Outpatient Psychotherapy for Adults with High-Functioning Autism Spectrum Condition: Utilization, Treatment Satisfaction, and Preferred Modifications

  • Silke Lipinski
  • Elisabeth S. Blanke
  • Ulrike Suenkel
  • Isabel Dziobek
Original Paper


Many adults with autism spectrum condition (ASC) desire outpatient psychotherapy (PT). This study compared reasons for seeking PT, experiences with PT, and modifications preferred with respect to PT of individuals with ASC to non-autistic individuals with depression (MDD). Furthermore, factors predictive for treatment satisfaction were identified in individuals with ASC. A total of 262 adults with ASC without intellectual impairment and 304 non-autistic controls with MDD were surveyed. In this pilot study both groups predominantly sought treatment for depressiveness. A low level of expertise with autism was the main reason for being declined by therapists and a contributing factor to the overall treatment dissatisfaction of patients with ASC. ASC patients desire adjustments such as written communication, and clearly structured sessions.


Autism Autism spectrum disorder Asperger syndrome Adult psychotherapy Mental health Participatory research 



This research was funded by a dissertation scholarship from the Stiftung Irene (Irene Foundation). We are grateful to the participants for taking part in the study and we thank the great number of people, especially those from the Autism-Research-Collaboration (AFK), who donated their time and dedication to the project.

Author Contributions

SL conceived of the study, participated in its design and coordination, performed the measurement, performed the statistical analysis, participated in the interpretation of the data, and drafted the manuscript. EB conceived of the study, participated in the design of the study, helped with the statistical analysis, participated in the interpretation of the data and helped to draft the manuscript. US conceived of the study, participated in the design of the study, participated in the interpretation of the data, and critically reviewed the manuscript. ID conceived of the study, participated in its design and coordination, helped with the statistical analysis, participated in the interpretation of the data, and helped to draft the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of interest

