Neurodiversity: From Phenomenology to Neurobiology and Enhancing Technologies 1615373020, 9781615373024

Table of contents :
Cover
Half Title
Title
Copyright
Dedication
Contents
Contributors
Foreword
Preface
Acknowledgments
CHAPTER ONE: Neurodiversity: The New Diversity
CHAPTER TWO: Positive Psychology and Strengths-Based Approaches to Neurodiversity
CHAPTER THREE: Strengths-Based Model and Savantism
CHAPTER FOUR: Strengths-Based Model of Neurodiversity and Autism
CHAPTER FIVE: Strengths-Based Model of Neurodiversity and ADHD
CHAPTER SIX: Strengths-Based Model of Dyslexia
CHAPTER SEVEN: Neurobiology of Neurodiversity
CHAPTER EIGHT: Neurodiversity in Higher Education: Support for Neurodiverse Individuals and Professionals
CHAPTER NINE: Specialized Employment Initiatives for Neurodiverse Individuals: A Model Program
CHAPTER TEN: Technologies and Difference: Insights from Education Breakdown and Exclusion
CHAPTER ELEVEN: Using Technology to Provide Transition Support for Neurodiverse Young Adults
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
Y
Z
Plate Section
Back Cover

Citation preview

Neurodiversity: From Phenomenology to Neurobiology and Enhancing Technologies provides clinicians, educators, and other professionals with cutting-edge, practical, and positive information to understand and assist their patients, students, and other neurodiverse individuals to operate from a position of strength.

Lawrence K. Fung, M.D., Ph.D., is Director of the

Stanford Neurodiversity Project and an Assistant Professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine in Palo Alto, California.

Neurodiversity FROM PHENOMENOLOGY TO NEUROBIOLOGY AND ENHANCING TECHNOLOGIES

Neurodiversity

addresses the totality of neurodiversity through positive explorations of “invisible diversities”—from ADHD and savantism to autism and dyslexia. Edited by the director of the Stanford Neurodiversity Project, the book emphasizes strengths-based approaches to clinical practice and investigates interventions to improve the lives of neurodiverse individuals. Following a compelling foreword by Temple Grandin, the book proceeds to address neurodiversity in four parts: frst, an introduction that presents neurodiversity’s differences in brain function and behavior as part of the normal variation of the human population; second, presentation of the strengths-based model of neurodiversity (SBMN), including positive psychology, neurobiology, and SBMN in savantism, autism, ADHD, and dyslexia; third, a discussion of neurodiverse individuals in the real world, including higher education and employment; and fnally, a review of technologies that enhance our abilities to maximize the potential of neurodiversity, including inclusive design and assessment tools that provide support for neurodiverse young adults seeking meaningful employment.

FROM PHENOMENOLOGY TO NEUROBIOLOGY AND ENHANCING TECHNOLOGIES

Phenomenology to NeurobiNeurodiversity: From ology and Enhancing Technologies

Fung

Edited by Cover design: Tammy J. Cordova

Cover image: © royaltystockphoto.com Used under license from Shutterstock

Lawrence K. Fung, M.D., Ph.D.

Neurodiversity From Phenomenology to Neurobiology and Enhancing Technologies

Neurodiversity From Phenomenology to Neurobiology and Enhancing Technologies

Edited by

Lawrence K. Fung, M.D., Ph.D. Director, Stanford Neurodiversity Project Assistant Professor of Psychiatry and Behavioral Sciences Stanford University School of Medicine Palo Alto, California

Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Association Publishing represent the findings, conclusions, and views of the individual authors and do not necessarily represent the policies and opinions of American Psychiatric Association Publishing or the American Psychiatric Association. If you wish to buy 50 or more copies of the same title, please go to www.appi.org/ specialdiscounts for more information. Copyright © 2021 American Psychiatric Association Publishing ALL RIGHTS RESERVED First Edition Manufactured in the United States of America on acid-free paper 25 24 23 22 21 5 4 3 2 1 American Psychiatric Association Publishing 800 Maine Avenue SW, Suite 900 Washington, DC 20024-2812 www.appi.org Library of Congress Cataloging-in-Publication Data Names: Fung, Lawrence K., 1970- editor. | American Psychiatric Association, publisher. Title: Neurodiversity : from phenomenology to neurobiology and enhancing technologies / edited by Lawrence K. Fung. Description: First edition. | Washington, DC : American Psychiatric Association Publishing, [2021] | Includes bibliographical references and index. Identifiers: LCCN 2021001921 (print) | LCCN 2021001922 (ebook) | ISBN 9781615373024 (paperback ; alk. paper) | ISBN 9781615373956 (ebook) Subjects: MESH: Neurodevelopmental Disorders—genetics | Nervous System Physiological Phenomena—genetics | Biodiversity | Neurobiology—methods Classification: LCC QP360 (print) | LCC QP360 (ebook) | NLM WS 350.7 | DDC 612.8—dc23 LC record available at https://lccn.loc.gov/2021001921 LC ebook record available at https://lccn.loc.gov/2021001922 British Library Cataloguing in Publication Data A CIP record is available from the British Library.

Dedicated to Michele, who has been my companion in this journey of neurodiversity; Zachary, who has inspired me to devote my life to the field of neurodiversity; and Hannah, whose whipped coffee has gotten me through some challenging times.

Contents Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Temple Grandin, Ph.D.

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix

CHAPTER ONE Neurodiversity: The New Diversity . . . . . . . . . . . . . . . . . 1 Lawrence K. Fung, M.D., Ph.D. Nancy Doyle, Ph.D.

CHAPTER TWO Positive Psychology and Strengths-Based Approaches to Neurodiversity . . . . . . . . . . . . . . . . . . . . 19 Michael L. Wehmeyer, Ph.D.

CHAPTER THREE Strengths-Based Model and Savantism . . . . . . . . . . . . . 39 Matthew Doll, Ph.D. Darold Treffert, M.D. Thomas Fabricius, M.D. Edward Jedlicka, Ph.D. Vivian Hazell, LPC Tara Geier, M.A., BCBA Bryan Mischler, LCSW Erin Whittington, B.A.

CHAPTER FOUR Strengths-Based Model of Neurodiversity and Autism. . . . . . . . . . . . . . . . . . . . . . . 65 Lawrence K. Fung, M.D., Ph.D.

CHAPTER FIVE Strengths-Based Model of Neurodiversity and ADHD . . . . . . . . . . . . . . . . . . . . . . 109 Lawrence K. Fung, M.D., Ph.D.

CHAPTER SIX Strengths-Based Model of Dyslexia. . . . . . . . . . . . . . . 123 Nicole S. Ofiesh, Ph.D. Henry B. Reiff, Ph.D.

CHAPTER SEVEN Neurobiology of Neurodiversity . . . . . . . . . . . . . . . . . 149 Lawrence K. Fung, M.D., Ph.D.

CHAPTER EIGHT Neurodiversity in Higher Education: Support for Neurodiverse Individuals and Professionals. . . . . . . . 175 Nancy Doyle, Ph.D.

CHAPTER NINE Specialized Employment Initiatives for Neurodiverse Individuals: A Model Program . . . . . . . 201 Jose Velasco, M.S.

CHAPTER TEN Technologies and Difference: Insights from Education Breakdown and Exclusion . . . . . . . . . . . . . 235 Jutta Treviranus, Ph.D.

CHAPTER ELEVEN Using Technology to Provide Transition Support for Neurodiverse Young Adults . . . . . . . . . . . . . . . . . . 259 Steven M. Keisman, M.A., M.S.

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

Contributors Matthew Doll, Ph.D. Director of Behavioral Health, Outpatient Services, Treffert Center, Fond du Lac, Wisconsin Nancy Doyle, Ph.D. Research Fellow, Birkbeck College, University of London; CEO and founder, Genius Within, London, United Kingdom Thomas Fabricius, M.D. Research Director, Family Practice, Treffert Center, Fond du Lac, Wisconsin Lawrence K. Fung, M.D., Ph.D. Director, Stanford Neurodiversity Project, and Assistant Professor of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California Tara Geier, M.A., BCBA Behavior Analyst, Treffert Center, Fond du Lac, Wisconsin Temple Grandin, Ph.D. Professor, Department of Animal Sciences, Colorado State University, Fort Collins, Colorado Vivian Hazell, LPC Senior Psychotherapist, Treffert Center, Fond du Lac, Wisconsin Edward Jedlicka, Ph.D. Senior Psychotherapist, Treffert Center, Fond du Lac, Wisconsin Steven M. Keisman, M.A., M.S. Senior Vice President, Identifor, Mendham, New Jersey

ix

x

Neurodiversity

Bryan Mischler, LCSW Psychotherapist, Treffert Center, Fond du Lac, Wisconsin Nicole S. Ofiesh, Ph.D. Co-founder and Chief Innovation Officer, Potentia Institute, Half Moon Bay, California Henry B. Reiff, Ph.D. Professor of Education, McDaniel College, Westminster, Maryland Darold Treffert, M.D. Research Consultant, Treffert Center, Fond du Lac, Wisconsin Jutta Treviranus, Ph.D. Professor, Inclusive Design Research Centre, OCAD University, Toronto, Ontario, Canada Jose Velasco, M.S. Vice President, Product Management, SAP Labs, Austin, Texas Michael L. Wehmeyer, Ph.D. Chair, Department of Special Education; Ross and Marianna Beach Distinguished Professor in Special Education; and Director and Senior Scientist, Beach Center on Disability, University of Kansas, Lawrence, Kansas Erin Whittington, B.A. Senior Assistant II, Quest Lab Team Lead, Carmel Clay Public Library, Carmel, Indiana

Foreword Temple Grandin, Ph.D.

In my work as a designer of livestock handling facilities, I have been working with neurodiverse individuals since the 1970s. Back in the 1970s, 1980s, and early 1990s, most people were not aware of the term neurodiversity. When I was designing equipment and working with major corporations, almost nobody knew I was an autistic person. They viewed me as different, but I was recognized for the quality of my work. I learned to sell my work instead of selling myself. I did this by showing potential clients a portfolio of design drawings and photos of completed projects. It is likely that approximately 20% of the people who constructed the equipment I designed would have been diagnosed as autistic, dyslexic, or ADHD or given some other label if they had been children today. None of my colleagues was formally diagnosed, but when I look back on the different places where I worked, it has become obvious that many of these talented people were autistic or dyslexic or had sensory processing problems. Two of the autistic people I worked with had multiple patents. To maintain confidentiality, I have to be vague in describing the equipment they invented. Both of these people invented clever mechanical devices and were owners of equipment companies. One of them sells products all over the world, and both were poor students in high school. Another person headed into a successful career after he took a high school welding class. He then started selling his creations and built up his business with one satisfied client at a time. Throughout a long career, I worked with welders, inventors, and designer drafting people who would have been special education students today. The most clever ones quickly progressed to inventing and patenting major pieces of mechanical equipment. They then sold their inventions to large corporations.

xi

xii

Neurodiversity

We Need Neurodiverse People to Prevent Loss of Essential Skills Today, the people I worked with are retiring, and they are not being replaced because high schools have removed skilled trades, art, drafting, and other hands-on classes. Vital skills are being lost because talented neurodiverse children are not having opportunities to develop their abilities. The children who should become the replacements are often deprived of the opportunity to be introduced to hands-on skills. I did not realize how serious the problem was until I visited four stateof-the-art poultry or pork processing plants in 2017 and 2019. I had been brought in to consult on animal handling. After touring these plants from one end to the other, I learned that almost all of the specialized equipment was now imported from Europe. European schools have kept their skilled trades and have trained neurodiverse people who can build it. Other things the United States no longer builds are elevators, ski lifts, and conveyors for moving stuff in warehouses and factories. It is a part of engineering that I call the “clever engineering department.” The parts of the factory that are still built in the United States are the building, boilers, and refrigeration systems. The reason for this is neurodiverse thinking. The more mathematically inclined thinkers excel in traditional college engineering classes; refrigeration systems, boilers, and structural engineering of the building require this type of education. The visual thinkers, like me and many of the people I worked with, cannot do abstract math such as algebra. I had to drop a biomedical engineering class because I could not do the math. Boilers and refrigeration systems require abstract math, but designing and building a complex packaging machine requires a neurodiverse visual thinker. In my own work with almost every meat company, I have observed the same pattern. The clever engineering people I worked with at many companies almost never touched boilers or refrigeration systems. The mathskilled engineer and the visual thinking equipment designer have skills that complement each other. Building a complete factory requires both kinds of skills. It is also likely that many of the more mathematically inclined engineers are on the autism spectrum. At autism meetings, grandfathers who were either NASA engineers or computer scientists have told me that they discovered they were autistic when a grandchild was diagnosed. Mathematical thinkers and visual thinkers have skills that complement each other. A common denominator for both kinds of diverse minds is that they are highly specialized; they are good at one skill and poor at another. People who are extremely good at either mathematics or visual thinking skills are often socially awkward.

Foreword

xiii

Different Kinds of Thinking Howard Gardner’s multiple intelligences (Gardner 1983; Gardner and Hatch 1989) are featured in this book. There are nine types of intelligences. They cover a wide range of skills that include thinking styles, interpersonal skills, and athletic skills. A theme throughout this book is to develop a person’s area of strength. This is called strengths-based learning. It is a concept I fully support. My mother always helped me to develop my ability in art. Art and visual skills were a foundation of my design career. Since the publication of Gardner’s book in 1983, many studies now support my observation that there are visual thinkers and math pattern thinkers. In my book Thinking in Pictures (Grandin 1996), I discussed how I see everything in photorealistic pictures, but there are other autistic people who think in patterns. Scientific studies show that some people are object visualizers similar to me, whereas others are visual-spatial and mathematical (Kozhevnikov et al. 2002, 2005; Mazard et al. 2004). The object visualizers often go into fine arts or industrial design, and the visual-spatial processors enter engineering or computer science. Psychology is a field that is populated mainly by verbal thinkers who think mostly in words (Perez-Fabello et al. 2018). The first step in helping neurodiverse minds to be successful is to recognize that different people think differently. Educators and parents need to work to develop a person’s unique skills and recognize that verbal language is only one way of thinking.

References Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1983 Gardner H, Hatch T: Multiple intelligences go to school: educational implications of the theory of multiple intelligences. Educational Researcher 18(8):4–10, 1989 Grandin T: Thinking in Pictures: And Other Reports From My Life With Autism. New York, Vintage Books, 1996 Kozhevnikov M, Hegarty M, Mayer RE: Revising the visualizer-verbalizer dimension: evidence for two types of visualizers. Cogn Instruct 20:47–77, 2002 Kozhevnikov M, Kosslyn S, Shephard J: Spatial versus object visualizers: a new characterization of visual cognitive style. Mem Cognit 33(4):710–720, 2005 Mazard A, Tzourio-Mazoyer N, Crivello F, et al: A PET meta-analysis of object and spatial mental imagery. Eur J Cogn Psychol 16(5):673–695, 2004 Perez-Fabello MJ, Campos A, Felisbeeti FM: Object-spatial imagery in fine arts, psychology and engineering. Think Skills Creat 27:131–138, 2018

Preface This book was completed at the strangest era of our time, as the world faces both the coronavirus pandemic and the Black Lives Matter movement. Although more people are now acknowledging that diversity is one of the most precious aspects of humanity, diversity remains a very confusing concept in practice. Most people treasure moral values of equality and justice, yet racial and gender disparities in health care, education, employment, and other opportunities continue to impact affected groups negatively and profoundly. Although initiatives for diversity and inclusion have been implemented in many large organizations, the total societal impact has not been quite enough. Cultural change to embrace diversity in our society continues to be slow, and most of the change that has occurred has been focused toward the visible diversities of skin color and sex. What about the invisible diversities? We can only expect that it is even more challenging to achieve cultural changes that embrace invisible differences. This is why we write this book. In particular, we are focusing on neurodiversity, a concept that regards differences in behavior and brain function as part of the normal variation of the human population. When we talk about neurodiverse conditions, we include conditions such as autism, ADHD, and dyslexia. Like racial disparities, inequalities in health care, education, employment, and other opportunities are significant issues facing neurodiverse individuals. Many neurodiverse individuals face significant mental health issues. Co-occurring conditions such as depression and anxiety are common in this population. Psychiatrists, psychologists, and other mental health providers have used the medical model to identify symptoms, with the ultimate goal of removing them. It is rare for providers to assess the strengths of their patients and to incorporate that information into their interventions. It is even more uncommon for providers to use strengths-based approaches to enhance patients’ abilities to help them overcome their challenges. This book is an introduction to the strengths-based model of neurodiversity (SBMN), designed to integrate and build upon existing theories of

xv

xvi

Neurodiversity

positive psychology (Seligman and Csikszentmihalyi 2000), positive psychiatry (Jeste et al. 2015), multiple intelligences (Gardner 1983; Gardner and Hatch 1989), and developmental psychology (Chickering and Reisser 1993) and to apply them to devise strengths-based assessments and interventions for neurodiverse individuals. Nancy Doyle and I describe, in Chapter 1, what neurodiversity means and how we define this concept in the context of leveraging the strengths of individuals with various neurodiverse conditions. In Chapter 2, Michael Wehmeyer describes what positive psychology is, how strengths-based approaches converge with social and person-environment fit models, and how they are practiced in assessing character strengths and self-determination. In Chapter 3, Matthew Doll, Darold Treffert, and their colleagues provide accounts of how their six-pronged, core-component approaches to assessment, diagnosis, organized treatment, and support are applied to the strengths-based curriculum at Treffert Center in Wisconsin. In Chapter 4, I describe the strengths of people on the autism spectrum and discuss how the SBMN is applied in assessments and treatments of autistic people. Similarly, in Chapter 5, I use the SBMN as the framework to describe the assessments and treatments of individuals with ADHD. In Chapter 6, Nicole Ofiesh and Henry Reiff formulate the strengths of dyslexic individuals using the MIND framework. (MIND is an acronym for four strengths: Material reasoning, Interconnected reasoning, Narrative reasoning, and Dynamic reasoning.) In Chapter 7, I reveal the neurobiology of neurodiversity using a systems approach. Rather than describing the neurobiology of neurodiverse conditions, I dissect the cognitive constructs behind various domains of intelligences, including mathematical, reading, visual-spatial, musical, inter- and intrapersonal abilities, and creativity. Then I describe the neural correlates of the constructs in the general population and selected groups, including people who are autistic, those who are dyslexic, and people with ADHD. In Chapter 8, Nancy Doyle discusses the disparities for neurodiverse individuals in higher education and explores what active ingredients may be needed to level the playing field for neurodiverse students. In the United States, about 80% of autistic adults are unemployed or underemployed. In Chapter 9, Jose Velasco provides a detailed case example of SAP SE’s Autism at Work program, a specialized employment program that has changed the lives of many autistic adults. These individuals in turn have contributed significantly to that company through remarkable innovations and productivity. The book concludes with two chapters related to technology and neurodiversity. In Chapter 10, Jutta Treviranus discusses how the technology mindset is biased against diversity and how this impacts neurodiverse individuals. In Chapter 11, Steven Keisman details obstacles facing neurodi-

Preface

xvii

verse individuals as they find and sustain employment and explains how artificial intelligence may be used to help them identify their strengths and potential career options. The field of neurodiversity is in its infancy. Much still needs to be investigated to further advance our understanding of its strengths; how those strengths can be uncovered accurately, efficiently and practically; and what interventions can be designed to improve the lives of neurodiverse individuals. I hope this book provides some first answers as we begin to promote neurodiversity as a necessary societal value, incorporate strengths-based approaches into our clinical practice, and advance the understanding of the phenomenology, neurobiology, and clinical research of neurodiversity. Lawrence K. Fung, M.D., Ph.D.

References Chickering AW, Reisser L: Education and Identity, 2nd Edition. San Francisco, CA, Jossey-Bass, 1993 Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1983 Gardner H, Hatch T: Multiple intelligences go to school: educational implications of the theory of multiple intelligences. Educational Researcher 18(8):4–10, 1989 Jeste DV, Palmer BW, Rettew DC, Boardman S: Positive psychiatry: its time has come. J Clin Psychiatry 76(6):675–683, 2015 Seligman ME, Csikszentmihalyi M: Positive psychology: an introduction. Am Psychol 55(1):5–14, 2000

Acknowledgments This book would not be a reality without the support and encouragement of Dr. Laura Roberts. She is a champion of neurodiversity. Her trust in our team has allowed us to embark on the Stanford Neurodiversity Project (SNP), which secures our base to pursue works of passion such as this book. I would like to thank the SNP’s first (anonymous) donor, who believes in the importance of neurodiversity and empowers us to expand our work from a pilot to a full project. Without her support, we could not have written this book. I also want to thank my team in the SNP, especially Mark Gavartin, Vicky Lam, Christy Matta, Isabelle Morris, and Marci Schwartz. Discussions with this team have both challenged and refined my thinking about neurodiversity every day. I thank John McDuffie at American Psychiatric Association Publishing, who has shown tremendous support for this work. Finally, I thank all of the patients and research participants with whom I have interacted throughout the years. They give me the privilege to understand their strengths and challenges. They will continue to be my constant inspiration for how I can do better with neurodiversity advocacy, education, research, and clinical service. Lawrence K. Fung, M.D., Ph.D.

xix

ONE Neurodiversity The New Diversity Lawrence K. Fung, M.D., Ph.D. Nancy Doyle, Ph.D.

