Feasibility and preliminary efficacy of behavioral activation for treatment of depression in autistic adolescents

Abstract

Depression is common among autistic youth and is associated with worse quality of life in this group. Despite significant need for high-quality efficacious treatments, there has been very limited research on interventions for depression in autistic youth. This single-arm pilot study examined the feasibility and preliminary efficacy of a novel, behavior-based approach for treatment of depression symptoms in autistic adolescents without intellectual disability (i.e. Behavioral Activation for Autistic Adolescents, BA-A). BA-A is an individually delivered manualized 12-session treatment that utilizes established BA strategies and incorporates common mental health treatment adaptations for autistic young people. Of the 18 youth (11–16 years old) who enrolled, 15 completed all 12 treatment sessions, as well as pre-treatment, post-treatment, and follow-up assessment visits. Clinician treatment fidelity was quite high. Paired sample t-tests found that depression symptoms decreased pre- to post-BA-A according to multiple informants (i.e. self, caregiver, and independent evaluator), and treatment gains were maintained at 1-month follow-up. Paired sample t-tests also found that caregiver-reported anxiety symptoms and social skills improved pre-treatment to post-treatment. The results, although preliminary, indicate that BA-A may improve depression symptoms in autistic youth without intellectual disability. Furthermore, these promising findings suggest that a randomized controlled trial of BA-A is warranted. This trial was pre-registered at ClinicalTrials.gov (NCT05018169). Lay Abstract Depression is common among autistic youth and has a significant negative impact on quality of life and day-to-day functioning. Despite great need for efficacious treatments, there are currently limited research-supported interventions for depression symptoms in autistic young people. This study tested a novel, behavior-based approach or psychotherapy for treatment of depression symptoms in autistic adolescents without intellectual disability (i.e. Behavioral Activation for Autistic Adolescents, BA-A) with 15 youth (11–16 years old). BA-A is an individually delivered 12-session therapy that was developed for and to meet the needs of autistic youth with depression. Results found that autistic youth and their caregivers were able to participate in BA-A therapy sessions, and clinicians were able to deliver BA-A in accordance with the treatment manual. Notably, results demonstrated that autistic youth depression symptoms significantly improved after participating in BA-A. Furthermore, anxiety symptoms and social skills significantly improved following BA-A.