Cite: Roberts, J. (2023, March 16). SLPs are directly contributing to autistic trauma and suicidality. Therapist Neurodiversity Collective.
“I have parents that would like their 7-year-old child (who has autism) to have “scheduled time to speak 85% of the time with peers and adults while engaging in games, etc.” He’s highly verbal, yet has aggressive behaviors. They would also like him to carry on conversations at home since he doesn’t extend or elaborate his discussions. One of the proposed ILC goals is:
Child will attend a two-way conversation on a non-preferred topic with 3 exchanges using structured social skills activities (Ex. role-playing, social scenarios, and social videos) and adult support at school.
Would the We Thinkers Series be a reasonable curriculum to help this child reach this goal?”
I read this question at 5 am this morning and feel anguish, both as an autistic person and a speech-language pathologist. Two hours later, I read it out loud to my son over breakfast. He is aghast.
“Why would this be okay to do to this kid? Can you imagine a non-autistic person being forced to speak 85% of the time, especially about things they aren’t interested in? It’s horrible!”
My thoughts: First of all, my heart breaks for this kid, and I think that it’s no wonder he’s exhibiting aggression. Who wouldn’t be with this kind of oppression? How much would this kid’s social interaction improve if the people around him had to engage 85% of the time on the topics he wants to talk about, in environments that are comfortable for him? How much more would it improve if he were in an environment with other autistic kids, engaging in preferred activities, and communicating in similar autistic ways? Research indicates, dramatically. (Williams et al, 2021; Chin et al, 2021; Crompton et al, 2023)
Second of all, why are ASHA SLPs not attuned to The Double Empathy Problem+, neurodiversity, the Neurodiversity Movement, autistic human rights and “passing.”
This social skills goal is:
- Domineering, oppressive and abusive, and frankly, a violation of this kid’s human rights (United Nations Convention on the Rights of the Child, Article 37).
- Uninformed (contemporary autism research, especially regarding The Double Empathy Problem) and not evidence-based (because social skills training is not an evidence-based practice). (Bellini et al. 2007; IES What Works Clearing House, 2013; Sasson, et al, 2017; Bottema‑Beutel et al, 2018; Morrison et al 2020; Book et al 2020; Ryan-Enright et al, 2022; Libster, et al, 2022; Roberts, et al, 2022; Keating and Cook, 2022.)
- Designed to literally train this autistic kid to mask and camouflage his authentic social communication for the purpose of maximizing the comfort of others. Even in children, autistic masking has been shown to have poor and even detrimental mental health outcomes, including suicide.
“The neurotypically developing brain learns over time to be a super-sensitive detector to what others are doing, saying, thinking, planning, and feeling in the social world.”
– Michelle Garcia Winner, MA CCC-SLP, and Pamela Crooke, PhD CCC-SLP. (2022).
Autistic people are not neurotypical people, and all the training in the world isn’t going to change that fact. Autistic people socialize differently than neurotypicals, not deficiently. It’s unfathomable that in 2023, speech-language pathologists continue to believe that it’s an altruistic and acceptable practice to train autistic masking and camouflage to reduce autistic social communication traits and replace them with “superior” neurotypical ones.
What’s more, although most people who write social skills goals believe that these goals will benefit the autistic person, for instance, by reducing bullying from peers, research shows that this practice has the opposite outcome.
“While one could assume that having fewer ASD symptoms would improve peer relationships, evidence suggests that stronger social skills may increase the likelihood of experiencing and reporting peer conflict.” (Libster, et al, 2022)
“In neurotypically developing children it (social interpretation) occurs when an individual’s brain attends to interpret socially based information. As mentioned previously, social interpretation is more than making inferences; it involves understanding self and others to make sense of people’s information, plans, intentions, even humor! To interpret well is to understand that each of us has unique thoughts and feelings while we share information, plans and goals.”
– Michelle Garcia Winner, MA CCC-SLP, and Pamela Crooke, PhD CCC-SLP. (2022).
Although they label it “self-otherness”, “we thinking” or “we cooperation,” with this statement, the authors invoke the dehumanizing myth that autistic people (and everyone else that doesn’t employ White, Western, Neurotypical styles of social communication) are lacking in Theory of Mind (ToM).
