Psychosocial Treatments Targeting Anxiety and Depression in Adolescents and Adults on the Autism Spectrum: Review of the Latest Research and Recommended Future Directions

White, Susan W.; Simmons, Grace Lee; Gotham, Katherine; Conner, Caitlin M.; Smith, I.; Beck, Kelly B.; Mazefsky, Carla

doi:10.1007/s11920-018-0949-0

Cited by 120 publications

(90 citation statements)

References 90 publications

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“…In addition, it is notable that the autistic adults' stated preferences for therapy sessions fit nicely with CBT, which is a practical, present-focused, structured therapeutic approach with a growing evidence base for use in this population (Spain et al, 2015). The autistic participants' recommendations to consider sensory issues, slow the pace, incorporate special interests, use direct language, and set clear expectations align with published guidelines for modifying CBT for autistic adults (Kerns, Roux, Connell, & Shattuck, 2016;White, Conner, & Maddox, 2017;White et al, 2018).…”

Section: Discussionmentioning

confidence: 79%

“I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults

Maddox

Crabbe

Beidas

et al. 2019

Autism

130

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Most autistic adults struggle with mental health problems, and traditional mental health services generally do not meet their needs. This study used qualitative methods to identify ways to improve community mental health services for autistic adults for treatment of their co-occurring psychiatric conditions. We conducted semistructured, open-ended interviews with 22 autistic adults with mental healthcare experience, 44 community mental health clinicians, and 11 community mental health agency leaders in the United States. The participants identified clinician-, client-, and systems-level barriers and facilitators to providing quality mental healthcare to autistic adults. Across all three stakeholder groups, most of the reported barriers involved clinicians’ limited knowledge, lack of experience, poor competence, and low confidence working with autistic adults. All three groups also discussed the disconnect between the community mental health and developmental disabilities systems, which can result in autistic adults being turned away from services when they contact the mental health division and disclose their autism diagnosis during the intake process. Further efforts are needed to train clinicians to work more effectively with autistic adults and to increase coordination between the mental health and developmental disabilities systems. Lay Abstract Most autistic adults struggle with mental health problems, such as anxiety and depression. However, they often have trouble finding effective mental health treatment in their community. The goal of this study was to identify ways to improve community mental health services for autistic adults. We interviewed 22 autistic adults with mental healthcare experience, 44 community mental health clinicians (outpatient therapists, case managers, and intake coordinators), and 11 community mental health agency leaders in the United States. Our participants identified a variety of barriers to providing quality mental healthcare to autistic adults. Across all three groups, most of the reported barriers involved clinicians’ limited knowledge, lack of experience, poor competence, and low confidence working with autistic adults. All three groups also discussed the disconnect between the community mental health and developmental disabilities systems and the need to improve communication between these two systems. Further efforts are needed to train clinicians and provide follow-up consultation to work more effectively with autistic adults. A common suggestion from all three groups was to include autistic adults in creating and delivering the clinician training. The autistic participants provided concrete recommendations for clinicians, such as consider sensory issues, slow the pace, incorporate special interests, use direct language, and set clear expectations. Our findings also highlight a need for community education about co-occurring psychiatric conditions with autism and available treatments, in order to increase awareness about treatment options.

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Section: Discussionmentioning

confidence: 79%

“I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults

Maddox

Crabbe

Beidas

et al. 2019

Autism

130

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“…In addition, it is unclear whether social skills interventions can be generalized to other social settings and situations, that is, whether skills learned in the treatment context are used by the participants in other settings, such as with peers or at work. There is some evidence for the use of cognitive-behavioural therapy (CBT) for effectively treating anxiety in people with autism who have sufficient cognitive and language skills to participate in current programs 203 . However, nearly all of the existing research has been conducted with children and adolescents rather than in adults 202 , and individuals with substantial communication challenges are excluded from CBT studies.…”

Section: [H2] Adult Servicesmentioning

confidence: 99%

Autism spectrum disorder

Lord

Brugha

Charman

et al. 2020

Nat Rev Dis Primers

1,063

741

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Autism Spectrum Disorder (ASD) is a construct used to describe individuals with a specific combination of impairments in social communication and repetitive behaviours, highly restricted interests and/or sensory behaviours beginning early in life. The worldwide prevalence of autism is just under 1%, but estimates are higher in high-resource countries. Although gross brain pathology is not characteristic of autism, subtle anatomical and functional differences have been observed in postmortem, neuroimaging and electrophysiological studies. Initially it was hoped that accurate measurement of behavioural phenotypes would lead to specific genetic subtypes, but genetic findings have mainly applied to heterogeneous groups that are not specific to autism. Psychosocial interventions in children can improve specific behaviours, such as joint attention, language and social engagement that may affect further development and could reduce symptom severity. However, further research is necessary to identify the long-term needs and treatments and the mechanisms behind them that could result in improved independence and quality of life over time. Families are often the major source of support for people with AUTISM throughout much of life and need to be considered, along with the perspectives of autistic persons, in both research and practice. [H1] Introduction Autism spectrum disorder (ASD) is a common, highly heritable and heterogeneous neurodevelopmental disorder that has underlying cognitive features and commonly co-occurs with other conditions. The Autism spectrum disorder-or autism-is a neurodevelopmental disorder that typically manifests in young children. This Primer by Lord and colleagues reviews the epidemiology, mechanisms, clinical detection and treatment of autism.

