Posted April 15, 2013
Nancy Minshew, M.D. and Shaun M. Eack, Ph.D., University of Pittsburgh
In Fiscal Year 2010, the Autism Research Program (ARP) funded the clinical trial project proposed by Drs. Nancy Minshew and Shaun Eack of the University of Pittsburgh. This project represented a unique interdisciplinary collaboration between Dr. Minshew, at the Departments of Psychiatry and Neurology, and Dr. Eack, at the School of Social Work, to study adults with autism spectrum disorders (ASD). Autism is a brain disorder that at its core is characterized by fundamental difficulties in processing and interpreting social and non-social information. These challenges greatly limit the ability of individuals with ASD to succeed in adulthood and build a good quality of life. Cognitive rehabilitation has proven effective for addressing brain-based challenges in information processing. Originally developed by Professor Gerard E. Hogarty for individuals with schizophrenia, Cognitive Enhancement Therapy (CET), in particular, has proven to be highly effective at remediating impairments in both social and non-social cognition that generalize to meaningful improvements in real-world functioning.
Because CET is the only cognitive rehabilitation intervention that has demonstrated evidence of addressing problems in both social and non-social information processing in adults with a neurodevelopmental disorder, its adaptation and application to adults with autism is highly promising. The study proposed by Drs. Minshew and Eack is a controlled trial comparing the efficacy of CET versus Enriched Supportive Therapy (EST) in 54 verbal adults with ASD. Both groups of participants will undergo imaging studies pre-treatment and at the end of treatment in order to define the brain basis of improvements resulting from CET and EST intervention. The researchers have successfully completed pilot studies to adapt CET for individuals with ASD as well as a pilot study that has demonstrated acceptability and efficacy. Imaging studies of individuals with schizophrenia who have participated in CET demonstrate prevention of brain tissue loss and even enhancement in some areas of the brain. In other words, this intervention has a positive impact on the brain. It was also shown to be self-propagating: Individuals with schizophrenia demonstrated even greater gains one year after completion of treatment compared to the end of treatment.
It is hoped that through this clinical trial, adults with ASD will be able to improve their social abilities and cognition through CET. If effective, then CET will represent one of the first evidence-based treatments for core deficits in adults with autism. It is expected that this research will lead to a significant advance in treatment for the many adults and families who live with these conditions.
Eack SM, Bahorik AL, Hogarty SS, Greenwald DP, Litschge MY, Mazefsky CA, and Minshew NJ. 2013. Is cognitive rehabilitation needed in verbal adults with autism? Insights from initial enrollment in a trial of Cognitive Enhancement Therapy. Journal of Autism and Developmental Disorders.
Fitzpatrick LB, Minshew NJ, and Eack SM (in press). A systematic review of psychosocial interventions for adults with autism spectrum disorders. Journal of Autism and Developmental Disorders.
A Randomized Clinical Trial of Cognitive Enhancement Therapy for Adults with Autism Spectrum Disorders