June 17, 2024
Cindy Lopez: Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen.
Join our guest host, Natalie Tamburello, Community Engagement Manager at CHC, as she discusses the unique challenges and strengths that students with autism navigate while learning in school. She’s joined by two of our CHC experts and licensed psychologists, Dr. Melanie Hsu and Dr. Cassandra Sanchez. They share how the social challenges associated with autism can pose barriers to learning when in a highly stimulating environment, like a classroom. Listen in to gain a deeper understanding of these unique challenges and learn how to leverage students strengths to support the learning journey.
Natalie Tamburello: I’m Natalie Tamberello and I’m excited to guest host today’s episode discussing autism and learning with Dr. Melanie Hsu and Dr. Cassandra Sanchez, who are both experts in autism. Dr. Hsu and Dr. Sanchez, can you tell us a little bit about yourselves and why this topic is important to you?
Cassandra Sanchez, PsyD: Hi, I’m Dr. Cassandra Sanchez. I’m a licensed clinical psychologist here at CHC, and I specialize in young child work, so ages birth to five as well as working with kids on the spectrum. I mostly do assessment and also see some kids for therapy, and I’m a bilingual clinician speaking Spanish and English.
I see a lot of children and families who are being exposed to this diagnosis for the first time. So I’m very passionate about providing education and information to families as they enter into this new space.
Melanie Hsu, PhD: And I’m Dr. Melanie Hsu. I’m a licensed clinical psychologist. I am also the evaluation program manager at CHC. So I get to oversee a lot of the evaluation services. I also do work a little bit in research in autism, and so also am very passionate about working with families and making sure that children are connected to good, high-quality services.
Natalie Tamburello: Thank you both. So let’s start off with talking about what autism looks like in a school setting. What is the spectrum of experiences that you see, and what does it look like at different ages?
Melanie Hsu: So a lot of times children enter into the school setting at the age of three right after early intervention. So working with the regional center, this is often right after diagnosis. And so a lot of the focus on the first part of like three to five is getting ready for school. So a lot of it is functional communication, making sure that children can use words and understand what’s being said to them, getting ready to learn and be able to listen to directions, working on any motor skills.
Natalie Tamburello: So are most students diagnosed at three to five for autism, or what does it look like to be diagnosed at different ages?
Melanie Hsu: I would say that a lot of times it’s bimodal. We see a large number of children that are diagnosed early. So between the ages of about 24 to 48 months and then children who are diagnosed a little bit later, especially if they’re higher functioning. So around school age then there’s also, again, the research is showing that, for example, people who are assigned female at birth often will get diagnosed even later, so in later adolescence or even in adulthood.
Natalie Tamburello: I just want to touch on some of the challenges that might start to present at that really young age of three to five when kids are starting to enter preschool. A lot of times kids are coming into preschool, maybe for an identified speech delay or something that might be related to autism but has not yet been labeled as autism. So if you start to notice signs of your child being quite independent in their play, having some withdrawal from the group, maybe not joining in on those structured activities or having a hard time with that circle time, maybe not showing so much interest in other children or in the lesson plan, that might be a good moment to speak to the teacher and try to get some more information about socialization or the behaviors that they may be engaging in when they’re not part of the group.
Melanie Hsu: And just to add to that also, a lot of times families are focused on some of the skill acquisitions. So saying, “Oh, my child knows all their colors, all their letters,” and especially before they go into a more social situation like early elementary school. And so sometimes again, where you start to see some of those gaps is being able to use those skills and to be able to play with others and use their skills across a variety of settings.
Natalie Tamburello: So we’ve talked, I think, mainly about three to five. So what about middle, upper elementary and transition to high school? What does that look like?
Cassandra Sanchez: It’s so important to keep in mind that autism is a spectrum. So what this usually translates to is that the challenges can be varied between different areas. It could include a challenge in the area of socialization, like I mentioned previously. It could be in executive functions, such as with planning and organizing, or the challenges may present with verbal communication, such as with understanding social cues and using variations in tone and pitch in a way to effectively communicate.
