YOUTH WITH 

AUTISM

Federal Agencies 

Should Take 

Additional Action to 

Support TransitionAge Youth 

Report to Congressional Requesters

May 2017

GAO-17-352

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-17-352, a report to 

congressional requesters

May 2017

YOUTH WITH AUTISM

Federal Agencies Should Take Additional Action to 

Support Transition-Age Youth 

What GAO Found

According to GAO’s nationwide survey of school district special education 

directors, GAO estimates that about 85 percent of districts in school year 2015-

16, provided youth with Autism Spectrum Disorder (ASD) services such as 

instruction on life, social, and behavioral skills, as they transition from high 

school to adulthood. ASD is a group of complex developmental disorders 

characterized by difficulties with social interactions, communication, and 

repetitive behaviors. Districts provided these services as part of the planning for 

the transition to adulthood required by the Individuals with Disabilities Education 

Act (IDEA). Fewer, though still a majority of, districts reported providing certain 

types of employment-related supports. For example, GAO estimates that 69 

percent provided work experiences and 63 percent provided job coaching. While 

the majority of districts reported providing transition services to students with 

ASD, the services provided varied by factors such as the size and poverty level 

of the district, according to GAO’s analysis of survey responses. 

Youth with ASD face key challenges transitioning from high school to adulthood,

such as untimely transition planning by school districts, complex adult service 

systems, and lack of job opportunities, according to stakeholders. IDEA requires 

districts to begin providing transition services when students with disabilities 

reach age 16, with the option to start earlier. However, according to GAO’s prior 

work and stakeholders GAO interviewed, providing discretion in this area may 

not serve some students well. School officials, advocates, and others report that 

earlier transition planning—with age 14 commonly cited—can have multiple 

benefits such as allowing more time to obtain important work and academic 

experiences; however, the Department of Education (Education) is not funding 

research on the appropriate age to begin transition planning. Unless Education,

which administers IDEA, examines the merits of earlier transition planning, 

policymakers may not have critical information when considering changes to

IDEA. Currently, about 32 percent of districts begin transition planning when 

students are older than age 14, according to GAO’s analysis of survey 

responses. 

While the Department of Health and Human Services’ (HHS) Interagency Autism 

Coordinating Committee (IACC) has facilitated collaboration across its member

agencies, including Education, to support research for transition-age youth with 

ASD, it has missed opportunities to collaborate with relevant nonmember 

agencies. Specifically, the Autism Collaboration, Accountability, Research, 

Education, and Support Act of 2014 calls for the IACC to include in its strategic 

plan, as practicable, services for individuals with ASD. However, HHS has not 

regularly engaged certain federal agencies that provide services or financial 

assistance to transition-age youth with ASD, but are not IACC members, such as 

the Departments of Labor and Housing and Urban Development. These

agencies are not part of working groups tasked with updating the current 

strategic plan nor has HHS invited them to join the IACC. As a result, IACC may 

continue to miss opportunities to leverage the knowledge of other agencies—a 

leading practice for effective federal interagency collaboration—as it works to 

fulfill its expanded responsibilities under the Act and improve the well-being of 

individuals with ASD.

View GAO-17-352. For more information, 

contact Jacqueline M. Nowicki at 

(617) 788-0580 or nowickij@gao.gov.

Why GAO Did This Study

Research suggests that youth with 

ASD are less likely than youth with 

other disabilities to be successful in 

transitioning to work and 

postsecondary education and 

therefore, they may face a lifetime of 

reliance on public assistance. GAO 

was asked to examine services 

provided under IDEA to assist youth 

with ASD in transitioning to adulthood. 

For this report, GAO examined (1) 

services and supports provided to 

assist youth with ASD in transitioning 

to adulthood, (2) key challenges in 

successfully transitioning, and (3) the 

extent to which federal agencies have 

collaborated to assist in the transition. 

GAO reviewed relevant federal laws 

and regulations and conducted a 

nationally generalizable survey of 588 

school districts to gather information on 

services provided in school year 2015-

16. GAO also interviewed federal 

officials and state and local 

stakeholders in three states selected to 

highlight a mix of localities with and 

without initiatives serving this 

population, urbanicity, and geographic 

dispersion, and GAO evaluated federal 

collaborative efforts against leading 

practices.

What GAO Recommends

GAO is making three

recommendations to federal agencies, 

including one to Education to examine 

the merits and implications of 

amending IDEA to require earlier 

transition planning and one to HHS to 

enhance collaboration with non-IACC 

member agencies. Education neither 

agreed nor disagreed with the IDEA 

recommendation. The agencies 

generally agreed with or did not 

comment on other recommendations.
Page i GAO-17-352 Youth with Autism

Letter 1

Background 4

Most School Districts Reported Providing Life and Social Skills 

Services; Other Services Varied Based on Factors Such as 

Size and Poverty Level 13

Untimely Transition Planning, Complex Adult Systems, and Few 

Employment Opportunities Are Key Challenges to Transitioning 

to Adult Life, According to Stakeholders 26

Federal Collaborative Efforts Have Missed Opportunities to 

Enhance Support of Transition-age Youth with Autism 37

Conclusions 43

Recommendations for Executive Action 44

Agency Comments and Our Evaluation 45

Appendix I Objectives, Scope, and Methodology 47

Appendix II Federal Agency Collaboration Has Highlighted Priority 

Research Needs 55

Appendix III Comments from the Department of Education 57

Appendix IV Comments from the Department of Labor 59

Appendix V Comments from the Social Security Administration 61

Appendix VI GAO Contact and Staff Acknowledgments 63

Related GAO Products 64

Contents
Page ii GAO-17-352 Youth with Autism

Tables

Table 1: Key Services Needed to Support Transitioning Youth with 

Autism Spectrum Disorder 6

Table 2: Transition Services School Districts Reported Providing 

to Youth with Autism Ages 16-21 of Varying Needs, 

School Year 2015-16 18

Figures

Figure 1: Autism Spectrum Disorder (ASD) Characteristics 4

Figure 2: Variation in Autism Spectrum Disorder Characteristics 5

Figure 3: Estimated Percentage of School Districts That Reported 

Providing Transition Services to Youth with Autism Ages 

16-21, School Year 2015-16 15

Figure 4: A Higher Percentage of Large School Districts Provided 

Transition Services to Youth with Autism Ages 16-21 in 

Special Education Compared to Small Districts, School 

Year 2015-16 20

Figure 5: A Higher Percentage of Low-Poverty School Districts 

Provided Certain Transition Services to Youth with 

Autism Ages 16-21 in Special Education Compared to 

High-Poverty Districts, School Year 2015-16 22

Figure 6: Students Move from Services Provided through Their 

High Schools to Services Delivered through Multiple 

Programs 31
Page iii GAO-17-352 Youth with Autism

Abbreviations

ASD Autism Spectrum Disorder

Autism CARES Act Autism Collaboration, Accountability, Research, 

Education, and Support Act of 2014

CDC Centers for Disease Control and Prevention 

CMS Centers for Medicare and Medicaid Services

DOL U.S. Department of Labor

Education U.S. Department of Education

EPA Environmental Protection Agency

FPT Federal Partners in Transition

FRPL Free or Reduced Price Lunch

HHS U.S. Department of Health and Human Services

HUD U.S. Department of Housing and Urban 

Development

IACC Interagency Autism Coordinating Committee

ICDR Interagency Committee on Disability Research

IDEA Individuals with Disabilities Education Act

IEP Individualized Education Program

LEA local educational agency

NLTS2 National Longitudinal Transition Study-2 

OARC Office of Autism Research Coordination

SSA Social Security Administration 

VR Vocational Rehabilitation 

WIOA Workforce Innovation and Opportunity Act

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product may be reproduced and distributed in its entirety 

without further permission from GAO. However, because this work may contain 

copyrighted images or other material, permission from the copyright holder may be 

necessary if you wish to reproduce this material separately.
Page 1 GAO-17-352 Youth with Autism

441 G St. N.W.

Washington, DC 20548

May 4, 2017

The Honorable Greg Walden

Chairman

Committee on Energy and Commerce

House of Representatives

The Honorable Michael C. Burgess

Chairman

Subcommittee on Health

Committee on Energy and Commerce

House of Representatives

The Honorable Christopher H. Smith

House of Representatives

The Honorable Fred Upton

House of Representatives

Students with disabilities are less likely than their peers to successfully 

transition to postsecondary education or the workforce, and youth with 

autism are even less likely to successfully transition than youth with other 

disabilities, according to recent research.1 When young adults with 

disabilities do not successfully transition out of high school, they may face 

a lifetime of continued reliance on public assistance, potentially leading to 

substantial costs to their families, the government, and society. 

Commonly known as autism, Autism Spectrum Disorder (ASD) is a group 

of complex developmental disorders characterized by difficulties with 

social interactions and communication, highly focused interests, or 

repetitive or ritualized behaviors.2

Much of the focus on autism has been placed on early diagnosis and 

intervention and little is known about the services and supports provided 

 1

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

Anderson, National Autism Indicators Report: Transition into Young Adulthood 

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

Drexel University, 2015).

2

In this report, we use the following terms interchangeably: “individuals on the autism 

spectrum,” “individuals with autism,” “individuals/youth with ASD,” and “autistic 

individuals.”

Letter
Page 2 GAO-17-352 Youth with Autism

to help youth with ASD begin managing their lives as adults. You asked 

us to study the services and supports provided to youth with ASD as they 

transition to adult life. This report, which builds upon our recent work 

identifying this population’s needs,3 examines (1) the types of services 

and supports provided at the local level to assist youth with ASD in 

transitioning to adult life, (2) the key challenges for youth with ASD in 

successfully transitioning to adult life, and (3) the extent to which key 

federal agencies have collaborated to assist youth with ASD in 

successfully transitioning to adult life.4

To examine the types of services and supports provided at the local level 

to assist youth with ASD in transitioning to adult life and the key 

challenges for youth with ASD in successfully transitioning to adult life, we 

used multiple methodologies. We conducted a nationally representative 

web-based survey of 588 school districts within the 50 states and the 

District of Columbia to gather information on services and supports 

provided to students aged 16 to 21 with ASD to assist in transitioning to 

adult life during the 2015-16 school year, as well as challenges in 

providing these services. We also asked about services provided to 

students by level of service need. This survey had a weighted response 

rate of 71 percent, the results of which are generalizable. We also 

selected three states—Arizona, New Jersey, and South Carolina—to 

conduct interviews with local and state stakeholders, such as service 

providers and advocacy groups.5 We selected these states to highlight a 

mix of local areas with adult providers specifically involved with initiatives 

to serve individuals with autism and those that are not, as well as a mix of 

rural, suburban, and urban localities, and geographic dispersion. In two of 

these states (Arizona and New Jersey), we conducted site visits and 

phone interviews with local and state entities. As part of these local 

interviews, we held five discussion groups with youth with ASD and family 

 3

GAO, Youth with Autism: Roundtable Views of Services Needed During the Transition to 

Adulthood, GAO-17-109 (Washington, D.C.: Oct. 18, 2016). We convened a roundtable 

panel to identify the needs of transition-age youth with ASD. Because our report is 

intended to build on that work, we present findings from that work throughout this report.

4

Consistent with our prior work on transition-age youth, throughout this report, we 

generally use the term “youth” to describe individuals aged 14 to 24, the age range when 

they generally may be eligible for transition services. During the transition years, youth 

may receive services for children, adults, or both. 

5

For this report, unless otherwise noted, we use the term “stakeholders” to include parents 

and family members from our discussion groups, service providers, and/or advocacy 

groups.
Page 3 GAO-17-352 Youth with Autism

members of youth with ASD who had exited high school within the last 5 

years, and we conducted interviews with officials of school districts and 

staff from postsecondary education institutions. We also met with public 

high school special education teachers and multiple adult service 

providers in each state. At the state level, we conducted interviews by 

phone with representatives of state special education, developmental 

disabilities, vocational rehabilitation, as well as behavioral health services 

agencies. We also interviewed representatives of university centers of 

excellence, parent training and information centers, the state 

developmental disabilities council, and state disability advocacy 

organizations. To gather additional information on service provision after 

high school, we conducted phone interviews in South Carolina with adult 

service providers and state agencies. Information gathered from our state 

and local interviews and discussion groups, while not generalizable, 

provides more in-depth examples of services provided and perspectives 

on the challenges facing youth with ASD in transitioning to adult life.

To examine the extent to which key federal agencies have collaborated to 

assist youth with ASD in successfully transitioning to adult life, we 

reviewed relevant federal laws, regulations, policy, and guidance and 

interviewed officials from the Departments of Education (Education), 

Health and Human Services (HHS), Housing and Urban Development 

(HUD), Labor (DOL), and the Social Security Administration (SSA), as 

well as the Interagency Autism Coordinating Committee (IACC) and the 

Federal Partners in Transition (FPT) interagency workgroup, which is 

composed of Education, HHS, DOL and SSA. We evaluated their 

collaborative efforts against leading federal practices for interagency 

collaboration, as appropriate.6 To inform all of our objectives, we 

interviewed additional stakeholders, such as employers and several 

national disability advocacy organizations. For more information on our 

scope and methodologies, please see appendix I.

We conducted this performance audit from November 2015 through April 

2017 in accordance with generally accepted government auditing 

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

 6

GAO, Results-Oriented Government: Practices That Can Help Enhance and Sustain 

Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 21, 2005) 

and Managing for Results: Key Considerations for Implementing Interagency Collaborative 

Mechanisms, GAO-12-1022 (Washington, D.C.: Sept. 27, 2012). We reviewed 

collaboration efforts of the FPT against all of the leading practices for interagency 

collaboration. Because we have conducted recent reviews of collaboration related to the 

IACC, we selected the practices most relevant to the focus of our review.
Page 4 GAO-17-352 Youth with Autism

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 (CDC), 

about 1 in 68 children were identified as having ASD in 2012 (about 1.5 

percent of 8-year-olds).7 ASD is a complex developmental disorder with 

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

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.

 7

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

funded by the CDC 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

Characteristics, Needs, 

and Outcomes of 

Transitioning Youth with 

Autism Spectrum Disorder
Page 5 GAO-17-352 Youth with Autism

Figure 2: Variation in Autism Spectrum Disorder Characteristics

To successfully transition into adulthood, youth with ASD need to be able 

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

community- and evidence-based, among other things, according to a 

roundtable panel we convened in 2016 to examine the needs of 

transitioning youth with ASD.8 The panel also identified 14 key services 

and supports that may help youth with ASD attain the goals of education, 

employment, health and safety, independent living, and community 

integration as they transition to adulthood (see table 1).

