Introduction

Autism spectrum disorders (ASD) represent a category of developmental disorders, characterised by difficulties in social reciprocity, communication and unusual or repetitive behaviour [1]. With a population of 23 million in the working age 15–64 years, it is estimated that there are approximately 115, 400 adults with ASD in Australia [2]. These numbers are expected to increase over the next 10 years. This increase in the number of individuals diagnosed with ASD may partly be due to a change in the diagnostic criteria, resulting in a more accurate and earlier diagnosis [3]. As many adolescents with ASD are now exiting the school system and entering into adulthood, adult services are aware that they are under resourced to manage this period of transition [4].

In Western countries, the labour force participation rate for adults with ASD is 34%, compared with 54% for all individuals with disabilities, and 83% for individuals without disabilities [5, 6]. In fact, individuals with ASD without an intellectual impairment are three times less likely to participate in daytime activities than those with ASD who have an intellectual impairment [6, 7]. For many individuals with ASD interactional difficulties have the largest impact on their ability to apply for and maintain stable employment [8, 9]. This is particularly evident during the interview process as it is the expected requirement of demonstrating social skills and the ‘ability to sell yourself’ that often poses as an obstacle to gaining employment [10]. Once employed social aspects of the work environment are essential to job retention and require employees to continuously engage in social interactions and communication with colleagues [11].

For individuals with ASD it is their ability to manage the social and communication aspects of work [12, 13], rather than their actual job performance that influences their success in finding and maintaining employment [7, 9]. Despite high levels of skills and the desire to work [8], individuals with ASD continue to remain unemployed or underemployed [14]. The consequences of unemployment remains an important issue, as participation in work not only provides the opportunity to earn a livelihood, but is important in identity formation [15]. Work offers a sense of accomplishment and competence, provides structure, and offers an outlet for socialisation and enables people to be full participants in society [15, 16].

The need to support individuals with ASD in obtaining and maintaining employment is widely recognised. To date, most workplace strategies have been impairment focused and have been directed at training for individuals with ASD to overcome their social and communication difficulties [7]. Environmental factors are an essential component in understanding the complex interactions and possible success factors for individual with ASD participating in the workplace [17]. Despite this, there is a paucity of research examining the role of environmental factors in facilitating successful employment of individuals with ASD. Both personal and environmental factors are considered to impact successful employment for adults with ASD [17]. However, it remains unknown how adults with ASD view personal and environmental factors and effect on their workplace success. Hence, the primary aim of the present study was to explore the key factors for successful employment from both the viewpoints of adults with ASD and employers. A secondary aim was to contrast the viewpoints of adults with ASD and employers to explore whether their views on factors for successful employment were similar or different and how these viewpoints impact the process of employment.

Methods

The Q method provides an in-depth understanding of individuals’ perspectives, attitudes and beliefs regarding a specific topic [18, 19]. In the present study, Q method was utilised to identify, categorise and reveal the viewpoints of adults with ASD and employers on factors for successful employment. The Q method has particular utility in research with adults with ASD, as it allows investigation of viewpoints while reducing the need for verbal communication and social interaction [18].

Q method has the following five phases: 1) developing the ‘concourse’, 2) identifying the Q sort statements, 3) administering the Q sort, 4) factor analysis and 5) interpretation of factors.

Administering the Q sort

Participants who met the DSM-IV criteria for ASD were invited to take part in the study and were given the opportunity to self-select as having high functioning autism or Asperger’s Syndrome. This group included participants over the age of 18 years, living in Australia, who were currently employed or seeking employment. From this point forward this group of adults with ASD will be referred to as the ‘Employee group’. Participants were excluded from the study if they reported co-morbid conditions distinctly different to the characteristics of ASD that would potentially require additional consideration in successfully attaining employment. The exclusion criteria included: ADHD, epilepsy and psychotic disorders. The employer group included employers who previously have employed and/or are currently employing an adult/s with ASD in their workplace and were accustomed to the employment procedure and management of the workplace environment.

