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research-article2021
AUT0010.1177/1362361321990325AutismEditorial
Editorial
“We believe in good jobs, fair jobs,
dignifying jobs that give you a good sense
of identity”1: Career and job guidance
counseling in autism
Work and employment are fundamental to societies and peo-
ple, enabling adults to reach economic independence with
dignity. Optimally, jobs allow individuals to pursue interests
and talents to reach their full potential. Unfortunately, unem-
ployment rates are still high among autistic individuals, and
autistic adults and their parents have identified work and jobs
as a priority area for research (Pellicano et al., 2014).
Together with colleagues from the Center for Occupational
and Environmental Medicine at Region Stockholm, Sweden,
I am working on a project called “Jobba Frisk NPF” (engl.:
“Work Healthy Neurodevelopmental Conditions”). Its objec-
tive is to generate evidence-based recommendations on how
to identify and support career paths for autistic people and
those with other neurodevelopmental conditions that lead to
safe, long-term employment, and well-being on the job. The
project is part of a more comprehensive effort by Region
Stockholm, the responsible authority for health care in
Stockholm County, seeking to ensure health and well-being
at work for individuals with these conditions. While the pro-
ject is run and financed by the Region, it is meant to be a
national resource for all who are interested in the issue. The
Region’s effort initially focused on individuals with physical
conditions (e.g. allergy; www.jobbafrisk.se), but many career
and job guidance counselors and people from the community
requested information for neurodevelopmental conditions.
Jobba Frisk NPF was subsequently initiated. I am excited to
be part of the project and hope the platform will make a dif-
ference for many autistic people in Sweden.
It is encouraging that the Region prioritizes autism and
other neurodevelopmental conditions, but when I started
working on the project I asked myself why a project like
this is driven by health care authorities when the responsi-
bility to ensure high quality career guidance in Sweden lies
with the municipalities (schools and social services) and
state (universities and job agencies). While there is at the
moment a governmental proposal in Sweden aiming to
improve career guidance in school in order to promote
equality of career opportunity for students with disabili-
ties, the initiative is still in the administrative pipeline, not
explicit about neurodevelopmental conditions, and more
strategic than hands-on.2 I am afraid that the reason is that
many policy and decision-makers outside of health care do
not realize that the lives of autistic people and those with
Autism
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DOI: 10.1177/1362361321990325
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other neurodevelopmental conditions are as much their
responsibility as they are the healthcare system’s responsi-
bility. We have discussed this bad state of affairs in prior
editorials, for example, regarding inclusive education
(Pellicano et al., 2018). Even health care has, for a long
time, neglected neurodevelopmental conditions and is
only slowly starting to recognize the importance of
addressing the increase in diagnoses, high comorbidity,
and premature mortality rates (Hirvikoski et al., 2016; Pan
& Bölte, 2020; Zablotsky et al., 2019).
I also wondered about current career and job guidance in
Sweden with regards to autism and neurodevelopmental
conditions. The Jobba Frisk NPF project is going to map
current practice in detail. But briefly, the two most promi-
nent sources of career and job support are counselors in
schools and social services and job guides at the national
health employment agency.3 Three universities (Stockholm,
Lund, and Umeå) offer studies and degrees in career and
job guidance. The secondary school years in Sweden also
include two mandatory job practice experiences (“Prao,”
praktisk arbetslivsorientering), but they are not profession-
ally guided. High-school choice is decisive for career paths
in Sweden as there are 18 regular national programs of
3 years to choose from, six of which are preparatory for
higher education, such as university, and twelve of which
are vocational. Here, career guidance is offered by schools,
but individual support is limited. There also are more scat-
tered public services and an increasing number of private
companies trying to facilitate work opportunities. Typically,
these options lack continuity and coordination, they are not
standardized across the country, they have rarely been eval-
uated properly, and there are no guidelines supporting
appropriate career and job guidance counseling in autism
and other neurodevelopmental conditions.
I could not spontaneously name colleagues conducting
research in autism and career guidance counseling or name
any prominent articles or reviews on the topic. This, despite
the fact that I have worked in closely connected fields and
helped generate the International Society of Autism Research
(INSAR) policy brief,4 which is based on a systematic
review, and a qualitative and quantitative study (Black et al.,
2019, 2020; Scott et al., 2019), as well as other neighboring
issues such as mentoring programs at universities and the
858 Autism 25(4)
significance of environmental adaptation to autistic students’
needs (Leifler et al., 2020; Thompson et al., 2019, 2020).
