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2013, 2015) have reviewed the literature on interventions targeting employment for individuals with ASD, this review is outdated and does not account for recent developments in the field.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 Unpublished dissertations and theses were also identified through database searches.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.

A Self-Determination Theory Approach to Work Motivation of Autistic Adults: A Qualitative Exploratory Study

The study explores work motivation of autistic adults through the lens of Self-Determination Theory (SDT). Twelve autistic employees (ages 28–47; 3 females) participated in semi-structured qualitative interviews about their work experience. Analysis combined inductive and deductive approaches, identifying motivational themes emerging from the interviews, and analyzing them according to SDT concepts. Two major themes emerged: (1) work motivation factors positioned on the self-determination continuum: income and self-reliance; a daily routine; social/familial internalized norms; meaning and contribution; and job interest; and (2) satisfaction of psychological needs at work, postulated by SDT: competence, social-relatedness, and autonomy and structure. Findings are discussed in relation to current literature, and practical applications are suggested for meeting the motivational needs of autistic employees and promoting employment stability.

Autism at work: How internal and external factors influence employee outcomes and firm performance

Research and the popular press have provided confusing perspectives concerning the strategic integration of autistic individuals into organizations; some touting the benefits of a neurodiverse workforce and others noting the difficulty that many autistic individuals face in finding and maintaining employment. In this article, we examine these disparate views and build a reconciling framework that incorporates both the internal support that top management teams show for the integration of autistic individuals and the external visibility that can lead to their firm’s social approval. In turn, the combination of these internal and external perspectives contributes to explaining an organization’s ability to gain competitive advantage from hiring and managing autistic individuals. The proposed framework is augmented by vignettes, providing practitioners with takeaways for how to approach the topic of neurodiversity more successfully.

Critical Reflections on Employment Among Autistic Adults

Encouraging efforts have emerged in recent years to study and build employment opportunities for adults on the autism spectrum. In this Perspectives piece, we acknowledge this important work while offering critical reflections for consideration as the field of employment in autism advances. We call for five areas of increased focus: (1) nurturing long-term versus short-term employment success; (2) broadening employment readiness efforts beyond only the individual to the entire community employment ecosystem; (3) providing professional development that starts with an individual's strengths, and not with their disability; (4) building community employment support that can be independent of family support; and (5) striving for a good life versus just the next job. Overall, we aim to help galvanize the field toward greater consideration of individuals' quality of life and development, the broader community ecosystem around individuals and their families, and vocational stability over the life course, all on individuals' own terms.

Lay summary

Why is this topic important?: Despite encouraging international efforts for the past 15 years to advance employment for autistic adults, a low percentage of autistic adults are employed at any given point in time. Moreover, research shows that some who are employed struggle in their work situations.What is the purpose of this article?: Our goal is to begin a conversation about what we believe to be promising areas of future focus in advancing employment for autistic adults. We hope that autistic adults and their families, practitioners, researchers, and policy makers find these reflections useful as we work together toward better employment options for adults on the autism spectrum.What is the perspective of the authors?: As advocates, practitioners, researchers, and as a family member for one of us, we believe it is time to look beyond employment statistics and a historically short-term focus on employment. We would like to see a reorientation of our collective energies toward a longer-term view of employment that contributes to a good life for individuals, on their terms.What is already known about this topic?: Over the last 15 years, many employment advancement programs for autistic adults have shown promising results. We have seen positive impacts from evaluations of these programs that include improved skills, more hiring of autistic individuals, shifting employer attitudes, more inclusive work environments, and high levels of productivity among hired autistic adults. We also have increased our understanding about the characteristics of supportive work environments for autistic people. That said, we also know that there are continuing low levels of employment for autistic adults. Furthermore, whereas there are some successful stories of autistic adults gaining employment, there are also, as noted earlier, stories of adults who are struggling in the workplace, with some in low-paying jobs and not able to use their skills.What do the authors recommend?: We recommend five shifts in focus for the future: (1) nurture long-term rather than short-term employment success; (2) seek community-wide programming to support people on an ongoing basis, as opposed to a more narrow focus on individual-level job readiness; (3) provide professional development that starts with an individual's strengths, and not with their disability; (4) develop more comprehensive and accessible community resources instead of relying on families to offset community service gaps; and (5) uphold the goal of having a good life on one's own terms instead of only getting a job.How will these recommendations help autistic adults now or in the future?: We hope that these recommendations help spark new conversations and collective approaches toward improving the employment landscape for autistic individuals. These approaches would move beyond a short-term job focus and individual-level readiness programming to also build supportive community ecosystems around individuals over time. In this way, we hope that individuals can more easily achieve employment over the long term that both works for them and contributes to the important and overarching aim of quality of life.

