Employment for adults with autism spectrum disorders: A retrospective review of a customized employment approach

Mental health counseling is rated as most helpful by autistic adults: Service perspectives in adulthood

LAY ABSTRACT

The number of autistic adults is growing, but there are fewer services to support them in adulthood. Many autistic adults need some support services to lead successful adult lives. We know a lot about the services autistic adults use and some of the problems with using these services, but we do not know which services are most helpful to them and how the services they use relate to how they interact with their communities. Forty autistic adults took part in a study about service use and community participation. They completed surveys, interviews, and carried a global positioning system tracker. They answered questions about which services are most helpful in adulthood, things that make it hard to use services, and what services they needed. Most participants used two services in the past 2 years, most frequently mental health and employment services. Adults who were currently seeing a mental health counselor were more likely to be working full-time and visit more locations in the community compared to those who were not seeing a counselor. Mental health services were reported as the most helpful service they received as adults, followed by employment services. We often focus on the importance of employment services after high school, but our findings show a need for both mental health and employment services for autistic adults.

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.

Employment Interventions for People With Intellectual and Developmental Disabilities: A Delphi Study of Stakeholder Perspectives

The purpose of this study was to examine the social validity of five different evidence-based and emerging pathways to employment (i.e., supported employment, customized employment, internships, apprenticeships, and postsecondary education) from the perspective of multiple stakeholders. A Delphi method was used to determine whether stakeholders are in consensus regarding the accessibility, affordability, acceptability, efficacy, and the cost-benefit ratio of these interventions. Findings indicated that all pathways were deemed socially valid via stakeholder consensus except for apprenticeships, which could not be determined as a result of limited stakeholder knowledge and experience with the pathway. Future efforts to improve employment outcomes for people with intellectual and developmental disabilities (IDD) should focus on better training for service providers and increased access to services.

Promoting Self-Efficacy of Individuals With Autism in Practicing Social Skills in the Workplace Using Virtual Reality and Physiological Sensors: Mixed Methods Study

BACKGROUND

Individuals with autism often experience heightened anxiety in workplace environments because of challenges in communication and sensory overload. As these experiences can result in negative self-image, promoting their self-efficacy in the workplace is crucial. Virtual reality (VR) systems have emerged as promising tools for enhancing the self-efficacy of individuals with autism in navigating social scenarios, aiding in the identification of anxiety-inducing situations, and preparing for real-world interactions. However, there is limited research exploring the potential of VR to enhance self-efficacy by facilitating an understanding of emotional and physiological states during social skills practice.

OBJECTIVE

This study aims to develop and evaluate a VR system that enabled users to experience simulated work-related social scenarios and reflect on their behavioral and physiological data through data visualizations. We intended to investigate how these data, combined with the simulations, can support individuals with autism in building their self-efficacy in social skills.

METHODS

We developed WorkplaceVR, a comprehensive VR system designed for engagement in simulated work-related social scenarios, supplemented with data-driven reflections of users' behavioral and physiological responses. A within-subject deployment study was subsequently conducted with 14 young adults with autism to examine WorkplaceVR's feasibility. A mixed methods approach was used, compassing pre- and postsystem use assessments of participants' self-efficacy perceptions.

RESULTS

The study results revealed WorkplaceVR's effectiveness in enhancing social skills and self-efficacy among individuals with autism. First, participants exhibited a statistically significant increase in perceived self-efficacy following their engagement with the VR system (P=.02). Second, thematic analysis of the interview data confirmed that the VR system and reflections on the data fostered increased self-awareness among participants about social situations that trigger their anxiety, as well as the behaviors they exhibit during anxious moments. This increased self-awareness prompted the participants to recollect their related experiences in the real world and articulate anxiety management strategies. Furthermore, the insights uncovered motivated participants to engage in self-advocacy, as they wanted to share the insights with others.

CONCLUSIONS

This study highlights the potential of VR simulations enriched with physiological and behavioral sensing as a valuable tool for augmenting self-efficacy in workplace social interactions for individuals with autism. Data reflection facilitated by physiological sensors helped participants with autism become more self-aware of their emotions and behaviors, advocate for their characteristics, and develop positive self-beliefs.

The Efficacy of Disability Employment Service (DES) Providers Working with Autistic Clients

The efficacy of the Australian Disability Employment Services (DES) for autistic jobseekers has not been examined and is currently undergoing Government reform. To help inform the new DES strategy, we sought the views of: 24 autistic individuals; seven family members of autistic individuals, and; 46 DES employees. Data were collected using surveys and interviews. Data were analysed using Mann Whitney tests plus deductive thematic analysis based on Nicholas and colleagues' ecosystems model. Participants highlighted a need to adapt existing policies to enhance flexibility of the DES model. There was participant consensus that DES staff require specific education and training to meet the needs of autistic people. Suggestions to inform the new model of DES for autistic people are made.

