Clinician factors related to the delivery of psychotherapy for autistic youth and youth with attention-deficit hyperactivity disorder.
Ontario clinicians back away from treating autistic youth mainly because they feel less knowledgeable, less positive, and less backed-up than when treating kids with ADHD.
01Research in Context
What this study did
Flora’s team sent an online survey to 220 Ontario clinicians. The survey asked how willing they were to give talk-therapy to autistic youth versus youth with ADHD.
Each clinician also rated their own autism knowledge, their feelings about working with autistic clients, and how much social support they felt from co-workers.
What they found
Clinicians said they were less ready to treat autistic kids than kids with ADHD. The gap was big: weaker knowledge, cooler attitudes, and less peer support explained almost all of the difference.
When clinicians felt they knew more, liked the work, and believed their team backed them, their willingness to treat autistic youth jumped.
How this fits with other research
Mason (2007) ran a similar UK survey for clients with intellectual disability and found the same three brakes: low confidence, high client severity, and bias. The pattern repeats across diagnoses—clinicians first ask “Can I handle this?”
Appelqvist-Schmidlechner et al. (2020) show why this matters. In their survey of young adults with ASD or ADHD, strong social ties and daily-living skills predicted better mental health. If Flora’s clinicians bow out, kids miss the very therapy that could build those skills.
Bürki et al. (2021) add a twist: in Germany, autism severity did NOT drive who gets special-education help; IQ and age did. Together the papers hint that service gates open more for measurable traits (IQ, age) than for autism itself, leaving talk-therapy intentions stuck behind clinician comfort.
Why it matters
Before you refer an autistic client to a talk-therapy colleague, check the clinician’s comfort, not just their degree. A quick 5-minute chat about autism facts, a pep talk from you, or pairing them with a confident co-therapist can flip “I’d rather not” into “Yes, I’ll take this case.”
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02At a glance
03Original abstract
Autistic children and youth often experience mental health problems, such as anxiety, depression and behavioural challenges. Although there are therapy programmes that have been found helpful in reducing these issues, such as cognitive behaviour therapy, autistic children often struggle to receive adequate mental health care. Clinicians' knowledge, attitudes, confidence and beliefs about treating mental health problems in autistic people may be related to their choices in providing psychotherapy. Across Ontario, Canada, 611 mental health clinicians, working in publicly funded agencies, completed an online survey about their experiences and opinions on delivering therapy for autistic clients compared to those with attention-deficit hyperactivity disorder. Clinician knowledge was associated with their intention to treat autistic clients or clients with attention-deficit hyperactivity disorder, partly because of their attitudes and the social pressures or values they felt. Clinicians reported feeling less intent on providing therapy to autistic youth compared to youth with attention-deficit hyperactivity disorder because of differences in their attitudes, social pressures and knowledge. This research can inform the training and educational initiatives for mental health practitioners.
Autism : the international journal of research and practice, 2023 · doi:10.1177/13623613221106400