Journal of Autism and Developmental Disorders

, Volume 49, Issue 11, pp 4421–4428 | Cite as

Factors Influencing the Use of Cognitive–Behavioral Therapy with Autistic Adults: A Survey of Community Mental Health Clinicians

  • Brenna B. MaddoxEmail author
  • Samantha R. Crabbe
  • Jessica M. Fishman
  • Rinad S. Beidas
  • Lauren Brookman-Frazee
  • Judith S. Miller
  • Christina Nicolaidis
  • David S. Mandell
Original Paper


Cognitive–behavioral therapy (CBT) can improve anxiety and depression in autistic adults, but few autistic adults receive this treatment. We examined factors that may influence clinicians’ use of CBT with autistic adults. One hundred clinicians completed an online survey. Clinicians reported stronger intentions (p = .001), more favorable attitudes (p < .001), greater normative pressure (p < .001), and higher self-efficacy (p < .001) to start CBT with non-autistic adults than with autistic adults. The only significant predictor of intentions to begin CBT with clients with anxiety or depression was clinicians’ attitudes (p < .001), with more favorable attitudes predicting stronger intentions. These findings are valuable for designing effective, tailored implementation strategies to increase clinicians’ adoption of CBT for autistic adults.


Adults Autism spectrum disorder Cognitive–behavioral therapy Community mental health Implementation science Theory of planned behavior 



The authors are grateful to our community partners and the study participants.

Author Contributions

RSB, LB-F, BBM, and DSM conceived of the study. RSB, LB-F, JMF, BBM, DSM, JSM, and CN developed and reviewed the survey questions. SRC participated in the coordination of the study and data collection. BBM participated in data collection, performed the statistical analyses, and drafted the manuscript. JMF, BBM, and DSM led the interpretation of the data. All authors read and revised earlier drafts of the manuscript. All authors approved the final manuscript for publication.


This work was funded by the National Institute of Mental Health (F32MH111166; PI: Maddox) and the FAR Fund (PI: Maddox).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with the Ethical Standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

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


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Brenna B. Maddox
    • 1
    • 2
    Email author
  • Samantha R. Crabbe
    • 1
  • Jessica M. Fishman
    • 1
    • 3
  • Rinad S. Beidas
    • 1
    • 2
    • 4
  • Lauren Brookman-Frazee
    • 5
    • 6
    • 7
  • Judith S. Miller
    • 1
    • 8
  • Christina Nicolaidis
    • 9
    • 10
  • David S. Mandell
    • 1
  1. 1.Department of Psychiatry, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI)University of PennsylvaniaPhiladelphiaUSA
  3. 3.Annenberg School for CommunicationUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Medical Ethics and Health Policy, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of PsychiatryUniversity of CaliforniaSan DiegoUSA
  6. 6.Child and Adolescent Services Research CenterSan DiegoUSA
  7. 7.Autism Discovery Institute at Rady Children’s HospitalSan DiegoUSA
  8. 8.Center for Autism Research, Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  9. 9.School of Social WorkPortland State UniversityPortlandUSA
  10. 10.Department of Medicine, Oregon Health and Science UniversityPortlandUSA

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