RESEARCH ARTICLE

Multi-informant International Perspectives on the Facilitators

and Barriers to Employment for Autistic Adults
Melissa H. Black , Soheil Mahdi, Benjamin Milbourn, Melissa Scott, Alan Gerber , Christopher Esposito,
Marita Falkmer, Matthew D. Lerner , Alycia Halladay, Eva Ström, Axel D’Angelo, Torbjorn Falkmer,
Sven Bölte , and Sonya Girdler

Employment rates for autistic individuals are poor, even compared to those from other disability groups. Internationally,
there remains limited understanding of the factors influencing employment across the stages of preparing for, gaining,
and maintaining employment. This is the third in a series of studies conducted as part of an International Society for
Autism Research (INSAR) policy brief intended to improve employment outcomes for autistic individuals. A multi-
informant international survey with five key stakeholder groups, including autistic individuals, their families, employers,
service providers, and researchers, was undertaken in Australia, Sweden, and the United States to understand the facilita-
tors and barriers to employment for autistic adults. A total of 687 individuals participated, including autistic individuals
(n = 246), family members (n = 233), employers (n = 35), clinicians/service providers (n = 123), and researchers (n = 50).
Perceptions of the facilitators and barriers to employment differed significantly across both key stakeholder groups and
countries, however, ensuring a good job match and focusing on strengths were identified by all groups as important for
success. Key barriers to employment included stigma, a lack of understanding of autism spectrum disorder (ASD) and
communication difficulties. Results suggest that a holistic approach to employment for autistic individuals is required,
aimed at facilitating communication between key stakeholders, addressing attitudes and understanding of ASD in the
workplace, using strength-based approaches and providing early work experience. Autism Res 2020, 00: 1–20. © 2020
International Society for Autism Research, Wiley Periodicals, Inc.

Lay Summary: Autistic individuals experience significant difficulty getting and keeping a job. This article presents a sur-
vey study involving autistic individuals, their families, employers, service providers and researchers in Australia, Sweden,
and the United States to understand their perspectives on the factors that support or act as barriers to employment. While
perspectives varied across key stakeholders, strategies such as using a holistic approach, targeting workplace attitudes and
understanding, focusing on strengths, and providing early work experience are important for success.

Keywords: autism; cross-cultural; employment; key stakeholders; adults

Introduction Australia [Aspect], 2013), and specific skills, traits, and

knowledge beneficial to the workplace [de Schipper et al.,
While employment rates of the general population in 2016; Jacob, Scott, Falkmer, & Falkmer, 2015; Kirchner,
Australia, Sweden and the United States of America (USA) Ruch, & Dziobek, 2016; Scott et al., 2018], successfully
exceed 70% (Organisation for Economic Co-operation gaining and maintaining employment are key challenges
and Development [OECD], 2018), these same employ- facing autistic individuals. In Australia and the United
ment outcomes are not shared by those with a diagnosis States, only 40.8% and 38% of autistic individuals respec-
of autism spectrum disorder (ASD). Despite often having tively are gainfully employed [Australian Bureau of Statis-
a desire to engage in paid employment (Autism Spectrum tics, 2017; Roux, Rast, Anderson, & Shattuck, 2017], with

From the School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia (M.H.B., B.M., M.S.,
M.F., T.F., S.B., S.G.); Curtin Autism Research Group, Curtin University, Perth, Western Australia, Australia (M.H.B., B.M., M.S., M.F., T.F., S.B., S.G.); Cen-
ter of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women’s and Children’s Health, Karolinska Institutet, &
Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden (S.M., A.D., S.B.); Stony Brook University, New York, Stony Brook, New York
(A.G., C.E., M.D.L.); CHILD, Swedish Institute for Disability Research, School of Education and Communication, Jönköping University, Sweden (M.F.);
Autism Science Foundation, New York, New York (A.H.); Swedish Public Employment Service, Unit for Rehabilitation and Work, Hallunda-Norsborg,
Stockholm, Sweden (E.S.); Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping,
Sweden (T.F.); Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden (S.B.); Department of Pharma-
cology and Toxicology, Rutgers University, New Jersey, USA (A.H.)
Received August 6, 2019; accepted for publication February 17, 2020
Address for correspondence and reprints: Melissa H. Black, School of Occupational Therapy and Social Work, Curtin University. Postal address: GPO
Box U1987, Perth, 6845, Western Australia, Australia. E-mail: [email protected]
Published online 00 Month 2020 in Wiley Online Library (wileyonlinelibrary.com)
DOI: 10.1002/aur.2288
© 2020 International Society for Autism Research, Wiley Periodicals, Inc.

INSAR Autism Research 000: 1–20, 2020 1

just over half of autistic adults in Sweden in employment highly variable, with considerably decentralized poli-
(62%) [Statistics Sweden, 2015]. cies (United States) [Organisation for Economic Co-
Core characteristics associated with ASD [American Psy- operation and Development, 2010]. Thus, these coun-
chiatric Association, 2013] may pose significant chal- tries present a broad range of approaches, even among
lenges across all stages of employment including otherwise highly resourced and industrialized nations.
preparing for, gaining and maintaining employment. The present study was preceded by a scoping review of
When seeking employment, the social and communica- factors impacting employment for autistic people
tive impairments associated with ASD may contribute to [Scott, Milbourn, et al., 2018] and community consulta-
difficulties engaging in traditional job search and inter- tion obtaining a cross-cultural perspective of key stake-
view processes [Lorenz, Frischling, Cuadros, & Heinitz, holders in the employment of autistic individuals
2016; Robertson, 2010; Scott, Girdler, & Falkmer, 2015], [Black et al., 2019]. Using the International Classifica-
with further environmental factors, such as stigma poten- tion of Functioning Disability and Health (ICF), a bio-
tially negatively influencing employment prospects psychosocial framework used to understand health-
[Unger, 2002]. While some autistic individuals success- related functioning [World Health Organization, 2002],
fully gain employment, there is evidence that negative these studies identified a number of factors influencing
experiences are pervasive [Baldwin, Costley, & Warren, employment, with findings particularly highlighting
2014], and many face challenges in sustaining employ- the role of the environment, impacting employment
ment. Difficulties in social interaction and communica- outcomes. While these preceding studies identified key
tion, sensory processing atypicalities [Hurlbutt & factors influencing employment outcomes, it remains
Chalmers, 2004], challenges understanding task require- unknown whether perspectives differ across informant
ments [Lorenz et al., 2016; Robertson, 2010], employer groups. It has been shown previously that responses dif-
and colleague attitudes [Unger, 2002], and the workplace fer across stakeholder groups when considering research
setting [Lorenz et al., 2016] are all factors identified as questions related to ASD [Pellicano, Dinsmore, &
hindering the long-term success even when work task Charman, 2014] and given the diversity of individuals
performance is adequate [Hurlbutt & Chalmers, 2004]. involved in the employment of autistic individuals, it is
While factors influencing employment outcomes for likely that perspectives also differ in the context of
autistic individuals have been identified [Chen, Leader, employment. It is important to capture the perspectives
Sung, & Leahy, 2015], there remains little understanding from multiple stakeholders to gain a holistic and com-
of both the facilitators and barriers to employment across prehensive understanding of the barriers and facilita-
the stages of preparing for, gaining and maintaining a tors to employment for autistic individuals,
job. Employment research to date has largely focused on emphasizing the unique expertise of the autistic indi-
examining the significance of the core challenges of ASD viduals and the autistic community in their own experi-
in influencing vocational prospects [Scott, Milbourn, ences. For this reason, this study, the third in this
et al., 2018]; however, there is increasing recognition of series, undertook a multi-informant international sur-
the role that factors, such as the environment [Scott, Mil- vey, gaining the perspectives of autistic individuals,
bourn, et al., 2018] and the strengths of autistic individ- their families, employers, clinicians/service providers
uals [de Schipper et al., 2016], play in influencing and researchers on the facilitators and barriers to
employment outcomes [Scott, Milbourn, et al., 2018]. employment for autistic individuals.
There is a need to develop a holistic understanding of
the factors that may facilitate or hamper employment
outcomes for autistic individuals across all stages of
Method
employment to inform policies and interventions that Design
support autistic adults in employment. As part of a
larger policy brief effort commissioned by the Interna- To gain perspectives from a range of key stakeholders
tional Society for Autism Research (INSAR), this internationally, a multi-informant international survey
study aimed to inform recommendations for improving [Kaufmann & Astou Saw, 2014] was undertaken in
the employment outcomes of autistic individuals. Australia, Sweden, and the United States with five key
This policy brief was conducted across Australia, Swe- stakeholder groups including autistic adults, families of
den and the United States to capture the differing autistic individuals, employers, service providers and
employment and disability policies employed by these researchers examining their perspectives on the facilita-
countries as described in more detail in Black et al. tors and barriers across the stages of employment for
[2019]. In brief, these countries represent a range of autistic adults. This study is part of a larger project led by
approaches to employment supports for autistic indi- the Curtin Autism Research Group (CARG) in Australia,
viduals, ranging from highly centralized, with substan- the Center of Neurodevelopmental Disorders at
tial nationalized institutional support (Sweden) to Karolinska Institutet (KIND) in Sweden, Stony Brook

