Abstract
Background:
Autistic individuals are underrepresented in employment and postsecondary education. Research is hampered by a lack of psychometrically valid instruments that can be used to assess the vocational activities of autistic people. This study examined the psychometric properties of an Australian modified version of the Vocational Index for Adults with Autism (M-VIAA), an assessment of vocational independence.
Methods:
Participants were 105 autistic and 106 nonautistic young adults aged 17–26 years recruited from the longitudinal Study of Australian School Leavers with Autism. We examined psychometric properties of the M-VIAA by (1) comparing scores between autistic and nonautistic participants, (2) examining convergent validity with daily living skills, and (3) divergent validity with autistic traits. We explored change over time by comparing baseline and 24-month follow-up scores in autistic participants.
Results:
We found vocational independence to be significantly higher in nonautistic participants compared with autistic participants. We did not find a significant relationship between daily living skills and the M-VIAA. There was a small but significant relationship between the M-VIAA and autistic traits. Scores on the M-VIAA remained stable over time for a subsample of autistic participants.
Conclusions:
The present study provides preliminary support for the M-VIAA with some limitations. Support for construct validity was mixed with support for concurrent and discriminant, but not convergent validity. We suggest that the M-VIAA may not capture the full complexity of vocational challenges faced by autistic people. Future research should build on the structure of the VIAA while ensuring applicability across cultures and contexts, as well as ensuring the richness of vocational activities of autistic people is captured.
Lay summary
Why was this study done?
Despite the urgent need to improve employment and other vocational outcomes of autistic people, there are few instruments that measure the range of vocational independence demonstrated by these individuals. The Vocational Index for Adults with Autism (VIAA) is an instrument that identifies the common vocational activities that autistic people engage in following high school. There is a need, however, for researchers to examine the usefulness of the instrument and its applicability in countries outside the United States.
What was the purpose of this study?
The goal of this study was to evaluate a modified version of the VIAA (M-VIAA) in a group of autistic people from Australia.
What did the researchers do?
We examined responses to the M-VIAA in 211 autistic and nonautistic young adults. We compared the M-VIAA with participant's daily living skills and level of autistic traits, as well as any change in scores over time.
What were the results of the study?
Vocational independence was higher in nonautistic participants than in autistic participants. Vocational independence was not related to daily living skills; however, it was related to autistic traits. Over 2 years, scores on the M-VIAA did not change a lot for the autistic participants.
What do these findings add to what was already known?
Our study provides some initial support for the M-VIAA in a non-US-based population. However, we also identified that the instrument may not represent the full range of challenges nor the richness of vocational activities experienced by autistic individuals in postsecondary vocational settings.
What are potential weaknesses in the study?
The M-VIAA provides limited information about the richness of postsecondary vocational and education activities that autistic individuals may be engaged in. Because few individuals reported having an intellectual disability, we are unable to say how our results might apply to these individuals. Because we modified the instrument for use in Australia, our results may not apply to different countries or to the original version of the instrument.
How will these findings help autistic adults now or in the future?
Our study provides preliminary support for the Australian version of the VIAA but suggests that it could be improved to better reflect the richness and range of vocational challenges experienced by autistic people. Our findings therefore identify areas for improvement for assessing the vocational activities and independence of autistic people.
Keywords: autism, autistic adults, employment, survey development and psychometrics, vocational independence
Introduction
Relative to nonautistic individuals, autistic adults are substantially underrepresented in employment and postsecondary education.1–3 In Australia, only 28% of working age autistic adults are employed, with labor force participation rate at ∼41%.4 These rates are well below that of nonautistic individuals, including those with a range of disabilities.4 High underemployment and unemployment among the autism community has broad negative impacts on individual and family well-being.5 In addition, unemployment affects individuals' financial security and society more broadly through reduced economic participation.5,6 As has been highlighted in the recent expert discussion on employment in autism by Nicholas et al., there is an urgent need for improving postsecondary employment and education outcomes among this population.7
Research and practice in employment requires reliable and valid instruments that can be used by autistic people. However, few instruments assess vocational (i.e., employment-related as opposed to recreational) activities in this population, and available instruments often fail to capture the diversity of postsecondary vocational and education activities in which autistic people are likely to be engaged.8 Specifically, research has been affected by poor definition of qualitatively different vocational activities (e.g., supported or open employment, education, volunteering), and reliance on descriptive, subjective, and nonstandardized measures.1–3
The Vocational Index for Adults with Autism (VIAA)8 is a standardized instrument developed in North America that was designed to systematically capture the postsecondary vocational (i.e., employment related) and educational activities of autistic adults. In the validation study, ∼350 parents of adolescents and adults with an autism diagnosis responded to questions regarding their child's employment, vocational activities, and educational activities. Autistic participants were aged 10–52 years at baseline, more than two thirds of whom had an intellectual disability (ID). The VIAA includes 11 distinct postsecondary activities, demonstrating reasonable inter-rater reliability and consistency among its categories.
