Work and well-being: Vocational activity trajectories in young adults with autism spectrum disorder

Resilience in the face of neurodivergence: A scoping review of resilience and factors promoting positive outcomes

Neurodivergent individuals, including a range of conditions impacting neurological function, are at an increased likelihood of poor life outcomes, such as in functional adaptation, mental health, and well-being. Yet, many live meaningful and fulfilling lives. Resilience may provide some explanation for the heterogeneity in outcomes observed in neurodivergent populations. We conducted a scoping review embedded in a neurodiversity-affirmative approach to provide an understanding of resilience in neurodivergent populations. A total of 176 articles were included in this review and were synthesized using a two-phased process. First, findings were synthesized narratively to examine how resilience has been conceptualized and explored in neurodivergent populations. Second, to identify the bio-psycho-social factors important for resilience in neurodivergent individuals, we converted concepts identified in articles to the nomenclature of the World Health Organizations' International Classification of Functioning, Disability and Health (ICF) using a standardized linking process. We find considerable variability in how resilience is conceptualized and measured in neurodivergent populations. We identified 83 unique ICF categories representing resilience factors, of which only 20 appeared in more than 5% of the articles. Identified ICF categories highlight the importance of support systems such as families and friends, community participation and acceptance, and individual capabilities for resilience.

What is the Meaning of Paid Employment for Well-Being? A Focus Group Study on Differences and Similarities Between Autistic Adults With and Without Employment

PURPOSE

The aim of the present study was to explore the meaning of work for the subjective well-being of autistic adults with and without paid (competitive) employment and to evaluate the differences and similarities between these groups.

METHODS

Eight focus groups were conducted, including a total of 64 autistic adults. Four groups entailed participants with current paid employment (including part-time) and four groups entailed participants without paid employment. All discussions were audiotaped and transcribed verbatim to enable inductive thematic content analysis. Data were analyzed using ATLAS.ti 9.

RESULTS

Generally, both groups viewed paid employment as very important for well-being, albeit for different reasons. Three themes were found: (1) Not having paid employment was associated with lacking societal recognition, and subsequent low self-esteem, which was a dominant theme in those without work; (2) Work can seriously damage (mental) health and well-being, found in both groups; and (3) Paid employment provides many benefits for well-being, with subthemes: 'purpose,' 'social contacts,' 'growth and use of talents,' 'structure and calmness,' and 'income and freedom', which was a dominant theme in those with paid employment.

CONCLUSIONS

Both groups found paid employment highly important for their well-being, albeit for different reasons. However, both also agreed that paid employment can be very harmful to (mental) health and well-being. Suitable, well-supported jobs are important for well-being, may help to buffer stress in other life areas, and may even prevent autistic burnout. More studies are needed on how healthy jobs can be created where autistic individuals get positive energy and experience high well-being. This will also help to reduce socio-economic inequality.

Effectiveness of a Stigma Awareness Intervention on Reemployment of People with Mental Health Issues/Mental Illness: A Cluster Randomised Controlled Trial

PURPOSE

A barrier for reemployment of people with mental health issues/mental illness (MHI) is workplace stigma and discrimination. In this RCT the effectiveness of a stigma-awareness intervention addressing finding work, retaining work and decisional stress were evaluated.

METHODS

A cluster RCT was conducted in 8 Dutch municipal practices. Randomisation took place at practice level. Participants were unemployed people with MHI, receiving social benefits. The intervention consisted of a decision aid for workplace disclosure for participants and a 2 × 3 h stigma-awareness training for their employment specialists. Primary outcomes were measured at baseline, 3-, 6- and 12-months. Multilevel analyses, containing random intercepts of participants nested in organizations, were conducted to analyse the effects of the intervention.

RESULTS

Participants (N = 153) were randomized to an experimental (n = 76) or control group (n = 77). At six months, significantly more participants of the experimental group (51%) had found work compared to the control group (26%). At twelve months, significantly more participants of the experimental group (49%) had retained work compared to the control group (23%). Intention-to-treat analyses showed that randomization to the experimental group was associated with finding (OR(95%CI) = 7.78(1.33-45.53), p = 0.02) and retaining (OR(95%CI) = 12.15(2.81-52.63), p < 0.01) work more often at twelve months. Analyses showed that the experimental and control group did not differ in decisional stress.

CONCLUSIONS

Our stigma awareness intervention was effective for finding and retaining work. As the percentage of people who found and retained work almost doubled, this suggests that on a societal level, a vast number of unemployed people could be reemployed with a relatively simple intervention.

TRIAL REGISTRATION

The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

Trajectories of Competitive Employment of Autistic Adults through Late Midlife

Autistic adults experience challenges in maintaining employment; however, little is known about patterns of competitive employment through late midlife. This longitudinal study examined the change in hours of competitive employment for a cohort of autistic adults over a 22-year period. The study's aims were to provide a fine-grained analysis of competitive employment patterns, to determine whether there was age-related change, and to test whether trajectories differed between those with and without intellectual disability (ID). Using an accelerated longitudinal design, trajectories of hours of competitive employment were estimated from young adulthood through late midlife in a community-based cohort (n = 341; 1327 observations). Results indicated a significant curvilinear trajectory of age-related change in hours of competitive employment, with differences between those with and without ID. For those without ID, the number of competitive employment hours increased from young adulthood until early midlife, then leveled off and decreased into late midlife. For those with ID, engagement in competitive employment was low throughout. Although competitive employment is just one option for vocational engagement, it is a goal often articulated by autistic adults who seek entry into the general workforce. The present research reveals their degree of engagement in the competitive workforce across the decades of adulthood.

