How can we make therapy better for autistic adults? Autistic adults’ ratings of helpfulness of adaptations to therapy

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Paynter, J., Sommer, K., & Cook, A. (2025). How can we make therapy better for autistic adults? Autistic adults’ ratings of helpfulness of adaptations to therapy. Autism, 29(6), 1540-1553. https://doi.org/10.1177/13623613251313569

Publication date: 22 Jan 2025 Added to AutiHub: 4 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
3
Publication authors identified as autistic
1 / 3 (33.3%)
  1. Jessica Paynter
  2. Kristyn Sommer *
  3. Amanda Cook

Abstract

Autistic people are at elevated risk of mental health conditions and experience significant barriers to effective support. While adaptations to therapy for autistic people have been proposed by clinicians, there is limited research on how helpful autistic people themselves rate these. We aimed to address this gap. Participants were 130 autistic adults aged 18 to 64 years (85.4% female) who completed an online survey of the helpfulness of 55 therapy adaptations. Overall, we found positive ratings of helpfulness for approximately half of the adaptations. However, significant variability was found at an individual level with most adaptations rated from not helpful through to extremely helpful. Neurodiversity-affirming adaptations were rated highest overall. Participants shared additional adaptations including general good practice, financial, modality, neurodiversity-affirming practices, practical, sensory/environmental, structure, and therapy style/techniques. Findings highlight similarities and differences between clinician and autistic people's perspectives, underscoring the need to include autistic people. Limitations of the restricted sample and generalizability are acknowledged. Future research including more diverse samples would be of value to expand on this research. The need to understand general preferences of autistic people and to individualize to the specific client is underscored by findings to begin bridging the mental health support gap for autistic people.Lay AbstractAutistic people experience more mental health conditions like depression or anxiety than non-autistic people. They are also more likely to experience difficulties in accessing mental health supports Clinicians have published suggestions on how to improve therapy for autistic people. However, whether these ways to adapt (i.e. adaptations) therapy for autistic people are seen as helpful by autistic people themselves has not been investigated. We recruited 130 autistic adults to complete an online survey. They rated 55 adaptations to therapy from "Not at all helpful" to "Extremely helpful." We also asked for ideas of additional adaptations. Adaptations classified as neurodiversity affirming (e.g. having a therapist that embraces differences in brains and provides support to affirm neurodivergent identity) were rated highest. Approximately half of adaptations were rated positively at a group level. However, for almost every adaptation at least one person rated it as not at all helpful and at least one rated it as extremely helpful. Additional adaptations were around general good practice, financial cost, neurodiversity-affirming practices, practical, sensory/environmental, structure, and therapy style/techniques. Our findings add how helpful autistic people themselves rate adaptations to therapy and similarities and differences to clinicians. This is important to consider how these perspectives can differ. Findings also identify additional suggestions that clinicians could use in their practice and ideas for future research. Findings can help autistic adults in advocating for adaptations to therapy that address their needs by providing a list of possible adaptations. Furthermore, findings may help clinicians to better support their autistic clients.

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Cited references
41
Total cited references integrated for this publication.
Cited references with an identified autistic author
3 / 41 (7.3%)
Cited author occurrences identified as autistic
4 / 141 (2.8%)
Among occurrences linked to AutiHub author records: 4 / 65 (6.2%). Distinct cited authors identified as autistic: 3 / 127 (2.4%).
Cited author occurrences linked to AutiHub author records
65 / 141 (46.1%)
Distinct linked cited authors: 53 / 127 (41.7%)
Linked cited-author occurrences not identified as autistic
61 / 65 (93.8%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 61 / 141 (43.3%). Distinct linked cited authors not identified as autistic: 50 / 53 (94.3%).
  1. Christina Boulter , Mark Freeston , Mikle South , Jacqui Rodgers (2014). Intolerance of Uncertainty as a Framework for Understanding Anxiety in Children and Adolescents with Autism Spectrum Disorders . Journal of Autism and Developmental Disorders, 44(6), 1391-1402. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-013-2001-x OpenAlex: https://openalex.org/W1988921119
    Crossref OpenAlex OpenCitations
  2. Dawn Adams , Kate Young (2021). A Systematic Review of the Perceived Barriers and Facilitators to Accessing Psychological Treatment for Mental Health Problems in Individuals on the Autism Spectrum . Review Journal of Autism and Developmental Disorders, 8(4), 436-453. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40489-020-00226-7 OpenAlex: https://openalex.org/W3094212365
    Crossref OpenAlex OpenCitations
  3. Tatja Hirvikoski , Ellenor Mittendorfer-Rutz , Marcus Boman , Henrik Larsson , Paul Lichtenstein , Sven Bölte (2016). Premature mortality in autism spectrum disorder . British Journal of Psychiatry, 208(3), 232-238. Royal College of Psychiatrists.
