A Systematic Review Examining ASD Vocational Practices, Supports and Models

Background:  The Canadian Participation in Activity Limitation Survey(PALS, 2006) database suggests that adult males (25-64 years) with Autism Spectrum Disorder (ASD), have remarkably lower employment and labour force participation.  It appears that only 40% of men with ASD are employed.  Less than half participate in the labour force, i.e., either (i) employed or (ii) unemployed but looking for work.  These employment outcomes are ~10% lower than that observed among other disabled male counterparts.  Given these outcomes, it is not surprising that there is a substantial reliance on social assistance and disability benefits (PALS, 2006).  Vocation-related service needs for adults with ASD have thus emerged with increased urgency as a growing cohort of adolescents with ASD are aging into adulthood.

Objectives:  This systematic review examined interventions addressing vocational services for adults with ASD.

Methods: This systematic review followed Campbell Collaboration standards in examining peer reviewed intervention literature related to vocational services for adults with ASD.  Research questions were as follows: (1) What interventions supporting vocational opportunities for adults with ASD, are reported in the literature?, and (2) What evidence of outcome is indicated? 

Results:  Fourteen studies (1984-2011) met inclusion criteria for vocational focus on ASD and the presence of data.  Studies identified 5 key areas of intervention, as follows.

(i) Supported employment:  This involves the implementation of support to an individual with ASD in order to secure and maintain paid work in a regular work environment through formal training and ongoing workplace support.

(ii) Community placement:  Placement in the community is supervised and supported directly by the employer. Additional support is provided as necessary, but is tapered over time.

(iii) Job coaching:  ‘Coaches’ teach skills relevant to job searching and interviews, act as a liaison between individuals and employers/coworkers, deal with crisis situations, and generally seek to ensure the success of individuals with ASD in the workplace.

(iv) Technological support tools:  Technology applications have been demonstrated to support vocational success for individuals with ASD (e.g., use of PDAs to improve independent functioning, and video modeling of job-specific vocational skills).

(v) Indirect vocational models: Programs for social skill development include non vocation-specific approaches that demonstrate improved social skills needed in the vocational setting.  These are attributed to increased vocational opportunities, employment retention, and career advancement.

Conclusions:  Existing studies demonstrate positive outcomes for identified interventional approaches.  However, given the relatively weak study designs in existing studies, stronger methodology in future research is recommended.  Future studies should increasingly address the role and importance of interpersonal relationships at work and how employment affects the development of identity and self-esteem.  Labor market and economic analyses need to be implemented within future analyses. Notwithstanding these recommendations and yet unanswered questions, this literature base identifies promising vocational practices for further evaluation.