Adapting Cognitive Enhancement Therapy for ASD

描述（由申请人提供）：自闭症谱系障碍（ASD）被定义为社交互动，语言和非语言（凝视，面部表情，手势，韵律）沟通，想象力游戏以及限制和重复的兴趣和行为方面的特定行为障碍。这些行为的基础是社会和非社会认知和信息处理的缺陷。对自闭症的干预主要集中在学龄前和行为方法上。针对成年自闭症患者的干预措施很少，而针对认知和社会情感缺陷的补救措施，旨在改善成人生活中成功和成就所必需的复杂适应行为的关注就更少了。因此，许多有语言障碍的成年人经历了严重的终身残疾，给个人和家庭带来了巨大的痛苦，并造成了巨大的经济损失。为了响应RFA-MH-09-021，“神经发育障碍的新干预”，我们提出了第一步，即适应，试点和初步测试认知增强疗法（CET）对年轻过渡年龄高功能成人ASD患者的疗效，以改善这一人群的适应功能和成年生活成就。CET是一项基于神经发育、社会认知和神经认知的康复计划，最初是为精神分裂症开发的，已经证明在认知和重要功能结果方面有显著改善。ASD患者所经历的许多社交、沟通和认知障碍（例如，心智理论受损、情绪感知缺陷、情绪调节和表达不良、缺乏灵活性、执行功能障碍）也存在于精神分裂症患者身上。这些缺陷是CET的直接目标，这表明CET可能会给自闭症患者带来实质性的好处，这些人成年后通常表现不佳，而且很少有干预措施。该项目将分为两个阶段。在第一阶段（R21），将通过开发现有CET治疗手册的补充来适应反映自闭症独特性的CET治疗。自闭症和精神分裂症的临床专家将合作调整CET，然后对12名患有ASD的年轻成年人进行一项无控制的试点研究，以证明这些适应性，确定额外适应性的必要性，并对该方法潜在的社会情感和认知影响进行初步评估。在第二阶段（R33），将对55名年轻ASD患者进行一项小规模随机试验，以获得广泛的认知、功能和神经生物学结果的初步疗效数据，以支持更大规模、更明确的CET治疗ASD试验的可行性。拟议的R21-R33将导致完成首个严格的临床试验，证明认知康复方法对言语成人ASD患者有效。如果成功，该项目将使成人自闭症患者的可用干预措施向前迈出一大步，并对年轻自闭症患者和其他具有类似认知、情感和社会障碍的神经发育障碍患者产生影响。

DESCRIPTION (provided by applicant): Autism spectrum disorders (ASD) are defined by specific behavioral impairments in social interactions, verbal and non-verbal (gaze, face expression, gestures, prosody) communication, imaginative play, and by restricted and repetitive interests and behavior. Underlying these behaviors are deficits in social and non- social cognition and information processing. Interventions for autism have largely focused on the preschool years and behavioral methods. Few interventions are available for adults with ASD, and even fewer focus on the remediation of cognitive and social-emotional deficits in a way designed to improve complex adaptive behavior essential for success and achievement in adult life. As a consequence, many verbal adults with ASD experience substantial lifetime disability resulting in great personal and family suffering and great financial cost. In response to RFA-MH-09-021, "Novel Interventions for Neurodevelopmental Disorders," we propose the first step in adapting, piloting and preliminarily testing of the efficacy of Cognitive Enhancement Therapy (CET) for young transitional age high functioning adults with ASD to improve adaptive functioning and adult life achievement in this population. CET is a neurodevelopmentally-based, social-cognitive and neurocognitive rehabilitation program originally developed for schizophrenia that has demonstrated significant improvements in cognition and important functional outcomes. Many of the social, communication, and cognitive impairments experienced by persons with ASD (e.g., impaired theory of mind, deficient emotion perception, poor emotion regulation and expression, inflexibility, executive dysfunction) are also shared by individuals with schizophrenia. These impairments are directly targeted by CET, suggesting that CET may confer substantial benefits to verbal individuals with ASD who often do poorly as adults and for whom few interventions exist. This project will consist of two phases. In the first (R21) phase, adaptations to the CET treatment reflecting the uniqueness of autism will be made through the development of a supplement to the existing CET treatment manual. Clinical experts in autism and schizophrenia will collaborate to adapt CET, and then conduct an uncontrolled pilot study of these adaptations with 12 young adults with ASD to demonstrate feasibility, identify the need for additional adaptations, and provide an initial evaluation of the potential social-emotional and cognitive effects of the approach. In the second (R33) phase, a small-scale randomized trial with 55 young adults with ASD will be conducted to obtain initial efficacy data on a broad range of cognitive, functional, and neurobiological outcomes to support the feasibility of a larger and more definitive trial of CET for ASD. The proposed R21-R33 will result in the completion of the first rigorous clinical trial of a proven cognitive rehabilitation approach with verbal adults with ASD. If successful, this project will result in a major step forward in available interventions for adults with ASD, and have implications for both younger individuals with autism and other neurodevelopmental disorders that share similar cognitive, affective and social impairments.