For me, the key significance of the “Autistic Spectrum” lies in its call for and anticipation of a politics of Neurological Diversity, or “Neurodiversity.” The “Neurologically Different” represent a new addition to the familiar political categories of class/gender/race and will augment the insights of the social model of disability. Judy Singer (1999)

Neurodiversity is a concept that regards differences in brain function and behavior as part of the normal variation of the human population. It represents a new way of understanding and embracing diversity based on cognitive differences. To operationalize the neurodiversity movement, we propose the use of the strengths-based model of neurodiversity (SBMN), which is composed of four components: Gardner’s theory of multiple intelligences, positive psychology, positive psychiatry, and Chickering’s seven vectors of development. This model can be applied in clinical, educational, and employment settings. For all these settings to benefit from the positive outcomes brought by the neurodiversity movement, cultural change is a prerequisite. This chapter illustrates various driving forces of this important movement.

1

2

Neurodiversity

At our core, we are who we are because we internalize our unique individual identities. We perceive the world, communicate with others, and behave in our own distinctive ways because of our identities, beliefs, and experiences. We develop a sense of belonging and tend to identify ourselves as a part of our family, school, workplace, volunteer organizations, and other social circles because we feel we have a role in these groups. This sense of belonging leads to personal satisfaction. In many large organizations, the composition of the membership is diverse. The extent to which one believes he or she belongs to an organization depends on many factors, but it is intuitive to accept that that sense of belonging depends on the diversity represented in the organization, how the organization handles diversity issues, and members’ feelings about the acceptance of their own identities within the organization. Diversity refers to the inclusion of a range of individuals who are different from each other. The main subtypes of diversity include demographic, experiential, and cognitive (de Anca and Aragón 2018). Demographic diversity, which refers to diversities in race, gender, sexual orientation, religious affiliation, educational background, functional background, and organizational tenure, has been the most visible subtype of diversity in human history. Breakthroughs in diversity movements involving demographics have been about social justice and human rights. More than 150 years ago, in 1863, President Abraham Lincoln issued the Emancipation Proclamation, which abolished the slavery of African Americans in the United States. In 1920, the 19th amendment of the U.S. Constitution was approved, granting women the right to vote. In the early 1970s, the lesbian, gay, bisexual, and transgender (LGBT) social movements began. In 1973, the American Psychiatric Association proposed removing “homosexuality” from the third edition of DSM (American Psychiatric Association 1980). Based on the understanding of behaviors of human beings and cultures in our society, these monumental movements created opportunities for people with various demographic diversities and advanced human rights for billions of people. Experiential diversity refers to differences in life experiences that shape the decisions people make, ranging from daily minutiae to major life decisions. However, there is not much that people can do to control their personal life trajectories. Also, because there are so many experiential trajectories, we cannot really anticipate that experiential diversity will be the center of any significant movements of social justice. Cognitive diversity refers to differences in how people think. Many companies have embraced the idea that cognitive diversity is the essential ingredient of innovation. Therefore, companies have invested in this idea by forming offices of diversity and inclusion. This trend is not a result of promoting social justice but, rather, a strategy for companies to attract talent

Neurodiversity

3

and meet their bottom lines. “Companies in the top quartile for racial and ethnic diversity are 35 percent more likely to have financial returns above their respective national industry medians” (Hunt et al. 2015). Neurodiversity is closely related to cognitive diversity. In this book, we define neurodiversity as a concept that regards individuals with differences in brain function and behavioral traits as part of normal variation in the human population. In this chapter, we describe definitions of neurodiversity in previous movements. We discuss being in the midst of a new movement of neurodiversity, which involves uncovering the strengths of neurodiverse individuals and utilizing their talents to increase innovation and productivity of the society as a whole. We discuss the SBMN briefly in this chapter and more extensively in Chapters 4 and 5.

Origin of the Term Neurodiversity Judy Singer, a self-advocate and sociologist, is credited as being the first person to have used the term neurodiversity in her 1998 honors thesis, titled “Odd People In: The Birth of Community Amongst People on the Autism Spectrum. A Personal Exploration of a New Social Movement Based on Neurological Diversity” (Singer 1998). She then contributed a chapter based on this work to the book Disability Discourse, a volume in a series focused on disability, human rights, and society (Singer 1999). The title of her chapter was “‘Why Can’t You Be Normal for Once in Your Life?’ From a ‘Problem With No Name’ to the Emergence of a New Category of Difference.” In her work, Singer described the need to change the autism spectrum condition from a medicalized disability to a new social movement. She discussed that the “rise of autistic advocacy” was similar to the movements based on disability or difference but was different from the LGBT movements in that the neurodiversity movement was greatly accelerated. Singer explained that the rise of the neurodiversity movement might be related to the invention and rapid development of the computer and the internet. She called computers an autistic invention and an essential prosthetic device for autistic people. As Singer explained, without these technological advances and the affinities of autistic individuals with computers, this group would not have enough social, organizational, and networking skills to further the autistic movement. Singer described three objectives of the neurodiversity movement. First, she advocated for recognition of the characteristics of autistic individuals by neurotypical individuals. She described how autistic individuals were sometimes misjudged as incompetent or lazy. Second, she promoted civil rights for autistic individuals. She explained that autistic individuals

4

Neurodiversity

were often teased, bullied, and discriminated against at school and in the workplace. She pointed out that even autistic people who were highly skilled and intelligent were not given the same rights to earn a living as neurotypical people. Finally, Singer argued that autistic individuals should receive services appropriate to their level of functioning. She stated that the variety of services that were available to people on the autism spectrum were limited and that many of these individuals were not benefiting from the services available to them. In addition to Singer’s work, Harvey Blume’s 1998 article in The Atlantic was often cited as one of the first articles to use the term neurodiversity. He wrote, “Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general. Who can say what form of wiring will prove best at any given moment? Cybernetics and computer culture, for example, may favor a somewhat autistic cast of mind” (Blume 1998). The autism rights movement (ARM) in the 1980s and 1990s encouraged stakeholders to move away from the medical model of disability. The ARM was initiated by Jim Sinclair, who argued that autism is “a variation in functioning rather than a disorder to be cured” (Solomon 2008). Sinclair advocated for providing therapies that teach autistic individuals coping skills rather than treatments that are meant to “normalize” their behaviors. He also advocated for autistic people to be recognized as a minority group. A common criticism of this movement was that most ARM activists were “high-functioning” self-advocates and therefore did not represent autistic individuals at all levels of functioning. Another criticism was that ARM trivialized the disabilities of autistic individuals.

Ontology of Neurodiversity Singer’s (1999) contention was that human minds are naturally diverse, with between-person variations being part of the rich tapestry of human experience, intellect, and skill. Formed in the 1990s, the neurodiversity concept aligned with the social model of disability (Oliver 1983), which proposed that disability may be a socially constructed oppression, a feature of being different or unusual as opposed to ill or injured. Although neurodiversity is still often referenced solely in relation to autism (Kapp et al. 2013), it is increasingly used in psychology and education as an umbrella term associated with autism, dyslexia, dyspraxia (or developmental coordination disorder), ADHD, and dyscalculia (Armstrong 2010; Grant 2009; Weinberg and Doyle 2017). Even though the ontological status of included conditions is still predicated on a medical model of deficit via DSM, the public perception of neurodiversity has shifted paradigmatically in recent years. A pro-

Neurodiversity

5

liferation of articles espousing the benefits of neurodiversity in the business press (Austin and Pisano 2017; Bernick 2019; Comaford 2017) is supported by an albeit much smaller yet consistent voice from academia (Meilleur et al. 2015; Riddick 2001; Taylor and Walter 2003; White and Shah 2006). As the “diamond in the rough” narrative gains traction, it is time for ontological reflection from psychiatry and psychology, in an effort to understand how our work may be enhancing and limiting inclusion outcomes for individuals with these variations. In this section, we outline the issues in language, ontology, and epistemology that influence research and sociolegal practice. As is typical in emerging narratives, language is evolving rapidly, through common discourse between stakeholders. The neurodiversity paradigm has stimulated much discussion on social media and spawned a movement among activists, seeking the right of self-determination, to choose nomenclature that reflects their experience, which may or may not relate to ill health (Ortega 2009). With neurodiversity as the umbrella, individuals with qualifying diagnoses may prefer the terms neurodiverse, neurodivergent, neurodifferent, or neurominority; these terms are currently used interchangeably, and debates are ongoing within the movement regarding which terms are “correct.” Some disability campaigners have eschewed “person-first” descriptors such as “person with autism,” which sound as though the person has an illness, in favor of autistic or autist, dyslexic, or dyspraxic, which describe the person’s diagnosis as an identity (note there is no equivalent for ADHD). Conclusions are yet to be drawn, but clinicians should be aware of the deeply felt positions regarding language and the identity level to which it speaks. Diagnosis within this context may be interpreted as affliction, catharsis, or vindication; it may empower or produce self-limiting beliefs, depending on what the diagnosis has meant to the person and how the associated experiences have resulted (positive or negative) in the past. Identity-first language was found to be preferred in one study involving 3,470 autistic individuals, parents, and their broader support network in the United Kingdom (Kenny et al. 2016). The term autistic was endorsed by 61% of autistic adults, 52% of family members/friends, and 51% of parents (51%) but only 38% of professionals. In contrast, person with autism was endorsed by 49% of professionals, 28% of autistic adults, and 22% of parents. In a more recent study involving 198 autistic adults in Australia, participants were asked to rank-order six choices (person with autism, person on the autism spectrum, autistic, autistic person, person with autism spectrum disorder, person with autism spectrum condition). The term autistic was found to be the most preferred and second-least offensive, whereas the term person on the autism spectrum was shown to be the least offensive and secondmost preferred (Bury et al. 2020). In this book, we choose to use identity-

6

Neurodiversity

first descriptors for consistency. However, it is important to note that some neurodiverse individuals do prefer person-first language, whereas others do not have a strong preference either way. Using identity-first or person-first language is meant to demonstrate respect toward neurodiverse people. Therefore, it is ultimately the neurodiverse individual’s personal choice to declare a preference. The language debate highlights a key ontological tenet of the neurodiversity movement: the evolutionary critique. The traditional medical model (Shelley-Tremblay and Rosén 1996) proposes that the high prevalence of conditions, their heritability (D’Souza and Karmiloff-Smith 2017; Siegel 2006), and their persistent comorbidity (Hendren et al. 2018) are indicative of evolved, advantageous benefits that sufficiently outweigh deficits. For example, benefits include the capacity for detail and memory in autism (Meilleur et al. 2015), entrepreneurial flair in dyslexia (Logan 2009), and creativity in ADHD (White and Shah 2006). In this model, the notion of disability or deficit exists in relation to sociohistorical norms rather than neurophysiological deficit or damage. To illustrate, we consider the skills of literacy, numeracy, sitting still, single focus, eye contact, and small talk to be so essential within education and development that those who have difficulty with these skills must be “broken,” yet we do not acknowledge the situational essence of these skills. In terms of human biological adaptation to environment, such behaviors are modern in the context of the human species and may indeed prove to be temporary. On this basis, some campaigners have gone so far as to argue that research aimed at “cure” or “intervention” is threatening these individuals’ right to exist (Baker 2011; Krcek 2012). As the language and ontology shift from diagnosis toward identity, tools such as DSM, which may change criteria or remove conditions (e.g., Asperger’s disorder), appear to some within the neurodiverse community as being adversarial because they make a patriarchal assertion that defines the boundaries of acceptable human form. Moving forward, there will be opportunities for the neurodiversity paradigm to influence and be influenced by a collaboration of academics, practitioners, and stakeholders. The social model of disability research suggests that there should be “nothing about us without us” (Charlton 1998), calling for greater involvement of service users within research design (e.g., involving actually autistic persons in autism-related research development). Practitioners have access to research participants. Academics seek ecological validity for their work. A grounded theory approach (Ralph et al. 2015) (whereby we critique the questions we are asking through various lenses) can support the rigor of the hierarchy of evidence (whereby we note the answers to our questions) within the epistemological stance of critical realism (Houston 2014; Pawson 2006). Using iterative inductive, hypothetico-deductive,

Neurodiversity

7

and abductive reasoning (Van Maanen et al. 2007) within this “pragmatic paradigm” (Simpson 2018), we can build on our understanding of naturally occurring variations in cognition, neurobiology, and genetics and go further. The end goals for both individuals and society are inclusion, equality, and the fulfillment of human potential (Doyle 2018). To succeed, we must embrace the medical, evolutionary, social, and policy models at our disposal and work toward a more unifying theory of neurodiversity.

Redefining Neurodiversity In the 1980s and 1990s, the neurodiversity movement was organized by high-functioning autistic individuals. The agenda was mainly set to benefit the people advocating for themselves. We use the term neurodiversity with a broader meaning: the diversity that views differences in brain function and behavior as normal variations in the human population. We consider neurodiverse conditions to include autism, dyslexia, ADHD, dyspraxia, dyscalculia, dysphonia, Tourette syndrome, synesthesia, and other behavioral and neurobiological differences. Each of these conditions has been defined historically within the medical model, which emphasizes the characterization of symptoms or deficits. We emphasize that these are neurodiverse conditions instead of disorders. Although we acknowledge the challenges of these conditions, we recognize that these characteristics can be both strengths and challenges depending on the context. Most importantly, we apply these concepts across the entire spectrum of neurodiverse conditions. To articulate the essence of the new definition of neurodiversity, we designed the SBMN. The SBMN is a formulation of approaches to maximize the potential of neurodiverse people based on their strengths and interests. This model focuses on enhancing their abilities and engaging other stakeholders to help them achieve developmental tasks during their formative years. The four main components of the SBMN are Gardner’s theory of multiple intelligences (Gardner 1983; Gardner and Hatch 1989), positive psychology (Seligman and Csikszentmihalyi 2000), positive psychiatry (Jeste et al. 2015), and Chickering’s seven vectors of development (Chickering and Reisser 1993). For many years, human abilities have been benchmarked by the IQ test. This test, however, has significant limitations. The IQ test assesses only a few areas of human abilities, such as visual-spatial abilities, language aptitude, and mathematical abilities. In contrast, Gardner’s theory of multiple intelligences allows for more comprehensive understanding of human abilities. First introduced in 1989, Howard Gardner and Thomas Hatch proposed that separate psychological processes are involved in dealing with linguistic,

8

Neurodiversity

numerical, pictorial, gestural, and other kinds of symbolic systems (Gardner and Hatch 1989). They reviewed the literature in several areas: the development of cognitive capacities in normal individuals; the breakdown of cognitive capacities under various kinds of organic pathology; the existence of abilities in “special populations,” such as prodigies, autistic individuals, idiot savants, and learning-disabled children; forms of intellect that exist in different species; forms of intellect valued in different cultures; the evolution of cognition across the millennia; and two forms of psychological evidence—the results of factor-analytic studies of human cognitive capacities and the outcome of studies of transfer and generalization. (p. 5)

Gardner’s original list of intelligences included musical-rhythmic, visualspatial, verbal-linguistic, logical-mathematical, bodily kinesthetic, interpersonal, and intrapersonal (Gardner 1983). He later added naturalistic as an eighth intelligence. He has also written about existential intelligence. Table 1–1 provides more details about the core components of the multiple intelligences and their associated potential occupations. The second component of the SBMN is positive psychology. Founded by Martin Seligman and Mihaly Csikszentmihalyi, positive psychology is designed to promote individual well-being, contentment, and satisfaction through hope, optimism, and full immersion of oneself in experiences (Seligman and Csikszentmihalyi 2000). Hart and Sasso (2011) reported that 53 definitions of positive psychology had been published since the late 1990s. The top three themes of positive psychology they derived from these definitions included the following (Hart and Sasso 2011, p. 84): 1. Virtues, character strengths, positive personality traits and related attributes and abilities, and talents 2. Phenomena indicative of happiness, positive emotional well-being, subjective sense of fulfillment, and satisfaction with the quality of life 3. Developmental process of becoming, growth, fulfillment of capacities, actualization of potential, and development of the highest/authentic self As we apply positive psychology to interactions with neurodiverse individuals, we focus on the strengths that enable them to progress toward meeting their personal goals. Positive psychology is designed to help individuals develop a healthy, strengths-oriented life by raising their awareness of personal strengths, increasing their trust in personal abilities, helping them learn to engage in relationships, and increasing their self-satisfaction through success (Wehmeyer 2013). Positive psychology can also be useful in moving neurodiverse individuals away from negativity and immobility. Although co-occurring conditions, such as anxiety, depression, and execu-

Gardner’s multiple intelligences

Intelligence

Potential occupations

Capacities and abilities

Bodily kinesthetic

Athlete, dancer, artist, firefighter, surgeon

Abilities to control one’s body movements and to handle objects skillfully; gross and fine motor control

Existential

Cosmologist, philosopher, theologian

Appreciate and develop a deeper understanding of the existence of beings and of matters that make up the universe

Interpersonal

Salesman, therapist

Relate with people based on their understanding of their emotions, needs, language, and nonverbal gestures

Intrapersonal

A higher intelligence needed for success Conscious awareness of self in various domains, such as appearance, emotions, in many occupations behavior, and communication

Neurodiversity

TABLE 1–1.

Logical-mathematical Economist, accountant, mathematician, Appreciate the reasoning of abstract concepts, principles, and rules related to engineer, programmer, scientist numbers Musical-rhythmic

Composer, musical performer, music teacher, acoustic engineer

Appreciate the core components of music (amplitude, expression, harmony, melody, overtone, pitch, rhythm, timbre) or produce the musical experience via instruments

Naturalistic

Botanist, farmer, ranger, environmentalist, zoologist

Have an affiliation and tendency to be close to nature and a deeper experience and understanding of the natural environment

Verbal-linguistic

Historian, journalist, lawyer, linguist, poet

Grasp deeper understanding of the meaning of words, functions of language (e.g., communication, identification, physiological, recording, transmission of thoughts, social), and use of language to perform intended functions

Visual-spatial

Architect, artist, interior designer, navigator, physicist, sculptor

Perceive visual and spatial details of parts and whole of objects and how they interact with each other

9

10

Neurodiversity

tive dysfunction, are common in neurodiverse individuals, the practice of positive psychology guides these individuals to identify themselves by their strengths rather than their diagnoses or problems. The third component of the SBMN is positive psychiatry (Jeste et al. 2015). In contrast to traditional psychiatry, positive psychiatry focuses on uncovering positive attributes and strengths. Instead of assessing risk factors, it emphasizes protective factors. In traditional psychiatry, treatment is typically about symptom relief through medication and short-term psychotherapy. In positive psychiatry, the goal is to increase well-being and growth through psychoeducational approaches. Positive psychiatry’s approaches are expected to reduce the emergence of mental health issues. The final component of the SBMN is Chickering’s seven vectors of development: developing competence, managing emotions, moving through autonomy toward interdependence, developing mature interpersonal relationships, establishing identity, developing purpose, and developing integrity (Chickering and Reisser 1993). Our approach is to practice the seven vectors of development by 1) teaching neurodiverse individuals, either at school or in the workplace, to work toward fulfilling their developmental tasks; 2) encouraging other stakeholders (e.g., school officials or employers) to create neurodiversity-friendly environments; and 3) empowering mental health providers to provide services that can support neurodiverse individuals in fulfilling developmental tasks. Collectively, the theory of multiple intelligences, positive psychology, positive psychiatry, and Chickering’s seven vectors of development provide a framework to practice the SBMN. This framework can be used to develop strengths-based programs in educational, employment, and clinical settings. In Chapters 4, 5, and 6, we illustrate the use of the SBMN for autism, ADHD, and dyslexia, respectively.

Changing the Culture Successful diversity movements serve to change the culture by generating a wider acceptance of differences that results in a higher sense of equity and belonging. All cultural changes have to go through stages of development to achieve progression and sustained outcomes. Any person who knows that a particular behavior change is good for him- or herself has to go through precontemplation, contemplation, preparation, action, and maintenance. Change is generally hard for anyone. However, if the environment is shaped in a manner that facilitates change, the person will feel empowered, and the challenges encountered will be less overwhelming. Similarly, in organizations that embrace neurodiversity and desire to make it part of their culture,

Neurodiversity

11

implementing changes that will benefit neurodiverse individuals will be much easier if the managers and employees believe that neurodiversity is beneficial for them and their organizations. More and more corporations are becoming interested in the neurodiversity movement. Employees and executives are forming grassroots efforts to initiate discussions on neurodiversity and to propagate the reasons why their organizations will benefit from practicing inclusion and building neurodiversity-friendly environments. As companies formalize their efforts to hire neurodiverse people, a sociocultural evolution will gradually happen. Neurodiversity will not only be a discussion in businesses; it will also be an important topic for students at all ages to learn and discuss. Neurodiversity will gradually become part of our societal culture. Much has been achieved in women’s rights over the past 100 years. In 1920, the 19th amendment to the U.S. Constitution was ratified, empowering all American women to possess the same rights and responsibilities of citizenship. Today, women are holding key leadership positions in many state and federal government agencies, small and large businesses, and academic institutions. One might ask: Will it take 100 years for neurodiversity to become part of our culture? Will it take many years for neurodiverse individuals to truly receive equal rights and opportunities? Only time will tell. However, as our society becomes more and more digital, the environmental changes may become more and more friendly to neurodiversity. As the internet and digital technology advance, a major evolutionary transition that merges technology, biology, and society is bound to happen (Gillings et al. 2016). Digital technology has already become part of the social fabric of our society. Although digital technology can be a barrier for sustaining the human social interactions we are accustomed to, it has opened doors for neurodiverse people to communicate with others, thus enhancing their ability to be assimilated into their communities and into society at large.