2 Black et al./Facilitators and barriers to employment INSAR

University and the Autism Science Foundation in the Survey Development
United States in collaboration with INSAR.
An international online multi-informant survey was
developed by the Australian team to examine perspec-
tives of the facilitators and barriers to employment for
Participants autistic individuals and adapted to Swedish and United
States contexts by the national teams respectively. Sur-
Across the three countries a total of 687 individuals par-
veys were largely similar across the three countries; how-
ticipated including autistic individuals (n = 246), parents
ever, variations were made to several statements
and other family members (n = 233), employers (n = 35),
accommodating for cultural and national differences,
service providers (including clinicians, educators, service
with the survey designed for Sweden translated to Swed-
provider managers; n = 123), and researchers (n = 50). Par-
ish prior to distribution. Due to variations between coun-
ticipants were required to identify as belonging to one
tries, only those items where variations did not alter the
stakeholder group, however, if a participant identified as
intended meaning of the statement were included in
multiple groups (e.g., autistic adult and parent), they
analysis. The survey was divided into three primary
could recomplete the survey in the additional role.
sections.
Recruitment of participants was undertaken through
snowball and convenience sampling [Saumure & Given,
2012] led by the participating institutions and research Demographic information. The initial sections of the
groups in each country. In Australia, participants were survey sought to obtain demographic and employment
recruited by CARG through existing recruitment lists and data from the respondents. Demographic questions varied
social media with assistance from the Autism Association according to the key stakeholder group and were tailored
of Western Australia. Recruitment was also undertaken for differences across countries (e.g., employment type).
through various ASD and disability services in Australia.
Similarly, recruitment of participants by KIND in Sweden Facilitators and barriers to employment. In order to
involved recruitment through the centers network and explore the barriers and facilitators to employment, thirty
mailing lists, the Swedish Public Employment Service, questions were developed. Using a 4-point Likert scale,
and various Swedish-based interest organizations, such as participants rated the barriers (very challenging, challeng-
the Autism and Asperger Association. Recruitment in the ing, somewhat challenging, not challenging at all) and facili-
United States was undertaken via web postings, flyers, tators (very important, important, unimportant, not at all
and social media, as well as existing mailing lists through important) across the stages of preparing for, gaining and
Stony Brook University, the Autism Science Foundation, maintaining a job. Statements for these questions were
and the Autism Society of America. Across the three developed in collaboration with key stakeholders and
countries, researchers in the field of ASD were also invited researchers in the field of ASD and were designed to be
to participate through advertising by INSAR. Demo- inclusive of personal and body function factors, activity
graphic information for all participants is shown in and participation factors and environmental domains of
Table 1. Across countries, autistic individuals were com- the ICF [World Health Organization, 2002]. Items were
parable on gender distribution, however, differed for age. divided into three sections based on the stages of employ-
Family members reporting on their autistic children were ment (refer to Appendix A for an outline of questions)
similar across countries in regard to their child’s age and including preparing for, gaining and maintaining
gender. employment.

Viewpoints on successful employment. To further

Ethical Considerations understand viewpoints on the factors contributing to suc-
cessful employment for autistic individuals, participants
This study complied with the Helsinki Declaration then viewed an additional 36 four-point Likert scale state-
[World Medical Association, 2008] and ethical approval ments (strongly agree to strongly disagree) relating to
was obtained by all sites. In Australia, ethical approval their agreement on the factors contributing to successful
was obtained from the Curtin University Human employment. These items were taken from a previous
Research Ethics Committee (HREC: HR141/2014). Ethical study seeking to understand successful employment in
approval in the USA was obtained from the Stony Brook autistic individuals [Scott et al., 2015]. In this previous
Institutional Review Board (CORIHS#: 2017-4108-F). In study, autistic individuals and employers were asked to
Sweden, ethical approval was obtained from the Regional rank a series of statements (k = 52) in regard to impor-
Ethical Review Board in Stockholm (reg nr. 2017/ tance. For the purposes of the current study, those state-
1251–31/5). ments which autistic individuals endorsed or disagreed

INSAR Black et al./Facilitators and barriers to employment 3

Table 1. Demographic Information
Stakeholder group AUS Sweden USA Total Test of significance

Autistic individuals
N 77 65 104 246
Age, years mean (SD) 37.1 (12.4) 41.6 (10.3) 33.7 (12.0) 36.9 (12.11)
Range min–max years 18–70 20–69 18–70 18–70 F(2,244) = 9.29, P < 0.01
Gender, n (%) χ2 (2) = 4.5, P = 0.10
Male 32 (41.6) 19 (29.2) 47 (45.2) 98 (39.8)
Female 42 (54.5) 43 (66.2) 52 (50) 137 (55.7)
Transgender 2 (2.6) 0 (0) 3 (2.9) 5 (2)
Other 1 (1.3) 3 (4.6) 2 (1.9) 6 (2.4)
Current employment status, n (%)a
Unemployed and not seeking work 6 (7.8) 2 (3.1) 8 (7.7) 16 (6.5)
Unemployed and seeking work 26 (33.8) 10 (15.4) 23 (22.1) 59 (24)
Working in supported workshop/business 0 (0) 0 (0) 1 (1.0) 1 (0.4)
Employed on a casual per-diem basis 9 (11.7) 1 (1.5) 2 (1.9) 12 (4.9)
Employed on a part-time basis 8 (10.4) 6 (9.2) 19 (18.3) 33 (13.4)
Employed on a full-time basis 13 (16.9) 17 (26.2) 31 (29.8) 61 (24.8)
Student 9 (11.7) 4 (6.2) 10 (9.6) 23 (9.3)
Wage subsidized employment - 6 (92) - 6 (2.4)
Other 6 (7.8) 26 (40) 9 (8.7) 41 (16.7)
Industry, n (%)
Agriculture, forestry, and fishing 0 (0) 0 (0) 1 (1.0) 1 (0.4)
Retail trade 5 (6.5) 0 (0) 9 (8.7) 14 (5.7)
Accommodation and food service 0 (0) 1 (1.5) 7 (6.7) 8 (3.3)
Transport, postal, and warehousing 1 (1.3) 0 (0) 2 (1.9) 3 (1.2)
Information media and telecommunications 3 (3.9) 3 (4.6) 5 (4.8) 11 (4.5)
Financial insurance and services 2 (2.6) 2 (3.1) 1 (1.0) 5 (2.0)
Rental hiring and real estate services 1 (1.3) 0 (0) 1 (1.0) 2 (0.8)
Professional, scientific, and technical services 4 (5.2) 2 (3.1) 6 (5.8) 12 (4.9)
Administrative and support services 6 (7.8) 5 (7.7) 12 (11.5) 23 (9.3)
Public administration and public safety 1 (1.3) 1 (1.5) 1 (1.0) 3 (1.2)
Education and training 3 (3.9) 6 (9.2) 10 (9.6) 19 (7.7)
Health care and social assistance 3 (3.9) 2 (3.1) 11 (10.6) 16 (6.5)
Arts and recreation services 2 (2.6) 3 (4.6) 3 (2.9) 8 (3.3)
Other services 4 (5.2) 16 (24.6) 17 (16.3) 37 (15)
Not applicable or missing 42 24 18 84
Family member
N 68 23 142 233
Age, years (of descendent)
mean (SD) 21.3 (6.2) 23.3 (6.3) 20.8 (5.3) 21.2 (5.7) F (2,232) = 1.93, P = 0.15
Range min–max years 6–39 15–41 13–50 6–50
Gender (of descendent), n (%) χ2 (2) = 4.1, P = 0.13
Male 53 (77.9) 14 (60.9) 116 (81.7) 183 (78.5)
Female 14 (20.6) 8 (34.8) 25 (17.6) 47 (20.2)
Transgender 0 (0) 0 (0) 1 (0.7) 1 (0.4)
Other 1 (1.5) 1 (4.3) 0 (0) 2 (0.9)
Current employment status (of descendent), n (%)
Unemployed and not seeking work 9 (13.2) 2 (8.7) 14 (9.9) 25 (10.7)
Unemployed and seeking work 12 (17.6) 1 (4.3) 33 (23.2) 46 (19.7)
Working in supported workshop/business 2 (2.9) 1 (4.3) 3 (2.1) 6 (2.6)
Employed on a casual per-diem basis 12 (17.6) 2 (8.7) 1 (0.7) 15 (6.4)
Employed on a part-time basis 3 (4.4) 1 (4.3) 28 (19.7) 32 (13.7)
Employed on a full-time basis 3 (4.4) 0 (0) 2 (1.4) 5 (2.1)
Student 24 (35.3) 9 (39.1) 51 (35.9) 84 (36.1)
Wage-subsidized - 1 (4.3) - 1 (0.4)
Other 3 (4.4) 7 (30.4) 9 (6.3) 19 (8.2)
Industry descendent is employed in, n (%)
Agriculture, forestry, and fishing 1 (1.5) 0 (0) 0 (0) 1 (0.4)
Manufacturing 1 (1.5) 0 (0) 2 (1.4) 3 (1.3)
Construction 1 (1.5) 0 (0) 0 (0) 1 (0.4)
Wholesale trade 1 (1.5) 0 (0) 0 (0) 1 (0.4)

(Continues)

