Developing more accessible mental health screening tool for autistic adolescents

While approximately 1 in 5 adolescents ages 12–19 experience anxiety or depression, rates may be higher among autistic youth, who are more likely to experience bullying, social isolation and household instability.

However, the true prevalence remains unclear because autistic adolescents are less likely to be screened and often face barriers when completing traditional assessments.

“The reason we don’t have a precise estimate is that, compared to their nonautistic peers, autistic adolescents are less likely to be screened for anxiety and depression, and when they are, we often see more variable responses,” said Celeste Campos-Castillo, associate professor of media and information in the Michigan State University College of Communication Arts and Sciences.

Campos-Castillo and her colleague Susan Bonner, also an associate professor of media and information at MSU, are working to improve how mental health is assessed among autistic adolescents by redesigning screening tools to be more accessible, precise and inclusive.

“We need a better screening experience to help autistic adolescents get the supports they need,” said Campos-Castillo.

Rethinking how screening tools communicate

Commonly used mental health screeners, such as the Generalized Anxiety Disorder scale and Patient Health Questionnaire, often rely on vague or complex language that can be difficult to interpret. Questions may include imprecise phrasing, combine multiple internal states or use response options that lack clarity.

Campos-Castillo and Bonner are applying principles of universal design to create a more accessible screening experience.

The redesigned tool presents one question at a time, includes audio recordings of each prompt and separates questions that address multiple concepts. It also incorporates visual and animated elements to clarify meaning and improve response accuracy.

“Autistic adolescents prefer precise language,” Campos-Castillo said. “We’re enhancing existing screeners by providing multiple ways to communicate the information so that it is clearer and more accessible.”

Codesigning with autistic adolescents

Bonner and Campos-Castillo codirect the Transforming Tools Together Lab, which focuses on using entertainment and games to transform healthcare.

A central component of the project is its codesign approach, which involves autistic adolescents as active collaborators in shaping the tool.

Participants help develop visuals, audio and design elements that reflect their lived experiences, an approach both researchers say is critical to the project’s success.

“Thanks to their creativity, we now view the transformed tool as a way for autistic adolescents to help explain the screeners to other autistic adolescents,” Campos-Castillo said.

Hands-on learning across disciplines

The project provides experiential learning opportunities for students across MSU. Undergraduate and graduate students from six colleges are involved in all stages of the work, from research and data analysis to design and production — including some students who are autistic themselves.

Students conduct interviews, analyze findings, test user experiences and produce multimedia content documenting the project. Many also work directly with autistic adolescents to cocreate elements of the screening tool.

Daniel Isobel Galisteo, a student majoring in game design, contributes to the project as an artist, helping develop visuals and animations that support how screening questions are communicated.

During codesign sessions in Lansing, Galisteo guided autistic adolescents and student collaborators in translating screening questions into visual forms, including watercolor paintings that represented emotions, movement and lived experiences tied to anxiety and depression.

“It has given all of us a deeper understanding of what may be miscommunicated or misinterpreted in mental health screeners,” Galisteo said. “Some of the questions and response options can feel vague or confusing, and this process has helped us think about new ways to make them clearer.”

Galisteo said the experience has also been personally meaningful.

“Being able to create something that will help others with their mental health is incredibly important to me,” he said. “As someone who was diagnosed with anxiety later in life, it was frustrating not understanding what I was experiencing. This work can help others access support earlier.”

Expanding access to mental health support

Campos-Castillo and Bonner hope the project will lead to more effective and equitable mental health screening for autistic adolescents, helping ensure those who need support are accurately identified and connected to care.

“We hope this will transform the screening experience so that autistic adolescents who need support can get what they need,” Campos-Castillo said. “We also see this as a model for how the creativity of autistic adolescents can help solve problems through design.”

The project is supported by the Blue Cross Blue Shield of Michigan Foundation and several MSU programs, including the Center for Teaching and Learning Innovation, Diversity Research Network, Honors College and the Office of Research and Innovation.