Case Example George is a neurodiverse college student majoring in computer science. He identifies as an Aspie (i.e., person with Asperger’s disorder) who loves computer programming and music. George took a course about the interface between artificial intelligence and human experience last quarter and was anxious about this required class because the assignments were known to be open-ended. As good as he is at programming, he has been struggling with assignments that require understanding of the “big picture.” Dr. Chan has been teaching this course for 10 years and using the same assignments year after year. In past years, one-quarter of the class struggled with getting the essence of her assignments. This year, she is determined to help her students with her assignments.

12

Neurodiversity With the encouragement of staff members from the Office of Accessible Education, George approached Dr. Chan and explained his tendency to not get the “big picture.” Dr. Chan recognized George as someone who was talented in debugging Python programs but who found the open-ended objectives of assignments confusing. She had recently attended a lecture on the SBMN and recalled that autistic students are often good at attention to details. She leveraged this information and reformulated the assignments with logical and coherent details. George had no problem with lots of details. He worked hard in this class and eventually received an A. Dr. Chan found that her change in the assignments helped not only George but other students as well. For the first time in 10 years, she found that all of her students understood all of her assignments. She ultimately was nominated for and won a teaching award in the computer science department.

Conclusion Despite the promises of neurodiversity, barriers to inclusion are currently real, whether socially constructed, congenital, or acquired. Research shows that neurodiverse people are more likely to be incarcerated (Snowling et al. 2000; Young et al. 2018), unemployed (Dickson 2012; Jensen et al. 2000), and unable to achieve academic or career potential (de Beer et al. 2014; Holliday et al. 1999; Kirby et al. 2011; Painter and Welles 2011). Provisions for neurodiverse conditions or “invisible disability” are enacted in disability legislation across the world (e.g., in the United States, the Individuals with Disabilities Education Act in 2004 and the Americans with Disabilities Amendments Act in 2008; in the United Kingdom, the Equality Act in 2010). These laws oblige both educators and employers to make “reasonable” adjustments and accommodations to their environments. Accommodations for neurodiversity are more nuanced than are those for physical disability (e.g., access ramps for wheelchairs, screen readers for visual impairments, and sign language interpreters for hearing impairments). Neurodiversity accommodations may involve changes to the sensory environment, flextime or additional time, assistive technology, extended training, and performance coaching (Telwatte et al. 2017; Weinberg and Doyle 2017). Treatment and intervention research for neurodiverse conditions, however, is predominantly medical (e.g., Amen et al. 2011; Doyle and McDowall 2019). Notably, one article reviewed the volume and location of dyslexia research in the English language since 1995 (Doyle and McDowall 2015). The authors reported that 62% of articles were published in neuroscience journals, and out of more than 11,000 studies, only 42 single studies (no randomized controlled trials) related to functional, occupational presentation. The paucity of applied psychological research for neurodiversity is well reported (Adamou et al. 2013, Baldwin et al. 2014; Doyle and McDow-

Neurodiversity

13

all 2019; Kirby et al. 2011; Weinberg and Doyle 2017) yet remains unaddressed. Our society seems to be heavily invested in neuroscience research instead of research associated with functional adaptation in neurodiverse conditions. Legislative branches worldwide have not spurred sufficient research in education or occupational fields to address barriers (KarmiloffSmith 2009; Santuzzi et al. 2014). Our epistemological frame is divergent from the ontological paradigm shift, and research has not maintained pace with practice. We therefore lack reliable evidence upon which to base inclusion activity. In conclusion, much work has to be done at the legislative level to maximize the potential of neurodiversity. More research is needed to devise better instruments to assess the many strengths of neurodiverse individuals. Meanwhile, the SBMN provides a framework that enables practitioners to develop their programs for the benefit not only of neurodiverse individuals but also of everyone in society.

KEY CONCEPTS •

Neurodiversity is about recognizing that differences in brain function and behavior are part of the normal variation of the human population.

•

Neurodiverse conditions include but are not limited to autism, dyslexia, dyscalculia, dysgraphia, dyspraxia, ADHD, Tourette syndrome, and synesthesia.

•

Neurodiverse conditions are conditions instead of disorders.

•

Depending on the context, traits of neurodiverse conditions can be seen as strengths or challenges.

•

Much debate on the language related to neurodiversity is still ongoing. Use of adjectives such as neurodiverse and neurodivergent is a personal decision that should be respected.

•

The four major components of the strengths-based model of neurodiversity are Gardner’s theory of multiple intelligences, positive psychology, positive psychiatry, and Chickering’s seven vectors of development.

14

Neurodiversity

Recommendations for Educators, Clinicians, and Other Professionals • Get to know the neurodiverse people around you. Use Gardner’s theory of multiple intelligences to discover the strengths of neurodiverse individuals in multiple domains. • Clinicians: Consider incorporating positive psychology or positive psychiatry into patient care. Guide patients in writing blessings journals, using signature strengths in a new way, and making gratitude visits. Engage patients to speak about positive emotions; become immersed in activities that give satisfaction; develop positive, trusting relationships; find meaning and purpose in life; and celebrate personal accomplishments. • Educators and professionals in educational settings: Become involved in changing the school environment so as to help neurodiverse students achieve their developmental tasks during these formative years. Help make change by doing the following: • Cultivate inclusion by educating neurotypical students and teachers about neurodiversity. • Assess and identify learning styles of neurodiverse students. • Provide academic support, coaching, or tutoring accordingly. • Recommend reasonable academic accommodations to help neurodiverse students succeed. • Reach out to students who need assistance with regulating their emotions. • Help students move through autonomy toward interdependence by being involved in peer mentoring programs and other group activities. • Create more accessible environments for neurodiverse students in their career exploration. • Provide vocational counseling and programs designed to help neurodiverse students navigate into the workforce. • Employers and professionals in employment settings: Promote change by doing the following: • Cultivate inclusion by educating supervisors and employees about neurodiversity. • Assess and identify learning styles of neurodiverse employees. • Provide vocational supports and coaching accordingly. • Recommend reasonable accommodations to help neurodiverse students succeed in the workplace.

Neurodiversity

15

• Reach out to neurodiverse employees who need assistance with regulating their emotions. • Help neurodiverse employees move through autonomy toward interdependence via mentoring programs and other group activities. • Create more accessible environments for neurodiverse employees to explore their career trajectories.

Discussion Questions 1. What are some commonalities among diversity movements throughout history? 2. What are the psychological bases for the language used in the discussion of neurodiversity? 3. What is the empirical evidence for the utility of each component of the strengths-based model of neurodiversity? 4. What are the ethical implications of the neurodiversity movement?

Suggested Readings Austin RD, Pisano GP: Neurodiversity as a competitive advantage. Harv Bus Rev, May–June 2017 Baron-Cohen S: Editorial perspective: neurodiversity—a revolutionary concept for autism and psychiatry. J Child Psychol Psychiatry 58(6):744– 747, 2017 Doyle NE, McDowall A: Context matters: a review to formulate a conceptual framework for coaching as a disability accommodation. PLoS One 14(8):e0199408, 2019

References Adamou M, Arif M, Asherson P, et al: Occupational issues of adults with ADHD. BMC Psychiatry 13:59, 2013 Amen SL, Piacentine LB, Ahmad ME, et al: Repeated N-acetyl cysteine reduces cocaine seeking in rodents and craving in cocaine-dependent humans. Neuropsychopharmacology 36(4):871–878, 2011 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Washington, DC, American Psychiatric Association, 1980 Armstrong T: The Power of Neurodiversity: Unleashing the Advantages of Your Differently Wired Brain. Cambridge, MA, Da Capo Press, 2010

16

Neurodiversity

Austin RD, Pisano GP: Neurodiversity as a competitive advantage. Harv Bus Rev, May–June 2017 Baker DL: The Politics of Neurodiversity: Why Public Policy Matters. Boulder, CO, Lynne Rienner, 2011 Baldwin S, Costley D, Warren A: Employment activities and experiences of adults with high-functioning autism and Asperger’s disorder. J Autism Dev Disord 44(10):2440– 2449, 2014 Bernick M: Effective autism (neurodiversity) employment: a legal perspective. Forbes, January 15, 2019 Blume H: Neurodiversity: on the neurological underpinnings of geekdom. The Atlantic, September 1998 Bury SM, Jellett R, Spoor JR, Hedley D: “It defines who I am” or “It's something I have”: what language do [autistic] Australian adults [on the autism spectrum] prefer? J Autism Dev Disord 2020 Epub ahead of print Charlton J: Nothing About Us Without Us: Disability Oppression and Empowerment. Berkeley, University of California Press, 1998 Chickering AW, Reisser L: Education and Identity, 2nd Edition. San Francisco, CA, Jossey-Bass, 1993 Comaford C: Is neurodiversity the right talent path for your organization? Forbes, June 24, 2017 de Anca C, Aragón S: The 3 types of diversity that shape our identities. Harv Bus Rev, May 24, 2018 de Beer J, Engels J, Heerkens Y, van der Klink J: Factors influencing work participation of adults with developmental dyslexia: a systematic review. BMC Public Health 14:77, 2014 Dickson E: Supporting service users into employment: a literature review. Mental Health Practice 16(4):15–18, 2012 Doyle N: A critical realist analysis of coaching as a disability accommodation. Unpublished doctoral thesis, Department of Psychology, London, University of London, 2018 Doyle N, McDowall A: Is coaching an effective adjustment for dyslexic adults? Coaching: An International Journal of Theory, Research and Practice 8(2):154– 168, 2015 Doyle NE, McDowall A: Context matters: a review to formulate a conceptual framework for coaching as a disability accommodation. PLoS One 14(8):e0199408, 2019 D’Souza H, Karmiloff-Smith A: Neurodevelopmental disorders. Wiley Interdiscip Rev Cogn Sci 8(1–2), 2017 Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1983 Gardner H, Hatch T: Multiple intelligences go to school: educational implications of the theory of multiple intelligences. Educ Res 18(8):4–10, 1989 Gillings MR, Hilbert M, Kemp DJ: Information in the biosphere: biological and digital worlds. Trends Ecol Evol 31(3):180–189, 2016

Neurodiversity

17

Grant D: The psychological assessment of neurodiversity, in Neurodiversity in Higher Education: Positive Responses to Specific Learning Differences. Edited by Pollak D. Chichester, UK, Wiley-Blackwell, 2009, pp 33–62 Hart KE, Sasso T: Mapping the contours of contemporary positive psychology. Can Psychol 52(2):82–92, 2011 Hendren RL, Haft SL, Black JM, et al: Recognizing psychiatric comorbidity with reading disorders. Front Psychiatry 9:101, 2018 Holliday GA, Koller JR, Thomas CD: Post-high school outcomes of high IQ adults with learning disabilities. Journal for the Education of the Gifted 22(3):266–281, 1999 Houston S: Critical realism, in The Sage Encyclopedia of Qualitative Research Methods. Edited by Coghlan D, Brydon-Miller M. London, Sage, 2014, pp 220–222 Hunt V, Layton D, Prince S: Why diversity matters. McKinsey and Company, January 1, 2015. Available at: https://www.mckinsey.com/business-functions/organization/ our-insights/why-diversity-matters. Accessed July 14, 2019. Jensen J, Lindgren M, Andersson K, et al: Cognitive intervention in unemployed individuals with reading and writing disabilities. Appl Neuropsychol 7(4):223– 236, 2000 Jeste DV, Palmer BW, Rettew DC, Boardman S: Positive psychiatry: its time has come. J Clin Psychiatry 76(6):675–683, 2015 Kapp SK, Gillespie-Lynch K, Sherman LE, Hutman T: Deficit, difference, or both? Autism and neurodiversity. Dev Psychol 49(1):59–71, 2013 Karmiloff-Smith A: Nativism versus neuroconstructivism: rethinking the study of developmental disorders. Dev Psychol 45(1):56–63, 2009 Kenny L, Hattersley C, Molins B, et al: Which terms should be used to describe autism? Perspectives from the UK autism community. Autism 20(4):442–462, 2016 Kirby A, Edwards L, Sugden D: Emerging adulthood in developmental co-ordination disorder: parent and young adult perspectives. Res Dev Disabil 32(4):1351–1360, 2011 Krcek TE: Deconstructing disability and neurodiversity: controversial issues for autism and implications for social work. J Progress Hum Serv 24(1):4–22, 2012 Logan J: Dyslexic entrepreneurs: the incidence; their coping strategies and their business skills. Dyslexia 15(4):328–346, 2009 Meilleur AA, Jelenic P, Mottron L: Prevalence of clinically and empirically defined talents and strengths in autism. J Autism Dev Disord 45(5):1354–1367, 2015 Oliver M: Social Work With Disabled People. Basingstoke, UK, Macmillan International, 1983 Ortega F: The cerebral subject and the challenge of neurodiversity. Biosocieties 4(4):425–446, 2009 Painter C, Welles T: Career beliefs and job satisfaction in adults with symptoms of attention-deficit/hyperactivity disorder. J Employ Couns 45(4):178–189, 2011 Pawson R: Evidence-Based Policy: A Realist Perspective. London, Sage, 2006 Ralph N, Birks M, Chapman Y: The methodological dynamism of grounded theory. Int J Qual Methods 14(4):1–6, 2015

18

Neurodiversity

Riddick B: Dyslexia and inclusion: time for a social model of disability perspective? International Studies in Sociology of Education 11(3):37–41, 2001 Santuzzi AM, Waltz PR, Finkelstein LM, Rupp DE: Invisible disabilities: unique challenges for employees and organizations. Ind Organ Psychol 7(2):204–219, 2014 Seligman ME, Csikszentmihalyi M: Positive psychology: an introduction. Am Psychol 55(1):5–14, 2000 Shelley-Tremblay JF, Rosén LA: Attention deficit hyperactivity disorder: an evolutionary perspective. J Genet Psychol 157(4):443–453, 1996 Siegel LS: Perspectives on dyslexia. Paediatr Child Health 11(9):581–587, 2006 Simpson B: Pragmatism: a philosophy of practice, in SAGE Handbook of Qualitative Business and Management Research Methods. Edited by Cassell C, Cunliffe AL, Grandy G. London, Sage, 2018, pp 54–68 Singer J: Odd people in: the birth of community amongst people on the autistic spectrum. A personal exploration of a new social movement based on neurological diversity. Unpublished dissertation, Department of Humanities and Social Sciences, University of Technology, Sydney, Australia, 1998 Singer J: “Why can’t you be normal for once in your life?” From a “problem with no name” to the emergence of a new category of difference, in Disability Discourse. Edited by Corker M, French S. Buckingham, UK, Open University Press, 1999, pp 59–67 Snowling MJ, Adams JW, Bowyer-Crane C, Tobin VA: Levels of literacy among juvenile offenders: the incidence of specific reading difficulties. Crim Behav Ment Health 10(4):229–241, 2000 Solomon A: The autism rights movement. New York Magazine, May 23, 2008. Available at: https://nymag.com/news/features/47225. Accessed January 4, 2021. Taylor KE, Walter J: Occupation choices of adults with and without symptoms of dyslexia. Dyslexia 9(3):177–185, 2003 Telwatte A, Anglim J, Wynton SKA, Moulding R: Workplace accommodations for employees with disabilities: a multilevel model of employer decision-making. Rehabil Psychol 62(1):7–19, 2017 Van Maanen J, Sørensen JB, Mitchell TR: The interplay between theory and method. Acad Manage Rev 32(4):1145–1154, 2007 Wehmeyer ML (ed): The Oxford Handbook of Positive Psychology and Disability. New York, Oxford University Press, 2013 Weinberg A, Doyle N: Psychology at Work: Improving Wellbeing and Productivity in the Workplace (policy report). Leicester, UK, British Psychological Society, November 20, 2017 White HA, Shah P: Uninhibited imaginations: creativity in adults with attentiondeficit/hyperactivity disorder. Pers Individ Dif 40:1121–1131, 2006 Young S, González RA, Fridman M, et al: The economic consequences of attentiondeficit hyperactivity disorder in the Scottish prison system. BMC Psychiatry 18(1):210, 2018

TWO Positive Psychology and Strengths-Based Approaches to Neurodiversity Michael L. Wehmeyer, Ph.D.

People with autism should be treated with the same dignity, respect, and equality as people without autism. Jean-Paul Bovee (2000)

Disability, throughout most of its history, has been understood within the context of diseases and deficits. Social models of disability, however, emphasize understandings of disability as derived from lived experiences and stress that disability is rooted in attitudes, structures, and environments in society and the restrictions inherent therein. Strengths-based approaches to neurodiversity take, as a starting point, the assumptions of the social model of disability and then translate them into approaches that support, educate, or enable people with disabilities to function successfully in typical contexts. This chapter examines the historical development of strengths-based approaches to disability and the convergence of social and person-environment fit models of disability with positive psychology in moving the field toward strengths-based approaches. The chapter then highlights progress on mindfulness, character strengths, and self-determination as examples of how strengths-based approaches are increasingly impacting disability services and supports.

19

20

Neurodiversity

For much of history, disability, as a construct, was conceptualized as an internal pathology and viewed as a chronic or long-term health condition (Wehmeyer 2013b). Unfortunately, the resulting societal perceptions of people with disability were that they were somehow different from the norm, and consequently, societal responses to disability were characterized by segregation, discrimination, and maltreatment (Smith and Wehmeyer 2012). This situation began to change in the 1980s because the medical community began to recognize that conceptualizing long-term or chronic health problems solely within a disease model was inadequate and because people with disability themselves began to reject these understandings of disability and to organize around a civil rights agenda emphasizing equal rights and access, social justice, and protection against discrimination. A worldwide self-advocacy and civil rights movement took root (Driedger 1989; Williams and Shoultz 1982). Jean-Paul Bovee, whose quote began the chapter and who is autistic himself, was an early leader in the self-advocacy movement: “People with autism need to join the disability rights movement and the People First movement. These groups know what we face is prejudice and discrimination. We need to fight for our humanity, our rights, respect, and dignity that we deserved from the day we were born” (Bovee 2000, p. 252). One outcome of the self-advocacy movement was the “advancement of a positive disability identity and culture” (Caldwell 2011, p. 315). Historian and disability rights pioneer Paul Longmore described the establishment of disability identity and culture as the second phase of the disability rights movement (Longmore 2003). Longmore and Umansky (2001) explained, While public policy has sought to fashion disability as a generic category and attempted to impose that classification on people with an assortment of conditions, disability has never been a monolithic grouping. There has always been a variety of disability experiences....[These] experiences of cultural devaluation and socially imposed restriction, of personal and collective struggles for self-definition and self-determination...recur across the various disability groups and throughout their particular histories. (p. 4)

What leaders in the self-advocacy movement emphasize is that by embracing disability identity, they recapture their personhood and lay claim to social justice, full citizenship, and participation. Self-advocates with neurodevelopmental disabilities (NDDs) have been at the forefront of movements to embrace disability identity, as illustrated by the positions articulated by the Autistic Self Advocacy Network (ASAN). ASAN’s positions illustrate this in myriad ways. For example, ASAN states the following:

Positive Psychology and Strengths-Based Approaches

21

Within the broader context of the disability rights movement, ASAN seeks to bring about more accommodation and acceptance of neurological diversity in our society. We believe that self-advocacy is essential to this process and that there must be meaningful involvement of Autistic individuals in making policy at all levels: Nothing About Us Without Us. (Autistic SelfAdvocacy Network 2019)

Nothing about us without us is the universal rallying call for the disability civil rights movement, and its use in the ASAN position statement situates the neurodiversity movement within the historic context of that movement. Neurodiversity and disability rights are inextricably linked by ASAN: The disability rights perspective within the Autistic community is represented in the neurodiversity movement, which promotes social acceptance of neurological difference as part of the broad landscape of human diversity and seeks to bring about a world in which Autistic people enjoy the same access, rights, and opportunities as all other citizens. (Autistic Self-Advocacy Network 2019)

What ASAN and the neurodiversity movement emphasize is what Bovee stated in the quote at the beginning of the chapter: that autistic people deserve to be treated with dignity and respect. Of course, there are real challenges associated with autism and other neurological differences. The social model draws a distinction between the underlying condition, which exists regardless of cultural attitudes, and the disability, which consists of everything that goes into society’s representation of the condition. In advocating recognition of the civil rights and dignity of Autistics and others with disabilities,...we are seeking to create a world in which all people can benefit from whatever supports, services, therapies, educational tools, and assistive technologies may be necessary to empower them to participate fully in society, with respect and self-determination as the guiding principles. (Autistic Self-Advocacy Network 2019)

The ASAN position statement references the social model (of disability), which provides the foundation for the strengths-based approaches discussed in this chapter. Two models or conceptualizations of disability are typically at the center of discussions about understanding disability: the biomedical model and the social model. The latter became the dominant perspective of disability with the growth of institutional care and the “need for regulation, licensing, and due process in committal to institutions,” roles that were taken on by the medical profession (Bach 2017, p. 38). It was logical that in a system led by medical professionals, disability would be conceptualized within a medical model. There are benefits to a medical model in the form of advances in understanding underlying conditions and generating knowledge for preventive action, but the main limitation of the model, according

22

Neurodiversity

to Bach (2017), is that in viewing disability primarily as an internal pathology, the person becomes perceived to be in some way deficient, in some way outside the norm. Psychology’s wide adoption of intelligence testing furthered this perception of subnormality (and indeed mental subnormality became a term referring to people who did not perform well on such tests). The social model views disability as arising “from the discrimination and disadvantage individuals experience in relation to others because of their particular differences and characteristics” (Bach 2017, p. 40). In a social model, the so-called pathology is not individual, but rather social in nature. The unit of analysis shifts from the individual to the legal, social, economic, and political structures that calculate value and status on the basis of difference. Informed by principles of human rights and an equality of outcomes that takes account of differences, the social model does not reject biomedical knowledge of impairments and research on individual rehabilitation. Rather, it celebrates impairment as part of the human condition and looks at achieving equity for people with impairments in terms of the social, cultural, and political contexts. (Bach 2017, p. 40)

It was during the transition from a biomedical model to a social model of disability that strengths-based approaches to disability began to emerge, and these emerging strengths-based approaches coincided with the emergence of the field of positive psychology. The remainder of this chapter examines strengths-based approaches to disability, their application in positive psychology, their and implications for disability services and supports.

