A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum

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Lipinski, S., Boegl, K., Blanke, E. S., Suenkel, U., & Dziobek, I. (2021). A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum. Autism, 26(6), 1509-1521. https://doi.org/10.1177/13623613211057973

Publication date: 26 Nov 2021 Added to AutiHub: 6 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
5
Publication authors identified as autistic
1 / 5 (20.0%)
  1. Silke Lipinski *
  2. Katharina Boegl
  3. Elisabeth S. Blanke
  4. Ulrike Suenkel
  5. Isabel Dziobek

Abstract

Most adults on the autism spectrum have co-occurring mental health conditions, creating a high demand for mental health services – including psychotherapy – in autistic adults. However, autistic adults have difficulties accessing mental health services. The most-reported barriers to accessing treatment are therapists’ lack of knowledge and expertise surrounding autism, as well as unwillingness to treat autistic individuals. This study was conducted by a participatory autism research group and examined 498 adult-patient psychotherapists on knowledge about autism and self-perceived competency to diagnose and treat autistic patients without intellectual disability compared to patients with other diagnoses. Psychotherapists rated their education about autism in formal training, and competency in the diagnosis and treatment of patients with autism, lowest compared to patients with all other diagnoses surveyed in the study, including those with comparable prevalence rates. Many therapists had misconceptions and outdated beliefs about autism. Few had completed additional training on autism, but the majority were interested in receiving it. Greater knowledge about autism was positively linked to openness to accept autistic patients. The results point to an alarming gap in knowledge necessary for adequate mental health care for individuals with autism. Lay abstract Most autistic adults experience mental health problems. There is a great demand for psychotherapeutic support that addresses the specific needs of autistic individuals. However, people with autism encounter difficulties trying to access diagnostic and therapeutic services. This study was conducted by a participatory autism research group: a group in which autistic individuals and scientists collaborate. The group developed a questionnaire for psychotherapists in Germany to assess their knowledge about autism. Psychotherapists also rated their ability to diagnose and treat autistic patients without intellectual disability, and patients with other psychological diagnoses. Many of the 498 psychotherapists that responded reported little knowledge and outdated beliefs about autism, as well as little training on treating patients with autism. Their expertise about other psychological conditions was more comprehensive. However, many psychotherapists were interested in professional training on autism. Those with more knowledge were also more open to treating autistic patients. In conclusion, psychotherapists’ lack of knowledge and expertise seem to be a major barrier for adults with autism to receiving helpful psychotherapeutic support. The results demonstrate the need for an advancement in autism education during psychotherapists’ training and in continuous education.

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Cited references
54
Total cited references integrated for this publication.
Cited references with an identified autistic author
1 / 54 (1.9%)
Cited author occurrences identified as autistic
1 / 260 (0.4%)
Among occurrences linked to AutiHub author records: 1 / 76 (1.3%). Distinct cited authors identified as autistic: 1 / 237 (0.4%).
Cited author occurrences linked to AutiHub author records
76 / 260 (29.2%)
Distinct linked cited authors: 59 / 237 (24.9%)
Linked cited-author occurrences not identified as autistic
75 / 76 (98.7%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 75 / 260 (28.8%). Distinct linked cited authors not identified as autistic: 58 / 59 (98.3%).
  1. A. Gawronski , B. Kuzmanovic , A. Georgescu , H. Kockler , F.-G. Lehnhardt , L. Schilbach et al. (2011). Erwartungen an eine Psychotherapie von hochfunktionalen erwachsenen Personen mit einer Autismus-Spektrum-Störung . Fortschritte der Neurologie · Psychiatrie, 79(11), 647-654. Georg Thieme Verlag KG.
    Type: Article DOI: 10.1055/s-0031-1281734 OpenAlex: https://openalex.org/W90585380
    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. Declan Murphy , Karen Glaser , Hannah Hayward , Hanna Eklund , Tim Cadman , James Findon et al. (2018). Crossing the divide: a longitudinal study of effective treatments for people with autism and attention deficit hyperactivity disorder across the lifespan . Programme Grants for Applied Research, 6(2), 1-240. National Institute for Health and Care Research.
