Introduction

In recent years, the diagnosis of autism spectrum disorder (ASD) has become increasingly common, with 1 in 68 children in the USA diagnosed with the disorder (Centers for Disease Control and Prevention [CDC] 2014). Traditionally, research and clinical focus has been on early intervention for individuals with ASD, with a lack of emphasis on supporting adolescents or adults as they progress through life. This is particularly problematic as research suggests that post-second-level employment opportunities for individuals with ASD are typically limited (Hendricks and Wehman 2009), and among employment-aged adults with disabilities, some of the lowest employment rates are reported for individuals on the autism spectrum (Burke et al. 2010).

The Individuals with Disabilities Education Act (IDEA 2004) ensures that in the USA, special education services are provided to youth with disabilities, including autism (Chiang et al. 2013). Further, IDEA specifies that appropriate postsecondary goals, including further education or employment, based upon students’ interests and strengths, should be included in their individualized education plan (IEP) and that students should receive the support necessary to achieve these aims (Chiang et al. 2013). However, research indicates that, in reality, approximately as few as 25 % of individuals with ASD are employed (Holwerda et al. 2012). A recent study of 169 adults with high-functioning ASD found that only about half of the participants were in paid employment (49 %) and many (36 %) were on social security benefits (Barneveld et al. 2014).

The limited employment opportunities available to those with ASD may be the result of the challenges associated with the disorder. The impairments in social and communicative functioning associated with ASD can impact every aspect of adaptive functioning (American Psychological Association 2000). Due to these deficits, traditional training methods used by employers (e.g., lengthy verbal instruction or the use of modeling) are often counterproductive for individuals with ASD and may negatively impact their ability to secure employment (Burke et al. 2010). Further, most workplaces require adherence to social norms and an understanding of social decorum which may also be problematic for those with ASD (Vogeley et al. 2013). Individuals on the spectrum may also have physical health problems, behavioral issues, and various comorbid diagnoses that may complicate their participation in employment-related activities. Behavioral issues such as stereotyped motor movements and vocalizations, insistence on maintaining routines or sameness, and sensory difficulties are all associated with ASD (Schall 2010). Persons with ASD also frequently present with comorbid disorders including gastrointestinal disorders, intellectual disabilities, epilepsy, and anxiety among others (e.g., Hofvander et al. 2009; Lugnegård et al. 2011). These challenges may create barriers to securing and maintaining employment for those diagnosed with ASD.

However, in spite of the identified difficulties, some individuals with ASD possess traits and attributes that are often highly desired by employers and should be viewed as strengths in the workplace. Persons with ASD may have the ability to be highly focused in certain situations and possess excellent visual perception abilities (Kellems and Morningstar 2012). Thorkil Sonne, founder of the Specialist People Foundation and Specalisterne, which employs individuals with ASD in Denmark, seeks to transform the way society perceives autism from viewing it as a handicap to recognizing that it can become a competitive advantage (Sonne 2009). While communication and repetitive behavior can be a barrier to employment for people on the autism spectrum, Sonne (2009) emphasizes the value of employing those with ASD by describing the ability to focus on a given task, exceptional persistency, attention to detail, and the tendency to thrive on routine as pertinent skills that any employer would value.

However, an adequate employment service, including environmental accommodations and individualized support and skills training, is necessary to aid individuals with ASD to join the workforce. Currently, the specific interventions that lead to positive employment outcomes for individuals with ASD are poorly understood, and the lack of specific employment-related skills may prevent individuals with ASD from accessing available employment opportunities. Existing employment options for people with disabilities described in the literature include sheltered employment, supported employment, and competitive employment. Sheltered employment involves people with disabilities working, below minimum wage, together in a segregated setting designed to employ people with disabilities (Gottlieb et al. 2010). Supported employment represents an integrated model of employment where workers with disabilities are assisted throughout the employment process and work in community-based settings (Gottlieb et al. 2010). Competitive employment involves people with disabilities working at an equivalent rate to those without disabilities, and research illustrates that between 6 and 10 % of individuals with ASD are competitively employed (Wilczynski et al. 2013). Although these employment options exist, positions are limited and are typically directed toward individuals who are high functioning (Sonne 2009).

