Background
Autism spectrum disorders (ASD) are associated with qualitative impairment in using and contextualizing communication for social purposes and the capacity to process socially relevant information, and with restrictive repetitive behaviour patterns [
1,
2]. Given that the capacity to process socially relevant information and to interact in a socially suitable manner are essential requirements in occupational environments, everyday work processes can pose major challenges for adults with ASD [
3], as most workplaces require adherence to social norms and decorum. With respect to social and sensory issues interfering with their job performance [
4] as well as potential problems regarding their ability to manage social and interactional aspects of work [
5,
6], earlier studies revealed challenges in obtaining, securing and maintaining employment in adults with ASD [
7‐
9]. Furthermore, successful participation in the labour market can be hindered by differences with employers, for example regarding the understanding of productivity requirements or required support in work [
10], and by possible ASD-related problems, for example prioritization and self-organization of work-tasks.
Even in adults with ASD and no co-occuring intellectual disability, studies show high rates of unemployment up to 60% [
4,
5,
8,
9,
11‐
14]. In this context, it is important to recognize that adults with ASD are often high educational achievers in terms of school and university qualifications [
12,
13] and therefore apparently have good prerequisites for adequate participation in the labour market. However, a recent Australian study by Baldwin et al. [
15] showed that 46.2% of employed adults with ASD were inadequately employed or overeducated, meaning that their highest level of formal education and training exceeded the occupational skill level needed for their current occupation. These findings indicate that even though individuals with ASD often possess high levels of formal education and training [
12,
15] and desire to work [
16], adults with ASD often struggle to participate in the labour market or to achieve and maintain appropriate professional positions.
Apart from studies reporting rates of 60% not-working (employable age, but no occupation due to i.e. being retired for health reasons, being homemaker or being unemployed) [
12] or of 36.0% being unemployed [
4] knowledge on the participation of adults with ASD in the German labour market in terms of adequate employment is scarce. Therefore, the aim of our study was to examine, by means of a cross-sectional-survey, the integration of a sample of clinically mostly late-diagnosed and most likely not intellectually disabled adults with ASD in the German labour market in terms of employment status, type of occupation and, in particular, regarding adequate or inadequate employment in terms of over- or undereducation.
Results
The response rate was 43.2% (
N = 185 of
N = 428 potential participants). Participants’ sociodemographic and clinical characteristics are summarized in Table
3.
Table 3
Sociodemographic and clinical characteristics
Sociodemographic Characteristics |
Gender (N = 185) | | Family status (N = 183)d | |
malea | 61.6 | unmarrieda | 71.0 |
Age (N = 185) | | marrieda | 22.4 |
mean (SD)b | 39.5 (11.3) | divorceda | 6.6 |
minimumc | 21 | Relationship status (N = 183)d | |
maximumc | 64 | long-term relationship > 6 monthsa | 36.6 |
Clinical Characteristics |
Primary Diagnosis (N = 185) | | Comorbiditiesa,e,f (N = 184) | 70.1 |
aspergera | 78.9 | Depressiona | 48.9 |
atypicala | 9.7 | orthopedic diseasesa | 19.0 |
infantilea | 4.3 | OCDa | 13.0 |
not specified / unknowna | 7.1 | respiratory diseasesa | 11.4 |
Age when diagnosed I (N = 184)e | | Age when diagnosed II (N = 184)e,g | |
mean (SD)b | 34.7 (12.5) | ≥ 18 years of agea | 94.6 |
minimumc | 3 | ≤ 18 years of agea | 5.4 |
maximumc | 60 | | |
The majority of the participants is male (61.6%) and the mean age of the sample was 39.5 (SD 11.3) years (c.f. Table
3). 36.6% were in a long-term relationship. The most frequent self-reported ASD diagnosis was asperger’s syndrome (78.9%), while the mean age at first-time diagnosis of any ASD was 34.7 (SD 12.5) years. 94.6% were 18 years of age or older at first-time diagnosis of any ASD and hereby can be classified as clinically late-diagnosed. The most frequent self-reported comorbidity was depression, at 48.9% (c.f. Table
3).