    Type: Article DOI: 10.3310/pgfar06020 OpenAlex: https://openalex.org/W2810952367
    Crossref OpenAlex OpenCitations
  4. Ailsa Russell , Amita Jassi , Miguel A. Fullana , Hilary Mack , Kate Johnston , Isobel Heyman et al. (2013). COGNITIVE BEHAVIOR THERAPY FOR COMORBID OBSESSIVE-COMPULSIVE DISORDER IN HIGH-FUNCTIONING AUTISM SPECTRUM DISORDERS: A RANDOMIZED CONTROLLED TRIAL . Depression and Anxiety, 30(8), 697-708. Hindawi Limited.
    Type: Article DOI: 10.1002/da.22053 OpenAlex: https://openalex.org/W1896892849
    Crossref OpenAlex OpenCitations
  5. González Moreno, Andrés Santiago (2013). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association.
    Type: Book DOI: 10.1176/appi.books.9780890425596 OpenAlex: https://openalex.org/W4247665917
    Crossref OpenAlex OpenCitations
  6. Alisa G Woods , Esmaeil Mahdavi , Jeanne P Ryan (2013). Treating clients with Asperger’s syndrome and autism . Child and Adolescent Psychiatry and Mental Health, 7(1), 32. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1186/1753-2000-7-32 OpenAlex: https://openalex.org/W2061369937
    Crossref OpenAlex OpenCitations
  7. Björn Hofvander , Richard Delorme , Pauline Chaste , Agneta Nydén , Elisabet Wentz , Ola Ståhlberg et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders . BMC Psychiatry, 9(1), 35. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1186/1471-244x-9-35 OpenAlex: https://openalex.org/W1970834718
    Crossref OpenAlex OpenCitations
  8. Autism Research Collaboration (Autismus-Forschungs-Kooperation; AFK). (n.d.). https://www.autismus-forschungs-kooperation.de
    Type: Other
    Crossref
  9. Aalia Akhtar Hayat , Areej Habib Meny , Nabila Salahuddin , Faisal M. Alnemary , Kumar-Ricky Ahuja , Muhammad Waqar Azeem (2019). Assessment of knowledge about childhood autism spectrum disorder among healthcare workers in Makkah-Saudi Arabia . Pakistan Journal of Medical Sciences, 35(4), 951-957. Pakistan Journal of Medical Sciences.
    Type: Article DOI: 10.12669/pjms.35.4.605 OpenAlex: https://openalex.org/W2954187849
    Crossref OpenAlex OpenCitations
  10. Michele Raja (2014). Suicide risk in adults with Asperger's syndrome . The Lancet Psychiatry, 1(2), 99-101. Elsevier BV.
    Type: Article DOI: 10.1016/s2215-0366(14)70257-3 OpenAlex: https://openalex.org/W1976629685
    Crossref OpenAlex OpenCitations
  11. Sheena K. Au‐Yeung , Louise Bradley , Ashley Robertson , Rebecca Shaw , Simon Baron-Cohen , Sarah Cassidy (2019). Experience of mental health diagnosis and perceived misdiagnosis in autistic, possibly autistic and non-autistic adults . Autism, 23(6), 1508-1518. SAGE Publications.
    Type: Article DOI: 10.1177/1362361318818167 OpenAlex: https://openalex.org/W2905534692
    Crossref OpenAlex OpenCitations
  12. Megan A. Farley , William M. McMahon , Éric Fombonne , William R. Jenson , Judith S. Miller , Michael Gardner et al. (2009). Twenty‐year outcome for individuals with autism and average or near‐average cognitive abilities . Autism Research, 2(2), 109-118. Wiley.
    Type: Article DOI: 10.1002/aur.69 OpenAlex: https://openalex.org/W1983204707
    Crossref OpenAlex OpenCitations
  13. Susanna Baldwin , Debra Costley (2016). The experiences and needs of female adults with high-functioning autism spectrum disorder . Autism, 20(4), 483-495. SAGE Publications.
    Type: Article DOI: 10.1177/1362361315590805 OpenAlex: https://openalex.org/W2279904543
    Crossref OpenAlex OpenCitations
  14. Matthew J Hollocks , Jian Wei Lerh , Iliana Magiati , Richard Meiser-Stedman , Traolach Brugha (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis . Psychological Medicine, 49(4), 559-572. Cambridge University Press (CUP).