After conducting a systematic literature search on the
topic with the objective to prepare for a scoping review of
career and job guidance counseling in neurodevelopmen-
tal conditions,5 it is clear that there is very little research
examining the matching of autistic characteristic and spe-
cific jobs requirements or on associated risks or aspects of
well-being. There is helpful observational research from
matching of skills and job profiles in general and related
areas in autism, however, such as employment rates,
employment programs, and forms of employment;
strengths, weaknesses, interests, and preferences of autis-
tic people; facilitators and barriers in the work environ-
ment; educational and vocational transitions; prognostic
work factors of health and quality of life; interventions
related to work (e.g. skills training, training on the job,
and cognitive and interview training); organization of ser-
vices around employment; and good practice in career and
job guidance counseling, just to mention a few. My
impression is that the autism-specific research predomi-
nantly examines how to employ autistic people at all,
rather than investigating an optimal match of individual
and job, work safety, and well-being.
The lack of research was discouraging for the Jobba
Frisk NPF project. We also received contradictive feed-
back from experienced career and job guidance counselors
who are on the advisory team. They were not only very
supportive and confirmed the project’s significance but
also recommended caution when generating “manuals,”
“checklists,” or “guidelines” for career and job guidance in
autism and other neurodevelopmental conditions. In their
view, all career and job guidance must be highly individu-
alized and codifying career and job guidance for autistic
people and those with others with neurodevelopmental
conditions could be considered malpractice.
I would like to give several reasons for why creating
this type of manualized content is important. First, I have
often encountered that even the most experienced profes-
sionals show a good deal of space for improvement of their
autism skills and practice. Some practitioners falsely per-
ceive scientific findings as irrelevant or useless for their
practice. Everyone of course agrees that there is no cook-
book, and autistic people must be treated individually in
career and job guidance but apparently this is currently not
happening sufficiently. What exactly hinders career and
job guides already today from implementing highly indi-
vidualized solutions for autistic people in practice?
All professionals can be better at what they are doing to
serve their clients and there is no better strategy to achieve
it than by translating research into useful, standard practice.
This is even true for the most experienced experts, who
over the years might have developed or conserved obsolete
attitudes paired with resistance to change and limited self-
insight. It is not a lèse-majesté to use manuals, checklists,
or guidelines. Many autism clinicians and researchers use
manuals and checklists more and more every day, and they
are a tool to improve practice. In Sweden, it took until 2009
before checklists became mandatory in surgery, after stud-
ies showed a significant positive impact on patient safety,
post-surgery complications, and mortality (Gustafson et al.,
2018). These checklists include basic points, such as ensur-
ing that the correct patient is on the sick bed, the team
greets, and presents themselves to each other and that all
tools and materials are back where they belonged after the
operation. Professional resistance to such checklists had
been massive initially, and they were deemed an unneces-
sary burden to staff (Treadwell et al., 2014). In this context,
it is of paramount significance that research on the work
performed by career and job guides indicate that there is a
risk that basic aspects of good practice (e.g. analyzing
school and work biographies, including relative’s experi-
ences) are regularly left out in daily work practice (Migliore
et al., 2010), indicating that simple checklists probably
would be helpful.
Second, and most importantly, there is evidence from
career and job guidance research in general, and autism
and other neurodevelopmental conditions, in particular,
which can inform practice. This editorial does not provide
a comprehensive review, but here some of the most essen-
tial ingredients in a manual and checklist should entail in
terms of do’s and don’ts:
It is critical to move from a problem-oriented view
regarding autism and work to a possibility-oriented view.
Career and job guidance counselors must focus on inven-
torying strengths, interests, and preferences of autistic
people and identify supportive facilitating environments as
well as appropriate career paths matching these. Strengths
may be attention to detail, attention focus, logical thinking
and systemizing, visual skills, numeracy, specific exper-
tise, and work requiring repetitive action (Baldwin et al.,
2014; Black et al., 2019; Lorenz & Heinitz, 2014).
Career and job guidance counselors also should provide
job-related advice regarding handling and disclosure of
diagnosis and help with work-related stress and conflict
avoidance. Currently, research indicates that career and
job guidance counselors are not helpful to autistic individ-
uals for career planning and decisions, employment, and
well-being on the job; about half of autistic individuals do
not meet with career and job guidance counselors at all
(Briel & Getzel, 2014).
Studies show that autistic people work in diverse jobs.
Autistic individuals may be overrepresented in science,
education, architecture, libraries administration, culture,
economy and production of raw material, and underrepre-
sented in tourism, sales and the general service sector
(Frank et al., 2018; Lorenz & Heinitz, 2014).
While there are no jobs that autistic people are a priori
unqualified for, there are autistic traits which counselors
must keep in mind when helping with person-job match.
