The feasibility of low-intensity psychological therapy for depression co-occurring with autism in adults: The Autism Depression Trial (ADEPT) – a pilot randomised controlled trial

Russell, Ailsa; Gaunt, Daisy; Cooper, Kate; Barton, Stephen; Horwood, Jeremy; Keßler, David; Metcalfe, Chris; Ensum, Ian; Ingham, Barry; Parr, Jeremy; Rai, Dheeraj; Wiles, Nicola

doi:10.1177/1362361319889272

Cited by 29 publications

(36 citation statements)

References 38 publications

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“…Our results suggested that AN treatment recommended by the UK’s National Institute for Health and Care Excellence (NICE, 2017) like traditional CBT tended to be unsuccessful for autistic women. However, CBT has been successfully modified to treat autistic individuals for other mental health disorders such as anxiety ( Lang et al, 2010 ), depression ( Russell et al, 2020 ) and obsessive-compulsive disorder ( Kose et al, 2018 ), suggesting there may be scope for modifications to CBT-ED ( Fairburn, 2008 ). Furthermore, our findings highlight the potential value of other treatment options, such as DBT ( Linehan, 1993 ).…”

Section: Discussionmentioning

confidence: 99%

‘It’s not that they don’t want to access the support . . . it’s the impact of the autism’: The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals

Babb

Brede

Jones

et al. 2021

Autism

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This study explores autistic women’s experiences of eating disorder services. Estimates suggest that 20%–30% of women in treatment for anorexia nervosa display diagnostic features characteristic of autism. Research suggests that autistic individuals’ needs are not being met by standard anorexia nervosa treatments. In the current study, in-depth interviews were conducted with 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 eating disorder healthcare professionals. Using thematic analysis, three overarching themes were identified: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that there were diverse barriers facing autistic women when in treatment for anorexia nervosa, and these were accentuated by a lack of autism understanding within eating disorder services. Future research should focus on developing interventions that are tailored to the specific needs of autistic individuals with anorexia nervosa. Lay Abstract This study explores autistic women’s experiences of eating disorder services. About 20%–30% of people with anorexia nervosa are also autistic, and current treatments seem not to work as well for them. We interviewed 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 healthcare professionals working in eating disorder services. We asked autistic women and parents about their experiences of eating disorder services, and we asked healthcare professionals about their experiences treating autistic women with anorexia nervosa. Participants’ views were represented by three overall themes: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that autistic women face many barriers when in treatment for anorexia nervosa, often because of a lack of autism understanding within eating disorder services. Future research should look at developing anorexia nervosa treatments that can specifically help autistic individuals.

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Section: Discussionmentioning

confidence: 99%

‘It’s not that they don’t want to access the support . . . it’s the impact of the autism’: The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals

Babb

Brede

Jones

et al. 2021

Autism

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“…By 16 weeks post randomisation, the mean scores for several outcome measures (PHQ-9, BDI-II, OCI-R, HAM-D, PANAS negative and GAD-7) in the GSH treatment group had further decreased (lower score, better outcome) or had increased (SF-12 physical function; higher score, better outcome) compared with scores at 10 weeks ( Table 5). The mean scores of the outcome measures in the TAU group had also changed (compared with scores at 10 weeks), but not by as much, and the score changes were more Reproduced with permission from Russell et al 48 variable and not consistently in the same direction. Differences between the group mean scores on HAM-D and quality of life (as measured with the EQ-5D-5L) presented as slightly larger at 16 weeks than at 10 weeks.…”

Section: Sixteen Weeksmentioning

confidence: 96%

“…The Consolidated Standards of Reporting Trials (CONSORT) flow diagram from recruitment to randomisation by site and recruitment pathway. Reproduced with permission from Russell et al48 …”

mentioning

confidence: 99%

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Guided self-help for depression in autistic adults: the ADEPT feasibility RCT

