Employment and Vocational Skills Among Individuals with Autism Spectrum Disorder: Predictors, Impact, and Interventions

'A certain magic' - autistic adults' experiences of interacting with other autistic people and its relation to Quality of Life: A systematic review and thematic meta-synthesis

LAY ABSTRACT

Research has suggested that autistic people enjoy spending time with other autistic people and find them easier to talk to. We wanted to find out what autistic people say about spending time with other autistic people and whether this makes their life better. We found 52 papers which described this and reviewed what they found. We found that many autistic people had positive experiences of spending time with other autistic people and these experiences had positive impact on their lives in a range of different ways. The papers did not tell us whether this also happens for autistic people with a learning disability. More research is needed to find out more about why spending time with other autistic people helps some autistic people.

Cognitive functioning in adults with autism spectrum disorder

INTRODUCTION

Neuropsychological deficits in areas of Executive Functioning (EF), theory of mind, and central coherence have been well-documented among children and adolescents with autism spectrum disorder (ASD); however, there remains a significant gap in knowledge with regards to neuropsychological profile in adults with ASD. This study aims to investigate the intellectual functioning and neuropsychological profiles of a clinical population of adults with ASD.

METHODS

This cross-sectional study included 40 available autistic individuals referred to an adult developmental disorders clinic at a hospital between 2021 and 2022. All participants were assessed using the Stanford-Binet Intelligence Scale (SBIS), Autism Spectrum Quotient (AQ), Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and Social Responsiveness Scale (SRS).

RESULTS

Individuals with ASD exhibited lower IQ scores across all domains of the Stanford-Binet Intelligence Scale, compared to the general population, although the mean IQ scores remained within the normal range. Significant differences were observed in Full Scale IQ, Verbal IQ, Non-Verbal IQ, Fluid Reasoning, Knowledge, Quantitative Reasoning, Visual-Spatial Processing, and Working Memory compared to the general population. Additionally, autistic individuals' performance on verbal knowledge was higher compared to non-verbal knowledge. No significant correlations were found between the total and subscale scores of verbal and nonverbal IQ and AQ, RAADS-R, and SRS scores.

CONCLUSION

Considering the significant impacts of cognitive and executive function on the social and occupational aspects of autistic adults, further investigations in this area are warranted.

Perspectives on Employer-Initiated Terminations Among Young Adults on the Autism Spectrum

Job instability is high among autistic adults, with employer-initiated terminations a common reason for job loss. The current study used qualitative methods to code reasons that autistic adults identified for their employer-initiated termination. From 315 autistic individuals ages 18-35 who completed an online survey, 93 (29.5%) reported having been terminated from a job. These individuals were asked about the reasons for their termination and responses were coded into thematic categories. Common reasons included work performance, social difficulties, attendance, and mental health challenges. Adults were more likely to attribute terminations to internal causes (related to the individual) than to external causes (environment-related). A good fit between workplace, individual preferences, skills, and abilities is likely key to promoting job continuity for autistic adults.

"Maybe No One Knows We Need Help": Understanding the Experiences of Autistic Working Mothers in Australia

Background

Although there are no known studies investigating autistic working mothers, research has demonstrated that managing employment and motherhood in non-autistic populations has specific challenges, as does employment in autistic populations. This autistic-led study aimed at investigating the experience of autistic working mothers to identify benefits, challenges, and support needs.

Methods

We utilized a subjectivist epistemological perspective to learn about the experiences of autistic working mothers. We recruited 10 autistic working mothers (aged 34-50 years) via social media advertisements, who participated in a 45- to 60-minute semi-structured interview where we asked questions developed in consultation with a community reference group. We transcribed interviews and then analyzed them using inductive reflexive thematic analysis.

Results

We identified three key themes. The first theme, "Wellbeing: Work gives me purpose," discusses how employment supports mental well-being. The second theme, "Challenges: It's hard being an autistic working mother," includes the challenges of balancing work and caregiving, guilt related to being a working mother, and issues with part-time work. The third theme, "The invisible disability: Everyone thinks I look okay," discusses the lack of understanding of participants' challenges, with assumptions they are coping, and the lack of supports that led to some participants no longer seeking assistance.

Conclusions

The responses of the autistic women who took part support a view that autistic working mothers may experience some similar challenges to non-autistic working mothers, including stress in juggling caring and work roles. They identified additional challenges related to their gender and their autistic identity, including a lack of understanding of the female (or "internalized") presentation of autism. These findings will help autistic working mothers by promoting a better understanding of their experiences and challenges when they speak with health professionals, government, and employers seeking support and accommodations.

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.

Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Psychological Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

(1) Background: Psychological interventions are effective in alleviating neuropsychiatric symptoms, though results can vary between patients. Repetitive transcranial magnetic stimulation (rTMS) has been proven to improve clinical symptoms and cognition. It remains unclear whether rTMS can augment the efficacy of psychological interventions. (2) Methods: We examined the effects of rTMS combined with psychological interventions on clinical, functional, and cognitive outcomes from randomized controlled trials conducted in healthy and clinical populations. We searched PubMed, EMBASE, Cochrane Library, and PsycINFO databases up to April 2023. (3) Results: Twenty-seven studies were ultimately included. Compared to sham rTMS combined with psychological interventions, active rTMS combined with psychological interventions significantly improved overall clinical symptoms (k = 16, SMD  =  0.31, CIs 0.08 to 0.54, p  <  0.01). We found that 10 or more sessions of rTMS combined with cognitive behavioural therapy significantly improved clinical outcomes overall (k = 3, SMD  =  0.21, CIs  0.05 to 0.36, Z = 2.49, p  <  0.01). RTMS combined with cognitive training (CT) significantly improved cognition overall compared to sham rTMS combined with CT (k = 13, SMD  =  0.28, CIs 0.15 to 0.42, p  <  0.01), with a significant effect on global cognition (k = 11, SMD  =  0.45, CIs 0.21 to 0.68, p  < 0.01), but not on the other cognitive domains. (4) Conclusion: The current results provide preliminary support for the augmentation effects of active rTMS on clinical and cognitive outcomes across diverse populations. Future clinical trials are required to confirm these augmentation effects for specific psychological interventions in specific clinical populations.

Video prompting procedures to teach science electronic journaling to students with intellectual disability: Leveraging students with disabilities' learning endeavors

The purpose of this research exploration was to investigate the impact of video prompting procedures on the acquisition of electronic journaling skill, and how to create and present scientific knowledge previously learned by students with intellectual disabilities. Using single-subject, multiple probe, and multiple baseline-design across four participants with moderate intellectual disabilities, results revealed that participants could increase their number of correct, completed steps for creating their electronic journals for the science classes. Results also showcased that participants had an opportunity to encounter the tablet-based, evidence-based instructional strategy to learn how to introduce their scientific pieces, talk about and communicate their ideas and thoughts. Implications for future research and practice were provided.

An individual-supported program to enhance placement in a sheltered work environment of autistic individuals mostly with intellectual disability: a prospective observational case series in an Italian community service

Introduction

Autism spectrum disorder is a lifelong neurodevelopmental disorder. The profile of functioning in autistic people is very heterogeneous, and it is necessary to take into account individual characteristics to better support integration in the workplace. However, unemployment rates are higher for autistic people than for other types of disabilities. We present a prospective case series to explore the feasibility and efficacy of an individual-supported program to enhance placement in a sheltered work environment delivered by an Italian community day care center.

Methods

Autistic subjects, aged from 12 to 31 years, participated in an individual-supported program regarding employment in sheltered art workshops, integrated into the regular activity of a semi-residential center three times a week for 1 year. Their feasibility retention rate and time worked per session were registered; moreover, working methods efficacy and self-organization improvement were tracked by the Likert-based rating system. Secondary outcome measures span functional levels, challenge behaviors, and sensory problems.

Results

All the individuals presented a good adaptation to the environment, with a significant increase in time worked per session. After 1 year, the intervention allowed an increase in tasks completed in an assigned complex job and an improvement in self-organization within the work schedule in a group of subjects consisting mainly of severe-to-moderate levels of autism severity (86.6%). Finally, we observed a significant increase in independent functioning areas of the TEACCH transitional assessment profile. Challenge behaviors and sensory problems were also recorded.

Conclusion

This case series supports the idea that individual-supported programs for placement in sheltered job environments delivered by community day care centers could be feasible and effective for ASD with higher levels of severity and co-occurring intellectual disability. Further targeted studies based on community models and accessible methods need to be planned to define the effectiveness of the intervention and promote improved practice at the community level with a better social impact.

[From the Placement Paradigm to Sustainable Support of Companies in the Integration of People with High-Functioning Autism - Results of an Employer Survey]

As part of the AUT-1A project, 123 employers were surveyed by questionnaires about their experiences with the employment of autistic employees. The aim was to identify the factors that promote and hinder employment. The study indicates that the vocational qualification in vocational training centers (BBW) has a positive effect on sustainable employment of people with autism spectrum diagnosis (ASD), but the support for companies is not sufficient yet. Also, a lack of education regarding autism-friendly environmental design as well as a lack of education about the diagnosis autism of the direct colleagues could be worked out.

