Predictors for work participation in individuals with an Autism spectrum disorder: a systematic review

The Autism Constellation and Neurodiversity: Long-Term and Adult Outcomes in Autism Spectrum Disorder

Research on autistic adults suggests significant heterogeneity in outcomes. A significant proportion of individuals struggle with intellectual disability and limited communication skills. Of the 67% who have age-appropriate cognitive skills, around half are expected to attain a college education, and 25% are likely to hold a full-time job. Outcomes have been improving over time, in part because of earlier diagnosis and earlier intervention. Indeed, an estimated 10% to 20% are expected to lose all symptoms of autism by adolescence.

"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.

Influence of parental education on the intelligence quotient profiles and socially adaptive behavior of school-age children with autism spectrum disorder in eastern China

Intelligence quotient (IQ) and adaptive behavior are the influencing factors of autism spectrum disorder (ASD) in children entering mainstream schools. This study explored the association between parental education level, IQ, and adaptive behavior in ASD groups. A total of 257 school-age ASD children were enrolled in our study from January 2017 to June 2021. Their parents completed a standard demographic form, including age at autism diagnosis, gender, school placement, and parents' educational background. The Chinese version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) was completed by a certified assessor for each enrolled child. Parents were interviewed on adaptive behavior using the Chinese version of the Adaptive Behavior Assessment System, Second Edition (ABAS-II). The average IQ of school-age ASD children was 76.88 (standard deviation (SD)=22.62) and boys had higher IQ levels than girls. The IQ was positively correlated with age. The General Adaptive Composite (GAC) score was 82.47 (SD=15.86) and adaptive behavior did not increase with age. ASD children who attended mainstream schools had better adaptive behavior profiles than other children. The mother's education level showed a significant correlation with the IQ and adaptive behavior of autistic children, while the father's education level did not. Consequently, better training and support for parents may help autistic children enter mainstream schools, with adaptive training being the most urgently required skill for parents.

Understanding the prospective associations between neuro-developmental problems, bullying victimization, and mental health: Lessons from a longitudinal study of institutional deprivation

Studies suggest that children who have experienced neglect are at risk for bullying which in turn increases the risk for poor mental health. Here we extend this research by examining whether this risk extends to the neglect associated with severe institutional deprivation and then testing the extent to which these effects are mediated by prior deprivation-related neuro-developmental problems such as symptoms of inattention, hyperactivity and autism. Data were collected at ages 6, 11, 15, and young adulthood (22-25 years) from 165 adoptees who experienced up to 43 months of deprivation in Romanian Orphanages in 1980s and 52 non-deprived UK adoptees (N = 217; 50.23% females). Deprivation was associated with elevated levels of bullying and neuro-developmental symptoms at ages 6 through 15 and young adult depression and anxiety. Paths from deprivation to poor adult mental health were mediated via cross-lagged effects from earlier neuro-developmental problems to later bullying. Findings evidence how deep-seated neuro-developmental impacts of institutional deprivation can cascade across development to impact social functioning and mental health. These results elucidate cascade timing and the association between early deprivation and later bullying victimization across childhood and adolescence.

Employment profiles of autistic people: An 8-year longitudinal study

LAY ABSTRACT

Autistic adults experience difficulties finding and keeping employment. However, research investigating reasons that might explain this difficulty produce mixed results. We gave a survey to 2449 autistic adults and used a statistic method to group them based on their employment status over 8 years. We identified four employment groups that best captured the experiences of autistic adults; this included a group that experienced stable unemployment, a group that experienced stable employment, a group that had high employment that reduced over time, and a group whose employment increased over the 8 years. Further analysis showed that those with fewer autistic traits, younger age, male gender, higher education, later diagnosis age and no co-occurring conditions were more likely to have stable employment. People whose employment changed over time were more likely to have a higher level of education than the stable unemployment group, and those in the increasing employment group were younger age and had no co-occurring conditions. These findings help us better understand that not all autistic adults' experiences of employment are the same, which helps focus where employment programmes and support may be most needed, for example, people who identify as women or have a co-occurring condition.

Anxiety, depression, and well-being in autistic adults and adults with other developmental disabilities: A longitudinal cross-lagged analysis

Autistic people and people with other developmental disabilities (DD) are at high likelihood for anxiety and depression, which can negatively affect adult life. Therefore, this study sought to understand temporal links between anxiety and depression over time in autistic adults and adults with DDs, and how these conditions impact specific aspects of positive well-being. A sample of 130 adults with autism or other DDs and their caregivers were drawn from a longitudinal study. Participants complete measures of anxiety (Adult Manifest Anxiety Scale), depression (Beck Depression Inventory, 2nd Edition), and well-being (Scales of Psychological Well-Being). Cross-lagged panel analyses revealed significant autoregressive effects for anxiety and depressive symptoms over time, based on both caregiver and self-report (all p < 0.01). Additionally, although findings differed across reporter, cross-lagged links between anxiety and depression emerged over time. Based on caregiver-report, anxiety symptoms predicted later depressive symptoms (p = 0.002) but depressive symptoms did not predict later anxiety (p = 0.10); the opposite pattern was identified for self-report. Aspects of positive well-being (purpose in life, self-acceptance, personal growth) demonstrated differential links with anxiety and depression (p = 0.001-0.53). These findings highlight the utility of a transdiagnostic approach to mental health services for autistic adults and adults with DDs, and the need to monitor for anxious or depressive symptoms in autistic adults and adults with DDs presenting with depression or anxiety, respectively.

