Transition Planning for Students with Autism and Intellectual Disability: A Review of Research

Jane Roitsch* and Annemarie L. Horn
Department of Communication Disorders & Special Education
Old Dominion University

*Corresponding author: Dr. Jane Roitsch, 200 Child Study Center, Old Dominion University, Norfolk, VA, USA 23529-0136, jroitsch@odu.edu; phone: 757-683-4024

Receiving special education and/or related services under the Individuals with Disabilities Education Improvement Act (hereafter IDEA) begins with a referral, and an extensive assessment process follows to determine eligibility and placement (Yell & Drasgow, 2007).  Once found eligible, IDEA requires reevaluation to occur on an annual basis, at minimum, and a triennial reevaluation must be conducted at least every three years.  Though there is some overlap, these evaluations (i.e., annual and triennial) serve different purposes.  The annual evaluation determines individual educational needs of the student, evaluates progress, and assesses whether adjustments to special education or related services are required for the student to meet his or her annual IEP goals.  The triennial reevaluation, on the other hand, “is to determine if a student is still eligible for services under IDEA” (Yell & Drasgow, 2007, p. 200).  After reviewing student data, the parents and team may agree to waive the triennial reevaluation, if it is determined that the student continues to have the disability and his or her educational needs are being met in the current placement. 

If a student has significant disabilities or multiple disabilities (e.g., ASD and comorbid ID), and is making adequate progress, the IEP team may be more likely to decline triennial reevaluation testing, compared to a student with a specific learning disability (SLD) who receives special education services in the general education classroom. 

Given the unique characteristics, abilities, and social and communicative limitations observed in students with ASD and comorbid ID, it is plausible to think that it may be challenging to obtain reliable assessment data from these students.  Further, the team-based decision to waive the triennial reevaluation may not impact the educational programming of such students.  Nevertheless, could underlying potential be overlooked in students with ASD and ID?  For example, a student with ASD who, according to the DSM-5, falls in the Level 3 severity range (i.e., “requiring very substantial support;” American Psychiatric Association, 2013) and has comorbid ID may have strengths and abilities that are overshadowed by the severity of the disabilities and the hidden potential may fail to be unlocked, consequently affecting post school success. Despite the fact that federal mandates governed by IDEA require students with disabilities to have an individualized transition plan (ITP) on or before their sixteenth birthday, the unique social and communicative deficits observed in many students with ASD may misleadingly lower perceived cognitive abilities. Consequently, academic expectations may be lowered, affecting the post school trajectory of the student and focus of transition planning and services leading up to that point.  Essentially, a key question is, what determines the most successful CBI placement and opportunities for students with ASD and underlying ID in transition services?

Prior Research

We identified reviews of literature, systematic reviews, and meta-analyses in order to have a comprehensive representation and analysis of intervention outcomes, and included studies that met the following criteria:

1) included transition-aged youth (i.e., between 14 and 21 years) with a diagnosis of ASD and comorbid ID,

2) who were receiving special education transition services as part of their individualized education program (IEP); and

3) original research, systematic reviews, or meta-analyses of original research,  

4) that were published in a peer-reviewed journal,

5) and were conducted in the years since IDEA was passed (2004-2020).

Research design and treatment duration did not limit study inclusion. Databases and websites, including ASHA, ASHA Perspectives, Google Scholar, Academic Search Complete, Education Full Text, Education Research Complete, Education Source, ERIC, Psychology and Behavioral Sciences Collection, PubMed, EBSCOhost, and PsycINFO, were searched using the following terms: Transition services AND high school AND IEP goals AND post-secondary transition OR post-secondary employment AND autism spectrum disorder OR ASD AND intellectual disability OR ID OR mental retardation OR MR AND systematic review OR review OR meta-analysis.

We used a three-step process to identify article abstracts (see Figure 1). Initially, the search terms provided 37 records. After excluding duplications and utilizing the inclusion criteria, the list was narrowed to 20 possible articles. Upon further analysis, 14 review articles were deemed appropriate for full text analysis. After full text analysis, five review articles were found to meet the inclusion criteria. A hand-search of references revealed no other articles were missed during the online search. Of the review articles, three were systematic reviews (Hedley et al., 2017; and Chandroo, Strnadová, and Cumming, 2018). One article was a synthesis review of the literature (Nicholas, Attridge, Zwaigenbaum, & Clarke, 2015), and two articles were research reviews (Chen, Leader, Sung, & Leahy, 2015; Anderson, Sosnowy, Kuo, & Shattuck, 2018). 

