Running Head: COUNSELING ADULTS WITH ASPERGER‟S
Counseling Asperger‟s 1
Rehabilitation and Vocational Counseling for Adults with Asperger’s Syndrome
University of Pittsburgh
Scholarly Paper: HRS 2926
Dr. Donald Angelone, Dr. Michael McCue, and Dr. John McGonigle
April 18, 2008
Counseling Asperger‟s 2
Adults with Asperger‟s Disorder, despite being of typical intellectual ability, struggle without
supports in higher education and the workplace. The following literature review begins by
defining the population, specifically the social deficits, restricted and repetitive interests, sensory
issues, executive function deficits, and common co-morbid diagnoses of adults with Asperger‟s.
Social rehabilitation should revolve around cognitive behavior therapy, social skills groups,
education, and visual assistive technologies that promote generalization of skills. Cognitive
rehabilitation should include modifying the client‟s sensory environment to improve attention
and visual cues to promote memory and organization. Finally, implications for rehabilitation and
vocational counselors are discussed, including challenges and techniques for promoting success
in higher education and in the workplace. Specifically, the importance of forming a therapeutic
relationship, providing communication and social supports, and matching the job to the client are
highlighted. While this paper reviews interventions and strategies that are generally effective for
adults with Asperger‟s, each client should be considered on an individual basis and receive
distinctive services and supports.
TABLE OF CONTENTS
Counseling Asperger‟s 3
List of Figures .............................................................................................................................5
Introduction and Statement of the Problem ..................................................................................6
Electronic Search .....................................................................................................................7
Analysis of Resources..............................................................................................................7
Literature Review ........................................................................................................................9
Psychological and Medical Aspects .........................................................................................9
Impairment in Social Interaction ..........................................................................................9
Restricted and Repetitive Interests...................................................................................... 11
Sensory Integration ............................................................................................................ 11
Academic/Vocational Characteristics ................................................................................. 13
Co-Morbid Diagnoses ........................................................................................................ 15
Psychosocial Rehabilitation ................................................................................................... 18
Cognitive Behavioral Therapy ............................................................................................ 19
Social Skills Groups ........................................................................................................... 24
Psycho-Education .............................................................................................................. 28
Assistive Technology ......................................................................................................... 29
Cognitive Rehabilitation ........................................................................................................ 33
Attention ............................................................................................................................ 34
Memory ............................................................................................................................. 35
Organization ...................................................................................................................... 37
Problem Solving ................................................................................................................ 38
Counseling Asperger‟s 4
Flexibility .......................................................................................................................... 39
Central Coherence .............................................................................................................. 40
Implications for Rehabilitation Counselors ............................................................................ 42
Rehabilitation Counseling Techniques ............................................................................... 42
Meeting Educational Support Needs................................................................................... 46
Meeting Vocational Support Needs .................................................................................... 49
Summary and Conclusions ........................................................................................................ 57
References ................................................................................................................................ 59
Appendix .................................................................................................................................. 68
LIST OF FIGURES
Counseling Asperger‟s 5
Figure 1. Characteristics of specific sensory processing patterns according to Dunn‟s conceptual
model of sensory processing (Dunn et al., 2002, p. 175) ............................................................ 12
Figure 2. Social skills group program (Howlin & Yates, 1999, p. 301) ...................................... 25
Figure 3. Topics and guiding questions covered in Aspirations sessions (Hillier et al., 2007, p.
111) .......................................................................................................................................... 27
Figure 4. Types of jobs found by supported clients with Asperger‟s (Howlin et al., 2005, p. 538)
Counseling Asperger‟s 6
INTRODUCTION AND STATEMENT OF THE PROBLEM
Adults with Asperger‟s Disorder are becoming more common in society, due to either an
increase in prevalence of the disorder or more accurate diagnosis. However, most research on
Asperger‟s is conducted with children; which is to be expected given Asperger‟s is a
developmental disorder most often diagnosed in early childhood. Regrettably, many programs
are only funded for children and services for individuals with Asperger‟s taper off dramatically
after the child turns 18 or graduates from high school. While there are a plethora of books,
resources, and training available for primary education teachers on how to work with children on
the autism spectrum, once these young adults enter the real world, they find that their professors
and bosses are either unaware of or unsympathetic towards their disability. Rehabilitation and
vocational counselors struggle to apply strategies that have been successful with other
populations—traumatic brain injury, ADHD, and learning disabilities—to Asperger‟s. While
some of these interventions may be effective, they do not fully address the social and cognitive
deficits that are unique to individuals with Asperger‟s. To date, there is not a comprehensive
account of what Asperger‟s looks like, and what interventions and therapeutic techniques would
be effective for helping adults achieve success in higher education and careers.
The following discussion will begin by defining the population, examining both the
diagnostic criteria and common characteristics and co-morbid diagnoses of Asperger‟s. Social
and cognitive interventions, counseling and technology-based, will be examined. Finally,
specific techniques rehabilitation and vocational counselors can use to form a solid working
relationship with clients and help them to be successful at school or on the job will be reviewed.
With the right therapies, interventions, and supports, individuals with Asperger‟s can lead
fulfilling lives as productive members of society.
Counseling Asperger‟s 7
The OVID databases PsycINFO, MEDLINE, and CINAHL, as well as the PubMed
database were searched using terms that included but were not limited to: Asperger‟s Disorder,
psychological, medical, impairment, social interaction, restricted and repetitive interests, sensory
integration, co-morbid diagnosis, rehabilitation, cognitive behavioral therapy, social skills
groups, assistive technology, attention, memory, organization, problem solving, flexibility,
counseling, vocational, academic, higher education, and support. Articles led to the discovery of
several pertinent journals, including Focus on Autism and other Developmental Disabilities,
Journal of Autism and Developmental Disabilities, Autism, and Journal of Vocational
Rehabilitation, which were then browsed for relevant articles. The reference sections of all
important articles were searched for further resources and also for prominent authors and
researchers in the field. The author also interviewed several individuals who are currently active
in the field of Asperger‟s rehabilitation.
Analysis of Resources
Ideal resources are recent (within the last 10-15 years) adult-focused, and Asperger‟s
specific. Most information reviewed is relatively recent, but all important research, whenever
conducted, is included.
Most autism spectrum research is child-focused. Given the motivation of this paper,
research focusing on high school graduates and adults was the primary focus. However, due to a
lack of publications that focus on adults with Asperger‟s, occasionally younger population-
focused articles were included if the results could theoretically be applied to adults. It is clearly
stated when the results described are based on research that used children or adolescent subjects.
Counseling Asperger‟s 8
An attempt was made to focus on articles that were concerned solely with Asperger‟s
Disorder, not the entire autism spectrum. However, in research, often individuals with
Asperger‟s and high functioning autism were grouped together. Also, because there are
similarities between Asperger‟s and autism, (e.g. restricted and repetitive interests), if research
was concerned with an aspect of autism that is shared by individuals with Asperger‟s, it was
included. In these ways the meager recent research on adults with Asperger‟s was supplemented.
Psychological and Medical Aspects
Counseling Asperger‟s 9
Asperger‟s Disorder is a Pervasive Developmental Disorder (PDD). The American
Psychiatric Association‟s (ADA) Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, gives the following criteria for Asperger‟s Disorder:
A. Qualitative impairment in social interaction
B. Repetitive and restricted stereotyped patterns of behavior, activities, and
C. Clinically significant social, occupational, or other functioning impairment
D. Absence of a clinically significant general language delay
E. Absence of a clinically significant delay in cognitive development or in
development of age-appropriate adaptive behavior (other than social
interaction), self-help skills, and childhood curiosity about the environment
F. Failure to meet diagnostic criteria for schizophrenia, or for other types of
pervasive developmental disorders (p. 84).
In an effort to define the population, what follows is a more detailed description of criteria A and
B, as well as an explication of other common characteristics and co-morbid diagnoses of
Asperger‟s, as they apply to the adult population.
Impairment in Social Interaction
Asperger‟s is primarily a social disorder. However, unlike individuals with profound
autism, those with Asperger‟s desire social interaction, but they do not know how to
appropriately achieve it (Myles & Simpson, 2002).
Counseling Asperger‟s 10
Individuals with Asperger‟s struggle with spontaneously inferring the meaning of facial
expressions, matching events with facial expressions, interpreting subtle social prompts, and
performing within social norms regarding eye contact, proximity to others, gestures, and posture
(Myles & Simpson, 2002; Koning & McGill-Evans, 2001; Myles & Southwick, 1999). It is
unsurprising that the combination of the desire to be social and the inability to comprehend the
complex and subtle social rules leads to a great deal of stress and anxiety for this population.
However, because these individuals are unskilled at expressing their emotions through the
typical means (e.g. voice inflection, posture), situations can escalate to an explosion before
others realize the individual was feeling anger or excitement (Myles & Simpson, 2002; Myles &
Individuals with Asperger‟s especially struggle with “theory of mind” issues, (i.e.,
understanding that others have feelings and thoughts different from their own). Myles &
Simpson (2002) identified three areas where theory of mind is especially difficult for those with
Asperger‟s: ability to understand the intentions of others, ability to understand how their
behavior affects others, and ability to participate in reciprocal skills, such as turn-taking.
In an interesting study, Klin (2000) showed a silent cartoon with geometric shapes
enacting a social plot to three groups of adolescents and adults: (1) high-functioning autism, (2)
Asperger‟s, and (3) a neurologically typical group. In both clinical groups, one third of their
attributions were irrelevant to the cartoon, they missed three-fourths of the social elements in the
cartoon, and they used significantly fewer theory of mind cognitive and affective terms. Even
when provided with explicit verbal information regarding the nature of the cartoon, the
Asperger‟s group was still unable to significantly improve their performance. According to Klin,
these results suggest that:
Counseling Asperger‟s 11
When coming face to face with a complex social situation—say, a high school
cafeteria—they might be able to identify only a small number of important clues
required for creating the social context of that setting. Failing to do so might
place them at great disadvantage when having to predict other people‟s intentions
and the select responses that will be appropriate to the social demands of that
situation (p. 840-841).
Restricted and Repetitive Interests
Individuals with Asperger‟s often have restricted and repetitive interests. There does not
seem to be a theme or pattern to the interests; they may be engrossed in geology, astronomy,
mechanics, numbers, fabrics, (Myles & Simpson, 2002) computers, chairs, wrestling, trains,
weapons, or forensic science. However, these interests are not completely random. Individuals
with Asperger‟s are significantly more interested in areas of folk physics (an interest in how
things work) than in folk psychology (an interest in how people work) (Baron-Cohen &
Wheelwright, 1999). This is not surprising given the previously discussed inability of those with
Asperger‟s to comprehend social phenomena. There are several hypothesized reasons for these
obsessive interests: something to talk about, to either facilitate or avoid social interactions, to
demonstrate intelligence, a fun, intensely enjoyable activity, a way to relax, or a way to create
order and consistency, security, and comfort (Barnhill, 2001, p. 262; Bashe & Kirby, 2001).