Employment Outcomes for People With Autism Spectrum Disorder: A Theory Mapping of the Evidence

Background:People with autism spectrum disorder (ASD) are three to four times less largely to be with employment compared to neurotypical others. Theory based studies may provide helpful indicators for the design and implementation of employment supports for people with ASD.

Objective:This critical review examined the extent of the evidence for theory in studies on employment outcomes for people with ASD and taking into account social inequality. For the evidence, 35 studies were selected for review if they were published in the period 2000–2016 and assessed for the association between work participation with ASD applying descriptive survey or quasi-experimental design.

Methods:Studies were examined for use of any theory, including four predetermined theory types: social liminality, psychosocial, behavioral, and structural-infrastructural. They were also content-analyzed to determine if they cited any evidence of social inequality influences on employment outcomes with ASD.

Findings:Results indicated that none of the studies explicitly applied and tested a theory on work participation with ASD. Rather, the majority of the studies were implicitly framed on predominantly behavioral type theory with minor elements of workplace psychosocial support theory-oriented interventions. Regard of structural-infrastructural type theory addressing social inequality is incidentally addressed by a few of the studies (n= 3) that examined family income status influences.

Conclusion:In conclusion, extant studies on the association between employment outcomes and ASD are seriously limited in their explanatory value by a lack of theoretical grounding. They also neglect influences of antecedent social inequality in employment outcomes with ASD. Future studies should apply specific theory to questions on employment outcomes with ASD to provide usable evidence to inform employment support policy instruments and interventions for people with ASD.

A Meta-Analysis of Video Modeling Interventions to Enhance Job Skills of Autistic Adolescents and Adults

Background

Autistic transition-aged youth and young adults face many societal barriers to competitive integrated employment (CIE). Existing evidence-based practices (EBPs) for autistic individuals, such as video modeling (VM), may be a viable on-the-job training method to enhance employment experiences and outcomes for this population.

Methods

The purpose of this meta-analysis was to synthesize VM studies to teach job skills for autistic individuals. We applied the Council for Exceptional Children's (CEC) Standards for Evidence-Based Practices in Special Education to evaluate the methodological rigor of included studies using a weighted coding scheme. We further evaluated methodologically sound studies by calculating an omnibus Tau-U effect size.

Results

Twenty articles met our inclusion criteria, and 11 of those studies were classified as methodologically sound according to the CEC's criteria. Results indicate that VM is an EBP to improve job skills of autistic individuals. The overall effect size for methodologically sound studies was strong (0.91), but most studies occurred in contrived or school-based employment settings rather than CIE settings in the local labor market.

Conclusions

Employers, transition professionals, and related service providers can consider VM a viable method to teach job skills to autistic employees. However, additional research conducted in CIE settings is needed to better understand the effects of VM in contexts where autistic employees earn regular wages.

Lay summary

Why was this study done?: Autistic adolescents and adults often experience barriers obtaining employment in their local communities. They may also benefit from on-the-job supports for successful employment. Video modeling is one intervention technique that has been used to teach a variety of skills to autistic individuals. Video modeling involves creating short video clips that show the person how to do specific skills or tasks. We wanted to learn about how video modeling has been used to teach job skills to autistic employees.What was the purpose of this study?: The purpose of this study was to evaluate the quality of research studies that used video modeling to teach job skills to autistic employees. Understanding how video modeling interventions can be used in employment settings may help autistic employees have more positive work experiences.What did the researchers do?: The researchers analyzed the video modeling research studies with autistic participants aged 14 years or older. We evaluated the quality of each study, type of employment setting, type of job skill, and how much the job skills improved. We used a criteria established by a professional organization, the Council for Exceptional Children, to evaluate the quality of the research studies.What were the results of the study?: We analyzed 20 research studies and found that video modeling was an overall effective intervention to teach job skills to autistic adolescents and adults. However, most of the studies focused on general job tasks rather than employment-related social skills. In addition, most of the studies were conducted in employment settings where the autistic employees did not earn regular wages, such as school settings or internships. We encourage future researchers to study how video modeling can be used to promote competitive integrated employment in community settings.What do these findings add to what was already known?: Prior research studies have used video modeling to teach skills such as academic, play, and social skills to autistic children and youth. This study showed us that video modeling is an effective intervention to teach job skills to autistic adolescents and adults.What are the potential weaknesses of the study?: There are disagreements about how to evaluate the quality of research studies in the field of special education. We used a popular criterion by the Council for Exceptional Children organization, but our results may be different from other researchers. We also did not find a large number of studies, so some of our findings should be considered with caution.How will these findings help autistic adults now or in the future?: These findings demonstrate that video modeling is an effective on-the-job training method for autistic employees. Autistic adults can use video modeling at work to learn new job skills. Employers, job coaches, and secondary transition professionals could use brief videos to support autistic employees.