4 Black et al./Facilitators and barriers to employment INSAR

Table 1. Continued
Stakeholder group AUS Sweden USA Total Test of significance
Retail trade 6 (8.8) 1 (4.3) 9 (6.3) 16 (6.9)
Accommodation and food services 3 (4.4) 1 (4.3) 11 (7.7) 15 (6.4)
Transport, postal and warehousing 1 (1.5) 2 (8.7) 2 (1.4) 5 (2.1)
Information media and telecommunications 1 (1.5) 0 (0) 2 (1.4) 3 (1.3)
Financial insurance and services 1 (1.5) 0 (0) 0 (0) 1 (0.4)
Professional, scientific, and technical services 1 (1.5) 0 (0) 1 (0.7) 2 (0.9)
Administrative and support services 1 (1.5) 1 (4.3) 7 (4.9) 9 (3.9)
Public administration and public safety 0 (0) 1 (4.3) 1 (0.7) 2 (0.9)
Education and training 0 (0) 0 (0) 3 (2.1) 3 (1.3)
Health care and social assistance 0 (0) 0 (0) 1 (0.7) 1 (0.4)
Arts and recreation services 2 (2.9) 0 (0) 3 (2.1) 5 (2.1)
Other services 3 (4.4) 3 (13.0) 8 (5.6) 14 (6.0)
Not applicable or missing 45 15 91 151
Employers
N 9 14 12 35
Total number of employees 60 86 131 277
Employment type (number of employees), n (%)
Supported employment 30 (50) 20 (23.3) 8 (6.1) 58 (20.9)
Per-diem/casual basis 3 (5.0) 5 (5.8) 13 (9.9) 21 (7.6)
Part-time basis 9 (15.0) 12 (14.0) 49 (37.4) 70 (25.3)
Full-time basis 18 (30) 11 (12.8) 61 (46.6) 90 (32.5)
Wage-subsidized - 38 (44.2) - 38 (13.7)
Industry, n (%)b
Agriculture, forestry, and fishing 1 (11.1) 0 (0) 0 (0) 1 (2.9)
Manufacturing 0 (0) 1 (7.1) 0 (0) 1 (2.9)
Construction 0 (0) 0 (0) 2 (16.7) 2 (5.7)
Retail Trade 0 (0) 2 (14.3) 1 (8.3) 3 (8.6)
Transport, postal, and warehousing 1 (11.1) 1 (7.1) 0 (0) 2 (5.7)
Information media and telecommunications 0 (0) 6 (42.9) 0 (0) 6 (17.1)
Financial insurance and services 0 (0) 0 (0) 1 (8.3) 1 (2.9)
Professional, scientific, and technical services 0 (0) 0 (0) 2 (16.7) 2 (5.7)
Administrative and support services 1 (11.1) 2 (14.3) 1 (8.3) 4 (11.4)
Public administration and public safety 0 (0) 1 (7.1) 0 (0) 1 (2.9)
Education and training 1 (11.1) 0 (0) 1 (8.3) 2 (5.7)
Health care and social assistance 0 (0) 1 (7.1) 0 (0) 1 (2.9)
Other services 5 (55.6) 2 (14.3) 4 (33.3) 11 (31.4)
Service providers
N 21 63 39 123
Employment types supported, n (%)
Supported employment 5 (23.8) 36 (57.1) 26 (66.7) 67 (54.5)
Per diem/casual basis 9 (42.9) 33 (52.4) 10 (25.6) 52 (42.3)
Part-time basis 9 (42.9) 45 (71.4) 22 (56.4) 76 (61.8)
Full-time basis 5 (23.8) 32 (50.8) 15 (61.5) 52 (42.3)
Wage-subsidized - 52 (82.5) - 52 (42.3)
Other - 6 (9.5) - 6 (4.9)
Industry that individuals currently employed in, n (%)c
Agriculture, forestry, and fishing 2 (9.5) 2 (3.2) 1 (2.6) 5 (4.1)
Manufacturing 4(19.0) 8 (12.7) 5 (12.8) 17 (13.8)
Electricity, gas water, and waste service 0 (0) 4 (6.3) 4 (10.3) 8 (6.5)
Construction 0 (0) 5 (7.9) 1 (2.6) 6 (4.9)
Wholesale trade 2 (9.5) 7 (11.1) 0 (0) 9 (7.3)
Retail trade 9 (42.9) 26 (41.3) 14 (35.9) 49 (39.8)
Accommodation and food services 6 (28.6) 15 (23.8) 23 (59.0) 44 (35.8)
Transport, postal, and warehousing 6 (28.6) 26 (41.3) 7 (17.9) 39 (31.7)
Information media and telecommunications 3 (14.3) 33 (52.4) 17 (17.9) 43 (35.0)
Financial and insurance services 1 (4.8) 3 (4.8) 3 (7.7) 7 (5.7)
Rental hiring and real estate services 0 (0) 0 (0) 1 (2.6) 1 (0.8)
Professional, scientific, and technical services 0 (0) 11 (17.5) 9 (23.1) 20 (16.3)
Administrative support services 7 (33.3) 30 (47.6) 10 (25.6) 47 (38.2)
Public administration and safety 1 (4.8) 7 (11.1) 0 (0) 8 (6.5)

(Continues)

INSAR Black et al./Facilitators and barriers to employment 5

Table 1. Continued
Stakeholder group AUS Sweden USA Total Test of significance
Education and training 0 (0) 7 (11.1) 11 (28.2) 18 (14.6)
Health care and social assistance 2 (9.5) 17 (27.0) 8 (20.5) 27 (22.0)
Arts and recreation services 1 (4.8) 13 (20.6) 11 (28.2) 25 (20.3)
Other services 5 (23.8) 12 (19.0) 7 (17.9) 24 (19.5)
Researchers
N 6 0 44 50

a
n = 6 Swedish participants provided multiple responses.
b
n = 2 Swedish participants provided multiple responses.
c
Includes multiple responses from all countries.

with most strongly (received highest or lowest rankings) disagreement were calculated for each key stakeholder
[Scott et al., 2015] were used. Two statements were group for each statement. These frequencies were used to
reversed in Swedish surveys, therefore for the purposes of derive rankings for each statement, revealing those items
analysis, scores were reversed for Swedish results. with the highest and lowest levels of agreement.

Procedure
Results
Online survey tools were used for the purposes of data Preparing for Employment
collection. Qualtrics [Qualtrics, 2005] was used by both
All stakeholders endorsed that matching skills, abilities
Australian and the US sites while Karolinska SUNET Sur-
and interests to the job criteria (good job matching) was
vey was employed in Sweden [Artologik, 2018]. Survey
the most important factor in regard to preparing for
links were distributed by each study site via their recruit-
employment. Autistic adults and families responded that
ment avenues. Participants were provided with informa-
employer knowledge of an individual’s diagnosis was
tion outlining the purposes of the study and provided
least important to preparing for employment while learn-
informed consent through the online survey tools prior
ing how to participate in an interview was least impor-
to proceeding to the survey. While survey completion
tant for employers and service providers. Researchers
time varied, completion took approximately 1 hr, with
found the statements regarding employer knowledge of
participants able to save their progress and return to the
diagnosis and learning the skills required to support an
survey at any point in time. Surveys generated Excel and
autistic person similarly unimportant (Table 2).
other output files for further data processing.

Key stakeholder comparisons. Both families

Data Analysis
(P < 0.01) and service providers (P < 0.01) responded
Data were analyzed using SPSS statistical software [IBM that matching skills, abilities and interests to the job
Corp, 2015]. Demographic data were examined using criteria was more important in preparing for employ-
nonparametric (Chi square/Fischer’s exact, Kruskal- ment than did autistic adults (Table 2). Similarly, fami-
Wallis) and parametric (Analysis of Variance) tests to lies (P < 0.01), service providers (P = 0.01), and
investigate differences between countries for each respon- employers (P < 0.01), reported that employers having
dent group. In examining the differences in perception of knowledge of the autism diagnosis was more important
those factors important for employment, the frequencies than did autistic adults. Learning how to interview for a
of all responses and respondent groups were extracted, job was more important in preparing for employment to
with Kruskal-Wallis H tests conducted on each statement service providers (P = 0.018) and researchers (P = 0.016)
to determine if key stakeholders differed in regard to their in comparison to employers, and to families in compari-
perception of facilitators and barriers to employment. son to autistic individuals (P < 0.01). Families also per-
Where significant differences were observed, post-hoc ceived learning how to interview for a job as less
Bonferroni-Dunn adjusted pairwise comparisons were important than did employers (P < 0.01).
undertaken to examine where differences between key
stakeholder groups occurred. Analysis was further con- Cross-cultural comparisons. Autistic adults in the
ducted to explore potential cross-cultural differences in United States endorsed employer knowledge of the ASD
the perception of facilitators and barriers to employment diagnosis as less important than autistic adults in Sweden
across the three countries. To examine key stakeholder (P = 0.029) and Australia (P < 0.01). Autistic adults in the
perspectives on viewpoints for successful employment United States also responded that learning how to inter-
[Scott et al., 2015], frequencies of agreement and view (P < 0.01), and matching skills, abilities and,

6 Black et al./Facilitators and barriers to employment INSAR

Table 2. Ratings of Importance for Factors Associated with Preparing for Employment and Tests of Significance for Responder
Group and Country
Tests of significance

Very important Important Unimportant Very unimportant Key stakeholder comparison Cross-cultural comparison

Employer knowledge of diagnosis χ2 (4) = 62.15, P < 0.01*

Autistic individual 28.0% 49.2% 19.5% 3.3% χ2 (2) = 16.64, P < 0.01*
Family member 57.9% 34.8% 5.6% 1.7% χ2 (2) = 14.91, P < 0.01*
Employer 62.9% 34.3% 0.0% 2.9% χ2 (2) = 2.73, P = 0.26
Service provider 37.4% 59.3% 3.3% 0.0% χ2 (2) = 3.75, P = 0.15
Researcher 30.0% 68.0% 2.0% 0.0% χ2 (2) = 0.07, P = 0.8
Learning how to interview for a job χ2 (4) = 32.62, P < 0.01*
Autistic individual 53.3% 36.2% 9.3% 1.2% χ2 (2) = 11.81, P < 0.01*
Family member 73.4% 21.0% 3.4% 2.1% χ2 (2) = 5.39, P = 0.07
Employer 37.1% 40.0% 20.0% 2.9% χ2 (2) = 2.22, P = 0.33.
Service provider 61.8% 33.3% 4.9% 0.0% χ2 (2) = 7.97, P = 0.02*
Researcher 66.0% 32.0% 2.0% 0.0% χ2 (2) <0.01, P = 0.94
Matching skills, abilities,
and interests to the job criteria χ2(4) = 28.64, P < 0.01*
Autistic individual 77.1% 19.6% 2.4% 0.8% χ2 (2) = 10.5, P = 0.01*
Family member 92.3% 6.4% 0.4% 0.9% χ2 (2) = 13.5, P < 0.01*
Employer 74.3% 25.7% 0.0% 0.0% χ2 (2) = 3.99, P = 0.14
Service provider 91.1% 8.9% 0.0% 0.0% χ2 (2) = 3.02, P = 0.22
Researcher 86.0% 14.0% 0.0% 0.0% χ2 (2) = 0.04, P = 0.84

*Indicates significant at P < 0.05.