As students get into middle and high school, there is more collaboration and group work participation that at times can feel somewhat challenging. I’ve also seen challenges with the expectation of switching classrooms between each period. And having to manage workloads for each class individually. So during this time, it’s important to make sure that your child has the supports that they need to be able to transition between each classroom and manage each workload separately and to start developing skills to feel comfortable working in group projects and in collaboration with their peers.
Melanie Hsu: Something we see families say a lot is that they feel like there’s a big gap between early elementary school and later, because again, a lot of those skills are more applied. So it’s not just fact repetition, but it’s being able to reason with and use those facts more flexibly. And so a lot of times families think, “Oh, my child is regressing.” And in reality, it’s just that some of those social expectations are more built into what we expect from children, the older they get. And then, as Dr. Sanchez was saying, there is a lot more collaborative things as well. So, for example, when you’re in early elementary school, it might be, where did the ducks go? But then as they get older, it’s why did the ducks go there? What would you think if you were a duck? What would happen next? And again, a lot more of those social aspects of perspective taking and things that might be a little more nuanced.
Cassandra Sanchez: It’s important to keep in mind that social relationships are also going to be a bigger focus in middle school and high school, not just with friendships, but maybe even starting to breach romantic relationships. And I think that at times, kids that have autism might not be developing at the same pacing as their peers and may have younger interests, and of course that is, you know, perfectly acceptable, but it may mean finding the right friend group where they’re not feeling peer pressured to start talking about other themes or maybe engaging in ways that they’re not ready to yet. So remembering that the development in socialization, whether that’s with friendships or relationships may just be a bit slower than that of others in their same grade.
Natalie Tamburello: I think a lot of people separate the social component of school from the learning component of school, but what I’m hearing you both say is that that social component just kind of becomes expected and maybe an unknown or an unmeasured part of learning that we don’t really notice as people without autism.
Melanie Hsu: Absolutely.
Natalie Tamburello: It’s interesting to think about it that way.
Cassandra Sanchez: Yeah I definitely agree with you, Natalie, and I think that at this age, too, it’s something that maybe isn’t talked about because people, especially, you know, friends and teachers and others in the school environment may take for granted, such as raising your hand and asking to use the restroom. That might feel so simple to one student, but to another, it might bring on some stress around, “How do I form my question? At what moment can I ask it? If I get up, am I going to miss important content?” Right? And so there might just be a lot more stress and energy that goes into simple interactions that we take for granted, many of us who are neurotypical may take for granted, and it’s important to have empathy and patience for those who are having to use up resources to participate in those types of simple requests.
Melanie Hsu: Absolutely. You bring up a really good point that I think a lot of people take a lot of things for granted. So autism as a neurodevelopmental disorder affects your entire neurobiology in many ways. And so things that we can take for granted as a neurotypical individual, for example, sensory types of things, being able to regulate your body as well as your emotions, all of those take energy. And so when you have less of those issues, you have more energy to use on other parts of learning. We always say, especially in early childhood, that learning is best in a place of joy. And a lot of times, if you are more stressed, you’re not going to be able to learn novel concepts, and then when you also start to put that social piece on it that doesn’t come easily, there are more difficulties with regulation, and then you don’t have the energy to do things as easily.
Cassandra Sanchez: Yeah, Dr. Hsu, you’re absolutely right. And I just am thinking about how that sensory experience can be really draining. In middle school and high school, that time between periods in the hallway or in a crowded bathroom can be really noisy, can be busy, might include brushing shoulders with peers as they’re passing through, and that can be really stressful both at a conscious level where, you know, the child might be aware that that’s stressful, but in some cases, kids might feel themselves becoming overwhelmed and not necessarily be able to name it was when, you know, this person brushed into me and then the fluorescence lights were on and the bathroom was crowded and the hallway was noisy. So there’s so many different components to keep in mind. And again to support your child with being able to identify so they know how their body responds and so that they’re prepared with the coping skills to be able to manage as that stress builds during the school day.
Mike Navarrete: CHC’s Voices of Compassion podcast is made possible by the generosity of people like you. To learn more about supporting CHC, go to chconline.org/donate. Also make sure to follow us on social media for more inspiring and educational content from CHC.
