Background: Review addresses evidence that supports employment supports for persons with autism spectrum disorders.
Objective: The objective of the review is to determine the effectiveness of adult employment interventions in securing and maintaining employment for adults with autism spectrum disorders.
Search Strategy: Comprehensive search of electronic and gray literature sources.
Selection Criteria: Studies were identified through independent reviews of two independent reviewers.
Data Collection and Analysis: Information retrieval activities identified 8,528 studies for the first stage review. Second stage review of 77 studies occurred. Two studies were found to meet the inclusion criteria.
Results: This review was not able to identify definitive interventions that predictably and positively supported the development of employment outcomes for individuals with ASD. There were two included studies. One, Mawhood and Howlin (1999), described outcomes directly related to employment by comparing an experimental group (n = 30) who received guidance from a support worker in the form of job finding, work preparation, and communication with the employers with a control group (n = 20) that did not receive any support. At the end of the two-year study period, the authors found that the experimental group demonstrated significantly higher rates of having found paid employment (d = 1.067, 95% CI = 0.123 to 2.010), significantly longer periods of working time (d = 0.684, 95% CI = 0.111 to 1.257), and significantly higher wages (d = 1.177, 95% CI = 0.169 to 0.819). The experimental group also worked more hours per work week (d = 0.328, 95% CI = -0.628 to 1.284), but this effect was not significant. The second included study, Garcia-Villamisar, Ross, and Wehman (2000), described differential effects of supported employment and sheltered employment for persons with autism. The experimental group received supported employment, i.e., jobs working between 15 and 30 hours per week in their communities and received job coach support services. The control group received sheltered employment, i.e., jobs that were not in their communities and with no job coaching services. Using measures of the Childhood Autism Rating Scale (CARS), the supported employment group was not significantly different from the sheltered employment group after treatment (d = -0.229, 95% CI = - 0.764 to 0.306). The study did not report any differences in employment acquisition or maintenance between the two groups. In an analysis of risk bias of the included studies, it was found that there was a high level of substantial potential for bias across three of the five sources of bias analyzed including unit of assignment, unit of analysis, attrition, fidelity of implementation, and blinding. The methodological quality of both included studies was low. Therefore, these review results should not be interpreted as indicating definitive results related to the development of employment outcomes for persons with ASD.
Authors Conclusion: Qualitative and other relevant research studies connected to the employment of persons with ASD were also reviewed and suggest that the following may be elements of successful employment placement for persons with ASD: (1) identification of the most appropriate work settings and placements, (2) provision of effective supports on the job, (3) need for long-term support services for the employer and the consumer, (4) costs for support, and (5) positive effects of employment on persons with ASD. While qualitative studies point to a number of promising issues for future research, they do not provide a definitive statement about what works. In addition, the authors noted that costs for community-based employment interventions such as those included in this review are more expensive than other employment alternatives such as sheltered non-integrated workshops. However, Howlin, Alcock & Burkin (2005) and others (e.g., Cimera & Cowan, 2009) show that supported employment service interventions, such as those identified in our included studies, are becoming less expensive to deliver. It seems important to note that community-based integrated employment interventions, while expensive, do expand options for mainstream social integration, competitive wages, and community involvement.