finding work that fits with asd - altogether autism€¦ · altogether autism 2015 - finding work...

Altogether Autism 2015 - Finding work that

fits with ASD

(c) 2015 Frank O'Connor for Instep and Mental

Health Foundation 1

FINDING WORK

THAT FITS WITH ASD

Frank O’Connor

Auckland – 23 July, 2015

+64 21 386-911 [email protected]

There is great concern within the autism world about the un- and under-employment of people on the spectrum

Many people with autism have considerable skills and knowledge, but find it very hard to work, to be independent and thus contribute to society

There is interest – from would-be-employees and employers, professionals and families – in how to get adults on the spectrum into work, and keep them there

We’ll explore some strategies that seem to work (or not) for adults on the spectrum to find and keep work they want to do


fits with ASD


Health Foundation 2

FINDING WORK THAT FITS

1 There is great concern ...

2 Considerable skills and knowledge

3 How to get into work, and stay

4 Employer strategies that seem to work (or not)

The un- and underemployment

figures are discouraging, sitting

above 80% around the world

“There is limited large-scale empirical research into the working lives of adults who have an autism spectrum disorder with no co-occurring intellectual disability”

Baldwin et al (2014)


fits with ASD


Health Foundation 3

“Employment results are …”

“Even for individuals who are considered to be higher functioning, employment results are appalling. Adults:o experience underemployment

o switch jobs frequently

o have difficulty adjusting to new job settings

o make less money than their counterparts

o are much less l ikely to be employed than:� typically developing peers

� individuals with less severe language disorders

� individuals with learning disabilities”

“Even for those individuals who have postsecondary educational experience, employment difficulties are common”

Hendricks, D. (2010) Employment and adults with autism spectrum

disorders: Challenges and strategies for success. Journal of Vocational

Rehabilitation, 32 (2), 127

o Some studies estimate that 50-75% of adults with ASD are unemployed� Other popular media reports are

much higherThe reasons matter more

than the numbers

Few global facts

22,878 autism-related intervention studies

o 3974 articles identifying an ASD intervention

o 501 studies targeted participants 18+ years of age

o 10 studies evaluated vocation-related interventions in ASD

Nicholas, D.B., Attridge, M., Zwaigenbaum, L. & Clarke, M. (2015)

Vocational support approaches in autism spectrum disorder: A synthesis

review of the literature. Autism, 19 (2), 235-245


fits with ASD


Health Foundation 4

Fewer local facts

A study of 130 Australian adults at the high-functioning end of the spectrumo Most in scientific, technical, and

information-based jobs

o Some in education, healthcare work, hospitality, retail, gardening

54% needed help to find a job

72% not currently receiving any ASD specific support in their workplaceso 66% would like more support

Baldwin, S., Costley, D. & Warren, A. (2014) Employment activities and

experiences of adults with high-functioning autism and Asperger’s disorder. Journal of Autism and Developmental Disorders, 44,

2440-2449

Concerns about over-educationo 86% post-school qualifications cf.

57% in general Australian population

o 45% overqualified for their position cf. ANZSCO

Summing up

Adults with ASD often experience difficulty securing and maintaining work

… periods of unemployment are common, as is ‘under-employment’, or working below one’s skills level

… few specialist support systems

… most individuals relied heavily on the support of their families in finding jobs

§5.1.c, NZASD Guidelines, 2008


fits with ASD


Health Foundation 5

Many facets affect this outcome,

and something can be done

about some - at least sometimes

If we separate what we can change from what we

can’t, then we can look for where it will help most

Focus on the obstacles

“The countless permutations and combinations of social interactions, language, learning, sensory, and behavior deficits and excesses found in these individuals, in combination with their wide range of abilities, developmental levels, isolated skills, and unique personalities make autism an especially baffling disability”

Simpson, R.L. (2001) ABA and students with autism spectrum disorders:

Issues and considerations for effective practice. Focus on Autism and Other

Developmental Disabilities 16 (2), p69


fits with ASD


Health Foundation 6

Wouldn’t you avoid taking the risk

too …

If you were fearful of a difficult working situation, as

either would-be employee and employer?