    Type: Article DOI: 10.1192/bjp.bp.114.160192 OpenAlex: https://openalex.org/W2168424072
    Crossref OpenAlex OpenCitations
  4. S. Berthoz , S. Consoli , F. Perez-Diaz , R. Jouvent (1999). Alexithymia and anxiety: compounded relationships? A psychometric study . European Psychiatry, 14(7), 372-378. Cambridge University Press (CUP).
    Type: Article DOI: 10.1016/s0924-9338(99)00233-3 OpenAlex: https://openalex.org/W2017018914
    Crossref OpenAlex OpenCitations
  5. Dawn Adams , Kate Young , Kate Simpson , Deb Keen (2019). Parent descriptions of the presentation and management of anxiousness in children on the autism spectrum . Autism, 23(4), 980-992. SAGE Publications.
    Type: Article DOI: 10.1177/1362361318794031 OpenAlex: https://openalex.org/W2887610027
    Crossref OpenAlex OpenCitations
  6. Janina Brede , Eilidh Cage , Joseph Trott , Lisa Palmer , Anika Smith , Lucy Serpell et al. (2022). “We Have to Try to Find a Way, a Clinical Bridge” - autistic adults' experience of accessing and receiving support for mental health difficulties: A systematic review and thematic meta-synthesis . Clinical Psychology Review, 93, 102131. Elsevier BV.
    Type: Article DOI: 10.1016/j.cpr.2022.102131 OpenAlex: https://openalex.org/W4210911395
    Crossref OpenAlex OpenCitations
  7. Magdalena Glod , Deborah M. Riby , Emma Honey , Jacqui Rodgers (2015). Psychological Correlates of Sensory Processing Patterns in Individuals with Autism Spectrum Disorder: A Systematic Review . Review Journal of Autism and Developmental Disorders, 2(2), 199-221. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40489-015-0047-8 OpenAlex: https://openalex.org/W2076793654
    Crossref OpenAlex OpenCitations
  8. Carrie Allison , Bonnie Auyeung , Simon Baron-Cohen (2012). Toward Brief “Red Flags” for Autism Screening: The Short Autism Spectrum Quotient and the Short Quantitative Checklist in 1,000 Cases and 3,000 Controls . Journal of the American Academy of Child & Adolescent Psychiatry, 51(2), 202-212.e7. Elsevier BV.
    Type: Article DOI: 10.1016/j.jaac.2011.11.003 OpenAlex: https://openalex.org/W2100429511
    Crossref OpenAlex OpenCitations
  9. Tamara E. Rosen , Carla A. Mazefsky , Roma A. Vasa , Matthew D Lerner (2018). Co-occurring psychiatric conditions in autism spectrum disorder . International Review of Psychiatry, 30(1), 40-61. Informa UK Limited.
    Type: Article DOI: 10.1080/09540261.2018.1450229 OpenAlex: https://openalex.org/W2801913374
    Crossref OpenAlex OpenCitations
  10. Altman D. G. (1999). Practical statistics for medical research . Practical statistics for medical research.
    Type: Other
    Crossref
  11. Kate Cooper , M.E. Loades , Ailsa Russell (2018). Adapting psychological therapies for autism . Research in Autism Spectrum Disorders, 45, 43-50. Elsevier BV.
    Type: Article DOI: 10.1016/j.rasd.2017.11.002 OpenAlex: https://openalex.org/W2770749461
    Crossref OpenAlex OpenCitations
  12. Tom Booth , Aja Louise Murray , Karen McKenzie , Renate Kuenssberg , Michael O’Donnell , Hollie Burnett (2013). Brief Report: An Evaluation of the AQ-10 as a Brief Screening Instrument for ASD in Adults . Journal of Autism and Developmental Disorders, 43(12), 2997-3000. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-013-1844-5 OpenAlex: https://openalex.org/W2138476560
    Crossref OpenAlex OpenCitations
  13. Australian Government: Department of Health and Aged Care. (2024). National roadmap to improve the health and mental health of autistic people: Consultation draft. https://www.health.gov.au/resources/publications/autism-roadmap-consultation-draft?language=en
    Type: Other
    Crossref
  15. Hsiu-Fang Hsieh , Sarah E. Shannon (2005). Three Approaches to Qualitative Content Analysis . Qualitative Health Research, 15(9), 1277-1288. SAGE Publications.
