Advances in Autism

Psychological interventions for adults with ASD: clinical approaches

Debbie Spain Lucy O'Neill Laura Harwood Eddie Chaplin
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Debbie Spain Lucy O'Neill Laura Harwood Eddie Chaplin , (2016),"Psychological interventions for adults with ASD: clinical
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Ashleigh Saunders, Karen E. Waldie, (2016),"Distinguishing autism from co-existing conditions: a behavioural profiling
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 Psychological interventions for adults
with ASD: clinical approaches
Debbie Spain, Lucy O’Neill, Laura Harwood and Eddie Chaplin
Debbie Spain is based at the
Department of Forensic and
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Neurodevelopmental Sciences,
Institute of Psychiatry, King’s
College London, London, UK.
Lucy O’Neill is based at MRC
SGDP Centre, King’s College
London, London, UK.
Laura Harwood is based
at the Goldsmiths University,
London, UK.
Dr Eddie Chaplin is based at
London South Bank University,
London, UK and Estia Centre,
South London and Maudsley
NHS Foundation Trust,
London, UK.
Received 18 September 2015
Revised 18 September 2015
Accepted 3 November 2015
PAGE 24 j ADVANCES IN AUTISM
Abstract
Purpose – Empirical research indicates that adults who have autism spectrum disorders (ASD) can derive
clinically and statistically meaningful benefits from individual and group-based psychological interventions,
specifically those which employ skills-based, behavioural, and cognitive techniques. Given the inherent
socio-communication, executive functioning, and theory of mind impairments that individuals with ASD can
experience, it is deemed necessary to modify the design and delivery of interventions so as to enhance
engagement and outcomes. The paper aims to discuss these issues.
Design/methodology/approach – This general review provides a summary of the extant literature and
clinical guidelines for the provision of psychological interventions for adults with ASD.
Findings – Adaptations to the structure, process, content, and outcome measurement are outlined. It is
likely that optimal treatment gains for adults with ASD are contingent on a prolonged assessment phase,
pre-therapy interventions including psycho-education and skills-based interventions, thoughtful regard to the
formulation of presenting difficulties, and consideration of, and methods to overcome, the difficulties that may
arise when seeking to implement change, identify goals, and manage endings.
Originality/value – This is one of the first reviews to condense the clinical implications for providing
psychological interventions for adults with ASD.
Keywords Cognitive behaviour therapy, Autism spectrum disorder, Psychological interventions
Paper type General review
Introduction
Autism spectrum disorders (ASD) are common neurodevelopmental conditions. Increasingly, ASD
is diagnosed during adulthood (Wilson et al., 2013), which in part reflects the fact that core
characteristics, i.e. social and communication difficulties, engagement in routines, and narrow
interests (APA, 2013; WHO, 1992), are often subtle, becoming more evident over time. Adults with
ASD often experience co-occurring psychiatric conditions, including anxiety and affective disorders
(Hofvander et al., 2009; Joshi et al., 2013; Russell et al., 2015). UK Clinical Guidelines (NICE, 2012)
and Legislation (HM Government, Autism Act, 2009) stipulate that the needs of adults with ASD
should be assessed and appropriately met, including provision of psychological interventions.
To date, a handful of studies have investigated the feasibility and effectiveness of skills-based
and cognitive behaviour therapy (CBT) interventions. Studies have utilised non-randomised
methods, such as case or single-arm studies (e.g. Cardaciotto and Herbert, 2004; Hare, 1997;
Hillier et al., 2011; Weiss and Lunsky, 2010), quasi-experimental methods (e.g. Russell et al.,
2008; Turner-Brown et al., 2008), in addition to randomised controlled designs (e.g. Hesselmark
et al., 2013; Russell et al., 2013; Spek et al., 2013). Preliminary results are promising:
self-informant, and clinician-ratings indicate some improvement in social skills, as well as
reductions in general anxiety, OCD, rumination, and low mood (see Spain et al., 2015; Spain and
Blainey, 2015, for a comprehensive review). While all studies appear to have incorporated
j VOL. 2 NO. 1 2016, pp. 24-30, © Emerald Group Publishing Limited, ISSN 2056-3868 DOI 10.1108/AIA-09-2015-0016
 adaptations to accommodate core and associated ASD characteristics, requisite methods for
enhancing treatment gains are yet to be determined. Nevertheless, it is likely that a considered
approach to the provision and evaluation of interventions may glean further positive outcomes
(see also, Anderson and Morris, 2006; Attwood, 2004; Gaus, 2011). This general review
provides a summary of the main principles, outlined in Clinical Guidelines and the extant
literature, regarding how best to design and deliver psychological interventions for adults with
high-functioning ASD (i.e. individuals who do not have a concurrent intellectual disability).

