Autism: Making the Transition to College, feat. Chris Keary, MD

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Posted in: Multimedia, Podcast, Teenagers, Young Adults

Topics: Autism Spectrum, College Mental Health, Learning + Attention Issues

Starting college for the first time can be a big deal for all kids, but for those with Autism Spectrum Disorder there’s even more to consider for making it a smooth transition. As parents, how do we provide the best support? How involved should we be?

Special guest Dr. Christopher Keary of the MGH Lurie Center for Autism joins Gene and Khadijah with helpful advice and answers to these questions and more. Be sure to tune in.

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Episode Transcript


Gene Beresin, MD, MA; Khadijah Booth Watkins, MD, MPH; Chris Keary, MD.


Chris Keary, MD  00:00

I think that there’s also a whole big conversation to have around What does it mean to live in a world where there’s this much autism that’s diagnosed, it really forces us to change what we think about as being orphans and a disability and how we design a neurotypical world and kind of supports the need to be successful.


Gene  00:28

Welcome back to shrinking it down mental health made simple. I am Gene Beresin.

Khadijah  00:33

And I’m Khadijah Booth Watkins.

Gene  00:35

We’re to Child and Adolescent Psychiatrists at the center for young healthy minds at the Massachusetts General Hospital. And today, we’re going to talk about going to college.

Khadijah  00:47

So May 1 was the US was the national college decision day. And so if you have a young person in your life, they had to make a commitment by now as to where they’re going to go in the fall. And this can be an incredibly stressful time for some kids and credibly exciting time. But needless to say, it’s fraught with lots of emotion.

Gene  01:06

And I must say before we before we start about the kids, I just want to acknowledge all the parents who are listening that while it’s an exciting time for you, it’s also extraordinarily anxious, and invariably, it’s a loss, because your kids are like, not at home. But we can we could do that on another podcast today, we’re gonna focus on today. Well, today, we’ll focus I do get, I do get a little wave sometimes. Because I’ve said for kids to college, and I keep feeling a loss. But today, we’re going to talk about making this transition. But we’re gonna take a slightly different focus. We’re not just going to talk about all kids, we’re going to talk about certain young people with autistic, autism spectrum disorder and making a successful transition. And we have a special guest, Dr. Chris Keary, who’s joining the conversation. Chris is a child and adolescent and adult psychiatrist who specializes in care for individuals with developmental disabilities, including Autistic Spectrum Disorder, or what we’ll call ASD. And among the other roles he plays, he’s a psychiatrist at the Lurie Center for Autism. He’s Assistant Program Director for the multidisciplinary kit clinic for children, adolescents and adults with Autistic Spectrum Disorder. In addition to his clinical work, Dr. Currie teaches medical students, residents and fellows at Harvard Medical School, and has been involved in developing guidelines for the evaluation and treatment of mental illness in autism spectrum disorder. So Chris, did I get that right?

Chris Keary, MD  02:42

Yes that sounds great. I am really pleased to be here today. Gene Khadijah thank you both so much for having me.

Gene  02:50

Well, and by the way, Chris began a fellowship. Is it just is it just an ASD? Or is it in all

Chris Keary, MD  03:00

Just ASD it’s one of the first out there when we first started it, providing extra training for psychiatrists, child adolescent psychiatrist who want to further improve the quality of the treatment for the patients that have autism kids, teens and adults who have autism. So that’s been a really gratifying thing.

