Psychological Intervention to Treat Depression in autistic adolescents
Research type
Research Study
Full title
Developing a Remotely Delivered Psychological Intervention to Treat Depression in Adolescents with Autism Spectrum Disorder: A Case Series Design
IRAS ID
303173
Contact name
Matthew Hollocks
Contact email
Sponsor organisation
South London and Maudsley NHS Foundation Trust
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 10 months, 31 days
Research summary
Research Summary
Around 700,000 people in the UK have autism, and at least 11% of this population suffer from depression across all ages. Depression tends to emerge in adolescence, increasing up to 23% in adulthood. However, there are no psychological interventions with demonstrated efficacy for treating depression accessible for autistic adolescents. Adaptations are needed, considering differences in communication and neuro-cognitive differences.
We will develop a psychological intervention, for autistic adolescents (aged 13-19 years) with co-occurring depression. The intervention will be based on the principles of behavioural activation (BA), and prior advice from autistic adolescents and NHS Clinicians. It is hoped participants will benefit from a specifically adapted intervention. This will be delivered via tele-therapy and developed as a part of a co-design case series with young people. As a part of this case series, we will measure whether young people find this intervention acceptable and if it is feasible to move on to a pilot RCT. The intervention will include 12 sessions with content including i) increasing understanding about autism and low mood, ii) managing emotions, and iii) promoting positive activities & behaviours. Between session tasks, commonly used in BA and CBT, will also be used and agreed with participants. Participants will be recruited through NHS services. Acceptability and Feasibility of the intervention will be measured using participant and carer interview, retention rates of therapy, and drop-out rates. Clinical outcomes will be used as a secondary measure.
Procedure:
- Develop resources to help with adaptation, utilizing the current evidence base for depression in adult autism, and resources for BA used in adult autism.
- Deliver an adapted manualized intervention to 8-10 young people with autism and depression, via Microsoft Teams. The intervention is intended to be for 12 sessions, and to last between 12 and 16 weeks. The study is intended to be complete by August 2023.Summary of Results
Previous research has suggested autistic individuals are more likely to develop depression compared to neuro-typical populations. However, there is limited evidenced based intervention for depression, adapted specifically for autistic young people. CBT without adaptation is likely to be more less effective for autistic individuals – including difficulty identifying emotions, not considering restrictive and repetitive behaviours, and social communication difficulties. We propose that Behavioural Activation may be effective at intervening with depression in autistic adolescents – especially when the manual/approach used is co-designed from autistic adolescents. We explored whether an online treatment called Behavioural Activation (BA, an evidence-based treatment for depression involving increasing pleasurable activity), is effective for autistic adolescents with low mood.
After holding a co-design group with autistic adolescents, and adapting the intervention, we recruited 7 autistic young people with depression, by using a method called case-iterative design: providing therapy for two young people, reviewing if the therapy is working and asking patients for their feedback, making any necessary adaptations, and then providing another two people with therapy, and so on.
We evaluated this treatment by looking at how many people completed treatment, questionnaires, and interview feedback. We found positive results; 86% of people completed the treatment protocol, and 4 out of 6 participants who completed the intervention found a reliable reduction in at least one depression or anxiety score. From interview feedback, 100% of participants & parents who completed the intervention recommended this intervention to other autistic adolescents, and 100% of participants & parents found this intervention to be a positive experience. 4 themes from feedback interviews were noted: Connecting with the therapist, Benefits with online therapy, Behaviour change, & barriers to accessing therapy.
Overall in autistic adolescents, there are positive indications for future clinical use of online interventions, with those experiencing low mood. However, interpretation should be cautious at this stage - and future larger scale study is indicated.
REC name
London - Brent Research Ethics Committee
REC reference
22/LO/0368
Date of REC Opinion
28 Jun 2022
REC opinion
Further Information Favourable Opinion