Clinical approaches
Access to services
While recent initiatives in the United Kingdom National Health Service (NHS) have sought to reduce
stigma and encourage self-referral to mental health services – e.g. the Improving Access to
Psychological Therapy service (NICE, 2011) – individuals with ASD do not typically initiate social
overtures, nor are they necessarily aware of the need for, or possibility of obtaining help. This may be
due to difficulties with introspection (Bird and Cook, 2013) and insight, a lack of confidence in terms
of asking for help, or difficulties knowing how best to access support. Therefore, they are likely to
require a more proactive approach by others (such as family members), if changes in mental health
or well-being are observed.
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Assessment for psychological therapies

Adaptations to the assessment structure and process may aid information gathering and
enhance engagement. It is ideal to provide information about the assessment remit and structure
in advance of the appointment, in order to reduce anticipatory anxiety. This may include outlining
who will be present at the appointment, the likely duration of the assessment, whether
(and where) breaks can take place, and the types of topics that may be covered during conversation
with a caveat that there are no “right or wrong” answers. Resources permitting, it is good practice to
offer a choice of appointment date and time, so that the assessment does not interfere with potential
daily rituals and routines, and to facilitate ease of travelling (e.g. using public transport outside of
off-peak hours, or so that the individual can be accompanied by another).
At the outset of an assessment, it is important to check that the environment, i.e. lighting and noise
level, are acceptable, given that individuals with ASD can experience hypo- and hyper-sensory
sensitivities (APA, 2013), contributing to them becoming distracted or ill at ease. While service
constraints can dictate that an assessment is time-limited (e.g. taking place over one or two
sessions), this is highly unlikely to be sufficient for many adults with ASD given that the novel situation
(e.g. a new building), social setting (e.g. interacting with new people), and remit (i.e. talking about
thoughts, feelings, current and past experiences), may exacerbate anxiety and worry. Hence, it is
often necessary to shift the emphasis and primary aim of the initial appointment; that is, it may be
more useful to consider the potential for therapeutic work and any fundamental reasons why this
would be inappropriate (e.g. due to significant current risk, or a clear articulation from the individual
that they do not wish to proceed), rather than making a concrete decision about the nature of the
ensuing intervention. Where possible, information gleaned from multiple sources is likely to enhance
the assessment, albeit adults with ASD can be socially isolated and/or they may not wish to have
others involved. Finally, while use of self-report screening questionnaires is commonplace,
particularly in UK psychological therapy services (NICE, 2011) individuals with ASD can experience
significant difficulties with form-filling – either due a tendency for perseveration, performance anxiety,
or alexithymia – and so it is unwise to solely form a clinical judgement about need, or lack thereof,
based on responses to questionnaires.

Treatment options
It is feasible that several treatment interventions, for example social skills interventions as well as
CBT, will be indicated. Where clinically appropriate, it is ideal to offer one intervention at a time; or at
least stagger-start interventions (in order to allow for sequential hypothesis testing). Discussion about
which treatments to offer – and what these may, or may not entail – requires a considered approach.