Gene  03:19

So first, can you remind us all of what Autistic Spectrum Disorder is, as a diagnosis says it’s on a spectrum, but what does that mean? And what does it look like, especially with our older kids, who are going off to college,

Chris Keary, MD  03:36

I think about autism spectrum disorder as being a kind of a behavioral profile constellation of different behaviors that can come together characterized largely by challenges in social functioning, or differences in social functioning around using reciprocity, within relationships are picking up on and using nonverbal communication, these important aspects of communication, which are not verbal, recognizing it and others and, and using it themselves. In addition to some of these social differences and functioning, there are these other grab bag of different behavioral features that can kind of come along with it a need for or a preference for sameness in routine, strong interests in which can be kind of a double edged sword a situation strong interests can also lead to deep expertise. But it can also lead to challenges and distractions from more practical concerns, some sensory sensitivities or hypo sensitivities, and then for some individuals ritualized or repetitive behaviors, but it’s like you said, Gene, it’s there’s a spectrum right of severity. And there’s been huge changes over the past 20 years and what we understand of as being Autism Spectrum Disorder from to include much more people who don’t have intellectual disability as part of their autism, which is a lot of what we’re going to talk about today, people All who have autism, and who could, you’re more than equal intellectually to what college has to throw at them, but struggle in other ways to do well in college, and in thinking about how to support them.

Khadijah  05:13

So let’s just get right into it. This is college and transitioning to college is huge for most kids and families. And it’s particularly or can be particularly challenging for kids with ASD. And so as parents, how do we know how to best support them? You know, how evolved, we get there’s so much to coordinate, you know, with respect to academic accommodation, their personal needs, roommate situations, how do we help them navigate that we talked about some of the personal things that challenges that might get in the way? Their mental health services? Do we just leave it all to them to negotiate and coordinate? Or do we kind of jump in?

Chris Keary, MD  05:48

There’s a lot to think about, I think, understanding where people are going to need supports, it should be a really individualized kind of question. Because there is such a range in terms of the challenges that people with autism spectrum disorder, may struggle with, from major challenges and major supports to people who don’t need a whole lot of supports, maybe just need some understanding. I think it’s across the range, but it should start with so bride, let’s get real kind of moment of what supports you’re currently putting in place for somebody with with autism spectrum disorder. And we may use the the older term for Asperger’s here as well. And what kind of supports is the school currently providing what kind of supports are parents themselves providing maybe without even realizing that they’re providing because they’re so used to providing these supports, and what kind of supports exist outside of the school and I think about three particular domains to kind of think about to like, have that assessment around.

One domain is academic, how people are functioning academically, how much support they’re getting, these might be all the accommodations that are currently being provided in school, tutors, things like that. What sort of supports are on IEP or the Individualized Educational Plan? That’s all what we might put a think about as academics. Then we’ve got social functioning. That’s another important domain to think about. How much support does someone need and making friends? How much support does someone need in interacting with professors, teachers, peers, in discussion groups? How do they do socially? How do we anticipate them to do socially with a roommate, thinking about that sort of domain as well as important sort of domain number two. And the third domain I think about as being sort of self care skills? How people are going to do with living away from home around things like taking care of themselves with their room, laundry, that sort of self care skills? You know, how much is somebody following up on that? If they have medical issues? Are they taking their medicines? You know, how much are they attending to? I have one kid I work with called adulting, which I thought was like, perfect, like this, the skills of adulthood adulting. You know, the reality is, most people in their early 20s, are still working at adulting. Some of us may still be in our 40s working on it. But everybody’s different. And for some people with autism, they can be extremely bright, knock it out of the park with school, but when it comes to adulting, needs some areas of support. So, so a kind of a sobering assessment in those three areas starting around 15 or 16 years old, can give you a good sense of where people are likely to need support.

Khadijah  08:39

So how do we as the parents help them to get the supports in place, either to the school community or we ourselves as parents society continue? Do we let them tell us what they need or what they want? Like? How do we go about making sure they have what they need in place without being overbearing, and allowing them to adult a little bit? As much as they can?

