Program Time & Date

Report of the WHO Collaborating Centre Seminar

Promotion of Employment of People with

Autism Spectrum Disorders

March 2, 2008
National Rehabilitation Center for Persons with Disabilities

Japan

WHO Collaborating Centre for Disability Prevention and Rehabilitation
　　　　　　　 Program

Time & Date: 13:00～16:30 March 2 (Sunday), 2008

Place : Auditorium of the College, National Rehabilitation Center for Persons with Disabilities (NRCD)

Facilitator: Dr. Yasoichi Nakajima, Director, College, NRCD

13:00-13:10 Opening Address

Dr. Tsutomu Iwaya, President, NRCD

13:15-14:00 Keynote Lecture

“Promoting Success for People with Autism in Employment through

Education and Matching of Strengths and Interests: An Inside View”

Dr. Stephen Shore

President Emeritus and Board Member, Asperger’s Association of New England

Member, Board of Directors, Autism Society of America

14:10-16:10 Panel Discussion

Moderators : Dr. Reiko Fukatsu, Director, Dept. of Medical Social Work & Psychology, NRCD

Dr. Yayoi Kitamura, Researcher, Dept. of Social Rehabilitation, NRCD
14:10-15:22 Presentation by Panelists

① “Act on Support for Persons with Developmental Disabilities”

Mr. Masafumi Hizume, Developmental Disability Specialist,

Mental Health and Welfare Division, Ministry of Health, Labour and Welfare (MHLW)

② “Efforts of Employment Support of Persons with Developmental Disabilities”

Mr. Hiroki Ichikawa, Specialist in Employment of Persons with Disabilities, Disabled Worker’s Affairs Division, MHLW

③ “Establishing Consistent Support of Education and Treatment”

Dr. Kunio Yoshino, Director of Nishitama Ryouiku Shien Center

④“Employment of People with Asperger Syndrome and High-functioning Autism”

Ms. Hatsue Suda, Vice Chair, Autism Society Japan and

Executive Director, Keyaki no Sato

⑤ “Self-help Group”

Mr. Morio Minta, Psychiatric Social Worker

(he is with Aspereger Syndrome)

⑥ “Medical Diagnostic Treatment and Support of Autistic Spectrum Disorders”

Dr. Makiko Kaga, Director General, National Institute of Mental Health, National Center of Neurology and Psychiatry

15:25-15:55 Discussion

by Dr. Stephen and above 6 panelists

15:55-16:10 Question and answer with audience

16:20-16:30 Closing Address

Dr. Fumio Eto, Director, Training Center, NRCD


　　　　　　　　 Table of Contents

Opening Address

Promoting Success for People with Autism in Employment through Education and Matching of Strengths and Interests: An Inside View Stephen Shore

Act on Support for Persons with Developmental Disabilities Masafumi Hizume

Efforts of Employment Support of Persons with Developmental Disabilities

Hiroki Ichikawa

Establishing Consistent Support of Education and Treatment Kunio Yoshino

Employment of People with Asperger Syndrome and High-functioning Autism

Hatsue Suda
Self-help Group Morio Minta

Medical Diagnostic Treatment and Support of Autistic Spectrum Disorders

Makiko Kaga

Panel Discussion　

Closing Address

Opening Address

Tsutomu Iwaya

President, National Rehabilitation Center for Persons with Disabilities
Thank you very much for coming and welcome to the WHO Collaborating Centre Seminar “Promotion of Employment of People with Autism Spectrum Disorders” held at the National Rehabilitation Center for Persons with Disabilities.

Today, we have Dr. Stephen Shore as a guest speaker from the United States.

From Japan we have guest speakers who are persons with developmental disabilities, people from medical establishment, education and treatment, job placement and government people. It is an extreme honor for us to have this opportunity to hold this seminar on employment of people with developmental disorders.

For the past few years we have been holding seminars on medical rehabilitation, independent lives and employment support for people with disabilities. Last year with the adoption of the Convention on the Rights of Persons with Disabilities at the General Assembly of the United Nations we held a seminar on the Convention on the Rights of Persons with Disabilities and the Creation of an Inclusive Society. This year we will be holding this seminar in relation to the research and establishment of employment assistance for adolescent people with developmental disabilities, which is research that we started last year in April. That was a response to the law to support persons with developmental disabilities being implemented in 2005.

