What do we Know About Improving Employment Outcomes for Individuals with Autism Spectrum Disorder?

Autism spectrum disorder (ASD) is the most commonly diagnosed neurological disorder in children. Adults with ASD have some of the poorest employment outcomes in comparison to others with disabilities. While data in Canada is limited, roughly 25 per cent of Americans living with ASD are employed and no more than six per cent are competitively employed. Most earn less than the national minimum hourly wage, endure extended periods of joblessness and frequently shuffle between positions, further diminishing their prospects. Poor employment outcomes result in lower quality of life and often lead to steep economic costs. Governments are wise to pay attention to the poor employment outcomes as the high numbers of children now diagnosed with ASD will become adults in the future in need of employment opportunities. Improving employment outcomes for those living with ASD is an important policy objective. Work opportunities improve quality of life, economic independence, social integration, and ultimately benefit all. Adults with ASD can succeed with the right supports. Fortunately, there are many emerging policy and program options that demonstrate success. This paper conducts a review of studies and provides policy recommendations based on the literature, to help governments identify appropriate policy options. Some key factors are both those that are unique to the individual and the external supports available; namely school, work, and family. For example, factors that contribute to successful employment for people living with ASD may include IQ, social skills and self-determination, but for all, even for the less advantaged, external assistance from schools, employers and family can help. Inclusive special education programs in high school that offer work experiences are critical as are knowledgeable employers who can provide the right types of accommodation and leadership. In the work environment the use of vocational and rehabilitative supports, from job coaching to technology-mediated training are a few of the work related factors that enhance success. Information in this paper provides policy makers with a way to move forward and enhance the current employment situation for those living with ASD ultimately improving quality of life and economic independence.

WHY IS THIS AN IMPORTANT ISSUE?An estimated 1 in 86 children are diagnosed with Autism Spectrum Disorder (ASD)1 making it the most commonly diagnosed childhood neurological condition in Canada.2 Adults living with ASD3 have the poorest employment outcomes of those with disabilities. Most earn less than the national minimum hourly wage, endure extended periods of joblessness and frequently shuffle between positions, further diminishing their prospects. These poor employment outcomes result in lower quality of life and often lead to steep economic costs. WHAT DOES THE RESEARCH TELL US?Employment success increases quality of life Employment enhances quality of life, cognitive functioning and overall well-being of persons with ASD by increasing economic self-sufficiency, financial security, independent living, community participation and self-esteem.4, 5, 6 Unfortunately, employment outcomes for those living with ASD are poor; only 25 per cent of adults with ASD are employed, most of this group is considered high-functioning and only six per cent are competitively employed.7, 8 Success in employment is attributable to a combination of individual characteristics, external supports and policy enabling employment opportunities.

Introduction/BackgroundTo review the literature on chronic pain and autism spectrum disorder (ASD). A key aim is to explore the prevalence of chronic pain in children with ASD and the impact that ASD could have on the experience of chronic pain.Description/MethodAfter reviewing the literature, a thematic analysis was completed in order to identify key patterns. The thematic analysis identified four key topics: Prevalence of chronic pain in ASD; Impact of comorbid ASD and chronic pain; Psychological flexibility; Sensory sensitivities.Discussion/ResultsThe literature demonstrates that the prevalence of chronic pain is higher in children with ASD than the general population; studies show the prevalence of pain to be almost doubled in children with ASD (ASD = 15.6%; without ASD = 8.2%). Chronic pain can also have a more significant impact on functioning in children who exhibit ASD traits, shown through higher pain interference, higher depression levels and lower health related quality of life. This greater functional impairment means interventions are particularly important, however, challenges are highlighted by the literature; ASD traits may affect the efficacy of talking therapies and treatment guidelines are not specific, such as those for comorbid ASD and anxiety not being intended for use with physical health conditions.An important protective factor identified in comorbid chronic pain and ASD is psychological flexibility; acting on long-term values rather than current thoughts and feelings. However, this is typically low in ASD thus highlighting a role for Acceptance and Commitment Therapy (ACT), which aims to increase psychological flexibility. This is supported in chronic pain research where ACT leads to improved functioning, particularly in those with higher ASD traits.A discrepancy exists in chronic pain literature as there is a higher prevalence of children with clinically significant ASD traits than with confirmed ASD diagnosis. It appears that medically unexplained pain can interfere with ASD diagnosis, with it often being the first presenting symptom in undiagnosed ASD, and oversensitivity to pain has been associated with delayed ASD diagnosis. Sensory and perceptual abnormalities are commonly seen in ASD, with research indicating an underlying link between hypersensitivity and pain. However, current pain sensitivity findings can often not be generalised to children with comorbid chronic pain and ASD; studies tend to exclude those with such physical health conditions and investigate only acute pain sensitivity in ASD.Key learning points/ConclusionThere is a link between chronic pain and ASD evident in the literature as children with ASD are at a higher risk of developing chronic pain than the general population, particularly if they also experience abnormal or hypersensitivities.Chronic pain is likely to have a greater impact on children with ASD, including higher depression levels and lower quality of life.Due to the risk for greater functional impairment, it is particularly important to manage chronic pain in children with ASD, however common ASD traits and a lack of specific guidelines pose challenges in doing so.Due to a lack of existing research, further research is required to gain understanding of the link between chronic pain and ASD, including exploring sensory abnormalities in chronic pain and the management of comorbid chronic pain and ASD.It is important raise awareness of this association amongst clinicians, particularly due to the prevalence of undiagnosed ASD, the impact on intervention, and the risk for more severe functional impairment in paediatric chronic pain.

