Journal of Autism and Developmental Disorders (2024) 54:477–490

https://doi.org/10.1007/s10803-022-05804-8

ORIGINAL PAPER

Vocational Outcomes in ASD: An Examination of Work Readiness

Skills as well as Barriers and Facilitators to Employment Identified
by Autistic Adults
Nancy Raitano Lee1 · Goldie A. McQuaid2 · Hannah E. Grosman1 · Sanjana Jayaram3 · Gregory L. Wallace3

Accepted: 16 October 2022 / Published online: 17 November 2022

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

Abstract
Little is known about work readiness skills among autistic adults. This study sought to address this by examining work
readiness skills and their relation to vocational outcomes among 281 autistic young adults. It also examined perceived barriers
and facilitators to employment as articulated by a subset of autistic adults. Results revealed a variegated work readiness
profile. Stronger work readiness skills (particularly work style/adaptability) were associated with more favorable vocational
outcomes. Autistic participants articulated both barriers and facilitators to employment related to the autism phenotype,
job search/work readiness, and workplace education. These findings indicate the need for research on phenotype-driven
vocational rehabilitation strategies as well as workplace psychoeducation/accommodations to support vocational outcomes
for autistic adults.

Keywords Employment · Adult outcomes · Vocational soft skills · Behavioral flexibility · Workplace accommodations

Autism spectrum disorder (ASD) impacts greater than 2% of interview (Newman et al., 2011), a rate that was lower than
children and adults in the United States (Dietz et al., 2020; not only peers in the general population (U.S. Department
Maenner et al., 2021). It is a lifelong neurodevelopmen- of Commerce, 2009) but also peers from other disability
tal disorder associated with significant underemployment/ groups (Roux et al., 2013). These findings from the NLST2
unemployment and high rates of income assistance (Ander- converge with numerous other reports in the literature doc-
son et al., 2020; Esbensen et al., 2010; Harvery et al., 2021; umenting poor vocational outcomes among autistic adults
Taylor & Seltzer, 2011). Despite the fact that the majority of (e.g.,Anderson et al., 2020; Mason et al., 2021; Taylor &
autistic high school students are on the diploma track in the DaWalt, 2017; Taylor & Mailick, 2014; Taylor et al., 2015).
United States (U.S. Department of Education, 2017), post- Despite evidence pointing to poor vocational outcomes,
secondary outcomes, including employment, are poor. For we know remarkably little about aspects of cognition and
example, according to the National Longitudinal Transition behavior that predict more favorable vocational outcomes
Study—2 (NLTS2), which followed students with disabili- among autistic young adults. Existing research on this
ties up to 8 years following high school graduation, only 37% topic has tended to focus on blunt measures of cognition
of autistic young adults were employed at the time of their and behavior and/or include individuals with widely vary-
ing intellectual abilities. For example, several studies have
documented that having a lower IQ in childhood is asso-
* Nancy Raitano Lee ciated with poorer employment outcomes (Howlin et al.,
[email protected] 2004; Lord et al., 2020). Similarly, conversational difficulties
1 (probed via a single question on a survey) have been linked
Department of Psychological and Brain Sciences, Drexel
University, 3201 Chestnut Street, Stratton 119, Philadelphia, to poorer employment outcomes (Roux et al., 2013; Wei
PA 19104, USA et al., 2015) as have difficulties with daily living or ‘func-
2
Department of Psychology, George Mason University, tional’ skills (Chan et al., 2021; Roux et al., 2013; Taylor &
Fairfax, VA, USA Mailick, 2014) and academics (Wong et al., 2021).
3
Department of Speech, Language, and Hearing Sciences, The These studies provide evidence that individual charac-
George Washington University, Washington, DC, USA teristics are meaningfully related to vocational outcomes

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478 Journal of Autism and Developmental Disorders (2024) 54:477–490

