Higher Prevalence of Depression in Autism Research consistently shows that depression is 2–3 times more common in individuals on the autism spectrum compared to the general population (Hollocks et.pdf
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Oct 16, 2025
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About This Presentation
M
Slide Content
Co-designing
Behavioural Activation
for Depression for
Autistic Adolescents:
A case series
Ms. Akhila S Kumar
Asst. Professor
Clinical Psychologist, AIMS Kochi
Supervised byPresented by
Vishnuprasad T
M. Phil CP Trainee
AIMS Kochi
Behavioural Activation
for Depression for
Autistic Adolescents:
A case series
Ms. Akhila S Kumar
Asst. Professor
Clinical Psychologist, AIMS Kochi
Supervised byPresented by
Vishnuprasad T
M. Phil CP Trainee
AIMS Kochi
Author Note
Zameer Mohamed: Trainee Clinical Psychologist at King’s College London. His research
focuses on autism spectrum disorder, particularly co-occurring depression and anxiety,
and the adaptation of psychological interventions for autistic adolescents.
Dr. Ailsa Russell: Senior Lecturer in Clinical Psychology at the University of Bath. She
specializes in the assessment and treatment of mental health conditions in autism, with
expertise in anxiety, depression, and obsessive–compulsive disorder in neurodivergent
populations.
Melanie Palmer: Research Assistant at King’s College London. She has contributed to
projects on autism and child mental health, focusing on supporting research
implementation and participant engagement in clinical studies.
Professor Emily Simonoff: Professor of Child and Adolescent Psychiatry at King’s College
London and Consultant Child and Adolescent Psychiatrist at the South London and
Maudsley NHS Foundation Trust. She is internationally recognized for her work on
psychiatric disorders in young people with autism and ADHD.
Dr. Matthew J. Hollocks: Clinical Psychologist and Senior Lecturer at King’s College
London, leading the Translational Mental Health and Autism group. His research examines
co-occurring depression and anxiety in autism, aiming to adapt and evaluate accessible
psychological interventions.
2
Zameer Mohamed: Trainee Clinical Psychologist at King’s College London. His research
focuses on autism spectrum disorder, particularly co-occurring depression and anxiety,
and the adaptation of psychological interventions for autistic adolescents.
Dr. Ailsa Russell: Senior Lecturer in Clinical Psychology at the University of Bath. She
specializes in the assessment and treatment of mental health conditions in autism, with
expertise in anxiety, depression, and obsessive–compulsive disorder in neurodivergent
populations.
Melanie Palmer: Research Assistant at King’s College London. She has contributed to
projects on autism and child mental health, focusing on supporting research
implementation and participant engagement in clinical studies.
Professor Emily Simonoff: Professor of Child and Adolescent Psychiatry at King’s College
London and Consultant Child and Adolescent Psychiatrist at the South London and
Maudsley NHS Foundation Trust. She is internationally recognized for her work on
psychiatric disorders in young people with autism and ADHD.
Dr. Matthew J. Hollocks: Clinical Psychologist and Senior Lecturer at King’s College
London, leading the Translational Mental Health and Autism group. His research examines
co-occurring depression and anxiety in autism, aiming to adapt and evaluate accessible
psychological interventions.
2
Clinical Child Psychology and Psychiatry
Clinical Child Psychology and Psychiatry is an international, interdisciplinary, peer-
reviewed journal that publishes clinically relevant research in the fields of child and
adolescent psychology and psychiatry. Established in 1996, it is published quarterly by
SAGE Publications.
Editors-in-Chief: Prof. Anna Brazier (University Hospital of Wales) and Prof. Michael
Tarren-Sweeney (University of Canterbury)
Scope: The journal focuses on understanding emotional well-being, mental health, and
treatment issues for children, adolescents, and young adults aged 0–25 years. It brings
together clinically oriented content of the highest distinction, offering comprehensive
coverage of clinical and treatment issues across a range of treatment modalities.
Indexing: Included in PubMed Central (PMC), Scopus, Web of Science (SSCI), and the
Directory of Open Access Journals (DOAJ), among others.
2
Clinical Child Psychology and Psychiatry is an international, interdisciplinary, peer-
reviewed journal that publishes clinically relevant research in the fields of child and
adolescent psychology and psychiatry. Established in 1996, it is published quarterly by
SAGE Publications.
Editors-in-Chief: Prof. Anna Brazier (University Hospital of Wales) and Prof. Michael
Tarren-Sweeney (University of Canterbury)
Scope: The journal focuses on understanding emotional well-being, mental health, and
treatment issues for children, adolescents, and young adults aged 0–25 years. It brings
together clinically oriented content of the highest distinction, offering comprehensive
coverage of clinical and treatment issues across a range of treatment modalities.
Indexing: Included in PubMed Central (PMC), Scopus, Web of Science (SSCI), and the
Directory of Open Access Journals (DOAJ), among others.
2
Clinical Child Psychology and Psychiatry
Discipline: Child psychology, child psychiatry
Language: English
Edited by: Anna Brazier (University Hospital of Wales) and Michael Tarren-Sweeney
(University of Canterbury)
History: 1996–present
Publisher: SAGE Publications
Frequency: Quarterly
Impact Factor: 2.0 (5-Year Impact Factor: 2.2) SAGE Journals
Abbreviation: Clin. Child Psychol. Psychiatry
Electronic ISSN: 1461-7021
OCLC Number: 41383796
Website: journals.sagepub.com/home/ccp
2
Discipline: Child psychology, child psychiatry
Language: English
Edited by: Anna Brazier (University Hospital of Wales) and Michael Tarren-Sweeney
(University of Canterbury)
History: 1996–present
Publisher: SAGE Publications
Frequency: Quarterly
Impact Factor: 2.0 (5-Year Impact Factor: 2.2) SAGE Journals
Abbreviation: Clin. Child Psychol. Psychiatry
Electronic ISSN: 1461-7021
OCLC Number: 41383796
Website: journals.sagepub.com/home/ccp
2
Rationale
As someone drawn to both neurodivergence and mood disorders, I find it
powerful that this study brings these two areas together in such a practical way.
I value that Behavioral Activation was not just applied “as is,” but thoughtfully
adapted for autistic adolescents, showing that evidence-based care can also be
flexible and responsive.
The co-design aspect really resonates with me—seeing young people shape
their own therapy reflects the kind of collaborative practice I aspire to.
The structured, visual, and concrete approach feels very usable in day-to-day
clinical work, which excites me because I can see myself applying it with clients.
The online format is meaningful, since so many of the barriers I’ve seen in
practice—sensory overwhelm, travel difficulties, limited access—are directly
addressed here.
What draws me most is that this research points toward a future of therapy that
is both inclusive and evidence-based, reminding me why I chose this field in the
first place.
2
As someone drawn to both neurodivergence and mood disorders, I find it
powerful that this study brings these two areas together in such a practical way.
I value that Behavioral Activation was not just applied “as is,” but thoughtfully
adapted for autistic adolescents, showing that evidence-based care can also be
flexible and responsive.
The co-design aspect really resonates with me—seeing young people shape
their own therapy reflects the kind of collaborative practice I aspire to.
The structured, visual, and concrete approach feels very usable in day-to-day
clinical work, which excites me because I can see myself applying it with clients.
The online format is meaningful, since so many of the barriers I’ve seen in
practice—sensory overwhelm, travel difficulties, limited access—are directly
addressed here.
What draws me most is that this research points toward a future of therapy that
is both inclusive and evidence-based, reminding me why I chose this field in the
first place.
2
Overview
Higher Prevalence of Depression in Autism
Research consistently shows that depression is 2–3 times more common in individuals
on the autism spectrum compared to the general population (Hollocks et al., 2019).
This elevated risk reflects both biological vulnerabilities (e.g., differences in emotion
regulation) and psychosocial challenges (e.g., social exclusion, bullying).
Adolescent-Specific Rates
Studies indicate that between 20–40% of autistic adolescents meet criteria for a
depressive disorder at some point (Hudson et al., 2019).
This is considerably higher than prevalence estimates for non-autistic adolescents,
which generally range between 10–15%.
A Developmental Disability & Public Health Concern
Depression in autism is not a minor comorbidity—it has broad developmental
consequences, worsening adaptive functioning and family stress.
These findings highlight a significant public health issue, emphasizing the urgent need
for specialized, autism-sensitive interventions within clinical psychology.
2
Higher Prevalence of Depression in Autism
Research consistently shows that depression is 2–3 times more common in individuals
on the autism spectrum compared to the general population (Hollocks et al., 2019).
This elevated risk reflects both biological vulnerabilities (e.g., differences in emotion
regulation) and psychosocial challenges (e.g., social exclusion, bullying).
Adolescent-Specific Rates
Studies indicate that between 20–40% of autistic adolescents meet criteria for a
depressive disorder at some point (Hudson et al., 2019).