Employment profiles of autistic adults in Australia

Autistic adults experience a high number of job changes, reduced working hours, minimal workplace supports, and overrepresentation in entry-level and low paid positions. This study adds to the existing evidence base to guide clinical decisions and interventions for this population. This study utilized baseline data collected between 2015 and 2017 from the Autism CRC's Australian Longitudinal Study of Autism in Adulthood. The aim was to describe the employment profiles and explore factors related to employment for Australian autistic adults aged 25 and older (N = 149). Comparisons between participants and the Australian workforce were made using Australian Bureau of Statistics (ABS) data. Two logistic regression models were conducted to explore the association between underemployment and underutilisation with personal and environmental factors. In comparison to the Australian workforce, autistic adults were more likely to work part-time, work reduced hours and be employed at skill levels lower than their qualifications warranted. Logistic regressions reported that more autistic traits, more social supports and having workplace adjustments implemented were significantly associated with a higher odds of autistic adults being appropriately employed and/or utilized in the workforce. Results suggest that interventions implementing appropriate workplace adjustments, a supportive workplace environment, and adequate social supports may improve employment outcomes for autistic adults. All employees may benefit from workplace resources targeted toward fostering an inclusive workplace environment. LAY SUMMARY: This study aimed to describe the employment profiles and explore factors related to employment for Australian autistic adults. We compared this with the Australian workforce using data from the Australian Bureau of Statistics. Autistic adults with more autistic traits and more social and workplace supports were more likely to be employed and have jobs that were better suited to them. Autistic adults might have better employment outcomes if they have the appropriate workplace adjustments, a supportive workplace and adequate social supports.

Visual Detection and Decoding Skills of Aerial Photography by Adults with Autism Spectrum Disorder (ASD)

Despite challenges in social communication skills people with ASD often display strengths in visual processing. Aerial photography analysis is an occupation reliant on strong visual processing skills that matches this unique profile. We investigated basic-vision and "real-life" visual tasks in 20 cognitively-able young adults with ASD and 20 typically-developed (TD) "gamers". Basic-vision tests included Visual-Search, Embedded-Figures, and Vigilance; "real-life" tests included aerial-photograph detection and identification. Groups performed equally well, and did not differ significantly on any tasks. The study demonstrates strong visual skills in people with ASD in basic and "real-life" settings, and supports the idea that they may be well suited for employment in occupations that demand high visual perception skills such as aerial photography analysis.

Video Modeling Use in Work Occupations for People With Autism: A Systematic Review

IMPORTANCE

Occupational therapy practitioners should use evidence-based practices, such as video modeling, to address work occupations supporting people with autism spectrum disorder, including those with co-occurring intellectual and developmental disabilities.

OBJECTIVE

To examine the evidence and relevance of video modeling supporting engagement in work occupations for people with autism and to translate these findings to occupational therapy practice.

DATA SOURCES

Cochrane Collection Plus, CINAHL, PubMed, ERIC, ProQuest, and peer-reviewed occupational therapy literature from 2008 to 2018. Study Selection and Data Collection: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study selection and data collection focused on occupational therapy scope of practice, autism spectrum disorder, co-occurring intellectual and developmental disabilities, video modeling, and work occupations for people age 16 yr and older.

FINDINGS

A total of 464 articles were screened. Six articles met inclusion criteria. Results indicated moderate evidence for video modeling to support work occupations for people with autism, specifically employment seeking and acquisition and specific job-performance skills. Samples were limited to people younger than age 28 yr and represented varied intellectual abilities, indicating potential for benefits across the spectrum of cognitive functioning.

CONCLUSIONS AND RELEVANCE

This systematic review highlights the promising potential of video modeling to address work occupations for people with autism. However, more rigorous effectiveness research is needed, including studies by occupational therapy practitioners. What This Article Adds: Occupational therapy expertise paired with video modeling, as a strengths-based, client-centered, customizable, socially acceptable intervention, can provide meaningful support for work occupations.

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.

Identifying School-Based Factors that Predict Employment Outcomes for Transition-Age Youth with Autism Spectrum Disorder

There is a growing need to provide appropriate services to help students with autism spectrum disorder (ASD) transition to employment. Limited research has investigated what aspects of support should be prioritized when preparing youth with ASD for employment. By conducting structural equation modeling using a nationally-representative dataset on high school students receiving special education services (NLTS-2), this study examined the malleable predictors of employment during the transition and developed a model to examine the relationships between predictors and employment outcomes. The findings suggested two pathways for youth with ASD. For youth with higher daily functioning skills (DFS), academic performance mediated the relationship between parent participation and employment. For youth with lower DFS, school-based transition supports was the key mediator.