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“…First, previous studies have often utilised clinical or diagnostic cut-points to determine whether associated symptoms are absent or present -an approach which may underestimate the impact of these symptoms on QoL. Indeed, there are several diagnostic challenges to identifying cooccurring mental health/neurodevelopmental symptoms, meaning some individuals never receive a formal diagnosis and therefore remain underrepresented in such research (Hollocks et al, 2019;White et al, 2009). Second, where existing research has taken a dimensional approach to assess the impact of associated symptoms on QoL, across their full range of severity, other factors like core autism traits are not consistently controlled for in analyses (Adams et al, 2019) and/or internalising and emotional problems are considered as a general, unitary construct.…”

Section: Factors Associated With Subjective Qol In Autismmentioning

confidence: 99%

How do core autism traits and associated symptoms relate to quality of life? Findings from the Longitudinal European Autism Project

Oakley

Tillmann

Ahmad

et al. 2020

Autism

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Previous studies have reported reduced quality of life in autism. Improving quality of life for autistic people is, therefore, a key priority for clinical research and practice. However, the relative impact of core autism traits (e.g. social-communication difficulties), as compared to associated mental health symptoms (e.g. anxiety, depression) on quality of life remains poorly understood. This is despite at least 20%–50% of autistic individuals experiencing associated anxiety and/or depression symptoms. Hence, we measured subjective quality of life in 573 six to thirty-year-olds (autism spectrum disorder N = 344), using two widely validated questionnaires. Adults self-reported on the World Health Organization Quality of Life–Brief instrument. Parents of children/adolescents completed the Child Health and Illness Profile. We assessed individual variability across both measures and modelled associations between quality of life, core autism traits, anxiety, and depression symptoms. Across both age groups and quality of life measures, autistic individuals scored lower than comparison individuals, on average, particularly for physical health in adults ( d = −1.24, 95% confidence interval: [−1.56, −0.93]) and school achievement for children/adolescents ( d = −1.06, 95% confidence interval: [−1.29, −0.84]). However, a notable proportion of autistic individuals (36%–71% across quality of life domains) did not have reduced quality of life. Across ages and quality of life measures, severity of associated symptoms was significantly related to reduced quality of life on several domains, after accounting for core autism traits. Most notably, depression symptoms were related to reduced physical/psychological well-being in both adults ( β ⩾ −0.34) and children/adolescents ( β = −0.29, 95% confidence interval: [−0.36, −0.14]). For children/adolescents, anxiety symptoms ( β ⩾ −0.28) and core social-communication difficulties ( β ⩾ −0.22) were also related to subjective quality of life outcomes. Overall, findings indicate that not all autistic individuals experience reduced subjective quality of life. Variability in quality of life is significantly influenced by associated symptoms, across developmental stage. This may provide a tractable target for mental health services to improve quality of life for autistic individuals over the lifespan. Lay abstract Previous studies suggest that some autistic individuals report lower satisfaction, or well-being, with different aspects of everyday life than those without autism. It is unclear whether this might be partly explained by symptoms of anxiety and/or depression, which affect at least 20%–50% of autistic people. In this study, we measured individual differences in well-being in 573 six to thirty-year-olds with and without a diagnosis of autism. We investigated whether individual differences in well-being were explained by autism traits (e.g. social-communication difficulties) and/or anxiety and depression symptoms. We showed that, though well-being was lower for some autistic individuals, compared to those without autism, many autistic individuals reported good well-being. Where well-being was reduced, this was particularly explained by depression symptoms, across all ages. For children/adolescents, anxiety and social-communication difficulties were also related to some aspects of well-being. Our study suggests that support and services for improving mental health, especially depression symptoms, may also improve broader outcomes for autistic people.

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Psychosocial Treatments Targeting Anxiety and Depression in Adolescents and Adults on the Autism Spectrum: Review of the Latest Research and Recommended Future Directions

Cited by 120 publications

References 90 publications

“I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults

“I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults

Autism spectrum disorder

How do core autism traits and associated symptoms relate to quality of life? Findings from the Longitudinal European Autism Project

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