Access to employment: A comparison of autistic, neurodivergent and neurotypical adults' experiences of hiring processes in the United Kingdom

LAY ABSTRACT

Autistic people are less likely to have a job than non-autistic people. One reason for this may be that hiring processes (e.g. job applications, interviews) can be challenging for autistic people. To better understand the experiences of hiring processes in the United Kingdom, we asked 225 autistic, 64 neurodivergent (but not autistic) and 64 adults with no reported area of neurodivergence questions about their experiences using an online survey. We found a range of similarities and differences in responses. For example, participants in all three groups were frustrated with the focus on social skills in recruitment and said they wanted more practical methods (e.g. work trials) that help them show their skills and abilities. Autistic and otherwise neurodivergent participants discussed the importance of the environment (e.g. the interview/assessment room) in improving experiences. Participants also discussed how employers can impact whether somebody decides to disclose their diagnosis or needs - or not. Autistic people experienced some barriers to successful recruitment that non-autistic people did not. For example, autistic people felt they had to hide their autistic traits to gain employment and many autistic people were worried about being discriminated against if they disclosed that they were autistic during the hiring process. To make experiences better, our participants said that employers should offer candidates different recruitment methods and give them more information about the hiring process. They also said employers should improve their understanding of autism and other hidden disabilities so they know the challenges that people might face during recruitment.

Development and Psychometric Properties of Self-Reported Job Interview Skills and Job Interview Anxiety for Autistic Transition-Age Youth

BACKGROUND

The study of job interview training is an emerging area among transition-age autistic youth who face significant challenges when navigating job interviews. The autism field has limited measures that have undergone rigorous psychometric evaluation.

OBJECTIVE

We sought to evaluate the psychometric properties of adapted self-report measures assessing job interview skills and job interview anxiety.

METHODS

As part of two parent randomized controlled trials, eighty-five transition-age autistic youth completed measures related to the strength of their job interview skills and their level of job interview anxiety. We conducted classical test theory analyses, exploratory and confirmatory factor analyses, and Rasch model analytic and calibration analyses. Pearson correlations were used to establish concurrent, divergent, and criterion validity by correlating these scales with measures of social differences, depressive symptoms, behaviors, neuropsychological functioning, and work history.

RESULTS

Our analyses yielded two brief and reliable scales: Measure of Job Interview Skills (MOJO-iSkills) and Measure of Job Interview Anxiety (MOJO-iAnxiety), which demonstrated initial concurrent, divergent, and criterion validities when correlated with measures of depressive symptoms, social differences, internalizing and externalizing behavior, and work history.

CONCLUSIONS

This study presents initial evidence that MOJO-iSkills and MOJO-iAnxiety have acceptable psychometric properties supporting they can be used to reliably and validly assess job interview skills and interview anxiety.

A pilot study of PEERS® for Careers: A comprehensive employment-focused social skills intervention for autistic young adults in the United States

BACKGROUND

Autistic young adults are at elevated risk for poor employment/internship outcomes, despite having many strengths relevant to the workplace. Currently, very few employment interventions for this population comprehensively promote skills development and success across the various stages of employment.

AIMS

To address this gap, the current study aimed to test the feasibility, acceptability, and efficacy of a novel college to career intervention program, PEERS® for Careers.

METHODS AND PROCEDURES

Twelve autistic young adults (19-30 years old) were enrolled and matched to a career coach. The pilot program consisted of 90-minute sessions delivered twice per week, for 10 weeks, covering content relevant to obtaining, maintaining, and thriving in employment/internship settings.

OUTCOMES AND RESULTS

Results indicated that young adults showed a significant improvement in employment-related social skills knowledge, p < .001. Participants also reported significant improvements in their feelings of preparedness for employment over the course of the study, p = .009, with all young adults self-identifying as "somewhat prepared" or "very prepared" post-intervention. Additionally, in only a brief 10-week intervention, a slight increase in participants who secured or maintained internship/employment-related activities was observed. Overall, lesson content and coaching were perceived as helpful. No significant changes were observed in self-reported autism symptomatology.

CONCLUSIONS AND IMPLICATIONS

In sum, the PEERS® for Careers program shows promise as a college to career intervention program for autistic young adults.

WHAT THIS PAPER ADDS

There is a dearth of evidence-based interventions for autistic young adults, despite significant need for supports to bolster vocational and relational success. This paper is the first to evaluate the PEERS® for Careers intervention in a pilot study by exploring feasibility, acceptability, and efficacy of this novel college to career intervention program, which teaches ecologically valid employment-related skills using a strengths-based approach. Results suggest PEERS® for Careers shows significant potential as a comprehensive intervention to address the multi-faceted needs of autistic individuals in the workplace through didactic lessons, behavioral rehearsals to practice skills, and out of group assignments. Autistic young adult participants reported a high level of satisfaction with the program and lessons surrounding employment-related social skills. They also endorsed increased feelings of internship/employment readiness and increased knowledge of workplace etiquette, with most participants maintaining or securing employment. This study supports PEERS® for Careers as a feasible intervention that likely benefits autistic individuals' vocational outcomes, which emerge as a strong correlate of well-being in adulthood. This work is essential to furthering the development and provision of effective services to meet needs of the autism community.