in ASD. However, the metrics used in most studies do not qualitative methods to highlight possible intervention
provide fine-grained targets for vocational rehabilitation targets.
(VR) activities, particularly for autistic adults without co-
occurring intellectual disability who comprise ~ 70% of
autistic individuals (Baio et al., 2018; Rydzewska et al., Method
2018). In order to inform VR services, there is a need
to measure finer grained aspects of cognition and behav- Participants
ior and relate these to vocational outcomes. The current
research focuses on a set of skills relevant to vocational Par ticipants included 281 autistic young adults
outcomes, namely work readiness skills. (22–39 years) recruited via the Simons Powering Autism
Work readiness skills are qualities that make an Research—SPARK—Research Match service for a larger
individual ready for success in the workforce (Caballero study of adult outcomes in ASD. To qualify for inclusion
et al., 2011; Cunningham and Villaseñor, 2016; Deming, in the larger study, a self-reported community-based
2017; Heckman & Kautz, 2012). These so-called soft- diagnosis of an ASD as evaluated by a medical/clinical
skills (i.e., non-job specific interpersonal, metacognitive, professional was required. Although SPARK does not
and behavioral characteristics): (a) are foundational confirm diagnoses, they partner with autism clinical sites
components of employability, (b) can be measured and for recruitment, greatly increasing the probability of the
targeted before autistic adults enter the workforce, and (c) participant having a professionally ascertained diagnosis
may represent a key gateway to achieving employment (SPARK Consortium, 2018). Support for this comes
success. According to the Office of Disability Employment from a study demonstrating that 98.8% of a sample of
Policy (2019), examples of work readiness skills include SPARK participants had a confirmed ASD diagnosis as
communication, teamwork, problem solving/critical ascertained via electronic medical records (Fombonne
thinking, and professionalism. These skills have been et al., 2022). Consistent with the findings of Fombonne
noted in surveys of employers to be among the most et al. (2022), ~ 94% of the current study’s sample met
important characteristics they are seeking in job candidates autism screening criteria (total score of > 65) on the
(National Association of Colleges & Employers, 2018). Autism Spectrum Quotient-28 (AQ-28; Hoekstra et al.,
Moreover, research on other clinical populations has 2011). See Table 1.
linked work readiness skills to more favorable employment The cur rent study’s sample was drawn from
outcomes (for review, see Hergenrather et al., 2018). SPARK’s “independent” adult cohort. These individuals
Among autistic adults, there is a small body of are ≥ 18 years old, do not have a court-appointed legal
research focused on work readiness skills regardless of guardian, and are able to consent to research participation
employment status. This work has largely been conducted independently. Given (a) SPARK’s designation of
in Israel by Gal and colleagues using a questionnaire “independent adult” status, (b) the demands of the
developed for autistic adults called the Autism Work Skills study (i.e., completing self-ratings probing medical
Questionnaire (AWSQ; Ben Meir et al., 2010). On the and psychosocial functioning), and (c) no self-report of
AWSQ, autistic young adults were found to demonstrate intellectual disability in the study’s medical history form,
poorer work readiness skills relative to their same age participants in the current sample are very unlikely to have
neurotypical peers (Gal et al., 2015) and also to present co-occurring intellectual disability.
with a variegated work readiness profile (Gal et al., 2013), The 281 participants in the current investigation were
with relative strengths in some skill areas (e.g., persistence drawn from a sample of 362 participants in the targeted age
in work) and relative weaknesses in others (e.g., work- range of 22–39 years of age. The lower age limit of 22 was
related independence and adaptability). chosen to ensure that participants were out of high school,
The current research sought to extend the work of given the study’s focus on vocational outcomes. The upper
Gal and colleagues by describing work readiness skill age limit was chosen to focus this investigation on young
profiles among a large American cohort (n = 281) of adulthood, as developmental conceptualizations of adult life
autistic young adults. In addition, novel to the current generally consider the late 30s as the end of this develop-
investigation, this research sought to examine relations mental period (e.g., Erikson, 1982). In addition to the profes-
between work readiness skills and vocational outcomes sionally ascertained ASD diagnosis, inclusion criteria for the
in order to identify skill domains that are most strongly current study required participants to (a) not be enrolled in a
associated with more favorable employment outcomes. post-secondary education program, given the study’s focus
To complement these study aims, written responses of on employment and work readiness skills (n = 56 excluded),
autistic adults to open-ended questions about barriers (b) have complete data on measures of vocational activities
to and facilitators of employment were examined using and work readiness skills (n = 6 excluded); and (c) be free of

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Journal of Autism and Developmental Disorders (2024) 54:477–490 479

Table 1  Demographic Characteristics of Complete Sample (n = 281)

White, non- Birth sex: Participant Household AQ28: History of Receipt Receipt of SSI Age
hispanic*^ Female Ed: BA/ Income: Below US above special ed of VR
BS✝ median♦# cutoff receipt services

N 224a 172 106 195b 263 155 22c 38d M 31.17

% 81.16 61.21 37.72 77.1 93.6 55.16 7.86 13.82 SD 4.73
a −d
Missing data from n = 281 total: an = 5 bn = 28 [due to participants selecting = ‘don’t know’ or ‘prefer not to say’]; cn = 1; dn = 6
*
Racial breakdown: Unknown: n = 1 (0.4%); Asian: n = 5 (1.8%); Black/African American: n = 3 (1.1%); Native America/Alaskan Native: n = 2
(0.7%); White/Caucasian: n = 237 (84.3%); More Than One Race: n = 27 (9.6%); Other: n = 6 (2.1%)
^
Ethnic breakdown: Hispanic: n = 20 (7.1%); Non-Hispanic: n = 255 (90.7%); Unknown: n = 5; (1.8%); Missing: n = 1 (0.4%)
✝
Educational breakdown: Some high school: n = 6 (2.1%); GED: n = 17 (6.0%); High school: n = 49 (17.4%); Trade School: n = 22 (7.8%); Some
college: n = 50 (17.8%); Associates degree: n = 31 (11%); Bachelor’s degree: n = 65 (23.1%); Graduate or professional degree: n = 41 (14.6%)
♦
Per US Census Bureau (2021), median household income in the US in 2020 was $67,521
#
Income breakdown: < $20,000: n = 87 (31.0%); $21,000-$35,000: n = 53 (18.9%); $36,000-$50,000: n = 35 (12.5%); $51,000-$65,000: n = 20
(7.1%); $66,000-$80,000: n = 17 (6.0%); $81,000-$100,000: n = 16 (5.7%); $101,000-$130,000: n = 12 (4.3%); $131,000-$160,000: n = 4 (1.4%);
Over $160,000: n = 9 (3.2%); Don’t Know: n = 22 (7.8%); Prefer not to answer: n = 6 (2.1%)

