Online Therapy For Autistic Adults Seeking Mental Health Therapy

Due to a variety of factors, such as communication difficulties, social anxiety, financial barriers, and transportation limitations, many adults with autism are not receiving the treatment they need to improve daily functioning and enhance their quality of everyday life. Adults with autism are more likely to experience symptoms of anxiety and depression but may be less likely to reach out for professional help due to those barriers.

Online therapy for autistic adults enables individuals or families to participate in therapy from a comfortable home environment. Internet-based intervention or therapy for autistic adults can include learning new coping skills, stress management techniques, and emotional management. The parent or caregiver of an autistic child may also benefit from attending online autism therapy to learn how to best support their child.

Online autism therapy may also include speech therapy and improving social skills in addition to traditional psychotherapy like cognitive behavior therapy (CBT). In this article, we discuss how online therapy can benefit adults with autism and caregivers of children with autism. 

What is autism spectrum disorder?

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder listed in the Diagnostic and Statistical Manual 5th Edition (DSM-5) that typically presents in two ways: 1) difficulty with social interactions and verbal communication and 2) specific patterns of behavior and interests that are often repetitive and may be limited to certain areas. Autism spectrum disorders exist across a spectrum and symptoms vary in severity.

Recent studies have also shown that adults with ASD often have psychiatric comorbidities, which means they are more likely to experience symptoms of anxiety and depression. Autistic traits are characterized by difficulties with social interactions and communication and onset symptoms of autism usually start to show during preschool years. While it is common for people with autism to be diagnosed as children, others may not get an autism diagnosis until adulthood. 

According to the National Institute of Health (NIH), there is no specific autistic treatment recommended for people with autism. There are however a variety of therapeutic approaches for improving the quality of life for people with autism, such as:

• Behavioral management therapy
• Cognitive behavioral therapy
• Education and school-related therapies
• Occupational therapy
• Social skills training
• Speech-language therapy

Common symptoms of ASD make it more likely for adults with ASD to avoid seeking treatment (e.g., difficulty using public transport due to perceptual sensitivity, and being uncomfortable in healthcare settings due to communication challenges). Having to articulate their needs to a stranger may be stressful for adults with ASD, especially in situations where environmental factors increase challenges.

Why might online therapy for autistic adults be beneficial?

One of the benefits of online therapy is that adults with ASD can stay in a familiar environment and focus on communication without the external demands of a foreign location. A recent review of the use of technology to facilitate learning in adults with ASD showed that computer-mediated communication allows for an increase in thinking time during conversations, an increase of control during conversations, a reduction of external sensory distractions, and an overall more comfortable environment. Technology-based interactions also decrease stress related to non-verbal communication such as eye contact, tone of voice, and body language. With internet therapy autism spectrum disorder can be better catered to by giving the client more control over their environment.

A familiar environment

Studies on internet-based treatment for ASD

Another benefit of internet-based therapy is that it can be tailored to the participant. For example, depending on the participant’s preferences, communication can be live (e.g., over video call or through live chat) or it can be over an asynchronous chat such as email. Therapeutic professionals are also able to tailor specific internet-based treatment alternatives and content to the needs of the participant.

Despite the high suitability of internet-based therapy for adults with ASD, there has historically been minimal research directly exploring its use in this context. Recent research studies have focused specifically on using internet-based therapy for patient populations with ASD, and the results have been promising.

In one study performed by Backmanet al., the feasibility of internet-based psycho-educative programs was studied for young adults and adolescents with ASD. In this study, participants reported positively about the program and clinicians felt that they were able to work with participants effectively through this medium of communication. In a qualitative content analysis, Sehlin et al. investigated how young adults and adolescents with ASD felt about an internet-based program they participated in. Participants reported that they felt the coach was the most important part of the program, and they enjoyed communicating via written text and being able to complete the program at home. While these results are promising, the studies did not look at adults with ASD directly.

To design an appropriate program for adults with ASD, it is important to understand the needs of the specific patient population and preferences for the structure of the program. To do this, researchers performed a study to understand the experience of adults with ASD who participated in an individual internet-based therapy program with integrated group-based components.

Results of online therapy for autistic adults

To understand the specific needs and preferences of adults with ASD when it comes to internet-based therapy, a qualitative interview study was performed to evaluate the experiences of participants who completed internet-based cognitive behavioral therapy (ICBT). To understand the experiences of participants, interviews were given, and participants were able to voice their experiences and insights.

How was the ICBT structured?

The ICBT that participants completed within this study was an 18-week program specifically aimed at adults with ASD. The goals of this program were to increase the quality of everyday life through:

• Improving independent function and ability to complete daily tasks
• Improving self-acceptance
• Improving self-knowledge

This internet-based program was created by adapting a manual called the Method for Internet-Based Treatment for Life Quality of Adults with Autism Spectrum Disorder, or MILAS. This manual was converted into an internet-based cognitive behavioral therapy intervention. During this program, participants were given weekly text-based modules based on weekly themes.