    Type: Article DOI: 10.1017/s0033291718002283 OpenAlex: https://openalex.org/W2889987209
    Crossref OpenAlex OpenCitations
  15. Debbie Spain , Jacqueline Sin , Trudie Chalder , Declan Murphy , Francesca Happé (2015). Cognitive behaviour therapy for adults with autism spectrum disorders and psychiatric co-morbidity: A review . Research in Autism Spectrum Disorders, 9, 151-162. Elsevier BV.
    Type: Article DOI: 10.1016/j.rasd.2014.10.019 OpenAlex: https://openalex.org/W1987537720
    Crossref OpenAlex OpenCitations
  16. Traolach Brugha , Sally McManus , John Bankart , Fiona Scott , Susan Purdon , Jane Smith et al. (2011). Epidemiology of Autism Spectrum Disorders in Adults in the Community in England . Archives of General Psychiatry, 68(5), 459. American Medical Association (AMA).
    Type: Article DOI: 10.1001/archgenpsychiatry.2011.38 OpenAlex: https://openalex.org/W2138372369
    Crossref OpenAlex OpenCitations
  17. Linda J. Sax , Shannon K. Gilmartin , Alyssa N. Bryant (2003). Assessing Response Rates and Nonresponse Bias in Web and Paper Surveys . Research in Higher Education, 44(4), 409-432. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1023/a:1024232915870 OpenAlex: https://openalex.org/W2130835641
    Crossref OpenAlex OpenCitations
  18. Mohammad Hossein Rahbar , Khalid Ibrahim , Parisa Assassi (2011). Knowledge and Attitude of General Practitioners Regarding Autism in Karachi, Pakistan . Journal of Autism and Developmental Disorders, 41(4), 465-474. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-010-1068-x OpenAlex: https://openalex.org/W1997218688
    Crossref OpenAlex OpenCitations
  19. 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
  20. Sarah Cassidy , L. Bradley , E. Bowen , Sarah Wigham , Jacqui Rodgers (2018). Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review . Autism Research, 11(5), 738-754. Wiley.
    Type: Article DOI: 10.1002/aur.1922 OpenAlex: https://openalex.org/W2783826777
    Crossref OpenAlex OpenCitations
  21. Ailsa Russell , Daisy M Gaunt , Kate Cooper , Stephen Barton , Jeremy Horwood , David Kessler et al. (2020). 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 . Autism, 24(6), 1360-1372. SAGE Publications.
    Type: Article DOI: 10.1177/1362361319889272 OpenAlex: https://openalex.org/W2991110875
    Crossref OpenAlex OpenCitations
  22. Mary E. Stewart , Louise Barnard , Joanne Pearson , Reem Hasan , Gregory O’Brien (2006). Presentation of depression in autism and Asperger syndrome . Autism, 10(1), 103-116. SAGE Publications.
    Type: Article DOI: 10.1177/1362361306062013 OpenAlex: https://openalex.org/W2096548756
    Crossref OpenAlex OpenCitations
  23. Sarah Cassidy , L. Bradley , E. Bowen , Sarah Wigham , Jacqui Rodgers (2018). Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review . Clinical Psychology Review, 62, 56-70. Elsevier BV.
    Type: Article DOI: 10.1016/j.cpr.2018.05.002 OpenAlex: https://openalex.org/W2800246475
    Crossref OpenAlex OpenCitations
  24. Lilly Schmidt , Jennifer Kirchner , Sandra Strunz , Julia Broźus , Kathrin Ritter , Stefan Roepke et al. (2015). Psychosocial Functioning and Life Satisfaction in Adults With Autism Spectrum Disorder Without Intellectual Impairment . Journal of Clinical Psychology, 71(12), 1259-1268. Wiley.
