Secondary Effects of Dialectical Behaviour Therapy on Social Functioning, Quality of Life, and Autism Traits in Autistic Adults with Suicidality
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| Title: | Secondary Effects of Dialectical Behaviour Therapy on Social Functioning, Quality of Life, and Autism Traits in Autistic Adults with Suicidality |
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| Language: | English |
| Authors: | Anne Huntjens (ORCID |
| Source: | Autism: The International Journal of Research and Practice. 2025 29(5):1333-1345. |
| Availability: | SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com |
| Peer Reviewed: | Y |
| Page Count: | 13 |
| Publication Date: | 2025 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Therapy, Quality of Life, Autism Spectrum Disorders, Symptoms (Individual Disorders), Behavior Modification, Suicide, Outcomes of Treatment, Interpersonal Competence, Mental Health, Health Services, Adults, Foreign Countries |
| Geographic Terms: | Netherlands |
| DOI: | 10.1177/13623613241302875 |
| ISSN: | 1362-3613 1461-7005 |
| Abstract: | The effect of psychological treatment on social functioning, quality of life and autism traits in autistic people with suicidal behaviour remains largely unknown. At six Dutch mental health centres, 123 adult outpatients with "Diagnostic and Statistical Manual of Mental Disorders" (5th edition) diagnosed autism spectrum condition and suicidal behaviours were randomly assigned to dialectical behaviour therapy (n = 63) or treatment as usual (n = 60) to address their suicidal behaviours. This article analysed secondary outcomes on social functioning, quality of life and autism traits. Outcomes were compared at baseline, post-treatment at 6 months, and 12-month follow-up. At post-treatment, both social functioning (p < 0.001) and quality of life (p = 0.002) were significantly improved in the treatment condition compared to the control condition and remained so at 12-month follow-up (p = 0.003; p = 0.002). Autism traits did not differ between conditions. Autistic individuals with suicidal behaviours benefit modestly from treatment with dialectical behaviour therapy in social functioning and quality of life. |
| Abstractor: | As Provided |
| Entry Date: | 2025 |
| Accession Number: | EJ1469166 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwFY9xwkxID-lpzrbVDzAZwlAAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDCFYWT9OGHoQaGozRAIBEICBmkjIvJ47B8k8Ug7rVGL0-PgbKc8awC9_U9jREbqRq5sO8_OpJSSEDj-r3tCqn2b8bTWrQKgUh8ijTYgjPj32J4A6Jkeb9iIgvjoOBVe4_cyCVJP7B0mDPUfQGn2UGZ3KH3u09rvcUes2TLmQZqO9k63WbA-Q1MBNu3emW2btWHDl9kcrtGPVm_U4ZI4c9RXjxeiNlmV73SbRFMo= Text: Availability: 1 Value: <anid>AN0184797752;f9d01may.25;2025Apr30.05:47;v2.2.500</anid> <title id="AN0184797752-1">Secondary effects of dialectical behaviour therapy on social functioning, quality of life, and autism traits in autistic adults with suicidality </title> <p>The effect of psychological treatment on social functioning, quality of life and autism traits in autistic people with suicidal behaviour remains largely unknown. At six Dutch mental health centres, 123 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders (5th edition) diagnosed autism spectrum condition and suicidal behaviours were randomly assigned to dialectical behaviour therapy (n = 63) or treatment as usual (n = 60) to address their suicidal behaviours. This article analysed secondary outcomes on social functioning, quality of life and autism traits. Outcomes were compared at baseline, post-treatment at 6 months, and 12-month follow-up. At post-treatment, both social functioning (p &lt; 0.001) and quality of life (p = 0.002) were significantly improved in the treatment condition compared to the control condition and remained so at 12-month follow-up (p = 0.003; p = 0.002). Autism traits did not differ between conditions. Autistic individuals with suicidal behaviours benefit modestly from treatment with dialectical behaviour therapy in social functioning and quality of life. Dialectical behaviour therapy is a comprehensive treatment that helps individuals improve distress tolerance, mindfulness, interpersonal effectiveness and emotion regulation. It is commonly used to assist those experiencing self-harm and suicidal thoughts or behaviours. Despite its broad application, our understanding of how dialectical behaviour therapy impacts autistic individuals with suicidal behaviour remains limited. This study compared dialectical behaviour therapy with treatment as usual in 123 autistic adults experiencing suicidal behaviours. Participants were recruited from six mental health centres, with 63 receiving dialectical behaviour therapy and 60 receiving treatment as usual. The study assessed outcomes such as social functioning, quality of life and specific autism traits over 12 months. Findings revealed that dialectical behaviour therapy led to significant improvements in social functioning and quality of life compared to treatment as usual, though there were no effects on autism traits. These improvements suggest that dialectical behaviour therapy holds promise as an effective treatment for autistic individuals grappling with suicidal behaviour. The findings strongly support the broader implementation of dialectical behaviour therapy in mental health centres, especially given the limited treatment options available for autistic individuals with suicidal tendencies.</p> <p>Keywords: autism; autism traits; dialectical behaviour therapy; quality of life; social functioning; suicidal behaviour</p> <hd id="AN0184797752-2">Introduction</hd> <p>Autism spectrum condition is a lifelong neurodevelopmental condition characterised by social communication, interaction differences and restricted, repetitive patterns of behaviour, interests or activities ([<reflink idref="bib1" id="ref1">1</reflink>]). Previous narrative reviews have consistently demonstrated an increased risk of suicidal behaviour among autistic adults ([<reflink idref="bib24" id="ref2">24</reflink>]; [<reflink idref="bib67" id="ref3">67</reflink>]). A recent meta-analysis found a 12-month prevalence of 25% for suicidal ideation and 14% for suicide attempts ([<reflink idref="bib28" id="ref4">28</reflink>]).</p> <p>Among the risk factors for suicidality in autistic individuals are depression, poor social functioning ([<reflink idref="bib25" id="ref5">25</reflink>]), likely lower quality of life and possibly the intensity of autism traits ([<reflink idref="bib13" id="ref6">13</reflink>]). Depression, in general, and specific characteristics such as the inability to imagine alternative strategies ([<reflink idref="bib58" id="ref7">58</reflink>]), rumination, low self-esteem ([<reflink idref="bib4" id="ref8">4</reflink>]) and feelings of defeat and entrapment ([<reflink idref="bib46" id="ref9">46</reflink>]), significantly contribute to suicidality in autism.</p> <p>Challenges in social functioning, including social exclusion and isolation, are also notable risk factors for suicidality ([<reflink idref="bib9" id="ref10">9</reflink>]; [<reflink idref="bib11" id="ref11">11</reflink>]; [<reflink idref="bib13" id="ref12">13</reflink>]; [<reflink idref="bib18" id="ref13">18</reflink>]; [<reflink idref="bib24" id="ref14">24</reflink>]; [<reflink idref="bib40" id="ref15">40</reflink>]). Feelings of thwarted belonging ([<reflink idref="bib48" id="ref16">48</reflink>]) and lack of societal acceptance ([<reflink idref="bib8" id="ref17">8</reflink>]) further contribute to the high rates of suicidal behaviour among autistic individuals, as well as those with high autistic traits ([<reflink idref="bib52" id="ref18">52</reflink>]).</p> <p>Autistic adults frequently report a lower quality of life compared to the general population, as demonstrated in numerous studies ([<reflink idref="bib31" id="ref19">31</reflink>]; [<reflink idref="bib32" id="ref20">32</reflink>]; [<reflink idref="bib34" id="ref21">34</reflink>]; [<reflink idref="bib37" id="ref22">37</reflink>]; [<reflink idref="bib38" id="ref23">38</reflink>]; [<reflink idref="bib45" id="ref24">45</reflink>]; [<reflink idref="bib61" id="ref25">61</reflink>]).</p> <p>The intensity of autism traits, such as social communication challenges, is associated with a lower subjective quality of life among many autistic individuals ([<reflink idref="bib15" id="ref26">15</reflink>]; [<reflink idref="bib49" id="ref27">49</reflink>]; [<reflink idref="bib59" id="ref28">59</reflink>]). However, the impact varies widely among individuals, influenced by personal differences, life stages, comorbid conditions, environmental factors, life events and support ([<reflink idref="bib45" id="ref29">45</reflink>]).</p> <p>Recently, we evaluated the effectiveness of dialectical behaviour therapy (DBT) in treating suicidal behaviour in autistic adults through a multicentre, assessor-blind controlled trial at six Dutch mental health centres involving 123 adult outpatients ([<reflink idref="bib30" id="ref30">30</reflink>]). Participants were randomly assigned to DBT or treatment as usual (TAU), with assessments at baseline, end of treatment at 6 months and follow-up at 12 months. The findings were that DBT not only reduced suicidal ideation and suicide attempts but also mitigated symptoms of depression ([<reflink idref="bib30" id="ref31">30</reflink>]).</p> <p>While DBT has traditionally been studied in individuals with personality disorders, demonstrating improvements in well-being and quality of life ([<reflink idref="bib54" id="ref32">54</reflink>]; [<reflink idref="bib65" id="ref33">65</reflink>]), it has also been shown to enhance social functioning ([<reflink idref="bib10" id="ref34">10</reflink>]; [<reflink idref="bib39" id="ref35">39</reflink>]; [<reflink idref="bib65" id="ref36">65</reflink>]). DBT addresses multiple aspects of social interaction by incorporating individual therapy, skills training to enhance and strengthen social skills, a therapist consultation team and phone consultations as needed ([<reflink idref="bib36" id="ref37">36</reflink>]). The DBT skills group includes modules on mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, conducted in a classroom format with weekly practice and homework assignments.</p> <p>This study analyses secondary outcome data from a randomised controlled trial (RCT) targeting suicidal behaviour in autistic individuals. We hypothesise that DBT will improve social functioning and quality of life in autistic people as it has for those with personality disorders. In addition, autism traits are associated with quality of life. Although no research has documented the effect of DBT on autism traits, this study will explore the effects of DBT on these traits.</p> <hd id="AN0184797752-3">Methods</hd> <p>This study involves a secondary data analysis of data collected from the original RCT titled "The effectiveness and safety of dialectical behaviour therapy for suicidal ideation and suicidal behaviour in autistic adults' ([<reflink idref="bib30" id="ref38">30</reflink>]). The secondary analysis utilises data from the Personal and Social Performance Scale (PSP) for social functioning ([<reflink idref="bib41" id="ref39">41</reflink>]), the Manchester Short Assessment of Quality of Life (MANSA) for quality of life ([<reflink idref="bib50" id="ref40">50</reflink>]) and autism traits, which were quantitatively measured using the Social Responsiveness Scale-Adult version (SRS-A) ([<reflink idref="bib14" id="ref41">14</reflink>]; [<reflink idref="bib44" id="ref42">44</reflink>]) collected during the original trial.