Strengths-Based Approaches to Neurodiversity Strengths-based approaches to neurodiversity are predicated on social models of disability, but the two are not necessarily identical. “Social models of disability” refers to an understanding of disability that emphasizes lived experiences and the attitudes, structures, and environments in society and the restrictions inherent therein. Strengths-based approaches take, as a starting point, these assumptions of the social model and translate them into approaches to support, educate, or enable people with disabilities to function successfully in typical contexts. It is worth noting that strengths-based approaches are not unique to the disability context. The field of social welfare, for example, introduced a strengths model in the late 1990s (Rapp 1997) in regard to case management practices for people experiencing severe and persistent mental health issues.

Positive Psychology and Strengths-Based Approaches

23

Hall et al. (2013) defined a strengths-based approach in social welfare as providing a “foundation for clients and emphasiz[ing] personal growth, empowerment, and coping skills based on ideals that focus on strengths instead of pathology.” As noted, the medical community recognized in the 1980s that an understanding of long-term or chronic health issues, including disability, that was based strictly on health impairments was insufficient. The conceptualization of disability that has most influenced strengths-based approaches in psychology and education is the World Health Organization’s International Classification of Functioning, Disability and Health (ICF; World Health Organization 2001), the framework for which is presented in Figure 2–1. The ICF provides “a multidimensional framework for the description of human functioning and disability” (Buntinx 2013, p. 9). In the ICF, functioning is used as an umbrella term for “neutral or non-problematic functional states,” and disability is used as “an umbrella term for problems in functioning” (Buntinx 2013, p. 9). Importantly, disability is presented in the ICF as part of and not apart from typical human functioning. As can be seen in Figure 2–1, the ICF framework looks at the interactions of impairments to body structure and functions (due to health or medical issues) with environmental factors and personal factors on a person’s activity and participation. It is important to note that, as stated by Bach (2017), “There remains some question about the place of ‘impairment’ within the social and human rights model of disability” (p. 40). Advocates such as Bach view the ICF as still in the realm of biomedical models but recognize that it also reflects elements of social models. Others are willing to accept the inclusion of impairments in a social model as long as disability is clearly distinct from impairment and refers to the restrictions caused by society. The ICF is often viewed as more of a person-environment fit model of disability or as a social-ecological model rather than a strictly social model. In both of these frameworks, disability is understood as resulting from a lack of fit or a gap between a person’s capacities and the demands of the environment or context. According to the ICF, whether an impairment results in disability is a function not of the presence of the impairment itself but of the interaction between personal and environmental factors that mediate the impact of the impairment on activity and participation (see Figure 2–1). Activity refers to a person’s execution of a task or action. Participation refers to a person’s involvement in life situations. The ICF framework enabled the emergence of strengths-based approaches to disability in psychology and education. In this framework, disability is situated not within the person, as in biomedical models, but in the gap between the person’s capacities and the environment’s demands. A person’s strengths is the starting point for supports to en-

24

Neurodiversity

Health condition (Disorder or disease)

Body functions and structure

Activity

Environmental factors

Participation

Personal factors

FIGURE 2–1. The International Classification of Functioning, Disability and Health framework. Source. Reprinted from World Health Organization: International Classification of Functioning, Disability and Health (ICF). Geneva, World Health Organization, 2001. Used under a Creative Commons Attribution–NonCommercial ShareAlike 4.0 International License.

able that person to function successfully (i.e., engage in activities leading to full participation). Publication of the ICF in 2001 stimulated the development of strengthsbased approaches. At the same time, a new discipline, positive psychology, was taking shape within psychology.

Positive Psychology In 1998, Martin Seligman, then president of the American Psychological Association, called for a “reoriented science that emphasizes the understanding and building of the most positive qualities of an individual” (Seligman 1999, p. 559) and introduced a field that he referred to as positive psychology. Positive psychology is “the pursuit of understanding optimal human functioning and well-being” (Wehmeyer et al. 2009, p. 357). Seligman and Csikszentmihalyi (2000), in an introduction to a special issue of American Psychologist on positive psychology, wrote the following:

Positive Psychology and Strengths-Based Approaches

25

The field of positive psychology at the subjective level is about valued subjective experiences: well-being, contentment, and satisfaction (in the past); hope and optimism (for the future); and flow and happiness (in the present). At the individual level, it is about positive individual traits: the capacity for love and vocation, courage, interpersonal skill, aesthetic sensibility, perseverance, forgiveness, originality, future mindedness, spirituality, high talent, and wisdom. (p. 5)

A comprehensive review of the positive psychology literature identified six major themes in definitions of the field (Hart and Sasso 2011, p. 84): 1. Virtues, character strengths, positive personality traits, abilities, and talents 2. Happiness, positive emotional well-being, fulfillment, and quality of life 3. Development processes associated with growth, fulfillment, actualization of potential, and the authentic self 4. The good life or the life worth living 5. Thriving and flourishing 6. Resilience or adaptive functioning/behavior Among the constructs that are frequently identified in positive psychology are subjective well-being, optimism, happiness, self-determination, hope, emotional intelligence, resilience, creativity, lifestyle satisfaction, quality of life, and positive affect.

Positive Psychology and Neurodiversity As the field of disability supports and services began to adopt and operationalize strengths-based approaches, it was logical that the emergence of positive psychology would influence the understanding of such approaches. The disability field had a relatively rich history of applying some positive psychological constructs—particularly quality of life and self-determination—to practice. In other areas, however, there was very little application. Shogren et al. (2006b) conducted a content analysis of 30 years (1975–2004) of literature in the area of intellectual disability to examine the use of a strengths focus in research during that period and, for research that had adopted a strengths focus, to consider what positive psychological constructs were represented. Research articles were coded in each of three 10-year periods (1975–1984, 1985–1994, and 1995–2004) with regard to these factors. Research using a strengths-based approach increased across time, from about

26

Neurodiversity

20% in the first decade to 50% in the third decade. Deficits-focused articles decreased, although only slightly overall. The application of positive psychological constructs increased among articles that used a strengths focus, from 27% of articles in the first decade to 44% in the second decade and 63% during the final decade. In 2013, The Oxford Handbook of Positive Psychology and Disability (Wehmeyer 2013a) was published, providing a comprehensive examination of the application of positive psychological constructs such as optimism, hope, and resilience in the disability context and providing an opportunity to synthesize the use of constructs that had received more attention—such as selfdetermination, quality of life, adaptive behavior, and decision making. In a chapter in that handbook, Shogren (2013) reported on a content analysis of the positive psychological literature pertaining to the degree to which disability was addressed. Reviewing all articles published in the Journal of Positive Psychology from its inception in 2006 through 2012, Shogren found six articles (4%) that mentioned people with disabilities. Most of those articles focused on issues pertaining to chronic, long-term health issues (e.g., asthma, cancer). Even though a focus on disability remains underrepresented within the positive psychology literature, there is an increased focus on the application of positive psychology in the disability sphere, with long-standing topics such as self-determination continuing to be areas of concentration and with newer topics (within the disability literature, that is) such as mindfulness and character strengths beginning to be explored. There remains a dearth of research on topics such as hope, optimism, and resilience within the disability context, but progress has been made overall. For example, a handbook on the application of positive psychology in the lives of people with NDDs was published in 2017 (Shogren et al. 2017c), adding chapters on topics not included in the Oxford handbook (Wehmeyer 2013a), including mindfulness, character strengths, intrinsic motivation, and supported decision making. As a means of providing a snapshot of areas of progress, the remainder of this chapter reviews mindfulness, character strengths, and self-determination as they have been explored within the context of NDDs.

Mindfulness Neither mindfulness nor character strengths was originally included as a topic in The Oxford Handbook of Positive Psychology and Disability (Wehmeyer 2013a) because there was insufficient research on these constructs in the disability context at the time. The situation has changed in the intervening years, and an additional chapter on mindfulness and character strengths was added to the online version of the handbook (Shogren et al. 2017a) and fea-

Positive Psychology and Strengths-Based Approaches

27

tured in the handbook on applications of positive psychology in NDDs (Shogren et al. 2017c). Mindfulness is a good example of a strengths-based approach because research in mindfulness and NDDs focuses on applications of mindfulness interventions to help individuals with NDDs function more successfully. Mindfulness (in a Western context) has been defined as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn 1994, p. 4). Mindfulness has been defined as a two-part process: The first component involves the self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. The second component involves adopting a particular orientation toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance. (Bishop et al. 2004, p. 232)

Nirbay Singh et al. (2008) pointed out that mindfulness can be described not only as a practice but also as a state, a trait, a process, and an outcome. In the NDD context, however, it is most frequently used to describe a practice (or, actually, a set of related practices). Singh and his colleagues (Singh and Jackman 2017; Singh et al. 2017) have pioneered the application of two mindfulness practices, Soles of Feet (SoF) and Mindful Observation of Thoughts (MOT), to decrease stress, increase wellness, and improve self-regulation of emotions and behavior for people with NDDs, their family members, and caregivers. Singh and Jackman (2017) described the SoF practice as a means to help a person attend to the emotions that arise in a context or situation and to self-manage those emotions by “consciously redirecting attention away from the emotionally arousing situation to a neutral place, the soles of the feet” (p 289). As they practice SoF, individuals increase their capacity to self-regulate their emotions. Singh and Jackman (2017) found that participants with NDDs who learned and applied the SoF practice experienced improvements in depression, anxiety, self-compassion, and compassion. A number of studies have demonstrated that people with NDDs can learn and use the SoF practice to self-regulate behavior (Singh et al. 2013). For example, Singh et al. (2011a) taught three autistic adolescents to use the practice to manage their anger and to replace aggressive action with the SoF meditation. The positive effects of this intervention were still in place after 3 years. MOT practices involve meditative processes that help people disengage from their thoughts through practices such as closing their eyes and focusing on their breathing, visualizing their emotions or thoughts, and visualizing alternatives to acting on those emotions or thoughts. For example,

28

Neurodiversity

Singh et al. (2011b) sought to increase health and wellness outcomes for people with Prader-Willi syndrome. Prader-Willi syndrome is a genetic disorder associated with, among other issues, intellectual impairments and hyperphagia (abnormally increased appetite) leading to obesity. The intervention involved MOT components (mindful eating to manage rapid eating, visualizing and labeling hunger, and engaging in SoF to rapidly shift attention away from hunger) along with physical exercise and food awareness activities to enable participants to self-regulate their eating. All three participants in the study were able to set and attain goals pertaining to a desired weight and to maintain that weight over a 3-year period.

Character Strengths Character strengths are described as “positive, trait-like capacities for thinking, feeling, and behaving in ways that benefit oneself and others, and...as specific psychological processes that define broader virtues” (Shogren et al. 2017a, p. 2). A prominent framework for classifying character strengths is the Values in Action (VIA) Classification of Strengths (Peterson and Seligman 2004). The VIA framework identifies 24 character strengths classified within six virtues, as depicted in Table 2–1. In positive psychology, there has been a recent trend in integrating mindfulness and character strengths (Ivtzan et al. 2016). This should come as no surprise; Shogren et al. (2017a) pointed out that two character strengths—self-regulation and curiosity— are at the core of their definition of mindfulness. Much of the work in the area of character strengths has involved measuring these strengths and then using the results to design interventions that focus on them. The VIA Inventory of Strengths (VIA-IS), for individuals ages 18 years and older, and the VIA Inventory of Strengths–Youth (VIA-Youth), for children and youth ages 10–17 years, use the VIA framework depicted in Table 2–1 (available at www.viacharacter.org). These tools have strong measurement properties (Macdonald et al. 2008; McGrath 2014). As a first step in applying character strengths to the disability context, Shogren et al. (2017b, 2018a) examined the reliability and factorial validity of the VIA-Youth in youth with intellectual disability compared with youth without disability. These analyses determined that, with supports, young people with NDDs can assess their character strengths using the VIA-Youth, and the measure performs similarly to its performance for youth without disability. To provide such supports, Shogren et al. (2015a) created a guide for helping youth with intellectual and developmental disabilities complete the VIA-Youth. Because the emphasis was on ensuring that the items remained the same (so that young people with NDDs would

29

Positive Psychology and Strengths-Based Approaches

have the same experience as youth without disabilities), the guide provides suggestions for explaining the intent of items, gives examples, and so forth. TABLE 2–1.

Values in Action Classification of Strengths: virtues and character strengths

Virtue

Character strengths

Wisdom

Creativity Curiosity

Judgment Perspective Love of learning

Courage

Bravery Perseverance

Honesty Zest

Humanity

Love

Kindness

Social intelligence

Justice

Teamwork

Fairness

Leadership

Temperance

Forgiveness Humility

Prudence Self-regulation

Transcendence Appreciation of beauty Gratitude and excellence Hope

Humor Spirituality

Another measure of character strengths is the Assessment Scale for Positive Character Traits–Developmental Disabilities (ASPeCT-DD; Woodard 2009), which was designed to help caregivers provide information about the character strengths of young people with NDDs who cannot self-report. The ASPeCT-DD examines 10 character strengths and has strong psychometric properties (Woodard 2009). Some researchers have explored the application of character strengths to people with NDDs. Kirchner et al. (2016) measured the character strengths of people with NDDs using the VIA-IS and examined the relationship between character strengths and life satisfaction for that group. Samson and Antonelli (2013) used the VIA-IS to explore the role of humor as a character strength for persons with Asperger syndrome. Both studies found links between certain character strengths and higher life satisfaction. Niemiec et al. (2017) illustrated the use of character strengths in interventions within education. For example, one intervention was to “use your signature strengths in new ways each day,” a strategy in which teachers work with students to identify their signature strengths (typically the five highest ranked strengths from an assessment) and then to use each strength daily. Niemiec and colleagues found only limited applications of interventions utilizing character strengths in the disability literature, but they illustrated the use of the Aware-Explore-Apply intervention (designed to help students identify and use character strengths) with youth with NDDs in transition-

30

Neurodiversity

planning contexts. Clearly, the application of character strengths information and interventions to the disability context is in its earliest stages.

Self-Determination Unlike character strengths, the self-determination construct has a relatively long and rich literature on its application to the disability context, so much so that it is not feasible to comprehensively review it in this context. The relative importance of this focus was ably represented in the quotes in the chapter introduction from Longmore and Umansky (2001) and the ASAN position statement (Autistic Self-Advocacy Network 2019), both of which explicitly stated the right to and importance of self-determination for people with NDDs. Self-determination is a construct with a long history and multiple applications, beginning with discussions in philosophy in the late 1600s pertaining to self-determination and free will (Wehmeyer et al. 2017b). The construct was first applied to psychology in the 1930s and 1940s in the context of the emergence of personality psychology, emphasizing a focus on self-caused action. In the 1980s, the construct became a central focus in motivation theory, and in particular self-determination theory (SDT; Ryan and Deci 2017). SDT is a well-researched meta-theory of motivation that explains how and why people act volitionally. SDT posits that a person’s experience of autonomy, competence, and relatedness, referred to as basic psychological needs, fosters autonomous motivation, leading to enhanced well-being and satisfaction with life (Wehmeyer 2020). As such, when positive psychology emerged as a discipline in the early 2000s, self-determination was immediately included under its umbrella. The special issue of American Psychologist on positive psychology edited by Seligman and Csikszentmihalyi that was mentioned earlier included an article by Ryan and Deci (2000) on SDT and its application to positive psychology. The self-determination construct became important to the disability context in two ways. First, through the disability civil rights movement described earlier, people with disabilities began to demand the right to autonomy and self-determination. Second, as psychology and education began to adopt strengths-based approaches, the issue of promoting self-determination surfaced as critically important. Within the psychology and education context in disability, perhaps the most well-known theory of self-determination is causal agency theory (Shogren et al. 2015b). Causal agency theory was proposed to align theory in self-determination from education with the motivation to describe a model for the development of self-determination and to facilitate the development and validation of educational interven-

Positive Psychology and Strengths-Based Approaches

31

tions that promote it (Wehmeyer et al. 2017a). Causal agency theory defines self-determination as a “dispositional characteristic manifested as acting as a causal agent in one’s life” (Shogren et al. 2015b, p. 258). Causal agents make or cause things to happen. Research has shown that people with NDDs are less self-determined than their nondisabled peers (Shogren et al. 2018b); that if provided opportunities, both educational and experiential, people with NDDs can become more self-determined (Wehmeyer et al. 2012a, 2012b); that enhanced selfdetermination contributes to more positive school, employment, and community inclusion outcomes (Shogren et al. 2012, 2015c); and that higher self-determination status contributes to more positive life satisfaction and quality of life (Nota et al. 2007; Shogren et al. 2006a; Wehmeyer and Schwartz 1998). Youth and young adults with NDDs may be at particular risk for limited opportunities to learn and practice skills related to selfdetermination and, thus, may experience limited self-determination. Chou et al. (2017) compared the self-determination status of groups of youth with autism, intellectual disability, and learning disabilities. They found that autistic youth had significantly lower scores in the domain of autonomous functioning and, as a result, in overall self-determination.

Case Example Today, Jean-Paul Bovee is a widely recognized advocate for the rights of people with NDDs. In his life, Jean-Paul has overcome many barriers to selfdetermination, from those related to his personal experience with autism, to those imposed upon him by society. Jean-Paul’s mother reported that he, like many children with NDDs, was passive as a child, preferring others to do things for him (Donnelly et al. 2000). When Jean-Paul was growing up on a farm in the 1970s, his family provided structure that enabled him to better self-regulate his emotions and his responses, set expectations for him that were comparable to those of his siblings, and encouraged him to explore his interests in sports, reading, and music. Unfortunately, school was not an experience that offered similar opportunities for success. He was teased and experienced bullying, particularly as he got older and entered secondary education. He says that as a result of these experiences, his “self-concept and self-esteem were shattered” and that he did not like himself because he had internalized the teasing and bullying (Donnelly et al. 2000). Because of the support of his family, Jean-Paul persevered through these difficult years and in high school became involved in various extracurricular activities, from honor clubs to student government to serving as a mascot for the sports teams. He found ways in which his unique talents could contribute, and his History Bowl team achieved state and regional successes (Donnelly et al. 2000). These successes and his involvement in student government, in turn, led to receipt of a scholarship to a university in his state. Jean-Paul had difficulty adjusting to college and, once more, it was involve-

32

Neurodiversity ment in activities such as student government and other extracurricular activities that helped him break out of his isolation and excel. He decided that he wanted to get his driver’s license and, despite the fact that others were skeptical, he focused and worked diligently to attain that goal. Jean-Paul completed his undergraduate degree and went on to earn two master’s degrees. He has worked professionally for a number of years and lives on his own. He has passionate interests in ethnic food, history, travel, sports, and books. In writing about his life and his experiences as an autistic person, Jean-Paul provided a roadmap to a better life. He emphasized that people with NDDs “need to learn to cope in a world where they are a minority” and that they should be supported to make “their own choices about what to do in the community” (Bovee 2000, p. 251). In talking about his personal experience with autism, he said, “I am proud of who I am, and autism is a part of who I am. In fact, you cannot separate the autism from what I do, think or am” (Bovee 2000, p. 252).

Conclusion When Jean-Paul Bovee is viewed through a lens of deficits and disorders, his passions are framed as obsessions and are seen as deficits to be remedied or behavior problems to be eliminated. When viewed through a social model of disability and strengths-based approaches, his passions become elements that enhance and enrich his life, help him obtain a scholarship to higher education, and provide opportunities to be with others who share similar passions. The trajectory of his life could have been very different if Jean-Paul’s family had not held high expectations for him and provided structure and freedom, and if he had not found groups of students who were interested in the same things he was passionate about, such as government and history. On the other hand, how much sooner would Jean-Paul have discovered these strengths if his classmates had recognized him as a person and not as someone different to be picked on or bullied? How many years of self-doubt and self-criticism might have been eliminated if people had recognized JeanPaul’s strengths and not perceived deficits? Strengths-based approaches to disability operationalize social and personenvironment fit models that recognize that disability is not a problem within the person but, rather, is a function of the complex, multifaceted interaction between a person, the person’s strengths and abilities, the available supports that enable the person to function, and the demands of the environment. Strengths-based approaches build on advances in positive psychology to enable people with disabilities to obtain optimal outcomes in their lives. These strengths-based approaches and the application of positive psychological constructs to the disability context are, in many ways, in their earliest stages, but there have been significant shifts in these directions in the past two de-

Positive Psychology and Strengths-Based Approaches

33

cades. The progress in applying strengths-based approaches such as mindfulness, character strengths, and promoting self-determination exemplifies the direction in which efforts to help people with NDDs live full, rich lives must proceed. As Jean-Paul Bovee’s mother noted, he “knew his faults and his weaknesses,” but “letting his strengths shine took his focus off the people that made fun of him” (Donnelly 2013, p. 27).