The basic program for persons with disabilities was established in 2002. Japan sets as its target to build a cooperative society in which all persons with or without disabilities can mutually respect their personalities and individuality in the 21^st century. “Symbiosis” in biology is living in close physical relationship. It means that people who have different characteristics live together to help their descendents for the future. Our society nowadays aims at multiculturalism where people live together as they acknowledge differences as differences.

The difference between people with disabilities and people without disabilities comes from unique psychosomatic functionalities. In other words, they are differences in how they perceive things and how they act. In the society, this is seen as leading to inconveniences being experienced by people with disabilities. In order to coexist with each other we will have to understand these differences. We have to expand our commonalities with each other. No matter how much we increase the commonalities, it would be very difficult to assimilate all unique psychosomatic functionalities. A symbiotic society (in other words, a cooperative and inclusive society) does not simply mean assimilation and amalgamation. It means we have to pursue multiculturalism.

Looking back in history, people with disabilities were seen as losers in the survival race at one point in time. Following that, we saw an era where we tried to overcome the differences by improving or recovering their functionalities and assimilating and amalgamating these people with disabilities. We seek to aim at multiculturalism where people will live as equal components of the society. Multiculturalism means to admit the differences and, in addition to that, develop those differences as diversity and to create a diverse society.

In order to create a symbiotic society where we can overcome the differences, we will need to understand the differences and explain the commonalities but we should not stop at assimilation or amalgamation. In addition to expanding the commonalities, we should expand and build upon the uniqueness of each group and expand diversity.

Having said that, there are people who are still suffering from the differences. In today’s seminar we have to come to grips with and face the difficult reality in society. However, with your participation in this seminar I hope the seminar will be an active seminar to promote the understanding of people with developmental disorders. I hope this seminar will be useful to establish a societal structure to assist the employment of people with disabilities.

Thank you very much for your attention.

Promoting Success for People with Autism in Employment through Education and Matching of Strengths and Interests: As Inside View
Stephen Shore

President Emeritus and Board Member, Asperger’s Association of New England

Member, Board of Directors, Autism Society of America
Konnichi wa. It is my honor to speak in front of you today. I wish to thank everybody involved in bringing me in front of you to share my experiences regarding employment as a person on the autism spectrum.

Work is more than just going to a place to earn money. Work in its best sense is a way of adding meaning to life. We all hope to find employment in areas that interest us. If we’re interested in something we’re probably also good at it. Temple Grandin, who is probably the most well-known person with autism, reports that her life would not be worth living if she did not have intellectually satisfying work. One of Temple Grandin’s strengths has to do with meat processing. As a matter of fact, if you go to the United States and you eat beef the likelihood is greater than 50% that you will have eaten beef that has been processed by one of the cattle processing plants that was designed by Temple Grandin.

While many of us are fortunate to find employment that matches our likes and our strengths, there is a difference with people on the autism spectrum. The reality is for those of us on the autism spectrum there is a combined unemployment and underemployment rate of at least 90%. This is according to a study done by the National Autistic Society in England. In other words, only 10% of us at most on the autism spectrum find employment that matches our strengths and matches our interests. However, if we can find a way to provide proper support we can find ways for people with autism to lead fulfilling and productive lives in employment.

It is our job to change this prognosis. We need to work towards preparing those of us with autism for the world of work. On the other side or one of the other facets is educating the world of work about people with autism at all levels. Then finally is thinking outside of the box. In other words, how creative can we be in regards to finding employment for people with autism and by extension people with other disabilities?

I think one way to look at it maybe is not to use the word “disability” but, as was mentioned before, “difference.” Autism is a different way of being. It’s not necessarily a disordered way of being. Certainly there may be a number of things about autism that are disordering. If you have someone with autism who has not developed a reliable means of communication, that’s quite disordering and there’s something you need to do about that. You may have someone else with autism that has such digestive problems and they’re in such pain that they just cannot concentrate in order to work or to learn.

Let us begin with a little bit about me. Things were pretty typical at first. After a 2 hour labor, my wife says that of 24 hours of age I looked like an egg. Things move along pretty well for those 18 months and then I was hit with the autism dragon. When the autism dragon blew his fire I lost functional communication, had tantrums, got involved in self-stimulatory activities, withdrew from the environment and had self-abusive behaviors. In other words, I was a pretty autistic little child. This was at 18 months.

In those days, my parents had no idea what to do. We’re talking about the early to mid-‘60s. No one had much of an idea of what to do. The incidence rate of autism was considered to be 1 in 10,000. However, for almost a generation now that incidence rate has been climbing to where the Center for Disease Control in the United States now accepts an incidence rate of 1 in 150. That’s a lot of autism.