Chris Keary, MD  09:00

Yeah, well, I love how you’re starting this conversation of how how much parents need to lean in versus how much they start to just take a step back, because for a lot of reasons that we’re gonna get into here. transitionally we’ll use the term kids but really, we’re talking about adults here transitional age adults need to start to take on the being the heads of their accommodations and supports when it comes to school and starting to self monitor with how they do with those things. And so there’s got to be a sort of a change in philosophy over the two three years leading up to college of starting to give transitional age adults and teenagers, some chance rooms to make mistakes, some rooms to start to step into that responsibility to see how they do how they rise to the occasion and that It gives, I think parents some guidance around how much they need to lean in. Because of course, once we get to college, we’re at a whole different world where the expectation is that transitional age adults, the individual with autism is advocating starting to advocate for themselves and seek out these supports on their own. In fact, it’s such an important step to take, that all encourage the families I work with, to make that a goal on the IEP make that a goal in terms of sort of self advocacy, or starting to speak up for themselves in terms of what accommodations are help and which don’t. And have that be that taking on increased voice for yourself being a separate goal to work for an IEP?

Gene  10:46

Or just following up on that, Chris, you know, in some ways, it’s easier for parents because their kids are at home. Many colleges, as you know, once the kid has turned 18 parents are and I don’t, I don’t agree with this. But they they’re not allowed to get involved. They don’t they’re not allowed to be involved with their academics, they’re not allowed to do any coaching. They’re not allowed to kind of, you know, they don’t get the grades. And so and so, you know, I think the times may be shifting a little bit, but in many schools, parents are persona non grata. I mean, they’re, they’re not, it’s not as though that schools are, you know, being nasty to them. They’re just saying, when you’re over 18, you’re an adult, and we want to value autonomy, and independence, which is certainly fine. But how do parents find out what they are going to be allowed to or not be allowed to do, and maybe set up a structure or help set up a structure at school, so that the kids, because I can’t imagine an Asperger’s kid advocating for him or herself themselves?

Chris Keary, MD  12:02

It really, really depends on the person. But I think you’re right, that this is a this is an area of challenge for a lot of people with autism spectrum disorder, Asperger’s diagnosis, it’s, you know, all of a sudden, you are the one fighting for these kinds of supports. And in a world that’s very different from the high school world, where there is all this accountability around ensuring that kids are meeting the goals of an IEP, where the college world is much more oriented around, okay, we’re going to provide accommodations that allow you to access college, but there’s much less of a we’re expecting success kind of thing. So, um, so yeah, I think, you know, how can parents remain involved is a really good question here that you both are bringing up. And I think a lot of that is around developing a good collaborative system, a good collaborative alliance with the kid and transitional age adults, with with autism with Asperger’s Syndrome, that we’re going to have a good system where we kind of check up on how we’re doing with us, and we’re gonna collaborate together. And how well, kids or teenagers or traditionally as adults collaborate with their parents on this issue start to become a really important factor on how well people do going into college.

Khadijah  13:25

I think, um, that same thing a lot of our kids come from, you know, they might come from general high school, but a lot of them also come from very specialized private schools, where they have a family of accommodation that supports and so transitioning to colleges can be really challenging in terms of, to your point gene, with parents not really being included. And so how do you help them monitor and become aware of what’s working and what’s not? But also, how do you know, what you’re looking for in terms of what a school has to offer that make, to some degree match what they will have what they have for that allow them to be successful? No one that is not going to be exact, but, you know, we don’t want to go from full service, all hands on deck to give up, you know, with this college… experiment?

Chris Keary, MD  14:10

Yes, yeah, definitely. I, I think, you know, we’re one of the themes that we’re starting to talk about here is assessing where individuals are going to need help and starting that process, ideally, in a perfect world, you starting that process around 15, 16. You’re talking about that in the IEP meetings have, you know, we want to make self advocacy a goal, we’re thinking about preparing for college here, we want college readiness to be on the goal. And parents can request a transitional assessment as part of their IEP and I encourage families to do that starting around the age of 14, 15, 16. To help provide an assessment from the high school standpoint, what kind of skills someone needs and then also you can ask, you can get transitional assessments outside In high school, there are sort of like private organizations that are sort of college readiness organizations where they will do their own sort of transitional assessments, you know, and what kind of challenges in those three domains I told you about, you know, what are some areas. So, asking for these transitional assessments, so that we’re all on the same page with knowing where people are going to need help, you know, early on 15, 16, 17 years, 17 is really key. And making self advocacy a goal.