KEY CONCEPTS •

Self-determination: Acting as the causal agent in one’s life; making or causing things to happen in one’s life.

•

Dignity: A state of worthiness; being valued and respected because of one’s inherent humanity.

•

Respect: A state of being admired or given due regard; being held in positive esteem.

•

Positive psychology: The field of study focused on human strengths and promoting optimal human functioning.

•

Strengths-based approaches: Approaches that are based on social models of disability and emphasize self-determination.

•

Social models of disability: Models of disability that emphasize lived experiences and the attitudes, structures, and environments in society and the restrictions inherent therein.

Recommendations for Educators, Clinicians, and Other Professionals • Focus on strengths and abilities and hold high expectations for the person’s full participation. • Identify supports that can enable people with neurodevelopmental disabilities to function successfully in typical environments and contexts. • Promote self-determined learning, self-regulation, and self-advocacy. • Structure learning and supports around activities that are meaningful and based on student interests and preferences. • Support goal setting and attainment and focus on the process, not only the outcome. • Support people with neurodevelopmental disabilities to find communities that share their passions and interests.

34

Neurodiversity

• Support active involvement in educational and life planning and in decisions that impact quality of life. • Structure environments that support autonomy and choice and that ensure learners feel competent and cared for.

Discussion Questions 1. How does a shift to a social model of disability change the disability supports and services systems? 2. What barriers might limit opportunities for people with neurodevelopmental disabilities to fully participate, and how does focusing on positive psychology and strengths address these barriers? 3. Discuss the roles that people with neurodevelopmental disabilities have and should have had in changing paradigms in the ways in which disability is understood.

Suggested Readings Donaldson A, Krejcha K, McMillan A: A strengths-based approach to autism: neurodiversity and partnering with the autism community. Perspect ASHA Spec Interest Groups 2(1):56–68, 2017 Dykshoorn KL, Cormier DC: Autism spectrum disorders research: time for positive psychology. Autism Open Access 9:235, 2019 Longmore PK, Umansky L: The New Disability History: American Perspectives. New York, New York University Press, 2001 Morraine P: Autism and Everyday Executive Function: A Strengths-Based Approach for Improving Attention, Memory, Organization, and Flexibility. London, Jessica Kingsley Publishers, 2015 Mottron L: Should we change targets and methods of early intervention in autism, in favor of a strengths-based education? Eur Child Adolesc Psychiatry 26(7):815–825, 2017 Shogren KA, Wehmeyer ML, Singh NN: Handbook of Positive Psychology in Intellectual and Developmental Disabilities: Translating Research Into Practice. New York, Springer, 2017 Wehmeyer ML (ed): The Oxford Handbook of Positive Psychology and Disability. New York, Oxford University Press, 2013 Wehmeyer ML: Strengths-Based Approaches to Educating All Learners With Disabilities: Beyond Special Education. New York, Teachers College Press, 2019

Positive Psychology and Strengths-Based Approaches

35

Wehmeyer ML, Zhao Y: Teaching Students to Become Self-Determined Learners. Alexandria, VA, ASCD, 2019 Wehmeyer ML, Shogren KA, Little TD, Lopez SJ: Development of SelfDetermination Through the Life-Course. New York, Springer, 2017 World Health Organization: International Classification of Functioning, Disability and Health. Geneva, World Health Organization, 2001 Zager D, Wehmeyer ML: Teaching Adolescents and Young Adults With Autism Spectrum Disorders: Curriculum Planning and Strategies. New York, Routledge, 2020 Zhao Y: Reach for Greatness: Personalizable Education for All Children. Thousand Oaks, CA, Corwin, 2018

References Autistic Self-Advocacy Network: Position statements. Our motto: what is “nothing about us without us”? Available at: https://autisticadvocacy.org/about-asan/ position-statements. Accessed November 21, 2019. Bach M: Changing perspectives on intellectual and developmental disabilities, in A Comprehensive Guide to Intellectual and Developmental Disabilities, 2nd Edition. Edited by Wehmeyer ML, Brown I, Percy M, et al. Baltimore, MD, Paul H Brookes, 2017, pp 35–45 Bishop SR, Lau M, Shapiro S, et al: Mindfulness: a proposed operational definition. Clin Psychol Sci Pract 11:230–241, 2004 Bovee J-P: A right to our own life, our own way. Focus Autism Other Dev Disabil 15(4):250–252, 2000 Buntinx WHE: Understanding disability: a strengths-based approach, in The Oxford Handbook of Positive Psychology and Disability. Edited by Wehmeyer ML. New York, Oxford University Press, 2013, pp 7–18 Caldwell J: Disability identity of leaders in the self-advocacy movement. Intellect Dev Disabil 49(5):315–326, 2011 Chou Y, Wehmeyer ML, Palmer S, Lee JH: Comparisons of self-determination among students with autism, intellectual disability, and learning disabilities: a multivariate analysis. Focus Autism Other Dev Disabil 32(2):124–132, 2017 Donnelly JA: Healing from bullying for the individual with autism spectrum disorder. Autism Advocate 65(2):26–29, 2013 Donnelly JA, Bovee J-P, Donnelly SJ, et al: A family account of autism: life with Jean-Paul. Focus Autism Other Dev Disabil 15(4):196–201, 2000 Driedger D: The Last Civil Rights Movement: Disabled Peoples’ International. New York, St Martin’s Press, 1989

36

Neurodiversity

Hall JC, Blundo R, Bolton KW: Strengths-based frameworks, in Encyclopedia of Social Work. New York, National Association of Social Workers Press and Oxford University Press, June 2013. Available at: https://oxfordre.com/socialwork/view/ 10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-381. Accessed November 21, 2019. Hart K, Sasso T: Mapping the contours of contemporary positive psychology. Can Psychol 52:82–92, 2011 Ivtzan I, Niemiec RM, Briscoe C: A study investigating the effects of MindfulnessBased Strengths Practice (MBSP) on wellbeing. International Journal of Wellbeing 6(2):1–13, 2016 Kabat-Zinn J: Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York, Hyperion, 1994 Kirchner J, Ruch W, Dziobek I: Brief report: Character strengths in adults with autism spectrum disorder without intellectual impairment. J Autism Dev Disord 46(10):3330–3337, 2016 Longmore P: The second phase: from disability rights to disability culture, in Why I Burned My Book and Other Essays on Disability. Philadelphia, PA, Temple University Press, 2003, pp 214–224 Longmore PK, Umansky L: Introduction. Disability history: from the margins to the mainstream, in The New Disability History: American Perspectives. Edited by Longmore PK, Umansky L. New York, New York University Press, 2001, pp 1–29 Macdonald C, Bore M, Munro D: Values in action scale and the Big 5: an empirical indication of structure. J Res Pers 42(4):787–799, 2008 McGrath RE: Scale- and item-level factor analyses of the VIA Inventory of Strengths. Assessment 21:4–14, 2014 Niemiec RM, Shogren KA, Wehmeyer ML: Character strengths and intellectual and developmental disability: a strengths-based approach from positive psychology. Educ Train Autism Dev Disabil 52(1):13–25, 2017 Nota L, Ferrari L, Soresi S, Wehmeyer ML: Self-determination, social abilities, and the quality of life of people with intellectual disability. J Intellect Disabil Res 51(pt 11):850–865, 2007 Peterson C, Seligman MEP: Character Strengths and Virtues: A Handbook and Classification. New York, Oxford University Press, 2004 Rapp CA: The Strengths Model: Case Management With People Suffering From Severe and Persistent Mental Illness. Oxford, UK, Oxford University Press, 1997 Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 55:68–78, 2000 Ryan RM, Deci EL: Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. New York, Guilford, 2017 Samson AC, Antonelli Y: Humor as character strengths and its relation to life satisfaction and happiness in autism spectrum disorders. International Journal of Humor Research 26(3):477–491, 2013 Seligman MEP: The President’s address. Am Psychol 54(8):559–562, 1999 Seligman MEP, Csikszentmihalyi M: Positive psychology: an introduction. Am Psychol 55:5–14, 2000

Positive Psychology and Strengths-Based Approaches

37

Shogren KA: Positive psychology and disability: a historical analysis, in The Oxford Handbook of Positive Psychology and Disability. Edited by Wehmeyer ML. New York, Oxford University Press, 2013, pp 19–33 Shogren KA, Lopez SJ, Wehmeyer ML, et al: The role of positive psychology constructs in predicting life satisfaction in adolescents with and without cognitive disabilities: an exploratory study. J Posit Psychol 1:37–52, 2006a Shogren KA, Wehmeyer ML, Buchanan CL, Lopez SJ: The application of positive psychology and self-determination to research in intellectual disability: a content analysis of 30 years of literature. Res Pract Persons Severe Disabil 31(4):338– 345, 2006b Shogren KA, Palmer S, Wehmeyer ML, et al: Effect of intervention with the SelfDetermined Learning Model of Instruction on access and goal attainment. Remedial Spec Educ 33(5):320–330, 2012 Shogren KA, Wehmeyer ML, Forber-Pratt AJ, Palmer SB: VIA Inventory of Strengths for Youth (VIA-Youth): Supplement for Use When Supporting Youth With Intellectual and Developmental Disabilities to Complete the VIA-Youth. Lawrence, Kansas University Center on Developmental Disabilities, 2015a Shogren KA, Wehmeyer ML, Palmer SB, et al: Causal agency theory: reconceptualizing a functional model of self-determination. Educ Train Autism Dev Disabil 50(3):251–263, 2015b Shogren KA, Wehmeyer ML, Palmer SB, et al: Relationships between selfdetermination and postschool outcomes for youth with disabilities. J Spec Educ 48(4):256–267, 2015c Shogren KA, Singh NN, Niemiec RM, Wehmeyer ML: Character strengths and mindfulness, in The Oxford Handbook of Positive Psychology and Disability. Edited by Wehmeyer ML. New York, Oxford University Press, 2017a Shogren KA, Wehmeyer ML, Lang K, et al: The application of the VIA Classification of Strengths to youth with and without disabilities. Inclusion 5(3):213–228, 2017b Shogren KA, Wehmeyer ML, Singh NN (eds): Handbook of Positive Psychology in Intellectual and Developmental Disabilities: Translating Research Into Practice. New York, Springer, 2017c Shogren KA, Shaw LA, Raley SK, et al: Assessing character strengths in youth with intellectual disability: reliability and factorial validity of the VIA-Youth. Intellect Dev Disabil 56(1):13–29, 2018a Shogren KA, Shaw LA, Raley SK, et al: Exploring the effect of disability, race-ethnicity, and socioeconomic status on scores on the Self-Determination Inventory: Student Report. Except Child 85(1):10–27, 2018b Singh NN, Jackman MM: Meditation on soles of the feet, in Resources for Teaching Mindfulness: A Cross-Cultural and International Handbook. Edited by McCown D, Reibel DK, Micozzi MS. New York, Springer, 2017, pp 287–306 Singh NN, Lancioni GE, Wahler RG, et al: Mindfulness approaches in cognitive behavior therapy. Behav Cogn Psychother 36:659–666, 2008 Singh NN, Lancioni GE, Manikam R, et al: A mindfulness-based strategy for selfmanagement of aggressive behavior in adolescents with autism. Res Autism Spect Disord 5:1153–1158, 2011a

38

Neurodiversity

Singh NN, Lancioni GE, Singh ANA, et al: A mindfulness-based health wellness program for individuals with Prader-Willi syndrome. J Ment Health Res Intellect Disabil 4:90–106, 2011b Singh NN, Lancioni GE, Karazsia BT, et al: Mindfulness-based treatment of aggression in individuals with intellectual disabilities: a waiting list control study. Mindfulness 4:158–167, 2013 Singh NN, Lancioni GE, Hwang Y-S, et al: Mindfulness: an application of positive psychology in intellectual and developmental disabilities, in Handbook of Positive Psychology in Intellectual and Developmental Disabilities. Edited by Shogren KA, Wehmeyer ML, Singh NN. New York, Springer, 2017, pp 65–79 Smith JD, Wehmeyer ML: Good Blood, Bad Blood: Science, Nature and the Myth of the Kallikaks. Washington, DC, American Association on Intellectual and Developmental Disabilities, 2012 Wehmeyer ML (ed): The Oxford Handbook of Positive Psychology and Disability. New York, Oxford University Press, 2013a Wehmeyer ML (ed): The Story of Intellectual Disability: An Evolution of Meaning, Understanding, and Public Perception. Baltimore, MD, Paul H Brookes, 2013b Wehmeyer ML: Self-determination in adolescents and adults with intellectual and developmental disabilities. Curr Opin Psychiatry 33(2):81–85, 2020 Wehmeyer ML, Schwartz M: The relationship between self-determination, quality of life, and life satisfaction for adults with mental retardation. Education and Training in Mental Retardation and Developmental Disabilities 33:3–12, 1998 Wehmeyer ML, Little T, Sergeant J: Self-determination, in Handbook of Positive Psychology, 2nd Edition. Edited by Lopez S, Snyder R. New York, Oxford University Press, 2009, pp 357–366 Wehmeyer ML, Palmer S, Shogren K, et al: Establishing a causal relationship between interventions to promote self-determination and enhanced student selfdetermination. J Spec Educ 46(4):195–210, 2012a Wehmeyer ML, Shogren K, Palmer S, et al: The impact of the Self-Determined Learning Model of Instruction on student self-determination. Except Child 78(2):135–153, 2012b Wehmeyer ML, Shogren KA, Little TD, Lopez SJ (eds): Development of SelfDetermination Through the Life-Course. New York, Springer, 2017a Wehmeyer ML, Shogren KA, Little TD, Lopez SJ: Introduction to the selfdetermination construct, in Development of Self-Determination Through the Life-Course. Edited by Wehmeyer ML, Shogren KA, Little TD, Lopez SJ. New York, Springer, 2017b, pp 3–16 Williams P, Shoultz B: We Can Speak for Ourselves: Self-Advocacy by Mentally Handicapped People. Bloomington, Indiana University Press, 1982 Woodard C: Psychometric properties of the ASPeCT-DD: measuring positive traits in persons with developmental disabilities. J Appl Res Intellect Disabil 27:433–444, 2009 World Health Organization: International Classification of Functioning, Disability and Health. Geneva, World Health Organization, 2001

THREE Strengths-Based Model and Savantism Matthew Doll, Ph.D. Darold Treffert, M.D. Thomas Fabricius, M.D. Edward Jedlicka, Ph.D. Vivian Hazell, LPC Tara Geier, M.A., BCBA Bryan Mischler, LCSW Erin Whittington, B.A.

Different kinds of minds can complement each other. Temple Grandin, Ph.D., October 8, 2019 Teach to the talent; to help often; to comfort always. Darold Treffert, M.D.

The Treffert Center was created in 2016 as an institute for the collection, organization, and worldwide dissemination of historical and current information on savant syndrome and other forms of the exceptional mind. The Treffert Center includes a school with integrated classrooms for neurodiverse students that utilizes a strengths-based curriculum. This chapter describes a six-pronged, core-component approach to assessment, diagnosis, organized treatment, and support that can be applied successfully to a variety of neurodiverse students using a strengths-based approach.

39

40

Neurodiversity

Neurodiverse individuals have many strengths that are often overlooked. Sometimes this oversight is related to delayed speech, distinct communication styles, or simply a failure of inclusion. Moreover, strengths in these individuals are often seen as interesting but as unrelated to the condition. A broader perspective on neurodiversity considers the term as being reflective of everyone, including those who are labeled as “neurotypical.” All variation is contained under the “normal” curve, with some variations occurring less or more frequently than others. Temple Grandin, one of world’s most prolific autistic self-advocates and a professor, talks of different types of thinkers: visual thinkers, pattern thinkers, and verbal thinkers. Howard Gardner, a developmental psychologist and professor, proposed eight types of intelligences: verbal-linguistic, logical-mathematical, visual-spatial, musical-rhythmic, naturalistic, bodily kinesthetic, interpersonal, and intrapersonal (Gardner 1983, 2011; Gardner and Hatch 1989). Given the potential for varied degrees of neurological combinations, the fact remains that we can all be considered neurodiverse, rather than either neurotypical or neurodiverse. When they are used to describe such a dichotomy, these terms serve to replace and reinforce previous dichotomous understandings of “learning differences.” However, neurotypical and neurodiverse currently serve as more progressive terminology to convey the wide variety of strengths that exist. What is considered pathology has now become a more complex discussion as the varying degrees of neurodiversity stretch our understanding of individual differences versus pathology. Labels can be viewed as an identity rather than a diagnosis in some circumstances; however, when significant impairment is evident, or is more likely to exist without early intervention, the need for accurate assessment and appropriate intervention is much clearer. We have had the privilege and honor to work with and learn from individuals and families with remarkable skills and resilience. We find that, even in the most profoundly impacted individuals, there exists an “island of intactness” that we may grow and nurture. This strengths-based focus works well for both individuals and the professionals who work with them, no matter what the areas of concern. To articulate how a strengths-based focus can be implemented in practice, we have developed the Treffert Approach. We have used this approach with success in our clinical work and are now sharing it with other providers, child and adult daycare centers, schools, higher education and technical colleges, vocational rehabilitation organizations, and businesses. Since the 1988 movie Rain Man, which markedly increased recognition and awareness of autism and savant syndrome, much has happened in the recognition and treatment of autism. Some savant skills, rather than being considered frivolous, are sought after in the workplace. Microsoft and many other companies are recruiting neurodiverse people with savant exception-

Strengths-Based Model and Savantism

41

alism in coding and computing, for example. Although there is still much work to be done, many communities have begun to be more welcoming and accommodating to neurodiverse people than in the past. Using an organized approach to assessment, treatment, and support can be helpful in conveying the core components needed for the long-term success of neurodiverse individuals. The Treffert Approach comprises six core areas that are modified and applied depending on setting and use. It is not a series of steps but, rather, a series of interrelated “pillars” that guide the user to consider key perspectives. These six components, described in the following sections, are accurate assessment, strengths-based focus, nature and natural environment, nurturing relationships, sensory awareness, and systems.

Accurate Assessment The first pillar in the Treffert Approach is to call things by the right name— accurate diagnoses and descriptions are key to understanding and intervention. Using a multidisciplinary evaluation can help the clinician determine what basic disability or disorder underlies a person’s special abilities. This helps expand the understanding of the interplay between strengths and challenges. A few of the many challenges that a multidisciplinary team can address include delayed language acquisition, communication disorders, learning differences, sensory disorders, medical conditions, trauma, and comorbid disorders such as ADHD, Tourette syndrome, OCD, bipolar disorder, and schizophrenia. Accurate diagnosis is especially pertinent to autism because the word autism has lost its specificity. Autism was originally used in 1943 by Dr. Leo Kanner, the psychiatrist and physician commonly referred to as the “father of child psychiatry.” He used the term to describe a group of youngsters to whom he had attached the diagnosis of early infantile autism (Kanner 1943). Over the years, autism has been expanded to include what now is referred to as autism spectrum disorder. Although Kanner’s original term is no longer limited, his original early infantile autism group may reflect different etiology from individuals with a later onset of symptoms. The search for multiple etiologies and “subtypes” within the field is ongoing, but the axiom “If you’ve met one child with autism, you’ve met one child with autism” reflects the diagnostic reality of neurodiversity. Even this one diagnostic category is more accurately named “the group of autistic disorders,” because it appears that these disorders stem from multiple factors. Autism as a disorder needs to be separated from autism-like symptoms that may appear in other neurological disorders. An example of this is when autism-like symptoms appear in people who were born blind. Autism-like

42

Neurodiversity

symptoms can appear, for a time, in children who read early or speak late and can be confused with autism spectrum disorder itself (Treffert 2011a). Accurate assessment leads to informed interventions. The importance of this is evidenced by hyperlexia research. These early reading skills can be evidenced in “neurotypical,” autistic, and autistic-like children. The latter group may go on to outgrow their autism spectrum characteristics (Treffert 2011a). However, they may not be challenged academically due to an initial misdiagnosis or poorly aligned interventions. Focusing on hyperlexia as a strength, rather than focusing on the autism-like presentation, opens up a wide range of interventions, as it does with children who speak late or not at all (Treffert 2011a). Exceptional memory and pattern recognition skills can also be found in many hyperlexic children. It is important to remember that all behavior is communication; the key to accurate assessment is to determine what the behavior is communicating. Thus, the issue of accurate assessment or lack thereof can have a profound impact on long-term outcomes. Although most of us are trained in the traditional medical model of assessment, focused on identifying deficits, a strengths-based focus can lead to more hopeful and pragmatic recommendations. For example, when assessing with a strengths-based focus, one does not need to look very hard to see where some skills in autistic individuals are also used in academic learning. Three-dimensional block rotation and visual matrix analysis, which are well-documented strengths in many people diagnosed with autism (Dawson et al. 2007), are involved in mathematical analysis, reading graphs, and visualizing and understanding data. Behaviorally, many children on the spectrum are found to have “sticky attention”; in other words, they will become fixated on something for lengthy periods of time. The academic correlation of this is the ability to sit still and focus on learning new material without feeling the need for interruption. This skill alone can account for significant academic progress. Many children on the autism spectrum display rigid thinking patterns. Cognitive inflexibility is a hallmark of this cognitive style. Although flexible thinking dramatically helps social interaction, it hinders some tasks, such as mathematics and computer coding. A relatively rigid and precise thinking style enhances performance in both areas. As computers turn code into ones and zeros that, in turn, alter the flow of electricity through a computer chip, precision is the key; a computer is incapable of determining intent from sloppy code. Socially adept people can discern intent despite the imprecise words and phrasing that dominate verbal conversation. Rigid thinking can be assessed as a weakness on sociability scores or assessed as a strength on tasks that require careful and logical thinking and reasoning. Recognizing the neurodiversity of individuals can help to identify appropriate teaching strategies and eventual job opportunities.