interests to the job criteria (P < 0.01) were less important skills (such as social skills) were less important to gaining
in preparing for employment compared to autistic adults employment compared to service providers (work experi-
in Sweden. Similar to autistic adults, families in the ence: P = 0.03, job skills P = 0.02) and employers (P < 0.01),
United States endorsed employer knowledge of the diag- however, they believed these items were more important
nosis as less important than did families in Sweden than did autistic adults (P < 0.01). Educating staff about
(P < 0.01). Matching skills, abilities and, interests to the ASD prior to the individual beginning work was also seen
job criteria was also more important to families in Swe- as more important to service providers compared to families
den in comparison to those in Australia (P < 0.01) and (P < 0.01), while families found this item more important
the United States (P < 0.01). Australian service providers compared to autistic adults (P < 0.01).
ranked learning how to interview as less important in
preparing for employment than did service providers in
Sweden (P = 0.03). Researchers and employers did not dif- Cross-cultural comparisons. All key stakeholders
fer across countries in their importance rankings of fac- across Australia, Sweden, and the United States provided
tors relevant to preparing for employment. similar ratings in regard to the importance of work experi-
ence in preparing for employment. In considering learning
job skills, autistic adults in the United States perceived this
Facilitators in gaining employment. Autistic adults,
item as less important than their counterparts in Australia
families, service providers and researchers responded that
(P = 0.01) and in Sweden (P < 0.01). Employers in Sweden
learning the skills needed for work (including social skills,
found learning job skills as more important than employers
life skills, preparing for social norms or vocational train-
in the United States (P = 0.03), while service providers in
ing) was the most important factor for gaining employ-
Sweden also found learning job skills as more important
ment. Employers considered educating staff about ASD
than did service providers in both the United States
prior to the individual commencing work as the most
(P < 0.01) and Australia (P = 0.01). Educating staff about
important factor. Providing training to employers about
ASD prior to the individual beginning employment was
ASD was the least important factor in regard to preparing
also seen as more important to employers in Sweden com-
for employment in all key stakeholder groups (Table 3).
pared to employers in the United States (P < 0.01), and to
service providers in Australia compared to service providers
Key stakeholder comparisons. Groups did not differ in Sweden (P = 0.01).
significantly when considering the importance of training Providing training to employers about ASD was found
employers about ASD in the workplace. Families responded to be more important for autistic adults, families,
that work experience (such as internships) and learning job employers and service providers in Australia compared to

INSAR Black et al./Facilitators and barriers to employment 7

Table 3. Ratings for Facilitators Associated with Gaining Employment and Tests of Significance for Responder Group and
Country
Tests of significance

Very
Very important Important Unimportant unimportant Key stakeholder comparison Cross-cultural comparison

Work experience χ (4) = 30.02, P < 0.01*

2

Autistic individual 52.8% 39.4% 6.1% 1.6% χ2 (2) = 0.99, P = 0.61

Family member 73.4% 23.6% 1.7% 1.3% χ2 (2) = 4.51, P = 0.11
Employer 42.9% 42.9% 14.3% 0.0% χ2 (2) = 0.22, P = 0.90
Service provider 54.5% 45.5% 0.0% 0.0% χ2 (2) = 5.82, P = 0.06
Researcher 54.0% 44.0% 2.0% 0.0% χ2 (2) = 2.33 P = 0.13
Learning the skills you may need χ2(4) = 50.54, P < 0.01*
Autistic individual 53.3% 39.8% 6.5% 0.4% χ2 (2) = 25.83, P < 0.01*
Family member 82.0% 16.3% 0.4% 1.3% χ2 (2) = 5.03, P = 0.08
Employer 48.6% 42.9% 8.6% 0.0% χ2 (2) = 6.68, P = 0.04*
Service provider 65.0% 32.5% 2.4% 0.0% χ2 (2) = 24.76 P < 0.01*
Researcher 70.0% 28.0% 2.0% 0.0% χ2 (2) = 0.59, P = 0.44
Training employers about ASD χ2(4) = 4.40 P = 0.36
Autistic individual 42.6% 33.2% 6.1% 18.0% χ2 (2) = 127.25, P < 0.01*
Family member 54.1% 21.5% 1.3% 23.2% χ2 (2) = 154.65, P < 0.01*
Employer 40.0% 42.9% 0.0% 17.1% χ2 (2) = 18.71, P < 0.01*
Service provider 39.0% 46.3% 3.3% 11.4% χ2 (2) = 45.29, P < 0.01*
Researcher 52.0% 36.0% 2.0% 10.0% χ2 (2) = 16.47, P < 0.01
Educating staff on ASD prior to
an employee with ASD beginning
in the workplace χ2 (4) = 43.52, P < 0.01*
Autistic individual 44.3% 38.6% 15.0% 2.0% χ2(2) = 1.01, P = 0.60
Family member 68.2% 27.9% 3.4% 0.4% χ2(2) = 3.70, P = 0.16
Employer 45.7% 51.4% 2.9% 0.0% χ2 (2) = 12.34, P < 0.01*
Service provider 38.2% 55.3% 6.5% 0.0% χ2 (2) = 11.19, P < 0.01*
Researcher 56.0% 40.0% 4.0% 0.0% χ2 (2) = 2.07, P = 0.15

*Indicates significant at P < 0.05.

those in the USA (P < 0.01), but less important compared employers (families: P = 0.01, autistic adults: P = 0.03).
to those in Sweden (autistic adults, families and service Families rated the lack of knowledge of the interview and
providers: P < 0.01, employers: P = 0.01). Researchers in employment process as less challenging than did both
Australia also found training employers as more impor- employers (P = 0.02) and service providers (P = 0.01), but
tant than did researchers in the United States (P < 0.01). as more challenging than did autistic adults (P < 0.01).
Families also endorsed communication skills as more
Barriers for Gaining Employment challenging to gaining employment than did autistic
adults (P = 0.03). While a significant difference between
All key stakeholders, except autistic adults, endorsed key stakeholders was observed for understanding of ASD
communication skills as the most challenging barrier to in the workplace, no pairwise comparisons were signifi-
employment. In contrast, autistic individuals identified a cant, (P > 0.11) indicating that all key stakeholders rated
lack of understanding of ASD in the workplace as the this item similarly.
most challenging factor. A lack of knowledge of the
employment application and interview process were seen Cross-cultural comparisons. Cross-cultural compari-
as the least challenging factors for autistic adults, families sons showed that family perceptions of the challenges
and employers, while researchers and service providers related to gaining employment did not differ across coun-
rated stigma in the workplace as the least challenging tries. While differences between countries for employers
(Table 4). was significant for stigma, pairwise comparisons revealed
no significant differences across countries (P > 0.07), with
Key stakeholder comparisons. Families and autistic all other items being nonsignificant, indicating that
adults rated stigma as more challenging than did service employers provided similar ratings on the challenges to
providers (P < 0.01). Families and autistic adults also gaining employment across countries. Autistic adults in
found a lack of acceptance in the workplace as more chal- Sweden rated understanding in the workplace as more
lenging than did both service providers (P < 0.01) and challenging to gaining employment than did those in

8 Black et al./Facilitators and barriers to employment INSAR

Table 4. Ratings for Barriers Associated with Gaining Employment and Tests of Significance for Responder Group and Country
Test of significance

Very Slightly Not challenging Key stakeholder

challenging Challenging challenging at all comparisons Cross-cultural comparisons

Stigma in the workplace χ2 (4) = 24.95, P < 0.01*

Autistic individual 51.6% 30.9% 15.0% 2.4% χ2 (2) = 1.15, P = 0.56
Family member 46.6% 40.5% 12.1% 0.9% χ2 (2) = 2.86, P = 0.24
Employer 22.9% 54.3% 20.0% 2.9% χ2 (2) = 6.50, P = 0.04*
Service provider 27.0% 49.2% 22.1% 1.6% χ2 (2) = 1.22, P = 0.54
Researcher 32.0% 50.0% 18.0% 0.0% χ2 (2) = 3.96, P = 0.05*
Acceptance in the workplace χ2 (4) = 25.96, P < 0.01*
Autistic individual 49.2% 34.0% 14.8% 2.0% χ2 (2) = 4.98, P = 0.08
Family member 48.3% 41.8% 8.6% 1.3% χ2 (2) = 2.73, P = 0.26
Employer 20.0% 57.1% 20.0% 2.9% χ2 (2) = 0.90, P = 0.64
Service provider 27.9% 49.2% 21.3% 1.6% χ2 (2) = 1.05, P = 0.59
Researcher 36.7% 53.1% 10.2% 0.0% χ2 (2) = 1.53, P = 0.22
Understanding of ASD in the workplace χ2 (4) = 14.39 P = 0.01*
Autistic individual 56.5% 32.5% 8.9% 2.0% χ2 (2) = 7.65, P = 0.02*
Family member 57.4% 36.5% 5.2% 0.9% χ2 (2) = 0.08, P = 0.96
Employer 37.1% 48.6% 14.3% 0.0% χ2 (2) = 0.04, P = 0.98
Service provider 41.8% 52.5% 4.9% 0.8% χ2 (2) = 5.14, P = 0.08
Researcher 34.7% 59.2% 6.1% 0.0% χ2 (2) = 1.68, P = 0.20
Knowledge of employment
application interview process χ2 (4) = 22.68 P < 0.01*
Autistic individual 41.1% 32.9% 23.2% 2.8% χ2 (2) = 1.90, P = 0.39
Family member 55.6% 31.5% 9.9% 3.0% χ2 (2) = 0.86, P = 0.65
Employer 26.5% 50.0% 17.6% 5.9% χ2 (2) = 0.48, P = 0.79
Service provider 31.1% 53.3% 14.8% 0.8% χ2 (2) = 2.16, P = 0.34
Researcher 40.0% 46.0% 14.0% 0.0% χ2 (2) = 0.69, P = 0.41
Communication skills χ2 (4) = 12.32 P = 0.02*
Autistic individual 52.4% 34.6% 11.4% 1.6% χ2 (2) = 0.27, P = 0.87
Family member 63.8% 31.5% 3.9% 0.9% χ2 (2) = 1.59, P = 0.45
Employer 42.9% 42.9% 14.3% 0.0% χ2 (2) = 0.59, P = 0.74
Service provider 54.1% 40.2% 4.1% 1.6% χ2 (2) = 7.95, P = 0.02*
Researcher 54.0% 44.0% 2.0% 0.0% χ2 (2) = 0.02, P = 0.88

*Indicates significant at P < 0.05.