Reconceptualizing Leadership From a Neurodiverse Perspective

While scholarship has increased on the topic of neurodiversity in organizations, which refers to individuals with pervasive developmental disorders in the workforce, leadership theory and research has not yet integrated this perspective. Consistent with conventional conceptualizations of disability as an impairment, the few relevant leadership studies tend to approach these differences as special cases, rather than as a population to which theory may be generalized. As a result, management scholars have yet to develop theories and models that are inclusive of neurodiversity. Using the critical disability theory as a lens for reframing assumptions about leadership behavior as described in existing theory and research, we postulate that neurodiversity may serve as a cognitive strength from which leadership derives. We offer a conceptual model that articulates how cognitive characteristics associated with neurodiversity may lead to task-based leadership behavior, and we trace the influence of such behaviors on leader and follower outcomes. The model also includes enabling conditions that may positively influence the emergence and recognition of neurodiverse individuals as leaders. We conclude by proposing directions for future research to better integrate the neurodiversity and leadership literatures and reflecting on the associated practical implications.

Autism Spectrum Disorder from the Womb to Adulthood: Suggestions for a Paradigm Shift

The wide spectrum of unique needs and strengths of Autism Spectrum Disorders (ASD) is a challenge for the worldwide healthcare system. With the plethora of information from research, a common thread is required to conceptualize an exhaustive pathogenetic paradigm. The epidemiological and clinical findings in ASD cannot be explained by the traditional linear genetic model, hence the need to move towards a more fluid conception, integrating genetics, environment, and epigenetics as a whole. The embryo-fetal period and the first two years of life (the so-called 'First 1000 Days') are the crucial time window for neurodevelopment. In particular, the interplay and the vicious loop between immune activation, gut dysbiosis, and mitochondrial impairment/oxidative stress significantly affects neurodevelopment during pregnancy and undermines the health of ASD people throughout life. Consequently, the most effective intervention in ASD is expected by primary prevention aimed at pregnancy and at early control of the main effector molecular pathways. We will reason here on a comprehensive and exhaustive pathogenetic paradigm in ASD, viewed not just as a theoretical issue, but as a tool to provide suggestions for effective preventive strategies and personalized, dynamic (from womb to adulthood), systemic, and interdisciplinary healthcare approach.

Empirical evaluation of the association between daily living skills of adults with autism and parental caregiver burden

BACKGROUND

Despite the joy of parenting, the burden of daily caregiving for children with autism spectrum disorders (ASD) can be overwhelming and constant. Parents can expect to provide enduring care for their children with ASD. Given that the majority of individuals with autism spectrum disorders (ASD) remain in their family homes well into adulthood, often the need for assistance with activities of daily living (ADLs) is placed on parents. Providing ongoing support to adult children who have difficulty with completing ADLs can increase parental caregiving demands. Therefore, the purpose of this study was to examine the relationship between the ability of adults with ASD to perform ADLs with parental perceptions of caregiver burden.

METHODS

Quantitative analysis of cross-sectional multi-state data gathered electronically using Qualtrics from 320 aging parents of adults with ASD was conducted. Regression models were fit to examine the association of ADL challenges with total caregiver burden and its four domains (emotional, financial, time dependence, and developmental).

RESULTS

Parental perceptions of caregiver burden decreased, particularly time dependence and developmental burden, when adult children were less dependent in ADLs, even after adjusting for parental health and behavioral challenges.

CONCLUSIONS

Findings support the need for family-centered interventions to improve the capacity of adults with ASD to perform ADLs independently.

Evaluation of a Transition to University Programme for Students with Autism Spectrum Disorder

Applying to university can be an anxiety-provoking time for many autistic students, though enrolment can be increased by actively involving them in transition planning. We provide an evaluation of a transition to university pilot programme (Autism Summer School) for autistic students (16–19 years) who are seeking to apply/attend university. The content focused on introducing students to various aspects of university life including academic (sample lectures), social (e.g., clubs and societies), and daily living (eating in university canteen and staying in student accommodation). Students’ quantitative and qualitative feedback are positive and promising, showing significant reduction across a range of concerns related to transition to university after the programme, as well as general optimism related to starting university.

Dual perspectives in autism spectrum disorders and employment: Toward a better fit in the workplace

BACKGROUND

Compared with people with other disabilities, individuals with autism spectrum disorder (ASD) have the lowest rates of employment and switch jobs at a higher frequency. Thus, understanding how to support workplace success for people with ASD is important.

OBJECTIVE

Grounded in an ecological conceptual model, this study explores the dual employment perspectives of adults with ASD and supervisors who worked with individuals with ASD.

METHODS

Using participatory research methods, a purposive sample of ten adults with ASD (all verbal with high school diplomas) and ten supervisors participated in semi-structured interviews on employment experiences. Qualitative analyses were used to identify themes.