Editorial 859
For example, workplaces with a high social load and com-
munication requirements may pose a barrier for autistic
people (Chen et al., 2015). The same is true for unstruc-
tured, chaotic, unpredictable, and stressful environments
with sensory exposure, high demands on verbal skills,
cognitive flexibility, and group work as well as vaguely or
broadly defined work descriptions (Noel et al., 2017).
Most of the negative causes of job termination relate to
such factors in autism (West et al., 2015). Still, autistic
people should be assessed individually using assessment
center to determine their fit for any given job and consid-
ered for a position as typical people if they pass.
Mental and physical health issues, such as anxiety,
depression, sleep problems, and autistic burn-out, may
impede autistic people from maximizing their work poten-
tial and complicate successful employment and well-being
on the job. Counselors should aim not to confuse the autis-
tic person’s general capacities with psychiatric issues
(Baker et al., 2019; Noel et al., 2017).
Lack of work experience is the top barrier to employ-
ment for autistic people. A priority for career counselors
and job guides is to ensure that autistic people obtain
hands-on experiences as early as possible (Lee et al.,
2020; Noel et al., 2017). Protected and especially sup-
ported employment may increase chances for subsequent
competitive employment and usually have beneficial
effects on the quality of life (Almalky, 2020; Pillay &
Brownlow, 2017).
Career and job guidance counselors must perform a
comprehensive and detailed analysis and map the autistic
individual’s skill, interest, and preference profile and the
specific job characteristic. Supports should relate to help-
ing the autistic client become familiar with the work place,
its culture, routines, and expectancies. These supports are
potentially time consuming, requiring operational and
strategic actions (Wehman et al., 2012).
Most work environments still lack an inclusive culture
(Hagner et al., 2015). Therefore, career and job guidance
counselors need to examine not only in detail the autistic
person’s skills but also the job and job environment in all
its facets. For instance, the work place culture toward
diversity and stigma, the effect and handling of autism
diagnosis disclosure, smells, lighting, temperature, visual
distractions, clarity of procedures, location, and social
expectations all can affect workplace performance and
well-being (Pfeiffer et al., 2017).
Many studies find that a host of supports, including job
preparation, training, and placement; interview training;
mentoring; peer support; teaching compensatory strate-
gies; skills training; and other related programs can
increase employment and job-related mental health (Kaya
et al., 2016; Pfeiffer et al., 2017; Pillay & Brownlow, 2017;
Schall et al., 2020; Taylor et al., 2012).
Career-related transitions, for example, from school to
post-secondary education or employment, are crucial life
events, and particularly challenging for autistic people.
Such transitions should be anticipated and planned for by
career and job guidance counselors to ensure continuity of
individual career development and avoidance of disrup-
tions of career paths (Anderson et al., 2018; Hatfield et al.,
2018; Sansosti et al., 2017).
In conclusion, there is little specific evidence on which
jobs are the best fit for autistic people in terms of generat-
ing quality of life, minimizing work related risks, and gen-
erally make a good person-job fit. Research in the area
may not yield strong evidence, given that autism is one of
many traits of an individual, its heterogeneity of expres-
sion, and co-existing features. As a starting point, best
practice of career and job guidance counseling in typically
developing individuals should also apply to autistic peo-
ple. However, it is of paramount significance that best
practice is performed with all necessary resources,
patience, good-will, and awareness of autism. Carefully
applying evidence from closely neighboring fields is cru-
cial to enhance the likelihood that autistic people ulti-
mately gain satisfying and safe jobs matching their
interests and level of skills. During my literature search,
two articles caught my attention, which I deem are solid
and hands-on in describing how constructive career and
job guidance practice could look like and common devia-
tions from it. Both Migliore et al. (2010) and Bross and
Travers (2017) convey nicely necessary actions for interest
and skill identification in autism to achieve job develop-
ment activities, occupational experiences, and prospective
employment. In my view, there is sufficient research that
can be translated to some form of standardized guidance
and checklist to ensure completeness and quality of action
in career and job guidance practice. I am also sure it can be
done in a way appreciated by career and job guidance
counselors and others involved supporting autistic people
who might have reservations and doubts that such recom-
mendations can enhance practice. This will be the mission
of the Jobba Frisk NPF project.
Sven Bölte
Karolinska Institutet & Region Stockholm, Sweden
Acknowledgements
The author thanks Editor-In-Chief of Autism, David Mandell, for
overseeing this editorial and his dear colleagues Marina Jonsson
and Allan Toomingas from Center for Occupational and
Environmental Medicine at Region Stockholm, Sweden, for
comments of the text, the invitation to participate in Jobba Frisk
NPF, and a great work spirit.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship and/or publication of this article: The
author receives funds for the Jobba Frisk project from Region
Stockholm.