Effects of Customized Employment on the Independence of Youth With Intellectual and Developmental Disabilities

Participation in work during school is a known predictor of postsecondary employment for transition-age youth with intellectual and developmental disabilities (IDD). Recent research has demonstrated the benefits of work on skill development in major life domains. The purpose of this study was to examine the impact of customized employment on the support needs of youth with IDD with a significant disability compared to those receiving treatment as usual. Findings indicated significant increases in independence in three specific domains for the treatment group versus control on the Supports Intensity Scale-Adult Version, including Home Living, Employment, and Protection and Advocacy. Findings suggest a therapeutic effect of work activities on growth and development in important life domains. Implications for future research, policy, and practice are discussed.

Perceptions of direct care workers in two sustainable communities on services provided

Currently, outcomes for people with autism and intellectual disabilities are poor, leaving some needing optimal life-long services. Little is known regarding the services provided at sustainable communities. This study's purpose is to explore the make-up of sustainable communities, those participating in them, and the services provided. One survey containing demographic, descriptive, and quality of life questions was sent to sustainable communities. Survey results revealed that the two communities offer similar services, employ similar staff, and have a common central theme throughout their community. However, the two communities carry out services in very different ways. Quantitative results demonstrate participants achieving statistically similar mean quality of life scores. A correlation indicates that as the frequency of services increases, so does the quality of life. This research suggests these two communities deliver services leading to high levels of quality of life. Results should guide future avenues of research. We also make recommendations for sustainable communities and those considering sustainable communities.

Autistic Employees' Technology-Based Workplace Accommodation Preferences Survey-Preliminary Findings

BACKGROUND

There has been an increase in the number of research studies focused on the design of accommodations aimed at improving the well-being and work performance of autistic employees. These accommodations took various forms; some of them were based on modification of management practices, for example, support in the area of effective communication, or involved modifications to the physical working environment aimed at limiting sensory vulnerabilities. Many of these solutions were based on digital technology.

METHODS

This quantitative research aimed to learn about the opinions of the autistic respondents as potential end users and their assessment of the proposed solutions within four main challenge areas: (1) effective communication; (2) time management, task prioritizing, and organization of work; (3) stress management and emotion control; and (4) sensory sensitivities.

RESULTS

Respondents gave the highest ratings to solutions aimed at limiting overstimulation and a flexible approach toward working time, support of a job coach, remote work, and support by allowing electronic-mediated communication based on non-direct contact.

CONCLUSIONS

The results can be the starting point for further research on the highest rated solutions dedicated to improving working conditions and the well-being of autistic employees and can be an inspiration for employers who plan to introduce such solutions.

Toward an understanding of occupational burnout among employees with autism - the Job Demands-Resources theory perspective

This article aims to gain insight into the phenomenon of occupational burnout among employees with autism based on the theoretical framework of the Job Demands-Resources theory and the literature on employees with autism in the workplace. Firstly, we argue that although the resources and demands of the neurotypical and neurodivergent employees might be different, the theoretical mechanism of occupational burnout formation remains similar among the neurotypical and neurodivergent employees, leading to the similar burnout experience. Next, we distinguish key demands that might drain neurodiverse employees' energy, and spark burnout, and propose a set of resources that might foster their achievement of work goals and mitigate demanding working conditions. We emphasise that the nature of job demands/resources that may cause burnout is not universal but might depend on how employees evaluate them, thus neurotypical and neurodiverse workers who evaluate the same work characteristics differently might complement each other, increasing organisational diversity without losing productivity. Our conceptual elaboration contributes to the theory and practice of healthier workplaces by providing tools and inspiration to managers, policymakers, and all stakeholders interested in creating a diverse and productive workplace. Moreover, our work might spark a much needed debate on occupational burnout among employees with autism and encourage conducting further empirical studies.

"[I] don't wanna just be like a cog in the machine": Narratives of autism and skilled employment

LAY ABSTRACT

Autistic people are less likely to be employed than the general population. Autistic people with skilled training (e.g. training for jobs in acting, plumbing, science, or social work) might be even less likely to get a good job in their field. Little is known about the experiences of autistic people in skilled employment or what employment success means to them. We interviewed 45 autistic people with skilled training in a wide range of fields, 11 job supervisors, and 8 topic experts. We asked them about their experiences, what they felt helped them to be successful at work, and what employment success means to them. Participants talked about the high stakes of disclosure, taking unconventional pathways to careers, disconnects with service and support systems, mental health challenges from trauma and burnout, the autistic advantages in the workplace, and complex dimensions of discrimination. Participants said success meant opportunities for growth, good work/life balance, financial independence, sense of community, and feeling valued, accepted, and like their work had meaning. Things that helped them be successful included flexible, accepting workplaces, supportive and respectful supervisors, and direct communication. What we learned suggests that an individualized, wholistic approach to autism employment intervention that considers both employers and employees and employee mental health could be useful. We also recommend more research into disclosure and destigmatizing disability at work.