Because individuals with Asperger‟s don‟t gain much enjoyment from the social aspects of life,
they find pleasure in their special interests (Bashe & Kirby, 2001).
Though it is not a criterion listed in the DSM-IV, Hans Asperger, who first identified and
described Asperger‟s Disorder in 1944, observed that in addition to social deficits and restricted
Counseling Asperger‟s 12
and repetitive interests, his clients had abnormal reactions to sensory input (Dunn, Myles, & Orr,
2002). Individuals with Asperger‟s have a sensory profile that is different from that of neuro-
typical individuals. Specifically, they may differ when interpreting information from the seven
different sensory systems: tactile (touch), vestibular (balance), proprioception (body awareness),
visual (sight), auditory (hearing), gustatory (taste), and olfactory (smell) (Dunn, Saiter, & Rinner,
The following table concisely describes the potential sensory profiles of individuals with
amount of stimuli
we need to notice or
this pattern of
this pattern of
Low Registration Sensation Seeking Sensory Sensitivity Sensation Avoiding
High ability to focus
Appears to be
May have a dull
affect or seem selfabsorbed
May seem “overly
tired” or apathetic
High ability to
generate ideas and
Notices and enjoys
all the activity in the
High ability to
notice what is going
on in the
Particular about task
Distractible in busy,
May seem like a
High ability to
design & implement
Resistant to change
Reliant on rituals to
Figure 1. Characteristics of specific sensory processing patterns according to Dunn’s conceptual model of
sensory processing (Dunn et al., 2002, p. 175)
It is important to understand that individuals may not necessarily have only one consistent
sensory processing pattern. They may have different patterns for different locations, times of
day, or sensory systems. For instance, someone might avoid all tactile stimulation but seek out
or have moderate responses to visual or auditory input (Dunn, Saiter, & Rinner, 2002).
Counseling Asperger‟s 13
Of particular interest in Figure 1 is the bottom row, “Potentially interfering characteristics
of this pattern of sensory processing.” These are the symptoms of Asperger‟s that are often
misattributed to behavioral or attitudinal problems. However, when the sensory needs of
individuals with Asperger‟s are not met, it is very difficult to behave appropriately (Dunn,
Myles, & Orr, 2002).
Because Asperger‟s does not include intellectual or language impairments, one might
assume that these individuals would do well in a school or work environment, especially if they
are not pressured to socialize and have their sensory needs met. In fact, individuals with
Asperger‟s do excel in understanding and retention of factual information (Church, Alisanki, &
Amanullah, 2000). However, it is difficult to predict how someone with Asperger‟s will perform
on a variety of educational tasks. In a 2002 study, Griswold, Barnhill, Myles, Hagiwara, and
Simpson found that participants with Asperger‟s scores on tests including Wechsler IQ, WIAT,
and TOPS-R/TOPS-A were notable for their variety and unpredictability. Participants scored
from far below what might be expected given their grade level to far above average. This
seeming disconnect might be due to the belief that individuals with Asperger‟s struggle with
concrete and literal thinking styles, inflexibility, difficulty comprehending abstract materials,
difficulty understanding inferentially based materials, difficulty with generalizing information,
poor organizational skills, difficulty in discerning relevant from irrelevant stimuli, and difficulty
applying skills and knowledge to solve problems (Frith, 1991; Siegel, Minshew, & Goldstein,
1996; Myles & Simpson, 2002). In other words, individuals with Asperger‟s may struggle with
Counseling Asperger‟s 14
Executive function is an umbrella term for abilities such as problem and goal
identification, organization and planning, insight and awareness, initiation and modulation, and
dexterity, flexibility, and speed. While there is mixed evidence as to the presence of executive
dysfunction in individuals with Asperger‟s, Hill and Bird (2006) conducted an interesting study
in which they compared a group of 22 adults with Asperger‟s to a well-matched control group of
22 neuro-typical adults on a range of tests of executive functions. The executive function tests
were: Behavioural Assessment of the Dysexcecutive Syndrom (BADS), Hayling test, Modified
Cared Sorting test (MCST), Stroop test, and Trail-making test. Overall, once difficulties in
psychomotor processing and visual search were accounted for, there were no significant
differences between those with and without Asperger‟s. However, there were significant
differences on two tests, the Six Elements task of the BADS and the Hayling test. The Six
Elements task consists of giving participants six tasks to work on in ten minutes: two dictation,
two arithmetic, and two picture-naming tasks. Participants are told they are not expected to
complete each task, but they must work on each task, and they cannot work on two tasks in the
same category in a row. This is a test of planning, organization, and monitoring of behavior.
The Hayling test is comprised of two parts. In the first part, participants must complete a
sentence with a word that makes sense, which fits into the context. In the second part,
participants must complete sentence with a word that does not make sense. This is a test of
response initiation and suppression. From these results, the researchers concluded that
individuals with Asperger‟s may have especial deficits in areas of planning, organization, action
monitoring, initiation, intentionality, and goal/sub-goal coordination (Hill & Bird, 2006), all of
which could clearly have dramatic impacts on an individual in a higher education or work
Counseling Asperger‟s 15
Individuals with Asperger‟s exhibit a high rate of co-morbid diagnoses (Sverd, 2003).
Co-morbid, or overlapping/associated conditions, are defined as either (a) coincidental, (b)
causally directly related (i.e., one condition leads to the other), or (c) causally indirectly related
(i.e., another underlying condition led to both the Asperger‟s and the overlapping condition)
(Gillberg & Billstedt, 2000).
Both major depressive disorder and bipolar disorder have been associated with
Asperger‟s (Ghaziuddin, 2002). Most individuals with Asperger‟s present with depression once
they reach puberty (Ghaziuddin, Weidmer-Mikhail, & Ghaziuddin, 1998). For individuals who
want to be social but lack the necessary tools, and are becoming more aware of their isolation,
the development of depression is unsurprising.
Because restricted and repetitive interests are diagnostic criteria for Asperger‟s, it is often
difficult to determine where to draw the line between Asperger‟s and OCD. However, with
Asperger‟s, the obsessions are pleasurable and desirable, whereas with OCD, the thoughts and
compulsions are unwanted. Occasionally, Asperger‟s and OCD do occur together. It is
important to recognize the addition of OCD because of its implications for treatment
All PDD disorders experience a higher level of anxiety than the neuro-typical population
(Matson & Love, 1990). In a 2006 study, Farrugia and Hudson found that adolescents with
Asperger‟s experienced comparable amounts of anxiety with a group of adolescents diagnosed
Counseling Asperger‟s 16
with anxiety disorder, and both groups experienced significantly more anxiety than a non-clinical
adolescent group. The high levels of anxiety were reported by both the individuals with
Asperger‟s and their parents. Possible explanations for this high level of anxiety include
reactions to having to deal with the core symptoms of Asperger‟s, peer relationship problems,
and negative peer interactions (Farrugia & Hudson, 2006), and an inability to be flexible
combined with an inability to predict common life events.
Non-Verbal Learning Disorder
There may be an overlap between people with Asperger‟s and people with non-verbal
learning disabilities (NLD). Individuals with NLD display a tendency towards social
withdrawal, which is similar to the social impairment found in Asperger‟s (Klin, Volkmar,
Sparrow, Dichetti, & Rourke, 1995).
According to the DSM-IV, Attention Deficit Hyperactivity Disorder (ADHD) cannot be
diagnosed if the disturbance occurs exclusively during the course of a PDD (AMA, 1994, p. 93).
As Asperger‟s is characterized as a PDD, it is clinically impossible to have a duel diagnosis of
ADHD and Asperger‟s. However, most individuals with Asperger‟s do present with ADHD-like
symptoms in their childhood and middle school years (Ghaziuddin et al., 1998; Ghaziuddin,
2002), and it can be difficult to differentiate between Asperger‟s symptoms and ADHD
symptoms. For instance, social oddities and intrusiveness can be misinterpreted as inattention
and hyperactivity (Ghaziuddin, 2002). However, some studies have shown that attention deficits
are prominent, if not universal in disorders on the autism spectrum. In fact, there may be a
subgroup of individuals with Asperger‟s that is better defined as having a duel diagnosis of
Asperger‟s and ADHD than simply being on the autism spectrum (Gillberg & Billstedt, 2000).
Counseling Asperger‟s 17
DAMP is a Scandinavian concept that is conceptualized as the combination of ADHD
and motor-perceptual dysfunctions (Gillberg & Billstedt, 2000). It is not uncommon for
hyperactivity to be found in conjunction with poor coordination. Individuals with Asperger‟s
disorder tend to have poor motor skills, including coordination and balance difficulties (Wing,
1981; Smith, 2000). Clumsiness is often present (Ghaziiuddin & Butler, 1997). Children and
youth with Asperger‟s also report difficulty with handwriting (Myles, Huggins, Rome,
Hagiwara, & Barnhill, 2003).
Tics and Tourette Syndrome
There appears to be a close relationship between Asperger‟s and tic disorders or Tourette
Syndrome. Ghaziuddin (2002) describes two studies in which 40-50% of participants with
Asperger‟s experienced tics. In another study, 20% of all school-age children with Asperger‟s
met the criteria for Tourette‟s, while 80% demonstrated some sort of tics (Ehlers & Gillberg,
1993). Kadesjo and Gillberg (2000) found that approximately one third of their participants with
Tourette‟s also displayed symptoms of autism or Asperger‟s.
Violence and Aggression
Individuals with Asperger‟s‟ behavioral problems may be connected to the fact that it is
extremely stressful to function in a world perceived as utterly unpredictable (Myles & Simpson,
2002). However, there is currently not enough information to make a general statement about
whether or not having a diagnosis of Asperger‟s increases one‟s propensity for crime and
violence. When individuals with Asperger‟s do commit crimes, they usually have some similar
characteristics: (a) the criminal or violent acts are an extension of their restricted and repetitive
interests, (e.g., a fixation on weapons leads one to experiment with guns), (b) unlike most
Counseling Asperger‟s 18
individuals or individuals with conduct disorder, when someone with Asperger‟s commits a
crime, he or she is unlikely to attempt to hide or cover-up his or her actions or motivations, and
(c), violence and crime might not have anything to do with Asperger‟s but with an unrelated
undiagnosed psychiatric disorder, (e.g., a major depressive disorder could be the cause of an
attempt to hurt oneself or others) (Ghaziuddin, 2002).
