Alarmingly large unemployment gap despite of above-average education in adults with ASD without intellectual disability in Germany: a cross-sectional study

Abstract

For individuals with autism spectrum disorder (ASD), both getting access to as well as staying in the labor market are very challenging. However, the detailed educational, vocational, and employment characteristics of persons with ASD without intellectual disabilities are not yet studied. We conducted a retrospective study on a sample of 232 clinically late-diagnosed adults with ASD without intellectual disabilities. Data were compared to the general German population obtained from the public database of the German Federal Employment Agency. Results showed that the majority of persons with ASD graduated from high school and obtained a university entrance qualification (ASD: 50.4%; general population: 32.5%). Also, lower rates of basic secondary education were found in the ASD sample (ASD: 16.5%, general population: 29.6%). Significantly less individuals with ASD completed vocational training (40.1%) in comparison to the German population (56.3%). Despite the above-average level of education, the unemployment rate of the sample substantially exceeds that of the general population by the factor 5 (ASD: 25.2%; general population: 5.2%). Periods of unwanted unemployment of persons with ASD lasted on average 23 months with interpersonal problems being the main reason for contract termination. A higher level of educational qualification does not protect against a higher risk of unemployment for individuals with ASD presumably due to autism-specific interpersonal difficulties. Data emphasize the necessity to develop and spread both specific employment support activities for individuals with ASD as well as adequate awareness raising strategies. Funded by a public grant of the “Landschaftsverband Rheinland (LVR)”.

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European Archives of Psychiatry and Clinical Neuroscience (2023) 273:731–738
https://doi.org/10.1007/s00406-022-01424-6
ORIGINAL PAPER
Alarmingly large unemployment gap despiteofabove‑average
education inadults withASD withoutintellectual disability
inGermany: across‑sectional study
JuliaEspelöer1 · JuliaProft1· ChristineM.Falter‑Wagner2· KaiVogeley1
Received: 23 December 2021 / Accepted: 22 April 2022 / Published online: 14 May 2022
© The Author(s) 2022
Abstract
For individuals with autism spectrum disorder (ASD), both getting access to as well as staying in the labor market are very
challenging. However, the detailed educational, vocational, and employment characteristics of persons with ASD without
intellectual disabilities are not yet studied. We conducted a retrospective study on a sample of 232 clinically late-diagnosed
adults with ASD without intellectual disabilities. Data were compared to the general German population obtained from the
public database of the German Federal Employment Agency. Results showed that the majority of persons with ASD gradu-
ated from high school and obtained a university entrance qualification (ASD: 50.4%; general population: 32.5%). Also, lower
rates of basic secondary education were found in the ASD sample (ASD: 16.5%, general population: 29.6%). Significantly
less individuals with ASD completed vocational training (40.1%) in comparison to the German population (56.3%). Despite
the above-average level of education, the unemployment rate of the sample substantially exceeds that of the general popu-
lation by the factor 5 (ASD: 25.2%; general population: 5.2%). Periods of unwanted unemployment of persons with ASD
lasted on average 23months with interpersonal problems being the main reason for contract termination. A higher level of
educational qualification does not protect against a higher risk of unemployment for individuals with ASD presumably due
to autism-specific interpersonal difficulties. Data emphasize the necessity to develop and spread both specific employment
support activities for individuals with ASD as well as adequate awareness raising strategies. Funded by a public grant of the
“Landschaftsverband Rheinland (LVR)”.
Keywords Autism· Employment· Education· General German population· Adults
Abbreviations
ASD Autism spectrum disorder
ICD-10 International Statistical Classification of
Diseases and Related Health Problems 10th
Revision
Introduction
One of the most important milestones in the transition from
adolescence to adulthood is entering working life. An unsuc-
cessful transition can have far-reaching consequences for
further socialization and may lead to social exclusion [1, 2].