BackgroundThe incidence of autism spectrum disorders (ASD) is on the rise. Currently, 1 in 59 children are identified with ASD in the United States. ASD refers to a range of neurological disorders that involve some degree of difficulty with communication and interpersonal relationships. The range of the spectrum for autism disorders is wide with those at the higher functioning end often able to lead relatively independent lives and complete academic programs even while demonstrating social awkwardness. Those at the lower functioning end of the autism spectrum often demonstrate physical limitations, may lack speech, and have the inability to relate socially with others. As persons with ASD age, options such as employment become increasingly important as a consideration for long‐term personal planning and quality of life. While many challenges exist for persons with ASD in obtaining and maintaining employment, some research shows that, with effective behavioral and social interventions, employment can occur. About 37% of individuals with ASD report having been employed for 12 months or more, 4 years after exiting high school. However, several studies show that individuals with ASD are more likely to lose their employment for behavioral and social interaction problems rather than their inability to perform assigned work tasks. Although Westbrook et al. (2012a, 2013, 2015) have reviewed the literature on interventions targeting employment for individuals with ASD, this review is outdated and does not account for recent developments in the field.ObjectivesThe objective of this review is to determine the effectiveness of employment interventions in securing and maintaining employment for adults and transition‐age youth with ASD, updating two reviews by Westbrook et al. (2012a, 2013).Search MethodsThe comprehensive search strategy used to identify relevant studies included a review of 28 relevant electronic databases. Search terminology for each of the electronic databases was developed from available database thesauri. Appropriate synonyms were used to maximize the database search output. Several international databases were included among the 28 databases searched. In addition, the authors identified and reviewed gray literature through analysis of reference lists of relevant studies. Unpublished dissertations and theses were also identified through database searches. The programs of conferences held by associations and organizations relevant to ASD and employment were also searched. In sum, the search strategy replicated and expanded the prior search methods used by Westbrook et al. (2012a, 2013).Selection CriteriaSelection criteria consisted of an intervention evaluation using a randomized controlled trial or quasi‐experimental design, an employment outcome, and a population of individuals with ASD.Data Collection and AnalysisWe updated the search from Westbrook et al., replicating and broadening the information retrieval processes. Our wide array of sources included electronic databases, gray literature, and conference and organization websites. Once all potentially relevant studies were located, pairs of coders evaluated the relevance of each title and abstract. Among the studies deemed potentially relevant, 278 were subjected to full‐text retrieval and screening by pairs of coders. Because many intervention studies did not include employment outcomes, only three studies met our inclusion criteria. Given the small number of included studies, meta‐analytic procedures were not used; rather, we opted to use more narrative and descriptive analysis to summarize the available evidence, including an assessment of risk of bias.ResultsThe systematic review update identified three studies that evaluated employment outcomes for interventions for individuals with ASD. All three studies identified in the review suggest that vocation‐focused programs may have positive impacts on the employment outcomes for individuals with ASD. Wehman et al. indicated that participants in Project SEARCH had higher employment rates than control participants at both 9‐month and 1‐year follow‐up time points. Adding autism spectrum disorder supports, Project SEARCH in Wehman et al.'s study also demonstrated higher employment rates for treatment participants than control participants at postgraduation, 3‐month follow‐up, and 12‐month follow‐up. Smith et al. found that virtual reality job interview training was able to increase the number of job offers treatment participants received compared to control participants.Authors' ConclusionsGiven that prior reviews did not identify interventions with actual employment outcomes, the more recent emergence of evaluations of such programs is encouraging. This suggests that there is a growing body of evidence regarding interventions to enhance the employment outcomes for individuals with ASD but also greater need to conduct rigorous trials of vocation‐based interventions for individuals with ASD that measure employment outcomes.