There is a relationship between autism and epilepsy; at least 30% of individuals with
autism experience seizures. However, the link between Asperger‟s and epilepsy, while likely, is
less clear (Ghaziuddin, 2002).
Godbout, Bergeron, Limoges, Stip, and Mottron (2000) found that individuals with
Asperger‟s demonstrated a variety of sleep abnormalities, including decreased sleep time in the
first two thirds of the night, increased number of shifts into REM sleep, and evidence of REM-
sleep disruption. The authors suggested that there is a link between Asperger‟s and defective
Some studies suggest that individuals with Asperger‟s are often underweight and
experience disordered eating (Sobanski, Marcus, Hennighausen, Hebebrand, & Schmidt, 1999).
Psychosocial rehabilitation addresses the first and perhaps most debilitating symptom of
Asperger‟s: impairments in social interactions. At college, socializing is arguably as important
as education; at work, while employers do value an employee who can successfully perform the
functional aspects of the job, “failing coffee break” can lead to termination. Even individuals
Counseling Asperger‟s 19
with Asperger‟s of normal intelligence will likely have difficulty in school and on a job due to
their previously detailed social impairments (Barnard, Prior, & Potter, 2000; Morgan, 1996).
Unfortunately, scientific evaluations of the current social skills training programs for adults are
lacking. This section will focus on specific therapies, counseling-based and technology-based,
that have demonstrated success in improving the social functioning of individuals with
Asperger‟s. Specifically, cognitive-behavioral therapy, group therapy, education, and hardware
and software interventions will be described and evaluated.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is based on the cognitive model of psychotherapy
that believes psychiatric problems are caused by faulty cognitions and beliefs about the world
(Beck, 1976). While Asperger‟s is certainly not caused by faulty beliefs, growing up with a
dramatic lack of social skills can lead to negative thoughts that are over-generalized, self-
defeating behaviors, and rigidity, all of which are potentially treatable by CBT (Ramsay et al.,
2005; Anderson & Morris, 2006) . While there is little available literature detailing treatments
for adults with Asperger‟s, behavior modification programs have been effective with children on
the autism spectrum, and CBT is effective in treating the mood and anxiety symptoms that are
often co-morbid with Asperger‟s. Another benefit of CBT is that it has an experiential
component. Individuals with Asperger‟s learn more by doing than by talking. Role-playing and
behavioral experiments will help the individual to fully understand and generalize behaviors that
are learned (Ramsay et al., 2005).
Therapy for individuals with Asperger‟s is going to look different than typical therapy. It
must be sensitive to the social and cognitive limitations of the population. According to Ramsay
Counseling Asperger‟s 20
et al. (2005, p. 484) there are two features of the therapeutic relationship that must be
emphasized when working with someone with Asperger‟s: 1) therapists are in a position to
provide information and explicit guidance regarding various aspects of social relationships, and
2) the therapeutic relationship provides a useful laboratory for helping individuals with
Asperger‟s learn and practice how to better handle social situations.
Attwood (2003) identified several cognitive distortions that are common in individuals
with Asperger‟s. These include errors of commission (faulty thinking) such as interpreting
situations in all or nothing terms, engaging in magical thinking, tending to overestimate the
likelihood of desired outcomes, resisting taking actions to influence an outcome, and blaming
others for events that are beyond their own control. Ramsay et al. (2005) identified errors of
omission (overlooked information) common in the Asperger‟s population. These include errors
such as not noticing when others are making friendly social overtures.
For errors of commission, Ramsay et al. (2005) suggest using Socratic questions. These
questions can assume the other person had a different point of view, such as, “If that is what you
were thinking, what do you think he/she was thinking?” Questions can also point out objective
or subjective cues, “Did they say they were angry? Was his/her voice raised?” (Ramsay et al,
2005). Instruct the client to practice flexible thinking and seek clarification by using questions
and comments during ambiguous conversations, such as, “Are you serious?” or “I don‟t
understand what you just said” (Attwood, 2004). The therapist can explore automatic cognitions
by asking the client what they thought about something the therapist did or said, then providing
information about actual thoughts and feelings. The therapist can also point out where possible
miscommunications might erupt due to the client‟s communication style, such as not smiling
Counseling Asperger‟s 21
when pleased. Visual cues are also encouraged. Illustrations can be effective in demonstrating
different thoughts from different points of view (Ramsay et al., 2005).
Sometimes a client simply needs more explicit social directions and behavioral
suggestions. Making scripts or creating lists of acceptable and unacceptable small talk topics of
conversation may help an individual feel less anxious in social situations. Role playing with the
therapist, then walking down the street to practice with store employees, can be a valuable
therapeutic activity. The therapist can help an individual develop ways to recognize when it is
time to stop talking, how to make eye contact, when to ask questions, and when to say goodbye.
“Mirroring” the physical behavior of others and summarizing the ideas expressed by others can
be practiced in the counseling setting (Ramsay et al., 2005). However, if even more structure is
needed, the therapist and client together can work to develop concrete guidelines such as: during
conversations, make eye contact and periodically look away, pause and give the other person an
opportunity to talk after you have spoken two sentences, or conversations during work hours
should not last more than five minutes (Ramsay et al., 2005, p. 92).
For errors of omission, affective education should play an important role in the
therapeutic interaction. Naming emotions, discussing why we have emotions, and identifying
different levels of emotions are all important therapeutic activities (Anderson & Morris, 2006;
Attwood, 2004). During the counseling session, social cues during the conversation should be
commented on. The therapist can tell the clients what feelings he/she perceives from the client‟s
facial expression and posture, and the client can practice reading emotions on the face of the
therapist (Ramsay et al., 2005)
One means of learning about emotions of others is comic strip conversations. In this
activity, stick figures are drawn in a social situation, with thought and speech bubbles identifying
Counseling Asperger‟s 22
what the characters are doing, saying, and thinking. Colors can be used to identify the characters
emotions and intensity (Gray, 1998).
When discussing the client‟s own emotions, especially negative emotions, a visual
activity designed to help learn about and moderate emotions is the “emotional thermometer.”
This is a diagram that demonstrates different levels of emotions. Physiological, behavioral, and
cognitive cues to the level of emotion can be marked on the thermometer, and when the
“temperature gets too high,” action steps, such as relaxation techniques, can be taken (Sofronoff
& Attwood, 2003).
Attwood (2004) developed a strategy he has found useful for treating anxiety and anger
in children with Asperger‟s, but which he postulates will also be useful for adults. This strategy
involves creating a personal toolbox full of actions or thoughts that can be used to fix problems
associated with negative emotions. (Perhaps when someone‟s emotional thermometer gets too
hot, they are prompted to choose a strategy from their emotional toolbox.) There are five main
types of tools that go into the toolbox: (1) physical tools, (2) relaxation tools, (3) social tools, (4)
thinking tools, and (5) special interest tools.
Physical tools, represented by a hammer, are tools or actions that physically release
energy. These may include walking, running, riding a bike, shooting hoops, playing a sport, or
dancing. Relaxation tools, represented by a paintbrush, are tools that help calm a person down
and lower the heart rate. Examples of these types of tools are drawing, reading, listening to
music, taking a nap, or routine household chores. Social tools, represented by a two-handle saw,
are tools that use other people as a way of managing emotions. These social situations must be
enjoyable without the stress that can accompany social interaction. The interaction should be
limited to with one other person, a family member or friend who truly appreciates and enjoys the
Counseling Asperger‟s 23
person. Social tools can also involve on-line communication, perhaps in an Asperger‟s support
chat room. Spending time with a favorite pet can also be considered a social tool. Thinking
tools, represented by a screwdriver or wrench, are tools that are used to change thinking or
knowledge. These are the most cognitively based tools. Examples of thinking tools include self-
talk such as “I can do it,” “I can control my emotions,” or “The smart thing to do is ask for help.”
Other thinking tools include putting the event into perspective or making an intellectual project
out of the source of stress (e.g. researching why sounds are so loud in a gymnasium). A therapist
might recommend keeping a picture on hand that reminds the person with Asperger‟s of solitude
and tranquility, that they can look at in times to stress to promote relaxation. The last category of
tools in the emotional toolbox is special interest tools. These tools focus on the restricted and
repetitive interests that individuals with Asperger‟s derive pleasure from. Some other,
miscellaneous tools that may be helpful to individuals with Asperger‟s are medication (if the
individual has a co-morbid diagnosis of depressive or anxiety disorder), enjoyable activities
(such as watching a favorite movie), reading the autobiographies of individuals with Asperger‟s,
and managing the sensory environment. The emotional toolbox is something that can be
incorporated into group therapy or a social skills group. Individuals can share their own
strategies and “borrow” tools from others‟ toolboxes (Attwood, 1994).
It is also important to recognize and discuss inappropriate tools. These are tools such as
violence, engaging in retaliation, taking out stress on an innocent bystander, destruction of their
own or other‟s belongings, thoughts of suicide, self-injury, retreating into a fantasy world, and
drugs and alcohol. Family, friends, professors, coworkers, and bosses might also use
inappropriate tools. Gestures that are designed to be comforting (e.g. a hug or pat on the back)
may serve only to increase the anxiety of an individual with Asperger‟s. Once these
Counseling Asperger‟s 24
inappropriate tools are discovered, the individual should work towards informing the person of
better ways to help them in times of anxiety and stress (Attwood, 2004).
Social Skills Groups
Social skills groups for young adults are far rarer than social skills groups for children,
but the few that have been formed have shown some success (Hillier, Fish, Cloppert, &
Beversdorf, 2007). For example, Mesibov (1984) conducted a 12-week group for adolescents
and young adults with autism and found improvements in areas such as initiating and
maintaining conversations and understanding and expressing emotions. Ozonoff and Miller
(1995) demonstrated that individuals with autism spectrum disorder in a social skills group
showed significant improvement in social-cognitive skills compared to a control group that was
not in a therapy group. There are several benefits to group counseling. It provides an
opportunity for individuals to learn they are not alone, to meet others who think like them; it is
ideal for replicating problematic social situation, receiving behavioral feedback, and practicing
new skills in a safe and structured environment (Ramsay et al., 2005). The following discussion
will look more closely into two successful social skills group and attempt to discern the specific
keys to their success.