</p> <hd id="AN0184797752-4">Design</hd> <p>This study is a single-blind RCT with two parallel arms (DBT and TAU) and measurements at baseline (t<subs>0</subs>), at the end of DBT treatment after 6 months (t<subs>6</subs>) and at a follow-up at 12 months (t<subs>12</subs>). To increase clinical relevance, the trial was conducted across six mental health services with minimal exclusion criteria. With <emph>N</emph> = 128 consenting participants (64 in each arm), the study would be well-powered to detect a medium-sized standardised effect of <emph>d</emph> = 0.50 in a test with a power of (1−β) ⩾ 0.80 and α ⩽ 0.05 (two-tailed). The study was registered at Current Controlled Trials (ISRCTN 96632579) and approved by the Medical Ethics Committee of the VU University Medical Centre (NL59497.029.17) in March 2018. Further details are available from the study protocol ([<reflink idref="bib29" id="ref43">29</reflink>]).</p> <hd id="AN0184797752-5">Participants</hd> <p>Participants were recruited from six specialised autism departments within mental health services in the Netherlands. Prior to inclusion, all participants had received an autism diagnosis from experienced clinicians following national guidelines ([<reflink idref="bib33" id="ref44">33</reflink>]). All patients were already in treatment and were informed about the study by their treating therapist. The participants were screened using the autism-spectrum quotient (AQ-short; [<reflink idref="bib26" id="ref45">26</reflink>]) to verify their autism diagnosis and with the Suicidal Ideation Attributes Scale (SIDAS; [<reflink idref="bib63" id="ref46">63</reflink>]) and Lifetime Parasuicide Count (LPC; [<reflink idref="bib16" id="ref47">16</reflink>]) to assess inclusion criteria. Written informed consent was obtained from patients who were eligible and willing to participate. The inclusion criteria were (<reflink idref="bib1" id="ref48">1</reflink>) age 18 to 65 years, (<reflink idref="bib2" id="ref49">2</reflink>) fulfilment of Diagnostic and Statistical Manual of Mental Disorders (5th edition; <emph>DSM</emph>-V) criteria for autism spectrum condition ([<reflink idref="bib1" id="ref50">1</reflink>]), (<reflink idref="bib3" id="ref51">3</reflink>) outpatient status, (<reflink idref="bib4" id="ref52">4</reflink>) suicidal ideation defined as SIDAS score ⩾ 21 ([<reflink idref="bib63" id="ref53">63</reflink>]) and (<reflink idref="bib5" id="ref54">5</reflink>) level of suicidal behaviour rated as severe on the LPC (score of 2 on each item; [<reflink idref="bib16" id="ref55">16</reflink>]). Exclusion criteria were (<reflink idref="bib1" id="ref56">1</reflink>) IQ &lt; 80 assessed with Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV) only if baseline testing was difficult due to intellectual deficits ([<reflink idref="bib66" id="ref57">66</reflink>]), (<reflink idref="bib2" id="ref58">2</reflink>) addiction to drugs and need for clinical detoxification and (<reflink idref="bib3" id="ref59">3</reflink>) insufficient mastery of the Dutch language.</p> <hd id="AN0184797752-6">Measures</hd> <p>Social functioning was assessed using the PSP ([<reflink idref="bib41" id="ref60">41</reflink>]). The PSP is a clinician-rated instrument designed to distinguish between psychopathological and psychosocial aspects, providing a more precise operationalisation of occupational, socialand personal functioning domains. It evaluates social functioning across four primary domains: (<reflink idref="bib1" id="ref61">1</reflink>) socially useful activities (e.g. housekeeping, voluntary work) including work and study; (<reflink idref="bib2" id="ref62">2</reflink>) personal and social relationships (e.g. partner, family and friends); (<reflink idref="bib3" id="ref63">3</reflink>) self-care (e.g. personal hygiene, care of one's appearance); and (<reflink idref="bib4" id="ref64">4</reflink>) disruptive and aggressive behaviour. Each domain's impairment is rated on a six-point scale: absent (0), mild (<reflink idref="bib1" id="ref65">1</reflink>), moderate (<reflink idref="bib2" id="ref66">2</reflink>), marked (<reflink idref="bib3" id="ref67">3</reflink>), severe (<reflink idref="bib4" id="ref68">4</reflink>) and very severe (<reflink idref="bib5" id="ref69">5</reflink>). A higher score within a domain indicates worse functioning in that particular area. The PSP total score, ranging from 1 to 100, is not merely a sum of the individual domain scores. Instead, it is calculated through a multiple-weighting process that integrates the four domains of functioning. For instance, a total score of 41–50 may indicate significant impairments in work and social relationships, work and self-care, social relationships and self-care or serious dysfunction in a single domain, even in the absence of aggressive behaviour. By combining and weighting nominal categories, a numerical score is generated (see Table 1 in the Supplemental File).</p> <p>Table 1. Baseline characteristics of participants.</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th /&gt;&lt;th align="left"&gt;DBT (&lt;italic&gt;n&lt;/italic&gt; = 63)&lt;/th&gt;&lt;th align="left"&gt;TAU (&lt;italic&gt;n&lt;/italic&gt; = 60)&lt;/th&gt;&lt;th align="left"&gt;All (&lt;italic&gt;n&lt;/italic&gt; = 123)&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt;Age in years, &lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/td&gt;&lt;td&gt;36.9 (10.6)&lt;/td&gt;&lt;td&gt;37.9 (12.1)&lt;/td&gt;&lt;td&gt;37.4 (11.3)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="4"&gt;Gender, &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Male&lt;/td&gt;&lt;td&gt;33 (52)&lt;/td&gt;&lt;td&gt;31 (52)&lt;/td&gt;&lt;td&gt;64 (52)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Female&lt;/td&gt;&lt;td&gt;30 (48)&lt;/td&gt;&lt;td&gt;28 (47)&lt;/td&gt;&lt;td&gt;58 (47)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Non-binary&lt;/td&gt;&lt;td&gt;0 (0)&lt;/td&gt;&lt;td&gt;1 (2)&lt;/td&gt;&lt;td&gt;1 (1)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Non-Dutch origin, &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;2 (3)&lt;/td&gt;&lt;td&gt;1 (2)&lt;/td&gt;&lt;td&gt;3 (2)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="4"&gt;Living conditions, &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Married or cohabitating&lt;/td&gt;&lt;td&gt;20 (32)&lt;/td&gt;&lt;td&gt;15 (25)&lt;/td&gt;&lt;td&gt;35 (28)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Children&lt;/td&gt;&lt;td&gt;18 (29)&lt;/td&gt;&lt;td&gt;11 (18)&lt;/td&gt;&lt;td&gt;29 (24)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Alone&lt;/td&gt;&lt;td&gt;24 (38)&lt;/td&gt;&lt;td&gt;30 (50)&lt;/td&gt;&lt;td&gt;54 (44)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Sheltered housing&lt;/td&gt;&lt;td&gt;6 (10)&lt;/td&gt;&lt;td&gt;7 (12)&lt;/td&gt;&lt;td&gt;13 (11)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Employed, &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;20 (32)&lt;/td&gt;&lt;td&gt;23 (38)&lt;/td&gt;&lt;td&gt;43 (35)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="4"&gt;Education, &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; University&lt;/td&gt;&lt;td&gt;8 (13)&lt;/td&gt;&lt;td&gt;6 (10)&lt;/td&gt;&lt;td&gt;14 (11)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Higher professional&lt;/td&gt;&lt;td&gt;4 (6)&lt;/td&gt;&lt;td&gt;8 (13)&lt;/td&gt;&lt;td&gt;12 (10)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Middle vocational&lt;/td&gt;&lt;td&gt;22 (35)&lt;/td&gt;&lt;td&gt;19 (32)&lt;/td&gt;&lt;td&gt;41 (33)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Lower vocational&lt;/td&gt;&lt;td&gt;2 (3)&lt;/td&gt;&lt;td&gt;0 (0)&lt;/td&gt;&lt;td&gt;2 (2)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Secondary&lt;/td&gt;&lt;td&gt;21 (35)&lt;/td&gt;&lt;td&gt;22 (37)&lt;/td&gt;&lt;td&gt;43 (35)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="4"&gt;&lt;italic&gt;DSM&lt;/italic&gt;-V diagnosis&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; ASD, &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;63 (100)&lt;/td&gt;&lt;td&gt;60 (100)&lt;/td&gt;&lt;td&gt;123 (100)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Age at diagnosis of ASD, &lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/td&gt;&lt;td&gt;29.2 (12.7)&lt;/td&gt;&lt;td&gt;30.5 (14.3)&lt;/td&gt;&lt;td&gt;29.8 (13.4)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Number of diagnoses, &lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/td&gt;&lt;td&gt;2.0 (0.7)&lt;/td&gt;&lt;td&gt;1.8 (0.7)&lt;/td&gt;&lt;td&gt;1.9 (0.7)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Prior &lt;italic&gt;DSM&lt;/italic&gt; diagnoses&lt;xref ref-type="table-fn" rid="tfn2"&gt;a&lt;/xref&gt; (%)&lt;/td&gt;&lt;td&gt;54 (86)&lt;/td&gt;&lt;td&gt;46 (77)&lt;/td&gt;&lt;td&gt;81 (100)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="4"&gt;&lt;italic&gt;DSM&lt;/italic&gt; comorbidity&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Depressive disorder &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;28 (44)&lt;/td&gt;&lt;td&gt;20 (33)&lt;/td&gt;&lt;td&gt;48 (39)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Personality disorder &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;8 (10)&lt;/td&gt;&lt;td&gt;4 (7)&lt;/td&gt;&lt;td&gt;12 (10)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Post-traumatic stress disorder&lt;/td&gt;&lt;td&gt;5 (8)&lt;/td&gt;&lt;td&gt;4 (7)&lt;/td&gt;&lt;td&gt;9 (7)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Anxiety disorder &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;2 (3)&lt;/td&gt;&lt;td&gt;4 (7)&lt;/td&gt;&lt;td&gt;6 (5)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Obsessive compulsive disorder &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;4 (6)&lt;/td&gt;&lt;td&gt;3 (5)&lt;/td&gt;&lt;td&gt;7 (6)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Attention deficit hyperactivity disorder&lt;/td&gt;&lt;td&gt;14 (22)&lt;/td&gt;&lt;td&gt;15 (25)&lt;/td&gt;&lt;td&gt;29 (24)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Bipolar disorder &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;1 (2)&lt;/td&gt;&lt;td&gt;&amp;#8211;&lt;/td&gt;&lt;td&gt;1 (1)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Eating disorder &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;4 (6)&lt;/td&gt;&lt;td&gt;4 (7)&lt;/td&gt;&lt;td&gt;8 (7)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Substance-related disorder &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;td&gt;7 (11)&lt;/td&gt;&lt;td&gt;4 (7)&lt;/td&gt;&lt;td&gt;11 (9)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="4"&gt;Medication use&lt;xref ref-type="table-fn" rid="tfn3"&gt;b&lt;/xref&gt;, &lt;italic&gt;n&lt;/italic&gt; (%)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Antidepressants&lt;/td&gt;&lt;td&gt;36 (57)&lt;/td&gt;&lt;td&gt;28 (47)&lt;/td&gt;&lt;td&gt;64 (52)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Antipsychotics&lt;/td&gt;&lt;td&gt;23 (37)&lt;/td&gt;&lt;td&gt;21 (35)&lt;/td&gt;&lt;td&gt;44 (36)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; ADHD&lt;/td&gt;&lt;td&gt;10 (16)&lt;/td&gt;&lt;td&gt;9 (15)&lt;/td&gt;&lt;td&gt;19 (15)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="4"&gt;Outcomes variables, &lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Social functioning (PSP)&lt;/td&gt;&lt;td&gt;39.9 (12.0)&lt;/td&gt;&lt;td&gt;40.8 (13.2)&lt;/td&gt;&lt;td&gt;40.3 (11.7)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Quality of life (MANSA)&lt;/td&gt;&lt;td&gt;3.37 (0.96)&lt;/td&gt;&lt;td&gt;3.48 (0.92)&lt;/td&gt;&lt;td&gt;3.39 (0.81)&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Autism traits, (SRS-A)&lt;/td&gt;&lt;td&gt;89.3 (20.4)&lt;/td&gt;&lt;td&gt;93.3 (17.5)&lt;/td&gt;&lt;td&gt;91.5 (16.9)&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>1 DBT: dialectical behaviour therapy; TAU: treatment as usual; <emph>n</emph>: number of participants; M: mean; <emph>SD</emph>: standard deviation; <emph>DSM</emph>-V: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ASD: autism spectrum disorder; ADHD: attention deficit hyperactivity disorder.