Australia (P = 0.03). Service providers in Sweden rated (P = 0.02) as less important than employers (P = 0.02).
communication skills as more challenging compared to Families (P < 0.01) and service providers (P = 0.01) also
service providers in the United States (P = 0.02) and rated mentor or external supports as more important
researchers in the United States found stigma more chal- than did autistic adults. Key stakeholder groups did not
lenging to gaining employment than did researches in differ when considering the importance of making the
Australia (P = 0.05). workplace more accessible and friendly. Further, while a
significant effect of group was observed for the impor-
Facilitators in Maintaining Employment tance of focusing on the strengths in the workplace,
pairwise comparisons revealed no significant differences.
In regard to maintaining employment, all key stake-
holder groups endorsed focusing on strengths in the Cross-cultural comparisons. Autistic adults in
workplace as the most important factor. Making work- Australia found that making the workplace more accessi-
places more accessible was rated as the least important in ble and friendly was more important to maintaining
maintaining employment by families, services providers employment than did autistic adults in the United States
and researchers. Employers and autistic adults perceived (P = 0.04). Families, employers and researchers were
mentors or external support as the least important factor found to have similar ratings on the importance of fac-
(Table 5). tors relating to maintaining employment across coun-
tries. While a significant difference between countries
Key stakeholder comparisons. Families rated educa- was found for service providers when considering the
tion and understanding of ASD in the workplace importance of making the workplace more accessible, no

INSAR Black et al./Facilitators and barriers to employment 9

Table 5. Ratings for Facilitators Associated with Maintaining Employment and Tests of Significance for Responder Group and
Country
Tests of significance

Very Very Key stakeholder Cross-cultural

important Important Unimportant unimportant comparisons comparisons

Focusing on their strengths in the workplace χ2 (4) = 11.53, P < 0.02*

Autistic individual 78.0% 21.1% 0.4% 0.4% χ2 (2) = 4.13, P = 0.13
Family member 84.4% 14.7% 0.0% 0.9% χ2 (2) = 0.94, P = 0.62
Employer 71.4% 28.6% 0.0% 0.0% χ2 (2) = 0.17, P = 0.92
Service provider 72.1% 27.9% 0.0% 0.0% χ2 (2) = 4.63, P = 0.1
Researcher 68.0% 30.0% 2.0% 0.0% χ2 (2) = 0.75, P = 0.39
Education and understanding
of ASD in the workplace χ2 (4) = 18.09, P < 0.01*
Autistic individual 55.7% 36.6% 6.9% 0.8% χ2 (2) = 2.08, P = 0.35
Family member 64.5% 33.3% 1.3% 0.9% χ2 (2) = 3.07, P = 0.22
Employer 37.1% 54.3% 8.6% 0.0% χ2 (2) = 2.78, P = 0.25
Service provider 48.4% 48.4% 3.3% 0.0% χ2 (2) = 0.08, P = 0.96
Researcher 42.0% 56.0% 2.0% 0.0% χ2 (2) = 1.72, P = 0.19
Mentor or some form of external support χ2 (4) = 44.22, p < 0.01*
Autistic individual 49.8% 32.7% 16.7% 0.8% χ2 (2) = 2.57, P = 0.28
Family member 75.7% 22.2% 1.7% 0.4% χ2 (2) = 0.25, P = 0.88
Employer 54.3% 31.4% 8.6% 5.7% χ2 (2) = 0.13, P = 0.94
Service provider 63.1% 35.2% 1.6% 0.0% χ2 (2) = 5.54, P = 0.06
Researcher 56.0% 42.0% 2.0% 0.0% χ2 (2) = 0.34, P = 0.56
Making the workspace more
accessible and friendly χ2 (4) = 4.40, p = 0.35
Autistic individual 52.8% 34.6% 12.2% 0.4% χ2 (2) = 7.70, P = 0.02*
Family member 56.3% 39.0% 3.9% 0.9% χ2 (2) = 1.41, P = 0.49
Employer 54.3% 40.0% 2.9% 2.9% χ2 (2) = 2.40, P = 0.30
Service provider 57.4% 38.5% 4.1% 0.0% χ2 (2) = 6.85, P < =0.03*
Researcher 46.0% 44.0% 10.0% 0.0% χ2 (2) = 0.55, P = 0.46

*Indicates significant at P < 0.05.

pairwise comparisons were significant (P > 0.08), indicat- Key Stakeholder Comparisons
ing that service providers also provided similar ratings
across countries for all factors associated with Families endorsed both behavior difficulties and commu-
maintaining employment. nication difficulties as more challenging to maintaining
employment compared to autistic adults (behavior:
P < 0.01, communication: P = 0.03), but found these
Barriers to Maintaining Employment items less challenging when compared to employers
(behavior: P = 0.03, communication: P < 0.01). Families
Communication difficulties were found to be the most also found ASD understanding and education in the
challenging barrier to maintaining employment by autis- workplace to be less challenging than did service pro-
tic adults, families, service providers and researchers, viders. Service providers rated communication difficulties
while ASD education and understanding in the workplace as more challenging compared to employers (P = 0.02)
were seen as the most challenging barrier by employers. and found being able to change tasks as needed more
Difficulties with communication were rated as least chal- challenging than autistic adults (P = 0.04).
lenging by employers, with service providers and autistic
adults finding behavior difficulties (i.e., meltdowns, hand Cross-Cultural Comparisons
flapping) to be the least challenging. Researchers per-
ceived being able to change tasks if necessary as the least Autistic adults and service providers in Sweden rated
challenging in maintaining employment, while families being able to change tasks occasionally as needed as more
perceived being able to change tasks if necessary and challenging than did autistic adults (P = 0.03) and service
behavior difficulties as both being least challenging providers (P = 0.03) in the United States. Service providers
(Table 6). in Sweden found that behavior difficulties were less

10 Black et al./Facilitators and barriers to employment INSAR

Table 6. Ratings for Barriers Associated with Maintaining Employment and Tests of Significance for Responder Group and
Country
Tests of significance

Very Slightly Not challenging

challenging Challenging challenging at all Key stakeholder comparisons Cross-cultural comparisons

Behavior difficulties χ (4) = 31.08 p < 0.01*

2

Autistic individual 30.6% 41.6% 22.9% 4.9% χ2 (2) = 2.17, P = 0.34

Family member 51.3% 34.3% 12.2% 2.2% χ2 (2) = 5.16, P = 0.08
Employer 17.1% 65.7% 17.1% 0.0% χ2 (2) = 0.44 P = 0.80
Service provider 42.1% 41.3% 16.5% 0.0% χ2 (2) = 12.58, P < 0.01*
Researcher 44.0% 46.0% 10.0% 0.0% χ2 (2) = 3.48, P = 0.06
Communication difficulties χ2 (4) = 20.54 P < 0.01*
Autistic individual 51.4% 38.0% 9.8% 0.8% χ2 (2) = 4.62, P = 0.10
Family member 64.3% 30.0% 5.2% 0.4% χ2 (2) = 0.31, P = 0.86
Employer 31.4% 48.6% 20.0% 0.0% χ2 (2) = 0.45, P = 0.80
Service provider 56.6% 40.2% 3.3% 0.0% χ2 (2) = 7.07, P = 0.03*
Researcher 56.0% 42.0% 2.0% 0.0% χ2 (2) = 0.07, P = 0.8
Being able to change tasks
occasionally if needed χ2 (4) = 12.39 P = 0.02*
Autistic individual 30.6% 42.0% 25.3% 2.0% χ2 (2) = 7.20, P = 0.03*
Family member 35.8% 48.0% 15.7% 0.4% χ2 (2) = 4.15, P = 0.13
Employer 20.0% 71.4% 5.7% 2.9% χ2 (2) = 0.67, P = 0.72
Service provider 41.3% 43.8% 14.9% 0.0% χ2 (2) = 7.63, P = 0.02*
Researcher 22.0% 56.0% 22.0% 0.0% χ2 (2) = 0.42, P = 0.52
Understanding of ASD in
the workplace χ2 (4) = 14.03 P = 0.01*
Autistic individual 51.4% 31.4% 15.5% 1.6% χ2 (2) = 1.83, P < 0.40
Family member 53.7% 36.7% 8.7% 0.9% χ2 (2) = 2.52, P = 0.28
Employer 31.4% 51.4% 17.1% 0.0% χ2 (2) = 4.33, P = 0.12
Service provider 33.9% 52.9% 13.2% 0.0% χ2 (2) = 2.60, P = 0.27
Researcher 38.0% 56.0% 6.0% 0.0% χ2 (2) = 0.06, P = 0.81

*Indicates significant at P < 0.05.

challenging than service providers in Australia (P < 0.01) providers, and researchers when considering both
and the United States (P = 0.03), while service providers increased attention to detail on tasks (all: P < 0.01) and
in the United States perceived communication difficulties accuracy in work tasks (service providers: P < 0.01, fami-
to be less challenging than those in Sweden (P = 0.03). lies: P < 0.01 and researchers: P = 0.01). Autistic adults
Families, employers and researchers across countries did also had lower levels of agreement compared to all other
not differ significantly when considering barriers to stakeholders (families: P < 0.01, employers: P = 0.01, ser-
maintaining employment. vice providers: P < 0.01, and researchers: P < 0.01) for
increased attention and high levels of concentration.
Benefits of Autistic Adults in the Workplace Family members had lower levels of agreement than ser-
vice providers for low absenteeism (P < 0.01). While a sig-
Autistic adults and employers had the highest agreement nificant effect was observed for niche skills in specific
ratings for increased attention to detail as a benefit of areas, no significant differences between individual key
autistic adults in the workplace, while families, service stakeholder groups emerged, suggesting that all groups
providers and researchers had the highest agreement rat- had similar agreement levels.
ings for specific skills in niche areas. Families, employers
and, service providers had the highest disagreement rat-
Cross-Cultural Comparisons
ings for low absenteeism, while autistic adults had the
highest disagreement ratings for specific skills in niche Key stakeholders had similar agreement ratings for
areas (Table 7). increased attention to detail, focused attention and high
levels of concentration, and specific skills in niche areas.
Key stakeholder comparisons. Autistic adults had Perceptions of key stakeholders on accuracy in works tasks
lower levels of agreement compared to families, service and low absenteeism however, differed across countries.