Speech-Language Pathologist's Role in Understanding and Promoting Self-Advocacy in Autistic Adults

PURPOSE

This tutorial introduces speech-language pathologists (SLPs) to strategies that promote and support self-advocacy among autistic college students. The discussion for this tutorial is grounded within the framework of the social model of disability and the need for addressing environmental barriers to communication and self-advocacy.

METHOD

We provide a self-advocacy framework to guide SLPs in developing programs for autistic adults. We describe factors that impact self-advocacy in autistic college students and the role of university-based SLPs and speech-language pathology graduate students in program implementation. Scenarios and examples are included to aid SLPs in implementing the recommendations.

CONCLUSIONS

Self-advocacy is a predictor of retention, adaptation, and graduation of autistic postsecondary students. Prior research on autistic self-advocacy is minimal, and guidance for SLPs on promoting and supporting self-advocacy of their autistic clients is limited. SLPs play a very important role as they can increase understanding and appreciation for autistic social communication differences among nonautistic peers and professors and address autistic stigma through meaningful engagement of autistic individuals in planning and program development.

The value of employment support services for adults on the autism spectrum and/or with intellectual disabilities: Employee, employer, and job coach perspectives

BACKGROUND: Employment rates among individuals on the autism spectrum or with intellectual disabilities (ID) remain extremely low. Although job coaching services have contributed to successful employment for these individuals, few studies have examined the importance of such support, and even fewer have explored which services are valued most by stakeholders. OBJECTIVE: We examined the importance of employment support services through employee, employer, and job coach perspectives, and employee and employer satisfaction of job coach support. METHODS: A multiple-case study was designed with a community organization providing employment support to individuals on the autism spectrum or with ID, and their employers. Nine employee-employer-job coach triads evaluated the importance of specific services and rated their satisfaction with the job coach support. RESULTS: Services were rated as important, however, some discrepancies were observed between the groups in their ratings of services (e.g., soliciting regular feedback about the employee’s performance). Satisfaction was high for employees and employers; both groups indicated that they would recommend these services. CONCLUSIONS: Job coach support was highly valued by all groups, underscoring the need for these services to be widely available, and suggesting that this support may serve as a critical factor in improving employment outcomes among this population.

Mixed methods analysis of an exploratory apprenticeship model employment program for young adults with developmental disabilities

BACKGROUND: Individuals with developmental disabilities experience lower employment, higher underemployment, and higher job switching rates than the general population. OBJECTIVE: The current study investigated: (1) the vocational and support experiences of individuals with developmental disabilities, and (2) the differences in participant outcomes between an apprenticeship-model employment program and the comparison group. METHODS: Qualitative and quantitative methods were used to assess outcomes and experiences of participants in the apprenticeship model employment program (N = 22) and a community-based “Job Club” (N = 11). Thematic analysis was used to analyze interview transcripts. Independent samples T-tests and paired samples T-tests were utilized to analyze within-group and between group differences. RESULTS: Parent interview data regarding past and current experiences of the participants in the apprenticeship model employment program suggest 6 major themes. Independent samples T-tests determined that the apprenticeship program participants were significantly less employed than the comparison group at pre-, then similarly employed as the comparison group at post-intervention. Within-group analyses determined that some aspects of participant confidence in their vocational skills and problem-solving skills significantly increased from pre- to post-intervention, according to parent report. CONCLUSIONS: The apprenticeship model of employment appears to be a promising model in need of further study with a larger sample size.

Interventions for improving employment outcomes for persons with autism spectrum disorders: A systematic review update

BACKGROUND

The incidence of autism spectrum disorders (ASD) is on the rise. Currently, 1 in 59 children are identified with ASD in the United States. ASD refers to a range of neurological disorders that involve some degree of difficulty with communication and interpersonal relationships. The range of the spectrum for autism disorders is wide with those at the higher functioning end often able to lead relatively independent lives and complete academic programs even while demonstrating social awkwardness. Those at the lower functioning end of the autism spectrum often demonstrate physical limitations, may lack speech, and have the inability to relate socially with others. As persons with ASD age, options such as employment become increasingly important as a consideration for long-term personal planning and quality of life. While many challenges exist for persons with ASD in obtaining and maintaining employment, some research shows that, with effective behavioral and social interventions, employment can occur. About 37% of individuals with ASD report having been employed for 12 months or more, 4 years after exiting high school. However, several studies show that individuals with ASD are more likely to lose their employment for behavioral and social interaction problems rather than their inability to perform assigned work tasks. Although Westbrook et al. (2012a, 2013, 2015) have reviewed the literature on interventions targeting employment for individuals with ASD, this review is outdated and does not account for recent developments in the field.