Yet even if this transition is accomplished, working envi-
ronments with their complex social dynamics pose further
challenges, especially for individuals with autism spectrum
disorder (ASD) for whom deficits in social interaction skills
and stereotyped, repetitive behavior are characteristic [1,
3–5]. Qualitative impairments in processing social informa-
tion intuitively may add to the risk of exclusion. Individuals
with ASD describe requirements imposed by their workplace
with a ratio of 80% social to 20% working skills, which is
a misfit to their own strengths and weaknesses [6]. Indeed,
communicative difficulties, inappropriate social behaviors
and adherence to ritualistic and routine behavior in adult-
hood are reported to hinder access to and maintenance of
C. M. Falter-Wagner and K. Vogeley are the joint last authors.
* Julia Espelöer
julia.espeloeer@uk-koeln.de
1 Department ofPsychiatry, University Hospital Cologne,
Kerpener Strasse 62, 50924Cologne, Germany
2 Department ofPsychiatry, Medical Faculty, LMU Munich,
Nussbaumstrasse 7, 80336Munich, Germany
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732 European Archives of Psychiatry and Clinical Neuroscience (2023) 273:731–738
1 3
employment [4–9]. Fragmented professional career paths
due to an increased number of job terminations interspersed
with long periods of unemployment can be the consequence
[4, 6, 8]. When reviewing the literature on concrete employ-
ment rates in ASD, previous research indicates unemploy-
ment rates between 39 and 73% in the USA [10, 11] and
24 to 54% in Great Britain [5, 7, 12], whereby no differ-
entiation was made with regard to the severity of autism
symptoms or the level of functioning and age at diagnosis.
Further research suggests that the majority of early-diag-
nosed adults with ASD with and without intellectual dis-
abilities are employed in sheltered or supported settings [5,
13]. Especially, the psychosocial outcome of young adults
with ASD lags behind that of adults with other impairments
and comparable demographic and disability characteristics
[1–3, 12, 14]. Many adults with ASD remain dependent on
their parental home or other institutional sources of support
[5]. Individuals with ASD are at heightened risk of poorer
post-secondary educational and vocational outcomes when
showing greater functional impairments [4]. Taylor and
Seltzer [13] indicated that young adults with ASD and co-
occurring intellectual disability were more likely to have
post-high school employment compared to individuals with
ASD without intellectual disabilities. However, especially
late-diagnosed adults with ASD without intellectual dis-
abilities appear to be neglected in professional support ser-
vices compared to individuals with other disabilities such
as learning or language disabilities and other mental health
problems [2, 7, 12, 13, 15]. Despite high education levels,
where normal employment rates could be expected, indi-
viduals with ASD suffer from high rates of unemployment
thus demonstrating a need for specific support systems [11,
15–18].
Research on unemployment rates in Germany suggests
similar findings as obtained in international studies of unem-
ployment rates in the range of 13.5 and 58% [18–20]. For
the first time, the German general population was included
in the current study as a control group and was quantita-
tively compared with occupational qualifications and unem-
ployment rates in a large clinical sample of late-diagnosed
individuals with ASD without intellectual disabilities. The
current study corroborates findings of Maslahati and col-
leagues [21] of an imbalance of increased educational levels
as well as increased unemployment rates in adults with ASD
with and without intellectual disabilities compared to the
general population of Germany. The occupational status of
individuals attending the adult autism outpatient clinic was
assessed at the beginning of the diagnostic process; all indi-
viduals were without experiences of ASD-specific profes-
sional support service. Similar previous studies either solely
studied the influence of special interests on occupational
success [18] or on the classification of occupation [20]. The
comparison of an ASD sample with the general German
population by Maslahati [21] was extended by quantitative
approximation between groups. The survey period of our
study—2014–2019—follows previous research (2009–2011
by Riedel etal. [19]; 2009–2014 by Frank etal. [20]; sam-
pling period was not provided by Kirchner and Dziobek
[18]). The purpose of the current study was to provide
detailed education and employment characteristics by focus-
ing on the specific group of late-diagnosed high-functioning
adults with ASD in comparison with the general population
in Germany.