RESULTS

Four major themes emerged from an ecological framework to create a strong person-environment fit in the workplace: 1) building on interest/experiences/strengths/skills, 2) reducing social demands, 3) clear communication and expectations, and 4) ASD awareness for work environment. Comparisons between the two groups of participants showed substantive differences in expectations and accommodations.

CONCLUSIONS

Supervisors, although eager to employ individuals with ASD, could benefit by employing an ecological model to successful employment. Results indicate that multiple lenses on the process of employment for those with ASD can lead to better outcomes in the workplace.

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.

Transition Into Adulthood With Autism Spectrum Disorders: A Longitudinal Population Cohort Study of Socioeconomic Outcomes

This longitudinal population cohort study tracks the transition of 1,405 adolescents with autism spectrum disorders (ASDs) into adulthood, and highlights functional and social skills as core predictors of social outcomes (tertiary education, civic volunteering, and employment). Applying regression methods with sample selectivity to administrative data records obtained from Israel’s National Insurance Institute, we show that these outcomes are not highly correlated, suggesting that the high/low functioning dichotomy frequently used to categorize individuals with ASD is not supported by these data. We show that there is no causal relation between civic volunteering at an earlier stage and subsequent participation in tertiary education. This suggests that the traditional sequential model of developmental disability does not apply to ASD, and that the social-functional model of disability seems more applicable. We also show that functional and social severity vary inversely with year of diagnosis, due probably to the application of more liberal diagnostic standards. Disability among successive birth cohorts has been decreasing and is expected to decrease further in the future. Parents’ income has only a modest beneficial association with the transition into adulthood, and socioeconomic environments have no effect at all. Findings are discussed with respect to policy and practice.

Adult neurodevelopmental services in Singapore: A sociodemographic and clinical profile at a tertiary psychiatric hospital

INTRODUCTION

The Adult Neurodevelopmental Service in Singapore is the first service of its kind in South-East Asia for adults with intellectual disability (ID) and/or autism spectrum disorder (ASD). However, few studies have documented and compared the sociodemographic characteristics and clinical needs of this subpopulation group.

METHODS

Initial assessments conducted from 1 January 2015 to 31 December 2016 were retrospectively reviewed for this descriptive study.

RESULTS

A total of 272 patients were included in the study (mean age 28.3 ± 11.5; 200 males, 72 females). Adults with ID comprised the largest percentage (52.9%), followed by those with ASD (30.2%), and then those with co-occurring ASD and ID (16.9%). The ASD subgroup had the highest proportion of individuals with employment, postsecondary school education, functional capabilities, and a psychiatric disorder. In comparison, adults with only ID and adults with co-occurring ASD and ID shared similar lower levels of education and employment, and had a higher proportion of individuals with epilepsy and aggressive behavior.

DISCUSSION

In this study, adults with ASD had a unique social profile with different clinical needs compared to adults with only ID or to adults with co-occurring ASD and ID. Adults with only ID and those with co-occurring ASD shared many of the same social characteristics and high clinical needs. The analysis of these profiles will be useful in developing services that better meet the needs of this complex group.

“What should I say to my employer… if anything?”- My disability disclosure dilemma

Purpose

The purpose of this paper is to explore the key issues surrounding teacher/staff disability disclosures in the UK's further education (FE) sector.

Design/methodology/approach

In total, 15 semi-structured interviews were conducted in a medium-sized FE college (case study) setting in the South East of England. To compare the experiences, views and perceptions of leaders, managers and teachers, interviews were carried out with leaders and managers who are accountable for ensuring disability legislation is adhered to, and with teachers who are responsible for complying with equality and disability legislation. The 15 interviewees who volunteered to take part in this research represent the various layers of the organisational structure and different academic departments in the college.

Findings

Two major themes discussed include: the desire for teaching staff to “come out” and make a disability disclosure and the perception of disability as a “deficit”. A number of staff that disclosed their hidden disabilities stated they would not do so again. To avoid the negative side effects, developing a “culture of disability disclosure” and providing long-term employer support are required.

Research limitations/implications

This is an exploratory qualitative case study that highlights some of the key issues from a teacher/staff perspective. It is not meant to be generalisable research, but the ideas therein should help to develop a wider (empirical) research agenda.

Originality/value

There is an abundance of critical and sociological research concerning disability disclosure in general; there are also a number of scholarly studies that focus on disability issues from the student perspective. However, this is the first scholarly study that explores the key issues involving FE staff.

Targeting IEP Social Goals for Children with Autism in an Inclusive Summer Camp

Children with autism spectrum disorder demonstrate challenges in socialization that can interfere with their participation in common childhood activities and can persist or worsen if not addressed. The purpose of this study was to assess whether individualized education program (IEP) social goals could be targeted by a supervised paraprofessional during a short-term inclusive summer camp program. Data were collected using a concurrent multiple baseline design across four children. Results showed that following a 2-week summer camp program all participants made social improvements, reaching their year-long IEP goals, that maintained at follow-up in natural environments. Further, the paraprofessionals reached fidelity of implementation. Findings are discussed in terms of the value and feasibility of providing social interventions in inclusive summer camps.