OBJECTIVES

The objective of this review is to determine the effectiveness of employment interventions in securing and maintaining employment for adults and transition-age youth with ASD, updating two reviews by Westbrook et al. (2012a, 2013).

SEARCH METHODS

The comprehensive search strategy used to identify relevant studies included a review of 28 relevant electronic databases. Search terminology for each of the electronic databases was developed from available database thesauri. Appropriate synonyms were used to maximize the database search output. Several international databases were included among the 28 databases searched. In addition, the authors identified and reviewed gray literature through analysis of reference lists of relevant studies. Unpublished dissertations and theses were also identified through database searches. The programs of conferences held by associations and organizations relevant to ASD and employment were also searched. In sum, the search strategy replicated and expanded the prior search methods used by Westbrook et al. (2012a, 2013).

SELECTION CRITERIA

Selection criteria consisted of an intervention evaluation using a randomized controlled trial or quasi-experimental design, an employment outcome, and a population of individuals with ASD.

DATA COLLECTION AND ANALYSIS

We updated the search from Westbrook et al., replicating and broadening the information retrieval processes. Our wide array of sources included electronic databases, gray literature, and conference and organization websites. Once all potentially relevant studies were located, pairs of coders evaluated the relevance of each title and abstract. Among the studies deemed potentially relevant, 278 were subjected to full-text retrieval and screening by pairs of coders. Because many intervention studies did not include employment outcomes, only three studies met our inclusion criteria. Given the small number of included studies, meta-analytic procedures were not used; rather, we opted to use more narrative and descriptive analysis to summarize the available evidence, including an assessment of risk of bias.

RESULTS

The systematic review update identified three studies that evaluated employment outcomes for interventions for individuals with ASD. All three studies identified in the review suggest that vocation-focused programs may have positive impacts on the employment outcomes for individuals with ASD. Wehman et al. indicated that participants in Project SEARCH had higher employment rates than control participants at both 9-month and 1-year follow-up time points. Adding autism spectrum disorder supports, Project SEARCH in Wehman et al.'s study also demonstrated higher employment rates for treatment participants than control participants at postgraduation, 3-month follow-up, and 12-month follow-up. Smith et al. found that virtual reality job interview training was able to increase the number of job offers treatment participants received compared to control participants.

AUTHORS' CONCLUSIONS

Given that prior reviews did not identify interventions with actual employment outcomes, the more recent emergence of evaluations of such programs is encouraging. This suggests that there is a growing body of evidence regarding interventions to enhance the employment outcomes for individuals with ASD but also greater need to conduct rigorous trials of vocation-based interventions for individuals with ASD that measure employment outcomes.

"It's like a ramp for a person in a wheelchair": Workplace accessibility for employees with autism

BACKGROUND, AIMS AND METHODS

Participation in employment by individuals with autism spectrum disorders (ASD) remains restricted despite their high motivation and evident abilities. Challenges to employment result from personal characteristics and environmental barriers. This phenomenological research explores the accessibility of a competitive work environment according to the perceptions of adults with ASD.

PROCEDURES AND OUTCOMES

We conducted in-depth interviews with 19 employees with ASD, followed by a thematic content analysis. Three themes emerged: (a) the employees' motivation for employment, (b) challenges and abilities at work, and (c) workplace accessibility (types of accommodations, implementation process).

RESULTS AND CONCLUSIONS

The findings contribute a classification of accommodations that addresses the core characteristics of autism-challenges as well as abilities and motivations for employment. Four types of accommodations were identified: job-performance communication, attitudes and interpersonal communication, daily workplace routines, and physical and sensory environments. Hence, this study supports the centrality of environmental factors in successful employment of individuals with ASD.

IMPLICATIONS

This study presents an evidence-based foundation for autism-related workplace accessibility. It offers an approach to enhance employees' abilities, strengths, and motivation for employment, as well as to decrease barriers and challenges. The findings may expand organizational policies regarding accessibility and thereby anchor workplace accommodations within organizations' corporate cultures.

Acceptability of employment readiness measures in youth and young adults on the autism spectrum: a mixed-methods study

PURPOSE

Reliable, valid, and pragmatic measures are essential for monitoring and evaluating employment readiness and comparing the effectiveness of alternative implementation strategies. The Work Readiness Inventory (WRI) and Ansell-Casey Life Skills Assessment (ACLSA) are valid measures of employment readiness in neurotypical populations; however, their acceptability (i.e., user perception of measure as agreeable/satisfactory) for persons on the autism spectrum is not yet known. This investigation assesses the acceptability of the WRI and a modified ACLSA (ACLSA-M) in measuring employment readiness in youth/young adults on the spectrum.

METHODS

A concurrent triangulation mixed-methods study design utilizing quantitative pre-post measurement of a community-based employment readiness program alongside qualitative survey assessment was employed to determine concurrent acceptability. For robustness, further explication through peer debriefing of experts evaluated the retrospective acceptability via interview and acceptability-rate assessment.

