Autistic adults have high risk of mental ill-health and some available interventions have been associated with increased psychiatric diagnoses. Understanding prevalence of psychiatric diagnoses is important to inform the development of individualised treatment and support for autistic adults which have been identified as a research priority by the autistic community. Interventions require to be evaluated both in terms of effectiveness and regarding their acceptability to the autistic community.
This rapid review identified the prevalence of psychiatric disorders in autistic adults, then systematic reviews of interventions aimed at supporting autistic adults were examined. A rapid review of prevalence studies was completed concurrently with an umbrella review of interventions. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed, including protocol registration (PROSPERO#CRD42021283570).
Study eligibility criteria
English language; published 2011–2022; primary studies describing prevalence of psychiatric conditions in autistic adults; or systematic reviews evaluating interventions for autistic adults.
Appraisal and synthesis
Bias was assessed using the Prevalence Critical Appraisal Instrument and AMSTAR2. Prevalence was grouped according to psychiatric diagnosis. Interventions were grouped into pharmacological, employment, psychological or mixed therapies. Strength of evidence for interventions was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Autistic researchers within the team supported interpretation.
Twenty prevalence studies were identified. Many included small sample sizes or failed to compare their sample group with the general population reducing validity. Prevalence of psychiatric diagnoses was variable with prevalence of any psychiatric diagnosis ranging from 15.4% to 79%. Heterogeneity was associated with age, diagnosis method, sampling methods, and country. Thirty-two systematic reviews of interventions were identified. Four reviews were high quality, four were moderate, five were low and nineteen critically low, indicating bias. Following synthesis, no intervention was rated as ‘evidence based.’ Acceptability of interventions to autistic adults and priorities of autistic adults were often not considered.
Citation: Curnow E, Rutherford M, Maciver D, Johnston L, Prior S, Boilson M, et al. (2023) Mental health in autistic adults: A rapid review of prevalence of psychiatric disorders and umbrella review of the effectiveness of interventions within a neurodiversity informed perspective. PLoS ONE 18(7): e0288275. https://doi.org/10.1371/journal.pone.0288275
Editor: Weihua YUE, Peking University, Institute of Mental Health, CHINA
Received: July 15, 2022; Accepted: June 23, 2023; Published: July 13, 2023
Copyright: © 2023 Curnow et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its supporting information files
Funding: This study was supported by funding from Scottish Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Mental ill-health is a common experience for autistic adults . The recent Lancet Commission on autism research described a ‘deep scarcity’ of evidence regarding interventions and supports for this population [2, 3]. Considering the recent increase in interest in outcomes for autistic adults, research and policy advancements in this field are urgently required.
There is a known increased risk for experiencing mental ill-health in autism this varies widely in terms of reported prevalence . Estimated prevalence of autism in adults aged 16–64 years in UK is 2.9% [95% CI 2.7, 3.1] . Prevalence of autism is 3.46 times higher for boys . Autistic people have a wide range of needs which vary depending on environment, and co-occurrence of intellectual or physical factors, sensory factors, co-occurring neurodevelopmental differences, intellectual disabilities, or other psychiatric diagnoses [6–8]. Autistic people, and people with intellectual disabilities have more mental and physical needs than other people , and research indicates that needs prevalence will be even higher for people with co-occurring autism and intellectual disability .
Worldwide prevalence of psychiatric disorders is estimated at 13%, including anxiety disorders (4.1%), depressive disorders (3.8%), bipolar disorders (0.5%), schizophrenia (0.3%), and eating disorders (0.2%) . In Scotland, census data indicates that 5.4% of adults aged 16–64 years (4.6% for people aged 65+) without co-occurring intellectual disabilities and autism reported mental ill-health which had lasted or was expected to last at least 12 months . Whilst there has been previous consideration of prevalence of psychiatric disorders in autistic populations , there is a need to distinguish between adult and child populations. Further consideration of the measurement tools used with autistic adults is also required to ensure that they are validated for this population . The significance of co-occurring mental ill-health was identified in research which demonstrated that that up to 66% of autistic adults without intellectual disability have contemplated suicide compared to 17% of non-autistic adults, and research has linked this to social camouflaging .
Mental health has been identified as a top priority research area for autistic adults . Mental health is a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community . As understanding of mental health in autism evolves, it is also recognised that personal factors cannot be separated from environmental factors. Attitudes, understanding and expectations of those around an individual and adaptations in society and everyday environments are fundamental to supporting meaningful participation and positive mental health in autism .
For the purposes of this review a psychiatric disorder is defined as a mental illness diagnosed by a mental health professional according to diagnostic criteria . Relevant diagnoses were identified according to search terms and strategies described by Cochrane Common Mental Disorders .
There is limited understanding of effective interventions for supporting mental health in autistic adults . A recent umbrella review found that research evidence did not support one best intervention for autism in children, and that there was a concerning lack of consideration of adverse effects of interventions . Previous research has focussed on children and adolescents, often evaluating interventions designed to reduce or mask behaviours associated with autism  but there is now recognition of the stress and detriment such interventions can create [20, 21]. The ‘neurodiversity’ movement considers autism and other neurodevelopmental conditions as neurological variation, rather than disorders requiring treatment [2, 22, 23], Therefore, autism is a difference not a deficit, which brings into question the use of interventions which seek to ‘cure, fix or normalise’ . This movement has provided tools to critique research and to consider what is important in research and practice for autistic adults [16, 23, 24]. This has led to the development of research priorities which focus on the best interests of autistic people and recognise that the inclusion of both autistic people and non-autistic people in research processes is of key importance . Although, there is a need for progress as only 5% of funded autism research included autistic adults . Historical research must be reviewed through a contemporary lens which considers the acceptability of terminology, interventions, supports and outcomes to the autistic community . Research indicates that autistic people prioritise outcomes associated with quality of life, reduction in anxiety, depression or sleep related problems, social well-being, interpersonal relationships, and increased participation in activities of daily living, community, and work .
These measures are key to evidence-based practice which requires the integration of the best available research with clinical expertise and the patient’s unique values and circumstances [26, 27]. Evidence based practice requires that health care is not only based upon the best available, valid, and current evidence as defined by GRADE (Grading of Recommendations, Assessment, Development and Evaluation) , but also that decisions are made by those receiving care and informed by those providing care [27, 29]. Strong GRADE evidence indicates all or almost all people would choose that intervention . This umbrella review of interventions will therefore consider the results of studies not only in terms of their effectiveness, but also regarding the acceptability of the interventions to the autistic community .