Method
Participants
Retrospective data were obtained from the Adult Autism
Outpatient Clinic, Department of Psychiatry, of the Univer-
sity Hospital of Cologne, Germany. Registration for diag-
nostics in the outpatient clinic requires a referral and thus a
prior assessment by a specialist. 3964 individuals registered
for diagnostic clarification during the period of 2014–2019
received a questionnaire [22] before their first interview to
assess their occupational status of which 1765 questionnaires
were returned corresponding to a response rate of 45%. 443
individuals were clinically diagnosed with ASD according
to ICD-10 criteria of which 232 individuals provided a com-
pleted questionnaire [23]. IQ testing is not standard in the
diagnostic process. Due to educational qualification level
in our sample, the exclusion of cognitive disabilities in the
ASD sample can be assumed [24]. The average age of the
ASD sample was 35years (19–67), 67 individuals (28.9%)
were female, 165 (71.1%) were male. The catchment area of
the sample consists of 43.5% of individuals who came from
the wider area of Cologne, the rest of the sample came from
other regions in Germany. The manuscript was submitted to
the local Ethics Committee of the Medical Faculty, Univer-
sity of Cologne, which confirmed that the study is exempt
from the requirement of ethical approval as under German
law no separate ethics application to and statement of ethi-
cal approval by the local ethics committee are required for
performing purely retrospective clinical studies.
Instruments
The vocational questionnaire consists of two parts [22]. The
first part, which is reported in the current analysis, captures
descriptive data about formal education level, occupational
skill level, employment status, psychosocial situation, peri-
ods of unemployment, and frequency and reasons of ter-
minations (For the German translation of levels of formal
qualification see Table1). The second part is composed of
the two subscales ‘workplace experiences’ and ‘wishes and
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733European Archives of Psychiatry and Clinical Neuroscience (2023) 273:731–738
1 3
requirements of an ideal workplace’. Ratings in the second
part were performed using five-point Likert scales. Data of
the ASD sample was compared to whole population data
obtained from the public databases of the German Federal
Employment and the German National Education Report
[25–27]. These databases are not updated yearly so that we
selected the 2018 data from the aforementioned institutions
that were closest to our data collection period.
Results
Education andvocational qualification
Results for the successful general school education at
least reaching basic secondary education were comparable
between groups, Χ2(1) = 1.1, p = 0.29. More specifically,
results show that in the ASD group, significantly more
individuals reached the highest possible school education
of a general or discipline-specific university entrance-level
qualification (Χ2(1) = 33.7, p < 0.001), complementary to
a significantly lower proportion of individuals with ASD
who only reached a basic secondary education, as com-
pared to the general population (Χ2(1) = 18.9, p < 0.001)
(see Table2).
After school-based education, significantly less indi-
viduals with ASD obtained vocational qualification com-
pared to the general population (Χ2(1) = 19.1, p < 0.001).
Significant differences were found for vocational training,
with significantly less completed qualifications in the ASD
group compared to the general population (Χ2(1) = 24.8,
p < 0.001). In the ASD group, increased rates of academic
degrees were found, but differences were not significant
(see Table2).
Table 1 Levels of formal qualification
Levels of formal qualifications with related German translation
a Compulsory education lasts 9 or 10years, depending on the federal state of the Federal Republic of Germany
School education, summarized School education German Required
School
attendance
University entrance qualification General university entrance-level
qualification
“Allgemeine Hochschulreife” Upper secondary level 12 or 13years
University entrance qualification Discipline-specific university
entrance-level qualification
“Fachhochschulreife” Upper secondary level 12 or 13years
Other qualifications General certificate of secondary
education
”Realschulabschluss” Lower secondary level 10years
Other qualifications Basic secondary educationa“Hauptschulabschluss” Lower secondary level 9years
Table 2 Highest qualification
achieved by group
Values in % by group
Group: ASD autism spectrum disorder (2014–2019), Population German general population (2018), Χ2
Chi-square goodness of fits test
*p < .05
a It is possible that some participants are still in education at the time of the survey
Education Group
ASD Population Χ2(1) p
University entrance-level qualification 50.4 32.5 33.7 < .001*
General certificate of secondary education 27.0 29.9 0.9 .330
Basic secondary education 16.5 29.6 18.9 < .001*
No school-leaving certificate/unspecifieda6.1 7.8 0.9 .333
Vocational Qualification
Vocational Qualification 61.7 74.2 19.1 < .001*
Academic degree 21.6 17.9 2.1 .147
Vocational training 40.1 56.3 24.8 < .001*
In process of graduation 10.8 8.9 1.0 .316
Sheltered training measure 4.3 n.p
Without completed vocational qualification 16.8 16.5 0.02 .899
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734 European Archives of Psychiatry and Clinical Neuroscience (2023) 273:731–738
1 3
Employment
36.5% of the participants in the ASD group reported to be
employed (full-time, part-time, self-employed, civil serv-
ant). 16.9% were in education (school, vocational training,
studies) and 11.4% of participants underwent preparatory
activities (supportive interventions, side jobs, internships),
25.2% of individuals with ASD were unemployed, 5.2%
were already retired (Fig.1).