RESULTS

Findings indicated that both measures are acceptable, although individual- and job-specific item modifications are advised, particularly due to disability-specific needs. Significant change in employment readiness in youth/young adults on the spectrum supports concurrent acceptability. Peer debriefing provided rich data on retrospective acceptability. Acceptability-rates of 0.84 and 0.91 confirm broad acceptability of these measures.

CONCLUSIONS

Implications are presented for clinicians and researchers, highlighting the relevance for autism-specific measurement development and acceptability.Implications for rehabilitationGiven the lower labor force participation of persons on the autism spectrum, a combination of measures should be used in the assessment of an individual's employment readiness.In youth and young adults on the spectrum, employment readiness can be measured using the Work Readiness Inventory (WRI) and a modified version of the Ansell-Casey Life Skills Assessment (ACLSA-M).In clinical practice and research, modifying the contents of these measures may be advised to minimize language complexity, and maximize ease in self report.When designing, developing, and testing new measures in rehabilitation practice or research, the intent should be broadened by involving diverse representation from the project outset, by engaging both those on the spectrum and neurotypical populations.

Brief report: Changes in quality of life and social functioning during vocational program - a pilot study of autistic adults

BACKGROUND

Quality of life (QoL), social-emotional and occupational functioning are often diminished in young autistic adults. Measuring these constructs as vocational training outcomes may inform future programming and relevancy of measures.

METHODS

This pilot study analyzed changes in social-emotional functioning and QoL during the involvement at a vocational program for autistic adults using the WHOQOL-BREF, a modified version of the Birchwood- Social Functioning Scale (SFS-m) and a piloted measure. Participants completed these self-reported questionnaires upon admission and at 3 months.

RESULTS

Significant change was found on the SFS-m and two WHOQOL-BREF domains: psychological and environmental.

CONCLUSIONS

This pilot study suggests that autistic adults, similar in characterization, can self-report using these QoL and social measures; further, these measures are sensitive to certain changes over time in such group programs.

Barriers experienced by people with disabilities participating in income-generating activities. A case of a sheltered workshop in Bloemfontein, South Africa

Background

People with disabilities often participate in income-generating activities (IGAs) in sheltered workshop in South Africa. However, they face many barriers that limit their ability to participate effectively in economic activities hosted by the workshops.

Objectives

To illustrate the barriers that limit the participation of people with disabilities in IGAs in a sheltered workshop.

Method

A qualitative exploratory single case study was conducted in a sheltered workshop. Eighteen participants, age 22 to 52 years with various disabilities were purposively sampled. Observations and semi-structured interview guides were used to generate data. Verbatim transcription was used after which content analysis was applied to identify ideas and concepts relating to barriers experienced by people with disabilities participating in IGAs.

Results

Some of the barriers participants experienced included institutional barriers (ability to use working tools, inability to concentrate for long periods, lack of funds, language barriers, lack of motivation, activities that are not stimulating and lack of artistry skills) and attitudinal barriers (exclusion from decision making) These barriers had an adverse influence on their performance in IGAs.

Conclusion

The study found eight different barriers that existed in a sheltered workshop which limited the participation of the people with disabilities that attended the workshop. This information can be used to develop strategies to address each barrier and promote increased participation of the individual thereby improving their quality of life.

Workplace Social Challenges Experienced by Employees on the Autism Spectrum: An International Exploratory Study Examining Employee and Supervisor Perspectives

Social challenges represent a significantly under-researched area when it comes to the poor employment outcomes in autism. In this exploratory study employees on the autism spectrum (N = 29) and supervisors (N = 15), representing seven continents, provided 128 written examples of workplace-based social challenges, their interpretation, consequences and resolution. Content analysis revealed that types of social challenges were individually oriented or associated with the work-environment. Social challenges were frequently attributed to internal or personal factors with direct consequences for the employee. Resolutions were more frequently targeted toward the individual than the workplace, and hindered employees' experience of work. This international study represents a first look at the types of social challenges that impact equitable work participation of autistic people.

Exploring Key Physiological System Profiles at Rest and the Association with Depressive Symptoms in Autism Spectrum Disorder

Depression is often associated with dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). Individuals with autism spectrum disorder (ASD) may experience physiological dysregulation and psychological comorbidities; however, the extent to which the interactions between these systems predict internalizing symptoms in ASD has not been investigated. The study examined interactions with the HPA axis and ANS in 10-13-year-old children with ASD (n = 41) and typical development (TD; n = 46). The interrelated systems uniquely contributed to depressive symptoms in ASD above and beyond any system in isolation. A reciprocal, parasympathetic-dominant ANS was related to fewer affective symptoms in ASD. Findings highlight the importance of examining arousal across multiple systems to more precisely identify profiles associated with maladaptive psychiatric outcomes in ASD.