And then being aware of, there are a variety of different areas where the person can get support. There’s areas of support that come from the college itself. There are areas of support that come from sort of private pay organizations. And then there are areas of support that can come from services that are paid for by the Department of Developmental Services, DDS. If I get the sense that someone is likely going to need a lot of supports to be successful in college, I’ll oftentimes try to advocate for a young adult to connect with the Department of Developmental Services, because they’ll pay for a lot of the supports that we’re going to talk about here in just a moment. But let’s start with talking a little bit about some of the supports that the college can provide. Now, all colleges will have a sort of disabilities Resource Center or the other name for that maybe school support office, wherever the name for the school is meeting with them beforehand, as part of the college sort of visit. If you’re interested in that school, and really serious about that school is a really key and helpful thing, because college is different in terms of what kind of supports they’re willing to provide. So a meeting with the college disabilities Support Center, to say, look, you know, we’re getting these kinds of supports in high school, the text extra time for tests has been great. The note taker has been great. Is there anything along those lines that is, is provided at your school, that conversation can open a lot in terms of knowing whether this is a good college fit, but that can be a really key part of the college visit? You know, you’re going to get to visit the school, you’re going to take a look at it. Let’s also schedule a meeting with the school disability office. We might be interested in whether the what the school’s mental health resources are, do they have therapists that are present on campus? And do they have students who are seeing the therapists on a weekly basis, we might be also curious about sort of special interest groups at the school, like getting socially isolated can be a really common situation. So do they have clubs, activities, groups that are in a particular person’s area of interest, if they love Pokemon, and Pokemon club or things like that, those things can really make a big difference in not getting socially isolated.

And then, when I think about the services that Department of Developmental Services provides, or will pay for, there’s a service out there called a college navigator, the college Navigator is kind of like a fixer, for challenges functioning in college. So they might help academically, with like meeting and planning out your schedule your study schedule, they might help with liaison between the individual with autism and professors who might be kind of rigid in and of themselves, they may, they can be sort of someone in your corner for a lot of people with autism as they’re going off to college. And there’s individual coaches can also be something paid for by the Department of Developmental Services. And that can be another major support to think about. And then I think about services that are outside DDS, outside of the school, this might be a child’s individual therapist or psychiatrist that they meet with parents who might pursue coaches outside of the school by you know, paying for that privately there are these transitional programs that can be kind of expensive, where you’re sort of signing up for a particular set of series of coaching, that might even continue to work with a child and their first year of college. So that’s going to be a really helpful support as well. I hope I haven’t chalk talk to you’re off on this particular subject. But those are some, like resources that can be really helpful and kind of domains to think about. But it all starts with a transitional assessment as a teenager.

Khadijah  19:28

Really, you know, we all think that the schools are so many of us think that the school’s ability to provide stops when they are in high school. So I think it would be really helpful for parents to know that there are other resources, but it’s also challenging or barrier is the cost to some of these things in getting your kids.

Chis Keary, MD  19:49

Right, Absolutely and that’s where I often think about you know, it’s a small percentage of my patients that are able to pay for like a transitional program where you’re staying overnight and you’re learning to do laundry and live with them. Roommate and, and you know those, those can be really expensive processes. But working with a coach who you’re meeting with on a once a week basis and then having a college navigator, those might be services paid for by the Department of Developmental Services. In Massachusetts, there’s an organization called Massachusetts rehabilitation commission MRC, which actually works with kids, people don’t realize that it works with, they work with teenagers, and they work with transitional aged adults. And they also do coaching or think about people’s readiness for college. So these are all resources that don’t, you know, that could be paid for by, you know, other sources and help decrease the cost related to these things. So these are all, you know, you have to be independently wealthy to get these supports.

