A Synthesis Review of Employment Support Interventions in ASD

Background: Evidence suggests that adults with ASD are at risk for poor employment outcomes. Of those who obtain employment, underemployed or being employed in positions that are not meaningful or rewarding may limit employment engagement. These challenges can negatively impact individual quality of life and self-esteem, and potentially impose gaps in labor market productivity. A relatively small body of literature explores employment support interventions for individuals with developmental and/or intellectual disabilities. While some models and interventions show promise, little is known about their use and effectiveness with the ASD population. 

Objectives:  This synthesis review explored employment support interventions applied in ASD, along with respective outcomes.

Methods:  A synthesis review of ASD employment support interventions was implemented. The peer-reviewed literature on vocational interventions in ASD was reviewed. A librarian trained in Cochrane collaboration synthesis/systematic review methods conducted the search, exploring Cochrane, Scholar’s Portal, CINAHL, EMBASE, ERIC, Medline and PsycINFO databases, and the gray literature. Studies were included if they identified a vocational intervention in ASD and outcome data.

Results:

This search yielded 501 articles targeted to adults with ASD (18 years of age or older); however, only 10 studies were included due to meeting inclusion criteria of evaluating an ASD employment support intervention. Two broad categories of interventions were identified: supported employment (community placement and job coaching) and technology-based applications (media and online use). It is important to note that the literature disproportionately reported on the cognitively-able ASD population, with less consideration of diversities relative to variability across the ASD spectrum, gender or other social determinants of health.

Supported employment literature in ASD tended to favor positive outcomes from interventions when protracted, commenced earlier in life, and tailored to the needs of the individual.  Supported employment was identified as potentially offering positive impacts on cognitive performance. A community placement model was shown to offer better outcomes than a sheltered work approach.  Job coaching was often viewed as integral to employment access.  Interventions that utilized technology were perceived to yield positive outcomes, as was video-modeling which was posited to teach modeled skills, with some participants replicating these in work settings. The use of personal digital assistants (PDAs) was also shown to nurture work-related behaviors.

It is important to note that the reviewed studies were generally limited by methodology limitations including design, small sample size and imprecise outcome measurement, leading to concerns over the generalizability of this literature.

 Conclusions: There is a need for research with stronger empirical designs as well as inclusion of diversities in ASD and the social determinants of health.  Addressing both access and retention of employment is critical in evaluation and practice, as is building employer engagement and community capacity.