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

Jeremy Horwood, Kate Cooper, Hannah Harvey, Lauren Davies, Ailsa Russell

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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 participants 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.
Original languageEnglish
Article number101802
JournalResearch in Autism Spectrum Disorders
Early online date25 May 2021
Publication statusPublished - 31 Aug 2021


  • Adults
  • Autism spectrum disorders
  • Cognitive behaviour therapy
  • Depression
  • Qualitative research

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Clinical Psychology
  • Psychiatry and Mental health


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