Development and Reliability of the Autism Work Skills Questionnaire (AWSQ)
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BRIEF REPORT
Development and Reliability of the Autism Work Skills
Questionnaire (AWSQ)
Eynat Gal, Anat Ben Meir, Noomi Katz
MeSH TERMS OBJECTIVE. The Autism Work Skills Questionnaire (AWSQ), a new, comprehensive self-report assessment of
autistic disorder a person’s vocational profile, was developed to help produce a good person–job match. This preliminary study
was aimed at developing the questionnaire and determining its content validity and internal consistency.
employment
METHOD. Forty-six adults with high-functioning autism spectrum disorder (HFASD), ages 18–39, were
questionnaires
interviewed with the questionnaire. A two-phase study was conducted: (1) constructing the questionnaire and
self-report
determining its content validity and (2) ascertaining internal consistency reliability.
vocational guidance
RESULTS. We found that the AWSQ had initial content validity and moderate to high internal consistency
reliability (Cronbach’s a 5 .64–.90).
CONCLUSION. The AWSQ can be a useful clinical and research tool in occupational therapy for evaluating
work skills of adults with HFASD. Further studies with larger samples and including both typically developing
individuals and individuals with HFASD are required to further support the questionnaire’s reliability and
validity.
Gal, E., Ben Meir, A., & Katz, N. (2013). Brief Report—Development and reliability of the Autism Work Skills Questionnaire
(AWSQ). American Journal of Occupational Therapy, 67, e1–e5. http://dx.doi.org/10.5014/ajot.2013.005066
A utism spectrum disorder (ASD) is
Eynat Gal, PhD, OTR, is Director, Developmental employed in jobs that do not meet their
Disabilities Department, Department of Occupational typically diagnosed in early childhood abilities and preferences (Muller, Schuler,
Therapy, University of Haifa, Mount Carmel, Haifa 31905
and has a lifelong course. Despite the Burton, & Yates, 2003). Current surveys in
Israel; eynatgal@gmail.com
development of improved methods of the United States and United Kingdom in-
Anat Ben Meir, MSc, OTR, is Occupational Therapy assessment and treatment, the long-term dicate that 90% of adults with ASD > age
Supervisor, Education Department, Ariel, Israel, and prognosis is grim. Most people with ASD 22 cannot gain or maintain competitive
Graduate, School of Occupational Therapy, Hebrew
and high-functioning autism spectrum employment (Seltzer et al., 2003). In the
University in Jerusalem, Israel.
disorders (HFASD) have difficulty par- United Kingdom, only 2% at the low end
Noomi Katz, PhD, OTR, is Director, Research Institute ticipating in everyday life occupations. and 12% at the high end of the autism
for Health and Medical Professions, Ono Academic The International Classification of Func- spectrum work in full-time paid jobs
College, Kiryat Ono, Israel. tioning, Disability and Health (World (National Autistic Society, 2010).
Health Organization [WHO], 2001) states By definition, people with HFASD
that one’s ability to work is significant have difficulties in social and communi-
for one’s health and well-being. However, cation skills and a restricted repertoire of
although approximately 20%–25% of activities and interests. The disabilities of
people with ASD have average and above- people with HFASD may affect complex
average intelligence, are capable of work- interactions such as those needed in the
ing in competitive employment (Howlin, various stages of finding and retaining
Alcock, & Burkin, 2005), and can work a job. The social, communication, and
successfully in community businesses (Capo, behavioral differences that people with
2001), people with HFASD face substantial HFASD present may therefore hinder their
difficulty finding and retaining paid em- professional success even if they have excellent
ployment (Barnard, Harvard, Potter, & technical and vocational skills. Other barriers
Prior, 2001; Hagner & Cooney, 2005). As to employment for this population are en-
a result, many are not employed or are vironmental, namely employers’ ignorance
The American Journal of Occupational Therapy e1
Downloaded From: http://ajot.aota.org/ on 11/13/2018 Terms of Use: http://AOTA.org/termsof the characteristics of autism and of po- nesses of adults with HFASD, and to assess identified through this process included
tential adaptations to improve the accessi- its internal consistency reliability. 117 items that were formulated with clear
bility of people with ASD to the world of and understandable terminology, encom-
work. passing the main strengths and weaknesses
Method
However, people with HFASD often of people with ASD that could potentially
possess qualities such as a high level of Research Design affect their vocational success. These items
math and computer skills and memory were divided into six domains that relate to
skills that may be of benefit for work. The study was performed in two phases: the ability to work.