Intersectional Stigma for Autistic People at Work: A Compound Adverse Impact Effect on Labor Force Participation and Experiences of Belonging

Background

Little research addresses the experiences of autistic people at work, yet employment prospects remain bleak. The extant literature takes a largely remedial perspective and does not focus on harnessing this population's considerable talents. In global organizational practice, several programs purposefully target autistic people for their abilities. However, preliminary evidence suggests that such programs are inadvertently attracting mainly White males, to the exclusion of other demographics. Therefore, stigma surrounding autism at work remains, creating potential compound adverse impacts by marginalizing identities, including gender, race, ethnicity, sexuality, and socioeconomic status. We explored the intersection of autism with other marginalizing identities in the context of work. The research focused on labor force participation for autistic people and, for those in employment, perceptions of exclusion and inclusion. We compared the aforementioned variables by gender identity, racial identity, sexuality, socioeconomic background, and geographic origin.

Methods

We undertook a global cross-sectional survey, advertised through various social media platforms and promoted directly to relevant organizations. The survey included a range of validated measures as well as demographic information. We analyzed the data with frequencies, cross tabulations, chi-square tests, and non-parametric, group-wise comparisons.

Results

We found preliminary evidence of reduced rates of employment participation by race and geographic location. Females and non-binary people had lower perceptions of inclusion and belonging at work. The perception of accommodation provision had a strong association with inclusion and belonging; more so than incidental provision of flexibility in environment and scheduling not framed as a specific accommodation.

Conclusions

The findings highlight the relational aspects of accommodation and a more universal inclusion perspective. We urge practitioners and researchers to monitor employment participation and levels of inclusion/exclusion using intersectional demographic identification. We appeal for cross-cultural collaboration with academic institutions outside the anglosphere to improve our knowledge of global programs and their impact.

Exploring the experiences of individuals living with autism spectrum disorder about their worker role: The South African and Central United States contextual experience

BACKGROUND: Individuals living with autism spectrum disorder (ASD) experience challenges when they enter the open labor market or competitive employment. OBJECTIVE: The aim of the study is to explore the experiences of individuals living with ASD and the perceptions of health therapists with regard to establishing and maintaining the worker role. METHODS: The data was collected through interviews with two groups of participants diagnosed with ASD working in the open market, and key informants from South Africa and central United States of America participated in the study. RESULTS: The data were collected by means of descriptive qualitative research methods and analysed using thematic content analysis. Three themes emerged from the study. Theme one: Facilitation of integration into the workplace after work training; Theme two: A need for client-centred practice in matching the client’s job to their interest; Theme three: Work enables a sense of normality. CONCLUSION: In conclusion the study presented findings that were common among participants in both cities, especially the importance of exercising supported employment and client-centred practice in placing the individual with ASD in the workplace.

How Well Environmental Design Is and Can Be Suited to People with Autism Spectrum Disorder (ASD): A Natural Language Processing Analysis

The quality of life of people diagnosed as having Autistic Spectrum Disorder (ASD) is essential for increasing their self-reliance and reducing their communication problems in order to allow them to work, take care of themselves, and develop a capacity to intercommunicate with their surroundings. Their need to organize their day-to-day and workplace surroundings has been addressed in the literature via long-term intervention programs aimed to imbue people with ASD with interpersonal communication capabilities. Yet, there is still a gap in the literature regarding new design methods aimed at creating a safe and friendly environment adapted to the needs of people with ASD. Therefore, this study has two objectives: (1) to shed light on the existing factors and methods related to workplaces designed to be friendly to people with ASD, specifically adults, through a natural language processing (NLP) analysis of existing scientific papers in the field of architecture and design; and (2) to explore the factors that might assist in improving the design and architecture of adaptive spaces for people with ASD by analyzing a corpus of experts' documents. The study findings and their implications are analyzed and discussed.

Seeing is Disliking: Evidence of Bias Against Individuals with Autism Spectrum Disorder in Traditional Job Interviews

Job interviews are an integral component of the hiring process in most fields. Our research examines job interview performance of those with autism spectrum disorder (ASD) compared to neurotypical (NT) individuals. ASD and NT individuals were taped engaging in mock job interviews. Candidates were rated on a variety of dimensions by respondents who either watched the interview videos or read the interview transcripts and were naïve to the neurodiversity of the interviewees. NT candidates outperformed ASD candidates in the video condition, but in the absence of visual and social cues (transcript condition), individuals with ASD outperformed NT candidates. Our findings suggest that social style significantly influences hiring decisions in traditional job interviews and may bias evaluators against otherwise qualified candidates.

The Strengths and Abilities of Autistic People in the Workplace

Introduction

At present, very few autistic people are employed, even though many want to be. It is important that their strengths are identified and valued to help them to find jobs that they enjoy, and that make good use of their skills. The aim of this study was to investigate what strengths autistic people have in the workplace, self-reported by autistic people themselves.

