Mental health care use of autistic adults Identifying longitudinal patterns using sequence analysis

To improve mental health care for autistic adults, a better understanding of their real-world intervention use is required. The aim of this study is to investigate individual differences in the intervention trajectories of autistic adults, by examining longitudinal patterns of therapy, counseling, and medication use. Self-reported intervention use of 445 autistic adults (18-87 years) across at least five consecutive measurements (2015-2021) was collected to identify clusters using sequence analysis and hierarchical clustering. Sensitivity analyses and cross-method validation (group-based multivariate trajectory modeling) were used to verify the obtained clusters. Four out of five obtained clusters had sufficient internal consistency and were replicated. These four clusters had distinct intervention trajectories (least intervention, mostly counseling, mostly medication, mixed use) and differed on several demographic variables. Most notably, the "mixed cluster" contained relatively more females and individuals with self-reported co-occurring psychiatric conditions. Many autistic adults used interventions, although they varied in type and duration of intervention use. This reflects the clinical complexity of tailoring intervention approaches and highlights that accessible and multidisciplinary care is essential to adequately support autistic adults. An important next step is to investigate whether available interventions sufficiently support autistic females and those with co-occurring psychiatric conditions.
Lay abstract
Many autistic adults experience co-occurring mental health problems, which have a negative effect on their well-being and result in increased use of mental health services. To improve mental healthcare for autistic adults, a better understanding is needed of what type of support they use in real life. Clinical guidelines recommend three kinds of mental health interventions: therapy, counseling, and medication. We investigated the use of these types of interventions in a sample of 445 autistic adults (aged 18-87 years) across a 5-to-7-year period. We found evidence for four different patterns of intervention use, or so-called subgroups: (1) least intervention use, (2) mostly counseling, (3) mostly medication, and (4) mixed intervention use. The group with mixed intervention use consisted of relatively more females and individuals with co-occurring psychiatric conditions, especially compared to the subgroup with the least intervention use. It appeared that many, but not all, autistic individuals used mental health services for an extended period. However, there was considerable variability in the type, combination, and duration of intervention use. This means that determining the optimal support for autistic adults is often a complex task, which requires collaboration of clinical experts and autistic individuals themselves, to make informed decisions.