The spectrum of potential benefits and ethical considerations for psychedelic-assisted therapy in autistic adults

There is currently an ongoing resurgence in research on the therapeutic potential of psychedelics for psychiatric conditions. Psychedelic-assisted therapy (PAT) differs from most current forms of psychiatric treatment in two primary domains: its requirement for fewer doses (often just one), and its documented ability to promote profound insights, introspection, and cognitive shifts. Autism Spectrum Disorder (ASD) is a DSM-5 category that has historically been treated with a combination of psychiatric medication and behavioral therapies. However, adverse effects from pharmaceuticals and negative perceptions of therapy within the autistic community have prompted research into new treatment modalities. Further, overlap in the proposed neuropsychological effects of psychedelics with autism, including serotonergic signaling and prosocial effects on behavior, has led researchers to consider the use of PAT for autistic adults. Unlike other diagnoses targeted by PAT like, major depressive disorder, post-traumatic stress disorder, and substance use disorder, autism also functions for some as a social identity beyond its medical context. Additionally, PAT traditionally involves a sensation-heavy experience that has been noted to induce stress in a small subset of participants. While research has been conducted on designing the best physical spaces to reduce distressing experiences, these studies generally focus on neurotypical populations. The modalities, goals, and integration aspects of PAT may need to be altered to best serve the unique behavioral, sensory, and social differences within the autistic adult population. The goal-defining, logistical, and societal interactions of PAT with the autistic community warrant special ethical consideration to prepare physicians before the implementation of large-scale clinical trials.