Since its introduction, the VIAA has been used to examine the postsecondary vocational and educational activities of autistic individuals, factors associated with participation, and trajectory of these outcomes over time.9–14 In one study, the VIAA was used to compare postsecondary vocational outcomes between autistic adults with and without co-occurring ID.9 Adults with ID, who are more likely to be reliant on supports to access vocational services than those without ID (i.e., less independent), were more likely to receive supported employment or education services, and least likely to be engaged in normative education or employment. Thus, the VIAA can be construed as providing an index of vocational independence, ranging from low to high levels of independence. The VIAA can also be used to assess intervention outcomes. In one randomized control trial, the VIAA was used to examine the efficacy of a community-based work internship program for secondary students.14 Scores on the VIAA indicated significant increases in work participation for those in the intervention compared with the control condition. However, apart from the original validation study,8 there have been no independent studies that have examined the psychometric properties of the VIAA. Furthermore, given its development in North America, the utility of the VIAA in other cultures or countries is unknown.
Current Study
The present study examined the psychometric properties of the VIAA in young autistic adults from Australia. The original VIAA was slightly modified (henceforth M-VIAA) to account for cultural differences between North America and Australia. For example, the term “sheltered employment” used in the original version is not common in Australia and was substituted with the term “alternative activities.” We first report scores on the M-VIAA in autistic and nonautistic participants, to establish whether vocational independence was different among the autistic cohort to what would be expected among same age nonautistic peers. We predicted significantly higher scores in nonautistic participants given the lower labor force participation rates among autistic people (i.e., concurrent validity). Next, we examined construct validity by assessing (1) convergent validity by reviewing correlations with daily living skills, predicted to be strongly correlated with M-VIAA scores and (2) discriminant validity by examining correlations with autistic traits. We predicted autistic traits would be only weakly associated with M-VIAA scores. This finding would indicate that the constructs are related, yet theoretically different. First, we note that postsecondary education and employment are often found to be related to autism symptoms, with those with fewer symptoms assessed with standard diagnostic instruments more likely to participate in postsecondary education and employment.10–12 However, when assessed with the Autism Spectrum Quotient (AQ),15,16 autistic traits are often not found to highly correlate with functional independence or daily living skills.17–20 Thus, we were primarily interested in the size of the effect; a nonsignificant or small effect size would support discriminant validity. Last, given limited data reporting postsecondary vocational outcomes among young autistic adults in Australia, we examined change over time by comparing scores at baseline (T1) and 24-month follow-up (T2) in the autistic subsample. Research suggests fewer jobs and less variation in the types of jobs among autistic people,21 and poor transition into postsecondary employment and education among autistic youth.3 Given this, and also that the original VIAA study revealed stability in the vocational categories over time,8 we predicted that there would be stability of scores between the two time points in our sample.
Methods
Participants
Participants were 211 young autistic and nonautistic adults aged 17–26 years (autistic: n = 105, 61.9% male, Mage = 20.27, SD = 2.08; nonautistic controls: n = 106, 21.7% male, Mage = 20.48, SD = 1.91). All autistic participants had a self-reported clinical diagnosis of an autism spectrum disorder. Sixteen autistic participants (15.2%) reported co-occurring ID, with no co-occurring ID reported by the nonautistic participants.
Procedures
Participants were part of the longitudinal Study of Australian School Leavers with Autism (SASLA). We recruited participants from Australian autism organizations, parent support groups, secondary and tertiary education institutions, participant databases, and online recruitment platforms. We provided written information sheets to prospective participants. Those who wished to participate signed a written or online consent form. We obtained self and parental consent from participants younger than 18 years. Upon consent, participants were e-mailed a link to the survey on Qualtrics.22 Paper versions of the survey were posted to participants upon request. Data were collected at baseline and 24-month follow-up (the latter included autistic participants only). In the present study, baseline reflected the first postsecondary data point that was available for each participant. Data for n = 19 participants were available for an earlier time point, when they were still in secondary school. However, given that the VIAA is a measure of postschool activities, the first available postsecondary data were substituted for these participants.