This research was completed in part fulfillment of the first author’s Ph.D./dissertation at the Humboldt-Universität zu Berlin. Silke Lipinski received a dissertation scholarship from the Stiftung Irene (Irene Foundation). None of the authors have any potential conflicts of interest to disclose. This paper’s contents are solely the responsibility of the authors.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.CrossRefGoogle Scholar
  3. Anderson, A. H., Carter, M., & Stephenson, J. (2018). Perspectives of university students with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(3), 651–665. Scholar
  4. Attkisson, C. C., & Zwick, R. (1982). The client satisfaction questionnaire. Evaluation and Program Planning, 5(3), 233–237. Scholar
  5. Bacher, J. (2002). Statistisches Matching: Anwendungsmöglichkeiten, Verfahren und ihre praktische Umsetzung in SPSS. ZA-Informationen, 51, 38–66.Google Scholar
  6. Baez, S., Rattazzi, A., Gonzalez-Gadea, M. L., Torralva, T., Vigliecca, N. S., Decety, J., et al. (2012). Integrating intention and context: Assessing social cognition in adults with Asperger syndrome. Frontiers in Human Neuroscience. Scholar
  7. Baldwin, S., & Costley, D. (2015). The experiences and needs of female adults with high-functioning autism spectrum disorder. Autism, 20(4), 483–495. Scholar
  8. Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. Scholar
  9. Baron-Cohen, S. (2008). Autism and asperger syndrome (the facts) (1st ed.). Oxford: Oxford University Press.Google Scholar
  10. Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2008). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1–11. Scholar
  11. Byers, E. S., Nichols, S., & Voyer, S. D. (2013). Challenging stereotypes: Sexual functioning of single adults with high functioning autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(11), 2617–2627. Scholar
  12. Byers, E. S., Nichols, S., Voyer, S. D., & Reilly, G. (2012). Sexual well-being of a community sample of high-functioning adults on the autism spectrum who have been in a romantic relationship. Autism, 17(4), 418–433.CrossRefGoogle Scholar
  13. Centers for Disease Control and Prevention (CDC). (2009). Prevalence of autism spectrum disorders: Autism and Developmental Disabilities Monitoring (ADDM) Network, United States, 2006. Morbidity and Mortality Weekly Report Surveillance Summaries, 58(10), 1–20.Google Scholar
  14. Deane, F. P. (1993). Client satisfaction with psychotherapy in two outpatient clinics in New Zealand. Evaluation and Program Planning, 16(2), 87–94. Scholar
  15. Driessen, E., & Hollon, S. D. (2010). Cognitive behavioral therapy for mood disorders: Efficacy, moderators and mediators. Psychiatric Clinics of North America, 33(3), 537–555. Scholar
  16. Ebert, D., Fangmeier, T., Lichtblau, A., Peters, J., Biscaldi-Schäfer, M., & Tebartz van Elst, L. (2013). Asperger-Autismus und hochfunktionaler Autismus bei Erwachsenen: Das Therapiemanual der Freiburger Autismus-Studiengruppe (1st ed.). Göttingen: Hogrefe Verlag.Google Scholar
  17. Factor, R. S., Condy, E. E., Farley, J. P., & Scarpa, A. (2016). Brief report: Insistence on sameness, anxiety, and social motivation in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(7), 2548–2554. Scholar
  18. Fitzgerald, M. (2018). The broader autism phenotype: Expanding the clinical gestalt of autism and broadening DSM V criteria of autism spectrum disorder. Journal of Psychology and Clinical Psychiatry, 9(3), 316–324.Google Scholar
  19. Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric Research, 65(6), 591–598. Scholar
  20. Fricker, M. (2009). Epistemic injustice: Power and the ethics of knowing. Oxford: Oxford University Press.Google Scholar
  21. Frith, U. (2004). Emanuel Miller lecture: Confusions and controversies about asperger syndrome. Journal of Child Psychology and Psychiatry, 45(4), 672–686. Scholar
  22. Gawronski, A., Kuzmanovic, B., Georgescu, A., Kockler, H., Lehnhardt, F.-G., Schilbach, L., et al. (2011). Erwartungen an eine Psychotherapie von hochfunktionalen erwachsenen Personen mit einer Autismus-Spektrum-Störung. Fortschritte der Neurologie · Psychiatrie, 79(11), 647–654. Scholar
  23. Gawronski, A., Pfeiffer, K., & Vogeley, K. (2012). Hochfunktionaler Autismus im Erwachsenenalter: Verhaltenstherapeutisches Gruppenmanual. Weinheim: Beltz Verlag.Google Scholar
  24. Gelbar, N. W., Shefcyk, A., & Reichow, B. (2015). A comprehensive survey of current and former college students with autism spectrum disorders. The Yale Journal of Biology and Medicine, 88(1), 45–68.PubMedPubMedCentralGoogle Scholar
  25. Gillberg, C., & Coleman, M. (1996). Autism and medical disorders: A review of the literature. Developmental Medicine & Child Neurology, 38(3), 191–202. Scholar
