Autistic individuals often seek therapy for co-occurring mental health conditions (such as anxiety and depression) and life challenges.
However, traditional therapy may not accommodate autistic traits like sensory sensitivities, communication differences, and cognitive styles. This mismatch can lead to ineffective treatment and negative experiences.
Researching adaptation effectiveness is crucial to develop evidence-based, autism-friendly therapy approaches that improve accessibility, engagement, and outcomes for autistic clients.
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. https://doi.org/10.1177/13623613251313569
Key Points
- Autistic adults rated the helpfulness of 55 therapy adaptations proposed by clinicians.
- About half the adaptations were rated positively at the group level, but with significant individual variability.
- Neurodiversity-affirming adaptations were rated highest overall.
- Participants suggested additional adaptations including financial, practical, and structural changes.
- Findings highlight the need to include autistic perspectives and individualize therapy adaptations.
- The study had limitations in sample diversity and generalizability.
Rationale
Autistic individuals experience elevated rates of mental health conditions and face barriers accessing effective support (Lever & Geurts, 2016).
Clinicians have proposed adaptations to therapy for autistic clients, but research on autistic people’s perspectives on these adaptations is limited (Cooper et al., 2018; Petty et al., 2021, 2023).
This study aimed to address this gap by exploring how autistic adults rate the helpfulness of clinician-recommended adaptations and what additional adaptations they suggest.
Understanding autistic perspectives is essential for developing more suitable and effective mental health support for this population.
Method
Design
Online survey using Redcap platform
Procedure
Participants completed an online survey rating 55 therapy adaptations on helpfulness (1-5 Likert scale) and suggested additional adaptations via open-ended responses.
Sample
130 autistic adults in Australia (94.6%) and New Zealand (5.4%)
- 85.4% female, 4% male, 6.9% non-binary, 0.8% another gender
- Ages 18-64 (majority 25-44 years)
- 53.8% formally diagnosed, 46.2% self-identified as autistic
- Highly educated: 63.1% with bachelor’s degree or higher
Measures
- Demographics questionnaire
- Autism Quotient-10 (AQ-10): 10-item measure of autistic traits
- Adaptations to Therapy Scale: 55-item Likert scale developed for this study
- Open-ended question on additional helpful adaptations
Statistical Analysis
- Qualitative content analysis for open-ended responses
- Descriptive statistics for individual adaptation ratings
- Within-participants ANOVA to compare adaptation categories
- T-tests to compare formal vs. self-identified diagnosis groups
Results
- About half (47.27%) of adaptations were rated as helpful/extremely helpful at the group level
- Significant individual variability in ratings for most adaptations
- Neurodiversity-affirming adaptations rated highest, followed by information and sensory adaptations
- Participants with formal diagnoses rated neurodiversity-affirming adaptations higher than self-identified
- 37 additional adaptations suggested, including financial, practical, and structural changes
Insight
This study provides valuable insights into autistic adults’ perspectives on therapy adaptations.
The high variability in individual ratings highlights the importance of tailoring adaptations to each client rather than applying a one-size-fits-all approach.
The strong preference for neurodiversity-affirming practices aligns with increasing calls for such approaches in mental health care.
The additional adaptations suggested by participants, such as financial and practical considerations, expand on clinician-focused research and underscore the importance of including autistic voices in developing mental health supports.
Implications
Clinicians should prioritize neurodiversity-affirming practices and actively seek input from autistic clients on preferred adaptations.
Mental health services should consider implementing a range of adaptations, including those addressing financial and practical barriers.
Future research should explore the effectiveness of implementing these adaptations and develop standardized tools for assessing autistic clients’ preferences.
Policy makers should consider these findings when developing guidelines for autism-specific mental health care.
Strengths
This study had several methodological strengths, including:
- Large sample size for this type of study
- Inclusion of both formally diagnosed and self-identified autistic adults
- Mixed-methods approach combining quantitative ratings with qualitative suggestions
- Co-design approach involving autistic researchers
Limitations
This study also had several methodological limitations, including:
- Sample predominantly female, highly educated, and from Australia/New Zealand
- Reliance on online survey may have excluded less verbal or literate individuals
- Self-report measures may be subject to bias
- Cross-sectional design limits causal inferences
References
Primary reference
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. https://doi.org/10.1177/13623613251313569
Other references
Cooper, K., Loades, M., & Russell, A. (2018). Adapting psychological therapies for autism. Research in Autism Spectrum Disorders, 45, 43-50. https://doi.org/10.1016/j.rasd.2017.11.002
Lever, A. G., & Geurts, H. M. (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, 1916-1930. https://doi.org/10.1007/s10803-016-2722-8
Petty, S., Bergenheim, M. L., Mahoney, G., & Chamberlain, L. (2021). Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting. Current Psychology, 1-12. https://doi.org/10.1007/s12144-021-02061-3
Stephanie, P., Donaldson, C., Jesse, W., & Natasha, B. (2023). Recommended adaptations to therapy services for autistic adults from specialist clinicians. Current Psychology, 42(33), 29581-29588. https://doi.org/10.1007/s12144-022-04034-6
Keep Learning
- How might the preference for neurodiversity-affirming practices impact traditional therapeutic approaches?
- What ethical considerations arise when adapting therapy for autistic individuals?
- How can researchers balance the need for standardized measures with individual variability in autistic experiences?
- What role should autistic individuals play in developing and implementing mental health interventions?
- How might the findings of this study inform broader disability rights and inclusion efforts?
