As a growing number of individuals diagnosed with autism spectrum disorder (ASD) reach adulthood, the need to recruit, train, and support mental health providers to serve this clinical population also grows. Additionally, families of autistic adults often struggle to identify appropriate and strategic community-based supports as school-based accommodations are phased out (Bernstein, 2021). Board certified specialists are in the forefront of assessing and treating “neuro-diverse” individuals and their families as well as training and supervising service providers regarding best practices.
Evidence-based assessment and treatment guidelines are intended to support all clinicians serving autistic adults and their families. Although DSM-5TR criteria provide guidance for diagnosis of ASD and categories of levels of needed support, its scope is limited to descriptions of social communication and restricted, repetitive behaviors. Waizbard-Bartov et al., 2023 report that “At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person’s life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments (Waizbard-Bartof et al., 2023, p.1).”
The Lancet Commission (2022) and Clark et al. (2026) identify key clinical concerns related to research and clinical practice. The researchers acknowledge that, worldwide, most individuals with autism do not receive support and the authors strongly believe that quality of life for autistic adults and their families should be a priority. A review of the trajectory of autism over several decades, from childhood to adulthood, indicates that symptoms of autism “both change and are changed by development, so studying this condition across the lifespan is essential” (Clarke et al., 2026, p. 18).
Underserved groups of autistic adults that are of note include (a) those who are minimally verbal, (b) girls and women, (c) minority ethnic groups, (d) individuals and families from socially disadvantaged backgrounds, and (e) those with severe co-occurring medical and behavior health issues. Zhang et al. (2025) contribute to an understanding of the heterogeneity of the autism diagnosis. The authors delineate two “polygenic” pathways to an autism diagnosis, each with differing developmental features. One group of autistic adults present with an early childhood autism diagnosis and display a greater degree of communication deficits, but fewer co-existing mental health conditions. A second group, autistic adult patients who received a later diagnosis, may present with several social, emotional, and behavioral challenges including ADHD and co-existing mental-health conditions. A growing number of adults who have not been previously diagnosed or who have been misdiagnosed are advocating for support and services (Adult Autism Diagnosis Tool Kit | Autism Speaks) including mental health services.
Symptom Severity is Autistic Adults
Estimating the severity of ASD symptoms and co-existing conditions is an essential element of goal setting, treatment planning, and evidence-based determination of response to treatment. There are individuals who achieve high levels of adaptive behaviors and academic success who may or may not have been diagnosed with ASD before adulthood. Their lived experience may involve exhaustion and isolation related to conscious suppression of their ASD traits. (e.g., Geng, 2026 ). This group is at risk of psychiatric conditions when environmental supports decrease or interpersonal demands increase, such as death of parents, job loss, and parenting their own children.
Documentation of Functional Capabilities
There are realistic and concrete steps that clinicians can take to address the needs and improve the support of autistic adults and their families. Foremost, documentation of the ASD diagnosis, as well as co-existing conditions such as anxiety, depression, and ADHD, helps to determine the incidence, prevalence, and clinical scope of ASD. Board certified clinicians appreciate that assessment involves more than confirming diagnoses (Rutherford & Johnson, 2023). Assessment lays the foundation for treatment, including identifying functional abilities and recommending support based on specific needs.
Modification of Treatment Techniques
Modifications of evidence-based treatments increase the engagement and efficacy of clinical interventions with autistic adults. Cognitive behavior therapy (CBT) can be modified to accommodate the preferences of autistic adult patients including direct instruction for social problem-solving (Riches et al., 2023; Spain et al., 2023). Mindfulness techniques have been effectively integrated into therapy with autistic adults to support emotional identification and regulation (Simione et al., 2024). A simple modification involves clinician use of closed-ended questions in contrast to the open-ended questions. For example, it may be more effectives to replace “How does that make you feel?” with “Does that make you feel sad?”. The switch reduces the demand for autistic patients to produce spontaneous verbal expressions and provides them with vocabulary to inform their responses. For some clients, social stories make reflection hypothetical, “Some people in that situation might feel this way, other people might feel this way, and other people might even feel this way. Which way sounds familiar to you?” For additional social stories for autistic adults see Resources for Adults with High Functioning Autism: Social Stories for Adults. The CBT Worksheet Packet (Beck, 2020) provides modifiable materials to guide treatment.
SCRIPT: Conceptualizing Autistic Adults and their Families
Direct service providers in counseling, family therapy, clinical, and school psychology may consider organizing the above guidelines for working with autistic adults and their families using a simple mnemonic, SCRIPT. The goal of SCRIPT is to empower community-based clinicians and trainees to engage current and new adult patients and their caregivers in supportive therapeutic care that incorporates key features of ASD.