Brief Report: A Job-Based Social Skills Program (JOBSS) for Adults with Autism Spectrum Disorder: A Pilot Randomized Controlled Trial

Adults with autism spectrum disorder (ASD) have low employment rates; even those who are employed have low wages and limited hours. This study evaluated the effectiveness of the Job-Based Social Skills (JOBSS) curriculum, a manualized, 15-week, group-delivered intervention for adults with ASD. The intervention aimed to increase social-pragmatic skills necessary to obtain and maintain employment. Twenty-two adults were randomly assigned to either JOBSS intervention or wait-list control groups. Results showed significant improvement in social cognition, as reported by caregivers, among JOBSS group participants compared to wait-list control participants. Forty-five percent of intervention participants gained employment in the six months following participation. This curriculum has potential to improve social skills of adults with ASD, thereby increasing successful employment.

A Review of CommunityWorks Canada®: Toward Employability Among High School-Age Youth With Autism Spectrum Disorder

CommunityWorks Canada^® is a 12-week (30-hour) program that provides social, communication, and job skill–building activities as well as peer mentorship to youth with autism spectrum disorder. Administration of a pre- and postprogram employment readiness measure (n = 76 participants) demonstrated positive changes as reflected by the participants’ decreased concerns about their responsibility, flexibility, job skills, communication, self-view, and health and safety. Postprogram qualitative interviews and survey data collected from a range of program stakeholders (participants, parents, peer mentors, and community partners/employers) corroborated identified gains in personal development, employment exposure, work proficiency, and comfort in work settings. For community partners/employers and peer mentors, greater understanding about autism spectrum disorder and commitment to inclusive hiring reportedly resulted from program engagement. Implications and recommendations are offered.

Comparing Mobile Technologies for Teaching Vocational Skills to Individuals with Autism Spectrum Disorders and/or Intellectual Disabilities Using Universally-Designed Prompting Systems

The purpose of this study was to compare mobile technologies with universally-designed prompting systems to improve the independent vocational performance of four adolescents with ASD and/or ID in school-based employment settings. Specific aims were to (1) compare the effectiveness of universally-designed prompting systems presented on iPads and HP Slates that involved participant-selection and participant-fading of available on-screen media prompts; (2) compare the usability of different mobile devices; and (3) determine if built-in decision prompts could improve problem-solving behavior during task completion. Results indicated that both devices resulted in immediate and substantial increases in independent responding for three of the four participants. All participants performed better with their preferred device and all self-faded reliance on instructional prompts as skill acquisition increased.

Prioritizing barriers and solutions to improve employment for persons with developmental disabilities

Purpose: Persons with a developmental disability have the lowest rate of labour force participation relative to other disabilities. The widening gap between the labour force participation of persons with versus without disability has been an enduring concern for many governments across the globe, which has led to policy initiatives such as labour market activation programs, welfare reforms, and equality laws. Despite these policies, persistently poor labour force participation rates for persons with developmental disabilities suggest that this population experiences pervasive barriers to participating in the labour force.Materials and methods: In this study, a two-phase qualitative research design was used to systematically identify, explore and prioritize barriers to employment for persons with developmental disabilities, potential policy solutions and criteria for evaluating future policy initiatives. Incorporating diverse stakeholder perspectives, a Nominal Group Technique and a modified Delphi technique were used to collect and analyze data.Results: Findings indicate that barriers to employment for persons with developmental disabilities are multi-factorial and policy solutions to address these barriers require stakeholder engagement and collaboration from multiple sectors.Conclusions: Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities. Policy and decision makers need to address barriers to employment for persons with developmental disabilities more holistically by designing policies considering employers and the workplace, persons with developmental disabilities and the broader society. Findings call for cross-sectoral collaboration using a Whole of Government approach.Implications for RehabilitationPersons with a developmental disability face lower levels of labour force participation than any other disability group.Individual, environmental and societal factors all impact employment outcomes for persons with developmental disabilities.Decision and policy makers need to address barriers to employment for persons with developmental disabilities holistically through policies guiding employers and broader societal behaviour in addition to those aimed at the individuals (such as skill development or training).Due to multi-factorial nature of barriers to employment for persons with developmental disabilities, policy solutions are wide-ranging and fall under the responsibility of multiple sectors for implementation. This calls for cross-sectoral collaboration using a "Whole of Government" approach, with shared goals and integrated responses.

The Experiences of College Students on the Autism Spectrum: A Comparison to Their Neurotypical Peers

This study describes the academic, social, and health experiences of college students on the autism spectrum as they compare to students with other disabilities and their non-disabled, neurotypical peers. Data were from an online survey of college students at 14 public institutions (N = 3073). There were few significant differences between students on the spectrum and students with other disabilities. Both groups of students reported significantly worse outcomes than neurotypical students on academic performance, social relationships and bullying, and physical and mental health. The findings suggest that some of the challenges students on the spectrum face in college result from the stigma and social rejection associated with disability rather than from the unique characteristics of autism.

