Therapy shows promise in adults with autism
Pittsburgh Post-Gazette
Faster thinking skills and techniques to understand the perspective of other people, when added together, may give adults with autism more success on the job and in personal relationships, say University of Pittsburgh researchers who are developing interventions to make that happen.
“The hope is this will open the window for more cognitive and emotional intervention in addition to behavioral ones that dominate the field today,” said Pitt’s Shaun Eack, Ph.D., professor of social work and psychiatry. Mr. Eack is lead author of a newly published study in Autism Research examining two types of interventions for adults with autism spectrum disorder. One intervention focused on improving thinking skills, the other on emotion/social skills. The six-year study in Pitt’s School of Social Work and the Department of Psychiatry is being followed up by a larger one to confirm its findings, he said.
A second recent Pitt study pinpointed slower processing speed in adults with autism, indicating they would benefit from building skills in processing new information, according to Mr. Eack’s colleague, Nancy Minshew, director of Pitt’s Center for Excellence in Autism Research.
“When you do treatment, they want to know the mechanism that leads to improvement,” Dr. Minshew said. “If you know the mechanism, you can improve that.” She praisedthe results of using the intervention called cognitive enhancement therapy (CET), which focuses on improving processing speed and acquiring the capacity to see other people’sperspectives.
CET was first developed for schizophrenia and is well established as an intervention, Mr. Eack said.
“Although schizophrenia and autism have major differences, they have some similarities,” he said. There are social challenges in both conditions, he explained, “Cognitive impairment is pretty pervasive, also social impairment. It’s very disabling; it keeps people from getting work, making friends and living independently.”
About 10 years ago, he said, he began thinking about this approach for adults with autism and started a collaboration with Dr. Minshew.
Very few services are available for young adults, he said. “An evidence-established protocol is nonexistent. These skills need to start building way before 22.”
In the two-intervention study, participants who had enriched supportive therapy (EST) had face-to-face sessions to work on managing emotions and stress and improving social skills. The second group got CET and did computer-based exercises to enhance attention, memory and problem-solving. The CET participants were found to benefit more than those who had EST in the areas of mental quickness, attention and employment. Both groups had improved social understanding skills at the end of the study.
Researchers had begun the study by selecting a group of 54 subjects with autism, predominantly white male and ranging in age from 16 to 45 with an average age of 22. They were split into two groups, one for EST and the other for CET. Few were employed or living independently at the start. All were treated for 18 months.
“CET focuses on improving processing speed and acquiring the capacity to see other people’s perspective,” Dr. Minshew said. “They also learn things like social wisdom, building knowledge through inference.”
For example, in CET, participants learned how to share information with people, when the time is right, and what information should be kept private, she said.
Mr. Eack said many study participants didn’t get services they needed as children.
“At least 30 percent of people in the trial didn’t know they had autism until we saw them. Given the level of disability they experience, it was something I found so surprising.”
Although the group getting EST had more people competitively employed at the start, no improvement in employment was seen over the 18 months. In contrast, the CET group showed “a rapid and significant differential increase in competitive employment at nine months,” the study said, and it stayed high at 18 months.
“These are not just jobs for people with a disability,” Mr. Eack said. “They’re jobs in the mainstream employment market; they pay regular wages.”
Adults with autism need these kinds of intervention services, Dr. Minshew said. “About 50-70 percent do not have mental retardation. … They have the potential to be productive and happy citizens. We need to do something.”