Examples of weekly themes include:

• Individual goals
• Behavioral analysis
• Social interaction
• Emotions and body language
• Social anxiety
• Depression
• Central coherence
• Other topics specific to the common needs of adults with ASD

For each module, therapists reviewed the submissions of each participant and provided feedback. Communication was asynchronous, and participants were able to write to the therapist at any time during the program with any questions or concerns.

While the design of the program was specific to ASD, individual goals and needs were used to tailor the program slightly to the individual. In addition to the individual exercises, participants had the option of participating in group chat sessions with the other participants, led by therapists involved in the program.

How was this program evaluated?

After completion of the program, participants were interviewed about their experiences within the program’s process and how they felt about different aspects. Participants were given semi-structured, open-ended interviews asking questions about 1) the participant’s experience within the program, 2) the program’s impact on self-perception, 3) experiences interacting with the therapists and other participants, and 4) thoughts and preferences regarding the design of the program.

What were the results?

Overall, adults with ASD who participated in the online cognitive behavioral therapy program were satisfied with it and found it to be beneficial. In line with previous findings regarding internet-based therapies, the ability to complete the programs at home and in a self-paced manner was a big factor in program satisfaction. Participants also enjoyed the bi-weekly chat sessions to interact with other participants.

Multiple adults within this program preferred online-based therapy to in-person healthcare due to decreased feelings of stress and anxiety and an increased ability to focus on the treatment material without external distraction. The therapists within the program were also generally perceived to be competent, and interactions were considered to be sufficient.

One place in which internet-based therapy may be improved is the individualization of participants. While in-person therapy delivered in real-time is usually tailored to the individual, online therapy often consists of modules that are made to fit the needs of the greater majority. This can be difficult for diverse groups. While the breadth generally meets the needs of the majority, tailoring the material to the individual would decrease the completion of materials that are less relevant to them.

Several participants in this study said that they felt more comfortable without having to focus on body language and facial expressions during interactions. This lessens the likelihood of mental exhaustion and over-stimulation and increases the suitability of internet-based therapy for adults with ASD. For future studies, finding a balance between adequate support from therapists in the program while still providing the previously mentioned benefits will be important. It is also crucial for the therapists involved to have experience treating adults with ASD and to have an in-depth knowledge of the condition. This need was mentioned by multiple participants.

Taking this study forward

Overall, research in internet-based interventions using cognitive behavioral treatment for mental health conditions in the general population and specifically for adults with ASD, has shown great potential. 

In addition to these factors, adults with ASD who completed internet-based cognitive behavioral therapy felt that the program was able to significantly improve independence, quality of everyday life, and self-confidence. Interactions with therapists were considered to be useful and sufficient, and group activities provided an optional way to interact with other participants.

Online speech therapy

Children and adults with autism may experience speech difficulties of varying severity. Autism treatments for improved speech may be able to be administered online and internet-based treatment constitutes a more available form of therapy for many individuals. While more research still needs to be done, current research shows that internet-based speech therapy may be an effective form of treatment. As a result of the Covid-19 pandemic, many speech pathologists and therapists started practicing remotely. Studies of the effectiveness of online speech therapy found that telehealth and online therapy reduced travel costs for patients and that speech therapists and their clients have both reported increased satisfaction with the results of internet-based therapy. Through online therapy, a therapist can evaluate treatment adaptations tailored for each client. 

Another research study on how feasible internet-based speech therapy was for patients with dementia found that many participants in the study had increased confidence in communication* during a six-month follow-up. These studies show that speech therapy for autism and other mental health conditions could be just as effective as in-person therapy and could serve as an energy-saving alternative to traditional therapy.

*Mental health research is constantly evolving, so older sources may contain information or theories that have been reevaluated since their original publication date.

Online therapy for parents and families of autistic children

Caregivers, parents, and families of autistic children and adults can also benefit from online therapy. The Internet-Based Parent-Implemented Communication Strategies [i-PiCS] program* is one example of an online training and coaching program for parents of young children with ASD. These types of online programs teach evidence-based strategies for parents to best support their autistic child with social skills. 

*Mental health research is constantly evolving, so older sources may contain information or theories that have been reevaluated since their original publication date.

Attending a peer support group can be another great way for caregivers to connect with other families and parents of autistic children. The benefits of a peer support group may include increased social support in the form of encouragement and learning new things from group constituents. Peer support groups have also begun to move online; it is easier than ever to find an online group to connect with. Online therapy and support groups may be more available for busy parents and caregivers. 

Parents should also have an understanding of the potential negatives of controversial forms of autism therapy out there, such as Applied Behavior Analysis (ABA) therapy. Adults with autism have reported long-lasting trauma associated with experiencing ABA therapy. The reason why ABA therapy is controversial is that it focuses on eliminating “unwanted” behaviors in a person with autism by using punishment and reward systems. Many believe that ABA therapy may be more harmful than beneficial for people with autism. 

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.