medical conditions likely to adversely impact employment informed consent, they completed all study questionnaires
prospects [exclusionary medical conditions: brain injury online via a secure web platform.
resulting in hospitalization (n = 13); stroke (n = 4); cerebral
palsy (n = 1); Becker Muscular Dystrophy (n = 1)]. Note Measures
that we included participants with epilepsy (n = 11), given
its increased prevalence among autistic individuals (Luk- Autistic Traits
manji et al., 2019). In addition, participants with multiple
sclerosis (n = 1), narcolepsy (n = 1), and visual impairment Participants completed the AQ-28 (Hoekstra et al., 2011).
(n = 1) were included in the sample. Analyses were run with See Supplementary Material for details.
and without these individuals and results were substantively
unchanged. Thus, to be more inclusive, the analyses pre- Vocational Outcomes
sented in the manuscript include these 14 individuals.
Demographic characteristics can be found in Table 1. Participants were queried about their current employment
Briefly, the sample was predominantly (a) assigned female status as well as the receipt of employment services in order
sex at birth and (b) both white and non-Hispanic. The to rank vocational activities from most to least independent,
ethno-racial breakdown of the sample along with infor- consistent with the Taylor Vocational Index (TVI; Taylor &
mation about annual household income, education, and Seltzer, 2012). Using the TVI as a guide, a modified scoring
the receipt of special education (i.e., receipt of an Indi- system, with ranks of 1 through 6, was utilized. Specifically,
vidualized Education Plan [IEP] via the United States based on available information, scores consistent with the
public school system, in which specialized supports and/ original TVI rankings of 1, 2, 6, 7, 8, and 9 were assigned
or instruction are provided to students with documented (see Table 2). Because questions related to sheltered
disabilities), job support/VR services, and supplemental employment settings were not included in the current study’s
security income (SSI) are provided in Table 1. questionnaires, we were unable to assign TVI scores of 3,
4, or 5. As a result, ordinal ranks of 1 (least independent)
to 6 (most independent) were assigned using the rubric
Procedures summarized in Table 2.

The current research was approved by The George Wash- Work Readiness Skills
ington University Institutional Review Board following
guidelines from the Declaration of Helsinki. Data collec- Participants completed the Autism Work Skills Question-
tion was completed between December 2019 and January naire (AWSQ; Ben Meir et al., 2010). It is composed of 74
2020, prior to the major shutdowns that occurred in the items assessing work skills (across five domains) and 14
United States (where the current study was completed) due items assessing sensory challenges (one domain). The five
to the COVID-19 pandemic. After participants provided work skills scales are Work Habits, Work Style, Level of
Independence, Routine Daily Activities, and Interpersonal

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480 Journal of Autism and Developmental Disorders (2024) 54:477–490

Table 2  Vocational ranking system—modification of the Taylor Vocational Index (TVI)

Rank Description

6 Employed for > 10 h per week and is not receiving employment assistance or job support, such as vocational rehabilitation (consistent
with TVI rank 9)
5 Employed for ≤ 10 h per week and is not receiving employment assistance or job support, such as vocational rehabilitation (consistent
with TVI rank 8)
4 Employed for > 10 h per week and is receiving employment assistance or job support, such as vocational rehabilitation (consistent with
TVI rank 7)
3 Employed for ≤ 10 h per week and is receiving employment assistance or job support, such as vocational rehabilitation (consistent with
TVI rank 6)
2 Completing unpaid employment (i.e., volunteering; consistent with TVI rank 2)
1 No vocational activities (consistent with TVI rank 1)

Table 3  Description of Autism Work Skills Questionnaire (AWSQ) scales

Scale # of Items Description
a
Work readiness s­ kills
Work habits 12 Assesses work habits like adhering to rules and regulations including attendance and timeliness, work
quality, material organization, and precision
Work style 13 Assesses the ability to adjust to the work environment and cope with different demands; being aware of
errors; attending to detail; preferring routine and repetitive versus complex work
Level of independence 11 Assesses the need for written and oral instructions and for supervision and approval as well as the ability
to complete work-related tasks independently
Routine daily activities 22 Assesses activities of daily living such as attending to hygiene, navigating with a map or GPS, using
public transport or driving, and completing computer-related tasks
Interpersonal skills 16 Assesses skills related to following supervisor instructions, receiving feedback, cooperation, asking for
help when needed, and coping with stressful work situations
Sensory ­difficultiesb
Environmental sensory 14 Assesses the degree to which an individual is bothered by touching different materials or being exposed to
needs and challenges different sounds or smells; also evaluates ability to cope with different types of lighting
a
Likert scale; rankings of 1 (‘Never’) to 5 (‘Always’); higher scores = stronger skills
b
Likert scale; rankings of 1 (‘Very Low’) to 5 (‘Very High’); higher scores = greater challenges

