Vocational Outcomes of Adults with ASD: Patterns Over Time and Relation to Daily Living Skills

Background: With few exceptions, studies of vocational outcomes among adults with ASD find low rates of employment and occupational engagement. Predictors of vocational outcomes, such as IQ and early language, tend to be static and difficult to change.  Studies have yet to examine patterns of employment and vocational outcomes over time.  As the number of youth with ASD exiting high school and entering the adult service system increases, it is increasingly important to determine the malleable factors – such as daily living skills - that predict vocational activities.

Objectives: This study had two aims: 1) to examine patterns of change in vocational and educational activities of adults with ASD over a 12-year period; and 2) to determine whether these patterns can be predicted from daily living skills, as well as other characteristics of the adult with ASD and their familial resources.

Methods: We used a sub-sample of 92 adults with ASD drawn from a larger longitudinal study.  Adults averaged 30.9 years of age at the start of the study (range = 20-48 years), were 70.7% male, primarily European American, and 82.6% had an intellectual disability.

Vocational and educational data used in the present study were drawn from the first and most recent time points of the study, separated by 12 years.  Vocational/educational activities at each time were coded into an ordinal scale using our previously developed Vocational Index.  Independent variables included autism symptoms, maladaptive behaviors, number of medications taken by the adult, physical health, age, gender, residential status, and whether the adult had a diagnosis of intellectual disability.  In terms of family resources, we included family income and maternal social support.  All independent variables were measured at the initial study time point.

 

Results: Exactly 50% of adults with ASD had stable vocational categories at the first and last time point, meaning that they were participating in the same type of activity at each time.  Of those who were stable, most (39.1% of the entire sample) were classified as “stable low,” meaning that their employment activities were primarily in sheltered settings or they had no employment activities at both time points.  The remaining adults (10.9% of the entire sample) were classified as “stable-high,” and were working in the community at both time points.  Nearly 30% (29.3%) of the sample was downwardly mobile, and 20.7% were upwardly mobile, meaning that the independence of their vocational activities increased from the first to last time point.

Adults in the stable-high category had higher scores on activities of daily living, fewer autism symptoms, were taking fewer medications, and were less likely to have an intellectual disability than those who were in the stable-low, upwardly mobile, or downwardly mobile groups.

Conclusions: The majority of adults with ASD (approximately 70%) remained in sheltered placements over the study period or had vocational activities that were decreasing in independence over time (or had no employment).  Improving daily living skills may lead to more independent vocational outcomes.