Many of these people have other traits (1) construction of the questionnaire and For each item, the participants with
that employers may find advantageous, determination of its content validity and HFASD were asked to rate their perfor-
such as honesty, reliability, and persis- (2) determination of the internal consis- mance on a 5-point Likert scale ranging
tence (Mawhood & Howlin, 1999). Re- tency reliability of the questionnaire’s from 5 (very high) to 1 (very low); higher
search aimed at determining the needs domains. Approval for the study was ob- scores indicated better performance. Some
and strategies that may benefit people tained from the ethics committee of the items were worded for reverse coding.
with ASD has suggested that they require Israeli Ministry of Welfare, Ministry of Next, content validity was assessed on
vocational supports that differ from those Education, and the Hebrew University. the basis of the experts’ evaluation of the
recommended for people with other types Participants and their parents or guardians AWSQ items (Benson & Clark, 1982).
of developmental disabilities, mental retarda- signed the informed consent forms. The original 117-item questionnaire was
tion, or both (Muller et al., 2003). Phase 1: Construction of the Question- reviewed by two expert consultants and
It is often possible to make the naire and Determination of Content Val- three vocational rehabilitation specialists
working environment accessible to people idity. The AWSQ was developed specifically experienced in working with people with
with special needs, but the needs of those to assess adults with HFASD who have ASD. They were asked to evaluate whether
with HFASD are unique to each in- completed high school as well as adults who these 117 items would provide the in-
dividual and must be identified by reports are ready to begin their vocational life, are formation needed to assess work readiness
of caregivers, the person with HFASD already working, or have worked in the past. and abilities and then to rate the clarity of
himself or herself, or both. However, vo- Its purpose is to form the basis of an each item. They further assessed, through
cational support services for people with individual’s vocational profile, hence fa- a table of specifications, whether each
ASD rarely exist; services that have been cilitating a good person–job match. The remaining item related to one of the six
implemented mainly support the needs of questionnaire addresses personal and edu- domains previously identified. After the
lower functioning workers in protected cational data, employment history, work specialists’ input, and to shorten the ques-
employment environments (Inge, Dymond, habits and styles, independence in work and tionnaire, 39 of the questions that were
& Wehman, 1996) and in work site coach- studying, work-related strengths and weak- identified as unclear or too complicated,
ing, supplemented by training by means nesses, previous obstacles to work, preferred repetitive of other questions, or irrelevant
of mock-ups of job-related situations physical and social environment, routine to assessing work-related abilities were
(Lattimore, Parsons, & Reid, 2006). daily activities, interpersonal skills, and fu- omitted. The remaining 78 questions con-
Considering the degree to which ture goals. stituted the final version of the questionnaire.
therapists are involved in evaluating and The first phase of AWSQ construc- To define the relatedness of each item
planning vocational intervention, a valid tion began with the selection of the to a domain, the agreement between the
and reliable assessment tool can be in- questionnaire items by the authors, all of specialists was divided into three levels: full
strumental in guiding clinicians’ decisions whom are experts in the area of ASD, agreement (i.e., percentage of items in
as to what kind of job placement could rehabilitation assessment, or both and have a domain on which all people agreed),
match the needs of people with HFASD >20 yr of clinical and research experience. partial agreement (i.e., percentage of items
(Baker, 2005; Bliss & Edmonds, 2008). They deliberated over what data were in a domain on which 3–4 people agreed),
Thus, the information provided by an ap- needed to assess work-related strengths and and poor agreement (i.e., percentage of
propriate assessment tool may serve as the weaknesses in people with HFASD; in items in a domain on whichobtained in the table of specifications until HFASD ages 18–39 yr (mean age 5 25.32 moderate, ranging from .65 to .69, which
an agreement was reached as to which do- yr, standard deviation 5 6.24) participated may indicate more variable responses to the
main it best reflected. in the study. All participants had at least more subjective items. No items were de-
Next, in a secondary qualitative pilot 10–12 yr of education. leted because this would not have improved
evaluation process, 3 people with HFASD Participants were recruited from Beit the level of reliability (see Table 1). The
and 3 of their parents were asked to re- Ekstein centers, which provide housing, AWSQ was originally developed in Hebrew
spond to the 78 questionnaire items with employment, and educational services and underwent a standardized translation
respect to themselves or their children. for people with special needs. All partic- process into English after validation.
