YOUTH WITH 

AUTISM

Roundtable Views of 

Services Needed 

During the Transition 

into Adulthood

Report to Congressional Requesters

October 2016

GAO-17-109

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-17-109, a report to 

congressional requesters

October 2016

YOUTH WITH AUTISM

Roundtable Views of Services Needed During 

the Transition into Adulthood

What GAO Found

Youth with Autism Spectrum Disorder (ASD) transitioning to adulthood may need

a wide range of services and supports to help them achieve their goals, 

according to a panel GAO convened in March 2016. ASD is a highly 

individualized condition with characteristics that vary in degree and type from 

person to person. Autism characteristics may hinder or help youth achieve their 

goals—such as postsecondary education and community integration. For each 

goal, the panel described services and supports that youth (ages 14-24) with 

ASD transitioning to adulthood may need to address autism characteristics and 

other health conditions that affect their ability to attain the goal. GAO grouped 

these services into 14 broad categories.

Key Services Needed to Support Transitioning Youth with Autism Spectrum Disorder

Behavioral interventions Mental health care

Case management/ coordination Postsecondary education planning and supports

Communication services Residential supports

Day programming Social supports

Family Education and Supports Transition Planning Services

Life Skills Education and Experience Transportation Supports

Medical care Vocational supports

Source: GAO analysis of roundtable discussion. | GAO-17-109

To support a successful transition into adulthood, the panel said youth need to 

be able to access services that are individualized, timely, equitable, and 

community- and evidence-based, among other things. The panel discussed the 

need for timely, individualized services that address the variation in autism 

characteristics and any changes over a person’s lifetime. For example, a

person’s verbal abilities may change over time, and their needs for

communication services would also change. The panel said transitioning youth 

with ASD need equitable access to services regardless of their race, gender, 

family income, or location. For instance, the panel said that female and minority 

youth may be diagnosed at a later age and thus receive fewer services during 

school and may need additional transition planning services. The panel also 

emphasized the need for services within youths’ local communities in order to 

foster access and community involvement. In addition, the panel said that while 

services should be evidence-based, more research into program efficacy is 

needed.

To improve the ability of autistic youth to fully integrate into society, the panel 

cited the need for a new approach to providing supports and better public 

understanding of autism. Such an approach would place a shared responsibility 

for inclusion on both society and youth with ASD. For example, according to the 

panel, youth with ASD should learn workplace social expectations and meet 

them to the extent they can, but employers should also recognize that some 

social rules, such as expecting individuals to smile, can be difficult for some 

individuals with autism. The panel also said that widespread knowledge of autism 

could lead to better understanding of autistic youths’ potential and enhance their 

chances of attaining it. 

View GAO-17-109. For more information, 

contact Jacqueline M. Nowicki at (617) 788-

0580 or nowickij@gao.gov.

Why GAO Did This Study

About a half a million youth with ASD 

will enter adulthood over the next 

decade. As they exit high school, they 

must obtain services as adults. 

Previous GAO work has shown that 

students with disabilities who are 

transitioning to adulthood face 

challenges identifying and obtaining 

adult services. GAO was asked to 

study the services and supports youth 

with ASD need during the transition to 

adulthood. This is the first in a series of 

reports.

GAO studied (1) the services and 

supports transitioning youth with ASD 

need to attain their goals for adulthood, 

(2) the characteristics of these services 

and supports, and (3) how youth with 

ASD can be fully integrated into 

society. To address these objectives,

GAO convened a roundtable 

discussion on March 3 and 4, 2016. 

GAO selected 24 panelists, including 

adults with ASD, service providers, 

researchers, and parents of youth with 

ASD. GAO interviewed prospective 

panelists in advance of the discussion

and selected a panel with a broad base 

of expertise reflecting the diversity of 

the autism community. 

The panel described the services and 

supports that youth with ASD may 

need to help them achieve five goals 

for adulthood: postsecondary 

education; employment; maximizing

independent living; health and safety; 

and maximizing community integration. 

GAO analyzed the transcripts of the 

panel as well as documents provided 

by panelists. GAO is not making 

recommendations in this report.
Page i GAO-17-109 Needs of Transitioning Youth with Autism

Letter 1

Background 4

Panel Theme: Needs for Services and Supports Depend on 

Transitioning Youths’ Goals for Adulthood 9

Panel Theme: The Need for Access to Evidence-Based Services 

that Are Individualized, Flexible, Timely, and Provided in the 

Community 17

Panel Theme: A New Approach to Supporting Youth with Autism 

to Enhance Their Integration into Society 24

Agency Comments 28

Appendix I Objectives, Scope, and Methodology 29

Appendix II Agenda and List of Invited Panelists 33

Appendix III Services and Supports for Transitioning Youth with Autism 

Identified By the Panel 37

Appendix IV GAO Contact and Staff Acknowledgements 46

Tables

Table 1: Services Panelists Identified as Supporting 

Postsecondary Education Goals of Transitioning Youth 

with Autism Spectrum Disorders 11

Table 2: Services Panelists Identified as Supporting Employment 

Goals of Transitioning Youth with Autism Spectrum 

Disorders 13

Table 3: Services Panelists Identified as Supporting Independent 

Living Goals of Transitioning Youth with Autism Spectrum 

Disorders 14

Table 4: Services Panelists Identified as Supporting Health and 

Safety Goals of Transitioning Youth with Autism Spectrum 

Disorders 16

Contents
Page ii GAO-17-109 Needs of Transitioning Youth with Autism

Table 5: Services Panelists Identified as Supporting Community 

Integration Goals of Transitioning Youth with Autism 

Spectrum Disorders 17

Table 6: Services that Support five Goals that Youth with Autism 

Spectrum Disorders (ASD) May Pursue in Adulthood, 

According to the Panel 37

Figures

Figure 1: Autism Spectrum Disorder (ASD) Characteristics 5

Figure 2: Variation in Autism Spectrum Disorder Characteristics 6

Figure 3: Roundtable Views of Goals Supported by Behavioral 

Services 38

Figure 4: Roundtable Views of Goals Supported by Case 

management/Coordination 38

Figure 5: Roundtable Views of Goals Supported by 

Communication Services 39

Figure 6: Roundtable Views of Goals Supported by Day 

Programming 39

Figure 7: Roundtable Views of Goals Supported by Family 

Education and Supports 40

Figure 8: Roundtable Views of Goals Supported by Life Skills 

Education and Experience 40

Figure 9: Roundtable Views of Goals Supported by Medical Care 

Services 41

Figure 10: Roundtable Views of Goals Supported by Mental 

Health Care Services 42

Figure 11: Roundtable Views of Goals Supported by 

Postsecondary Education Supports 42

Figure 12: Roundtable Views of Goals Supported by Residential 

Supports 43

Figure 13: Roundtable Views of Goals Supported by Social 

Supports 43

Figure 14: Roundtable Views of Goals Supported by Transition 

Planning Services 44

Figure 15: Roundtable Views of Goals Supported by 

Transportation Supports 44

Figure 16: Roundtable Views of Goals Supported by Vocational 

Supports 45
Page iii GAO-17-109 Needs of Transitioning Youth with Autism

Abbreviations

ADA American with Disabilities Act of 1990

ASD Autism Spectrum Disorder

Education U.S. Department of Education

HHS U.S. Department of Health and Human Services

IDEA Individuals with Disabilities Education Act

IEP Individualized Education Program

NLTS2 National Longitudinal Transition Study-2

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Page 1 GAO-17-109 Needs of Transitioning Youth with Autism

441 G St. N.W.

Washington, DC 20548

October 18, 2016

The Honorable Fred Upton

Chairman

Committee on Energy and Commerce

House of Representatives

The Honorable Joseph R. Pitts

Chairman

Subcommittee on Health

Committee on Energy and Commerce

House of Representatives

The Honorable Christopher H. Smith

House of Representatives

About a half million youth with Autism Spectrum Disorder (ASD) will enter 

adulthood over the next decade, according to a 2015 report.1 As these 

students exit high school, they leave their school-based support systems 

behind and must obtain services as adults, making the transition to 

adulthood particularly challenging.

2 Commonly known as autism, ASD is 

a group of complex developmental disorders characterized by difficulties 

with social interactions and communication, highly focused interests, and

repetitive or ritualized behaviors.3 While in elementary and secondary 

school, children with autism may receive many services—such as 

speech, behavioral, or occupational therapy, job training, and 

transportation—through their public schools, as required by the 

 1 Roux, Anne M., Shattuck, Paul T., Rast, Jessica E., Rava, Julianna A., and Anderson, 

Kristy, A. National Autism Indicators Report: Transition into Young Adulthood. 

Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, 

Drexel University, 2015.

2 For convenience, we use the term “youth” in this report to describe individuals aged 14 

to 24, the age range when they may be eligible for transition services, depending on their 

state. During the transition years, youth may receive services for children, adults, or both.

3 In this report, we use the following terms interchangeably: “individuals/youth with 

autism”, “individuals/youth with ASD”, and “autistic individuals.” Several panelists used the 

term “autistic” when describing themselves. 

Letter
Page 2 GAO-17-109 Needs of Transitioning Youth with Autism

Individuals with Disabilities Education Act (IDEA).4 However, according to 

our prior work, these services typically end when youth exit from school. 