    Type: Article DOI: 10.1177/1049732305276687 OpenAlex: https://openalex.org/W2142225512
    Crossref OpenAlex OpenCitations
  16. (n.d.). Australian Government Department of Social Services. (2024 April 2). National autism strategy. https://www.dss.gov.au/disability-and-carers/national-autism-strategy
    Type: Other
    Crossref
  17. Leanne O. Nieforth , A. J. Schwichtenberg , Marguerite E. O’Haire (2023). Animal-Assisted Interventions for Autism Spectrum Disorder: A Systematic Review of the Literature from 2016 to 2020 . Review Journal of Autism and Developmental Disorders, 10(2), 255-280. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40489-021-00291-6 OpenAlex: https://openalex.org/W3203373578
    Crossref OpenAlex OpenCitations
  18. John Ludbrook (1991). PRACTICAL STATISTICS FOR MEDICAL RESEARCH . Australian and New Zealand Journal of Surgery, 61(12), 963-964. Wiley.
    Type: Article DOI: 10.1111/j.1445-2197.1991.tb00019.x OpenAlex: https://openalex.org/W2142589250
    OpenAlex
  19. Richard Jenkinson , Elizabeth Milne , Andrew R. Thompson (2020). The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis . Autism, 24(8), 1933-1944. SAGE Publications.
    Type: Article DOI: 10.1177/1362361320932437 OpenAlex: https://openalex.org/W3035777676
    Crossref OpenAlex OpenCitations
  20. Caitlin M. Conner , Paul S. Kim , Susan W. White , Carla A. Mazefsky (2022). The role of emotion dysregulation and intolerance of uncertainty in autism: Transdiagnostic factors influencing co-occurring conditions . Research in Developmental Disabilities, 130, 104332. Elsevier BV.
    Type: Article DOI: 10.1016/j.ridd.2022.104332 OpenAlex: https://openalex.org/W4296329302
    Crossref OpenAlex OpenCitations
  21. Bosiljka Milosavljevic , Virginia Carter Leno , Emily Simonoff , Gillian Baird , Andrew Pickles , Catherine R. G. Jones et al. (2016). Alexithymia in Adolescents with Autism Spectrum Disorder: Its Relationship to Internalising Difficulties, Sensory Modulation and Social Cognition . Journal of Autism and Developmental Disorders, 46(4), 1354-1367. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-015-2670-8 OpenAlex: https://openalex.org/W2192012856
    Crossref OpenAlex OpenCitations
  22. Robert Chapman * (2020). Defining neurodiversity for research and practice . In Neurodiversity Studies (pp. 218-220). Routledge.
    Type: Book chapter DOI: 10.4324/9780429322297-21 OpenAlex: https://openalex.org/W3034044232
    AutiHub · Autistic Scholars Crossref OpenAlex OpenCitations
  23. Anne G. Lever , Hilde M. Geurts (2016). Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder . Journal of Autism and Developmental Disorders, 46(6), 1916-1930. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-016-2722-8 OpenAlex: https://openalex.org/W2272786625
    Crossref OpenAlex OpenCitations
  24. Lauren P. Lawson , Amanda L. Richdale , Alexandra Haschek , Rebecca L. Flower , Josh Vartuli , Samuel R. C. Arnold et al. (2020). Cross-sectional and longitudinal predictors of quality of life in autistic individuals from adolescence to adulthood: The role of mental health and sleep quality . Autism, 24(4), 954-967. SAGE Publications.
    Type: Article DOI: 10.1177/1362361320908107 OpenAlex: https://openalex.org/W3011778920
    Crossref OpenAlex OpenCitations
  25. Simon M. Bury , Rachel Jellett , Jennifer R. Spoor , Darren Hedley (2023). “It Defines Who I Am” or “It’s Something I Have”: What Language Do [Autistic] Australian Adults [on the Autism Spectrum] Prefer? Journal of Autism and Developmental Disorders, 53(2), 677-687. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-020-04425-3 OpenAlex: https://openalex.org/W3007056653
    Crossref OpenAlex OpenCitations
  26. Emma Hinze , Jessica Paynter , Nicole Dargue , Dawn Adams (2024). The Presentation of Depression in Depressed Autistic Individuals: A Systematic Review . Review Journal of Autism and Developmental Disorders. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40489-024-00480-z OpenAlex: https://openalex.org/W4402852631
    Crossref OpenAlex OpenCitations
  27. Louise Camm-Crosbie , Louise Bradley , Rebecca Shaw , Simon Baron-Cohen , Sarah Cassidy (2019). ‘People like me don’t get support’: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality . Autism, 23(6), 1431-1441. SAGE Publications.
