School and Employment Effects on Pathways to Service Use in Emerging Adults with ASD

Background:

With a large cohort of individuals with ASD reaching adulthood, there is pressing need to understand the dynamics of service utilization through the emerging adulthood period. This age cohort has high unmet service need and access to these services is an important predictor of quality of life for adults with ASD. Various clinical and systemic factors are known to contribute to service receipt across the lifespan, but to date, no one has investigated the dynamics of service use in this specific age group. Further, it is unclear how participation in further education or securing employment impacts service receipt through these factors.

Objectives:

In this study, we report on differences in service receipt in young adults with ASD-only compared to ASD+ID and examine if continuing in school/having employment moderates the relationship between having an ID in addition to ASD on service receipt and if so, by what mechanism.

Methods:

An online survey was administered across Canada through the Canadian Autism Spectrum Disorders Alliance, completed by caregivers reporting on young adults (ages 18-25) with ASD-only (n=251) or ASD+ID (n=333). We collected sociodemographic data (including current schooling/employment status), clinical need (including mental health, behavioural problems, overall function), and systemic variables related to service receipt (including barriers to services, caregiver-directed services). Current service use was operationalized as any service used in the last 6 months. We used a moderated mediation model to investigate the impact of having schooling and employment, after high school, on factors that influence service receipt.

Results:

Our results show that young adults with ASD+ID receive more services (ASD-only: 1.82 SD=1.87, ASD+ID: 3.28 SD=2.74; t=7.29, p<.001). There was a direct effect of having ID on the number of services received (Beta=1.23, SE=.2, CI: .84, 1.62, p<.001), while there was no direct effect of being in school or having employment (Beta=.21, SE=.21, p=.32). In the model, the increase in services was partially mediated by higher rates of both behavioural concerns (t=5.35, p<.001) and caregiver-directed services (t=2.83, p=.005) in those with ASD+ID compared to those with ASD alone. However, being in school or having employment moderated those factors, such that when one is in school/employed, only behavioural concerns was related to more services (Beta=.13, SE=.07, CI: .02, .30) and when one was not in school/employed, caregiver-directed services mediates the increase in service receipt for those with ASD+ID (Beta=.21, SE=.13, CI: .03, .57).

Conclusions:

These results suggest that contextual factors play a role in explaining why adults with ASD+ID may receive more services than young adults with ASD alone. When adults with ASD+ID remain in school or in an employment setting, higher rates of behavior problems can trigger referrals to additions supports. When a young adult with ASD+ID is not in school or employed though, caregiver-directed services explain why they access more services compared to individuals with ASD alone. Once individuals with ASD+ID transition out of school and are not yet involved in a vocational setting, parent support services becomes a pathway to service receipt.