VOL. 2 NO. 1 2016 j ADVANCES IN AUTISM j PAGE 25

 This is primarily because individuals with ASD can experience difficulty with decision making,
particularly when this concerns situations they have not yet engaged in, e.g. due to impairments in
imagination and abstract thinking (e.g. Low et al., 2010). It is also pertinent to avoid a scenario
whereby individuals acquiesce in conversation. Once a clinical decision has been reached, it is useful
to provide a written summary, including the outcomes and next steps, so as to accommodate
potential problems with recall and memory (e.g. Millward et al., 2000).

Therapy structure
Individuals with ASD generally prefer routine, so it is best to offer appointments at regular and
designated intervals, rather than arranging these on an ad hoc basis. Similarly, confidentiality
permitting, it can be useful to confirm leave dates (e.g. annual leave or study leave) a few weeks in
advance, so as to limit the element of surprise. Undertaking therapy sessions in the same clinic
room can enhance a sense of familiarity, and thereby indirectly encourage engagement. Sessions
that adopt a similar or the same structure (Gaus, 2011), for example agenda-setting at the outset,
recapping regularly, and planning homework tasks, are likely to be better tolerated than sessions
with a free-flowing format. Also, while agenda-setting is ideally a collaborative or client-led
endeavour, therapists may need to have a more didactic style.

Therapy duration
The duration of therapy sessions may depend on the individual’s preference: while many services
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stipulate that treatment sessions should be 50 or 60 minutes, slightly shorter or longer sessions
(including the option of a break) may be more clinically appropriate, in order to accommodate
executive functioning deficits (e.g. Wilson et al., 2014). It may also be that session duration varies
over the course of treatment, e.g. depending on whether the intention is to undertake in vivo
experiments or behavioural tasks which can require an extended amount of time.

Introducing change
Embarking on a course of therapy involves signing up to the idea that change(s) may be
necessary, and that the timing for doing so is apt. Given that individuals with ASD can experience
significant difficulty with change, and that adherence to routines and rituals may be associated
with anxiety (e.g. Rodgers et al., 2012), motivational interviewing techniques (Miller and Rollnick,
2012) may prove beneficial, e.g. so as to identify potential advantages and disadvantages for
change and/or maintaining the status quo, and thereby to address any concerns. Also, it may be
that individuals with ASD are less able to conceptualise what change may look like and entail, e.g.
as this relies on a degree of abstract thought, and theory of mind. Hence, it can prove useful to
provide concrete anonymised examples of others’ experiences.

Goal setting
Identifying initial treatment goals can prove challenging, either because of the impact of core ASD
features (such as difficulties with planning and abstract reasoning), or associated characteristics
(such as anxiety about making the wrong decision, or concerns about failure). Consequently,
discussions about goal-setting may need to take place several sessions after treatment
commences, i.e. when the individual feels more comfortable, has a better understanding of the
nature of the intervention, and using a more didactic questioning style. This may also involve
clinicians offering examples of potential treatment goals, and providing clarity that attainment of
goals typically requires a graded approach. Focusing on short-term goals, such as those based
upon behavioural activation principles (Martell et al., 2013), can be a helpful starting point;
particularly as this can enhance a sense of personal agency, and indirectly improve mood.
It is important to facilitate conversation about factors that may prevent goals from being achieved,
in order to minimise and overcome potential obstacles.

Formulating presenting difficulties

Several therapy modalities, particularly CBT approaches, rely on the development of a shared
understanding (i.e. a formulation) of causal and maintaining factors for presenting difficulties.

PAGE 26 j ADVANCES IN AUTISM j VOL. 2 NO. 1 2016

 Formulations used in ASD empirical research have included those that are disorder-specific
(e.g. Russell et al., 2008, 2013), or more generic (Weiss and Lunsky, 2010). Given that individuals
with ASD often have multiple comorbid symptoms (e.g. Russell et al., 2015), and long-standing
developmental difficulties, the process of formulations in practice can prove complex. Hence, it is
pragmatic to conceptualise difficulties at a slower pace than would typically be the case, and
potentially, so as to avoid overwhelming clients, a focus on maintaining mechanisms may be
beneficial, at least in the short term. Also, it may be that recognising the links between situations,
behavioural responses, and thoughts/beliefs may be easier and more understandable for
individuals with ASD, rather than emphasising intently the role of feelings and emotions in the
first instance. Finally, as is good clinical practice, it is critical to ensure that the process of
presenting problems does not incur a sense of blame, or lead clients to perceive that their
difficulties are insurmountable.

