Small Tasks, Big Triumphs: Adaptive Functioning in Autism
From communication and social skills to goal-oriented daily tasks, here's what you need to know about adaptive functioning in autism
For Ellen Geib, family meals are a reminder that life’s smallest tasks can also be its biggest triumphs. Her younger brother is severely autistic. At 8 years old, he began learning to set the table one utensil and cup at a time. Now 20, he does it daily without prompting.
“Adaptive functioning skills — daily activities such as brushing your teeth, unloading the dishwasher, setting a table, treating a minor cut — are what everyone needs for successful living,” says Geib, a third-year clinical psychology graduate student at Seattle Pacific University who is focusing on autism research.
Autism spectrum disorders (ASD) are developmental disorders that impact behavioral, cognitive, communication and social skills. According to the Centers for Disease Control and Prevention, one in 68 children has been diagnosed with ASD in the U.S.
“It can be easy to focus on academic performance and improving language and communication. There can even be great success in those areas with the promise of going onto college and getting a job,” says Gary Stobbe, director of Seattle Children’s Adult Autism Transitional Services.
“What is sometimes left behind are the important elements of adaptive skills, which are also needed for some sense of independence,” Stobbe says. “It’s amazing how learning even one basic skill can make a dramatic change in an individual’s life.”
From language to meals
Adaptive functioning encompasses communication and social skills in addition to goal-oriented tasks such as cooking, cleaning or riding a bus. However, impaired adaptive skills are not necessarily indicative of intellectual deficits.
“Intelligence is often separate from learning basic life skills,” Stobbe says. “It can be like a genius who doesn’t know to open an umbrella in the rain.”
According to a 2012 study by UCLA and the Children’s National Medical Center, early childhood language skills are a better predicator of increased adaptive abilities as an adult.
“Language is often a struggle for kids with autism. The hypothesis is that helping them gain language abilities earlier in life may help with both communication itself and have a spillover effect of improved [adaptive] skills like making a meal. It’s an exciting area of intervention,” Geib says.
According to Stobbe, such language skills are more than teaching the alphabet. It includes subtle communication cues, which are crucial in navigating adaptive functioning situations. For example, a raised eyebrow might signify surprise or excitement.
“Typically developing children often learn by what almost seems like osmosis. It’s a lot through observation or they’re shown an activity and it becomes innate,” Stobbe says. “Social rules and indicators we take for granted don’t come naturally for those with autism. They need to be explicitly taught.”
For Geib’s brother, mastering skills such as setting the table fostered a sense of confidence. He now helps sort clothes at Goodwill and folds towels at a local hotel.
“It’s often on parents’ minds about how they can help their child through the day safely and successfully,” Geib says. “Adaptive skills are not necessarily at the core symptoms of autism, but they are important in moving toward independence.”
Tucker Jack has a full schedule. The 23-year-old attends weekly music, art and cooking classes at the Alyssa Burnett Adult Life Center. Opened in April 2014, the Bothell center serves individuals 18 years and older with ASD and other developmental disabilities.
“Tucker had a lot of anger issues dealing with [ASD] during puberty. He’s calmer now. He gets up in the morning and loves to get dressed on his own. He shows me his artwork, makes toast with jam, feeds himself and is more amenable to instruction,” says Tucker Jack’s father, Kim Jack.
A weekly schedule of 25 classes ranges from gardening to fitness. Independent living instruction focuses on adaptive functioning skills, such as shopping, cooking, money management, job preparation, etiquette and more. Teaching is tailored to meet the special needs of students.
“Kids [with ASD] need more structure and repetition. It requires a longer period of time than it does for someone with typical development,” says Bev Wilson, professor of clinical psychology and director of Seattle Pacific University’s Initiative for Individuals with Intellectual and Developmental Disabilities.
Whether in a classroom or at home, mentors and teachers should break lessons into the smallest chunks possible. If setting a table, start by demonstrating the placement of just one utensil and help the student master that before adding another component. Always be explicit with instructions.
“Most people would say you put the peanut butter on the bread if they were explaining how to make a sandwich. To someone with autism, that would mean actually putting the jar of peanut butter on top of the bread. You have to break down each and every step and then repeat,” says Tammy Mitchell, program manager at the Alyssa Burnett center.
Many classes at Alyssa Burnett include visual cues in addition to oral prompts. Skills should build progressively. Level-one cooking focuses on basics, such as cleaning a counter and using a microwave. For students who reach level three, lessons include meat handling and cutting techniques.
“New issues emerge at different ages. Life skills change, and sometimes refreshers are needed, too,” Stobbe says.
The Alyssa Burnett center boasts an 85 percent retention rate, with most students returning to take new or more advanced classes. According to Mitchell, both youths with ASD and their families recognize that “consistency and practice are the only ways to continue to progress.”
“You realize that your kid can do a lot more than maybe you thought. There are things I can teach him to do. Alyssa Burnett was the catalyst for setting the tone for learning skills that can be introduced at home,” says Kim Jack. “It gives me so much hope for [my son’s] future.”Google+