This is considerably higher than prevalence estimates for non-autistic adolescents,
which generally range between 10–15%.
A Developmental Disability & Public Health Concern
Depression in autism is not a minor comorbidity—it has broad developmental
consequences, worsening adaptive functioning and family stress.
These findings highlight a significant public health issue, emphasizing the urgent need
for specialized, autism-sensitive interventions within clinical psychology.
2
Overview
Impact on Daily Functioning
Intensifies autism-related withdrawal from school, peers, and family (Hollocks et al., 2019).
Reduces motivation, engagement, and academic performance (Hollocks et al., 2019).
Quality of Life Impairments
Leads to lower life satisfaction and well-being compared to both autistic and neurotypical
peers (Hollocks et al., 2019).
Increases family stress due to added emotional and behavioral challenges (Hollocks et al.,
2019).
Increased Risk of Suicidality
Heightens self-harm and suicidal ideation, particularly in adolescence (Hudson et al., 2019).
Highlights urgency for early detection and intervention (Hudson et al., 2019).
Clinical and Public Health Relevance
Depression is a primary concern in autism, not secondary (Hollocks et al., 2019; Hudson et
al., 2019).
Treating it improves mental health, social participation, and development (Hollocks et al.,
2019; Hudson et al., 2019).
2
Impact on Daily Functioning
Intensifies autism-related withdrawal from school, peers, and family (Hollocks et al., 2019).
Reduces motivation, engagement, and academic performance (Hollocks et al., 2019).
Quality of Life Impairments
Leads to lower life satisfaction and well-being compared to both autistic and neurotypical
peers (Hollocks et al., 2019).
Increases family stress due to added emotional and behavioral challenges (Hollocks et al.,
2019).
Increased Risk of Suicidality
Heightens self-harm and suicidal ideation, particularly in adolescence (Hudson et al., 2019).
Highlights urgency for early detection and intervention (Hudson et al., 2019).
Clinical and Public Health Relevance
Depression is a primary concern in autism, not secondary (Hollocks et al., 2019; Hudson et
al., 2019).
Treating it improves mental health, social participation, and development (Hollocks et al.,
2019; Hudson et al., 2019).
2
Overview
Dependence on Cognitive Demands
Standard treatments like CBT rely on abstract reasoning and perspective-taking, which
can be difficult for autistic adolescents with literal thinking and reduced theory of mind
(Spain et al., 2015).
Communication and Processing Barriers
Conventional therapies assume strong verbal and open-ended discussion skills, often
leading to reduced engagement and frustration for autistic adolescents.
Difficulty with Generalization
Skills learned in therapy may not transfer to daily life due to inflexibility and reliance on
routines (Lai et al., 2019).
Treatment Gap in Clinical Practice
Many autistic adolescents do not benefit fully from standard depression treatments,
underscoring the need for structured, accessible, and adapted interventions.
2
Dependence on Cognitive Demands
Standard treatments like CBT rely on abstract reasoning and perspective-taking, which
can be difficult for autistic adolescents with literal thinking and reduced theory of mind
(Spain et al., 2015).
Communication and Processing Barriers
Conventional therapies assume strong verbal and open-ended discussion skills, often
leading to reduced engagement and frustration for autistic adolescents.
Difficulty with Generalization
Skills learned in therapy may not transfer to daily life due to inflexibility and reliance on
routines (Lai et al., 2019).
Treatment Gap in Clinical Practice
Many autistic adolescents do not benefit fully from standard depression treatments,
underscoring the need for structured, accessible, and adapted interventions.
2
What is Behavioral Activation?
Core Definition
Evidence-based therapy for depression emphasizing “doing” over “thinking” (Martell et al.,
2010).
Focuses on re-engaging with meaningful and rewarding activities.
Theoretical Basis
Depression linked to withdrawal and reduced reinforcement (Jacobson et al., 2001).
Increasing activity restores positive feedback loops in daily life.
Key Techniques
Activity monitoring and scheduling.
Values-based planning of meaningful tasks.
Reducing avoidance through gradual exposure (Lejuez et al., 2001).
Why Relevant for Autism
Structured, concrete, and visually adaptable.
Reduces reliance on abstract reasoning.
Fits autistic strengths in routine and step-wise learning (Stark et al., 2022).
2
Core Definition
Evidence-based therapy for depression emphasizing “doing” over “thinking” (Martell et al.,
2010).
Focuses on re-engaging with meaningful and rewarding activities.
Theoretical Basis
Depression linked to withdrawal and reduced reinforcement (Jacobson et al., 2001).
Increasing activity restores positive feedback loops in daily life.
Key Techniques
Activity monitoring and scheduling.
Values-based planning of meaningful tasks.
Reducing avoidance through gradual exposure (Lejuez et al., 2001).
Why Relevant for Autism
Structured, concrete, and visually adaptable.
Reduces reliance on abstract reasoning.
Fits autistic strengths in routine and step-wise learning (Stark et al., 2022).
2
Overview
Dependence on Cognitive Demands
CBT and similar therapies rely heavily on abstract reasoning and flexibility (Spain et al.,
2015).
Autistic adolescents often struggle with literal thinking and reduced theory of mind,
limiting effectiveness (Spain et al., 2015).
Communication and Processing Barriers
Standard approaches assume strong verbal skills and comfort with open-ended
discussion (Spain et al., 2015).
These demands can lead to frustration and reduced engagement in therapy for autistic
youth (Spain et al., 2015).
Difficulty with Generalization
Skills learned in therapy often fail to transfer into daily life contexts (Lai et al., 2019).
Inflexibility and reliance on routines make applying strategies outside therapy challenging
(Lai et al., 2019).
Treatment Gap in Clinical Practice
Many autistic adolescents receive limited benefits from conventional depression
treatments (Lai et al., 2019).
Highlights the need for structured, adapted, and accessible interventions for
neurodivergent populations (Lai et al., 2019).
2
Dependence on Cognitive Demands
CBT and similar therapies rely heavily on abstract reasoning and flexibility (Spain et al.,
2015).
Autistic adolescents often struggle with literal thinking and reduced theory of mind,
limiting effectiveness (Spain et al., 2015).
Communication and Processing Barriers
Standard approaches assume strong verbal skills and comfort with open-ended
discussion (Spain et al., 2015).
These demands can lead to frustration and reduced engagement in therapy for autistic
youth (Spain et al., 2015).
Difficulty with Generalization
Skills learned in therapy often fail to transfer into daily life contexts (Lai et al., 2019).
Inflexibility and reliance on routines make applying strategies outside therapy challenging
(Lai et al., 2019).
Treatment Gap in Clinical Practice
Many autistic adolescents receive limited benefits from conventional depression
treatments (Lai et al., 2019).
Highlights the need for structured, adapted, and accessible interventions for
neurodivergent populations (Lai et al., 2019).
2
Few autism-tailored interventions – Most depression programs are designed for
neurotypical populations and do not account for autistic cognitive, social, and affective
differences (Weston et al., 2016).
Sensory needs often overlooked – Standard therapies rarely address auditory, visual, or
tactile sensitivities, which can reduce participation and increase anxiety (Ashburner et al.,
2013).
Communication differences not addressed – Interventions assume typical social and
language skills, creating challenges for adolescents with pragmatic or expressive
difficulties (Howlin & Moss, 2012).
Learning preferences ignored – Autistic adolescents often benefit from structured,
concrete, and visually supported methods; standard abstract verbal instruction may
reduce comprehension and retention (Murray et al., 2020).
Lack of clear structure and visuals – Traditional therapy often lacks stepwise instructions,
visual cues, and session structure, increasing uncertainty and disengagement (Weston et
al., 2016).
Barrier to engagement – The combination of these limitations limits motivation,
participation, and therapeutic effectiveness, highlighting the need for autism-specific
adaptations (Weston et al., 2016).
2
Gaps: Limited Autism-Specific Adaptations
neurotypical populations and do not account for autistic cognitive, social, and affective
differences (Weston et al., 2016).
Sensory needs often overlooked – Standard therapies rarely address auditory, visual, or
tactile sensitivities, which can reduce participation and increase anxiety (Ashburner et al.,
2013).
Communication differences not addressed – Interventions assume typical social and
language skills, creating challenges for adolescents with pragmatic or expressive
difficulties (Howlin & Moss, 2012).
Learning preferences ignored – Autistic adolescents often benefit from structured,
concrete, and visually supported methods; standard abstract verbal instruction may
reduce comprehension and retention (Murray et al., 2020).
Lack of clear structure and visuals – Traditional therapy often lacks stepwise instructions,
visual cues, and session structure, increasing uncertainty and disengagement (Weston et
al., 2016).
