Co-production of a Neurodiversity-Affirmative Anxiety Intervention for Autistic Children

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Cullingham, T., Rennard, U., Creswell, C., Milton, D., Buckle, K. L., Godber, L., Gordon, K., Larkin, M., & Green, J. (2023). Co-production of a Neurodiversity-Affirmative Anxiety Intervention for Autistic Children [Preprint]. openRxiv. https://doi.org/10.1101/2023.07.05.23292219

Publication date: 7 Jul 2023 Added to AutiHub: 5 Jul 2026 Type: Preprint Article language: English
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Authors

Publication authors
9
Publication authors identified as autistic
2 / 9 (22.2%)
  1. Tasha Cullingham
  2. Una Rennard
  3. Cathy Creswell
  4. Damian Milton *
  5. Karen Leneh Buckle *
  1. Lucie Godber
  2. Kate Gordon
  3. Michael Larkin
  4. Jonathan Green

Abstract

Background Mental health difficulties are common for autistic people; however, few interventions have been co-produced with the autistic community. Mental health interventions constructed with a ‘non-autistic lens’ likely miss key understandings from autistic experiences and priorities of the autistic community. Additionally, the style and aims of intervention may be prone to unconscious bias around the pathologisation of autism. Currently, there are limited methodological and practical examples of how to rigorously co-produce mental health interventions with autistic people. This paper details the methodology and processes of co-adapting an intervention for autistic children with anxiety problems. Providing a worked example of co-producing a neurodiversity-affirmative mental health intervention which reflects autistic, parental, academic, and clinical, experience and expertise. Methods We co-adapted content from a brief, parent-led, CBT approach for non-autistic children with anxiety problems to meet the needs of autistic children and their parents. The adaptation for autistic children was co-constructed using processes and strategies adopted from Experience-Based Co-Design (EBCD). The research team, comprising autistic and non-autistic members, worked alongside an expert reference group (ERG). The ERG comprised parents (autistic and non-autistic) of autistic children with anxiety problems, autistic adults with experience of anxiety problems, and clinicians with experience supporting autistic children with mental health difficulties. Data were obtained from qualitative research interviews with autistic children with anxiety problems and parents. These data were considered reciprocally by the research team and the ERG. Results The resulting intervention includes a neurodiversity-affirmative perspective that considers how anxieties for autistic children can emerge from being neurodivergent in a neurotypical world integrated with traditional CBT techniques and understandings of anxiety. Conclusion Successful co-production can help to integrate multiple theoretical backgrounds and result in the creation of interventions that are potentially acceptable to clinicians, autistic people and their family members.

Bibliography cited by this reference

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Bibliography inclusion overview

These indicators describe the cited bibliography imported for this publication. Cited-reference metrics use the cited-reference total as denominator. Cited-author metrics state whether they use all cited-author occurrences or only occurrences linked to authors already integrated in the AutiHub database. They use cached links between cited authors and authors integrated in the AutiHub database. Last computed: 16 Aug 2026 11:30.

Cited references
21
Total cited references integrated for this publication.
Cited references with an identified autistic author
3 / 21 (14.3%)
Cited author occurrences identified as autistic
4 / 85 (4.7%)
Among occurrences linked to AutiHub author records: 4 / 15 (26.7%). Distinct cited authors identified as autistic: 4 / 84 (4.8%).
Cited author occurrences linked to AutiHub author records
15 / 85 (17.6%)
Distinct linked cited authors: 14 / 84 (16.7%)
Linked cited-author occurrences not identified as autistic
11 / 15 (73.3%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 11 / 85 (12.9%). Distinct linked cited authors not identified as autistic: 10 / 14 (71.4%).
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