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.

The quality of life and the future of young adults with Asperger syndrome

Purpose: This pilot study describes the socio-professional development and quality of life of young adults with Asperger syndrome in France.Methods: Those young adults, between 18 and 30 years old, receiving care in a child psychiatry department for autistic spectrum disorder, were requested to respond to the Ad Hoc, World Health Organization Quality Of Life - Bref and Copenhagen psychosocial questionnaires regarding their socio-professional background and feelings about their future.Results: Of the 79 eligible subjects, 24 were selected to participate in our study. Their average age at the time of the pilot study was 22.2 years (standard deviation 3.4 years), and their average age when they were diagnosed was 17.5 years (standard deviation 3.7 years.). There were 54% who reported a psychiatric comorbidity anxiety disorder. Half stated they had completed secondary school and benefitted from being professionally employed. During this study, only six were employed, while the others remained financially dependent on their parents. The group's quality of life self-assessment scores were significantly lower compared to the French general population in overall psychology (43.6 versus 68.7) and social relationships (48.9 versus 76.5). However, the study's participants perceived work as an important means to their personal development. Hence, in order to cope with their difficulties, they hoped to benefit from customized support adapted to their autistic disorder and for their workplace colleagues to be better informed about Asperger syndrome.Conclusions: Our results are in line with international data. Additional studies need to be done in order to determine socio-professional integration factors and, in particular, the integration of potential contributions by occupational health departments with those social and medical teams supporting these young adults.Implications for rehabilitationYoung adults with Asperger syndrome benefit from the support of their family in determining their professional goals.Support may be required to enhance social and communicative abilities to help integration.Employees would benefit from information on the syndrome and how best to support.

‘Sometimes you just need someone to take a chance on you’: An internship programme for autistic graduates at Deutsche Bank, UK

Autistic individuals often face significant challenges to obtaining and maintaining meaningful employment – more so than other disability groups. Work placements appear to be an important step to promote employment outcomes, yet there remains a lack of knowledge about the real-life experiences of those involved in such schemes. This study is the first to take a multi-informant, longitudinal approach to examine corporate work-placement schemes: specifically, an internship for autistic graduates at Deutsche Bank, UK. Semi-structured interviews were carried out with interns, their hiring managers and the colleagues who worked alongside them. Results demonstrated positive, meaningful experiences for the majority of those involved, however, some interns also reported anxiety, difficulties in judging communication and confusion regarding office rules. The current findings contribute to a better understanding of the experiences of skilled autistic individuals in work, and should inform the creation of subsequent programmes aimed to promote employment opportunities for autistic people.

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.

Community Mental Health Services for Autistic Adults: Good News and Bad News

Many autistic adults experience psychiatric conditions such as anxiety and depression. However, autistic adults often do not receive effective and affordable mental health (MH) treatment. Untreated psychiatric conditions in autistic adults are associated with a host of negative outcomes, including adaptive functioning impairments, difficulties with employment and independent living, and poor quality of life. The purpose of this Perspectives piece is to shed light on the current state of community MH services in the United States for autistic adults with co-occurring psychiatric conditions. Drawing on the available research and clinical experiences, we aim to (1) highlight positive developments in community mental healthcare for autistic adults; (2) summarize the barriers that continue to exist for autistic adults in need of MH services; and (3) provide recommendations for autistic adults and their families, community MH clinicians, and MH systems administrators to consider. Significant work is needed to provide autistic adults with affordable quality MH services. This Perspectives piece presents a summary of the needed changes and specific methods to continue to improve community MH services for autistic adults.

Employment status is related to sleep problems in adults with autism spectrum disorder and no comorbid intellectual impairment

Both sleep problems and unemployment are common in adults with autism spectrum disorder; however, little research has explored this relationship in this population. This study aimed to explore factors that may be associated with the presence of an International Classification of Sleep Disorders–Third Edition defined sleep disorder in adults with autism spectrum disorder (IQ > 80). A total of 36 adults with autism spectrum disorder and 36 controls were included in the study. Participants completed a 14-day actigraphy assessment and questionnaire battery. Overall, 20 adults with autism spectrum disorder met the International Classification of Sleep Disorders–Third Edition criteria for insomnia and/or a circadian rhythm sleep-wake disorder, while only 4 controls met criteria for these disorders. Adults with autism spectrum disorder and an International Classification of Sleep Disorders–Third Edition sleep disorder had higher scores on the Pittsburgh Sleep Quality Index and were more likely to be unemployed compared to adults with autism spectrum disorder and no sleep disorder. The findings demonstrate, for the first time, that sleep problems are associated with unemployment in adults with autism spectrum disorder. Further research exploring the direction of this effect is required; sleep problems that have developed during adolescence make attainment of employment for those with autism spectrum disorder difficult, or unemployment results in less restrictions required for optimal and appropriate sleep timing.