Adults with Autism Spectrum Disorders (ASD) may face challenges in employment settings due to difficulties in social functioning. Bespoke employment interventions aim to make it easier for adults with ASD to secure and maintain jobs. This Campbell systematic review finds that there is not yet enough high quality research to draw a conclusion on their effectiveness. This review focused on employment interventions for adults 18 years or older with a diagnosis of ASD, and who were no longer enrolled in a school‐to‐work or secondary‐level education programs. The review considered interventions that centered on competitive, supported or integrated employment but did not include those where the treatment groups were not in an integrated or mainstream format of employment. The review focused on one outcome, attainment of a job placement, based on specific information about the duration and/or retention of that placement. One of the two included studies looked at a program where support workers gave guidance on job searching, work preparation and employer communication. The second study looked at supported employment involving jobs located in the local community and guidance from job coaches. Executive summary/Abstract BACKGROUND The incidence of Autism Spectrum Disorders (ASD) has been increasing over the last two decades. Currently, 1 in 110 children are identified with ASD in the United States (CDC, 2009). ASD refers to a range of neurological disorders that involve some degree of difficulty with communication and interpersonal relationships. The range of the spectrum for autism disorders is wide with those at the higher functioning end often able to lead relatively independent lives and complete academic programs even while demonstrating social awkwardness. Those at the lower functioning end of the autism spectrum often demonstrate physical limitations, may lack speech, and have the inability to relate socially with others. As persons with ASD age, options such as employment become increasingly important as a consideration for long‐term personal planning and quality of life. While many challenges exist for persons with ASD in obtaining and maintaining employment, some research is showing that, with effective behavioral and social interventions, employment can occur (Schaller & Yang, 2005). In fact, about 37% of individuals with ASD report having been employed for 12 months or more, four years after exiting high school (Newman, Wagner, Cameto, & Knokey, 2009). However, several studies show that individuals with ASD are more likely to lose their employment for behavioral and social interaction problems rather than their inability to perform assigned work tasks (Dew & Alan, 2007; Hurlbutt & Chalmers, 2004; Unger, 1999). Research has been conducted in the area of autism and employment, but such research has not been reported in a comprehensive evidence review format before. Thus, a systematic review on the effectiveness of adult employment assistance interventions for individuals with ASD would not only demonstrate the extent and magnitude of the interventions' effects, but also provide ideas for further research that can inform implementation and refinement of related employment‐focused programs. OBJECTIVE The objective of this review is to determine the effectiveness of adult employment interventions in securing and maintaining employment for adults with ASD. SEARCH STRATEGY The comprehensive search strategy used to identify relevant studies included the review of 28 relevant electronic databases. Search terminology for each of the electronic databases was developed from available database thesauri. Appropriate synonyms were used to maximize the database search output. Several international databases were included among the 28 databases searched. In addition, the authors identified and reviewed grey literature through analysis of reference lists of relevant studies. Unpublished dissertations and theses were also identified through database searches. The programs of conferences held by associations and organizations relevant to ASD and employment were also searched. SELECTION CRITERIA A two‐stage process was used to determine inclusion or exclusion of studies: (1) two reviewers independently reviewed the title and abstract of each identified study, and (2) for studies advanced from the first stage, two independent reviewers reviewed the full text of each study for final determination of inclusion or exclusion. Inclusion criteria allowed the following research designs: randomized controlled, quasi‐experimental, and single subject experimental designs. DATA COLLECTION AND ANALYSIS The electronic searches of databases yielded 8,528 citations for the first stage of review. Of these, a total of 77 citations were selected for second stage full‐text review of each study. Upon review of the full‐text for each of the 77 studies, two studies were retained, having met the inclusion criteria. Of the two included studies, both were quasi‐experimental research designs. The studies generally described the effects of a supported employment intervention for adults with ASD on either employment outcomes or aspects of cognitive functioning. The nature of the data provided did not lend itself to a traditional meta‐analysis. Given the number of studies, study designs, and the diversity of outcomes across the two studies, it was not possible to aggregate results across studies. 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' CONCLUSIONS 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.

