Abstract
Autistic adults experience disproportionately high rates of common mental health difficulties yet often encounter barriers when accessing support within NHS mental health services. Cognitive Behavioural Therapy (CBT) is often the first-line treatment offered, but standard approaches may not fully meet the needs of autistic individuals. Emerging research suggests that tailored adaptations to CBT can improve both its accessibility and effectiveness for this population. Part A of this portfolio presents a scoping review of how CBT has been adapted for autistic people within NHS settings. The review synthesises evidence from 16 studies and examines the extent to which reported adaptations align with NICE guidance, neuroaffirmative principles, and co-production within research. The findings highlight commonly reported adaptations, while identifying limitations in the evidence base. Childhood anxiety is highly prevalent and associated with long-term adverse outcomes. Preventative parenting interventions offer one approach to interrupting the intergenerational transmission of anxiety by targeting parenting behaviours. Digital mental health interventions (DMHIs) can offer preventative strategies to wider populations, however, maintaining meaningful engagement remains a key challenge. Part B of this portfolio presents a secondary analysis of 899 participants from the intervention arm of a randomised controlled trial of a self-guided online parenting programme for highly anxious parents. Outcomes were compared for participants who completed the intervention and those who did not. The study examined changes in child anxiety and parental anxiety, explored factors associated with programme completion, and conducted exploratory mediation analyses to investigate whether changes in parenting behaviours partially accounted for the association between parental and child anxiety change. Findings suggested that participants who completed the full intervention experienced greater improvements in anxiety outcomes and that changes in parental overinvolvement partially mediated the relationship between changes in parental and child anxiety. Part C presents a summary of clinical practice and assessments.