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Background: Autistic adults experience psychiatric conditions at rates significantly higher than the general population yet remain severely underrepresented among those receiving mental health services. This study addresses critical gaps in autism mental health research by examining outcomes from individual autism-adapted cognitive behavioural therapy (CBT) delivered via telehealth and investigating whether participation in neurodivergent-led psychoeducation groups provides additional benefits for quality-of-life domains, as well as mood and anxiety symptoms. Methods: This naturalistic study was designed and conducted by a research team consisting of two-thirds neurodivergent psychologists, with integral involvement of autistic advocates and psychologists in measurement development, institutional review board oversight and service delivery. Participants were 460 English-speaking adults seeking telehealth services from a neurodiversity-affirming mental health organization. The sample included individuals across a broad autism phenotype, with 41.74% reporting formal autism diagnoses; however, it is likely that nearly all of the sample is autistic, as formal diagnosis is not required for care, and care is advertised specifically as being for autistic adults. All participants received individual autism-adapted CBT from trained clinicians, while 38.91% also attended at least one neurodivergent-led psychoeducation group. Changes in four domains (mood, anxiety, social relationships and overall quality of life) were analyzed using cumulative link mixed models to appropriately handle ordinal outcome data. Results: Significant improvements occurred across all domains for the entire sample. Individual therapy alone produced meaningful gains in mood (OR = 1.38), anxiety (OR = 1.44), social relationships (OR = 1.43) and quality of life (OR = 1.49). Participants who also attended psychoeducation groups demonstrated significantly steeper improvement trajectories for social relationships (29% greater odds of improvement per time point) and overall quality of life (32% greater odds of improvement per time point), while mood and anxiety improvements remained comparable between groups. Conclusions: This study provides compelling real-world evidence that neurodiversity-affirming mental health interventions delivered via telehealth can produce meaningful improvements for autistic adults. The additional benefits of brief, peer-led psychoeducation groups for social connection and quality of life suggest that comprehensive care may require multi-modal approaches combining individual therapy with community-based interventions. They additionally highlight the benefit of neurodivergent-led psychoeducation groups. These findings have implications for reducing global mental health disparities, as the telehealth delivery model can overcome traditional barriers to autism-informed care while enabling scalable implementation of peer-led interventions across diverse geographic and economic contexts. Lay Abstract What is already known about the topic? What is already known about the topic? Autistic adults experience depression, anxiety and other mental health challenges much more often than non-autistic people. Despite this greater need, most autistic adults struggle to find therapists who understand autism and can provide helpful support. Traditional therapy approaches often don’t work well for autistic people because they weren’t designed with autistic experiences in mind. What this paper adds? We studied 460 autistic adults who received online therapy specifically adapted for autistic people from a mental health organization run by neurodivergent professionals. Everyone received individual therapy sessions, and some people also joined online psychoeducation groups led by other neurodivergent people. We found that the adapted therapy helped improve mood, anxiety, relationships and overall quality of life. People who attended both individual therapy and the group (even just once) showed even greater improvements in their relationships and quality of life compared to those who only had individual therapy. Implications for practice, research or policy. Our findings show that when mental health care is designed with autistic people in mind and delivered by professionals who understand neurodiversity, and/or are neurodivergent themselves, it can make a real difference. Online therapy removes many barriers that prevent autistic adults from accessing support, such as travel difficulties or lack of autisminformed therapists locally. Adding peer-led support groups alongside individual therapy appears especially helpful for building social connections and improving quality of life. These results suggest that mental health services should adapt their approaches for autistic clients and consider including peer support as part of comprehensive care.