The majority of the ASD sample with a university
entrance qualification were employed (44.3%). One-fifth
were affected by unemployment (21.7%) or were in educa-
tion (21.7%), respectively. Moreover, one-third of all grad-
uates with a secondary education was employed (31.3%)
or unemployed (32.3%) (Table3).
Unemployment
Regarding the unemployment status, the ASD sample signif-
icantly exceeded the unemployment rate of the general popu-
lation with 25.2% of ASD participants currently unemployed
as compared to 5.2% in the general population, Χ2(1) = 187,
p < 0.001 (not in Table). 98.3% of all unemployed individu-
als with ASD had a successful school education (general
population: 82.4%), Χ2(1) = 10.1, p = 0.001, whereby 43.1%
had completed a university entrance qualification (general
population: 17.8%) (Χ2(1) = 25.4, p < 0.001) (Table4).
When comparing the highest school degree achieved
by unemployed persons, results show that significantly
more unemployed individuals in the ASD group show
general (Χ2(1) = 11.5, p < 0.001) or discipline-specific
(Χ2(1) = 12.2, p < 0.001) university entrance-level quali-
fications compared to the general population, whereas
Fig. 1 Employment situa-
tion of the ASD group in %
(not available for the general
German population). *Pre-
paratory activities = Supportive
interventions such as sheltered
workplace or rehabilitation, side
job, internship
36·5
16·9
11·4
25·2
5·2 4·8
0
5
10
15
20
25
30
35
40
Employed In Educaon Preparatory
acvies*
Unemployed Rerement Unspecified
Employment situaon
%
Table 3 Employment status by school education and vocational qualification of the ASD group
Employment status by school education and vocational qualification of the ASD group in %
Group: ASD autism spectrum disorder (comparable detailed data not available for the general German population)
Employment status in %
School Education Employed In education Preparatory
activities
Unemployed Retirement Unspecified Total
University entrance qualification 44.3 21.7 6.1 21.7 2.6 3.5 100
Secondary education 31.3 11.1 11.1 32.3 7.1 7.1 100
No school-leaving certificate 7.1 14.3 57.1 7.1 14.3 0.0 100
Average 36.4 16.7 11.4 25.4 5.3 4.8 100
Vocational Qualification
Academic degree 65.3 8.2 4.1 14.3 6.1 2.0 100
Vocational training 45.2 6.5 7.5 30.1 5.4 5.4 100
Without qualification 11.4 33.0 19.3 26.1 4.5 5.7 100
Average 36.5 17.0 11.3 25.2 5.2 4.8 100
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735European Archives of Psychiatry and Clinical Neuroscience (2023) 273:731–738
1 3
the proportion of persons with ASD who did not reach
a school-leaving certificate was significantly lower
(Χ2(1) = 10.1, p = 0.001) (Table4). Regarding the highest
vocational qualification achieved, results did not signifi-
cantly differ for unemployed individuals with academic
degree and vocational training in both groups. The rate
of unemployed persons who did not finish any voca-
tional qualifications was increased in the general popula-
tion compared to the ASD group, Χ2(1) = 4.4, p = 0.04
(Table5).
Participants reported periods of unemployment on
average of 23months, accordingly about two years on
average (comparable detailed data not available for the
general German population). 79.2% of all unemployed
individuals with ASD were significantly more often long-
term unemployed for at least 12months (general popula-
tion: 34.8%), Χ2(1) = 41.6, p < 0.001 [26].
Rates andreasons oftermination
The results showed an average termination frequency of per-
sons with ASD of almost two terminations per person with a
maximum up to twelve terminations. Interpersonal problems
were cited significantly more often than professional prob-
lems as a reason for termination (z = 4323, p < 0.001). There
were no differences between the rate of terminations given
by the employer or by the employee (z = 2366, p = 0.47).
