Confirmatory Efficacy Trial of Cognitive Enhancement Therapy for Adult Autism Spectrum Disorder

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. This study
will investigate and confirm the efficacy of two psychological treatments for adults with
autism spectrum disorder. Cognitive Enhancement Therapy (CET) is a cognitive remediation
intervention that aims to help adults with problems in thinking, planning, and socialization.
Enriched Supportive Therapy (EST) is an individual supportive therapy that aims to help
adults learn about their condition, manage their emotions and stress, improve their social
skills, and cope with everyday problems.

Participation in this study will last 30 months. Potential participants must be able to
attend weekly treatment sessions in Pittsburgh, PA.

The study design is a 30-month (2.5 years) randomized-controlled confirmatory efficacy trial,
where eligible participants will be randomized to the CET or EST study treatments.
Participants will be treated with the study interventions for 18 months, and then followed
for 12 additional months to assess the lasting impact of the study interventions. All
participants will complete cognitive, clinical, and neuroimaging (magnetic resonance imaging)
assessments prior to starting the study treatments and then at specified intervals thereafter
to evaluate the impact of the study treatments on cognition, adaptive function, and the
brain.

Inclusion Criteria:

- Age 16-45 years

- Diagnosis of autism, Asperger's syndrome, or pervasive developmental disorder not
otherwise specified (NOS) verified by the autism diagnostic observation schedule
(ADOS) or autism diagnostic interview-revised (ADI-R)

- Presence of significant social and cognitive disability, based on the Cognitive Style
and Social Cognition Eligibility Interview (Hogarty et al., 2004)

- Intelligence quotient (IQ) greater than 80

- Ability to read and speak fluent English

- Availability of a family member or close friend allowed to provide information on the
participant

- Ability to attend weekly treatment sessions in Pittsburgh, PA

Exclusion Criteria:

- Organic brain syndrome

- IQ < 80

- English language skills below a sixth grade level

- Persistent suicidal or homicidal behavior

- History of substance abuse or dependence within the past 3 months

- Comorbid attention deficit hyperactivity disorder (ADHD) that is untreated

- Comorbid personality disorder

- History of disruptive or violent behavior

- Any magnetic resonance imaging contraindications