 8 GAO-17-109.
Page 6 GAO-17-352 Youth with Autism

Table 1: 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-17-109 | GAO-17-352

Recent research analyzing the outcomes of youth with ASD suggests that 

they encounter obstacles to attaining their goals for adulthood. According 

to analysis of data from Education’s National Longitudinal Transition 

Study-2 (NLTS2), in 2009:

• 36 percent of young adults with ASD had attended some type of 

postsecondary education institution.9 Of those youth, 32 percent had 

attended a 4-year college; 70 percent had attended a 2-year college; 

and 33 percent had attended a vocational, business, or technical 

school.10

• 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 group home or medical facility, 

which may have provided services such as life skills education or 

vocational supports. The analysis further indicates that young adults 

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

 9

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 in 2009 at the final data 

collection.

10These percentages sum to greater than 100 percent 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: September 2001).
Page 7 GAO-17-352 Youth with Autism

disabilities, including intellectual disabilities and emotional 

disturbances.11

• 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.12

In elementary and secondary school, students with disabilities—including 

students with autism—are entitled to receive special education and 

related services through the Individuals with Disabilities Education Act 

(IDEA), which is overseen at the federal level by Education.13 Part B of 

IDEA requires states to make a free appropriate public education in the 

least restrictive environment available to eligible children with disabilities 

as a condition of grant eligibility.14 In general, under Part B, Education 

provides formula grants to assist states and school districts to pay the 

excess costs of providing special education and related services to 

eligible students with disabilities, including those with autism, beginning at 

age 3 and lasting through 21, depending on state law or practice.

15 In 

general, school districts provide public school students with special 

education and related services—such as speech therapy, psychological 

services, and physical therapy—tailored to their needs based on an 

individualized education program (IEP).16 An IEP is a written statement 

developed by a team of school officials, parents, the student if 

appropriate, and at the discretion of the parent or school, other individuals 

who have knowledge or special expertise regarding the student. The IEP

 11The 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.

12Roux et al.

13See 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).

14The least restrictive environment requirement means that to the maximum extent 

appropriate, students with disabilities are to be educated with other children who are not 

disabled. 20 U.S.C. § 1412(a)(5)(A). Least restrictive environment is determined 

individually for each child served under IDEA.

15In order for a child to be eligible to receive services under IDEA, a child must have a 

disability, such as autism, as defined in the Act. 20 U.S.C. § 1401(3).

16Federal law generally requires school districts to also provide special education and 

related services to children they place in or refer to private schools. However, children 

whose parents choose to place them in private school without a school district placement 

or referral generally have no individual entitlement to receive some or all of the services 

they would receive if enrolled in a public school. 

School-Based Special 

Education under IDEA
Page 8 GAO-17-352 Youth with Autism

includes, among other information, a statement of the child’s present 

levels of academic achievement and functional performance, annual

goals and a statement of the special education and related services and 

supplementary aid and services needed to attain those goals. Beginning 

no later than the first IEP to be in effect when the student turns age 16, or 

younger if determined appropriate be the IEP team, a student’s IEP must 

include postsecondary goals and the transition services needed to assist 

the student in reaching those goals.17 To the extent appropriate, and with 

the consent of the parents or student who has reached the age of majority 

under state law, schools must invite representatives from state vocational 

rehabilitation (VR) agencies to IEP team meetings where postsecondary 

goals and transition services will be discussed. These students remain 

eligible for transition planning and services, as well as other IDEA 

services, until they exit high school.18

Title I of the Rehabilitation Act of 1973 (Rehabilitation Act), as amended,

contains new federal requirements in the state VR program, administered 

by Education, that require state VR agencies to provide pre-employment 

transition services to students with disabilities who are eligible or 

potentially eligible for VR services.19 State agencies may also provide 

 17Transition services 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. 20 U.S.C. 

§ 1401(34). IDEA and its implementing regulations require that beginning no later than the 

first IEP in effect when the student turns 16, or younger if determined appropriate by the 

IEP team, school districts must ensure that the student’s IEP includes appropriate 

measureable postsecondary goals based on age-appropriate transition assessments 

related to training, education, employment, and where appropriate, independent living 

skills; and transition services needed to assist the student in meeting those goals. 20 

U.S.C. § 1414(d)(1)(A)(i)(VIII) and 34 C.F.R. § 300.320(b). According to IDEA and its 

implementing regulations, Education is to review states’ compliance with the IDEA 

transition services requirement through states’ annual performance reports. If a state does 

not report 100 percent compliance (percent of students with transition plans age 16 and 

above) with the secondary transition services requirement, it must provide detailed 

information on correction of the non-compliance. For the purpose of this report, we refer to 

the inclusion of transition services in a student’s IEP as “transition planning.”

18Students 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 earlier of age 21 or the eligibility age for a free appropriate public education 

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

education up until age 22, eligibility for students aged 18 and older is determined by 

states. 20 U.S.C. § 1412(a)(1) and 34 C.F.R. § 300.102(a).

19 See Workforce Innovation and Opportunity Act, Pub. L. No. 113-128, § 422, 128 Stat. 

1425, 1657-59 (2014) (codified at 29 U.S.C. § 733)..
Page 9 GAO-17-352 Youth with Autism

transition services to groups of students and youth with disabilities prior to 

or after applying for VR services. Finally, VR agencies may provide 

individualized VR services including individualized transition services, to 

students and youth with disabilities who have been determined eligible for 

VR services under an approved individualized plan for employment under 

the VR program.20 Students may apply for and be determined eligible for 

VR services prior to graduating from high school, and youth may apply for 

and be determined eligible for VR series prior to reaching adulthood. 

Generally, as they enter adulthood, youth and young adults with ASD 

may seek to obtain needed services from the state adult service systems, 

which are funded by multiple federal agencies:

• HHS’s Centers for Medicare & Medicaid Services (CMS) oversees 

Medicaid, which can be used to fund long-term and home- and 

community-based services.21 These services are generally 

administered to eligible individuals with ASD through state agencies 

serving individuals with developmental disabilities or disabilities more 

broadly.

• Education’s Rehabilitation Services Administration, within the Office of 

Special Education and Rehabilitative Services, funds the VR State 

Grants program to assist individuals with disabilities including 

transition-age students and youth with ASD in developing the skills to 

prepare for, secure, retain, advance in, and regain employment. This 

program is in the form of federal/state matching grants provided to

state VR agencies.22

 2029 U.S.C. § 723.

21Medicaid is a joint federal-state financing program for health care for certain low-income 

and medically needy individuals. States design and administer their Medicaid programs 

within broad federal rules and according to a state plan approved by CMS. States are 

required to cover all medically necessary state plan services, including institutional and 

community-based services, for beneficiaries under age 21; however, the majority of homeand community-based services provided through Medicaid are covered by optional state 

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

management, personal care attendants, or day habilitation. 

22To be eligible for VR services, an individual must (1) be an “individual with a disability,” 

meaning a person who has a physical or mental impairment which constitutes or results in 

a substantial impediment to employment for the individual, and who can benefit from VR 

services to achieve an employment outcome; and (2) require VR services to prepare for, 

secure, retain, advance in, or regain employment. State VR agencies determine 

individual’s eligibility for VR services.

System for Adult Services
Page 10 GAO-17-352 Youth with Autism

• SSA provides cash benefits to qualifying individuals through the 

agency’s Supplemental Security Income (SSI) and Disability 

Insurance (DI) programs.23 Individuals can apply for benefits through 

SSA field offices.

• DOL provides funding for employment and training for a broad array 

of individuals with barriers to employment, including youth and those 

with disabilities, often through the One-Stop delivery system.24 HUD 

provides funds for rental assistance for low-income individuals with 

disabilities through various programs, offers online tools to assist with 

locating housing resources, and funds Housing Counseling Agencies 

that assist families and individuals seeking affordable housing.25

The Autism Collaboration, Accountability, Research, Education, and 

Support Act of 2014 (Autism CARES Act) reauthorized the Interagency 

Autism Coordinating Committee,26 which is led by HHS and composed of 

representatives from multiple HHS subagencies, Education, the 

Department of Defense (DOD), and the Environmental Protection Agency 

 23The SSI program provides financial assistance to eligible individuals who are age 65 or 

older, blind, or disabled, and who have limited income and resources. 42 U.S.C. § 1381a. 

Children under age 18 may qualify for SSI benefits if they meet SSA’s disability definition 

and financial eligibility requirements. 20 C.F.R. § 416.906. Individuals known as “disabled 

adult children” can receive DI benefits if they are age 18 or older, were disabled before 

age 22, and have at least one parent who also receives Social Security payments 

because of retirement or disability, or who is deceased but worked long enough to be 

eligible to receive benefits. 20 C.F.R. § 404.350(a).

24Under the Workforce Innovation and Opportunity Act (WIOA), each state must establish 

a One-Stop delivery system to provide career services and access to training. Under Title 

I, three state formula grant programs for youth, adults, and dislocated workers authorize 

funding for employment and training activities available through the system of One-Stop 

centers (also known as American Job Centers) and provided by service providers in local 

communities. 

25For example, HUD administers the Section 811 Supportive Housing for Persons with 

Disabilities program, which funds supportive housing for very low-income persons with 

disabilities, and the Housing Choice Voucher program, which can be used by very lowincome persons with disabilities to find affordable, private housing of their choice.

26Autism CARES Act of 2014, Pub. L. No. 113-157, 128 Stat. 1831. The IACC was 

originally established under the Children’s Health Act of 2000 and reauthorized under the 

Combating Autism Act of 2006 (CAA). Children’s Health Act of 2000, Pub. L. No. 106-310, 

§ 104, 114 Stat. 1101, 1109 and Combating Autism Act of 2006 Pub. L. No. 109-416, § 3, 

120 Stat. 2821, 2827-28.

Interagency Autism 

Coordinating Committee
Page 11 GAO-17-352 Youth with Autism

(EPA), as well as certain non-federal stakeholders.27 Among other things, 

the IACC is responsible for developing and annually updating a strategic 

plan with budgetary recommendations for ASD research. The 2013 

strategic plan (the most recent plan), is divided into seven general topic 

areas that were created to address critical gaps and opportunities. Each 

general topic area includes specific objectives and a recommended 

budget for associated research-related activities. The 2014 

reauthorization expanded the scope of the strategic plan to include, as 

practicable, services and supports.28 The strategic plan is intended to 

promote public-private coordination and community engagement and to 

accelerate research and service efforts to improve the health and wellbeing of individuals with ASD. The IACC is also responsible for 

monitoring ASD research across federal agencies, and the 2014 

reauthorization also expanded this monitoring role to include, as 

practicable, monitoring of services and support activities. In the past, the 

IACC has fulfilled the responsibility for monitoring research by tracking 

and compiling information on ongoing research in the field. The Autism 

CARES Act led to the creation of the role of the Autism Coordinator within 

HHS, separately but in coordination with the IACC, to oversee and 

implement federal ASD activities nationwide, taking into account the 

strategic plan developed by the IACC, and ensure that federal ASD 

activities are not unnecessarily duplicative.29

We have conducted previous work on IACC’s federal autism activities. In 

2013 we reported that the IACC’s and federal agencies’ efforts to 

coordinate and monitor federal autism activities were limited.30

Specifically, IACC members provided mixed views on the usefulness of 

the IACC’s meetings, strategic plan, and portfolio analysis in aiding 

 27In accordance to the requirements of the Autism CARES Act, federal members include 

representatives of Education and DOD, as well as from the Administration for Children 

and Families, Administration for Community Living, Agency for Healthcare Research and 

Quality, CDC, CMS, Food and Drug Administration, Health Resources and Services 

Administration, and five institutes within and the director of the National Institutes of 

Health. The EPA is not a statutorily required member. The reauthorized IACC also 

includes representatives from advocacy groups, university professors, individuals with 

autism, and parents of children with autism.

28See Autism CARES Act of 2014, § 5.

29See Autism CARES Act of 2014, § 2. 

30GAO, Federal Autism Activities: Better Data and More Coordination Needed to Help 

Avoid the Potential for Unnecessary Duplication, GAO-14-16 (Washington, D.C.: Nov. 20, 

2013).
Page 12 GAO-17-352 Youth with Autism

coordination and monitoring activities, and only some agencies regularly 

used the committee’s strategic plan and research funding analysis.31

Additionally, we found that shortcomings in the data the IACC used for its 

research funding analysis limited its ability to coordinate HHS autism 

activities and monitor federal autism activities. We found that, collectively, 

these weaknesses limited the IACC’s ability to monitor its progress. For a 

complete list of our previous work in this area, see the Related GAO 

Products page at the end of this report.

 31The IACC holds meetings and issues reports as a means to coordinate HHS autism 

efforts and monitor federal autism activities.
Page 13 GAO-17-352 Youth with Autism

Based on the results of our nationally generalizable school district survey, 

we estimate that in school year 2015-16 most school districts (about 85 

percent) provided transition-age students with ASD instruction on life and 

social skills, as well as behavioral skills (see fig. 3),32 services we 

previously reported such youth may need to support their transition to 

adulthood.33 Self-advocacy (87 percent), social (86 percent), and 

organizational (86 percent) skills were provided by the most districts, 

according to our survey. Schools may employ different strategies for 

providing these services based on individual student needs. For instance, 

officials we interviewed in one district said that for many students with 

occasional behavior issues, staff teach students how to cope with and 

have control over their emotions. However, if a student needs intensive 

behavioral supports, the district may send the student to a nonpublic 

school that specializes in serving youth with ASD. The officials noted that 

 32In our survey, we asked school districts which services and supports to assist in 

transitioning to adult life they provided to students aged 16-21 with ASD in special 

education during the 2015-16 school year. Transition services provided through special 

education are determined by an IEP team and vary based on the needs of each individual 

student. Therefore, these estimates do not reflect services each transition-age student 

received, but rather services the district provided to transition-age students with ASD in 

aggregate. Further, in our survey we did not ask about all services districts may provide as 

part of special education. We only asked about services specifically aimed at assisting 

youth in transitioning beyond high school. All estimates presented in this report from this 

survey have a margin of error of plus or minus 11.8 percentage points or fewer at the 95 

percent confidence level, unless otherwise noted.

33In GAO-17-109, we reported on 14 key services and supports that may help youth with 

ASD in attaining goals of adulthood (also listed in table 1 of this report). Throughout this 

report, we provide examples from our interviews of how these 14 services are provided. 

