Adapting Cognitive Enhancement Therapy for ASD

描述（由申请人提供）：自闭症谱系障碍 (ASD) 的定义是社交互动、语言和非语言（凝视、面部表情、手势、韵律）交流、想象力游戏中的特定行为障碍，以及受限和重复的兴趣和行为。这些行为的背后是社会和非社会认知和信息处理的缺陷。自闭症的干预措施主要集中在学龄前阶段和行为方法。对于患有自闭症谱系障碍（ASD）的成年人来说，可用的干预措施很少，而专注于纠正认知和社会情感缺陷的干预措施则更少，而这种干预措施旨在改善对成人生活的成功和成就至关重要的复杂的适应行为。因此，许多患有自闭症谱系障碍的成人会经历严重的终生残疾，导致巨大的个人和家庭痛苦以及巨大的经济损失。为了回应 RFA-MH-09-021“神经发育障碍的新颖干预措施”，我们提出了第一步，对患有 ASD 的年轻过渡年龄高功能成人进行认知增强疗法 (CET) 的调整、试点和初步测试，以改善该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康复计划，最初是为精神分裂症开发的，已证明其在认知和重要功能结果方面有显着改善。自闭症谱系障碍患者所经历的许多社交、沟通和认知障碍（例如，心理理论受损、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）也是精神分裂症患者所共有的。这些障碍是 CET 直接针对的，这表明 CET 可能会给患有 ASD 的语言障碍患者带来实质性的好处，这些人在成年后往往表现不佳，而且几乎没有干预措施。该项目将分为两个阶段。在第一阶段（R21），将通过开发现有 CET 治疗手册的补充，对反映自闭症独特性的 CET 治疗进行调整。自闭症和精神分裂症的临床专家将合作调整 CET，然后对 12 名患有自闭症谱系障碍 (ASD) 的年轻人对这些调整进行不受控制的试点研究，以证明可行性、确定额外调整的必要性，并对该方法的潜在社会情感和认知影响提供初步评估。在第二阶段 (R33)，将对 55 名患有自闭症谱系障碍 (ASD) 的年轻人进行小规模随机试验，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 治疗自闭症谱系障碍试验的可行性。拟议的 R21-R33 将完成第一个针对患有自闭症谱系障碍 (ASD) 成人的经过验证的认知康复方法的严格临床试验。如果成功，该项目将在针对自闭症谱系障碍成人患者的可用干预措施方面迈出一大步，并对患有自闭症和其他具有类似认知、情感和社交障碍的神经发育障碍的年轻人产生影响。

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.