Discussion
The current study corroborates the general pattern of a strik-
ing imbalance of the high level of education of persons with
ASD without intellectual disability and their comparably
low employment rate in Germany. For the first time, we are
able to provide a quantitative approximation of a fivefold
higher unemployment rate compared to the general popula-
tion in Germany. Interpersonal difficulties were stated sig-
nificantly more often than other reasons leading to termina-
tion in the ASD group.
Our study confirms and extends previous research by
highlighting that a significantly higher level of education
in the ASD sample, e.g. 50.4% university entrance-level
qualifications (general population: 32.5%) and 21.6%
graduate university (general population: 17.9%), does not
protect from higher risk of unemployment. Previous stud-
ies in Germany with samples of late-diagnosed adults with
ASD reported comparable results [19–21]. However, these
studies examined smaller samples of individuals diagnosed
with ASD according to ICD-10. In contrast to our results, in
the general population the unemployment rate decreases the
higher the school-leaving qualification. Contrasting to our
sample of individuals with ASD, unemployed individuals
in the general population are characterized by a relatively
Table 4 Level of highest
school education achieved by
unemployed individuals per
group
Level of school education reached by unemployed individuals by group in %
Group: ASD autism spectrum disorder (2014–2019), Population German general population (2018), Χ2
Chi-square goodness of fits test
* p < .05
Education Group
ASD Population Χ2(1) p
Successful school education 98.3 82.4 10.1 .001
University entrance qualification 43.1 17.8 25.4 < .001*
General university entrance-level qualification 25.9 11.6 11.5 < .001*
Discipline-specific entrance-level qualification 17.2 6.2 12.2 < .001*
General certificate of secondary education 31.0 21.5 3.1 .077
Basic secondary education 24.1 33.5 2.3 .131
No school-leaving certificate 1.7 17.6 10.1 .001*
Unspecified – 9.7
Table 5 Level of highest vocational qualification achieved by unem-
ployed individuals per group
Level of vocational qualification reached by unemployed individuals
by group in %
Group: ASD autism spectrum disorder (2014–2019), Population Ger-
man general population (2018), Χ2 Chi-square goodness of fits test
* p < .05
Vocational Qualification Group
ASD Population Χ2(1) p
Academic education 12.3 7.9 1.5 .220
Vocational training 49.1 39.6 2.2 .142
Without completed voca-
tional qualification/unspeci-
fied
38.6 52.4 4.4 .037*
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736 European Archives of Psychiatry and Clinical Neuroscience (2023) 273:731–738
1 3
low qualification level (basic secondary education degree:
33.5%), and low rates (< 50%) of completed vocational
training.
In the current study, individuals with ASD show signifi-
cantly better school-leaving qualifications, including lower
rates of basic secondary education in addition to higher
rates of general university entrance-level qualifications (see
Table2). Furthermore, there is a higher rate of unemployed
individuals with ASD with completed school education
(see Table4) as well as completed vocational qualifications
(see Table5) compared to the general German population.
However, alarmingly high unemployment rates in the current
sample of 25.2%, which exceed the unemployment rates in
the German population of 5.2% by a factor of five, clearly
demonstrate the challenges of stable integration as well
as adaption to the demands of the labor market. It can be
assumed that requirements for social skills, flexible behav-
ior, quick adaptation to new processes as well as executive,
structuring and planning skills increase in university and
vocational training settings compared to lower level educa-
tional environments [28].
In particular, the context of vocational training and later
workplace situations in terms of job interviews and practi-
cal requirements could add to the challenge for individuals
with ASD. Due to the limited abilities of individuals with
ASD in social skills and flexible behavior, coping with these
requirements represent a major challenge. In the current
study, significantly less individuals with ASD completed
vocational training (40.1%) in comparison to the German
population (56.3%). Our results were comparable to those in
a previous German study by Frank and colleagues [20] with
43.1% who also included late-diagnosed adults with ASD
without intellectual disabilities. Maslahati and colleagues
[21] reported lower values (33%), which might be due to the
broader sample of individuals with and without intellectual
disabilities. Impairments in social skills as well as inflexible
routines and ritualistic behavior might hinder the transition
to successful employment with increased expectations for
social skills, especially in adulthood [1, 9, 22].