Most School Districts 

Reported Providing 

Life and Social Skills 

Services; Other 

Services Varied 

Based on Factors 

Such as Size and 

Poverty Level

School Districts Reported 

Providing Life and Social 

Skills Services; Fewer 

Provided Services to 

Prepare for Employment, 

Housing, and 

Transportation
Page 14 GAO-17-352 Youth with Autism

it is difficult to find teachers who understand how to support students with 

intense behavior issues.34

 34Behavioral 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 to manage responses 

to them. For example, 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. Our survey did not ask about the specific types of behavior 

interventions used by the districts.
Page 15 GAO-17-352 Youth with Autism

Figure 3: Estimated Percentage of School Districts That Reported Providing Transition Services to Youth with Autism Ages 

16-21, School Year 2015-16

Notes: All estimates in this figure have a margin of error of plus or minus 7.2 percentage points or 

fewer, at the 95 percent confidence level. For this question in our survey, we asked school districts 

about services and supports they provide to students aged 16-21 with Autism Spectrum Disorder 

(ASD) in special education to assist in transitioning to adult life. We gave respondents four response 

options: yes, provide service; no, do not provide but refer out; no, do not provide, do not refer out; and 

do not know. “Refer out” indicates that school staff do not provide or pay for the service but refer the 
Page 16 GAO-17-352 Youth with Autism

student to a service provider (likely in the community). We do not have information on the formality of 

the referral or whether the student’s family pursued and received such services from an outside 

provider. Transition services provided through special education are determined by an individualized 

education program team and vary based on the needs of each individual student. Therefore, these 

estimates do not reflect services each transition-age student received, but rather services the district 

provided to transition-age students with ASD in aggregate.

Fewer, though still a majority of, school districts reported providing certain 

types of services to support the transition to employment, according to 

our survey. Specifically, while an estimated 85 percent of districts 

reported providing career counseling, we estimate that 74 percent 

provided interview skills, 69 percent provided work experiences, and 63 

percent provided job coaching. In Arizona and South Carolina, state VR 

officials reported partnering with some school districts to provide 

employment-related services. For example, in South Carolina, VR state 

officials told us they partner with some school districts to provide job 

coaches to high school students with disabilities, including ASD.35 In all 

three states in our review, state VR agency officials told us they were 

developing plans for how they will enhance pre-employment transition 

services to school-age students with disabilities.36

Certain mental health and independent living skills were provided by the 

fewest districts, according to our survey. Specifically, an estimated 40 

percent reported providing one-on-one or group psychological counseling. 

About one-half of districts reported providing education and planning on 

transportation options and 35 percent of school districts reported 

providing housing education and awareness. As figure 3 illustrates, more 

districts reported referring students out to community providers for 

psychological counseling and housing education compared to other 

 35This effort was a Project SEARCH program, according to South Carolina VR officials. 

Project SEARCH partners with employers to provide work experience programs to 

students in their last year of high school. In addition to an internship, students take classes 

at the work site in life and work readiness skills.

36The Rehabilitation Act, as amended by WIOA, places additional emphasis on the 

provision of services to students and youth with disabilities to ensure that they have 

meaningful opportunities to receive the training and other services they need to achieve 

competitive integrated employment. For example, states must reserve no less than 15 

percent of the funds they received under the Vocational Rehabilitation State Grants 

program to provide pre-employment transition services to students with disabilities in need 

of such services who are eligible or potentially eligible for VR services. Pub. L. No. 113-

128, § 419, 128 Stat. 1425, 1656 (2014) (codified at 29 U.S.C. § 730(d)). Such preemployment transition services may include job exploration, counseling, self-advocacy 

instruction, work-based learning experiences, and workplace readiness training. 29 U.S.C. 

§ 733(a)-(b).

Life Skills Education and Experiences:

Examples of Key Service Needed to 

Support Transitioning Youth with 

Autism

Self-advocacy skills: Officials we 

interviewed at one school district reported 

that case managers work with students to 

build the skills they need to communicate 

their wants, needs, and to advocate for 

themselves.

Daily living skills: Teachers in one high 

school serving students with moderate- and 

high-intensity needs told us students take a 

weekly assisted daily living class that 

includes learning housekeeping, hygiene, 

washing dishes, and basic cooking recipes.

Source: GAO interviews. | GAO-17-352

Social Supports: Examples of Key 

Service Needed to Support Transitioning 

Youth with Autism

Social skills: In one high school, staff 

reported using community-based 

experiences to help students practice social 

skills, such as visiting the local food court to 

order food, pay, eat with friends, and learn 

how to wait for others to finish eating before 

leaving the table. In another high school, 

teachers reported using role-playing to help 

students with Autism Spectrum Disorder 

practice their social skills.

Source: GAO interviews. | GAO-17-352
Page 17 GAO-17-352 Youth with Autism

services; the extent to which these students actually receive these 

services is unknown. One reason school districts do not typically provide 

housing education and planning is that it may not be a priority for families 

as youth are leaving school. As one school district official said, parents 

typically are not looking for housing options for their transition-age youth.

Stakeholders we interviewed emphasized that the services provided to 

each individual student with ASD vary widely based on individual need 

and goals for transition. Likewise, in our survey school districts reported 

differences in the services provided to transition-age students with low-, 

moderate-, and high-intensity needs.37 This may be expected given that 

IDEA requires school districts to determine special education services 

based on the individual needs of each student; moreover, the needs of 

individuals on the spectrum vary widely.38 For example, we estimate that 

in the 2015-16 school year, a higher percentage of districts provided 

students with low-intensity needs with college counseling compared to 

those with moderate- and high-intensity needs. In contrast, a higher 

percentage of districts provided students with moderate- and highintensity needs with daily living skills compared to those with low-intensity 

needs in that same year. In general, for the majority of transition services 

we asked about, a higher percentage of districts reported providing 

services to students with high- and moderate-intensity needs. (See table 

2 for the services most and least frequently provided by level of student 

need).

 37In addition to asking about services provided to any students aged 16-21 with ASD in 

special education (as shown in fig. 3), our survey also asked about the services provided 

by the student level of need. Specifically, we asked how often school districts provided 

each service to students aged 16-21 with ASD with low-, moderate-, and high-intensity 

service needs during the 2015-16 school year. 

38In the survey, we used the following definitions of low-, moderate-, and high-intensity 

service needs, based on the U.S. Department of Education’s environmental categories for 

IDEA reporting: We defined students with low-intensity service needs as those students 

who spend 80 percent or more of their day in the regular classroom; students with 

moderate-intensity service needs as those students who spend between 79 and 40 

percent of their day in the regular classroom; and students with high-intensity service 

needs as those students who spend less than 40 percent of their day in the regular 

classroom. These terms are not found in IDEA or the Rehabilitation Act.

Vocational Supports: Examples of Key 

Service Needed to Support Transitioning 

Youth with Autism

Work experience: In one high school we 

visited, students begin with in-house jobs, 

such as custodial work, shredding, 

maintaining the fish pond, and gardening at 

the school. Once students demonstrate 

they are capable of these work 

experiences, they move on to work 

experiences in the community. According to 

special education teachers, at the job sites 

paraprofessionals make sure no one is 

taking advantage of the students and also 

supervise the student to make sure they 

are doing the work sufficiently.

Job coaching: Administrators from one 

school district told us job coaches help 

students stay focused on the job, and 

having a sufficient number of job coaches is 

important to being able to supervise the 

students.

Source: GAO interviews. | GAO-17-352
Page 18 GAO-17-352 Youth with Autism

Table 2: Transition Services School Districts Reported Providing to Youth with Autism Ages 16-21 of Varying Needs, School 

Year 2015-16

by Estimated Percent

Student need Three services districts most commonly 

reported they frequently provided 

Three services districts most commonly reported 

they never or rarely provided

Low intensity • Organizational/study (59)

• Self-advocacy (58)

• Career counseling (54)

• Specialized housing education (50)

• Psychological counseling (45)

• Transportation education (42)

Moderate intensity • Social (71)

• Behavior (70)

• Daily living (69)

• Specialized housing education (38)

• Psychological counseling (38)

• Transportation education (32)

High intensity • Daily living (90)

• Behavior (86)

• Social (81)

• College accommodations counseling (56)

• College counseling (53)

• Psychological counseling (40)

Source: GAO survey of school districts. | GAO-17-352

Note: All estimates in this table have a margin of error of plus or minus 10.1 percentage points or 

fewer, at the 95 percent confidence level. Transition services provided through special education are 

determined by an individualized education program team and vary based on the needs of each 

individual student. Therefore, these estimates do not reflect services each transition-age student 

received, but rather services the district provided to transition-age students with Autism Spectrum 

Disorder in aggregate.

While the majority of school districts reported providing some types of 

transition services to students with ASD, the specific services that districts 

reported providing varied depending on the size and poverty level of the 

district, according to our analysis of school districts’ survey responses. In 

particular, we estimate that a higher percentage of large school districts 

generally reported providing transition services compared to small school 

districts, and a higher percentage of low-poverty school districts reported 

providing transition services compared to high-poverty school districts for 

certain services.

According to our analysis of survey responses, a higher percentage of 

large school districts generally reported providing transition services 

compared to small school districts.39 When comparing larger school 

districts (those serving more than the median number of students per 

district) to smaller districts (those serving fewer than the median number 

 39Transition services provided through special education are determined by an IEP team 

and vary based on the needs of each individual student. School districts reporting that 

they did not provide certain services may not have had students in need of such services. 

We did not assess school districts’ compliance with IDEA as part of this study. 

District-Provided 

Transition Services Varied 

by District Size and 

Poverty Level

District Size
Page 19 GAO-17-352 Youth with Autism

of students per district),40 we estimate a difference of roughly 30 

percentage points in providing several services to support the transition to 

employment, daily living skills, training on community safety, and 

education on and awareness of transportation options (see fig. 4).41 For 

example, we estimate 82 percent of larger districts provided work 

experience compared to 52 percent of smaller districts. Similarly, we 

estimate 87 percent of larger districts provided interview skills training 

compared to 56 percent of smaller districts. The differences may be 

because larger districts are better able to provide services in-house, as—

for many of these services—a higher percentage of small school districts 

reported referring students to other providers.42 In addition, a higher 

percentage of respondents for smaller districts reported that they did not 

know if the school districts provided the services, compared to larger 

school districts.

 40The median of the population we defined was 1,110 total students (inclusive of all 

grades) in the district. For the purpose of this analysis, we defined smaller districts as 

those with total student size below the median number of students and larger districts as 

those with total student size above the median.

41To support the estimated differences identified in figure 4, we conducted a multivariate 

analysis for each of the 17 services we asked about in our survey. Based on these 

analyses, the estimated differences by size generally remain statistically significant when 

controlling for several other school district characteristics, such as poverty status, 

urbanicity, racial composition, and charter status. See appendix I for more details. 

42It is possible these differences are in part because larger districts are likely to have 

larger numbers of students with ASD; therefore, larger districts may need to provide a 

wider array of services to address the needs of more students.
Page 20 GAO-17-352 Youth with Autism

Figure 4: A Higher Percentage of Large School Districts Provided Transition 

Services to Youth with Autism Ages 16-21 in Special Education Compared to Small 

Districts, School Year 2015-16

Note: All estimates in this figure have a margin of error of plus or minus 13.8 percentage points or 

fewer, at the 95 percent confidence level. For the 15 services shown in this graphic, all estimates are 

generally statistically significant when controlling for other school district characteristics such as 

poverty status, urbanicity, racial composition, and charter status. For the purpose of this analysis, we 

defined smaller districts as those with total student size below the median number of students and 

larger districts as those with total student size above the median. Transition services provided 

through special education are determined by an individualized education program team and vary 

based on the needs of each individual student. Therefore, these estimates do not reflect services 

each transition-age student received, but rather services the district provided to transition-age 

students with Autism Spectrum Disorder in aggregate.

Services provided in school also varied by the type of community where 

the school district was located—urban, suburban, or rural—according to 

our analysis of school districts’ survey responses, but in some cases this 

was related to district size. We estimate that smaller urban and suburban 

districts were significantly more likely to provide certain vocational 
Page 21 GAO-17-352 Youth with Autism

supports (job coaching, interview skills, and formal vocational 

assessment), as well as daily living skills, transportation education and 

awareness, community safety, civic engagement, and behavior skills 

when compared to smaller rural districts. However, when we compared 

larger urban and suburban districts to larger rural districts, the differences 

in services were not statistically significant.

Based on our survey, we estimate that a higher percentage of low-poverty 

school districts reported providing transition services compared to highpoverty school districts for certain services.43 For example, we estimate 

that 70 percent of low-poverty districts provided job coaching to transitionage youth with ASD compared to about 50 percent of high-poverty 

districts. Similarly, we estimate that 58 percent of low-poverty school 

districts provided one-on-one or group psychological counseling to 

transition-age youth with ASD compared to roughly 38 percent of highpoverty districts—a difference of about 20 percentage points (see fig.5).44

In one high-poverty school district we visited, teachers and administrators 

said they had limited funding to enable students to get experiences 

outside of the school. Specifically, they said transportation and 

supervision costs make it difficult to provide students with community 

experiences. In our 2016 report on the needs of youth with ASD, the 

roundtable panel emphasized the importance of providing some 

educational services outside the classroom and locating services in the 

neighborhoods where youth live. Our panelists 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.45

 43Transition services provided through special education are determined by an IEP team 

and vary based on the needs of each individual student. School districts reporting that 

they did not provide certain services may not have had students in need of such services. 

We did not assess school districts’ compliance with IDEA as part of this study. 

44To support the estimated differences identified in figure 5, we conducted a multivariate 

analysis for each of the 17 services we asked about in our survey. Based on these 

analyses, the estimated differences by poverty level generally remained statistically 

significant for 5 of the 17 services when controlling for several other school district 

characteristics such as size, urbanicity, racial composition, and charter status. See 

appendix I for more details. 

45GAO-17-109.

Poverty
Page 22 GAO-17-352 Youth with Autism

Figure 5: A Higher Percentage of Low-Poverty School Districts Provided Certain 

Transition Services to Youth with Autism Ages 16-21 in Special Education 

Compared to High-Poverty Districts, School Year 2015-16

Note: All estimates in this figure have a margin of error of plus or minus 14.8 percentage points or 

fewer, at the 95 percent confidence level. For the five services shown in this graphic, all estimates are 

generally statistically significant when controlling for other school district characteristics such as size, 

urbanicity, racial composition, and charter status. For the purpose of this analysis, low-poverty 

districts were defined as those in which 25 percent or fewer students were eligible for free or reduced 

price lunch, and high-poverty districts were those in which more than 75 percent of students were 

eligible. See appendix I for more details. Transition services provided through special education are 

determined by an individualized education program team and vary based on the needs of each 

individual student. Therefore, these estimates do not reflect services each transition-age student 

received, but rather services the district provided to transition-age students with Autism Spectrum 

Disorder in aggregate.

Adult service providers offered various types of services to transition-age 

young adults with ASD as they transition from high school to adulthood.

