A personal digital assistant intervention reduced job coaching support hours without reducing work performance among workers with autism.

Research objective: To determine if using a personal digital assistant (PDA) reduced the need for personal supports and improved work performance and competence among adult workers with autism spectrum disorder (ASD). Design: Waitlisted randomised controlled trial (RCT) with two intervention groups: the experimental group received the PDA intervention upon starting their job placement; the control group received the same intervention 12 weeks after commencement. Setting: Competitive employment work settings in Virginia, United States. Participants: Fifty-five adults with ASD commencing paid work placements with the support of a job coach consented to participate. Participants were randomised to either the experimental group (n = 28) or control group (n = 27). Two and three participants dropped out of the experimental and control groups, respectively, and were not included in the final analysis, leaving a final sample of 50. Intervention: An occupational therapist determined individual participants’ support needs, configured relevant applications on PDAs and provided training to participants on how to use the applications at work. Applications included task lists and reminders, visual prompts, wayfinding tools, Wi-Fi-enabled communication with their job coach and behavioural adaptation cues. The occupational therapist shadowed participants at work and faded support as applications were integrated into work tasks. Outcome measures: Baseline functional independence was measured with the Craig Handicap Assessment and Rating Technique (CHART). Job coaches used the Employment Subscale of the Supports Intensity Scale (SIS-EPS) to assess participants’ work-related support needs at 4, 12 and 24 weeks. Quality of work performance was rated by job coaches using the Employee Performance Evaluation Report (EPER). Number of hours worked by participants and job coach support hours were reported by the job coaches. Main results: Participants used no more than five PDA applications for job support. The experimental group received 1.56 times less cumulative hours of job coach support compared to the control group at 12 weeks (P = 0.0056), and 1.67 times less support at 24 weeks (P = 0.0061). Occupational therapy support hours were not reported. Estimated savings in job coaching costs averaged $379 over 12 weeks and $2,025 over 24 weeks. SIS-EPS and EPER scores did not differ between the experimental and control groups at all time points. Authors’ conclusions: The PDA was a cost-effective adjuvant support, and when introduced at job commencement, did not decrease job performance while significantly reducing the number of personal support hours provided by job coaches. Occupational therapists should be trained in the use of PDAs as cognitivebehavioural aids before trialling them in vocational settings. Contact details of original author: [email protected]