Barrier to engagement – The combination of these limitations limits motivation,
participation, and therapeutic effectiveness, highlighting the need for autism-specific
adaptations (Weston et al., 2016).
2
Gaps: Limited Autism-Specific Adaptations
Gaps: Lack of Adolescent Focus
Adult-centric research – Most studies on depression interventions focus on adults, leaving
adolescent-specific needs underexplored (Hudson et al., 2019).
Unique developmental challenges – Adolescents experience identity formation, academic
stress, and changing peer relationships that influence mood and engagement in therapy.
School-related stress – Academic pressures, performance anxiety, and social dynamics at
school can exacerbate depressive symptoms in autistic adolescents (Hudson et al., 2019).
Peer and social influences – Peer acceptance, bullying, and social comparison uniquely
impact adolescent mental health and therapy outcomes.
Emotional regulation differences – Adolescents may have less developed coping skills
than adults, requiring tailored support for emotional management.
Need for adolescent-specific interventions – These factors highlight the importance of
designing interventions that address both autism-related and developmental needs.
2
Adult-centric research – Most studies on depression interventions focus on adults, leaving
adolescent-specific needs underexplored (Hudson et al., 2019).
Unique developmental challenges – Adolescents experience identity formation, academic
stress, and changing peer relationships that influence mood and engagement in therapy.
School-related stress – Academic pressures, performance anxiety, and social dynamics at
school can exacerbate depressive symptoms in autistic adolescents (Hudson et al., 2019).
Peer and social influences – Peer acceptance, bullying, and social comparison uniquely
impact adolescent mental health and therapy outcomes.
Emotional regulation differences – Adolescents may have less developed coping skills
than adults, requiring tailored support for emotional management.
Need for adolescent-specific interventions – These factors highlight the importance of
designing interventions that address both autism-related and developmental needs.
2
Gaps: Research Gap
Limited programs combining autism adaptation and adolescence – Few interventions
simultaneously address neurodivergent cognitive profiles and adolescent developmental
needs (Weston et al., 2016; Stark et al., 2022).
Developmentally sensitive design lacking – Most programs fail to integrate school, peer,
and identity-related challenges in adolescents.
Neurodiversity-informed adaptations underutilized – Sensory, communication, and
cognitive differences often ignored in standard interventions.
Digital and online delivery rarely explored – Technology-based adaptations could improve
accessibility and engagement but remain underdeveloped.
Participatory approaches uncommon – Youth involvement in shaping content and delivery
is rarely implemented in current research.
Highlights urgent need – Strong justification exists for interventions that are both autism-
adapted and adolescent-focused (Weston et al., 2016; Stark et al., 2022).
2
Limited programs combining autism adaptation and adolescence – Few interventions
simultaneously address neurodivergent cognitive profiles and adolescent developmental
needs (Weston et al., 2016; Stark et al., 2022).
Developmentally sensitive design lacking – Most programs fail to integrate school, peer,
and identity-related challenges in adolescents.
Neurodiversity-informed adaptations underutilized – Sensory, communication, and
cognitive differences often ignored in standard interventions.
Digital and online delivery rarely explored – Technology-based adaptations could improve
accessibility and engagement but remain underdeveloped.
Participatory approaches uncommon – Youth involvement in shaping content and delivery
is rarely implemented in current research.
Highlights urgent need – Strong justification exists for interventions that are both autism-
adapted and adolescent-focused (Weston et al., 2016; Stark et al., 2022).
2
Gaps: Sensory and Communication Needs
Sensory sensitivities reduce participation – Autistic adolescents often experience
heightened sensitivity to auditory, visual, or tactile stimuli, which can limit engagement in
standard therapy sessions (Ashburner et al., 2013).
Sensory overload impairs learning – Excessive sensory input may increase anxiety, distract
from therapeutic tasks, and interfere with skill acquisition (Weston et al., 2016).
Communication difficulties affect comprehension – Differences in pragmatic language,
social inference, and expressive abilities can hinder understanding of instructions or verbal
therapy content (Howlin & Moss, 2012).
Assumption of typical social skills – Standard interventions often presume neurotypical
communication patterns, leading to misalignment with autistic participants’ needs.
Reduced therapy efficacy – Ignoring sensory and communication differences can
decrease engagement, motivation, and overall intervention effectiveness.
Need for tailored approaches – Programs should integrate sensory accommodations,
visual supports, and concrete communication strategies to enhance participation and
learning (Weston et al., 2016).
2
Sensory sensitivities reduce participation – Autistic adolescents often experience
heightened sensitivity to auditory, visual, or tactile stimuli, which can limit engagement in
standard therapy sessions (Ashburner et al., 2013).
Sensory overload impairs learning – Excessive sensory input may increase anxiety, distract
from therapeutic tasks, and interfere with skill acquisition (Weston et al., 2016).
Communication difficulties affect comprehension – Differences in pragmatic language,
social inference, and expressive abilities can hinder understanding of instructions or verbal
therapy content (Howlin & Moss, 2012).
Assumption of typical social skills – Standard interventions often presume neurotypical
communication patterns, leading to misalignment with autistic participants’ needs.
Reduced therapy efficacy – Ignoring sensory and communication differences can
decrease engagement, motivation, and overall intervention effectiveness.
Need for tailored approaches – Programs should integrate sensory accommodations,
visual supports, and concrete communication strategies to enhance participation and
learning (Weston et al., 2016).
2
Study Aim: Primary Aim
Co-design of intervention – The study aimed to develop an online Behavioral Activation
(BA) program specifically for autistic adolescents experiencing depression (Stark et al.,
2022).
Autism-adapted content – The intervention was tailored to account for cognitive, social,
and sensory differences common in autism, including structured activities and visual
supports.
Focus on adolescent needs – Program design considered developmental challenges,
including peer relationships, identity formation, and school-related stress.
Engagement and adherence – Structured, stepwise sessions were intended to improve
motivation, reduce uncertainty, and support consistent participation.
Promoting practical skills – BA strategies emphasized concrete, actionable tasks to
manage low mood and encourage daily activity scheduling.
Evidence-informed approach – Behavioral Activation was selected as a validated, brief,
and action-oriented therapy for depression, adaptable to online delivery for autistic youth
(Jacobson et al., 2001).
2
Co-design of intervention – The study aimed to develop an online Behavioral Activation
(BA) program specifically for autistic adolescents experiencing depression (Stark et al.,
2022).
Autism-adapted content – The intervention was tailored to account for cognitive, social,
and sensory differences common in autism, including structured activities and visual
supports.
Focus on adolescent needs – Program design considered developmental challenges,
including peer relationships, identity formation, and school-related stress.
Engagement and adherence – Structured, stepwise sessions were intended to improve
motivation, reduce uncertainty, and support consistent participation.
Promoting practical skills – BA strategies emphasized concrete, actionable tasks to
manage low mood and encourage daily activity scheduling.
Evidence-informed approach – Behavioral Activation was selected as a validated, brief,
and action-oriented therapy for depression, adaptable to online delivery for autistic youth
(Jacobson et al., 2001).
2
Study Aim: Pilot Objectives
Feasibility assessment – Determine whether the program could be delivered
effectively to autistic adolescents online.
Acceptability evaluation – Explore adolescents’ engagement, satisfaction, and
perception of the program’s relevance and supportiveness.
Preliminary clinical effects – Assess reductions in depressive symptoms using
quantitative (PHQ-9A, MFQ) and qualitative measures.
Retention and adherence – Monitor session attendance, completion of home
tasks, and participation consistency.
Iterative improvement – Collect structured feedback to refine content, visuals,
and session structure during the pilot phase.
Establish groundwork for larger trials – Generate data to inform future
randomized controlled trials and broader implementation (Stark et al., 2022).
2
Feasibility assessment – Determine whether the program could be delivered
effectively to autistic adolescents online.
Acceptability evaluation – Explore adolescents’ engagement, satisfaction, and
perception of the program’s relevance and supportiveness.
Preliminary clinical effects – Assess reductions in depressive symptoms using
quantitative (PHQ-9A, MFQ) and qualitative measures.
Retention and adherence – Monitor session attendance, completion of home
tasks, and participation consistency.
Iterative improvement – Collect structured feedback to refine content, visuals,
and session structure during the pilot phase.
Establish groundwork for larger trials – Generate data to inform future
randomized controlled trials and broader implementation (Stark et al., 2022).
2
Study Aim: Broader Exploration
Participatory design benefits – Investigate how involving autistic adolescents in
co-design impacts engagement and ownership.
Therapy relevance – Explore whether user input enhances program content,
language, and activity structure to match adolescents’ cognitive and sensory
profiles.
Motivation and adherence – Examine whether co-design increases willingness
to participate and complete sessions.
Skill generalization – Assess whether adolescents apply learned BA strategies in
real-life contexts such as school, home, or social activities.