The prevalence of psychiatric disorders in autistic adults will be explored through rapid review of published literature. This knowledge synthesis will be rigorous and transparent but will be accelerated by resource-efficient methods including limiting the number of databases which will be searched for evidence. Handsearching, and forward and backward citation searches will also not be undertaken . Grey literature, and literature not published in English will not be considered. Article screening will be reviewed by two authors in 20% of publications.
An umbrella review facilitates a synthesis and appraisal of evidence across a broader topic area than can usually be achieved through an individual systematic review . In the current research, the aim was to incorporate these key viewpoints, integrating perspectives on evidence-based practice, and views from people with lived experience, experts, and practitioners. These key ideas are summarised below.
We conducted a rapid review of existing studies providing quantitative data on the prevalence of psychiatric diagnoses in autistic adults. We also conducted an umbrella review of systematic reviews of interventions for autistic adults . In both cases following Preferred Reporting Items for Systematic review and Meta-analyses (PRISMA) guidelines  (S1 Checklist). Our research was commissioned to inform an adult autism government policy review in Scotland which aimed to set priorities which are driven by autistic people. Considering these principles, our objectives for this review focussed on autistic adults were to:
- Establish prevalence of psychiatric diagnoses and explore associated heterogeneity.
- Investigate evidence for effectiveness of interventions.
- Consider the acceptability of interventions and research in this field with reference to the neurodiversity paradigm.
- How prevalent are psychiatric diagnoses in autistic adults?
- Which factors are associated with heterogeneity of prevalence of psychiatric diagnoses in autistic adults?
- Which interventions are effective in treating autistic adults?
- Do available interventions meet the needs and priorities of autistic adults?
The systematic review process was undertaken in two parts focussing on (a) primary prevalence data describing the occurrence of psychiatric diagnoses in autistic adults; and (b) umbrella reviews of interventions. This was a rapid review, and to reduce the time required limited databases were included in the searches, and the umbrella review of interventions considered systematic reviews only, due to their higher quality research design [34, 35]. Search date was restricted to 10 years as this is a valid and reliable approach for rapid reviews . The protocol was registered a priori (PROSPERO #CRD42021283570).
For both reviews, studies were included if: a) participants were autistic (however defined in the study which may include self-diagnosis or clinical diagnosis) b) participants were ≥18 years of age (or the mean age of the participant group ≥18 years) c) they were reported in English; d) they were published from 01/2011,
- For the investigation of prevalence of psychiatric diagnoses in autistic adults; studies were included if they reported primary prevalence data for occurrence of psychiatric diagnoses experienced by autistic adults.
- For the umbrella review of interventions; studies were included if a) they considered interventions for autistic adults; b) they were systematic reviews.
A systematic search of MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and PsycINFO databases was conducted in November 2022, through EBSCOhost to identify quantitative studies of psychiatric diagnoses in autistic adults using Medical Subject Headings (MeSH) and keywords. To identify systematic reviews of interventions, a systematic search of CINAHL, MEDLINE, PsycINFO, and Cochrane Database of Systematic Reviews was conducted in November 2022.
Databases were selected from available resources following current guidance , and through discussion with the university research librarian. CENTRAL, MEDLINE and Embase (if access to Embase is available to the review team) are recommended for systematic reviews [37–39]. Embase was not available to the research team. Cochrane Database of Systematic Reviews was included as a major repository of systematic reviews . Trials searches of JBI Database of Systematic Reviews and Implementation Reports did not reveal any additional relevant citations and was therefore excluded. Lists of search terms are included (S1 File).
Retrieved citations were uploaded to Covidence . Following removal of duplicates, titles and abstracts of the returned articles were examined blind by two researchers (EC, NJ) with irrelevant titles excluded. Full text articles were then reviewed against inclusion criteria (EC), with 20% examined by a second reviewer (NJ). Disagreements were resolved through discussion, and reference to a third party (MR) was not required. Inter-rater agreement was assessed using Cohens Kappa.
Data extraction sheets were developed and piloted by two researchers. For prevalence, extracted data included study details, setting, sample size, age, method of diagnosis, prevalence data for: any psychiatric diagnosis; anxiety; depression; psychosis; schizophrenia; obsessive-compulsive disorder; attention deficit hyperactivity disorder (ADHD); bipolar disorder; eating disorder. For interventions, extracted data included study details, methodology, aims, population age and gender, context, inclusion/exclusion criteria, intervention, psychiatric diagnosis, autism diagnosis, sample size, subgroups, views of autistic adults, concerns re acceptability of intervention, conclusions, recommendations, funding sources. Data extraction was conducted by one of the research team members, then reviewed by the research team as a group, inconsistencies were resolved through discussion.
Evaluation of risk of bias
Studies included in the prevalence review were assessed for risk of bias using the Prevalence Critical Appraisal Instrument . This assessment focusses on a) method of identification or diagnosis of the relevant condition, and b) sampling of the population, as these are issues particularly relevant to prevalence. Studies included in the intervention review were assessed for risk of bias using AMSTAR2 . This tool identifies domains critical to integrity of the study, including registration of protocol (Q2), adequacy of literature search (Q4), justification for excluding studies (Q7), risk of bias in inclusion of studies (Q9), selection of meta-analysis methods (Q11), consideration of risk of bias in interpretation of results (Q13), consideration of publication bias (Q15). Studies are rated as high, moderate, low, or critically low according to the number of weaknesses identified . Risk of bias was assessed by one member of the research team, then reviewed by another.
For synthesis of prevalence, studies were pooled according to psychiatric diagnosis.
For synthesis of interventions, results were grouped into pharmacological interventions; employment focussed interventions; psychological therapies; and mixed intervention or approaches. Within these broad categories, a list of detailed intervention sub-categories was identified. Next, evaluation of the strength of evidence for each sub-category was completed based upon the following criteria adapted from GRADE  from ‘not recommended- to ‘evidence based’ (Table 1).
Interventions were evaluated against the stated adapted GRADE criteria to determine not only evidence of effectiveness, but also evidence of negative consequences or harm. This involved consideration of reported benefit for each intervention type. An exploratory approach was used to review adverse outcomes identified during the conduct of the review. This opportunistic approach considers only the reported adverse effects or outcomes that may be associated with the interventions being investigated .
In considering negative consequences or harm associated with interventions we included criteria adapted from clinical guidelines and neurodiversity affirming practice. Specifically, we did not recommend:
- Interventions which focussed on the reduction of core features of autism are associated with harmful consequences and contradict current clinical guidelines [44, 45]. Core features include qualitative differences and impairments in reciprocal social interaction and social communication, restricted interests and activities, and rigid and repetitive behaviours .
- Interventions which contradicted current clinical guidelines [44, 46].
