Date Presented 04/13/21
Individuals with autism spectrum disorder (ASD) experience high rates of unemployment. To address this concern, a systematic review was conducted to examine the efficacy of work-related training for individuals with ASD. The results suggest that various elements of work-related training programs prove efficacious in increasing employment outcomes in individuals with ASD, but further research is needed to determine if these methods would be useful in OT practice.
Primary Author and Speaker: Marie-Christine Potvin
Additional Authors and Speakers: Mindy Garfinkel
BACKGROUND: Autism spectrum disorder (ASD) is characterized by marked and sustained social, behavioral, and communication impairments that can negatively impact participation in daily activities, including employment (Allen, Wallace, & Renes, 2010). ASD is considered a lifelong disability, and its prevalence continues to rise (Croen et al., 2015). Individuals with autism spectrum disorder are unemployed and underemployed at higher rates than other similar disability groups (Wehman et al., 2017). The poor employment outcomes are well documented throughout literature and have resulted in calls to deliver more effective ways of providing support and work-related interventions (Strickland, Coles, & Southern, 2013). Researchers have investigated the efficacy of work-related training on successful employment outcomes when used with individuals with autism. However, a systematic review summarizing this evidence is not available. Investigating the efficacy of work-related training for individuals with autism will help occupational therapists make an evidence-based decision when selecting important elements to be included in a vocational training program.
METHODS: A systematic review was conducted across four different databases (ERIC, PubMed, CINAHL, and PsycInfo) using specific subject headings and keywords. The results were limited to peer-reviewed and quantitative studies only. The search generated 730 articles. Six reviewers followed the protocol to identify, appraise and synthesize all relevant peer-reviewed studies. Articles studying participants diagnosed with ASD, Asperger’s, or Pervasive Developmental Disorder who are at least 14 years old were included. Articles were excluded if they were in a non-English language or single-case studies that were not A-B-A design. Each article was appraised independently by two reviewers to determine the level and quality of evidence. Both reviewers would then engage in a consensus process to resolve any differences. If an agreement could not be met, a third reviewer was consulted to resolve the differences. After exclusion criteria were applied and all duplicate articles were removed, 12 studies were found to be acceptable to include in the systematic review.
RESULTS: According to Sackett’s level of evidence pyramid, five of the 12 studies were a level I, four were a level III, and three were a level IV. Five of the studies were high quality, five were moderate quality, and two were low quality evidence. Results of the twelve studies varied for three primary outcomes (1) acquiring selected vocational skills; (2) increasing communication skills; (3) acquiring employment. Employment was the only outcome to achieve statistically significant results.
CONCLUSION: The results of this review suggest further evidence is necessary to evaluate the efficacy of work-related training for individuals with autism. With the limited evidence available, it can be concluded that customized work-related training has strengthened the employment skills for selected individuals. However, due to the small sample size of the studies and the individualization of the interventions, it is not possible to generalize to the whole population. There is sufficient evidence to suggest that work-related training should be recommended to address employment for individuals with autism. However, further research is needed to determine which elements of work-related training programs are most effective for individuals with autism so an informed and evidence-based decision can be made.
References
Allen, K. D., Wallace, D. P., Renes, D., Bowen, S. L., & Burke, R. V. (2010). Use of video modeling to teach vocational skills to adolescents and young adults with autism spectrum disorders. Education and Treatment of Children, 33(3), 339–349. https://doi.org/10.1353/etc.0.0101
Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism, 19(7), 814–823. https://doi.org/10.1177/1362361315577517
Strickland, D. C., Coles, C. D., & Southern, L. B. (2013). JobTIPS: A transition to employment program for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(10), 2472–2483. https://doi.org/10.1007/s10803-013-1800-4
Wehman, P., Schall, C. M., Mcdonough, J., Graham, C., Brooke, V., Riehle, J. E., Brooke, A., Ham, W., Lau, S., Allen, J., & Avellone, L. (2017). Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autism. Autism, 21(3), 276–290. https://doi.org/10.1177/1362361316635826