Adaptations to treatment
While different therapeutic approaches employ different techniques, there are some common
modifications that may well improve treatment outcomes. First, all psychological interventions rely
on the development of rapport, reciprocity, and trust, between both parties. Given the inherent
socio-communication deficits that individuals with ASD can experience, it is important that
therapists seek to cultivate rapport with their clients, bearing in mind there may be a reduced
perception of reciprocity. Second, “pre-therapy interventions” are likely to be useful, including
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psycho-education to enhance emotional literacy (Attwood, 2004), emotion regulation techniques

(Weiss, 2014), skills to augment non-verbal and verbal interactions (e.g. Cardaciotto and Herbert,
2004), and anxiety management (e.g. Russell et al., 2013). Also, clarification and
operationalisation of terms and constructs likely to be discussed during therapy, e.g. “anxiety”,
“depression”, and “thought processes”, are important for ensuring that there is a shared
understanding and common language between clients and therapists. Third, the pacing of
sessions is clearly dependent on individual need; however, it is key to introduce topics in a
considered fashion, and most likely at a slower pace that protocol-driven treatments stipulate.
Fourth, to encourage the generalisation of skills acquired, ample time is needed – during sessions
and on repeated occasions – to practice and solve any problems that arise. Fifth, a combination
of skills-based, behavioural, and cognitive techniques may be appropriate (Gaus, 2011; NICE,
2012; Spain et al., 2015); the order in which techniques are incorporated is dependent on the
treatment formulation, the extent to which individuals find it easy to access and discuss their
internal states, and therapy goals. Finally, it is ideal to offer and discuss information using visual as
well as verbal means (Attwood, 2004). Session summaries should also be provided at the end of
each appointment, to aid recall.

Adapting group-based interventions

Group-based approaches have been used with adults with ASD to enhance social skills
(Spain and Blainey, 2015), improve low mood and anxiety (Weiss and Lunsky, 2010), and to
cultivate mindfulness (Spek et al., 2013). Although group-based interventions are part of a
stepped-care approach to treating psychopathology symptoms (NICE, 2011), there are several
clinical caveats to inviting individuals with ASD to groups. For example, this clinical population
may benefit from individual sessions prior to engaging in groups, so as to support them to feel
less anxious about novel social situations, and to provide psycho-education about implicit
concepts which are likely to be discussed (e.g. mood or anxiety). They may also benefit from
attending closed groups with fewer participants, and regular facilitators. Additionally, it may be
helpful to augment groups with one-to-one sessions in order that general skills can be applied to
individual circumstances.

Homework
Many psychological therapies rely on individuals testing out new strategies and tasks between
sessions, i.e. homework. Individuals with ASD may experience difficulty with undertaking such
tasks, for example due to problems with recall or attention, a lack of clarity about what is
expected, or concerns about failure. To enhance compliance with homework it is important to

VOL. 2 NO. 1 2016 j ADVANCES IN AUTISM j PAGE 27

 ensure that there is sufficient time to plan tasks (and address any potential obstacles), schedule
specific times to complete these, practise examples during sessions, address any beliefs or
concerns that may impede task completion, and also, provide written instructions clearly and
simply (e.g. Helbig and Fehm, 2004; Harris and Hiskey, 2015).

Managing endings
Individuals with ASD may find therapy endings distressing, either because this implies a change
to a developed routine, or because this evokes anxiety about how they will manage post-support.
To avoid premature disengagement or an increase in symptoms towards the end of therapy, the
following are likely to be beneficial: slowly increasing the gap between sessions; provision of
relapse prevention materials on several occasions; and potential replacement of therapy sessions
with alternative activities. Also, it may be worthwhile instigating referrals and links to other services
early on, so that these can be actioned without a significant lag. While the number of follow-up
sessions available may be determined by resource constraints, this clinical group will require
several appointments, in order to support the generalisation of skills acquired and to reduce the
potential risk for relapse.

