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The aim of this study is to holistically synthesise the extent and range of literature relating to the employment of individuals with autism spectrum disorder. Database searches of Medline, CINAHL, PsychINFO, Scopus, ERIC, Web of Science and EMBASE were conducted. Studies describing adults with autism spectrum disorder employed in competitive, supported or sheltered employment were included. Content analysis was used to identify the strengths and abilities in the workplace of employees with autism spectrum disorder. Finally, meaningful concepts relating to employment interventions were extracted and linked to the International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder. The search identified 134 studies for inclusion with methodological quality ranging from limited to strong. Of these studies, only 36 evaluated employment interventions that were coded and linked to the International Classification of Functioning, Disability and Health, primarily focusing on modifying autism spectrum disorder characteristics for improved job performance, with little consideration of the impact of contextual factors on work participation. The International Classification of Functioning, Disability and Health Core Sets for autism spectrum disorder are a useful tool in holistically examining the employment literature for individuals with autism spectrum disorder. This review highlighted the key role that environmental factors play as barriers and facilitators in the employment of people with autism spectrum disorder and the critical need for interventions which target contextual factors if employment outcomes are to be improved.
Keywords: adult; intervention; strengths-based; vocational rehabilitation; work environment.
BACKGROUND:
The problem of persistently low rates of employment and earnings for people with autism is well established. In the U.S., the 2014 Workforce Innovation and Opportunity Act (WIOA) updated the legal framework for the federal Vocational Rehabilitation (VR) program which assists people with disabilities to find and maintain employment.
OBJECTIVE:
This study examined whether and how the needs of transition-age youth and adults with autism are addressed in state WIOA plans.
METHODS:
We analyzed WIOA documents for all states plus the District of Columbia using content analysis.
RESULTS:
Of the 51 state plans, 44 contained references to autism, and 19 explicitly identified autism as a disability group that is underserved by the state VR agency. Even among states that clearly defined autism as underserved, only 10 provided comprehensive plans which defined goals and strategies to address the vocational needs of this group. We discuss major themes related to VR service delivery for people with autism identified within the state plans.
CONCLUSIONS:
This study identifies state policy aimed at facilitating employment for people with autism and contributes to efforts to discover why individuals with autism in some states have better employment outcomes than in others.
Computational linguistics holds promise for improving scientific integrity in clinical psychology, and for reducing longstanding inequities in healthcare access and quality. This paper describes how computational linguistics approaches could address the “reproducibility crisis” facing social science, particularly with regards to reliable diagnosis of neurodevelopmental and psychiatric conditions including autism spectrum disorder (ASD). It is argued that these improvements in scientific integrity are poised to naturally reduce persistent healthcare inequities in neglected subpopulations, such as verbally fluent girls and women with ASD, but that concerted attention to this issue is necessary to avoid reproducing biases built into training data. Finally, it is suggested that computational linguistics is just one component of an emergent digital phenotyping toolkit that could ultimately be used for clinical decision support, to improve clinical care via precision medicine (i.e., personalized intervention planning), granular treatment response monitoring (including remotely), and for gene-brain-behavior studies aiming to pinpoint the underlying biological etiology of otherwise behaviorally-defined conditions like ASD.
Autism spectrum disorders (ASDs) are increasingly prevalent neurodevelopmental disorders characterized by sociocommunicative impairments. Growing consensus indicates that neurobehavioral abnormalities require explanation in terms of interconnected networks. Despite theoretical speculations about increased local and reduced distal connectivity, links between local and distal functional connectivity have not been systematically investigated in ASDs. Specifically, it remains open whether hypothesized local overconnectivity may reflect isolated versus overly integrative processing. Resting state functional MRI data from 57 children and adolescents with ASDs and 51 typically developing (TD) participants were included. In regional homogeneity (ReHo) analyses, pericalcarine visual cortex was found be locally overconnected (ASD > TD). Using this region as seed in whole-brain analyses, we observed overconnectivity in distal regions, specifically middle frontal gyri, for an ASD subgroup identified through k-means clustering. While in this subgroup local occipital to distal frontal overconnectivity was associated with greater symptom severity, a second subgroup showed the opposite pattern of connectivity and symptom severity correlations. Our findings suggest that increased local connectivity in ASDs is region-specific and may be partially associated with more integrative long-distance connectivity. Results also highlight the need to test for subtypes, as differential patterns of brain-behavior links were observed in two distinct subgroups of our ASD cohort.
Keywords: autism; frontal cortex; functional connectivity MRI; local connectivity; visual cortex.
There are two established electroencephalogram (EEG) indices that putatively relate to anxiety symptoms: a) the error-related negativity (ERN), which reflects endogenous threat sensitivity, and b) resting-state EEG relative right frontal activity (rRFA), which relates to approach/withdrawal motivation. We examined these indices conjointly to better elucidate differential mechanisms underlying the common anxiety phenotype in youth with autism spectrum disorder (ASD), in relation to subjective reports of symptomatology and treatment response. EEG was recorded from 53 youth with ASD who participated in a 10-week social skills intervention (SSI). More negative ERN related to higher self-reported social anxiety symptoms at baseline, and predicted improvements in self-reported social anxiety symptoms following SSI. Although rRFA did not relate to anxiety symptoms at baseline, more rRFA predicted improvement in parent-reported anxiety domains but worsening in self-reported anxiety symptoms. This study provides evidence for unique neural mechanisms of anxiety symptoms and changes in anxiety after SSI in youth with ASD.
Keywords: Anxiety; Autism spectrum disorder; Electroencephalogram (EEG); Error-related negativity (ERN); Hemispheric asymmetry.
Autistic self-advocates, family members, and community organizations have called for greater emphasis on enhancing quality of life (QoL) for people with autism. Doing this is critical to understand how QoL unfolds across the life course and to clarify whether gender affects QoL, health, and functioning for people with autism. The purpose of this study was to curate and test a lifespan QoL measurement tool using freely available and well-constructed National Institutes of Health Parent-Reported Outcomes Measurement Information System (PROMIS). To develop the PROMIS Autism Battery-Lifespan (PAB-L), we identified PROMIS scales relevant for autism, reviewed each item, consulted with a panel of autism experts, and elicited feedback from autistic people and family members. This battery provides a comprehensive portrait of QoL for children ages 5-13 (through parent proxy), teens 14-17 (parent proxy and self-report), and adults 18-65 (self-report) with autism compared to the general population. Participants and parent informants (N = 912) recruited through a children’s hospital and nationwide U.S. autism research registry completed the PAB-L online. Results indicate that compared to general population norms, people with autism of all ages (or their proxies) reported less desirable outcomes and lower QoL across all domains. Women and girls experienced greater challenges in some areas compared to men and boys with autism. The PAB-L appears to be a feasible and acceptable method for assessing patient-reported outcomes and QoL for autistic people across the life course. Autism Res 2020, 13: 970-987. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We developed a survey to measure the quality of life of children, teens, and adults with autism using free National Institutes of Health PROMIS questionnaires. People with autism and family members rated the PROMIS Autism Battery-Lifespan as useful and important. Some reported a good quality of life, while many reported that their lives were not going as well as they wanted. Women and girls reported more challenges in some areas of life than men and boys.
Keywords: adults; life course; life span/lifespan; patient-reported outcomes; quality of life; sex/gender; women with autism.