Empowerment and agency – Evaluate whether adolescents feel more control
over mood management and daily activity planning.
Inform future interventions – Use findings to guide autism-adapted,
developmentally sensitive mental health programs (Stark et al., 2022; Fletcher-
Watson et al., 2019).
2
Participatory design benefits – Investigate how involving autistic adolescents in
co-design impacts engagement and ownership.
Therapy relevance – Explore whether user input enhances program content,
language, and activity structure to match adolescents’ cognitive and sensory
profiles.
Motivation and adherence – Examine whether co-design increases willingness
to participate and complete sessions.
Skill generalization – Assess whether adolescents apply learned BA strategies in
real-life contexts such as school, home, or social activities.
Empowerment and agency – Evaluate whether adolescents feel more control
over mood management and daily activity planning.
Inform future interventions – Use findings to guide autism-adapted,
developmentally sensitive mental health programs (Stark et al., 2022; Fletcher-
Watson et al., 2019).
2
3
Method
Method
2
Procedure
Intervention design: An 12-session Behavioral Activation (BA) program
developed through participatory co-design with autistic adolescents, ensuring
relevance and inclusivity.
Format: Sessions were delivered online via a secure video platform, maximizing
accessibility and minimizing barriers related to travel and sensory environments.
Session structure: Each session followed a consistent format of activity
scheduling, mood monitoring, skill practice, and structured feedback to reduce
uncertainty.
Adaptations: Language was simplified, visuals and concrete task breakdowns
were incorporated, and materials were adjusted to align with autistic cognitive
and sensory preferences.
Therapist role: Clinicians provided structured guidance while actively integrating
adolescents’ perspectives to enhance engagement and ownership.
Feedback loop: Ongoing participant input directly influenced session
refinement, ensuring materials remained accessible, autism-friendly, and
meaningful (Stark et al., 2022).
2
Intervention design: An 12-session Behavioral Activation (BA) program
developed through participatory co-design with autistic adolescents, ensuring
relevance and inclusivity.
Format: Sessions were delivered online via a secure video platform, maximizing
accessibility and minimizing barriers related to travel and sensory environments.
Session structure: Each session followed a consistent format of activity
scheduling, mood monitoring, skill practice, and structured feedback to reduce
uncertainty.
Adaptations: Language was simplified, visuals and concrete task breakdowns
were incorporated, and materials were adjusted to align with autistic cognitive
and sensory preferences.
Therapist role: Clinicians provided structured guidance while actively integrating
adolescents’ perspectives to enhance engagement and ownership.
Feedback loop: Ongoing participant input directly influenced session
refinement, ensuring materials remained accessible, autism-friendly, and
meaningful (Stark et al., 2022).
2
Participants: Age Group
Target population – Adolescents aged 13–17 years were recruited for the study,
capturing mid- to late-adolescent developmental stages.
Developmental relevance – This age range encompasses key periods of identity
formation, social learning, and academic challenges, which influence depression
risk and therapy engagement (Hudson et al., 2019).
Homogeneity – Narrow age range helps reduce variability in developmental and
cognitive profiles, improving interpretability of pilot findings.
Clinical relevance – Adolescents in this range frequently exhibit emerging
depressive symptoms alongside social and communication challenges typical of
autism.
Alignment with intervention design – Online BA sessions were tailored for
adolescents’ cognitive abilities, attention span, and motivational needs (Stark et
al., 2022).
2
Target population – Adolescents aged 13–17 years were recruited for the study,
capturing mid- to late-adolescent developmental stages.
Developmental relevance – This age range encompasses key periods of identity
formation, social learning, and academic challenges, which influence depression
risk and therapy engagement (Hudson et al., 2019).
Homogeneity – Narrow age range helps reduce variability in developmental and
cognitive profiles, improving interpretability of pilot findings.
Clinical relevance – Adolescents in this range frequently exhibit emerging
depressive symptoms alongside social and communication challenges typical of
autism.
Alignment with intervention design – Online BA sessions were tailored for
adolescents’ cognitive abilities, attention span, and motivational needs (Stark et
al., 2022).
2
Participants: Diagnosis
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Participants: Clinical Profile
Depressive symptoms – All participants exhibited clinically significant
depressive symptoms, assessed via standardized questionnaires.
Assessment tools – Social Communication Questionnaire (SCQ) to confirm
autism characteristics, the Beck Depression Inventory–II (BDI-II) to assess
depressive symptom severity, and the Revised Child Anxiety and Depression
Scale (RCADS) to measure broader internalizing symptoms such as anxiety and
depression (Muhammad et al., 2023).
Symptom relevance – Inclusion ensured participants had meaningful
symptomatology to evaluate BA effectiveness.
Variation in severity – Captured mild-to-moderate depression typical of
outpatient adolescent samples.
Baseline documentation – Detailed assessment allowed comparison of pre- and
post-intervention outcomes.
2
Depressive symptoms – All participants exhibited clinically significant
depressive symptoms, assessed via standardized questionnaires.
Assessment tools – Social Communication Questionnaire (SCQ) to confirm
autism characteristics, the Beck Depression Inventory–II (BDI-II) to assess
depressive symptom severity, and the Revised Child Anxiety and Depression
Scale (RCADS) to measure broader internalizing symptoms such as anxiety and
depression (Muhammad et al., 2023).
Symptom relevance – Inclusion ensured participants had meaningful
symptomatology to evaluate BA effectiveness.
Variation in severity – Captured mild-to-moderate depression typical of
outpatient adolescent samples.
Baseline documentation – Detailed assessment allowed comparison of pre- and
post-intervention outcomes.
2
Participants: Eligibility Criteria
Online engagement – Participants needed ability to access and navigate video-
based sessions.
Feedback willingness – Adolescents were expected to provide structured input
on program content, usability, and delivery.
Cognitive and sensory capacity – Sufficient functioning to complete structured
activities and tolerate online sessions.
Parental consent – Informed consent from parents or guardians was obtained
per ethical guidelines.
Commitment to pilot program – Expected to attend 8 sessions and engage in
home-based BA tasks.
2
Online engagement – Participants needed ability to access and navigate video-
based sessions.
Feedback willingness – Adolescents were expected to provide structured input
on program content, usability, and delivery.
Cognitive and sensory capacity – Sufficient functioning to complete structured
activities and tolerate online sessions.
Parental consent – Informed consent from parents or guardians was obtained
per ethical guidelines.
Commitment to pilot program – Expected to attend 8 sessions and engage in
home-based BA tasks.
2
Social Communication Questionnaire
(SCQ) Purpose — Brief caregiver-report screening tool for autism-related social-communication symptoms
Format — 40 yes/no items (lifetime or current form) completed by parent/caregiver.
Use in study — Confirms autism-relevant features and assists in sample description/eligibility.
Suitability — Quick to administer remotely and useful when formal diagnostic instruments are not feasible.
Interpretation — Cut-off scores indicate likelihood of ASD and guide clinical characterization of participants.
Psychometrics — Widely used with acceptable sensitivity/specificity in clinical and research samples (Rutter,
Bailey, & Lord, 2003). 2
(SCQ) Purpose — Brief caregiver-report screening tool for autism-related social-communication symptoms
Format — 40 yes/no items (lifetime or current form) completed by parent/caregiver.
Use in study — Confirms autism-relevant features and assists in sample description/eligibility.
Suitability — Quick to administer remotely and useful when formal diagnostic instruments are not feasible.
Interpretation — Cut-off scores indicate likelihood of ASD and guide clinical characterization of participants.
Psychometrics — Widely used with acceptable sensitivity/specificity in clinical and research samples (Rutter,
Bailey, & Lord, 2003). 2
Measures: Beck Depression Inventory-II (BDI-
II)
Purpose — Self-report inventory measuring severity of depressive symptoms in
adolescents and adults
Format — 21 items rated 0–3, covering affective, cognitive, and somatic
domains.
Use in study — Primary quantitative measure of depressive symptom severity
and change over time.
Suitability — Well-validated, sensitive to change, commonly used in clinical trials
and applied settings
Administration — Feasible for online completion with clinician oversight;
interpretable as pre/post scores
Psychometrics — Robust reliability and validity across adolescent clinical
populations (Beck, Steer, & Brown, 1996).
2
II)
Purpose — Self-report inventory measuring severity of depressive symptoms in
adolescents and adults
Format — 21 items rated 0–3, covering affective, cognitive, and somatic
domains.
Use in study — Primary quantitative measure of depressive symptom severity
and change over time.
Suitability — Well-validated, sensitive to change, commonly used in clinical trials
and applied settings
Administration — Feasible for online completion with clinician oversight;
interpretable as pre/post scores
Psychometrics — Robust reliability and validity across adolescent clinical
populations (Beck, Steer, & Brown, 1996).