Skills. The Environmental Sensory Needs and Challenges (ADHD), respectively: the Generalized Anxiety Disorder
scale assesses sensory challenges that impact one’s ability questionnaire (GAD-7; Spitzer et al., 2006), the 9-item
to work. See Table 3 for details. The AWSQ has acceptable Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001),
to excellent internal consistency reliability (α ~ 0.64–0.90) and the Adult ADHD Self-Report Scale (A-ASRS; Ustun
and validity (Gal et al., 2013, 2015). For the current study, et al., 2017). See Supplementary Material for details.
the primary variables of interest were the mean item ratings
on the five work skills scales, which were used to character- Demographic Characteristics
ize the work readiness profile of the sample and to predict
vocational outcomes. Data are also provided on the Environ- Participant demographic characteristics, including age,
mental Sensory Needs and Challenges scale for descriptive race/ethnicity, sex assigned at birth, household income, and
purposes only. educational achievement were all probed via a background
questionnaire. Additionally, participants were asked about
Co‑occurring Psychiatric Symptomatology the receipt of VR services, SSI, and a history of special
education (i.e., receipt of an Individualized Education Plan
In order to assess three of the most commonly co-occurring [IEP] via the United States public school system, in which
forms of psychopathology in ASD across adulthood (Croen specialized supports and/or instruction are provided to stu-
et al., 2015; Hand et al., 2020), the following measures dents with documented disabilities).
were used to probe symptomatology associated with anxi-
ety, depression, and attention-deficit/hyperactivity disorder

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Journal of Autism and Developmental Disorders (2024) 54:477–490 481

Perceived Barriers and Facilitators to Job Attainment regression was implemented (with the adapted TVI score
as the dependent variable, and the AWSQ work-focused
To understand factors that may contribute to difficulties subscales as the independent variables). Prior to conducting
obtaining employment in those participants with relatively logistic regression analyses, fit parameters were evaluated
strong work readiness skills but poor employment outcomes, and were deemed acceptable.
written responses to two open-ended items from the Learn- As a follow-up to logistic regression analyses, an
ing Needs Screening Tool (LNST; Payne, 1997) were probed. examination of work readiness profiles for autistic adults
Although the LNST was created to screen for possible learn- engaged in full-time work (> 30 h per week), part-time
ing difficulties in job seekers receiving VR supports, the cur- work (≤ 30 h per week), and no vocational activities
rent study did not utilize the scale for this purpose. Rather, was completed using a mixed model ANOVA in order to
open-ended, written responses to two job-related questions ascertain if work readiness profiles varied as a function of
from the LNST were examined to identify possible barriers to full- versus part-time employment. Specifically, multiple
(“What makes it hard for you to get or keep this [desired] kind choice responses to the survey question ‘How many hours
of job?”) and facilitators of (“What would help?”) employ- per week do you work?’ were used to group participants into
ment in the words of autistic adults themselves. three categories to be compared via mixed model ANOVA:
(a) those who were unemployed (n = 122), (b) those who
Analytic Plan worked part-time (30 h per week or less; n = 45), and (c)
those who were engaged in full-time employment [31 h
Quantitative Analyses per week or more, which is broadly in line with the IRS
definition of full-time employment being at least 30 h per
Preliminary Analyses to Characterize the Sample Prior to week (Internal Revenue Service, 2021); n = 114].
conducting analyses to answer primary study questions,
descriptive statistics about the employment outcomes of Qualitative Analyses
participants were completed using a modified version of
the TVI. Details about hours worked and the participants’ Participants’ written responses to two open field questions
longest held jobs were also evaluated. Finally, demographic from the Learning Needs Screening Tool about facilitators
characteristics, ASD traits, and psychiatric symptomatol- and barriers to obtaining their desired job were examined: (a)
ogy for those who obtained the most versus least independ- “What makes it hard for you to get or keep this [desired] kind
ent vocational rankings were contrasted. These results are of job?” and (b) “What would help?” Specifically, two inde-
briefly summarized in the Results section and elaborated pendent coders reviewed written responses to these two ques-
upon in the Supplementary Material. tions serially (i.e., first responses to question (a) were coded
and then responses to question (b) were coded) following the
Characterizing the AWSQ Profile Work readiness profiles as steps outlined by Braun and Clarke (2012). In order to ensure
assessed via the AWSQ were evaluated using repeated meas- that the voices of autistic adults fueled the thematic analysis
ures ANOVA and paired samples t-tests [with false discov- (consistent with recommendations for qualitative research on
ery rate (FDR) correction (Benjamini & Hochberg, 1995) autism; van Schalkwyk & Dewinter, 2020), the two raters
for multiple comparisons] to identify relative strengths and employed an inductive (i.e., data driven) approach to code
weaknesses among work skill domains. Prior to conducting responses (rather than evaluating responses with hypoth-
these analyses, data from the primary measure, the AWSQ, esized themes in mind). Following completion of the steps
were examined for outliers and violations of normality for recommended by Braun and Clarke, an additional step was
ANOVA analyses. Data were normally distributed. Outli- taken, that of convening a consensus meeting to generate the
ers were not observed on the Work Style, Level of Inde- names of agreed-upon themes yielded from the independ-
pendence, Routine Daily Activities, and Interpersonal Skills ent coding/theme identification process. These agreed-upon
scales. However, three outliers (i.e., scores > 3 SDs from the themes are presented in the Results section.
mean) were identified on the Work Habits scale. Primary
analyses were run with and without these cases and results
were the same. Thus, study findings reported here include Results
these participants.
Preliminary Descriptive Statistics about Vocational
Using the AWSQ to Predict Vocational Outcomes To evalu- Outcomes
ate relations between work readiness (measured via the
five AWSQ work-focused subscales) and vocational attain- Prior to conducting primary analyses, an examination of the
ment (measured via an adapted version of the TVI), logistic vocational activities of the study participants was completed

