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CHÉOS Scientist examines evidence on employment for adults with autism spectrum disorders

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The findings of a recent scoping review suggest that evidence that pays mind to mental health considerations is needed to ensure appropriate supports, accommodation, and training exist to promote successful employment for adults with autism spectrum disorder (ASD), a complex neurodevelopment disorder.

“This review underlines the need to incorporate and acknowledge the implications of mental health challenges when discussing and recommending jobs to adults with autism,” said CHÉOS Scientist Dr. Skye Barbic, a lead researcher of the review and Assistant Professor in the Department of Occupational Science and Occupational Therapy, Faculty of Medicine, UBC.

For most people, employment is an essential defining factor of one’s identity and contributor to one’s quality of life. This holds perhaps even more true for individuals with ASD. The symptoms of the disorder, characterized by challenges with social communication and social interaction, are often perceived as barriers to employment. With the unemployment rate in some developed countries estimated at nearly 15 times higher for those with ASD than the overall unemployment rate, there is a clear need for better support to enable increased participation in the workforce among adults with ASD.

“Employment is a known issue in this community, but there has been very little done to improve and develop effective ways of supporting adults with autism to get and hold on to jobs,” said Dr. Barbic.

Dr. Barbic, together with a team of researchers consisting of occupational therapists, Dr. Anthony Bailey, Professor and Chair of Child and Adolescent Psychiatry, UBC librarian Charlotte Beck, and Ms. Tracy Adams from Vancouver Mental Health and Substance Use, sought to summarize the barriers and facilitators to employment for adults with ASD, highlighting key findings, gaps, and limitations in the current body of literature. To do so, they searched seven databases for articles that examined the complex personal, environmental, and work-specific needs of adults with ASD that effect employment.

The researchers identified 161 articles that met their inclusion criteria and through an iterative process were able to establish the scope and breadth of the existing evidence on how best to support adults with ASD in navigating employment. Among the articles included in the review, the type and quality of the evidence was mixed, with the majority having lower levels of evidence such as nonrandomized or descriptive studies. They found studies described based on a number of parameters including the type of work, hours worked, and compensation.

Reaffirming the issue of employment for adults with ASD, the review pointed out that studies repeatedly reported that employees with ASD tended to receive less pay than neurotypical employees, work fewer hours, and rarely achieve full-time employment. A variety of individual, environmental, and work-related factors influencing the success of employment were pulled from the literature. Key individual-person level facilitators included having lower levels of ASD-specific behaviours, and possessing insight into one’s strengths and barriers, and job-specific skills. An individual’s supportive network was identified as a strong context-specific facilitator and comprehensive training for skills development, emotion management, and other soft job skills was an important work-related facilitator.

People with ASD were also found to face a number of barriers when trying to secure or maintain employment.
“We found that co-occurring mental health conditions, mostly depression and anxiety, were a significant impediment to employment in this population,” explained Dr. Barbic.

This is particularly significant because mental health conditions are quite common among individuals with ASD, research indicating that at least one third also have an anxiety disorder. Other barriers to employment included communication and social difficulties, disruptive behaviour, including self-harm, repetitive behaviour, and sensitivity to surroundings.

Though mental health conditions were mentioned and recognized as a barrier to employment in some studies, the review identified a major gap in the literature around recommendations addressing these comorbid conditions. Relatively little attention was also given to the stigma related to mental health conditions in addition to that associated with ASD.

“As with other mental conditions or comorbidities, the elimination of stigma is key to building an inclusive workforce and community,” Dr. Barbic noted.

Drs. Barbic and Bailey are now planning a future project to develop a model of employment support for this population. “Employment and meaningful activity are key vehicles for health and well-being,” said Dr. Barbic. “Our province has the capacity, resources, and creativity to build a coordinated model of employment support to help every person thrive.”

The scoping review is published in the Annals of International Occupational Therapy

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