Howlin and Yates (1999) conducted a year-long social skills group for adults with
Asperger‟s and high-functioning autism. Their aims were to develop appropriate ways to deal
with social difficulties, with a focus on conversation skills and fostering independence. The
group met once a month for approximately two and a half hours. Each meeting had a specific
agenda (see figure 2), but the first part of each session was reserved for participants to discuss
important life events that had transpired in the last month. The teaching strategies relied heavily
on role-play, team activities, and structured games. Importance was placed on conversation
Counseling Asperger‟s 25
ability, so the group leaders stressed appropriate ways of responding to conversation, the need to
avoid repetitive or stereotyped responses, the need to reply directly and relevantly to questions,
and the ability to avoid inappropriate comments or verbalizations (p. 301). At the end of the
year, all families of the group members reported improvements in the participants‟
communication skills, social skills, appearance, self-confidence, and general independence.
Session Main activities and problem areas covered
1 Initial assessments and planning session
2 Identifying with others; talk and discussion related to „understanding autism‟
3 Identifying and expressing different emotions using role-play
4 Conversational skills: use of video and role play to practice and provide feedback on verbal and nonverbal
behaviors, e.g. body language; proximity; eye contact; turn-taking, etc.
5 Communication with friends and strangers: role-play of scenes in the street or a pub; practice in what to
say; how to initiate and maintain contact; how close to approach; how to take leave, etc.
6 Assertiveness: discussion, role-play and video of how to deal with shopkeepers/others, when there are
problems such as needing help, or being short-changed, etc.
7 Problem solving: how to cope in stressful situations, such as dealing with an emergency gas or water
leak; more work on assertiveness, making needs clearly known
8 Job interviews; how to dress; how to listen to and answer questions; asking question; responding to
verbal and non-verbal cues; general preparation; telephone conversations to apply for work ;practice
with non-autistic volunteers
9 Revision of work on body language; conversational skills and assertiveness; practice in using various
aspects of verbal/non-verbal expression to indicate different emotions
10 Coping with stressful situations: discussion and role-play of how to deal with problems faced by
individuals in the group
11 „Putting it all together‟: attending a lunch party organized by hosts unknown to the group members
12 Final assessment and feedback session
Figure 2. Social skills group program (Howlin & Yates, 1999, p. 301)
Howling & Yates (1999) noted one important limitation of the social skills group.
Individuals with Asperger‟s have difficulty generalizing, so although they were successful in the
group, their ability to use their new skills in the world at large remained limited. There are ways
to combat this limitation. There must be an experiential component of the therapy, e.g. initiating
conversations with strangers in a public pace or calling an acquaintance and asking them to go to
the movies. Because these are high-anxiety situations, therapists should be ready to provide
support to clients during these experiences, as well as provide valuable immediate feedback.
Another strategy is to work social events into the social skills group (Ramsay et al, 2006), which
Howling and Yates have done in session 11.
Counseling Asperger‟s 26
The Aspirations program is another successful social skills group that focused on adults
on the autism spectrum (Hillier et al., 2007). Aspirations is an 8-week program with weekly
one-hour meetings. The aims of the program are to “foster understanding of a range of social
and vocational issues, to enhance insight and awareness, and to provide social opportunities for
group members” (p. 109). The sessions are participant-led with two leaders acting or facilitators
that ensure the participants stay on task. Skills are not explicitly taught; instead, participants
discuss, learn from each other, and problem solve together to arrive at solutions. After
completing the program, participants attend monthly reunions. The objective of the reunions is
to facilitate the transference of skills to the real-world environment, and to continue to encourage
previously established friendships between participants. A description of the topics and guided
questions can be found in Figure 3.
Hillier et al. (2007) evaluated the success of Inspirations by self-report measures,
observational data, and notes. The largest improvement was found on the participants‟ responses
on the Empathy Quotient, a measure of participants‟ perceptions of other people‟s feelings and
their own behavior in social situations. However, the authors are also quick to point out that
many of the benefits they observed and reported by the participants are subtle and difficult to
measure, and were not reflected in any of their measures.
Session Topics Covered Guiding Questions
1: Introductions Member introductions
Group rules and expectations
Review of members‟ friendships &
2: Employment Importance of employment
Achieving member‟ employment goals
3: Friendship Characteristics of a good friend
How to find, make, and keep friends
What do you hope to get out of Inspirations?
Tell us about yourself.
Talk about your current friendships/work
Why is work important?
What job would you like/would suit you?
What do you need to do to get that job?
How does work make you feel about yourself?
What is an employer looking for in an employee?
Why are friends important?
How do you know whether someone is a good
friend or not?
Are you a good friend? In what way(s)?
How can you meet and make friends?
Difficulties that arise during interpersonal
relationships (friends, coworkers, family)
Strategies to overcome difficulties with
Counseling Asperger‟s 27
What problems have you experienced in
relationships with others?
Who has experienced bullying before?
Who has had problems with opposite-sex
How can (specific) issues/problems be avoided?
5: Social event Social even (pizza outing) to provide opportunity to interact socially, practice social skills, and
foster friendships among group members
6: General Important life problems experienced by What are you struggling with in your lives
Effective problem-solving strategies What do you worry about?
What things do you find particularly difficult?
What strategies have you tried in order to deal
with these problems?
What might be good strategies to try in the
Evaluating interactions with others How do you know whether you are getting on
communication Discussing how members‟ behavior well with someone?
and theory of influences the opinions of others What do people think of you (positive and
Are other people‟s opinions of you important?
How do you make judgments about people?
Why is nonverbal behavior important?
8: Review Review skills learned during program and What have you learned in Aspirations?
how these skills will be utilized
How will what you have learned be useful in the
Feedback regarding program
What have you learned about yourself and other
Will you keep in touch with other group
Have you seen any changes in yourself?
How could the program have been better?
What did you like/dislike about the program?
Figure 3. Topics and guiding questions covered in Aspirations sessions (Hillier et al., 2007, p. 111)
There are some notable similarities between Howlin and Yates‟ group and the
Aspirations group. For instance, the groups were of a similar size, 10 and 13 participants
respectively. Both groups had aims involving improving self-awareness. The outlines of the
programs also have some striking similarities. Both involve introductions and identifying others
at the beginning, and conclude with review and final assessments. Both include a social event,
attending a lunch party or a pizza outing. Both include employment related focuses, though
Howlin and Yates focus more on the interviewing aspect of employment. Both also focus on
problem solving and theory of mind awareness. Finally, both programs are fairly long-term.
Howlin and Yates‟ program lasts a year; Aspirations condenses the sessions into two months, but
Counseling Asperger‟s 28
then holds monthly maintenance meetings. By acknowledging the similarities, it is easy to
identify what are widely considered the most important therapeutic conventions for social skills
The main difference of between the programs is that Howlin and Yates took an active
role in leading the group by using teaching strategies such as role-playing, team games, and
structured games. The Aspirations group used a counseling support group model where the
group leaders‟ main role was to pose guiding questions and facilitate. This may be due to the
fact that Aspirations had a higher functioning group, as they only accepted Asperger‟s diagnoses,
while Howlin and Yates‟ group included all ASD diagnoses. It would be interesting to evaluate
the effectiveness of a group where both teaching strategies and support group strategies were
All authors agreed that an important benefit of group therapy is that it has the potential to
decrease the individual‟s sense of isolation. A therapeutic tool used several times by Stoddart
(1999) was to introduce a client to another individual with Asperger‟s. This served both a
learning experience and an opportunity to be accepted and to alleviate the sense of loneliness felt
by many individuals with Asperger‟s. There are other, less formal, ways this can be
accomplished: by providing access to both counseling (e.g. special friends, peer support groups)
and community (e.g. religious groups, hobby teams) supports. Regardless of where or when it
happens, participants in social skills groups often report valuing the friendships they form more
than the skills they learned (Hillier et al., 2007).
A final important CBT intervention is simple information about the diagnosis. Many
individuals have no idea what Asperger‟s is or why they experience the difficulties they do.
Counseling Asperger‟s 29
Information should be presented in an accurate and positive light that is sensitive to the literal
way it is likely to be interpreted. Counselors should be prepared to recommend autobiographies
of individuals with Asperger‟s to clients (Anderson & Morris, 2006). According to Stoddart
(1999) a large part of his therapy included education about Asperger‟s. He found it important
that his clients were able to identify those behaviors that were a symptom of Asperger‟s and
those that were typical of any adolescent or young adult. Howlin and Yate‟s (1999) social skills
group also focused on providing the clients with a better understanding of their social
It is also important to educate those who will be teaching or working with individuals
with Asperger‟s. For instance, what might be interpreted as selfish or even sociopathic
tendencies can be refrained as lacking theory of mind skills (Stoddart, 1999).
Video camera. It is generally believed that the Asperger‟s population has an easier time
understanding information that is presented visually as opposed to verbally (Bernad-Ripoll,
2007). It is also known that individuals with Asperger‟s have difficulty generalizing
information, so just because they can interpret the emotions of others, it does not mean they are
capable of effectively coping with their own emotions. For these reasons, using video tape of the
client him or herself can be an effective tool in learning to recognize and respond to emotions.
Bernad-Ripoll, (2007) conducted a study that aimed to provide direct instruction via
video modeling and social stories. The subject of this study was a 9-year-old boy, but one can
easily see how the same methods could be applied to adults. The researcher videotaped the
participant in his home environment, experiencing a variety of emotions. Social stories—brief,
Counseling Asperger‟s 30
straightforward, and personalized explanations of emotions and coping strategies that include
pictures—were written about five emotions: happiness, anger, anxiety, calmness, and frustration.
During baseline, the participant was shown videos and asked, “How are you feeling?” “Why did
you feel like this?” and “What should you do the next time?” During intervention, social stories
were introduced. The participant read the social stores related to the emotions he was about to
watch in the video. Then, the participant watched the videotaped segment. Then, same
questions as were asked in baseline were presented. In generalization, the participant reviewed a
social story over a four day period. After that period, anytime the participant experienced that
emotion, his parents were instructed to read the Social Sotry and prompt the participant to
engage in the coping techniques recommended in the story (e.g., if the participant recognizes he
is angry, he should sit in a favorite chair and squeeze a ball for a few minutes). Overall, this
intervention was successful. The participant went from a mean accuracy of recognizing
emotions of 55% during baseline to a mean accuracy of 95%; and from a mean accuracy of
correct explanations and action responses of 10% to a mean accuracy of 100% (Bernad-Ripoll,
2007). With a video camera and a digital camera, this intervention could be easily reproduced
and used in a variety of therapy environments.
In a slightly different use of a video camera, Howlin and Yates‟s (1999) recorded their
social skills group participants completing two social tasks (making small talk with a stranger
and requesting information about a job) at the beginning and the end of the sessions. These tapes
allowed participants to objectively evaluate their performance and also appreciate the amount of
progress they made over the year-long group.