</p> <ulist> <item>2 Prior <emph>DSM</emph> diagnoses are available on request.</item> <item>3 Which (and dosage) antidepressants, antipsychotics and ADHD medication are available on request.</item> </ulist> <p>The total score varies from 1 to 100 and is divided into 10 equal intervals, where a change of at least 10 points is considered clinically meaningful ([<reflink idref="bib35" id="ref70">35</reflink>]). Scores from 100 to 70 indicate mild difficulties, 70 to 31 manifest disabilities of varying degrees and below 30 points denote severe impairment requiring intensive support or supervision ([<reflink idref="bib41" id="ref71">41</reflink>]). The PSP scale was selected for its multidimensional nature, robust psychometric and minimal influence from specific patient symptoms ([<reflink idref="bib21" id="ref72">21</reflink>]). While not specifically validated for autistic individuals, the PSP scale may be suitable due to its broad applicability, holistic approach, objective clinician ratings, comparability with other studies, focus on daily functioning and relevance to key functional domains affected by autism. To gain a comprehensive understanding of participants' areas of difficulty and improvement, we initially assessed the total score followed by individual domain scores. In addition, the PSP scale demonstrated strong reliability in our sample (Cronbach's alpha = 0.87).</p> <p>Quality of life was assessed using the MANSA ([<reflink idref="bib50" id="ref73">50</reflink>]), designed to evaluate various facets of life satisfaction. It comprises four objective questions and 12 subjective questions that assess overall satisfaction with life in domains such as employment status, financial situation, friendships, leisure activities, living conditions, personal safety, household composition, intimacy, familial relationships, physical health and mental well-being. Responses are rated on a 7-point Likert-type scale, ranging from 1 (Could not be worse) to 7 (Could not be better). In addition, four objective questions require binary responses ('yes' or 'no'). This study employed an authorised Dutch translation of the MANSA ([<reflink idref="bib43" id="ref74">43</reflink>]; [<reflink idref="bib62" id="ref75">62</reflink>]). The MANSA provides two scoring methods: aggregating scores from its 12 subjective items or calculating the mean score of these items ([<reflink idref="bib43" id="ref76">43</reflink>]). This study employed the summed scores method, where a higher MANSA sum score indicates a higher perceived quality of life. The MANSA was chosen for its robust psychometric properties, including high correlations with other quality-of-life measures ([<reflink idref="bib7" id="ref77">7</reflink>]; [<reflink idref="bib50" id="ref78">50</reflink>]), sensitivity to longitudinal changes ([<reflink idref="bib51" id="ref79">51</reflink>]; [<reflink idref="bib56" id="ref80">56</reflink>]) and demonstrated reliability (Cronbach's alpha = 0.78) in our sample. Moreover, MANSA scores have shown independence from the type of treatment setting ([<reflink idref="bib19" id="ref81">19</reflink>]; [<reflink idref="bib51" id="ref82">51</reflink>]) further supporting its suitability despite the absence of specific validation for autistic individuals ([<reflink idref="bib50" id="ref83">50</reflink>]).</p> <p>Autism traits were quantitatively measured using the SRS-A ([<reflink idref="bib14" id="ref84">14</reflink>]; [<reflink idref="bib44" id="ref85">44</reflink>]). This self-report questionnaire has four dimensions of autism: 'social awareness' measures the ability to perceive social cues (e.g. 'Is aware of what others are thinking or feeling'); 'social communication' evaluates expressive social communication (e.g. 'Avoids eye contact or has unusual eye contact'); 'social motivation' gauges the general motivation to engage in social-interpersonal behaviour, including aspects of social anxiety, inhibition and empathic orientation (e.g. 'Would rather be alone than with others'); and 'restricted interests and repetitive behaviour', which measure stereotypical behaviours or highly restricted interests (e.g. 'Has an unusually narrow range of interests'). The SRS-A consists of 64 items rated on a Likert-type scale from 1 'not true' to 4 'almost always true'. A higher total score indicated more autism traits. The SRS-A has demonstrated excellent psychometric properties, and it was chosen for its focus on deficits aligning with the social domain of autism ([<reflink idref="bib44" id="ref86">44</reflink>]). In our study, we examined the overall outcomes of the SRS-A, and for a more nuanced understanding, we differentiated between social and behavioural traits.</p> <hd id="AN0184797752-7">Procedure</hd> <p>The demographic characteristics of the participants were recorded at baseline. Assessments were assessed at baseline, post-treatment at 6 months and follow-up at 12 months. After a baseline assessment, 123 patients were randomly assigned to either DBT or TAU. The independent randomisation office of the Parnassia Psychiatric Institute randomised participants using <ulink href="http://www.randomizer.org">www.randomizer.org</ulink>. Research assistants blinded to treatment allocation performed the post-treatment and follow-up assessments. After the 12-month follow-up, participants in the TAU condition were offered DBT treatment. All participants received financial compensation of €25 (USD 27) for each assessment.</p> <hd id="AN0184797752-8">Intervention</hd> <p>The intervention was based on the comprehensive DBT framework, which included: (<reflink idref="bib1" id="ref87">1</reflink>) weekly individual cognitive-behavioural psychotherapy sessions lasting 45 min with the primary therapist, (<reflink idref="bib2" id="ref88">2</reflink>) weekly 2 h and 15 min skills training group, (<reflink idref="bib3" id="ref89">3</reflink>) provision of telephone coaching with their individual therapist if necessary and (<reflink idref="bib4" id="ref90">4</reflink>) weekly 1 h therapist consultation ([<reflink idref="bib36" id="ref91">36</reflink>]). Participants assigned to the DBT group underwent pretreatment, which involved an introduction to the therapist and familiarisation with the demands and expectations of DBT treatment. The treatment period was shortened from 1 year to 6 months by increasing the frequency of skills training sessions from once to twice a week. This adjustment provided more opportunities for feedback, rehearsal, practice and enhanced skill learning, customising the training to meet the specific needs of autistic adults ([<reflink idref="bib3" id="ref92">3</reflink>]; [<reflink idref="bib22" id="ref93">22</reflink>]; [<reflink idref="bib23" id="ref94">23</reflink>]). The 26-week skill training in this study was adapted from the study by [<reflink idref="bib42" id="ref95">42</reflink>]. Prior to the study, some textual modifications were made to the DBT manual in collaboration with autistic adults to improve clarity and comprehension. Specifically, explanations of certain skills were simplified without changing the content, making the text more readable. In addition, mindfulness exercises introduced at the beginning of skill training were explained with precise and straightforward instructions tailored to the unique needs of autistic individuals ([<reflink idref="bib57" id="ref96">57</reflink>]). When a skill training was missed, the participants were asked to catch up by watching video recordings made of all the training sessions. The therapists kept track of self-reported viewing by the participants. Participants who missed four sessions in a row were considered treatment dropouts. All therapists in the DBT condition were psychologists or psychiatrists, and skills trainers were psychologists, registered nurses or social workers (<emph>N</emph> = 36).</p> <p>The control group received treatment as usual. This was any form of treatment for suicidal behaviour in autism that is common within the Dutch mental health system and was given in weekly 45-min sessions with a psychotherapist or social worker. Any form and intensity of treatment were permitted to ensure that the TAU condition realistically mirrored current clinical practice intensity, for example, psycho-education, social skills training, emotion regulation therapy, cognitive-behavioural therapy, trauma therapy, delivered in both group and individual formats, either independently or concurrently. Participants who dropped out of treatment were asked to complete the post-treatment and follow-up assessments.</p> <hd id="AN0184797752-9">Statistical analysis</hd> <p>Analyses were performed with the statistical software Stata (version 17.0) and SPSS (version 27). The analyses were based on the intention-to-treat (ITT) principle, thus including all participants as randomised. ITT analysis was achieved using mixed modelling. The Gaussian-distributed PSP, MANSA and SRS-A scales were regressed on Condition (0/1), Time and Time × Condition interaction with baseline scores on the outcome variables as a covariate for baseline adjustment. This was done in the fixed part of the equation. Participant ID was modelled as a level in the random part of the equation. An unstructured between-group variance and covariance structure was assumed. It was an a priori decision not to include the six treatment sites as an extra level, in that there were only six sites. Instead, we modelled the nesting of patients within sites by a series of site (0/1) indicators in the fixed part of the equation.</p> <hd id="AN0184797752-10">Sensitivity analyses</hd> <p>It was an a priori decision to assess the robustness of the base case analyses in a sensitivity analysis using last-observation-carried-forward (LOCF) imputation of missing observations caused by study dropout. To that end, all mixed models were repeated after LOCF imputation.