Outcome measurement
It is ideal to measure outcomes using a variety of methods. The extent to which self-report
measures are reliable and valid for adults with ASD is yet to be definitively established, although
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there is no reason not to use standardised questionnaires to monitor change, as long as these
methods are augmented. Individuals are likely to require, at least in the first instance, support to
complete these, e.g. due to the ambiguity of some questions – for example “how anxious do you
feel?” – and the ensuing perseveration that can occur as a result. For individual therapy sessions,
it is worth developing an idiosyncratic outcome measure (Attwood, 2004; Gaus, 2011), for
example that incorporates “special interests”, as well as assessing subjective units of distress
(i.e. SUDS ratings). The frequency of outcome measurement requires consideration, given that
completing questionnaires weekly may prove too time-consuming for individuals and as
change may be more gradual. When possible, and confidentiality permitting, obtaining an
informant-rating may be useful, e.g. as this can provide a more ecologically valid measure of
change beyond therapy sessions.

Understanding systemic influences

For some individuals, it may be worth exploring systemic factors, such as past and current familial
and social networks, narratives about what it means (for the individual themselves and
others around them) to have a diagnosis of ASD or other psychiatric conditions, or potential ways
in which the context (e.g. family members, or environment) may accommodate difficulties usefully
or otherwise. Although the applicability of systemic techniques, for example particular
questioning styles, have been relatively neglected in ASD research, gaining an understanding
of how the individual describes and makes sense of their context is likely to inform the treatment
formulation and choice of homework tasks. Also, where feasible involving significant others to
address potential family issues may enhance engagement and reduce the impact of core and
associated difficulties.

Therapist factors
Working therapeutically with individuals with ASD is rewarding, but as is the case when
working with complex presentations, there are some considerations for therapists. It is
important to access regular clinical supervision, so as to have sufficient time to discuss and
review treatment plans, and to gain support. For CBT therapists specifically, there may be
differences between the formulation used in therapy sessions with the individual (e.g. a
maintenance model), compared with a more comprehensive and detailed longitudinal formulation
discussed during supervision. Finally, resource constraints may dictate the number of sessions
therapists can offer, and so discussions with supervisors and line managers may be necessary in
order to facilitate flexibility.

PAGE 28 j ADVANCES IN AUTISM j VOL. 2 NO. 1 2016

 Conclusion
The extant literature indicates that adults with ASD derive benefit from skills-based, behavioural,
and cognitive interventions, assessed via self- or informant measures. Despite methodological
heterogeneity, empirical studies clearly suggest that adaptations to the standard structure,
process, and content of interventions are clinically appropriate. It is of course important not to
assume that individuals with ASD comprise a homogenous group, and therefore that the same
adaptations are needed by all. However, it is likely that the development of an effective therapeutic
relationship, and motivation and willingness to engage in therapy, involve accommodation of core
ASD characteristics (i.e. socio-communication difficulties), and associated neuropsychological
processes (e.g. theory of mind, and executive functioning deficits). Further research is now needed
to better understand how best to design and deliver psychological interventions so as to enhance
short- and longer-term treatment outcomes for this clinical population.

References
Anderson, S. and Morris, J. (2006), “Cognitive behaviour therapy for people with Asperger syndrome”,
Behavioural and Cognitive Psychotherapy, Vol. 34 No. 3, pp. 293-303.
APA (2013), Diagnostic and Statistical Manual of Mental Disorders, 5th ed., American Pychiatric Association,
Washington, DC.
Attwood, T. (2004), “Cognitive behaviour therapy for children and adults with Asperger’s syndrome”,
Downloaded by New York University At 06:43 05 February 2016 (PT)

Behaviour Change, Vol. 21 No. 3, pp. 147-61.