Gene  20:41

Let me let me just clarify a few legal issues or I should say, you know, issues that parents can rely on. So in you mentioned IEP a few times as individual educational plan. Yeah. And that’s and that, and that is under the individual Disabilities Education Act, which federally mandates that public schools provide accommodations for academic, social behavioral needs of kids. Does the DDS have the equivalent of a mandate for colleges or college age students? Is this federally mandated? So if so, if the school says, Oh, we don’t do that, then the parents can say, Well, wait a second, just like they say in high schools, and they have to advocate for their kid what’s mandated federally so that the parents can actually rely on that?

Chris Keary, MD  21:31

Yeah, it’s much, it’s much less specific changes, like you’re saying, so the laws that protect and support kids with a disability of some kind, you’re right under IDE, A, and the legal backing that supports young adults in going off to college is based on the Americans with Disabilities Act, and there’s a much more broad legal standard, that oriented around really just there needs to be supports that allows people to access college, it’s not about success. It’s about access. So we think about the IEP, you know, you set goals, and we’re going to make the goal specific, here’s what we’re going for. And our expectation is success. And if it’s not working, we’re going to change it. That’s different in college, and college is about access, being able to access the curriculum, it’s not necessarily about success. So as you can see, there’s less of a legal grounding to be based on but you bring it back to, these are accommodations that are required in order to be able to access college and you’re on more secure footing college. You know, with an IEP, you can make modifications to the curriculum, in order to be successful. You don’t have legal basis for modifications in the curriculum of a college course, you know what I mean? It’s going to be the same expectations for all students, you know, we’re going to provide accommodations to allow students to access it, we can’t change the curriculum itself.

But one exception to this is Massachusetts is one of the first in the nation to have funding put aside to have colleges develop a program for people with intellectual disability to go to college. This is these are new laws that have come out and for those kids or transitional age adult that are under that particular those particular rules, the Massachusetts initiative of concurrent enrollment in sorry, Massachusetts inclusion inclusive Concurrent Enrollment Initiative. Kids with intellectual disability can participate in some college, they’re essentially still under their IEP.

But for kids who don’t have an intellectual disability diagnosis, it really comes down to accommodations to allow people to access. And so for many kids I work with who are young adults I work with have autism, they may have some accommodations around extended times for tests, or they might have some accommodations for people helping with notes. But a lot of it is incumbent upon them to attend the professor’s college professors open office hours, and recognize if they’re falling behind. Notice if that’s happening, and seek out help. Again, this gets back to self advocacy. And so it’s really we kind of mentioned this before, it’s really important for transitional age youth to have a good working connection with their parents to identify when things are falling behind. Another person to recognize if someone is falling behind would be like a once a week, or once every two weeks meeting with the school disability office, to look at planning out of academics and going over how someone is doing because you want to catch that student before they get so far behind that now they’re not attending class anymore because it’s like a snowball That’s like going down the hill and you can’t stop it anymore. So you want to catch it early. So putting sort of in place, people that the student is going to connect with on a once a week or once every two week basis. is to see how they’re doing catches up before the snowball gets too big.

Gene  25:03

Does the DDS provide legal advocacy? Mr. Sometimes, I mean, even in high schools that are mandated under the Individuals with Disabilities Education Act, it’s sometimes turns into an argument, or at worst a battle to get services. And although we don’t want to see adversarial things happening, sometimes a disabilities attorney, or legal advocate can be a great ally. What’s the availability of that for parents that just don’t really know or understand the system?

Chris Keary, MD  25:41

I think a resource I’ll oftentimes direct families to will be the Autism Resource Central. This is a Massachusetts specific support. So I’m not sure other states might have an equivalent sort of organization that helps connect parents with learning more about what can be covered and not covered. And they will, they may provide parents information about educational advocates. And as I understand that, there may be some supports out there to help families where there’s a financial concern around that. So it’s a wonderful resource that exists in Massachusetts, the Autism Resource Central, and can be a good place to, to consider. And you’re right, it can get adversarial. It’s challenging because the college will treat the students as being the director of all of their supports and services. So in a population that can be taken advantage of more easily, that can be more socially naive, we want to make sure that they’re backed up enough. So I really like to think about starting college with routine check ins with, with, with other people, with family, with a therapist with maybe an outside coach or tutor to recognize, oh, things are going south, let’s get the cavalry together here sooner rather than later.