Methods

In this study, autistic participants (n = 66) completed an online questionnaire that asked their views about employment-related strengths that they experienced. We analyzed these data using thematic analysis to identify commonalities across participants' experiences, and areas where they felt that they could perform better than their nonautistic colleagues.

Results

The main strengths identified from these data revealed cognitive advantages such as superior creativity, focus, and memory; increased efficiency and personal qualities such as honesty and dedication; and the ability to offer a unique autism-specific perspective.

Conclusions

Overall, this study suggests that autistic people have many employment-related strengths that should be recognized and valued by autistic people and employers alike. By understanding the strengths that could be associated with autism in the workplace, autistic people may be better able to identify their own strengths in the workplace (with the help of support workers, where necessary). The results should also encourage employers to make an effort to recruit and retain autistic employees, making appropriate adjustments to interview processes and working conditions, and seeking out training when needed.

Tutorial: The Speech-Language Pathologist's Role in Return to Work for Adults With Traumatic Brain Injury

PURPOSE

Return to work (RTW) is a major life participation metric used for persons with a traumatic brain injury (TBI). Speech-language pathologists (SLPs) have clinical expertise in the cognitive-communication aspects of TBI. This clinical focus article aims to support the clinical practice of SLPs by summarizing key interprofessional vocational rehabilitation (VR) models and illustrating the role of the SLP throughout the RTW process with a case study.

METHOD

This clinical focus article was written by the Academy of Neurologic Communication Disorders and Sciences TBI Research Group along with a VR expert. Authors engaged in deliberative, agenda-based discussions beginning with a literature review based on previous systematic studies. Discussions explored relevant VR and SLP practices.

RESULTS

This clinical focus article presents key VR models in parallel with SLP assessment and treatment to illustrate best practice patterns in an RTW field with a dearth of SLP-specific literature. We summarize general VR approaches and four evidence-supported VR models for adults with TBI. We highlight how a model of interprofessional assessment can assist with planning and communication of important work-related concerns. We illustrate how the chronological model of work return can assist with developing goals and planning treatment.

CONCLUSIONS

SLPs play an important role in identifying, managing, and collaborating with an RTW team following TBI. A working knowledge of VR models can assist with improving the dialogue between SLPs and VR professionals and can inform practice when working with persons with TBI who have work return as a goal.

Vocational Interventions to Improve Employment Participation of People with Psychosocial Disability, Autism and/or Intellectual Disability: A Systematic Review

Objective: To systematically review interventions aimed at improving employment participation of people with psychosocial disability, autism, and intellectual disability. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, ERIC, and ERC for studies published from 2010 to July 2020. Randomized controlled trials (RCTs) of interventions aimed at increasing participation in open/competitive or non-competitive employment were eligible for inclusion. We included studies with adults with psychosocial disability autism and/or intellectual disability. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias II Tool. Data were qualitatively synthesized. Our review was registered with PROSPERO (CRD42020219192). Results: We included 26 RCTs: 23 targeted people with psychosocial disabilities (n = 2465), 3 included people with autism (n = 214), and none included people with intellectual disability. Risk of bias was high in 8 studies, moderate for 18, and low for none. There was evidence for a beneficial effect of Individual Placement and Support compared to control conditions in 10/11 studies. Among young adults with autism, there was some evidence for the benefit of Project SEARCH and ASD supports on open employment. Discussion: Gaps in the availability of high-quality evidence remain, undermining comparability and investment decisions in vocational interventions. Future studies should focus on improving quality and consistent measurement, especially for interventions targeting people with autism and/or intellectual disability.

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.

"Today I felt like my work meant something": A pilot study on job crafting, a coaching-based intervention for people with work limitations and disabilities

BACKGROUND

People's work life and career can ultimately be deconstructed to the day-to-day job tasks they perform, the people they interact with, and the value and meaning attached to their jobs. Individuals with work limitations and disabilities consistently experience disparities in the workplace resulting in a less than optimal work experience in all three areas.

OBJECTIVE

The purpose of this study is to conduct a pilot study to test the effectiveness of job crafting as an occupational therapy (OT) intervention strategy for workers with health conditions and impairments. Job crafting is a proactive, strengths-based, bottom-up approach where workers renegotiate and redefine their job tasks in a personally meaningful way.

METHODS

A mixed-methods study (n = 11) was conducted with workers who experience work limitations and disabilities. OT graduate students conducted in-depth interviews and facilitated the use of job crafting to improve work-related outcomes. Pre-and post-intervention data was analyzed using descriptive statistics and Wilcoxon signed-rank tests. Qualitative data was transcribed, coded, and synthesized.

