The limited extant research on post-high school activities for adults with autism spectrum disorders (ASD) paints a pessimistic picture of their employment. Howlin et al. (2004)
studied a sample of 68 adults with ASD in the United Kingdom, finding that just under one-third had some type of employment. About 13% were in a competitive employment situation, and another 18% were in a sheltered or supported setting. Similar patterns of employment were found in a sample of 45 adults with ASD in the US (Ballaban-Gil et al. 1996
); 27% had some sort of work activity. About one-half of those were competitively employed, and the other half were employed in supported positions or sheltered workshops. The remaining individuals had no employment activities at the time of the interview. However, even those who were able to find employment tended to have jobs that were poorly paid. Finally, Eaves and Ho (2008)
examined a sample of young adults with ASD in Canada and found that nearly 45% of their sample had never been employed. At the time of their follow-up interview, only 4% were competitively employed, with just one person in their sample able to financially support himself. Thus, underemployment of individuals with ASD is an international phenomenon.
Studies have yet to focus on how characteristics of individuals with ASD predict their post-high school occupational and employment activities. Investigators have, however, examined the behavioral correlates of a related composite measure of social functioning that incorporates independence in employment activities, living arrangements, and friendships (Howlin et al. 2004
). The most consistent correlate is IQ; individuals who have ASD and comorbid intellectual disability (ID) have less optimal social functioning (reflecting less independence) compared to those with ASD and higher IQ scores (Eaves and Ho 2008
; Farley et al. 2009
; Gillberg and Steffenburg 1987
; Howlin et al. 2004
; Lord and Bailey 2002
Our research, however, suggests that there may be a subgroup of young adults with ASD without ID who are at risk for poor employment outcomes in adulthood. Taylor and Seltzer (2010)
found that improvement in repetitive and maladaptive behaviors slowed more after high school exit for youths with ASD without ID, relative to youths with ASD with ID. Furthermore, the most pronounced change in symptoms and maladaptive behaviors after high school exit was observed for those youths without ID who were from lower income families; these individuals actually showed a worsening of their behavioral profile after high school exit. Improvements in functional abilities are related to more stimulating environments for individuals with Down syndrome (Shepperdson 1995
); the slowing in improvement in behaviors for young adults with ASD without ID may be related to less stimulating occupational activities after high school exit, especially for those youths from lower income families who may have greater barriers to service access (Liptak et al. 2008
; Thomas et al. 2007
Indices of behavioral functioning such as autism symptoms, maladaptive behaviors, functional independence, and comorbid psychiatric disorders are also likely related to the employment activities of young adults with ASD in the years following high school exit. Using the aforementioned composite measure of social functioning, investigators have found greater independence for adults with ASD who have fewer autism symptoms (Eaves and Ho 2008
; Howlin et al. 2004
). Although not a part of the diagnostic criteria of ASD, maladaptive behaviors are often exhibited by people with ASD (Aman et al. 2003
; Hollander et al. 2003
; Lecavalier 2006
; Shea et al. 2004
) and are a primary source of stress for caregivers (Hastings 2003
; Hastings and Brown 2002
; Lecavalier et al. 2006
; Tomanik et al. 2004
). Maladaptive behaviors interfere with day-to-day functioning and include such behaviors as self-injury, aggression, and uncooperative behaviors. Although they have not yet been studied in relation to employment in early adulthood, it is likely that young adults with ASD and high levels of maladaptive behaviors would require more supports in their adult day activities relative to those with fewer maladaptive behaviors.
Our research has found evidence for relationships between functional independence, comorbid psychiatric disorders and social functioning for individuals with ASD. In a study of adults with ASD aged 22–53 years, reduced independence in activities of daily living and psychological/psychiatric service receipt (indicative of a comorbid psychiatric diagnosis) were related to lower social functioning and less independence in adulthood (Esbensen et al. 2010
). These relations are consistent with a study by Farley et al. (2009)
, who found that adults with ASD and higher adaptive behaviors had more independent social functioning relative to those with lower adaptive behaviors.
Each of the previous studies focused on employment and social outcomes for a wide age range of adults with ASD. The present study extends this research in three ways. First, we evaluated the activities of young adults with ASD who had recently exited the secondary school system. Focusing on a narrow age range allowed us to better understand whether the employment difficulties reported in the literature are evident in the years immediately following high school exit in a cohort that finished high school in recent years. Second, our analysis of adult activities focused on employment/day activities instead of the less specific social functioning composite (e.g., combination of employment/day activities, living arrangements, and friendships) commonly used in extant research. In contrast to most previous studies, we expanded our categorization of employment/day activities to include enrollment in post-secondary degree-seeking educational programs. Finally, we examined the association between post-secondary employment/day activities and ID, as well as concurrent behavioral functioning including autism symptoms, behavior problems, functional independence, and comorbid psychiatric disorders. To the best of our knowledge, this is the first study to relate employment/day activities to concurrent behavioral functioning.
Our study had three research aims. First, we provided a rich description of the occupational and day activities for a group of young adults with ASD who had exited high school within the past 5 years. Second, we examined whether having an intellectual disability was related to the type of employment or day activity. We hypothesized that youths with ASD without ID would be more likely to have post-high school activities that required high levels of independence, such as competitive employment or a post-secondary degree-seeking educational program, relative to those with ID. Based on the Taylor and Seltzer (2010)
findings, we also hypothesized that there would be a subgroup of young adults with ASD without ID who would have limited day activities. Our third aim examined the relations between type of employment or day activity and family income as well as the behavioral functioning of the young adults with ASD. We hypothesized that youths with ASD who were participating in day activities that required few supports would exhibit fewer autism symptoms, maladaptive behaviors, and comorbid psychiatric diagnoses and higher levels of functional independence. We further hypothesized that youths with ASD who had limited day activities would have families with lower incomes (reflecting barriers in accessing services).