Khadijah  27:00

Yeah, you know, I think that’s so important for so many kids going to college to be able to have that open line of communication so that you do catch things before the bottom falls out. And we also are still dealing with so much stigma. Is there do you do you? Do you ever have concerns about patients disclosing that they have ASD like we’re talking about? How do we get accommodations and things put in place for them? But do you ever say I’m against challenges with patients either wanting to disclose or not wanting to disclose that they might have ASD to their school, their teachers, their peers? How do we help them navigate it? Because even you know, clinically, I often find myself having to talk about it as a constellation of symptoms, or better how you put it a constellation of features so that families can understand why the label exists so that we kind of can use similar language and kind of have an idea of what we’re speaking about. But how do we help them navigate disclosure?

Chris Keary, MD  27:55

Yeah, there are a lot of different aspects to disclosure who did is close to disclosing to school administration versus individual teachers versus peers and friends at school. As part of your transitional assessment, ideally, families get a sense of what kind of supports may be needed academically, socially. And if there’s a sense of there being significant supports, it’s important to remember that in order to get that support, sort of get a more understanding approach from school disclosure is kind of a key step in that in order to be protected under American Disabilities Act, to try and advocate for some of these accommodations. There needs to be a disclosure step of letting people know that we’re gonna call this a disability that a disability exists. So if they’re, I certainly have some patients who aren’t doing so well in high school without a lot of supports. And then it’s a more open question, really, there may not be that many supports needed in college, maybe we do or don’t need to disclose. But if we are going to be trying to push the school to get some additional accommodation, some supports to try and be understanding if there’s a social conflict with a professor or appear in school, then disclosure is a part of that.

A key aspect of talking about disclosure is also making sure that we’ve been really open with and worked with people with autism themselves to talk about the diagnosis sometimes see people where the parents have been reluctant, perhaps in talking about the diagnosis too much because they’re afraid that they’re afraid of stigmatizing their loved one or that you know, if we use too much of a label, people are going to worry that we don’t see all their positive qualities for instance, and having a conversation about autism and not the you know, that they’re, you know, this is not all negative and pathology that involves seeing the world in a different way that people with autism have a lot of things to contribute in terms of being successful and how different perspectives can can be a thing thing of value, I think it’s an important decision to have to help have an open conversation about autism spectrum disorder diagnosis with somebody who has autism diagnosis, and then be able to get into some of the details around the areas that may be a challenge for you socially, being reciprocal, and relationships. What are the some of the challenges that may be around anxiety? Are some of the challenges around needing some academic supports? Because we want there to be insight that’s built over time for the person with autism themselves to say, oh, yeah, you know, I’m working on organization. You know, if it comes to this particular subject, I can knock it out of the park, but I fall behind in academics because of organization. That’s something I’m working on. And so that’s a key step along disclosure, we’re disclosing not just the diagnosis, we’re disclosing, and I need help when it comes to organization, or and I need help with what I could do any sort of math and science question you ever ask about me, but languages, that’s tough for me. So these kinds of it starts, I think disclosure, another part of disclosure is making sure we’re being open and in developing insight with a person with autism themselves, which has to who has to know about these challenges, and it empowers them to advocate.

Gene  31:09

There’s a couple of… I love this idea of advocacy, because it also dovetails with a strength based approach, you know, savants, that have tremendous skills, and some of these. So I think, in some ways, some of the kids that I’ve worked with who’ve been successful, have been able to kind of offset stigma, by showcasing your strengths. That’s just a comment. But I don’t know if you think that’s a wise thing to do. And the second part of the question is, how often is is, is ASD associated with other psychiatric disorders that make complicated issues? And what do we do about that? Because a lot of parents ask about that.