860 Autism 25(4)
Notes
1. American Electronic Music Group. (1992). Play More
Music. Labor vs Leisure.
2. https://www.regeringen.se/rattsliga-dokument/statens-
offentliga-utredningar/2019/01/sou-20194/
3. https://arbetsformedlingen.se/other-languages/english-
engelska
4. https://cdn.ymaws.com/www.autism-insar.org/resource/
resmgr/files/policybriefs/2018-insar_policy_brief.pdf
5. https://osf.io/hjywf/
References
Almalky, H. A. (2020). Employment outcomes for individuals
with intellectual and developmental disabilities: A literature
review. Children and Youth Services Review, 109, Article
104656.
Anderson, K. A., Sosnowy, C., Kuo, A. A., & Shattuck, P. T.
(2018). Transition of individuals with autism to adulthood:
A review of qualitative studies. Pediatrics, 141(Suppl. 4),
S318–S327.
Baker, E. K., Richdale, A. L., & Hazi, A. (2019). Employment
status is related to sleep problems in adults with autism
spectrum disorder and no comorbid intellectual impairment.
Autism, 23(2), 531–536.
Baldwin, S., Costley, D., & Warren, A. (2014). Employment
activities and experiences of adults with high-functioning
autism and Asperger’s disorder. Journal of Autism and
Developmental Disorders, 44(10), 2440–2449.
Black, M. H., Mahdi, S., Milbourn, B., Scott, M., Gerber, A.,
Esposito, C., . . . Girdler, S. (2020). Multi-informant inter-
national perspectives on the facilitators and barriers to
employment for autistic adults. Autism Research, 13(7),
1195–1214.
Black, M. H., Mahdi, S., Milbourn, B., Thompson, C., D’Angelo,
A., Ström, E., . . . Bölte, S. (2019). Perspectives of key
stakeholders on employment of autistic adults across the
United States, Australia, and Sweden. Autism Research,
12(11), 1648–1662.
Briel, L., & Getzel, L. (2014). In their own words: The career
planning experiences of college students with ASD. Journal
of Vocational Rehabilitation, 40(3), 195–202.
Bross, L. A., & Travers, J. C. (2017). Special interest areas and
employment skills programming for secondary students with
autism. TEACHING Exceptional Children, 50(2), 74–83.
Chen, J. L., Leader, G., Sung, C., & Leahy, M. (2015). Trends
in employment for individuals with autism spectrum disor-
der: A review of the research literature. Review Journal of
Autism and Developmental Disorders, 2, 115–127.
Frank, F., Jablotschkin, M., Arthen, T., Riedel, A., Fangmeier, T.,
Hölzel, L. P., & Tebartz van Elst, L. (2018). Education and
employment status of adults with autism spectrum disorders
in Germany: A cross-sectional-survey. BMC Psychiatry,
18(1), Article 75.
Gustafson, P., Salomonsson, A., & Svensson, P. (2018). Tio år
med WHO:s checklista för säker kirurgi: Nu kommer den
nya svenska versionen—Checklistan 2.0 [Ten years with
the WHO checklist for safe surgery: A new Swedish ver-
sion is soon to be introduced]. Läkartidningen [Journal of
the Swedish Medical Association], 115, Article E7UR.
Hagner, D., Dague, B., & Phillips, K. (2015). Including employ-
ees with disabilities in workplace cultures: Strategies and
barriers. Rehabilitation Counseling Bulletin, 58(4), 195–
202.
Hatfield, M., Ciccarelli, M., Falkmer, T., & Falkmer, M. (2018).
Factors related to successful transition planning for ado-
lescents on the autism spectrum. Journal of Research in
Special Educational Needs, 18(1), 3–14.
Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H.,
Lichtenstein, P., & Bölte, S. (2016). Premature mortality in
autism spectrum disorder. The British Journal of Psychiatry,
208(3), 232–238.
Kaya, C., Chan, D., Rumrill, P., Hartman, E., Wehman, P.,
Iwanga, K., . . . Avellone, L. (2016). Vocational rehabilita-
tion services and competitive employment for transition-age
youth with autism spectrum disorders. Journal of Vocational
Rehabilitation, 45(1), 73–83.
Lee, E., Black, M. H., Falkmer, M., Tan, T., Sheehy, L., Bölte, S.,
& Girdler, S. (2020). “We can see a bright future”: Parents’
perceptions of the outcomes of participating in a strengths-
based program for adolescents with autism spectrum disor-
der. Journal of Autism and Developmental Disorders, 50(9),
3179–3194.
