Cognitive Enhancement Therapy for Adult Autism Spectrum Disorder: Interim Results from an Ongoing Confirmatory Efficacy Trial

Background and Purpose: Individuals with autism spectrum disorder (ASD) experience significant impairments in social and non-social information processing that limit functional outcome and quality of life in adulthood. Recently, we demonstrated the initial efficacy of a comprehensive cognitive rehabilitation approach, Cognitive Enhancement Therapy (CET), for improving cognitive and functional outcomes in adults living with autism. This study sought to confirm the previously observed benefits of CET in adult ASD in a larger confirmatory efficacy randomized controlled trial.

Methods: Adults with ASD (N = 82) were randomized to 18 months of treatment with either CET or an Enriched Supportive Therapy (EST) control condition. CET is a cognitive rehabilitation approach that integrates 60 hours of computer-based neurocognitive training in attention, memory, and problem-solving with 45 social-cognitive group sessions designed to facilitate the achievement of adult social milestones, such as perspective-taking and social context appraisal. EST is a individual-based supportive therapy condition that focuses on psychoeducation and stress management. Interim intent-to-treat linear mixed-effects models were used to examine the differential impact of CET compared EST on cognition and functioning among the first 82 adults with autism enrolled in this confirmatory efficacy trial.

Results: Preliminary analyses indicated that participants treated with CET (N = 42) had similar demographic characteristics as those treated with EST (N = 40). Interim intent-to-treat models indicated that adults treated with CET demonstrated significantly greater neurocognitive improvement, particularly in speed of processing (d = .29, p = .031), compared to those who received EST. A similar beneficial effect on social cognition favoring CET was also observed (d = .44, p = .055). Effects on functional outcome indicated medium-sized improvements in both CET (d = .75) and EST (d = .51), with significantly greater increases in functioning outside the home (d = .84, p = .029) and independence (d = .74, p = .023) in those treated with CET.

Conclusions and Implications: While the results of these interim analyses on the first 82 adults with autism enrolled in this confirmatory efficacy trial must be considered preliminary, findings to date confirm the previously observed benefits of CET on cognition and functional outcome in this population. Such findings increasingly point to the benefits of cognitive rehabilitation for improving outcomes in autism in adulthood, and underscore the potential of CET to serve as key evidence-based practice for adults living with autism.