Or on responses to obstacles

• Highly individual vocational

needs

• Social difficulties

• Impaired executive functioning

• Behavioural difficulties

• High distress and anxiety

• Comorbidities such as

depression, anxiety, epilepsy

Hendricks, D. (2010) Employment

and adults with autism spectrum

disorders: Challenges and strategies for

success. Journal of Vocational

Rehabilitation 32, 125-134

Obstacles to employmento Communication and social difficulties with supervisors

and co-workers, including difficulty understanding directions, inability to ‘read between the lines’ and read facial expressions and tone of voice, asking too

many questions, and communicating in an inappropriate manner

o Social impairment which may include inappropriate hygiene and grooming skills, difficulty following social rules, inability to understand affect, working alone, and acting inappropriately

o Cognitive functioning including impairments to executive functioning; problems with attention, motor planning, response shifting, and working memory; acclimatising to new job routines and settings; and for people with Asperger syndrome, problems with organisation and problem-solving

o Behavioural difficulties which may include tantrums, aggression, self-injury, property destruction, ritualistic behaviours, or pica, the experience of anxiety and stress relating to fitting into a new world, and sensitivity to workplace noise and other sensory stimuli

o Comorbid with psychiatric symptoms which may include anxiety, depression, bipolar disorder, and epilepsy

Ministry of Health. (2012) Guideline Supplementary Paper (to the New Zealand autism spectrum disorder guideline).

Wellington: Ministry of Health. p14.


fits with ASD


Health Foundation 7






A situation and complication

There is capacity for good work in many adults

on the spectrum

o Matching both task and context to the dynamics

of the person (and his or her piece of spectrum) is

something many employers are not at all sure of

o In my experience, many of those in work-finding

brokerage roles aren’t so confident either


fits with ASD


Health Foundation 8

Successes reported

1 Job placement, especially

supported employment and

community placement

2 Supervision and co-workers

3 On-the-job training and coaching

4 Work place modifications, media

and technology helping tools

5 Long-term supportHendricks, D. (2010) Employment and

adults with autism spectrum disorders: Challenges

and strategies for success. Journal of Vocational

Rehabilitation, 32 (2), 127

Supports for successo Job placement to be individualised and based on the

person’s strengths, interests and task preferences to ensure a job match ... job tasks and work environment should be considered (eg, predictable schedule,

defined tasks, require minimal social skills, allow adequate time, avoid excessive sensory stimulation)

o Supervisors and co-workers need to be tolerant, flexible, receptive and aware of a person with ASD’s characteristics and support needs and assist in social interactions

o On-the-job provisions, including training targeting job tasks, acclimatisation to the job site and social integration, as well as developing communication and interpersonal skills, management of inappropriate behaviour, and coping with stress. A job coach may be identified to assist in training, slowly lessening support

o Work place modifications including addressing distracting environmental stimuli, and providing a consistent schedule of work tasks

o Long-term support including natural supports (eg, identify supervisors and co-workers to take on support as the job coach’s role diminishes) and external supports (eg, follow-up and close monitoring, assisting with issues outside of work, introduction to social groups, and individual counselling to develop coping strategies)

Ministry of Health (2012) Guideline Supplementary Paper (to the New Zealand autism spectrum disorder guideline).

Wellington: Ministry of Health. p15

Risk is rarely evenly spread

Shattuck, P.T., Narendorf, S.C., Cooper, B., Sterzing, P.,

Wagner, M., & Lounds, J. (2012). Postsecondary

education and employment among youth with an

autism spectrum disorder. Pediatrics. 129 (6) p1048

“Youth from lower income

families and those with

greater functional

impairments …

particularly at risk for

poor employment

outcomes”


fits with ASD


Health Foundation 9

A quiz on assets or liabilities

Punctuality

Conscientiousness

Loyalty

Attention to detail

Perfectionism

Independence

Enjoyment of repetitive tasks

Careful attention to work area

… discomfort with lack of structure

Unique work routines

Preference for no interruptions

Stress reactions to deadlines

Difficulties with team work

Anxiety about performance

Reluctance to ask for help or support

Low awareness of danger to self or others

Difficulty with time management

Strong reactions to changes in work

Motivational issues regarding tasks of no personal interest

Difficulty with writing reports

NZASD Guideline p170-171

Assisting less able people

Even people with severe autism or co-morbid intellectual disability can become engaged in meaningful work

Specialist schemes for assisting less able people with ASD to get into work have recorded success

For many people with an intellectual disability, real work in real employment settings is preferable by far to vocational and day services

