How can we make therapy better for autistic adults? Autistic adults’ ratings of helpfulness of adaptations to therapy
Authors: Paynter Jessica , Sommer Kristyn , Cook Amanda 
Published: January 2025

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 Abstract Autistic 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.