A UK-based mixed-methods study investigating the mental health of autistic adolescents

Purpose This study explores the mental health experiences and therapeutic needs of autistic adolescents in the context of the COVID-19 pandemic, with particular attention to their perspectives on counselling and therapy. This research aims to address the limited representation of autistic adolescents’ voices in mental health research and to better understand how pandemic-related disruptions affected wellbeing. A further aim is to explore adolescents’ perceptions of therapeutic support and the potential relevance of nondirective therapeutic approaches. By foregrounding autistic adolescents’ experiences, the study seeks to inform the development of more responsive, neurodiversity-affirming mental health support and contribute to improving therapeutic provision for this population. Design/methodology/approach A sequential explanatory mixed-methods design was used. In phase one, an online survey was completed by 32 autistic adolescents aged 13–17. The survey explored mental health experiences, access to support and the perceived impact of COVID-19. Quantitative data were analysed using descriptive statistics and inferential analysis. In phase two, an online focus group with seven autistic adolescents provided qualitative data to further explore survey findings. Reflexive thematic analysis was used to identify patterns within the data. This design enabled quantitative trends to be contextualised through participants’ lived experiences and perspectives on mental health support and therapy. Findings Participants reported significantly poorer mental health following the COVID-19 pandemic, with loss of routine, reduced social contact and disruption to support services identified as key contributing factors. Qualitative findings generated three themes: 1) The changing nature of COVID-19; 2) Negative experiences of school; and 3) Understanding the individual’s needs. Adolescents highlighted the need for mental health professionals to have greater understanding of autism and emphasised the importance of flexible, individualised support. Participants responded positively to elements associated with nondirective therapeutic approaches, including increased time, autonomy and opportunities to feel heard, suggesting these principles may support engagement with therapeutic services. Originality/value This study contributes to autism and mental health research by centring autistic adolescents’ voices in exploring the long-term mental health impact of COVID-19. It extends existing literature by combining quantitative trends with qualitative accounts to highlight adolescents’ perspectives on therapeutic support. The findings also provide preliminary insight into the potential relevance of nondirective therapeutic approaches for autistic adolescents, an area that remains under-researched compared with directive interventions. By foregrounding lived experience, this research offers practical implications for improving therapist training and developing more neurodiversity-affirming mental health services for autistic young people.