Types of strain among family members of individuals with autism spectrum disorder across the lifespan

BACKGROUND

Although increased caregiver strain is often found among family caregivers of individuals with autism spectrum disorder, it is still unclear as to how different types of strain relate to amount and types of caregiving across the lifespan.

AIMS

The present study examined different types of strain (i.e. subjective internalized strain, subjective externalized strain, and objective strain) and how such strain relates to the amount of caregiving responsibilities.

METHODS

Data was collected via online survey from a sample of 193 family caregivers of individuals with ASD from the United States, Canada, and the Republic of Ireland. Participants completed measures of strain and caregiving responsibilities, as well as coping, demographics, and services needed and received by the individual with ASD.

RESULTS

Caregivers reported higher levels of objective strain than subjective, and caregiving responsibility was related to objective and subjective internalized strain. Coping style was strongly correlated with all types of strain, and unmet service needs were significantly related to objective and subjective internalized strain. Caregiving behaviors were only related to objective strain.

CONCLUSION

The present results indicate that, although caregiving responsibility is related to objective and subjective internalized strain, the relationship is perhaps not as strong as the relationship between coping mechanisms and strain. Future research is needed to understand different types of strain and develop strategies to help caregivers.

Factors associated with sustained community employment among adults with autism and co-occurring intellectual disability

Sustaining community employment is a challenge for adults with autism spectrum disorders, especially for those who have co-occurring intellectual disability, but factors contributing to this employment outcome have not been fully evaluated. This study utilized longitudinal data to explore the impact of contextual influences, family factors, and individual characteristics on sustained employment over approximately 18 months ( N = 105). Very few adults with autism spectrum disorder and intellectual disability achieved sustained employment (14.3%). The results indicated that more independent daily living skills, a higher family income, a larger maternal social network, an inclusive school environment in early childhood, and currently living in an area with a larger population size were associated with significantly greater odds of sustaining employment. Follow-up analyses suggested that managing personal care is particularly important for employment.

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.

Employment and choice-making for adults with intellectual disability, autism, and down syndrome

BACKGROUND

Adults with disabilities are employed at a significantly lower rate than adults without disabilities. Of adults with disabilities in the workforce, more individuals work in a facility setting rather than a community setting, despite efforts to improve community inclusion. Choice-making has been proposed as a predictive factor for employment for individuals with disabilities.

AIMS

The purpose of this research was to examine the current state of employment for three groups of adults with intellectual disability (ID): individuals with autism spectrum disorder (ASD), individuals with Down syndrome (DS), and individuals with idiopathic ID. Choice-making and its relation to improved employment outcomes was explored.

METHODS

This study used National Core Indicator's Adult Consumer Survey datasets from years 2011-2012 and 2012-2013. Factor analyses revealed latent variables from six choice-making questions in the Adult Consumer Survey. Ordinal logistic regression was used to identify factors related to employment status.

RESULTS

Adults with DS had the highest rates of paid community jobs, but adults with ID had the highest rates of choice-making. ID severity level and short-term choice-making had the greatest effects on employment status in all three groups.

CONCLUSIONS

Employment rates remain low despite national efforts to find jobs for people with disabilities. Choice-making is a unique factor that was found to be associated with employment status and provides a target for interventions to increase employability.

Usability of a video modeling computer application for the vocational training of adolescents with autism spectrum disorder

Introduction

Young adults with autism spectrum disorders often face substantial difficulty finding and retaining paid employment. This study aimed at evaluating the usability of Ready, Set, Work!, a video modeling application for use by adolescents with and without autism spectrum disorders, for participation in the vocational world, and to test whether it can discriminate between these two groups in terms of their response to simulated social dilemmas within vocational contexts.

Method

Twenty adolescents with autism spectrum disorders and 20 typically developing adolescents, aged 16–21 years, were trained to use the application, followed by completion of two usability tools: the Intrinsic Motivation Scale and a relevance questionnaire.

Result

Both groups found the application to be useful and relevant as a job readiness tool. The autism spectrum disorders group had significantly greater difficulty in identifying adaptive and maladaptive responses ( Z = −2.74, p ≤ 0.05) and found the application to be more relevant compared to the control group ( Z = −1.69, p ≤ 0.05).

Conclusion

Ready, Set, Work! appears to have good usability and social validity, suggesting the potential of this computerized video modeling tool to provide support for the acquisition and improvement of social vocational skills in adolescents in general and specifically in those with autism spectrum disorders.