Across the three states in our review, most state officials and providers of 

developmental disabilities and VR services reported offering vocational 

supports and some offered day programming to young adult clients with 

ASD—services we previously reported such youth may need to support 

Adult Service Providers 

Offer Employment and 

Other Transition Services 

to Young Adults after 

Leaving High School, as 

Seen in Selected States

Vocational Supports and Day 

Programming
Page 23 GAO-17-352 Youth with Autism

their transition to adulthood.46 For example, in Arizona one developmental 

disabilities service provider offered its adult clients supervised 

employment in group settings both at businesses in the community and 

in-house at an adult center. Another service provider ran a vocational 

training program for young adults with ASD. The program has a number 

of work areas, such as reception, technology, and design, in which the 

client chooses one area to train in for a year. In addition to learning the 

skills for a specific work area, youth learn pre-employment skills such as 

getting along with others, following instructions, and appropriate work 

etiquette. A few providers we interviewed sent their clients to workplaces 

with a coach to supervise and assist them on the job, with the level of 

coaching determined by the needs of the individual. For example, one 

provider said they have staff check on some clients at their place of work 

for an hour three times a week, while other clients who have a higher 

level of need have a full-time coach.

Some of the adult service providers we interviewed reported providing 

residential supports—another service we previously identified that youth 

may need to support their transition to adulthood—funded either through 

the state developmental disabilities services agency or private, out-ofpocket payments.47 In Arizona and South Carolina, a few adult service 

providers we interviewed were developing housing or independent living 

programs for individuals with ASD. For example, a provider in Arizona 

recently started a residential independent living program for individuals in 

its vocational program. The program serves six individuals and has a 

small waiting list. Individuals initially receive training on using public 

transportation, managing their own finances, and safety skills for being in 

the community and at home. They then move to supervised apartments 

with the ultimate goal of eventually living in apartments independently. In 

South Carolina, a non-profit organization serving adults with ASD was in 

the process of establishing a new independent living program with the 

goal of helping individuals live independently in an environment that 

meets their needs and interests.

 46GAO-17-109.

47GAO-17-109.

Day Programming: Examples of Key 

Service Needed to Support Transitioning 

Youth with Autism 

A day program in Newark, New Jersey serves 

adults with Autism Spectrum Disorder with 

high intensity needs from low-income families 

in the Newark community. The day program 

focuses on providing adult daily living skills, 

community exploration, pre-vocational skills, 

and social and emotional skills. Clients are 

served in small group environments. The staff 

said that while the program has a large 

waiting list it is important to keep the ratio of 

clients to staff small to ensure overall quality.

Source: GAO interviews. | GAO 17 352

Residential Supports

Residential Supports: Examples of Key 

Service Needed to Support Transitioning 

Youth with Autism

One service provider in Princeton, New 

Jersey provides residential group housing 

to the majority of the adults in its day 

program. The group homes and apartments 

have 24-hour supervision. 

A service provider in Phoenix, Arizona 

offers a new 2-year program designed for 

young adults age 18 and older. Clients live 

in apartments and work on independent 

living skills and community integration. 

They look for part-time paid employment in 

a competitive field of their choice. The 

provider offers 36 courses developed to 

teach the skills needed to live 

independently such as personal safety, 

personal finance, and advocacy. For 

example, as they are learning about 

personal finance, they create budgets and 

go to the bank to make deposits.

Source: GAO interviews. | GAO-17-352
Page 24 GAO-17-352 Youth with Autism

Postsecondary education supports is another service area we previously 

identified that youth with ASD may need to support their transition to 

adulthood,48 and representatives of postsecondary education institutions 

we interviewed in three states reported providing their students with ASD 

with accommodations, as they reported they do for all students with 

disabilities who self-identify and show need for an accommodation. 

Services commonly provided, according to college officials, include 

instruction in time management and organizational skills, or 

accommodations such as assistive technology or additional time and a 

distraction-free location for test-taking. A few of the colleges we contacted 

also had specialized postsecondary education programs for individuals 

with developmental and intellectual disabilities that focused on helping 

them prepare for employment and independent living. However, such 

programs may be cost prohibitive for many families, and some students 

may only participate for 1 or 2 years due to the cost, according to one 

college administrator.

 48GAO-17-109.

Postsecondary Education

Postsecondary Education Planning and 

Supports: Examples of Key Service 

Needed to Support Transitioning Youth 

with Autism

In South Carolina, one non-profit started a 

college mentor program to assist college 

students with ASD in navigating the 

organizational side of their postsecondary 

education at a local technical college. The 

mentors help the individual learn the way 

around campus and how to handle 

challenging social situations. The mentors 

also assist the participants with homework 

assignments, developing social networks, 

and they help with communicating between 

the student and the college counselors, 

professors, and parents. 

In New Jersey, a community college runs a 

program for young adults with intellectual 

disabilities. The program provides students 

with career exploration and experiences, 

academic experiences, independent living 

skills, and social experiences. Each student 

is paired with a peer mentor who provides 

academic, social, and emotional supports.

Source: GAO interviews. | GAO-17-352
Page 25 GAO-17-352 Youth with Autism

Non-profit advocacy groups in the states we visited provided supports to 

the families of young adults with ASD. Family education and supports is 

another service area we previously identified that may be needed to 

assist youth in the transition to adulthood.49 For example, one non-profit 

in New Jersey hosts a transition fair annually and maintains a referral 

database on its website to help families identify supports including 

transition and adult services. A non-profit organization in Phoenix, 

Arizona, holds monthly meetings for transition-age youth and their 

parents with speakers on various topics, such as financial planning, 

sexual education, and disability resources for college. The organization 

also provides individual assistance to families for how to apply for 

services and benefits as they transition to adulthood, such as Social 

Security benefits. Other adult service providers we interviewed reported 

offering in-home supports to family members or workshops for families.

A few adult service providers we interviewed told us they taught safety 

skills to individuals with ASD as part of their independent living and 

vocational training programs. One provider taught clients how and when 

to call 911, how to store food properly, and about sexual education. 

Parents and family members of transition-age youth in three of our five 

discussion groups expressed concern for the safety of their young adults, 

including interactions with law enforcement. For example, one father in a 

New Jersey discussion group worried about whether law enforcement 

officers would interpret his son’s literal answers to questions as being 

disrespectful or defiant. Staff we interviewed at a service provider in 

South Carolina reported they offer training for law-enforcement and first 

responders on how to identify signs that an individual has ASD and how 

to interact with these individuals.

 49GAO-17-109.

Family Education and Other 

Supports

Family Education and Supports: 

Examples of Key Service Needed to 

Support Transitioning Youth with 

Autism

In Princeton, New Jersey, staff at one 

service provider visit their adult clients and 

their families at home to help establish 

independent living routines. For example, 

staff will help set up systems to assist 

clients in becoming more independent in 

caring for themselves or doing chores 

around the house.

At a service provider in South Carolina, 

staff develop behavior plans and provide 

parents of adult clients with training on 

addressing behavior issues.

Source: GAO interviews. | GAO-17-352
Page 26 GAO-17-352 Youth with Autism

IDEA currently requires schools to include in the IEP transition services 

needed to assist youth in reaching their appropriate measurable 

postsecondary goals no later than the first IEP in effect when students 

reach age 16.50 According to our analysis of school districts’ survey 

responses, almost all school districts reported beginning transition 

planning for students by age 16.51 However, the majority of school 

districts surveyed (an estimated 72 percent) reported that age 14, or 

younger, would be the most beneficial age to begin transitioning students 

to adult life. Our estimates from school districts’ survey responses 

indicate that approximately 32 percent of districts—which represents 

about 4,000 school districts—begin transition planning when students are 

older than age 14. By not starting transition planning until after age 14, 

these districts—covering more than 1 million students with disabilities52—

may not be providing youth with the additional time needed to build the 

 50One 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).Transition services may 

begin before the age of 16 if the IEP team determines it is appropriate to do so, or if state

law requires transition planning to begin earlier than age 16.

51According to IDEA, the U.S. Department of Education is to review states’ compliance 

with the IDEA transition services requirement through states’ annual performance reports. 

We did not assess state or school district compliance with IDEA as part of this review.

52This estimate represents the lower bound of the 95 percent confidence interval for the 

estimated total number of students with disabilities in districts that begin transition 

planning when students are older than age 14 and has a relative error of about +/- 30 

percent.

Untimely Transition 

Planning, Complex 

Adult Systems, and 

Few Employment 

Opportunities Are Key 

Challenges to 

Transitioning to Adult 

Life, According to 

Stakeholders

Transition Planning 

Sometimes Occurs Too 

Late to Meet Students’

Needs, According to 

School Districts, Service 

Providers, and Others
Page 27 GAO-17-352 Youth with Autism

skills for adult life, and the time for schools, parents, and service 

providers to develop IEPs that align with the goals and needs of youth 

transitioning out of school.

The views of many school districts regarding earlier transition planning is 

consistent with the view of several stakeholders we interviewed, as well 

as panelists we talked to in our prior work who said that beginning 

transition planning before age 16 would be the most beneficial for 

students.53 Stakeholders said that beginning transition planning at an 

earlier age, with age 14 or younger being commonly cited in our survey 

and multiple interviews, can have many benefits. School officials we 

spoke with explained that earlier transition planning allows families more 

time to apply for and secure services in the adult system before a student 

leaves the school system.

According to Education officials, the agency does not have the authority, 

without statutory revisions to IDEA, to change the age requirement for 

beginning transition services and has not asked Congress for the 

authority to do so. Education officials reported that IDEA currently 

provides states and districts with the ability to provide transition services 

earlier if so desired. In guidance since at least 2007, and again in January 

2017, Education restated IDEA requirements that by age 16, students’

IEPs must address the transition services requirement, and that IEP 

teams can provide transition services earlier if determined appropriate. 

Education officials also stated they considered age 14 too early for some 

middle school age students to begin transition planning because students

may lack the experience and educational development to make decisions 

about future life choices.

However, providing discretion in this area may not serve some students 

well, according to stakeholders we interviewed. Based on our nationally 

generalizable sample of public school districts, we identified at least 29 

states that had one or more school districts that do not start transition 

planning until the age of 16 or older.54 Our prior work and stakeholders 

we interviewed also reported that starting transition planning at age 16 

 53GAO-17-109.

54Because this analysis is based on the results of a sample of school districts that was not 

designed to be representative at the state level, it is possible there are school districts in 

additional states that do not start transition planning until the age of 16 or older. 

Transition Planning Services: Example 

of Key Service Needed to Support 

Transitioning Youth with Autism

In one school district, officials we 

interviewed said they start transition 

planning in middle school with 

conversations with the student and family 

about their interests. Officials said that once 

the student reaches high school the 

transition planning meetings become the 

driving force of the individualized education 

program. They conduct assessments of the 

student and use online tools to explore the 

career options that match the student's 

interests and needs.

Source: GAO interview.| GAO-17-352
Page 28 GAO-17-352 Youth with Autism

may be too late.55 For example, by age 16, students with ASD may be in 

their junior year of high school, and many students interested in college 

need to be positioning themselves to meet college admissions 

requirements before that point. Consistent with findings from our school 

district survey, an official from an organization representing school district 

officials stated that it is good practice to begin conversations about 

transition at or before the beginning of high school, to ensure that 

students secure the coursework needed to meet graduation and other 

requirements, and that most districts already do so. In addition, research 

has shown that some of the most typically at-risk students—low-income 

youth and African-American youth—receive transition planning later than 

other youth.56 Although Education funds research on transition planning 

for students with disabilities, Education currently does not fund research 

evaluating the appropriate age to begin transition planning.57

Education guidance specifically identifies taking an appropriate 

preparatory curriculum in high school as critical for success in 

postsecondary education, stating that students with disabilities need to 

make high school curriculum choices that support the goal of 

postsecondary education. Early planning also allows more time to ensure 

that youth obtain the work, community, and academic experiences 

needed to successfully transition to adult life. For example, one district 

reported that it lowered its transition planning age to 14 so that youth had 

more time to gain valuable work experience by sampling different types of 

jobs in the community. Further, lowering the IDEA transition age could 

expose students to employment-related services sooner because 

transition services and pre-employment transition services through the 

 55GAO, Students with Disabilities: Better Federal Coordination Could Lessen Challenges 

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

GAO-17-109.

56Roux et al.

57According to Education officials, through the Institute of Education Sciences National 

Center for Special Education Research, since 2006, Education has funded 29 research 

grants related to transition planning for students with disabilities representing an 

investment of about $53 million, and includes the development of online tools for use by 

IEP teams in developing transition goals for students with disabilities.
Page 29 GAO-17-352 Youth with Autism

VR program are provided to students with disabilities using the IDEA 

transition age requirements.

58

The 2004 IDEA reauthorization increased the age of the transition 

services requirement for students with ASD, as well as for youth with 

other disabilities, from age 14 to age 16. The legislative history of the 

2004 reauthorization of IDEA does not fully explain why this change was 

made.59 During the 2006 public comment period for the current IDEA 

regulations on transition services, many commenters disagreed with 

changing the transition age from 14 to 16, and a few specifically 

requested that Education consider beginning transition services before 

age 16.60 In 2013, public commenters responding to the Federal Partners 

in Transition’s (FPT) national online dialogue identified lowering the 

transition age as a top idea for addressing regulatory or legislative 

barriers for youth.61 The Advisory Committee on Increasing Competitive 

Integrated Employment for Individuals with Disabilities, which was 

established to help advance competitive employment opportunities for 

individuals with intellectual disabilities, developmental disabilities, or other 

significant disabilities, also recommended that Congress amend IDEA to 

lower the transition age for all students with significant disabilities to begin 

 58A student with a disability must meet age and program requirements to be eligible to 

receive transition services or pre-employment transition services under the Rehabilitation 

Act, as amended by WIOA. Under the Act, students with disabilities are not younger than 

the earliest age for the provision of transition services under IDEA or, if the State elects to 

use a lower minimum age, not younger than that minimum age. 29 U.S.C. § 705(37).

59Education officials said they reviewed the legislative history and noted that in order to 

reduce confusion among parents and school districts the 2004 reauthorization 

consolidated two separate age requirements for the IEP – one for “transition service 

needs” and the other for “needed transition services”—into one age standard for both 

transition planning and services, i.e. age 16. Education official said that the legislative 

history does not explain why Congress chose age 16 over 14.

60In response to these comments, Education included the phrase “or younger if 

determined appropriate by the IEP team” in 34 C.F.R. § 300.320(b), which generally 

discusses transition services required in the IEP. However, in the same response, 

Education reiterated that the agency could not require that IEPs include transition planning 

or assessments, as it is beyond what is specifically required in the Act.