Because of behaviors specific to autism spectrum disorder (ASD), children with ASD may have a poor quality of life, and maintain their nutritional and gastrointestinal (GI) health can be quite challenging. This study aimed to holistically examine the diet quality and diversity, quality of life, and nutritional and GI problems in children with ASD and compare their outcomes with healthy peers. Nutritional and GI problems were evaluated through a questionnaire according to the parents’ responses. Healthy Eating Index-2015 (HEI-2015) was used to evaluate diet quality, diet diversity score (DDS) was used to examine the food groups consumed, and Pediatric Quality of Life (PedsQL) was used to evaluate the quality of life. A total of 56.0% of children with ASD had a normal body weight for their age, 66.0% had a normal height for their age, and 70.0% had a normal body mass index (BMI) for their age. Various parameters were evaluated for ASD and healthy children, respectively and children with ASD had lower BMI Z scores (ASD = 0.35 ± 0.90, Healthy = 1.03 ± 1.44), lower quality of life (5–7 years ASD = 49.0 ± 5.94, Healthy = 89.0 ± 13.24; 8–12 years ASD = 47.1 ± 7.59, Healthy = 86.9 ± 14.07) and lower diet quality (Healthy = 73.8 ± 3.92, ASD = 71.5 ± 4.11) (p < 0.05). No significant difference was found between the two groups in terms of diet diversity (p > 0.05). Gastrointestinal system problems, food refusal, food neophobia, food obsession and fast eating were seen more frequently in children with ASD compared to healthy children (p < 0.05). In conclusion, children with ASD were found to have more nutritional and GI problems, a lower quality of life, and poorer diet quality compared to their peers. Growth curves, diet quality and diversity, quality of life, nutrition and GI problems of children with ASD should be carefully monitored and individualized nutrition strategies should be developed.

Background:People with autism spectrum disorder (ASD) are three to four times less largely to be with employment compared to neurotypical others. Theory based studies may provide helpful indicators for the design and implementation of employment supports for people with ASD.Objective:This critical review examined the extent of the evidence for theory in studies on employment outcomes for people with ASD and taking into account social inequality. For the evidence, 35 studies were selected for review if they were published in the period 2000–2016 and assessed for the association between work participation with ASD applying descriptive survey or quasi-experimental design.Methods:Studies were examined for use of any theory, including four predetermined theory types: social liminality, psychosocial, behavioral, and structural-infrastructural. They were also content-analyzed to determine if they cited any evidence of social inequality influences on employment outcomes with ASD.Findings:Results indicated that none of the studies explicitly applied and tested a theory on work participation with ASD. Rather, the majority of the studies were implicitly framed on predominantly behavioral type theory with minor elements of workplace psychosocial support theory-oriented interventions. Regard of structural-infrastructural type theory addressing social inequality is incidentally addressed by a few of the studies (n= 3) that examined family income status influences.Conclusion:In conclusion, extant studies on the association between employment outcomes and ASD are seriously limited in their explanatory value by a lack of theoretical grounding. They also neglect influences of antecedent social inequality in employment outcomes with ASD. Future studies should apply specific theory to questions on employment outcomes with ASD to provide usable evidence to inform employment support policy instruments and interventions for people with ASD.

The persistence of disappointing employment outcomes for youth and adults with autism spectrum disorder (ASD) indicates the importance of efforts to prepare them for the workplace. We conducted a systematic review of intervention/follow-up intervention studies on employment skills and outcomes for youth and adults with ASD. We reviewed 39 studies in terms of their participant characteristics, research methodologies, intervention features, and employment outcomes. These studies highlight practices and programs that promote vocational skill acquisition, improve employment outcomes, and provide collateral benefits (e.g., mental health, confidence, time management). It is unclear, however, which individuals with ASD are likely to benefit most from particular interventions. We offer implications for practice and research to improve employment experiences of youth and adults with ASD.

