A look at “Meta-analysis of Psychotherapy for Autistic Youth” by Kashia A. Rosenau, Junok Kim, An-Chuen Billy Cho, Michael Seltzer, Ana M. Ugueto, John R. Weisz and Jeffrey J. Wood (2026)
Parents of autistic children are sometimes told, in one way or another, that talking therapy “won’t work” for their child. Too literal, too rigid, not reflective enough, the myth goes. This American study pools the results of the best-quality trials to see whether that holds up. Spoiler: the myth trots off with its tail between its legs.
What they found
The researchers searched for randomised controlled trials (the gold standard, where participants are randomly assigned to therapy or a comparison group) involving autistic young people aged 6 to 17. They found 29 trials with nearly 1,500 participants, published between 2005 and 2021, and combined the results.
The headlines:
- Overall, therapy helped, with a small-to-moderate effect. Importantly, this is similar to how well therapy works for young people in general. Autistic young people benefited just as much as their peers.
- CBT was by far the most studied approach, appearing in 21 of the 29 trials, and showed the strongest effects. These were particularly strong for general mental health and for what the authors call “autism-related clinical needs”.
- Effects were moderate for behaviour that others find challenging, and small for anxiety and low mood. Effects were smaller still for social communication and peer relationships.
- Therapy made no real difference to repetitive behaviours. Arguably, that’s no bad thing, given that stimming and routines often serve a useful purpose.
- A handful of creative approaches, such as drama, LEGO-based therapy and horse riding, showed small effects, but there were too few studies to say much.
A grain of glitter ✨
This is a well-conducted analysis that sticks to rigorous trials, which deserves credit. But the details matter.
The participants were overwhelmingly boys (85%), mostly white, and in the studies that reported it, of average-or-above IQ. That’s a narrow slice of autistic young people. Girls, gender-diverse youth, those with learning disabilities and young people of colour are barely represented. The youngest study is from 2021, so newer, more neurodiversity-affirming approaches aren’t included.
The largest effect was for “autism-related clinical needs”, which partly means reducing autistic traits. From a neurodiversity-affirming perspective, that’s not necessarily what we should be aiming for. And one of the authors led six of the 29 included trials. That’s not unusual in a small field, but it’s worth knowing. The authors also acknowledge that their groupings of therapy types are rough, and that they couldn’t examine important details like the type of comparison group or therapist training.
Why this matters
If you’re the parent of an autistic young person, or an autistic adult wondering whether therapy could help, the message here is encouraging. Autistic people can and do benefit from therapy, about as much as anyone else. The key is that it’s adapted to how they think and communicate, and aimed at what they actually want help with, such as anxiety, mood or overwhelm, rather than at making them less autistic.
Therapy isn’t a one-size-fits-all saddle. But with the right fit, unicorns of all ages can ride it just fine.