Once students with disabilities complete their high school program, many 

of them face significant challenges obtaining the services they need to 

make a successful transition to higher education, work, or community 

life.

5

You asked us to provide information on the transition needs of youth with 

ASD. This report examines three questions:

1. What services and supports do transitioning youth with autism need to 

attain their goals for adulthood?

2. What are the characteristics of needed services and supports?

3. How can youth with autism be fully integrated into society?

This is the first in a series of reports on youth with autism who are 

transitioning to adulthood. In this report, we focus on describing the 

services that youth with ASD need to help them make a successful 

transition into adulthood. A second engagement will examine the services 

provided to transitioning youth with ASD and any challenges they may 

face obtaining them.

To answer our research questions, we convened a roundtable discussion 

on March 3 and 4, 2016. We selected a total of 24 panelists, including 

autistic adults, service providers, employers, researchers, and parents of 

youth with autism.6 We selected panelists based on their experience with 

or knowledge about autism, recommendations from other stakeholders 

with subject matter knowledge, and to ensure a variety of backgrounds 

and perspectives that reflect the diversity of the autism community, 

including variations in service areas, income, race, gender, geographic 

location, and urbanicity. See appendix I for our scope and methodology, 

 4 Individuals with Disabilities Education Improvement Act of 2004, Pub. L. No. 108-446, 

118 Stat. 2647 (codified as amended at 20 U.S.C. §§ 1400-1482).

5 GAO, Students with Disabilities: Better Federal Coordination Could Lessen Challenges 

in the Transition from High School, GAO-12-594 (Washington, D.C.: July 12, 2012).

6 Of the 24 invited panelists, 2 were not present at the meeting, including an autistic 

individual who does not use spoken language. We interviewed them afterward on the 

same topics covered during the panel and included this information in our analysis.
Page 3 GAO-17-109 Needs of Transitioning Youth with Autism

including more details about how we selected our panelists, and appendix 

II for a copy of the agenda for the event. We asked the panel about the 

services that transitioning youth across the autism spectrum need to help 

them achieve five goals for adulthood:

1. Postsecondary education.

2. Employment.

3. Maximizing independent living.

4. Health and safety.

5. Maximizing community integration.

We chose these goals because they were either listed in the transition 

planning requirements for high school students receiving special 

education services (goals 1, 2, and 3) or described by potential panelists 

in pre-selection interviews as particularly important (goals 4 and 5).7

We asked the panel to describe services ideally needed for a successful 

transition to adulthood, regardless of what services may currently be 

available or feasible. We did not verify the accuracy of the information 

they provided. The panel also pointed out that many of the services 

needed to support youth with ASD may also support youth with other 

disabilities. While we focus on how these services would particularly 

address characteristics associated with autism, the panel also cautioned 

against singling out autistic youth unnecessarily.

We identified the emerging themes which form the body of this report by 

conducting a content analysis of the transcript of the 2-day event as well 

as documents the panelists submitted to clarify or support information 

 7 See the background section for more information about special education and transition 

planning requirements. 
Page 4 GAO-17-109 Needs of Transitioning Youth with Autism

discussed during the panel meeting.8 Our systematic content analysis 

allowed us to attribute these themes, as well as specific examples given 

for illustrative purposes, to “the panel” throughout this report. We asked 

panelists for comments on a draft of this report, which we incorporated as 

appropriate.

For the purpose of this report, when discussing services that transitioning 

youth with autism may need, we grouped services under 14 broad 

categories, such as life skills education and experience, family education 

and supports, and vocational supports. The actual range of services 

provided under these terms could be quite broad, with significant variation 

in method, purpose, philosophy, and effectiveness. See appendix III for 

details on these service categories.

We conducted this performance audit from July 2015 to October 2016 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

According to the Centers for Disease Control and Prevention, about 1 in 

68 children were identified as having ASD in 2012 (about 1.5 percent of 

8-year olds).9 ASD is a complex developmental disorder with 

characteristics that can range from mild to more pronounced (see fig. 1).

 8 We used the NVivo content analysis software to categorize each sentence according to 

the goals, services, and/or cross-cutting needs being discussed. We identified the 

categories of services and cross-cutting needs—issues that applied to several services or 

goals, such as the need for sufficient access to supports or service provider 

accountability—by creating lists of each service and issue mentioned at least once during

the discussion or documents. We then grouped services into 14 broad categories and 

cross-cutting needs into 13 broad categories based on their relatedness and our 

understanding of autism services garnered from literature and interviews. We analyzed 

the text in each category to identify emerging themes. 

9 The Autism and Developmental Disabilities Monitoring Network is a group of programs 

funded by the Centers for Disease Control and Prevention that provides estimates of the 

prevalence of ASD and other characteristics among 8-year-old children whose parents or 

guardians live in 11 sites in the United States.

Background
Page 5 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 1: Autism Spectrum Disorder (ASD) Characteristics

Each autism characteristic may vary in type and degree from person to 

person and can fluctuate over time. The combination of characteristics 

results in a highly individualized condition, as illustrated in figure 2.
Page 6 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 2: Variation in Autism Spectrum Disorder Characteristics

Certain medical or mental health conditions—called comorbid 

conditions—often occur with autism. For example, data from the 2011 

Survey of Pathways to Diagnosis and Services showed that over half of 

autistic youth aged 15-17 had also been diagnosed with an attention 

deficit disorder (53 percent) or anxiety (51 percent), nearly one quarter 

had depression, and 60 percent had at least two comorbid conditions.10

Other common comorbid conditions include sleep disorders, intellectual 

disability, seizure disorders, and gastrointestinal ailments.

 10 The Survey of Pathways to Diagnosis and Services studied children 6-17 years old who 

had special health care needs, including youth with autism. The data reported here were 

collected from the parents of autistic youth aged 15 to 17 who were receiving special 

education services. These data were reported by Roux et al. 

Other Health Conditions 

Often Associated with 

Autism
Page 7 GAO-17-109 Needs of Transitioning Youth with Autism

To support the educational needs of children with disabilities, Congress 

originally passed IDEA in 1975.11 IDEA requires states and local 

educational agencies to identify and evaluate children with disabilities and 

provide special education and related services to those who are eligible. 

Such services and supports are formulated in an Individualized Education 

Program (IEP)12 and may include speech or occupational therapy and 

behavioral supports, among others. The 2004 reauthorization of IDEA13

required that, beginning no later than age 16, a student’s IEP must 

include measurable postsecondary goals, based on age-appropriate 

transition assessments, related to training, education, employment, and, 

where appropriate, independent living skills.14 The IEP must specify the 

transition services needed to assist the student in reaching those goals.15

Not all youth with autism received timely transition planning services, 

according to an analysis of data from the Department of Education’s 

(Education’s) National Longitudinal Transition Study-2 (NLTS2).16 That 

analysis showed that in 2009, 58 percent of young adults with ASD 

 11 IDEA was originally enacted as the Education for All Handicapped Children Act of 1975, 

Pub. L. No. 94-142, 89 Stat. 773 (codified as amended at 20 U.S.C. §§ 1400-1482).

12 20 U.S.C. § 1414(d)(1)(A)(i)(IV).

13 Individuals with Disabilities Education Improvement Act of 2004, Pub. L. No. 108-446, 

118 Stat. 2647 (codified as amended at 20 U.S.C. §§ 1400-1482). See 20 U.S.C. § 

1414(d)(1)(A)(i)(VIII). Since 1990, IDEA has required transition services to be part of a 

student’s IEP with refinements in subsequent reauthorizations.

14 Students remain eligible for transition planning and services, as well as other IDEA 

services, until they graduate from high school with a regular high school diploma or 

exceed the age range for which the state makes a free and appropriate public education 

available. While federal law authorizes students to receive a free appropriate public 

education until age 22, eligibility for students aged 18 to 21 is determined by states. 

Additionally, state laws may provide for high school attendance beyond age 22. 20 U.S.C. 

§ 1412(a)(1); 34 C.F.R. § 300.102(a)(1).

15 Transition services may include instruction, related services, community experiences, 

the development of employment and other post-school adult living objectives, and when 

appropriate, acquisition of daily living skills and functional vocational evaluation. See 20 

U.S.C. § 1401(34).

16 Roux et al. NLTS2 was funded by Education and documented the experiences of a 

national sample of students as they moved from secondary school into adult roles. The 

students were 13 to 16 years old in 2000 and 21 to 25 years old at the final data collection 

in 2009. While Education planned another longitudinal study, no data were available at the 

time of this report.

Federally Required 

Education and Transition 

Services for Children and 

Youth with Disabilities
Page 8 GAO-17-109 Needs of Transitioning Youth with Autism

reported that they had been given a transition plan by the federally 

required age. This percentage was lower for youth from lower income 

households, African-American youth, and youth with the highest 

conversation skills.17

Upon exiting high school, youth with autism may obtain services by 

applying as adults and establishing eligibility for a number of programs. 

