Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials.

This large review looked at treatments for anxiety, depression and other mental health issues in autistic people. It found that some types of talking therapy (cognitive behavioural therapy and mindfulness) might help autistic people without intellectual disability, but more research is needed. Medications aimed at autism traits didn't help with mental health. The researchers suggest using the same mental health treatments that work for non-autistic people until we have better evidence.

This systematic review and network meta-analysis examined 71 randomised controlled trials (3,630 participants) investigating interventions for mental health conditions in autistic people. The review found that nearly three-quarters of autistic people experience mental health problems including stress, anxiety, and depression. For autistic people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy showed potential benefits, though further research is needed. Medications targeting core autism features did not improve mental health outcomes.

The studies only reported short-term outcomes and did not provide evidence for people with intellectual disability. Current evidence suggests following mental health treatment guidelines developed for non-autistic populations until more autism-specific research becomes available.

Clinicians should consider CBT and mindfulness-based interventions for autistic people without intellectual disability experiencing mental health conditions. Avoid medications targeting core autism features for mental health treatment. Follow evidence-based mental health guidelines developed for non-autistic populations as interim approach while awaiting autism-specific research.

Studies only reported short-term outcomes, limiting understanding of long-term effectiveness. No evidence was available for autistic people with intellectual disability, representing a significant research gap. The review notes that further research is necessary to confirm preliminary findings about CBT and mindfulness interventions.

Nearly three out of four autistic people experience mental health problems such as stress, anxiety or depression. The research already done does not guide us on how best to prevent or treat mental health problems for autistic people. Our aim was to look at the benefits and harms of different interventions on mental health outcomes in autistic people. We searched all the published randomised controlled trials (RCTs) about interventions for mental health conditions in autistic people until 17 October 2020.

We also searched for RCTs that were not published in peer-reviewed journals. These were obtained from registers of clinical trials online. We then combined the information from all these trials using advanced statistical methods to analyse how good the interventions are. Seventy-one studies (3630 participants) provided information for this research.

The studies reported how participants were responding to the intervention for only a short period of time. The trials did not report which interventions worked for people with intellectual disability. In people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy may be helpful. However, further research is necessary.

Many trials used medications to target core features of autism rather than targeting mental health conditions, but these medications did not help autistic people. Until we have more evidence, treatment of mental health conditions in autistic people should follow the evidence available for non-autistic people. We plan to widely disseminate the findings to healthcare professionals through medical journals and conferences and contact other groups representing autistic people.