RESULTS

The job crafting intervention improved work-related self-efficacy (p < 0.05) and crafting behaviors (p < 0.05) in the workplace. Participants accomplished goals to manage their work limitations, meet job demands, and other non-disability related challenges.

CONCLUSIONS

Job crafting has the potential to be used as a holistic OT intervention strategy to improve work-related self-efficacy among workers with work limitations and disabilities.

Experiences of autistic and non-autistic individuals participating in a corporate internship scheme

Autistic people have significant challenges in obtaining and maintaining employment yet there remains a shortage of research in this area, especially research directly comparing the experiences of autistic individuals to their non-autistic colleagues in the same organisation. The present study examined the experiences of autistic and non-autistic interns, and their managers, taking part in a corporate internship scheme. Data were gathered via semi-structured interviews and online questionnaires prior to, and following, the internship. Many commonalties were identified, with both groups of interns and managers sharing positive journeys through the internship. Specific issues raised by autistic interns centred around impact of prior employment experiences, mental health and communication. Compared to managers of non-autistic interns, managers of autistic interns reported having a greater range of pre-internship concerns, including concerns about providing the right level of support, communicating successfully and being equitable in treatment of all employees. Structured delegation of tasks and flexible communication were successful strategies used by managers to support autistic interns; clear communication and more consistent support were perceived to benefit both intern groups. The findings highlight specific challenges experienced by autistic individuals in the workplace and suggest effective ways to ensure that autistic interns succeed alongside non-autistic peers.

Diamond in the rough? An “empty review” of research into “neurodiversity” and a road map for developing the inclusion agenda

Purpose

The aims of the paper were to highlight the dearth of applied practitioner research concerning the expression of neurodiversity at work and develop an epistemological framework for a future research agenda.

Design/methodology/approach

A systematic empty review protocol was employed, with three a priori research questions, inquiring as to the extent of neurodiversity research within mainstream work psychology, psychology in general and lastly within cross-disciplinary academic research. The results of the final search were quality checked and categorized to illustrate where studies relevant to practice are currently located.

Findings

The academic literature was found to be lacking in contextualized, practical advice for employers or employees. The location and foci of extracted studies highlighted a growing science-practitioner gap.

Research limitations/implications

The research focused on common neurominority conditions such as autism and dyslexia; it is acknowledged that the neurodiversity definition itself is broader and more anthropological in nature. A need for a comprehensive research agenda is articulated, and research questions and frameworks are proposed.

Practical implications

Guidance is given on applying disability accommodation to both individual and organizational targets.

Social implications

The disability employment gap is unchanged since legislation was introduced. The neurodiversity concept is no longer new, and it is time for multi-disciplinary collaborations across science and practice to address the questions raised in this paper.

Originality/value

This paper offers an original analysis of the neurodiversity paradox, combining systematic inquiry with a narrative synthesis of the extant literature. The conceptual clarification offers clear directions for researchers and practitioners.

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.

Non-pharmacological Interventions for Adults with Autism: a Systematic Review of Randomised Controlled Trials

To determine the effects of non-pharmacological randomised controlled trials in adults with autism, a systematic review was conducted across five electronic databases. A total of 3865 abstracts were retrieved, of which 41 articles met all inclusion criteria: randomised controlled trial; non-pharmacological intervention; adults with autism; and English publication. Twenty included studies had strong methodological quality ratings. No meta-analysis could be performed due to heterogeneity between studies. Articles reported on interventions for (1) social functioning and language skills, (2) vocational rehabilitation outcomes, (3) cognitive skills training, and (4) independent living skills. Social functioning was the most studied intervention. PEERS for young adults and Project SEARCH plus ASD support interventions had the strongest evidence. Emerging evidence suggests non-pharmacological interventions could be effective.

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.

Challenges to parental involvement in transition planning for children with intellectual disabilities: The perspective of special education teachers in Saudi Arabia

BACKGROUND

A transition plan refers to post-high school goals identified and developed on the basis of the needs, strengths, skills, and interests of students. A significant factor for achieving successful transition planning is parental involvement. In this regard, many studies in Saudi have explored the barriers to effective collaboration between schools and parents.

AIM

From the perspective of special education teachers, the study examined parental participation in transition planning for students with intellectual disability enrolled in schools in Saudi Arabia. Furthermore, parental challenges were discussed.

METHODS

A questionnaire was used to collect data from 91 special education teachers. The t-test, confirmatory factor analysis, and Cronbach's alpha were used for statistical analysis.

OUTCOMES AND RESULTS

Results indicated that parents lacked participation in transition planning for several reasons, such as lack of time and lack of knowledge about transition. However, the study found that schools did not proactively seek parental participation nor provide substantial guidance about transition services to enable parents to provide a meaningful contribution to planning.

CONCLUSIONS AND IMPLICATIONS

Limitations and implications for future research and practice are discussed.

