Examining Environmental Predictors of Social Participation and Service Use for Adults with ASD Using Geographic Information Systems (GIS)

Background: Limited research on adults with ASD reports poorer community participation and social interaction compared to both typically developing peers and those with other disabilities (Liptak et al., 2011, Orsmond et al., 2013; Roux et al., 2013). Where adults live, including size of community and proximity to resources may be important environmental factors influencing participation and service use, but are rarely studied in this population (Badia et al., 2011).

Objectives: A geographic information systems (GIS) approach was used to systematically examine whether size of community and distribution of community resources contributed to community participation and service use outcomes for adults with ASD.

Methods: Outcomes were reported by 124 caregivers of adults (aged 21-54, M = 34.8) who were diagnosed with an ASD as children. Caregivers completed the TEACCH Autism in Adulthood Survey assessing adult outcomes, including community participation and service use. GIS mapping determined the population density where the adult lived, as well as how accessible it was to various features, including bus stops, grocery stores, coffee shops, religious organizations, and health care (see example in Figure 1). Accessibility was measured by both proximity to and density of features relative to the home location. Regression analyses examined whether these GIS measures predicted adult outcomes and service use, while also accounting for adult age, conversation ability, childhood IQ, and activities of daily living (ADL) skills.

Results: Results indicated that while person factors of better conversation ability and greater ADL skills significantly affected outcomes, community size was not significantly related to outcomes. Specifically, those from more and less densely populated areas had similar outcomes across a variety of domains including employment, social activity, adult well-being, and access to services. However, accessibility to specific features in the community such as public transportation and religious organizations were significant predictors of outcomes; those with better access to these features had better outcomes than those with poorer access. For example, greater access to religious organizations in the community was related to more frequently getting together with friends outside of organized activities or groups (p < .001) and increased involvement in community activities (volunteering and attending religious services) (p = 0.02; p = .01, respectively). Similarly, greater access to public transportation was related to use of a greater number of services in the last two years (p < .001). Accessibility to public transportation was also a significant predictor of increased satisfaction with services overall (p = .008) and was one of the significant predictors of better wages from employment (p< .001).

Conclusions: These findings suggest it is not the size of the community but access to specific community features such as public transportation and religious organizations that are important environmental considerations impacting social participation and service use for adults with ASD. As the numbers of adults with ASD increases and families focus on identifying factors associated with improved quality of life, these findings suggest that communities that provide opportunities for community integration via public transportation and religious organizations are important components in supporting positive adult outcomes.