Natalie Tamburello: So we’ve talked a lot about autism and socialization and how that impacts learning. So what are some other areas to look out for and be aware of when it comes to challenges?
Melanie Hsu: One thing that we’ve touched on a little bit is executive functioning. So the older we get, the more we are expected to be able to use our executive function. So like Dr. Sanchez was saying earlier, being able to plan, to sequence, to understand consequences, to be able to organize both yourself and your task and your environment. And again, these demands increase the older we get. And so as a neurodevelopmental disorder, executive functioning is often affected in individuals with autism, and so making sure that there are accommodations to support executive functions growing naturally, and meeting the demands of the situation, can be an area to monitor for sure.
Cassandra Sanchez: Another area that I think is important to consider for older children especially is identity development. A lot of times in a neurotypical world, the traits of autism that make somebody unique or that, you know, make them stand apart might be picked on by peers or might stand out even more in a typical school environment. As students are in the age of exploring who they are, which parts of them they identify with, and maybe developing new traits or new hobbies, new interests, it’s important to be supportive of the way that they are starting to understand their own identity as neurodivergent or somebody with autism. I think that there’s a lot more information and awareness out there now, but it is definitely something to have open communication with as much as your child is willing to and able to, because it’s something that is likely to come up in the school environment. So a lot of times giving them space to talk about that in a trusted, safe home space might be helpful for them to be able to explore that identity.
Melanie Hsu: Yeah, and Dr. Sanchez brings up a really good point. We also know that individuals on the autism spectrum have more of a tendency to identify as nonbinary, or to, you know, be more explorative and fluid in gender expression, in sexuality, and so that is a big part of normal, typical development that may look a little different, again, in the way that they’re able to talk about it in finding their peer group when there are also some social difficulties. And so, as we know, again, the more stressors that are happening in an environment in general, the less energy is available for doing hard things like math, for example. So making sure that the child, the individual, is well-rounded and supported in all of these different areas supports academic success as well and helps the child grow into a well-balanced person who understands their strengths and weaknesses.
Natalie Tamburello: We’ve talked about this a little bit at the end of kind of all of your statements where there’s some suggestions around how to be supportive with these challenges, but if we could talk a little bit more explicitly about what students need to be successful in school that would be really great to discuss, especially accommodations or maybe some modifications we can make in the classroom.
Cassandra Sanchez: As Dr. Hsu mentioned, many families start their child off with an IEP or an Individualized Educational Plan to enter into the preschool schooling at age three with a special classroom or with certain therapeutic supports that will really get that early intervention going in the school environment. An IEP usually consists of an evaluation that’s done by a school psychologist, and possibly a speech language pathologist or an occupational therapist, depending on the needs of your child. And it really results in this plan that will help to support the child with their education, from learning to social functioning and behavioral functioning in some cases.
And the IEP can carry through until they need it or until they graduate from it. So that IEP evaluation is refreshed every three years. And there is an opportunity to add more accommodations or more services every year, or also to dial them back if your child has been meeting their goals. So they’re very flexible plans that will help to ensure that your child has the right classroom, the right class size, the right therapies that they can participate in during the school day, and then any extra accommodations they need to be successful.
If a need isn’t quite as high as to warrant an IEP, the school can also offer a 504 plan. A lot of times 504 plans are used for physical health accommodations, like for a child who might need a break to go take medication at the school office. But the 504 plan can also be used for kids who have autism and who might not have as many developmental delays or as many needs as somebody with a full IEP. The 504 plan can, in those cases, provide accommodations like preferential seating, maybe in a quieter part of a classroom, or a reduced homework load that might help if they have executive functioning differences. Or it could even include support with smaller group projects or, you know, some scaffolding until they get up to the same level as other peers in certain areas. So families really have options when it comes to seeking those accommodations and the school would be the guide to evaluate and to help start off that plan or that accommodation that they would need.