2
Measures: Revised Child Anxiety
and Depression Scale (RCADS) Purpose — Child/adolescent self-report assessing symptoms of anxiety
disorders and depression across subscales.
Format — 47 items (RCADS-47) rated on a 4-point Likert scale; yields disorder-
specific and total internalizing scores.
Use in study — Provides broader dimensional assessment of internalizing
symptoms (anxiety + depression) alongside BDI-II.
Suitability — Sensitive to comorbid anxiety (common in autistic youth) and
useful for profiling symptom clusters and functional impact.
Administration — Appropriate for online delivery; allows examination of change
in anxiety comorbidity as well as depressive symptoms.
Psychometrics — Good reliability and factor structure in clinical and community
youth samples (Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000).
2
and Depression Scale (RCADS) Purpose — Child/adolescent self-report assessing symptoms of anxiety
disorders and depression across subscales.
Format — 47 items (RCADS-47) rated on a 4-point Likert scale; yields disorder-
specific and total internalizing scores.
Use in study — Provides broader dimensional assessment of internalizing
symptoms (anxiety + depression) alongside BDI-II.
Suitability — Sensitive to comorbid anxiety (common in autistic youth) and
useful for profiling symptom clusters and functional impact.
Administration — Appropriate for online delivery; allows examination of change
in anxiety comorbidity as well as depressive symptoms.
Psychometrics — Good reliability and factor structure in clinical and community
youth samples (Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000).
2
Measures: Qualitative Interviews
Purpose – Explores acceptability, usability, and perceived benefits in-depth.
Format – Semi-structured interviews conducted post-intervention with
participants.
Content focus – Experiences with session structure, activities, visuals, and
online format.
Analysis – Thematic analysis identifies recurring patterns, barriers, and
facilitators (Braun & Clarke, 2006).
Participant voice – Captures lived experiences and perceptions not reflected in
quantitative scores.
Clinical relevance – Provides insight into real-world impact and guides
refinement of autism-adapted BA interventions.
2
Purpose – Explores acceptability, usability, and perceived benefits in-depth.
Format – Semi-structured interviews conducted post-intervention with
participants.
Content focus – Experiences with session structure, activities, visuals, and
online format.
Analysis – Thematic analysis identifies recurring patterns, barriers, and
facilitators (Braun & Clarke, 2006).
Participant voice – Captures lived experiences and perceptions not reflected in
quantitative scores.
Clinical relevance – Provides insight into real-world impact and guides
refinement of autism-adapted BA interventions.
2
3
Results
Results
Feasibility: Completion & Retention
High completion rate – 6 of 7 adolescents (≈86%) completed all 12 BA sessions,
demonstrating strong engagement for a pilot study (Muhammad et al., 2023).
Minimal dropout – Only one participant discontinued, suggesting that the online
format was manageable for autistic adolescents.
Consistency with pilot standards – Completion rates exceed typical thresholds
for small-scale feasibility studies.
Implication for adherence – High retention supports the practicality of delivering
structured BA interventions online.
Participant motivation – Adolescents’ willingness to continue indicates
perceived relevance and acceptability of session content.
Supports scalability – Feasibility data suggest potential for larger trials with
similar delivery methods.
2
High completion rate – 6 of 7 adolescents (≈86%) completed all 12 BA sessions,
demonstrating strong engagement for a pilot study (Muhammad et al., 2023).
Minimal dropout – Only one participant discontinued, suggesting that the online
format was manageable for autistic adolescents.
Consistency with pilot standards – Completion rates exceed typical thresholds
for small-scale feasibility studies.
Implication for adherence – High retention supports the practicality of delivering
structured BA interventions online.
Participant motivation – Adolescents’ willingness to continue indicates
perceived relevance and acceptability of session content.
Supports scalability – Feasibility data suggest potential for larger trials with
similar delivery methods.
2
Feasibility: Adherence & Attendance
High session attendance – Participants consistently attended scheduled online
sessions, reflecting commitment.
Engagement with home tasks – Adolescents actively completed activity
scheduling and behavioral exercises outside sessions.
Structured BA helpful – Stepwise instructions and visual supports promoted
adherence to both in-session and home-based activities.
Reduced barriers – Online format minimized transportation, scheduling, and
social anxiety obstacles.
Participant feedback alignment – Session adherence correlated with positive
satisfaction ratings and engagement levels (Fletcher-Watson et al., 2019).
Feasibility indicator – High attendance and task completion demonstrate the
intervention’s practical implementation potential.
2
High session attendance – Participants consistently attended scheduled online
sessions, reflecting commitment.
Engagement with home tasks – Adolescents actively completed activity
scheduling and behavioral exercises outside sessions.
Structured BA helpful – Stepwise instructions and visual supports promoted
adherence to both in-session and home-based activities.
Reduced barriers – Online format minimized transportation, scheduling, and
social anxiety obstacles.
Participant feedback alignment – Session adherence correlated with positive
satisfaction ratings and engagement levels (Fletcher-Watson et al., 2019).
Feasibility indicator – High attendance and task completion demonstrate the
intervention’s practical implementation potential.
2
Feasibility: Clinical Feasibility
Navigating online delivery – Adolescents managed video-based sessions with
minimal technical support or disruptions.
Sensory considerations – Online format reduced exposure to potentially
overwhelming stimuli (e.g., classroom noise, crowded settings).
Session structure efficacy – Clear, predictable session flow supported focus and
understanding.
Applicability for autism – Structured, visual, and concrete BA strategies were
well-suited for participants’ cognitive profiles.
Real-world readiness – Findings suggest that online BA is a viable format for
routine clinical use with autistic adolescents.
Supports broader adoption – Feasible online delivery indicates potential for
scalable, accessible interventions in mental health services (Stark et al., 2022).
2
Navigating online delivery – Adolescents managed video-based sessions with
minimal technical support or disruptions.
Sensory considerations – Online format reduced exposure to potentially
overwhelming stimuli (e.g., classroom noise, crowded settings).
Session structure efficacy – Clear, predictable session flow supported focus and
understanding.
Applicability for autism – Structured, visual, and concrete BA strategies were
well-suited for participants’ cognitive profiles.
Real-world readiness – Findings suggest that online BA is a viable format for
routine clinical use with autistic adolescents.
Supports broader adoption – Feasible online delivery indicates potential for
scalable, accessible interventions in mental health services (Stark et al., 2022).
2
Acceptability: Overall Feedback
High satisfaction – Adolescents reported positive experiences across all
sessions, rating the program as helpful, relevant, and easy to follow (Fletcher-
Watson et al., 2019).
Value of co-design – Input from participants led to simplified language, clear
visuals, and structured session formats, reducing confusion and enhancing
engagement.
Tailored content – Adaptations for autistic cognitive and sensory profiles made
activities feel inclusive and autism-friendly.
Perceived benefits – Adolescents felt supported and encouraged, describing
increased ability to manage low mood through structured activities.
Empowerment and agency – Participants expressed a sense of control over
daily routines and mood management.
Overall impression – Intervention was seen as accessible, acceptable, and
engaging for autistic adolescents.
2
High satisfaction – Adolescents reported positive experiences across all
sessions, rating the program as helpful, relevant, and easy to follow (Fletcher-
Watson et al., 2019).
Value of co-design – Input from participants led to simplified language, clear
visuals, and structured session formats, reducing confusion and enhancing
engagement.
Tailored content – Adaptations for autistic cognitive and sensory profiles made
activities feel inclusive and autism-friendly.
Perceived benefits – Adolescents felt supported and encouraged, describing
increased ability to manage low mood through structured activities.
Empowerment and agency – Participants expressed a sense of control over
daily routines and mood management.
Overall impression – Intervention was seen as accessible, acceptable, and
engaging for autistic adolescents.
2
Acceptability: Online Delivery
Preference for online format – 64% of adolescents indicated that they preferred
sessions delivered online rather than in-person (Hudson et al., 2019).
Flexibility – Online sessions allowed scheduling around school and home
commitments, enhancing participation.
Reduced social stress – Video-based sessions minimized anxiety related to
face-to-face interactions and group settings.
Convenience – Participants could attend sessions from home, reducing travel
time and logistical barriers.
Sensory advantages – Online delivery limited overstimulation from crowded or
noisy environments.
Clinical implication – Digital-first models may enhance accessibility and
engagement for autistic adolescents with depression.
2
Preference for online format – 64% of adolescents indicated that they preferred
sessions delivered online rather than in-person (Hudson et al., 2019).
Flexibility – Online sessions allowed scheduling around school and home
commitments, enhancing participation.
Reduced social stress – Video-based sessions minimized anxiety related to
face-to-face interactions and group settings.
Convenience – Participants could attend sessions from home, reducing travel
time and logistical barriers.
Sensory advantages – Online delivery limited overstimulation from crowded or
noisy environments.