    Type: Article DOI: 10.1002/jclp.22225 OpenAlex: https://openalex.org/W2115984364
    Crossref OpenAlex OpenCitations
  25. Sarah Cassidy , Louise Bradley , Rebecca Shaw , Simon Baron-Cohen (2018). Risk markers for suicidality in autistic adults . Molecular Autism, 9(1), 42. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1186/s13229-018-0226-4 OpenAlex: https://openalex.org/W2887488849
    Crossref OpenAlex OpenCitations
  26. Matthew J. Maenner , Kelly A. Shaw , Jon Baio , EdS1 , Anita Washington , Mary Patrick et al. (2020). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016 . MMWR. Surveillance Summaries, 69(4), 1-12. Centers for Disease Control MMWR Office.
    Type: Article DOI: 10.15585/mmwr.ss6904a1 OpenAlex: https://openalex.org/W3027179734
    Crossref OpenAlex OpenCitations
  28. Adam O. Horvath , A. C. Del Re , Christoph Flückiger , Dianne Symonds (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16. American Psychological Association (APA).
    Type: Article DOI: 10.1037/a0022186 OpenAlex: https://openalex.org/W2134813353
    Crossref OpenAlex OpenCitations
  29. Conor Davidson , Alwyn Kam , Frances Needham , Alison Jane Stansfield (2015). No exclusions – developing an autism diagnostic service for adults irrespective of intellectual ability . Advances in Autism, 1(2), 66-78. Emerald.
    Type: Article DOI: 10.1108/aia-08-2015-0010 OpenAlex: https://openalex.org/W2283689136
    Crossref OpenAlex OpenCitations
  30. Isabel Dziobek , Sandra Stoll (2019). Hochfunktionaler Autismus bei Erwachsenen . W. Kohlhammer GmbH.
    Type: Book DOI: 10.17433/978-3-17-032032-1 OpenAlex: https://openalex.org/W2990101879
    Crossref OpenAlex OpenCitations
  31. Wendy L. Stone (1987). Cross-Disciplinary Perspectives on Autism . Journal of Pediatric Psychology, 12(4), 615-630. Oxford University Press (OUP).
    Type: Article DOI: 10.1093/jpepsy/12.4.615 OpenAlex: https://openalex.org/W2139695988
    Crossref OpenAlex OpenCitations
  32. Effatpanah M. (2019). bibr14-13623613211057973 Iranian Journal of Child Neurology, 13(2), 29.
    Type: Other
    Crossref
  33. Darren Hedley , Mirko Uljarević (2018). Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications . Current Developmental Disorders Reports, 5(1), 65-76. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40474-018-0133-6 OpenAlex: https://openalex.org/W2788605551
    Crossref OpenAlex OpenCitations
  34. Johnny L Matson , Lindsey W Williams (2013). Differential diagnosis and comorbidity: distinguishing autism from other mental health issues . Neuropsychiatry, 3(2), 233-243. OMICS Publishing Group.
    Type: Article DOI: 10.2217/npy.13.1 OpenAlex: https://openalex.org/W2144692942
    Crossref OpenAlex OpenCitations
  35. Meng-Chuan Lai , Caroline Kassee , Richard Besney , Sarah Bonato , Laura Hull , Will Mandy et al. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis . The Lancet Psychiatry, 6(10), 819-829. Elsevier BV.
    Type: Article DOI: 10.1016/s2215-0366(19)30289-5 OpenAlex: https://openalex.org/W2936336589
    Crossref OpenAlex OpenCitations
  37. Gaus V. (2019). Cognitive-behavioral therapy for adults with autism spectrum disorder . Cognitive-behavioral therapy for adults with autism spectrum disorder.
    Type: Other
    Crossref
  38. Farhad Montazeri , Annelies de Bildt , Vera Dekker , George M. Anderson (2020). Network Analysis of Behaviors in the Depression and Autism Realms: Inter-Relationships and Clinical Implications . Journal of Autism and Developmental Disorders, 50(5), 1580-1595. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-019-03914-4 OpenAlex: https://openalex.org/W2911885086
    Crossref OpenAlex OpenCitations
  39. S D Rhodes , D A Bowie , K C Hergenrather (2003). Collecting behavioural data using the world wide web: considerations for researchers . Journal of Epidemiology and Community Health, 57(1), 68-73. BMJ.
