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 making 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
- burn-out
- chronic debilitating anxiety
- depression
- low-self-esteem
- 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 may directly contribute to these grim statistics through the dehumanizing, deficit-based framework of social skills training, or whatever other clever, but still deficit-based ballyhoo people use to sell the tens of thousands of products, therapy and educational materials, and CEU events intended to fix autistic people’s social skills. 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.
This statement of clarification in response to a direct threat of litigation:
THIS ARTICLE IS NOT A CAUSATION STATEMENT LINKING AUTISTIC SUICIDE STATISTICS SPECIFICALLY TO SOCIAL THINKING – SOCIAL CONTEMPORARY MODEL (ST-SCM) OR ITS AUTHORS, NOR IS THERE AN IMPLIED CAUSATION.
Sources:
+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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Baron-Cohen S, Leslie AM, Frith U. Does the autistic child have a “theory of mind”? Cognition. 1985 Oct;21(1):37-46. doi: 10.1016/0010-0277(85)90022-8. PMID: 2934210.
Best, C., Arora, S., Porter, F. et al. The Relationship Between Subthreshold Autistic Traits, Ambiguous Figure Perception and Divergent Thinking. J Autism Dev Disord 45, 4064–4073 (2015). https://doi.org/10.1007/s10803-015-2518-2
Botha M, Dibb B, Frost DM. “Autism is me”: an investigation of how autistic individuals make sense of autism and stigma. Disabil Soc. 2022;37(3):427–53.
Botha M, Frost DM. Extending the minority stress model to Understand Mental health problems experienced by the Autistic Population. Soc Mental Health. 2020;10(1):20–34.
Cage E, Troxell-Whitman Z. Understanding the Reasons, Contexts and Costs of Camouflaging for Autistic Adults. J Autism Dev Disord. 2019 May;49(5):1899-1911. doi: 10.1007/s10803-018-03878-x. PMID: 30627892; PMCID: PMC6483965.
Cassidy, SA, Gould, K, Townsend, E, Pelton, M, Robertson, AE, Rodgers J. Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample. J Autism Dev Disord. 2020 Oct;50(10):3638-3648. doi: 10.1007/s10803-019-04323-3. PMID: 31820344; PMCID: PMC7502035.
Chen YL, Senande LL, Thorsen M, Patten K. Peer preferences and characteristics of same-group and cross-group social interactions among autistic and non-autistic adolescents. Autism. 2021 Oct;25(7):1885-1900. doi: 10.1177/13623613211005918. Epub 2021 Jun 25. PMID: 34169757; PMCID: PMC8419288.
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
Gernsbacher, M. A., & Yergeau, M. (2019). Empirical failures of the claim that autistic people lack a theory of mind.Archives of Scientific Psychology, 7(1), 102–118. https://doi.org/10.1037/arc0000067
Lucas G Casten, Taylor R Thomas, Alissa F Doobay, Megan Foley-Nicpon, Sydney Kramer, Thomas Nickl-Jockschat, Ted Abel, Susan Assouline, Jacob J Michaelson. medRxiv 2022.02.17.22271086; doi: https://doi.org/10.1101/2022.02.17.22271086
Crompton CJ, Ropar D, Evans-Williams CV, Flynn EG, Fletcher-Watson S. Autistic peer-to-peer information transfer is highly effective. Autism. 2020;24(7):1704-1712. doi:10.1177/1362361320919286
Henderson, G. E. (2021). Autistic children’s explanations of their own behavior: Evidence of other-attentiveness. Journal of Interactional Research in Communication Disorders, 10(2), 99–124. https://doi.org/10.1558/jircd.20363
Abigail Holt, Khadija Bounekhla, Christie Welch & Helene Polatajko (2022) “Unheard minds, again and again”: autistic insider perspectives and theory of mind, Disability and Rehabilitation, 44:20, 5887-5897, DOI: 10.1080/09638288.2021.1949052
Kirby, A.V., Bakian, A.V., Zhang, Y., Bilder, D.A., Keeshin, B.R. and Coon, H. (2019), A 20-year study of suicide death in a statewide autism population. Autism Research, 12: 658-666. https://doi.org/10.1002/aur.2076
Libster, N., Knox, A., Engin, S. et al. Personal victimization experiences of autistic and non-autistic children. Molecular Autism 13, 51 (2022). https://doi.org/10.1186/s13229-022-
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IEPs, Ableist Goals and Parents’ Rights
A neurodiversity-affirming parent’s anonymous post to Therapist Neurodiversity Collective requested information that might help them advocate for their special education student in the IEP meeting. From the information contained in the post, it appeared that the school, although possibly unintentionally, was not aware of IDEA and Supreme Court decisions, and therefore violated parental rights to meaningfully participate in and contribute to the IEP meeting. Additionally, it is clear that our public school system is lagging in knowledge and application of contemporary research evidence about autism, and as a result, the kids are paying the consequences with poor mental health outcomes.