 Theoretical Rationale

Systematic reviews (SRs) provide a comprehensive review of the literature. Although SRs can identify best practices and outcomes for transition placement of students with ASD, not all reviews are conducted with the same rigor (Schlosser, Wendt, & Sigafoos, 2007). Therefore, we used the Evidence in Augmentative and Alternative Communication (EVIDAAC) Systematic Review Scale (Schlosser et al., 2008) to provide a quality assessment of the three systematic reviews. The EVIDAAC scale is a 20-question appraisal tool, of which 14 questions directly address the quality of systematic reviews (the remaining 6 questions include meta-analyses). To ensure reliability of answers, the authors individually rated the articles and compared ratings. There were no discrepancies in our ratings comparisons.

The Hedley et al (2017) systematic review identified and assessed studies involving the employment programs and interventions for persons with ASD 18 years of age and older. The authors summarized that the 50 empirical studies were limited by small sample sizes, outcome measures and conceptualization of outcomes, lack of randomization, and poor or no use of appropriate control groups. The EVIDAAC score for Hedley et al. (2017) the authors of this paper agreed upon was 11/14. Hedley et al. (2017) reported to follow the Preferred Reporting items for Systematic Reviews and Meta-Analyses: PRISMA statement (Moher, Liberati, Tetzlaff, and Altman, 2009) in their review. The PRISMA statement is a 27-item checklist to guide authors in their reporting of systematic reviews and meta-analyses. However, we were not able to identify whether the authors had attempted three of the criteria in the EVIDAAC scale: 1) to locate unpublished studies, 2) fully list inclusion criteria, or 3) reported a log of rejected studies.

Chandroo et al. (2018) conducted a systematic review to research how much involvement students with ASD have in their transition planning. In the 15 articles that met inclusion criteria for their study, the authors reported an overall lack of student involvement in their transition planning processes. Similar to the Hedley et al (2017) results, the Chandroo et al. (2018) systematic review earned a score of 11/14 on the EVIDAAC rating scale. We were not able to identify if the authors attempted to locate unpublished studies, conducted hand-searches of references, or posted a log of rejected studies.

Other Reviews 

We also used a synthesis of the literature to provide a close look at studies specifically focusing on individualized student supports provided and the acquisition of new job-related skills gained during transition years in students with ASD and ID. Other researchers reported the results of 10 studies in their synthesis review examining employment supports for adults with ASD (Nicholas et al., 2015). Although supported employment in community settings was evidenced to show potential as an emerging construct for persons with ASD, the authors caution that definitive research regarding supports for adults with ASD is limited in quality and number of publications.

To provide a review of employment trends in persons with ASD, Chen et al. (2015) conducted a review of the research. In their review, the authors assessed adult outcome studies and national data sets to discern employment outcomes for individuals with ASD, with a significant focus of their work reporting the challenges that faces persons with ASD regarding employment. Although the authors echo the caution of the prior reviews, Chen et al. (2015) suggest that internal challenges such as social deficits, challenging behaviors, comorbid diagnoses, and education level were found in the literature to adversely impact employment in persons with ASD. Additionally, employers, characteristics, vocational services, receiving disability benefits, and socioeconomic family status were external factors influencing outcomes. The authors also reference the works of Cimera et al (2013), Hendricks and Wehman (2009), and Westbrook et al. (2014) when seeking to identify research on the impact of transition services in students with ASD.   

To ascertain the perspectives of individuals or stakeholders involved in the transition of school-age individuals with ASD into the workplace, Anderson et al. (2017) reviewed 17 qualitative research studies. The authors report that stakeholders felt effective interventions focused on relationships and collaborations more than on changing or modifying individual behaviors. The authors further report that the variation in support needs of individuals with ASD, lack of support outside the family, and differing goals and expectations among stakeholders can impair effective transitional workplace interventions for individuals with ASD. 

