Importance: The coronavirus disease 2019 (COVID-19) pandemic highlighted unique neurodiversity-affirming practices that may support autistic people’s mental health, many of which run contrary to typical notions of autism. These insights are critical for occupational therapists working with this population.

Objective: To (1) understand the self-reported mental health experiences of autistic adults during the COVID-19 pandemic and (2) identify ways that occupational therapy practitioners and other clinicians can help autistic adults during unexpected and challenging times.

Design: This qualitative interpretative phenomenological study used surveys and interviews to collect data between August 15, 2020, and May 1, 2021. Two researchers independently coded interview transcripts. Any disagreements were resolved through consensus.

Setting: Qualtrics survey and Zoom interviews.

Participants: Participants (N = 34) met the following inclusion criteria: self-reported diagnosis of autism spectrum disorder or Asperger’s syndrome, ages 18 to 35 yr, residing in the Eastern United States, able to understand English, and able to participate in a one-on-one interview using verbal or written communication. Recruitment was conducted via snowball sampling through local agencies serving autistic people.

Results: Two themes emerged from the data: (1) autistic adults’ social experiences during the COVID-19 pandemic paradoxically supported and hindered their mental health and (2) during the COVID-19 pandemic, mental health was tied to daily activity among autistic adults.

Conclusions and Relevance: Participants reported feelings of anxiety and depression, as well as a need for social interaction on their own terms. Clinical recommendations are provided.

What This Article Adds: This article includes suggestions generated from autistic people’s input on how clinicians can support this population. The suggested supports and alteration to occupations can be both applied in the case of another unexpected event (e.g., another pandemic) and incorporated to promote the participation and well-being of autistic adults.

Positionality Statement: We use identity-first language (e.g., autistic person) throughout this article because disability advocates and scholars assert that person-first language (e.g., person with autism) contributes to disability stigma (Collier, 2012; Gernsbacher, 2017).

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