Where is this increase coming from? There are many questions. However, there are no conclusive answers. Some of it can be attributed to better diagnostics. We are better at categorizing people according to their characteristics. Some people are looking at vaccines. Other people are looking at diet. Some people are considering the environment as a possible cause. The best minds in this area consider autism to start out as a genetic predisposition which then gets triggered by one or more of those other categories that I mentioned. All we know is that if the increase in autism continues the way it has been probably within the next generation we’ll be here talking about employment for people who are not on the autism spectrum because there will be more of us than there are of you.

Continuing on, there’s a lot of autism. I know all through my public school days I was the only child I knew with autism. Now where I live in Boston there are 5 schools within about 15 miles of where I live exclusively for children with autism. The largest one is the Boston Higashi School, which is the sister school of the Musashino Higashi Gakuen. Boston has 189 students with autism there. There are other schools with 89 students with autism and still others in pleasant rooms in public schools devoted to children with pervasive developmental disorders.

It took a full year for my parents to find a place for me to get diagnosed, again due to lack of information. This was at a time when autism was blamed on poor parenting and in particular poor mothering, so the mother was blamed for psychologically damaging her child. The mother rejected the child. The child now in turn rejects the mother and rejects the environment, as well. Fortunately, this myth has been debunked and we no longer believe that.

However, there is still a role for psychiatrists and other mental health professionals for people with autism because there are things about autism that may generate secondary psychological challenges. If you think about it, perhaps anyone who experiences the difficulty that many people with autism experience in successfully interacting in the world, developing relationships and finding successful employment, maybe that will cause depression or some other psychological challenges. If we find a way to work on those with this understanding, that can be very helpful.

At 2 and a half I did get diagnosed with strong autistic tendencies, psychosis and atypical development. My parents were recommended to send me to an institution because the professionals had never seen a child who was so sick. My parents, like so many parents here who advocate on your children’s behalf, refused to listen. Instead, they took my situation into their own hands and provided what we would today call a home-based early intervention program emphasizing music, movement, sensory integration, narration and imitation. In today’s terms, it would probably look like one of the more developmental approaches such as the Neuro method, Floor Time or RDI.

I was very lucky because my parents figured out what I needed. That’s the basis of my doctoral research, matching the existing approaches to best fit the child’s needs. I think that’s an important thing to consider when helping children with autism lead fulfilling and productive lives.

By the time I reached age 4 my speech had started to come back. I got admitted to that special school, the school that had initially rejected me. My diagnosis got upgraded from psychotic to neurotic, so things were moving up in the world. By about age 5 my speech had pretty much normalized but many challenges remained. Public school kindergarten was very difficult. I didn’t know how to interact with my classmates in a way that they could understand so there was a lot of teasing and bullying. Teachers didn’t quite know how to reach me. I was usually about a grade behind in math and in reading.

I remember spending hours at my desk in elementary school reading books on my favorite subjects (various sciences like geology, geography, electricity and dinosaurs) and sometimes wondering if there was more to school than just reading my favorite books. I was very happy to do that but shouldn’t I be reading in groups, for example? I think what that translates to is that teachers didn’t know how to reach me but since I wasn’t a challenge behaviorally they just left me alone to do my own thing, for better or for worse. I think in this particular situation it was probably for better. I remember in about 3^rd grade I had a stack of astronomy books on my desk. My teacher told me that I’d never learn how to do math but somehow I figured out just enough math to teach statistics at the college level—no more, just enough.

Fortunately, today a teacher would see a special interest in this nature. They would see the strength and power behind a focused interest or a passion in astronomy and find a way to link it to mathematics, reading and anything else that needed to be studied.

I consider my first employment delivering newspapers. This was in elementary school, starting at about age 9. That was my first business. It worked very well. You might say that it was a self-employed type of business. I’d get a stack of papers, put them in my bicycle basket, ride around on my bicycle and deliver newspapers. That worked out pretty well.

By the time middle school came around, I was old enough to work in a more formal type of setting. My first job was as a busboy in a restaurant. Initially that seemed good but soon I was overwhelmed by the sensory over-stimulation that is created by working in a busy restaurant. As a result, I’d go into a sort of shut-down mode and work very slowly. That wasn’t helpful and as a matter of fact I lost that job.