Regarding the general education level, 11.9% of the participants held a certificate of basic secondary education (German: Hauptschulabschluss; 9 years school attendance; lower secondary level), 28.6% had a general certificate of secondary education (German: Realschulabschluss; 10 years school attendance; lower secondary level), 56.8% had a general university entrance-level qualification (German: Hochschulreife; 12 or 13 years school attendance; upper secondary level), and 2.7% had no school-leaving certificate or had a qualification that was not further specified (missing data N = 0).
With regard to the level of formal education and training according to the KldB, 13.3% of the participants were assigned to skill level 1 (10.5% no vocational qualification; 2.8% other vocational qualification), 43.1% to skill level 2 (43.1% apprenticeship I), 12.7% to skill level 3 (8.8% apprenticeship II; 3.9% Bachelor’s degree), 24.9% to skill level 4 (8.8% Master’s or diploma degree from university of applied sciences; 16.0% Master’s or diploma degree from university), and 6.1% were still in vocational education and training, meaning that their skill level was not specified within the KldB classification (missing data N = 4).
Employment status
Regarding the employment status, 94.1% (N = 174) of the participants reported having ever been employed (missing data N = 0). Of these, 68.4% (N = 119) reported being employed at present, with an average number of 33.3 h worked per week (SD 12.1; missing data N = 6) and 8.0% reported working in a sheltered workshop (missing data N = 6). Regarding the current employment situation of participants who had ever been employed, 17.0% were in early retirement for health reasons (missing data N = 3) and 13.5% stated that they were unemployed (missing data N = 3). Of those who had ever been employed, 49.0% reported no periods of unemployment in the five years prior to this survey (missing data N = 17). Participants with periods of unemployment within this time frame (N = 80) reported an average of 24.4 (SD 20.0; Range 0.50 to 60.00) months of unemployment in the last five years (missing data N = 0).
Type of occupation
Apart from the occupational area “armed forces”, all KldB occupational areas were represented in the study sample (c.f. Table
4).
Table 4
Occupational area by KldB
Agricultural, forestry and horticulture sectora | 1.2 | 1.0 | 1.5 |
Commodity extraction, production and manufacturinga | 16.1 | 12.6 | 22.5 |
Construction, architecture, surveyinga | 2.5 | 3.9 | 5.8 |
Natural sciences, geography and informaticsa | 13.7 | 15.5 | 3.6 |
Traffic, logistics, protection and securitya | 9.3 | 9.7 | 13.2 |
Commercial services, commodity trading, sale, tourisma | 9.3 | 8.7 | 12.1 |
Corporate organization, accounting, legal and administrative sectorsa | 19.3 | 19.4 | 20.6 |
Health and social sector, teaching and educationa | 22.4 | 23.3 | 17.7 |
Linguistics, literature, humanities, social and economic sciences, media, art, culture and designa | 6.2 | 5.8 | 2.7 |
Regarding the longest-practised and the current occupation, the highest proportion of participants was found in the occupational area “health and social sector, teaching and education” (22.4% and 23.3%, respectively) followed by “corporate organization, accounting, legal and administrative sectors” (19.3% and 19.4%, respectively). A comparison of participants’ distribution across the various occupational areas (regarding their current occupation) with data from the German Federal Employment Agency [
23] revealed a significant difference between the study sample and the general population (Chi
2 = 54.0; df 8;
p < .001). In particular, the proportion of participants working in the field of “natural sciences, geography and computer science” was higher than in the general population (c.f. Table
4).
Occupational skill level, inadequate employment and overeducation
To assess inadequate employment in terms of over- or undereducation in participants who had ever been employed (N = 174) not including education and training (N = 9), a vocational orientation phase (N = 1), or a so-called one-euro-job (N = 1; one-euro jobs are public services jobs that pay at least one euro per hour and do not affect unemployment benefits in individuals who are registered as unemployed), the KldB skill levels with respect to the longest-practised occupation were compared with participants’ highest level of formal education and training according to the KldB skill levels (missing data N = 9). Likewise, for participants who were employed at the time of the survey (N = 119), not including education and training (N = 8), retraining (N = 1) or an internship (N = 1), the KldB skill levels with respect to the current occupation were also compared with participants’ highest level of formal education and training according to the KldB skill levels (missing data N = 10).