The lack of employment opportunities for persons with ASD is further problematic given the positive impact of employment on quality of life (QoL) that has been frequently evidenced for typically developing persons (Barneveld et al. 2014). Research has shown that the three key domains of QoL common to all adults are residential living, employment, and socialization (Graetz 2010). Further, among typically developing persons, employment has been related to a variety of other important outcomes; a meta-analysis by McKee and colleagues (2005) indicated that across 52 studies, employed individuals demonstrated greater mental health, life satisfaction, marital or family satisfaction, and self-perceived physical health than those who were unemployed. It has also been recognized that work is an important means of social inclusion and offers individuals often excluded from society, such as those with disabilities, a social outlet and a chance to contribute to society (Carew et al. 2010). Employment is also a necessary step toward economic self-sufficiency and, hence, greater inclusion in society (Migliore et al. 2014). With the considerable benefits of employment across many domains, it is important that individuals with ASD have the opportunity to gain meaningful, supported, or competitive employment.

Thus, given the positive outcomes associated with employment and the seeming dearth of employment opportunities for individuals with ASD, the present literature review sought to critically examine the predictors and impact of employment for individuals with ASD and to evaluate the interventions described in the literature to teach employment and vocational skills.

Method

Literature Search

Systematic searches were conducted using five electronic databases: Academic Search Complete (EBSCO), ERIC, Scopus, PsycInfo, and Psychology and Behavioral Science Collection (EBSCO). In all databases, searches were conducted by inputting the words “employment AND autis*” as well as “vocational skills AND autis*” as sole search terms. Autism was also inputted as a search term in combination with the following keywords: vocational education, vocational training, and work. Developmental disabilit* was inputted as a search term in combination with the following keywords: vocational skills, vocational education, vocational training, and work. All abstracts returned during the initial electronic searches were reviewed to determine their suitability for inclusion.

Inclusion and Exclusion Criteria

The criteria for inclusion in this review were (a) the inclusion of at least one participant diagnosed with ASD, Asperger’s syndrome, or a pervasive developmental disorder; (b) the examination of either predictors of employment, the impact of employment, or an intervention designed to increase vocational or employment-related skills; and (c) publication in an English language, peer-reviewed journal. Studies which evaluated interventions implemented for skills other than employment-related or vocational skills were excluded. Studies which utilized group designs in which the data for participants with ASD were analyzed in conjunction with participants with other developmental disabilities were excluded as this precluded the extraction of data pertaining to those diagnosed with ASD specifically.

Categorization of Studies

The studies which met the inclusion criteria were separated into three categories: Predictor Studies examined the factors correlated with successful employment outcomes among individuals with ASD. These studies were reviewed as an account of the predictors of employment may potentially indicate skills or other variables which can be targeted to improve the likelihood of individuals on the autism spectrum gaining employment. Impact Studies assessed the consequences of employment on the overall life or well-being of individuals with ASD and were reviewed in order to further our understanding of the benefits or outcomes of employment for those with ASD. Intervention Studies included an evaluation of training programs or behavioral strategies implemented with the intention of teaching new employment-related skills, developing existing skills, or otherwise preparing individuals for the workplace. The review of such studies may allow for the suggestion of appropriate and effective interventions for the promotion of employment or employment-related skills for individuals on the spectrum.

Results

A total of 26 studies met the criteria for inclusion in the current review. Of these, 6 were classified as predictor studies, 3 studies were categorized as impact studies, and 17 were interventional studies.

Predictor Studies

Burt et al. (1991) conducted a series of case studies investigating factors relating to success or failure of employment among four unemployed adults with ASD. Participants were aged between 21 and 29 years old and had not previously been able to secure employment due to behaviors associated with their autism diagnosis. The predictors identified for successful employment were individual characteristics (i.e., level of communication ability, interpersonal skills, and control of self-stimulatory behaviors), amount of family and work support, and characteristics of the job (i.e., success was less likely if the job involved problem solving, flexibility, decision making, or prioritization skills). Participants were in competitive employment for 6 to 30 months. The individual characteristics that predicted job failure were lack of motivation, inability to make decisions and solve problems, lack of flexibility and speed, and, in one participant, uncontrolled encopresis. Family support in the form of financial incentives, daily praise, and maintenance of program contingencies was a predictor of successful employment. Lack of family support was a predictor of job failure. Elements of employer support which promoted job success were participation in educational programs, modifications of the environment, and supervision and implementation of behavioral contracts. A final predictor identified was the consistency of long-term support.