- Interventions associated with adverse events or adverse outcomes .
- Interventions which attempt to ‘cure, fix or normalise’ autistic people [2, 47] due to their negative impact upon quality of life .
- Interventions which target outcomes contradictory to the identified priorities of the autistic community [14, 24, 48–50].
The research team was made up of autistic and non-autistic professionals within speech and language therapy, psychology, psychiatry, occupational therapy, and teaching fields. Members of the team had research experience, and experience working with autistic people in clinical and education settings. As integrated members of the research team, autistic researchers contributed to the planning and design of this research study, and decision-making related to study outcomes alongside non-autistic colleagues. All team members held professional roles and contributed expertise to the study thus possibly reducing issues associated with power hierarchy sometimes found in autism research . Arising disagreements concerning the classification of evidence were resolved through team discussion with reference to research recommendation classification (Table 1) and criteria regarding negative consequences or harm listed above until agreement was achieved. Inter-rater reliability was not recorded for this process.
The database searches returned 283 papers for the prevalence review and 448 papers for the interventions review. Of these 20 papers describing the prevalence of psychiatric diagnoses for autistic adults (Fig 1), and 32 papers describing interventions for autistic adults (Fig 2), met the inclusion criteria. Citations for excluded papers are provided (S2 File).
Cohen’s kappa of inter-rater reliability was 0.70 for both studies, indicating substantial agreement between reviewers.
Characteristics of included papers relating to prevalence are described (Table 2), together with a summary of issues highlighted during completion of the Prevalence Critical Appraisal Instrument . Studies often included small sample sizes or failed to compare their sample group with the general population reducing understanding of the validity of their findings. Prevalence data was not pooled due to heterogeneity , which was associated with age, co-occurring conditions, sampling method, mode of diagnosis, variation in the categorisation or grouping of diagnoses, and the country in which the study took place. Prevalence ranges, across all studies, locations, and lifetime vs current diagnosis, were any psychiatric diagnosis 15%-79%; Attention-deficit hyperactivity disorder 2%-33%; Depression 10%-54%; Anxiety 10%-54%; Psychotic disorders 0.2%-18%; bipolar disorder 1%-25%; obsessive compulsive disorder 2%-33%; and eating disorders 2%-11% (Table 2).
Characteristics of the systematic reviews relating to interventions for autistic adults are described in Table 3. This includes effect size from any data synthesis conducted within the reviews. Five reviews were focussed on pharmacological interventions, nine examined employment focussed interventions, seven reviewed the evidence for psychological therapies, and the remaining 12 explored evidence for mixed interventions and approaches. Critical appraisal was conducted using AMSTAR2 . Four reviews were rated high, four were moderate, five were rated low and 18 critically low, indicating strong risk of bias (see Table 3).
Exceptionally, one paper described the inclusion of autistic researchers within the research process . This study included a community council comprising 18 people who mostly identified as autistic or were the parent of an autistic adult, and were researchers, medical or mental health professionals, authors, or advocates. This council reviewed study results and contributed to study recommendations .
Heterogeneity in outcome measures and variation in the content, length, and delivery of interventions prevented pooling. Outcome measures were often not referenced adequately to permit investigation into their reliability or validity for this population. Full name and authors of outcome measures where reported are included in S3 File. Reviews did not always report results of individual outcome measures and often used diagnostic assessment tools as outcome measures which are not only insensitive to change but indicate a focus on the reduction of core autistic features . Few interventions were manualised, and there was limited reporting on the training, skills, or experience of practitioners.
Summary of evidence for effectiveness and acceptability of interventions.
The summary synthesis of intervention sub-categories with GRADE recommendation is presented in Table 4. There was considerable overlap in the primary studies reported within the retrieved systematic reviews (S4 File) which prevented further data synthesis. Column 3 of Table 4 outlines factors which may impact the acceptability of interventions to autistic adults including research limitations, indications of adverse effects, adverse outcomes, or priorities contradicting those identified by the autism community. Overall, results indicate a need for further robust research. None of the included interventions were rated as ‘evidence based’, and eight were ‘Not Recommended.’ There was ‘Unestablished’ or ‘Emerging Evidence’ for the remaining interventions.
Five reviews [81, 88, 89, 98, 100] considered 139 studies evaluating pharmacological intervention for autistic individuals. One review was high quality (Table 3). Managing behaviours with medication as a first line of intervention or using medication including SSRIs (Selective Serotonin Reuptake Inhibitors) or Oxytocin for core features of Autism is not recommended (Table 4) [46, 100]. However, there was emerging evidence for use of medication as a last line of intervention. Oxytocin may offer some benefit but did not affect global clinical status . Risperidone may be useful in the management of repetitive, aggressive, and self-injurious behaviour , although side-effects are problematic . There was limited evidence to support the use of opioid antagonists to reduce self-injury in autistic adults . However, fluoxetine or fluvoxamine may be useful in the management of repetitive and obsessive-compulsive behaviour and anxiety where other interventions are not available or possible due to the individual’s level of distress or aggression . Overall, there is a need for future research to consider the acceptability of pharmacological interventions including further investigation of side-effects.
Employment focused interventions.
Nine reviews of evidence for employment focussed interventions considered 100 unique publications [78, 80, 82, 83, 85–87, 90, 97]. None of the reviews were high quality (Table 3). Reviews revealed emerging evidence that supported employment including Individual Placement Support (IPS) and Project Search, yields positive outcomes for autistic people [78, 80, 82, 86, 87, 90, 97]. Notably, autistic adults, undertaking Project SEARCH with autism support were eleven times more likely to achieve employment than those attending special education . However methodological concerns mean this result must be interpreted with caution as studies did not include comparable control groups or consider participant attrition . Evidence for technology-supported interventions such as virtual reality training was unestablished as the relationship to paid employment was not confirmed . Employment related social skills training research often focussed on alternative outcomes to employment status, such as interview skills performance, and therefore the evidence for such an approach is unestablished. Sheltered workshops were not recommended as they were not associated with supporting autistic people into employment but could provide other benefits. Further research is required to consider the impact of employment focussed interventions not only on employment status and wage, but also on quality of life .
There were 7 reviews of psychological therapies including 215 studies [74, 75, 79, 93–95, 99]. Only one review was of high quality (Table 3). The reviews revealed emerging evidence (Table 4) for the use of mindfulness for the reduction of self-reported depression symptoms in autistic adults without intellectual disability [71, 79, 84]. Studies provided emerging evidence for use of Cognitive remediation therapy to improve cognitive function, but small sample sizes and limited follow-up made it difficult to determine meaningful impact or maintenance of any benefit in the longer term .