    Type: Article DOI: 10.1136/jech.57.1.68 OpenAlex: https://openalex.org/W2160780574
    Crossref OpenAlex OpenCitations
  40. Lorcan Kenny , Caroline Hattersley , Bonnie Molins , Carole Buckley , Carol Povey , Elizabeth Pellicano (2016). Which terms should be used to describe autism? Perspectives from the UK autism community . Autism, 20(4), 442-462. SAGE Publications.
    Type: Article DOI: 10.1177/1362361315588200 OpenAlex: https://openalex.org/W2227393071
    Crossref OpenAlex OpenCitations
  41. Jonathan Vincent , Kevin Ralston (2020). Trainee teachers’ knowledge of autism: implications for understanding and inclusive practice . Oxford Review of Education, 46(2), 202-221. Informa UK Limited.
    Type: Article DOI: 10.1080/03054985.2019.1645651 OpenAlex: https://openalex.org/W2967383145
    Crossref OpenAlex OpenCitations
  42. 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
  43. Brenna B. Maddox , Samantha Crabbe , Rinad S Beidas , Lauren Brookman-Frazee , Carolyn C Cannuscio , Judith S. Miller et al. (2020). “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, 24(4), 919-930. SAGE Publications.
    Type: Article DOI: 10.1177/1362361319882227 OpenAlex: https://openalex.org/W2988923336
    Crossref OpenAlex OpenCitations
  44. Max Wiznitzer (1988). Handbook of Autism and Pervasive Developmental Disorders . Neurology, 38(10), 1663. Ovid Technologies (Wolters Kluwer Health).
    Type: Article DOI: 10.1212/wnl.38.10.1663-d OpenAlex: https://openalex.org/W2330088398
    OpenAlex
  45. Desiree R. Jones , Kilee M. DeBrabander , Noah J. Sasson (2021). Effects of autism acceptance training on explicit and implicit biases toward autism . Autism, 25(5), 1246-1261. SAGE Publications.
    Type: Article DOI: 10.1177/1362361320984896 OpenAlex: https://openalex.org/W3124162729
    Crossref OpenAlex OpenCitations
  46. R Core Team (2026). R: A Language and Environment for Statistical Computing . R Foundation for Statistical Computing.
    Type: Article DOI: 10.32614/r.manuals OpenAlex: https://openalex.org/W2582743722
    OpenAlex
  47. Leiner D. J. (2019). SoSci Survey (Version 2. 0) [Computer software]. https://www.soscisurvey.de
    Type: Other
    Crossref
  48. Rae Morris , Andrea Greenblatt , Michael Saini (2019). Healthcare Providers’ Experiences with Autism: A Scoping Review . Journal of Autism and Developmental Disorders, 49(6), 2374-2388. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-019-03912-6 OpenAlex: https://openalex.org/W2911241604
    Crossref OpenAlex OpenCitations
  49. National Institute for Health and Care Excellence. (2016). Autism spectrum disorder in adults: Diagnosis and management [NICE Guideline (CG142)]. https://www.nice.org.uk/guidance/cg142
    Type: Other
    Crossref
  50. Mohammad Effatpanah , Ghazal Shariatpanahi , Amirsina Sharifi , Rozita Ramaghi , Reza Tavakolizadeh (2019). A Preliminary Survey of Autism Knowledge and Attitude among Health Care Workers and Pediatricians in Tehran, Iran. PubMed, 13(2), 29-35.
    Type: Article OpenAlex: https://openalex.org/W2931632663
    OpenAlex
  51. R Core Team. (2019). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. https://www . R-project.org/
    Type: Other
    Crossref
  52. Anne M. Roux , Jessica Rast , Kristy A. Anderson , Julianna A Rava , Paul Shuttuck (2015). Transition into Young Adulthood: National Autism Indicators Report . A.J. Drexel Autism Institute.
    Type: Report DOI: 10.17918/nairtransition2015 OpenAlex: https://openalex.org/W4313567965
    Crossref OpenAlex OpenCitations
  53. Statistisches Bundesamt (DeStatis). (2020). https://www.destatis.de/DE/Presse/Pressemitteilungen/2021/03/PD21_N022_23.html
    Type: Other
    Crossref
  54. Volkmar F. R. (1997). Handbook of autism and pervasive developmental disorders . Handbook of autism and pervasive developmental disorders, 5.
    Type: Other
    Crossref