Specifically, we reported in 2012 that four federal agencies—Education, 

the Department of Health and Human Services (HHS), the Department of 

Labor, and the Social Security Administration—administer the key federal 

programs that provide services to youth with disabilities as they transition 

from high school. In addition, these and other federal agencies fund a 

number of other programs through grants to states, localities, and 

nongovernmental organizations, which often have flexibility on how to 

administer services. For example, Education’s Rehabilitation Services 

Administration funds state vocational rehabilitation agencies through 

formula grants, which have a state matching requirement, to help people 

with disabilities prepare for and engage in gainful employment,18 and 

some states use Medicaid funds to provide home and community-based 

services for individuals with certain types of disabilities who might 

otherwise be cared for in an institutional setting.19

In our 2012 report, we found that youth and their families faced 

challenges in identifying, navigating, and establishing eligibility for 

services for adults with disabilities, including autism.20 In addition, we 

 17 Roux et al. The report found that less than half of youth with autism from low-income

households had received transition planning services in a timely fashion, compared to 60 

percent of youth with autism whose household incomes were above $75,000. Also, 63 

percent of youth with the lowest conversation skills and 48 percent of those with the 

highest skills had received timely transition planning. 

18 29 U.S.C. §§ 702, 706 and 721(a)(1)-(3).

19 States must obtain a waiver from Medicaid to provide home- and community-based 

care. Services provided with these waivers are individualized and may include case 

management, personal care attendants, or day or residential habilitation. Habilitation 

services are defined as “services designed to assist individuals in acquiring, retaining, and 

improving self-help, socialization, and adaptive skills necessary to reside successfully in 

home and community-based settings.” 42 U.S.C. § 1396n(c)(5). GAO-12-594.

20 GAO-12-594.

Adult Service Delivery 

System
Page 9 GAO-17-109 Needs of Transitioning Youth with Autism

found that the adult service system did not routinely provide a coordinated 

plan of services or objectives for youth making the transition to adulthood 

and—unlike the special education system for younger children—did less 

to ensure that needed services would be provided.21 Youth with autism 

who are entering the adult service system may have to apply to multiple 

agencies for services and establish their eligibility for each agency’s 

services. The difficulty obtaining adult services has been called “falling off 

a cliff” by the autism community.22

The panel told us that youth with ASD may need services addressing 

individual autism characteristics—or a combination of autism 

characteristics and other health conditions—that affect their ability to 

attain their goals for adulthood. The services needed to address any 

specific characteristic may differ depending on the goal. The panel told us 

that some characteristics of autism can be strengths that may help 

individuals with ASD achieve their goals—for example, intense focus on a 

specific interest can be very productive in the workplace. The panel 

discussed the importance of valuing the characteristics that may facilitate 

goals and warned against assuming that autism characteristics need to 

be “fixed.” The panel discussion, however, focused primarily on services 

and supports needed to address autism characteristics that can hinder 

progress toward goal attainment.

The panel told us that, like their peers without autism, many youth with 

ASD pursue postsecondary education or training, although not all of them 

finish their academic programs. According to NLTS2, in 2009, 36 percent 

of young adults with ASD had attended some type of postsecondary 

education institution. Of those youth, 32 percent had attended a 4-year 

college, 70 percent had attended a 2-year college, and 33 percent had 

 21 As we recommended in our 2012 report, Education, HHS, the Department of Labor, and 

the Social Security Administration announced a strategy to enhance interagency 

coordination. The strategy features development of a shared vision, compatible outcome 

goals, and policy priorities that aim ultimately to lead to improved outcomes for youth with 

disabilities by 2020. See The 2020 Federal Youth Transition Plan: A Federal Interagency 

Strategy, prepared by the Federal Partners in Transition Workgroup, February 2015.

22 Roux et al.

Panel Theme: Needs 

for Services and 

Supports Depend on 

Transitioning Youths’

Goals for Adulthood

Goal: Postsecondary 

Education
Page 10 GAO-17-109 Needs of Transitioning Youth with Autism

attended a vocational, business, or technical school.23 According to the 

panel, in addition to more traditional classroom settings, some youth with 

ASD also attend online programs and an increasing number of 

specialized colleges designed to meet the specific needs of students with 

disabilities.

According to the panel, youth with autism may need some of the same 

supports as other postsecondary students to help them succeed in the 

higher education environment, but may require increased intensity or 

providers with training in autism. For example, many students need help 

with organizational skills, such as managing time or prioritizing tasks, to 

keep up with the pace of academic demands. The panel cited mental 

health conditions, especially anxiety, as some of the biggest impediments 

to success in postsecondary education and said these conditions can 

have a greater effect than youths’ autism characteristics. Youth may also 

need supports to help them navigate social demands of college life, such 

as relationships with roommates, dating, and issues with alcohol and drug 

use. The panel noted that self-care is especially important because poor 

personal hygiene can lead to isolation. The panel also discussed the 

need to have stronger supports at the beginning of college that taper 

down as students experience success and learn to navigate the 

environment. Table 1 shows some of the services and supports that may 

be needed in a postsecondary education environment.

 23 These percentages sum to greater than 100% because some students may have 

attended more than one type of postsecondary institution. These data were reported by 

Roux et al. Education also produced a peer-reviewed report using the same data, which 

found that 44 percent of youth with autism had attended a postsecondary school. See 

Newman, L., Wagner, M., Knokey, A.-M., Marder, C., Nagle, K., Shaver, D., Wei, X., with 

Cameto, R.,Contreras, E., Ferguson, K., Greene, S., and Schwarting, M, The Post-High 

School Outcomes of Young Adults With Disabilities up to 8 Years After High School: A 

Report From the National Longitudinal Transition Study-2, NCSER 2011-3005 (SRI 

International, Menlo Park, CA: Sept. 2001).
Page 11 GAO-17-109 Needs of Transitioning Youth with Autism

Table 1: Services Panelists Identified as Supporting Postsecondary Education 

Goals of Transitioning Youth with Autism Spectrum Disorders 

Selected aspects of the goal

Succeeding in academics Handling social demands and living 

on campus

Services and 

supports that 

may address the 

needs

Organization and time 

management coachinga Social supports, including mentoring, peer support, coaching, and training

Autism assessments to help 

qualify for campus-based 

supportsb

Training or coaching on daily living 

skills, such as laundry, cooking, and 

self carea

Sexual education and health careb

Self-advocacy coaching or traininga

Mental health care

Source: GAO analysis of roundtable discussion. | GAO-17-109

a

For the purposes of this report, we have classified these supports under “life skills training and 

experience.”

b

For the purposes of this report, we have classified these supports under “medical care.”

Young adults with ASD have lower rates of employment than some other 

people with disabilities. For example, in 2009, 58 percent of youth with 

autism in their early 20s had ever worked for pay outside the home, 

compared to 91 percent of youth with emotional disturbances and 74 

percent of youth with intellectual disabilities.24 The diverse nature of 

autism means no single workplace setting or set of supports is 

appropriate for all autistic individuals. Examples of various workplace 

settings include the following:

• Full-time or part-time employment with market wages and 

responsibilities, with or without long-term supports—such as a job 

coach to help with communication and social navigation;

• Self-employment, which may offer the flexibility to tailor the job to the 

individual’s strengths and the work environment to their needs; and

• A workplace that primarily or exclusively employs individuals with 

disabilities—with wages that can fall below the federal minimum 

 24 Roux et al. 

Goal: Employment
Page 12 GAO-17-109 Needs of Transitioning Youth with Autism

wage.25 Some workplaces provide services, supervision, or training in 

life skills or vocational skills.

Customized employment may provide an opportunity for some individuals 

with autism who might otherwise not be able to find employment. 

Employers create a job specifically designed for an individual’s strengths, 

abilities and support needs.

The panel told us that the type and level of supports that youth may need 

to succeed in the workplace may vary over time. For example, youth may 

need training in job-seeking, interviewing, or organizational skills at the 

beginning of their employment, while they may need job coaching 

throughout their employment. The panel noted that while some programs 

may teach youth with autism how to interview and some of the logistics of 

work, youth also need to learn about navigating the social aspect of 

employment and may require ongoing support in this area. The panel 

noted that social difficulties in the workplace could lead to isolation, 

marginalization, or job termination. Additionally, according to the panel, 

some vocational supports could help youth find jobs that build on some of 

their autism strengths, such as the ability to focus intensely on a problem 

or activity or skills in following routines and performing tasks consistently. 

Some of the services and supports the panel discussed in conjunction 

with successful employment are highlighted in table 2.

 25An employer may obtain authority to pay wages lower than the otherwise applicable 

minimum wage to workers whose productivity is impaired by age, physical or mental 

deficiency, or injury. 29 U.S.C. § 214(c)(1); 29 C.F.R. pt. 525. 
Page 13 GAO-17-109 Needs of Transitioning Youth with Autism

Table 2: Services Panelists Identified as Supporting Employment Goals of Transitioning Youth with Autism Spectrum 

Disorders

Selected aspects of the goal

Finding the right job; building on 

strengths

Accomplishing daily 

work tasks Handling the work environment 

Services and supports that 

may address the needs

Vocational/career assessments; 

vocational/career training; assistance 

with job searches or interviewing 

skills; facilitating communication with 

employersa

Organization and time 

management training or 

coachingb

Social skills coaching, mentoring, 

peer supportc

Assessments of autism 

characteristics and needsd Transportation supports Personal hygiene coaching or aidsb

Job coaching, job aidsa

Employer supports, including information about hiring and 

working with autistic employeesa Workplace adaptations to address sensory issues, such as non-flourescent lighting, 

sound protection, and privacy

Self-advocacy coaching or trainingb

Source: GAO analysis of roundtable discussion. | GAO-17-109.

a

For the purposes of this report, we have classified these supports under “vocational supports.”

b

For the purposes of this report, we have classified this support under “life skills training and 

experience.”

c

For the purposes of this report, we have classified this support under “social supports.”

d

For the purposes of this report, we have classified this support under “medical care.”