According to the feedback obtained in the ipants were in transition from an educa-
1-hr-long interviews, the items were easy tional setting to employment or had been
to understand, and the questionnaire re- employed in the past and needed a job.
Discussion
flected its prescribed objective and pro- Participants with known serious ill- The development of the AWSQ is a first
vided a thorough profile of the participants’ nesses, injuries, physical disabilities, or step in addressing an urgent need to en-
work-related strengths and weaknesses. intellectual disability were excluded from hance the ability of therapists and edu-
After this process, the final product the study. cators to assess work-related skills to assist
contained nine subscales, of which three people with HFASD in finding jobs that
address personal and educational data and Procedure and Data Analysis meet their needs. The AWSQ derives from
information regarding the person’s work- the perception of participation as an in-
The AWSQ was completed during in-
related past and present. The remaining six dicator of function and health, also reflected
dividual interviews with the participants
subscales focus on work-related skills and by the ability to engage in appropriate
by the second author (Anat Ben Meir),
consider the following six domains: work vocations (WHO, 2001). Moreover, re-
an experienced clinician with intensive
habits, working style, independence in liable and valid assessments that specifi-
experience working with people with
work and studying, sensory responses and cally relate to the work-related strengths
ASD. After data collection, descriptive
needs, routine daily activities, and in- and weaknesses of those with HFASD are
statistics (means, standard deviations) of
terpersonal skills. The number of items in lacking. This study established the AWSQ’s
all domains of the AWSQ were calcu-
each domain vary; thus, the means of the content validity by expert qualitative evalu-
lated, and Cronbach’s a coefficient was
scores in each of these six domains consti- ation, and internal consistency reliabilities of
used for internal consistency reliability of
tute the final scores (Table 1). the six work-related questionnaire domain
the domain scales.
Phase 2: Internal Consistency Reliability. subscales were found to range from moderate
After the AWSQ was constructed, we ex- to high (Cronbach’s as 5 .65–.90). Thus, the
amined the internal consistency reliability
Results study results suggest that the AWSQ reliably
of the questionnaire’s domains. Internal consistency reliability of the ques- informs therapists about vocationally related
tionnaire domains ranged from moderate issues for people with HFASD in the various
Participants to high (Cronbach’s as 5 .65–.90), rep- work domains (work habits, working style,
The study sample consisted of a conve- resenting acceptable levels. The domains independence in work and studying, sensory
nience sample of adults who had pre- with the highest reliability values were responses and needs, routine daily activities,
viously been diagnosed with HFASD work habits (a 5 .89), routine daily ac- and interpersonal skills).
according to DSM–IV–TR criteria. Their tivities (a 5 .90), and independence in The questionnaire domains with the
diagnosis was validated for this study with work and studying (a 5 .79). These do- highest reliability values were work habits,
the Social Communication Questionnaire mains seem to be clearer and more objec- routine daily activities, and independence
(Berument, Rutter, Lord, Pickles, & Bailey, tive to the participants, resulting in higher in work and studying, indicating that most
1999; Rutter, Bailey, & Lord, 2003). internal consistency between the items. of those items do reflect the respective
Forty-six people (36 men, 10 women) with The a values of the other domains were domain. Indeed, the domains of work
Table 1. Autism Work Skills Questionnaire: Subscales, Example Items, Number of Items and Range of Scores, Means and Standard
Deviations, and Cronbach’s a
Domain Example Item Items in Each Domain (Range) M (SD) Cronbach’s a
Work habits Follows directions regarding work assignments 12 (12–60) 4.31 (0.50) .89
Working style Easily adjusts to changes at work (e.g., changes 10 (10–50) 3.36 (0.58) .65
in job assignment or environment)
Independence in work Can learn a new subject by self from written 10 (10–50) 3.34 (0.86) .79
and studying material
Sensory responses and needs Bothered by artificial lighting? 13 (13–65) 3.56 (0.63) .68
Routine daily activities Fits clothing to the work requirements 14 (14–70) 3.98 (0.78) .90
Interpersonal skills Likes to cooperate with colleagues at work 19 (19–95) 3.94 (0.40) .69
The American Journal of Occupational Therapy e3
Downloaded From: http://ajot.aota.org/ on 11/13/2018 Terms of Use: http://AOTA.org/termshabits, routine daily activities, and in- abilities (e.g., follow safety rules at work) and construct validity are recommended to dem-
dependence in work and studying, which their preferences (e.g., has to work in silence). onstrate its usefulness as a clinical tool.