There was unestablished evidence for the use of cognitive behavioural therapy (CBT), although small positive clinical effects on self-reported outcomes were observed [71, 99]. Within nine systematic reviews, which included CBT studies, 11 different types of CBT were described and included CBT combined with other interventions including behavioural techniques, mindfulness, and psychoeducation [93, 94]. These major variations in the intervention provided meant it was not possible to conclude this intervention was effective. Additionally, there were expressed concerns regarding CBT which are outlined in Table 4 and which should be considered in future research.
There was unestablished evidence for family therapy due to limited quality research  although non-randomised intervention studies suggest there may be improved knowledge and understanding of core disorder (ASD), and coping styles post-intervention . Acceptance and Commitment Therapy was not recommended due to limited research and insufficient rigour  to suggest ACT is effective in the management of psychological distress for individuals with ID .
Mixed interventions and approaches.
Twelve systematic reviews considered 300 studies within 11 sub-categories of intervention identified [20, 71–73, 76, 77, 83, 84, 91, 92, 96, 101]. Two reviews were rated as high quality (Table 3). Evidence for most of interventions in this grouping was unestablished or not recommended (Table 4). However, there was emerging evidence for the use of the PEERS programme in reducing social anxiety and loneliness . Although, concerns regarding social skills interventions including PEERS includes the risk they teach camouflaging which has been associated with suicidality [71, 103]. There was also emerging evidence for social cognitive interventions [73, 83] although there is a need to explore whether these interventions are required by the autism community. There was unestablished evidence for social skills interventions [20, 77, 83, 84, 92, 101] and studies were criticised for their limited input from autistic people instead relying on parent or caregiver reports , Results indicate positive effects from communication interventions [20, 83, 101] but there is a need for additional robust research. Music, and dance therapies research did not demonstrate the effectiveness of this type of intervention [72, 83]. Music therapy intervention studies suggest this may have a positive impact on autistic children regarding social interaction and communication, although studies did not find significant difference in symptom severity . These studies relied heavily on diagnostic measures to analyse social or behavioural differences before and after intervention . Diagnostic measures are generally insensitive to change and indicate a focus on the treatment of core symptoms. There were no randomised controlled trials investigating the impact of music therapy. There is also a need for further robust research investigating the benefits of environmental, leisure and participation focussed interventions [20, 71, 73, 76, 83]. Evidence for behaviourist approaches was unestablished [71, 73, 76, 101]. Although, the autistic community have expressed concerns regarding the use of applied behaviour analysis and further engagement is required to determine whether these approaches should be used . Electro-convulsive therapy was not recommended, and autistic researchers involved in the systematic review did not feel this was an appropriate intervention for autistic people . There is evidence of negative responses to this intervention and of high risk of bias in research studies . Major concerns were expressed about this intervention including possible damage to brain and memory . Auditory Integration Training was not recommended due to absence of evidence, and safety concerns . Group academic and social skills training  were not recommended. Group social skills interventions were more effective for enhancing knowledge and understanding, rather than increasing specific social skills .
Acceptability to the autistic community in retrieved studies.
One systematic review, exceptionally, reported including autistic individuals and families who checked results, recommendations, and acceptability of interventions . Evidence for interventions aimed at the reduction of core features of autism were not recommended, Intervention studies were limited by restricted reporting of outcome measures, or use of outcome measures not validated for autistic adults.
Improved understanding of the relationship between individual characteristics and mental health in autistic adults is required to target interventions. Our review of studies exploring the occurrence of mental ill-health in autistic adults revealed wide variation in prevalence associated with means of diagnosis, age, co-morbidity, and country of residence. Study populations included higher proportions of male participants reflecting the historical gender imbalance in autism diagnosis.
We identified prevalence of psychiatric diagnoses in autistic adults. Attention-deficit hyperactivity disorder (2%-33%); Depression (10%-54%); and Anxiety (10%-54%) were most common. Population-based studies reflecting lifetime diagnoses identified higher prevalence than current diagnosis studies. Prevalence of mental health related diagnoses was higher in studies which used clinical samples. Most studies included smaller samples. Clinical studies may mean greater chance of clinician and service contact, raising chance of diagnosis for individuals. Diagnoses in clinical populations are also more likely to conform to identified diagnostic criteria.
This rapid review supports previous findings that age was associated with heterogeneity in prevalence of psychiatric diagnoses . Autistic people over the age of 65 were more likely to report a lifetime mental health condition than autistic people aged 55–65, although this pattern was not found when examining current diagnoses  possibly due to additional time available to experience mental ill-health. Age related differences may be due to changes in diagnosis patterns and criteria over time, or to the reduced life expectancy of autistic people [59, 60]. Additionally, autistic people with intellectual disability are more likely to experience mental ill-health, than people with either intellectual disability or autism alone . Prevalence of psychiatric diagnoses in autistic people also appears higher for people living in USA than UK [61, 62].
Prevalence may also be influenced by the lack of diagnostic tools validated for the autistic community, and which may be unable to discriminate mental ill-health from autistic features resulting in diagnostic inaccuracy or overshadowing [12, 60]. Self-reporting, and the varying ability to report internal emotional experiences, may also impact diagnostic accuracy .
The use of resource efficient methodologies may have reduced the number of prevalence studies revealed during this rapid review . However, search strategies focussed on the identification of research aimed at identifying the prevalence of psychiatric diagnoses in autistic adult population rather than in small purposive samples. The sampling of the population within prevalence studies is particularly important . Therefore, studies which examined small purposive samples which were not compared with the wider population, were less likely to be representative of the general population.
The umbrella review revealed evidence across 31 systematic reviews relating to interventions for autistic adults, but no intervention was rated ‘evidence based’ and several interventions were ‘not recommended.’ A key issue was acceptability to the autistic community. Reviews mostly failed to consider the views of autistic adults or include autistic adults in planning or conducting the research. One systematic review, exceptionally, included autistic individuals and families who checked results, recommendations, and acceptability of interventions . Research rarely focussed on the identified priorities of the autistic community which include interventions focussed on skills development and training from childhood; employment; physical health, wellbeing; mental health; and expertise, coordination, availability, and accessibility of lifespan services . It should be noted that these priorities may not reflect the views autistic people who are minimally verbal.
Despite the availability of knowledge on priorities according to autistic people, the identified research mostly reflected changes to the autistic person including the development of social skills, and the reduction of ‘symptoms’ associated with autism or behaviours deemed undesirable. Such behavioural and psychological interventions have been criticised for aiming to remediate aspects of autism resulting in stress or harm for autistic people rather than focussing on outcomes identified as meaningful . Reviewed studies incorporated a wide range of outcomes which were measured using heterogeneous tools with little discussion of their relevance to priorities identified by the autistic community. This has implications for the interpretation of the results, as measured outcomes may or may not be meaningful to autistic people and reflects the limited range of assessments validated for use with autistic adults .