Participants were recruited across Australia via: the autism associations or organisations within states, universities, disability employment services providers and social media. Information was either posted or emailed to participants explaining the purpose of the study. In total, 75 individuals agreed to participate in this study. The two groups were the employee group (n = 40) and the employer group (n = 35). Participants were presented with the choice of completing the Q sort either online or in-person using the hard copy, as shown in Fig 1. Participants were asked to carefully read through each statement, followed by sorting the 52 statements onto a sorting grid. The sorting grid ranged from ‘strongly agree’ to ‘strongly disagree’ with ranking values of +6 (strongly agree) through 0 (neutral) to -6 (strongly disagree). The sorting grid presented participants with the maximum number of statements allowed for each rank or column as shown in Fig 1. Participants were instructed that they could only place one statement in each block and that each block required a statement for the sorting grid to be complete. Participants were instructed to take their time, that there were no right or wrong answers and that they had the opportunity to re-position the statements on the grid until they were satisfied with the representation of their views. The time taken to complete the Q sort was recorded for both the online version and hard copy version completed in-person.

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Fig 1. Q sort online and hard copy versions of the sorting grids.

(A) Screen shot of participants sorting Q sort statements onto the grid using the online version of the Q sort. (B) Example of the Q sort grid normal distribution.

https://doi.org/10.1371/journal.pone.0139281.g001

Results

Interpretation of factors

In the employee group, the three factors were defined by 37 participants (92%), where only 3 participants did not load significantly on any of the three factors. In the employer group, the three factors were defined by 33 participants (94%), and only 2 participants did not load significantly on any of these factors. Participants’ demographics are presented in Table 1. A list of each statement and the corresponding rankings and z-scores across each factor can be seen in S1 Table. Once the factors for each group were identified, experts in the field were invited to participate in an open group discussion to name each viewpoint.

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Table 1. Participant demographics.

https://doi.org/10.1371/journal.pone.0139281.t001

Factor interpretation in the employee group

Employee viewpoint 1: “I commit to work and work commits to me”.

Viewpoint one was defined by 17 participants, as shown in Table 2. Participants in this group included: 11 males and 6 females, with a mean age of 27.5 years ranging between 18 and 45 years. This group of participants placed great importance on commitment to work as supported by statement 11 given the ranking +5; henceforth labelled 11: +5. This employee group revealed that another factor that enhanced their commitment to work and consequently successful employment occurred when participation in their job was valued, encouraged and supported (7: +4; 3:-5; 10:-5; 8:-6). Participants were not necessarily concerned with being effectively matched to a job that promoted their skill set. Instead, these employees sought a workplace with a designated manager capable of providing the necessary workplace support (31: -4; 4: +6). This required a manager to be approachable, effective and direct in communicating and invested in creating an inclusive workplace (16:+6; 5: +5; 15:-6; 14: +5). An inclusive workplace demonstrated commitment to the employee’s participation. Participants wanted to be included in the workplace and support-related decisions (8: -6). Overall, these participants’ life satisfaction increased when regularly working (27: -5).

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Table 2. Employee Viewpoint One.

https://doi.org/10.1371/journal.pone.0139281.t002

Employee viewpoint 2: “I’m motivated when I have the right job”.

Viewpoint 2 was defined by 17 participants, as shown in Table 3. This group of participants included: 10 males and 7 females with a mean age of 29.1 years ranging between 18 and 56 years. Participants in this group valued the independence they gained from being able to work (52:+6), particularly when working in a job matched to their skills and interests (48: +5; 51:-6). This group felt that their motivation and productivity at work was enhanced when they had: the skills and abilities to fulfil their role and a thorough understanding of the workplace culture and job expectations (25:+5; 24:+5, 15:-6). As this group of participants’ confidence increased in their work tasks they required less support, but still valued regular follow up from one, designated manager (28:-5; 3: -4, 31:-5).

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Table 3. Employee Viewpoint Two.

https://doi.org/10.1371/journal.pone.0139281.t003

Employee viewpoint 3: “I’m confident in a structured work environment”.

Viewpoint 3 was defined by 3 participants, as shown in Table 4. Participants in this group included: 2 males and 1 female with a mean age of 20.5 years ranging between 20 and 21 years. These participants felt confident in their work skills, provided they had ongoing and high levels of support in their workplace (28:+5, 2:+5). This support was viewed as important and needed to be structured to include: broken-down tasks, setting work goals and simplifying tasks (40:+6). Participants also viewed job trials as an effective means to demonstrate their work capacity rather than discussing their skills in an interview (22:+5; 43:+4). To this group, the process of finding a job was not difficult, nor did they find being able to work added any significant value to their independence as adults (47:-6; 52:-4).

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Table 4. Employee Viewpoint Three.

https://doi.org/10.1371/journal.pone.0139281.t004

Factor interpretation for employer group

Employer viewpoint 1: “We rely on external support”.