Strengths-Based Model and Savantism

43

Another example of strengths-based assessment is to focus on the demands of a task and the skills and abilities needed to complete the task. For example, a trend in some educational communities is to teach group problem solving as a substitute for mathematics education, often with no explicit teaching of the skills needed to learn and perform in a group. This may lead to avoidant and challenging behaviors in some students that, if not further explored, could lead to inaccurate assessment and interventions. The strengths that characterize a more rigid, precise, detail-oriented cognitive style are very useful for science, technology, engineering, and mathematics careers; however, this cognitive style is much more challenging for social interaction, especially in group learning. People who are very social have a cognitive style that is fluid and more in tune with emotionally relating to others by trying to understand their perspectives; this style is heavily dependent on a flexible style of interpreting and understanding what is being communicated. Facial expressions or mannerisms may negate the meaning of what is being said verbally. The so-called social deficits might at times disappear when a group of like-minded engineers gather to discuss a project and suddenly reappear when the sales team arrives. Thinking about strengths in the context of neurodiversity allows for a richer and more detailed understanding of a person than does our current deficit-based medical model of diagnostics.

Strengths-Based Focus The Treffert Approach focuses on the strengths of an individual, as well as those of the parents, teachers, clinicians, and community. A strengths-based approach must expand from the person to the larger community for longterm success and sustainable outcomes. We recognize the importance of identifying areas of difficulty, but drilling down into struggles often leads to increased frustration and the illusion of control. Control is not influence; influence is not control. We seek to support self-determination, and we recognize that focusing on even the smallest area of strength and expanding it will help decrease areas of concern. Research has shown that sustained engagement in cognitively stimulating activities that specifically target weak skills has an impact on neural structure; focusing on strengths leads to even greater gains. Given appropriate practice, students can improve their cognitive ability (Willis et al. 2006). Strengths-based treatments leverage differences rather than attempting to extinguish them, allowing children to lead their own learning and use their unique skills. We recognize that although high-focus interests may not last, they can be used to engage children across educational tasks and subjects they face each day.

44

Neurodiversity

Children with hyperlexia, for example, have the unique ability to read, code, categorize, and memorize, strengths that can be expanded into greater cognitive understanding and social communication. Children can learn to use this strength as a springboard for understanding and comprehending passages that they read about social interaction. Their high-interest areas are not simply splinter skills, which are abilities that are in isolation from typical context or purpose, but a fundamental source of information for them. They may leverage that to cultivate a shared understanding with their peers and themselves. Specific strategies are outlined in our hyperlexia manual to further understand how these strengths can be operationalized in educational settings (Treffert et al. 2017). The most common savant abilities are often referred to as splinter skills, which include behaviors such as an obsessive preoccupation with and memorization of music, game or sports trivia, license plate numbers, maps, historical facts, or obscure items such as vacuum cleaner motor sounds. As noted earlier, these are savant skills out of typical context. The next level of savant abilities is the talented savants, who have musical, artistic, mathematical, or other special skills that are more prominent and highly honed, usually within an area of a single expertise. The third level of abilities is the prodigious savants. These very rare persons have a special skill or ability, typically in the area of music, art, or mathematics, that is so outstanding as to be spectacular were it to occur in a “neurotypical” person. There are probably fewer than 75 prodigious savants currently living worldwide who meet this high-threshold special skill. Musical ability is the most frequent savant skill. Artistic talent, usually painting or drawing, is the next most frequent, although other forms of artistic talent, such as sculpting, can occur. Mathematical savant skills include lightning-fast calculating and the ability to repeat multidigit prime numbers, sometimes in people who are unable to perform even simple arithmetic. Mechanical ability, such as constructing or repairing intricate machines or motors, can occur, as can exceptional spatial skills, such as intricate map memorizing that enables individuals to compute distances with precise accuracy from visualization. Other occasional skills include multilingual acquisition ability or other unusual language skills, exquisite sensory discrimination such as smell and touch, perfect perception of the passing of time without access to a clock, or outstanding knowledge of a specific field such as neurophysiology, statistics, history, or navigation. Although controversial, there have been some reports of extrasensory perception skills occurring as well. The special skills and abilities of savants can be used as tools to overcome other areas of challenge. These strength areas can be used as the focus of treatment efforts. In many cases, these extraordinary abilities can be used as a way to engage the person to improve communication capacity, enhance

Strengths-Based Model and Savantism

45

social interaction, and master daily living skills with movement toward greater independence. For example, famous architectural artist Stephen Wiltshire was largely nonverbal at age 9 but one day requested paper from his nurse. His interest in drawing was supported by his caregivers, and this talent grew into his ability to fly over a city in a helicopter for part of an hour and then spend the next several days drawing the city in such accurate detail as to have the same numbers of flutes in a column and windows in a building, as well as dimensions and street directions accurately represented. Stephen’s journey began with the ability to correctly reproduce cities, which was a novel skill. As he continued to repeat his drawings, he began to interact with those who would watch him draw. Over the course of time, he has also begun to introduce more color into his art and has become more social and engaged with his audience. The process of identifying strengths and teaching to a talent is a fundamental underpinning of the Treffert Approach. Stephen Wiltshire’s journey is a good representation of what is possible with a strengths-based focus, as is Leslie Lemke’s story. Leslie was born premature and developed retrolental fibroplasia that resulted in blindness. He was placed in the care of May Lemke through the foster program. She became his foster mother, tutor, therapist, and mentor. He remained developmentally delayed but had an amazing splinter skill of echolalia. He could repeat verbatim an entire day's conversations while impersonating each individual speaker he had heard. Although echolalia is typically dismissed as a developmental defect, May had a hunch that this awareness of the details of sound could be transferred to music. She introduced Leslie to the piano at age 7. She would run his fingers up and down the keyboard and identify notes, which allowed him to learn to play by ear. His acute sense of the qualities of sound allowed him to exactly re-create both dialogue and music after just one exposure. When he was 14, his mother found him at the piano at 3 A.M. recreating a television show he had seen earlier that evening. He played Tchaikovsky’s Piano Concerto No. 1 while voicing the introduction—“Tonights movie is Sincerely Yours, starring Dorothy Malone...”—after hearing it exactly once. Leslie initially was able to repeat any song that he had heard. Over time, his ability grew into a wonderful ability to improvise. Now Leslie is creating his own music. This is another example of how unique skills and talents can be used to identify and nurture islands of genius and grow them into increased independence. As these two remarkable individuals have shown us, the passage from repetition to improvisation to creation correlates with increased socialization and independence. As an aside, the art world has come to accept the artwork and music of extraordinary people such as Stephen Wiltshire and Leslie Lemke (and Ping Lian Yeak, discussed in the next section), and the public views them more

46

Neurodiversity

and more as artists in their own right rather than as artists who happen to be autistic or savants. No longer is their work “outsider art”; it is art that stands on its own alongside that of other artists who happen not to be on the spectrum. It is important to note that the difference between what are considered splinter skills and savant skills is related to context and does not negate the ability for either to be utilized in a strength-based approach. In a conversation with one of the authors, Dr. Jeremy Chapman used two hypothetical examples to illustrate this point: Individual A has an exceptional ability to memorize and perform pop songs. This talent is embraced by society, and she finds great success as a singer, winning contests, recording her own album, and garnering a large following. These accomplishments give her confidence, self-efficacy, and financial independence. She also develops social and communicative skills by interacting with her fan base and collaborating with other artists, and her skills continue to grow from repetition, to improvisation, to creativity. Individual B has an exceptional ability to memorize and recite license plates. Unfortunately, people are not as interested in live recitations of license plate digits as they are in live “recitations” of pop songs. Individual B is therefore at risk of being marginalized, never finding a suitable job, and living a reclusive life due to anxiety, negative self-image, and limited practice with social interaction. The Treffert Approach helps people like Individual B avoid this outcome by playing directly into their talents. By demonstrating interest in her license plate talent, the staff builds rapport with her, earning her trust and buy-in. She starts to gain self-worth. We encourage her to demonstrate her license plate memorization talent in a natural environment, perhaps a hardware store parking lot. In this way, we can address her anxiety and support her exploration outside of her home. We then help her generalize her memory skills into the related—but more practical—skill of inventory management. We assist her in applying for a job at the hardware store. We work with the store to provide her with appropriate staff mentorship and sensory accommodations. When the store discovers the value in having an employee with her skill, we help them implement systems-wide changes to hire more individuals like Individual B, who then go on to mentor each other, develop friendships, and continue to grow. In this way, we can view all splinter skills as unique talents that can be systematically leveraged to benefit the individual in terms of confidence-building, self-efficacy, social reciprocity, and autonomy. Savant skills can be used as tools or as a conduit toward engaging children in increased language interchange and increased socialization. Recognition and praise of these special skills are powerful reinforcing tools. To counteract a child’s excessive preoccupation, other people can help the child

Strengths-Based Model and Savantism

47

channel repetitive behaviors toward more purposeful activities. Parents are often very innovative in that regard. Work with savants is highly individualized. Each professional can use whatever ideas and intuitions spring from daily contact with that person. Dr. Trevor Clark and colleagues have ongoing research in this area, and these two books are exceptional resources: A Practical Guide for Teachers of Students With an Autism Spectrum Disorder in Secondary Education (Costley et al. 2012) and Exploring Giftedness and Autism: A Study of a Differentiated Educational Program for Autistic Savants (Clark 2016). Both Treffert’s and Clark’s views assisted in the development of a public charter school, the Treffert Way for the Exceptional Mind. This school stemmed from years of shared research, evaluations, and educational approaches implemented in a local public school and specific programming focused on assessment and treatment work related to hyperlexia. Because the defining characteristics of autism present in widely varying degrees and interact in numerous and unpredictable ways, one set of curriculum would not likely be successful. The Treffert Approach has been used in educational settings during our consultations and trainings with other organizations. Its initial use occurred at the Treffert Center's inclusive Treffert Academy, which has a daycare for children from birth to age 12, a 3-year-old preschool, and a public 4-year-old kindergarten (4K) classroom. In 2018, the Treffert Way, a public charter school, was started, which teaches kindergarten through seventh grade (with plans to expand through twelfth grade). These settings serve as an incubator for innovations and advanced techniques for inclusive instruction. We strive to introduce the children to early experiences in the workforce and to engage them in service learning, mentorships, and mentoring others to help them learn what is possible for their futures. For our young adults, our Leadership Group provides guidance using established skills to improve less developed skills necessary for sustainable employment based on their unique talents. They have even created a Dr. Treffert puppet and hope to have a new home in the Treffert Studio. In our efforts to build further on the ideas of neurodiversity and community, we have found that the best sources of advice for channeling unique skills, as well as for dealing with problematic behaviors, are often parents who have found useful techniques by trial and lived experience. Local parent support groups can be a rich resource for such ideas and inspiration for new families struggling with a neurodiverse youngster. These groups can also be a rich source of understanding, encouragement, and support. Such groups exist in almost every community, and many similar information and support groups exist on the internet for autism, Asperger syndrome, and hyperlexia, as well as for even rarer conditions, such as Williams syndrome and Rett syndrome.

48

Neurodiversity

Nature and Natural Environment Nature and the natural environment play an important role at the Treffert Center and in the Treffert Approach. The Treffert Center houses the Treffert Academy, an inclusive daycare for all children ages 3–12 years. The services for autistic children are provided in the context of a typical daycare setting that includes both neurodiverse and neurotypical children. This approach embraces neurodiversity and brings out the strengths of all children while focusing on the primary indicators of life success: self-regulation, social-emotional skills, and compassion. Teaching is done through motion and play. Children are out in nature, our true natural environment, as often as possible. The benefits of playing and learning in nature are abundant. Play is “scaffolded” as needed to help neurodiverse children navigate the complexities of spontaneous interactions with their peers. For example, “Ginny” was a neurodiverse student who was spinning in place twirling around and around. A teacher asked if she would like to have others join her. Classmates then spun with her, creating a shared experience. Later on the playground, as some children jumped on the merry-goround, Ginny joined them and spun them around and around. Staff were able to create an initial shared experience for Ginny, which was parallel play with other twirlers. This later progressed to actual play with her peers. The scaffolding that was able to take place with her peers in a natural environment would not have existed if Ginny had been at a traditional autism center attended only by children on the spectrum. An academy boy recently was overheard introducing a peer to a friend: “This is Timmy. He doesn’t use his words yet, but he is okay.” In another setting, a child of one of the chapter authors observed, “You know, I have noticed that the kids who have siblings with special needs are the nicest ones.” Neuroinclusive environments are good for everyone. The magic of a neurodiverse setting is that it provides unexpected and unplanned moments that move individuals closer to each other within the natural environment. When people are able to share experiences, especially through collaborative actions, relationships grow, trust is developed, and much richer and generalizable skills develop than in traditional treatment approaches. The following story is an example: Exceptional artwork by savant artist Ping Lian Yeak decorates many of the halls and classrooms of the Treffert Center. The children love him and his work and have been inspired by him. During a visit to the Treffert Center, Ping Lian (age 18), who was primarily nonverbal, was working on his art surrounded by children from the Treffert Academy. A particularly precocious 4-year-old girl slowly worked her way closer to Ping Lian, eventually coming shoulder to shoulder

Strengths-Based Model and Savantism

49

with him in his workspace. Ping Lian’s mother looked on, worried. Slowly the girl’s and artist’s eyes met; they looked from the painting to each other and clearly were sharing joint attention as Ping Lian and his new friend drew together. Ping Lian’s mother was tearful as she looked on, stating that she had not seen him do that before. The children’s versions of the horses that Ping Lian drew later surrounded his artwork, all hung on Treffert Center’s walls—amazing artwork by all. The concept of natural environment also translates to how classrooms are set up to teach the skills that may be necessary for children transitioning from a young age into other daycare centers or into the school system. Circle time can engage the children in routine and teach them how to respond, for example, to the unexpected removal of a toy by a classmate. Natural environment extends to young adults as well, helping them transition from school to work through early exposure to the trades, manufacturing firms, and other businesses. For some savants, the natural environment is full-inclusion school classrooms, but others are placed in special education classrooms (for developmental or educational disabilities). Still others, in some areas of the country, are in gifted and talented classrooms with other neurodiverse children. In each of those settings, a mentoring program can be helpful to focus on the special abilities and challenges of each child or young adult with exceptional skills. The natural environment allows for unlimited opportunities for students to become more social by involving their peers—the people who can often teach the best. For example, during a tour of the Treffert Way School for the Exceptional Mind, the two students guiding the visitors were discussing their efforts to engage younger peers in play. One lamented that his peer would not talk to him when he tried. The other student responded, “You have to put in the time!” She went on to explain how over the course of several months, she would slowly approach her peer on the playground and was proud of how he now “looks forward to seeing me.” Natural environment applies similarly to the workplace. Compared with neurotypical students, neurodiverse students are often at an increased risk for unemployment and underemployment. This disparity means not only that our youth and adults who are neurodiverse are negatively impacted vocationally, economically, and socially but also that they are less likely to obtain positive occupational and social experiences that promote their overall well-being. Neurodiverse adults are known to face significant challenges in navigating typical interview processes and transitioning to the workplace, yet their ability to think differently can make them an asset if they are given the opportunity. Today, many large companies are recruiting, selecting, training, and supporting young neurodiverse students. These companies have re-

50

Neurodiversity

ported that these individuals have generated significant innovations in their companies (Austin and Pisano 2017). To assist neurodiverse students entering the workplace, it is imperative that educational programs provide the relationships and early experiences needed in the transition from high school to postsecondary options. The Treffert Center's multidisciplinary staff have been working with local technical colleges, 2-year colleges, and 4-year universities to help these schools better meet the needs of neurodiverse students. We also work and consult with the local chamber of commerce on mental health and neurodiverse workplace issues, which leads to training for human resource departments and associations to create more diverse and inclusive work environments. Our work with the state vocational rehabilitation department is designed to help staff understand the unique talents and opportunities neurodiverse individuals can offer a workplace. Students are typically invited to their first Individualized Education Program (IEP) meeting at age 14, where they are often asked, “What do you want to do for a living?” With no prior exposure to or experience with what is possible, these individuals often have no idea how to respond. Vocational training staff in attendance at the meeting often have limited experience with the strengths of neurodiverse individuals and may misread or misunderstand the exceptional talents and abilities that exist, focusing instead on “placement” as the measure of success rather than quality of “fit” with the needed supports and mentors.

Nurturing Relationships A student’s ability to develop relationships with both peers and adults contributes to the development of a sense of self. Students benefit from learning to accept others for who they are, respect differences, and appreciate commonalities. Meaningful, healthy relationships have been found to enhance students’ development, engage them more fully in their education (Cullen and Monroe 2010), and foster resiliency, a critical factor in academic success (Dappen and Isernhagen 2005). Both peer and student/adult mentoring programs have been shown to have the potential for dramatic academic effects for students, including being more confident of school performance and less likely to skip school (Tierney et al. 1995). Research has validated that students with learning disabilities who were mentored are more likely to pursue an advanced degree program. Findings also show that, when students feel like they matter to their teachers, their level of academic motivation increases (Ahrens et al. 2010). Factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome than specialized treatment interventions (Lambert and Bar-

Strengths-Based Model and Savantism

51

ley 2001). Relationship building, which accounts for 60% of the variance in psychotherapy outcome studies, is the most frequently cited component by savants as to what helped them the most on their journeys. Nurturing relationships is very important. Clinicians who work with children on the autism spectrum know that the first meeting is often crucial to forming a positive relationship and developing a therapeutic response. Showing genuine interest and a sense of wonder in the other person sets the stage for a positive relationship. It helps to remember connection, compassion, creativity, and community. Connection starts when one feels safe and open to new ideas and guidance from others. Compassion is understanding what an individual is going through and developing the strategies and techniques to help that person. Creativity is used to find a person’s gift and a way for that person to share it. Community is when one feels accepted and develops self-esteem and finds value and worth in being part of something greater than oneself. To help students form healthy relationships, schools are increasingly incorporating social-emotional curricula and evidence-based practices. In Wisconsin, the Department of Public Instruction has expectations and curriculum in place (https://dpi.wi.gov/sspw/mental-health/social-emotionallearning). The Treffert Academy uses movement and play to focus on three main areas: social-emotional skills, self-regulation, and compassion. Various strategies are used, but the Kindness Curriculum (https://news.wisc.edu/ preschool-kindness-curriculum-is-now-available-free) and Conscious Discipline (https://consciousdiscipline.com) are particularly effective core trainings that can help all children and the adults who care for them to create a culture to support neurodiversity across the lifespan. Teachers and counselors have the special ability to teach students the different types of emotions, as well as strategies to use their emotional brain and logical thinking brain to process these feelings in a much more positive fashion. When students use self-regulation strategies at school, discipline rates decline, and more positive behaviors are presented daily. Teachers and counselors can spend more time on academics and on proactive activities, rather than just reacting to behaviors. Helping students identify these emotions and their underlying causes empowers them to act to understand, express, and, if need be, change their emotional states. Children who can regulate their emotions are more successful academically and socially. These skills are best taught through example and in relationships. The Treffert Center has created the group Leaders in Creative Media. This group focuses on the strengths of its participants in the areas of art, music, acting, computer technology, and audio/video editing. Our leadership team uses these passions to make a connection with and facilitate relationships between group members. Bringing other members together in tasks focused on their gifts creates self-awareness, self-improvement, and immediate

52

Neurodiversity

positive change in these individuals. They begin socializing independently because they can discuss their talents with others who share their passion. There is additional synergy when they see how they can come together with others with different passions to create unique and amazing projects. Using passion to create these connections builds relationships that are intrinsically motivating and reinforcing, facilitating skill development in a context that is enjoyable and supportive. Group leaders use compassion based on a foundation of evidence-based practices to understand the group’s needs and support members when they struggle. Such techniques include visual modeling, sensory breaks, and developing supportive environments in which members feel safe to fail without judgment. Creativity is used to bring these members together and find unique ways to work toward treatment goals.