One of the goals of IDEA is to prepare students for independent living.26

The level of independence that autistic youth may achieve varies widely—

some are able to live in their own home (with or without supports), while 

others require 24-hour care. According to an analysis of NLTS2, young 

adults with autism are less likely to live independently than youth with 

other disabilities, including intellectual disabilities and emotional 

disturbances.27 Specifically, in 2009, 19 percent of autistic adults in their 

early 20s had lived independently at some point, either with or without 

supports. Fourteen percent had lived in a supervised setting, such as a 

 26 One purpose of IDEA is “to ensure that all children with disabilities have available to 

them a free appropriate public education that emphasizes special education and related 

services designed to meet their unique needs and prepare them for further education, 

employment, and independent living.” 20 U.S.C. § 1400(d)(1)(A).

27 The study found that 34 percent of youth with an intellectual disability and 66 percent of 

youth with an emotional disturbance had lived independently. See Roux et al.

Goal: Maximizing Independent 

Living
Page 14 GAO-17-109 Needs of Transitioning Youth with Autism

group home or medical facility, which may have provided services such 

as life skills education or vocational supports.28

The panel discussed two key aspects of independence—performing daily 

living activities and making and carrying out decisions. Daily living 

activities may include tasks such as cleaning, shopping, paying bills, 

maintaining personal hygiene, and preparing meals. Again, while some 

youth with ASD do not need help with these activities, some may need to 

learn these skills step by step and then practice them in real life to gain 

proficiency. For example, some youth may need a list of each step of 

washing hair—shampoo in hand, lather into hair, rinse, etc. The panel 

said that some youth may be able to perform tasks in isolation, but may 

have trouble combining them with employment or social demands. 

Youths’ abilities to make their own decisions may also vary, depending on 

their skills in communication and self-advocacy—identifying and 

expressing their needs to others. Regardless of their level of disability, the 

panel said that it is critically important that all youth be given the 

opportunities to state their own preferences to the extent of their 

capabilities. Table 3 shows some of the services and supports that the 

panel said may help youth reach their maximum independence.

Table 3: Services Panelists Identified as Supporting Independent Living Goals of 

Transitioning Youth with Autism Spectrum Disorders

Selected aspects of the goal

Performing tasks of daily life Making own decisions

Services and 

supports that 

may address 

the needs

Training, coaching, and practicing 

activities of daily lifea Communication aids

Organization and time management 

aids or coachinga Formal or informal assistance with medical, legal, financial, or 

privacy decisionsb

Transportation supports

Housing models that include 

appropriate supports 

Mental health care

Self-advocacy coaching or traininga

Source: GAO analysis of roundtable discussion. | GAO-17-109

 28 Roux et al.
Page 15 GAO-17-109 Needs of Transitioning Youth with Autism

a

For the purposes of this report, we have classified these supports under “life skills training and 

experience.”

b

For the purposes of this report, we have classified this support under “family education and 

supports.”

Health and safety are essential to maintaining a quality life for all people, 

including youth with ASD. According to the panel, health and safety are

the primary goals for some youth with high support needs. The panel said 

that in order for youth with ASD to achieve health and safety, there need 

to be enough medical and mental health caregivers who are trained in the 

unique needs of patients with ASD and prepared to accommodate them. 

The panel noted that physical or mental comorbid conditions are 

sometimes more of a concern than autism. For example, unaddressed 

mental health issues like depression or anxiety can lead to lower social 

and life skills and increased self-injurious behavior, family stress, and 

suicidal thoughts and behaviors. The panel also discussed sleep issues—

such as difficulty going to sleep or remaining asleep—and noted that 

youth with ASD can have sleep disruptions lasting several days. 

Extended sleep deprivation could have severe effects on a person’s 

ability to function and manage their autism characteristics. Finally, the 

panel said that reproductive and sexual health care were often 

overlooked due to mistaken assumptions that autistic youth would not 

engage in sexual relationships.

In addition, the panel discussed several reasons that youth with ASD may 

need supports to help them maintain their safety. For example, the panel 

told us that youth with ASD are more likely to be bullied or abused than 

other youth; some youth with ASD experience aggressive or self-injurious 

behavior, especially when they are frustrated or in pain; and some autistic 

youth wander away from their caregivers and are hit by cars or drown. 

The panel also discussed how some of the social and communication 

difficulties of ASD can make it hard for youth to tell when a situation or 

person is dangerous, and gave examples of youth who were coerced by 

gang members into committing crimes, unintentionally provoked police 

officers, or didn’t know when they were being sexually abused or bullied. 

Some of the services and supports the panel discussed in conjunction 

with health and safety are highlighted in table 4.

Goal: Health and Safety
Page 16 GAO-17-109 Needs of Transitioning Youth with Autism

Table 4: Services Panelists Identified as Supporting Health and Safety Goals of Transitioning Youth with Autism Spectrum 

Disorders 

Selected aspects of the goal

Physical health Mental health Safety

Services and 

supports that may 

address the needs

Medical services from providers 

trained about the needs of youth 

with ASD, including 

neurodevelopmental medicine, 

dental care, sleep interventions, 

reproductive health, and needs of 

adults 

Mental health services from providers trained about the needs of youth with 

ASD and willing to accept them as patients, access to cognitive behavior 

therapy and counseling in addition to medication, crisis care, specialized 

hospitals, and residential treatment facilities 

Organization and time management coaching on such tasks as making 

appointments or medication managementa Social skills training, mentorship, schoolwide anti-bullying training

Case management and coordination, including assistance with 

insurance paperwork, benefits, and finding medical providers

Sexual safety training

Sexual orientation and gender identity supportb Autism training for first responders and 

law enforcement

Behavioral or mental health services to reduce self-injurious behaviors and increase emotional regulation

Transportation services

Coaching or training on medical self-advocacy—explaining symptoms, making sure they are understooda

Source: GAO analysis of roundtable discussion. | GAO-17-109

a

For the purposes of this report, we have classified these supports under “life skills training and 

experience.”

b

For the purposes of this report, we have classified this support under “medical care.”

Community integration includes both individual social interactions and 

broader community participation. In 2009, according to NLTS2 data, 

about one-third of young adults with autism did not participate in any 

community activities, and one-quarter had not had any contact with 

friends for at least a year.29 The panel noted that community integration is 

closely tied to higher education and employment because these are 

where adults tend to establish their social circles. The panel said that 

having housing, jobs, services, and social opportunities that are located in 

the community can facilitate interaction with neighbors who do not have 

ASD and help increase societal acceptance of autism. The panel also 

described transportation as one of the most important factors in achieving 

this goal, as it enables physical access to the community, and said that 

many youth with ASD can use public transportation independently if they 

 29 Roux et al.

Goal: Maximizing Community 

Integration
Page 17 GAO-17-109 Needs of Transitioning Youth with Autism

receive adequate training. Table 5 shows some of the services and 

supports that the panel said may be needed for community integration.

Table 5: Services Panelists Identified as Supporting Community Integration Goals of Transitioning Youth with Autism 

Spectrum Disorders 

Selected aspects of the goal

Social interactions Community participation

Services and supports that may 

address the needs

Supports facilitating social connections, such as 

peer social groups or volunteer programs that 

bring together youth with and without autisma

Supports that facilitate higher education or 

employment

Social skills training and practicea

Personal hygiene coaching or aidsb

Transportation services, including travel training to teach youth how to use transportation 

independently

Communication aids

Supports facilitating self-advocacy skillsb

Direct support providersc

Source: GAO analysis of roundtable discussion. | GAO-17-109

a

For the purposes of this report, we have classified these supports under “social supports.”

b

For the purposes of this report, we have classified these supports under “life skills training and 

experience.”

c

For the purposes of this report, we have classified this support under “medical care.”

The panel said that, like other transitioning youth with disabilities, autistic 

youth need a personalized mix of services that address their unique 

support needs. Given the individualized and complex nature of ASD, no 

single combination of supports and services will prepare all youth with 

Panel Theme: The 

Need for Access to 

Evidence-Based 

Services that Are 

Individualized, 

Flexible, Timely, and 

Provided in the 

Community

Individualized and Flexible 

Supports
Page 18 GAO-17-109 Needs of Transitioning Youth with Autism

ASD for success as adults, according to the panel. For example, for a 

successful transition to a higher education environment, one student may 

need organizational coaching in order to develop study skills, while 

another may need mental health support for anxiety and peer mentoring 

in order to attend class every day. According to the panel, having the right 

combination of supports to meet each person’s individual needs may 

contribute to success in higher education, employment, community 

integration, and overall quality of life. The panel also told us that the 

creation of an individualized support system begins with a comprehensive

assessment of a person’s skills and abilities.

On Individualized Supports 

“Education, employment, health care, access to communication and self-determination, 

and support for overall community integration are all critical components for our 

community. A comprehensive approach which provides individualized, consumerdirected supports in all of these areas can enable all autistic people to participate in their 

communities, self-advocate, and live meaningful and productive lives with a high quality 

of life, regardless of level of disability.” 

