Cognitive Enhancement Therapy for Adults with Autism Spectrum Disorder: Results and Durability of an 18-Month Feasibility Study

Background: Adults with autism experience significant impairments in social and non-social information processing for which few treatments have been developed.  Cognitive rehabilitation represents a potentially effective approach to the remediation of information processing impairments in individuals.  This feasibility study examined how Cognitive Enhancement Therapy (CET), an effective cognitive rehabilitation intervention for schizophrenia, could impact the impairments of social and neurocognition in adults with ASD, and whether or not those effects are maintained after a year following treatment.

Methods: This study conducted an 18-month uncontrolled trial of CET in 14 verbal adults with ASD to investigate its feasibility, acceptability, and initial efficacy in treating social and cognitive impairments. Individuals included met criteria for ASD using the Autism Diagnostic Observation Schedule, met autism cutoffs on the Autism Diagnostic Interview-R, were between the ages 18-45 years, had an IQ > 80 as assessed by the Wechsler Abbreviated Scale of Intelligence and demonstrated cognitive and social disability on the Cognitive Style and Social Cognition Eligibility Interview.  Eligible participants were then assigned to 18 months of active treatment with CET, and administered cognitive and behavioral outcome measures at baseline, 9 months, and 18 months. Participants were also administered the outcome measures 12 months after treatment completion.

Results: Results indicated that CET was satisfying to participants, with high treatment attendance and retention.  Of the 14 individuals who enrolled in the study, 11 (79%) completed the entire 18 months of treatment.  Treatment adherence was high across both neurocognitive training (89%) and social-cognitive group (85%) sessions, with an 87% average overall attendance rate at treatment sessions.  Treatment satisfaction among all participants was also high with average CSQ-8 total and overall satisfaction scores for the program of 3.27 (SD = .46) and 3.57 (SD = .51) out of 4.00.  Ratings indicated that individuals were "mostly satisfied" to "very satisfied" with CET.  Highly significant (all p < .001) and large (d = 1.40 to 2.29) levels of improvement were observed across composite domains of neurocognition, cognitive style, social cognition, and social adjustment at the 18-month time point. Neurocognitive improvement was particularly large in the domain of processing speed and significant levels of improvement were observed in all neurocognitive domains. Social cognition was significantly improved across both clinician-rated and performance-based measures. At 12 months following treatment completion, cognitive improvement was broadly maintained. Although there was a small reduction of gains in neurocognition, no such reduction was seen in overall functioning. Interestingly, social cognition showed continued improvement after treatment completion.

Conclusions: Such findings suggest that CET is a feasible, acceptable, and potentially effective approach to the treatment of cognitive impairments in adults with ASD that can confer substantial and durable benefits to social and adaptive function in verbal adults with autism.  The results of a randomized-controlled trial to evaluate efficacy are eagerly anticipated.