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.
Toxic Social Skills Training Goals, “Be yourself, but not like that.”
The vast majority of new-to-me students come with IEPs that have, probably well-meaning, but in actuality, toxic social skills goals. Here are some alternatives.
Not allowed to say “I can’t”
“The kids in my class aren’t allowed to say I can’t.” I’m in an IEP meeting for young neurodivergent student who’s struggling in class. The committee is talking about all the reasons why this student should not be struggling because their standardized cognitive and language scores show they have the ability to learn and do the work.
Neurodiversity-Affirming Therapy: Positions, Therapy Goals, and Best Practices
Neurodiversity-affirming therapy: Dozens of neurodiversity-affirming therapy goals and best practice resources for ally SLPs and OTs.
Influencer Therapists: Dubious Ethics & Poor Quality Services
“And, at the end of the day, that’s what a lot of therapy “influencers” are after: exploiting vulnerable families to benefit their own bottom line and their online image. And it’s time that professionals and parents begin talking about it and pushing back.”
She is a frequent speaker, educator, and trainer who delivers high-energy presentations that challenge audiences to re-examine their beliefs about Autism and re-access outdated and damaging therapy and education practices.
Julie’s work focuses on professional, and public education about empathetic evidence-based therapy alternatives to ABA and behavioral therapy models that are non-trauma inducing and respectful of autistic social communication differences, social justice, and human rights. Her articles and educational resources have reached well over three-quarters of a million people and are frequently cited in other presentations and articles.
- IEPs, Ableist Goals and Parents’ Rights - April 1, 2023
- 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
Julie:
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.
Hi Adelaide,
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
Hi again Julie:
Oh my!
I had been reading Brené Brown’s ATLAS OF THE HEART
where she deals with pride, humility and humiliation – which are all in a section of the atlas.
I had known already about “cultural diversity” and “cultural humility” as a phrase – a core value and an aspiration.
And then I went to Roget’s Thesaurus.
Good to know that it is fixed.
I noticed, too, that Simon Baron-Cohen was correct in the bibliography.
When I scrolled up and backwards from your reply, I saw a lot of “Baren-Cohen”.
If I had been reading only through my ear and not known that name for so long [25 years and counting] …
There is an interesting story about how Simon got his hyphen – that none of his brothers or cousins have.
It was an edit in a journal some time in the 1980s when he was first publishing and before the Spearman early career award.
[and then there are Cohens who take the Baron in their passages through nobility. No hyphen for them, sirree!]
When I was on Virginia Sole-Smith’s Substack, an Autistic Fat Activist called Amy H wrote about the costs of masking.
The only reason she didn’t use “fat” was to keep the neurotypicals around her comfortable.
[Neurotypicals apparently find it comfortable – or not distressing – if you don’t comment on their bodies as part of something you notice].
[Whether it’s a corporeal or a written or a spoken body].
And this denied her a useful and beautiful word and way to relate to people.
[The podcast in the Substack was called HOW DO YOU FEEL ABOUT THE WORD FAT?]
Hope you have a great set of conferences, Julie.