Thus, the transition from school to the working life is a
specific problem for persons with ASD that requires ade-
quate measures like early intervention programs [29]. Early
interventions need to be installed additionally for the first
2years after leaving school, targeting the person-environ-
ment fit, the role of parents as well as a comprehensive,
integrated support system [3, 12, 30].
Until today, there is clearly a lack of suitable support ser-
vices for individuals with ASD without intellectual disabili-
ties [3]. Parents are forced to be continuously supportive and
engaged, because support ended after leaving school [7].
Reduced soft skills and adaptation to social rules as well as
stereotypical behavior appear to be a barrier in the labor mar-
ket and might result in repeated terminations. In the current
sample, periods of unemployment on average of 23months
were reported, which are comparable results to previous
research with 24.4months [20]. Compared to the general Ger-
man population (34.8%), individuals with ASD were signifi-
cantly more often long-term unemployed (79.2%). In accord-
ance with previous findings, interpersonal difficulties were
reported to be the main reason for terminations in our sample
[6]. 35% of the ASD sample report to have experienced job
termination at least once due to interpersonal reasons and 63%
of the participants reported to struggle due to high expecta-
tions of interpersonal relationships. Unfortunately, comparison
data on terminations of employments are not available for the
general population in Germany.
As a hypothesis for future research, we propose that espe-
cially adults with ASD without intellectual disabilities are at
risk of being overlooked in supported employment services.
Company-integrated workplaces are suggested to avoid seg-
regated settings and thus social exclusion [31].
Limitations
The present study examined individuals attending the Adult
Autism Outpatient Clinic of the University Hospital of
Cologne likely due to self-perceived or externally perceived
difficulties and with preceding professional assessment. We
were studying a specific group of patients from an outpatient
clinic by focusing on late-diagnosed high-functioning adults
without intellectual disabilities. It needs to be emphasized
that results could not be generalized to all individuals with
autism. A large sample size as well as a sufficient response
rate of 45% was achieved based on data from individuals
who were motivated and capable to complete the full ques-
tionnaire. Help-seeking behavior might be reduced in a sam-
ple of high-functioning autistic individuals, which should
have tended to reduce the unemployment rate. Data from
the general German population are not as fine-grained as
the data from the ASD sample (e.g. missing information
on terminations of employments). Although the ASD group
represents a separately studied sample, it is still part of the
general population, which was used for comparison. Comor-
bid disorders have been discussed as an important factor in
research on the employment situation of people with ASD
[1, 19]. This aspect has not been included in the current
study and should be investigated as an important further
aspect in future studies.
Conclusions
The relation between educational achievements on one hand
and employment rate on the other hand is clearly dysbal-
anced in persons with ASD compared to the general popu-
lation. Professional supported employment programs are
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737European Archives of Psychiatry and Clinical Neuroscience (2023) 273:731–738
1 3
urgently needed aligning to long-term support for employees
with ASD [22]. In addition, it is most important to increase
societal knowledge and awareness about autism-related
strengths and weaknesses addressing public authorities,
potential employers, and colleagues. This should improve
the hiring situation for adults with ASD and support stable
employments.
Acknowledgements We thank all the participants who took part in
this study.
Author contributions All authors contributed to the study conception
and design. Material preparation and analysis were performed by JE.
The first draft of the manuscript was written by JE and all authors com-
mented on previous versions of the manuscript. All authors listed have
made a substantial, direct, and intellectual contribution to the work
and approved the final manuscript for publication. All authors had full
access to data and CMFW verified the data. CMFW and KV should be
considered joint last author.
Funding Open Access funding enabled and organized by Projekt
DEAL. The study was funded by a grant of the “Landschaftsverband
Rheinland (LVR)” for a project that developed a supported employment
program for adults with ASD in Germany.
Data availability The datasets generated and analyzed in the current
study are not publicly available as they are part of an ongoing project
at the Adult Autism Outpatient Clinic, Department of Psychiatry, of the
University Hospital of Cologne, Germany. The datasets are intended
to be used for further analysis and publication, but are available upon
request from the corresponding author.
Declarations
Conflict of interest On behalf of all authors, the corresponding author
states that there is no conflict of interest.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
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