Adapting Cognitive Enhancement Therapy for ASD

描述(由申请人提供)：自闭症谱系障碍(ASD)由社交、语言和非语言(凝视、面部表情、手势、韵律)交流、想象力游戏以及受限和重复的兴趣和行为中的特定行为障碍定义。这些行为的背后是社会和非社会认知和信息处理方面的缺陷。对自闭症的干预主要集中在学龄前阶段和行为方法上。对于患有自闭症的成年人来说，可用的干预措施很少，更没有人专注于以一种旨在改善复杂的适应行为的方式来补救认知和社会情绪缺陷，这对成人生活的成功和成就至关重要。因此，许多患有自闭症的成年人会经历严重的终生残疾，导致巨大的个人和家庭痛苦和巨大的经济成本。针对RFA-MH-09-021，“神经发育障碍的新型干预措施”，我们提出了适应、试点和初步测试认知增强疗法(CET)对患有自闭症的年轻过渡年龄高功能成年人的有效性的第一步，以改善这一人群的适应功能和成人生活成就。CET是一种基于神经发育、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，现已显示出认知和重要功能结果的显著改善。自闭症患者经历的许多社交、沟通和认知障碍(如心理理论受损、情绪感知不足、情绪调节和表达能力差、灵活性差、执行功能障碍)也与精神分裂症患者相同。这些损害是CET直接针对的，这表明CET可能会给患有自闭症的口头个人带来实质性的好处，这些人成年后往往表现不佳，而且对他们几乎没有干预措施。该项目将分为两个阶段。在第一阶段(R21)，将通过编制现有CET治疗手册的附录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适应CET，然后对12名患有自闭症的年轻人进行一项关于这些适应的非受控试点研究，以证明可行性，确定额外适应的必要性，并对该方法的潜在社会、情感和认知影响进行初步评估。在第二阶段(R33)，将对55名患有ASD的年轻人进行小规模随机试验，以获得关于广泛的认知、功能和神经生物学结果的初步疗效数据，以支持CET治疗ASD的更大规模和更明确试验的可行性。拟议的R21-R33将导致完成第一个严格的临床试验，对患有自闭症的成年人进行经过验证的认知康复方法。如果成功，该项目将在成人自闭症干预方面向前迈出重大一步，并对患有自闭症和其他具有类似认知、情感和社会障碍的神经发育障碍的年轻人都有影响。

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.