Source: Panelist quotation. | GAO-17-109

The panel said that individuals with ASD need flexible services and 

supports that can adapt to changes in their needs. Autism is a lifelong 

disability with characteristics that can shift over time, especially as 

personal circumstances and comorbid health conditions change. For 

example, the panel described people whose verbal skills fluctuated from 

nonverbal to highly fluent during their lifetimes. During their nonverbal 

periods, they would need communication aids that were not needed 

during their fluent periods. Additionally, the panel said that the ability to 

fall and remain asleep could fluctuate over time, and youth may need 

behavioral therapy or medication during sleepless periods. The panel also 

cautioned against removing supports that may be needed over the long 

term. For example, a job coach may be used at the beginning of an 

autistic person’s employment to help them acclimate to their employer 

and vice versa. However, the individual may also benefit from continued 

support—either ongoing or occasional—from a job coach to help address 

new issues that arise over the course of their employment. Flexible job 

coaching that was available when needed could help the individual retain 

the job.

The panel said that youth with autism need timely access to services and 

supports, beginning with having enough service providers to meet the 

demand. For example, according to the panel, youth receiving care from 

service providers who primarily work with children, such as 

Timely Access to Supports
Page 19 GAO-17-109 Needs of Transitioning Youth with Autism

developmental pediatricians and speech and language therapists, may 

need access to adult providers after their transition, because their needs 

for the service do not necessarily end when they reach a certain age. The 

panel also said that waiting lists for services have gotten longer due to a 

“tsunami” of increased demand. Furthermore, due to the unpredictable 

nature of ASD, there may be times when autistic youth need immediate 

access to services. For example, if autistic youth become aggressive or 

self-injurious, they and their families may need such services as 

emergency rooms, hospitals with specialized units, residential behavioral 

treatment programs, or direct support providers. Our panel described 

situations where families lacked immediate access to these services, and 

hence tried to care for aggressive youth at home, which can risk the 

safety and well-being of both the person with ASD and others present in 

the home.

The panel told us that in order for autistic youth to have adequate access 

to supports, providers of adult services—including basic services 

important to all adults—would ideally have the expertise necessary to 

serve clients with autism. For example, dentists may need to be prepared 

for behaviors often associated with autism, such as the inability to sit in 

the dental chair, agitation, or self-injury (e.g., head banging). Additionally, 

according to the panel, youth with autism may have difficulty developing 

new relationships with service providers and are negatively affected by 

high turnover rates. The panel noted that support providers who work 

directly with autistic individuals have a physically and emotionally 

demanding job and that turnover among these providers is likely related 

to prevailing wages for this work.

On Provider Expertise 

“One of the things we need to do is teach the adult physicians how to deal with adults 

who have developmental disabilities. Beyond checking their blood sugar and their 

cholesterol levels and blood pressure, you need to be checking their life. How are they 

doing psychologically? How is their self-esteem? How are they doing occupationally? 

And how is their living environment with their families or away from their families?” 

Source: Panelist quotation. | GAO-17-109

The panel cited research noting that any gaps or loss of services during 

the transition from a school-based support system to adulthood could 

have long-lasting detrimental effects on youths’ health, employment, 

educational attainment, and family stability. To avoid gaps, according to 

the panel, the various programs for adults should have compatible 

eligibility requirements so that youth do not have to re-establish eligibility. 

Specifically, the panel said there should be a single point of entry into 
Page 20 GAO-17-109 Needs of Transitioning Youth with Autism

adult services, much as the school provides a single point of entry for 

many services for children. The panel also suggested that transition 

planning start earlier—as early as middle school—and end when youth 

turn 25. Finally, the panel noted that autistic youth and their parents need 

information to help them navigate the adult service system and find the 

supports they need.

The panel said that transitioning youth with ASD should have access to 

the services they need regardless of their income, geographical location, 

race, or gender. For instance, the panel told us that low- and middleincome youth with ASD whose families cannot afford to pay for their 

services out-of-pocket would ideally be able to rely on public programs to 

help them pay for their adult services—which is not always the case 

currently. The panel also stated that access to services should not vary 

depending on the states and communities where youth live. For example, 

in rural areas, support services like transportation or telemedicine—

wherein providers serve patients remotely, such as via video 

conference—may help improve access to services that are more common 

in large cities. The panel also discussed the need to maintain a 

continuum of care as youth move across state lines, noting that even 

though eligibility rules and service provision may differ from state to state, 

youths’ needs for services and funding do not necessarily change when 

they move. The panel suggested a portable and flexible funding 

mechanism that would allow youth to pay for services in any location.

Finally, in order to have equitable opportunities to pursue their adult 

goals, the panel said that some demographic groups, such as females or 

minorities, may have specific needs. For example, according to the panel, 

workplaces may have higher social expectations for women than men, 

and mentoring from other women on the spectrum could help them learn 

how to react to these expectations. The panel also noted that girls and 

minority students are diagnosed with ASD at a later age than other youth, 

on average—sometimes after they have left high school. As a result, the 

panel said, they may have received fewer services and may need more 

help as they transition to adulthood. Additionally, the panel said that 

minority students—especially those living in low-income, urban areas—

may face issues compounded by having less preparation for the transition 

during their school years, including less parental education on available 

resources as well as less access to medical care. To address their needs, 

the panel discussed services such as additional transition planning, 

education and training for parents on services youth are entitled to, and 

medical case managers who can help these youth locate, access, and 

communicate with medical care providers.

Equitable Access to Supports
Page 21 GAO-17-109 Needs of Transitioning Youth with Autism

On Access to Services 

“Without transportation, it can be difficult or impossible for autistic youth to hold jobs, 

pursue higher education, go to community events, meet with peers, access healthcare, 

or develop relationships, hobbies, or interests outside of the home.” 

Source: Panelist quotation. | GAO-17-109

According to the panel, services for transitioning youth with ASD should 

be well-coordinated, with service providers, youth, and their families 

agreeing on common goals and communicating regularly. The panel told 

us that, because autism can affect so many aspects of an individual’s 

health and behavior, coordinated care that supports the whole person is 

particularly important for youth with ASD. For example, according to the 

panel, an individual needing care from both a mental health practitioner 

and a developmental disability doctor may not be adequately supported 

by either provider, because each may assume the other has primary 

responsibility and thus neither may take a holistic view of the individual’s 

care. Additionally, the panel said that some medical personnel find that 

other service providers are among the best sources of information about 

their patients. The panel advocated for a comprehensive approach in 

which service providers work together to simultaneously address issues 

of employment, housing, health care, and behavioral health. The panel 

specifically mentioned two examples of holistic supports: (1) mental 

health services should be coordinated with other services, such as 

employment, housing, or education; and (2) medication should be 

managed in coordination with a person’s behavioral health goals and 

current status.

On Holistic Services 

“I think the need is for holism. You really need a team approach with health care, 

behavioral health, and supported employment. It kind of becomes a necessity that 

that’s a package deal at this point.” 

Source: Panelist quotation. | GAO-17-109

The panel emphasized the importance of providing services in the 

community, both by providing some educational services outside the 

classroom and by locating services in the neighborhoods where youth 

live. First, the panel noted that many life skills, such as grocery shopping 

or taking a bus, are best learned experientially—by practicing them in the 

community—especially for youth with ASD who may have difficulty 

transferring skills learned in one location, such as the classroom, to 

another environment, such as the community. Additionally, the panel told 

us that some youth with ASD may have difficulty making decisions that 

Well-Coordinated, Holistic 

Supports

Community-Based Supports
Page 22 GAO-17-109 Needs of Transitioning Youth with Autism

depend on changing input. For example, when deciding whether to cross 

the street, it is not enough to know whether a car is coming. The decision 

also depends on judging how far away the car is, a factor that continually 

changes. It is difficult to gain experience making these types of decisions 

without practicing them experientially.

On Experiential Learning 

“Curricula are just words on paper without the supportive environments needed to 

practice these.” 

Source: Panelist quotation. | GAO-17-109

Second, the panel also discussed several benefits of providing services 

close to youths’ homes:

• Local services may be easier to reach for youth with limited access to 

transportation.

• Local venues may be more familiar, which may help mitigate 

difficulties navigating new situations.30

• Local services may help youth better integrate into their community. 

Rather than youth with ASD becoming known as those who are bused 

away, receiving services near home may help their neighbors get to 

know them as members of the community.

On Community-Level Solutions 

“I think we need to be fostering community-level solutions. If all of our focus is entirely on 

clinical interventions for one person at a time, we're going to be missing the more 

important questions about how do we create the communities, neighborhoods, and social 

institutions that are welcoming and inclusive of people with disabilities.” 

Source: Panelist quotation. | GAO-17-109

Consistent with our recent work on autism research, the panel 

emphasized that limited research exists on the service needs of 

transitioning youth or adults with ASD. In a June 2015 report, we found 

 30 The Supreme Court has held that mental health services provided by state and local 

governments must be community-based when the placement is appropriate, the affected 

persons do not oppose such treatment, and the placement can be reasonably 

accommodated, taking into account the resources available to the state and the needs of 

others with mental disabilities. Olmstead v. L.C. ex rel. Zimring, 527 U.S. 581, 607 (1999).