The Development and Evaluation of a Cross-Context Employment Program for Autistic Adolescents

Vocational programs typically focus on building the skills of autistic youth. However, there is growing recognition that the supportive environment (or ecosystem) around an individual plays an important role in finding and maintaining work. Programs at the ecosystem-level can be established by coordinating support before high school ends. Cocreation of a vocational program by support providers can facilitate an integrated effort to prepare autistic youth for employment. In this study, we describe and evaluate the Job-Train Program (JTP), a vocational program for autistic high school students codesigned with educators and a community-based social services agency. A school board, community-based social services agency, and academics partnered to cocreate JTP. JTP combined skill teaching and paid supported employment on a university campus. This pilot study evaluated JTP using qualitative and quantitative data. Twelve autistic youth were recruited, aged 15-18 years (10 males, 2 females) with an average intelligence quotient of 101.9 (standard deviation = 14.4), from the Wechsler Abbreviated Scale of Intelligence-2. Youth and parents completed self-report measures (pre-post), including the primary outcome, Canadian Occupational Performance Measure (COPM). Post-JTP, interviews, focus groups, and surveys collected additional information from youth (n = 11), parents (n = 10), job coaches (n = 5), and employers (n = 8). Youth COPM scores indicated significant improvements in self-perceived ratings of skill performance (z = -2.5, p = 0.01) and satisfaction (z = -2.6, p = 0.01). Qualitative data corroborated COPM results noting youth skill improvements in self-esteem, independence, communication, and understanding work. Findings demonstrated a promising vocational training model for autistic high school students informing the development of integrated service pathways to support preparation for employment.

School-based social skills group training (SKOLKONTAKT™): a pilot randomized controlled trial

Purpose

Differences in socio-communicative behaviors contribute to social challenges for autistic learners at school and, in turn, are associated with increased risks of educational underachievement, social exclusion, and mental health issues. Given that intervention delivery in natural contexts may enhance skills generalization, build support capacities in society, and have practical advantages for youth and families, SKOLKONTAKT™ has been adapted from the clinically based social skills group training KONTAKT™ for mainstream educational settings to mitigate these risks.

Methods

A pilot, randomized controlled trial with active controls was conducted in a mainstream Swedish high school. Autistic learners and students with social skills challenges (N = 33; MAGE = 17.5) were randomized to SKOLKONTAKT™ (n = 17) or active control (n = 16). Efficacy was measured at post and follow-up (3 months) on social skills [Social Skills Group Assessment Questionnaire (SSGQ); primary outcome] by parent-, self-, and (masked) teacher-report as well as self-reported life quality and social goal attainment.

Results

Despite COVID-19 challenges, 70.6% (n = 12) completed SKOLKONTAKT™, and 87.5% (n = 14) completed control groups. SKOLKONTAKT™ improved on a series of items on SSGQ as well as subjective life quality beyond controls. A larger proportion of social goals were attained, and side-effects were of little impact and proportionally fewer in SKOLKONTAKT™.

Conclusion

SKOLKONTAKT™ is a safe, feasible, and promising intervention option for autistic learners in mainstream educational settings. A larger-scale study is desirable to confirm the effects identified in this pilot study.

Social competence as a predictor of adult outcomes in autism spectrum disorder

There is a wealth of literature characterizing social difficulties in autism spectrum disorder (ASD). However, little work has replicated longitudinal findings from typical development that adolescent social competence predicts positive adult outcomes in ASD. The current study examined social competence trajectories from 2 to 26 and the utility of three social competence measures collected in adolescence in predicting work, residential status, friendship, and romantic outcomes in a longitudinal cohort (n = 253) of ASD. Using group-based trajectory modeling, we identified two patterns of social competence development: a low trajectory characterized by slow linear gains throughout childhood and plateauing in adulthood, and a high trajectory characterized by steeper linear gains in childhood followed by decline in adulthood. Regression models indicated one social competence measure, Vineland Social-AE scores, significantly predicted employment, residential status, and friendships in adulthood. One other social competence measure, SSQ total scores, also significantly predicted friendship in adulthood. Only nonverbal IQ at 9 predicted the likelihood of having ever had a romantic relationship. These findings highlight the role of social competence in both atypical and typical development and suggest the social impairments associated with ASD do not necessarily impact all realms of social functioning equally.

Self-Monitoring Intervention for Adolescents and Adults with Autism: A Research Review

The ability to work and function independently is one of the most important skills for the achievement of ideal post-school outcomes. The use of self-monitoring to improve independence and/or reduce undesirable behaviors is an imperative need for individuals with autism. The purpose of this literature review was to examine technology-based self-monitoring interventions for individuals with autism. We used a four-step literature search process to identify studies for review. Online databases, such as ERIC, were used to search for studies. Using four inclusion criteria and PRISMA guidelines for the selection and screening process, we identified 16 studies that met the inclusion criteria. We used coding to summarize the following information from the included studies: participants who met the inclusion criteria, primary dependent variable, primary intervention, and study design. The results of the review revealed three primary functions of technology performed in self-monitoring. The included studies targeted on-task behaviors, skill acquisition, and socially relevant behaviors as primary dependent variables. The findings of the review suggested that future research could use self-monitoring interventions to support an adult with autism in employment settings and that a self-monitoring intervention could be tailored by considering individual differences.