4 - (SYM 47) Leveraging Community-based Participatory Research Approaches to Design and Test Cognitive Behavioral Therapy for Depression in Autistic Youth (CBT-DAY)

Autistic youth are 3x more likely to experience depression and 7x more likely to attempt suicide than their non-autistic peers. Though autism-adapted treatments for anxiety and obsessive-compulsive disorder have been developed and consistently outperform standard treatments, this work has not been extended to depression. Further, to align clinical research with community priorities, community-based participatory research (CBPR) approaches are critical to intervention development. To address this research-to-practice gap, the present study leveraged CBPR methods to co-design a neurodiversity-affirming, cognitive-behavioral group therapy for depression in autistic youth. 

The CBPR methods in the present study were used to: (1) design Cognitive Behavioral Therapy for Depression in Autistic Youth (CBT-DAY), (2) adapt a safety monitoring plan during treatment, and (3) test the preliminary feasibility, acceptability, and efficacy of CBT-DAY in improving depressive symptom severity for autistic youth.

 
To design CBT-DAY, the research team formed and funded a Neurodivergent Advisory Team to develop treatment content, provide ongoing feedback, and co-facilitate weekly group therapy sessions. The Neurodivergent Advisory Team also participated in the interpretation and dissemination of study findings through academic (e.g., conferences, peer-reviewed publications) and community (e.g., lectures) platforms. The co-designed safety monitoring plan included routine procedures for assessing, addressing, recording, and reporting harms experienced by participants. Finally, 24 autistic youth (11–17 years old) participated in a pre-registered pilot non-randomized trial. Youth received 12 weeks of CBT-DAY and their depressive symptoms (i.e., clinical outcome) and emotional reactivity and self-esteem (i.e., intervention mechanisms) were assessed at four timepoints. Preliminary results suggest that CBT-DAY is feasible (16.67% attrition) in an outpatient setting and acceptable to families. Bayesian linear mixed-effects models show that CBT-DAY may be efficacious in targeting emotional reactivity [βT1-T3 = −2.53, CrI95% (−4.62, −0.58), Pd = 0.995, d = −0.35], self-esteem [βT1-T3 = −3.57, CrI95% (−5.17, −2.00), Pd > 0.999, d = −0.47], and depressive symptom severity [β = −2.72, CrI95% (−3.85, −1.63), Pd > 0.999]. Treatment gains were maintained at follow-up. Findings highlight the importance of CBPR approaches to intervention development for depression in autistic youth.