In Table
5, the column “all” shows the distribution of participants across KldB skill levels regarding their longest-practised and their current occupation. For both, the majority of participants were situated in skill level 2 (50.6% and 41.4%, respectively). The following columns in Table
5 sort participants into three categories relating to the match or mismatch between the skill level of their longest-practised respectively current occupation and their level of formal education and training according to the KldB. In total, 62.3% were found to be at parity regarding the skill requirements of their longest-practised occupation, 15.6% were undereducated, meaning that their skill levels of formal qualification were below the occupational skill requirements, and 22.1% were classified as overeducated (c.f. Table
5). With respect to the current occupation 54.5% were found to be in parity, 14.1% were undereducated and 31.3% were classified as overeducated, meaning that their formal qualifications exceeded the skill requirements needed for the current occupation (c.f. Table
5).
Table 5
Occupational skill level, overeducation and undereducation
skill level longest-practiced joba | all | parity | undereducated | overeducated |
1 | n | 16 | 4 | – | 12 |
% | 10.4 | 25.0 | – | 75.0 |
2 | n | 78 | 56 | 7 | 15 |
% | 50.6 | 71.8 | 9.0 | 19.2 |
3 | n | 21 | 6 | 8 | 7 |
% | 13.6 | 28.6 | 38.1 | 33.3 |
4 | n | 39 | 30 | 9 | – |
% | 25.3 | 76.9 | 23.1 | – |
column total | n | 154 | 96 | 24 | 34 |
% | 100 | 62.3 | 15.6 | 22.1 |
skill level current jobb | all | parity | undereducated | overeducated |
1 | n | 17 | 3 | – | 14 |
% | 17.2 | 17.6 | – | 82.4 |
2 | n | 41 | 26 | 2 | 13 |
% | 41.4 | 63.4 | 4.9 | 31.7 |
3 | n | 11 | 1 | 6 | 4 |
% | 11.1 | 9.1 | 54.5 | 36.4 |
4 | n | 30 | 24 | 6 | – |
% | 30.3 | 80.0 | 20.0 | – |
column total | n | 99 | 54 | 14 | 31 |
% | 100 | 54.5 | 14.1 | 31.3 |
According to data from the employment statistics of the German Federal Employment Agency, 63.0% of the general population in Germany are at parity, 22.0% are undereducated and 15.0% are overeducated in their employment [
25]. In this regard, there is a significant difference between the general population and the study sample with respect to under- and overeducation regarding the current occupation (Chi
2 = 21.0; df 2;
p < .001).
Discussion
This study aimed to examine the participation of clinically mostly late-diagnosed and most likely not intellectually disabled adults with ASD in the German labour market by means of a postal cross-sectional survey in former patients of the “specialised outpatient assessment clinic for ASD in adulthood” of the Medical Center – University of Freiburg.
A sufficient response rate of 43.2% was achieved. However, as not all potential participants replied, the critical issue is the representativeness of this sample. It remains unclear whether individuals with, for instance, higher psychosocial functioning or better opportunities and achievements in the labour market were more likely to participate in this survey, which might have biased the results. It is most probable that the employment rate and appropriate occupational positions were overestimated, as it is well known in research that individuals are more likely to report positive aspects than negative aspects [
29].
Although the majority of our sample was male, the proportion of women was higher than in the typical male-to-female ratio in ASD [
30]. However, this ratio is in accordance with comparable studies, which showed higher proportions of women among late-diagnosed adults with ASD [
12,
13,
31]. This might be explained by gender specific compensation strategies [
32], for example imitation learning, which lead for example to a better social adjustment and therefore a later identification of ASD. Thus, the late first-time diagnosis in 94.6% of the participants in this sample can be deemed as a specificity of this study. Our sample probably represents a subsample of adults with ASD comprising more able individuals with comparatively good adaptive and compensatory social skills. This is also reflected in the specificity of our study design and sample, addressing adults with clinically mostly late-diagnosed ASD and most likely no co-occuring intellectual disability. As a consequence, this might also explain the high proportion of participants who were married or in a long-term relationship compared to other studies on psychosocial outcomes in adults with ASD [
13,
33,
34]. However, high rates of self-reported comorbidities were found, comparable to those reported in other studies [
13,
33], which might also influence participants’ employment situation. All participants were at an employable age, with an age range of 21 to 64 years, and therefore represent the relevant target group of this survey.