Research by Schaller and Yang (2005) investigated predictive factors of competitive employment and supported employment for 815 individuals with autism aged between 15 and 64 years. Data were extracted from the Rehabilitation Services Administration (RSA) 911 database for 2001. It was found that for competitive employment, individual characteristics (i.e., being older, having accrued 10 to 15 years of education, and not having a comorbid diagnosis) and employment support services (i.e., support with job finding, job placement, and maintenance) were significant predictors of employment. For supported employment, race (i.e., being Caucasian) and availability of appropriate job placements were the significant predictors.

Lawer et al. (2009) examined predictive factors for participation in competitive employment for individuals with disabilities aged between 18 and 65 years old (including 1,707 individuals with autism) using the US Department of Education, Office of Special Education, and Rehabilitative Services data. It emerged that gender (i.e., being male), having more education, and greater service expenditures predicted better employment outcomes. Age was also identified by the authors as a predictor of competitive employment with increased age associated with a greater likelihood of success in competitive employment.

Yokotani (2011) investigated whether attachment style, specifically an avoidant attachment style, was related to job adaptation in competitive employment settings of people with high-functioning ASD. The questionnaire-based study involved 22 participants all with an IQ of at least 69. Results showed that an avoidant attachment style was an indicator of better job adaptation of people among individuals with high-functioning ASD.

Research by Migliore et al. (2012) investigated predictors of participation in integrated employment and postsecondary education of youth with autism. The study consisted of 2,913 participants with ASD aged between 16 and 26 years old. Predictors identified for participation in integrated employment were supportive placement services (i.e., those who had support were more likely to participate), higher education, shorter time in the vocational rehabilitation program, receiving training, not receiving college services, and being male.

Most recently, research by Chiang et al. (2013) investigated predictive factors for participation in employment for high school leavers with autism (N = 830) aged between 13 and 16 years old. The predictors of employment identified were annual household income, parental education, gender (females were more likely to participate in employment), social competence, presence of a comorbid intellectual disability (ID), graduation from high school, and whether the participant’s school liaised with postsecondary vocational training programs or potential employers.

Impact Studies

García-Villamisar et al. (2002) investigated the impact of supported employment versus sheltered workshops on quality of life. Participants were divided into two groups: 26 were assigned to a sheltered workshop group and 21 were assigned to a supported employment group. All participants worked 15 to 30 h and were paid competitive wages. The results indicated that individuals in the supported employment group had higher scores on a quality of life measure than those in the sheltered employment group.

García-Villamisar and Hughes (2007) examined the effects of a supported employment program on measures of executive functioning for 44 adult participants with ASD. They described two groups: a supported employment group and a non-supported employment group. The type of employment was varied and included positions in food services and retail. Participants in both groups worked 20 h a week and were paid competitive wages. Participants’ memory and executive functioning were evaluated at the beginning and end of the program. While both groups presented similarly at baseline, post-test outcomes indicated that the participants in the supported employment group had higher scores for executive functioning and memory than those in the other group.

Hillier et al. (2011) evaluated the impact of an 8-week vocational and social skills program, “Aspirations,” on 49 participants with ASD aged 18 to 28 years. Participants completed questionnaires measuring depression, anxiety, and peer relationships. The results indicated significantly reduced anxiety and depression following participation in the program. Peer relationships were also improved post-intervention, but this did not reach statistical significance.

Intervention Studies

A summary of the 17 studies evaluating interventions implemented to teach or improve employment-related skills is presented in Table 1. A total of 78 participants were included in these studies (69 male, 9 female). Participants had a diagnosis of ASD (n = 121) or AS (n = 39) and some participants had comorbid diagnoses (intellectual disability (n = 1), attention deficit hyperactivity disorder (n = 1), seizure disorder (n = 1), and Tourette’s syndrome (n = 1). The weighted mean age of participants was calculated across all studies which provided information on participants’ ages and was found to be 18.2 years (range 13–30 years).