  26. Grandin, T., & Panek, R. (2014). The autistic brain: Helping different kinds of minds succeed. Boston: Houghton Mifflin Harcourt.Google Scholar
  27. Hannöver, W., Dogs, C. P., & Kordy, H. (2000). Patientenzufriedenheit - ein Maß für Behandlungserfolg? Psychotherapeut, 45(5), 292–300. Scholar
  28. Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9(1), 35. Scholar
  29. Howlin, P. (2000). Assessment instruments for Asperger syndrome. Child and Adolescent Mental Health, 5(3), 120–129. Scholar
  30. Howlin, P. (2004). Autism and asperger syndrome: Preparing for adulthood (2nd ed.). New York: Routledge.CrossRefGoogle Scholar
  31. Hudson, C. C., Hall, L., & Harkness, K. L. (2018). Prevalence of depressive disorders in individuals with autism spectrum disorder: A meta-analysis. Journal of Abnormal Child Psychology. Scholar
  32. Joosten, A. V., Bundy, A. C., & Einfeld, S. L. (2008). Intrinsic and extrinsic motivation for stereotypic and repetitive behavior. Journal of Autism and Developmental Disorders, 39(3), 521–531. Scholar
  33. Kanne, S. M., Christ, S. E., & Reiersen, A. M. (2009). Psychiatric symptoms and psychosocial difficulties in young adults with autistic traits. Journal of Autism and Developmental Disorders, 39(6), 827–833. Scholar
  34. Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442–462. Scholar
  35. Kriz, D., Nübling, R., Steffanowski, A., Wittmann, W. W., & Schmidt, J. (2008). Patientenzufriedenheit in der stationären Rehabilitation: Psychometrische Reanalyse des ZUF-8 auf der Basis multizentrischer Stichproben verschiedener Indikation. Zeitschrift für Medizinische Psychologie, 17(2–3), 67–79.Google Scholar
  36. Lai, J. K. Y., & Weiss, J. A. (2017). Priority service needs and receipt across the lifespan for individuals with autism spectrum disorder. Autism Research, 10(8), 1436–1447. Scholar
  37. Lai, M.-C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11–24. Scholar
  38. Lehnhardt, F., Gawronski, A., Volpert, K., Schilbach, L., Tepest, R., Huff, W., et al. (2011). Autismus-Spektrum-Störungen im Erwachsenenalter: klinische und neuropsychologische Befunde spätdiagnostizierter Asperger-Syndrome. Fortschritte der Neurologie · Psychiatrie, 79(05), 290–297. Scholar
  39. Lehnhardt, F., Gawronski, A., Volpert, K., Schilbach, L., Tepest, R., & Vogeley, K. (2012). Das psychosoziale Funktionsniveau spätdiagnostizierter Patienten mit Autismus-Spektrum-Störungen – eine retrospektive Untersuchung im Erwachsenenalter. Fortschritte der Neurologie · Psychiatrie, 80(02), 88–97. Scholar
  40. Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(6), 1916–1930. Scholar
  41. Lewis, L. F. (2017). A mixed methods study of barriers to formal diagnosis of autism spectrum disorder in adults. Journal of Autism and Developmental Disorders, 47(8), 2410–2424. Scholar
  42. Lugnegård, T., Hallerbäck, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of asperger syndrome. Research in Developmental Disabilities, 32(5), 1910–1917. Scholar
  43. Möller-Leimkühler, A. M., Dunkel, R., Müller, P., Pukies, G., de Fazio, S., & Lehmann, E. (2002). Is patient satisfaction a unidimensional construct? European Archives of Psychiatry and Clinical Neuroscience, 252(1), 19–23. Scholar
  44. Murray, J. L., Lopez, A. D., World Health Organization, World Bank, & Harvard School of Public Health. (1996). The Global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Geneva: World Health Organization.Google Scholar
  45. National Institute for Health and Care Excellence (2016). Autism spectrum disorder in adults: Diagnosis and management. NICE guideline (CG142). Retrieved September 07, 2018, from
  46. Nicolaidis, C., Kripke, C. C., & Raymaker, D. (2014). Primary care for adults on the autism spectrum. Medical Clinics of North America, 98(5), 1169–1191. Scholar
  47. Nicolaidis, C., Raymaker, D., McDonald, K., Dern, S., Boisclair, W. C., Ashkenazy, E., et al. (2012). Comparison of healthcare experiences in autistic and non-autistic adults: A cross-sectional online survey facilitated by an academic-community partnership. Journal of General Internal Medicine, 28(6), 761–769. Scholar
  48. Paul, R., Orlovski, S. M., Marcinko, H. C., & Volkmar, F. (2008). Conversational behaviors in youth with high-functioning ASC and asperger syndrome. Journal of Autism and Developmental Disorders, 39(1), 115–125. Scholar
  49. Piccinelli, M., Homen, F. G., WHO Nations for Mental Health Initiative, & World Health Organization. Division of Mental Health and Prevention of Substance Abuse (1997). Gender differences in the epidemiology of affective disorders and schizophrenia. Geneva: World Health Organization.Google Scholar
  50. Remschmidt, H., & Kamp-Becker, I. (2006). Asperger-Syndrom (Manuale psychischer Störungen bei Kindern und Jugendlichen). Berlin: Springer.Google Scholar
