A Systematic Review of Employment Outcomes for Adults with ASD
Employment services or interventions for individuals with neurodevelopmental disabilities (NDD), including ASD, have been described in the literature to include counseling, job skill training, coaching and training of supports. In the employment disability literature, outcomes are often measured based on dichotomous approaches (e.g., whether an individual is employed), as well as continuous metrics (e.g., tenure and compensation over time). These outcomes are unable to evaluate what is specifically going well/poorly in multi-service employment interventions for individuals with ASD. To identify the outcomes measured in employment and ASD research, a comprehensive search across NDDs could identify measures that better evaluate existing or novel interventions.
To review studies describing standardized employment-focused measures and assessment procedures in ASD.
The review targeted employment outcomes using standardized measures or procedures for adults with neurodevelopmental disabilities, based on DSM-5 criteria. One reviewer (HV) conducted the search of ERIC, MEDLINE, CINAHL, HaPI, and PsycINFO databases. Our search generated 2,151 citations, and after duplicate removal we screening in two stages. Reviewers used a predetermined list of eligibility criteria, with a key focus on finding articles that looked at employment outcomes beyond typical metrics (i.e., employed/unemployed, wages, and hours). For the first stage, two reviewers (HV and RP) conducted independently title and abstract screening of 2,075 articles, with all disagreements adjudicated by the senior advisor (BDR). For the second stage both reviewers conducted full text screening and eliminated all but 54 articles. Both reviewers conducted data extraction using a standardized form for population, recruitment setting, standardized measures, and employment outcomes. A descriptive examination of the studies was conducted to identify the population characteristics, construct of outcome measures, and measurement properties.
Among the 54 articles included, the majority focus on persons with intellectual disability (ID) (35 papers), and the next largest focus is on persons with ASD (14 papers). From the ASD studies, seven focused exclusively on individuals with ASD; four included both individuals with ASD and others with NDD; and three examined individuals with a combined diagnosis of ASD and ID or other NDD. ASD studies included standardized measures and job skill evaluation procedures. Two ASD-specific measures included the Autism Work Skills Questionnaire and the Vocational Index for Adults with ASD. Measurement constructs in ASD involved mainly six person-focused outcomes such as job satisfaction, preference, performance, as well as, work personality, motivation and readiness. Three constructs were represented by measures related to the work environment, such as workplace culture, supports (e.g., co-worker involvement) and social integration.
Conclusions: This review demonstrates the breadth of research measuring a variety of employment outcomes for adults with ASD - detailing both person and work environment-focused measures. ASD measures could serve as potential examples of new directions for research across other NDDs and conversely, constructs of measures identified in NDD could be areas of consideration in future ASD research.