</p> <p>In response to the challenges posed by the COVID-19 pandemic, a post hoc decision was made to conduct an additional sensitivity analysis, examining the impact of disrupted access to healthcare and the transitions to telehealth during three COVID-19 lockdowns ([<reflink idref="bib53" id="ref97">53</reflink>]). The swift transition from face-to-face treatment to telehealth, primarily using Zoom, was prompted by national lockdowns and social distancing regulations ([<reflink idref="bib30" id="ref98">30</reflink>]). Proactively addressing challenges, the study facilitated telehealth through Zoom and overcame obstacles such as patients lacking smartphones by providing borrowed devices. Assessments, usually conducted face-to-face, were shifted to video calls during lockdowns. Three COVID lockdown indicators were created for each participant at each data collection wave (baseline, post-treatment and follow-up). These indicators were set at 1 if the participant's access to face-to-face care was disrupted by a lockdown at that time and 0 otherwise. The COVID lockdown indicators were included as time-varying confounders in the mixed model equations. Subsequently, the base case analyses were compared with the lockdown-adjusted analyses.</p> <hd id="AN0184797752-11">Community involvement</hd> <p>The study was conducted with autistic adults and therapists from routine mental health services. In collaboration with autistic adults, text modifications were made to the DBT manual before the study's commencement, simplifying explanations of certain DBT skills to make them more concrete and understandable for autistic individuals. The first author received significant language feedback from many participants during the trial. This feedback was utilised after the study to improve the treatment material and ultimately incorporated into the DBT manual. The study included disseminating 10 newsletters to all participants and therapists, providing up-to-date study information, and conducting interviews with the participants and therapists to gather their feedback and experiences. Once this study has been published, participants will be informed, and details of the results will be sent in a study newsletter suitable for a non-specialist audience.</p> <hd id="AN0184797752-12">Results</hd> <p></p> <hd id="AN0184797752-13">Sample at baseline</hd> <p>Recruitment was from September 2018 to December 2022, with 167 potential participants assessed for eligibility. Of these, 44 did not meet inclusion criteria and 123 participants were randomly assigned to either the DBT group (<emph>n</emph> = 63) or the TAU group (<emph>n</emph> = 60; see Figure 1). Table 1 shows the baseline characteristics of the secondary symptoms per condition and in total. No baseline differences were observed between the conditions on any variables. Similarly, no significant differences were noted between patients with and without medication changes at baseline, after treatment or at follow-up (data not shown).</p> <p>Graph: Figure 1. Flow of participants.DBT: dialectical behaviour therapy; TAU: treatment as usual; PSP: personal and social functioning; MANSA: the Manchester short assessment of quality of life; SRS-A: Social Responsiveness Scale.</p> <p>Social functioning (PSP) improved significantly more with DBT than TAU at post-treatment as well as at the 12-month follow-up (see Table 2 and Figure 2). For the four domains of the PSP scale, the nominal categories were assigned scores from 0 to 5. The results showed improvement across all domains for DBT; however, statistical significance was only reached in self-care at the 12-month follow-up. No significant improvements were observed in the work, social relations or aggressive domains, either post-treatment or at follow-up, see Table 2.</p> <p>Table 2. Means, standard deviations and test results.</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th /&gt;&lt;th align="left" colspan="3"&gt;DBT&lt;/th&gt;&lt;th align="left" colspan="3"&gt;TAU&lt;/th&gt;&lt;th align="left" colspan="5"&gt;Time&lt;xref ref-type="table-fn" rid="tfn5"&gt;a&lt;/xref&gt;&lt;/th&gt;&lt;th align="left" colspan="3"&gt;Time &amp;#215; treatment&lt;xref ref-type="table-fn" rid="tfn6"&gt;b&lt;/xref&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th /&gt;&lt;th align="left"&gt;t&lt;sub&gt;0&lt;/sub&gt;&lt;/th&gt;&lt;th align="left"&gt;t&lt;sub&gt;6&lt;/sub&gt;&lt;/th&gt;&lt;th align="left"&gt;t&lt;sub&gt;12&lt;/sub&gt;&lt;/th&gt;&lt;th align="left"&gt;t&lt;sub&gt;0&lt;/sub&gt;&lt;/th&gt;&lt;th align="left"&gt;t&lt;sub&gt;6&lt;/sub&gt;&lt;/th&gt;&lt;th align="left"&gt;t&lt;sub&gt;12&lt;/sub&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;t&lt;sub&gt;6&lt;/sub&gt;&lt;/th&gt;&lt;th align="left" rowspan="3"&gt;&lt;italic&gt;p&lt;/italic&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;t&lt;sub&gt;12&lt;/sub&gt;&lt;/th&gt;&lt;th align="left" rowspan="3"&gt;&lt;italic&gt;p&lt;/italic&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;DBT &amp;#215; t&lt;sub&gt;6&lt;/sub&gt;&lt;/th&gt;&lt;th align="left" rowspan="3"&gt;&lt;italic&gt;p&lt;/italic&gt;&lt;/th&gt;&lt;th align="left" rowspan="2"&gt;DBT &amp;#215; t&lt;sub&gt;12&lt;/sub&gt;&lt;/th&gt;&lt;th align="left" rowspan="3"&gt;&lt;italic&gt;p&lt;/italic&gt;&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th /&gt;&lt;th align="left"&gt;&lt;italic&gt;n&lt;/italic&gt; = 63&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;n&lt;/italic&gt; = 57&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;n&lt;/italic&gt; = 57&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;n&lt;/italic&gt; = 60&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;n&lt;/italic&gt; = 56&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;n&lt;/italic&gt; = 55&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th /&gt;&lt;th align="left"&gt;&lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;M&lt;/italic&gt; (&lt;italic&gt;SD&lt;/italic&gt;)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;b&lt;/italic&gt; (95% CI)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;b&lt;/italic&gt; (95% CI)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;b&lt;/italic&gt; (95% CI)&lt;/th&gt;&lt;th align="left"&gt;&lt;italic&gt;b&lt;/italic&gt; (95% CI)&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt;PSP&lt;/td&gt;&lt;td&gt;39.9(12.0)&lt;/td&gt;&lt;td&gt;46.0(13.3)&lt;/td&gt;&lt;td&gt;47.5(14.9)&lt;/td&gt;&lt;td&gt;40.8(13.2)&lt;/td&gt;&lt;td&gt;41.1(14.8)&lt;/td&gt;&lt;td&gt;42.9(14.7)&lt;/td&gt;&lt;td&gt;&amp;#8211;0.53(&amp;#8211;3.15 to 2.09)&lt;/td&gt;&lt;td&gt;0.691&lt;/td&gt;&lt;td&gt;1.93(&amp;#8211;0.68 to 4.56)&lt;/td&gt;&lt;td&gt;0.148&lt;/td&gt;&lt;td&gt;6.69(3.01&amp;#8211;10.3)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.000&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;5.62(1.91&amp;#8211;9.33)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.003&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;PSP&amp;#95;work&lt;/td&gt;&lt;td&gt;2.98&lt;/td&gt;&lt;td&gt;2.88&lt;/td&gt;&lt;td&gt;2.53&lt;/td&gt;&lt;td&gt;3.11&lt;/td&gt;&lt;td&gt;3.03&lt;/td&gt;&lt;td&gt;2.67&lt;/td&gt;&lt;td&gt;&amp;#8211;0.57(&amp;#8211;0.35 to 0.19)&lt;/td&gt;&lt;td&gt;0.572&lt;/td&gt;&lt;td&gt;&amp;#8211;3.54(&amp;#8211;0.77 to &amp;#8211;0.22)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.000&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&amp;#8211;0.47(&amp;#8211;0.47 to 0.29)&lt;/td&gt;&lt;td&gt;0.641&lt;/td&gt;&lt;td&gt;0.92(&amp;#8211;0.36 to 0.40)&lt;/td&gt;&lt;td&gt;0.929&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;PSP&amp;#95;rel&lt;/td&gt;&lt;td&gt;2.57&lt;/td&gt;&lt;td&gt;2.14&lt;/td&gt;&lt;td&gt;1.83&lt;/td&gt;&lt;td&gt;2.55&lt;/td&gt;&lt;td&gt;2.26&lt;/td&gt;&lt;td&gt;2.05&lt;/td&gt;&lt;td&gt;&amp;#8211;2.81(&amp;#8211;0.52 to &amp;#8211;0.94)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.005&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&amp;#8211;5.05(&amp;#8211;0.77 to &amp;#8211;0.34)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.000&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&amp;#8211;0.91(&amp;#8211;0.44 to 0.16)&lt;/td&gt;&lt;td&gt;0.365&lt;/td&gt;&lt;td&gt;&amp;#8211;1.14(&amp;#8211;0.48 to 0.12)&lt;/td&gt;&lt;td&gt;0.254&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;PSP&amp;#95;care&lt;/td&gt;&lt;td&gt;2.55&lt;/td&gt;&lt;td&gt;2.16&lt;/td&gt;&lt;td&gt;2.03&lt;/td&gt;&lt;td&gt;2.44&lt;/td&gt;&lt;td&gt;2.42&lt;/td&gt;&lt;td&gt;2.03&lt;/td&gt;&lt;td&gt;&amp;#8211;0.14(&amp;#8211;0.26 to 0.23)&lt;/td&gt;&lt;td&gt;0.888&lt;/td&gt;&lt;td&gt;&amp;#8211;0.63(&amp;#8211;0.32 to 0.16)&lt;/td&gt;&lt;td&gt;0.531&lt;/td&gt;&lt;td&gt;&amp;#8211;1.79(&amp;#8211;0.66 to &amp;#8211;0.03)&lt;/td&gt;&lt;td&gt;0.073&lt;/td&gt;&lt;td&gt;&amp;#8211;2.13(&amp;#8211;0.73 to &amp;#8211;0.02)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.033&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;PSP&amp;#95;agres&lt;/td&gt;&lt;td&gt;1.46&lt;/td&gt;&lt;td&gt;.096&lt;/td&gt;&lt;td&gt;1.15&lt;/td&gt;&lt;td&gt;1.46&lt;/td&gt;&lt;td&gt;1.32&lt;/td&gt;&lt;td&gt;1.11&lt;/td&gt;&lt;td&gt;&amp;#8211;0.56(&amp;#8211;0.43 to 0.24)&lt;/td&gt;&lt;td&gt;0.575&lt;/td&gt;&lt;td&gt;&amp;#8211;1.45(&amp;#8211;0.56 to 0.87)&lt;/td&gt;&lt;td&gt;0.414&lt;/td&gt;&lt;td&gt;&amp;#8211;1.50(&amp;#8211;0.83 to 0.11)&lt;/td&gt;&lt;td&gt;0.135&lt;/td&gt;&lt;td&gt;&amp;#8211;0.29(&amp;#8211;0.54 to 0.40)&lt;/td&gt;&lt;td&gt;0.773&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;MANSA&lt;/td&gt;&lt;td&gt;3.37(0.96)&lt;/td&gt;&lt;td&gt;3.91(1.07)&lt;/td&gt;&lt;td&gt;4.02(1.13)&lt;/td&gt;&lt;td&gt;3.48(0.92)&lt;/td&gt;&lt;td&gt;3.66(0.90)&lt;/td&gt;&lt;td&gt;3.87(1.04)&lt;/td&gt;&lt;td&gt;0.10(&amp;#8211;0.10 to 0.31)&lt;/td&gt;&lt;td&gt;0.319&lt;/td&gt;&lt;td&gt;0.31(0.11&amp;#8211;0.52)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.002&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;0.45(0.17&amp;#8211;0.74)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.002&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;0.31(0.04&amp;#8211;0.61)&lt;/td&gt;&lt;td&gt;0.024&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;SRS-A&lt;/td&gt;&lt;td&gt;89.3(20.4)&lt;/td&gt;&lt;td&gt;81.6(15.9)&lt;/td&gt;&lt;td&gt;82.9(21.3)&lt;/td&gt;&lt;td&gt;93.3(17.5)&lt;/td&gt;&lt;td&gt;90.6(19.1)&lt;/td&gt;&lt;td&gt;88.9(18.2)&lt;/td&gt;&lt;td&gt;&amp;#8211;3.36(&amp;#8211;6.64 to &amp;#8211;0.86)&lt;/td&gt;&lt;td&gt;0.044&lt;/td&gt;&lt;td&gt;&amp;#8211;4.47(&amp;#8211;7.73 to 1.21)&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.007&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&amp;#8211;4.10(&amp;#8211;8.66 to 0.46)&lt;/td&gt;&lt;td&gt;0.078&lt;/td&gt;&lt;td&gt;&amp;#8211;2.00(&amp;#8211;6.58 to 2.57)&lt;/td&gt;&lt;td&gt;0.390&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <ulist> <item>4 DBT: dialectical behaviour therapy; TAU: treatment as usual; t<subs>0</subs>: baseline; t<subs>6</subs>: post-treatment; t<subs>12</subs>: 12-month follow-up assessment; <emph>M</emph>: mean; <emph>SD</emph>: standard deviation; <emph>b</emph>: regression coefficient; CI: confidence interval; <emph>n</emph>: number of participants; PSP: Personal and Social Performance Scale; PSP_work: PSP work domain; PSP_rel: PSP relation domain; PSP_care: PSP care domain; PSP_agres: PSP agressive domain; MANSA: Manchester short assessment of quality of life; SRS-A: Social Responsiveness Scale-adult version.</item> <item>5 Values indicate the <emph>p</emph>-values of time of the multilevel models; <emph>p</emph>-values &lt; 0.05 are presented in bold.</item> <item>6 Values indicate the <emph>p</emph>-values of time × treatment of the multilevel models; <emph>p</emph>-values &lt; 0.05 are presented in bold.