A Conflict of Interests: A Motivational Perspective on Special Interests and Employment Success of Adults with ASD

A course of action often suggested in an attempt to improve employment outcomes of adults with autism spectrum disorder, is to match between special interests and job opportunities. In this commentary, we propose that the match may be more complicated than it seems, possibly overseeing more pressing employment needs that should be answered such as: the job's characteristics, labor market demands, and stress resulting from job expectations. Self determination theory of motivation is suggested as a lens through which the association between special interests and a paying job can be examined, highlighting important considerations that hold the potential to increase employment success. Recommendations for new research directions and vocational rehabilitation practice are discussed.

Gender matters in career exploration and job-seeking among adults with autism spectrum disorder: evidence from an online community

Purpose: The purpose of this study was to explore the role of gender in career exploration and job-seeking experiences among adults with autism.Methods: The study drew on qualitative content analysis of 714 randomly sampled posts (357 by women and 357 by men) from an online autism forum. The stages of considering work: contemplation, preparation, and action informed the analysis.Results: The analysis showed several similarities and some differences. In the initial stage of deciding whether or not to seek employment, low self-esteem, rejecting paid employment as a life goal, fear of losing disability benefits and parental overprotection influenced both genders. Gender role and family responsibilities further constrained women. In the stage of defining career goals, common issues included the need for autism-tailored career-matching tools and sector-specific guidance, and lack of self-employment support. Women were further limited by assumptions about stereotypical jobs to which they should aspire. In the job search stage, overly specific job descriptions, a lack of social networks, and transportation barriers influenced both genders. While women talked more frequently about unfavorable experiences in employment support services, men recounted more difficulties with job applications and interviews.Conclusion: Gender-sensitive vocational approaches are needed to assist adults with autism throughout the career decision-making process.Implications for rehabilitationVocational psychologists, clinicians, and policymakers should help to overcome the psychological, social, and financial reasons that may lead adults with autism to decide not to pursue paid work.To assist in setting career goals, vocational specialists need to be aware of the challenges facing adults with autism across various employment sectors and provide them with tailored career-matching tests and tools.Vocational rehabilitation specialists and educators should encourage women with autism into non-traditional areas of employment.Vocational rehabilitation services should empower both males and females with autism by encouraging negotiation and self-advocacy, promoting autism-focused programs, and reducing paperwork and processing time.Vocational rehabilitation specialists should tailor their practice to the gender-specific needs of adults with autism throughout their career decision-making process.

#Trending topics in careers: a review and future research agenda

Purpose

Virtually all contemporary scientific papers studying careers emphasize its changing nature. Indeed, careers have been changing during recent decades, for example becoming more complex and unpredictable. Furthermore, hallmarks of the new career – such as individual agency – are clearly increasing in importance in today’s labor market. This led the authors to ask the question of whether these changes are actually visible in the topics that career scholars research. In other words, the purpose of this paper is to discover the trending topics in careers.

Design/methodology/approach

To achieve this goal, the authors analyzed all published papers from four core career journals (i.e. Career Development International, Career Development Quarterly, Journal of Career Assessment, and Journal of Career Development) between 2012 and 2016. Using a five-step procedure involving three researchers, the authors formulated the 16 most trending topics.

Findings

Some traditional career topics are still quite popular today (e.g. career success as the #1 trending topic), whereas other topics have emerged during recent years (e.g. employability as the #3 trending topic). In addition, some topics that are closely related to career research – such as unemployment and job search – surprisingly turned out not to be a trending topic.

Originality/value

In reviewing all published papers in CDI, CDQ, JCA, and JCD between 2012 and 2016, the authors provide a unique overview of currently trending topics, and the authors compare this to the overall discourse on careers. In addition, the authors formulate key questions for future research.