My next job was more related to one of my special interests, one of my passions, and that’s bicycles. As a matter of fact, I have 14 bicycles at home. That turned out to be much better because now I was working on something focused on my special interest. Additionally, it was lower stimulation as I worked in the shop room in the back of the bicycle store fixing bicycles. My interactions with other people were also based on my special interests.

I think it’s important for us to learn what the special interests are of people on the autism spectrum. Again, this is the same as for everybody else but for those of us on the autism spectrum it’s a matter of extremes. Whereas most of us are able to tolerate working in a job that we don’t like and we wish we were doing something else, we see employment as way to fund doing fun things in life after we get out of work. Many people work this way. However, for people on the autism spectrum that doesn’t quite seem to work, so it’s imperative that we find a way to link a special interest to employment.

Another thing that we need to consider (and this is one of those “thinking outside the box” things) is how do we find employment for people on the autism spectrum? In finding employment for people on the autism spectrum I refer back to Dr. Temple Grandin, who I mentioned before, who recommends the use of a portfolio. A portfolio is a sample of a person’s work.

As I was looking for bicycle repair jobs I didn’t realize that I was using a portfolio but that’s exactly what it was. I’d get on my bicycle that I built by myself from the spokes and the hubs, the rims, putting it all together down to the last ball bearing. I would ride into a bicycle shop and strike up a conversation with the manager of the bicycle shop. We’d talk about my bicycle. The manager would be very interested. Then I would ask him for a job. By then, it was already clear to him that he knew what I was doing in so far as bicycle repair and they’d be eager to hire me.

That is in contrast to the typical way most people find a job, and that is through a job interview. The job interview is particularly challenging for those of us on the autism spectrum because it requires a lot of social interaction that is difficult for us with autism, one of them being eye contact. You’re expected to make good eye contact with the interviewer and it has to be appropriate eye contact. What I mean by that is that we know that making eye contact is difficult for people on the autism spectrum. However, every now and then I meet with someone with autism who is told, “You have to make eye contact,” and then that’s all they do. They just stare at the other person’s eyes and don’t look away.

In reality, typical eye contact involves glancing back and forth between a person’s eyes, their nose, their mouth, their forehead, objects in the room and then back again. It’s a continuously moving thing. People with autism can learn this type of eye contact. We can approximate it but it requires direct instruction rather than just learning by observation. It’s this type of behavior that’s expected at an interview and if those of us with autism cannot successfully perform this behavior, we’re not the ones to get a job.

In the United States studies have shown that the greatest predictor for success in employment has to do with social interaction. Of course, being able to do the job helps but you have to be able to get along with others in a way they understand and in a way they expect. If that’s a challenge for us, we’re not going to even get in the door from an interview.

Bicycle repair was very successful for me. I continued that all through grade school and continued it into college, where I repaired bicycles to fund my college tuition at the undergraduate level. Again, that worked out very well for me.

Speaking of college, college can be a wonderful place for people on the autism spectrum. It can be very liberating. I remember in college I had more friends. If I wanted to ride a bicycle at midnight I could find someone just as strange as I was to also ride at midnight. College is where I met my wife through a special interest in music, specifically. We’ve been married for almost 18 years. You can find out more about my autobiography plus read the contributions that my wife and my mother have made to my book in the Japanese translation of “Beyond the Wall,” which is available from Gakken Publishers.

I’ve also successfully finished my doctoral dissertation on matching best practice to the needs of children on the autism spectrum. That was another challenge that I saw facing people. People would get stuck in various approaches, such as applied behavioral analysis, to the exclusion of others and to the detriment of children on the autism spectrum. What I see is that autism is a widely diverse condition. Again, it’s a condition, not necessarily a disorder. It’s a difference. It’s a different way of being and by definition there is so much diversity within the autism spectrum that’s going to call for different approaches for people who have different needs.

Speaking of autism, autism is often considered as a spectrum. That’s how most of us look at it these days. It’s a good way to start. It’s a spectrum ranging from severe autism. That’s what most of society considers as autism, a small, non-verbal child rocking in the corner, having tantrums and difficulties with transitions.

One thing that we need to consider (and this has direct relationship to employment) is what happens to these children after about 15 to 17 years. The answer is they grow up to become adults with autism. The leading edge of this increased incidence rate is about 15 to 17 years of age. This bubble of 1 in 150 started almost a generation ago. We have all of these children who have now become very young adults who will leave grade school to go out into the community. The question is what kind of supports are we going to have in order for them to find fulfilling and productive employment, residences and in general lead a fulfilling and productive life?

