Fit-for-purpose Psychological Interventions to Support the Well-Being of Autistic Adults: A Systematic Review

Autism Dev Lang Impair. 2026 May 15;11:23969415261436238. doi: 10.1177/23969415261436238. eCollection 2026 Jan-Dec.

ABSTRACT

BACKGROUND AND AIMS: There are high levels of co-occurring mental health diagnoses reported for autistic adults, yet research into psychological interventions that support wellbeing is only just emerging. This mixed-methods systematic review characterized all available psychological interventions for autistic adults, the measures used to evaluate their effectiveness, the extent to which the interventions have been designed or adapted for autistic people, and the elements theorized to contribute to wellbeing.

METHODS: A protocol was registered with PROSPERO (CRD42023385232) before commencement. The review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A Patient and Public Involvement process sought input from an expert panel of autistic counselors who work with autistic people to develop the search strategy. All study designs were included in the review to meet the objective of summarizing the available evidence since 2012, the point at which National Institute for Health and Care Excellence introduced Clinical Guidelines for working with autistic adults in the United Kingdom. Screening was performed on 100% of the records by two independent reviewers. Risks of bias that can occur in autism research specifically were assessed. Quality appraisal was undertaken using the Quality Assessment Tool for Studies with Diverse Designs. Mixed-methods and qualitative syntheses were used to summarize the findings.

MAIN CONTRIBUTION: A total of 4,186 papers were identified from the literature search, resulting in 69 papers meeting the criteria for inclusion. The majority (n = 42) were pilot or exploratory designs. Few studies identified how adaptations to existing therapeutic interventions affected wellbeing outcomes. Similarly, few studies described the theorized mechanisms of change in reported wellbeing or designed interventions specifically for autistic people.

CONCLUSIONS: There are few empirical studies of psychological interventions for autistic adults, and imprecise definitions of what wellbeing means for autistic people demonstrate conceptual and methodological ambiguity. Further discussion to agree community-based prioritization of the relevance of mental health outcomes is required. A minority of studies (n = 29) used outcome measures designed for, or standardized with, autistic people. The most common therapeutic interventions were based on mindfulness or cognitive-behavioral therapies, suggesting limited choice of evidence-based psychological interventions for autistic people and practitioners.

IMPLICATIONS: Research into improving the wellbeing of autistic adults is still at an early stage of development, principally focused on assessing the feasibility of interventions. Current intervention studies are reliant on outcome measures with unknown suitability to evaluate meaningful change for autistic adults. This review provides an essential point of reference for clinical researchers and practising clinicians. A list of outcome measures that have been validated for use with autistic people is shared as a finding. The findings add to literature advocating for neurodiversity-affirmative clinical and research practices, which incorporate autistic phenomenology and recommend a critical approach towards psychological interventions.

PMID:42152856 | PMC:PMC13180214 | DOI:10.1177/23969415261436238