Table 1 Studies evaluating interventions for teaching employment and vocational skills
Full size table

Table 1 shows the type of employment-related skills that were targeted across the studies reviewed. Four studies taught participants the skill of wearing a “WalkAround” costume and promoting stores or entertaining customers (Allen et al. 2010a, b, 2012; Burke et al. 2010). Photocopying skills were targeted in two studies (Bennett et al. 2013c; Bereznak et al. 2012), one of which also taught additional vocational skills of using a washing machine and making noodles (Bereznak et al. 2012). Interview skills were successfully taught in one study (Strickland et al. 2013). Dotto-Fojut and colleagues (2011) taught four participants how to request assistance for a work-related problem while in an employment setting. Other targeted skills included T-shirt folding (Bennett et al. 2013b), clerical skills (Bennett et al. 2013a; Dotson et al. 2013), shipping products (Burke et al. 2013), newspaper route (Robinson and Smith 2010), cover letter writing (Pennington et al. 2014), cleaning (Kellems and Morningstar 2012), recycling (Bennett 2013), stocking inventory (Kellems and Morningstar 2012), self-employment skills (Dotson et al. 2013), and sorting mail (Alexander et al. 2013). All reviewed studies reported that participants acquired the target skills to satisfactory levels of performance. Out of 17 intervention studies, maintenance data was not reported for 4 studies. Maintenance assessments varied from a 1-month follow-up to a 3-month follow-up and, in the majority of cases, indicated maintenance of the skills acquired during intervention.

All studies, excepting one (Allen et al. 2010a), reported the use of reinforcement-based procedures, such as verbal praise, in conjunction with other interventions. Seven of the studies used video modeling interventions (Allen et al. 2010a, b; Alexander et al. 2013; Bennett et al. 2013a; Bereznak et al. 2012; Burke et al. 2013; Kellems and Morningstar 2012) which involved showing participants a videotape of a person(s) engaging in the target behavior (Flynn and Healy 2012). A further two studies used video modeling in combination with other procedures such as audio cuing, and visual supports (Allen et al. 2012; Strickland et al. 2013). Covert audio coaching was used in two studies (Bennett et al. 2013b, c) and involved the delivery of antecedent prompts and performance feedback delivered privately through a pair of two-way radios and headsets from a distance (Bennett et al. 2013b). Two studies used a combination of instruction, modeling, performance cue systems, and time delay prompting with graduated guidance (Burke et al. 2010; Dotto-Fojut et al. 2011). Pennington et al. (2014) used a combination of self-monitoring, modeling, and response prompts. Robinson and Smith (2010) also used a combination of reinforcer assessment, written schedules, and simulation-based training. Fourteen studies reported overall treatment success across participants (Allen et al. 2010a, b; Bennett 2013; Bennett et al. 2013a, b, c; Bereznak et al. 2012; Burke et al. 2013; Dotson et al. 2013; Dotto-Fojut et al. 2011; Kellems and Morningstar 2012; Pennington et al. 2014; Robinson and Smith 2010; Strickland et al. 2013). Of the remaining studies, Allen et al. (2012) reported treatment success for an audio cuing intervention and not for video modeling. Burke et al. (2010) reported success for all but one participant, and Alexander et al. (2013) reported treatment success for five out of seven participants. Maintenance data were reported for 14 of the studies (Alexander et al. 2013; Allen et al. 2010a, b, 2012; Bennett 2013; Bennett et al. 2013b, c; Bereznak et al. 2012; Burke et al. 2010; Dotson et al. 2013; Dotto-Fojut et al. 2011; Kellems and Morningstar. 2012; Pennington et al. 2014; Robinson and Smith 2010) across 1 month or less in 9 studies (Allen et al. 2010b; Bennett 2013; Bennett et al. 2013b, c; Bereznak et al. 2012; Burke et al. 2010; Dotto-Fojut et al. 2011; Kellems and Morningstar 2012; Pennington et al. 2014), 3 months or less in 4 studies (Alexander et al. 2013; Allen et al. 2010a, 2012; Robinson and Smith 2010). Only one study assessed maintenance across a period of longer than 3 months (Dotson et al. 2013).

