A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders

28 Aug

Autism is more than something which concerns children. Autistics, like everyone, grow up. Some will find jobs, some could use supports to obtain jobs. At present, most do not gain employment. How can we as a society better support autistics in gaining employment? Well, that question is largely unanswerable. A paper out yesterday in Pediatrics A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders (full text is free), shows that there is little data on vocational services for adults.

The abstract is below, and the paper online, but a quick view of the study can be found in this Reuters article, quoting lead author Julie Lounds Taylor and Paul Shattuck, an autism researcher not involved with the study:

“Even though there are vocational services out there, they haven’t been rigorously studied,” Taylor said.

She stressed, though, that the findings do not mean the programs don’t work – just that better studies are needed.

An autism researcher not involved in the new report agreed.

“I think this is more a critique of the research community, not the programs themselves,” said Paul Shattuck, an assistant professor at Washington University in St. Louis.

Why have there been so few studies, and no high-quality ones?

Both Taylor and Shattuck said that in autism, the research focus has historically been on children.

“But children with autism grow up,” Taylor pointed out. “We have startlingly little evidence on how to help adults.”

Prof. Shattuck was, in my opinion, being polite. Autism parents such as myself will have a hard time finding someone to blame for this. We have dominated the discussion and advocacy efforts for some time and we have not called for better research on such critical areas as the effectiveness of adult supports.

BACKGROUND AND OBJECTIVE: Many individuals with autism spectrum disorders (ASDs) are approaching adolescence and young adulthood; interventions to assist these individuals with vocational skills are not well understood. This study systematically reviewed evidence regarding vocational interventions for individuals with ASD between the ages of 13 and 30 years.

METHODS: The Medline, PsycINFO, and ERIC databases (1980–December 2011) and reference lists of included articles were searched. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes, and assigned overall quality and strength of evidence ratings based on predetermined criteria.

RESULTS: Five studies were identified; all were of poor quality and all focused on on-the-job supports as the employment/vocational intervention. Short-term studies reported that supported employment was associated with improvements in quality of life (1 study), ASD symptoms (1 study), and cognitive functioning (1 study). Three studies reported that interventions increased rates of employment for young adults with ASD.

CONCLUSIONS: Few studies have been conducted to assess vocational interventions for adolescents and young adults with ASD. As such, there is very little evidence available for specific vocational treatment approaches as individuals transition to adulthood. All studies of vocational approaches were of poor quality, which may reflect the recent emergence of this area of research. Individual studies suggest that vocational programs may increase employment success for some; however, our ability to understand the overall benefit of supported employment programs is limited given the existing research.

By Matt Carey

6 Responses to “A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders”

  1. Science Mom August 28, 2012 at 18:20 #

    Part of the blame can be laid at the doorstep of both federal and state governments that have cut off funding for mental health services for adults. I’ve seen many wonderful programmes that included group homes, organised social activities and workshops get completely disbanded. That and some so-called parent groups diverting funding from what could have been autism research with emphasis on adults to research into the ever-shifting hypothesis of vaccines causing autism.

    • Sullivan (Matt Carey) August 29, 2012 at 00:56 #

      Science Mom,

      I wouldn’t put so much emphasis on diverting funding as much as diverting effort and attention. Sure, a lot of money went into chasing down the MMR and thimerosal questions..over and over again. But that was a while back now. But there is not just a lack of interest in gaining information on adults, there is an intent to avoid these topics. There has been no support from the more vocal autism organizations for these topics. When the Brugha studies came out of the UK, people looked at one number (the 1% prevalence in adults) and quickly looked for ways to dismiss the work. Little attention was payed to the real meat of the studies–how are adult autistics living? What can we learn and change? This is an example of the major failure of the parent-advocates of the last decade.

      I would say further that there is resistance in acknowledging that a large fraction of autistics are not intellectually disabled. If the situation isn’t acknoweldged, how can we bring about the supports and services needed?

  2. Science Mom August 29, 2012 at 01:50 #

    Your excellent points are well-taken Sullivan. The prevalence, existence and problems that adult autists face should be a unifying call to action, instead as you mentioned is just being dismissed as inconvenient information. I will also add that there may be a sub-population of upcoming adult autists with a whole new set of issues to deal with.

  3. Dee McVicker August 29, 2012 at 03:42 #

    Sometimes we get so concerned about what we perceive as disadvantages that it’s easy to overlook the advantages of this particular community. So many on the spectrum have an aptitude for computers, for example. That could be a real advantage as the world becomes more high tech. Many are also extremely talented artists. We’re just beginning to see what these individuals can contribute to society if given the chance. One vocational school called Exceptional Minds near Hollywood is shattering a lot of those perceived limitations. The school/working studio was started less than a year ago and already these students — all on the spectrum –are working and earning money in the post-production world. In fact, they just finished doing post-production work on the movie Lawless coming out in theaters tomorrow.

    • Chris August 29, 2012 at 07:51 #

      My son does not live any where near Hollywood.

      His aspirations were totally failed with the local services. While they checked him out in both grocery store services (okay), and clerical skills (much better), there was no follow through.

      Even though the social worker was to help him create resume, that never happened. She was never in contact. There was always a systemic disconnect.

      In the mean time, he takes classes at the local community college. With luck he will find some way to go on his own.

      And we really thank Obamacare to allow us to pay for his cardiac surgery because he was only 23 years old. We really hope he can be employable in the next couple of yeasr.

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