Employment was considered in many studies and has been identified as a research priority by the autism community  as autistic adults are often excluded from participating in integrated competitive employment. However, studies often failed to report outcomes directly reflecting employment status following intervention , instead reporting outcomes such as improvement in interview skills or cognition, which may or may not support people in achieving employment. This may be due to limited follow-up after the intervention concluded. Other studies examined complex work programmes making it difficult to identify the ‘effective’ components.
Further high-quality research must be designed with the autistic community focussing on their needs and priorities. Improved understanding of processes for matching individual needs and preferences with evidence-based interventions is required [3, 50]. Interventions offered to autistic people should take account of the person’s preferences, needs and communication differences, and the impact these may have upon mental health . Research must consider the benefits of interventions which focus on individual communication, sensory or thinking preferences. Interventions which consider adaptations to the environment must also be prioritised .
Staff and organisations, including health staff, adult mental health practitioners, and human resources/employment specialists, should consider what support can be offered in workplace environments [50, 71]. There are significant training needs in the workplace. This includes training needs of autistic people and non-autistic people. Reviews particularly identified transition into employment as a key time requiring focussed attention .
The findings of this review suggest that practitioners and organisations who support autistic adults with their mental health should prioritise individual needs and consider focussing on approaches to building self-understanding of individual neurodevelopmental profiles before (or in conjunction with) talking therapies . Ideally, practitioners should be part of a multi-disciplinary team and should not only have training in approaches or therapies but have experience in working with autistic people, assessing communication support needs, and understand alternative supports and adaptations for autism [48, 49, 71]. Intervention decisions should take account of autistic people’s individual preferences and needs, their day-to-day environments, neurodevelopmental and particularly communication differences, and the way sensory, communication or thinking preferences might impact on their mental health [14, 49]. Such approaches could address the current tendency to focus on people’s difficulties rather than consideration of environmental supports and individual needs [49, 50].
Inclusion of autistic people
Autistic researchers were an integral part of the research team which conducted this review and were included throughout the rapid review and umbrella review process. The team provided critique of evidence for interventions which could potentially be detrimental to autistic people, including encouraging the expression of neurotypical behaviours which is a form of masking. Papers were examined for the inclusion of autistic researchers, and for views expressed by autistic people on the acceptability of interventions.
Rapid review methodologies were used ; including date and language restrictions, limiting the number of databases that were searched, and focussing on systematic reviews of intervention studies. The research team did not have access to EMBASE which is recommended for intervention reviews where available to researchers . While the review team completed a comprehensive search using recognised methods no forward or backward citation search, hand searching or follow up with authors was completed to identify missing studies. These methods and the selection of databases used in the search may have contributed to the low number of studies identified. The intervention research displayed very high heterogeneity across included studies, interventions used, and outcome measures applied. An exploratory approach to reviewing adverse effects considers only reported information, and is therefore restricted by incomplete reporting, or inadequate monitoring of adverse outcomes. Separate searches for adverse effects of interventions were not conducted and therefore results are unlikely to be comprehensive . Retrieved studies did not declare that they did not include autistic researchers and research teams may therefore have included autistic researchers. Autistic researchers were integral to the research team conducting this study and their views were not recorded separately from other research team members. Autistic research team members have professional backgrounds within research, health and education and are therefore not representative of all sections of the autistic community.
There is limited understanding of mental ill-health and how this can impact quality of life for autistic people despite evidence indicating increased prevalence. There is a need for diagnostic tools and outcome measures to be validated for use with this population. Future research should fully include autistic people at every stage and focus on priorities identified by the autistic population.
Queen Margaret University Research Ethics Panel do not require researchers undertaking systematic review to apply for ethical approval.
- 1. Rydzewska E, Hughes-Mccormack LA, Gillberg C, Henderson A, Macintyre C, Rintoul J, et al. Prevalence of long-term health conditions in adults with autism: observational study of a whole country population. BMJ Open. 2018;8(8):e023945. pmid:30173164
- 2. Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, et al. The Lancet Commission on the future of care and clinical research in autism. The Lancet. 2021. pmid:34883054
- 3. Camm-Crosbie L, Bradley L, Shaw R, Baron-Cohen S, Cassidy S. ’People like me don’t get support’: Autistic Adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism. 2019;23(6):1431–41. pmid:30497279
- 4. Office for National Statistics. Census 2021 Data and Analysis from Census 2021; Autism Prevalence, UK, 2020 Autism prevalence, UK, 2020—Office for National Statistics (ons.gov.uk): Office for National Statistics,; 2021 [cited 2022 25/11/2022].
- 5. Kogan MD, Vladutiu CJ, Schieve LA, Ghandour RM, Blumberg SJ, Zablotsky B, et al. The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics. 2018;142(6). Epub December 2018. pmid:30478241
- 6. Gillberg C. The ESSENCE of Autism and Other Neurodevelopmental Conditions: Rethinking Co-Morbidities: Jessica Kingsley Publishers; 2021.
- 7. Croen LA, Zerbo O, Qian Y, Massolo ML, Rich S, Sidney S, et al. The health status of adults on the autistic spectrum. Autism. 2015;19(7):814. pmid:25911091
- 8. Dunn K, Rydzewska E, Fleming M, Cooper S-A. Prevalence of mental health conditions, sensory impairments and physical disability in people with co-occurring intellectual disabilities and autism compared with other people: a cross-sectional total population study in Scotland. BMJ Open. 2020;10. pmid:32341043
- 9. Hughes-Mccormack LA, Rydzewska E, Henderson A, Macintyre C, Rintoul J, Cooper S-A. Prevalence of mental health conditions and relationship with general health in a whole-country population of people with intellectual disabilities compared with the general population. BJPsych Open. 2017;3(5):243–8. pmid:29034100
- 10. Castaldelli-Maia JM, Bhugra D. Analysis of global prevalence of mental and substance use disorders within countries: focus on sociodemographic characteristics and income levels. International Review of Psychiatry. 2022;34(1):6–15. pmid:35584016
- 11. Hossain MM, Khan N, Sultana A, Ma P, Mckyer J, Lisako E., et al. Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses. Psychiatry Research. 2020;287:112922. pmid:32203749
- 12. Cassidy SA, Bradley L, Bowen E, Wigham S, Rodgers J. Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review. Autism research: official journal of the International Society for Autism Research. 2018;11(5):738–54. pmid:29360200.