Evidence suggests that youth with autism spectrum disorder (ASD) are at increased risk for experiencing a mental health crisis. Yet, limited systematic research exists on this topic. This study examines the prevalence, phenomenology, and correlates of mental health crisis in children, adolescents, and young adults with ASD. Participants included 462 parents of individuals with ASD (83% male, 86% Caucasian, M = 13.7 years, SD = 4.7) who were enrolled in the Interactive Autism Network, a large online registry of families of individuals with ASD. Parents completed the Mental Health Crisis Assessment Scale, a psychometrically sound measure of mental health crisis for youth with ASD, as well as measures of parental depression, family quality of life, and mental health treatment history. Overall, 32% of parents reported that their child had experienced a mental health crisis during the last 3 months. In the younger group, elopement (88%) and self-injury (81%) were the most frequent behaviors contributing to crisis; physical (60%) and verbal (42%) aggression were the most frequent crisis behaviors in the older group. Correlates of crisis included younger age, increased parental depressive symptoms, and lower family quality of life. Approximately 75% of individuals in crisis had seen a psychiatrist or behavioral therapist/psychologist within the last 3 months and 25% were not engaged in any mental health treatment. In summary, mental health crises were quite prevalent in this online sample of youth with ASD. Identification and treatment of these serious events is critical to reduce morbidity in this population. Autism Res 2020, 13: 112-121. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study examines the prevalence and characteristics of mental health crisis in children, adolescents, and young adults with autism spectrum disorder. We found that 32% of individuals in our study had experienced a mental health crisis within the last 3 months. Younger age, increased parental depression, and lower quality of life were associated with crisis. These findings emphasize the importance of developing child and family-based interventions to prevent and treat the mental health crisis in this population.

Mitochondrial Dysfunction in Autism Spectrum Disorder: Unique Abnormalities and Targeted Treatments

Social communication and interaction deficits are characteristics of autism spectrum disorder (ASD). However, no study reported the association between living alone and quality of life (QOL) in participants with ASD. To evaluate the association among solitude, connection with society, low quality of life, and ASD. We conducted a web survey-based cross-sectional study of 3,865 Japanese participants with ASD living alone and may not view a connection to society as important. Participants were asked to choose three answers from 13 items for the question, 'What do you think is the most important matter to elevate your quality of life (QOL)?' If participants answered 'connection with society', we defined it as 'thinking connection with society is important'. Living alone was inversely connected with the Life Satisfaction Scale scores for participants with and without ASD. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of living alone on the life satisfaction scale (one standard deviation) for those without and with ASD were 0.78 (0.72, 0.85) and 0.74 (0.58, 0.95), respectively. However, the association between living alone and 'thinking connection with society is important' is positive for those without ASD but inverse for those with ASD. The adjusted ORs (95% CIs) for patients without and with ASD were 1.25 (1.03, 1.53) and 0.28 (0.11, 0.70), respectively. Living alone might strengthen the 'thinking connection with society is important' for participants without ASD but weaken it for those with ASD.

OBJECTIVE: We sought to examine the independent and interactive effects of common mental health disorders and chronic pain conditions on employment and work outcomes among individuals younger than 65 years of age. METHODS: We analyzed cross-sectional data from the second wave of Healthcare for Communities (HCC2), a household telephone survey of U.S. civilian adults conducted in 2000 to 2001 (N=5328). Common mental disorders were assessed using the short-form versions of the World Health Organization’s Composite International Diagnostic Interview (CIDI-SF). Chronic pain conditions and labor market outcomes were identified by self report. Logistic and linear regression analysis was used to provide estimates for work impairment based on the presence of a mental health disorder and/or a chronic pain condition. RESULTS: The interaction between presence of a mental health disorder and presence of a chronic pain condition was significantly associated with no work for pay in the past 12 months (OR 2.3 [1.2–4.2]) and number of days of work missed in the past month due to health (regression coefficient 1.5 [0.6]). In stratified analyses, this effect persisted in women but not men. The presence of a mental health disorder or chronic pain condition were each independently associated with limitations in work and any work missed in the past 30 days due to health, although the interaction was not significant. CONCLUSION: Mental health disorders and chronic pain are each associated with work disability. Mental health disorders are more highly associated with some work disability outcomes when accompanied by chronic pain, especially in women.

