Case Study: Supporting Autistic Burnout through Neuroaffirmative Outreach Therapy 

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Therapist: Louisa is an HCPC-registered dramatherapist with extensive experience in trauma-informed approaches, autism, and Pathological Demand Avoidance (PDA) profiles. She qualified in 2014 and is our therapy lead at Express CIC. 

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Client Background: Client A is a young teenager who received an autism diagnosis in early 2024. His parents initially contacted Express CIC after noticing a significant decline in school attendance and growing difficulties at home. They described challenges with setting boundaries, often met with what they referred to as "extreme and bordering on violent" reactions, including threats of self-harm. Client A would also sometimes refuse food in protest and frequently complained of stomach pain, fatigue, and a strong desire to avoid school altogether. Louisa worked with Client A from November 2024-July 2025. ​

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Presenting Issues and Context 

Client A had previously been regarded as a high-achieving pupil, which often masked the extent of his internal struggles. It became apparent that he was experiencing autistic burnout — a state of physical and emotional exhaustion caused by prolonged masking and unmet sensory or social needs. 

Autistic masking refers to the coping strategy of suppressing natural behaviours (such as stimming or avoiding eye contact) to conform to neurotypical expectations. While masking can help individuals navigate certain environments, it is cognitively and emotionally exhausting, particularly in sensory-demanding settings like schools. Over time, this can lead to burnout, withdrawal, and even physical symptoms, such as the ones Client A was experiencing. 

 

Why Outreach Therapy Matters 

Client A’s presentation reflected exactly the kind of need Express CIC envisioned when developing its outreach therapy service — designed to support children who are unable to access therapy via traditional routes or clinical environments. By meeting children in familiar spaces, such as the home (or when appropriate school) we reduce the pressure to ‘perform’ or adapt, allowing for a more authentic and supportive therapeutic relationship. 

In Client A’s case, outreach therapy meant he could access sessions in his own home, surrounded by comforting elements such as his dog and personal belongings. 

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Therapeutic Approach 

Louisa adopted a neuroaffirmative, person-centred approach, focused on meeting Client A where he was. This included following his lead, engaging in his special interests, and creating a non-judgemental environment. At times, this meant playing computer games alongside him — something that may not traditionally be seen as ‘therapy’, but which was crucial in building trust, safety, and rapport. 

By engaging in these shared activities, Louisa not only honoured Client A’s autonomy, but also allowed space for moments of connection, co-regulation, and even humour. These foundations enabled more in-depth conversations later on, including completing CAMHS-related paperwork together — a task that would have previously been overwhelming for Client A. 

 

Parental Involvement 

Client A’s parents were proactive and engaged throughout the therapeutic process, seeking guidance on how to support him outside of sessions. Louisa worked closely with them to explore strategies rooted in kind and consistent boundaries, as well as insight into autistic burnout and PDA. 

In addition to therapy with Louisa, they sought specialist support from occupational therapists (OTs), psychiatrists, and nutritionists, helping to create a truly holistic support package around their child. This joined-up, multidisciplinary approach ensured that Client A’s needs were met not only emotionally, but also physically and nutritionally. 

This collaborative, wraparound support helped to ensure that Client A was receiving congruent and compassionate care across home, therapy, and other services. 

 

Outcomes and Impact 

Over time, as Client A was given the space to recover from burnout and his needs were validated rather than challenged, he began to show marked improvements in both wellbeing and function: 

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• Significantly reduced anxiety and low mood 

• Fewer complaints of stomach pain and fatigue 

• Increased school attendance 

• Repaired relationships with adults, particularly his parents 

• The ability to engage in family holidays 

• Less fixation on his computer 

• A better relationship with food- even finding his own love of cooking 

• More regular engagement in everyday routines and activities 

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He is now a happier, healthier, and more connected young person, with greater capacity to manage everyday demands on his own terms. The intervention has now finished; however the family are aware that they can contact Louisa in the future should Client A need ad hoc sessions now that a strong therapeutic rapport has been built. 

 

Reflections on Neuroaffirmative Practice 

This case clearly illustrates the transformative power of neuroaffirmative therapy. By validating Client A’s neurodivergent identity, honouring his need for autonomy, and shifting the therapeutic focus from "fixing behaviour" to understanding need, healing became possible. 

Rather than forcing compliance, the therapeutic journey allowed for connection, safety, and trust to emerge — paving the way for genuine growth. 

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Comments from Parents 

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When we first contacted Express CIC as a family we were in crisis. A refused to leave the house, attend school or even brush his teeth. He wouldn't engage with online therapy or the face-to-face counselling at an external venue offered by CAMHS. He had been recovering from physical illness and was very tired with level 3 mental health issues. He had also had a late autism diagnosis as a teenager which wasn’t good timing. As parents we felt unsupported; caught in the cracks, unable to access traditional counselling but not severe enough for help at home with CAMHS. 

 

Louisa quickly built a rapport with A, connecting with him through gaming and shared interests. She also adored our dog which was very important to the dynamics. She became a vital lifeline, visiting weekly and providing much-needed advice, positive energy, and a trustworthy adult for A. 

 

Over several months, Louisa helped A regain his confidence, understand his experiences, and accept his autism diagnosis, allowing him to envision a positive future. She was also a constant source of support and guidance for us as parents in a difficult situation. She was always able to find time to chat things through. She worked with all the professionals who were looking after A and also helped us fill in the forms that were needed for assessments. Often having a 3rd adult in our team helped us get things done with Louisa more able to help A fill in forms and register his requests. 

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A is now back in mainstream school with some adjustments and doing well. 

 Louisa was truly a lifeline when no one else could help.