    Type: Article DOI: 10.1177/1362361318816053 OpenAlex: https://openalex.org/W2902777586
    Crossref OpenAlex OpenCitations
  28. Robert Chapman * , Monique Botha * (2023). Neurodivergence‐informed therapy . Developmental Medicine & Child Neurology, 65(3), 310-317. Wiley.
    Type: Article DOI: 10.1111/dmcn.15384 OpenAlex: https://openalex.org/W4295008953
    AutiHub · Autistic Scholars Crossref OpenAlex OpenCitations
  29. Emma Kinnaird , Catherine Stewart , Kate Tchanturia (2019). Investigating alexithymia in autism: A systematic review and meta-analysis . European Psychiatry, 55, 80-89. Cambridge University Press (CUP).
    Type: Article DOI: 10.1016/j.eurpsy.2018.09.004 OpenAlex: https://openalex.org/W2899269258
    Crossref OpenAlex OpenCitations
  30. Themistoklis Pantazakos , Gert-Jan Vanaken (2023). Addressing the autism mental health crisis: the potential of phenomenology in neurodiversity-affirming clinical practices . Frontiers in Psychology, 14, 1225152-1225152. Frontiers Media SA.
    Type: Article DOI: 10.3389/fpsyg.2023.1225152 OpenAlex: https://openalex.org/W4386419062
    Crossref OpenAlex OpenCitations
  31. den Houting J (2021). Participatory and inclusive autism research practice guides . Participatory and Inclusive Autism Research Practice Guides, 192236536X.
    Type: Other
    Crossref
  32. Stephanie Petty , Milja-Leea Bergenheim , Georgina Mahoney , Lucy Chamberlain (2023). Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting . Current Psychology, 42(9), 7489-7500. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s12144-021-02061-3 OpenAlex: https://openalex.org/W3183816515
    Crossref OpenAlex OpenCitations
  33. Caitlyn Gallant , Flora Roudbarani , Alaa T. Ibrahim , Brenna B. Maddox , Jonathan A. Weiss (2023). Clinician Knowledge, Confidence, and Treatment Practices in Their Provision of Psychotherapy to Autistic Youth and Youth with ADHD . Journal of Autism and Developmental Disorders, 53(11), 4214-4228. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-022-05722-9 OpenAlex: https://openalex.org/W4295078798
    Crossref OpenAlex OpenCitations
  34. Sarah Hampton , Carrie Allison , Simon Baron-Cohen , Rosemary Holt (2023). Autistic People’s Perinatal Experiences II: A Survey of Childbirth and Postnatal Experiences . Journal of Autism and Developmental Disorders, 53(7), 2749-2763. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-022-05484-4 OpenAlex: https://openalex.org/W4224257827
    Crossref OpenAlex OpenCitations
  35. Jessica R. Steinbrenner , Kara Hume , Samuel L. Odom , Kristi L. Morin , Sallie W. Nowell , Brianne Tomaszewski et al. (2020). Evidence-Based Practices for Children, Youth, and Young Adults with Autism. Evidence-based practices for children, youth, and young adults with autism.
    Type: Article OpenAlex: https://openalex.org/W3130268150
    Crossref OpenAlex
  36. Jeremy Horwood , Kate Cooper , Hannah Harvey , Lauren Davies , Ailsa Russell (2021). The experience of autistic adults accessing adapted cognitive behaviour therapy: ADEPT (Autism Depression Trial) qualitative evaluation . Research in Autism Spectrum Disorders, 86, 101802. Elsevier BV.
    Type: Article DOI: 10.1016/j.rasd.2021.101802 OpenAlex: https://openalex.org/W3164498960
    Crossref OpenAlex OpenCitations
  37. Petty Stephanie , Charlotte Donaldson , Whetton Jesse , Baxter Natasha (2023). Recommended adaptations to therapy services for autistic adults from specialist clinicians . Current Psychology, 42(33), 29581-29588. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s12144-022-04034-6 OpenAlex: https://openalex.org/W4309706879
    Crossref OpenAlex OpenCitations
  40. Sebastian Rosenberg , Shin Ho Park , Ian Hickie (2022). Paying the price – out-of-pocket payments for mental health care in Australia . Australian Health Review, 46(6), 660-666. CSIRO Publishing.
    Type: Article DOI: 10.1071/ah22154 OpenAlex: https://openalex.org/W4307431858
    Crossref OpenAlex OpenCitations
  41. The Royal Australian & New Zealand College of Psychiatrists. (2022). Autism: Addressing the mental health needs of Autistic people. https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/autism-addressing-the-mental-health-needs-of-autistic-people
    Type: Other
    Crossref