</item> </ulist> <p>Graph: Figure 2. Change in secondary outcomes by condition over time.DBT: dialectical behaviour therapy; TAU: treatment as usual; PSP: personal and social functioning; MANSA: the Manchester short assessment of quality of life; SRS-A: Social Responsiveness Scale.</p> <p>Quality of life (MANSA) improved significantly more in DBT than in TAU at post-treatment. At follow-up, these treatment effects remained significant and in favour of DBT, see Table 2. Figure 2 illustrates these treatment effects by condition and over time.</p> <p>However, for traits of autism (SRS-A), we observed no statistically significant effects.</p> <hd id="AN0184797752-14">Sensitivity analyses</hd> <p>To ascertain the robustness of the main analyses conducted with the mixed models, a pre-planned sensitivity analysis was conducted in which missing observations due to dropout were imputed using the LOCF method. Table 3 compares regression coefficients, standard errors and <emph>p</emph>-values for time effects and condition × time (DBT vs TAU) from base case analyses, LOCF sensitivity analysis, and COVID lockdown-adjusted analyses for PSP social functioning, MANSA quality of life and SRS-A autism traits. Overall, minimal differences were noted between the main and LOCF sensitivity analyses.</p> <p>Table 3. Main vs Sensitivity vs Covid over time.</p> <p>Graph</p> <p> <ephtml> &lt;table&gt;&lt;colgroup&gt;&lt;col align="left" /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;col align="char" char="." /&gt;&lt;/colgroup&gt;&lt;thead&gt;&lt;tr&gt;&lt;th align="left" rowspan="2"&gt;Outcome analysis&lt;/th&gt;&lt;th align="left" colspan="2"&gt;Time (month)&lt;/th&gt;&lt;th align="left" colspan="2"&gt;Time &amp;#215; treatment (month)&lt;/th&gt;&lt;th align="left" colspan="2"&gt;Time (month)&lt;/th&gt;&lt;th align="left" colspan="2"&gt;Time &amp;#215; treatment (month)&lt;/th&gt;&lt;th align="left" colspan="2"&gt;Time (month)&lt;/th&gt;&lt;th align="left" colspan="2"&gt;Time &amp;#215; treatment (month)&lt;/th&gt;&lt;/tr&gt;&lt;tr&gt;&lt;th align="left"&gt;6&lt;/th&gt;&lt;th align="left"&gt;12&lt;/th&gt;&lt;th align="left"&gt;6&lt;/th&gt;&lt;th align="left"&gt;12&lt;/th&gt;&lt;th align="left"&gt;6&lt;/th&gt;&lt;th align="left"&gt;12&lt;/th&gt;&lt;th align="left"&gt;6&lt;/th&gt;&lt;th align="left"&gt;12&lt;/th&gt;&lt;th align="left"&gt;6&lt;/th&gt;&lt;th align="left"&gt;12&lt;/th&gt;&lt;th align="left"&gt;6&lt;/th&gt;&lt;th align="left"&gt;12&lt;/th&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td colspan="13"&gt;PSP&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Base Case&lt;/td&gt;&lt;td&gt;&amp;#8211;0.5330&lt;/td&gt;&lt;td&gt;193.7&lt;/td&gt;&lt;td&gt;6.692&lt;/td&gt;&lt;td&gt;5.626&lt;/td&gt;&lt;td&gt;1.339&lt;/td&gt;&lt;td&gt;1.339&lt;/td&gt;&lt;td&gt;1.876&lt;/td&gt;&lt;td&gt;1.892&lt;/td&gt;&lt;td&gt;0.691&lt;/td&gt;&lt;td&gt;0.148&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.000&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.003&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Sens LOCF&lt;/td&gt;&lt;td&gt;&amp;#8211;0.5166&lt;/td&gt;&lt;td&gt;1.6&lt;/td&gt;&lt;td&gt;5.897&lt;/td&gt;&lt;td&gt;5.019&lt;/td&gt;&lt;td&gt;1.239&lt;/td&gt;&lt;td&gt;1.239&lt;/td&gt;&lt;td&gt;1.731&lt;/td&gt;&lt;td&gt;1.731&lt;/td&gt;&lt;td&gt;0.677&lt;/td&gt;&lt;td&gt;0.197&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.001&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.004&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Sens COVID&lt;/td&gt;&lt;td&gt;&amp;#8211;0.7334&lt;/td&gt;&lt;td&gt;0.248&lt;/td&gt;&lt;td&gt;5.895&lt;/td&gt;&lt;td&gt;4.984&lt;/td&gt;&lt;td&gt;1.593&lt;/td&gt;&lt;td&gt;1.651&lt;/td&gt;&lt;td&gt;1.728&lt;/td&gt;&lt;td&gt;1.728&lt;/td&gt;&lt;td&gt;0.645&lt;/td&gt;&lt;td&gt;0.881&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.001&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.004&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="13"&gt;MANSA&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Base Case&lt;/td&gt;&lt;td&gt;0.1045&lt;/td&gt;&lt;td&gt;0.3189&lt;/td&gt;&lt;td&gt;0.4595&lt;/td&gt;&lt;td&gt;0.3317&lt;/td&gt;&lt;td&gt;0.1050&lt;/td&gt;&lt;td&gt;0.1037&lt;/td&gt;&lt;td&gt;0.1495&lt;/td&gt;&lt;td&gt;0.1465&lt;/td&gt;&lt;td&gt;0.319&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.002&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.002&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.024&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Sens LOCF&lt;/td&gt;&lt;td&gt;0.0818&lt;/td&gt;&lt;td&gt;0.2969&lt;/td&gt;&lt;td&gt;0.4131&lt;/td&gt;&lt;td&gt;0.2860&lt;/td&gt;&lt;td&gt;0.0968&lt;/td&gt;&lt;td&gt;0.0968&lt;/td&gt;&lt;td&gt;0.1335&lt;/td&gt;&lt;td&gt;0.1335&lt;/td&gt;&lt;td&gt;0.398&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.002&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.002&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.035&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Sens COVID&lt;/td&gt;&lt;td&gt;0.0715&lt;/td&gt;&lt;td&gt;0.1369&lt;/td&gt;&lt;td&gt;0.4125&lt;/td&gt;&lt;td&gt;0.2820&lt;/td&gt;&lt;td&gt;0.1240&lt;/td&gt;&lt;td&gt;0.1284&lt;/td&gt;&lt;td&gt;0.1346&lt;/td&gt;&lt;td&gt;0.1346&lt;/td&gt;&lt;td&gt;0.564&lt;/td&gt;&lt;td&gt;0.286&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.002&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.036&lt;/bold&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td colspan="13"&gt;SRS-A&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Base Case&lt;/td&gt;&lt;td&gt;&amp;#8211;3.368&lt;/td&gt;&lt;td&gt;&amp;#8211;4.471&lt;/td&gt;&lt;td&gt;&amp;#8211;4.100&lt;/td&gt;&lt;td&gt;&amp;#8211;2.007&lt;/td&gt;&lt;td&gt;1.674&lt;/td&gt;&lt;td&gt;1.664&lt;/td&gt;&lt;td&gt;2.330&lt;/td&gt;&lt;td&gt;2.335&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.044&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.007&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;0.078&lt;/td&gt;&lt;td&gt;0.390&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Sens LOCF&lt;/td&gt;&lt;td&gt;&amp;#8211;2.883&lt;/td&gt;&lt;td&gt;&amp;#8211;4.45&lt;/td&gt;&lt;td&gt;&amp;#8211;3.45&lt;/td&gt;&lt;td&gt;&amp;#8211;0.7722&lt;/td&gt;&lt;td&gt;1.525&lt;/td&gt;&lt;td&gt;1.525&lt;/td&gt;&lt;td&gt;2.131&lt;/td&gt;&lt;td&gt;2.131&lt;/td&gt;&lt;td&gt;0.059&lt;/td&gt;&lt;td&gt;&lt;bold&gt;0.004&lt;/bold&gt;&lt;/td&gt;&lt;td&gt;0.106&lt;/td&gt;&lt;td&gt;0.717&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt; Sens COVID&lt;/td&gt;&lt;td&gt;&amp;#8211;1.278&lt;/td&gt;&lt;td&gt;&amp;#8211;2.935&lt;/td&gt;&lt;td&gt;&amp;#8211;3.429&lt;/td&gt;&lt;td&gt;&amp;#8211;0.7382&lt;/td&gt;&lt;td&gt;1.942&lt;/td&gt;&lt;td&gt;2.010&lt;/td&gt;&lt;td&gt;2.112&lt;/td&gt;&lt;td&gt;2.112&lt;/td&gt;&lt;td&gt;0.510&lt;/td&gt;&lt;td&gt;0.144&lt;/td&gt;&lt;td&gt;0.105&lt;/td&gt;&lt;td&gt;0.727&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <ulist> <item>7 PSP: Personal and Social Performance Scale; Base Case: base case analysis; Sens: sensitivity analysis; LOCF: last observation carried forward; Sens COVID: lockdown adjusted analyses; MANSA: Manchester short assessment of quality of life; SRS-A: Social Responsiveness Scale-Adult version.</item> <item>8 Statistically significant values at <emph>p</emph> &lt; 0.05 are presented in bold.</item> </ulist> <p>Regarding the comparison between COVID-adjusted and main analyses, slight differences were found in <emph>b</emph>-coefficients favouring DBT, with negligible changes in <emph>p</emph>-values for PSP, see Table 3. However, DBT lost significance at post-treatment and follow-up in SRS-A and MANSA adjusted analyses. Time effects on SRS-A at post-treatment and follow-up and MANSA at follow-up lost significance in adjusted analyses. In summary, lockdown-adjusted analyses did not materially alter the original conclusions.</p> <hd id="AN0184797752-15">Discussion</hd> <p></p> <hd id="AN0184797752-16">Key findings</hd> <p>This study focused on examining the secondary effects of DBT on social functioning, quality of life and autism traits in autistic individuals with suicidal behaviour. While the larger RCT established the efficacy of DBT in reducing suicidal ideation and attempts ([<reflink idref="bib30" id="ref99">30</reflink>]), this study specifically explores how these secondary outcomes are impacted by the treatment. The results are consistent with our hypotheses that social functioning and quality of life significantly improved in the DBT group compared to the TAU group, both at 6 and at 12 months follow-up. Autism traits showed no group differences.</p> <hd id="AN0184797752-17">Findings in context</hd> <p>The literature review presented in the introduction highlights the significant challenges in addressing suicidal behaviour among autistic individuals, emphasising the scarcity of research on effective interventions such as DBT and other psychological treatments. Factors such as diminished well-being and limited social engagement are recognised as potentially exacerbating the severity of suicidal behaviour in autistic individuals ([<reflink idref="bib9" id="ref100">9</reflink>]; [<reflink idref="bib11" id="ref101">11</reflink>]; [<reflink idref="bib13" id="ref102">13</reflink>]; [<reflink idref="bib18" id="ref103">18</reflink>]; [<reflink idref="bib24" id="ref104">24</reflink>]; [<reflink idref="bib40" id="ref105">40</reflink>]). Emerging research suggests that reductions in suicidality coincide with improvements in social functioning and overall quality of life (([<reflink idref="bib6" id="ref106">6</reflink>]; [<reflink idref="bib10" id="ref107">10</reflink>]; [<reflink idref="bib39" id="ref108">39</reflink>]). Expanding on these findings, this study explores significant enhancements in social functioning and quality of life observed in the DBT group, within a larger RCT investigating the effectiveness of DBT for suicidal behaviours in autistic adults ([<reflink idref="bib30" id="ref109">30</reflink>]). It must be emphasised that the improvements in social functioning and quality of life are only modest. The change in PSP scores is approximately 6 points. While this is statistically significant, it does not meet the threshold of 10 points required for clinical significance ([<reflink idref="bib35" id="ref110">35</reflink>]). The separate domains generally show non-significant improvements. The statistical significance observed in self-care is likely due to a slight improvement in the DBT condition, coupled with a slight worsening in the TAU condition.</p> <p>Improvement in social functioning and quality of life was also observed in the TAU group. This improvement may possibly reflect a regression-to-the-mean effect, considering that participants who were initially at high risk for suicide might naturally present with deteriorated social functioning and quality of life prior to treatment. In addition, the enhanced outcomes observed at post-treatment and follow-up in the TAU group might also reflect the beneficial influence of therapeutic support and mental health services ([<reflink idref="bib9" id="ref111">9</reflink>]). The results of this study, extending insights from prior research ([<reflink idref="bib30" id="ref112">30</reflink>]) that highlighted DBT's significant impact on comorbid symptoms such as depression, further support the concept of DBT as a transdiagnostic intervention. This approach not only addresses distinct behaviours and symptoms, but also seems to target underlying mechanisms ([<reflink idref="bib5" id="ref113">5</reflink>]; [<reflink idref="bib60" id="ref114">60</reflink>]).