Television/movies. In a case study, Breen (2007) used soap operas to promote theory of
mind and recognition of emotions. Soap operas are a visual media, and have a focus on inter-
Counseling Asperger‟s 31
character relationships. The researcher discovered the client‟s love of soap operas before
deciding to use them as a therapeutic intervention (Breen, 2007), suggesting that is a good idea to
use the interests of the client as a starting point for social therapy. If the client is not interested in
soap operas, perhaps another fictional, ongoing media captures their interest (e.g. Harry Potter
movies, sitcoms, dramas, cartoons, etc.). Breen‟s therapeutic plan was to explore a character‟s
situation and emotions through recently broadcast episodes and promotional pictures in
magazines. Pictures were selected that depicted a variety of emotions. The client was asked to
describe the emotions and sometimes speculate about the character‟s thought process. The
accuracy of the client‟s predictions was evaluated though monitoring the storylines. No data
collection occurred, and it was unclear what extent these skills translated to real life. However,
the client‟s teachers did report an improvement in class participation and reduction in imitative
behaviors. Breen (2007) does caution that when using this or a similar therapeutic intervention,
it is important to keep in mind that individuals with Asperger‟s may have difficulty
distinguishing fantasy from reality.
Emotion recognition. One promising method of teaching emotion recognition (ER) is
through an interactive software program called Mind Reading: The Interactive Guide to
Emotions TM (Baron & Cohen, 2006). This software has three components: (a) emotions library,
(b) learning center, and (c) game zone. The emotions library uses photographs, short movie
clips, audio clips, and contextual examples to demonstrate 412 emotions and mental states.
Users can navigate freely, make their own notes, and add faces to a scrapbook for comparison.
In the learning center, emotions can be accessed in groups, lessons, and quizzes that require
matching emotions in faces, voices, and labels. You can also access quizzes about the 20 and
Counseling Asperger‟s 32
100 most common emotions. Rewards (birds, trains, etc., chosen for their potential appeal to
users with Asperger‟s) are given when questions are answered correctly. The game zone
consists of five different games that involve skills such as determining emotions on partially
concealed faces, matching emotions, and evaluating real-world faces. Mind Reading has six
levels of difficulty (Baron & Cohen, 2006).
After using the software for 10-20 hours over a period of 10-15 weeks, adult participants
significantly improved their ability to recognize emotions, compared to both their pre-
intervention scores and to a control group. However, the participants were still limited in how
much they could generalize this new knowledge. (Golan & Baron-Cohen, 2006). An enjoyment
of activities that involve using clear, rule-based systems is consistent with an Asperger‟s
diagnosis. Many individuals with Asperger‟s enjoy using technology and computer programs.
Using software like Mind Reading—predictable, routine, systems-oriented visual technologies—
is an ideal way to support the learning of emotion recognition and other functional deficits
possessed by individuals with Asperger‟s (Lacava, Golan, Baron-Cohen, & Myles, 2007).
Simulation games. While emotion recognition software may help a user to identify
solitary emotional states, software programs that simulate complex social situations are another
potential intervention. Early work indicates that The Sims 2, a simulation game in which players
create characters who navigate a slew of real life activities such as finding a job, maintaining a
home, and forming romantic relationships, has strong therapeutic potential to assist with self-
awareness and exploration of social issues (LoPresti, McCue, and Endres, 2007). If a client
creates a character who has goals and personality characteristics similar to his or her own, issues
such as poor hygiene or lack of motivation will be reflected in the life of the client‟s character,
who will also experience the negative consequences that go along with those behaviors. In The
Counseling Asperger‟s 33
Sims, individuals can navigate stressful social situations in a safe and familiar environment,
which is ideal for individuals with Asperger‟s. According to LoPresti et al. (2007), one client
played multiple characters and observed the different reactions characters had to the same event.
Character‟s reactions to social situations (sadness in response a death) can be starting points for
discussions on social behavior and etiquette. A benefit of the game is that individuals with
Asperger‟s cannot simply focus on their job and home, as every character has a socialization
need that must be met to avoid negative consequences (e.g., character becomes too depressed to
leave the house).
Another simulation game with therapeutic potential is Second Life
(www.secondlife.com), an online 3-D virtual world created entirely by its residents. To
participate in Second Life, a user must first create an avatar. Then, the user can explore the
world, meet other people, buy land, create anything from clothing to buildings, and participate in
the marketplace where items are bought and sold for real US dollars. Because Second Life has
the capacity for real-time interaction between peers, several support groups have already sprung
up, including one for individuals with autism spectrum disorder (Lester, 2005). Real time
communication between a therapist and client is also possible when using second life, which
lends itself well to social role-playing. Role-playing provides an opportunity to flush out social
anxieties such as intimacy, scrutiny, and assertiveness (Gagglio & Riva, 2007).
While there is some research available regarding executive function deficits in the
Asperger‟s population, there is a definite need for research of successful interventions.
Interventions for executive functions deficits for other disorders, such as TBI, ADHD, and
Learning Disorders, should be evaluated for effectiveness with the Asperger‟s population. What
Counseling Asperger‟s 34
follows is a review of the specific areas of difficulty typically associated with Asperger‟s—
attention, memory, organization, problem solving, flexibility, and central coherence—and
suggestions for rehabilitation. The interventions fall into one of two categories: developing the
individual‟s skills in a specific area of weakness, or using the individual‟s strengths to work
around the area of weakness.
Individuals with Asperger‟s struggle with attention. However, as previously discussed,
appearing bored or hyperactive can be misinterpreted as an attention deficit when the actual
problem is sensory. It is an important task of the counselor or therapist to gain an understanding
of the client and his or her sensory profile by observation, ecological assessment (including
checklists, histories, and questionnaires) to determine what the first step is to making meaningful
changes (Dunn, Saiter, & Rinner, 2002).
Changing an individual‟s sensory profile (e.g., making them more tolerant of loud noise)
is not viable. Therefore, the counselor must work with the client to develop ways to compensate
for or work around these sensory distracters, in order to improve attention. Dunn, Saiter, &
Rinner (2002) identified four cognitive and behavioral paradigms that would likely positively
affect a client‟s ability to pay attention. 1
1. Priming: A preview activity that is meant to decrease anxiety and allow exploration. For
example, allow a student to explore a new computer program before a class lesson is
devoted to using it.
1 See Appendix for an adaptation of Dunn, Saiter, and Rinner‟s (2002) table specifying examples of interventions
using learning strategies adjusted for various sensory processing patterns.
Counseling Asperger‟s 35
2. Working Independently: After initial introduction and practice, allow the individual to
compete work in a quiet, solitary environment where they are not reliant on another
individual to assist, initiate, or terminate an activity.
3. Visual Supports: Provide visual cues that help individuals anticipate upcoming activities,
anticipate upcoming transitions, and understand expectations. Auditory cues are transient
and cannot be referred to. This strategy is helpful especially with clients who request
constant confirmation, or spend so much time worrying about what is going to happen
next that they cannot focus on the present.
4. Home Base: Provide access to a location apart from the routine environment where the
client can go to plan, regroup, or recover.
Research is minimal and somewhat conflicting concerning memory deficits in individuals
with Asperger‟s. The overarching theme seems to be that while individuals with Asperger‟s may
have strengths in rote memory skills, they struggle with free recall and use of semantic
information in free recall (Bowler, Gardiner, & Grice, 2000). It has also been suggested that
individuals with Asperger‟s might not have deficits in memory, but deficits in handling the
information to be remembered (Minshew, Goldstein, Taylor, & Siegel, 1994).
In an interesting study, Bowler, Gardiner, & Grice (2000) examined differences in
remembering (“bringing back to mind contextual details of previous events and experiences that
include an awareness of one‟s self,” p. 295) and knowing (“a more abstract awareness of
knowledge,” p. 295) in individuals with Asperger‟s compared to IQ-matched controls.
Researchers found that even though both groups had a similar capacity for memory, the
Counseling Asperger‟s 36
Asperger‟s group relied more on knowing and less on remembering than the matched control
Building on this research, Bowler, Gardiner, and Berthollier (2004) conducted a study in
which they examined whether or not individuals with Asperger‟s would perform better on a test
of source memory when there was support for the correct recall versus when such support is
absent. Participants were shown a list of words and instructed to carry out a simple action with
that word, (“Think of a word close in meaning to…”). Then participants were shown another list
of words, some of which they had seen before and some of which were novel. When they saw a
word they had seen before, they were instructed to say yes. In the unsupported trials, they were
asked to explain what action they did with the word. In the supported trials, they were given a
list and asked to pick which action they did with that word. In a similar experiment, words were
presented either at the top of the screen, bottom of the screen, or read by a male or female voice.
When participants saw or heard a work they had been exposed to earlier, they were to explain
how the word was presented. There were supported and unsupported trials in this experiment, as
well. According to the results, showing supports enhances the source memory to a level
comparable to that of the controls. Without the supports, individuals with Asperger‟s performed
significantly worse than the controls (Bowler, Gardiner, & Berthollier, 2004).
According to the 2000 experiment, individuals with Asperger‟s have trouble with
forming episodic memories. Their memory is based on knowing, not remembering. However, it
is unclear whether or not these individuals are not creating contextual memories, or are not
retrieving them. The 2004 experiment demonstrates that individuals with Asperger‟s benefit
from contextual cues or supports, indicating that episodic memories are made but not retrieved.
Awareness of these memory strengths and weaknesses is invaluable to rehabilitation counselors
Counseling Asperger‟s 37
working with individuals with Asperger‟s. Memory strategies that are likely to make a
significant improvement are those that provide the episodic or contextual cues that individuals
with Asperger‟s are unable to retrieve. Visual cues are better, and verbal information should be
presented concisely to prevent confusion (Kamio & Toichi, 2007).
Individuals with Asperger‟s often have difficulty with organization. When they do not
complete assignments, it is not necessarily because they do not know how to do the work. They
may have forgotten to obtain the necessary materials, or have written down the wrong due date.
Individuals with Asperger‟s thrive on structure and cuing systems (Marks, Shaw-Hegwer &
Schrader, 2003). Because of its unobtrusiveness and ability to present information in a format
that is tailored to the sensory needs of the individual, a Personal Digital Assistant (PDA) is an
ideal support in an educational or vocational setting.