Melanie Hsu: I think for me also, I like to think about it in terms of what are we trying to change or what are we trying to support? And so a lot of times, one of the core things, again, as we talked about earlier, is regulation, right, making sure that the child or the individual is in a space where they can be successful. And so accommodations around that can be, again, like Dr. Sanchez said, preferential seating, using noise, canceling headphones, being able to take a test in another environment so that if they have self-regulatory behaviors, they can do them without worrying about either their peers saying things or disturbing other people. Also, making sure that we are addressing again, common things that we also see. So the executive functioning, helping them break down assignments, giving them accommodations for having guided notes. And so the purpose of a lot of these accommodations is to reduce the amount of stress on the individual because it takes so much more energy to be successful than other people.
And so making sure that we’re leveling the playing field and making sure that everything is equitable, so that they have the same access. A lot of times families will ask us, well, what if my child isn’t in a public school–because IEPs and 504s are only in public schools. And we always recommend the same types of accommodations with the same goal of reducing the amount of stress on an individual to get them to a place where they are functioning at an energy level that’s more equivalent to their peers, so they can focus on learning and being successful, as well as the very big part of it, which is also being successful socially.
Cassandra Sanchez: Yeah, I have seen some social accommodations as well. I have heard of some schools that have buddy programs where a child with autism might be linked up with a neurotypical student or another child with autism who has a friend group and who can stay with them during the lunch hour to be able to find some nice activities to do and to make sure that socially and emotionally they have some support. I’ve also seen a lot of accommodations or IEPs, 504 plans, include access to a school counselor, and so that can be on demand visits as needed to get a little bit of extra support to practice some coping skills in a safe space or to discuss maybe a social conflict that occurred that they don’t know how to navigate. It could just be an extra person on campus that they know that they can trust and that they can turn to. And, that a lot of schools are really happy to provide access to.
Melanie Hsu: And something that could be helpful in guiding a plan for accommodations is assessment. So in the public school setting, for example, they will do assessments. Again, at CHC, we do evaluations as well and a lot of times it is for when families want more specific understanding of their child’s strengths and weaknesses, areas that we can support, things that are not as obvious sometimes, they’re more hidden where we can, again, adjust things to make the child as efficient as possible. So an evaluation is a really great place to start to identify strengths and weaknesses.
Natalie Tamburello: What are some strengths that you see in a school environment?
Cassandra Sanchez: A lot of times, kids with autism have very specific interests, and this means that they can really deep dive into some of the themes or topics that they’re really interested in. So sometimes we see kids with autism being extremely advanced in their art skills because they want to practice their drawing or painting, right, all the time. Similarly, you could see a skill in marine biology or in something that’s just unique and special and not just at a superficial level but this really deep analytical understanding of a subject that other students just may not dedicate the same time to or also just may not enjoy quite as much.
Melanie Hsu: Another thing is just seeing the world in a different way, right? We’ve talked before about how different perspectives can be helpful, right, understanding strengths and weaknesses, but when you are neurodivergent, or some people like to say neuro-spicy, you see the world in a very different way, and we as a society are all the richer for that. Being able to see things like what the normal kind of distribution is, for example, in like 50 percent of people would see it this way, there is a creativity in that, in being able to shift that perspective and not feel as constrained by some of the social boundaries, I think sometimes that we adhere to without even thinking. Part of it is also like Dr. Sanchez was saying, those deep interests usually mean that there are strengths in being able to be a mentor to peers about some of these things. So, again, some of these interests can be an area where they can feel very successful in being able to teach someone about it. They have the patience to really go into the nuances of things, cause that’s just an interest of theirs.
Natalie Tamburello: I love your idea of allowing the student with autism who has deep knowledge in a subject to be the master of that subject for another student and giving them that moment of strength and leadership that they might not always get in a school setting. I really like that. I think that’s a really good thing for educators who are listening to take away as an opportunity to look for, to develop maybe social skills and someone with autism who has a lot of strength and a lot of confidence in a particular area.
So that’s kind of my next question is what are some suggestions you have for parents and educators to encourage those strengths and also support what might be challenging?