INSAR Black et al./Facilitators and barriers to employment 11

Table 7. Agreement Ratings for Autistic Strengths in the Workplace and Tests of Significance for Responder Group and Country
Tests of significance

Strongly agree Agree Disagree Strongly disagree Key stakeholder comparisons Cross-cultural comparisons

Increased attention to detail χ (4) = 31.29 P < 0.01*

2

Autistic individual 76.1% 22.2% 1.6% 0.0% χ2 (2) = 0.36, P = 0.84

Family member 56.6% 38.2% 3.9% 1.3% χ2 (2) = 3.66, P = 0.16
Employer 65.7% 28.6% 5.7% 0.0% χ2 (2) = 0.78, P = 0.68
Service provider 53.3% 41.8% 4.1% 0.8% χ2 (2) = 4.58, P = 0.10
Researcher 50.0% 44.0% 6.0% 0.0% χ2 (2) = 0.07, P = 0.79
Focused attention and high
levels of concentration χ2 (4) = 43.20 P < 0.01*
Autistic individual 67.9% 28.4% 3.3% 0.4% χ2 (2) = 5.28, P = 0.07
Family member 50.2% 36.6% 11.9% 1.3% χ2 (2) = 1.190, P = 0.55
Employer 40.0% 45.7% 11.4% 2.9% χ2 (2) = 1.31, P = 0.52
Service provider 37.7% 50.0% 11.5% 0.8% χ2 (2) = 4.94, P = 0.09
Researcher 36.0% 54.0% 10.0% 0.0% χ2 (2) = 0.31, P = 0.58
Accuracy in work tasks χ2 (4) = 36.96 P < 0.01*
Autistic individual 69.1% 28.4% 2.5% 0.0% χ2 (2) = 6.62, P = 0.04*
Family member 46.1% 43.0% 9.6% 1.3% χ2 (2) = 8.59, P = 0.01*
Employer 45.7% 48.6% 5.7% 0.0% χ2 (2) = 2.45, P = 0.29
Service provider 46.7% 47.5% 4.9% 0.8% χ2 (2) = 6.20, P = 0.05*
Researcher 42.0% 52.0% 6.0% 0.0% χ2 (2) = 0.53 p = 0.47
Low absenteeism χ2 (4) = 17.68 P < 0.01*
Autistic individual 41.6% 35.0% 21.0% 2.5% χ2 (2) = 10.39, P = 0.01*
Family member 50.0% 35.1% 11.8% 3.1% χ2 (2) = 2.63, P = 0.27
Employer 34.3% 37.1% 25.7% 2.9% χ2 (2) = 6.68, P = 0.035*
Service provider 32.8% 33.6% 27.0% 6.6% χ2 (2) = 22.04, P < 0.01*
Researcher 40.0% 44.0% 14.0% 2.0% χ2 (2) = 0.16, P = 0.69
Specific skills in niche areas χ2 (4) = 9.80 P = 0.04*
Autistic individual 75.4% 14.8% 9.8% 0.0% χ2 (2) = 3.99, P = 0.14
Family member 65.8% 23.2% 11.0% 0.0% χ2 (2) = 1.02, P = 0.60
Employer 62.9% 17.1% 20.0% 0.0% χ2 (2) = 5.01, P = 0.08
Service provider 60.8% 30.0% 9.2% 0.0% χ2 (2) = 1.18, P = 0.56
Researcher 57.1% 36.7% 6.1% 0.0% χ2 (2) = 0.02, P = 0.89

*Indicates significant at P < 0.05.

Autistic adults in Sweden had higher agreement ratings for independence.” Autistic individuals and researchers
than those in Australia (P = 0.03) for accuracy in work provided high agreement ratings for “It is OK to choose
tasks, while families in Sweden had higher agreement rat- to be alone during the lunchbreak,” while both family
ings for accuracy in work tasks than families in the members and employers provided high agreement rank-
United States (P = 0.04). While a significant effect for ings for the statement “a good manager assists in resolv-
accuracy in work tasks was also found for service pro- ing conflict between employees to help keep the
viders, no significant differences between counties were workplace fair and equal.” Family members and
found. Autistic adults (P = 0.01) and employers (P = 0.04) researchers had high agreement ratings for the statement
in Sweden had higher agreement ratings for low absen- “on the job training helps with understanding workplace
teeism than those in the United States. Service providers rules”, with families also providing high agreement rat-
in Sweden also had higher agreement ratings for low ings for “It is important that managers are approachable
absenteeism than did service providers both in Australia in the workplace”. Autistic individuals provided high rat-
(P < 0.01) and the United States (P < 0.01). ings for the statement “To be productive at work a thor-
ough understanding of job expectations is essential.”
Statements including “Commitment to work is a valuable
Viewpoints on Factors for Successful Employment
employee attribute” and “Job matching employees to
Table 8 shows the distribution of agreement with view- their specific interests motivates work participation” were
points related to employment for autistic individuals. provided high agreement ratings by employers and ser-
When considering the top-ranked statements which key vices providers, respectively.
stakeholders agreed and disagreed with, it was found that All key stakeholders except for autistic individuals had
all key stakeholder groups except for families had high high disagreement ratings for “Working on a regular basis
agreement ratings for “Being able to work is important decreases life satisfaction,” similarly, all key stakeholders

12 Black et al./Facilitators and barriers to employment INSAR

Table 8. Agreement Ratings for Viewpoints Associated with Employment for Autistic Individuals (Bold Indicates Top Three
Highest Ranking of Agreement or Disagreement for Key Stakeholder Group)
Strongly agree Agree Disagree Strongly disagree

It is important that managers are approachable in the Autistic individual 71.6% 22.2% 6.2% 0.0%
workplace Family member 72.8% 25.0% 1.8% 0.4%
Employer 62.9% 31.4% 5.7% 0.0%
Service provider 48.8% 42.1% 8.3% 0.8%
Researcher 55.3% 44.7% 0.0% 0.0%
Receiving honest feedback on work performance assists with Autistic individual 68.7% 28.8% 2.1% 0.4%
personal and professional development Family member 57.3% 41.4% 0.9% 0.4%
Employer 57.1% 42.9% 0.0% 0.0%
Service provider 57.0% 42.1% 0.8% 0.0%
Researcher 63.8% 36.2% 0.0% 0.0%
Commitment to work is a valuable employee attribute Autistic individual 68.2% 30.2% 1.2% 0.4%
Family member 66.1% 32.6% 0.9% 0.4%
Employer 71.4% 28.6% 0.0% 0.0%
Service provider 57.0% 42.1% 0.8% 0.0%
Researcher 52.1% 47.9% 0.0% 0.0%
A good manager assists in resolving conflict between Autistic individual 69.5% 28.0% 2.1% 0.4%
employees to help keep the workplace fair and equal Family member 68.2% 30.0% 0.5% 1.4%
Employer 74.3% 17.1% 8.6% 0.0%
Service provider 64.1% 35.9% 0.0% 0.0%
Researcher 60.9% 39.1% 0.0% 0.0%
Being direct with colleagues is helpful when asking work Autistic individual 59.7% 34.6% 4.9% 0.8%
related questions Family member 56.8% 41.4% 0.9% 0.9%
Employer 45.7% 54.3% 0.0% 0.0%
Service provider 48.8% 47.1% 4.1% 0.0%
Researcher 27.7% 61.7% 10.6% 0.0%
Regular followup by an employee coordinator during the Autistic individual 15.7% 19.4% 47.9% 16.9%
probation period hinders the work progress Family member 25.1% 21.1% 35.7% 18.1%
Employer 14.3% 14.3% 42.9% 28.6%
Service provider 14.0% 7.4% 38.0% 40.5%
Researcher 13.0% 21.7% 52.2% 13.0%
Working on a regular basis decreases life satisfaction Autistic individual 11.7% 13.0% 39.7% 35.6%
Family member 6.7% 4.0% 44.8% 44.4%
Employer 11.4% 2.9% 37.1% 48.6%
Service provider 5.8% 5.8% 43.3% 45.0%
Researcher 2.1% 4.3% 42.6% 51.1%
Ongoing support from an employment coordinator limits work Autistic individual 8.3% 12.1% 57.5% 22.1%
performance Family member 3.6% 4.0% 51.1% 41.3%
Employer 8.6% 14.3% 45.7% 31.4%
Service provider 5.8% 3.3% 48.3% 42.5%
Researcher 6.4% 0.0% 59.6% 34.0%
Communication skills (e.g., listening when others are talking, Autistic individual 58.9% 36.9% 3.7% 0.4%
responding and interacting to conversations, body language) Family member 44.8% 23.8% 19.3% 12.1%
are important in most workplaces Employer 45.7% 48.6% 5.7% 0.0%
Service provider 60.8% 32.5% 6.7% 0.0%
Researcher 55.3% 44.7% 0.0% 0.0%
A support plan for work should only be agreed upon by the Autistic individual 11.7% 16.3% 29.2% 42.9%
employer, not the employee, employment coordinator or any Family member 27.2% 17.0% 17.9% 37.9%
colleagues or managers involved Employer 5.7% 20.0% 37.1% 37.1%
Service provider 15.0% 20.8% 25.8% 38.3%
Researcher 8.7% 2.2% 26.1% 63.0%
Being able to work is important for independence Autistic individual 75.8% 21.7% 2.1% 0.4%
Family member 63.2% 7.6% 9.9% 19.3%
Employer 82.9% 14.3% 2.9% 0.0%
Service provider 78.3% 21.7% 0.0% 0.0%
Researcher 78.3% 21.7% 0.0% 0.0%
Punctuality is important in the workplace Autistic individual 61.0% 32.4% 5.8% 0.8%
Family member 67.1% 30.7% 1.3% 0.9%
Employer 45.7% 45.7% 8.6% 0.0%
Service provider 49.2% 41.7% 9.2% 0.0%
Researcher 44.7% 53.2% 2.1% 0.0%