</p> <p>Variability in core autism traits is characterised by inter-individual differences and intra-individual changes over time, spanning specific symptomatic domains such as social communication and restricted/repetitive behaviours ([<reflink idref="bib64" id="ref115">64</reflink>]). This variability can be ascribed to distinct personal traits such as gender, IQ and sociodemographic factors and may be modulated by evolving developmental trajectories. Notably, behavioural interventions correlate with reduced restricted/repetitive behaviours and enhanced social skills, highlighting autism's dynamic nature ([<reflink idref="bib2" id="ref116">2</reflink>]; [<reflink idref="bib12" id="ref117">12</reflink>]; [<reflink idref="bib17" id="ref118">17</reflink>]; [<reflink idref="bib20" id="ref119">20</reflink>]; [<reflink idref="bib27" id="ref120">27</reflink>]; [<reflink idref="bib47" id="ref121">47</reflink>]; [<reflink idref="bib64" id="ref122">64</reflink>]).</p> <hd id="AN0184797752-18">COVID-19 impact</hd> <p>The impact of the COVID-19 pandemic on autistic adults was profound, with escalating rates of infection and hospitalisation, increased distress and depression and diminished quality of life ([<reflink idref="bib55" id="ref123">55</reflink>]). Nonetheless, our clinical observations suggest that many autistic individuals found the reduced public social interactions and increased online engagement provided by pandemic restrictions beneficial. These individuals noted improvements such as reduced external stressors, increased autonomy over sensory exposures and a newfound sense of solidarity with their peers in coping with these shared challenges. This adaptive response may have enhanced their quality of life and social interactions. It might also account for our minimal attrition rate and explain why the COVID-adjusted analyses yielded results closely mirroring those from the base case analysis.</p> <hd id="AN0184797752-19">Strengths and limitations</hd> <p>This study has several notable strengths, including its controlled design and recruitment from routine clinical settings, the inclusion of autistic individuals with significant levels of comorbidity, and the application of widely used DBT treatment protocols. These strengths increase the generalisability of the observed effects to patients in routine clinical practice and lend credibility to the feasibility of offering DBT to autistic individuals with suicidal behaviour in a clinical setting.</p> <p>The study has several limitations. First, the reliance on self-reported outcomes risks socially desirable responses, though the scales demonstrated high test–retest reliability across clinical populations. Second, the psychological nature of the intervention prevented therapist and patient blinding, but outcome assessors remained blind to randomisation status. Third, while an 8.9% loss-to-follow-up occurred, a sensitivity analysis using the conservative LOCF method revealed outcomes comparable to those of the base case analysis. Fourth, COVID-19 lockdowns shifted our approach from in-person to virtual, but a sensitivity analysis confirms this change did not have a major impact on treatment outcomes. Fifth, the use of measures not psychometrically validated in autistic samples or created for the autistic population may affect the accuracy of the results. Sixth, DBT was offered in 6 months (not in the usual 12 months), and this intensity may have contributed to DBT's effectiveness. Finally, there was limited training for clinicians new to DBT and low-to-moderate DBT adherence was observed.</p> <hd id="AN0184797752-20">Implications for clinical practice</hd> <p>DBT was reported to be effective in reducing suicidal ideation, suicide attempts and depression. This article underscores the modest effects of DBT on social functioning and quality of life in autistic individuals. This promising evidence encourages clinicians and researchers to use DBT in clinical services and research.</p> <hd id="AN0184797752-21">Implications for future research</hd> <p>Future studies should explore the potential benefits of incorporating booster sessions to better evaluate the enduring effects of DBT interventions on autistic individuals' social outcomes. In addition, future research should use longer follow-up periods to adequately evaluate the regaining social roles in broader society.</p> <hd id="AN0184797752-22">Conclusion</hd> <p>To our knowledge, this is the first RCT examining the effects of DBT treatment in autistic individuals, with a focus on clinically relevant secondary outcomes. DBT treatment significantly improved quality of life and social functioning, though modestly. Autistic traits showed no differences.</p> <hd id="AN0184797752-23">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-aut-10.1177_13623613241302875 for Secondary effects of dialectical behaviour therapy on social functioning, quality of life, and autism traits in autistic adults with suicidality by Anne Huntjens, LMC (Wies) van den Bosch, Bram Sizoo, Ad Kerkhof, Filip Smit and Mark van der Gaag in Autism</p> <p>We sincerely appreciate Marion Bruns's crucial role in organising data collection, filing and fact-checking. Thanks to the six mental health services – Rivierduinen, Lentis, Vincent van Gogh, Parnassia Den Haag, Haarlem/Zaandam and Antes/Rotterdam – for participating in the trial. Special thanks to participants, therapists, research assistants (especially Sophie Wissenburg and Gaby van der Palm), local researchers, and all contributors. Our heartfelt gratitude to the participants for their commitment and valuable feedback on treatment material and session content.</p> <ref id="AN0184797752-24"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> American Psychiatric Association. (2013). DSM-5 Diagnostic and Statistical Manual of mental disorders (5th ed) (5th ed.). American Psychiatric Publishing.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref49" type="bt">2</bibl> <bibtext> Anderson D. K., Liang J. W., Lord C. (2014). Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 55(5), 485–494. https://doi.org/10.1111/jcpp.12178</bibtext> </blist> <blist> <bibl id="bib3" idref="ref51" type="bt">3</bibl> <bibtext> Anderson S., Morris J. (2006). Cognitive behaviour therapy for people with Asperger syndrome. Behavioural and Cognitive Psychotherapy, 34(3), 293–303. https://doi.org/10.1017/S1352465805002651</bibtext> </blist> <blist> <bibl id="bib4" idref="ref8" type="bt">4</bibl> <bibtext> Arwert T. G., Sizoo B. B. (2020). Self-reported suicidality in male and female adults with autism spectrum disorders: Rumination and self-esteem. Journal of Autism and Developmental Disorders, 50(10), 3598–3605. https://doi.org/10.1007/s10803-020-04372-z</bibtext> </blist> <blist> <bibl id="bib5" idref="ref54" type="bt">5</bibl> <bibtext> Barlow D. H., Allen L. B., Choate M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35(2), 205–230. https://doi.org/10.1016/S0005-7894(04)80036-4</bibtext> </blist> <blist> <bibl id="bib6" idref="ref106" type="bt">6</bibl> <bibtext> Bemmouna D., Coutelle R., Weibel S., Weiner L. (2022). Feasibility, acceptability and preliminary efficacy of dialectical behavior therapy for autistic adults without intellectual disability: A mixed methods study. Journal of Autism and Developmental Disorders, 52(10), 4337–4354. https://doi.org/10.1007/s10803-021-05317-w</bibtext> </blist> <blist> <bibl id="bib7" idref="ref77" type="bt">7</bibl> <bibtext> Björkman T., Svensson B. (2005). Quality of life in people with severe mental illness: Reliability and validity of the Manchester Short Assessment of Quality of Life (MANSA). Nordic Journal of Psychiatry, 59(4), 302–306. https://doi.org/10.1080/08039480500213733</bibtext> </blist> <blist> <bibl id="bib8" idref="ref17" type="bt">8</bibl> <bibtext> Cage E., Di Monaco J., Newell V. (2018). Experiences of autism acceptance and mental health in autistic adults. Journal of Autism and Developmental Disorders, 48(2), 473–484. https://doi.org/10.1007/s10803-017-3342-7</bibtext> </blist> <blist> <bibl id="bib9" idref="ref10" type="bt">9</bibl> <bibtext> Camm-Crosbie L., Bradley L., Shaw R., Baron-Cohen S., Cassidy S. (2019). 'People like me don't get support': Autistic adults' experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism, 23(6), 1431–1441. https://doi.org/10.1177/1362361318816053</bibtext> </blist> <blist> <bibtext> Carter G. L., Willcox C. H., Lewin T. J., Conrad A. M., Bendit N. (2010). Hunter DBT project: Randomized controlled trial of dialectical behaviour therapy in women with borderline personality disorder. Australian &amp; New Zealand Journal of Psychiatry, 44(2), 162–173. https://doi.org/10.3109/00048670903393621</bibtext> </blist> <blist> <bibtext> Cassidy S. (2020). Suicidality and self-harm in autism spectrum conditions. In White S. W., Maddox B. B., Mazefsky C. A. (Eds.) The Oxford handbook of autism and co-occurring psychiatric conditions (pp. 349–368). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780190910761.013.18</bibtext> </blist> <blist> <bibtext> Cassidy S., Au-Yeung S., Robertson A., Cogger-Ward H., Richards G., Allison C., Bradley L., Kenny R., O'Connor R., Mosse D. (2022). Autism and autistic traits in those who died by suicide in England. The British Journal of Psychiatry, 221(5), 683–691. https://doi.org/10.1192/bjp.2022.21</bibtext> </blist> <blist> <bibtext> Cassidy S., Bradley L., Shaw R., Baron-Cohen S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9, Article 42. https://doi.org/10.1186/s13229-018-0226-4</bibtext> </blist> <blist> <bibtext> Chan W., Smith L. E., Hong J., Greenberg J. S., Mailick M. R. (2017). Validating the social responsiveness scale for adults with autism. Autism Res, 10(10), 1663–1671. https://doi.org/10.1002/aur.1813</bibtext> </blist> <blist> <bibtext> Chiang H. M., Wineman I. (2014). Factors associated with quality of life in individuals with autism spectrum disorders: A review of literature. Research in Autism Spectrum Disorders, 8(8), 971–986. https://doi.org/10.1016/j.rasd.2014.05.003</bibtext> </blist> <blist> <bibtext> Comtois K. A., Linehan M. M. (1999, April). Lifetime parasuicide count: Description and psychometrics [Conference session]. 9th Annual Conference of the American Association of Suicidology, Houston, TX, United States.</bibtext> </blist> <blist> <bibtext> Costa A. P., Loor C., Steffgen G. (2020). Suicidality in adults with autism spectrum disorder: The role of depressive symptomatology, alexithymia, and antidepressants. Journal of Autism and Developmental Disorders, 50(10), 3585–3597. https://doi.org/10.1007/s10803-020-04433-3</bibtext> </blist> <blist> <bibtext> Crane L., Adams F., Harper G., Welch J., Pellicano E. (2019). 