Clinical implication – Digital-first models may enhance accessibility and
engagement for autistic adolescents with depression.
2
Acceptability: Perceived Benefits
Increased sense of agency – Adolescents reported feeling more in control of
their activities and mood.
Improved mood regulation – Participants applied BA strategies to manage low
mood and negative emotions in daily life.
Reduced withdrawal and inactivity – Engagement in structured, rewarding
activities increased, decreasing patterns of avoidance.
Enhanced self-efficacy – Completing BA tasks reinforced confidence in
managing depressive symptoms.
Relevance of content – Co-designed language, visuals, and structured tasks
increased participants’ perception that the program was supportive.
Evidence beyond scores – Qualitative feedback complemented quantitative
measures, highlighting real-world impact (Stark et al., 2022).
2
Increased sense of agency – Adolescents reported feeling more in control of
their activities and mood.
Improved mood regulation – Participants applied BA strategies to manage low
mood and negative emotions in daily life.
Reduced withdrawal and inactivity – Engagement in structured, rewarding
activities increased, decreasing patterns of avoidance.
Enhanced self-efficacy – Completing BA tasks reinforced confidence in
managing depressive symptoms.
Relevance of content – Co-designed language, visuals, and structured tasks
increased participants’ perception that the program was supportive.
Evidence beyond scores – Qualitative feedback complemented quantitative
measures, highlighting real-world impact (Stark et al., 2022).
2
Clinical Outcomes: Quantitative
BDI-II improvements - Most participants demonstrated notable reductions in
depressive symptom severity following the intervention *(Beck et al., 1996).
RCADS improvements– Scores indicated broader gains in emotional well-being
and reductions in internalizing symptoms such as anxiety *(Chorpita et al.,
2000).
Consistency across measures – Parallel improvements on both BDI-II and
RCADS strengthened confidence in the observed clinical effects.
Preliminary evidence– Despite the small sample size, results suggested early
therapeutic benefits of autism-adapted Behavioral Activation (BA).
Functional relevance– Mood improvements were accompanied by increased
participation in daily and school activities, indicating meaningful real-world
change.
Support for intervention model - Quantitative outcomes reinforce the feasibility
and potential effectiveness of a structured, online BA program for autistic
adolescents (Muhammad et al., 2023).
2
BDI-II improvements - Most participants demonstrated notable reductions in
depressive symptom severity following the intervention *(Beck et al., 1996).
RCADS improvements– Scores indicated broader gains in emotional well-being
and reductions in internalizing symptoms such as anxiety *(Chorpita et al.,
2000).
Consistency across measures – Parallel improvements on both BDI-II and
RCADS strengthened confidence in the observed clinical effects.
Preliminary evidence– Despite the small sample size, results suggested early
therapeutic benefits of autism-adapted Behavioral Activation (BA).
Functional relevance– Mood improvements were accompanied by increased
participation in daily and school activities, indicating meaningful real-world
change.
Support for intervention model - Quantitative outcomes reinforce the feasibility
and potential effectiveness of a structured, online BA program for autistic
adolescents (Muhammad et al., 2023).
2
Clinical Outcomes: Qualitative
Increased sense of agency – Adolescents felt more control over planning
activities and managing mood.
Improved mood regulation – Participants reported applying BA strategies in
daily life to cope with negative emotions.
Reduced withdrawal – Engagement in structured, rewarding activities increased,
reducing social avoidance.
Skill generalization – Strategies learned in sessions were transferable to school,
home, and social contexts.
Empowerment – Participants felt supported, motivated, and capable of self-
managing depressive symptoms.
Real-world significance – Qualitative feedback complemented numerical scores,
demonstrating tangible life improvements (Stark et al., 2022).
2
Increased sense of agency – Adolescents felt more control over planning
activities and managing mood.
Improved mood regulation – Participants reported applying BA strategies in
daily life to cope with negative emotions.
Reduced withdrawal – Engagement in structured, rewarding activities increased,
reducing social avoidance.
Skill generalization – Strategies learned in sessions were transferable to school,
home, and social contexts.
Empowerment – Participants felt supported, motivated, and capable of self-
managing depressive symptoms.
Real-world significance – Qualitative feedback complemented numerical scores,
demonstrating tangible life improvements (Stark et al., 2022).
2
2
3
Discussion
Discussion
BA Fits Autistic Cognitive Style
Structured approach – Clear session flow and step-by-step activity plans
reduce uncertainty and enhance comprehension (Jacobson et al., 2001).
Concrete and practical – Focus on actionable tasks rather than abstract
discussions aligns with autistic cognitive strengths.
Supports routine preference – BA’s predictable format fits the need for
structure, aiding engagement and adherence.
Visual supports – Use of diagrams, charts, and activity trackers enhances
understanding and retention.
Encourages self-monitoring – Stepwise exercises allow participants to track
progress and reflect on mood changes.
Clinical relevance – Structured, action-oriented BA may improve motivation,
therapy adherence, and functional outcomes in autistic adolescents (Stark et al.,
2022).
2
Structured approach – Clear session flow and step-by-step activity plans
reduce uncertainty and enhance comprehension (Jacobson et al., 2001).
Concrete and practical – Focus on actionable tasks rather than abstract
discussions aligns with autistic cognitive strengths.
Supports routine preference – BA’s predictable format fits the need for
structure, aiding engagement and adherence.
Visual supports – Use of diagrams, charts, and activity trackers enhances
understanding and retention.
Encourages self-monitoring – Stepwise exercises allow participants to track
progress and reflect on mood changes.
Clinical relevance – Structured, action-oriented BA may improve motivation,
therapy adherence, and functional outcomes in autistic adolescents (Stark et al.,
2022).
2
Online Delivery & Co-Design
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Strengths : Participatory Co-Design & Youth Involvement
Active youth participation – Adolescents shaped session content, visuals, and
activities, ensuring relevance and engagement (Fletcher-Watson et al., 2019).
Enhanced accessibility – Feedback improved clarity, structure, and autism-
friendly presentation, reducing confusion.
Ownership and motivation – Co-design fostered a sense of control and personal
investment in therapy.
Neurodivergent alignment – Language, activities, and instructions adapted to
match cognitive, sensory, and communication profiles.
Model for inclusive research – Demonstrates the value of integrating
neurodivergent voices in intervention development.
Engagement and relevance – Tailored approach ensured therapy was
meaningful, motivating, and appealing to participants.
2
Active youth participation – Adolescents shaped session content, visuals, and
activities, ensuring relevance and engagement (Fletcher-Watson et al., 2019).
Enhanced accessibility – Feedback improved clarity, structure, and autism-
friendly presentation, reducing confusion.
Ownership and motivation – Co-design fostered a sense of control and personal
investment in therapy.
Neurodivergent alignment – Language, activities, and instructions adapted to
match cognitive, sensory, and communication profiles.
Model for inclusive research – Demonstrates the value of integrating
neurodivergent voices in intervention development.
Engagement and relevance – Tailored approach ensured therapy was
meaningful, motivating, and appealing to participants.
2
Strengths: Evidence-Based Adaptation & Digital Feasibility
Validated therapy – Behavioral Activation (BA) chosen for its established
effectiveness in reducing depression (Jacobson et al., 2001).
Autism-specific modifications – Session structure, concrete tasks, and visuals
adapted to neurodivergent needs.
Action-oriented approach – Emphasis on behavior activation rather than
abstract discussion supports skill application in daily life.
Research-to-practice bridging – Adapts mainstream therapy for neurodivergent
adolescents while maintaining fidelity.
Successful online delivery – Video-based sessions had minimal technical issues
and high completion rates (Stark et al., 2022).
Scalability and accessibility – Digital format reduces transportation barriers,
supports home-based participation, and minimizes sensory overload.
2
Validated therapy – Behavioral Activation (BA) chosen for its established
effectiveness in reducing depression (Jacobson et al., 2001).
Autism-specific modifications – Session structure, concrete tasks, and visuals
adapted to neurodivergent needs.
Action-oriented approach – Emphasis on behavior activation rather than
abstract discussion supports skill application in daily life.
Research-to-practice bridging – Adapts mainstream therapy for neurodivergent
adolescents while maintaining fidelity.
Successful online delivery – Video-based sessions had minimal technical issues
and high completion rates (Stark et al., 2022).
Scalability and accessibility – Digital format reduces transportation barriers,
supports home-based participation, and minimizes sensory overload.
2
Limitations: Sample & Study Design
Small sample size – Only 7 participants, limiting statistical power and
generalizability (Stark et al., 2022).
Pilot study – Findings provide preliminary insights but cannot confirm efficacy.
No control group – Limits ability to attribute improvements solely to the BA
intervention.
Open-label design – Self-report measures may introduce bias in outcome
assessment.