Russell

Gaunt

Cooper

et al. 2019

Health Technol Assess

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Background Co-occurring depression frequently occurs in autism. Evidence-based psychological interventions have been successfully adapted to treat co-occurring anxiety, but there is little evidence about the usefulness of adapted cognitive–behavioural therapy for depression. To the authors’ knowledge, to date there have been no randomised trials investigating the usefulness of low-intensity cognitive–behavioural therapy for depression in autism. Objectives The objectives of the study were to (1) develop a low-intensity psychological intervention for depression adapted for autism, (2) assess the feasibility and patient and therapist acceptability of the intervention, (3) estimate the rates of recruitment and retention for a full-scale randomised controlled trial and (4) identify an appropriate measure of depression to be used in a full-scale randomised controlled trial. Design The study comprised a randomised controlled trial (n = 70) with a nested qualitative evaluation (n = 21). Seventy eligible and consenting participants were randomly allocated to guided self-help or to treatment as usual. Setting Adult autism services in two NHS regions. Participants Adults with a diagnosis of autism spectrum disorder with depression, that is, a Patient Health Questionnaire-9 items score of ≥ 10. People who had attended more than six sessions of cognitive–behavioural therapy in the previous 6 months were excluded. Interventions The low-intensity intervention (guided self-help) comprised materials for nine individual sessions, based on behavioural activation adapted for autism, facilitated by therapist guides (coaches) who were graduate-level psychologists who attended training and regular supervision. Treatment as usual was standard NHS care for depression. Main outcome measures Outcomes were measured 10, 16 and 24 weeks post randomisation using self-report and interview measures of depression, anxiety, obsessive–compulsive symptoms, social function and quality of life, and a health-care and service use questionnaire. As this was a feasibility study also designed to identify the most appropriate measure of depression, it was not possible to specify the primary outcome measure or outcome point a priori. Results The aims of the study were met in full. The guided self-help intervention was feasible and well received by participants and coaches. The majority of allocated participants attended the intervention in full. The most practical outcome point was determined to be 16 weeks. There were differential rates of attrition across the treatment groups: 86% of the guided self-help group remained in the study at 24 weeks, compared with 54% of treatment as usual group. The qualitative study suggested that guided self-help had enhanced credibility with participants at the point of randomisation. Inter-rater reliability of the interview measure of depression was less than adequate, limiting the conclusions that can be drawn from the prespecified sensitivity to change analyses. Conclusions The intervention was feasible and well received. Although this feasibility study was not a fully powered trial, it provided some evidence that the guided self-help intervention was effective in reducing depressive symptoms. A full-scale clinical effectiveness and cost-effectiveness trial of the intervention is warranted. Future work Improvements to the intervention materials as a result of qualitative interviews. Stakeholder consultation to consider future trial design, consider strategies to improve retention in a treatment as usual arm and select a self-report measure of depression to serve as the primary outcome measure. Trial registration Current Controlled Trials ISRCTN54650760. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 68. See the NIHR Journals Library website for further project information. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.

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“…Behavioral, cognitive, and mindfulness-based techniques have been shown to be moderately effective for problems such as anxiety, depressive symptoms and social anxiety, although less so for severe depression (e.g. Bishop-Fitzpatrick et al 2014 ; Gaigg et al 2020 ; Russell et al 2020 ; Spain et al 2017 ; Sizoo and Kuiper 2017 ). The quality of most existing research is also limited.…”

Section: What Is a “Good Outcome” In Autism?mentioning

confidence: 99%

Adults with Autism: Changes in Understanding Since DSM-111

Howlin

2021

J Autism Dev Disord

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Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.

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The feasibility of low-intensity psychological therapy for depression co-occurring with autism in adults: The Autism Depression Trial (ADEPT) – a pilot randomised controlled trial

Cited by 29 publications

References 38 publications

‘It’s not that they don’t want to access the support . . . it’s the impact of the autism’: The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals

‘It’s not that they don’t want to access the support . . . it’s the impact of the autism’: The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals

Guided self-help for depression in autistic adults: the ADEPT feasibility RCT

Adults with Autism: Changes in Understanding Since DSM-111

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