Cost-benefit analyses of employment services for individuals with intellectual and developmental disabilities: A scoping review

BACKGROUND: Understanding the cost-benefit of vocational rehabilitation services is critical to improve competitive integrated employment outcomes for individuals with intellectual and developmental disabilities (IDD). OBJECTIVE: The purpose of this scoping review was to analyze and synthesize micro and macroeconomic analyses of various types of vocational services which promote the employment outcomes of individuals with IDD. METHODS: This scoping review searched peer-reviewed and grey literature sources published between 2000 and 2020, examining both micro and macroeconomic analyses. RESULTS: A total of 26 studies met inclusion criteria. The majority of studies reported positive effects for the cost-benefit of integrated service approaches such as supported and customized employment. Conversely, our findings show no cost-benefit for sheltered workshops, and in some cases, negative effects. CONCLUSION: Limitations to the included studies as well as implications and recommendations for practice, policy, and future research are discussed.

Competitive Integrated Employment for Youth and Adults with Autism: Findings from a Scoping Review

A scoping review was conducted to map existing literature on effective interventions for competitive employment for individuals with autism spectrum disorder. Empirical database searches were conducted. A filter for level of methodological rigor was implemented. A total of 25 articles met inclusion criteria. Findings were categorized by level of evidence. Findings revealed strong empirical support for a transition-to-work program called Project SEARCH plus ASD Supports and traditional supported employment services. Receipt of specific vocational rehabilitation and transition services in high school were also identified as effective interventions. Recommendations per level of evidence are provided in more detail.

Aging Well on the Autism Spectrum: An Examination of the Dominant Model of Successful Aging

There is a gap in our knowledge of aging with autism. The present study examined the applicability of the popular gerontology concept of "aging well" to autistic adults. Using survey data, a model of "aging well" was operationalised and applied to 92 autistic adults and 60 controls. A very small proportion (3.3%) of autistic adults were found to be aging well. Significantly less autistic adults were "maintaining physical and cognitive functioning" and "actively engaging with life" in comparison to controls. Whilst important differences in health and functioning status were found, the current dominant model of "aging well" is limited for examining autistic individuals. Suggested adjustments include development of a broader, more flexible and strengths -based model.

Neurodiversity at work: a biopsychosocial model and the impact on working adults

INTRODUCTION

The term neurodiversity is defined and discussed from the perspectives of neuroscience, psychology and campaigners with lived experience, illustrating the development of aetiological theories for included neurodevelopmental disorders. The emerging discourse is discussed with relevance to adults, social inclusion, occupational performance and the legislative obligations of organizations.

SOURCES OF DATA

Literature is reviewed from medicine, psychiatry, psychology, sociology and popular press. No new data are presented in this article.

AREAS OF AGREEMENT

There is consensus regarding some neurodevelopmental conditions being classed as neurominorities, with a 'spiky profile' of executive functions difficulties juxtaposed against neurocognitive strengths as a defining characteristic.

AREAS OF CONTROVERSY

The developing nomenclature is debated and the application of disability status versus naturally occurring difference. Diagnosis and legal protections vary geographically, resulting in heretofore unclear guidance for practitioners and employers.

GROWING POINTS

The evolutionary critique of the medical model, recognizing and updating clinical approaches considering the emerging consensus and paradigmatic shift.

AREAS TIMELY FOR DEVELOPING RESEARCH

It is recommended that research addresses more functional, occupational concerns and includes the experiences of stakeholders in research development, moving away from diagnosis and deficit towards multi-disciplinary collaboration within a biopsychosocial model.

Competitive Employment for Transition-Aged Youth with Significant Impact from Autism: A Multi-site Randomized Clinical Trial

This study reports the results of a multi-site, parallel block randomized clinical trial to expand the previous findings regarding the implementation of Project SEARCH plus ASD Supports (PS + ASD) on employment outcomes upon graduation from high school. Participants were 156 individuals with significant impact from ASD between the ages of 18-21. There was a significant difference between treatment and control groups with 73.4% of the treatment group acquiring competitive employment at or above minimum wage by 1-year after graduation compared to 17% of the control group for whom data was provided. At 1-year, employed treatment group participants worked an average of 21.2 h per week (SD = 9) for a mean hourly wage of $9.61 per hour (SD = $1.55).Clinical Trial Registration: clinicaltrials.gov Identifier: NCT03560453.

Quality of Life Among School-Age Children With Autism: The Oak Hill School Outcomes Study

Prior studies have documented a lower quality of life (QOL) in children with autism spectrum disorder (ASD) compared to typically developing peers, but few studies have examined the trajectory of QOL over time in the same population. We conducted a 2-year cohort study in 29 children attending a specialized school for ASD with quarterly measures of parent-rated QOL as well as parent and teacher measures of behavior and social skills to determine the trajectory of change in QOL and predictors of change. The average change in QOL was constant (no change over time), but there was substantial variation with some students showing significant gains and others showing declines. Exploratory analyses revealed that improvements in behavior and social skills were greater (nonsignificantly) among children with improvements in QOL. Children with improved QOL were also younger and had a lower initial symptom burden. This study suggests that early intervention programs that provide social skills and behavioral management strategies may improve QOL in children with ASD. The study also highlights the need to develop and study novel, qualitative measures of QOL in this population.