Regarding the general level of education, the sample considerably exceeds the educational attainment of the general population, with 56.8% of participants possessing university entrance-level qualifications, compared to 29.5% within the general population in Germany in 2015 [
35]. In Germany the university graduate ratio was 32.0% in 2014 [
36], and 14.8% of the general population possessed a Masters’ or diploma degree as their highest vocational qualification in 2015 [
35] and would therefore be assigned to skill level 4 of the KldB in terms of the level of formal education and training. This falls well below the percentage of study participants in our sample assigned to skill level 4 (24.9%). As the proportion of participants with no qualifications (10.5%) or a not further specified qualification (2.8%) who can therefore be assigned to KldB skill level 1, is also below that of individuals with no vocational qualifications in the general population in Germany (16.8%) in 2015 [
35], our sample shows a comparatively high level of formal education and training in adults with late-diagnosed ASD, which potentially leads to promising chances in the labour market. In this respect – at first glance – participants’ participation in the labour market seems satisfactory, as only 5.9% had never been employed. However, only 68.4% of those who had ever been employed were currently employed at the time of the survey. Moreover, a self-reported unemployment rate of 13.5% was found, which considerably exceeds the current unemployment rate in Germany, which lay at 6.4% in 2015 [
37]. It appears that – despite partly high formal qualifications and a share of 49.0% of participants having never experienced times of unemployment – adults with ASD often experience problems in maintaining stable employment relationships. In this regard, international studies suggest, that challenges in maintaining employment in adults with ASD can be explained by social and sensory issues interfering with their job performance as well as their ability to manage interactional aspects of work [
4‐
6]. In view of the fact that 17.0% of those participants who had ever been employed later retired early for health reasons, and taking into account the reported high prevalence of comorbidities, it would appear that employment support is necessary that takes into account the specific characteristics of ASD regarding social and sensory issues, as well as further health-related aspects regarding the ability to work.
Although we found a strong trend towards occupations within the area “natural sciences, geography and computer sciences” compared to the general population [
23], adults with ASD cover a broad range of occupational areas. In particular, the occupational area “health and social sector, teaching and education” was represented by a high proportion of our sample. This result does not tie in with the stereotype that adults with ASD are only found in more technically orientated, and not socially orientated, professions. These findings are in line with a study by Baldwin et al. [
15] who also found that adults with ASD are employed in a wide variety of different occupational environments.
Even though the proportion of participants who were inadequately employed and overeducated was lower than that found in similar studies [
12,
15], a significant difference emerged compared to the general population regarding the current occupation, with 31.3% of participants being inadequately employed in terms of overeducation. Moreover, the proportion of participants who were overeducated in their current profession was higher than the proportion of participants who were overeducated in their longest practised profession (22.1%). Thus, it appears that adults with ASD are partly unable to maintain professional positions in accordance with their level of formal qualification. This finding can be linked to studies, showing that differences with employers, i.e. regarding the understanding of productivity requirements and self-organization of work tasks, or possible ASD-related issues, i.e. impaired ability to handle social aspects, can hinder successful participation in the labour market [
5‐
10].
According to our findings, while adults with ASD as seen in our specialised outpatient clinic have above-average levels of formal education and training, at least in part, they experience problems and challenges to establish themselves in the German labour market and/or to sustain professional positions that are appropriate to their level of formal education and training. This is alarming and in need of explanation. It can be assumed that the constraints associated with ASD are better compensated in educational contexts, as potentially impaired executive and soft-skills meet with higher tolerance, and individuals with ASD experience more assistance than is provided in working environments. Furthermore, greater flexibility and autonomy for individuals to utilize their own style of learning and working, with reduced impact of social difficulties, may also be a factor in the higher attainment of individuals with ASD in educational context compared with their employment status. This underlines the need for a better integration and improved support of adults with ASD in occupational settings, and demonstrates that potential strengths associated with ASD, such as honesty, efficiency or precision [
38], should be identified and reinforced. This is of particular relevance since support programs for adults with ASD, addressing, e.g., work preparation and communication with employers, proved to be effective in increasing employment rates [
39,
40]. A promising approach to meet the support requirements of adults with ASD could be “training-on-the-job” measures, as the most important issue does not seem to lie in obtaining professional positions, but rather in maintaining them. For the development and implementation of such measures, further research on the experience of employment situations in adults with ASD is needed, i.e. expectations regarding workplace design, challenges in professional transitions or experiences with ASD related sensory and interactional difficulties in occupational environments as well as support needs concerning these matters.