Measures
The VIAA is an index designed for autistic people that measures the type, number of hours, and level of independence demonstrated in postsecondary vocational and education settings.8 Items are ranked on a 9-point scale (range 1–9), with higher scores indicating greater independence and engagement in vocational or educational settings. For the present study, we modified the VIAA to account for cultural differences (M-VIAA).
Modified version of the Vocational Index for Adults with Autism
The original instrument was modified to reflect terminology characteristic of the Australian environment. Specifically, “sheltered employment” was replaced with “day program” (recreational or other vocational activities that are not educational or paid employment); “degree- and nondegree-seeking program” was replaced with “University” and “TAFE (Technical and Further Education) or community college”; and “community employment” was replaced with “employment.” Participants were able to endorse multiple items on the M-VIAA with their highest ranked item reported. In the original VIAA, items are mutually exclusive. Table 1 provides all questions in the M-VIAA.
Table 1.
Modified Vocational Index for Adults with Autism for Autistic Participants
| Activity | Score | Frequency (%) |
|
|---|---|---|---|
| Time 1 | Time 2 | ||
| n | 105 | 39 | |
| University, TAFE, community college (mainstream or disability specific), and/or employment with no additional support—greater than 10 hours per week | 9 | 63 (60.0) | 20 (23.0) |
| University, TAFE, community college (mainstream or disability specific), and/or employment with no additional support—10 hours per week or less | 8 | 15 (14.3) | 8 (9.2) |
| Employment with additional supports—greater than 10 hours per week | 7 | 5 (4.8) | 4 (4.4) |
| Employment with additional supports—10 hours per week or less | 6 | 1 (1.0) | 0 (0) |
| Day program and supported employment—total activities greater than 10 hours per week | 5 | 2 (1.9) | 0 (0) |
| Day program and volunteering—total activities greater than 10 hours per week | 4 | 5 (4.8) | 0 (0 |
| Day program—10 hours per week or less | 3 | 2 (1.9) | 3 (3.4 |
| Volunteering with no other activities | 2 | 4 (3.8) | 2 (2.2) |
| No daytime activities | 1 | 8 (7.6) | 2 (2.2) |
TAFE, Technical and Further Education.
The Waisman Activities of Daily Living Scale (W-ADL)23 is a 17-item parent-report measure of independence in activities of daily living. We selected the W-ADL because, at the time, there were no available self-report measures of daily living skills that were designed for and validated in an autistic population and suitable for adolescents and adults with and without ID.23 Items are rated from 0 to 2 (range 0–34), with higher scores representing greater levels of independence. In the present study, we used the W-ADL to assess convergent validity as we predicted that vocational and functional independence (i.e., daily living skills) would be strongly related constructs. Parent report data were only available for 60 autistic participants. For the present study, Cronbach's alpha value is 0.89.
The Autism Spectrum Quotient-Short (AQ-Short)15 is a 28-item self-report measure of autistic traits, based on the original long version.16 Scores range from 28 to 112, with higher scores indicating greater level of autistic traits. In the present study, we used the AQ-Short to assess discriminant validity, predicting vocational independence would be weakly correlated with autistic traits. Internal reliability (α = 0.77–0.80) and test–retest reliability (r = 0.83), indicative of stability over time, have been shown to be good.24 For the present study, Cronbach's alpha value is 0.90.
Data cleaning and analysis strategy
For the included measures, only the AQ-Short had missing data––this was at random with five missing values (0.085%) imputed by the mean of the adjacent values. Missing cases at Time 2 for the M-VIAA were due to attrition. The M-VIAA and W-ADL were negatively skewed. Consequently, we conducted analyses with continuous variables with 1000 bootstrap samples with bias corrected and accelerated 95% confidence intervals (BCa 95% CIs). We determined significance by identifying confidence intervals that did not cross zero.25
We used chi-square tests with exact significance to examine the differences in categorical demographic categories (e.g., gender, education level). We conducted independent t-tests to investigate mean score differences between groups and used Pearson's correlations between the M-VIAA, W-ADL and AQ-Short, to test convergent and discriminant validity, respectively. Finally, we used paired sample t-tests to assess change over time on the M-VIAA in a subsample of autistic individuals who had responses available for two time points.
