neurodiversity sensitive therapy for autism
LinkedIn

Summary: Neurodiversity-informed inpatient mental health care for people with autism – a.k.a. autism spectrum disorders (ASD) – is an approach to inpatient treatment that adopts an affirming, strengths-based approach to supporting people with ASD and co-occurring disorders in an inpatient treatment setting.

Key Points:

  • Neurodivergence can create unique needs among people with ASD and co-occurring mental health disorders seeking professional treatment and support.
  • Neurodiversity-informed inpatient mental health care for people with autism (ASD) is a new concept, with very few programs designed for this specific demographic.
  • Designing inpatient mental health treatment programs for people with ASD requires the input of people with ASD, first and foremost.
  • Specialized clinician training and the ability to adapt existing therapies to meet the challenges and leverage the assets associated with neurodivergence can make treatment programs acceptable and effective for people with ASD.

Autism Spectrum Disorders (ASD) and Co-Occurring Mental Health Disorders

When people with autism spectrum disorders seek treatment and support for a co-occurring mental health disorder, experts in ASD and mental health treatment report they frequently share the following common experience:

“Autistic adults…report unhelpful experiences when engaging with mental health support. Limited clinician knowledge of autism and a failure to tailor neurotypical approaches may be contributing factors.”

That quote appears in a recent publication called “Developing a Neurodiversity-Affirming Group Therapy Program for Autistic Adults Through Co-Design,” in which a group of mental health providers specializing in neurodiversity – with a focus on autism and ASD – designed a study with the following goal:

“[We] attempted to harness the ideas, thoughts, and preferences of autistic adults in the design of mental health treatment options, best suited to their needs, and steps towards the ’nothing about us, without us’ ideology.”

This information begs an important question we should answer before we discuss the topic further:

How common are co-occurring mental health disorders among people with ASD?

We’ll share that data now.

How Many People With ASD Have Co-Occurring Mental Health Disorders?

First, however, the bigger picture.

Data published by the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) estimate that ~3.2 percent of children in the U.S. have an ASD diagnosis, and that ~2.2 percent of adults in the U.S. have an ASD diagnosis, or around 2.3 million children and 5.8 million adults.

Next, the data on the prevalence of co-occurring mental health disorders among people with ASD, which we collected from two sources:

  1. A meta-analysis published in 2019 called “Prevalence of Co-Occurring Mental Health Diagnoses in the Autism Population: A Systematic Review And Meta-Analysis.”
  2. A meta-analysis published in 2023 called “Prevalence of Co-Occurring Conditions in Children and Adults With Autism Spectrum Disorder: A Systematic Review And Meta-Analysis.”

These two large-scale reviews – with data from over half a million people with autism/ASD – show the following:

ASD and Mental Health Disorders: Latest Prevalence Estimates

Note: variability in prevalence between adults and children in study two reflect variation in pooled estimates from studies reporting wide ranges of incidence/occurrence.

Attention-deficit hyperactivity disorder:

  • 2019: 28%
  • 2023 (total): 37%
    • Adults: 22%
    • Children: 45%

Anxiety disorders:

  • 2019: 20%
  • 2023: 35%
    • Adults: 28%
    • Children: 42%

Sleep–wake disorders:

  • 2019: 13%
  • 2023: 25%
    • Adults: 21%
    • Children: 30%

Disruptive, impulse-control, and conduct disorders:

  • 2019: 12%
  • 2023: 17%
    • Adults: 7%
    • Children: 20%

Depressive disorders:

  • 2019: 11%
  • 2023: 18%
    • Adults: 34%
    • Children: 19%

Obsessive-compulsive disorder:

  • 2019: 9%
  • 2023: 9%
    • Adults: 10%
    • Children: 10%

Bipolar disorders:

  • 2019: 5%
  • 2023: 7%
    • Adults: 9%
    • Children: 7%

Schizophrenia spectrum disorders:

  • 2019: 4%
  • 2023: 10%
    • Adults: 10%
    • Children: 10%

To ensure we’re on the same page for the rest of this article, here’s a very brief, non-clinical description of ASD and its main characteristics.

Autism Spectrum Disorder (ASD): Fast Facts

Defining features:

  • Differences in social communication and interaction in more than one context, i.e. at home and at school.
  • Focused and repetitive patterns of behavior, interest, and activity, i.e. self-soothing behaviors considered atypical by people without ASD.
  • Resistance to change/novelty, i.e. dislike of/difficulty with transitions and disruptions to chosen schedule.
  • Severity of ASD can vary from barely detectable to highly disruptive.

With all of that in mind, let’s take a look at what people with ASD themselves say should be core components of neurodiversity-informed inpatient mental health care for people with autism.

Inpatient Mental Health Care: What Do People with ASD Need?

Two things from the “Developing a Neurodiversity-Affirming Group Therapy Program for Autistic Adults Through Co-Design” study leap out and require immediate attention. First, in that group of adults with ASD, their stated preference was for inpatient group treatment. Second, people with ASD need people without ASD or people unfamiliar with neurodivergence to understand the double-empathy problem, defined as follows:

“The double-empathy problem was conceptualized to highlight that neurotypical people are just as likely to misunderstand and misinterpret the intentions and communication style of autistic people, as autistic people are likely to do in reverse.”