Population-based data on educational and employment outcomes in adulthood among individuals diagnosed with autism spectrum disorder (ASD) in childhood are currently limited. To evaluate educational attainment and employment among individuals with and without a diagnosis of ASD before age 12 years in Denmark. This nationwide cross-sectional prevalence study was conducted using data from Danish registers. Individuals with a diagnosis of ASD recorded before age 12 years were identified among all individuals born in Denmark between January 1, 1989, and December 31, 1991, who were alive at age 25 years. Individuals with ASD were then matched on a 10:1 ratio by age, sex, and region of residence with a comparison population of individuals without a diagnosis of ASD at age 12 years. Data were analyzed from March 2019 to December 2020. Autism spectrum disorder diagnosis and diagnostic subtype recorded before age 12 years. Adjusted prevalence ratios (aPRs) with 95% CIs for the completion of compulsory primary and lower secondary school (grade 9), upper secondary school (grades 10-12 or vocational), and tertiary school (university) and for employment by age 25 years were estimated using log-binomial regression analysis. A total of 810 individuals with a diagnosis of ASD before age 12 years were matched with a comparison population of 8100 individuals without ASD. The prevalence of ninth-grade completion was similar among those with and without ASD (785 individuals [96.9%] and 7982 individuals [98.5%], respectively; aPR, 0.98; 95% CI, 0.97-1.00). Compared with those without ASD, persons with ASD had a lower prevalence of completing upper secondary school (6338 individuals [78.2%] vs 286 individuals [35.3%], respectively; aPR, 0.46; 95% CI, 0.42-0.50) and tertiary school (2185 individuals [27.0%] vs 70 individuals [8.6%]; aPR, 0.33; 95% CI, 0.26-0.41) and obtaining employment (4284 individuals [77.7%] vs 177 individuals [27.2%]; aPR, 0.35; 95% CI, 0.31-0.40) at age 25 years. A ninth-grade final examination score was available for 394 individuals (48.6%) with ASD and 7417 individuals (91.6%) without ASD. In an analysis stratified by ASD subtype, individuals diagnosed with childhood autism had lower educational attainment and employment than those diagnosed with Asperger syndrome or pervasive developmental disorder not otherwise specified. A total of 461 individuals (56.9%) with ASD were receiving public assistance or a pension (ie, disability benefits) at age 25 years compared with 1094 individuals (13.5%) without ASD in the comparison population. In this population-based cross-sectional study, a diagnosis of ASD in childhood was not associated with the completion of compulsory primary and lower secondary education (ninth grade). An ASD diagnosis before age 12 years was associated with a lower prevalence of attaining education beyond ninth grade and obtaining employment by age 25 years, indicating a substantially higher risk of reliance on public assistance in young adulthood.

Research has consistently documented poor employment outcomes for young adults with autism spectrum disorder (ASD). Vocational rehabilitation (VR) services provide substantial federal and state commitments to individuals with disabilities to obtain and maintain employment. To date, little research has examined the relationship between VR services and employment outcomes of clients with ASD. The purpose of this descriptive study was to better understand employment outcomes of individuals with ASD. Data spanning 10 years from the Rehabilitation Services Administration (RSA) 911 database were analyzed to identify characteristics of VR clients with ASD and the services they received. The percent of individuals who achieved competitive employment averaged 37% across the 10 years. Those who achieved an employment outcome participated in twice as many services as those who did not achieve an employment outcome.

We examined the prevalence and correlates of postsecondary education and employment among youth with an autism spectrum disorder (ASD). Data were from a nationally representative survey of parents, guardians, and young adults with an ASD. Participation in postsecondary employment, college, or vocational education and lack of participation in any of these activities were examined. Rates were compared with those of youth in 3 other eligibility categories: speech/language impairment, learning disability, and mental retardation. Logistic regression was used to examine correlates of each outcome. For youth with an ASD, 34.7% had attended college and 55.1% had held paid employment during the first 6 years after high school. More than 50% of youth who had left high school in the past 2 years had no participation in employment or education. Youth with an ASD had the lowest rates of participation in employment and the highest rates of no participation compared with youth in other disability categories. Higher income and higher functional ability were associated with higher adjusted odds of participation in postsecondary employment and education. Youth with an ASD have poor postsecondary employment and education outcomes, especially in the first 2 years after high school. Those from lower-income families and those with greater functional impairments are at heightened risk for poor outcomes. Further research is needed to understand how transition planning before high school exit can facilitate a better connection to productive postsecondary activities.