Chris Keary, MD  31:55

Yeah, I think, um, savant abilities is, an interesting subject in the world of autism, because, you know, it’s, it sometimes can be a stereotype associated with autism, I’ve certainly met some people with autism who have extraordinary abilities in certain areas. And, oh, there’s also a stereotype around it being maths and science based. And you know, the reality is I’ve met as many people with autism who are whizzes when it came to English and an incredibly creative when it comes to stories and everything like that. And they sometimes say, I want as soon as I’m math and science person, I hate math and science. So, you know, we, we careful a little bit with our, with that with the sense of what our stereotypes might be, and understanding that each person is different. But I think what you’re bringing up is important, because for some people with autism, they struggle with, they may have one academic area where they are remarkable, and they have a lot to contribute to the world, probably in that academic area. But we think of college we think of broad we think of we’re going to give somebody a broad education. That’s nice. And that’s important. And that’s a good goal in college, but it may make it hard for people with autism who have a lot to contribute in one area, really struggle in, in other areas. So I’d like to see that as a as a direction that, you know, allowing people with college who are you’re really good in one area to still be in college, you know, that maybe that would create a more conclusive college experience. The second part of your question, I forgot you what was the second part again,

Gene  33:31

I, a lot of parents that I work with, have kids with, with ASD of one kind or another, and they have associated psychiatric disorders, such as depression, anxiety, anxiety is a huge one. But I mean, what do you see as being as being other psychiatric issues that that it should be addressed?

Chris Keary, MD  33:53

Thank you, Gene. Um, one of the common ones that gets missed is ADHD. And sort of, in that kind of same area, challenges with executive function, planning and organization. I think as we’re understanding, you know, in the same ways that we’re understanding that, you know, autism without intellectual disability as exists existed for a while we’ve missed it. We’re also learning about ADHD in adults is something that’s important that we don’t want to miss. It’s a really common comorbid issue  if you want to use that term comorbid, or co-occurring issue and autism that that we don’t want to miss because it can allow people to be a lot more successful in college. There are some ways in which some of the features of autism itself can sometimes get in the way of being successful in college for instance, strong interests can lead to deep expertise, but it can also lead to getting distracted from this might be the child that that could tell you all the different stages of the Saturn five rocket but fails physics one to one because they’re reading about the Saturn five rocket. You know, so, just being aware that you know, we’ve got a balanced practicality with some areas of interest.

And then Depression, depression is a really common challenge for a lot of people with autism, because they may have the academic abilities all in the world to be super successful in college, but struggle in many areas in their life. And that’s, I think that’s hard for a lot of autistic people, you know, and also to live in a world that’s very much designed for a neurotypical person, like the example of a broad college experience is a good example of that, you know, and, and struggling with being able to do jobs, but not being able to, you know, be hired. So, depression is a common challenge. And something to think about.

Social Anxiety is another one I’d put up there as a common one. Everybody with autism is different in terms of how much social interaction they need. There’s a stereotype out there that people with autism don’t need much social interaction, some people really do. But we should also similarly not apply our sense of what adequately social is, and for somebody to be that same level of social. So for people who want social relationships, where that’s important to them, and they want deep relationships, they can get isolated in college, and they can get social anxiety can be a part of that, and lead to that isolation, and then lead to depression. So those are some of the most common, I guess, we could say, co occurring mental health issues that I can see being a wrench in the works for college.

Khadijah  36:23

This is really helpful, I think, we’ve covered so much. And again, I think college is just such a emotional experience for so many kids and families. But really, you know, with this population, this group really, really the challenge of trying to find the right environment as they transition from, you know, a place where they’ve had a lot of support can can be really daunting, and how to pick a school. And so this was really helpful in terms of giving some guidance, are there things that we didn’t talk about that you think is really important for us to spend a little bit of time on before we end?