Now we zoom all the way up to the right-hand side of the spectrum where we see high-functioning autism and Asperger syndrome. What becomes clear here, as it is with the entire spectrum, is the idea of twice exceptionality. What that means is that people with autism have extreme challenges. That’s what people seem to notice. However, we also have extreme strengths because for each challenge there is going to be a corresponding strength.

We all have weaknesses. We all have strengths. If we take a look at a profile of a person it might go like this. Then you’ll have a weak point over here, you’ll have a strength over here and so on. For those of us on the autism spectrum, our challenges will go down into the basement and there will be corresponding strengths that will go through the roof. How do we use these strengths to help people with autism lead fulfilling and productive lives in employment and other areas?

One example of twice exceptionality is a friend and colleague of mine, Kassiane Ana Sibley, a 25 year old lady with autism. She contributed probably the best chapter to my second book, “Ask and Tell,” available from Creates Kamogawa. She has a verbal IQ of over 200. Those of you familiar with scoring IQ tests know that IQ tests don’t go up to 200, so it’s just a guess. She’s an excellent writer and an excellent presenter. She has a lot to contribute to the world. However, on the other side she has extreme challenges in social interaction. She has extreme learning disabilities. She is on a 25 item food diet. If she goes off of this diet not only does she pay for it but so does everybody else around her.

This person, Cassie Ana, is considered to have high functioning autism. Some people would refer to her as having mild autism. The question is what is mild about her autism? Again, she’s not going to be able to find employment the way most of us think about finding employment due to her challenges. What this signifies is that people all over the autism spectrum need support. People with Asperger syndrome may be brilliant at math or some other subjects. They may be brilliant at doing particular jobs. They are often still going to need support in the areas of social interaction and other areas. If we are able to get that support, it’s incredible what we can contribute to the world of work.

That little circle represents where I landed on the autism spectrum, as I mentioned before, at 18 months when the autism dragon breathed its fire and I lost functional communication.

Getting back to employment, it’s important to consider our characteristics. What are the strengths and what are the interests of people on the autism spectrum? This makes me think of a fellow who works in Paddington Station in England. He has high functioning autism. His job is to provide public transportation information to lost patrons. He uses his verbal interaction style to provide this information to questions that people have. What is the communication style of people on the autism spectrum who are verbal? He tends to be direct, factual, to the point and truthful. Is this the way that you want to receive your information when you’re lost or do want to be wading your way through idioms and jokes and trying to figure that out? His communication style is a real plus for him in this employment situation.

There is another part of this employment situation. That has to do with where he gets the information. His coworkers have to look up this information in a manual or in a computer. However, he has this information memorized. That’s because the public transportation system of greater London is one of his passions or special interests. As a result, he can do his job must faster than anybody else.

This is also an example of what I often talk about regarding reframing the characteristics of autism. If we look at the characteristics of autism we see challenges in communication, social interaction, restricted interests and repetitive motions. However, if we look at the communication style and instead of calling it a deficit, which is what so often happens to people who are diagnosed with autism or any other condition. When a person receives a diagnosis the first thing we hear are all of the challenges that they’re going to face, all of the things that they won’t be able to do, all of the challenges that they’ll have in successful employment and all of the challenges that he’ll have in making friends. If we look at these characteristics such as communication and instead of looking at it as a challenge or a weakness, we know that the communication style of people with autism tends to be direct, to the point and factual. If this is the case, let’s use these characteristics as strengths.

If we take a look at what the DSM-IV refers to as “restricted interests,” let’s change that and call it “a passion,” “a focused interest” or “a special interest.” Many people think that Thomas Edison, for example, had Asperger syndrome. At the very least we can say that he had some Asperger tendencies. It might have been this focused passion that led him to try 50,000 times before he got the light bulb right. With situations like this there is a focused interest, intense interest, in an area that benefits him and as it turns out it benefits society. The light bulb is a very useful invention.

What is a special interest? If we look at the work of Tony Attwood, who is probably the most well-known expert on Asperger syndrome, he says a special interest is an interest of such great intensity that it interferes with daily functioning. That’s exactly how he says it, too.

Here are some of my special interests. They come and they go. Sometimes there is more than one of them that occurs at a time. I find them very interesting. There’s going to be a quiz on these at the end, so make sure you get them all.