Discussion

With the abundance of resources invested in early intervention research for individuals with ASD, it is somewhat surprising that fewer published studies are available that have examined the long-term planning for, and support of, these individuals during adolescence and adulthood. The current literature review has highlighted the paucity of research which addresses employment and the teaching of vocational skills among those with ASD, in spite of findings which highlight the positive impact of engagement in employment-related activities on well-being, cognitive functioning, and quality of life for these individuals. However, the extant research, while limited, suggests that there are promising interventions available that can teach employment skills and which warrant further research and development.

The current review suggests that that there is a complex interplay between personal and external factors in the prediction of employment of those with ASD. Individual characteristics and employment service characteristics were found to predict employment in the studies reviewed. Two studies reported that being male was a predictor factor for employment (Lawer et al. 2009; Migliore et al. 2012) while Chiang et al. (2013) found that females were more likely to find employment. Increased age in adulthood was also found to be a predictor of employment (Lawer et al. 2009; Schaller and Yang 2005) as well as the absence of any comorbid condition (Chiang et al. 2013; Schaller and Yang 2005). Participant education levels were also implicated as a predictive factor (Chiang et al. 2013; Lawer et al. 2009; Migliore et al. 2014; Schaller and Yang 2005). Family support and employment support were found to predict employment (Burt et al. 1991; Chiang et al. 2013; Lawer et al. 2009; Migliore et al. 2014; Schaller and Yang 2005). The importance of treating challenging behaviors and the symptoms of comorbid diagnoses was also evident with these variables being implicated as predictors of job failure or impediments to securing employment (Burt et al. 1991; Schaller and Yang 2005). The identification of such predictors of employment, or job failure, suggests an important target area for intervention by practitioners. Applied behavior analysis has had much success in improving variables associated with many of the identified predictors of employment such as communication abilities, interpersonal abilities, self-stimulatory behavior, social skills, self-management skill, safety skills, and organization skills (e.g., Flynn and Healy 2012; Holloway et al. 2014; Matson et al. 2012; Mulligan et al. 2014). The evidence-based procedures that exist to teach these skills should be utilized and further investigated to improve employment prospects among this population. Findings of the current review also suggest that a supportive work environment leads to better success in employment outcomes for people with ASD. Thus, the provision of support to, and education of, employers and other staff members around working with people with ASD may also be considered imperative to successful employment.

There is evidence that employment can positively impact the lives of individuals with ASD similar to that of typically developing individuals (Capo 2001). Across the studies reviewed, employment had positive outcomes relating to cognitive performance (García-Villamisar and Hughes 2007), reduced anxiety and depression (Hillier et al. 2011), and improvements in peer relationships and quality of life (García-Villamisar et al. 2002; Hillier et al. 2011), all considered important variables in the context of ASD. While relatively few studies have examined the impact of employment, the positive outcomes observed mirror those that have been reported among typically developing individuals (McKee-Ryan et al. 2005). The importance of these outcomes further underscores the need to promote employment, and supportive interventions for employment, among individuals diagnosed with ASD.

Of the interventional studies reviewed, all reported that participants made gains in the targeted skill repertoire. However, the range of skills taught was somewhat limited. Four studies taught participants very specific skills such as wearing a WalkAround costume that may not be transferable to other workplaces. Other studies targeted more general skills such as making photocopies or interview skills which could be applied in many different employment settings. It was also noted that participants included in the intervention studies were predominantly male. Out of 78 participants, only 9 were female. This imbalance may be attributable to the greater prevalence of ASD among males; however, future research studies should ensure that the female population is adequately represented. Also, across the studies reviewed, individuals were generally on the high-functioning end of the autism spectrum (IQ > 80) or described as having Asperger’s syndrome. Research is needed to investigate possible employment opportunities for individuals with ASD who are presenting with lower functioning profiles. Additionally, future intervention studies should aim to examine the effects of teaching social skills in conjunction with vocational skills when preparing an individual with ASD for employment, given the importance of these skills for successful functioning in an employment setting. Identified predictor variables such as communication abilities, presence of challenging behavior, and education levels should also be targeted. In order to enhance the experience of individuals, both as they transition from school to work and for those already in employment, a collaborative effort is needed. Schools and vocational rehabilitation services should work together to ensure that students with ASD are provided with the necessary training needed to become successful employees (Chappel and Somers 2010). Thus, while the studies reviewed reported successful teaching techniques, the current research base is limited given the paucity of studies in the area, the limited skills that have been taught, the questionable relevance of some of the skills targeted, the non-consideration of employers or coworkers during interventions, the high level of functioning of the individuals included, and the sole focus on the employment skills and non-consideration of other vital skills for success in the workplace such as communication and social skills.