Leifler, E., Carpelan, G., Zakrevska, A., Bölte, S., & Jonsson, U.
(2020). Does the learning environment ‘make the grade’?
A systematic review of accommodations for children on
the autism spectrum in mainstream school. Scandinavian
Journal of Occupational Therapy. Advance online publica-
tion. https://doi.org/10.1080/11038128.2020.1832145
Lorenz, T., & Heinitz, K. (2014). Aspergers—Different, not
less: Occupational strengths and job interests of individu-
als with Asperger’s Syndrome. PLOS ONE, 9(6), Article
e100358.
Migliore, A., Hall, A. C., Butterworth, J., & Winsor, J. (2010).
What do employment specialists really do? A study on job
development practices. Research and Practice for Persons
with Severe Disabilities, 35(1Y2), 15–23.
Noel, V. A., Oulvey, E., Drake, R. E., & Bond, G. R. (2017).
Barriers to employment for transition-age youth with devel-
opmental and psychiatric disabilities. Administration and
Policy in Mental Health, 44(3), 354–358.
Pan, P. Y., & Bölte, S. (2020). The association between ADHD
and physical health: A co-twin control study. Scientific
Reports, 10(1), Article 22388.
Pellicano, E., Dinsmore, A., & Charman, T. (2014). What should
autism research focus upon? Community views and priori-
ties from the United Kingdom. Autism, 18(7), 756–770.
Pellicano, L., Bölte, S., & Stahmer, A. (2018). The current illu-
sion of educational inclusion. Autism, 22(4), 386–387.
Pfeiffer, B., Braun, K., Kinnealey, M., Matczak, M., & Polatajko,
H. (2017). Environmental factors impacting work satisfac-
tion and performance for adults with autism spectrum disor-
ders. Journal of Vocational Rehabilitation, 47, 1–12.
Pillay, Y., & Brownlow, C. (2017). Predictors of successful
employment outcomes for adolescents with autism spectrum
disorders: A systematic literature review. Review Journal of
Autism and Developmental Disorders, 4(1), 1–11.
Sansosti, F. J., Merchant, D., Koch, L. C., Rumrill, P., & Herrera,
A. (2017). Providing supportive transition services to indi-
viduals with autism spectrum disorder: Considerations
Editorial 861
for vocational rehabilitation professionals. Journal of
Vocational Rehabilitation, 47(2), 207–222.
Schall, C., Wehman, P., Avellone, L., & Taylor, J. P. (2020).
Competitive integrated employment for youth and adults
with autism: Findings from a scoping review. Child and
Adolescent Psychiatric Clinics of North America, 29(2),
373–397.
Scott, M., Milbourn, B., Falkmer, M., Black, M., Bӧlte, S.,
Halladay, A., . . . Girdler, S. (2019). Factors impacting
employment for people with autism spectrum disorder: A
scoping review. Autism, 23(4), 869–901.
Taylor, J. L., McPheeters, M. L., Sathe, N. A., Dove, D.,
Veenstra-Vanderweele, J., & Warren, Z. (2012). A system-
atic review of vocational interventions for young adults with
autism spectrum disorders. Pediatrics, 130(3), 531–538.
Thompson, C., Bölte, S., Falkmer, T., & Girdler, S. (2019).
Viewpoints on how students with autism can best navigate
university. Scandinavian Journal of Occupational Therapy,
26(4), 294–305.
Thompson, C., McDonald, J., Kidd, T., Falkmer, T., Bölte, S.,
& Girdler, S. (2020). “I don’t want to be a patient”: Peer
mentoring partnership fosters communication for autistic
university students. Scandinavian Journal of Occupational
Therapy, 27(8), 625–640.
Treadwell, J. R., Lucas, S., & Tsou, A. Y. (2014). Surgical
checklists: A systematic review of impacts and implemen-
tation. British Medical Journal Quality and Safety, 23(4),
299–318.
Wehman, P., Lau, S., Molinelli, A., Brooke, V., Thompson, K.,
Moore, C., & West, M. (2012). Supported employment for
young adults with autism spectrum disorder: Preliminary
data. Research and Practice for Persons with Severe
Disabilities, 37(3), 160–169.
West, M., Targett, P., Wehman, P., Cifu, G., & Davis, J. (2015).
Separation from supported employment: A retrospective
chart review study. Disability and Rehabilitation, 37(12),
1055–1059.
Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A.,
Danielson, M. L., Bitsko, . . . Boyle, C. A. (2019).
Prevalence and trends of developmental disabilities among
children in the United States: 2009-2017. Pediatrics, 144(4),
Article e20190811.