Games plus group therapy may help adults with autism find jobs

Adults with autism who undergo a therapy designed to bolster social learning show cognitive benefits that may increase their chances of employment, according to a new study¹.

So-called ‘cognitive enhancement therapy’ combines computer-based tasks to improve problem-solving and memory with structured group sessions that provide practice reading nonverbal cues, taking someone else’s perspective and other social skills.

The program is known to help adults with schizophrenia find steady jobs². The new work extends this work to adults and adolescents with autism.

“Improved cognition seemed to lead to more competitive employment outcomes,” says lead researcher Shaun Eack, professor of psychiatry at the University of Pittsburgh. “The cognitive effects weren’t unrelated from the employment effects; in fact, they cascaded each other.” The results appeared 29 December in Autism Research.

The study is the largest and most comprehensive evaluation of cognitive enhancement therapy for people with autism.

“The results are very encouraging, in particular the effect on employment,” says Evdokia Anagnostou, senior clinician scientist and co-lead of the Autism Research Centre at Holland Bloorview Kids Rehabilitation Hospital in Canada, who was not involved in the study. “In previous smaller studies, it has been somewhat hard to show generalization of skills beyond what is explicitly taught.”

Mind games:

Eack and his colleagues gave 7 women and 47 men with autism, aged 16 to 45, either cognitive enhancement therapy or supportive counseling for 18 months.

In the cognitive arm, 29 participants performed tasks on a computer for one hour each week. Some of the tasks are designed to increase processing speed, such as typing certain letters when prompted. Other tasks tap short-term memory.

These individuals also participated in activities designed to train them to act appropriately in everyday situations. For instance, in an ‘airport’ exercise, participants had to announce via a mock public address system that a wallet had been found. They were to do so without revealing information that could lead to the wrong person claiming the wallet.

The other 25 participants received one hour of so-called ‘enriched supportive therapy’ per week. In these sessions, a therapist taught them strategies for coping with their emotions and managing their stress.

The same therapist delivered both types of therapy for consistency.

The researchers assessed the participants’ working memory, mental-processing speed and other cognitive functions halfway through the program and at the end. They also measured social skills, such as the ability to understand others’ perspectives and feelings, and the ability to manage their own emotions. (A single researcher who was not privy to the treatment type recorded all the scores.)

Job gains:

The participants who received cognitive enhancement therapy scored higher on social learning measures than the control group at 9 months, but that difference disappeared at 18 months.

This result suggests that both treatments are effective, but cognitive enhancement therapy works faster, Eack says.

Only cognitive enhancement therapy has a positive impact on employment, however.

Of the 29 participants who received it, only 7 were employed at the start of the study. But after 18 months of therapy, 10 of the 21 who remained in the study had jobs.

By contrast, in the other group employment rates dropped slightly: 10 of the 25 people in the original group were employed, compared with 6 of the 20 people who completed the study.

Although the study is small, it shows that cognitive enhancement therapy has promise, experts say.

“The most encouraging thing is that the authors are now undertaking a second trial, which reflects these initially fairly encouraging results,” says Terry Brugha, professor of psychiatry at the University of Leicester in the United Kingdom, who was not involved in the study.

Eack and his team are testing cognitive enhancement therapy in a study of 100 individuals with autism. This work includes brain scans to determine whether changes in brain structure track with the treatment’s effects.