'Something needs to change': Mental health experiences of young autistic adults in England. Autism, 23(2), 477–493. https://doi.org/10.1177/1362361318757048</bibtext> </blist> <blist> <bibtext> Dehn L. B., Driessen M., Steinhart I., Beblo T. (2022). Participating in longitudinal observational research on psychiatric rehabilitation: Quantitative results from a patient perspective study. Frontiers in Psychiatry, 13, Article 834389. https://doi.org/10.3389/fpsyt.2022.834389</bibtext> </blist> <blist> <bibtext> Elias R., Lord C. (2022). Diagnostic stability in individuals with autism spectrum disorder: Insights from a longitudinal follow-up study. Journal of Child Psychology and Psychiatry, 63(9), 973–983. https://doi.org/10.1111/jcpp.13551</bibtext> </blist> <blist> <bibtext> Fernández-Lafitte M., Cobo J., Coronas R., Parra I., Oliva J. C., Àlvarez A., Esteba-Castillo S., Giménez-Palop O., Palao D. J., Caixàs A. (2022). Social responsiveness and psychosocial functioning in adults with Prader-Willi syndrome. Journal of Clinical Medicine, 11(5), Article 1433. https://doi.org/10.3390/jcm11051433</bibtext> </blist> <blist> <bibtext> Geurts H. M., Corbett B., Solomon M. (2009). The paradox of cognitive flexibility in autism. Trends in Cognitive Sciences, 13(2), 74–82. https://doi.org/10.1016/j.tics.2008.11.006</bibtext> </blist> <blist> <bibtext> Hartmann K., Urbano M., Manser K., Okwara L. (2012). Modified dialectical behavior therapy to improve emotion regulation in autism spectrum disorders. In Richardson C. E., Wood R. A. (Eds.), Autism spectrum disorders: New research (pp. 41–72). Nova Science.</bibtext> </blist> <blist> <bibtext> Hedley D., Uljarević M. (2018). Systematic review of suicide in autism spectrum disorder: Current trends and implications. Current Developmental Disorders Reports, 5(1), 65–76. https://doi.org/10.1007/s40474-018-0133-6</bibtext> </blist> <blist> <bibtext> Hedley D., Uljarević M., Foley K. R., Richdale A., Trollor J. (2018). Risk and protective factors underlying depression and suicidal ideation in autism spectrum disorder. Depression and Anxiety, 35(7), 648–657. https://doi.org/10.1002/da.22759</bibtext> </blist> <blist> <bibtext> Hoekstra R. A., Vinkhuyzen A. A., Wheelwright S., Bartels M., Boomsma D. I., Baron-Cohen S., Posthuma D., van der Sluis S. (2011). The construction and validation of an abridged version of the autism-spectrum quotient (AQ-Short). Journal of Autism and Developmental Disorders, 41(5), 589–596. https://doi.org/10.1007/s10803-010-1073-0</bibtext> </blist> <blist> <bibtext> Hudry K., McConachie H., Le Couteur A., Howlin P., Barrett B., Slonims V., Consortium P. A. C. T. (2018). Predictors of reliable symptom change: Secondary analysis of the Preschool Autism Communication Trial. Autism &amp; Developmental Language Impairments, 3, Article 764760. https://doi.org/10.1177/2396941518764760</bibtext> </blist> <blist> <bibtext> Huntjens A., Landlust A., Wissenburg S., van der Gaag M. (2024a). The prevalence of suicidal behavior in autism spectrum disorder. Crisis, 45(2), 144–153. https://doi.org/10.1027/0227-5910/a000922</bibtext> </blist> <blist> <bibtext> Huntjens A., van den Bosch L. M. W., Sizoo B., Kerkhof A., Huibers M. J. H., van der Gaag M. (2020). The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/ or self-destructive behaviour (DIASS): Study protocol for a multicentre randomised controlled trial. BMC Psychiatry, 20(1), Article 127. https://doi.org/10.1186/s12888-020-02531-1</bibtext> </blist> <blist> <bibtext> Huntjens A., Van Den Bosch L. M. W., Sizoo B., Kerkhof A., Smit F., Van Der Gaag M. (2024b). The effectiveness and safety of dialectical behaviour therapy for suicidal ideation and behaviour in autistic adults: A pragmatic randomised controlled trial. Psychological Medicine, 4(12), 1–12.</bibtext> </blist> <blist> <bibtext> Jennes-Coussens M., Magill-Evans J., Koning C. (2006). The quality of life of young men with Asperger syndrome: A brief report. Autism, 10(4), 403–414. https://doi.org/10.1177/1362361306064432</bibtext> </blist> <blist> <bibtext> Kamio Y., Inada N., Koyama T. (2013). A nationwide survey on quality of life and associated factors of adults with high-functioning autism spectrum disorders. Autism, 17(1), 15–26. https://doi.org/10.1177/1362361312436848</bibtext> </blist> <blist> <bibtext> Kan C. C., Geurts H. M., Sizoo B. B. (2013). Multidisciplinaire richtlijn diagnostiek en behandeling van autismespectrumstoornissen bij volwassenen [Multidisciplinary guideline for the diagnosis and treatment of autism spectrum disorders in adults]. De Tijdstroom.</bibtext> </blist> <blist> <bibtext> Lawson L. P., Richdale A. L., Haschek A., Flower R. L., Vartuli J., Arnold S. R., Trollor J. N. (2020). Cross-sectional and longitudinal predictors of quality of life in autistic individuals from adolescence to adulthood: The role of mental health and sleep quality. Autism, 24(4), 954–967. https://doi.org/10.1177/1362361320908107</bibtext> </blist> <blist> <bibtext> Lee S. C., Tang S. F., Lu W. S., Huang S. L., Deng N. Y., Lue W. C., Hsieh C. L. (2016). Minimal detectable change of the Personal and Social Performance scale in individuals with schizophrenia. Psychiatry Research, 246, 725–729. https://doi.org/10.1016/j.psychres.2016.10.058</bibtext> </blist> <blist> <bibtext> Linehan M. M. (1993). Cognitive behavioural therapy of borderline personality disorder. Guilford Press.</bibtext> </blist> <blist> <bibtext> Mason D., McConachie H., Garland D., Petrou A., Rodgers J., Parr J. R. (2018). Predictors of quality of life for autistic adults. Autism Research, 11(8), 1138–1147. https://doi.org/10.1002/aur.1965</bibtext> </blist> <blist> <bibtext> McConachie H., Mason D., Parr J. R., Garland D., Wilson C., Rodgers J. (2018). Enhancing the validity of a quality of life measure for autistic people. Journal of Autism and Developmental Disorders, 48(5), 1596–1611. https://doi.org/10.1007/s10803-017-3402-z</bibtext> </blist> <blist> <bibtext> McMain S. F., Chapman A. L., Kuo J. R., Dixon-Gordon K. L., Guimond T. H., Labrish C., Isaranuwatchai W., Streiner D. L. (2022). The effectiveness of 6 versus 12 months of dialectical behavior therapy for borderline personality disorder: A noninferiority randomized clinical trial. Psychotherapy and Psychosomatics, 91(6), 382–397. https://doi.org/10.1159/000525102</bibtext> </blist> <blist> <bibtext> Mitchell P., Sheppard E., Cassidy S. (2021). Autism and the double empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39(1), 1–18. https://doi.org/10.1111/bjdp.12350</bibtext> </blist> <blist> <bibtext> Morosini P. L., Magliano L., Brambilla L., Ugolini S., Pioli R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand, 101(4), 323–329. https://pubmed.ncbi.nlm.nih.gov/10782554</bibtext> </blist> <blist> <bibtext> Neacsiu A. D., Eberle J. W., Kramer R., Wiesmann T., Linehan M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behaviour Research and Therapy, 59, 40–51. https://doi.org/10.1016/j.brat.2014.05.005</bibtext> </blist> <blist> <bibtext> Nieuwenhuizen C. V., Schene A. H., Koeter M. (2000). Manchester-verkorte Kwaliteit van Leven meting [Manchester Short Quality of Life Measure]. Institute of Mental Health Care Eindhoven.</bibtext> </blist> <blist> <bibtext> Noens I., De la Marche W., Scholte E. (2012). SRS-A-Screeningslijst voor autismespectrumstoornissen: Handleiding [SRS-A Screening List for Autism Spectrum Disorders: Manual]. Hogrefe. https://lirias.kuleuven.be/1768513?limo=0</bibtext> </blist> <blist> <bibtext> Oakley B. F., Tillmann J., Ahmad J., Crawley D., San José Cáceres A., Holt R., Charman T., Banaschewski T., Buitelaar J., Simonoff E., Murphy D., Loth E. (2021). How do core autism traits and associated symptoms relate to quality of life? Findings from the Longitudinal European Autism Project. Autism, 25(2), 389–404. https://doi.org/10.1177/1362361320959959</bibtext> </blist> <blist> <bibtext> O'Connor R. C., Kirtley O. J. (2018). The integrated motivational–volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B: Biological Sciences, 373(1754), Article 20170268. https://doi.org/10.1098/rstb.2017.0268</bibtext> </blist> <blist> <bibtext> Orinstein A. J., Helt M., Troyb E., Tyson K. E., Barton M. L., Eigsti I. M., Naigles L., Fein D. A. (2014). Intervention for optimal outcome in children and adolescents with a history of autism. Journal of Developmental and Behavioral Pediatrics, 35(4), 247–256. https://doi.org/10.1097/DBP.0000000000000037</bibtext> </blist> <blist> <bibtext> Pelton M. K., Crawford H., Robertson A. E., Rodgers J., Baron-Cohen S., Cassidy S. (2020). Understanding suicide risk in autistic adults: Comparing the interpersonal theory of suicide in autistic and non-autistics. Journal of Autism and Developmental Disorders, 50, 3620–3637. https://doi.org/10.1007/s10803-020-04393-8</bibtext> </blist> <blist> <bibtext> Pisula E., Danielewicz D., Kawa R., Pisula W. (2015). Autism spectrum quotient, coping with stress and quality of life in a non-clinical sample–an exploratory report. Health and Quality of Life Outcomes, 13, Article 173. https://doi.org/10.1186/s12955-015-0370-x</bibtext> </blist> <blist> <bibtext> Priebe S., Huxley P., Knight S., Evans S. (1999). Application and results of the Manchester Short Assessment of Quality of Life (MANSA). International Journal of Social Psychiatry, 45(1), 7–12. https://doi.org/10.1177/002076409904500102</bibtext> </blist> <blist> <bibtext> Priebe S., Marchi F., Bini L., Flego M., Costa A., Galeazzi G. (2011). Mental disorders, psychological symptoms and quality of life 8 years after an earthquake: Findings from a community sample in Italy. Social Psychiatry and Psychiatric Epidemiology, 46(7), 615–621. https://doi.org/10.1007/s00127-010-0227-x</bibtext> </blist> <blist> <bibtext> Richards G., Kenny R., Griffiths S., Allison C., Mosse D., Holt R., O'Connor R. C., Cassidy S., Baron-Cohen S. (2019). Autistic traits in adults who have attempted suicide. Molecular Autism, 10, Article 26. https://doi.org/10.1186/s13229-019-0274-4</bibtext> </blist> <blist> <bibtext> Rijksoverheid. (2021). Timeline coronavirus. https://<ulink href="http://www.rijksoverheid.nl/onderwerpen/coronavirus-tijdlijn">www.rijksoverheid.nl/onderwerpen/coronavirus-tijdlijn</ulink></bibtext> </blist> <blist> <bibtext> Robinson S., Lang J. E., Hernandez A. M., Holz T., Cameron M., Brannon B. (2018). Outcomes of dialectical behavior therapy administered by an interdisciplinary team. Archives of Psychiatric Nursing, 32(4), 512–516. https://doi.org/10.1016/j.apnu.2018.02.009</bibtext> </blist> <blist> <bibtext> Scheeren A. M., Crane L., Heyworth M., Pellicano E. (2023). Impact of the COVID-19 pandemic on autistic adults: A scoping review. Current Developmental Disorders Report, 10(1), 92–122. https://doi.org/10.1007/s40474-023-00268-6</bibtext> </blist> <blist> <bibtext> Slade M., McCrone P., Kuipers E., Leese M., Cahill S., Parabiaghi A., Priebe S., Thornicroft G. (2006). Use of standardised outcome measures in adult mental health services: Randomised controlled trial. British Journal of Psychiatry, 189, 330–336. https://doi.org/10.1192/bjp.bp.105.015412</bibtext> </blist> <blist> <bibtext> Spek A. A., van Ham N. C., Nyklíček I. (2013). Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Research in Developmental Disabilities, 34(1), 246–253. https://doi.org/10.1016/j.ridd.2012.08.009</bibtext> </blist> <blist> <bibtext> South M., Beck J. S., Lundwall R., Christensen M., Cutrer E. A., Gabrielsen T. P., Cox J. C., Lundwall R. A. (2020). Unrelenting depression and suicidality in women with autistic traits. Journal of Autism and Developmental Disorders, 50, 3606–3619. https://doi.org/10.1007/s10803-019-04324-2</bibtext> </blist> <blist> <bibtext> Steensel F. J. A. V., Bögel S. M. (2012). Anxiety and quality of life: Clinically anxious children with and without autism spectrum disorders compared. Journal of Clinical Child &amp; Adolescent Psychology, 41(6), 731–738. https://doi.org/10.1080/15374416.2012.698725</bibtext> </blist> <blist> <bibtext> Tan M. Y. L., McConnell B., Barlas J. (2022). Application of dialectical behaviour therapy in treating common psychiatric disorders: Study protocol for a scoping review. British Medical Journal Open, 12(9), Article e058565. https://doi.org/10.1136/bmjopen-2021-058565</bibtext> </blist> <blist> <bibtext> van Heijst B. F., Geurts H. M. (2015). Quality of life in autism across the lifespan: A meta-analysis. Autism, 19(2), 158–167. https://doi.org/10.1177/1362361313517053</bibtext> </blist> <blist> <bibtext> van Nieuwenhuizen C., Schene A., Boevink W., Wolf J. (1998). The Lancashire Quality of Life Profile: first experiences in The Netherlands. Community Ment Health J, 34(5), 513–524. https://doi.org/10.1023/a:1018794530481</bibtext> </blist> <blist> <bibtext> van Spijker B. A., Batterham P. J., Calear A. L., Farrer L., Christensen H., Reynolds J., Kerkhof A. J. (2014). The suicidal ideation attributes scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation. Suicide &amp; Life-Threatening Behavior, 44(4), 408–419. https://doi.org/10.1111/sltb.12084</bibtext> </blist> <blist> <bibtext> Waizbard-Bartov E., Miller M. (2023). Does the severity of autism symptoms change over time? A review of the evidence, impacts, and gaps in current knowledge. Clinical Psychology Review, 99, Article 102230. https://doi.org/10.1016/j.cpr.2022.102230</bibtext> </blist> <blist> <bibtext> Webb E. L., Girardi A., Fox E., Wallang P. (2023). An evaluation of value-based outcomes for women admitted to a dialectical behaviour therapy integrated practice unit: A follow-up study. Behavioural and Cognitive Psychotherapy, 51(1), 110–115. https://doi.org/10.1017/S1352465822000467</bibtext> </blist> <blist> <bibtext> Wechsler D. (2008). Wechsler Adult Intelligence Scale–Fourth Edition (WAIS–IV). NCS Pearson, 22(498), 816–827.</bibtext> </blist> <blist> <bibtext> Zahid S., Upthegrove R. (2017). Suicidality in autistic spectrum disorders. Crisis, 38(4), 237–246. https://doi.org/10.1027/0227-5910/a000458</bibtext> </blist> </ref> <ref id="AN0184797752-25"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Dutch support foundation Stichting tot Steun Vereniging voor Christelijke Verzorging van Geestes en Zenuwzieken (grant number 240) and by the Innovatie Platform Parnassia Groep (grant number 211001). The funding sources had no role in the design and execution of this study; collection, analysis and interpretation of the data; preparation, review or approval of the article; or the decision to submit the article for publication.</bibtext> </blist> <blist> <bibtext> Anne Huntjens</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-0520-9212</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> </ref> <aug> <p>By Anne Huntjens; LMC van den Bosch; Bram Sizoo; Ad Kerkhof; Filip Smit and Mark van der Gaag</p> <p>Reported by Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib24" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib67" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib28" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib25" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib13" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib58" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib46" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib11" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib18" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib40" firstref="ref15"></nolink> <nolink nlid="nl11" bibid="bib48" firstref="ref16"></nolink> <nolink nlid="nl12" bibid="bib52" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib31" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib32" firstref="ref20"></nolink> <nolink nlid="nl15" bibid="bib34" firstref="ref21"></nolink> <nolink nlid="nl16" bibid="bib37" firstref="ref22"></nolink> <nolink nlid="nl17" bibid="bib38" firstref="ref23"></nolink> <nolink nlid="nl18" bibid="bib45" firstref="ref24"></nolink> <nolink nlid="nl19" bibid="bib61" firstref="ref25"></nolink> <nolink nlid="nl20" bibid="bib15" firstref="ref26"></nolink> <nolink nlid="nl21" bibid="bib49" firstref="ref27"></nolink> <nolink nlid="nl22" bibid="bib59" firstref="ref28"></nolink> <nolink nlid="nl23" bibid="bib30" firstref="ref30"></nolink> <nolink nlid="nl24" bibid="bib54" firstref="ref32"></nolink> <nolink nlid="nl25" bibid="bib65" firstref="ref33"></nolink> <nolink nlid="nl26" bibid="bib10" firstref="ref34"></nolink> <nolink nlid="nl27" bibid="bib39" firstref="ref35"></nolink> <nolink nlid="nl28" bibid="bib36" firstref="ref37"></nolink> <nolink nlid="nl29" bibid="bib41" firstref="ref39"></nolink> <nolink nlid="nl30" bibid="bib50" firstref="ref40"></nolink> <nolink nlid="nl31" bibid="bib14" firstref="ref41"></nolink> <nolink nlid="nl32" bibid="bib44" firstref="ref42"></nolink> <nolink nlid="nl33" bibid="bib29" firstref="ref43"></nolink> <nolink nlid="nl34" bibid="bib33" firstref="ref44"></nolink> <nolink nlid="nl35" bibid="bib26" firstref="ref45"></nolink> <nolink nlid="nl36" bibid="bib63" firstref="ref46"></nolink> <nolink nlid="nl37" bibid="bib16" firstref="ref47"></nolink> <nolink nlid="nl38" bibid="bib66" firstref="ref57"></nolink> <nolink nlid="nl39" bibid="bib35" firstref="ref70"></nolink> <nolink nlid="nl40" bibid="bib21" firstref="ref72"></nolink> <nolink nlid="nl41" bibid="bib43" firstref="ref74"></nolink> <nolink nlid="nl42" bibid="bib62" firstref="ref75"></nolink> <nolink nlid="nl43" bibid="bib51" firstref="ref79"></nolink> <nolink nlid="nl44" bibid="bib56" firstref="ref80"></nolink> <nolink nlid="nl45" bibid="bib19" firstref="ref81"></nolink> <nolink nlid="nl46" bibid="bib22" firstref="ref93"></nolink> <nolink nlid="nl47" bibid="bib23" firstref="ref94"></nolink> <nolink nlid="nl48" bibid="bib42" firstref="ref95"></nolink> <nolink nlid="nl49" bibid="bib57" firstref="ref96"></nolink> <nolink nlid="nl50" bibid="bib53" firstref="ref97"></nolink> <nolink nlid="nl51" bibid="bib60" firstref="ref114"></nolink> <nolink nlid="nl52" bibid="bib64" firstref="ref115"></nolink> <nolink nlid="nl53" bibid="bib12" firstref="ref117"></nolink> <nolink nlid="nl54" bibid="bib17" firstref="ref118"></nolink> <nolink nlid="nl55" bibid="bib20" firstref="ref119"></nolink> <nolink nlid="nl56" bibid="bib27" firstref="ref120"></nolink> <nolink nlid="nl57" bibid="bib47" firstref="ref121"></nolink> <nolink nlid="nl58" bibid="bib55" firstref="ref123"></nolink> |
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| Items | – Name: Title Label: Title Group: Ti Data: Secondary Effects of Dialectical Behaviour Therapy on Social Functioning, Quality of Life, and Autism Traits in Autistic Adults with Suicidality – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Anne+Huntjens%22">Anne Huntjens</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-0520-9212">0000-0002-0520-9212</externalLink>)<br /><searchLink fieldCode="AR" term="%22LMC+%28Wies%29+van+den+Bosch%22">LMC (Wies) van den Bosch</searchLink><br /><searchLink fieldCode="AR" term="%22Bram+Sizoo%22">Bram Sizoo</searchLink><br /><searchLink fieldCode="AR" term="%22Ad+Kerkhof%22">Ad Kerkhof</searchLink><br /><searchLink fieldCode="AR" term="%22Filip+Smit%22">Filip Smit</searchLink><br /><searchLink fieldCode="AR" term="%22Mark+van+der+Gaag%22">Mark van der Gaag</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2025 29(5):1333-1345. – Name: Avail Label: Availability Group: Avail Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 13 – Name: DatePubCY Label: Publication Date Group: Date Data: 2025 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Therapy%22">Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+Life%22">Quality of Life</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Modification%22">Behavior Modification</searchLink><br /><searchLink fieldCode="DE" term="%22Suicide%22">Suicide</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink> – Name: Subject Label: Geographic Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Netherlands%22">Netherlands</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1177/13623613241302875 – Name: ISSN Label: ISSN Group: ISSN Data: 1362-3613<br />1461-7005 – Name: Abstract Label: Abstract Group: Ab Data: The effect of psychological treatment on social functioning, quality of life and autism traits in autistic people with suicidal behaviour remains largely unknown. At six Dutch mental health centres, 123 adult outpatients with "Diagnostic and Statistical Manual of Mental Disorders" (5th edition) diagnosed autism spectrum condition and suicidal behaviours were randomly assigned to dialectical behaviour therapy (n = 63) or treatment as usual (n = 60) to address their suicidal behaviours. This article analysed secondary outcomes on social functioning, quality of life and autism traits. Outcomes were compared at baseline, post-treatment at 6 months, and 12-month follow-up. At post-treatment, both social functioning (p < 0.001) and quality of life (p = 0.002) were significantly improved in the treatment condition compared to the control condition and remained so at 12-month follow-up (p = 0.003; p = 0.002). Autism traits did not differ between conditions. Autistic individuals with suicidal behaviours benefit modestly from treatment with dialectical behaviour therapy in social functioning and quality of life. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2025 – Name: AN Label: Accession Number Group: ID Data: EJ1469166 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1177/13623613241302875 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 13 StartPage: 1333 Subjects: – SubjectFull: Therapy Type: general – SubjectFull: Quality of Life Type: general – SubjectFull: Autism Spectrum Disorders Type: general – SubjectFull: Symptoms (Individual Disorders) Type: general – SubjectFull: Behavior Modification Type: general – SubjectFull: Suicide Type: general – SubjectFull: Outcomes of Treatment Type: general – SubjectFull: Interpersonal Competence Type: general – SubjectFull: Mental Health Type: general – SubjectFull: Health Services Type: general – SubjectFull: Adults Type: general – SubjectFull: Foreign Countries Type: general – SubjectFull: Netherlands Type: general Titles: – TitleFull: Secondary Effects of Dialectical Behaviour Therapy on Social Functioning, Quality of Life, and Autism Traits in Autistic Adults with Suicidality Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Anne Huntjens – PersonEntity: Name: NameFull: LMC (Wies) van den Bosch – PersonEntity: Name: NameFull: Bram Sizoo – PersonEntity: Name: NameFull: Ad Kerkhof – PersonEntity: Name: NameFull: Filip Smit – PersonEntity: Name: NameFull: Mark van der Gaag IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 1362-3613 – Type: issn-electronic Value: 1461-7005 Numbering: – Type: volume Value: 29 – Type: issue Value: 5 Titles: – TitleFull: Autism: The International Journal of Research and Practice Type: main |
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