61Staff from Education, HHS, DOL and SSA formed the Federal Partners in Transition 

(FPT) interagency workgroup in 2005 to improve interagency coordination around 

transition-aged youth issues. The FPT seeks to support all youth, including youth with 

disabilities, in successfully transitioning from school to adulthood. Concepts, Inc., Federal 

Partners in Transition National Online Dialogue Participation Metrics Final Report 

(September 23, 2013).
Page 30 GAO-17-352 Youth with Autism

at 14 or earlier.62 Panelists we spoke to for our prior work also suggested 

that transition planning should start earlier—as early as middle school—

and 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.63

Stakeholders, including parents, service providers, and advocates, cited 

challenges in navigating the transition from the public school system to 

adult service systems and accessing needed services.

According to parents and other stakeholder, youth with disabilities, 

including those with ASD, and their families often face challenges 

navigating the complex adult service systems after exiting from school, 

which is consistent with our prior work (see fig. 6).64 For example, about 

70 percent of school districts surveyed identified “lack of assistance 

navigating the (adult) service systems” as a challenge for youth with ASD 

trying to obtain needed services and supports once they leave high 

school. Further, many district officials and teachers we interviewed 

expressed doubts that students with ASD would be able to obtain the 

necessary services and supports outlined in their final transition plan after 

they exit the school system.

 62The Advisory Committee on Increasing Competitive Integrated Employment for 

Individuals with Disabilities Final Report (September 15, 2016). WIOA created the 

Advisory Committee on Increasing Competitive Integrated Employment for Individuals with 

Disabilities composed of several federal and non-federal stakeholders to provide 

recommendations on ways to increase competitive employment opportunities for people 

with intellectual or developmental disabilities or other individuals with significant 

disabilities, as well as the use and oversight of the certificate program as carried out under 

Section 14(c) of the Fair Labor Standards Act of 1938.

63GAO-17-109.

64See GAO-12-594; GAO, Young Adults with Serious Mental Illness: Some States and 

Federal Agencies Are Taking Steps to Address Their Transition Challenges, GAO-08-678 

(Washington, D.C.: June 23, 2008); GAO, Summary of a GAO Conference: Helping 

California Youths with Disabilities Transition to Work or Postsecondary Education, 

GAO-06-759SP (Washington, D.C.: June 20, 2006); and GAO, Special Education: Federal 

Actions Can Assist States in Improving Postsecondary Outcomes for Youth, GAO-03-773 

(Washington, D.C.: July 30, 2003).

Families, Service 

Providers, and Advocates 

Reported That Adult 

Systems and Services Are 

Often Difficult to Navigate 

and Access

Navigating Service Systems
Page 31 GAO-17-352 Youth with Autism

Figure 6: Students Move from Services Provided through Their High Schools to 

Services Delivered through Multiple Programs

a Students remain eligible for transition planning and services, as well as other special education 

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

of age 21 or the eligibility age for a free appropriate public education under state law. While federal 

law authorizes students to receive a free appropriate public education up until age 22, eligibility for 

students aged 18 and older is determined by states. 20 U.S.C § 1412(a)(1) and 34 C.F.R. § 

300.102(a).

b

Students with disabilities do not need to apply to receive Vocational Rehabilitation (VR) preemployment or group transition services. 

c

States may choose to provide VR program services under their state educational, labor, or health 

and human services agencies.
Page 32 GAO-17-352 Youth with Autism

Stakeholders and parents in two of our five discussion groups reported 

that parents often are not aware of, or do not know how to access, the 

adult services available to them after exiting the school system. As one 

provider and parents we spoke with explained, parents of young adults 

with ASD may not have the time or knowledge needed to successfully 

navigate the multiple adult care agencies and paperwork, due to other 

responsibilities such as full-time jobs or additional children. Parents and 

family members in all five discussion groups described some of these 

difficulties navigating adult systems. For example, in one discussion 

group, a parent of a young adult reported that she had to work with nine 

different state agencies to obtain needed services, including housing and 

behavioral management services, and she only learned how to do so by 

speaking with other parents and following email listservs. In another 

discussion group, a family member reported that her sister was assigned 

to at least three service coordinators from the state developmental 

disabilities agency before receiving a coordinator who was willing to 

research and follow up on services that aligned with her needs.

In addition to the challenge of navigating a complex system of services, 

parents, providers, and experts we interviewed described the challenge of 

access and availability of adult services, which affect the ability of youth 

with ASD to attain their goals for adulthood. Specific concerns we heard 

include: waiting lists for services, lack of service options available, lack of 

trained providers, and cost of services.

Waiting lists. Developmental disabilities councils in all three states in our 

review cited waiting lists as a challenge to receiving services. Specifically, 

South Carolina and New Jersey had waiting lists for at least some 

developmental disabilities services, and Arizona had a waiting list for VR 

services. According to an Arizona official, the state groups individuals on 

the list using three “priority groups”; however, two of the three groups 

have been effectively closed since 2009 because of resource 

constraints.65 In South Carolina, state officials reported that individuals 

will likely face a waiting list once they are determined eligible for 

developmental disabilities services. While waiting lists in this state are 

operated on a first come first serve basis, officials estimated that 

individuals can wait up to 3 years to receive services. Youth with ASD 

 65In cases in which a VR agency is unable to provide services to all eligible applicants due 

to capacity constraints (e.g., limited fiscal and/or personnel resources), the VR agency is 

required to prioritize service provision to individuals with the most significant disabilities 

and implement an “order of selection.”

Case Management and Coordination: 

Example of Key Service Needed to 

Support Transitioning Youth with 

Autism

In Arizona, a federally funded grant pilot 

program provides case management to 

assist young adults and families with 

navigating adult service programs, 

processes, and requirements across state 

agencies. According to program officials, 

the case managers serve as an overall 

connecting piece for young adults and 

families, providing them with information on 

community resources, training on selfadvocacy, as well as referrals to adult 

service agencies.

Source: GAO interview. | GAO-17-352

Access and Availability of Adult 

Services
Page 33 GAO-17-352 Youth with Autism

who exit the school system and then go without services for a period of 

time may experience detrimental effects in the future, such as losing 

progress made on skill development, according to stakeholders and our 

recent work.66 Parents in four of five discussion groups also reported 

waiting lists for housing. One parent reported that there is currently a 10-

to 12-year wait for supportive housing. Parents in our discussion groups 

noted that the lack of housing options in general was particularly 

concerning since parents may become unable, either through aging or 

poor health, to care for their children with autism.

Lack of service options. While there are multiple adult service systems 

available, parents in discussion groups, multiple providers, and our recent 

work cited lack of service options available to young adults with ASD and 

their families. Family members in one discussion group reported that 

adult service programs sometimes combine groups with very different 

needs—that is, by serving low-needs and high-needs individuals at the 

same time—which could be challenging for both groups, or they combine 

a wide range of ages together for services. In addition, a lack of providers 

can limit service options in rural areas. For example, in South Carolina, a 

hospital closure in a rural area meant that individuals had to travel further 

to get health care, and in some parts of the state there is only one state 

developmental disabilities provider available. Our recent work also 

highlighted the need for youth with autism to receive timely access to 

services and supports, including having enough service providers to meet 

the demand.67 Further, as roundtable panelists in our recent work also 

noted, girls and minority students are diagnosed with ASD at a later age 

than other youth, on average, which could delay needed services while in 

school.68 A lack of service options may be a challenge for transition-age 

youth with disabilities more broadly—in 2015, the FPT highlighted as a 

policy priority the need to expand service opportunities, such as 

internships and other training options, for transition-age youth with 

disabilities.69

 66GAO-17-109.

67GAO-17-109.

68GAO-17-109.

69Federal Partners in Transition Workgroup, The 2020 Federal Youth Transition Plan: A 

Federal Interagency Strategy (February 2015).

Mental Health Care: Example of Key 

Service Needed to Support Transitioning 

Youth with Autism

Arizona state officials said the state 

provides behavioral health services to 

assist clients with their mental health 

stability and community integration, and to 

help them obtain and maintain their 

employment goals.

Source: GAO interview. | GAO-17-352
Page 34 GAO-17-352 Youth with Autism

Lack of trained providers. According to multiple adult service providers 

and parents, there are few providers trained to work with young adults 

with ASD. As one health provider explained, doctors may not receive 

training, in medical school or otherwise, on how to correctly interpret and 

manage potentially disruptive behaviors in an adult patient with ASD 

during an exam, including proper use of sedation as needed. Further, in 

2015 the FPT identified supporting professional development for service 

providers, including job coaches and health care providers, as a policy 

priority to improve transition outcomes for youth with disabilities seeking 

competitive employment.70 In 2016, the federal Advisory Committee on 

Increasing Competitive Integrated Employment for Individuals with 

Disabilities also reported that service providers needed more training to 

support individuals with significant disabilities seeking competitive 

employment.71

Similarly, in our review, multiple advocates and providers reported that 

vocational and other service providers need more training on how to work 

with young adults with ASD. Providers, as well as a state VR official and 

an advocacy group, also noted that VR counselors may have a 

disincentive to learn how to work with individuals with ASD because these 

young adults may need more assistance to attain and sustain 

employment. Multiple providers also reported difficulties with retaining 

staff, at times due to low rates of state payments for providers’ services, 

which can contribute to lower staff salaries overall. Our recent work also 

noted that youth with autism may have difficulty developing new 

relationships with service providers and can be negatively affected by 

high turnover rates.72

Cost of services. Parents of young adults with ASD and providers also 

reported that the cost of services can be a challenge as youth transition to 

adult life. For example, a rural provider reported that youth may wait 6 to 

18 months to receive a diagnosis, a qualifying requirement for that state’s 

developmental disabilities services, and teachers in one district observed

that some families pay as much as $6,000 to have an examination for the 

diagnosis. Because autism is highly individualized, young adults with ASD 

frequently require an individualized program of services that can be 

 70Federal Partners in Transition Workgroup, The 2020 Federal Youth Transition Plan. 

71The Advisory Committee on Increasing Competitive Integrated Employment for 

Individuals with Disabilities Final Report (September 15, 2016).

72GAO-17-109.

Medical Care: Example of Key Service 

Needed to Support Transitioning Youth 

with Autism

At one nonpublic school we visited, the 

health office is set up like a doctor and 

dentist office and the nurses wear scrubs, 

to help familiarize students with being at a 

doctor or dentist office.

Source: GAO interview. | GAO 17 352

Behavioral Interventions: Example of 

Key Service Needed to Support 

Transitioning Youth with Autism

A New Jersey state official said the state 

provides intensive supports to help stabilize 

families in crisis situations, such as when 

families do not know how to handle their 

youth’s challenging behavior. According to 

the official, youth in these situations receive 

the agency’s intensive short-term supports 

while staying in their home school, with the 

goal of ensuring the youth is able to 

continue living at home.

Source: GAO interview. | GAO-17-352
Page 35 GAO-17-352 Youth with Autism

expensive, according to one provider. The IACC has also highlighted 

research on the costs associated with certain services provided to 

individuals with ASD, such as vocational services.73 This issue was also 

identified by our roundtable participants. Panelists in our prior work 

reported that low- and middle-income youth with ASD whose families 

cannot afford to pay for services out-of-pocket may not always be able to 

rely on public programs to help them pay for their adult services.74

Parents in two of our discussion groups noted that needed adult services 

can be beyond the family’s ability to pay. For example, one parent and 

our prior work reported that moving from school services to adult services 

can feel like falling off a cliff. Another parent reported that the primary 

autism-specific provider in her area does not accept state developmental 

disability funding or regular insurance, and most families cannot afford to 

pay out-of-pocket. One advocate also noted that local transitional living 

programs’ costs are higher than what the families she worked with could 

cover. Several providers noted that state reimbursement rates did not 

align with actual provider expenses. Cost of services may also contribute 

to some of the challenges previously mentioned, such as lack of service 

options and trained providers.

After young adults with ASD transition to adult life, they may encounter 

challenges similar to other young adults with disabilities, such as securing 

employment, housing, and transportation. We estimate that a majority of 

school districts consider a lack of employment options to be a top 

challenge to providing transition services across youth with ASD with 

low-, moderate-, and high-intensity service needs (ranging from 73 to 88 

percent, respectively). In addition, we estimate that over one-quarter of 

school districts also reported that both job coaching and work 

experiences were difficult to provide to individuals with ASD.

Similarly, stakeholders we interviewed reported that youth with ASD face 

unique challenges to securing employment. For example, teachers at one 

high school told us that there are limited opportunities to provide work 

experiences for youth with ASD due to potential employers’ lack of 

exposure to autism, fears around the extent of job-related supports 

 73Interagency Autism Coordinating Committee (IACC), 2015 IACC Summary of Advances 

in Autism Spectrum Disorder Research (April 2016). 

74GAO-17-109.

Youth Face Lack of 

Employment Opportunities 

and Related Supports, 

According to Districts 

Surveyed and Others
Page 36 GAO-17-352 Youth with Autism

needed, and lack of financial incentives for employing youth with autism 

or other disabilities. Some stakeholders said that employers may not 

understand that individuals with ASD can be valuable employees or know 

how to create an environment where they can thrive. The employers we 

interviewed that have specific efforts to hire individuals with ASD 

highlighted the importance of educating managers about ASD and how 

best to interview, support, and utilize an employee with ASD. Similarly, 

panelists in our prior work also discussed providing employers with 

information about hiring and working with autistic employees, as a 

support associated with successful employment of individuals with 

autism.75

In addition to securing work, stakeholders reported that youth with ASD 

face challenges to obtaining the supports needed to sustain employment, 

such as reliable transportation and job coaching. For example, one state 

official noted that transportation may be a challenge to maintaining 

employment for individuals with ASD, particularly in rural and suburban 

areas, due to limited public transportation options. Our prior work also 

noted that limited access to reliable transportation to and from 

employment programs and services providers, especially in rural areas, 

was a major challenge for students with disabilities.

76 Similarly, an 

estimated 69 percent of school districts identified lack of transportation as 

a factor that would negatively affect the ability of youth with ASD to obtain 

needed services and supports. Stakeholders also reported that eligibility 

and timely access to job coaching was another challenge. Our prior work 

also noted that while some programs may teach youth with ASD how to 

interview for a job, youth also need to learn about navigating the social 

aspect of employment and may require ongoing support in this area.77

 75GAO-17-109.

76GAO-12-594.

77GAO-17-109.

Communication Services: Example of 

Key Service Needed to Support 

Transitioning Youth with Autism

In one nonpublic high school serving 

students with Autism Spectrum Disorder 

(ASD), we observed a literature class in 

which the students used tablets to answer 

questions in writing posed by the teacher 

as a way to engage students who have 

difficulty expressing themselves through 

verbal communication. The teacher asked a 

question and the students’ answers would 

appear on the large screen at the front of 

the room.