Vocational Rehabilitation Service Utilization and Employment Outcomes Among Secondary Students on the Autism Spectrum

U.S. policy interventions encourage earlier provision of Vocational Rehabilitation (VR) services to support students and youth with disabilities such as autism spectrum disorder (ASD) during the transition from school to work. We analyzed Rehabilitation Services Administration (RSA-911) data using multivariable logistic regression to determine the association of VR services receipt with employment outcomes for students ages 16-21, same-age non-student youth and young adults with ASD. Students with autism received job-related services (job search, job placement, and on-the-job supports) at rates significantly below comparison groups, even though odds of successful employment at VR exit were significantly higher if they received these services. Findings suggest that rates of employment among students with autism might be improved with intentional delivery of job-related services.

Competitive Integrated Employment for Youth and Adults with Autism: Findings from a Scoping Review

A scoping review was conducted to map existing literature on effective interventions for competitive employment for individuals with autism spectrum disorder. Empirical database searches were conducted. A filter for level of methodological rigor was implemented. A total of 25 articles met inclusion criteria. Findings were categorized by level of evidence. Findings revealed strong empirical support for a transition-to-work program called Project SEARCH plus ASD Supports and traditional supported employment services. Receipt of specific vocational rehabilitation and transition services in high school were also identified as effective interventions. Recommendations per level of evidence are provided in more detail.

Services for Adults With Autism Spectrum Disorder: a Systems Perspective

PURPOSE OF REVIEW

We review original research about services for adults on the autism spectrum published from January 2013 through December 2018. The main aim is to characterize the topical and methodological aspects of research about services. We review research on services related to employment, living in the community, and social participation. We compare our results with those from a similar review published in 2012 to assess progress and identify where new directions in research about services for adults with autism are needed.

RECENT FINDINGS

We found the evidence base about services for adults on the autism spectrum remains very small and highly variable in aims and methods. There is wide variability in methods used to define sampling frames and recruit participants. Most studies focus on employment. Almost no studies examine the overall ecosystem of services serving autistic adults. Few studies use a conceptual framework for understanding access to, or improvement of, services. The small size of the extant research coupled with inconsistent quality prevents the accumulation of new knowledge in ways that would significantly inform the improvement of systems of care for the growing population of adults on the autism spectrum.

Autism aging

Many people perceive autism spectrum disorder (ASD) as a childhood disorder, yet ASD is a lifelong condition. Although little is known about the mental and physical health issues of aging individuals with ASD, there are increasing numbers of older adults being diagnosed with ASD. Although there has been a recent "call to action" (to address lack of knowledge and the dearth of services and programs for aging individuals with autism, the authors think it is also important for those who are involved in educational programs related to gerontology and geriatrics settings to be aware of "autism aging." This term conceptualizes the demographics, person and contextual factors, and intellectual awareness of the trends and patterns of ASD as a life course challenge and opportunity for well-being and quality of life. The purposes of this article are to (1) provide a general overview of autism issues and to examine several dimensions of ASD in the context of the emergent and relevant scholarship in the adult and aging domain, (2) propose how to address the "gap" in the literature on autism and aging in terms of a conceptual model and by improving the methodology, and (3) to discuss the implications of these dimensions for educators in gerontology and geriatrics, and for those professionals who work in clinical and health care services. It is the goal of the authors to have this article represent a general introduction to ASD and to be a part of the foundation for educational awareness for educators in gerontology and geriatrics.

Identifying Patterns of State Vocational Rehabilitation Performance in Serving Transition-Age Youth on the Autism Spectrum

Background

Transition-age youth on the autism spectrum (TAY-ASD) face many challenges when attempting to find and keep employment. Vocational rehabilitation (VR) is a key public source of support for employment for people with disabilities in the United States, and TAY-ASD increasingly use VR services. However, rates of VR service utilization and employment outcomes are known to vary dramatically across states for these youth, for reasons that are not fully understood.

Methods

This study aimed to examine a set of indicators for measuring the state VR performance in serving TAY-ASD, compared with youth with other disabilities, and to identify classes of homogenous patterns of state performance across these indicators. We used latent profile analysis (LPA) to model patterns of state performance in serving TAY-ASD.

Results

We identified five classes of states with unique patterns of performance across four key indicators (service receipt, early reach, timely services, and employment rates) and then matched states to each class based on their probability of inclusion. One class featured above average performance across all four indicators, and approximately one-fourth of states had a high probability of membership in this class.

