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

Background: Adults with autism spectrum disorders (ASD) experience significant disability due to pervasive social and non-social cognitive impairments. Despite the growing evidence of the neurobiologic basis of these deficits, comprehensive interventions designed to remediate the core cognitive impairments experienced by adults with ASD have yet to be developed or tested.

Objectives: The purpose of this research was to adapt and preliminarily test an integrated social and non-social cognitive rehabilitation intervention that has shown significant benefits in patients with schizophrenia, Cognitive Enhancement Therapy (CET), to adults with autism spectrum disorders.

Methods: A total of 14 verbal adults with ASD were recruited for an 18-month uncontrolled pilot study of CET. Treatment adherence data were collected continuously along with measures of treatment satisfaction to assess the feasibility and acceptability of CET in this population. In addition, comprehensive measures of neurocognitive and social-cognitive functioning were collected prior to treatment, and at 9 and 18 months of treatment to provide preliminary estimates of potential efficacy.

Results: In total, 11 of 14 (79%) participants completed the entire 18-month trial. Participants uniformly endorsed high rates of satisfaction with CET. Pre-treatment data collection indicated significant and broad levels of cognitive impairment among participants, despite intact intelligence scores. After 18 months of treatment, large and significant levels of cognitive improvement were observed. Overall neurocognitive improvement was large (d = 1.40), with effect sizes for individual domains ranging from d = .43, p = .034 (verbal learning and memory) to d = 1.22, p < .001 (processing speed). Social-cognitive improvement was also considerable (d = 2.00, p < .001). In addition, preliminary evidence suggested that these improvements translated into large and significant gains in social adjustment (d = 2.29, p < .001), including vocational and interpersonal domains.

Conclusions: CET is a feasible and acceptable approach to cognitive rehabilitation in verbal adults with ASD that shows promise for remediating the core cognitive deficits that limit adaptive function and behavior in this population. The results of an ongoing randomized-controlled trial to evaluate efficacy are eagerly anticipated.