Research Needs
Page 23 GAO-17-109 Needs of Transitioning Youth with Autism

that research into the needs of adults consistently received less federal 

funding than other areas of autism research, such as the biology of 

autism.31 Also consistent with our work, the panel said that services 

should be grounded in evidence-based research and programs should be 

held accountable for delivering results, but they underscored that more 

research was needed for this to be feasible. The panel recommended 

studying the developmental disability system as a whole to determine 

what large-scale changes may be needed. Some of the specific areas of 

research they recommended included:

• the needs of transitioning youth and adults with ASD,

• effective adult services,

• interventions for women,

• comorbid conditions and health needs,

• improving collaboration among service providers, and

• efficient uses of funding.

On Need for Research 

“I would rather see investments in performance measurement, quality improvement, and 

accountability that promise to help all people by incentivizing learning systems that aim 

to continuously experiment and improve...for everyone. The really shocking thing in all 

this is that we spend roughly $130 billion per year on services for autism across the 

lifespan but we have so little insight into who gets what and with what effect.” 

Source: Panelist quotation. | GAO-17-109

 31 GAO, Federal Autism Research: Updated Information on Funding from Fiscal Years 

2008 through 2012, GAO-15-583R (Washington, D.C.: June 30, 2015).
Page 24 GAO-17-109 Needs of Transitioning Youth with Autism

To improve the ability of youth with ASD to fully participate in society, the 

panel cited the need for a paradigm shift, including a new approach to 

supports. In this new paradigm, society and autistic youth alike would 

share the responsibility for inclusion, and the public and service providers 

would have better understanding of autistic youths’ potential. The panel 

likened this new paradigm to the magnitude of the changes made to 

physical infrastructure, such as curb cuts, ramps, and elevators, to 

improve mobility for people with physical disabilities.32

The panel told us that one element of the new paradigm would be the 

understanding that the responsibility for the inclusion of autistic youth 

rests on both the individual with autism and society. The panel said 

society expects individuals with autism to continually adapt to situations 

that are difficult for them—even though adaptation itself is difficult for 

many people with ASD. The panel acknowledged that people with autism 

are responsible for learning about social expectations for school, work, 

and social settings, but said that institutions and communities should also 

learn how best to support individuals with ASD, given the characteristics 

of autism. For example, the panel said that explaining the “unwritten 

rules” of workplace social behavior to youth with autism may facilitate 

their inclusion. On the other hand, the panel emphasized that society 

should acknowledge that some unwritten rules may lead to the exclusion 

of autistic youth. For example, the panel noted that it may not be 

reasonable to expect people with autism to smile or make small talk even 

though smiling and chatting are often expected in certain situations, such 

as in the workplace.

On a New Approach to Supporting Youth with Autism:

And if you think about social navigation and autism, and you think about physically 

navigating a space if you have a mobility difference, what are universal design 

standards? I don't mean just the structure of a building but what kinds of things could be 

universally implemented to make those places more accessible for us with our specific 

disability...so that the onus isn't always on the individual to have to mimic social 

behaviors that are expected in order to have a standard of living of some kind.

Source: Panelist quotation. | GAO-17-109

 32 Curb cuts, ramps, and elevators are examples of physical adjustments made in 

response to the Americans with Disabilities Act of 1990 (ADA). Pub. L. No. 101-336, 104 

Stat. 327 (codified as amended at 42 U.S.C. §§ 12101-12213). This report does not 

address whether these physical adjustments have been sufficient to meet the needs of 

those with disabilities in all aspects of society.

Panel Theme: A New 

Approach to 

Supporting Youth with 

Autism to Enhance 

Their Integration into 

Society

New Approach to Supporting 

Youth with ASD
Page 25 GAO-17-109 Needs of Transitioning Youth with Autism

The panel said that some of the changes they envision might already be 

supported by federal laws that govern services to people with disabilities, 

including youth with autism. For example, the panel told us that although 

existing law requires the provision of experiential learning opportunities 

for youth with disabilities, including autism, some teachers provide 

instruction only in a classroom setting despite the benefits of experiential 

learning.

The panel described how greater public understanding of the 

characteristics, potential, and challenges of autism would be key to the 

new paradigm. According to the panel, lack of knowledge about autism 

can result in misinterpretations of the meanings behind some behaviors.

For example, an autistic student with anxiety and depression may miss 

classes due to those comorbid conditions and may not seek help due to 

communication difficulties caused by autism. Without an understanding of 

autism and the behavioral effects of its interaction with comorbid 

conditions, professors or university personnel may attribute the student’s 

absences to a lack of interest or motivation, underestimate the severity of 

the situation, and miss an opportunity to help that student. The panel also 

said a public awareness campaign could deepen the public’s 

understanding of autism and help people think about how they can better 

support people with ASD. The panel suggested educational sessions that 

describe the diversity among people with autism, promote tolerance, and 

help create a safe environment to support youth on the spectrum.

In addition to the wider public, the panel said that professionals who 

interact with people with autism need education and training about 

autism. The panel cited a wide range of fields—such as health care, 

justice, education, transportation, mental health, public safety, and public 

services—whose members need to understand autism characteristics 

and be prepared to support them. Specifically, the panel noted that, while 

youth with autism have clear needs for supports, people should not make 

assumptions about an individual’s competence based on a single 

characteristic of autism. The panel told us that some people may base 

their assumptions about the capabilities of an autistic youth on the youth’s 

ability to communicate verbally. For example, people may erroneously 

equate a lack of verbal communication skills with an inability to make 

decisions or express preferences, while assuming that those autistic 

youth who can speak have no communication issues and no need for 

supports. Consistent with this, the panel noted that those people closest 

to youth with autism should foster high expectations when preparing them 

for adulthood. For example, one panelist said that parents and teachers 

should expect youth to learn to be more independent, noting that people 

Greater Public Understanding 

of Autism
Page 26 GAO-17-109 Needs of Transitioning Youth with Autism

often adopt a risk-averse approach to teaching autistic youth, coming to 

the rescue when someone does not succeed at a task. This can create a 

“learned helplessness” and missed opportunities to teach the valuable life 

skill of perseverance. Rather, the panel said that youth should begin 

building self-advocacy skills—identifying and asking for what they need—

in middle and high school. For example, one panelist said that youth 

should learn to identify their sensory, social, and communication 

differences and strengths.

The new paradigm would include fostering a better understanding of the 

potential of youth with ASD, according to the panel. Specifically, the panel 

told us that recognizing the strengths of individuals with ASD can greatly 

improve their opportunities, while focusing on the difficulties associated 

with autism may limit them.

On Contributing to Society 

These aren't just people who are service users and need things all the time. These are 

people who can contribute to society, their campus communities. And how do we create 

opportunities for them to be leaders, to be mentors, as part of the service delivery 

process?

Source: Panelist quotation. | GAO-17-109

The panel said some characteristics of autism, such as a tendency 

toward repetitive actions and a preference for routine, could be an 

advantage in the workplace. For example, the panel told us about a youth 

who enjoyed stacking boxes—an interest that translated into a job skill 

needed in the community’s home improvement store—and another young 

man whose intense focus and interest resulted in encyclopedic 

knowledge of heating, ventilation and air conditioning. The second youth 

became the most reliable worker in his internship and reported to work 

early every day. The panel discussed a national financial services 

company that initiated an agricultural program for employing youth with 

disabilities, including autism, because the company saw their comfort with 

routine and reliability as strengths. The panel also discussed a national 

retailer that hired workers with disabilities, including autism, and found 
Page 27 GAO-17-109 Needs of Transitioning Youth with Autism

that those workers had lower job turnover rates and were just as 

productive as workers without disabilities.33

The panel noted that better inclusion of people with ASD could help 

reduce the stigma associated with autism and reduce bullying, which the 

panel suggested occurred frequently among youth with ASD. The panel 

told us that some youth miss out on supports, including helpful medical 

devices, that may be available to them because they fear being 

stigmatized if they disclose their autism. A greater understanding of 

autism in general could decrease the sense of stigma, similar to the way 

that physical disabilities are becoming less stigmatized over time. In 

addition, people may be less likely to make flawed judgments or act on 

stereotypes if they have an increased understanding and acceptance of

the different interaction styles characteristic of individuals with autism. 

The panel noted that one way to reduce bullying was to implement 

school-based anti-bullying training, that focused on respect and 

acceptance from pre-kindergarten to 12th grade. Greater public 

awareness of autism could also improve the safety of autistic youth when 

they are in the community. For example, the panel discussed the 

prevalence of abuse, including sexual abuse, among youth with autism 

and noted that increased awareness of the risks to autistic youth in the 

community would increase their safety.

On Benefits of Community Awareness and Integration

If someone abused our son, we wouldn't know. He cannot tell us. ...The best safety and 

security system is more eyes and ears. And so the more people that are coming and 

going, the more eyes and ears, the more than we are part of community and integrated 

into community, the better off we are and the safer we will be.

Source: Panelist quotation. | GAO-17-109

Additionally, the panel described the benefits of police officers knowing 

how to appropriately aid an autistic person who is acting erratically, as 

well as teaching youth with autism how to interact with the police. The 

 33 In 2012, one retailer reported these findings from an evaluation of their workplace 

inclusion project that was designed to provide work opportunities for people with 

disabilities, including autism. See Kaletta, James P., Binks, Douglas, J., and Robinson, 

Richard, Creating an Inclusive Workplace: Integrating Employees with Disabilities into a 

Distribution Center Environment, Professional Safety: Journal of the American Society of 

Safety Engineers, June 2012. 
Page 28 GAO-17-109 Needs of Transitioning Youth with Autism

panel said that because some youth with autism may not appropriately 

respond to verbal commands, increased awareness of autism among 

police officers was critical given the potential consequences of 

miscommunication—such as incarceration or violence.

