* short-term choice-making was strongly associated with employment. This is an area that could be targeted for intervention, with studies investigating the directionality of choice-making and employment. 

* Employment as a dependent variable of adult outcome, instead of one component of a global outcome variable. 

* The field needs to better understand barriers and facilitators to employment and explore different factors that may account for the wide variability of employment rates in adults with developmental disabilities beyond simple demographic variables.

* Employment and choice-making are critical to understanding successful independent living and community inclusion

Choice-making- ID, ASD and DS- employment

In a study Butterworth et al. (2015) reported 19% of all individuals receiving services from state developmental disability agencies were in integrated community employment in 2013, a percentage that had dropped from 25% in 2001. 



The differences in employment trends between adults with ASD, DS, and ID. 

* There was a research study conducted on individuals with down syndrome, autism spectrum disorder and intellectual disabilities.
 *  Individuals with down syndrome were the youngest, followed by individuals with DS, then individuals with ID. 
 * Individuals with DS were expected to be younger than individuals with ID, as individuals with DS have a slightly reduced life expectancy.

Age- ASD, ID, DS

* Individuals with ASD were the most impaired. 
* The NCI Adult Consumer Survey population represents: 
      adults receiving services from state developmental disability systems 
      and a diagnosis of ASD alone is not always sufficient to receive state 
       funded DD services. 
* The subset of individuals in this dataset with ASD may represent 
        * a population of individuals with comorbid diagnoses 
        * More complex service needs
         * Beyond that of an individual with only an ASD diagnosis.

NCI Adult Consumer Survey population represents adults receiving services from state developmental disability systems and a diagnosis of ASD:

* Individuals with DS were still significantly more likely to be employed in a community paid job than individuals with ID or individuals with ASD. 

* Inherent differences within diagnostic groups that accounts for variability in employment status, regardless of differences in cognitive and behavioral functioning. 

* The relationship between choice making and employment is important, only partially because of its intervention implications. It is a skill that can be targeted for intervention and potentially expanded.

Community Paid Job than Individuals With ID or Individuals With ASD:

* Approximately 70% of individuals with ASD have at least one comorbid mental illness and 40% have two or more (Simonoff et al., 2008). 

* Adults with comorbid ASD and ID are at greater risk for behavior problems than individuals with ID: 
*  Griffith et al. (2010) found that children with ASD had significantly more behavior problems than either children with DS or children with ID. 
 *  Esbensen et al. (2008) found that adults with DS had fewer behavior problems and less externalizing problem behaviors compared with adults with ID alone. 
  *  Tassé et al. (2016) reported a similar trend in their sample of adults with DS, reporting a lower prevalence rate of co-occurrence of mental and behavioral health issues than a comparable group of adults with idiopathic ID.  

Note: This study was in the article that I read.

behavior support needs- severity of intellectual disability.

Three disability groups: 
*Lower severity levels of ID were associated with increased probability of paid community employment.
 * ID severity level also had the highest effect sizes for employment status compared to all other independent variables.

Intellectual Disabilities- Paid Community Employment and Medications

The three research groups: 
* Autism 
* Intellectual disabilities 
* Down Syndrome 


Bridgewater College

Significant barriers continue to be the financial incentives to earn a lower wage to qualify for benefits such as Medicaid or Social Security Income. This was included in the article by the author of the article. (SSI; Butterworth et al., 2015; Nord, Luecking, Mank, Kiernan,&Wray, 2013).


Significant barrier- ASD ,  ID, DS.


Bush, K. L., & Tassé, M. J. (2017). Employment and choice-making for adults with intellectual disability, autism, and down syndrome. Research in Developmental Disabilities, 65, 23–34. https://doi.org/10.1016/j.ridd.2017.04.004

References


is to prepare individuals for future community employment. 
the literature has shown that this is not always accomplished.
significant barriers exist in transitioning from facility-based to community-based employment

Goal of Facility-Based Work: ASD, ID, DS

* Individuals with DS worked fewer hours in the community than those with ID. In paid facility jobs individuals with DS were paid a lower hourly wage than individuals with ID. 

* More research is needed to better understand why adults with DS work fewer hours in facility-based work programs and earn lower hourly wages in the community. 

In a Research Study: 
* Rates of paid facility work continue to overshadow rates of community paid jobs. 
* This finding is troubling, since community employment is often the goal for adults with intellectual and developmental disabilities.

Research Study Rates of Paid Facility work

In their national report on employment services and outcomes,
* Butterworth et al. (2015) found that employment for individuals with disabilities receiving SSI reached a 20-year low in 2013 (4.3%). This was included in the article by the author of the article

* SSI recipients with ID did not use work incentive programs, such as Ticket-to-Work and Plans for Achieving Self-Support, as frequently as adults with other disabilities (Butterworth et al., 2015). This was included in the article by the author of the article

National Report: Significant Barrier - ASD, DS, DS

* Rates of paid employment in the community and facility settings were greater for individuals with DS than either individuals with ID and ASD. 
* NLTS-2 data found a similar trend, where individuals with ASD experienced lower rates of paid work following high school compared to individuals with other disabilities (Roux et al., 2013).  This was included in the article by the author of the article

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