(Continues)

INSAR Black et al./Facilitators and barriers to employment 13

Table 8. Continued
Strongly agree Agree Disagree Strongly disagree
A good understanding of the workplace culture is important Autistic individual 57.0% 36.8% 5.8% 0.4%
when beginning a new job. i.e., dress code, social etiquette, Family member 60.0% 37.8% 1.3% 0.9%
workplace values, and attitudes Employer 37.1% 54.3% 8.6% 0.0%
Service provider 56.7% 37.5% 5.8% 0.0%
Researcher 48.9% 51.1% 0.0% 0.0%
It is important to have the right skills and abilities to Autistic individual 56.0% 39.8% 3.7% 0.4%
contribute to the needs and productivity requirements of the Family member 54.0% 43.3% 2.2% 0.4%
workplace Employer 40.0% 51.4% 5.7% 2.9%
Service provider 45.0% 48.3% 5.8% 0.8%
Researcher 41.3% 58.7% 0.0% 0.0%
Job matching employees to their specific interests motivates Autistic individual 69.8% 26.9% 3.3% 0.0%
work participation Family member 61.8% 36.4% 1.3% 0.4%
Employer 55.9% 41.2% 2.9% 0.0%
Service provider 70.0% 28.3% 1.7% 0.0%
Researcher 59.6% 40.4% 0.0% 0.0%
Constant high level support from an employment coordinator is Autistic individual 18.7% 35.3% 32.8% 13.3%
required, even when an employee’s confidence in work skills Family member 36.2% 32.6% 28.1% 3.1%
increases Employer 17.1% 40.0% 34.3% 8.6%
Service provider 24.2% 34.2% 35.8% 5.8%
Researcher 10.6% 27.7% 51.1% 10.6%
Reporting to several different managers, rather than one main Autistic individual 5.4% 7.9% 34.0% 52.7%
manager for work is preferable Family member 5.9% 13.5% 48.6% 32.0%
Employer 0.0% 5.7% 42.9% 51.4%
Service provider 3.4% 7.6% 41.5% 47.5%
Researcher 2.1% 4.3% 63.8% 29.8%
It does not matter that employees are motivated by their work a Autistic individual 2.1% 4.6% 27.0% 66.4%
Family member 1.8% 1.8% 41.0% 55.4%
Employer 0.0% 0.0% 48.6% 51.4%
Service provider 1.7% 1.7% 31.4% 65.3%
Researcher 2.1% 0.0% 53.2% 44.7%
It would be good if an employee could have weekly contact Autistic individual 29.7% 48.5% 18.4% 3.3%
with an employment coordinator to discuss his/her work Family member 28.7% 36.8% 15.7% 18.8%
tasks (e.g., breaking the steps of a big task down into Employer 34.3% 45.7% 14.3% 5.7%
smaller tasks, workplace difficulties) Service provider 44.1% 49.2% 5.9% 0.8%
Researcher 34.0% 57.4% 8.5% 0.0%
The lighting of the room can affect an employee’s ability to Autistic individual 55.0% 37.5% 7.1% 0.4%
work Family member 35.1% 54.5% 8.1% 2.3%
Employer 20.0% 65.7% 14.3% 0.0%
Service provider 53.4% 44.1% 2.5% 0.0%
Researcher 34.0% 59.6% 4.3% 2.1%
It is helpful when the support required from an employment Autistic individual 33.3% 61.6% 3.8% 1.3%
coordinator is reassessed and adjusted after the probation Family member 45.0% 51.8% 1.8% 1.4%
period Employer 28.6% 62.9% 5.7% 2.9%
Service provider 44.1% 54.2% 1.7% 0.0%
Researcher 44.7% 53.2% 2.1% 0.0%
Job trials are helpful to demonstrate specific skills required in a Autistic individual 35.9% 46.8% 13.5% 3.8%
workplace Family member 40.0% 54.5% 4.1% 1.4%
Employer 40.0% 48.6% 8.6% 2.9%
Service provider 47.0% 43.6% 7.7% 1.7%
Researcher 25.5% 70.2% 4.3% 0.0%
To be productive at work a thorough understanding of job Autistic individual 70.5% 28.3% 0.4% 0.8%
expectations is essential Family member 49.1% 47.7% 2.3% 0.9%
Employer 54.3% 45.7% 0.0% 0.0%
Service provider 59.8% 38.5% 1.7% 0.0%
Researcher 57.4% 38.3% 4.3% 0.0%
If required, workplace mentors can give advice on appropriate Autistic individual 38.0% 56.5% 5.1% 0.4%
social behavior Family member 46.6% 49.8% 2.7% 0.9%
Employer 42.9% 57.1% 0.0% 0.0%
Service provider 53.0% 42.7% 3.4% 0.9%
Researcher 48.9% 51.1% 0.0% 0.0%

(Continues)

14 Black et al./Facilitators and barriers to employment INSAR

Table 8. Continued
Strongly agree Agree Disagree Strongly disagree
Short, regular breaks during the day interrupt concentration Autistic individual 16.0% 21.9% 39.7% 22.4%
Family member 15.5% 18.6% 43.2% 22.7%
Employer 2.9% 14.3% 57.1% 25.7%
Service provider 4.3% 19.7% 51.3% 24.8%
Researcher 4.3% 4.3% 38.3% 53.2%
Education training on autism spectrum disorders for all Autistic individual 6.3% 25.2% 30.3% 38.2%
employed staff is unnecessary in the work environmenta Family member 5.5% 12.7% 45.9% 35.9%
Employer 8.6% 17.1% 48.6% 25.7%
Service provider 7.7% 34.2% 34.2% 23.9%
Researcher 2.2% 4.3% 52.2% 41.3%
The process of finding a job is difficult Autistic individual 69.9% 20.3% 8.9% 0.8%
Family member 53.4% 22.2% 11.8% 12.7%
Employer 65.7% 34.3% 0.0% 0.0%
Service provider 70.1% 29.1% 0.9% 0.0%
Researcher 55.6% 42.2% 2.2% 0.0%
Increased support is required for employers and employees Autistic individual 36.1% 54.4% 8.9% 0.6%
when significant changes occur in the workplace (e.g., Family member 58.6% 37.4% 3.5% 0.5%
change in job task, adjustment in work hours, manager is on Employer 47.6% 42.9% 9.5% 0.0%
leave or has resigned) Service provider 48.1% 44.4% 7.4% 0.0%
Researcher 41.3% 54.3% 4.3% 0.0%
The development of an individual support plan (i.e., provides Autistic individual 37.3% 55.0% 7.1% 0.6%
clarity on the type, frequency, and duration of support Family member 51.0% 47.5% 1.0% 0.5%
required) assists in achieving successful work outcomes Employer 47.6% 38.1% 9.5% 4.8%
Service provider 59.3% 38.9% 1.9% 0.0%
Researcher 54.3% 45.7% 0.0% 0.0%
A readily available support from an employment coordinator is Autistic individual 36.1% 43.8% 17.2% 3.0%
essential to help with difficult work situations Family member 52.3% 42.6% 4.6% 0.5%
Employer 52.4% 33.3% 9.5% 4.8%
Service provider 51.9% 40.7% 7.4% 0.0%
Researcher 45.7% 47.8% 6.5% 0.0%
On the job training helps with understanding the workplace Autistic individual 53.4% 39.2% 6.0% 1.3%
rules (e.g., start times, finish times, break times, sick leave, Family member 71.7% 26.9% 0.9% 0.5%
holiday leave, and emergencies evacuation procedures) Employer 57.1% 37.1% 2.9% 2.9%
Service provider 58.1% 34.2% 6.0% 1.7%
Researcher 65.9% 34.1% 0.0% 0.0%
Financial assistance from an Employment Assistance Fund is Autistic individual 38.8% 47.0% 11.6% 2.6%
helpful in allowing workplaces to make workplace Family member 38.7% 53.5% 7.4% 0.5%
adjustments for employees Employer 37.1% 42.9% 14.3% 5.7%
Service provider 42.2% 44.0% 12.1% 1.7%
Researcher 36.6% 61.0% 2.4% 0.0%
Assistance from an employment coordinator is necessary when Autistic individual 23.0% 52.7% 21.8% 2.4%
applying for funding for workplace adjustments Family member 27.6% 57.8% 14.1% 0.5%
Employer 10.0% 55.0% 25.0% 10.0%
Service provider 38.5% 48.1% 13.5% 0.0%
Researcher 17.5% 67.5% 15.0% 0.0%
Businesses value a broad range of skills in their employees Autistic individual 48.5% 36.1% 10.3% 5.2%
(e.g., communication, problem solving, learning, Family member 42.0% 47.5% 8.2% 2.3%
technology) Employer 28.6% 62.9% 5.7% 2.9%
Service provider 31.6% 52.1% 14.5% 1.7%
Researcher 40.9% 52.3% 6.8% 0.0%
Workplace mentors can assist with daily work issues Autistic individual 41.6% 50.2% 7.4% 0.9%
Family member 47.5% 51.6% 0.5% 0.5%
Employer 40.0% 57.1% 2.9% 0.0%
Service provider 59.8% 39.3% 0.9% 0.0%
Researcher 43.2% 56.8% 0.0% 0.0%
It is OK to choose to be alone during the lunchbreak Autistic individual 76.2% 19.1% 3.4% 1.3%
Family member 55.5% 39.5% 4.5% 0.5%
Employer 45.7% 54.3% 0.0% 0.0%
Service provider 60.7% 32.5% 6.8% 0.0%
Researcher 73.3% 24.4% 2.2% 0.0%

a
Indicates statements where reverse scoring for Swedish participants was used.