Results
Between-group comparisons
Table 2 provides basic demographic information for the final sample. Chi-square analysis on categorical demographic data revealed no significant difference between groups on living arrangements, country of birth, ethnicity, or English spoken at home, but there were significant group differences between gender and highest level of education. Table 3 reports means and standard deviations for age, the AQ-Short, M-VIAA for autistic and nonautistic participants, and the W-ADL for a subgroup of autistic participants. Age did not differ significantly between groups; however, as expected, the autistic sample scored significantly higher on autism traits than the nonautistic group. Overall, nonautistic participants returned significantly higher scores on the M-VIAA compared with autistic participants.
Table 2.
Participant Characteristics by Group and Between-Group Differences Tested with Chi-Square Test with Exact Significance
| Variable | Label | n (%) |
Group comparisons | |
|---|---|---|---|---|
| Autistic | Control | |||
| Gender | Male | 65 (61.9) | 23 (21.7) | χ2(1) = 35.07, p < 0.001 |
| Female | 40 (38.1 | 83 (78.3 | ||
| Living | Both parents | 65 (61.9 | 66 (62.3 | χ2(7) = 12.04, p = 0.09 |
| One parent | 21 (20.0 | 9 (8.55) | ||
| One parent + carer | 2 (1.9 | 7 (6.6) | ||
| Relatives | 3 (2.9 | 1 (0.9) | ||
| Alone | 2 (1.9) | 6 (5.7 | ||
| Others/share | 5 (4.8) | 7 (6.6 | ||
| Couple | 3 (2.9 | 6 (5.7 | ||
| Other | 3 (2.9) | 4 (3.8) | ||
| Education | Some primary school | 0 (0) | 0 (0 | χ2(7) = 20.91, p < 0.001 |
| Completed primary school | 0 (0 | 0 (0 | ||
| Some high school | 8 (8.4 | 0 (0) | ||
| Completed high school | 59 (62.1) | 65 (61.9) | ||
| TAFE | 21 (16.6) | 14 (13.3 | ||
| Trade | 1 (1.1 | 2 (1.9) | ||
| Undergraduate | 6 (6.3) | 21 (20.0) | ||
| Postgraduate | 0 (0 | 3 (2.9) | ||
| Country of birth | Australia | 91 (86.7) | 89 (84.0) | χ2(1) = 0.33, p = 0.57 |
| Other | 13 (12.4) | 16 (15.1) | ||
| Ethnicity | Australia | 74 (70.5) | 73 (68.9) | χ2(3) = 1.43, p = 0.70 |
| Aboriginal | 1 (1.0) | 1 (0.9) | ||
| Other | 26 (24.8) | 31 (29.2) | ||
| Prefer not to answer | 3 (2.9) | 1 (0.9 | ||
| English at home | Yes | 104 (99.0 | 99 (93.4 | χ2(1) = 4.62, p = 0.07 |
| No | 1 (1.0) | 7 (6.6) | ||
Table 3.
Means (SD) by Group, Including 1000 Bootstrapped Between Group Comparisons
| Autistic (n = 105) |
Nonautistic (n = 106) |
t(df) | BCa 95% CIa | d | |||||
|---|---|---|---|---|---|---|---|---|---|
| M | SD | Range | M | SD | Range | ||||
| Age | 20.27 | 2.08 | 17–26 | 20.48 | 1.91 | 17–24 | 0.78 (209) | −0.27 to 0.77 | 0.11 |
| AQ-Short | 77.62 | 12.07 | 36–106 | 61.03 | 11.87 | 33–92 | 10.07 (209) | 13.13 to 19.80 | 1.39 |
| M-VIAA | 7.43 | 2.63 | 1–9 | 8.59 | 1.50 | 1–9 | 3.94 (164.98) | 0.58 to 1.75 | 0.54 |
| W-ADLb | 24.90 | 6.12 | 3–34 | — | — | — | — | — | |
Bold indicates that BCa 95% CI does not cross zero.
Autistic participants only, n = 60.
AQ-Short, Autism Spectrum Quotient-Short; BCa 95% CI, bias corrected and accelerated 95% confidence intervals; M-VIAA, modified version of the Vocational Index for Adults with Autism; W-ADL, Waisman Activities of Daily Living Scale.
Convergent and discriminate validity
Table 4 shows correlations between key variables for the autistic sample. A review of BCa 95% CIs revealed that the M-VIAA was negatively and significantly correlated with the AQ-Short, exhibiting a small effect size. The W-ADL was not significantly correlated with the M-VIAA or the AQ-Short.
