Although autism symptoms may improve with age, mental health issues may worsen in adolescence or adulthood. As a result, there are a significant number of adults on the spectrum who are now seeking help to deal with feelings of social isolation, interpersonal difficulties, anxiety, depressed mood, and coping problems. Unfortunately, co-occurring mental health issues such as anxiety and depression and even the diagnosis of an autism spectrum condition itself often go unrecognized. Although the rate of mental health issues for adults on the spectrum is high, accessing services to address these symptoms is frequently difficult and the extent of the problem will only increase as more and more youth transition to adulthood.
Evidence is beginning to emerge for interventions targeting this growing and underserved group of adults, including cognitive-behavioral therapy (CBT). CBT has direct applicability to adults on the autism spectrum who often have difficulty understanding, managing, and expressing emotions. It has been shown to be effective in changing the way a person thinks about and responds to feelings such as anxiety and depression. With CBT, the individual learns skills to modify thoughts and beliefs through a variety of strategies which improve interaction with others in helpful and appropriate ways, thereby promoting self-regulation and mental health. It is a goal oriented approach and primarily emphasizes here-and-now problems, regardless of one’s past history, traits, or diagnosis. CBT also provides a more structured approach than other types of psychotherapy, relies less on insight and judgment than other models, and focuses on practical problem-solving. Moreover, because individuals learn self-help in treatment they are often able to maintain their improvement after therapy has been completed. Evidence-based CBT holds considerable promise as an effective intervention for improving the quality of life and psychological well-being of adults on the autism spectrum. Nevertheless, it should not be assumed that CBT interventions will universally produce positive outcomes for all individuals on the spectrum. Research findings are only one component of evidence-based practice. Intervention selection is complicated and must take into consideration not only the best available research, but each individual’s unique presentation including specific strengths and needs, individual and family values and preferences, and available family and community resources.
Despite the availability of effective psychological treatments for anxiety and depression, a substantial number of adults on the autism spectrum do not seek professional help. Common barriers to mental health care access include limited availability and affordability of services, confidentiality issues, lack of insurance coverage, frequent delays and long waiting periods, and social stigma. Moreover, many service providers do not have the experience or expertise to work with individuals on the autism spectrum, particularly those with co-occurring mental health issues. Self-help interventions represent an increasingly popular alternative to therapist-delivered psychological therapies, offering the potential of increased access to cost-effective treatment for a range of different mental health issues. They provide an opportunity for the individual to gain some useful insights and begin to work through their problems with limited guidance from a therapist or mental health professional. Research has clearly shown that self-help strategies are effective, practical, and acceptable for many individuals in reducing mental health problems such as mild to moderate anxiety and depression. As a result, self-help interventions have the potential to play an important role in providing effective treatment to the large proportion of adults on the spectrum who are experiencing mental health issues. Of course, the use of self-help strategies alone are not appropriate for all individuals on the spectrum. Some adults will need the ongoing supportive assistance and direct services of a qualified mental health professional.
Lee A. Wilkinson, PhD, is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools. He is also editor of a best-selling text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).