- 13. Parliament UK. Autism Postnote. Westminster, London, UK: The Parliamentary Office of Science and Technology; 2020.
- 14. Frazier TW, Dawson G, Murray D, Shih A, Sachs JS, Geiger A. Brief Report: A Survey of Autism Research Priorities Across a Diverse Community of Stakeholders. Journal of Autism and Developmental Disorders. 2018;48(11):3965–71. pmid:29948533
- 15. World Health Organization. Mental Health: strengthening our response Mental health: strengthening our response (who.int): World Health Organization; 2022 [cited 2023 25 January]. Available from: Mental health: strengthening our response (who.int).
- 16. Jellett R, Muggleton J. Implications of Applying “Clinically Significant Impairment” to Autism Assessment: Commentary on Six Problems Encountered in Clinical Practice. Journal of Autism and Developmental Disorders. 2022;52(3):1412–21. pmid:33893595
- 17. Salters-Pedneault K. Types and Symptoms of Common Psychiatric Disorders Types of Psychiatric Disorders (verywellmind.com): verywellmind; 2021 [cited 2023 05 January 2023]. Available from: Types of Psychiatric Disorders (verywellmind.com).
- 18. Cochrane Common Mental Disorders. Search strategies for the identification of studies Search strategies for the identification of studies | Cochrane Common Mental Disorders: Cochrane Library; 2014 [cited 2023 05 Jan 2023].
- 19. Trembath D, Varcin K, Waddington H, Sulek R, Bent C, Ashburner J, et al. Non-pharmacological interventions for autistic children: An umbrella review. Autism. 2022. pmid:36081343
- 20. Monahan J, Freedman B, Pini K, Lloyd R. Autistic Input in Social Skills Interventions for Young Adults: a Systematic Review of the Literature. Review Journal of Autism and Developmental Disorders. 2021.
- 21. Sandoval-Norton AH, Shkedy G, Shkedy D. Long-term ABA Therapy is abusive: A response to Gorycki, Ruppel and Zane. Cogent Psychology. 2020;7:126.
- 22. Lai M-C, Anagnostou E, Wiznitzer M, Allison C, Baron-Cohen S. Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit. Lancet Neurology. 2020;19:434–51. Epub March 3, 2020. pmid:32142628
- 23. Happé F, Frith U. Annual Research Review: Looking back to look forward–changes in the concept of autism and implications for future research. Journal of Child Psychology and Psychiatry. 2020;61(3):218–32. pmid:31994188
- 24. Benevides TW, Shore SM, Palmer K, Duncan P, Plank A, Andresen M-L, et al. Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project. Autism. 2020;24(4):822–33. pmid:32429818
- 25. Pellicano L, Dinsmore A, Charman T. A Future Made Together: Shaping Autism Research in the UK. London: Institute of Education; 2012.
- 26. Straus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based medicine: How to practice and teach it. 4th ed: Churchill Livingstone Elsevier; 2011.
- 27. Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, et al. Sicily statement on evidence-based practice. BMC Medical Education. 2005;5(1). pmid:15634359
- 28. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. pmid:18436948
- 29. Vivanti G. What does it mean for an autism intervention to be evidence‐based? Autism Research. 2022. pmid:36065991
- 30. Siemieniuk R, Guyatt G. What is GRADE? What is GRADE? | BMJ Best Practice: BMJ.
- 31. Hamel C, Michaud A, Thuku M, Skidmore B, Stevens A, Nussbaumer-Streit B, et al. Defining Rapid Reviews: a systematic scoping review and thematic analysis of definitions and defining characteristics of rapid reviews. Journal of Clinical Epidemiology. 2021;129:74–85. Epub 8 October 2020. pmid:33038541
- 32. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach. International Journal of Evidence-Based Healthcare. 2015;13:132–40. pmid:26360830
- 33. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD. PRISMA 2020 Statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed). 2021;372(71). pmid:33782057
- 34. Garritty C, Gartlehner G, Nussbaumer-Streit B, King VJ, Hamel C, Kamel C, et al. Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. Journal of Clinical Epidemiology. 2021;130:13. pmid:33068715
- 35. Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Systematic Review. 2012;1(10). pmid:22587960
- 36. Furuya‐Kanamori L, Lin L, Kostoulas P, Clark J, Xu C. Limits in the search date for rapid reviews of diagnostic test accuracy studies. Research Synthesis Methods. 2022. pmid:36054082
- 37. Lefebvre C, Glanville J, Briscoe S, Feathertone R, Littlewood A, Marshall C, et al. Searching for and selecting studies. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. version 6.3 (updated February 2022) ed: Cochrane; 2022.
- 38. Pollock M, Fernandes RM, Becker LA, Featherstone R, Hartling L. What guidance is available for researchers conducting overviews of reviews of healthcare interventions? A scoping review and qualitative metasummary. Systematic Reviews. 2016;5(1). pmid:27842604
- 39. Hartling L, Featherstone R, Nuspl M, Shave K, Dryden D, Vandermeer B. The contribution of databases to the results of systematic reviews: a cross-sectional study. BMC Medical Research Methodology. 2016;16(13).
- 40. Veritas Health I. Covidence systematic review software. Melbourne, Australia: www.covidence.org.
- 41. Munn Z, Moola S, Riitano D, Lisy K. The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence. International Journal of Health Policy Management. 2014;3(3):123–8. pmid:25197676
- 42. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised and non-randomised studies of healthcare interventions, or both. Bmj. 2017;Sep(21):358.
- 43. Peryer G, Golder S, Junqueira D, Vohra S, Loke YK. Adverse Effects. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane Handbook for Systematic Reviews of Interventions. 6.3 (Updated February 2022) ed: Cochrane; 2022.
- 44. Scottish Intercollegiate Guidelines Network (SIGN). Assessment, diagnosis and interventions for autism spectrum disorders. Edinburgh: Scottish Intercollegiate Guidelines Network, 2016 June 2016. Report No.
- 45. Linden A, Best L, Elise F, Roberts D, Branagan A, Tay YBE, et al. Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials. Autism. 2023;27(1):7–30. pmid:35957523
- 46. National Institute for Healthcare and Excellence. Autism spectrum disorder in adults: diagnosis and management. UK: NICE, 2012.
- 47. Rutherford M, Johnston L. Rethinking Autism Assessment, Diagnosis, and Intervention Within a Neurodevelopmental Pathway Framework. Autism Spectrum Disorders—Recent Advances and New Perspectives [Working Title]: IntechOpen; 2022.