Myles, Ferguson, and Hagiwara (2007) conducted a study in which they evaluated how
effective a PDA was in prompting a 17-year-old boy with Asperger‟s to record his homework
assignments. The target behavior was that the participant would record the subject the
homework was assigned in, the date the assignment was due, and the important details of the
assignment (page numbers, sections to complete, etc.). During baseline, the participant entered
his homework assignments in his planner with a mean accuracy of 33% for history, 29% for
English, and 34% for science. After the intervention, he entered assignments into his PDA with
a mean accuracy of 75% for history, 75% for English, and 33% for science. The authors note
that though this demonstrates improvement, a longer time span would have allowed more
detailed information on the PDA‟s effectiveness (Myles, Ferguson, & Hagiwara, 2007). For
instance, by the time the PDA was introduced into science class, there were only a few days left
Counseling Asperger‟s 38
in the study. It is likely his mean accuracy for entering assignments in science would have
shown improvements similar to history and English, given more time.
In another study, Ferguson, Myles, and Hagiwara (2005) demonstrated that use of a PDA
effectively decreased a participant‟s reliance on adults to complete tasks at home and school.
Why does a PDA prove to be so effective in this population? There are three hypotheses. First,
using a PDA eliminates handwriting demands. As previously mentioned, individuals with
Asperger‟s often report difficulty with handwriting skills (Myles et al., 2003). Second, the PDA
is easy to use. Technology is often appealing to individuals with Asperger‟s, and they pick it up
easily. It is important to note, however, that an individual‟s success with technology is
somewhat limited by the expertise of the person who is supporting them. Finally, using a PDA
can be highly motivating. It is unobtrusive and does not cause the user to stand out from his or
her peers (Myles, Ferguson, & Hagiwara, 2007).
Overlapping with their organizational difficulties, individuals with Asperger‟s also have
difficulty problem solving. Channon, Charman, Heap, Crawford, and Rios (2001) conducted a
study in which they compared a group of adolescents with Asperger‟s to a control group on a
measure of real-life-type problem solving. Several “predicaments,” videotaped awkward
everyday situations, were presented to the participants. Participants were given an opportunity to
ensure they understood the facts, instructed to generate solutions, to select the best solution for
the main character in the predicament (optimal) and the solution they would most likely use if
they were in the predicament (personal), and finally rated their degree of satisfaction with their
optimal and personal solutions.
Counseling Asperger‟s 39
Results showed that the Asperger‟s group required significantly more prompts to
correctly recall the relevant information in the predicament. They generated the same number of
solutions as the non-clinical group, but their solutions were of a lower quality concerning
problem awareness, social appropriateness, and practical effectiveness. Their final solution
quality was also poor, especially concerning social appropriateness. There was no significant
difference in the degree of satisfaction with solutions in the Asperger‟s and non-clinical group
(Channon et al., 2001).
The results of this study show that the participants with Asperger‟s had difficulty with
memory and social awareness, especially. It would be interesting to see if social skills training
as described in the previous section would have a positive impact on problem solving ability, or
help individuals to more accurately evaluate the appropriateness of their solutions. Specifically,
the previously described simulation game The Sims provides opportunities to practice planning
and problem solving skills. For instance, characters have a budget and they must decide which
items are most important to buy, and live with the consequences of their decisions. LoPresti et
al. (2007) report one client spent all his money on a large house, could not afford to eat, and
died. Another client frugally avoided buying a bed, slept on an uncomfortable sofa, and was
very unhappy as a result. Clients must learn to prioritize how they spend their money. For
instance, wants must be addressed before needs, and safety issues must take precedence. Clients
must evaluate which of their character‟s needs can be met quickly, and which are going to take
some time. Characters also encounter problems which much be solved, such as a cooking fire.
This problem might be solved by learning to cook better or buying a microwave, however each
solution will come with its own consequences (LoPresti et al., 2007).
Counseling Asperger‟s 40
The second criterion for Asperger‟s is restricted and repetitive interests. Individuals with
Asperger‟s appreciate routine and predictable activities. Situations in which individuals on the
autism spectrum were said to show an insistence on sameness and/or resistance to change are
(Green et al., 2006, p. 231):
1. A preferred item is unavailable or may have been broken, moved, or misplaced
2. A desirable event or activity is interrupted, cancelled, or delayed
3. The person is subjected to unexpected sensory stimulation
4. The person fails a task
5. A task is left unfinished
It is clear how this kind of inflexibility could cause friction at school or on the job,
however, there is a dearth of information on interventions to help facilitate flexibility. The
clearest way to support someone who is in flexible in any of the above areas is to do as much as
possible to modify the environment to reduce the likelihood of items being misplaced or sudden
sensory input. Other strategies include providing external structure, organization, and stability,
provide predictable and safe environments, educate peers, professors, and supervisors, use
positive reinforcements to widen the range of interests, and teach stress coping skills (Williams
1995). It is also important for counselors to know that flexibility is a weakness of individuals
with Asperger‟s, and placement in a job that requires novel problem solving skills, unpredictable
day formats, or generation of innovative ideas, is going to be difficult to impossible.
Individuals with Asperger‟s have been described as having weak central coherence—
difficulty drawing together diverse information in context (Frith & Happe, 1994). Unlike neuro-
typical individuals who tend to pull information together in an effort to gather a higher meaning,
Counseling Asperger‟s 41
often at the expense of remembering specifics, those with Asperger‟s focus on details rather than
the global picture. This may be due to a lack of schema. According to schema theory,
individuals interpret incoming information based on our own personal schema, our personal store
of knowledge and past experiences. When we learn new information, it is added, ignored, or
transformed to fit into our schema (Bartlett, 1932). Kamio and Toichi (2007) hypothesis that
individual with high functioning autism, similar to Asperger‟s, have difficulty forming schema.
“If schemata are not formed appropriately, new information remains fragmented: it cannot be
integrated into a coherent whole, leading to difficulties in understanding the outer world” (p.
Concept mapping has potential to be a therapeutic tool in helping individuals with
Asperger‟s to focus on the overarching connections between concepts and form schema. The
process of concept mapping involves externalizing a typically internal process. A visual map is
created to document knowledge on a topic, and as new knowledge is gained, links are drawn to
show connections between concepts and ideas. This method, being visual and concrete, draws
on the strengths of individuals with Asperger‟s (Roberts & Joiner, 2007). Concept maps can be
drawn by hand, or with the help of computer programs such as Inspiration Software. Inspiration
has integrated outline and diagram views, and has the ability to create graphic organizers and
expand topics into writing (Inspiration Software, Inc., n.d.). Diagram view has the most
potential to help individuals with Asperger‟s to visualize ideas, concepts, and relationships.
Researchers have found that students with autism spectrum disorder improved their ability to
retain and recall information after a concept mapping session. The participants learned four
times more after concept mapping than they did after traditional teaching methods (e.g. verbal
instruction). Promisingly, participants were able to generalize information learned in concept
Counseling Asperger‟s 42
mapping to other methods of recall. The researchers did point out that some students will need
more structure than others when completing a concept map, and providing a starting point
(usually a title) is often necessary to provide a structural foundation and reduce anxiety about
where to begin (Roberts & Joiner, 2007).
Implications for Rehabilitation Counselors
The following section will review counseling techniques to use when working with
clients with Asperger‟s, as well as specifics on how to meet educational and vocational support
Rehabilitation Counseling Techniques
Clients with Asperger‟s are likely to derive more benefit from counselors who provide
structure, directions, information, and suggestions than counselors who rely on reflection,
emotional encouragement, and support while clients develop their own solutions to problems. It
follows that cognitive-behavioral therapy (CBT), which, as previously described, has been
adapted for Asperger‟s and combined with psycho-education to enhance social and empathy
skills, has potential to be effective with this population. CBT is theorized to be a more effective
therapy than psychoanalysis and other psychotherapies that stress symbolic constructs,
introspection, and interpretation (Attwood, 2003; Cardaciotto & Herbert, 2004).
Individuals with Asperger‟s are likely seeking therapy as a result of pressure or
encouragement from others in their lives. If things are not going well at home or at work, family
members may suggest the individual seek counseling. Reaching out for help is not a common
reaction to difficulties of people with Asperger‟s (Ramsay, 2005).
Counseling Asperger‟s 43
An effective therapeutic relationship is vital to effective counseling. However, it is
difficult to form this relationship with someone whose primary deficits are in understanding and
engaging in social relationships (Ramsay et al., 2005; Hare & Flood, 2000). As previously
discussed, individuals with Asperger‟s have poor communication skills, making interpretation of
their verbal and non-verbal cues difficult. Clients may have poor eye contact, poor voice
modulation, inappropriate affect, or other idiosyncratic communication tendencies.
Perseverating on one topic or making odd metaphors is not uncommon. On the other hand, the
therapist must be aware that some comments made by clients should be taken entirely literally
(Ramsay et al., 2005).
Techniques for Successful Therapeutic Intervention
Forming a relationship with clients, understanding them, and gaining their trust is often
the most difficult part of therapy. When working with someone with Asperger‟s, Ramsay et al.
(2005) suggest make a concerted effort to enter the world of the client. Learn about their inner
experiences. Ask about their interests and hobbies; have them explain their metaphors or media
references (Ramsay et al., 2005). Find out what idiosyncratic ways of expressing thoughts and
emotions the client uses, so that you, the therapist, can also use these specific names of
symptoms and experiences (Anderson & Morris, 2006). Speaking to a stranger is a daunting task
for those with Asperger‟s, if you ask them to talk about something familiar, it will likely
significantly lower their anxiety levels.
Another good starting point is to invite someone close to the client to one of the initial
therapy sessions. This will help the counselor to obtain more objective information about the
client‟s functioning. (Ramsay et al., 2005). Perhaps even recruit this person as a “co-therapist.”
This is someone who the client will communicate his or her goals to, and will help him or her to
Counseling Asperger‟s 44
practice strategies in the real world. Generalization is a difficult skill for individuals with
Asperger‟s and having someone to prompt them to use their techniques in everyday life could be
an invaluable tool.
One way to engage the client in therapy is to provide structure. Individuals with
Asperger‟s struggle with planning, organizing, and prioritizing; external structure can
compensate for these weaknesses (Anderson & Morris, 2006). Be clear about details concerning
where to wait, where to sit, the beginning and ending time of the session, etc. Set an agenda for
each session, including appropriate topics of discussion (Ramsay et al., 2005). Be aware that the
typical therapy hour may not be appropriate for this population. Clients may need shorter
sessions because they are mentally exhausted due to the combined stressors of social interaction
and CBT therapy. Conversely, clients may need longer sessions if they need extra time to
process information or are particularly difficult to redirect from their restricted and repetitive
interests (Anderson & Morris, 2006).