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482 Journal of Autism and Developmental Disorders (2024) 54:477–490

and activities were ranked using a modified version of the factor revealed a significant main effect of scale (F[4,
TVI. This revealed that 49% (n = 138) of participants were 1029] = 268.26, p < 0.001; note: Greenhouse Geisser adjust-
currently employed for > 10 h per week and not receiving ment applied), indicating a variegated work readiness pro-
employment assistance or job support (vocational ranking of file. See Fig. 1. To identify relative strengths and weaknesses
6: most independent) while 43% (n = 122) were not engaged among these work skills, follow-up paired samples t-tests with
in any vocational activities (vocational ranking of 1: least FDR correction for multiple comparisons were completed and
independent). Just 8% (n = 21) of study participants received revealed that all five work skills scales of the AWSQ differed
intermediate rankings. Further details about the participants’ significantly from one another except for the Interpersonal
vocational outcomes are provided in the Supplementary Skills and Level of Independence scales which did not differ
Material (text and Figure S1). significantly from one another. An evaluation of mean item
Following this initial characterization of the sample, ratings on the different scales indicated that the Work Habits
factors associated with less versus more independent scale (assessing items related to adhering to rules and regula-
vocational outcomes were probed by comparing those who tions, organization, work efficiency) was an area of relative
received vocational rankings of 6 (most independent) versus strength (i.e., higher than all other scales) and the Work Style
1 (least independent) on background characteristics, ASD scale (assessing adjustment to the work environment and
symptomatology, and co-occurring depression, anxiety, and coping with work-related challenges) was an area of relative
ADHD symptomatology. These findings are detailed in the weakness (i.e., lower than all other scales).
Supplementary Material (Table S1). Briefly, we note that at
a nominal p < 0.05 level, the most independent group had Associations between Work Readiness Domains
proportionally fewer females, lower rates of SSI receipt, and Vocational Outcomes
higher rates of bachelor’s degree completion, lower ASD
traits, and fewer symptoms of depression, anxiety, and As 92% of participants (n = 260) received vocational rank-
ADHD symptomatology than the least independent group. ings corresponding to the least versus most independent cat-
When FDR correction was applied for multiple comparisons, egories, logistic regression was used to predict vocational
all results except for the difference in sex ratio remained group membership in these two categories using the five
statistically significant. AWSQ scores. Overall model accuracy was 72.2%. The
model that included the five AWSQ scale scores represented
Work Readiness Profile an almost 20% increase from the baseline model’s prediction
accuracy of 52.9% (which is based on the rate of scores of
Results of the repeated measures ANOVA with the five 6—most independent category—in the model). The overall
work skills scales of the AWSQ as the within-subjects model was associated with Cox and Snell r­ 2 value of 0.25

Fig. 1  Mean item ratings on the

AWSQ scales

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Journal of Autism and Developmental Disorders (2024) 54:477–490 483

Table 4  Prediction accuracy (for vocational group membership) of following were significant predictors (at a nominal p < 0.05):
logistic regression model including the five AWSQ scales having earned a bachelor’s degree, receipt of SSI, and the
Predicted Group AWSQ Work Style scale. See Table 6.
As the TVI’s highest tier of vocational independence
Observed 1 6 % Correct
Group involves working greater than 10 h per week without sup-
ports, it cannot be used to ascertain whether those who
1 n = 81 n = 41 66.40% work full-time have a different work readiness profile than
6 n = 31 n = 107 77.50% those who engage in part-time employment. Thus, to com-
Overall: 72.30% plement logistic regression analyses, AWSQ profiles for
Group 1 = No vocational activities; Group 6 = Employed for > 10 h participants engaged in full-time (> 30 h per week), part-
per week with no employment assistance or job support time (30 h per week or less), and no vocational activities
were compared using a 3 × 5 mixed model ANOVA with
one between-subjects factor (group) and one within-sub-
and Nagelkerke ­r2 value of 0.34. See Table 4 for prediction jects factor (AWSQ scale). Results revealed a main effect of
accuracy. scale (F[4, 1020] = 221.22, p < 0.001; Greenhouse–Geisser
An evaluation of both the beta coefficients and odds ratio adjustment applied), indicating variation in work readiness
values (with associated confidence intervals) in the model skills across domains (consistent with study findings for
revealed that Work Style, Level of Independence, and the whole sample considered together). See Supplementary
Routine Daily Activities added significant unique variance Material (Figure S2). A main effect of group was also found
to the prediction of vocational group membership after FDR (F[2,278] = 43.17, p < 0.001), such that those who were
correction for multiple comparisons. See Table 5. employed full-time had the highest AWSQ scores overall
To be conservative, the logistic regression described (M = 3.71), followed by those who were employed part-time
above was run a second time to include variables that dif- (M = 3.52), and followed by those who were unemployed
fered between the most and least independent groups as (M = 3.23). No group x scale interaction was evidenced,
probed in preliminary analyses and documented in the Sup- indicating that profiles of scores did not differ by group.
plementary Material, Table S1. These covariates included However, to be thorough, tests of simple effects were com-
sex assigned at birth, receipt of a bachelor’s degree, receipt pleted to examine which scales differed among the three
of SSI, and measures of ASD traits and co-occurring depres- groups. These findings are summarized in Supplemental
sive, anxious, and ADHD symptomatology. When covariates Fig. 2. As can be seen, after implementing FDR-correction
were included, the model’s overall prediction accuracy was for multiple comparisons, groups differed on all scales
quite similar to the model without covariates. Specifically, (q < 0.05) in the direction described above (full-time > part-
77% of variance was explained by the complete model. The time > unemployed) with two exceptions. Specifically, those
addition of the covariates in Step 1 increased the variance engaged in part-time versus full-time work did not differ
explained by just under 17% (from a baseline accuracy of significantly from one another on Work Habits and Inter-
53.9% to 70.6%). An evaluation of the beta coefficients for personal Skills.
this model indicated that higher ADHD symptomatology,
lower educational achievement (i.e., less than a bachelor’s Barriers to and Facilitators of Desired Vocational
degree), and receipt of SSI were associated with less inde- Outcomes as Articulated by Autistic Adults
pendent vocational outcomes. When the five AWSQ sub-
scale scores were added to the model in Step 2, the pre- To complement quantitative analyses and begin to under-
dicted variance increased by an additional 6.5%. When the stand why some participants with relatively strong work
beta coefficients for the final model were considered, the readiness skills were not employed, open-ended, written