In another nonpublic high school for 

students with ASD, we observed non-verbal 

students working in the canteen using voice 

recognition systems through tablets to have 

conversations with customers.

Source: GAO observations from facility 

tours. | GAO-17-352

Transportation Services: Example of 

Key Service Needed to Support 

Transitioning Youth with Autism

One service provider in Phoenix, Arizona 

offers a new 2-year program designed for 

young adults age 18 and older that was 

designed to be in close proximity to public 

transportation to help residents get to work. 

Students attend a local community college 

and take courses on independent living 

topics, including how to use transportation.

Source: GAO interview. | GAO-17-352
Page 37 GAO-17-352 Youth with Autism

The IACC, managed by HHS, has facilitated collaboration across its 

member federal agencies on research related to individuals with ASD, 

including transition-age youth, but it has not regularly engaged several 

key federal agencies that serve transition-age youth with ASD.78 In 

particular, the IACC has collaborated on transition-age issues for youth 

with autism by inviting researchers to present their findings related to 

transition-age youth during meetings and including research related to 

this population in its strategic plan and portfolio analysis (for more 

information on research needs related to transition-age youth, see app. 

II). However, IACC has missed opportunities to collaborate with nonmember federal agencies to report on and monitor services and supports 

activities for individuals with ASD, which Congress has called for IACC to 

include in its annual strategic plan and monitoring activities.79 HHS 

officials reported that the IACC plans to begin including some services 

and supports information in its next strategic plan, which it expects to 

release in early or mid-2017.80 However, HHS officials told us that the 

IACC has not engaged certain key federal agencies with responsibility for 

 78Within HHS, the National Institutes of Health (NIH) Office of Autism Research 

Coordination (OARC) provides assistance to IACC through coordination and management 

of IACC-related activities.

79The Autism CARES Act has required the IACC to include in its annual strategic plan and 

in its monitoring activities, to the extent practicable, services and supports for individuals 

with ASD. Autism CARES Act of 2014, Pub. L. No. 113-157, § 5, 128 Stat. 1831, 1832-33. 

The most recent IACC annual strategic plan, the 2013 update, was published in April 

2014. 

80In response to the Autism CARES Act requirement that the IACC strategic plan include 

budgetary estimates for services and supports to the extent practicable, HHS officials said 

that they may delay the inclusion of budgetary estimates for services and supports until 

the subsequent IACC strategic plan. With regard to the expanded responsibility to monitor 

services and supports activities for individuals with ASD to the extent practicable, HHS 

officials said that the IACC would not determine the approach it will use for meeting this 

requirement until the update of the IACC strategic plan is completed.

Federal Collaborative 

Efforts Have Missed 

Opportunities to 

Enhance Support of 

Transition-age Youth 

with Autism

The Interagency Autism 

Coordinating Committee 

Has Not Regularly 

Engaged Key Federal 

Agencies That Support 

Youth with Autism
Page 38 GAO-17-352 Youth with Autism

serving or providing financial assistance to populations including 

transition-age youth with ASD to gather their input on the content of the 

plan, nor has it invited such agencies to serve on the committee.81 The 

Autism CARES Act authorizes the Secretary of Health and Human 

Services to include other federal agencies that serve individuals with ASD 

as members of the IACC. While, according to HHS officials, the IACC 

welcomes engagement with agencies interested in focusing attention on 

issues related to autism, they said that the department would not reach 

out to federal agencies for potential membership unless such agencies 

expressed interest and that few agencies have done so.82 For example, 

when we asked SSA officials if they had considered requesting 

membership on the IACC, they told us that although they had not 

previously considered it, as of January 2017, they were planning to do so. 

On April 26, 2017, the IACC announced SSA as a new member. 

Similarly, when we asked DOL officials the same question, they told us 

they had not previously considered it, but that in the future they would 

look for additional opportunities to work with the IACC. They further stated 

that the agency will contact the IACC to determine interest in working on 

employment issues.83

DOL, HUD, and SSA manage programs and research that serve or 

provide financial assistance to populations including transition-age youth 

with disabilities, including youth with ASD, which potentially provides 

those agencies with experience, expertise, and unique viewpoints that 

could benefit the work of the IACC. For example, DOL provides grants to 

states through the Disability Employment Initiative to improve effective 

and meaningful participation of transition-age youth and adults with 

 81DOL and HUD are examples of federal agencies that could be considered for IACC 

membership; we did not explore whether agencies not included in our review should be 

considered for IACC membership. Our review identified two instances in which an official 

from one of these agencies presented at an IACC meeting since November 2015, which 

was the first meeting of the current IACC. Specifically, an official from DOL presented on 

the Advisory Committee on Increasing Competitive Integrated Employment for Individuals 

with Disabilities during the April 2016 and April 2017 IACC meetings. However, the IACC 

has not engaged non-member agencies for input on its strategic plan. 

82According to HHS officials, the EPA requested membership on the IACC in 2015 and 

was subsequently added.

83A DOL official stated that the agency has been in contact with the Department of 

Education Rehabilitation Services Administration regarding business community interest 

in, and business developed tools to work with, individuals with ASD to share resources. 

DOL officials also stated that the agency provides funding for the Job Accommodation 

Network that has created technical assistance resources related to individuals with ASD. 
Page 39 GAO-17-352 Youth with Autism

disabilities in the workforce system. Additionally, in 2014 SSA completed 

the Youth Transition Demonstration evaluation which sought to identify 

and test the most promising service strategies to enhance work incentives 

for helping youth with disabilities maximize their economic self-sufficiency 

as they transition to adulthood.84 In past strategic plans, the IACC 

specifically identified research needs related to employment, community 

housing, and Social Security programs, which are areas within DOL, 

HUD, and SSA’s purview. Further, during an IACC working group 

conference call in November 2016, some members of an IACC working 

group tasked with updating the lifespan and transitions area for the 

strategic plan suggested that HHS invite representatives of federal 

agencies who serve transition-age youth and adults to join the IACC to 

better inform development of the strategic plan.85 However, thus far there 

have been no representatives from DOL, HUD, or SSA on any of the 

working groups tasked with updating the current IACC strategic plan. 

There is precedence for these agencies collaborating in support of youth 

with disabilities. DOL, HUD, SSA, and Education are part of a joint 

research grant initiative called the Promoting the Readiness of Minors in 

Supplemental Security Income (PROMISE) that focuses on improving the 

life outcomes of youth with disabilities by supporting improved 

coordination of services.86 One of the leading federal practices for 

effective collaboration stresses the importance of ensuring that all 

relevant participants are included in collaborative activities as efforts can 

be limited when they do not have the right agencies fully engaged.87

Unless HHS finds ways to regularly engage certain non-member federal 

agencies that serve or provide financial assistance to populations 

 84Mathematica Center For Studying Disability Policy, Final Report on the Youth Transition 

Demonstration Evaluation (November 2014)

85Recently, some members of this IACC working group specifically requested that federal 

agencies, such as HUD, the Department of Transportation (DOT), and DOL, be potentially 

added as IACC member agencies. The lifespan and transitions area is one of seven 

general topic areas of the IACC strategic plan. 

86The PROMISE program is a joint initiative administered by Education. According to 

Education officials, under the PROMISE program, states have developed partnerships 

and are implementing coordinated services, supports, and interventions to project 

participants. Additionally, according to officials, in fiscal year 2013, Education awarded 5-

year model demonstration research projects to five states and a consortium of six states 

to improve the education and employment outcomes of children receiving SSI and their 

families.

87GAO-12-1022.
Page 40 GAO-17-352 Youth with Autism

including individuals with ASD, including transition-age youth, the IACC 

may miss the opportunity to leverage the knowledge of other agencies as 

it works to fulfill its expanded responsibilities under the Autism CARES 

Act. In particular, it may inhibit its ability to create an up-to-date strategic 

plan that includes comprehensive and accurate information on research 

and services that can be used to advance research and services that aim 

to improve the health and well-being of individuals with ASD.

As part of the Federal Partners in Transition (FPT), Education, HHS, 

DOL, and SSA have collaborated to identify priorities for supporting 

transition-age youth with disabilities, but they have not consistently 

followed leading collaboration practices to implement these priorities. As 

part of its 2020 plan,88 the FPT established several priorities for federal 

action including:89

• promoting work-based learning,

• supporting professional development for service providers,

• bridging the service gap between youth and adult programs,

• demonstrating the value of hiring youth and young adults with 

disabilities, and

• improving education and outreach to the public regarding policy and 

practices governing transition programs.

Since identifying these priorities in the plan, the FPT has not developed a 

comprehensive strategy for how these priorities will be carried out. To 

achieve mutually agreed upon outcomes, one leading collaboration 

practice calls for establishing mutually reinforcing or joint strategies,90

such as through developing a comprehensive strategy for accomplishing 

goals, which would include specific actions to implement plans. For 

example:

• The FPT’s yearly action plan describes the activities it will address 

and policy priority areas it will focus on for an individual year, but the 

 88Federal Partners in Transition Workgroup, The 2020 Federal Youth Transition Plan.

89In response to our recommendation in 2012 the FPT released a strategic plan to 

enhance interagency coordination and improve the outcomes for youth with disabilities by 

2020. See GAO-12-594. 

90GAO-06-15.

The Federal Partners in 

Transition Identified 

Priorities to Support 

Transition-age Youth but 

Lacks Plans for 

Implementation
Page 41 GAO-17-352 Youth with Autism

plan does not include a long-term strategy to ensure progress is made 

on each priority area through 2020. Further, while the FPT establishes 

some timelines for deliverables and includes activities for some of the 

goals and policy priority areas, it does not establish timelines, 

milestones, or deadlines for making progress toward each of the goals 

and policy priority areas. Other leading collaboration practices are to 

clearly define short-term and long-term outcomes and to track and 

monitor progress toward these outcomes.91

• The FPT has not assigned roles and responsibilities among the 

member agencies or taken steps to make agencies responsible for 

particular outcome goals or policy priority areas.92 According to DOL 

officials, the FPT is a voluntary effort among member agencies to 

enhance coordination and does not have authority to compel member 

agencies to take action. However, another leading collaboration 

practice is to clarify and agree on the roles and responsibilities of 

each agency involved in a collaborative effort. Other agencies 

involved in collaborative efforts have addressed this in various ways, 

such as by implementing mutually reinforcing or joint policies—or a 

memorandum of understanding—that clarify roles and 

responsibilities.93

Representatives of the FPT and member agencies stated that resource 

constraints make it difficult to effectively collaborate and coordinate

across the federal agencies.94 However, we previously reported that, 

according to the Office of Management and Budget (OMB), agencies 

generally do not receive specific funding for interagency activities.95 We 

have also reported on strategies to leverage resources for interagency 

efforts, such as developing an inventory of relevant resources, which can 

result in better leveraging of resources. Although FPT has taken some 

 91GAO-12-1022.

92Representatives of the FPT stated that a specific agency may volunteer to take the lead 

on a particular effort, but that in general member agencies have not volunteered to take 

responsibility for particular efforts. 

93GAO-12-1022.

94In addition, representatives of the FPT and member agencies stated that the FPT has 

no designated staff or specifically appropriated funds for its activities. According to officials 

from some of the member agencies, staff who do related work are utilized for FPT 

activities in addition to the staff’s normal duties.

95GAO, Managing for Results: Implementation Approaches Used to Enhance 

Collaboration in Interagency Groups, GAO-14-220 (Washington, D.C.: Feb. 14, 2014).
Page 42 GAO-17-352 Youth with Autism

steps toward collaboration, without a long-term implementation plan that 

includes milestones and specific agency roles and assignments, it is less 

likely that the FPT will implement and accomplish the five compatible 

outcome goals and 12 policy priorities for future strategic focus by the 

2020 Plan’s stated timeline.

In addition to IACC, the Autism CARES Act required HHS to lead two 

collaborative efforts in support of transition-age youth with ASD, but 

federal agencies’ efforts to address these requirements are currently 

limited.

HHS is coordinating with other federal agencies to prepare a report on 

transition-age youth with ASD, but HHS officials told us that they did not 

meet the statutory deadline of August 2016 and will not be able to include 

all of the report elements required by the Autism CARES Act in the report 

due to resource constraints and the timing of the appointment of the 

Autism Coordinator.96 The Act requires HHS to coordinate with certain 

federal agencies to develop a report containing, among other things, 

proposals for best practices guidelines to ensure coordination among 

relevant service providers and comprehensive approaches to transitioning 

from existing school-based services to those services available during 

adulthood. According to the Autism Coordinator and other HHS officials, 

HHS has established a steering committee composed of representatives 

of various federal departments, including Education, Department of 

Transportation (DOT), DOL, the Department of Justice (DOJ), and HUD, 

as required by the Act, and has requested information from other federal 

departments, including DOD, for inclusion in the report. HHS officials 

have reported that HHS currently plans to finalize and submit the report to 

Congress by April 2017. According to the Autism Coordinator and other 

HHS officials, due to resource constraints, the report will be limited to 

describing current activities at HHS and other federal departments with 

respect to transition-age youth with ASD, gaps in federal programs, and

research needs and recommendations on ASD and transition issues.

 96The Autism Coordinator was not appointed until April 2016 and the Youth Transitions 

Report was due in August 2016 per the Autism CARES Act.

The Extent of 

Collaboration under 

Recent Autism CARES Act 

Requirements Has Been 

Limited

Youth Transition Report
Page 43 GAO-17-352 Youth with Autism

As we previously reported, in April 2016 the Secretary of HHS designated 

an official as the Autism Coordinator97 in response to a requirement 

contained in the Autism CARES Act to oversee and implement federal 

ASD activities nationwide and ensure that federal ASD activities are not 

unnecessarily duplicative.98 Since that time, the Coordinator has taken 

some steps to fulfill the responsibilities required by the Act, including 

leading the agency’s efforts to prepare the report on transition-age youth, 

according to HHS officials.99 In addition, according to the Autism 

Coordinator and other HHS officials, the official has received information 

from and reviewed ASD activities across HHS, Education, DOL, DOJ, 

DOT, DOD, HUD, and SSA. However, the Autism Coordinator and other 

HHS officials told us that the Coordinator would have limited capacity 

going forward to oversee ASD work across agencies and departments as 

required by the Act due to limited resources. Because the position was 

recently filled, it is too early to assess the Coordinator’s efforts toward 

meeting the requirements. It is therefore unclear whether HHS will meet 

the requirements to oversee and implement ASD activities or enhance 

coordination of ASD activities across federal agencies.