In order to develop workable treatment goals that are relevant to the client, motivational
interviewing techniques that delve into the client‟s desire to change and specific areas of social
interaction that are difficult may be helpful. However, open-ended questions can be difficult for
individuals with Asperger‟s. Use close-ended questions when possible, or give the client several
possible answers they may choose from or use as a starting point when formulating their own
answers (Ramsay et al., 2005). This strategy is especially helpful when clients generate
solutions that are not socially appropriate and the therapist needs to take a more directive
approach with concrete alternatives backed by logical evidence (Anderson & Morris, 2006). In
some cases, it may be helpful to write down questions so that the client can visualize the question
(Ramsay et al., 2005).
Counseling Asperger‟s 45
The use of visual strategies such as writing down questions, using diaries and diagrams,
simple drawings, tape recording, and working together on a computer program are not only ways
to communicate effectively, but also ways for the individual to distance him or herself from the
uncomfortable personal interaction. According to Anderson and Morris (2006), a promising
alternative to traditional therapy is computerized CBT. It works in terms of efficacy, (obtaining
the information regarding situations, thoughts, and emotions to be worked on in CBT) and cost-
effectiveness. One individual wrote on an internet forum requesting feedback from those with
autism who had experienced CBT:
One on one is really hard. I can talk to you like this because I am on a computer
but if I met you face to face it would be hopeless. I would be unable to
communicate very well at all. Most of the AS people I know can communicate
best in writing like this. CBT by computer would be helpful (Anderson & Morris,
2006, p. 295).
Another communication pitfall to be aware of is that of an expectation of reciprocity.
Individuals with Asperger‟s may begin speaking about a topic of interest to them that is either
inappropriate or boring, without noticing social cues indicating they are off topic or annoying. It
is a good idea for the therapist to warn the client early in treatment that he or she may sometimes
have to interrupt the client‟s monologue to ask for more information or provide feedback. It
might be useful to together develop a symbol (raised hand) that means the therapist needs to
interrupt (Ramsay et al, 2005).
It is important to determine the appropriate time to begin giving feedback. Individuals
with Asperger‟s are understandably sensitive to criticism and ridicule, especially by a
professional and a stranger. Feedback about the content of conversations, in the spirit of mutual
Counseling Asperger‟s 46
understanding, can occur in the first sessions. However, feedback about non-verbal behaviors
should generally wait until a therapeutic relationship has been developed. When offering
feedback, provide the rational behind it and do it in an educational way, in the service of
achieving goals stated by the client (Ramsay et al., 2005).
Finally, be attentive. Even though individuals with Asperger‟s might not be as cued in to
social niceties as other clients, they have a history of negative social experiences and interacting
with a counselor should not be one of them. People with Asperger‟s appreciate those who are
reliably present, who make an honest attempt to understand them, and who offer specific and
useful guidance. Ask clients what they think about your, the counselor‟s, statements and
behaviors. This is a useful activity to explore inaccurate interpretations and also for the therapist
to gain credibility as a useful source of information (Ramsay et al., 2005).
In conclusion, the following are five modifications of conventional CBT that will make it
more appropriate and useful for clients with Asperger‟s:
1. Place emphasis on social and affective education
2. Avoid use of metaphors or abstract concepts in favor or straightforward, literal meaning
3. Be directive
4. Use written and visual material whenever possible
5. Involve someone close to the client as co-therapist in order to learn about the client and to
help the client generalize skills outside of therapy
Meeting Educational Support Needs
Given that most individuals with Asperger‟s have average to above average intelligence
levels, it makes sense that many choose to seek post-secondary education. In fact, increasing
numbers of students with Asperger‟s are attending colleges and universities. According to the
Counseling Asperger‟s 47
Americans with Disabilities Act (ADA) of 1990, students with Asperger‟s cannot be
discriminated against based on their disability and reasonable accommodations must be
provided. However, many institutions are providing students with Asperger‟s with the same
accommodations used for students with very different disabilities, even though the needs of a
student with Asperger‟s are unique (Smith, 2007). The following discussion will detail both
obstacles faced by students seeking higher education and supports a counselor can either provide
or help the student to access.
Verbal, socially-based learning is the foundation for current educational practice (Jordan,
2005). Students are expected to discern the important information from a lecture to put in their
notes. Group projects are often a significant portion of a student‟s grade. This modality of
learning is not ideal for individuals with Asperger‟s. Communication barriers cause breakdowns
in other ways as well. Professors do not always provide the direct and specific instructions
individuals with Asperger‟s need to avoid confusion. Students often are unaware they are
allowed to approach professors with questions. The lack of structure in many college courses
can be debilitating to a student with Asperger‟s.
Socially, attending college is also a challenge. Dating and romantic relationships can be
especially confusing. Students with Asperger‟s have trouble interpreting signs from the opposite
sex meaning it is easy for them to either be taken advantage of or labeled a stalker. Failure at
school, socially and educationally, can lead to depression and anxiety (Jordan, 2005).
In an exploratory study, Smith (2007) found that most accommodations currently used
for individuals with Asperger‟s were developed for other disabilities, including extra time on
tests, moderately reduced course loads, registration assistance, limited leaves of absence,
Counseling Asperger‟s 48
assistance for applying for financial aid, preferential seating in the classroom, note-taking
assistance, and specialized housing accommodations. Some of these may be appropriate for
students with Asperger‟s, some may not. However, the types of services that are provided
should depend not on the institution or the labeled disability, but on the unique needs of the
Luckily, there have been some recent developments aimed at providing individualized
and appropriate supports for students with Asperger‟s. A handful of colleges and universities
have taken it upon themselves to provide at least a few appropriate supports for students with
Asperger‟s (e.g. a safe room to relax, peers assigned to be a social translator). One example is
The College Program for Student‟s with Asperger‟s Syndrome at created by The West Virginia
Autism Training Center at Marshall University. Its goal is to provide individualized and
appropriate academic and social supports; faculty, staff, and peer tutor training; and a positive
behavior support approach (West Virginia Autism Training Center, n.d.). The College Living
Experience program serves students in six locations across the country. This program provides
intensive assistance to students with Asperger‟s and other disabilities in three areas: academics,
independent living skills, and social skills. The social skills supports include a peer mentor,
social skills group, and social events (College Living Experience, 2008).
One exemplary program, Achieving in Higher Education with Autism/Developmental
Disabilities (AHEADD), was developed to provide on-site support to students with high-
functioning autism and Asperger‟s. Specifically, AHEADD addresses communication, social,
and organizational skills. Students working with AHEADD receive assistance from professional
staff and peer mentors who work as liaisons, personal advocates, and coaches. Regular meetings
Counseling Asperger‟s 49
are held both with the student and the faculty to help the student manage all aspects of his or her
college career, including: “self-advocacy; faculty/classroom communication, organizational
skills/time management, social skills development, utilization of campus resources, independent
living skills/workforce development” (AHEADD, 2007, n.p.). AHEADD is also committed to
educating the community about autism spectrum disorders.
Unfortunately, this program is neither universally available nor free. AHEADD began in
the Pittsburgh area but will be expanding to support students in Albany, New York, northern
Virginia, and Dallas, Texas, beginning in fall 2008. The cost depends on the school the student
is enrolled in. Some scholarships are available, and AHEADD is currently in the process of
campaigning for funding so that the student and his or her family do not have to pay out of
Meeting Vocational Support Needs
Individuals with Asperger‟s are chronically under- or un-employed. Vocational support
services specifically geared towards individuals with Asperger‟s are rare, but those that are in
effect have reported a high level of success (Nesbitt, 2000; Howlin, Alcock, & Burkin, 2005).
Supported employment results in not only higher rates of employment, but in higher quality jobs
that are more appropriate to the population‟s intellectual and educational levels (Howlin, Alcock,
& Burkin, 2005). The following section will detail both the obstacles people with Asperger‟s
face on the job, and the specific supports vocational rehabilitation counselors can provide to
Individuals with Asperger‟s have been demonstrated to have difficulty with job finding,
problems arising from lack of social understanding, failure to respect coworkers‟ personal space,
Counseling Asperger‟s 50
talking too much, talking too little, over-reliance on supervisors, poor time keeping, anxiety,
slowness, rigidity, and inappropriate dress or personal habits (Mawhood & Howlin, 2005, p.
250). In line with this, Müller, Schuler, Burton, and Yates (2003) conducted a study in which
they interviewed 18 adults with Asperger‟s about their vocational experience. Analysis of the
interview transcripts revealed four major themes identified by people with Asperger‟s
concerning why they have difficulty becoming successfully employed. The four themes are: 1)
mastering the job application process, 2) adapting to new job routines, 3) communication, and 4)
navigating social interactions with employers and coworkers.
There are several aspects of mastering the job application process that individuals with
Asperger‟s had difficulty with: creating a resume, filling out job applications, contacting
potential employers by phone, interviewing, and coordinating the job search process. Because of
their tendency to focus on the details as opposed to the big picture, several participants expressed
not knowing how much information to provide or which experiences to highlight when asked a
question on an application or in an interview. (Müller et. al., 2003).
Individuals with Asperger‟s reported tremendous effort required to learn new tasks,
criticism from supervisors for taking too long to learn new tasks, and being fired for taking to
long to learn new tasks, all of which fall under the heading of adapting to new job routines. New
experiences are both emotionally and cognitively taxing for individuals with Asperger‟s. While
they are fully capable of learning new tasks, mastering new tasks will likely take them longer
than the typical employee (Müller et al., 2003).
Specific communication difficulties experienced by individuals with Asperger‟s on the
job include difficulty processing incoming information, failure to understand instructions,
difficulty “reading between the lines,” being fired because of work place miscommunication, and
Counseling Asperger‟s 51
being reprimanded for asking too many questions. Supervisors may attribute uncompleted tasks
to a poor work ethic, when the real reason is failure to understand the directions. Individuals
with Asperger‟s are often caught in a “catch-22”: if they don‟t understand the directions, their
choices are to incorrectly or partially complete work, or annoy supervisors by asking them
questions about what they just explained (Müller et al., 2003).
Not surprisingly, individuals with Asperger‟s also expressed difficulty navigating social
interactions. Specifically, they had difficulty with small talk, reading facial expressions and tone
of voice, feeling “odd” or “different” from coworkers, feeling isolated or alienated, and being
fired for failing to understand the social requirements of the job. Participants in Müller et al.‟s
(2003) study fully recognized that even though they were capable of completing the work, their
lack of social skills kept them from being successful.
