Comparing mental health treatment outcomes for autistic and non-autistic people: a systematic review
- 1NIHR Policy Research Unit in Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's C
Abstract
BackgroundAutistic people experience substantially higher rates of mental health conditions and are overrepresented in mental health services. However, most interventions and service models have been developed for non-autistic people, and evidence is needed as to whether there are disparities in outcomes. This systematic review aimed to compare outcomes between autistic and non-autistic people receiving the same mental health interventions or services.
MethodsWe conducted a systematic review following PRISMA guidelines (PROSPERO: CRD420251021068). We searched academic databases (MEDLINE, Embase, PsycINFO, PubMed, CINAHL), a grey literature database (HMIC), a trial registry (ISRCTN), preprint servers (medRxiv and PsyArXiv), Google, and Google Scholar, to identify relevant papers published 01/01/1992-30/04/2026. We conducted backwards and forwards citation searching and contacted experts. Study quality was assessed using a modified Critical Appraisal Skills Programme Cohort Study Checklist and the Autism-Inclusive Research Assessment (AIRA). Data were synthesised narratively, with random effects meta-analyses where appropriate.
ResultsThirty-nine studies were included, comprising 4787730 participants, assessing outcomes of psychological therapies (n = 17) and multi-component or service-level approaches (n = 22). Nearly half (46.2%) were UK-based, and under a quarter (23.1%) included people with intellectual disabilities. Ten studies (25.6%) were rated low quality, twenty-two (56.4%) medium quality, and seven (17.9%) high quality. AIRA ratings highlighted concerns about research inclusiveness for autistic people, including limited involvement of autistic people and lack of validated or adapted outcome measures. Findings varied by intervention: for some, multiple large, higher-quality studies showed less favourable outcomes for autistic people (e.g., less improvement in symptoms or functioning, or higher rates of restrictive practices or acute service use). For other interventions, comparable or mixed outcomes were found across studies, with interpretation often limited by small samples.
ConclusionsMental health treatment outcomes for autistic versus non-autistic people varied across interventions and outcome types. Where significant differences were observed, these usually showed poorer outcomes for autistic people, although they generally reflected smaller improvements rather than a lack of benefit. Action is needed to improve the accessibility and appropriateness of mental health care for autistic people, supported by more high-quality, co-produced research across a broader range of countries and service contexts.
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BibTeX
@misc{griffiths2026comparing,
title = {{Comparing mental health treatment outcomes for autistic and non-autistic people: a systematic review}},
author = {J. L. Griffiths and F. Elise and J. Thompson and S. Li and R. R. Olive and A. Bhutta and W. Liu and M. Holden and M. Mandiangu and D. Baptiste and R. Appleton and P. Barnett and M. Conneely and L. Goldsmith and K. Halvorsrud and H. K. Lewis and P. Nyikavaranda and J. Edbrooke-Childs and W. Mandy and J. Onwumere and V. Totsika and K. Trevillion and B. Lloyd-Evans and A. Simpson and S. Johnson},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.08.26364831},
url = {https://www.medrxiv.org/content/10.64898/2026.10.08.26364831v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Comparing mental health treatment outcomes for autistic and non-autistic people: a systematic review
AU - J. L. Griffiths
AU - F. Elise
AU - J. Thompson
AU - S. Li
AU - R. R. Olive
AU - A. Bhutta
AU - W. Liu
AU - M. Holden
AU - M. Mandiangu
AU - D. Baptiste
AU - R. Appleton
AU - P. Barnett
AU - M. Conneely
AU - L. Goldsmith
AU - K. Halvorsrud
AU - H. K. Lewis
AU - P. Nyikavaranda
AU - J. Edbrooke-Childs
AU - W. Mandy
AU - J. Onwumere
AU - V. Totsika
AU - K. Trevillion
AU - B. Lloyd-Evans
AU - A. Simpson
AU - S. Johnson
PY - 2026
DA - 2026/10/08
PB - medRxiv
DO - 10.64898/2026.10.08.26364831
UR - https://www.medrxiv.org/content/10.64898/2026.10.08.26364831v1
AB - BackgroundAutistic people experience substantially higher rates of mental health conditions and are overrepresented in mental health services. However, most interventions and service models have been developed for non-autistic people, and evidence is needed as to whether there are disparities in outcomes. This systematic review aimed to compare outcomes between autistic and non-autistic people receiving the same mental health interventions or services. MethodsWe conducted a systematic review following PRISMA guidelines (PROSPERO: CRD420251021068). We searched academic databases (MEDLINE, Embase, PsycINFO, PubMed, CINAHL), a grey literature database (HMIC), a trial registry (ISRCTN), preprint servers (medRxiv and PsyArXiv), Google, and Google Scholar, to identify relevant papers published 01/01/1992-30/04/2026. We conducted backwards and forwards citation searching and contacted experts. Study quality was assessed using a modified Critical Appraisal Skills Programme Cohort Study Checklist and the Autism-Inclusive Research Assessment (AIRA). Data were synthesised narratively, with random effects meta-analyses where appropriate. ResultsThirty-nine studies were included, comprising 4787730 participants, assessing outcomes of psychological therapies (n = 17) and multi-component or service-level approaches (n = 22). Nearly half (46.2%) were UK-based, and under a quarter (23.1%) included people with intellectual disabilities. Ten studies (25.6%) were rated low quality, twenty-two (56.4%) medium quality, and seven (17.9%) high quality. AIRA ratings highlighted concerns about research inclusiveness for autistic people, including limited involvement of autistic people and lack of validated or adapted outcome measures. Findings varied by intervention: for some, multiple large, higher-quality studies showed less favourable outcomes for autistic people (e.g., less improvement in symptoms or functioning, or higher rates of restrictive practices or acute service use). For other interventions, comparable or mixed outcomes were found across studies, with interpretation often limited by small samples. ConclusionsMental health treatment outcomes for autistic versus non-autistic people varied across interventions and outcome types. Where significant differences were observed, these usually showed poorer outcomes for autistic people, although they generally reflected smaller improvements rather than a lack of benefit. Action is needed to improve the accessibility and appropriateness of mental health care for autistic people, supported by more high-quality, co-produced research across a broader range of countries and service contexts.
ER -