- 48. Roche L, Adams D, Clark M. Research priorities of the autism community: A systematic review of key stakeholder perspectives. Autism. 2021;25(2):336–48. pmid:33143455
- 49. Silverman C. What do autistic people want from autism research? Behavioral and Brain Sciences. 2019;42:E111.
- 50. Cusack J, Sterry R. Your questions: shaping future autism research. autistica.org.uk: Autistica, James Lind Alliance, 2016.
- 51. Bell J, Lim A, Williams R, Girdler S, Milbourn B, Black M. ‘Nothing about us without us’: co-production ingredients for working alongside stakeholders to develop mental health interventions. Advances in Mental Health. 2023;21(1):4–16.
- 52. Munn Z, Moola S, Lisy K, Riitano D. The Synthesis of Prevalence and Incidence Data. Philadelphia: Lippincott Williams and Wilkins, 2014 Contract No.: Report.
- 53. Bejerot S, Eriksson JM, Mörtberg E. Social anxiety in adult autism spectrum disorder. Psychiatry research. 2014;220(1–2):705. pmid:25200187.
- 54. Buck TR, Viskochil J, Farley M, Coon H, McMahon WM, Morgan J, et al. Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2014;44(12):3063. pmid:24958436.
- 55. Davignon MN, Qian Y, Massolo M, Croen LA. Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD. Pediatrics. 2018;141:S335. pmid:29610415.
- 56. Demartini B, Nisticò V, Bertino V, Tedesco R, Faggioli R, Priori A, et al. Eating disturbances in adults with autism spectrum disorder without intellectual disabilities. Autism research: official journal of the International Society for Autism Research. 2021;14(7):1434. pmid:33738980.
- 57. Ezell J, Hogan A, Fairchild A, Hills K, Klusek J, Abbeduto L, et al. Prevalence and Predictors of Anxiety Disorders in Adolescent and Adult Males with Autism Spectrum Disorder and Fragile X Syndrome. Journal of Autism and Developmental Disorders. 2019;49(3):1131. pmid:30430320.
- 58. Fortuna RJ, Robinson L, Smith TH, Meccarello J, Bullen B, Nobis K, et al. Health Conditions and Functional Status in Adults with Autism: A Cross-Sectional Evaluation. Journal of general internal medicine. 2016;31(1):77. pmid:26361965.
- 59. Hand BN, Angell AM, Harris L, Carpenter LA. Prevalence of physical and mental health conditions in Medicare-enrolled, autistic older adults. Autism: the international journal of research and practice. 2020;24(3):755. pmid:31773968.
- 60. Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine. 2019;49(4):559. pmid:30178724.
- 61. Houghton R, Ong RC, Bolognani F. Psychiatric comorbidities and use of psychotropic medications in people with autism spectrum disorder in the United States. Autism research: official journal of the International Society for Autism Research. 2017;10(12):2037. pmid:28963809.
- 62. Houghton R, Liu C, Bolognani F. Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom. Autism research: official journal of the International Society for Autism Research. 2018;11(12):1690. pmid:30380202.
- 63. Hudson CC, Hall L, Harkness KL. Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis. Journal of abnormal child psychology. 2019;47(1):165. pmid:29497980.
- 64. Karjalainen L, Gillberg C, Råstam M, Wentz E. Eating disorders and eating pathology in young adult and adult patients with ESSENCE. Comprehensive psychiatry. 2016;66:79. pmid:26995240.
- 65. Lever AG, Geurts HM. Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. 2016;46(6):1916. pmid:26861713.
- 66. Pehlivanidis A, Papanikolaou K, Mantas V, Kalantzi E, Korobili K, Xenaki L-A, et al. Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD). BMC psychiatry. 2020;20(1):423. pmid:32847520.
- 67. Russell AJ, Murphy CM, Wilson E, Gillan N, Brown C, Robertson DM, et al. The mental health of individuals referred for assessment of autism spectrum disorder in adulthood: A clinic report. Autism: the international journal of research and practice. 2016;20(5):623. pmid:26471427.
- 68. Rydzewska E, Hughes-McCormack L, Gillberg C, Henderson A, MacIntyre C, Rintoul J, et al. Prevalence of sensory impairments, physical and intellectual disabilities, and mental health in children and young people with self/proxy-reported autism: Observational study of a whole country population. Autism: the international journal of research and practice. 2019;23(5):1201. pmid:30328695.
- 69. Schott W, Tao S, Shea L. Co‐occurring conditions and racial‐ethnic disparities: Medicaid enrolled adults on the autism spectrum. Autism Research. 2022;15(1):70–85. pmid:34854249
- 70. Solberg BS, Zayats T, Posserud M-B, Halmøy A, Engeland A, Haavik J, et al. Patterns of Psychiatric Comorbidity and Genetic Correlations Provide New Insights Into Differences Between Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Biological psychiatry. 2019;86(8):587. pmid:31182215.
- 71. Benevides TW, Shore SM, Andresen M-L, Caplan R, Cook B, Gassner DL, et al. Interventions to address health outcomes among autistic adults: A systematic review. Autism: the international journal of research and practice. 2020;24(6):1345–59. pmid:32390461.
- 72. Marquez-Garcia AV, Magnuson J, Morris J, Iarocci G, Doesburg S, Moreno S. Music Therapy in Autism Spectrum Disorder: a Systematic Review. Review Journal of Autism and Developmental Disorders. 2021.
- 73. Bishop-Fitzpatrick L, Minshew NJ, Eack SM. A systematic review of psychosocial interventions for adults with autism spectrum disorders. Journal of Autism and Developmental Disorders. 2013;43(3):687. pmid:22825929.
- 74. Byrne G, O’Mahony T. Acceptance and commitment therapy (ACT) for adults with intellectual disabilities and/or autism spectrum conditions (ASC): A systematic review”. Journal of Contextual Behavioral Science. 2020;18:247.
- 75. Dandil Y, Smith K, Kinnaird E, Toloza C, Tchanturia K. Cognitive Remediation Interventions in Autism Spectrum Condition: A Systematic Review. Frontiers in Psychiatry. 2020;11. PubMed PMID: Art. No.: 722. pmid:32793009
- 76. Davis KS, Kennedy SA, Dallavecchia A, Skolasky RL, Gordon B. Psychoeducational Interventions for Adults With Level 3 Autism Spectrum Disorder: A 50-Year Systematic Review. Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology. 2019;32(3):139–63. pmid:31517698.
