Feasibility and Preliminary Efficacy of Behavioral Activation for Treatment of Depression in Autistic Adolescents

Depression is common among autistic youth and is associated with worse quality of life in this group. Despite significant need for high-quality efficacious treatments, there has been very limited research on interventions for depression in autistic youth. This single-arm pilot study examined the feasibility and preliminary efficacy of a novel, behavior-based approach for treatment of depression symptoms in autistic adolescents without intellectual disability (i.e. Behavioral Activation for Autistic Adolescents, BA-A). BA-A is an individually delivered manualized 12-session treatment that utilizes established BA strategies and incorporates common mental health treatment adaptations for autistic young people. Of the 18 youth (11-16 years old) who enrolled, 15 completed all 12 treatment sessions, as well as pre-treatment, post-treatment, and follow-up assessment visits. Clinician treatment fidelity was quite high. Paired sample t-tests found that depression symptoms decreased pre- to post-BA-A according to multiple informants (i.e. self, caregiver, and independent evaluator), and treatment gains were maintained at 1-month follow-up. Paired sample t-tests also found that caregiver-reported anxiety symptoms and social skills improved pre-treatment to post-treatment. The results, although preliminary, indicate that BA-A may improve depression symptoms in autistic youth without intellectual disability. Furthermore, these promising findings suggest that a randomized controlled trial of BA-A is warranted.