Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by differences in social interactions and in the understanding of others’ thoughts or feelings, restricted interests and repetitive behaviors. ASD can manifest in markedly different ways and experiences can vary greatly between affected individuals.
There are now various psychotherapeutic approaches designed to support autistic individuals, helping them to cope with feelings of anxiety, low mood and other challenging emotions that they might be struggling with. While some patients diagnosed with ASD respond well to these treatments, others find them less beneficial or entirely unhelpful.
Researchers at University College London (UCL) recently carried out a study aimed at delineating some of the factors that influence therapeutic outcomes for autistic adults. Their paper, published in Nature Mental Health, pinpoints different trajectories that these patients can take during the course of psychotherapy, particularly focusing on changes relating to anxiety or depression.
“The inspiration for this study was to improve mental health care for autistic people,” Richard Pender, first author of the paper, told Medical Xpress. “We know that, unfortunately, autistic people are less likely to benefit from routine psychological interventions than non-autistic people and report negative experiences of services. We wanted to look at large data from routine mental health care across England, to understand the different patterns of change in depression and anxiety that autistic people experienced during therapy.”
Exploring the therapeutic journeys of autistic patients
The main objective of this recent study was to explore the factors that contribute to a rapid or more gradual improvement of anxiety and depression in individuals with autism who are attending therapy sessions. Delineating these factors could ultimately help to improve available treatments.
To identify these factors, the researchers analyzed the MODIFY dataset, which includes the anonymized electronic health care records of thousands of individuals living in England. Pender and his colleagues specifically analyzed the records of 7,175 autistic adults who received psychotherapy in England over a 7-year period.
“We included people who had an autism diagnosis in their health care records and received a course of treatment in routine primary mental health care settings across England between 2012 and 2019,” explained Pender. “We used Growth Mixture Modeling, a data-driven statistical technique that relies on machine learning to find groups of individuals following distinct patterns of change over time.”
The researchers used this statistical technique to analyze the mental health outcomes of patients, which were reported by therapists during their sessions. In addition, they employed regression models to identify clinical and demographic variables that were associated with a greater likelihood of following a particular trajectory in the evolution of anxiety or depression during therapy.
“Firstly, we showed that there was notable variability in outcomes from psychological therapies for anxiety and depression received by autistic people,” said Pender. “The majority of people showed largely unchanging symptoms, but there were groups of individuals who experienced either gradual or rapid improvement, or a deterioration in their depression or anxiety. Secondly, we noted that some factors were associated with the likelihood of benefitting from treatment. These included ethnicity, and people’s ratings of the impact on their relationships, and their ability to carry out daily tasks at home or participate in social or private leisure activities.”
The researchers observed that the third psychotherapy session appeared to be an important milestone for most patients, as it marked the moment from which models started to reliably predict whether a patient was responding well or not. This means that these sessions could be a good moment for therapists to draw initial conclusions and plan any adaptations to their therapeutic approach.
“Our findings also suggest that research in this area urgently needs to pay more attention to the intersections between neurodivergence and race and ethnicity, in influencing service experiences and mental health outcomes,” said Pender.
An ongoing effort to improve autism support
The results of the team’s analyses allowed them to identify five ways in which anxiety typically evolves in autistic adults who are attending therapy sessions, as well as seven common trajectories for the patients’ depression. They also identified factors that appeared to be associated with an improvement or worsening of anxiety and depression during therapy.
For instance, the researchers found that people from ethnical minority backgrounds were more likely to experience a worsening of anxiety after the start of therapy. In addition, greater difficulties with completing daily tasks and engaging in leisure activities with others appeared to be linked with poorer therapeutic outcomes.
In the future, these observations could help to improve available psychotherapy interventions for autistic adults or the recommended practices for practitioners. The recent work by Pender and his colleagues is part of a broader research program aimed at improving psychological support for autistic individuals, relying on the MODIFY dataset and other available health records.
“Members of our team are working on future studies to further understand what influences outcomes for neurodivergent service users,” added Pender.
“There is only so much that numerical data like MODIFY can tell us, so listening to and learning from autistic people who have accessed mental health services is crucially important in terms of improving psychological therapies. This is why we are also working on qualitative, lived experience research, to understand more about people’s views and experiences on why therapy works, or doesn’t work, for them.
“This includes intersectional research, aiming to understand the experiences of ethnically minoritized autistic people and how to improve access and support.”