describe a person’s behavior, were shown Indeed, this study’s results may sug-
to be easier to respond to and received more gest that people with HFASD are able
Implications for Occupational
consistent responses than sensory needs to report their performance and prefer-
or interpersonal skills. However, expert ences in relation to others (e.g., interper-
Therapy Practice
content validity of sensory needs or in- sonal skills) with only moderate reliability. The results of this study have the fol-
terpersonal skills suggests high agreement However, the high reliability of AWSQ lowing implications for occupational ther-
regarding the domains that their items re- domains that relate to a more objective apy practice:
flect. These two domains, which relate to self-description (e.g., work habits), based • The AWSQ provides guidelines and
one’s relationship with self and others, re- on interviews with people with HFASD, information on domains, abilities, and
quire a stronger sense of self-awareness. may suggest that adolescents and adults difficulties of persons with HFASD.
Therefore, one may assume that the mod- with HFASD are able to report such skills • When using assessments that examine
erate internal reliability of these domains and abilities in a very reliable way. This vocational skills of people with HFASD,
may reflect the difficulty people with finding supports recent trends in health therapists need to consider self-report by
HFASD have in responding to items that care that have resulted in emphasizing the person with HFASD in addition to
require comparing themselves with others people’s self-reporting of their experi- the report of a parent or guardian or
and with social norms in a highly reliable ences, health care, and needs (Cremeens a therapist when interpreting results.
matter, in contrast to more objective re- et al., 2006). The self-report method of
porting about themselves. This assumption gathering information also ensures that
needs to be further studied because it may be information about subjective experiences
Conclusion
that the lower correlations indeed indicate and internal feelings is not overlooked and, The AWSQ, a self-report questionnaire
lower reliability; therefore, this portion of the in most cases, can be reported by the people for people with HFASD, was found to be
questionnaire requires further studies. concerned, in addition to their parents’ or easy to use, comprehensive, and reliable.
Caregiver reports have long repre- caregivers’ reports or clinical observations. This study represents the first stage in the
sented the major source of information development of a comprehensive inter-
about children and adults with ASD. Some vention program to assist in adapting vo-
advantages of using reports from caregivers
Limitations and Future Research cational placements for people with
are their familiarity with the child, their This initial study serves as a pilot only HFASD. The information that this tool
ability to comprehend the questions, and because the number of participants was provides may be useful in deciding what
their extensive observations of the fre- small. For the AWSQ to be appropriate for kind of job placement may meet the
quency and timing of behaviors (Grills & distribution to the broad occupational specific person’s needs and what kind of
Ollendick, 2002; Hanna & Rodger, 2002; therapy audience, it would be prudent to environment and support will meet his
Rogers, Hepburn, & Wehner, 2003). Pa- further establish the questionnaire’s val- or her needs as a worker. The results
rents’ and caregivers’ reports are also used idity by examining it with a larger pop- strengthen the contention that adolescents
to avoid potential problems that some- ulation of people with ASD as well as with and adults with HFASD are capable of re-
times arise when children and adults with other clinical and typically developing porting their own abilities and needs. s
disabilities are the information providers, populations. Ongoing studies focus on (1)
such as misunderstanding of questions be- collecting data from a group of typically
cause of low cognitive levels, a tendency to developing people matched on age, gender, Acknowledgment
be influenced by situational factors, and and education with people with HFASD to We thank all the participants who took
barriers encountered because of deficien- establish the AWSQ’s construct validity part in this study, as well as the facilities,
cies in language development and abilities and (2) a 9-mo follow-up of a group of especially the Beit Eckstein organization
(Cremeens, Eiser, & Blades, 2006; Grills people with HFASD who were placed in that enabled us to collect data.
& Ollendick, 2002). Some of these barriers jobs according to the AWSQ results and
may apply specifically to people with ASD, assessment of their work behavior and sat-
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