Cognitive Enhancement Therapy for Adult Autism Spectrum Disorder

成人自闭症谱系障碍的认知增强疗法

• 批准号: 8979854
• 负责人: SHAUN M EACK
• 金额: $ 73.04万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8979854
• 关键词: 22q11 Deletion Syndrome; Adaptive Behaviors; Address; Adult; Affect; Alzheimer' s Disease; Area; Attention deficit hyperactivity disorder; Autistic Disorder; Behavior; Behavioral; Brain; Brain imaging; Case Study; Child; Cognition; Cognitive; Cognitive deficits; Communication; Controlled Study; Data; Development; Disease; Early Diagnosis; Early Intervention; Employment; Enrollment; Evaluation; Face; Family; Functional Magnetic Resonance Imaging; Generations; Heterogeneity; Impaired cognition; Impairment; Independent Living; Individual; Intellectual functioning disability; Intervention; Intervention Studies; Longevity; Measures; Medial; National Institute of Mental Health; Neurobiology; Neurocognitive; Neurologic; Neuronal Plasticity; Outcome; Participant; Population; Process; Psychopathology; Psychosocial Assessment and Care; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Relative (related person); Research; Resources; Schizophrenia; Schools; Short-Term Memory; Social Functioning; Social Interaction; Societies; Supportive care; System; Traumatic Brain Injury; Underemployment; Unemployment; United States National Institutes of Health; autism spectrum disorder; base; behavioral outcome; blind; cognitive ability; cognitive enhancement; cognitive process; cognitive rehabilitation; comparative effectiveness; cost; design; effective therapy; efficacy trial; evidence base; executive function; functional disability; functional outcomes; improved; information gathering; interest; meetings; neuromechanism; processing speed; psychosocial; public health relevance; randomized trial; remediation; response; social; social cognition; success; systematic review; treatment response

 DESCRIPTION (provided by applicant): Autism spectrum disorder (ASD) is characterized by marked impairments in social and non-social cognitive ability that persist well into adulthood and contribute to significant functional disability. The treatment of ASD has focused almost exclusively on children, and few empirically supported interventions are available to address the core cognitive and functional challenges individuals with ASD face as they transition to adulthood. Cognitive rehabilitation has emerged as a set of systematic approaches to the remediation of cognitive impairments that hold considerable promise for the treatment of cognitive deficits in autism, yet adequately-powered and rigorously controlled studies of these interventions have not been conducted in this population. Cognitive Enhancement Therapy (CET) represents one of the most promising cognitive rehabilitation approaches for adult ASD due to its comprehensive and developmental approach to targeting neurocognitive and social-cognitive impairments as well as its established efficacy in schizophrenia, a disorder characterized by similar cognitive deficits. With support from NIMH, we have recently demonstrated the feasibility of adapting CET to adults with ASD, and evidence is emerging from our initial, small-scale randomized trial of CET in this population indicating target engagement on diverse areas of cognition with substantial downstream benefits to functional outcomes. Excitingly, these improvements in cognition associated with CET also appear to be supported by underlying neuroplastic changes in fronto-temporal brain function and connectivity. Such evidence suggests that CET has considerable promise as an evidence-based cognitive rehabilitation intervention for adult ASD, and it is critical that these early findings are followe-up with an adequately-powered efficacy trial. In response to the psychosocial intervention focus of PA-13-216, "Research on Autism Spectrum Disorders", this project proposes to conduct a randomized-controlled efficacy trial of CET in 100 verbal adults with ASD. Participants will be randomized to CET or an Enriched Supportive Therapy (EST) control condition and treated for 18 months. Specific aims of the project are to (1) evaluate the comparative effectiveness of CET versus EST on diverse cognitive and behavioral outcomes to assess target engagement and functional impact, (2) examine the effects of CET on fronto-medial temporal brain function and connectivity to elucidate the neural mechanisms of cognitive enhancement in this population, and (3) use personal and neurobiological indicators to explore heterogeneity in treatment response and identify moderators indicative of individuals most likely to benefit from CET. The proposed project will result in the largest psychosocial intervention study in adult ASD, and the first adequately-powered study of a promising cognitive rehabilitation approach for this population. If successful, this project will provide a major step forward in making interventions available for adults with ASD, and will demonstrate the plasticity of the adult ASD brain and its responsiveness to cognitive rehabilitation, paving the way for a new generation of treatments in autism.

 描述（由申请人提供）：自闭症谱系障碍（ASD）的特点是社交和非社交认知能力明显受损，这种损害持续到成年期并导致严重的功能障碍。自闭症谱系障碍的治疗几乎完全集中在儿童身上，很少有经验支持的干预措施可以解决自闭症谱系障碍患者在过渡到成年时面临的核心认知和功能挑战。认知康复已成为一套治疗认知障碍的系统方法，为治疗自闭症认知缺陷带来了巨大希望，但尚未在该人群中对这些干预措施进行充分有力和严格控制的研究。认知增强疗法 (CET) 是成人自闭症谱系障碍 (ASD) 最有前途的认知康复方法之一，因为它针对神经认知和社会认知障碍提供了全面和发展性的方法，并且在精神分裂症（一种以类似认知缺陷为特征的疾病）中已确立疗效。在 NIMH 的支持下，我们最近证明了将 CET 应用于患有自闭症谱系障碍 (ASD) 成人的可行性，并且我们在该人群中进行的初步小规模随机 CET 试验中出现的证据表明，目标参与不同的认知领域，对功能结果具有显着的下游益处。令人兴奋的是，这些与 CET 相关的认知改善似乎也得到了额颞叶脑功能和连接性的潜在神经可塑性变化的支持。这些证据表明，CET 作为成人自闭症谱系障碍 (ASD) 循证认知康复干预措施具有相当大的前景，并且至关重要的是，这些早期发现必须通过充分有力的疗效试验来跟进。针对 PA-13-216“自闭症谱系障碍研究”的心理社会干预重点，本项目拟对 100 名患有自闭症谱系障碍的成年人进行 CET 随机对照疗效试验。参与者将被随机分配到 CET 或强化支持疗法 (EST) 控制条件组并接受 18 个月的治疗。该项目的具体目标是（1）评估 CET 与 EST 对不同认知和行为结果的比较有效性，以评估目标参与度和功能影响，（2）检查 CET 对额内侧颞脑功能和连接的影响，以阐明该人群认知增强的神经机制，以及（3）使用个人和神经生物学指标来探索治疗反应的异质性并识别 主持人代表最有可能从 CET 中受益的个人。拟议的项目将导致成人自闭症谱系障碍 (ASD) 中最大规模的心理社会干预研究，也是第一个针对该人群有希望的认知康复方法的充分有力的研究。如果成功，该项目将在为成人自闭症谱系障碍患者提供干预措施方面向前迈出重要一步，并将展示成人自闭症谱系障碍大脑的可塑性及其对认知康复的反应能力，为新一代自闭症治疗铺平道路。