Wednesday, February 7, 2018

Adults with autism spectrum disorder showed good results with cognitive enhancement therapy compared to enriched supportive therapy

While there have been advances in early detection and many studies involving the treatment of children with autism spectrum disorder (ASD), few efforts to date have focused on interventions for adults. These individuals experience significant challenges throughout adulthood, including unemployment, social impairment and poor quality of life. It is believed that the challenges people with autism have in processing and understanding information contribute to these difficulties in adulthood. But treatments to address such problems are virtually non-existent. New research out of the University of signals a potential breakthrough for adults with autism spectrum disorder.

The six-year study, "Cognitive enhancement therapy for adult autism spectrum disorder: Results of an 18-month randomized clinical trial," involved 54 adults and was led by Shaun Eack, Ph.D., M.S.W., Pitt's David E. Epperson Professor of Social Work and Psychiatry, and Nancy Minshew, M.D., Pitt professor of psychiatry and neurology. The study tested two treatments, cognitive enhancement therapy (CET) and enriched supportive therapy (EST).

Cognitive enhancement therapy focused on helping adults improve their thinking and social understanding through computer-based exercises designed to improve attention, memory and problem-solving, along with small group exercises designed to help individuals take the perspectives of others and better understand social situations.

The computerized part of the treatment was administered to pairs of adults with autism to help improve their neurocognitive abilities, such as attention and cognitive flexibility which are important precursors to higher-level skills involved in problem-solving, self-regulation and social communication. After several months of computer training, the participant pairs then joined to form a small group focused on social cognition, or thinking abilities involved in understanding others and processing social information. Participants engaged in these computerized and group-based components for approximately three hours a week.

The second treatment tested, enriched supportive therapy, was a one-on-one hour-long session per week in which the participants learned to manage their emotions and stress, improve their social skills, and cope with everyday problems. Enriched supportive therapy builds on traditional psychotherapy practices, such as cognitive behavioral therapy, and uses them to help adults with autism become more aware of their triggers of stress and implement effective strategies to cope with stress and negative emotions. The treatment also provided education to help adults with autism understand their condition, which was an additional focus of the cognitive enhancement therapy group, as many affected adults have not been educated on the nature of autism, its treatment and the challenges it presents in adulthood. Participants were randomly assigned to either the cognitive enhancement therapy or enriched supportive therapy treatment.

The study's findings, published online in the journal Autism Research, revealed that after 18 months of treatment, adults with autism who received cognitive enhancement therapy had significant increases in neurocognitive function, particularly in attention and their ability to process information quickly. These cognitive gains helped some participants to be much more employable. Further improvements also were seen in social cognition and social understanding. Those treated with enriched supportive therapy showed a marked increase in social-cognitive behaviors, but it took nearly nine months longer for such benefits to emerge compared to adults treated with cognitive enhancement therapy, suggesting that the more intensive training offered in that approach may help speed improvement.

Citation: Eack, Shaun M., Susan S. Hogarty, Deborah P. Greenwald, Maralee Y. Litschge, Shannondora A. Porton, Carla A. Mazefsky, and Nancy J. Minshew. "Cognitive enhancement therapy for adult autism spectrum disorder: Results of an 18-month randomized clinical trial." Autism Research, 2017. doi:10.1002/aur.1913.

Funding: NIH/National Institute of Mental Health

Adapted from press release by University of Pittsburg.

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