  51. Rhodes, S. D., Bowie, D. A., & Hergenrather, K. C. (2003). Collecting behavioural data using the world wide web: considerations for researchers. Journal of Epidemiology and Community Health, 57(1), 68–73. Scholar
  52. Rutherford, M., McKenzie, K., Johnson, T., Catchpole, C., O’Hare, A., McClure, I., et al. (2016). Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder. Autism, 20(5), 628–634. Scholar
  53. Saulnier, C. A., & Klin, A. (2006). Brief report: Social and communication abilities and disabilities in higher functioning individuals with autism and asperger syndrome. Journal of Autism and Developmental Disorders, 37(4), 788–793. Scholar
  54. Sax, L. J., Gilmartin, S. K., & Bryant, A. N. (2003). Assessing response rates and nonresponse bias in web and paper surveys. Research in Higher Education, 44(4), 409–432. Scholar
  55. Schicktanz, S. (2015). The ethical legitimacy of patients’ organizations’ involvement in politics and knowledge production: Epistemic justice as conceptual basis. In P. Wehling, W. Viehöder, & S. Koenen (Eds.), The public shaping of medical research (pp. 246–265). Oxford: Routledge.Google Scholar
  56. Schmidt, J., & Nübling, R. (2002). ZUF-8. Fragebogen zur Messung der Patientenzufriedenheit. In E. Brähler, J. Schumacher, & B. Strauss (Eds.), Diagnostische Verfahren in der Psychotherapie (Diagnostik für Klinik und Praxis) (pp. 392–396). Göttingen: Hogrefe Verlag.Google Scholar
  57. Schmidt, L., Kirchner, J., Strunz, S., Broźus, J., Ritter, K., Roepke, S., et al. (2015). Psychosocial functioning and life satisfaction in adults with autism spectrum disorder without intellectual impairment. Journal of Clinical Psychology, 71(12), 1259–1268. Scholar
  58. Statistical Package for the Social Sciences (SPSS). IBM Corp. Released. (2015). IBM SPSS statistics for macintosh, version 23.0. Armonk: IBM Corp.Google Scholar
  59. Strunz, S., Dziobek, I., & Roepke, S. (2013). Komorbide psychiatrische Störungen und Differenzialdiagnostik bei nicht-intelligenzgeminderten Erwachsenen mit Autismus-Spektrum-Störung. PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie, 64(06), 206–213. Scholar
  60. Strunz, S., Schermuck, C., Ballerstein, S., Ahlers, C. J., Dziobek, I., & Roepke, S. (2016). Romantic relationships and relationship satisfaction among adults with asperger syndrome and high-functioning autism. Journal of Clinical Psychology, 73(1), 113–125. Scholar
  61. Szatmari, P., Georgiades, S., Bryson, S., Zwaigenbaum, L., Roberts, W., Mahoney, W., et al. (2006). Investigating the structure of the restricted, repetitive behaviours and interests domain of autism. Journal of Child Psychology and Psychiatry, 47(6), 582–590. Scholar
  62. Tebartz van Elst, L., Pick, M., Biscaldi, M., Fangmeier, T., & Riedel, A. (2013). High-functioning autism spectrum disorder as a basic disorder in adult psychiatry and psychotherapy: Psychopathological presentation, clinical relevance and therapeutic concepts. European Archives of Psychiatry and Clinical Neuroscience, 263(S2), 189–196. Scholar
  63. Tolin, D. F. (2010). Is cognitive–behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review, 30(6), 710–720. Scholar
  64. Turcotte, P., Mathew, M., Shea, L. L., Brusilovskiy, E., & Nonnemacher, S. L. (2016). Service Needs Across the Lifespan for Individuals with Autism. Journal of Autism and Developmental Disorders, 46(7), 2480–2489. Scholar
  65. Vogeley, K., Kirchner, J. C., Gawronski, A., Tebartz van Elst, L., & Dziobek, I. (2013). Toward the development of a supported employment program for individuals with high-functioning autism in Germany. European Archives of Psychiatry and Clinical Neuroscience, 263(S2), 197–203. Scholar
  66. Volkmar, F. R., Reichow, B., & McPartland, J. C. (2014). Adolescents and adults with autism spectrum disorders. New York: Springer.CrossRefGoogle Scholar
  67. WHO International Consortium in Psychiatric Epidemiology. (2000). Cross-national comparisons of the prevalences and correlates of mental disorders. Bulletin of the World Health Organization, 78(‎4)‎, 413–426.Google Scholar
  68. Woods, A. G., Mahdavi, E., & Ryan, J. P. (2013). Treating clients with Asperger’s syndrome and autism. Child and Adolescent Psychiatry and Mental Health, 7(1), 32. Scholar
  69. World Health Organization. (1993). ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Berlin School of Mind and BrainHumboldt-Universität zu BerlinBerlinGermany
  2. 2.Lebenswissenschaftliche Fakultät, Institut für PsychologieHumboldt-Universität zu BerlinBerlinGermany
  3. 3.Hertie Institute for Clinical Brain Research (HIH), Center of NeurologyUniversity of TübingenTübingenGermany

Personalised recommendations