Psychological therapy for children and young people with a diagnosis of autism or intellectual disabilities in mainstream child and adolescent mental health services: a cross-sectional survey of clinicians’ perspectives in England

Objectives To examine clinicians’ perspectives on delivering psychological therapy to autistic children and young people (CYP), CYP with intellectual disabilities and CYP with no autism or intellectual disabilities diagnoses in mainstream child and adolescent mental health services (CAMHS) in England. The study aimed to examine clinician-reported training, knowledge, confidence, skills, use of psychological therapies and adaptations and perceived barriers to access. Design Cross-sectional observational survey study. Setting Mainstream National Health Service (NHS) child and adolescent mental health services across 19 NHS Trusts in England. Participants A total of 135 CAMHS clinicians participated. Eligible participants were healthcare professionals involved in delivering, supervising or leading psychological therapy for CYP aged 5–18 years within participating NHS Trusts. Clinicians completed survey sections relevant to their experience using built-in skip logic. Of the participants, 117 (86.7%) reported experience working with autistic CYP and 64 (47.4%) reported experience working with CYP with intellectual disabilities. Interventions Not applicable. Primary and secondary outcome measures Primary outcomes were clinicians’ self-reported knowledge, confidence and skills in delivering psychological therapy to autistic CYP and CYP with intellectual disabilities. Secondary outcomes included reported training, psychological therapies used, treatment adaptations, perceived evidence base of therapies and reported service access criteria. Results Among clinicians with experience across the relevant CYP populations, clinicians reported lower knowledge, skills and confidence when delivering psychological therapy to CYP with intellectual disabilities, compared with autistic CYP and CYP with no autism or intellectual disabilities diagnoses. Self-reported preparedness was generally higher for autism than for intellectual disabilities. Seventy per cent of clinicians reported receiving autism-specific training compared with 47.6% for intellectual disabilities. Cognitive behavioural therapy was the most commonly reported psychological therapy, and making abstract concepts more concrete was the most frequently reported adaptation. Clinicians also reported greater uncertainty regarding the appropriateness of psychological therapies for CYP with intellectual disabilities. Conclusions Clinicians working in mainstream CAMHS reported lower preparedness for delivering psychological therapy to CYP with intellectual disabilities than for autistic CYP and CYP without these diagnoses. The findings highlight the need for enhanced clinician training, greater implementation of evidence-informed adaptations and review of service access criteria to improve equitable access to psychological therapy. Future research should evaluate interventions that strengthen clinician capability and improve access to psychological therapies for CYP with intellectual disabilities.