The feasibility of low-intensity psychological therapy for depression co-occurring with autism in adults: The Autism Depression Trial (ADEPT) – a pilot randomised controlled trial
Open accessAbstract
Low-intensity cognitive behaviour therapy including behavioural activation is an evidence-based treatment for depression, a condition frequently co-occurring with autism. The feasibility of adapting low-intensity cognitive behaviour therapy for depression to meet the needs of autistic adults via a randomised controlled trial was investigated. The adapted intervention (guided self-help) comprised materials for nine individual sessions with a low-intensity psychological therapist. Autistic adults (n = 70) with depression (Patient Health Questionnaire-9 score ⩾10) recruited from National Health Service adult autism services and research cohorts were randomly allocated to guided self-help or treatment as usual. Outcomes at 10-, 16- and 24-weeks post-randomisation were blind to treatment group. Rates of retention in the study differed by treatment group with more participants attending follow-up in the guided self-help group than treatment as usual. The adapted intervention was well-received, 86% (n = 30/35) of participants attended the pre-defined ‘dose’ of five sessions of treatment and 71% (25/35) attended all treatment sessions. The findings of this pilot randomised controlled trial indicate that low-intensity cognitive behaviour therapy informed by behavioural activation can be successfully adapted to meet the needs of autistic people. Evaluation of the effectiveness of this intervention in a full scale randomised controlled trial is now warranted.
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A smaller proportion of participants completed questionnaires at follow up than those who completed interviews at the same time point, although questionnaire return rate was in line with other recent research.
“A smaller proportion of participants completed questionnaires at follow up than those who completed interviews at the same time point, although questionnaire return rate was in line with other recent research (e.g., Russell et al., 2020).”
Participant retention and attrition were comparable to other similar feasibility RCTs in this population, including in the control group where uptake of the psychoeducational sessions was good.
“Participant retention and attrition were comparable to other similar feasibility RCTs in this population (Russell et al., 2020), including in the control group where uptake of the psychoeducational sessions was good.”
Only one study included participants with intellectual disability.
“Only one study included participants with intellectual disability.48”
From Approaches to improving mental healthcare for autistic people: Systematic review (2024) · cites this paper as [48]
The Methods > Participants section lists eligibility and exclusions but does not say whether any participants had intellectual disability. The Results > Baseline characteristics section does not report intellectual-disability status either. Searches for “intellectual disability,” “learning disability,” and cognitive impairment found no passage establishing that this trial included such participants. (LLM, conf=0.72)
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- Horwood J. Cooper K. Harvey H. Evans L. Russell A. (2018). Qualitative evaluation of a low-intensity psychological intervention for depression in adults with autism: The Autism Depression Trial (ADEPT) [Conference session]. International Society for Autism Research, Rotterdam. https://insar.confex.com/insar/2018/webprogram/Paper27708.html.
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Self-citationGhumman, U., Shafee, C., Altarawneh, L. N., Iorini, M., Kandel, H., Anand, N., Lopez, A., Mendoza, J., Romero, E., Dang, A., et al. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1906750
- Authors
- Russell, A., Gaunt, D. M., Cooper, K., Barton, S., Horwood, J., Kessler, D., Metcalfe, C., Ensum, I., Ingham, B., Parr, J. R., Rai, D., & Wiles, N.
- Affiliations
- University of Bath (GB)
- University of Bristol (GB)
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust (GB)
- Avon and Wiltshire Mental Health Partnership NHS Trust (GB)
- Corresponding author
- Russell, Ailsa
- ORCID
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2019-11-29
- Volume
- 24
- Issue
- 6
- Pages
- 1360-1372
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- PMC
- PMC8645299
- OpenAlex
- W2991110875
- Cited by
- 48
- References
- 41
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 17 · 2023: 6 · 2022: 2 · 2021: 7 · 2019: 1
- FWCI
- 2.82
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-12-09)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Autism (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (acceptedVersion, other-oa)
- Pure (University of Bath) (submittedVersion, cc-by-nc)
- Funders
- Health Technology Assessment Programme (14/043)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, autistic adults, behavioral activation, guided self-help, feasibility, treatment retention
- MeSH terms
- Autism Spectrum Disorder, Adult, Autistic Disorder, Cost-Benefit Analysis, Depression, Feasibility Studies, Humans, Pilot Projects, State Medicine, Treatment Outcome
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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