A lack of awareness of the double-empathy problem can have negative outcomes:

“If clinicians (mistakenly) anchor all issues with misunderstanding as related to the client’s skill set and communication abilities, rather than being aware of the gaps in their own understanding about autistic communication, this can lead to significant issues with rapport building and therapeutic effectiveness.”

With those two things heard – or read – and understood, let’s take a look at the details of what an inpatient group therapy program can look like, according to adults with ASD.

Program Type, Components, Delivery, Content

1. Type: Inpatient, Group.

Participants overwhelmingly endorsed an inpatient group therapy Reasons included:

    • Safety in numbers. A sense of solidarity with other people with ASD can increase participation and engagement. Maximum preferred group size: 10.
    • Sensory challenges. When everyone in the room understands the impact of sensory stimulation, asking for an ASD-friendly environment doesn’t feel stigmatizing.
    • Social masking. People with ASD often hide their individual traits in order to fit in with neurotypical peers. This can have a negative impact on disclosure and comfort in discussing difficult topics. An ASD specific or neurodiverse-specific group will likely reduce the frequency and impact of social masking.
    • Provider attitudes. Adults with ASD and therapists observed that communication from providers “perceived as condescending, patronizing, and infantilizing” would be regulated, and less likely, in a group context.

2. Length: Two Weeks, 2.5 hrs./day.

Participants endorsed – after collaborative discussion with differing views – a two-week residential program including 10 active therapy days with about 2.5 hours of therapy time per day. Reasons included:

    • Less chance of being overwhelmed by information.
    • Time to understand and process new information.
    • Long enough to get comfortable and learn
    • Short enough to promote participation

3. Therapeutic Modalities: DBT, ACT, Complementary support.

Participants endorsed specific treatment modalities, including DBT, ACT, and complementary suppor. Reasons included:

    • Dialectical behavioral therapy (DBT). Mindfulness, distress tolerance, and emotion regelation skills identified as practical, acceptable, and effective.
    • Acceptance and commitment therapy (ACT). This approach allows people with ASD to define treatment goals based on personal values, individual needs, and self-identified motivation for engaging in treatment. ACT focuses on developing self-defined values-driven behavior rather than focusing on reducing symptoms.
    • Complementary therapies. Adults with ASD endorsed including art, music, games, and experiences outside the typical treatment milieu.

4. Content, Education, Process.

Participants endorsed inclusion of focus groups on understanding autism, DBT skills, and predetermined guidelines for participation in groups. Reasons included:

    • Understanding/knowing what to expect ahead of time facilitates participation and decreases anxiety.
      • Learning more about autism itself can help participants learn more about themselves and their peers. Paper handouts and visual aids endorsed/encouraged.
    • Knowing group rules and norms ahead of time improves adherence and comfort. For example, participants want to know ahead of time if sensory aids are allowed, how discussions will actually work, and how confidentiality guidelines and practices work.

5. Follow-up, Ongoing Care.

Participants endorsed plans for ongoing care after formal program. Reasons included:

    • Desire to stay connected with peers after treatment.
    • Desire to consolidate and expand treatment progress.
    • Preference for group-only, dedicated platform for communication.
    • Some interest in creating Initial and Graduate programs, where graduate programs last longer for those interested in extending formal treatment and care.

Those five items and related subitems reflect what one group of adults with ASD, in collaboration with therapist-facilitators, identify as the things they’d like to see and/or experience in a neurodiversity-informed inpatient mental health care for people with autism.

We’ll discuss this content further, below.

Treating Co-Occurring Mental Health Disorders in People With ASD

When a group of people stand up and say, “Nothing about us without us,” it implies that they’ve been left out of the conversation before, and that exclusion skewed the outcome of the thing they’re talking about. In this case, the thing is mental health treatment for people with ASD.

But we need to be more specific than that. Here’s an important reminder:

This article, the study we cite, and the information we share are not about treatment for autism or ASD.
The five items on the list refer to how people with ASD – if asked – would design an inpatient program for people with ASD and a co-occurring mental health disorder. The components are designed to facilitate healing for people with ASD + depression, ASD + anxiety, and/or people with ASD + [any treatable mental health disorder].

While the group participating in this collaborative treatment program design was relatively small, this specific research built on years of previous research that included significant participation from people with ASD, people with ASD with co-occurring mental health disorders, and treatment providers with substantial skill and experience supporting people with autism and people with co-occurring mental health disorders and ASD.

In the past, a poor understanding of ASD, a lack of specialized training for mental health providers on ASD, and stigma and misconceptions about autism meant that many people with autism and a co-occurring mental health disorder did not get the full range of treatment and support for the challenges they face on a daily basis.

Now, with the input of the people with ASD, in collaboration with professional treatment providers, we can begin to understand what people with autism want and need in a mental health treatment program. This new information enables providers to offer appropriate care to this unique demographic group, and improve their chance at effectively managing mental health symptoms, which can help them learn, grow, and thrive on their own terms, in their own way, and in a supportive, compassionate environment focused on integrated, holistic, and comprehensive health and wellbeing.

Additional Reading and Resources

To learn more about neurodiversity, please read this article on our blog:

Am I Neurodivergent?

To learn about how we approach neurodiversity, please read our treatment page:

Neurodivergence Management and Support

For an in-depth look at neurodiversity, and to understand what people mean when they say The Neurodiversity Movement, please read this article from the National Autistic Society in the U.K.:

The Neurodiversity Movement

Finding Help: Online Resources for Mental Health Support

If you or someone you know needs professional mental health treatment and support, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.