For many youth with ASD, the transition to adulthood begins with an IEP 

that specifies the transition services needed to reach their measurable 

postsecondary goals and must be in effect no later than age 16, as 

required by IDEA. However, as our work and other research has shown, 

starting transition planning at 16 may be too late for many youth. Recent 

federal efforts have highlighted the need for transition planning to begin 

earlier than 16 for ASD youth. Our school district survey and stakeholders 

suggest that earlier transition planning can have multiple benefits, 

including providing the necessary education, work, and community 

experiences needed to successfully transition to adult life. Currently, 

 97In 2013, we recommended that to promote better federal coordination and avoid 

unnecessary duplication, certain federal agencies, including HHS, should determine 

methods for identifying and monitoring the autism research conducted by other agencies 

(GAO-14-16). In a follow-up report in 2016, we found that HHS had begun taking steps to 

implement the Autism CARES Act, such as designating an Autism Coordinator that could 

help coordinate federal autism research. GAO, Federal Autism Activities: Agencies Are 

Encouraging Early Identification and Providing Services, and Recent Actions Could 

Improve Coordination, GAO-16-446 (Washington, D.C.: May 20, 2016).

98Autism CARES Act of 2014, Pub. L. No. 113-157, § 2, 128 Stat. 1831, 1831.

99To see our recommendation follow up for our November 2013 report: 

http://www.gao.gov/products/GAO-14-16.

Autism Coordinator

Conclusions
Page 44 GAO-17-352 Youth with Autism

many students are not getting the opportunity to take advantage of these 

benefits, potentially further exacerbating gaps in college and work 

readiness. Further, although this report focuses on transition-age youth 

with ASD, stakeholders we interviewed indicated that earlier transition 

planning would likely be beneficial for other students with disabilities. 

Unless Education examines the outcomes for students who begin 

transition services at age 16 and the merits and implications of requiring 

earlier transition planning for all students with disabilities, policymakers 

may not have critical information when considering changes to IDEA.

Multiple federal collaborative entities, including the IACC and FPT, have 

identified gaps in research or services for transitioning youth and young 

adults with ASD. While the IACC has focused on coordinating research 

on individuals with ASD, federal law has recently called for the IACC to 

also report on and monitor services for adults, including transition-age 

youth. Given the increased scope of IACC’s responsibilities and per 

leading federal interagency collaboration practices, the IACC needs to 

regularly engage key federal agencies—such as DOL and HUD—that 

provide services or financial assistance to adults with ASD. Without such 

efforts, the IACC strategic plan may not include important information that 

these agencies have such as on services and supports, as well as 

potentially miss opportunities to identify critical gaps in these areas. 

Likewise, the FPT has helped to address the challenges facing transitionage youth with disabilities, including those with ASD, by identifying priority 

areas for federal action in its 2020 plan. While a positive initial step, 

without implementing milestones or assignments to move these priorities 

forward in line with leading federal interagency collaboration practices, it 

is less likely that these priorities will be achieved.

To determine whether IDEA’s current transition age requirement allows 

youth with disabilities, including those with ASD, the time needed to plan 

and prepare for the transition to adult life, the Secretary of Education 

should examine outcomes for students when transition services begin at 

age 16 and the merits and implications of amending IDEA to lower the 

age at which school districts are to begin providing transition services to 

students with disabilities, such as 14.

To improve collaboration and leverage the knowledge of key federal 

agencies serving youth with ASD, the Secretary of HHS should regularly 

engage key non-member federal agencies that serve or provide supports 

to young adults with autism in IACC activities. This could include, for 

example, directly engaging and soliciting input from federal agencies on 

Recommendations for 

Executive Action
Page 45 GAO-17-352 Youth with Autism

the IACC strategic plan, or inviting other federal agencies that serve or 

provide supports to young adults with autism to become IACC members.

To implement the goals and policy priorities of the 2020 Federal Youth 

Transition Plan, the Federal Partners in Transition (FPT) workgroup—the 

Secretaries of HHS, Education, DOL, and the Commissioner of SSA—

should develop a long-term implementation plan that includes milestones 

and specific agency roles and assignments.

We provided a draft of this report to the Departments of Education, Health 

and Human Services, Housing and Urban Development, Labor, and the 

Social Security Administration for review and comment. Education’s 

written comments are reproduced in appendix III. DOL’s written 

comments are reproduced in appendix IV. SSA’s written comments are 

reproduced in appendix V. HUD did not provide formal comments on our 

report. HHS did not provide formal comments in time to be included in the 

final report, but indicated that it agreed with both recommendations 

directed to HHS. Education and HHS provided technical comments, 

which we incorporated in the report, as appropriate.

Regarding the two recommendations we made to Education, in its written 

comments, Education neither agreed nor disagreed with the first 

recommendation that it examine outcomes for transition services for 

students with disabilities that begin at age 16 and to examine the merits 

and implications of lowering the transition age. Rather, it noted that its 

Institute of Education Sciences has funded 29 research grants related to 

transition planning since 2006, representing an investment of about $53 

million to improve outcomes for students in transition. Education also 

stated that transition outcome data it currently collects are not 

disaggregated by the age at which children received transition services.

We updated the report to provide additional detail on the research funded 

by Education. Education agreed with the second recommendation 

regarding the need for a long term implementation plan with milestones, 

roles, and responsibilities for the FPT. Finally, though our 

recommendation regarding the IACC was not directed to Education, it 

stated that, as an active member agency, it would be pleased to engage 

with additional federal agencies identified by HHS. 

In its written comments, DOL stated that it agreed with our

recommendation that the FPT should include a more comprehensive 

strategy describing precisely how its priorities will be carried out. DOL 

noted the FPT in 2017 has identified its annual policy priorities and will 

Agency Comments 

and Our Evaluation
Page 46 GAO-17-352 Youth with Autism

continue to develop plans, identify milestones, and assign responsibility 

for joint activities and deliverables. In addition, DOL stated that it agreed

that interagency collaboration will help the IACC fulfill its role in improving 

the well-being of individuals with ASD. 

SSA, in its written comments, stated that, as a member of the FPT, it 

agreed to work toward accomplishing the goals laid out in the 2020 

Federal Youth Transition Plan, but that the voluntary, ad hoc nature of the 

FPT precludes definitive implementation plans. However, we maintain 

being a voluntary initiative does not preclude the FPT from establishing 

long-term milestones and clarifying roles and responsibilities. As we 

stated in our report, we believe that without a long-term implementation 

plan that includes milestones and specific agency roles and assignments, 

it is less likely that the priorities outlined in the Federal Youth Transition 

Plan will be achieved. SSA also stated that HHS has extended an 

invitation for SSA to participate in an IACC meeting, and noted this will 

facilitate collaboration across federal agencies to improve the well-being 

of individuals with ASD.

We are sending copies of this report to the appropriate congressional 

committees, the Secretary of the Department of Education, the Secretary 

of the Department of Health and Human Services, the Secretary of the 

Department of Housing and Urban Development, the Secretary of the 

Department of Labor, and the Commissioner of the Social Security 

Administration, and other interested parties. In addition, the report is 

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 viii.

Jacqueline M. Nowicki

Director, Education, Workforce and

Income Security
Appendix I: Objectives, Scope, and 

Methodology

Page 47 GAO-17-352 Youth with Autism

In this report, we examined three objectives: (1) the types of services and 

supports provided at the local level to assist youth with Autism Spectrum 

Disorder (ASD) in transitioning to adult life, (2) the key challenges for 

youth with ASD in successfully transitioning to adult life, and (3) the 

extent to which key federal agencies have collaborated to assist youth 

with ASD in successfully transitioning to adult life. To address these 

objectives, we used a variety of methods, including a web-based survey 

of school districts;1 interviews with representatives of state agencies and 

local service providers in selected states; discussion groups with family 

members of and youth with ASD; reviews of federal laws and regulations; 

and interviews with representatives of federal agencies, employers, and 

national disability advocacy organizations.

We conducted this performance audit from November 2015 through April 

2017 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.

To examine the types of services and supports provided at the local level 

to assist youth with ASD in transitioning to adult life and the key 

challenges for youth with ASD in successfully transitioning to adult life, we 

designed and administered a generalizable, stratified random sample of 

U.S. local educational agencies (LEA), which we refer to as school 

districts throughout the report, serving high school-aged students. The 

survey included questions about services and supports school districts

provided to students aged 16 to 21 with ASD in special education during 

the 2015-16 school year to assist in their transition to adult life. We also 

 1

For the purposes of the survey, we used the term ASD to refer to students receiving 

special education services who are classified with autism for Individuals with Disabilities 

Education Act (IDEA) reporting purposes. For the purposes of reporting on students with 

disabilities under IDEA, the U.S. Department of Education defines autism as “a 

developmental disability significantly affecting verbal and nonverbal communication and 

social interaction, generally evident before age 3, that adversely affects educational 

performance. Other characteristics often associated with autism are engagement in 

repetitive activities and stereotyped movements, resistance to environmental change or 

change in daily routines, and unusual responses to sensory experiences. Autism does not 

apply if a child’s educational performance is adversely affected primarily because the child 

has an emotional disturbance.”

Appendix I: Objectives, Scope, and 

Methodology

Web-based Survey of 

School Districts
Appendix I: Objectives, Scope, and 

Methodology

Page 48 GAO-17-352 Youth with Autism

asked questions about services provided,2 the types of challenges in 

providing services, and the level of difficulty in providing services with 

regard to students with low-, moderate-, and high-intensity service 

needs.3 Further, we asked about the age at which transition services and 

supports are included in the students’ individualized education programs 

(IEP) and the age it would be most beneficial to begin including these 

services in their IEPs. We also asked about perspectives on the factors 

that may negatively affect students once they exit school in obtaining 

services to assist with transitioning to adult life. We directed the survey to 

school districts’ special education directors.

We defined our target population to be all currently operating LEAs 

offering at least one high school level grade (9, 10 ,11, or 12) operating 

within the 50 U.S. states and the District of Columbia that are not under 

the jurisdiction of the Department of Defense (DOD) or Bureau of Indian 

Education (BIE). We used the LEA Universe database from the 

Department of Education’s (Education) Common Core of Data (CCD) for 

the 2013-14 school year to build the sampling frame of 12,955 LEAs. We 

selected a stratified random sample of 606 LEAs. We stratified the 

sampling frame into 13 mutually exclusive strata based on LEA size, 

urban classification, and poverty classification. We further stratified the 

LEAs classified as being in a city by charter status. We selected the 

largest 100 LEAs with certainty and determined the minimum sample size 

needed to achieve precision levels of plus or minus 10 percentage points 

or fewer, at the 95 percent confidence level, for six sub-population 

estimates based on three urban classifications (city, suburban, and 

town/rural) and three classifications of poverty (high-, medium-, and lowpoverty districts). We then increased the sample size within each stratum 

for an expected response rate of 70 percent.

 2

To develop the list of transition-related services used in the survey, we reviewed related 

reports on transition and gathered feedback from transition coordinators and special 

education directors in various school districts. We continued to ask school districts for 

feedback on the list throughout our survey development. 

3

In the survey, we used the following definitions of low-, moderate-, and high-intensity 

service needs, based on the U.S. Department of Education’s environmental categories for 

IDEA reporting: We defined students with low-intensity service needs as those students 

who spend 80 percent or more of their day in the regular classroom; students with 

moderate-intensity service needs as those students who spend between 79 and 40 

percent of their day in the regular classroom; and students with high-intensity service 

needs as those students who spend less than 40 percent of their day in the regular 

classroom. These terms are not found in IDEA or the Rehabilitation Act.
Appendix I: Objectives, Scope, and 

Methodology

Page 49 GAO-17-352 Youth with Autism

We defined the three urban classifications based on the National Center 

for Education Statistics (NCES) urban-centric locale code, ULOCAL. To 

build a general measure of the poverty level for each LEA, we used the 

proportion of students eligible for free or reduced price lunch (FRPL) and 

classified these into the following three groups:

• High-poverty: More than 75 percent of students in LEA were eligible 

for FRPL;

• Mid-poverty: Between 25.1 and 75.0 percent of students in LEA were 

eligible for FRPL; and

• Low-poverty: 25 percent or fewer students in LEA were eligible for 

FRPL.

We identified that 18 of the 606 sampled LEAs were either closed or did 

not serve high school-aged students. We received valid responses from 

414 (70 percent) of the remaining 588 eligible sampled LEAs. The 

weighted response rate, which accounts for the differential sampling 

fractions within strata, is 71 percent. The survey was in the field from May 

to August 2016. To obtain the maximum number of responses to our 

survey, we sent reminder emails to nonrespondents and contacted 

nonrespondents over the telephone.

We conducted an analysis of our survey results to identify potential 

sources of nonresponse bias using two methods. First, we examined the 

response propensity of the sampled LEAs by several demographic 

characteristics. These characteristics included poverty, urbanicity and 

race. Our second methodology consisted of comparing weighted 

estimates from respondents and nonrespondents to known population 

values. The results of this nonresponse bias analysis showed no 

significant differences in response propensities or between known 

population values and estimates for nearly all of the characteristics we 

examined. Based on these results and the 71 percent weighted response 

rate, we determined that weighted estimates generated from these survey 

results are generalizable to the population of eligible LEAs and are 

sufficiently reliable for the purposes of this report.

We took steps to minimize non-sampling errors, including pretesting draft 

instruments and using a web-based administration system. During survey 

development, we met with officials from eight school districts to explore 

the feasibility of responding to the survey questions. We then pretested 

the draft instrument from March to April 2016 with officials in 11 school 

districts in a range of city, suburban, and rural districts. In the pretests, we 
Appendix I: Objectives, Scope, and 

Methodology

Page 50 GAO-17-352 Youth with Autism

asked about the clarity of the questions and the flow and layout of the 

survey. Based on feedback from the pretests, we made revisions to the 

survey instrument. To further minimize non-sampling errors, we used a 

web-based survey, which allowed respondents to enter their responses 

directly into an electronic instrument. Using this method automatically 

created a record for each respondent in a data file and eliminated the 

errors associated with a manual data entry process.

Because we followed a probability procedure based on random 

selections, our sample is only one of a large number of samples that we 

might have drawn. Because each sample could have provided different 

estimates, we express our confidence in the precision of our particular 

sample’s results as a 95 percent confidence interval (e.g., plus or minus 7 

percentage points). This is the interval that would contain the actual 

population value for 95 percent of the samples we could have drawn. As 

a result, we are 95 percent confident that each of the confidence intervals 

in this report will include the true values in the study population. All 

percentage estimates presented in this report from this survey have a 

margin of error of plus or minus 11.8 percentage points or fewer, unless 

otherwise noted.

