate private insurance cover up to $36,000, with some as much as $50,000 annually. But others don’t.

The impact of insurers

Even when coverage is mandated, that may not be a panacea. One private insurer, with whom I have had numerous frustrating conversations, reimburses at rates no provider can accommodate without significantly reducing quality and hiring interventionists who are not well-trained. The rates are fabricated on minimum wage pay as a baseline, precluding the necessary growth of clinical skills in technicians and advanced educational training, not to mention any ability to invest in recruitment and retention of talent.  At this wage level, service providers are competing with companies such as Walmart or Starbucks for skilled ABA behavior technicians whose work with vulnerable children requires many hours of ongoing training and supervision to meet quality standards. This is not an easy job, often requiring many hours of commuting between clients’ homes and management of complex family issues.

What we are left with are employees paid as if they are unskilled and fungible while tasked with building the brains of our precious children, teaching them the skills critical to communicate, learn, and become functioning, independent adults.

Even more important is what health insurance covers. As you are likely aware, lacking a consensus in the industry about outcome measurements, insurance companies are stepping into the breach and dictating their own standards. Because insurance companies are just learning about ABA they generally have limited appreciation for the complexity of maintaining a good ABA therapy program, and this is distorting the provision of care.

Cutting corners and thinking short-term

Let’s look at an example. Many programs require providers to demonstrate short-term outcomes, such as whether a child can respond to their name, often ignoring long-term goals such as developing the skills to care for themselves as an adult. Insurance companies have a short time horizon because they are not likely to provide coverage beyond age 18. Their entire worldview with respect to children with ASD is narrowly focused on childhood. Not surprisingly, recent studies of adults with autism have revealed a distressing lack of personal independence and quality of life.

A recent court case against United Healthcare illustrates the issues our industry has with insurance. A U.S. District Court judge ruled the company adopted coverage guidelines for people with disabilities that focused more on its bottom line than on patient care.

The subject concerns all of us; not just those connected to people with autism. Many people on the autism spectrum have spectacular neurodevelopmental assets in addition to their deficits, and that potential is being wasted. In addition, each child with autism whose treatment fails to prepare them to achieve any kind of self-reliance as an adult will continue costing families and society between $1.4 million and $3.2 million over their lifetime. It is an immense waste of human potential, both financial and otherwise, and we all pay the cost.

Article written for Forbes.com.