In the same study that asked individuals with Asperger‟s about major obstacles to
successful employment, individuals were asked what supports could help them achieve success
(Müller et al., 2003). Following is an explication of the significant responses—job matching,
individualized Asperger‟s support, Asperger‟s awareness training, communication, and
attitudinal supports—along with other proven successful interventions vocational rehabilitation
counselors can apply to help their clients with Asperger‟s achieve gainful employment.
Job matching. Vocational counselors must learn to develop jobs that are appropriate
matches for individuals with Asperger‟s. Good match jobs are those which:
1. Built on technical skills—particularly savant skills or special interests/obsessions
relating to ASDs
2. Required minimal social skill
3. Followed clearly defined routines
4. Allotted adequate time for learning new tasks
5. Did not result in excessive sensory stimulation
6. Allowed for flexible work schedules (Müller et al., 2003, p. 169)
Counseling Asperger‟s 52
Every individual with Asperger‟s is different, and the perfect job for someone might not have to
fit all of the above criteria. One person might be more sensitive to sensory stimulation but learns
new tasks quickly, another may have a valuable technical skill and not need a flexible work
schedule. Importantly, the perfect job match is not one that only accommodates for the
individual with Asperger‟s weakness. The perfect job will also exploit the client‟s strengths.
Some individuals with Asperger‟s report feeling a kind of pride in their ASD, and frustration that
their strengths are not fully taken advantage of (Müller, et al. 2003).
To further underscore the point that individuals with Asperger‟s are capable of a wide
variety of employment outcomes, following is a table listing the types of jobs found by 89
individuals with Asperger‟s who were supported in employment:
Type of work % of jobs Examples of Jobs
Administration/technical 8% Statistician, chemist, research officer,
Administration/accounts assistant 22% Archiving, accounts, etc.
Technical assistant 13% Library, finance, technical, BT operator
Data entry 6% Keyboard operator, data input
Data management 3.5% IT analyst, web design
Office work/clerical assistant 19% Offices, banks, etc.
Secretarial 1.5% Hospital and university posts
Shopwork 8% Customer service, travel agents, transport,
check-out till etc.
Stockroom 6% Shelf stocking etc.
Postal work 4% Mail delivery/sorting
Other 7% Support worker, nursery, messenger, joiner,
Catering 1.5% Chef, kitchen hand
Figure 4. Types of jobs found by supported clients with Asperger’s (Howlin et al., 2005, p. 538)
Counseling Asperger‟s 53
Before receiving vocational support these clients were either unemployed or working in low-
paying, temporary jobs. Eighty-five percent of the clients were satisfied with their job and 76%
felt their job lived up to their expectations. Ninety-eight percent believed being supported in
employment was helpful and 75% said they could not have managed without this support
(Howlin et al., 2005).
Individualized Asperger’s supports. Vocational rehabilitation counselors should be
willing and able to provide Asperger‟s-specific supports, including: assist with the job search
process, provide on-site job-coaching, facilitate social interactions, and provide mentoring
services (Müller et al., 2003). Supported employment schemes—defined as the process of
enabling a person with a disability to be successful in the work environment by providing, on-
site, all appropriate supports—specifically designed for individuals with Asperger‟s, are
relatively new (Mawhood & Howlin, 1999).
To help negate the previously mentioned difficulties individuals with Asperger‟s express
concerning the job search, the counselor must be prepared to help contact and follow up with
employers and ensure that the work site is a good match (Müller et al., 2003). Howlin, Alcock,
and Burkin (2005) reported that their vocational counselors spent 26% of their time with a client
in work finding activities 2 .
Once the individual gets a job, a job coach would have two primary functions. The first
is to make sure the individual with Asperger‟s is learning the new tasks. The job coach should
be able to help the client break down larger tasks into smaller, more manageable parts, and to
help the client develop strategies to prioritize which tasks should be completed first. The second
2 Of the remaining time, 34% was spent in work support and preparation programs and 40% was spent in
administrative duties (paperwork, meeting with job managers, dealing with enquiries, travel, etc.)
Counseling Asperger‟s 54
function of a job coach is to act as a social “translator” between the client and his or her
coworkers and supervisor. Some social skills training may be necessary. This training should be
specific to both the individual and the workplace environment he or she is going to be entering.
The job coach must be able to explicitly decode coworkers and supervisors‟ body language,
voice tone, and facial expressions for the individual with Asperger‟s (Müller et al., 2003).
In line with these self reports, the typical difficulties encountered in the workplace by
vocational counselors are organizational problems, low productivity, communication difficulties,
socially inappropriate behaviors, general anxiety, and difficulties coping with change. Strategies
used to overcome these problems include role playing, clear written guidelines/timetables, and
disability awareness training (Howlin, Alcock, & Burkin, 2005).
The final suggestion, mentoring services, has a lot of potential. The participants
suggested a mentoring program that is run by and for individuals with Asperger‟s. A job club
provides support and increases networking opportunities. More experienced individuals who
have successfully held jobs could be an invaluable source of information and support for younger
and less experienced individuals (Müller et al., 2003).
Individualized Asperger‟s supports may also include simple environmental
modifications. Requesting a cubicle in a corner and providing a client with a pair of noise
eliminating headphones may be the most effective way to decrease stress and increase
productivity. Vocational counselors should be prepared to conduct vocational community based
assessments and “think outside the box” to provide appropriate modifications to the job or the
Asperger’s awareness training. In general, the public is not as educated about
Asperger‟s as those who experience it would like. Participants in Müller et al.‟s (2003) study
Counseling Asperger‟s 55
expressed the belief that miscommunications and firings could be avoided if coworkers and
supervisors understood about what Asperger‟s is and how it affects an individual‟s performance.
In addition, employers should be aware of the strengths of employees with Asperger‟s.
Specifically, that these individuals typically excel areas such as mathematics and computing,
visuo-motor skills, memory for facts and dates, being punctual, attention to detail, honesty, and
reliability (Howlin, 1997).
The potential of these three vocational supports—job matching, individualized
Asperger‟s support, and Asperger‟s awareness training—was demonstrated in a study conducted
by Mawhood and Howlin (1999). Over two years, the researchers compared the vocational
outcomes of a supported group of 27 individuals with Asperger‟s and a control group of 20
individuals with Asperger‟s. The support program included identifying and obtaining a suitable
job, guidance from the support worker on a full-time basis for the first two to four weeks of
employment, gradual decrease of support while still being available in case of emergency (the
levels of support necessary depend greatly on the individual), and educating potential and
existing employers on how to deal with or avoid problems. The results of the study showed that
significantly more supported individuals found work (63.3%) than individuals in the control
group (25%). In the supported group, job levels were higher, they were in work for a greater
percentage of the time, and they received significantly higher wages 3 . None of the supported
clients who found work were fired due to behavioral or other work-related difficulties.
Significantly, employers and employees agreed that without the support, the extra demands
placed on coworkers and managers likely would have been so great as to result in terminating the
employee. Another reason the job placements worked was the great deal of time that was spent
3 One supported employee was earning more than his support worker.
Counseling Asperger‟s 56
collecting information on both clients and jobs so that successful matches were made. Several
employers had such a positive experience that they were willing to hire more employees with
Asperger‟s. One of the most important roles of the rehabilitation counselor was to form
relationships with employers in order to explore appropriate job opportunities and match those
jobs with individuals.
Communication supports. Communication supports should be offered even in the
interview phase. If possible, educate the interviewer on Asperger‟s and encourage him or her to
make questions as clear and direct as possible and to avoid abstract or misleading questions
(Mawhood & Howlin, 1999). On the job, individuals with Asperger‟s need coworkers and
supervisors to be as unambiguous and succinct as possible when giving instructions. No
instructions should be implied, vague, or incomplete. Ideally, instructions should be given not
only verbally, but also visually (a demonstration or checklist). Regular evaluations of
performance may help to keep individuals with Asperger‟s on track (Müller et al., 2003).
Attitudinal supports. While it may be unfair to expect a vocational rehabilitation
counselor to effect attitudinal changes, individuals with Asperger‟s note that their most
successful job experiences are those in which there is tolerance of differences within the
workplace and coworkers and supervisors are patient and caring (Müller et al., 2003). With the
right type of support, successful employment for individuals with Asperger‟s is possible.
SUMMARY AND CONCLUSIONS
Counseling Asperger‟s 57
Adults with Asperger‟s experience impairment in social interaction and repetitive and
restrictive interests and behaviors that prevent them from independently achieving success in
higher education or on the job. However, they also have typical intelligence levels and a unique
set of strengths. With the right supports, individuals with Asperger‟s have the potential to be
successful in higher education and employment.
Social rehabilitation must be structured with an aim of providing information which can
be practiced and generalized. CBT, social skills groups, psycho-education, and various assistive
technologies can help individuals with Asperger‟s learn about social relationships and to practice
behaving in a socially acceptable manner.
Cognitive rehabilitation should reflect the areas of executive function of particular
difficulty to individuals with Asperger‟s. These areas include attention, memory, organization,
problem solving, flexibility, and central coherence. It is important to recognize the impact
sensitivity to sensory input and being a primarily visual thinker has on these functions.
Finally, rehabilitation counselors face particular challenges when working with adults
with Asperger‟s, the first of which is forming an effective therapeutic relationship. By using
clear, literal language, being directive, using written and visual material as often as possible, and
placing emphasis on social education, the counselor is most likely to effectively use CBT with
individuals with Asperger‟s. Preparing an adult with Asperger‟s for college or a job both have
unique challenges and opportunities to provide supports. While most schools provide a standard
set of ineffective accommodations, some colleges and universities are developing programs
aimed at the specific social and organizational needs of individuals with Asperger‟s. When
working as a vocational counselor, the most important step is to find the right job for the client.
Counseling Asperger‟s 58
Finally, in addition to providing individualized Asperger‟s supports, it is time to educate the
public about Asperger‟s Disorder and begin to facilitate attitude changes.
Counseling Asperger‟s 59
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Overall approach to
Examples of Interventions Using Learning Strategies
Adjusted for Various Sensory Processing Patterns
Counseling Asperger‟s 68
Sensory processing pattern
Low registration Sensation seeking Sensory sensitivity Sensation
Embed sensation to
Priming Prepare for
upcoming task by
Working independently Embed sensations
that meet high
Visual support Place supports in
includes access to
Home base Arrange home base
to offer items that
need for calming
Adapted from Dunn, Saiter, & Rinner, 2002, p. 179.
Embed sensation to
individual dose not
seek out distracting
with sensations that
meet thresholds of
Offer access to
sensations in a
manner that assists
Add sensation to
in home base that
available to learn
sensation prior to
input during work
Place visual so it is
accessible with low
Offer expected or
when introducing a
during tasks with
Use visuals with
to the user
Set up safe room