The current review has several important implications for research on employment among those with ASD. First, and perhaps most conspicuously, it demonstrates the considerable need for further study in the area of employment and vocational skills for individuals with ASD. Given that only 26 studies were available for review, we echo Gerhardt and Lainer’s (2011) call for a greater research focus on determining effective and socially valid interventions for promoting employment and societal inclusion for those with ASD. The neglect of this area in the literature adversely impacts post-second-level outcomes for individuals with ASD as there is a lack of evidence-based interventions available. Response to early intervention varies and there is little data on how these interventions impact the need for support as adolescents or adults (Cimera and Cowan 2009; O’Connor and Healy 2010). This research gap could be effectively addressed through the consideration of the identified predictors of employment and using these to formulate effective interventions and supportive employment systems for individuals with ASD in the workforce. With the incidence of ASD rising and with the identification of the positive outcomes associated with employment for this vulnerable population, this issue is one of pressing concern. It is essential that employment programs and vocational skills not be viewed as relevant only upon graduation from the education system. The goals of education for individuals with ASD should provide opportunities to acquire skills that increase personal independence and social responsibility and subsequently employability (Hendricks and Wehman 2009). Second, it is pertinent that individuals with ASD have equal employment rights to their neuro-typical peers and their peers with other disabilities. A person-centered approach is vital in ensuring equality in the workplace. The first step in achieving equality may be to target employers’ and coworkers’ attitudes regarding the employability of people with ASD (Gerhardt and Lainer 2011). Research suggests that the willingness of employers to accommodate individuals with disabilities in their companies may be the most significant factor that determines success (Morgan and Alexander 2005). While companies such as Specialisterne are realizing the potential employability of individuals on the autism spectrum in practice, methods for changing employers’ and coworkers’ attitudes regarding employing adults with ASD should be examined. The training and education of those individuals who work as disability support workers with regards to the employability, and the importance of employment for individuals with ASD, may also be seen as crucial as we seek to better outcomes for those on the spectrum (Gerhardt and Lainer 2011). Gerhardt (2007) has also previously discussed the issue of underemployment in ASD and has suggested several other means in which those with ASD could be more effectively included in the workplace. These included the emphasis of the notion that all individuals with ASD are potentially suitable for employment, the viewing of first job experiences as opportunities for learning and future planning, the development of active links between support services and community businesses, and the use of creativity in job planning and development for individuals with ASD.

The current review demonstrates that at least some individuals with ASD are employable and can effectively contribute to the workplace. ASD may be seen as a competitive advantage in some business sectors, such as IT, where attention to detail is foremost (Sonne 2009). It may be possible that with adequate support and intervention, adults with ASD may function as contributing members of society in the workplace. Given appropriate education, training, and ongoing support, some persons with ASD could potentially flourish in employment settings. This would not only benefit the individual in terms of QoL but also their families and society in general. The cost in terms of resources, time, and effort of attending school until 18 years is immense; recent studies estimate that the lifetime cost of caring for an individual with ASD is $3.2 million dollars (Kellems and Morningstar 2012). This effort and expenditure should not go unrewarded by a limited availability of employment opportunities for adults with ASD. Without employment, long-term outcomes for individuals on the autism spectrum have been found to be quite poor, affecting those individuals, their families, and society (Allen et al. 2012). Gerhardt and Lainer (2011, p.43) have aptly described these poor outcomes faced by the majority of those with ASD as “completely unacceptable.” Autism is a spectrum disorder with individuals presenting with various levels of functioning. Every effort should be made so that opportunities for employment exist for all individuals, wherever they may lie on the autism spectrum.