A Mixed Methods Investigation of Autistic and Community Provider Perspectives on Adapting Cognitive Behavioral Therapy for Autistic Youth

Abstract

Individuals on the autism spectrum are at high risk of experiencing a range of co-occurring mental health problems, such as anxiety disorders, depressive disorders, and obsessive-compulsive disorder. However, clinicians report low confidence in treating autistic youth for such internalizing conditions, and autistic individuals often report that psychotherapy does not meet their needs. Cognitive behavioral therapy (CBT) adapted for autistic youth shows promise in reducing symptomology of co-occurring internalizing disorders; however, minimal published research has sought to systematically include end-users (i.e., autistic youth or community mental health clinicians) in the process of adapting CBT for this population. Therefore, the current study utilized a mixed methods convergent parallel research design in order to obtain community perspectives on adapting CBT for autistic youth. Community consultants, including adolescents on the autism spectrum and community mental health clinicians, aided in the design of qualitative interview questions. Ten autistic adolescents, ages 13-17, and 18 community mental health clinicians completed a battery of questionnaires and a 30-60-minute qualitative interview. Themes were gleaned from the qualitative interview using an inductive approach and were presented alongside quantitative data. Quantitative data suggested that autistic adolescents have moderately positive attitudes toward therapy and endorse significant internalizing symptoms and emotion regulation difficulties, while clinicians endorse relatively positive attitudes toward evidence-based practice and CBT. Qualitative identified in the dataset included (1) Building Engagement and Relationship; (2) "It's Different for Everybody": Individualizing Treatment; (3) Considering Autistic Experiences; (4) CBT in the Real World; and (5) Supporting Clinicians. Results will inform a set of guidelines for adapting CBT for autistic youth in community settings.