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Mental health challenges faced by autistic people

Nature Human Behaviour volume 7, pages 1620–1637 (2023)Cite this article

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Abstract

Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social–contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual–experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.

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Fig. 1: A framework to understand mental health challenges faced by autistic people.
Fig. 2: Principles of adapted psychotherapeutic interventions for autistic people.

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Acknowledgements

I thank Z. J. Williams and H.-Y. Lin for reading an earlier draft of this manuscript and offering invaluable input, Y. Lunsky and M. Stokes for sharing information about mental health resources, and S. H. Ameis, A. Sawyer, P. Szatmari and S.-K. Liu for clinical discussions. I am supported by the Academic Scholars Award from the Department of Psychiatry, University of Toronto, and the Canadian Institutes of Health Research Sex and Gender Science Chair (GSB 171373).

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Authors and Affiliations

  1. Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

    Meng-Chuan Lai

  2. Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Meng-Chuan Lai

  3. Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada

    Meng-Chuan Lai

  4. Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada

    Meng-Chuan Lai

  5. Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK

    Meng-Chuan Lai

  6. Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan

    Meng-Chuan Lai

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The author receives honoraria from SAGE Publications as an editor of the journal Autism.

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Lai, MC. Mental health challenges faced by autistic people. Nat Hum Behav 7, 1620–1637 (2023). https://doi.org/10.1038/s41562-023-01718-2

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