Short-term evaluation – Outcomes measured immediately post-intervention, no
longitudinal data.
Limited functional assessment – Impact on daily functioning, school, or social
engagement not formally measured.
2
Small sample size – Only 7 participants, limiting statistical power and
generalizability (Stark et al., 2022).
Pilot study – Findings provide preliminary insights but cannot confirm efficacy.
No control group – Limits ability to attribute improvements solely to the BA
intervention.
Open-label design – Self-report measures may introduce bias in outcome
assessment.
Short-term evaluation – Outcomes measured immediately post-intervention, no
longitudinal data.
Limited functional assessment – Impact on daily functioning, school, or social
engagement not formally measured.
2
Limitations: Generalizability & Long-Term Considerations
High-functioning bias – Online BA required sufficient verbal and cognitive
abilities, excluding some participants.
Technology access required – Limited access may prevent participation from
underserved populations.
Cultural and geographic constraints – Participants from restricted regions;
findings may not generalize globally.
Underrepresented co-occurring conditions – ADHD, learning disabilities, or
severe communication difficulties not fully included.
No long-term follow-up – Sustainability of symptom reduction and functional
improvements is unknown.
Need for broader studies – Inclusion of diverse autism subgroups needed to
enhance relevance and applicability.
2
High-functioning bias – Online BA required sufficient verbal and cognitive
abilities, excluding some participants.
Technology access required – Limited access may prevent participation from
underserved populations.
Cultural and geographic constraints – Participants from restricted regions;
findings may not generalize globally.
Underrepresented co-occurring conditions – ADHD, learning disabilities, or
severe communication difficulties not fully included.
No long-term follow-up – Sustainability of symptom reduction and functional
improvements is unknown.
Need for broader studies – Inclusion of diverse autism subgroups needed to
enhance relevance and applicability.
2
Future Research: Larger-Scale Trials & Long-Term Follow-Up
Randomized controlled trials (RCTs) – Needed to rigorously test efficacy of
autism-adapted BA interventions (Muhammad et al., 2023).
Increase sample size – Larger participant groups will improve statistical power
and strengthen confidence in outcomes.
Enhance generalizability – Including diverse autistic adolescents ensures
findings are applicable across the spectrum.
Evaluate intervention components – Identify which elements of co-design,
structure, and online delivery are most effective.
Long-term sustainability – Assess whether reductions in depressive symptoms
persist over months or years.
Monitor functional outcomes – Track impact on school performance, social
participation, and daily life activities.
2
Randomized controlled trials (RCTs) – Needed to rigorously test efficacy of
autism-adapted BA interventions (Muhammad et al., 2023).
Increase sample size – Larger participant groups will improve statistical power
and strengthen confidence in outcomes.
Enhance generalizability – Including diverse autistic adolescents ensures
findings are applicable across the spectrum.
Evaluate intervention components – Identify which elements of co-design,
structure, and online delivery are most effective.
Long-term sustainability – Assess whether reductions in depressive symptoms
persist over months or years.
Monitor functional outcomes – Track impact on school performance, social
participation, and daily life activities.
2
Future Research: Diverse Subgroups & Broader Implications
Include diverse cognitive and communication levels – Ensure accessibility for
adolescents with varying abilities.
Address co-occurring conditions – Incorporate participants with ADHD, anxiety,
or learning disabilities for real-world applicability.
Test cross-cultural applicability – Evaluate the program’s relevance across
different geographic and cultural contexts.
Adapt digital tools – Ensure intervention is accessible across devices and
varying internet access.
Guide adaptations for other developmental disabilities – BA could be tailored
for ADHD, intellectual disability, or learning disabilities (Hassiotis et al., 2013).
Promote participatory, scalable interventions – Inclusion of youth voices
ensures engagement, relevance, and potential for broad implementation.
2
Include diverse cognitive and communication levels – Ensure accessibility for
adolescents with varying abilities.
Address co-occurring conditions – Incorporate participants with ADHD, anxiety,
or learning disabilities for real-world applicability.
Test cross-cultural applicability – Evaluate the program’s relevance across
different geographic and cultural contexts.
Adapt digital tools – Ensure intervention is accessible across devices and
varying internet access.
Guide adaptations for other developmental disabilities – BA could be tailored
for ADHD, intellectual disability, or learning disabilities (Hassiotis et al., 2013).
Promote participatory, scalable interventions – Inclusion of youth voices
ensures engagement, relevance, and potential for broad implementation.
2
Clinical Implications
Adapted BA shows promise – Tailored behavioral activation can address
depression in autistic adolescents without losing therapeutic fidelity (Stark et al.,
2022).
Value of co-design – Incorporating autistic youth in intervention design
improves engagement, ownership, and treatment adherence (Fletcher-Watson
et al., 2019).
Need for autism-specific tailoring – Structured, concrete, and visually supported
strategies align better with neurodivergent cognitive and sensory styles.
Digital mental health potential – Online delivery reduces barriers such as
transportation, scheduling, and sensory overload, enhancing accessibility.
Scalable intervention – Adapted BA can be integrated into schools, community
clinics, and telehealth platforms, reaching underserved populations.
Foundation for inclusive therapies – Demonstrates that mainstream evidence-
based treatments can be effectively modified for neurodivergent groups,
guiding future clinical innovation.
2
Adapted BA shows promise – Tailored behavioral activation can address
depression in autistic adolescents without losing therapeutic fidelity (Stark et al.,
2022).
Value of co-design – Incorporating autistic youth in intervention design
improves engagement, ownership, and treatment adherence (Fletcher-Watson
et al., 2019).
Need for autism-specific tailoring – Structured, concrete, and visually supported
strategies align better with neurodivergent cognitive and sensory styles.
Digital mental health potential – Online delivery reduces barriers such as
transportation, scheduling, and sensory overload, enhancing accessibility.
Scalable intervention – Adapted BA can be integrated into schools, community
clinics, and telehealth platforms, reaching underserved populations.
Foundation for inclusive therapies – Demonstrates that mainstream evidence-
based treatments can be effectively modified for neurodivergent groups,
guiding future clinical innovation.
2
4
JARS–Mixed Heading Requirement Satisfied in Study?
Notes from Muhammad et al.,
2023
Title
Avoid purely qualitative or quantitative
terms; reference mixed methods.
Partially
Title emphasizes co-design and BA;
does not explicitly label as mixed
methods, but both quant + qual are
reported.
Abstract
Specify mixed methods design,
participants, analytic strategy, main
results, implications.
Partially
Abstract mentions case series,
participants, results, and acceptability;
does not clearly label “mixed
methods.”
Introduction – Problem/Questions
Identify gaps requiring both qualitative
and quantitative data.
Yes
Notes CBT limitations for autistic youth
→ need for structured, autism-adapted
interventions tested quantitatively +
qualitatively.
Objectives/Aims
State qualitative, quantitative, and
mixed methods aims.
Partially
Aims stated (feasibility, acceptability,
effects), but not explicitly divided into
qual/quant/mixed.
Method – Research Design Overview
Justify mixed methods; specify design
type (e.g., convergent, sequential).
Partially
Rationale for combining quant (PHQ-
9A, MFQ) with qual (feedback,
interviews). No explicit mixed design
label.
JARS - Mixed Methods
JARS–Mixed Heading Requirement Satisfied in Study?
Notes from Muhammad et al.,
2023
Title
Avoid purely qualitative or quantitative
terms; reference mixed methods.
Partially
Title emphasizes co-design and BA;
does not explicitly label as mixed
methods, but both quant + qual are
reported.
Abstract
Specify mixed methods design,
participants, analytic strategy, main
results, implications.
Partially
Abstract mentions case series,
participants, results, and acceptability;
does not clearly label “mixed
methods.”
Introduction – Problem/Questions
Identify gaps requiring both qualitative
and quantitative data.
Yes
Notes CBT limitations for autistic youth
→ need for structured, autism-adapted
interventions tested quantitatively +
qualitatively.
Objectives/Aims
State qualitative, quantitative, and
mixed methods aims.
Partially
Aims stated (feasibility, acceptability,
effects), but not explicitly divided into
qual/quant/mixed.
Method – Research Design Overview
Justify mixed methods; specify design
type (e.g., convergent, sequential).
Partially
Rationale for combining quant (PHQ-
9A, MFQ) with qual (feedback,
interviews). No explicit mixed design
label.
JARS - Mixed Methods
4
Participants/Data Sources
Identify qualitative + quantitative samples
separately.
Yes
Adolescents with autism (n = 7). Quant =
symptom scales; Qual = interviews &
feedback.
Researcher Description Reflexivity, background of researchers. No Not reported in the article.
Participant Recruitment
Describe strategies for both quant and
qual.
Partially
Inclusion criteria explained; recruitment
process briefly mentioned, but not
differentiated by data strand.