Table 5  Logistic regression B SE B p-value Odds ratio 95% CI of odds ratio

results for AWSQ scales
predicting (concurrent) Work habits 0.45 0.27 0.1 1.57 0.93–2.65
vocational outcomes
Work style 1.05 0.34 0.002* 2.85 1.46–5.57
Level of independence 0.64 0.28 0.02* 1.90 1.11–3.26
Routine daily activities 0.72 0.32 0.024* 2.05 1.10–3.82
Interpersonal skills 0.06 0.31 0.86 1.06 0.58–1.94

Bold values indicate statistically significant at p < .05

*
Survives FDR correction

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484 Journal of Autism and Developmental Disorders (2024) 54:477–490

Table 6  Logistic regression B SE B p-value Odds ratio 95% CI of odds ratio

results predicting (concurrent)
vocational outcomes using Model 1 (covariates only):
AWSQ scales and covariates
Sex-Female 0.49 0.31 0.12 1.64 0.89–3.03
ASD traits − 0.01 0.01 0.33 0.99 0.96–1.01
Anxiety symptoms 0.03 0.04 0.40 1.03 0.96–1.11
Depression symptoms − 0.02 0.03 0.61 0.99 0.93–1.04
ADHD symptoms − 0.07 0.03 0.04 0.93 0.87–1.00
Bachelor’s received 1.41 0.32 < .001 4.10 2.20–7.63
SSI receipt − 2.24 0.65 < .001 0.11 0.03–0.38
Model 2 (all predictors):
Sex-Female 0.55 0.34 0.11 1.72 0.89–3.35
ASD traits 0.01 0.02 0.71 1.01 0.97–1.04
Anxiety symptoms 0.03 0.04 0.47 1.03 0.95–1.12
Depression symptoms − 0.01 0.03 0.82 0.99 0.93 -1.06
ADHD symptoms 0.00 0.04 0.99 1.00 0.92–1.09
Bachelor’s received 0.94 0.35 0.01 2.56 1.29–5.09
SSI Receipt − 1.91 0.67 0.01 0.15 0.04–0.55
Work habits 0.41 0.31 0.18 1.51 0.83–2.74
Work style 0.93 0.39 0.02 2.52 1.19–5.37
Level of independence 0.42 0.32 0.18 1.52 0.82–2.82
Routine daily activities 0.50 0.37 0.18 1.65 0.80–3.41
Interpersonal skills 0.19 0.40 0.64 1.21 0.55–2.65

