Cognitive Enhancement Therapy for Adults with Autism Spectrum Disorder: Results from an Ongoing Randomized-Controlled Trial

Background: Adults with autism spectrum disorder (ASD) experience significant disability due to pervasive social and non-social cognitive impairments. Cognitive rehabilitation has emerged as an effective set of approaches for addressing cognitive deficits in numerous neurological and psychiatric populations, yet little is known about their efficacy in adults with ASD.

Objectives: The purpose of this research was to conduct the first adequately-powered randomized-controlled trial of Cognitive Enhancement Therapy (CET) in adults with ASD. CET is a promising social and non-social cognitive rehabilitation intervention that has shown significant benefits in patients with schizophrenia and in preliminary uncontrolled studies in adult autism.

Methods: Verbal adults with ASD were randomized to an 18-month controlled trial of CET or an active Enriched Supportive Therapy (EST) comparison treatment, which addresses psychoeducation, stress management, and emotion regulation. Comprehensive measures of cognitive and behavioral outcomes were collected prior to treatment and at 9 and 18 months of treatment by raters who were blind to treatment assignment.

Results: Analyses of the first 40 adults randomized to this trial are indicating significant and medium-to-large levels of differential improvements in neurocognitive and social-cognitive functioning favoring CET. The greatest domains of neurocognitive improvement in CET have included visual learning and processing speed, and the greatest area of social-cognitive improvement has been in the domain of facial emotion perception. Most importantly, these cognitive gains observed in CET are translating into large improvements on blinded measures of adaptive function, particularly major role and vocational functioning. Significant improvements in anxiety and depressive symptomatology, as well as functional outcome are also being observed in EST.

Conclusions: Cognitive rehabilitation may be an effective avenue for addressing core cognitive deficits that limit adaptive function in adults with ASD. CET represents a comprehensive and promising approach to cognitive rehabilitation in adult autism that may be able to significantly improve neurocognitive and social-cognitive information processing, with considerable benefits to real-world adaptive function. EST alone or in combination with CET also represents a feasible and potentially effective individual approach for improving symptom and functional outcomes in adults with ASD.