Sensory Awareness Sensory understanding informs all that we as people do. We understand that all behavior is communication, but sometimes it is difficult to figure out what a specific behavior is communicating. Incoming information is processed through our senses with only two channels for output—verbal and nonverbal. The Treffert Center and its programs seek to understand and help individuals integrate their senses and create environments that promote sensory sensitivity. Sheila Frick and Tracey Bjorling at Vital Links in Madison, Wisconsin (https://vitallinks.com), developers of Therapeutic Listening, present globally on the impact of sensory issues on development and functioning and educate others in their sensory work. They partner with the Treffert Center on various research projects in shared efforts to support evidence-based practices in this area. Sensory awareness is not simply about understanding that sensory processing is a significant issue for children and adults on the autism spectrum. It requires the knowledge that people gather information about the world through all of their senses, including balance, proprioception, and gravity. Patterns of over- and underwiring, past exposure to trauma, and sensoryseeking and sensory-avoidant behaviors all contribute to the unique ways in which we experience the world. As we learn more about how the body processes information, additional senses may be identified. Although DSM-5 (American Psychiatric Association 2013) now includes sensory issues as part of the diagnostic criteria for autism spectrum disorder, skepticism remains within the field regarding appropriate interventions and opportunities to assist people with sensory issues, such as synesthesia, blindness, and deafness, among others. For example, some children with dysgraphia describe writing as being literally painful to them; some teachers do not recognize the motor planning required for these students and view the resistance as defiance. Se-

Strengths-Based Model and Savantism

53

vere sensory difficulties can lead to responses that resemble trauma reactions. Adverse childhood experiences research points to the impact that trauma has on individuals’ brain development, genetics, and experience of the world. Interested readers are encouraged to review the work of Stephen Porges on the polyvagal theory (Porges 2011). It is also important to recognize that sensory differences exist in everyone. Perhaps the simplest way to understand and convey this information is to consider the aversions that developed perhaps as a result of some poorly executed decisions during one’s playful youth, or intolerances for certain smells or tastes that resulted during pregnancy or at other times. Unexpected behaviors can often be better understood from a sensory perspective. Some of the same behaviors seen in children who are trying to regulate (e.g., rocking, flapping, repeating sounds) are the same skills that soldiers are taught to use when enduring torture. Often, individuals seen at the Treffert Center have unique sensory issues. They might need to hum to themselves to block out a noisy room, or they might be driven to take off their shirt when the tag becomes too distracting. Sensory differences can also lead to differences in a sense of play. One child needed to triangulate his vision to a fine point by staring at the lines in the world around him—in the tile floor, in the wall’s cement blocks, or strung on telephone poles. When he surrendered himself to this triangulated vision, he found it delightful, especially if he could run in sync with the direction of the lines. One day, when he was “in his groove” running with the telephone wires that bordered the playground, a classmate joined him so that they both were giggling and running. The school bell rang to signal the end of recess, and his classmate ran to line up. The child was delighted that someone had finally realized the joy of running with the lines, and he called after his classmate, “Thanks for running with me!” Another example of sensory issues is demonstrated in this brief case: After months of working with a child who was demonstrating significant disruptive behavior in a school setting, a therapist realized why the child was disruptive. The trouble was a broken ballast in one of the lights, which was disturbing to the child, who was only engaging in escape behavior. Upon being moved to a different room, the child stopped the problematic behavior.

Systems: Increasing the Capacity for Success A systems approach recognizes multiple factors that influence a person’s success: genetics, family, language, and the culture in which the person develops, to name a few. The importance of these factors became apparent in our

54

Neurodiversity

work with neurodiverse individuals in various school and work systems. When we attempted to support individuals in a variety of settings, they were successful as long as we remained present. Once we faded and removed ourselves from the setting, problems resumed and sometimes led to the removal of students from settings in which they had previously been successful. We realized that unless a system was accepting, understanding, and able to support neurodiversity on its own, the default setting of exclusion and misunderstanding would recur. Now, when we work with school and work systems, we request that each system allow for “system” change in culture, process, policy, and training. It will not suffice to continue to teach neurodiverse individuals to “fit in” when their skills and perspectives are every bit as valid as those of their neurotypical peers and colleagues. A cultural shift toward sustainable change in education and the workplace is required. The support and freedom needed to implement lasting change and innovative solutions must be addressed at a systems level. Unfortunately, despite the efforts of well-intentioned staff, we have met many children and their parents who at first had appeared to be supported and successful in a school setting but who, through misunderstanding and missed opportunities, end up traumatized by their school experiences due to bullying, isolation, misunderstanding, and miscommunication. Staff training and the culture at schools and workplaces are among the many systems issues that need to be addressed for long-term individual and community success. One such issue frequently encountered is how behavior is perceived in various settings. Many children are perceived as “misbehaving on purpose” and being “oppositional” when they deviate from the expected learning trajectory. If children know the answer by doing the math in their heads, why must they “show their work”? If a child can learn while drawing, why should the child be considered “disrespectful,” “inattentive,” and “defiant”? We challenge ourselves and those we work with to question preexisting assumptions, to take multiple perspectives, and to seek understanding. An academic model must focus on and value a student’s strengths rather than any weaknesses that keep the student from fitting the traditional mold of a student. Teachers should be careful of how they communicate with students, because even innocent remarks can cause the student to have beliefs regarding ability that can affect effort and performance. A statement such as “You’re just not good at math” or even the more positively stated “You’re better at reading” can create that belief in a student. Then, because the student believes that this statement must be true, when math concepts are presented, the student lacks effort and determination and does not fully engage in the learning process. Most of us typically default to the “stop it” command rather than ask for the behavior we want to see. If we want children to take risks, make mistakes, and learn how to problem solve challenges in

Strengths-Based Model and Savantism

55

a positive way, we must also have the same culture and expectations for our staff. Children are adept at recognizing the “do/say” discrepancies in their world. It is our contention that a system that is in sync, focused on everyone’s strengths, and clearly communicates positive expectations will be more successful than one that is focused on eliminating deviations from the “norm.” Our version of the 80/20 rule is that we assume 80% of the time things are moving in the right direction. Rather than focusing on reducing the 20%, we focus on increasing the 80%. Applying these ideas to larger community systems can be done in various ways. For example, many schools have adapted social justice programs, used peer courts, and used positive behavioral interventions and supports with great success. Some communities have expanded these supports to include local sports, community spaces, and businesses. When the expected behavior is clearly defined, everyone does better. In the absence of a systems approach to change, one tends to default to what one has experienced in the past. At times, system changes can lead to quick gains. For example, some schools have reported that by increasing free time, play and movement, music, and art, they have seen academic performance improve and behavioral referrals decline. System-wide interventions, such as meditation, mindfulness, yoga, and biofeedback skills, can be taught in the classroom, benefiting both students and teachers. One concept to emphasize: self-regulation starts at the top. A regulated classroom and a dysregulated teacher or administration cannot coexist. The Zones of Regulation (www.zonesofregulation.com) and the Superflex Curriculum (www.socialthinking.com) and other similar evidence-based tools are good examples of classroom education that benefit both children and adults. What would it take to create a learning environment that focuses on students’ strengths rather on than the differences that separate them from the mainstream? Although careful communication is a beginning, the curriculum must also focus on relationship building, executive function training, cognitive and noncognitive skills training, self-regulation training, and postsecondary transition with early exposure to career opportunities and options. Outside of formal education and therapeutic groups, how does a community support and nurture neurodiversity? Libraries serve as a wonderful resource for these interactions. The Treffert Library has hosted local, national, and international art and music events showcasing savants and educational events on neurodiversity to share our focus on diversity. Another example that is replicable across libraries in any location is the Questers program, which is a wonderful example of the sixth pillar in the Treffert Approach. The Questers program at the Carmel Clay Public Library in Carmel, Indiana (https://carmelclaylibrary.org/questers), which is based on the Digital Climbers program at the Muncie Public Library in

56

Neurodiversity

Muncie, Indiana (www.munciepubliclibrary.org/digitalclimbers), works as a system in the Treffert Approach by encouraging and facilitating relationships that span the community. This adaptive program offers various science-, technology-, engineering-, art-, and mathematics-based categories, and learning through play is encouraged in a way that can be adapted for almost any learning style. The Questers program offers a positive space where participants can experience learning in an informal, non-classroom way. They are given the freedom to choose a topic, complete a challenge in their own time, and have a safe and encouraging space to both succeed and, even more importantly, learn how to fail. Through both tangible and digital challenges, participants learn skills in such categories as critical thinking, spatial ability, coding, and computer science through trial and error, encouragement to explore and experiment, and guided instruction, depending on each individual’s needs. Using different strategies and techniques, the expectation guides are able to focus on accurate assessment of Questers participants by facilitating the exploration of challenges in a variety of ways, including physical activities, digital activities, learning aids, and one-to-one assistance. Multisensory technology practices are engaged in the Questers program to help explore new ways to solve challenges. Team challenges allow participants to help each other by bringing their unique strengths to the table. Challenges also use current best practices to teach life skills by using technology to make the abstract visible, guide communication, and teach process. Avatars are created to help connect visually to the space and give it a sense of belonging to the participant. Computational thinking practices help participants break down the challenge process by completing games in small segments to learn a skill, following individual steps (recipe style) to help cement understanding of the process, and help recognize patterns in skill sets. Questers is also available in digital format for those participants who are unable to visit the physical space. Examples of Questers challenges include building and programming robots, utilizing board games that focus on logic or mathematics, playing online or physical games that teach algorithms and coding languages, designing or creating art in digital and physical ways, and creating and telling stories. Participants have an opportunity to work together or independently, depending on their preference. Each participant is encouraged to work through a challenge in his or her own way. Quest Lab provides an array of options, including flexible seating, auditory assistance, and space to move or be still. Staff have been trained in the Treffert Approach. Unless a broader perspective is taken and intervention provided, a system that is left unchanged will often continue to perpetuate maladaptive functioning, no matter who the identified patient is. The opportunity exists

Strengths-Based Model and Savantism

57

to use this broader systems perspective to create positive, strengths-based, sustainable, inclusive, and resilient communities. Systems that support, grow, and sustain this approach benefit us all.

Case Examples We have learned through working with neurodiverse people that if we can simply “be” with the individual before us, that person teaches us what we need to do together. Regardless of whether the child has been diagnosed with autism, oppositional defiant disorder, or another condition, in each case, we are with a real person. Every person we have worked with has wanted to feel accepted and connected, but each has had unique ways of sharing and responding.

The Architect A young mother whose child was 4 years old shared that when he was assessed, she was told that he would never speak, he would never be toilet trained, and she would simply need to accept the child that she had been given. The child had the amazing ability to make intricate block towers and add items that required the ability to precisely balance them, such as a spoon atop a block with an egg in the bowl of the spoon. He would do this for hours, and the mother would work to help supply him with whatever he was drawn to for his building, all the while talking and narrating to him the names of the objects, the colors, and the shapes. As we worked with this family, the young boy began to talk, to draw, to read, and to share his amazing skills that turned out to be about structure and shape. When taking walks, this amazing boy would want to enter a new space and walk around, always looking at the ceilings and corners and lines of the space. He would return home and draw the spaces from memory, complete with lighting, furniture, and cars in the parking lots, but never with people—structure was his passion. His mom was always there to guide and support him, to interpret the world and narrate it for him. Despite the poor “fit” for her son in school, she cultivated a relationship with a retired architect, who shared that this young boy had more knowledge of space than some of the college students he was teaching. We have met many parents like this mother and learn from them every day.

A Playful Tree Parents often despair when their child is not doing what peers enjoy. A young couple had just invested in constructing a wonderful outdoor play gym for their three children. The parents were delighted that their 3- and 4-year-old children loved the gym and spent time swinging, sliding, and playing. However, their oldest son, who had been diagnosed with autism,

58

Neurodiversity was not drawn to the gym. Instead, he would run toward the house giggling, then run away from the house and turn around and giggle some more. Working with the couple’s son, the therapist began developing a safe relationship and would follow the child’s lead, running beside him as he ran toward the house and then ran away. One day the boy said, through his laughter, “The tree is playing with me.” At that moment the therapist took the time to really notice that there was a pine tree on the other side of the house that they could not see when they were close to the house, but that came into their vision when they ran away from the house. This was the pine tree’s way of playing peek-a-boo for this young boy. The parents were hopeful when they learned that their child was playing, just in a different way. He helped his parents discover the games that he was already playing with the things around him. With common understanding came the opportunity for shared attention.

Using Relationships and Developmental Status to Teach Social Awareness Behaviors, or misbehaviors, are often tied to misunderstandings. A mother expressed frustration with her 7-year-old son because he “never learns.” The mother explained that when the child would misbehave, she would punish him, but soon afterward he would do the same things all over again. Her son, meanwhile, had his own frustrations with his mom. He told his therapist that his mom would lie to him, and he wished she would stop. When the young boy was asked for an example, he shared that his mom would say she was going to give him a popsicle, but then she would tell him he couldn’t have it. During further questioning, the boy revealed that in between his being told he could have a popsicle and the withdrawal of the offer, he had gone into the bathroom and squirted hand cream on the counters, rubbing it all around. He said he loved how it felt, and the smell was great. The child did not understand that his actions had changed how his mother responded, despite having said she would give him a popsicle. In sharing with the boy how cause and effect work—by using the controller for his video games—he was able to understand that his behavior was what changed his mother’s plan.

Leadership The Treffert Center Leaders in Creative Media group is composed of amazingly talented individuals. One young man has a comorbid diagnosis of selective mutism and autism spectrum disorder. He would often sit in the back of the room, observing the group and the presenters, and rarely made a sound. He would answer questions with one word or simply reply with a blank stare. One day, a new activity was introduced to the group to get everyone up and moving and break the ice. This new activity was improvisational acting, not the easiest form of acting. Group members shared ideas for character, place, and theme or conflict and volunteered to act in the scenes. This young man was one of the first people to volunteer. What he produced was nothing short of miraculous! The conflict was getting pulled over

Strengths-Based Model and Savantism

59

by the police and having to negotiate his way out of a ticket. He combined appropriate actions, body movements, intonation, social context, and the ability to think on his feet during this improvisation. Here was a person who would not answer a question when asked in a one-to-one setting, but who could get up in front of a group of peers, communicate and interact with another person, and make the whole audience laugh and enjoy the scene. Group members witnessed firsthand his social skills, communication skills, and self-confidence spike after this one session. In most of the sessions moving forward, he volunteered to act and even engaged in conversation with his peers outside of the improvisational exercises. Individuals on the autism spectrum often struggle with performance anxiety until they are performing within the context of their gifts.

Conclusion We all are neurodiverse, and each of us has a unique pattern of strengths and challenges. The idea that some savant capabilities—a little Rain Man— might reside in each of us arises from several observations. First and most persuasively, some previously nondisabled, neurotypical persons have experienced the emergence of previously latent savant skills following a head injury—a phenomenon called “acquired” savant syndrome (Treffert 2014). Second, Miller et al. (2000) reported 12 cases of elderly persons who were previously nondisabled with no extraordinary savant skills whose savant abilities newly emerged, sometimes at a prodigious level, as frontotemporal dementia began and progressed. Third, some procedures such as hypnosis or sodium amytal interviews in nondisabled persons, as well as brain surface electrode exploration during certain types of neurosurgical procedures, provide evidence that a huge reservoir of memories lies dormant and unaccessed in each of us (Treffert 2006). Fourth, the images and memories that surface (often to our surprise) during some dreams also tap that huge store of buried memories beyond what is available in our everyday waking state (Treffert 2011b). Finally, often as we relax or “tune out” other distractions, perhaps after “retirement,” for example, some previously hidden latent interests, talents, or abilities quite suddenly and surprisingly emerge (Treffert 1983, 2011b). Sometimes that emergence is actually a rekindling of some earlier childhood abilities, such as art, that were set aside for some reason during maturation and “growing up.” The most pressing research question—if buried potential does exist within us all—is how to tap that without a neurological catastrophe. Might there be other methods, short of injury or disease, to bring us in touch with buried skills and memory function? Could specific cognitive techniques or other procedures facilitate such a process in all of us? Some investigators are using repetitive transcranial magnetic stimulation to temporarily dis-

60

Neurodiversity

able the brain functions of nondisabled persons in certain areas of their brains to see if these more primitive, buried circuits can emerge in “normal” persons. Perhaps there are also pharmacological “brain booster” methods. Yoga and other meditation techniques do tap other levels of consciousness. As work in these areas continue, we have found in our work with savants, and all of the neurodiverse individuals we have had the honor to know, that a systematic approach to understanding, supporting, and helping them has been beneficial. The Treffert Approach consists of six key components that we have found to be effective in addressing a multitude of concerns and questions raised across settings: accurate assessment, strengths focus, natural environment, nurturing relationships, sensory awareness, and systems. This culminates in an overall approach that capitalizes on the strengths of neurodiverse individuals and a process for developing better ways to bring those strengths forward. This approach can be applied not only to work with savants and other neurodiverse people but also to staff, educational systems, health care providers, vocational rehabilitation services, human resource departments, and businesses. If nothing else, our research on exceptional brain performance, including that of savants and acquired savants, demonstrates the universality of strengths both in individuals and in all of us collectively. We simply need to look. The Treffert Approach provides a way to look at the multitude of variations in neurodiversity in a consistent fashion to guide what must be, by definition, uniquely designed strategies, to maximize life success and satisfaction. The search for hidden potential that perhaps lies within each of us is an intriguing area of research, and savant research may provide some clues to finding that potential, as well as some useful insights to the interface between savant functioning and genius overall. Savant syndrome provides an opportunity to propel us further along than we have ever been in better understanding the brain, the exceptional mind, and human potential. We feel that utilizing a systematic approach, such as the Treffert Approach, allows for a consistent structured response to the vast experiences of neurodiversity and is a way to expand upon the strengths of neurodiversity.

Acknowledgments We would like to acknowledge all the exceptional individuals and their families whom we have had the privilege to learn from over the years. Their willingness to share their triumphs and struggles, as well as their dedication and resiliency, is truly humbling. Thank you.

Strengths-Based Model and Savantism

61

KEY CONCEPTS •

The Treffert approach provides a consistent process for assessment and interventions for individuals, groups, and organizations.

•

The beginning of wisdom is to call things by their right name, and the first step in treatment is to make the correct diagnosis. Accurate assessment seeks understanding and uses multiple perspectives.

•

By focusing on strengths rather than deficits, even the smallest area of strength can be grown. We look to leverage strengths, to expand them and use them to help address areas of concern. We also look to strengths not only in individuals but in all aspects of our work and with those with whom we work, including larger systems.

•

Teaching, practicing, and mastering skills in natural environments leads to greater generalization and success. A neurodiverse setting is good for everyone. Learning in nature and natural environments prepares individuals for the expected and unexpected aspects they will face in school, relationships, and employment.

•

Forming trusting, safe, and mutually respectful relationships is a prerequisite for understanding, taking risks, and creating change.

•

We are all sensory beings. We experience information about our world in its simplest form through all our senses, including balance, proprioception, and gravity. Patterns of overwiring and underwiring, past exposure to trauma, and sensory-seeking and sensory-avoidant behaviors are all part of how one experiences the world. Although DSM-5 now includes sensory issues as part of the diagnosis for autism, there is controversy about the best way to approach that reality.

•

The Treffert Approach extends beyond individuals into the systems working with them by providing ongoing support and interventions in a variety of settings. Unless we can make an impact on the culture and the approach of the system we work with, gains can be lost, and future gains may be limited or more challenging. The systems approach includes all aspects of care and culture. To reach the goal of sustainable change, long-term success, and independence in all settings, including the workplace, we must pay attention to system processes and increase the system’s capacity to support and continue growth, problem solving, and resilience.

•

Education that focuses on the three primary predictors of life success— self-regulation, social-emotional skills, and compassion, taught through motion and play—is foundational for lifelong learning.

62

Neurodiversity

Recommendations For Educators, Clinicians, and Other Professionals • Try to understand a person’s interests as a way to initially engage that person. • Bridge off of these interests to help the person develop new skills or understanding. • Try to identify unrecognized skills or abilities in your patient. • Tailor expectations and pace to match the individual’s needs. • Provide early exposure to jobs and opportunities.

Discussion Questions 1. How accurate are parent and teacher reports of strengths and interests? How can the accuracy of these reports be better assessed? 2. How stable are strengths and interests? 3. Should strengths and interests be used as rewards?