Table 4.
Pearson's Correlations Between Key Variables for the Autistic Group with 1000 Bootstraps
| M-VIAA |
AQ-Short |
|||
|---|---|---|---|---|
| r | BCa 95% CIa | r | BCa 95% CI | |
| AQ-Short | −0.25 | −0.10 to −0.38 | ||
| W-ADL | 0.12 | −0.12 to 0.34 | −0.08 | −0.34 to 0.20 |
Bold indicates that BCa 95% CI does not cross zero.
Follow-up comparison
Follow-up (T2) M-VIAA data were available for a small sample of autistic participants (n = 39). A paired sample t-test revealed no significant T1–T2 difference (T1: M = 7.90, SD = 2.25; T2: M = 7.36, SD = 2.58) with a small effect size, suggesting that M-VIAA scores were relatively stable over time, t(38) = 1.18, p = 0.25, d = 0.19, BCa 95% CI [−0.18 to 0.92].
Discussion
Despite a growing concern regarding employment and postsecondary vocational and education outcomes in autistic adults, few measures reliably assess the vocational activities of these individuals. The VIAA was designed to provide a reliable measure of vocational independence for use in the autistic population; however, there are no studies that have examined its psychometric properties and utility outside North America.8 Using data collected from a nationwide cohort of autistic adults in Australia, we examined the psychometric properties of the VIAA. The instrument was modified (M-VIAA) to be consistent with Australian vocational terminology and cultural context.
We note three key patterns in these data. First, compared with nonautistic individuals, autistic adults experienced lower rates of vocational independence, as indexed by scores on the M-VIAA, supporting concurrent validity. This is consistent with the challenges autistic individuals face when seeking employment.5,7,26,27 Second, in the present study and based on our predictions of the hypothesized relationships between vocational independence, autistic traits and daily living skills, the M-VIAA demonstrated mixed construct validity. As predicted, M-VIAA scores showed good discriminant validity through a significant but small association with autistic traits, but our hypothesis of a significant relationship with daily living skills, which would have supported convergent validity, was not supported. In previous research, Maenner et al.23 identified a positive relationship between the W-ADL and VIAA. It was thus surprising that this finding was not replicated in the present sample, a point we address later. Consistent with previous research,10,12 autistic individuals who reported higher levels of autistic traits also tended to report lower levels of vocational independence; however, the strength of this relationship was weak, supporting the prediction that the two measures assess theoretically distinct, although related, constructs. Third, M-VIAA scores were found to be relatively stable over a 24-month period when examined in a subset of follow-up data from autistic participants. This result was unsurprising given what we know about the barriers to higher education and employment among autistic people, and consistent with our hypothesis, as well as previous research using the original VIAA.8
Despite relatively high average scores on the W-ADL suggesting participants did not generally have difficulties with daily living skills, daily living skills were not significantly related to vocational independence as assessed with the M-VIAA. It may be that the W-ADL is less effective in capturing daily living skills in individuals without cognitive impairment compared with those with ID. Nonetheless, and despite the overall high average scores on the W-ADL, it is important to note that the spread of scores on the instrument was reasonably wide suggesting variance in participants' adaptive living skills. The use of the parent-report W-ADL and self-report M-VIAA might account for the lack of a significant correlation between these measures. Unfortunately, the original W-ADL is not available as a self-report measure, and therefore, we were reliant on parent-report. However, our result might also reflect that additional complex barriers impact the ability to achieve vocational independence, affecting the relationship between daily living and independence assessed with the M-VIAA (i.e., vocational independence). Studies examining vocational outcomes in autistic adults have found several correlates of sustained employment, including higher family income, larger maternal social network, inclusive school environment in early childhood, well-managed personal care, lower levels of maladaptive behavior (primarily asocial behaviors), fewer maternal depressive symptoms, and being male.10,28 It is clear from these data, and that of previous research, that the relationship between daily living skills and vocational independence is less than straightforward.
Our finding of a small but significant negative relationship between autistic traits and vocational independence was consistent with research by Tillmann et al.28 They examined factors underlying adaptive functioning in the EU-AIMS cohort, finding more pronounced social-communicative symptoms on the SRS-2 were associated with lower levels of adaptive functioning in “real-world” settings. In autistic individuals without an ID, as was characteristic of the majority of the participants in the present study, those with increased level of autistic traits may experience more difficulties in adaptive functioning, which extend to vocational and employment activities.
