Abstract: Cognitive Enhancement Therapy Improves Social Brain Function in Adult Autism Spectrum Disorder (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Saturday, January 13, 2018: 8:00 AM

Marquis BR Salon 8 (ML 2) (Marriott Marquis Washington DC)

* noted as presenting author

Shaun Eack, PhD, David E. Epperson Professor of Social Work and Professor of Psychiatry, University of Pittsburgh, Pittsburgh, PA

Susan Hogarty, MSN, Research Administrator, University of Pittsburgh, Pittsburgh, PA

Deborah Greenwald, PhD, Psychologist, University of Pittsburgh, Pittsburgh, PA

Carla Mazefsky, PhD, Associate Professor of Psychiatry, University of Pittsburgh, Pittsburgh, PA

Nancy Minshew, MD, Professor, University of Pittsburgh, Pittsburgh, PA

Background and Purpose: Adults with autism spectrum disorder (ASD) experience significant disability due to pervasive challenges in social and non-social information processing, yet the the degree to which these impairments can be addressed in treatment remains largely unknown. Cognitive rehabilitation is emerging as an effective set of approaches for treating cognitive challenges in numerous neurological and psychiatric conditions in adulthood, and may be a promising approach for improving brain functions supporting social information processing in adults living with autism. This clinical trial sought to examine the differential benefits of Cognitive Enhancement Therapy (CET), a social and non-social cognitive rehabilitation intervention, compared to supportive therapy on social brain function in adult ASD, in an effort to identify the plasticity of the adult brain in autism and its responsiveness to cognitive intervention.

Methods: Verbal adults with ASD (N = 45) were randomized to an 18-month controlled trial of CET or an active Enriched Supportive Therapy (EST) comparison treatment. CET is an integrated approach to the remediation of social and non-social cognitive challenges in neurodevelopmental conditions that uses computer-assisted cognitive training and group-based experiential exercises focusing on the development of social cognition (e.g., perspective-taking, recognizing social and emotional cues). Function magnetic resonance imaging data were collected prior to treatment and at 9 and 18 months utilizing a previously validated theory of mind task to assess the changes in social brain functions throughout the course treatment. Intent-to-treat analyses examined differential changes in brain functions between CET and EST using mixed-effects models, and growth curve analysis was used to examine associations between improved brain function and outcome.

Results: Participants treated with CET demonstrated significantly greater differential increases in blood-oxygen-level-dependent signal during the theory of mind task in the medial prefrontal cortex, along the anterior cingulate and superior frontal gyrus, compared to those treated with EST (k = 143, x = 20, y = 30, z = 20, p = .001). In addition, significant increases in activity in the bilateral thalamus were observed (all k > 87, all p < .001) in CET, as well as increases in a pallidum-amygdala-hippocampal cluster (k = 38, x = -18, y = -8, z = -8, p = .001), compared to EST. Increased left thalamic activation significantly predicted improved emotion perception over the course of treatment (B = .30, p = .006).

Conclusions and Implications: Cognitive rehabilitation may be an effective avenue for addressing core challenges in social information processing in adults with ASD. CET, a psychosocial cognitive rehabilitation intervention, may improve social cognition through enhancing fronto-temporal brain function, with positive downstream effects on socio-emotional processing. Even after decades of living with ASD, the social brain in adults with autism may be more neuroplastic than previously recognized.