Bird, G. and Cook, R. (2013), “Mixed emotions: the contribution of alexithymia to the emotional symptoms of
autism”, Translational Psychiatry, Vol. 3, p. e285.
Cardaciotto, L. and Herbert, A.D. (2004), “Cognitive behaviour therapy for social anxiety disorder in the context of
Asperger’s syndrome: a single-subject report”, Cognitive and Behavioral Practice, Vol. 11 No. 1, pp. 75-81.
Gaus, V. (2011), “Cognitive behavioural therapy for adults with autism spectrum disorders”, Advances in
Mental Health and Intellectual Disabilities, Vol. 5 No. 5, pp. 15-26.
Hare, D.J. (1997), “The use of cognitive-behavioral therapy with people with Asperger syndrome: a case
study”, Autism, Vol. 1 No. 2, pp. 215-25.
Harris, D.L. and Hiskey, S. (2015), “Homework in therapy: a case of it ain't what you do, it’s the way that you
do it?”, The Cognitive Behaviour Therapist, Vol. 8, p. 11. doi: 10.1017/S1754470X15000549.

Helbig, S. and Fehm, L. (2004), “Problems with homework in CBT: rare exception or rather frequent?”,
Behavioural & Cognitive Psychotherapy, Vol. 32 No. 3, pp. 291-301.

Hesselmark, E., Plenty, S. and Bejerot, S. (2013), “Group cognitive behavioural therapy and group
recreational activity for adults with autism spectrum disorders: a preliminary randomized controlled trial”,
Autism, Vol. 18 No. 6, pp. 1-12.
Hillier, A., Fish, T., Siegel, J.H. and Beversdorf, D.Q. (2011), “Self-reported anxiety and depression among young
adults on the autism spectrum”, Journal of Developmental and Physical Disabilities, Vol. 23 No. 3, pp. 267-76.
Hofvander, B., Delorme, R., Chaste, P., Nyden, A., Wentz, E., Stahlberg, O., Herbrecht, E., Stopin, A.,
Anckarsäter, H., Gillberg, C., Råstam, M. and Leboyer, M. (2009), “Psychiatric and psychosocial problems
in adults with normal-intelligence autism spectrum disorders”, BMC Psychiatry, Vol. 9 No. 35, pp. 267-76.
doi: 10.1186/1471-244X-9-35.
HM Government (2009), “Autism Act”, HM Government.
Joshi, G., Wozniak, J., Petty, C., Martelon, M.K., Fried, R., Bolfek, A., Kotte, A., Stevens, J., Furtak, S.L.,
Bourgeois, M., Caruso, J., Caron, A. and Biederman, J. (2013), “Psychiatric comorbidity and functioning in a
clinically referred population of adults with autism spectrum disorders: a comparative study”, Journal of
Autism and Developmental Disorders, Vol. 43 No. 6, pp. 1314-25.
Low, J., Goddard, E. and Melser, J. (2010), “Generativity and imagination in autism spectrum disorder:
evidence from individual differences in children’s impossible entity drawings”, British Journal of Developmental
Psychology, Vol. 27 No. 2, pp. 425-44.

Martell, C.R., Dimidijian, S. and Herman-Dunn, R. (2013), Behavioural Activation for Depression, The Guilford
Press, New York, NY.

VOL. 2 NO. 1 2016 j ADVANCES IN AUTISM j PAGE 29

 Miller, W.R. and Rollnick, S. (2012), Motivational Interviewing: Helping People Change, 3rd ed., The Guilford
Press, New York, NY.

Millward, C., Powell, S., Messer, D. and Jordan, R. (2000), “Recall for self and other in autism: children’s
memory for events experienced by themselves and their peers”, Journal of Autism and Developmental
Disorders, Vol. 30 No. 1, pp. 15-28.
NICE (2011), Common Mental Health Disorders, Department of Health, London.

NICE (2012), Autism: Recognition, Referral, Diagnosis and Management of Adults on the Autism Spectrum,
Department of Health, London.
Rodgers, J., Glod, M., Connolly, B. and McConacjie, H. (2012), “The relationship between anxiety and
repetitive behaviours in autism spectrum disorder”, Journal of Autism and Developmental Disorders, Vol. 42
No. 11, pp. 2404-09.

