“They Didn’t Believe Me”: Barriers to Mental Health Care for Autistic LGBTQIA+ Young Adults—A Community-Partnered Study

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Baczewski, L., Gohari, D., Caplan, R., Nachman, B. R., Taylor, R., McDonald, M., Rodriguez, K., Sharp, K., Smith, M., Vu, A., & Massolo, M. L. (2025). “They Didn’t Believe Me”: Barriers to Mental Health Care for Autistic LGBTQIA+ Young Adults—A Community-Partnered Study. Autism in Adulthood. https://doi.org/10.1177/25739581251387936

Publication date: 21 Nov 2025 Added to AutiHub: 5 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
11
Publication authors identified as autistic
2 / 11 (18.2%)
  1. Lauren Baczewski
  2. Dena Gohari
  3. Reid Caplan *
  4. Brett Ranon Nachman *
  1. Ryan Taylor
  2. Meghan McDonald
  3. Kayla Rodriguez
  4. Kathryn Sharp
  1. McKinzie Smith
  2. Andrew Vu
  3. Maria L Massolo

Abstract

Background:Autistic Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and/or Questioning (LGBTQIA+) people are at a greater risk for mental health challenges than their Autistic non-LGBTQIA+ counterparts and experience disparities in access to health care. Although a growing research base provides evidence of these health disparities, we know relatively little about the mental health care experiences of Autistic LGBTQIA+ young adults from their own perspectives. Methods:This study contributes to the evidence base by exploring specific barriers that Autistic LGBTQIA+ young adults face when seeking mental health care (e.g., therapy). Twenty Autistic LGBTQIA+ young adults (18–28 years old, MAge = 23.3 years) from across the United States participated in semi-structured oral or written interviews about their mental health care experiences. Forty-five percent of interviewees (9/20) identified as gender fluid, nonbinary, or gender expansive, and more than half reported having anxiety, depression, and/or Attention-deficit/hyperactivity disorder (ADHD). We analyzed interviews using Coding Reliability Thematic Analysis. Results:Participants faced multiple barriers to mental health care. These barriers specifically related to their Autistic, LGBTQIA+, and other marginalized identities. We identified three primary themes: (1) disbelief and denial of Autistic LGBTQIA+ identities, (2) systemic biases toward marginalized identities and co-occurring diagnoses delay access to diagnosis and care, and (3) providers’ lack of fluency in supporting diverse Autistic clients. Conclusion:These findings highlight the importance of increased mental health provider training in autism and LGBTQIA+ identities, as well as the intersection. Future work should explore the unique experiences of Autistic LGBTQIA+ People of Color in accessing mental health care. Community BriefWhy is this an important issue?Autistic LGBTQIA+ people are more likely to have mental health diagnoses and report poor quality of life compared with Autistic people who are not LGBTQIA+. Despite this, there is still a lot we do not know about the mental health care experiences of Autistic LGBTQIA+ young adults.What was the purpose of this study?We wanted to learn what makes it difficult for Autistic LGBTQIA+ young adults to get therapy or other mental health supports.What did the researchers do?Our research team included Autistic people and non-autistic people of diverse genders and sexualities, and we designed the study together. We interviewed 20 Autistic LGBTQIA+ young adults (18–28 years old) about their experiences trying to receive mental health care in the United States. We learned about the things that get in the way for participants when seeking support.What were the results of the study?Many things made it harder for participants to get mental health care. These barriers specifically related to their Autistic, LGBTQIA+, and other marginalized identities. We identified three primary themes: (1) disbelief and denial of Autistic LGBTQIA+ identities, (2) systemic biases toward marginalized identities and co-occurring diagnoses delay access to diagnosis and care, and (3) providers’ lack of fluency in supporting diverse Autistic clients. Overall, participants felt that doctors struggled to diagnose them as Autistic if they had other diagnoses. They reported that doctors had trouble recognizing their autism if they had other marginalized identities (e.g., being LGBTQIA+ or a racial/ethnic minority). These experiences made it harder for participants to get mental health care. Participants felt that mental health providers need more training in autism across diverse identities and backgrounds.What do these findings add to what was already known?Other studies show that Autistic LGBTQIA+ people are at a high risk for mental health challenges and struggle to find providers that understand them. This study adds in-depth information about the challenges that Autistic LGBTQIA+ young adults face when seeking care and what providers can do to better support them.What are potential weaknesses in the study?This study included mostly White and college-educated participants. Future studies should focus on the mental health care experiences of Autistic LGBTQIA+ adults from racial/ethnic minority backgrounds. We interviewed young adults, and so future studies should include Autistic LGBTQIA+ individuals across ages.How will these findings help autistic adults now or in the future?Many mental health providers do not have adequate training in autism and LGBTQIA+ identities. These findings show that this training is urgently needed. Participants shared recommendations for how providers can better meet their needs.

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Cited references
51
Total cited references integrated for this publication.
Cited references with an identified autistic author
10 / 51 (19.6%)
Cited author occurrences identified as autistic
24 / 245 (9.8%)
Among occurrences linked to AutiHub author records: 24 / 125 (19.2%). Distinct cited authors identified as autistic: 22 / 219 (10.0%).
Cited author occurrences linked to AutiHub author records
125 / 245 (51.0%)
Distinct linked cited authors: 104 / 219 (47.5%)
Linked cited-author occurrences not identified as autistic
101 / 125 (80.8%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 101 / 245 (41.2%). Distinct linked cited authors not identified as autistic: 82 / 104 (78.8%).
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