To analyze differences we identified in the percentages of LEAs providing 

services between size, socioeconomic, and urban factors, we compared 

weighted survey estimates generated for different levels of these 

subgroups and conducted multivariate logistic regression analyses to 

confirm statistical significance while controlling for other factors. We 

estimated models independently for each of the 17 services in the survey 

and controlled for poverty status, urbanicity, LEA size, charter school 

status, racial composition, and the interaction between school LEA size 

and urbanicity.4 To account for the stratified random sample design and 

the unequal probabilities of selection, we used SAS PROC 

SURVEYLOGISTIC and included the final sampling weights and strata 

boundaries. For each model, we produced parameter estimates and 

standard errors for each level of the factors we included in the model and 

 4

We did not control for potential differences in the needs of students in school districts of 

different sizes, socioeconomics, or urbanicity.
Appendix I: Objectives, Scope, and 

Methodology

Page 51 GAO-17-352 Youth with Autism

used these results to confirm the significance of the differences between 

weighted survey estimates.5

To examine the types of services and supports provided at the local level 

to assist youth with ASD in transitioning to adult life and the key 

challenges for youth with ASD in successfully transitioning to adult life, we 

conducted interviews with stakeholders in selected states and local areas. 

We selected three states—Arizona, New Jersey, and South Carolina—to 

conduct interviews with local and state stakeholders.6 We selected these 

states because they include a variety of local areas with adult providers 

specifically involved with initiatives to serve individuals with autism and 

those that do not, as well as a mix of rural, suburban, and urban localities, 

and geographic dispersion.

In two states, Arizona and New Jersey, we conducted site visits and 

phone interviews with local and state entities. As part of these local 

interviews, in each of these states we conducted interviews with officials 

in two school districts and staff from at least one postsecondary education 

institution. We also met with public high school special education 

teachers and multiple adult service providers in each state. In each state, 

we focused our interviews on two local areas representing diversity in 

poverty status and urbanicity. In Arizona, our interviews focused on 

Phoenix and the rural areas around Flagstaff. In New Jersey, our 

interviews focused on the Princeton and Newark areas.

At the state level, we conducted interviews by phone with representatives 

of state special education, development disabilities, vocational 

rehabilitation, as well as behavioral health services agencies. We also 

interviewed representatives of university centers of excellence, parent 

training and information centers, the state developmental disabilities 

council, and state disability advocacy organizations.

To gather additional information on service provision after high school, we 

conducted phone interviews in a third state, South Carolina, with two 

 5

We used a 90 percent confidence level as a measure of general significance. We chose 

this as the measure of significance because this analysis was designed to be a 

confirmatory analysis to provide additional evidence that the observed differences in the 

weighted estimates were not a result of other factors.

6

For this report, unless otherwise noted, we use the term “stakeholders” to include parents 

and family members in our discussion groups, service providers, and/or advocacy group.

Interviews with State 

Officials and Local Service 

Providers
Appendix I: Objectives, Scope, and 

Methodology

Page 52 GAO-17-352 Youth with Autism

adult service providers and postsecondary institutions. We also 

conducted interviews with officials from the state vocational rehabilitation 

and disabilities agencies, as well as other state level disability 

organizations.

Information we gathered from these interviews represents only the 

conditions present in the states and local areas at the time of our 

interviews. These interviews focused on in-depth analysis of only a few 

selected states and local areas and therefore cannot be generalized 

nationwide. In addition, while we interviewed one health care provider in 

Arizona, we did not interview health care providers in all three states; 

thus, our findings related to medical services provided to transition-age 

youth with ASD are limited. However, we believe that these findings 

illustrate in-depth examples of services provided and perspectives on the 

challenges facing youth with ASD in transitioning to adult life.

To describe services and challenges that youth with ASD face in 

transitioning to adult life, we held five discussion groups with family 

members of and youth with ASD in two states, Arizona and New Jersey. 

To organize these discussion groups, we identified organizations in the 

states that provide outreach services to youth with ASD and other 

disabilities to help us reach out to potential participants. We asked these 

organizations to distribute notices about the discussion groups to their 

members. We invited family members of and youth who had exited high 

school within the last 5 years. We selected this age range to ensure we 

gathered first-hand experiences of those who were or had recently 

transitioned to adult life. The number of family members and youth 

participating in each discussion group ranged from 7 to 15. The youth 

with ASD in attendance included high-, medium-, and low-need 

individuals.

We held all of the discussion groups in the evening to accommodate the 

schedules of families. We conducted discussion groups in New Jersey 

first, with two each in Newark and Princeton. However, after these initial 

discussion groups, we determined that one discussion group per local 

area was sufficient for our purposes. As a result, in Arizona we held one 

discussion group in the Phoenix area. We also scheduled a discussion 

group in the Flagstaff area to gather perspectives of individuals from the 

rural northern area of the state, but no individuals responded that they 

would attend. We tried other methods to reach families and youth with 

ASD in the rural areas of Arizona, but we did not receive responses from 

Discussion Groups with 

Families and Youth with 

ASD
Appendix I: Objectives, Scope, and 

Methodology

Page 53 GAO-17-352 Youth with Autism

individuals who met our criteria for participating (i.e., age and diagnosis of 

ASD).

Each discussion group was led by a trained facilitator using an interview 

protocol designed for family members and youth with ASD. Information 

and views obtained from these discussion groups are not generalizable to 

other families, family members, or youth with ASD.

To examine the extent to which key federal agencies have collaborated in 

their efforts to assist youth with autism in successfully transitioning to 

adult life, we reviewed relevant federal laws, including the Autism 

Collaboration, Accountability, Research, Education, and Support Act of 

2014 (Autism CARES Act); the Individuals with Disabilities Education Act; 

and the Rehabilitation Act of 1973, as amended by the Workforce 

Innovation and Opportunities Act in 2014; regulations; policy and 

guidance. We also interviewed officials from the Departments of 

Education (Education), Health and Human Services (HHS), Housing and 

Urban Development (HUD), and Labor (DOL); the Social Security 

Administration (SSA); the Interagency Autism Coordinating Committee 

(IACC); and the Federal Partners in Transition interagency workgroup, 

which is composed of Education, HHS, DOL and SSA. We evaluated their 

collaborative efforts against leading federal practices for interagency 

collaboration, as appropriate.7 Four of the federal agencies included in 

our review—Education, HHS, DOL, and SSA—are the key agencies we 

identified in our 2012 report that administer key programs serving 

transition-age youth with disabilities in their transition out of high school.8

 7

GAO, Results-Oriented Government: Practices That Can Help Enhance and Sustain 

Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 21, 2005); 

and Managing for Results: Key Considerations for Implementing Interagency Collaborative 

Mechanisms, GAO-12-1022 (Washington, D.C.: Sept. 27, 2012). We reviewed 

collaboration efforts of the Federal Partners in Transition against all of the leading 

practices for interagency collaboration. Because we have conducted recent reviews of 

collaboration related to the IACC, we selected the practices most relevant to the focus of 

our review. For those recent reports, see GAO, Combating Autism Act: HHS Agencies 

Responded with New and Continuing Activities, Including Oversight, GAO-13-232 

(Washington, D.C.: Feb. 27, 2013; GAO, Federal Autism Activities: Better Data and More 

Coordination Needed to Help Avoid the Potential for Unnecessary Duplication, GAO-14-16 

(Washington, D.C.: Nov. 20, 2013); and GAO, Federal Autism Activities: Agencies Are 

Encouraging Early Identification and Providing Services, and Recent Actions Could 

Improve Coordination, GAO-16-446 (Washington, D.C.: May 20, 2016).

8

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).

Review of Federal Laws 

and Regulations, and 

Interviews with Federal 

Agency Officials
Appendix I: Objectives, Scope, and 

Methodology

Page 54 GAO-17-352 Youth with Autism

In addition, we also included HUD in our review based on federal agency 

feedback to that report and to consider any collaboration related to 

housing programs.

To inform all of our research objectives, we interviewed representatives of 

three businesses that have initiatives to hire individuals with ASD or with 

disabilities in general. We also interviewed representatives from a broad 

range of national disability advocacy organizations including The Arc, the 

Autism Self Advocacy Network, Autism Speaks, Autism Science 

Foundation, Easter Seals, and the National Association of Councils on 

Developmental Disabilities.

Interviews with Employers 

and National 

Organizations
Appendix II: Federal Agency Collaboration Has 

Highlighted Priority Research Needs

Page 55 GAO-17-352 Youth with Autism

The Interagency Autism Coordinating Committee (IACC) and the 

Interagency Committee on Disability Research (ICDR) have identified 

priority areas in which more research is needed to help youth with Autism 

Spectrum Disorder (ASD), or youth with disabilities more broadly, 

transition to adult life.1

• IACC: The IACC identified the need for additional research in areas 

related to transition-age youth and adults with ASD in multiple 

strategic plans, including its most recent strategic plan from 2013. In 

its 2013 plan, the IACC identified several areas related to transitionage youth and young adults that needed additional research, including 

understanding how ASD unfolds across the lifespan, development of 

treatments and interventions for individuals, developing specialized 

training for providers, and evaluating the effectiveness of service 

approaches.

2 The IACC expressed urgency for research on adult 

issues related to ASD, noting the lack of knowledge on effective 

approaches to service delivery. According to the 2013 IACC Portfolio 

Analysis of Federal and private autism research funding, the IACC 

Strategic Plan Question 6 topic area, which focuses on research 

related to quality of life for adults and transition-age adults with 

autism, including participation in the community and supports 

necessary for access to individualized services and supports, 

received roughly 1 percent of overall autism research funding, 

relatively little research funding compared to other Question areas 

that year.

• ICDR: The ICDR is tasked with promoting coordination and 

cooperation among federal departments and agencies conducting 

disability, independent living, and rehabilitation research programs.3 In 

 1

The Workforce Innovation and Opportunity Act (WIOA) advisory committee report is 

another example of a collaborative effort that has identified priority areas in which more 

focus is needed to help youth with disabilities, including youth with ASD, transition to adult 

life, but the report was not research focused. The Advisory Committee on Increasing 

Competitive Integrated Employment for Individuals with Disabilities Final Report 

(September 15, 2016).

2

The Interagency Autism Coordinating Committee: Strategic Plan For Autism Spectrum 

Disorder Research, 2013 Update. (April 2014). 

3

The ICDR was established in 1978 in an amendment to the Rehabilitation Act of 1973, 

and was initially called the Interagency Committee on Handicapped Research within the 

Department of Health, Education, and Welfare. It was originally tasked with promoting 

coordination and cooperation among federal departments and agencies conducting 

rehabilitation programs related to handicapped individuals and producing an associated 

report annually. Rehabilitation, Comprehensive Services, and Developmental Disabilities 

Amendments of 1978, Pub. L. No. 95-602, § 109, 92 Stat. 2955 , 2962-66.

Appendix II: Federal Agency Collaboration 

Has Highlighted Priority Research Needs 
Appendix II: Federal Agency Collaboration Has 

Highlighted Priority Research Needs

Page 56 GAO-17-352 Youth with Autism

2014, the Workforce Innovation and Opportunity Act (WIOA) included 

a requirement for the ICDR to develop a comprehensive governmentwide strategic plan for disability, independent living, and rehabilitation 

research. The ICDR draft strategic plan contains four overall crosscutting themes, one of which is transition, and the plan points to the 

need for methods to more efficiently advance research on transitions 

to education, employment, and community living.4 Additionally, one of 

the ICDR workgroups that assisted in creating the draft strategic plan 

highlighted additional research needs in the youth transition area, 

such as a focus on outcomes necessary to identify and share effective 

practices; and future research on the value of work experience and 

early VR involvement.

 4

The ICDR Draft Government Wide Strategic Plan was released in September 2016 and 

according to the draft plan, describes the planning process used to develop the 

Government Wide Strategic Plan for fiscal years 2017-2020, as well as the strategic goals 

and objectives the ICDR will pursue over the next 3 years.
Appendix III: Comments from the Department 

of Education

Page 57 GAO-17-352 Youth with Autism

Appendix III: Comments from the 

Department of Education
Appendix III: Comments from the Department 

of Education

Page 58 GAO-17-352 Youth with Autism
Appendix IV: Comments from the Department 

of Labor

Page 59 GAO-17-352 Youth with Autism

Appendix IV: Comments from the 

Department of Labor
Appendix IV: Comments from the Department 

of Labor

Page 60 GAO-17-352 Youth with Autism
Appendix V: Comments from the Social 

Security Administration

Page 61 GAO-17-352 Youth with Autism

Appendix V: Comments from the Social 

Security Administration
Appendix V: Comments from the Social 

Security Administration

Page 62 GAO-17-352 Youth with Autism
Appendix VI: GAO Contact and Staff 

Acknowledgments

Page 63 GAO-17-352 Youth with Autism

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

In addition to the contact named above, Scott Spicer (Assistant Director), 

Cady Panetta (Analyst-in-Charge), James Ashley, James Bennett, Holly 

Dye, Maria Gaona, Farrah Graham, Aaron Karty, Jamila Kennedy, Sheila 

McCoy, Walter Vance, Najeema Washington, Adam Wendel, and Khristi 

Wilkins made key contributions to this report.

Appendix VI: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments
Related GAO Products

Page 64 GAO-17-352 Youth with Autism

Youth with Autism: Roundtable Views of Services Needed During the 

Transition into Adulthood. GAO-17-109. Washington D.C.: October 18, 

2016.

Federal Autism Activities: Agencies are Encouraging Early Identification 

and Providing Services, and Recent Actions Could Improve Coordination. 

GAO-16-446. Washington D.C.: May 20, 2016.

Federal Autism Research: Updated Information on Funding from Fiscal 

Years 2008 through 2012. GAO-15-583R. Washington, D.C.: June 30, 

2015.

Federal Autism Activities: Funding and Coordination Efforts. 

GAO-14-613T. Washington, D.C.: May 20, 2014.

Federal Autism Activities: Better Data and More Coordination Needed to 

Help Avoid the Potential for Unnecessary Duplication. GAO-14-16. 

Washington, D.C.: November 20, 2013.

Combating Autism Act: HHS Agencies Responded with New and 

Continuing Activities, Including Oversight. GAO-13-232. Washington, 

D.C.: February 27, 2013.

Students with Disabilities: Better Federal Coordination Could Lessen 

Challenges in the Transition from High School. GAO-12-594. Washington 

D.C.: July 12, 2012.

Federal Autism Activities: Funding for Research Has Increased, but 

Agencies Need to Resolve Surveillance Challenges. GAO-06-700. 

Washington, D.C.: July 19, 2006.

Special Education: Children with Autism. GAO-05-220. Washington, D.C.: 

January 14, 2005.

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