Data Collection Procedures
Describe both qual and quant data
collection methods.
Yes SCQ, BDI, RCADS, interview
Data Analysis
Separate sections for quant, qual, and
integration (“mixing”).
Partially
Quant + qual analyses described; some
integration in discussion. No formal joint
display or explicit mixing model.
Validity/Reliability/Integrity
Report validity, reliability, and
methodological integrity for both strands.
Partially
Quant tools validated; qual credibility
addressed via thematic analysis;
integration validity not explicitly stated.
Findings/Results
Report qual, quant, and integrated mixed
results.
Partially
Quantitative improvements + qualitative
themes reported. No formal joint display.
Discussion
Reflect on implications of integrated
findings.
Yes
Discusses how BA is suitable, feasible, and
autism-adapted. Integration with both
strands noted.
JARS–Mixed Heading Requirement Satisfied in Study? Notes from Muhammad et al.,
2023
Participants/Data Sources
Identify qualitative + quantitative samples
separately.
Yes
Adolescents with autism (n = 7). Quant =
symptom scales; Qual = interviews &
feedback.
Researcher Description Reflexivity, background of researchers. No Not reported in the article.
Participant Recruitment
Describe strategies for both quant and
qual.
Partially
Inclusion criteria explained; recruitment
process briefly mentioned, but not
differentiated by data strand.
Data Collection Procedures
Describe both qual and quant data
collection methods.
Yes SCQ, BDI, RCADS, interview
Data Analysis
Separate sections for quant, qual, and
integration (“mixing”).
Partially
Quant + qual analyses described; some
integration in discussion. No formal joint
display or explicit mixing model.
Validity/Reliability/Integrity
Report validity, reliability, and
methodological integrity for both strands.
Partially
Quant tools validated; qual credibility
addressed via thematic analysis;
integration validity not explicitly stated.
Findings/Results
Report qual, quant, and integrated mixed
results.
Partially
Quantitative improvements + qualitative
themes reported. No formal joint display.
Discussion
Reflect on implications of integrated
findings.
Yes
Discusses how BA is suitable, feasible, and
autism-adapted. Integration with both
strands noted.
JARS–Mixed Heading Requirement Satisfied in Study? Notes from Muhammad et al.,
2023
References
Angold, A., Costello, E. J., Messer, S. C., & Pickles, A. (1995). Development of a short questionnaire for
use in epidemiological studies of depression in children and adolescents. International Journal of
Methods in Psychiatric Research, 5(4), 237–249.
Fletcher-Watson, S., Adams, J., Brook, K., & Charman, T. (2019). Shaping autism research through
meaningful participation. Autism, 23(7), 1941–1953. https://doi.org/10.1177/1362361319854648
Hassiotis, A., & Strydom, A. (2013). Behavioral activation for depression in people with intellectual
disabilities: A pilot study. Advances in Mental Health and Intellectual Disabilities, 7(3), 174–183.
https://doi.org/10.1108/AMHID-12-2012-0005
Hollocks, M. J., Lerh, J. W., Magiati, I., & Howlin, P. (2019). Anxiety and depression in adults with
autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 49(4),
559–572. https://doi.org/10.1017/S0033291718002283
Hudson, C. C., Hall, L., & Harkness, K. L. (2019). Prevalence of depressive disorders in individuals with
autism spectrum disorder: A meta-analysis. Journal of Abnormal Child Psychology, 47(1), 165–175.
https://doi.org/10.1007/s10802-018-0402-1
Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression:
Returning to contextual roots. Clinical Psychology: Science and Practice, 8(3), 255–270.
https://doi.org/10.1093/clipsy.8.3.255
Kazdin, A. E. (2021). Research design in clinical psychology (5th ed.). Cambridge University Press.
2
Angold, A., Costello, E. J., Messer, S. C., & Pickles, A. (1995). Development of a short questionnaire for
use in epidemiological studies of depression in children and adolescents. International Journal of
Methods in Psychiatric Research, 5(4), 237–249.
Fletcher-Watson, S., Adams, J., Brook, K., & Charman, T. (2019). Shaping autism research through
meaningful participation. Autism, 23(7), 1941–1953. https://doi.org/10.1177/1362361319854648
Hassiotis, A., & Strydom, A. (2013). Behavioral activation for depression in people with intellectual
disabilities: A pilot study. Advances in Mental Health and Intellectual Disabilities, 7(3), 174–183.
https://doi.org/10.1108/AMHID-12-2012-0005
Hollocks, M. J., Lerh, J. W., Magiati, I., & Howlin, P. (2019). Anxiety and depression in adults with
autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 49(4),
559–572. https://doi.org/10.1017/S0033291718002283
Hudson, C. C., Hall, L., & Harkness, K. L. (2019). Prevalence of depressive disorders in individuals with
autism spectrum disorder: A meta-analysis. Journal of Abnormal Child Psychology, 47(1), 165–175.
https://doi.org/10.1007/s10802-018-0402-1
Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression:
Returning to contextual roots. Clinical Psychology: Science and Practice, 8(3), 255–270.
https://doi.org/10.1093/clipsy.8.3.255
Kazdin, A. E. (2021). Research design in clinical psychology (5th ed.). Cambridge University Press.
2
References
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression
severity measure. Journal of General Internal Medicine, 16(9), 606–613.
https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Lai, M.-C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. The Lancet, 383(9920), 896–910.
https://doi.org/10.1016/S0140-6736(13)61539-1
Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for
depression. Behavior Modification, 25(2), 255–286. https://doi.org/10.1177/0145445501252005
Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral activation for depression: A
clinician’s guide. Guilford Press.
Mazzucchelli, T. G., Kane, R. T., & Rees, C. S. (2010). Behavioral activation interventions for well-being:
A meta-analysis. Journal of Positive Psychology, 5(2), 105–121.
https://doi.org/10.1080/17439760903569154
Spain, D., Sin, J., Chalder, T., Murphy, D., & Happé, F. (2015). Cognitive behaviour therapy for adults
with autism spectrum disorders and psychiatric co-morbidity: A review. Autism, 19(7), 865–874.
https://doi.org/10.1177/1362361315583659
Stark, J., McGillivray, J., & McDonald, S. (2022). Co-designing behavioural activation for depression
in autistic adolescents: A case series. Clinical Child Psychology and Psychiatry, 27(4), 1005–1018.
https://doi.org/10.1177/13591045221092868
Weston, L., Hodgekins, J., & Langdon, P. E. (2016). Effectiveness of cognitive behavioural therapy
with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clinical
Psychology Review, 49, 41–54. https://doi.org/10.1016/j.cpr.2016.08.001
2
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression
severity measure. Journal of General Internal Medicine, 16(9), 606–613.
https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Lai, M.-C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. The Lancet, 383(9920), 896–910.
https://doi.org/10.1016/S0140-6736(13)61539-1
Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for
depression. Behavior Modification, 25(2), 255–286. https://doi.org/10.1177/0145445501252005
Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral activation for depression: A
clinician’s guide. Guilford Press.
Mazzucchelli, T. G., Kane, R. T., & Rees, C. S. (2010). Behavioral activation interventions for well-being:
A meta-analysis. Journal of Positive Psychology, 5(2), 105–121.
https://doi.org/10.1080/17439760903569154
Spain, D., Sin, J., Chalder, T., Murphy, D., & Happé, F. (2015). Cognitive behaviour therapy for adults
with autism spectrum disorders and psychiatric co-morbidity: A review. Autism, 19(7), 865–874.
https://doi.org/10.1177/1362361315583659
Stark, J., McGillivray, J., & McDonald, S. (2022). Co-designing behavioural activation for depression
in autistic adolescents: A case series. Clinical Child Psychology and Psychiatry, 27(4), 1005–1018.
https://doi.org/10.1177/13591045221092868
Weston, L., Hodgekins, J., & Langdon, P. E. (2016). Effectiveness of cognitive behavioural therapy
with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clinical
Psychology Review, 49, 41–54. https://doi.org/10.1016/j.cpr.2016.08.001
2
Participants: Diagnosis
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Participants: Diagnosis
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Participants: Diagnosis
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Participants: Diagnosis
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Participants: Diagnosis
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
Formal autism diagnosis required – Inclusion mandated a prior clinical diagnosis
of Autism Spectrum Disorder (ASD) according to DSM-5 criteria (Hudson et al.,
2019).
Diagnostic confirmation – Clinician reports and parent/caregiver confirmation
ensured participant eligibility.
Focus on high-functioning autism – Participants needed sufficient verbal and
cognitive abilities to engage with online, structured BA tasks.
Comorbidity considerations – Presence of depressive symptoms was required;
co-occurring conditions were documented but did not preclude participation.
Representative sample for pilot – Aimed to reflect adolescents who could
benefit from individually adapted online therapy.
2
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