Results

The results of the systematic reviews and literature reviews can be found in Table 1.  All studies encouraged collaboration and student involvement with the transition planning process. Based on the EVIDAAC rating scale, the two systematic reviews were conducted with relative rigor. Both works emphasized the importance of more student-centered learning. However, both studies emphasized the need for further research to determine what successful transition interventions for students with ASD actually are, as the current research is limited at best. The literature reviews and the synthesis review echoed the results of the systematic reviews, encouraging collaboration and student involvement with the transition planning process. The authors also reference the paucity of research on transition planning and the poor postsecondary employment outcomes of persons with ASD as significant limitations of definitive transition planning.

The Need for Further Research and Collaboration

Current evidence suggests that although transition services for students with disabilities is an important topic, more research is needed regarding intervention strategy effectiveness and assessments that can best drive outcomes. In light of these findings, practitioners are encouraged to incorporate students in transition planning, as they [students] should be the core facilitators of all outcome-based collaborative planning efforts. Further, it is imperative for speech and other related service providers to collaboratively participate in transition planning and offer assessment-based recommendations. Special education teachers and speech-language pathologists alike should also trust their professional judgement and seek out specific measures as needed to best meet individual student needs and optimize strengths.  The reviewed studies caution that the paucity of research and the poor post-secondary employment outcomes of persons with ASD limit definitive transition planning to some extent. In sum, transition planning and providing adequate post-secondary transition services to students with disabilities is essential. However, more research is needed to examine various settings in which transition services are offered and how they relate to subsequent post school outcomes.  

References

American Psychiatric Association.  (2013). Diagnostic and statistical manual of mental disorders (5^th ed.).  Arlington, VA: American Psychiatric Association.

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(Supplement 4), S318-S327. https://doi.org/10.1542/peds.2016-4300I

Chandroo, R., Strnadová, I., & Cumming, T. (2018). A systematic review of the involvement of students with autism spectrum disorder in the transition planning process: Need for voice and empowerment. Research in Developmental Disabilities, 83, 8-17. https://doi.org/10.1016/j.ridd.2018.07.011

Chen, J. L., Leader, G., Sung, C., & Leahy, M. (2015). Trends in employment for individuals with autism spectrum disorder: A review of the research literature. Review Journal of Autism and Developmental Disorders, 2(2), 115-127 https://doi.org/10.1007/s40489-014-0041-6

Cimera, R. E., Burgess, S., & Bedesem, P. L. (2014). Does providing transition services by age 14 produce better vocational outcomes for students with intellectual disability? Research and Practice for Persons with Severe Disabilities, 39(1), 47–54. https://doi.org/10.1177/1540796914534633

Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168. https://doi.org/10.1146/annurev-psych-113011-143750

Hedley, D., Uljarević, M., Cameron, L., Halder, S., Richdale, A., & Dissanayake, C. (2017). Employment programmes and interventions targeting adults with autism spectrum disorder: A systematic review of the literature. Autism, 21(8), 929–941. https://doi.org/10.1177/1362361316661855

Landa, R. J., & Goldberg, M. C. (2005). Language, social, and executive functions in high functioning autism: A continuum of performance. Journal of Autism and Developmental Disorders, 35(5), 557–573. https://doi.org/10.1007/s10803-005-0001-1

Moher D., Liberati A., Tetzlaff J., Altman D, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. https://doi.org/10.1371/journal.pmed.1000097

Nicholas, D. B., Attridge, M., Zwaigenbaum, L., & Clarke, M. (2015). Vocational support approaches in autism spectrum disorder: A synthesis review of the literature. Autism, 19(2), 235–245. https://doi.org/10.1177/1362361313516548

Sackett, D. L., Strattus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000).  Evidence-based medicine: How to practice and teach EBM (2^nd ed.)  Edinburgh, Scotland: Churchill Livingstone.

Schlosser, R. W., Wendt, O., & Sigafoos, J. (2007). Not all reviews are created equal: Considerations for appraisal. Evidence-Based Communication Assessment and Intervention, 1, 138–150. https://doi.org/10.1080/17489530701560831

Westbrook, J., Fong, C., Nye, C., Williams, A., Wendt, O., & Cortopassi, T. (2015). Transition services for youth with autism: A systematic review. Research on Social Work Practice, 25(1), 10-20. https://doi.org/10.1177/1049731514524836

Yell, M. L. & Drasgow, E. (2007).  The individuals with disabilities education improvement act of 2004 and the 2006 regulations.  Assessment for Effective Intervention, 32(4), 194-201.

Photo by Audi Nissen on Unsplash