Suggested Readings Barnett K: The Spark: A Mother’s Story of Nurturing, Genius and Autism. New York, Random House, 2013 Clark T: Exploring Giftedness and Autism: A Study of a Differentiated Educational Program for Autistic Savants. New York, Routledge, 2016 Costley D, Keane E, Clark T, Lane K: A Practical Guide for Teachers of Students With an Autism Spectrum Disorder in Secondary Education. London, Jessica Kingsley Publishers, 2012 Fabricius T: Autism and the Savant Hypothesis: The Evolution of Human Cognition and Mind. Dubuque, IA, Ilama, 2012 Grandin T: Thinking in Pictures: And Other Reports From My Life With Autism. New York, Vintage Books, 1996 Grandin T: The Autistic Brain: Helping Different Kinds of Minds Succeed. New York, Houghton Mifflin, 2013 Grandin T: Calling All Minds: How to Think and Create Like an Inventor. New York, Philomel Books, 2018 Jordan R, Roberts JM, Hume K (eds): The SAGE Handbook of Autism and Education. Thousand Oaks, CA, Sage, 2019 Kupferstein H, Rancer S: Perfect Pitch in the Key of Autism: A Guide for Educators, Parents, and the Musically Gifted. iUniverse, 2016

Strengths-Based Model and Savantism

63

Porges SW: The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation (Norton Series on Interpersonal Neurobiology). New York, WW Norton and Co, 2011 Smith B: Mentoring At-Risk Students Through the Hidden Curriculum of Higher Education. Lanham, MD, Lexington Books, 2013 Tammet D: Born on a Blue Day: Inside the Extraordinary Mind of an Autistic Savant: A Memoir. New York, Free Press, 2006 Treffert DA: Mellowing. Self-published, 1983 Treffert DA: Extraordinary People: Understanding Savant Syndrome. Bloomington, IN, iUniverse, 2006 Treffert DA: Islands of Genius: The Bountiful Mind of the Autistic, Acquired and Sudden Savant. London, Jessica Kingsley, 2011

References Ahrens K, DuBois D, Lozano P, Richardson LP: Naturally acquired mentoring relationships and young adult outcomes among adolescents with learning disabilities. Learn Disabil Res Pract 25(4):207–216, 2010 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013 Austin RD, Pisano GP: Neurodiversity as a competitive advantage. Harv Bus Rev 95:96–103, 2017 Clark T: Exploring Giftedness and Autism: A Study of a Differentiated Educational Program for Autistic Savants. New York, Routledge, 2016 Costley D, Keane E, Clark T, Lane K: A Practical Guide for Teachers of Students With an Autism Spectrum Disorder in Secondary Education. London, Jessica Kingsley Publishers, 2012 Cullen K, Monroe J: Using positive relationships to engage the disengaged: an educational psychologist-initiated project involving professional sports input to a pupil referral unit. Educational and Child Psychology 27:64–78, 2010 Dappen L, Isernhagen J: Developing a student mentoring program; building connections for at-risk students. Prev Sch Fail 49:21–25, 2005 Dawson M, Soulières I, Gernsbacher MA, Mottron L: The level and nature of autistic intelligence. Psychol Sci 18:657–662, 2007 Gardner HE: Frames of Mind: The Theory of Multiple Intelligences. New York, Basic Books, 1983 Gardner HE: Frames of Mind: The Theory of Multiple Intelligences, 3rd Edition. New York, Basic Books, 2011 Gardner H, Hatch T: Multiple intelligences go to school: educational implications of the theory of multiple intelligences. Educ Res 18(8):4–10, 1989 Kanner L: Autistic disturbance of affective contact. Nerv Child 2:217–250, 1943

64

Neurodiversity

Lambert MJ, Barley DE: Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training 38(4):357–361, 2001 Miller BL, Boone K, Cummings JL, et al: Functional correlates of musical and visual ability in frontotemporal dementia. Br J Psychiatry 176:458–463, 2000 Porges SW: The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation (Norton Series on Interpersonal Neurobiology). New York, WW Norton and Company, 2011 Tierney JP, Grossman JB, Resch NL: Making a Difference: An Impact Study of Big Brothers Big Sisters. Philadelphia, PA, Public/Private Ventures, 1995 Treffert DA: Mellowing. Self-published, 1983 Treffert DA: Extraordinary People: Understanding Savant Syndrome. Bloomington, IN, iUniverse, 2006 Treffert DA: Hyperlexia III: separating “autistic-like” behaviors from autistic order: assessing children who read early or speak late. WMJ 110(6):281–287, 2011a Treffert DA: Islands of Genius: The Bountiful Mind of the Autistic, Acquired and Sudden Savant. London, Jessica Kingsley, 2011b Treffert DA: Accidental genius. Sci Am 311(2):52–57, 2014 Treffert DA, Bartelt K, Dardis B, Mischler B: Hyperlexia Manual: A Guide to Children Who Read Early. Fond du Lac, WI, Treffert Center, 2017 Willis SL, Tennstedt SL, Marsiske M, et al: Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 296(23):2805–2813, 2006

FOUR Strengths-Based Model of Neurodiversity and Autism Lawrence K. Fung, M.D., Ph.D.

[I]f we can recognize, realistically and on a case-by-case basis, what an individual’s strengths are, we can better determine the future of the individual. Temple Grandin, Ph.D.

The strengths-based model of neurodiversity (SBMN) has tremendous potential to benefit individuals on the autism spectrum. The principles of SBMN allow mental health providers to form a structure to assess people on the autism spectrum based on character strengths as well as specific talents in specific areas. They also guide providers to devise approaches to build the identity of the individuals based on their strengths instead of their challenges. To maximize the potential of the strengths-based approach, the principles of SBMN can be applied to families of autistic individuals, the organizations where the individuals work, and the larger community. The collective sum of the results from these efforts will help in changing culture to one that embraces neurodiversity.

65

66

Neurodiversity

Autistic individuals often appear to be relatively less flexible in behavior than others. Yet behaviors that might be viewed by others as challenges can also serve as strengths (Table 4–1). For instance, behavior that might be viewed as perseveration can also be viewed as persistence and self-determination, depending on the context. Similarly, people on the spectrum are often thought to have challenges in “seeing the big picture”; however, if the task at hand requires attention to details, they might be among the first to complete the work. For example, a person does not need to see the big picture if the task is to debug a computer program. Many people on the spectrum have few interests, yet they will learn all the details of those interests, even the details that neurotypical people might ignore. When the situation arises in which someone else needs those details, the autistic person will solve the problem for everyone. Autistic people also tend to have challenges in perspective taking and are overly concrete, making them less apt to social interactions. However, when they have friends, people appreciate their honesty and loyalty. As these examples demonstrate, the characteristics of autism are well defined, but these qualities can be both strengths and challenges. By deliberately assessing for the strengths of individuals on the autism spectrum, we can uncover their potential and steer them toward developing their identity based on those strengths. TABLE 4–1.

Strengths and challenges of individuals on the autism spectrum

Strengths

Challenges

Persistence

Perseveration

Attention to details

“Big-picture” thinking

Strong fund of knowledge

Few interests

Following rules

Solving problems that bend rules

Logical thinking

Understanding pragmatics in social interactions

Concrete/Honest Loyal

Perspective taking Overly concrete in social interactions

Since the first cases of autism were described by Leo Kanner in 1943, many studies have reported strengths in people on the spectrum (Table 4–2), including domains of abilities such as memory, music, art, verbal skills, math, and spatial skills. Chapter 1 described the SBMN, which incorporates four main components: positive psychology (Seligman and Csikszentmihalyi 2000), positive psychiatry (Jeste et al. 2015), Gardner’s theory of multiple intelligences (Gardner 1983; Gardner and Hatch 1989), and Chickering’s seven vectors of development (Chickering and Reisser 1993). In this chap-

Strengths of autistic individuals, as documented in selected reports

Study

N

Any

Memory

4

75%

50%

Bennett and Heaton 2012

125

42%

28%

10%

Bolte and Poustka 2004

254

13%

Howlin et al. 2009

137

26%

Jones et al. 2009a

100

73%

11

54%

54%

36%

254

63%

52%

17%

43

87%

540

10%

Asperger 1944/1991

Kanner 1943 Meilleur et al. 2015: Moderate functioning Meilleur et al. 2015: High functioning Rimland 1978

Music

Spelling

Symbols/ Reading

25%

Math

Dates

Spatial skills

FM/A skills

25% 10%

15%

9%

22%

17%

32%

47%

10%

38%

Rapin 1996: Highfunctioning

51

71%

28%

26%

45%

35%

22%

Rapin 1996: Lowfunctioning

125

44%

23%

10%

14%

26%

14%

Strengths-Based Model of Neurodiversity and Autism

TABLE 4–2.

FM/A=fine motor/artistic. Source. Modified from Meilleur et al. 2015.

67

68

Neurodiversity

ter, the SBMN is applied to autism. Topics include what strengths are common among individuals on the spectrum, how strengths are assessed in this population, what strengths-based approaches are available, and how such interventions are implemented.

Strengths in Individuals on the Autism Spectrum Many influential scientists have been identified as having traits of autism. Albert Einstein, the most prominent physicist of all time, is believed to have had autism traits (James 2003). He once said: “I do not socialize because social encounters would distract me from my work, and I really only live for that, and it would shorten even further my very limited lifespan” (James 2003). Einstein's challenges in social interactions, persistence in solving the most difficult problems, deep interest in theoretical physics, and genius intellect proved to make him one of the most productive and influential scientists ever. Einstein developed the theory of general relativity, derived the famous equation E=mc2 as a consequence of this theory, and discovered the law of the photoelectric effect (which won him the Nobel Prize in 1921). In 1916, Einstein predicted the existence of gravitational waves, produced from a collision of two black holes (Einstein 1916). A century later, this phenomenon was experimentally observed after a 40-year work shared by Rainer Weiss, Barry Barish, and Kip Thorne, who won the 2017 Nobel Prize in Physics for this work (Abbott et al. 2016). In 1924, Einstein predicted the existence of a fifth state of matter (also known as Bose-Einstein condensate), which was experimentally produced 70 years later by Eric Cornell, Carl Wieman, and Wolfgang Ketterle. These scientists went on to win the 2001 Nobel Prize in Physics. One of Einstein’s biographers remarked that he “never really needed human contacts; he deliberately freed himself more and more from all emotional dependence in order to become entirely selfsufficient” (James 2004). Because Einstein “freed himself from emotional dependence,” he was able to focus on advancing science, ultimately teaching us more about the world and the universe than anyone ever had. Sir Isaac Newton, one of the most influential scientists of all time, is also considered to have had traits of autism. One of Newton’s biographers stated that he was “singularly unable to form intimate friendships” (More 1934). However, Newton’s book Philosophiæ Naturalis Principia Mathematica (Mathematical Principles of Natural Philosophy), first published in 1687, laid the foundations of classical mechanics, and he also developed the fields of calculus and optics. We remember Newton, despite his personal challenges, as some-

Strengths-Based Model of Neurodiversity and Autism

69

one who made seminal contributions to many scientific disciplines that positively changed our lives over the past few hundred years. Several other Nobel Prize winners are also considered to have had traits of autism. Paul Dirac shared the 1933 Nobel Prize in Physics with Erwin Schrödinger “for the discovery of new productive forms of atomic theory” (www.nobelprize.org/prizes/physics/1933/summary). Dirac was known to be echolalic and extremely taciturn (James 2004). Marie Curie, the acclaimed physicist and chemist who conducted pioneering research on radioactivity, was the first woman to win a Nobel Prize, the first person and the only woman to win the prize twice, and the only person to win it in two different scientific fields (Physics in 1903 and Chemistry in 1911). She was described as having tremendous difficulty engaging in conversation and a tendency to misinterpret other people’s reactions to her. Irène Joliot-Curie (Marie Curie’s daughter) and her husband were awarded the Nobel Prize in Chemistry in 1935 for their discovery of artificial radioactivity. Joliot-Curie was described as a very reserved person who had difficulty making friends. She was also described as “rather awkward in her movements” (James 2003, p. 38). Hans Asperger wrote in his 1944 doctoral thesis, [W]e have seen that autistic individuals, as long as they are intellectually intact, can almost always achieve professional success, usually in highly specialized academic professions, often in very high positions, with a preference for abstract content. We found a large number of people whose mathematical ability determines their professions: mathematicians, technologists, industrial chemists and high-ranking civil servants. (Frith 1991, p. 89)

Although Asperger reported that many people on the autism spectrum were accomplished in mathematics and the sciences, many others are talented in the humanities and sciences. One of Asperger’s patients, Elfriede Jelinek, is a gifted Austrian playwright and novelist. Jelinek won the Nobel Prize in Literature in 2004 for her “musical flow of voices and counter-voices in novels and plays that with extraordinary linguistic zeal reveal the absurdity of society’s clichés and their subjugating power” (Nobel Foundation 2004). In 1970, when Jelinek was 24 years old, she published her first work, “we’re decoys baby!” The novel had no capitalizations, no punctuation, and plot involutions (de la Durantaye 2005). Lewis Carroll, author of Alice’s Adventures in Wonderland, was described as having struggled in communicating with his peers. Because of this, he spent more time with children than adults. This environment cultivated his vivid imagination, which enhanced his writing (Fitzgerald 2005). Michelangelo, the celebrated sculptor, painter, architect, and poet of the High Renaissance, has also been said to have had autism traits. He was described as having “single-minded work routine, unusual lifestyle, limited

70

Neurodiversity

interests, poor social and communication skills, and issues of life control” (Arshad and Fitzgerald 2004). Andy Warhol, a prominent artist in the twentieth century, is also considered to have had traits of autism (Fitzgerald 2005). Warhol, the father of pop art, is most famous for his series of paintings “Campbell’s Soup Cans.” The repetitive style of his art and his challenges in communicating with others have been stated to be consistent with some of the core features of autism. As illustrated, prominent people throughout history have demonstrated that their persistence in pursuing their deep interests helped them excel in their chosen fields, from the sciences to literature and fine arts. The strengths discussed in this section are not only absolute strengths but also relative strengths; they are not only about the technical excellence that autistic people demonstrate but also about strengths in their personal characteristics.

Character Strengths in Autism Honesty is one of the most mentioned character strengths in people on the autism spectrum (Jaarsma et al. 2012). This trait has been recognized by autistic individuals (Atherton et al. 2019; Russell et al. 2019) and experts in the field of autism (de Schipper et al. 2016; Mahdi et al. 2018). In a series of semistructured interviews with adolescents on the spectrum, Atherton et al. (2019) examined participants’ theory of mind experiences and strategies and revealed four core themes: honesty, humor, imagination, and anthropomorphism. Results from their interpretive phenomenological analysis highlighted that theory of mind in individuals on the spectrum is one of difference rather than deficit. For example, honesty in autism appears to be less dependent on systemizing than on personal experience and choice. Using a questionnaire developed by the World Health Organization’s International Classification of Functioning, Disability and Health research, de Schipper et al. (2016) extracted functional ability and disability concepts from responses among 225 autism experts representing 10 disciplines and 43 countries. These experts reported the following character traits associated with autism: strong sense of morality (e.g., honesty, lack of judgmental attitude), trustworthiness, loyalty, and kindness. Kirchner et al. (2016) assessed character strengths in 32 young autistic adults and 32 neurotypical control subjects using the Values in Action Inventory of Strengths (VIA-IS; Peterson and Seligman 2004) and explored associations with levels of satisfaction with life. As shown in the rightmost two columns of Table 4–3, the most frequently endorsed signature strengths (i.e., five top-ranked strengths within an individual’s strength ranking, often used in positive psychology) in the autism group were open-mindedness, authenticity, love of learning, creativity, and fairness. Among these five sig-

Comparing strengths and most frequently endorsed signature strengths* of young adults on the autism spectrum and TD control subjects using the Values in Action Inventory of Strengths

Character strength Emotional strengths Zest (enthusiasm) Hope (optimism) Bravery (courage) Humor (playfulness) Love Social intelligence Interpersonal strengths Kindness (generosity) Teamwork Fairness Leadership Forgiveness Modesty

Description of item

Correlations with SWLS Autism TD rank rank Autism TD

Approaching life with excitement and energy Expecting the best and working to achieve it Not shrinking from threat, challenge, difficulty, or pain Liking to laugh and joke, bringing smiles to other people Capacity to love and be loved, valuing close relations with others Being aware of the motives and feelings of self and others, knowing what to do to fit into different social situations

** ** 1 5

Doing favors and good deeds for others, helping others and taking care Working well as a member of a group or team, being loyal to the group Treating all people the same according to notions of fairness and justice Taking care of a group and its members, organizing activities and seeing that they happen Forgiving those who have done wrong, giving people a second chance Letting one’s accomplishments speak for themselves, not regarding oneself as more special than one is

4 5

**

** ** ** ** ** **

** **

**

**

1

Strengths-Based Model of Neurodiversity and Autism

TABLE 4–3.

**

71

Comparing strengths and most frequently endorsed signature strengths* of young adults on the autism spectrum and TD control subjects using the Values in Action Inventory of Strengths (continued)

Character strength

Description of item

Intellectual strengths Creativity (originality)

Thinking of novel and productive ways to do things, including but not limited to artistic achievements Curiosity (interest) Taking an interest in all ongoing experience, finding subjects and topics fascinating, exploring and discovering Open-mindedness (judgment) Thinking things through and examining them from all sides, not jumping to conclusions; being able to change one’s mind in light of evidence Love of learning Enjoyment of mastering new skills, topics, and bodies of knowledge Strengths of restraint Persistence (perseverance) Prudence

Authenticity (honesty)

Correlations with SWLS Autism TD rank rank Autism TD

4

1

1

3 **

** 2

Neurodiversity

Self-regulation Perspective

Finishing what one starts, persisting in a course of action in spite of obstacles Being careful about one’s choices; not saying or doing things that might later be regretted Regulating what one feels and does Being able to provide wise counsel to others, having ways of looking at the world that make sense to oneself and to other people Speaking the truth and presenting oneself in a genuine way

72

TABLE 4–3.

Comparing strengths and most frequently endorsed signature strengths* of young adults on the autism spectrum and TD control subjects using the Values in Action Inventory of Strengths (continued)

Character strength Theological strengths Spirituality (religiousness) Gratitude Appreciation of beauty

Description of item

Having coherent beliefs about the higher purpose and meaning of life Being aware of and thankful for the good things that happen Noticing and appreciating beauty, excellence, and/or skilled performance in all domains of life

SWLS=Satisfaction With Life Scale; TD=typically developing. *Five top-ranked strengths within an individual’s strength ranking. **Indicates significant correlations with satisfaction with life. Source. Adapted and modified from Kirchner et al. 2016.

Correlations with SWLS Autism TD rank rank Autism TD

** **

Strengths-Based Model of Neurodiversity and Autism

TABLE 4–3.

73

74

Neurodiversity

nature strengths, three are intellectual (open-mindedness, love of learning, creativity). In contrast, among neurotypical control subjects, the most frequently endorsed signature strengths were emotional (humor, love), interpersonal (kindness, fairness), and intellectual (open-mindedness). For both groups, hope and zest had the strongest associations with satisfaction with life. In the autism group, kindness, social intelligence, teamwork, and humor were most strongly related to satisfaction with life, whereas in the control group, persistence, curiosity, perspective, and humor were most strongly correlated. Notably, although autistic young adults perceive that they are strong intellectually, emotional and interpersonal strengths were most associated with personal satisfaction. Therefore, in order to improve the overall well-being of autistic individuals, interventions need to encompass approaches that maximize their emotional, interpersonal, and intellectual capacities. Parents of 427 youth and young adults with intellectual disability and/or autism (ages 13–21 years) assessed their children using the Assessment Scale for Positive Character Traits–Developmental Disabilities (ASPeCT-DD) (Carter et al. 2015). From the interpersonal strengths listed, compassion was the one parents rated highest as describing their children. Other highly desirable qualities parents mentioned were being social, loving, helpful, and loyal. In another study using ASPeCT-DD, 163 young adults (ages 18–30 years) were recruited to assess the strengths of their siblings with intellectual disability or autism (Carter et al. 2020). The three strengths rated highest were kindness to others, caring for other people, and having a sense of humor. Overall, parents and siblings provided additional insights into the character strengths of individuals on the autism spectrum. The parents of 98 autistic children reported their children’s strengths, which were categorized into five meta-themes: personality characteristics, cognitive functioning, social personality, behavioral characteristics/coping mechanisms, and skills (Sabapathy et al. 2017). Most parents reported more strengths in the cognitive functioning and personality characteristics metathemes. Experts in the field of autism have found other specific strengths in people on the spectrum as well (de Schipper et al. 2016); in particular, they reported mathematical abilities, technical abilities (computer skills, engineering), attention to detail, visual perception, artistic skills (e.g., music, drawing, visual arts), and creative talents (e.g., looking at the world differently).

Specific Domains of Competencies in Autism Domains of abilities generally follow a normal distribution. This is true for both the overall population and the autistic population. In other words, indi-

Strengths-Based Model of Neurodiversity and Autism

75

viduals on the spectrum do not have a specific profile of abilities. Some may be good at a particular domain, but others may not be good in the same domain. In this section, strengths of individuals on the autism spectrum are organized based on the construct proposed by Gardner’s theory of multiple intelligences (logical-mathematical, verbal-linguistic, visual-spatial, musicalrhythmic, naturalistic, kinesthetic, existential) (Gardner 1983). SBMN interventions that can be used to improve interpersonal and intrapersonal abilities are described in a later section of this chapter.

Logical-Mathematical Abilities Early studies found that most individuals with Asperger syndrome had average mathematical ability (Chiang and Lin 2007). Later studies found clusters of autistic children with strong mathematical abilities; in one study that involved 130 autistic children ages 6–9 years, 20% demonstrated hypercalculia and 39% showed hypercalculia and superior abilities in letter-word identification and passage comprehension (Wei et al. 2015). Compared with the general population, people on the autism spectrum tend to have less uniform performance among various domains of academic achievements. In a sample of 30 autistic children without intellectual disability, 13% had higher achievement scores in mathematics than in their full-scale IQs (FSIQs), whereas 40% had lower achievement scores in mathematics than in their FSIQs (Estes et al. 2011). In a larger sample comparing 114 autistic children and 96 matched control subjects, compared with the matched control group, the autism group showed marginally lower verbal IQ scores and significantly lower scores on numerical operations, mathematical reasoning, and reading comprehension (Chen et al. 2019). However, hierarchical clustering analysis yielded a subgroup of high-achieving autistic children (63%) who showed superior mathematical skills compared with their reading comprehension skills. In contrast, the low-achieving autistic children (37%) were found to demonstrate lower mathematical abilities compared with reading comprehension. Similar to autistic children, adolescents on the spectrum showed discrepancies between mathematical skills and IQ. In a group of 99 autistic adolescents (ages 14–16), 73% had at least one area of literacy or mathematical achievement that was highly discrepant (>14 points) from their FSIQs (Jones et al. 2009b). On the one hand, the authors found that 16% presented with average FSIQs alongside superior skills in numerical operations; 14% of the total were found to have superior reasoning in mathematics but average FSIQs. On the other hand, the authors reported that 15% had worse reasoning in mathematics relative to their FSIQs; 6% of the total had significantly lower skills in numerical operations. Although the participants had a

76

Neurodiversity

wide IQ range (50–119), both of the groups showing “arithmetic peak” or “arithmetic dip” presented with average FSIQs. In the only longitudinal study of academic achievements in individuals on the autism spectrum, Kim et al. (2018) used data from 111 children referred for possible autism diagnosis at age 2 years. The children completed assessments at ages 2, 3, and 9 years and had valid basal scores on achievement testing. The achievement testing was completed again at age 18. Participants were divided by FSIQs: the higher-IQ group had FSIQs ≥85, and the lowerIQ group had FSIQ scores