Russell, A.J., Mataix-Cols, D., Anson, M.A.W. and Murphy, D.G.M. (2008), “Psychological treatment for
obsessive-compulsive disorder in people with autism spectrum disorders – a pilot study”, Psychotherapy and
Psychosomatics, Vol. 78 No. 1, pp. 59-61.
Russell, A.J., Jassi, A., Fullana, M.A., Mack, H., Johnston, K., Heyman, I., Murphy, D.G. and Mataix-Cols, D.
(2013), “Cognitive behaviour therapy for comorbid obsessive-compulsive disorder in high-functioning autism
spectrum disorders: a randomized controlled trial”, Depression and Anxiety, Vol. 30 No. 8, pp. 697-708.
Russell, A.J., Murphy, C.M., Wilson, E., Gillan, N., Brown, C., Robertson, D.M., Craig, M.C., Deeley, Q., Zinkstok, J.,
Johnston, K., McAlonan, G.M., Spain, D. and Murphy, D.G. (2015), “The mental health of individuals referred for
Downloaded by New York University At 06:43 05 February 2016 (PT)

assessment of autism spectrum disorder (ASD) in adulthood: a clinical report”, Autism (ahead of print).
Spain, D. and Blainey, S. (2015), “Group social skills interventions for adults with high-functioning autism
spectrum disorders: a systematic review”, Autism. doi: 10.1177/1362361315587659.
Spain, D., Sin, J., Chalder, T., Murphy, D. and Happe´, F. (2015), “Cognitive behaviour therapy for adults with
autism spectrum disorders and psychiatric co-morbidity: a review”, Research in Autism Spectrum Disorders,
Vol. 9, pp. 151-62.
Spek, A.A., van Ham, N.C. and Nyklicek, I. (2013), “Mindfulness-based therapy in adults with an autism spectrum
disorder: a randomized controlled trial”, Research in Developmental Disabilities, Vol. 34 No. 1, pp. 246-53.

Turner-Brown, L.M., Perry, T.D., Dichter, G.S., Bodfish, J.W. and Penn, D.L. (2008), “Brief report: feasibility of
social cognition and interaction training for adults with high-functioning autism”, Journal of Autism and
Developmental Disorders, Vol. 38 No. 9, pp. 1777-84.
Weiss, J.A. (2014), “Transdiagnostic case conceptualization of emotional problems in youth with ASD:
an emotion regulation approach”, Clinical Psychology: Science and Practice, Vol. 21 No. 4, pp. 331-50.

Weiss, J.A. and Lunsky, Y. (2010), “Group cognitive behaviour therapy for adults with Asperger syndrome and
anxiety or mood disorder: a case series”, Clinical Psychology & Psychotherapy, Vol. 17 No. 5, pp. 438-46.

WHO (1992), ICD-10, WHO, Geneva.

Wilson, C.E., Happé, F., Wheelwright, S.J., Ecker, C., Lombardo, M.V., Johnston, P., Daly, E., Murphy, C.M.,
Spain, D., Lai, M.C., Chakrabarti, B., Sauter, D.A., Baron-Cohen, S., Murphy, D.G. and MRC AIMS
Consortium (2014), “The neuropsychology of male adults with high-functioning autism or Asperger
syndrome”, Autism Research, Vol. 7 No. 5, pp. 568-81.
Wilson, E.C., Gillan, N., Spain, D., Robertson, D., Roberts, G., Murphy, C.M., Maltezos, S., Zinkstok, J.,
Johnston, K., Dardani, C., Ohlsen, C., Deeley, P.Q., Craig, M., Mendez, M.A., Happé, F. and Murphy, D.G.
(2013), “Comparison of ICD-10R, DSM-IV-TR and DSM-5 in an adult autism spectrum disorder diagnosis
clinic”, Journal of Autism and Developmental Disorders, Vol. 43, pp. 2515-25.

Corresponding author
Dr Eddie Chaplin can be contacted at: eddie.chaplin@kcl.ac.uk

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