“A theory of mind remains one of the quintessential abilities that makes us human.” – Simon Baren-Cohen, 1985
Baren-Cohen and the authors of original 1985 study conclude that “normal” children and those with Down Syndrome were successful with the Sally-Ann ToM test, and that autistic children are singularly lacking in theory of mind (thus lacking in human qualities). The problem with this theory is that Baren-Cohen’s 1985 premise has been and continues to be repeatedly disproved in both autistic adults and children. (Gernsbacher & Yergeau, 2019; Henderson, 2021; Holt et al, 2022)
A stated goal of The Expanded Social Thinking–Social Competency Model (ST-SCM) is that children learn to “share space effectively without intruding or make others feel uncomfortable,” presumably because autistic people “don’t realize they are being offensive.” (Garcia-Winner, 2021)
However, ‘the double empathy problem’ research is increasingly proving that “the difficulties in autistic communication are apparent only when interacting with non-autistic people, and are alleviated when interacting with autistic people,” (Crompton, et al, 2020), and that autistic and non-autistic people have different embodied experiences of the world which may result in mismatched relevancy expectations. (Williams, Wharton, and Jagoe, 2021). If non-autistics have different expectations than autistic people of what has relevance in a social communication exchange, there’s naturally going to be a breakdown in communication. It’s a mutual breakdown, not an autistic deficit. Add to this the fact that many autistic people have monotropic interest systems* and find it difficult to maintain interest in uninteresting topics, and engage in banal, ping-pong chit-chat about meaningless subjects, and it’s no wonder the kid doesn’t find social interaction stimulating. Forcing him to perform like a monkey so he can please his parents isn’t likely to improve his ability to “extend or elaborate his discussions.” Forcing him to pretend to be non-autistic is more than likely going to increase aggressive behavior, not improve it. Other outcomes of this goal may include detrimentally poor mental health and possibly, loss of life.
I wonder if my SLP peers know that
- Autistic children, especially those with higher cognitive abilities are 28 times more likely to have suicidal thoughts compared to non-autistic children?
- Autistic suicidal thoughts are linked to the pressure to perform as a non-autistic and the associated autistic masking and camouflage to do that, and no matter whether an autistic person camouflages all the time or in some situations but not others, it still leads to poor mental health outcomes, including suicide? (Cassidy et al. 2018; Cage and Troxell-Whitman, 2019)
- Autistic children as young as four years old attempt to mask and camouflage their autistic traits and they have similar poor mental health outcomes as autistic adults? (Ross, Grove, McAloon, 2023).
- Autistic masking and camouflage have extremely poor mental health outcomes of
- mental exhaustion
- chronic debilitating anxiety
- confusion or loss of identity
- suicidal ideation
- suicide attempt
- death by suicide
- Autistic adults and youth have significantly higher rates of suicidal ideation?
- 28% higher in autistic children than non-autistic children
- 66% higher in autistic adults than non-autistic adults
- Autistic adults are nine times more to end their lives by suicide than non-autistic adults, that autistic adults die approximately16 years earlier than would be expected, and death by suicide is the leading cause of premature death in autistic adults?
Most professionals don’t go into a helping profession with plans of harming the people they are serving, but however unintentionally, speech-language pathologists directly contribute to these grim statistics through the dehumanizing, deficit-based framework of social skills training, (or “self-otherness”, “we thinking” or “we cooperation,” or whatever other clever, but still deficit-based ballyhoo people use to sell products, therapy and educational materials, and CEU events). Autistic people don’t need to be “fixed” through SLP conversion therapy. They don’t need to submit to the social communication tyranny of non-autistics who don’t share nor even understand autistic lived experiences.
Autistic people, including autistic children, need to be treated with dignity, humanity, and respect. Our job as ethical SLPs is to, with cultural humility, help this happen through self-education, and then through educating other non-autistic people on The Double Empathy Problem, the Neurodiversity Movement, and basic human rights.
+Rose, Kieran. The Autistic Advocate. (2022, July 4). An introduction to the double empathy problem. [Video]. YouTube.
* Rose, Kieran. The Autistic Advocate. (2022, July 4). An introduction to monotropism. [Video]. YouTube. (This animation was written and narrated by Kieran Rose (www.theautisticadvocate.com) and animated by Josh Knowles Animation. It was commissioned by Health Education England and produced by AT Autism and Anna Freud National Centre as an accessible 4 minute introduction to the key ideas of Monotropism, originally as part of training aimed at Tier 4 mental health practitioners (#Tier4AFC), led by Dr Pavlopoulou and Dr Moyse.)
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Crompton, C. J., Hallett, S., Axbey, H., McAuliffe, C., & Cebula, K. (2023). ‘Someone like-minded in a big place’: Autistic young adults’ attitudes towards autistic peer support in mainstream education. Autism, 27(1), 76–91. https://doi.org/10.1177/13623613221081189
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SLPs directly contribute to autistic outcomes of trauma and suicidality through social skills training
My hope is this article, if nothing else, ignites some #SLP self-reflection as well as deeper dives into contemporary autism research, especially #TheDoubleEmpathyProblem, #ActuallyAutistic perspectives, and how, despite altruistic intentions, our clinical practices continue to impact trauma on our autistic students and clients.
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- SLPs directly contribute to autistic outcomes of trauma and suicidality through social skills training - March 16, 2023
- Toxic Social Skills Training Goals, “Be yourself, but not like that.” - February 22, 2023
- Not allowed to say “I can’t” - February 16, 2023
Isn’t it more like “cultural humility”?
“Cultural humiliation” might be more like what happens to the SLPs and SLTs when they realise they have been harming Autistic people for years without this information and the research.
Thank you very much for bringing this to my attention. It was a typo, but yikes, as you state, it completely changes the meaning. I have fixed it.
Kind regards, Julie