Conclusions

Identification of states with patterns of more efficient and effective VR service delivery for TAY-ASD will help target efforts to learn how states are delivering, organizing, and coordinating VR services for these youth. The use of methods like LPA may also be beneficial for examining performance within other autism-related service systems in the United States and internationally.

Lay Summary

Background:: Achieving employment is an important milestone on the road to adulthood. Having a job is related to financial independence, health, and well-being but can also provide a sense of belonging and opportunities for inclusion. Transition-age youth on the autism spectrum (TAY-ASD) may find that getting and keeping a job is more difficult than it is for their peers with other types of disabilities. Vocational rehabilitation (VR) is a public source of support for employment for people with disabilities in the United States, and TAY-ASD are increasingly using VR services. However, whether youth receive VR services, and whether they gain employment following VR services, is highly dependent on which state they live in. We do not yet fully understand why state VR services vary so dramatically.About This Study:: New federal legislation, the Workforce Innovation and Opportunity Act, aims to reach students with disabilities with vocational services during secondary school (junior high and high school). Few studies exist to help us understand how well VR services are reaching students and what are the effects of these services. We tested new ways to measure VR services for TAY-ASD and also tested whether we could group states according to their results on these measurements. We wondered whether any groups of states performed better than other groups.We used the VR data for the 50 states and Washington DC to test the following four things: how often TAY-ASD received VR services if they were eligible for them; how often these youth applied for VR services during secondary school; how often their employment plan was finished on time; and how often they got a job after VR services. We compared youth on the autism spectrum with youth with other disabilities and found that they did about the same on these measures.What This Study Tells Us:: We identified five groups of states, which each had a unique pattern of how they performed on these measures. We named the groups-also called classes-according to their strengths. Class 1 had above average employment rates but below average performance on other measures. Class 2 had timely services, meaning that these states finished youth's employment plans on time, so that they could access services. Class 3 had both timely services and early reach to students, meaning that the students began services during secondary school. Class 4 had early reach to secondary students but low performance on other measures. Finally, Class 5 had above average performance on all measures. States in this class excelled at reaching students, developing employment plans quickly, enrolling students in services, and achieving employment by the time VR services ended. We then determined which states were most likely to belong in each class.This study gives us another way to think about how states are doing in delivering VR services to TAY-ASD. By studying states that have better overall performance, versus others, we can identify what states might be doing differently. Learning about how some states are adapting VR services for TAY-ASD and the innovations they are using is important information for other states who wish to improve their VR services. The methods we used may also be helpful for examining the performance of other autism-related service systems in the United States and internationally.

An Ecosystem Approach to Employment and Autism Spectrum Disorder

Relatively little is yet known about employment readiness and elements that promote access to, and the retention of, employment for adults with autism spectrum disorder (ASD). This paper posits elements within the ecosystem of employment and ASD. The ecosystem approach locates employment among persons with ASD as inextricably linked with broader community resources, family support, workplace capacity building (e.g., employer, co-workers) and policy. Application of the approach is offered through process evaluation data yielded from an ecosystem-informed job readiness program entitled, 'EmploymentWorks Canada'. Findings illustrate job readiness in the context of the broader ecosystem that envelopes salient components in the aim of community engagement and quality of life. Recommendations are offered for community-based applications and for program and research development.

Reintegrating Veterans with Polytrauma into the Community and Workplace

This article addresses employment as a critical part of community reintegration for polytrauma patients. Interdisciplinary polytrauma teams can work to effectively identify and eliminate known barriers to employment for veterans and offer continued support and guidance. This article discusses key themes pertinent to vocational reentry for service members/veterans, identifies evidenced-based employment models, highlights the essential role of everyday technology in meeting support needs, and describes 2 exemplar polytrauma models: the Louis Stokes Cleveland Veteran Affairs Medical Center in Cleveland, Ohio, and the Service member Transitional Advanced Rehabilitation (STAR) program at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, Virginia.

Autism Spectrum Disorder and Transition-Aged Youth

PURPOSE OF REVIEW

This article discusses common issues surrounding transition to adulthood in youth with autism spectrum disorder (ASD). We review recent evidence on co-occurring medical and mental health conditions and topics of education and employment, sexuality and relationships, independent living, and financial support.

RECENT FINDINGS

Transitioning individuals with ASD have increased risk for several medical and behavioral health comorbidities and should be routinely screened for co-occurring conditions. Evidence on interventions for mental health disorders is limited but emerging, particularly with respect to mindfulness training and cognitive behavioral therapy. Many autistic adults or their families express a desire for independent living, participation in education/employment, and intimacy and social relationships, but they often lack skills and/or resources to successfully achieve these outcomes. The time of transition to adulthood for adolescents with ASD is an opportunity for physicians to provide anticipatory guidance and necessary supports around issues of community participation. To allow time for planning, these discussions should occur well before the child reaches adulthood. Clinicians should also routinely screen for and address medical and/or behavioral health comorbidities.

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.