Our findings may also reflect our modification to the VIAA, the psychometric validity of the instrument in cultures outside North America, differences between how the instrument was applied in the present compared with the original studies, or sample differences. For example, our study differed from previous studies by predominantly including individuals without an ID,8,9 the use of parent-report instead of self-report W-ADL (which could be addressed in the future by including a self-report measure of daily living skills), and use of an Internet survey instead of in-person or telephone interviews to respond to the VIAA. In-person or telephone interviews in previous studies may have allowed for more in-depth discussion with the individual concerning their daytime activities, potentially leading to a change in the response item selected.8 However, more closely replicating previous VIAA studies was beyond the scope of the present study. With regard to these possibilities, it is also important to note that the VIAA and also the M-VIAA provide relatively simplistic categorization of all possible postsecondary vocational outcomes, particularly if not used in conjunction with an interview. In terms of our between-group comparisons, the M-VIAA clearly identified the vocational difficulties faced by autistic individuals compared with nonautistic controls. What was less clear is whether the instrument functions as much more than a means of gathering demographic data associated with vocational activities. Certainly, there is a need for a standardized instrument for assessing vocation across studies, research samples, and cultures, but it is not clear that the VIAA achieves this goal given that many of the terms are limited to a particular geographic region. Thus, while the VIAA provides a standardized assessment of vocational independence, it may require some adaption when applied to different settings (e.g., culture, sample) to the original context in which it was developed. Future research could build on the structure of the VIAA, but with a focus on designing the instrument to be applicable across cultures and contexts, providing a richer picture of vocational activities that autistic individuals are engaged in, and on better capturing some of the complexity underpinning vocational independence in this population. It will also be important for future designs to incorporate co-development with autistic people, to ensure relevance and appropriateness to the intended user group.
Several limitations need to be considered when interpreting the current findings. First, as touched on above, the M-VIAA produced a single item total score, which provides limited information about the richness of vocational activities that autistic individuals may be engaged in. Second, compared with some previous studies,9–14 the study was limited by the small portion of individuals reporting an ID, and the limited availability of follow-up data. Furthermore, we acknowledge that our assessment of change over time on the M-VIAA does not assess the reliability of the instrument, as the vocational activities an individual is engaged in are likely to reflect many external factors and may not be expected to be stable over time. However, as we have argued here, “vocational independence” as a construct is likely to reflect an interaction between individual and environment factors. The M-VIAA may therefore provide a useful measure for the evaluation of interventions aimed at improving postsecondary vocational and educational outcomes. Third, the use of the parent-report W-ADL, and potential issues with using the W-ADL in individuals who predominantly did not have ID, may have affected our findings concerning the relationship (or lack thereof) between daily living skills and vocational independence. Thus, it is difficult to determine whether the lack of a significant relationship is a function of the M-VIAA, or the W-ADL. Fourth, our use of a typically developing control group was limited as many of the M-VIAA categories (e.g., supported employment) would be inaccessible to people without a disability. It would be beneficial for future studies to use a control group with disabilities, who would demonstrate greater score variability on the instrument. Last, the modifications required to make the instrument applicable to an Australian context limit our findings to this particular version and may not reflect performance of the original VIAA. We also did not collect data on the usability of the instrument, or how it was perceived by the autistic participants who completed it.
Our study provides mixed support for the construct validity of the M-VIAA, supporting concurrent, discriminate but not convergent validity––although this latter finding may be the result of methodological limitations. The M-VIAA also demonstrated stability of scores over time. Our findings therefore support the use of the M-VIAA among autistic people.
Ethical Approval
The research was approved by La Trobe University Human Ethics Committee No. 14–095 (SLLS). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from participants after the nature of the study was explained.
Authorship Confirmation Statement
E.S., D.H., and S.B. conceived and designed the study. E.S. and S.B. analyzed the data. E.S., D.H., and S.B. drafted the article, incorporating edits, or suggestions from all authors. D.H. completed all final edits, and all authors critically reviewed the article and approved the final article as submitted. E.S. and D.H. contributed equally to the production of the article.
Acknowledgment
We thank the individuals who participated in this study.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
The authors acknowledge the financial support of the Cooperative Research Centre for Living with Autism (Autism CRC), established and supported under the Australian Government's Cooperative Research Centres Program. D.H. and S.B. receive funding from DXC Technology and the ANZ Bank. The funders had no role in the study design, data collection, analysis, data interpretation, or writing of the report.
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