Viewpoint 1 was defined by 19 participants, as shown in Table 5. Participants in this group included: 8 males and 11 females with a mean age of 43.7 years ranging between 24 and 57 years. This group of employers were open-minded with regard to employing adults with ASD in their workplace as they viewed working as an important factor in increasing life satisfaction (27:-6). However, this group felt more confident employing individuals with ASD when they received ongoing, external support from disability employment service providers (9:+6; 3:-5). The support that employers required from disability employment service providers was: assistance with difficulty work situations, periods of transition in the workplace (such as adjustments in work hours or the designated manager being on annual leave) and carrying out job trials in the workplace to identify areas where more support was needed (13:+5; 21:+4). This group viewed having a designated manager who worked directly with the employee with ASD as well as with the nominated disability employment service provider as a key factor for successful employment (31: -5; 8:-5; 10:-6).

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Table 5. Employer Viewpoint One.

https://doi.org/10.1371/journal.pone.0139281.t005

Employer viewpoint 2: “We provide internal support”.

Viewpoint 2 was defined by 12 participants, as shown in Table 6. This group of participants included: 5 males and 7 females with a mean age of 40 years ranging between 36 and 44 years. Participants viewed working as important to increasing life satisfaction and independence (27: -6; 52: +5). Participants in this group were not overly reliant on support from an external source instead, they welcomed the opportunity to work with an employee with ASD. This group’s approach was to provide support from within their team. This included: providing on the job-training, explaining the workplace culture and encouraging effective communication skills (41:+5; 25: +4; v15:-5). Team support was reliant on a manager who promoted a fair workplace, provided honest feedback and was approachable (31:-5; 16:+6; 14:+6; 4: +4). Participants viewed training on ASD for colleagues as moderately important (6:-4).

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Table 6. Employer Viewpoint Two.

https://doi.org/10.1371/journal.pone.0139281.t006

Employer viewpoint 3: “We give the opportunity, you work it out”.

Viewpoint 3 was defined by 2 participants, as shown in Table 7. This group of participants included: 1 male and 1 female with a mean age of 52.5 years ranging between 50 and 55 years. Participants in this group viewed work an important factor for independence (52: +6). This group was willing to provide job opportunities, however required employees to ensure their inclusion in the workplace. This group’s expectations of employees included: having an understanding of the job expectations to ensure productivity, having the capacity to work as team and engaging socially with colleagues (26:+5; 12: +4; 39: -4; 37: -6). Participants viewed financial assistance and ongoing support from disability employment service providers as helpful when making workplace adjustments (18: +5; 17: +5; 28: +4). This group did not view job matching employees to the workplace and being motivated by their work as particularly important (48: -4).

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Table 7. Employer Viewpoint Three.

https://doi.org/10.1371/journal.pone.0139281.t007

Discussion

This study identified three main viewpoints within both the employee and employer Q-sample. In order to better understand these results the International Classification of Functioning, Disability and Health (ICF) framework was used [23]. The ICF is based on a biopsychosocial perspective of health. It serves as a useful framework to understand functioning and disability and the complex interaction between contextual factors, namely environmental and personal factors, and their impact on adults with autism and employment [17]. The ICF highlights the necessary role that environmental factors play in acting as a facilitator or barrier to participation [24]. Therefore, the ICF was used to categorise the viewpoints on employment of both groups of participants according to the environment, participation or activity, as shown in S1 Fig. According the ICF, the environment includes: the physical, social and attitudinal contexts; participation is the involvement in a life situation and activity is the execution of a task by an individual [23]. Lastly, the ICF was used as a means of contrasting and interpreting the viewpoints between the employee and employer group. This was achieved by mapping the viewpoints for each group onto the ICF framework, as seen in S1 Fig.

Viewpoint one of the employee group, ‘I commit to work and work commits to me ‘, was categorised as participation according the ICF. This suggests that when the employee group is made to feel included in the workplace, whereby their talents and skills are valued and they are actively involved in workplace decisions, their dedication to work is reinforced [7, 8]. This suggests that employees view the inclusiveness of the workplace as an important facilitator to work participation. In contrast, Viewpoint one of the employer group, ‘We rely on external support’, was categorised as the environment according the ICF. Literature reports that one of the factors related to work participation for adults with ASD is having the support of the employer. This includes: modification of the work environment, job adjustments and behavioural management [25]. However, the employer group indicated a lack of confidence implementing workplace modifications without the support and guidance of disability employment organisations [26, 27]. These findings are of interest given that while both the employee and employer groups view support in the workplace as important, the type of support that each group requires differs significantly. The discrepancy in the type of support required by each group may in part account for miscommunication between employees and employers when attempting to create a successful workplace [9].