Regarding gearing work towards interests, let’s take a look at some examples. Back at home, during the times that I am home, one of my specialties is giving music lessons to children on the autism spectrum. One of the reasons why I do this is that in addition to the therapeutic benefits of interacting with music, music provides a real-life way in which to interact with other people, develop friends and get involved in the community (say by joining a community band).

These are one of the children that I worked with. He was really interested in subway maps. He focused on the entire transportation system of greater Boston. He also liked computers, so I often wonder that when he reaches an age where he can work what if he could design maps for the webpage of a public transit authority? I knew that the public transportation authority in Boston, Massachusetts was severely lacking in terms of a good webpage that was understandable and easy to navigate.

There was a young lady with autism who had a very difficult time verbally interacting with other people. She could talk just about as well as anyone else can talk but she was extremely shy. She was extremely challenged to interact with other people. Like Temple Grandin and many other people with autism, she had a close affinity with animals. She understood animals like most other people couldn’t. Her special interest was in being a horse doctor, an equestrian veterinarian. Here’s an example where we can use an interest in an area to promote in her case her working in an area of challenge. She wanted to do nothing more than be a doctor helping horses.

We had a conversation with her. The conversation started with her interest in horses. Boy was she interested in helping horses with any medical problems they had! Then we got into a conversation about what is required in terms of being a good veterinarian. Part of the requirements is being able to communicate with the horse’s owner, to be able to tell the horse’s owner what is wrong with the horse and then what to do to take care of your horse. The only way that’s going to happen is if she learns to talk to them. Once she became aware of this requirement in order for her to be successful as a veterinarian she started to work on her challenges with communication with other people. As a result, her communication skills improved. That helped, as well.

A similar thing happened with me. In undergraduate school I became aware that non-verbal communication was another mode of interaction. Studies show that 80% of the total communication package is non-verbal. In other words, what are peoples’ bodies saying in addition to or sometimes even opposite to the words that they are speaking? I was totally fascinated with this. It became clear to me that if I wanted to improve my social interaction with other people I was going to have to study this. As a result, it became another special interest where I’d spend hours in bookstores reading body language books. What I was doing was building a lexicon of non-verbal communication. I found that to be very helpful.

Another curious example is of a fellow with a very good sense of smell. One of the characteristics of people with autism has to do with sensory variations, otherwise known as “sensory issues.” Some of our senses are turned up too high so they’re oversensitive. Too much information comes in. That’s the reason why there was mention about not using a flash before we got started. Many of us with autism are hypersensitive to visual input. While a flash can be annoying to most people but they put up with it for many of us with autism a flash can be absolutely distracting and blinding. That’s just one example.

Let’s get back to this fellow with this hypersensitive sense of smell. His father is at home. He’s an engineer. His father, by the way, also has autism. He’s cooking up some food in a steel pot. The son from the other side of the house asks the father, “Why are you using a steel pot to cook food?” This made his father, who is an engineer, suddenly realize that his son had a good enough sense of smell to know what type of metal was being heated up to cook food.

Somehow he managed to move that along to the point where his son goes into aircraft hangers and smells the engines of an airplane. He doesn’t go up to the engine like a dog and sniff it. He just catches the ambient smell and from this smell he’s able to say, “This engine over here needs an oil change. The one over there needs” something else. This fellow is pretty strongly affected and he has autistic behaviors, behaviors which would not be tolerated in a typical workplace. However, he is able to do something that nobody else is able to do so the workplace puts up with him.

Let’s take a look at some other areas. You have someone who has difficulty with verbal communication. Might there be a type of employment that we can engage the person in that doesn’t require much verbal interaction? You may have someone else who is challenged with socialization. Is there something that they can do?

Sensory stimulation brings up the example of a parent here in Japan. I was giving a workshop and she mentioned something about her son. I think he was 13 years old. He would enjoy putting his finger under a running water faucet and spray it all around. He got really good at it. His mother realized the importance of promoting special interests but by the fifth time there was a big flood in the house, she had some other ideas. She asked, “What can my son do? He’s pretty severely affected. He has limited verbal ability. What kind of employment can he engage in?”

If we think about it, why is he spraying water like that from under the faucet? One reason he might be doing that is because he craves the sensory input of the water pressure on his thumb and he uses that to spray a high pressure stream of water. That then can get you thinking, what kind of employment opportunities involve spraying water at high pressure? One thing that may immediately come to mind is the idea of a firefighter. Sometimes it takes 4 or 5 strong men to hold a hose so that it doesn’t flip away from the backpressure and to spray it into a house that’s on fire.