Factors impacting employment for people with autism spectrum disorder: A scoping review

The aim of this study is to holistically synthesise the extent and range of literature relating to the employment of individuals with autism spectrum disorder. Database searches of Medline, CINAHL, PsychINFO, Scopus, ERIC, Web of Science and EMBASE were conducted. Studies describing adults with autism spectrum disorder employed in competitive, supported or sheltered employment were included. Content analysis was used to identify the strengths and abilities in the workplace of employees with autism spectrum disorder. Finally, meaningful concepts relating to employment interventions were extracted and linked to the International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder. The search identified 134 studies for inclusion with methodological quality ranging from limited to strong. Of these studies, only 36 evaluated employment interventions that were coded and linked to the International Classification of Functioning, Disability and Health, primarily focusing on modifying autism spectrum disorder characteristics for improved job performance, with little consideration of the impact of contextual factors on work participation. The International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder are a useful tool in holistically examining the employment literature for individuals with autism spectrum disorder. This review highlighted the key role that environmental factors play as barriers and facilitators in the employment of people with autism spectrum disorder and the critical need for interventions which target contextual factors if employment outcomes are to be improved.

Predictors of quality of life for autistic adults

Research with adults on the autism spectrum is as yet limited in scope and quality. The present study describes quality of life (QoL) of a large sample of autistic adults in the UK and investigates characteristics that may be predictive of QoL. A total of 370 autistic adults from the Adult Autism Spectrum Cohort-UK (ASC-UK) completed the WHOQoL-BREF, and the Social Responsiveness Scale (SRS, autism symptom severity), along with the ASC-UK registration questionnaire giving information on mental health and their life situation. QoL for autistic adults was lower than for the general population for each WHOQoL domain. Younger participants reported higher QoL than older participants in psychological and environment domains. Males reported higher physical QoL than females, and females reported higher social QoL than males. Significant positive predictors of QoL were: being employed (physical QoL), receiving support (social and environment QoL), and being in a relationship (social QoL). Having a mental health condition and higher SRS total score were negative predictors of QoL across all four domains. Autistic adults require access to effective mental health interventions, and informal and formal support for their social difficulties, to improve their quality of life. Autism Res 2018, 11: 1138-1147. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. LAY SUMMARY: There has been limited research into the lived experience of autistic adults. Using the World Health Organization quality of life measure, we found that autistic people (370) in the UK reported their quality of life to be lower than that of the general population. Better quality of life was associated with being in a relationship; those with a mental health condition had poorer quality of life. This research suggests some ways in which autistic people can be helped to improve their quality of life.

Describing heterogeneity of unmet needs among adults with a developmental disability: An examination of the 2012 Canadian Survey on Disability

BACKGROUND

As a signatory to the UN Convention on the Rights of Persons with Disabilities, Canada has committed to protect the rights and dignity of persons with developmental disabilities (DD), which means that labour markets, education, and training opportunities should be inclusive and accessible.

PURPOSE

Describe the unmet employment, education and daily needs of adults with DD, with a sub analysis of persons with autism spectrum disorder (ASD) and cerebral palsy (CP) in Canada, to inform efficient and equitable policy development.

METHODS AND PROCEDURES

Secondary analysis of 2012 Canadian Survey on Disability was used to study a sample including working age (15-64 years old) individuals with self-reported DD, CP and ASD. Persons with DD reported on their met and unmet needs in term of activities of daily living, education and employment.

OUTCOMES AND RESULTS

Labour force participation is the lowest for those with DD compared to any other disability. Individuals with CP and ASD report a high level of unmet needs that differ in terms of educational, vocational and daily living supports.

CONCLUSIONS AND IMPLICATIONS

Improving labour force participation to be inclusive and accessible requires policy that considers the range of unmet needs that exist for persons with DD.

Use of video modelling to teach complex and meaningful job skills to an adult with autism spectrum disorder

OBJECTIVE

To examine the effectiveness of a video modelling (VM) intervention to teach job-related telephone skills to an adult with Autism Spectrum Disorder (ASD).

METHODS

A multiple baseline design across four telephone-relevant behaviours was used to assess the effects of the intervention on the participant's ability to respond to telephone calls.

RESULTS

Use of the VM intervention led to immediate improvements in listening and responding to both orders and complaints; more gradual improvements were also observed in the participant's professional speech. All skill increases were maintained at follow-up.

CONCLUSION

VM may be an effective method of teaching complex vocational skills to adults with ASD, although a stronger focus on social skills may be warranted in the future.