Viewpoint two of the employee group, ‘I’m motivated to work in the right job’ and the employer group, ‘We provide internal support’ were categorised into activity and participation respectfully, according the ICF. The employee and employer groups agreed on the importance of work productivity, however their understanding of the job expectations required to achieve this goal of productivity differed [28, 29]. Job expectations are reciprocal and must be considered from both the employee and employer’s perspective. Employees expect responsibility, career advancement, fair pay and job tasks to match their skills and abilities [7, 28]. In exchange, employers expect hard work, loyalty, minimum length of stay and productivity [30]. However, unclear or conflicting expectations between employees and employers are unclear may result in demotivated employees, poor work performance, stress and increased employee turnover [30]. Successful work environments depend on clear descriptions of the specific requirements of the job, a shared understanding of the time in which tasks need to be completed, appropriate training, the necessary resources and a supportive workplace culture [7, 30]. It is likely that work environments which adopt these approaches will create workplaces in which individuals with ASD can excel.

Viewpoint three of the employee group, ‘I’m confident in a structured work environment’, and the employer group, ‘We give the opportunity, you work it out’ differed significantly in their approaches toward successful employment. This is indicated in the categorisation of each group into the environment and activity respectively according to the ICF. The employee and employer groups agreed on the ease of completing the basic business transaction of recruitment for a job position, which included applying for the job position and hiring for the job position. However, the two groups differed in their approach to the process of maintaining a job [29]. Using the ICF environmental component, employees require a supportive, structured and task-adapted work environment to perform their jobs successfully [7, 8, 31]. This suggests that it is the manner in which the environment is structured and modified that influences job retention [32]. In contrast, the employer group presented a different view regarding job retention. This best aligns with the ICF activity component in that employers are focused on the execution of job tasks to further business productivity [23]. This suggests that once employers have provided the opportunity to work it is the employee’s responsibility to meet the productivity requirements, in order to maintain their job [10, 28]. The strong differences in viewpoints regarding job retention may explain the difficulty employees have in maintaining a job, which likely results from the lack of available support [25, 27]. As well as, if an employee cannot meet the productivity requirements this may impact and lower the business’s profitability. As a result of lowered productivity employers may find it difficult to retain the jobs of employees who are not performing according to the productivity requirements of the business [8]. This suggests that if job retention is regarded as both the responsibility of the employee and the employer then effective communication regarding productivity in the workplace is required.

This study has revealed that the viewpoints between the employee and employer groups are positioned differently within the framework of the ICF. This difference in the groups’ viewpoints may explain why successfully gaining and maintaining employment for individuals with ASD is a challenge. Although both groups appear committed to the employment process, the difference in their understanding regarding the type of workplace support required, job expectations and productivity requirements continues to hinder successful employment. There is clearly a need for an approach which facilitates communication between employees and employers to bridge the communication gap. This study suggests that an ASD-specific workplace tool is required for employers, which may assist in bridging this communication gap between groups. This tool would also provide employers with essential and practical information to effectively manage and modify the workplace for successful employment outcomes.

Conclusion

According to the employee and employer groups, factors for successful employment include: comprehensive job expectations, knowledge of the productivity requirements and support in the workplace to assist in creating an inclusive and modified environment. However, it is the difference of interpretation of each factor that may explain the miscommunication between employees and employers in the workplace and ultimately impact on job retention. This study highlights the need for an approach which facilitates communication between both the employee and employer. The development of an ASD-specific workplace tool may assist in bridging the gap of miscommunication between employees and employers in the workplace as well as assisting with workplace modifications for successful employment outcomes.

Supporting Information

Acknowledgments

Our sincere thanks go to Wilson Waters, the software engineer from Alintech. The online version of the Q sort would not have been possible without your development and innovation. We are grateful to all the participants, their families and businesses who participated. A special mention goes to EDGE Employment Solutions, EPIC Employment Service, Barkuma’s Personnel Employment in South Australia, Autism Spectrum Australia and AIM Employment of the Autism Association of Western Australia, for their assistance with participant recruitment in this study.

The authors acknowledge the financial support of the Cooperative Research Centre for Living with Autism Spectrum Disorders (Autism CRC), established and supported under the Australian Government’s Cooperative Research Centres Program.