- 77. Dubreucq J, Haesebaert F, Plasse J, Dubreucq M, Franck N. A systematic review and meta-analysis of social skills training for adults with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2022;52(4):1598–609. PubMed PMID: 2021-44981-001. pmid:33963965
- 78. Fong CJ, Taylor J, Berdyyeva A, McClelland AM, Murphy KM, Westbrook JD. Interventions for improving employment outcomes for persons with autism spectrum disorders: A systematic review update. Campbell Systematic Reviews. 2021;17(3). PubMed PMID: Art. No.: e1185. pmid:37052419
- 79. Hartley M, Dorstyn D, Due C. Mindfulness for Children and Adults with Autism Spectrum Disorder and Their Caregivers: A Meta-analysis. Journal of Autism and Developmental Disorders. 2019;49(10):4306. pmid:31342444.
- 80. Hedley D, Uljarević M, Cameron L, Halder S, Richdale A, Dissanayake C. Employment programmes and interventions targeting adults with autism spectrum disorder: A systematic review of the literature. Autism: the international journal of research and practice. 2017;21(8):929. pmid:27542395.
- 81. Im DS. Treatment of aggression in adults with autism spectrum disorder: A review. 2021;29(1):35.
- 82. Lee GK, Chun J, Hama H, Carter EW. Review of Transition and Vocational Interventions for Youth and Adults with Autism Spectrum Disorder. Review Journal of Autism and Developmental Disorders. 2018;5(3):268.
- 83. Lorenc T, Rodgers M, Marshall D, Melton H, Rees R, Wright K, et al. Support for adults with autism spectrum disorder without intellectual impairment: Systematic review. Autism: the international journal of research and practice. 2018;22(6):654. pmid:28683565.
- 84. Menezes M, Harkins C, Robinson MF, Mazurek MO. Treatment of Depression in Individuals with Autism Spectrum Disorder: A Systematic Review. Research in Autism Spectrum Disorders. 2020;78. PubMed PMID: Art. No.: 101639.
- 85. Munandar VD, Morningstar ME, Carlson SR. A systematic literature review of video-based interventions to improve integrated competitive employment skills among youth and adults with Autism Spectrum Disorder. Journal of Vocational Rehabilitation. 2020;53(1):29.
- 86. Nicholas DB, Attridge M, Zwaigenbaum L, Clarke M. Vocational support approaches in autism spectrum disorder: A synthesis review of the literature. Autism. 2015;19(2):235. pmid:24449603
- 87. Ogawa Y, Itani O, Jike M, Watanabe N. Psychosocial Interventions for Employment of Individuals with Autism Spectrum Disorder: a Systematic Review and Meta-analysis of Randomized Clinical Trials. Review Journal of Autism and Developmental Disorders. 2021.
- 88. Preti A, Melis M, Siddi S, Vellante M, Doneddu G, Fadda R. Oxytocin and autism: A systematic review of randomized controlled trials. Journal of child and adolescent psychopharmacology. 2014;24(2):54. pmid:24679173
- 89. Roy A, Roy M, Deb S, Unwin G. Are opioid antagonists effective in reducing self-injury in adults with intellectual disability? A systematic review. Journal of intellectual disability research: JIDR. 2015;59(1):55. pmid:24397316.
- 90. Schall C, Wehman P, Avellone L, Taylor JP. Competitive Integrated Employment for Youth and Adults with Autism: Findings from a Scoping Review. Psychiatric Clinics of North America. 2020;43(4):701. pmid:33127003
- 91. Sinha Y, Silove N, Hayen A, Williams K. Auditory integration training and other sound therapies for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews. 2011:N.PAG-N.PAG. PubMed PMID: 105837819. Language: English. Entry Date: 20111014. Revision Date: 20150711. Publication Type: Journal Article.
- 92. Spain D, Blainey SH. Group social skills interventions for adults with high-functioning autism spectrum disorders: A systematic review. Autism. 2015;19(7):874. pmid:26045543
- 93. Spain D, Sin J, Chalder T, Murphy D, Happé F. Cognitive behaviour therapy for adults with autism spectrum disorders and psychiatric co-morbidity: A review. Research in Autism Spectrum Disorders. 2015;9:151.
- 94. Spain D, Sin J, Harwood L, Mendez MA, Happé F. Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review. Advances in Autism. 2017;3(1):34.
- 95. Spain D, Sin J, Paliokosta E, Furuta M, Prunty JE, Chalder T, et al. Family therapy for autism spectrum disorders. The Cochrane database of systematic reviews. 2017;5:CD011894. pmid:28509404.
- 96. Speyer R, Chen YW, Kim JH, Wilkes-Gillan S, Nordahl-Hansen AJ, Wu HC, et al. Non-pharmacological Interventions for Adults with Autism: a Systematic Review of Randomised Controlled Trials. Review Journal of Autism and Developmental Disorders. 2021.
- 97. Taylor JL, McPheeters ML, Sathe NA, Dove D, Veenstra-Vanderweele J, Warren Z. A systematic review of vocational interventions for young adults with autism spectrum disorders. Pediatrics. 2012;130(3):531. pmid:22926170.
- 98. Taylor LJ. Psychopharmacologic intervention for adults with autism spectrum disorder: A systematic literature review. Research in Autism Spectrum Disorders. 2016;25:58.
- 99. Weston L, Hodgekins J, Langdon PE. Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clinical psychology review. 2016;49:41. pmid:27592496
- 100. Williams K, Brignell A, Randall M, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews. 2013;(8). PubMed PMID: CD004677. pmid:23959778
- 101. Wilson KP, Steinbrenner JR, Kalandadze T, Handler L. Interventions Targeting Expressive Communication in Adults With Autism Spectrum Disorders: A Systematic Review. Journal of speech, language, and hearing research: JSLHR. 2019;62(6):1959. pmid:31091173.
- 102. Spain D, Happé F. How to Optimise Cognitive Behaviour Therapy (CBT) for People with Autism Spectrum Disorders (ASD): A Delphi Study. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2020;38(2):184–208.
- 103. Cassidy SA, Bradley L, Bowen E, Wigham S, Rodgers J. Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review. Clinical psychology review. 2018;62:56–70. pmid:29778930.
- 104. Weld-Blundell I, Shields M, Devine A, Dickinson H, Kavanagh A, Marck C. Vocational Interventions to Improve Employment Participation of People with Psychosocial Disability, Autism and/or Intellectual Disability: A Systematic Review. International Journal of Environmental Research and Public Health. 2021;18(22):12083. pmid:34831840
- 105. Brede J, Cage E, Trott J, Palmer L, Smith A, Serpell L, et al. ’We have to try to find a way, a clinical bridge’—autistic adults’ experience of accessing and receiving support for mental health difficulties: A systematic review and thematic meta-synthesis. Clinical Psychology Review. 2022;93:1–23. PubMed PMID: 2022-52858-001. pmid:35180632