SC: Social Cognition
Social Cognition refers to assessing and documenting social communication capabilities as well as features of social cognition, such as perspective-taking, conversation, and reciprocity. Screening measures for adults suspected of neurodevelopmental disorder might include the Autism Spectrum Rating Scale – Adult, (ASRS Adult Assessment and the Social Responsiveness Scale-2 ((SRS®-2). Therapy accommodation for social cognitive features of autistic adults may include (a) matching the patient’s vocabulary level, (b) minimizing expressed emotion, (c) increasing therapist talking, and (d) gauging how long to wait for the patient’s verbal expressions.
RI: Range of Interest
Range of Interest refers to assessing and documenting symptoms related to restricted, repetitive behaviors, rigid thinking, and sensory sensitivity. Screening measures for adults with suspected ASD might include the Repetitive Behaviour Questionnaire-3 (RBQ-3) and the Adult/Adolescent Sensory Profile Report. Therapy accommodation may include (a) the therapist’s planned ignoring of stimming behaviors, (b) therapy rooms with sensory-sensitive lighting, displays, aromas, and temperature, and (c) session agendas that include time for the autistic patient to talk about preferred interests and activities.
PT: Personalized Treatment/Perspective-taking
Personalized treatment/perspective-taking refers to treatment of the multidimensional aspects of ASD: (a) cognitive abilities, (b) adaptive behavior, including functional academic skills as well as daily living skills; (c) co-existing psychiatric conditions; (d) access to social support; and (e) the personal and environmental context in which individuals live their daily lives, including access to resources related to financial, residential, legal, social service, educational, and familial supports. The American Psychiatric Association offers a clinician scale that describes levels of support. (See Clinician rated severity of autism spectrum and social communication disorders.)
Community-based Psychologists: Specialists in Psychopathology, Committed to Diversity
Psychologists, with their clinical expertise and training, understand the importance of determining the D’s of psychopathology: (a) subjective distress; (b) behavioral deviation from social, cultural, or legal norms; and (c) impaired abilities that render dysfunction and disability. Psychologists are uniquely qualified to provide assessments regarding the severity of psychopathology while incorporating the need to respect the neurodiversity identity embraced by many autistic adults (Cooper at al., 2023). There are thousands of autistic adults and their families whose quality of daily life is compromised by depression, anxiety, ADHD, and trauma, co-existing conditions impacted by suspected or diagnosed ASD (Lord et al., 2023). Current assessment and treatment efforts focus upon ASD’s defined symptoms related to social communication and restricted or repetitive patterns of behaviors and interests. Addressing the challenges of ASD on the wellbeing of autistic adults and the need for strategic supports remains a challenge (Waizbard-Bartov, et al., 2023).
A Helpful SCRIPT
SCRIPT is a handy reminder of the symptoms of ASD, their impact on assessment and treatment of ASD and co-existing conditions, and the significant expertise and service that clinical psychologists bring to a growing population of individuals and their families seeking understanding, support and alleviation of suffering. For APA members, consider continuing education regarding positive autistic identity with R. Fairbank’s (2024) How practitioners can step up. Autistic adults, family members, and providers may enjoy E. Garcia’s (2022), We’re Not Broken and C. Oneal’s (2025) The Late Adult Autism Diagnosis Handbook. On-line resources for autistic adults include the Association for Autism and Neurodiversity AANE Homepage and Autism Speaks’ Adult Autism Diagnosis Tool Kit
References
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Bernstein, J. (2021). The 3 challenges for parents of adult children with autism. Psychology Today. The 3 Challenges for Parents of Adult Children With Autism | Psychology Today
Clarke, E., Singer, H., Schiltz, H., & Lord, C. (2026). Autism at 30: Conceptualizations for adult
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Geng, C. (2026). Autism masking: Signs and effects. Medical News Today. Autism masking: Signs, effects, and support strategies
Lord, C., Charman, T., Havdahl, A., Carbone, P., Anagnostou, E., Boyd, B., . . . McCauley, J. B. (2022). The Lancet commission on the future of care and clinical research in autism. The Lancet, 399(10321), 271-334. doi.org/10.1016/S0140-6736(21)01541-5
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Rutherford, M., & Johnston, L. (2022). Rethinking autism assessment diagnosis, and intervention within a neurodevelopmental pathway framework. In. M. Carotenuto (Ed.) Autism Spectrum Disorders-Recent Advances and New Perspectives. https://doi.org/10.5772/intechopen.108784
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Zhang, X., et al. (2025). Polygenetic and developmental profiles of autism differ by age of diagnosis. Nature, 646, 1146-1155. https://www.nature.com/articles/s41586-025-09542-6| Nature
Sandra Burkhardt, PhD, ABPP
Correspondence: burkhardt@sxu.edu