Study Finds Standard Therapy May Not Work for Many Autistic Adults

by Craig Perryman | 31 Mar 2026

At a glance

Mixed results from standard therapy: A large study of over 7,000 autistic adults in England found many saw little improvement in depression and anxiety symptoms from standard psychological treatments.
Early progress may predict outcomes: Researchers identified different symptom trajectories during therapy and found treatment response could often be predicted within the first few sessions.
Need for more tailored support: Factors such as daily functioning difficulties and social inequalities were linked to poorer outcomes, highlighting the importance of adapting mental health care for autistic people.

New research analysing thousands of therapy cases across England suggests many autistic adults see little improvement from standard treatments, highlighting the need for more tailored mental health care.

A study published in Nature Mental Health suggests that autistic adults experience mixed outcomes when receiving standard psychological therapies for depression and anxiety. While some individuals improve, many see little change in their symptoms and a smaller group experience worsening mental health.

The researchers analysed data from the MODIFY dataset, which includes information from routine mental health services across England. The study focused on 7,175 autistic adults who accessed therapy for anxiety or depression between 2012 and 2019 and attended at least three treatment sessions. Changes in symptoms were tracked across the first eight sessions using widely used questionnaires that measure depression and anxiety severity.

Using statistical modelling, the researchers identified several patterns in how symptoms changed over time. For depression, five different trajectories emerged. Most autistic individuals with moderate to severe depression showed little improvement or only limited progress during treatment. A smaller group experienced gradual improvement, while a small number recovered quickly. A minority saw their symptoms worsen.

For anxiety, seven different patterns of change were identified. As with depression, most participants experienced minimal improvement. Some showed gradual or rapid improvements, while a small proportion began therapy with moderate anxiety that later worsened into severe anxiety.

Explaining the study’s aim, researcher Pender said:

“We used large-scale data from routine mental health services across England to explore how symptoms of depression and anxiety changed for autistic people during therapy. We looked at different patterns of improvement, worsening, or little change, and examined which factors were linked to direction or speed of change.”

The researchers also found that a person’s likely treatment trajectory could often be identified early in the process. According to Pender, “This may be an important point to review progress and consider adapting the approach if needed.”

Certain background factors were linked to poorer outcomes. Individuals who reported greater difficulties with daily functioning before treatment began were less likely to improve, particularly those who struggled with social leisure activities such as attending social gatherings or dating. Many autistic people engage in camouflaging in these situations, masking autistic traits in order to fit in socially. Over time this effort can lead to severe exhaustion known as autistic burnout, which may make it harder to benefit from therapies that encourage increased social interaction.

Demographic factors also appeared to influence treatment success. Participants from ethnically minoritized groups in England were more likely to experience worsening anxiety symptoms during therapy compared with white participants. This finding suggests that social and structural inequalities may affect how people experience mental health services.

The researchers note several limitations. The questionnaires used to measure anxiety and depression were developed for the general population and may not fully capture how autistic people experience distress. The dataset also did not record whether therapies were adapted to meet autistic patients’ needs, and the study did not include people who dropped out of therapy before attending three sessions.

Despite these limitations, the findings highlight the need for mental health services to better support autistic individuals. As Pender explained, “The findings of this study underline the importance of adapting psychological interventions for autistic people.”