INSAR Black et al./Facilitators and barriers to employment 15

except researchers had high disagreement ratings for “It facilitating the identification and communication of
does not matter that employees are motivated by their individual needs in the workplace may contribute to a
work.” Autistic individuals, employers and service pro- greater understanding of an individual’s strengths and
viders had high disagreement ratings for “Reporting to difficulties, contributing to improved employment out-
several different managers, rather than one main man- comes [Scott et al., 2015].
ager for work is preferable.” Families had high disagree- Ensuring appropriate accommodations for autistic indi-
ment ratings for “Ongoing support from an employment viduals are made, however, requires employer knowledge
coordinator limits work performance.” Autistic individ- of the ASD [Santuzzi, Waltz, Finkelstein, & Rupp,
uals and researchers had high disagreement ratings for “A 2014]. It was found that while employers perceived this
support plan for work should only be agreed upon by the to be important for ensuring employment success, the
employer, not the employee, employment coordinator or same perception was not held by autistic individuals.
any colleagues or managers involved.” Researchers also Stigma and a lack of understanding of ASD in the work-
had high disagreement ratings for “Short, regular breaks place may contribute to autistic individuals being hesi-
during the day interrupt concentration.” tant to disclose a diagnosis [Santuzzi et al., 2014]. In fact,
autistic adults identified stigma as the most challenging
issue facing autistic individuals in gaining employment.
Discussion Stigma or misunderstanding related to ASD and other dis-
abilities is commonly identified in the employment liter-
This study presents the largest and most comprehensive ature as having a significant influence on an individual’s
international survey involving multi-informant groups of success in employment [Johnson & Joshi, 2016; Nesbitt,
the facilitators and barriers influencing employment out- 2000; Richards, 2012; Vornholt, Uitdewilligen, & Nijhuis,
comes for autistic individuals to date. Significant dispar- 2013]. Taken together, findings emphasize the need to
ity between key stakeholder groups internationally was address environmental factors, such as attitudes sur-
observed, highlighting the necessity of capturing multi- rounding ASD. In regard to employment, improving
ple viewpoints from a variety of perspectives. Findings understanding and acceptance of ASD and reducing
present significant implications for supporting autistic stigma in the workplace will facilitate open and honest
individuals in the workplace. communication, and approaches that support autistic
Discrepancies between key stakeholders regarding the individuals should they choose to disclose [Johnson &
perception of facilitators and barriers to employment Joshi, 2014].
were evident across all employment stages, possibly aris- It is perhaps interesting to note that key stakeholders
ing from divergent lived experiences, and understanding rated providing training to employers about ASD, and
of ASD. This disparity between key stakeholder percep- making the workplace more accessible as less important
tions of the facilitators and barriers to employment may in facilitating employment success. These findings may
compound the difficulties faced by autistic individuals appear at odds with previous research that identified the
in the workplace. For example, communication difficul- provision of employer training and implementing envi-
ties were perceived to be the most challenging barrier to ronmental supports as important to facilitating success
maintaining employment for all key stakeholders except [Scott, Falkmer, Falkmer, & Girdler, 2018]. However, it is
employers, with employers, in fact, reporting communi- possible that these factors remain important but were
cation to be the least challenging factor. It is possible perhaps not prioritized as strongly as other items, and in
that these differences may reflect a lack of recognition or fact, a majority of key stakeholders still rated these factors
knowledge of the communication difficulties autistic as important for success. Another potential interpretation
individuals’ face in the workplace, potentially contribut- is that respondents may have interpreted “training
ing to their needs not being adequately met. Impor- employers about ASD” as something generic and not tai-
tantly, the apparent disparity between key stakeholder lored to individual functioning. How ASD manifests can
groups, particularly between autistic adults and other be extremely diverse, therefore an individualized
key stakeholders, highlights the critical need to take into approach is important to consider when employing autis-
account the voices and experiences of autistic individ- tic individuals [Black et al., 2019]. While to date, some
uals themselves when developing priorities, strategies research has focused on the autistic individual, and the
and interventions. Though other key stakeholder groups employer, future interventions seeking to improve
were not examined, differences between the perceptions employment outcomes for autistic individuals may bene-
of autistic adults and employers on the factors influenc- fit from taking a more holistic approach to employment
ing successful employment have been identified previ- for autistic individuals [Scott, Milbourn, et al., 2018].
ously [Scott et al., 2015]. In agreement with this One such holistic framework is the ICF [World Health
previous research, providing avenues to increase com- Organization, 2002]. The ICF may provide a standardized
munication between all key stakeholders, and means to assist in the identification and communication

16 Black et al./Facilitators and barriers to employment INSAR

of an individual’s unique strengths and difficulties pro- While drawing conclusions based on this cross-cultural
file, enabling the development of a shared understanding exploration is limited by the significant variability across
between key stakeholders. Core-sets developed to samples, the analysis suggests that key stakeholder per-
improve the usability of the ICF to assess functioning in spectives vary significantly based on the cultural and
specific conditions have been developed for ASD [Bölte political environment. It is likely that these differences
et al., 2019]. The ICF ASD Core-sets captures a high per- may result from the different social and work policies and
centage of ICF categories related to activities and partici- structures employed in the countries examined. While
pation (54%) and environmental factors (28%), the United States Department of Labor, Office of Disabil-
highlighting the significant role that contextual factors ity Employment Policy, a nonregulatory federal agency
have on functioning for autistic individuals. Importantly, seeks to influence policy and support those with disabil-
using this framework, disability is considered the result of ities, such as autistic individuals in employment [U.S
the interaction between an individual and their environ- Department of Labor, 2018], the United States largely
ment [Bölte et al., 2019; World Health Organization, operates in the private sector. In comparison, Sweden is
2002]. Based on this conceptualization, occupational dis- more centralized, providing a number of government-run
ability cannot be fully attributed to an individual’s initiatives to support employment [Swedish Public
impairments, but is also result of the absence of environ- Employment Service [Arbetsförmedlingen], 2012], with
mental supports, emphasizing the responsibility of the Australia providing a combination of privatized and cen-
environment in ensuring that all individuals have equal tralized services. Key stakeholders in Sweden tended to
access to employment [Black et al., 2019]. For these rea- rate both facilitators and barriers as more important or
sons, the ICF ASD Core-sets may provide a useful frame- challenging than those in Australia and the United States.
work in developing a standardized measure to assess the While speculative, it is possible that these differences in
functioning of autistic individuals in employment and ratings may have arisen from a greater understanding of
facilitate communication between key stakeholders [Bölte the strengths and difficulties faced by autistic individuals
et al., 2019]. in regard to employment, and may be reflective of the
Despite several areas of discrepancy across key stake- social structures and policies in place to support autistic
holder groups, areas of consensus emerged. All key stake- individuals. Perhaps of particular interest is that autistic
holders endorsed matching skills, abilities, and interests individuals in the United States were significantly less
to the job criteria and focusing on strengths in the work- likely to perceive disclosure of diagnosis to employers as
place as key in facilitating success when preparing for important when compared to autistic adults in Sweden
and maintaining long term employment. These findings and Australia, perhaps resultant of the different structures
concur with previous findings supporting the need for in place to support autistic individuals across countries.
strengths-based approaches in ASD [Jones et al., These findings demonstrate the significant influence gov-
2018]. Similar to previous research [de Schipper et al., ernment policy may have on the employment outcomes
2016; Kirchner et al., 2016; Scott, Milbourn, et al., 2018] for autistic individuals, and on those with other disabil-
all key stakeholders generally had similar levels of agree- ities. In line with the original mandate of this study, find-
ment regarding ASD-related strengths. However, autistic ings may have significant implications for the
individuals tended to report significantly lower agree- development of future policies to promote inclusion of
ment compared to other key stakeholder groups. Autistic autistic individuals in employment.
individuals may have difficulty recognizing their Collectively, results highlight that employment for
strengths in the workplace and may require support in autistic individuals is a complex concept, with perspec-
identifying and communicating their strengths to others. tives varying across both key stakeholder groups and
Work experience and learning the skills required for countries. Given these varying perspectives, future
work were identified as key to ensuring employment suc- research seeking to improve employment outcomes for
cess for autistic individuals and were generally rated as autistic individuals should consider differing key stake-
important by stakeholders. Providing work experience holder perspectives on the facilitators and barriers to
may enable autistic individuals to prepare for the work- employment for autistic individuals and should seek to
place and to better identify their strengths and needs in capture these multiple perspectives. Interventions devel-
employment [Lee, Black, Tan, Falkmer, & Girdler, oping skills in autistic job seekers, their employers and
2019]. Engaging in early work experience opportunities employment support organizations, and simultaneously
has been shown to significantly improve employment addressing environmental issues across all stages of
outcomes for autistic youth [Siperstein, Heyman, & employment, combined with a holistic framework, such
Stokes, 2014; Wehman et al., 2014], thus providing addi- as the ICF [World Health Organization, 2002], to identify
tional opportunities for autistic youth to engage with individual strengths and limitations, may be beneficial.
early work experience may support employment out- Findings of this study must be interpreted with the fol-
comes in adulthood. lowing limitations in mind. Firstly, as no valid and

INSAR Black et al./Facilitators and barriers to employment 17

reliable survey for this topic exists, the surveys employed International Society for Autism Research for supporting
in the current study was developed by the research team. this research.
Limitations therefore exist in regard to the psychometric
properties of the surveys. The surveys were, however,
developed in collaboration with various ASD associations Conflict of Interest
and experts, and were informed by the two preceding
studies in this series. The results underpinned by this sur- All authors declare no conflict of interest. Sven Bölte
vey must be interpreted with caution and cannot be gen- declares no direct conflict of interest related to this arti-
eralized to the viewpoints and experiences of all autistic cle. Bölte discloses that he has in the last 5 years acted as
individuals and key stakeholders. Secondly, there was sig- an author, consultant, or lecturer for Shire, Medice,
nificant variability in sample composition across coun- Roche, Eli Lilly, Prima Psychiatry, GLGroup, System Ana-
tries, and it is generally difficult to reach a balanced lytic, Kompetento, Expo Medica, and Prophase. He
sample across different respondent groups. It is likely that receives royalties for text books and diagnostic tools from
some key stakeholders sought may not have had con- Huber/Hogrefe, Kohlhammer, and UTB.
firmed knowledge of the diagnosis of their employees or
clients. Not all individuals disclose their diagnosis to their
colleagues or employers. Service providers, particularly in References
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