December 21, 2023
Aryn Taylor (UNC, Professor), Aubrey Corwin (VDI, Director/Owner), Amber Allison (VDI, Director of Research) wrote a manuscript that was published in The Rehabilitation Professional, released September 2023. This article, titled “The Intersection of Developmental and Acquired Disabilities, Mental Health, and Employment: A Review for Rehabilitation Professionals,” discusses two complex disabilities that occur on a spectrum of severity: autism spectrum disorder (ASD) and traumatic brain injury (TBI), within the context of the mental health comorbidities and the employment outcomes associated with individuals with disabilities. Below is a brief synopsis of the article, but please email us if you are interested in reading the full manuscript.
Individuals working in fields such as vocational rehabilitation are responsible for serving individuals with complex and chronic disabilities, such as developmental and acquired disabilities. Developmental disabilities are characterized as “lifelong conditions due to an impairment in physical, language, or behavior areas;” these conditions can include Autism Spectrum Disorder (ASD), Learning Disabilities, Cerebral Palsy, and deafness. An acquired disability is one which occurs after birth and the manifestation depends on the particular body part injured or impacted; the two types of brain injury are traumatic and non-traumatic. Traumatic brain injury (TBI) is an insult to the brain caused by an external physical force, such as falls, assaults, sports injuries, or motor vehicle accidents. A non-traumatic brain injury causes damage to the brain by internal factors, such as a lack of oxygen, exposure to toxins, pressure from a tumor, or aneurysm.
In the case of both developmental and acquired brain injury, there are significant disparities in the comorbidity of mental health conditions, when compared to the nondisabled population. In fact, over half of individuals with ASD experience pathological levels of anxiety, and anxiety has been reported at rates as high as 70% in participants with a history of moderate-severe TBI. Clearly, the development of an anxiety disorder is a strong predictor of social, personal, and work dysfunction, which are areas that individuals with disabilities are already likely to struggle in.
Regardless of type of disability, age of onset, or demographics, individuals with disabilities have the right to full societal inclusion in their communities; however, historically, this right has been denied because of barriers ranging from access to attitudes. While the ability of individuals with disabilities to work has been proven repeatedly through initiatives, research, and demonstration projects, the percentage of jobless individuals with disabilities has remained high (approximately 80%) over the years. This may be related to the high level of comorbid mental health conditions that impact individuals with disabilities, though the current understanding of this phenomenon is largely lacking.
What is clear from the literature is that work has an essential role in people’s lives. The benefits of work are well described in the rehabilitation counseling literature and include positive impacts to social factors such as a sense of belonging, inclusion, psychological wellbeing, and productivity, as well as factors related to physical health, access to health insurance, and financial stability. A common theme across individuals with ASD or TBI and mental health diagnoses is that the person factors, the job factors, and the work environment are all important in facilitating work integration. Person factors, such as gender, race/ethnicity, age, and economic status impact employment outcomes, though employers and colleagues who are understanding and supportive are viewed as key enablers of work integration and employment success. Environmental barriers involve the factors outside of the individual’s control and beyond the job-specific factors, including labor market forces and benefit systems that do not support work integration opportunities.
Careful consideration must be given to all factors contributing to an individual’s disability when evaluating future care needs and earning capacity in a forensic setting. A forensic vocational expert should be aware that person factors, job factors, and environmental factors interact to create myriad functional outcomes in individuals with developmental and acquired disabilities. Assessing an individual’s job-related interests, aptitudes, and values can provide important information regarding the type of employment they would both enjoy and be qualified for and analyzing this information within the context of their documented deficits can guide the formulation of opinions regarding employability and earning capacity.