NZASD Guideline p171

People with an intellectual disability who receive relevant work experience as part of their school-based transition planning are more likely to maintain competitive jobs


fits with ASD


Health Foundation 10






We can reduce risk

… by avoiding the mismatch between capability and

practicality for would-be employees


fits with ASD



Preparation counts

For a person with ASD,

whatever their ability

level, becoming a worker

is more likely to be

achieved with careful

attention to preparation

and planningNZASD Guideline

Support needs include

o Assistance in finding a job

o Learning how to do the job

o Assistance with completing

the job

o Addressing work-related

issues

o Addressing non-work-

related issues

o Transportation

NZASD Guideline

How hard is job seeking?

For each question, choose one of: Never… Rarely… Often… Always

1 Do you understand complex job application materials?

2 Do you ‘think well on your feet’ in an interview?

3 Do you quickly adjust to new procedures and routines?

4 Do you remember and follow verbal instructions?

5 Do you respond pleasantly and flexibly to unexpected situations?

6 Do you cope with planning and juggling several tasks at once?

7 Do you communicate effectively with all of your co-workers?

8 Do you interact socially in a way that is comfortable for everyone?

9 Do you have to do unusual things to manage sensory sensitivities?


fits with ASD



What works often has something to

do with stuff we can do

something about

The diversity of the spectrum

means many intellectual,

sensory and social differences

Expressing an individual's set of these takes effort,

but they can be put constructively, as capacities

for useful work


fits with ASD



Remember who’s in charge!

… research suggests that

the responsibility for

‘making it work’ in an

employment setting

tends to rest on the

person with ASD, rather

than the employerNZASD Guidelines, 2008

We can do a lot

Constructive responses to

urban myths

o Provide sound information

and reassurance

Good help in preparing and

maintaining the

employment relationship

o For both parties, and their

helpers

Accommodate around work

that almost fits

o What this person is likely

to be good

o What this employer is

likely to know, learn, do

Communicate the match of

the person to the position

o Help both parties talk, flex

and accommodate


fits with ASD



Involving specialist

employment servicesIncreases chances of

positive work outcomes finding work

o maintaining work

o having good working relationships

NZASD Guidelines, 2008

See also Recommendation

5.1.13.B - Ministry of Health (2012) Guideline Supplementary

Paper p15

Associated with improved attitudes of employers towards people with ASD

o Employers more willing to be supportive and adapt circumstances to suit the person concerned

o Employers more likely to rate the employee’s effectiveness at their job (rather than to work in an established way and to adapt to the organisation)

From employees who succeed

Adults with ASD interviewed

about employment:

o Significant difficulty in the

workplace due to

insufficient knowledge

o Sought autism awareness

training for employers and

co-workers to:

� Understand who I am

� Know why I behave in a

certain way

Sophie Nesbitt (2000)


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What can employers do?

“Regardless of any useful individual supports, one thing is clear: employers need to be more understanding and accommodatingo Autistic workers are wired differently and thus experience

things differently

o Many like routine and structured tasks or information can aid work performance

Some employers have demonstrated that making changes to the work setting – instead of accommodating individual workers’ processing, sensory and social differences – benefits all of their employees”

Campbell Teague, Autism and Employment: A Reflection on the Poor Statistics www.ariconference.com/enews/adults/adult_enews_vol11


fits with ASD



Make a compelling case

“Employers need to know that it makes good business sense to employ: o people who are reliable,

punctual and loyal

o people who have good attention to detail and concentration levels

o people who have excellent problem solving skills and can be analytical, resourceful and creative

What good employer wouldn’t want an employee with those skills?

o … making a few small adjustments … someone with autism can make a loyal and hardworking employee

o … a huge pool of untapped talent out there …

We must make it clear that people with autism can work and want to work … they just need to be given the support and opportunities”

Lord David Freud, UK Minister for Welfare Reform, National Autistic Society Parliamentary Reception, 20

March 2012

Don’t forget employers …

… can adapt to challenges

found in others at work

o social interactions

o deficits and excesses

o wide range of abilities

o developmental levels

o isolated skills

o unique personalities


fits with ASD



Research on best practice

Individuals controlling their own vocational destinies through self-determination, facilitated by person-centred planning, and a career-based approach

Employment specialists acting as facilitators, not experts

Taking account of employers’ as well as individuals’ needs

Using ‘natural supports’ and supplementing jobs in ways that are ‘typical’ for each setting

Using intentional strategies to enhance social integration

…

Supporting self-employment

Post or follow-up support

Ensuring that people with severe disabilities can access supported employment

Quality outcomes result when services adopt a principles-and values-led approach to supported employment

NZASD Guideline after Ridley, J., Hunter, S. and Infusion Co-operative.

