Shaun M. Eack
Cognitive enhancement therapy was associated with improvements in neurological and social cognition in adults with autism spectrum disorder, according to data published in Autism Research.
“Initial studies of cognitive remediation in adults with ASD have been small and short-term, frequently used non-randomized or uncontrolled designs, and primarily targeted isolated aspects of social cognition,” Shaun M. Eack, PhD, School of Social Work, University of Pittsburgh, and department of psychiatry, University of Pittsburgh School of Medicine, and colleagues wrote. “Long-term trials of more comprehensive interventions are nonexistent.”
Researchers conducted an 18-month randomized clinical trial to test the efficacy of cognitive enhancement therapy (CET), a cognitive remediation approach that uses computer-based neurocognitive training and group-based training in social cognition, for improving neurocognitive, social-cognitive and employment outcomes in adults with ASD. They allocated 54 participants to receive CET for 3 hours a week, or enriched supportive therapy (EST), which focused on psychoeducation and managing their condition in a one-on-one hour-long session per week.
Analysis showed that participants who received CET had significant increases in neurocognitive function, especially in attention and their ability to process information quickly. Participants treated with EST also experienced neurocognitive gains, although to a smaller effect. Participants in CET and EST showed significant improvements in social cognition over the course of the study, with CET demonstrating an advantage at 9 months (P = .02), but not at 18 months (P = .298).
"Autism can be more complicated for adults because the adult world introduces new challenges," Eack said in a press release. "The support networks for children, like special education and other help they receive in school, are simply not there for adults. We hope this study will begin to establish effective treatments for adults with autism."
In addition, adults with ASD who received CET showed a rapid, significant increase in competitive employment at 9 months (P = .001), which remained significant at 18 months (P = .023). Furthermore, adults who received treatment with CET had a higher likelihood of obtaining competitive employment compared to those who received EST (OR = 6.21; 95% CI, 1.29–29.99; P = .005), and the overall advantage was similar among those aged 21 years or older (OR = 8.53; 95% CI, 1.34–54.4; P = .01).
"Cognitive enhancement therapy and enriched supportive therapy show promise for improving outcomes in adults with autism," Eack told Healio Psychiatry. "This suggests that cognitive rehabilitation and supportive psychotherapeutic practices may be effective for meeting some of the needs of adults living with this condition. However, significantly more work is needed on how best to support adults with autism and to ensure that the most effective practices are implemented and available to the community."– by Savannah Demko
Disclosure: This work was supported by grants from Autism Speaks, the Department of Defense, NIH and the Pennsylvania Department of Health.