Journal of Autism and Developmental Disorders, Vol. 2L No.

2, 1991

Brief Report: Competitive Employment of

Adults with Autism 1
Diana B. Burt, 2 S. Paige Fuller, and Kay R. Lewis
University of Texas Mental Sciences Institute and
University of Texas Medical School at Houston

Adults with autism have been employed when supervised by full-time

trained counselors (Smith & Coleman, 1986), but factors related to their
successful employment have not been identified. This report presents the
case studies of four adults with autism who have been employed as a result
of their enrollment in a 4-month work-training program. The program used
a behavioral social interaction approach, which integrates ideas from an
applied behavioral analysis approach with those from a social interaction-
al/communication developmental model (Alberto, & Troutman, 1982;
Fuller, Jasuta, & Smith, 1986; Peck, Schuler, Tomlinson, Theimer, &
Haring, 1986).

PARTICIPANTS AND PROCEDURES

The participants were a 26-year-old female with above-average intel-

ligence and three males with borderline intellectual functioning (ages 21,
25, and 29) who met DSM-III-R (American Psychiatric Association, 1987)
criteria for Autistic Disorder. They all exhibited low to moderate levels of
autistic behavior, as measured by the Autism Behavior Checklist (score
range = 62-73, Krug, Arick, & Almond, 1979). They were all unemployed
and unable to get jobs because of behaviors related to their autism. They

IS. Paige Fuller is now Director of the San Antonio Autism Center, San Antonio Texas. We
gratefully acknowledge Heidi Anderson and Michael Persicano for their teaching efforts,
Katherine Loveland for her diagnostic help, Ed Bradshaw for his counseling support, and
two anonymous reviewers for comments on a draft of this article.
2Address all correspondence to Diana Burt, Neuropsychology Clinic, University of Texas
Mental Sciences Institute, 1300 Moursund, Houston, Texas 77030.

237

0162-3257/91/0600-0237506.50/09 1991 Plenum PublishingCorporation

238 Burr, Fuller, and Lewis

were not placed directly into supported competitive employment, because

their behaviors were severe enough to prevent them from acquiring a sup-
ported position.
After an interdisciplinary evaluation and collection of baseline infor-
mation, an individualized training plan was developed for each adult. A
master's level special educator and two bachelor's level teachers taught
skills in the following areas: domestic living, communication, socialization,
interaction with nonhandicapped persons, community living, leisure
development, and vocational output. The skills were taught by a variety of
people using a variety of activities in numerous settings to accomplish the
following goals: (a) to facilitate generalization of effective communication,
socially acceptable skills, and alternative behaviors, (b) to decrease depend-
ency on prompts or cues, and (c) to enhance the ability of the adult with
autism to internalize and control his/her behavior. A physician monitored
and adjusted medication as needed, and all of the adults received group
and/or individual social skills training from a social worker.

CASE STUDIES

Sue. Factors contributing to Sue's inability to retain a job were inap-

propriate communication and interpersonal skills, poor hygiene, and throw-
ing tantrums. Inappropriate behaviors, such as rudely terminating or
interrupting conversations, failing to make eye contact, and throwing
tantrums were not controlled through shaping techniques, so a behavioral
contract was initiated making her social privileges contingent on the use
of appropriate alternative behaviors. Throughout her 4-month training pro-
gram, modeling, role playing, and behavior modification techniques were
used to teach alternative behaviors; such as ending conservations with ap-
propriate phrases, saying "Excuse me" rather than rudely interrupting,
making eye contact, and asking for a 5-min walk when angry. Before place-
ment in a competitive work setting, Sue achieved 75% of targeted behaviors
in the program setting where her behavior was supervised constantly, and
in other work settings where supervision was gradually faded and trans-
ferred to nonprogram staff (generalization). Sue's family participated in a
training session, implemented her behavioral contract, and provided money
for her incentive plan. Her 21/2-year employment as a clerical worker re-
quired transition training for her employer and co-workers prior to her
employment, the extensive use of a job coach for follow up (gradually
reduced over a 2-year period from 5 to 1 hours of supervision per week),
and continuation of behavioral contracting implemented by the employer
and job coach.
Competitive Employment 239

Robert. Factors contributing to Robert's inability to get a job were

his ritualistic behaviors such as walking sideways and waving his arms in a
robotlike fashion, his inability to use his language to communicate his
needs, and his response to work place noise with physical aggression. He
was highly motivated to learn and to please the staff, so modeling was ef-
fective for teaching new behaviors and for controlling inappropriate be-
haviors. Training staff modeled an "adult way" to walk (i.e., walking
forwards with appropriate arm motions), and reinforced Robert through
the use of a checklist and rewards, and through constant social reinforce-
ment faded to an intermittent schedule. He viewed himself and others walk-
ing on videotapes, so that he learned to discriminate his way of walking
from that of others. Throughout the program Robert was also taught to
make his sideways walking and arm-raising behaviors a part of work tasks
such as collating (e.g., raising his arms to pick up papers and moving
sideways to stack them). An integral part of Robert's program was a com-
munication notebook that he used to communicate his needs to the project
staff and to his father who provided extensive daily support. Like Sue,
Robert received extensive supervision in the training setting and learned
job core skills such as asking for help and to leave situations to "cool down"
when angry. He gradually received less supervision and worked in natural
work settings when it could be arranged. Before he started a clerical job,
his prospective employer and co-workers received training on autism and
modeling techniques. He lost his first job after 1 year due to economic
layoffs, and a second job that involved moving and setting up furniture,
because it required independent decision making (e.g., safe lifting) and
flexibility. He quit a third job after 6 months, because he missed com-
ponents of his first job (e.g., the consistent bus route and schedule) and
he wanted to stay home. Job coach support was initiated and he is currently
employed as a clerk.
Tim. Factors contributing to Tim's inability to get a job were his poor
problem-solving skills, lack of spontaneous speech, verbal tantrums, and
childlike dependency. He was not highly motivated by the praise provided
during modeling, so his training program included a behavioral contract
that made participation in social activities contingent upon appropriate
communication skills and socially acceptable behaviors. During the 4
months of the program, Tim received constant supervision in the program
setting and learned core job skills like talking appropriately to co-workers.
Modeling, shaping, delay, social reinforcement, and nonverbal cues were
used to teach him to initiate, continue, and terminate conversations ap-
propriately. He had an excellent memory and learned several conversation
scripts, which he used across people and settings. He gradually worked with
less supervision in nonprogram settings where his communication skills
240 Burt, Fuller, and Lewis

