2019Florida State UniversityVeronica Fleury
Targeting Low Resource Autism Preschoolers to Improve Literacy
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.
Despite efforts to improve employment outcomes for autistic individuals, internationally their employment rates remain low. There is a need to better understand the factors influencing successful employment for autistic adults in the labor market from the perspectives of multiple key stakeholders. This study represents the second in a series of papers conducted as part of an International Society for Autism Research policy brief aimed at improving employment outcomes for autistic individuals. A community consultation methodology using focus groups, forums, and interviews was applied with autistic individuals (n = 19), family members (n = 18), service providers (n = 21), employers (n = 11), researchers (n = 5), and advocacy group representatives (n = 5) in Australia, Sweden, and the United States, aiming to identify the factors perceived to determine gaining and maintaining employment for autistic individuals. Directed content analysis, guided by the International Classification of Functioning, Disability and Health (ICF), was conducted to investigate the key factors influencing employment outcomes for autistic individuals. Meaningful verbal concepts, or units of text with common themes, were also derived from the qualitative data and then linked and compared to the ICF Autism Spectrum Disorder (ASD) Core-sets. Across countries, activity and participation and environmental factor categories of the ICF were the most associated with employment outcomes. Results suggest that removal of environmental barriers and enhancing environmental facilitators may assist to remediate ASD-related difficulties in the workplace. Autism Res 2019, © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study sought to understand the perspectives of autistic individuals and key stakeholders on factors influencing if autistic adults get and keep jobs. Across Australia, Sweden, and the United States, focus groups and interviews were conducted to understand international perspectives on what helps and hinders getting and keeping a job for autistic individuals. The environment, including supports, relationships, attitudes, and services, were perceived to be the most important for workplace success. Intervention targeting barriers and facilitators in the workplace environment may support autistic adults to be successful in the labor market.
Keywords: ICF; autism; cross-cultural; employment.
Social impairment represents one of the most challenging core deficits of autism spectrum disorder (ASD) and greatly affects children’s school experiences; however, few evidence-based social engagement programs have been implemented and sustained in schools. This pilot study examined the implementation and sustainment of a social engagement intervention, Remaking Recess, for four elementary-aged children with ASD and four school personnel in two urban public schools. The improved peer engagement and social network inclusion outcomes suggest that Remaking Recess can be feasibly implemented in under resourced public schools with fidelity and has the potential to improve child outcomes for children with ASD.
Keywords: Autism spectrum disorder; implementation fidelity; school-based social engagement intervention.
Children with autism spectrum disorder (ASD) often face barriers when establishing peer connections at school. This aim of this study is to explore how social network inclusion in the classroom is associated with playground peer engagement. Independent observers administered friendship surveys to determine social network inclusion in the classroom and recorded the playground engagement states of 55 children with ASD from 42 general education classrooms in 16 public elementary schools in the northeastern United States. Linear regression models were used to examine associations between social network inclusion and playground engagement. Results indicated an association between social network inclusion and playground engagement. Children who were included to a greater degree in their classrooms’ social network spent more time engaged with peers on the playground. These findings highlight the importance of supporting social interactions in multiple contexts in schools.
Purpose: Previous research has identified termination of interruptions to repetitive behaviour as a reinforcer capable of maintaining problem behaviour. Effective treatments have included functional communication training and multiple schedules of reinforcement.
Methods: In the present study, a functional analysis determined that the aggression of an eight-year-old boy with autism spectrum disorder was maintained by termination of interruptions of repetitive behaviour. An intervention was implemented consisting of differential reinforcement of other behaviour and response cost.
Results: The intervention produced and maintained a reduction in aggression and increased tolerance for interruptions of systematically increasing durations.
Conclusions: This case study demonstrates an alternative approach to the treatment of problem behaviours such as aggression maintained by termination of repetitive behaviour that includes teaching the individual to tolerate interruption of repetitive behavior.
Keywords: Avoidance; differential reinforcement of other behaviour; interruption; repetitive behaviour.
We report the feasibility and preliminary efficacy of a structured behavioral intervention with a sample of minimally verbal girls with autism spectrum disorder between the ages of 2 and 6 years old. Ten participants with no functional vocal behavior were randomized to a 4-week behavioral intervention or waitlist control group. Caregivers reported child communicative repertoires at pre- and post-randomization assessments. Social communication was also assessed at these time points using the Early Social Communication Scales. All feasibility benchmarks were met and findings of preliminary efficacy showed large effect sizes within groups. The current findings suggest the feasibility of recruiting and retaining samples of young, minimally verbal girls with autism spectrum disorder in randomized clinical trials.
Keywords: Feasibility; Female; Intervention; Minimally verbal; Sex differences.
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.