We provided a draft of this report to Education and HHS for comment. 

They provided technical comments, which we incorporated as 

appropriate.

As agreed with your offices, unless you publicly announce the contents of

this report earlier, we plan no further distribution until 30 days from the

report date. At that time, we will send copies to interested congressional

committees and to the Department of Education. In addition, the report

will be available at no charge on the GAO website at http://www.gao.gov.

If you or your staff have any questions about this report, please contact 

me at (617) 788-0580 or nowickij@gao.gov. Contact points for our Offices 

of Congressional Relations and Public Affairs may be found on the last 

page of this report. GAO staff who made key contributions to this report 

are listed in appendix IV.

Jacqueline M. Nowicki, Director

Education, Workforce and Income Security Issues

Agency Comments
Appendix I: Objectives, Scope, and 

Methodology

Page 29 GAO-17-109 Needs of Transitioning Youth with Autism

This is the first in a series of reports on youth with autism transitioning to 

adulthood. In this report, we focus on describing the needs of transitioning 

youth with Autism Spectrum Disorder (ASD). A second engagement will 

examine the services provided to transitioning youth with ASD and any 

challenges they may face obtaining them.

To describe the needs of transitioning youth with ASD, we addressed the 

following questions:

1. What services and supports do transitioning youth with autism need to 

attain their goals for adulthood?

2. What are the characteristics of needed services and supports?

3. How can youth with autism be fully integrated into society?

To answer our research questions, we convened a roundtable discussion 

on March 3 and 4, 2016. We selected a total of 24 panelists,1 including:

• autistic adults;

• service providers, including teachers, developmental pediatricians, 

transition specialists, behavioral therapists, and leaders of programs 

providing employment supports, college supports, legal 

representation, social supports, and residential supports, among 

others;

• employers who provide supports for workers with autism;

• researchers; and

• parents of youth and adults with autism with a range of ages and 

support needs.

Most panelists fell into more than one of these categories. We chose 

panelists based on the following:

• their expertise about autism, as measured by their personal or 

professional experience with autism or participation on relevant 

 1 Of the 24 individuals who comprised our panel, two were not present at the roundtable 

discussion.

Appendix I: Objectives, Scope, and 

Methodology

Objectives

Choosing Panelists
Appendix I: Objectives, Scope, and 

Methodology

Page 30 GAO-17-109 Needs of Transitioning Youth with Autism

Boards of Directors or the Interagency Autism Coordinating 

Committee;2

• recommendations from others with subject matter knowledge, 

including researchers and organizations we interviewed during our 

background research as well as other panelists; and

• backgrounds and perspectives reflecting the diversity of the autism 

community, including variations in service areas, income, race, 

gender, geographic location, and urbanicity. We considered panelists’

personal backgrounds as well as the autistic populations they worked 

with.

The full list of panelists is included in the agenda in appendix II.

We asked the panel about the services that transitioning youth across the 

autism spectrum need to help them achieve five goals for adulthood:

1. Postsecondary education.

2. Employment.

3. Maximizing independent living.

4. Health and safety.

5. Maximizing community integration.

We chose these goals because they were either listed in the transition 

planning requirements for high school students receiving special 

education services (goals 1, 2, and 3) 3 or described by potential panelists 

in pre-selection interviews as particularly important (goals 4 and 5).

To guide our discussion, we asked the panel the following questions 

about each of the five goals:

• What autism characteristics impede or facilitate achieving the goal?

• What services/supports/institutional changes help youth manage or 

leverage those characteristics?

 2 The Interagency Autism Coordinating Committee is a federal advisory committee 

charged with monitoring and coordinating federal autism research. 

3 See the background section for more information about special education and transition 

planning requirements. 

Panel Topics of 

Discussion
Appendix I: Objectives, Scope, and 

Methodology

Page 31 GAO-17-109 Needs of Transitioning Youth with Autism

• What happens when youth receive each service/support?

• What happens when they do not receive it?

• Have we discussed youth with the greatest, moderate, and least 

needs for each service/support?

• Are there special considerations for young women, minorities, lowincome youth, rural youth, or other groups?

We asked the panel to describe services ideally needed for a successful 

transition to adulthood, regardless of what services may currently be 

available or feasible. We did not verify the accuracy of the information 

they provided. The panel also pointed out that many of the services 

needed to support youth with ASD may also support youth with other 

disabilities. While we focus on how these services would particularly 

address characteristics associated with autism, the panel also cautioned 

against singling out autistic youth unnecessarily.

Appendix II includes the agenda for the panel including a list of invited 

panelists. Of the 24 panelists, 2 were not present at the actual event, 

including an autistic individual who does not use spoken language. We 

interviewed them afterward to obtain their thoughts on the same topics 

covered during the panel and included this information in our analysis. 

We asked panelists to provide comments on a draft of this report, which 

we incorporated as appropriate.

We conducted a content analysis of the transcript of the 2-day event as 

well as documents the panelists submitted in writing to clarify and support 

information discussed during the panel meeting. Specifically, we used the 

NVivo qualitative analysis software to classify each sentence into one or 

more categories, depending on whether the speaker was discussing:

• One or more of the five goals for adulthood;

• One or more services; or

• One or more of several cross-cutting needs—issues that applied 

across services or goals.

We identified these categories by creating lists of all the services and 

cross-cutting issues the panel mentioned at least once during the 

discussion or in the documents. For brevity and organizational purposes, 

we then grouped them into broader categories based on their relatedness 

and our understanding of autism services garnered from literature and 

interviews. This process resulted in 14 broad categories of services, 

Analysis of 

Information from the 

Panel
Appendix I: Objectives, Scope, and 

Methodology

Page 32 GAO-17-109 Needs of Transitioning Youth with Autism

which are listed and described in appendix III,4 and 13 categories of 

cross-cutting needs:

• public awareness of autism;

• service provider awareness of autism;

• new paradigm;

• sufficient access to supports;

• individualized supports;

• adequate and flexible funding;

• coordination among service providers;

• service provider accountability;

• staff quality and training;

• service quality;

• research needs;

• equity issues for specific groups; and

• other cross-cutting issues.

Two analysts categorized the sentences in NVivo. To ensure consistency, 

both analysts classified the same sample of the transcript and a reliability 

analysis determined that they chose the same categories over 95 percent 

of the time. Each analyst also spot checked the other’s work. After 

categorizing the sentences, we analyzed the text in each category to 

identify the emerging themes. We attribute these themes, as well as 

specific examples given for illustrative purposes, to “the panel” throughout 

this report.

For convenience, we use the term “youth” in this report to describe 

individuals aged 14 to 24, the age range when they may be eligible for 

transition services, depending on their state. This age range is in keeping 

with our previous work as well as other federal programs and 

organizations. During the transition years, youth may receive services for 

children, adults, or both.

 4 The actual range of services provided under these broad categories could be wide, with 

much variation in method, purpose, philosophy, and effectiveness.
Appendix II: Agenda and List of Invited 

Panelists

Page 33 GAO-17-109 Needs of Transitioning Youth with Autism

Appendix II: Agenda and List of Invited 

Panelists
Appendix II: Agenda and List of Invited 

Panelists

Page 34 GAO-17-109 Needs of Transitioning Youth with Autism
Appendix II: Agenda and List of Invited 

Panelists

Page 35 GAO-17-109 Needs of Transitioning Youth with Autism
Appendix II: Agenda and List of Invited 

Panelists

Page 36 GAO-17-109 Needs of Transitioning Youth with Autism
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 37 GAO-17-109 Needs of Transitioning Youth with Autism

The panel identified 14 broad categories of services and supports that 

may help youth with Autism Spectrum Disorders (ASD) attain the goals of 

education, employment, health/safety, independent living, and community 

integration as they transition to adulthood. Table 6 shows which services 

may support each goal, according to the panel. Figures 3 through 16

illustrate the same information, as we describe each service.

Table 6: Services that Support five Goals that Youth with Autism Spectrum Disorders (ASD) May Pursue in Adulthood, 

According to the Panel

Goal for Adulthood that Youth with ASD May Pursue

Service

Postsecondary 

Education Employment

Maximizing 

Independent 

Living

Health and 

Safety

Maximizing 

Community 

Integration

Behavioral Interventions a a a ● a

Case Management/ 

Coordination

● ● ● ● ●

Communication Services ● ● ● ● ●

Day Programming ○ ○ b ● ○

Family Education and 

Supports

● ● ● ● ●

Life Skills Education and 

Experience

● ● ● ● ●

Medical Care ● ● ● ● ●

Mental Health Care ● ● ● ● ●

Postsecondary Education 

Planning and Supports

● ○ ○ ○ ●

Residential Supports ● ● ● ● ●

Social Supports ● ● ● ● ●

Transition Planning Services ● ● ● ● ●

Transportation Supports ● ● ● ● ●

Vocational Supports ○ ● ● ○ ●

● Service generally supports goal

○ Service does not generally support goal

Source: GAO analysis of roundtable discussion. | GAO-17-109

a

Panelists disagreed about the effectiveness of behavioral interventions. Some felt that behavioral 

interventions can help people of all ages with a variety of goals, including the 5 that we discussed. 