were naturally reinforced. Tim's family was supportive of his desire to get
a job, but expressed unrealistic expectations about potential positions. Tim
got a job polishing silver for 1 year 7 months. After three verbal tantrums
during his first 6 months of employment, a new job coach helped him han-
dle frustrations associated with job and interpersonal demands resulting in
no further tantrums. Three changes in supervisors occurred, each requiring
a different amount of job coach support as a function of their willingness
to give Tim their support. Tim is now successfully employed in a second
competitive position doing clerical work.
Dave. Factors contributing to Dave's inability to retain a job were his
inappropriate use of trendy language phrases and profanity; ritualistic walk-
ing, especially walking backward; self-abusive behavior when upset; and
stereotyped body position and jerky movements. Dave's inappropriate be-
haviors were more pervasive than the other adults, so his program involved
the daily use of a behavior checklist designed to teach him to self-monitor
and to control them. Modeling, redirection, shaping, nonverbal cues, delay,
gaze, and errorless learning were used to teach him to walk appropriately.
He was extremely time-conscious, so he was given a detailed task schedule
that allowed little time for ritualistic behaviors and encouraged internal
control. He was taught to control his self-abusive behavior by calming down
in a designated place, and social activity privileges were made contingent
on control of targeted behaviors. His family supported his desire to have
a job and participated in his training program, but they expressed doubts
about his ability to get a job. Dave filled a position as a lobby houseman
at a hotel chain, but he was unable to use good judgment regarding hotel
guests' privacy and his ritualistic behaviors resulted in slow job perfor-
mance, despite his task schedule. He was transferred to a job in the laundry
where his work required less judgment and speed, and where he had co-
workers to model appropriate behavior. With the help of a new job coach,
he successfully performed his job in the laundry for 6 months, but he was
not as fast as his co-workers and not as independent as he needed to be.
In addition, he had two incidences of encopresis on the job that resulted
in complaints from his co-workers to the hotel management and in his ter-
mination. After the encopretic incidents, the program staff discovered that
Dave had a history of encopresis.

DISCUSSION

As a result of the intensive training program, four adults with autism

were competitively employed for 6 to 30 months. Factors affecting their
Competitive Employment 241

success or failure appear to be similar to those affecting adults with other

developmental disabilities; namely, characteristics of the individual, the
amount of family and work system support, and job characteristics
(Greenspan & Shoultz, 1981; Hill, Wehman, Hill, & Goodall, 1986). In-
dividual characteristics related to job success were the attainment of ap-
propriate communication and interpersonal skills across a variety of settings
and with a variety of people, and the ability to either control their ritualis-
tic, rigid, and self-stimulatory behaviors or to integrate them into their job.
Individual characteristics that led to job failure were lack of motivation to
work, inability to make decisions and solve problems, lack of flexibility and
speed, and uncontrolled encopresis.
Job success appeared to be more likely if family support was pro-
vided in the form of financial incentives, daily praise, and maintenance of
program contingencies. Lack of complete family support, such as when
information was withheld about encopresis, prevented the implementation
of appropriate interventions and led to failure. Similarly, the following
forms of support from employers promoted job success: (a) participation
in educational programs; (b) modification of jobs, schedules, and work
settings to match the strengths and weaknesses of the adults with autism;
(c) supervision to assure that ritualistic or other inappropriate behaviors
did not interfere with job competency; and (d) implementation of be-
havioral contracts. Regarding job characteristics, success was more likely
if jobs did not require problem-solving, flexibility, decision-making, or
prioritization skills, and if the demands of the job were very similar to
those encountered during the training program (e.g., standing or sitting,
fixed vs. flexible schedules).
The success of the work training program depended on the work of
the highly competent and dedicated training staff, who were directly
responsible for implementing and individualizing the training programs.
Another important training program factor was the gradual fading of levels
of supervision and exposure to natural work settings. Finally, extensive job-
coach follow-up was eventually required by all of the adults.
Further research is needed to clarify the interactive role that the iden-
tified factors play in influencing job success. One future direction would
be to evaluate whether adults with autism can learn general strategies for
dealing with changes in their work environments, particularly changes in
supervisors and co-workers. Another direction would be to evaluate
methods for changing attitudes regarding the employment of adults with
autism. Further research is needed to determine the extent to which job
retention is dependent on job coach or similar support.
242 Butt, Fuller, and Lewis

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