Melanie Hsu: Something we always talk about in parent conferences is finding the child’s strength and building from there. So again, as I said before, the best place for learning is a place of joy, right? So anything that’s hard, if we can find something in it that there’s buy-in for the child, it’s going to go better. So for example, we talk about, oh, one of your child’s interest is robotics. Let’s find them a robotics club. And again, they could probably be a mentor in a lot of these things because they are really knowledgeable in it, really interested. So trying to find ways of leveraging their strengths to compensate for some of the areas that might be more difficult, like executive functioning weaknesses or social weaknesses.
Cassandra Sanchez: It’s also helpful to support your child through routines and structure. A lot of times kids with autism really thrive in environments where they can predict what the expectations are and the general flow of their schedule, and they might be able to prepare for any change that could be stressful. So just creating calm and organized space, both at home and as much as possible with their school schedule could also provide some support.
Melanie Hsu: I think another thing is also to understand that behaviors don’t happen in a vacuum. So understanding where a behavior is coming from will help us identify how to work with it. So a lot of times parents get frustrated because something is happening, and what can be helpful is taking a step back and saying, why is this behavior happening? What can we do to support the reasons that it’s happening so that we can find an alternative that works better for the family, for the child, for the situation.
Cassandra Sanchez: And lastly, I want to tie this all back to what Dr. Hsu said around communication with the teacher and with the educators that your child is around. It’s so important to collaborate with them. Just keep relaying those strengths, the challenges that you’re seeing at home, and to work with them to support your child. You might be able to learn some of the strategies that help your child in the classroom, apply those to homework time at home, or similarly, you might be able to share with the teacher about what you’re doing and what you know about your child to make sure that their school environment is also consistent, and supporting your child in the way that they best respond to. So, just keeping open communication with teachers and trying to relay that information to the team, if you are working with other therapists or other providers, could be really helpful.
Natalie Tamburello: So as you’re reflecting on this conversation and everything we’ve discussed, I’m wondering if there’s any final thoughts you have for our listeners to walk away with any tips or things to try.
Cassandra Sanchez, : I think that one of the things I really want parents to hear and feel is that you’re not alone. Schools are really eager to support. There are many clinics such as CHC and others in the community that have providers that can be allies as you advocate for services within the school or within the community. So just remembering that you can access a whole team of other parents who may be experiencing similar challenges, support groups, professionals, teachers, educators, school staff. There are always people to turn to to ask questions or to get support or to support you in this journey. It’s a lot of work for a parent to take this on, and we always say that it takes a village to support a child. So just remembering that you have many people eager to hop on board and be part of that village.
Melanie Hsu: I think another thing for me is also just that knowledge is power, right? So the more we know about an individual, the more we know about their strengths and weaknesses, the more we can support them to be successful–whatever successful means–that could be variable, right? So what parents say is success versus what the child views as success. We are mainly trying to remove barriers so that individuals can be as successful as possible, and that might look very different, but as Dr. Sanchez was saying, there are many, many supports to help along that journey, to be able to help understand strengths and weaknesses, and also to support the individual, again, to meet their own goals for what they determine is successful.
Natalie Tamburello: It’s always about meeting a child where they’re at. So understanding what a child’s capable of, it doesn’t necessarily mean we’re putting limits on a child, but we also want to make sure that scaffolding happens. So making sure that we understand where the child is so that we can support them to continue to stretch, but not putting our needs and our wants and expectations on the child to move at our pace. It’s always about supporting the child in being the best that they can be, whatever that means.
Well, thank you both for joining and sharing your perspectives. As a reminder to our listeners, CHC is here to support you. We have many free resources in addition to these podcast episodes, including our resource library, our parent support groups and we also have collaboratives for school counselors and learning specialists. These are all free resources. You can also visit chconline.org. org/autism to learn more about our specific services for autism. If you have any additional needs or support questions, you can always just go to our website or talk to our care team. Thank you both so much.
Melanie Hsu: Thank you.
Cassandra Sanchez: Thank you.
Cindy Lopez: Visit us online at podcasts.chconline.org. Make sure to subscribe to Voices of Compassion so you never miss an episode, and we’d love it if you’d leave us a rating and review. Have a question? Send us an email or a voice memo at podcasts@chconline.org. We’re here for you when you need us.