Employment programmes and interventions targeting adults with autism spectrum disorder: A systematic review of the literature

Individuals with autism spectrum disorder face significant challenges entering the workforce; yet research in this area is limited and the issues are poorly understood. In this systematic review, empirical peer-reviewed studies on employment programmes, interventions and employment-related outcomes in individuals with autism spectrum disorder over 18 years with and without intellectual disability were identified and evaluated. The review was prefaced by a summary of previous systematic reviews in the area. Web of Science, Medline, PsychINFO, ERIC and Scopus databases were systematically searched through to October 2015. From 32,829 records identified in the initial search, 10 review and 50 empirical articles, comprising N = 58,134 individuals with autism spectrum disorder, were included in the review. Selected articles were organised into the following themes: employment experiences, employment as a primary outcome, development of workplace skills, non-employment-related outcomes, assessment instruments, employer-focused and economic impact. Empirical studies were limited by poor participant characterisation, small sample size and/or a lack of randomisation and use of appropriate controls. Poor conceptualisation and measurement of outcomes significantly limited study quality and interpretation. Future research will require a multidisciplinary and multifaceted approach to explore employment outcomes on the individual, the family system, co-workers and the employer, along with the impact of individual differences on outcome.

Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autism

The purpose of this study was to develop and investigate an employer-based 9-month intervention for high school youth with autism spectrum disorder to learn job skills and acquire employment. The intervention modified a program titled Project SEARCH and incorporated the use of applied behavior analysis to develop Project SEARCH plus Autism Spectrum Disorder Supports. A randomized clinical trial compared the implementation of Project SEARCH plus Autism Spectrum Disorder Supports with high school special education services as usual. Participants were 49 high-school-aged individuals between the ages of 18 and 21 years diagnosed with an autism spectrum disorder and eligible for supported employment. Students also had to demonstrate independent self-care. At 3 months post-graduation, 90% of the treatment group acquired competitive, part-time employment earning US$9.53-US$10.66 per hour. Furthermore, 87% of those individuals maintained employment at 12 months post-graduation. The control group's employment outcomes were 6% acquiring employment by 3 months post-graduation and 12% acquiring employment by 12 months post-graduation. The positive employment outcomes generated by the treatment group provide evidence that youth with autism spectrum disorder can gain and maintain competitive employment. Additionally, there is evidence that they are able to advance within that time toward more weekly hours worked, while they also displayed increasing independence in the work setting.

Longitudinal Predictors of Outcomes for Adults With Autism Spectrum Disorder

To generate an evidence-based understanding of longitudinal predictors of social outcomes (i.e., employment, social relationships/participation, independent living) of adults with autism spectrum disorder (ASD), we conducted a systematic literature review of publications since 2000. Twelve publications deriving from eight study samples fit inclusion/exclusion criteria for the review. In these publications, statistically significant predictors of social outcomes fell into five categories: (a) personal characteristics, (b) individual functioning, (c) family context, (d) services, and (e) other factors (i.e., peer influence, health status). However, only two studies demonstrated high methodological quality, and only one category of predictors—individual functioning—was identified across multiple study samples. To inform practices for youth with ASD, there remains a need for high-quality outcome research related to adults with ASD to better understand predictors, especially related to environmental factors such as related to the family and services received.

Intelligence May Moderate the Cognitive Profile of Patients with ASD

BACKGROUND

The intelligence of individuals with Autism Spectrum Disorder (ASD) varies considerably. The pattern of cognitive deficits associated with ASD may differ depending on intelligence. We aimed to study the absolute and relative severity of cognitive deficits in participants with ASD in relation to IQ.

METHODS

A total of 274 children (M age = 12.1, 68.6% boys) participated: 30 ASD and 22 controls in the below average Intelligence Quotient (IQ) group (IQ<85), 57 ASD and 54 controls in the average IQ group (85<IQ<115) and 41 ASD and 70 controls in the above average IQ group (IQ>115). Matching for age, sex, Full Scale IQ (FSIQ), Verbal IQ (VIQ), Performance IQ (PIQ) and VIQ-PIQ difference was performed. Speed and accuracy of social cognition, executive functioning, visual pattern recognition and basic processing speed were examined per domain and as a composite score.

RESULTS

The composite score revealed a trend significant IQ by ASD interaction (significant when excluding the average IQ group). In absolute terms, participants with below average IQs performed poorest (regardless of diagnosis). However, in relative terms, above average intelligent participants with ASD showed the most substantial cognitive problems (particularly for social cognition, visual pattern recognition and verbal working memory) since this group differed significantly from the IQ-matched control group (p < .001), whereas this was not the case for below-average intelligence participants with ASD (p = .57).

CONCLUSIONS

In relative terms, cognitive deficits appear somewhat more severe in individuals with ASD and above average IQs compared to the below average IQ patients with ASD. Even though high IQ ASD individuals enjoy a certain protection from their higher IQ, they clearly demonstrate cognitive impairments that may be targeted in clinical assessment and treatment. Conversely, even though in absolute terms ASD patients with below average IQs were clearly more impaired than ASD patients with average to above average IQs, the differences in cognitive functioning between participants with and without ASD on the lower end of the IQ spectrum were less pronounced. Clinically this may imply that cognitive assessment and training of cognitive skills in below average intelligent children with ASD may be a less fruitful endeavour. These findings tentatively suggest that intelligence may act as a moderator in the cognitive presentation of ASD, with qualitatively different cognitive processes affected in patients at the high and low end of the IQ spectrum.