Others said that behavioral interventions are not helpful or even harmful for adults.

b

Panelists told us that, although some day programs are intended to provide life skills instruction, day 

programs are variable and as a whole they do not reliably contribute to maximizing independent 

living.

Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 38 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 3: Roundtable Views of Goals Supported by Behavioral Services

Behavioral interventions are treatments intended to help autistic youth 

develop skills and reduce challenging behaviors. Behavioral interventions 

may include, for example, identifying the reason for challenging behavior 

and teaching a positive behavior as a replacement, step-by-step teaching 

and practicing of skills, or teaching awareness of thoughts and feelings in 

order to manage responses to them. One specific intervention, Applied 

Behavior Analysis, uses a structured system of rewards to reinforce the 

desired behavior and has been the subject of extensive research. 

Panelists strongly disagreed about its efficacy in adults.

Figure 4: Roundtable Views of Goals Supported by Case management/Coordination

Case management and coordination services help people with autism 

navigate the multiple agencies and organizations that provide services, 

including vocational, educational, housing and life skills supports, among 

others. Case managers/coordinators do not provide the actual services 

themselves, rather, they provide information about the adult disability 

system, including the different eligibility criteria for the multiple agencies 

that provide services, and the managed health care system, including

requirements for insurance coverage.

Behavioral 

Interventions

Case Management/

Coordination
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 39 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 5: Roundtable Views of Goals Supported by Communication Services

Communication services can include aids or instruction to help nonverbal 

and verbal autistic youth communicate. For example, nonverbal youth 

may be able to point to pictures or letters on charts or use a smart phone, 

tablet, computer, or device designed specifically to provide speech 

functions. Communication services also include training on how to use 

communicative aids and support while using them.

Figure 6: Roundtable Views of Goals Supported by Day Programming

Day programs provide supervision and activities for individuals who have 

exited the school system. Some are designed to provide instruction in life 

skills, community activities, or therapy, but the panel said that their actual 

operations are highly variable and more often segregated from the 

community.

Communication 

Services

Day Programming
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 40 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 7: Roundtable Views of Goals Supported by Family Education and Supports

Families may play many roles in the lives of youth with ASD and may 

utilize a variety of supports. Training may help families learn how to 

access available resources, teach life skills, use communication aids, or 

identify mental health needs. In addition, some families may utilize social 

support from peers who understand their situations or may use respite 

services—short-term supervision for youth with ASD. Additionally, when 

youth turn 18, they and their families may need assistance making 

decisions about the legal aspects of adulthood, such as who will have 

access to their medical information or the ability to make financial or 

medical decisions.

Figure 8: Roundtable Views of Goals Supported by Life Skills Education and 

Experience

Life skills include daily living skills, executive functioning, and selfadvocacy. Daily living skills include household tasks, personal care, 

nutrition, and personal finance. Executive functioning includes organizing, 

planning, managing time, sequencing tasks, self-control, and adapting to 

change. Self-advocacy is the ability to understand one’s own needs and 

take action to meet them. Youth can learn these skills through training, 

coaching, and practice. Additionally, tools such as schedules, organizers, 

and visual prompts can help youth with autism improve their life skills.

Family Education and 

Supports

Life Skills Education 

and Experience
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 41 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 9: Roundtable Views of Goals Supported by Medical Care Services

Youth with autism have many of the same medical needs as other youth, 

but there are some areas where they have particular needs or may have 

difficulty locating providers with the expertise to treat patients with ASD.

• Autism assessments identify an individual’s autism characteristics and 

help youth, their families, and service providers plan for appropriate 

supports.

• Dental care can be a particularly challenging aspect of health care for 

many youth with ASD. Dentists may need to provide specific supports 

and devote extra time when treating patients exhibiting some of the 

behaviors of ASD, such as refusing to sit in the examination chair.

• Personal support providers work one-on-one with autistic youth to 

provide supervision and assist youth with their daily needs, such as 

medication, therapy, recreation, and transportation.

• Sexual health care includes reproductive care; education about 

puberty, sexual safety, and preventing exploitation and abuse; and 

trauma care after abuse.

• Sleep medicine includes evaluations and treatment for sleep issues, 

which are common among individuals with ASD and may manifest 

differently than in the general population.

• Therapeutic services may include speech/language, occupational, 

and physical therapy, among others.

Medical Care
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 42 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 10: Roundtable Views of Goals Supported by Mental Health Care Services

Counseling, therapy, and medication can help youth with ASD manage 

comorbid mental health conditions. Mental health conditions may 

manifest differently in people with ASD, and they need providers who can 

distinguish mental health symptoms from the characteristics of autism.

Figure 11: Roundtable Views of Goals Supported by Postsecondary Education 

Supports

Postsecondary education supports are intended to help youth with ASD 

succeed in a variety of postsecondary settings, including community 

colleges, 4-year universities, and vocational or technical schools. 

Academic supports include, for example, extended test-taking time, 

assistance with note-taking in class, and delivery of instructional material 

in various formats to support differences in learning styles. In addition, 

education supports can help autistic youth with skills such as organization 

as self-advocacy, which can also be important to success in 

postsecondary education programs.

Mental Health Care

Postsecondary 

Education Supports
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 43 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 12: Roundtable Views of Goals Supported by Residential Supports

Residential supports may range from assistance with housekeeping to 

24-hour onsite support. These supports may be may be chosen and hired 

by an adult with autism, or they may be provided by a housing facility. For 

adults with ASD who do not live on their own or with family, there are 

many residential housing models that vary by size, degree of community 

integration, and intensity of supports. For instance, one short-term 

residential model provides life skills education and experience to help 

youth transition to more independent living. A second model is a more 

permanent home that provides onsite employment opportunities, as well 

as other supports. A more intensive type of residential setting provides 

behavioral and medical services and supports.

Figure 13: Roundtable Views of Goals Supported by Social Supports

Social supports are intended to help individuals with ASD successfully 

interact with others. Some supports give youth with ASD opportunities to 

socialize with others or learn social skills, such as training and coaching 

in interpersonal skills and social expectations, peer support and 

mentoring by others with ASD, and structured social groups, events, or 

camps for youth both with and without autism. Other services are for 

people who interact with youth with ASD, such as guidance on how to 

make institutions welcoming and safe for people with autism or schoolwide anti-bullying and social skills training.

Residential Supports

Social Supports
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 44 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 14: Roundtable Views of Goals Supported by Transition Planning Services

Transition planning services help autistic youth identify their goals for 

adulthood and create a plan for achieving them, including obtaining the 

services and supports they will need to accomplish those goals. Initially, 

transition planning services are provided in high school by a student’s 

Individual Education Program team—teachers, school administrators, the 

student, parents, and service providers. Transition planning can also 

continue after high school in settings designed to provide that service.

Figure 15: Roundtable Views of Goals Supported by Transportation Supports

Many youth with ASD do not drive, and some may have difficulty 

navigating public transportation on their own or may live in areas with no 

public transportation. For these youth, transportation services can be 

critical for accessing community events, obtaining employment or 

education, maintaining friendships, or leaving their homes for any other 

reason. Transportation supports can include reduced public transportation 

fares, paratransit services that provide on-demand, door-to-door service 

or fixed-route services to specific locations like grocery stores or 

hospitals, volunteers who drive clients to their destinations, travel training 

on skills such as navigating public transit and other mobility services, 

adaptive driver’s education courses, and assistive technology for 

navigation.

Transition Planning 

Services

Transportation 

Supports
Appendix III: Services and Supports for 

Transitioning Youth with Autism Identified By 

the Panel

Page 45 GAO-17-109 Needs of Transitioning Youth with Autism

Figure 16: Roundtable Views of Goals Supported by Vocational Supports

Vocational supports may facilitate employment for youth with ASD. 

Examples include:

• vocational assessments to identify the specific supports a youth 

needs, based on their individual autism characteristics, skills, 

strengths, and preferences;

• vocational training;

• assistance finding careers that are a good match for youths’ interests 

and skills;

• job search, application and interviewing assistance;

• employer supports, such as incentives to hire employees with 

disabilities, facilitation of communication with autistic employees, and 

education about autism and how to work with an autistic employee;

• self-employment assistance; and

• job coaches to provide support in the workplace.

Vocational Supports
Appendix IV: GAO Contact and Staff 

Acknowledgements

Page 46 GAO-17-109 Needs of Transitioning Youth with Autism

Jaqueline M. Nowicki, (617) 788-0580, nowickij@gao.gov

In addition to the contact named above, Nagla’a El-Hodiri (Assistant 

Director); Brittni Milam (Analyst in Charge), Sandra Baxter, Farrah 

Graham, and Walter Vance made key contributions to this report. Also 

contributing to this report were: James Bennett, Holly Dye, David 

Forgosh, Flavio Martinez, Daniel Meyer, Sheila McCoy, Arthur Merriam, 

Vernette Shaw, and Adam Wendel.

Appendix IV: GAO Contact and Staff 

Acknowledgements

GAO Contact

Staff 

Acknowledgements

(100234)
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