Bold values indicate statistically significant at p < .05

responses of participants who were misidentified by the be noted that there were a few additional, low frequency
logistic regression as being engaged in the most independ- responses related to barriers (and facilitators) to employment
ent vocational pursuits (category 6) when they were, in fact, that fell under an umbrella that we refer to as ‘structural or
not engaged in any vocational activities (category 1; n = 41; systems level challenges’ (or ‘accommodations’ in the case
Table 4, upper right quadrant) were analyzed using qualita- of facilitators). Examples of items in this category included
tive methods. Specifically, written responses to open-ended challenges/facilitators related to transportation, racial/gender
questions about barriers and facilitators to employment (see discrimination, challenges with childcare, etc.
Statistical Analysis section for questions) were probed for
participants in this subsample who answered ‘yes’ to the
question “Do you have difficulty finding or keeping a job Discussion
you like?” Of the 31 participants who answered ‘yes,’ 28
participants provided open-ended responses that were evalu- The current study characterized work readiness skills (as
ated for themes in order to document the lived experience of assessed using the AWSQ; Ben Meir et al., 2010) of a
the autistic adults in this subgroup. large sample of autistic young adults (ages 22 to 39 years)
Regarding barriers to employment, themes that emerged without significant cognitive impairment living in the
via consensus from the two raters are summarized in Fig. 2. United States. It also examined relations between work
As can be seen, three themes emerged: (a) intrapersonal fac- readiness skills and postsecondary vocational outcomes
tors related to the ASD phenotype (e.g., physical and men- (as assessed using a modified version of the TVI; Taylor
tal health, cognitive/affective difficulties, and sensory chal- & Seltzer, 2012), as this relationship has not been
lenges), (b) difficulties with finding/securing the right job, formally evaluated among autistic adults to the best of our
and (c) lack of an autism friendly workplace and its sequelae, knowledge. Finally, it examined barriers and facilitators to
namely burnout. Regarding facilitators, themes that emerged employment as articulated by autistic adults.
via consensus are summarized in Fig. 3 and were as fol- Consistent with other reports (Anderson et al., 2020;
lows: (a) psychoeducation for employers/supervisors about Taylor & DaWalt, 2017; Taylor & Mailick, 2014; Taylor
the ASD phenotype, (b) the need for career and job train- & Seltzer, 2011; Taylor et al., 2015), a large proportion of
ing supports, and (c) suggested accommodations to create autistic adults enrolled in the current study did not engage
a more autism-friendly work environment. Lastly, it should in any daytime vocational activities (43%). Although

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Journal of Autism and Developmental Disorders (2024) 54:477–490 485

Fig. 2  Themes about barriers to employment

we utilized a 6-point ranking system (a modification of work versus self-generated, complex tasks) was a relative
the 9-point TVI) to describe variability in the degree of weakness. This profile is consistent with the long-standing
vocational independence experienced by participants, research on the autism behavioral phenotype in which
the vast majority of the sample fell into the extreme flexibility is noted as a prominent challenge (Kenworthy
categories of no daytime activities or engaged in work in et al., 2008; Wallace et al., 2016). In many ways, the strength
the community without supports for greater than 10 h pers in Work Habits and weakness in Working Style represent
week (49%). Only 8% of the sample received intermediate two sides of the same coin—i.e., adherence to rules and
rankings. expectations about work behavior versus the flexibility
Adding to the small literature on work readiness skills and fluidity in work behavior that permit the completion of
in ASD, the current research provides the first large-scale varied tasks in a changing environment.
description of work readiness skills among autistic adults Turning to relations between work readiness and
living in the United States. Consistent with the work of Gal vocational outcomes, this is the first study to document
and colleagues conducted in Israel (Gal et al., 2013), Work relations between soft-skills necessary for success in the
Habits, a scale that measures skills related to adhering to workplace and vocational outcomes among autistic adults.
rules and regulations in the workplace (e.g., attendance, Although this may seem like an intuitive finding (i.e.,
timeliness, following safety guidelines) and work quality those who are more prepared for work have better work
(e.g., precision, efficiency, error monitoring) was a relative outcomes—or—those who are working have stronger work-
strength. Also consistent with this prior research, Work related soft skills), no studies have examined this directly
Style, a scale that assesses flexibility in the workplace (e.g., and sought to identify which aspects of work readiness
adjusting to changes and coping with simultaneous requests) are associated with more favorable vocational outcomes
and the types of tasks completed (e.g., predefined, repetitive in autistic adults. The current study identified a positive

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486 Journal of Autism and Developmental Disorders (2024) 54:477–490

Fig. 3  Themes about facilitators of employment

association between vocational outcomes and the following such as physical and mental health difficulties (Hayward
work readiness domains: Work Style, Level of Independence, et al., 2018) and sensory challenges (Waisman-Nitzan et al.,
and Routine Daily Activities (the last of which is consistent 2021) have been noted as barriers to workplace success in
with prior work documenting relations between daily prior studies of autistic adults. Turning to other barriers,
living skills and vocational outcomes in ASD; Chan et al., an area of concern that emerged from this study and was
2021; Roux et al., 2013; Taylor & Mailick, 2014). Of these identified in one other study (Dreaver et al., 2020) was that
three work readiness domains, only Work Style persisted of ‘match’ between desired and actual job. For example, one
as a significant predictor of vocational outcomes after we participant noted “I’ve been forced to get the best available
conservatively included covariates (sex assigned at birth, job at the time instead of search for a job I really like.”
receipt of a bachelor’s degree, receipt of SSI, and measures Although the need for supports related to job training is
of ASD traits and co-occurring depressive, anxious, and well-documented in prior research (e.g., Ogawa et al., 2021;
ADHD symptomatology) in the model, suggesting that this Wehman et al., 2013), less is written about the importance of
may be a work readiness domain to target in future research. job fit within the context of VR services for autistic adults.
In order to understand the perspectives of autistic Thus, this is an area that warrants further attention, as part
individuals on barriers and facilitators to employment, of vocational training for autistic adults may need to focus
written, open-ended responses to one question about each not only on work readiness skills but also self-exploration
of these topics were analyzed for thematic content. Barriers of vocational interests to aid in the identification of jobs that
that emerged highlighted intrapersonal factors related to individuals will find fulfilling.
the autism phenotype, challenges with the job search and Finally, consistent with one prior investigation (Raymaker
training, and a lack of an autism-friendly workplace and its et al., 2022), occupational or job burnout was identified
sequelae, namely burnout. These themes are consistent with as a barrier to vocational success by several participants.
prior qualitative research. For example, intrapersonal factors Job burnout is a construct from the field of industrial/

