The authors of “Vocational support approaches in autism spectrum disorder: A synthesis review of the literature” have written a commendable review that finds a very weak academic evidence base about employment supports. Although the majority of a typical lifetime is spent in adulthood, we know the least about this stage of life—by far—when it comes to autism spectrum disorders (ASDs).
The authors make thoughtful suggestions for advancing this important area of research. We wish to offer complementary ideas rooted in life course and public health perspectives. These perspectives shift the focus of attention from the individual to the social level of analysis, shine light on measurement ideas seldom discussed in employment intervention research, and offer a set of research approaches that could help advance this area of inquiry.
In contrast to the dearth of research on vocational supports, many ASD program innovations are happening outside of academia (Autism Speaks, 2012). An outpouring of grassroots efforts and billions of public dollars for services each year aim to foster better outcomes for those affected by autism. In real-world settings, the problem is less about a shortage of effort than a shortage of processes for learning from effort. Our ability to meaningfully measure efforts and outcomes at program and population levels is woefully underdeveloped.
Imagine if a large corporation tried to operate without financial statements—without a clear picture of sales, expenditures, customer satisfaction, or assets. The company would quickly go under. Yet, this state of affairs is commonplace in many autism services. At a population level, we are almost completely unable to clearly describe the resources expended on services or measurable indicators of the population outcomes we hope to influence—including the employment rate.
Tracking sales and inventory, mining “Big Data,” visualizing performance indicators with data dashboards, and the huge toolbox of measurement approaches used in continuous quality improvement practices are transforming the landscape of business and health-care administration around the world. Wise organizations invest in creating measurement feedback loops to learn from experience in ways that help improve future performance.
We need a corresponding measurement revolution for ASD services, including employment supports. An abundance of opportunities exist for collaborating with community agencies to create practice-based evidence. Scientists with advanced training in measurement and analysis methods are uniquely positioned to be useful in this endeavor.
- Autism Speaks (2012) Employment Think Tank Report (Internet). Available at:http://www.autismspeaks.org/sites/default/files/as_think_tank_exec_summary_web1.pdf
- Shattuck PT, Roux AM, Hudson LE, et al. (2012) Services for adults with an autism spectrum disorder. Canadian Journal of Psychiatry 57(5): 284–291. MedlineOrder article via InfotrieveGoogle Scholar
- World Health Organization (WHO) (2001) International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.
- David B Nicholas, Mark Attridge, Lonnie Zwaigenbaum, and Margaret ClarkeVocational support approaches in autism spectrum disorder: A synthesis review of the literatureAutism February 2015 19: 235-245, first published on January 21, 2014doi:10.1177/1362361313516548 Abstract Full Text Full Text (PDF)