New Study Tests Mental Health Tools for Autism

How can therapists in publicly funded mental health settings better support autistic youth through evidence-based sustainable interventions?

Children with autism face higher rates of co-occurring mental health challenges than their neurotypical peers, yet many receive care in community or school-based settings where publicly funded providers report low confidence and inadequate training, especially in supporting executive functioning and emotion regulation, two critical areas for autistic and non-autistic youth alike.

To address this gap, a research team led by investigators at the University of Colorado Anschutz Medical Campus and San Diego State University launched the Trial of Outcomes of Unstuck and UP-C for Children’s Advancements in Neurodevelopment (TOUCAN) study — a five-year National Institute of Mental Health (NIMH)-funded clinical trial. Sarah Kennedy, PhD, of Children’s Hospital Colorado, serves as the site principal investigator for Colorado.

The study evaluates the effectiveness and real-world feasibility of two evidence-based interventions: Unstuck and On Target, which focuses on executive functioning, and the Unified Protocol for Children, which addresses emotion regulation. Through partnerships with outpatient clinics, Aurora Mental Health and Recovery and school-based programs, the study will train 224 therapists across 28 research sites in Colorado and California.

Researchers will assign each site to either Unstuck and On Target or the Unified Protocol for Children. Unstuck and On Target (UOT) was specifically designed for autistic youth to enhance skills like planning, flexibility and task management. Unified Protocol for Children (UP-C) is a cognitive-behavioral approach initially designed for broader pediatric populations to address various emotional disorders. Therapists at each site will enroll one autistic and one non-autistic child from their existing caseload to determine how agreeable and effective their assigned treatment is in real-world settings. The goal is twofold: improve outcomes for autistic youth and build a more sustainable, scalable system of care by empowering therapists to deliver effective treatment for children.

“This study is about giving therapists the tools and support they need to help autistic youth thrive — both now and in the long run,” Dr. Kennedy says.

Why executive functioning and emotional regulation matter

Executive functioning can be thought of as the “boss of the brain,” helping children manage tasks, shift attention and adjust strategies when problems arise. Emotion regulation is the ability to identify, understand and manage emotions — a skill that autistic children struggle with.

“These are areas that are important not just for autistic youth, but for all children,” Dr. Kennedy says. “The stakes are often higher in autism because challenges in these areas can significantly impact school success, peer relationships and daily functioning.”

By targeting these areas, TOUCAN hopes to address not only co-occurring mental health symptoms, such as anxiety and mood disorders, which affect 70% to 80% of autistic youth, but also promote long-term resilience. The two transdiagnostic interventions will help to find realistic methods therapists can implement to help all children.

In addition to the 224 therapists, the trial will recruit approximately 450 children. Researchers will evaluate outcomes such as changes in patient symptoms, therapist confidence, agreeableness to interventions and long-term sustainability and reach across populations.

The study will assess these measures at preimplementation, as well as at six-month and 12-month follow-ups. In addition to clinical outcomes, researchers are closely examining implementation and how well therapists maintain and accept the use of interventions after formal training ends.

Building a better future for autistic youth

Unlike some interventions that require specialized autism clinics, TOUCAN reaches kids where they are. It tests whether these strategies can work for therapists in real-world settings, such as Medicaid-accepting clinics or public school-based programs. This approach recognizes that many autistic children do not receive care in autism-specific environments.

“Part of what makes this study different is that we’re not just testing whether the interventions work — we’re asking if they can realistically be used by therapists in the places where most kids are already getting care,” Dr. Kennedy says.

The TOUCAN study represents a hopeful shift in how mental health services are designed and delivered for autistic youth. Instead of relying on specialized settings that are inaccessible to many, this model offers a path to standardized care by supporting therapists with the tools they need.

Although the study just began enrolling participants and has not begun analyses, early impressions are promising. Therapists report increased confidence and satisfaction with the training process.

“There’s real potential here to change how therapy is practiced in publicly funded systems,” Dr. Kennedy says. “If we can show these interventions are both effective and sustainable, it could change the future of mental health care for autistic youth — and all kids with similar needs.”

That potential depends not just on whether the interventions work for kids, but on whether they are realistic for therapists to use long after the study ends. By evaluating both clinical outcomes and implementation feasibility, TOUCAN aims to create a model that can be adopted across community clinics and publicly funded mental health centers nationwide.

If successful, the study could help close persistent gaps in care between autistic and non-autistic youth, give therapists more confidence in supporting children and ensure that effective mental health tools reach kids who need them the most — regardless of diagnosis.