Then you think a little more deeply about being a firefighter. What are the requirements? One of the requirements is good verbal interaction skills. You need to be able to listen to the fire chief issue a command to do something. At the same time, you need to be able to issue a command to your fellow firefighters if, for example, the house you’re in is about to collapse, so this job wouldn’t work for him. However, there are other jobs that involve spraying water at high pressure. One of them might be working in a carwash. Another one might be washing buildings or sidewalks with a high pressure stream of water. What about being a gardener? We need to be careful with that. If he can enjoy spraying water at low pressure to water plants, that’s great. However, if it’s got to be this high pressure thing then he’ll probably kill the flowers. We need to be careful about that, as well.

Later on in the conversation his mother said, “My son really likes schedules.” That brings up another idea. What about working as an assistant on a water delivery truck? He helps to make sure that every business and every customer gets their water when they’re supposed to. If he’s also craving the deep pressure on his thumb from spraying the water it might be that he would crave other deep pressure experiences. He might enjoy lifting heavy bottles of water and carrying them to other people’s houses. This is an example of using a characteristic of autism, in this case sensory-seeking behavior, and finding a way to work that into a successful employment situation.

Transitions are difficult for many people with autism. Can we find a workplace for this person that has little change, a stable work environment? Sometimes a nice, small family business is a good way to do that. An assembly line, for example, is perhaps another way to do that.

Many of us have strong visual-motor skills. As a result, we may be very good at putting together little pieces of things such as printed circuit boards for a computer, computer assembly. That might be good for someone with strong visual skills. If someone has challenges with behavior we need to find situations where this person won’t encounter triggers to those behaviors.

If we look at savant skills, extreme strengths, I have a friend with autism who is so good at math that one of his favorite things is to ask you when you were born. Then he’ll say, “Oh, yeah! That was a Sunday.” Then he’ll say, “You know, that makes you 947 million and so on 200 seconds old.” He’s done all of this in his head and he does it about as fast as I just spoke that sentence. He’s a tax preparer. That works very well.

I have another friend with autism who loves to stim on bright, shiny objects. He’ll take an object and he’ll look at it from all angles like this. If you are familiar with people with autism, that’s probably pretty familiar to you. It turns out that this fellow, who is about 55 years old, is a very successful coin dealer. He buys and sells old coins and he makes a lot of money doing it, as well.

It’s very important to be flexible in the types of job structures. Most of us focus on the first two. We think about employment as needing to be competitive, full-time employment. However, there are many other variations. Self-employment works well. Referring back to Temple Grandin, she’s self-employed with her meat processing design business. She says being self-employed allows her to go in, do a job, be successful at it and then leave before office politics take their toll. Office politics present a major challenge for many of us (I’d say most of us) on the autism spectrum. That’s true for people who are not on the autism spectrum, as well, but for us it’s even more so.

As for myself, I guess I consider myself as self-employed, as well. My mission is to help people with autism lead fulfilling and productive lives. A part of that is traveling around the world consulting and talking about autism and giving presentations. Writing books is another. Giving music lessons to children with autism is yet another.

Next I’ll talk about accommodations. If you can teach the skill, find a way to teach it. There may be times when we’re challenged to teach a skill. Let’s see if there’s a way that we can adapt it or work around it. For whatever task we’re asking a person with autism to do, can we figure out a way around it? If we can’t do any of the above, teach the neurotypicals to deal with it. There are many things that those of us with autism can contribute to the world of work. It’s just a matter of finding a way to provide needed support for those of us with autism so that we can lead fulfilling and productive employment lives.

If you want to take a look at it strictly from the financial end, if we don’t support somebody with autism in employment this may be a person who will be living say in an institution, spending most of their time doing nothing and not working. That’s a very expensive thing to do. Let us suppose that we find a way to support someone with autism to find successful employment to the best of their ability. Now we have someone who’s living with some independence. We have someone who is going out and contributing to society. We have someone who is happy and fulfilled because they have the pleasure of being able to do a good job because they’re being supported in doing so.

In closing, I want to say again it’s a pleasure to see all of you who are sitting here, all of you who are devoted to helping people with autism lead fulfilling and productive lives through employment. Doomo arigatou gozaimasu.

Act on Support for Persons with Developmental Disabilities
　　　　　　　　　Masafumi Hizume