The experience of autistic adults accessing adapted cognitive behaviour therapy: ADEPT (Autism Depression Trial) qualitative evaluation

Background: High rates of depression are frequently reported in autistic adults. There have been no randomised trials investigating low-intensity psychological interventions for mild-moderate depression adapted for autistic adults. Method: This qualitative evaluation investigated the acceptability of the ADEPT pilot randomised controlled trial (RCT) design and guided self-help intervention. Participants (autistic adults with a diagnosis of depression (PHQ-9 score >= 10)) were randomised to Guided Self-Help (GSH): low intensity psychological intervention based on Behavioural Activation adapted for autistic adults, or Treatment as Usual (TAU). 21 trial participants (14 GSH and 7 TAU), and 5 low intensity psychological therapists or 'coaches' were interviewed, and transcripts analysed thematically. Results: All participants and coaches welcomed an intervention for depression adapted for autistic adults due to current lack of provision in mainstream services. Interviews highlighted partici-pants' preference for GSH over TAU. Dissatisfaction with prior experience of TAU was identified as a potential driver for differential attrition from the TAU arm. Participants who received GSH appreciated the coaches having a good understanding of autistic adults and were positive towards the aim and structure of the GSH intervention. Suggested improvements include more regularly checking progress with therapy goals. Conclusions: A full scale RCT to evaluate the effectiveness of this intervention is now warranted. Future trial study design needs to address potential for differential rate of participant recruitment and attrition between the treatment and comparison groups due to negative prior experience of TAU.

Automated summary

All participants and coaches welcomed the intervention adapted for autistic adults due to a lack of provision in mainstream services. Participants showed a preference for GSH over TAU, with dissatisfaction with TAU being a potential reason for attrition. Those who received GSH appreciated the coaches' understanding of autistic adults and were positive towards the intervention's aim and structure. More regular progress checks with therapy goals were suggested for improvement. A full scale RCT to evaluate the effectiveness of this intervention is now warranted, with future trial design needing to address potential differential recruitment and attrition rates between treatment and comparison groups due to negative prior experiences with TAU.