Chris Keary, MD  36:55

Just the last thing I would mention is that there are so many ways to do college. We think in our mind, you know, college, we think going off, you’re gonna you’re leaving the home, you’re packing the bags, you’re going off to college, or staying in the dorms, you’re there for four years, and you come back. This is not how everybody does college. And some people do college part time, some people do college, or you know, they start with an associate’s degree, and then move to college. If that goes, well, some people are working part time and taking some classes, there are many different ways to do college, and we shouldn’t try to shoehorn our sense of, you know, the the way to do college for everybody, because that’s not the best way for it. And that can be a really nice way to start the college experience, if we’re a little uncertain about how it’s gonna go, we’re gonna stay at home, we’re going to take a couple classes, and we’re going to work part time, and we’re gonna see how you like it. And that’s a really nice place safe place to start. And then and then getting a sense of what people like, and you know, what I think I am ready for, you know, staying in the dorms, let’s let’s take that on, let’s start with, I’ll have my own room, then I’ll take on a roommate, you can kind of graduate to increasing levels of independence as you go. And, and that can setting somebody up for success can sometimes be starting with that.

Maybe I’ll just also say one other thought, which is that there can sometimes be, I think, for parents here, where you’ve got this really remarkable child who’s academically very capable and cares about doing a good job, and they seem for all the world, like they are going to the college is going to seem interesting for them, and then they struggle. And I think that that can bring up a lot of feelings of, you know, this is harder than I thought it would be considering what an academically capable person this is. And so opening up for the possibility that there may be some grieving, there may be some sadness, there may be some surprise at there being challenges. And, and just being open to those those feelings coming up as a parent, because, you know, you can have someone who’s academically very capable and still still struggling in some other areas.

Khadijah  39:01

This is like so kind of obvious, but we also need to hear it because there are so many different ways, especially in this day and age, we can do college and it is so important for us to also, you know, manage our expectations and make room and be flexible. We have to pivot or change along the process. And that’s and that’s okay, so it almost is like, you know, we need to hear it so that we have permission to do these things.

Chris Keary, MD  39:23

Yeah, absolutely.

Gene  39:25

I might have we should probably think of that for people without ASD.

Khadijah  39:30


Chris Keary, MD  39:31


Gene  39:32

A lot of kids need different kinds of transitions. They need to work maybe for a year or two or take a gap year. I mean, we need to be more flexible. I think we overall were, are this is just my own comment. We’re just to geared towards, you know, doing it one way one size fits all. Well, thanks, everyone for tuning in. We’ll see you back here on the third Thursday of next month. If you liked what you heard, please send us a review And we hope that our conversation will help you have yours. I’m Gene Beresin.

Khadijah  40:06

And I’m Khadijah Booth Watkins, thank you so much. Until next time.


Gene  40:22

Uh, Chris, what’s the thing you’re looking forward to this week? Oh,

Chris Keary, MD  40:27

Oh, I am planning to see the Super Mario Brothers movie with my kids. Super Mario is big in our house. The kids like it too. And we’re all excited to see the movie.

Gene  40:41


Chris Keary, MD  40:42

Maybe it’s just me that’s excited. I don’t know it hard to tell.

Gene  40:44

Well you know, I don’t play video games….


Music by Gene Beresin
Episode produced by Sara Rattigan

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Gene Beresin

Gene Beresin, Executive Director

Gene Beresin, MD, MA is executive director of The MGH Clay Center for Young Healthy Minds, and a staff child and adolescent psychiatrist at Massachusetts General Hospital. He is also...

To learn more about Gene, or to contact him directly, please see Our Team.

Khadijah Booth Watkins

Khadijah Booth Watkins, Associate Director

Khadijah Booth Watkins, MD, MPH, is associate director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital (MGH), and the Associate Director of the Child and...

To learn more about Khadijah, or to contact her directly, please see Our Team.

Christopher Keary, MD

Christopher Keary, MD

Dr. Keary is a child, adolescent and adult psychiatrist with a specific interest in the care for individuals with developmental disabilities including Autism Spectrum Disorder, Williams Syndrome and Angelman Syndrome. His educational work and researc...

To read full bio click here.