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Journal of Autism and Developmental Disorders (2024) 54:477–490 487

organizational psychology that describes a phenomenon that true—that is, individuals who are employed have better
involves feelings of exhaustion, detachment from one’s job, work readiness skills due to practicing these skills in the
and being ineffective or unsuccessful at work (Salvagioni workplace. Third, the study relied solely on self-report of
et al., 2017). The accounts of job burnout provided by the work readiness skills. Although this could be construed
autistic adults in our study primarily emphasized exhaustion as a limitation, and future research should include
resulting from the excessive energy needed to satisfy job complementary objective assessments of this construct,
expectations. This vocational experience likely overlaps with taking this approach permitted the examination of relations
the broader construct of ‘autistic burnout’ described in the between these skills and vocational outcomes that may
ASD literature (Raymaker et al., 2020). However, the current include unemployment. More specifically, because existing
study was not designed to disentangle this construct from informant report measures of work skills are designed
the broader construct of autistic burnout. Moreover, we are exclusively for individuals who are currently employed
unable to ascertain whether the experience of occupational (e.g., Becker, 2005), they preclude the ability to examine
burnout for autistic adults is similar to that experienced by relations between vocational soft-skills and actual success in
neurotypical individuals in the workforce. Thus, these topics securing employment. Thus, by using a self-report measure,
should be the focus of future research. we were able to include individuals who were and were not
With regard to facilitators, themes mirrored those employed, allowing the ability to link work skills to varied
of barriers—namely the need for tailored job training vocational outcomes. Fourth, although we did control for
(including as it applies to finding work), psychoeducation the possible contributions of three of the most commonly
of employers/supervisors about the autism phenotype, occurring psychiatric conditions associated with ASD
and accommodations in the work environment, including during adulthood (anxiety, depression, and ADHD; Croen
flexibility with hours and place of work. Interestingly, et al., 2015; Hand et al., 2020) to vocational outcomes,
the latter two facilitators, which focused on modifications we were unable to more comprehensively evaluate
within the work environment that support success, were co-occurring psychopathology beyond these conditions.
identified as ‘reasonable’ workplace accommodations Thus, future research should seek to evaluate this using a
by employers and autistic employees who participated in measure that taps psychiatric functioning more generally
a qualitative study focused on workplace adjustments for in order to augment our understanding of the relations
autistic adults conducted in the United Kingdom (Petty between different types of psychiatric symptomatology and
et al., 2022). Despite multiple studies citing the need for vocational outcomes. Finally, it is important to note that the
workplace accommodations (for a review, see Khalifa vast majority of participants included in the current research
et al., 2020), research by Davies and colleagues (Davies were white and non-Hispanic. Thus, we are limited in the
et al., 2022) has raised the concern that autistic adults feel generalizations we can make about these findings. Given
that the onus falls to them to determine the nature of these that individuals with more than one minority identity (in
accommodations and the manner in which they are to be this case, identifying as neurodivergent and as belonging to
implemented. This additional burden could contribute to a minority ethnic or racial group) may face discrimination
feelings of occupational burnout and should be investigated and experience marginalization in a unique way (Crenshaw,
in future research. 1989), it will be crucial for future studies of work readiness
Prior to discussing the implications of this research and vocational outcomes to target participants from
and directions for future research, we turn to our study’s historically underrepresented groups in research.
limitations. First, verification of ASD diagnosis was not In addition to the need for more diverse study sam-
feasible with the current sample, given the online study ples, future research should seek to employ longitudinal
design. However, three factors mitigate this limitation: research designs in order to examine factors that predict
(a) individuals were recruited from an autism participant more favorable employment outcomes. Although longi-
registry (SPARK) which partners with ASD clinics, tudinal investigations such as the NLST2 exist, many of
(b) independent research on the SPARK sample has these studies have used blunt measures to predict out-
demonstrated strong convergence between participant comes without identifying more refined cognitive-behav-
reports of medical diagnoses of ASD and documented ASD ioral skills to target in VR settings or transition services in
diagnoses in medical records (Fombonne et al., 2022), and high school. Another area for future research is to examine
(c) 94% of the sample screened positive on the AQ-28. whether the vocational strengths and challenges identified
Second, the study’s cross-sectional design did not permit by a measure such as the AWSQ can be used to guide more
an evaluation of a directional hypothesis about relations personalized vocational counseling for autistic adults that
between work readiness skills and vocational outcomes. includes an emphasis on job fit. As job fit was identified
Thus, we cannot argue that stronger work readiness skills by the autistic participants included in this study and oth-
drive vocational outcomes. Rather, the reverse may be ers (e.g., Pfeiffer et al., 2018) as an area of challenge,

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488 Journal of Autism and Developmental Disorders (2024) 54:477–490

this suggests that more attention should be paid to helping Declarations

individuals identify occupations and particular job oppor-
tunities that may be best suited to their strengths. In par- Conflict of interest The authors have no conflicts to disclose.
ticular, it has been suggested that approaches that incor-
porate individual differences (Bury et al., 2020) and that
are personalized (Harmuth et al., 2018), such as the Per-
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