(2005) “Go For It!”: Supporting People with Learning Disabilities and/or Autistic

Spectrum Disorder in Employment. Edinburgh: Scottish Executive Social

Research

Which can we affect?

Many attributes of an ‘autism

friendly’ environment help

everyone to do their work better

Such as clear goal setting, or a work place which

isn’t too bright or too loud


fits with ASD



Assisting employers

1 Job modification o maintain a consistent

schedule and job duties

o keep the social demands of the job manageable and practicable

o provide organisers to help structure and keep track of work

o add activities to reduce or eliminate unstructured time


Benefits for other workers too

Assisting work direction

2 Supervisiono be direct and specific when

giving directions

o verify that communications are correctly understood

o assist the employee in learning social rules and interpreting social cues encountered on the job

o explain and help the employees deal with changes on the job


Treat everyone like this?


fits with ASD



Assisting workmate strategies

3 Co-worker relationships and social interactions

o encourage co-workers to initiate interactions

o ensure that one or two co-workers play a role in helping to give job-related suggestions and ‘keep an eye out’ for the employee


Include everyone else

too

Assisting help-seeking

4 Support serviceso provide a sense of

familiarity and reassurance until the employee and company staff get to know one another

o transfer relationships and supports to company employees

o check in and remain on-call in case problems arise

o maintain a liaison role for non-work issues that affect the job



fits with ASD



Then the minor adjustments for

someone with autism are less

daunting

More levers on job success

o Role of workplace peers

o Social networks

o Workplace and social policies

o Ways successful employment programs benefit businesses and communities

o Strengths and benefits people on the autism spectrum contribute to workplaces and society

Shattuck, P.T. and Roux, A.M. (2015) Commentary on

employment supports research.Autism 19 (2) 246–247


fits with ASD



The things that help most

Supportive employment is a specific mechanism that is reported to o Facilitate finding a job

o Teach individuals with ASD how to apply and interview for a position

o Liaise between an individual with ASD and his or her co-workers or supervisor

o Deal with crisis situations that may arise […] to support overall vocational success

Notions of vocational “fit,” preparedness, and support, as needed, appear to be reflective of vocational success for individuals with ASD and their employers

Job coaches integral to:o Finding employment for the individual

o Providing needed support in the work environment

Close contact allowed foro Exploring appropriate job opportunities

o Matching the skills and abilities of a specific employee with a suitable job

o Developing individual’s understanding of the social aspects of work settings� Big investment of time and effort

necessary for both parties

Nicholas, D.B., Attridge, M., Zwaigenbaum, L. & Clarke, M. (2015) Vocational support

approaches in autism spectrum disorder: A synthesis review of the literature. Autism, 19 (2), 235-245

Workplace adaptations work

Many workers on the spectrum (and many other workers) benefit from clearly defined work tasks

o May require rearranging actual job scope / duties or the way a job is

performed

o Activity schedules, based on job analysis, can

assign tasks to be done to certain times or work conditions

o Using some form of work

organizers helps structure and keep track of work

� Examples: flowcharts, tick-

sheets, sorting boxes, notebooks, labels and

whiteboard run charts


fits with ASD



More changes that work

Identify potential

distractions and ways to

lessen their impact in

each relevant work area

o Assess noise level,

interruptions, crowding,

lighting, and movement

o Keep individual’s needs

in mind

Providing a consistent

schedule for completion

of work tasks increases

job predictability

o These reduce worry and

stress and need for re-

communication

o ‘Down time’ could

include taking a walk or

playing computer games

Employers who don’t know

don’t employ

Biggest difference in

awareness and

understanding of the

disorderNesbitt, S. (2000) Why and

why not? Factors impacting

employment for individuals

with Asperger syndrome,

Autism 4 (4), 357–369

Focused on potential

negative behaviours

rather than the person’s

capabilities

Didn’t know of or

appreciate employment

supports that could be

provided


fits with ASD



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