Professor Shaun M. Eack P.h.D. discusses emerging research on the comparative outcomes of cognitive enhancement therapy (CET) versus enriched supportive therapy (EST). He describes the lack of research and interventions for autistic adults and explores the relationship between schizophrenia and autism. Eack examines the impact of CET on underlying neural mechanisms of cognitive enhancement and underscores the importance of continued research and support for adults with autism.

Learn more about our speaker, Professor Shaun M. Eack P.h.D., HERE
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In this webinar:

1:20 – Adulthood outcomes
3:55 – Study – Employment rate
6:23 – Health care costs
7:16 – Lower life-expectancy
8:06 – Outcome contributions
8:35 – Illustration – Autism Cliff
9:44 – Lack of treatment studies
11:26 – Adult behavioral interventions
12:26 – Data on adolescents with autism
14:27 – Why CET
15:49 – Cognitive impairment in autistic adults
17:00 – Cognitive challenges
17:48 – Promise of cognitive remediation
20:50 – Cognitive Enhancement Therapy
23:01 – Neurocognitive training and example
26:32 – Social-cognitive training
28:10 – CET effects in schizophrenia
29:55 – Cognition in autism and schizophrenia
31:10 – Feasibility and acceptability
33:28 – Preliminary efficacy
34:52 – First clinical trial of CET in adults with autism
38:16 – Effects on cognition
39:55 – Neurocognition effect sizes by cognitive domain CET vs EST
40:42 – Social cognition effect sizes by cognitive domain CET vs EST
41:43 – Effects on employment
43:05 – Conclusions
44:10 – Preliminary MRI data
46:26 – Q & A

Eack discusses the lack of support and interventions for adults with autism (1:20). He highlights the excessive healthcare costs associated with autism in adulthood (6:23) and emphasizes that, despite such large expenditures, autistic individuals have a lower life expectancy on average than their non-autistic peers (7:16). The presenter uses the “Autism Cliff” illustration (8:35) to demonstrate the abrupt end of guaranteed schooling and services after ages 18 – 21. He notes that from 1965 to 2018, only 14 articles were published on effective interventions for autistic adults (11:26). While more data on adolescents with autism are available, most studies are based on single participants and cannot lend any general insights (12:26). Given this blatant lack of research and need for change, Eack discusses cognitive enhancement therapy (CET) and its potential use with autistic adults. 

Autism is a neurodevelopmental disorder that affects how the brain communicates with itself and, consequently, how it integrates and processes complex information (14:27). Challenges associated with cognitive impairment include processing speed, verbal learning, working memory, cognitive flexibility, and emotion management and perception (17:00). The speaker asserts that downstream behavioral and social effects of such cognitive difficulties can have a significant and lasting impact on relationships, employment, and life expectancy (15:49). Eack discusses various adulthood conditions related to cognitive challenges and outlines the success of cognitive remediation in treating multiple disorders (17:48). Based on such achievements, Eack and his team examined the feasibility and effectiveness of CET in autistic adults (20:10)

The speaker asserts that by the time an individual with autism reaches adulthood, a prolonged intervention that includes sustained support will most likely produce meaningful changes and construct a good quality of life (22:31). He defines CET as a recovery-phase intervention for remediating neurocognitive and social-cognitive deficits (20:50). CET generally takes 18 months to complete and contains two components: 

Neurocognitive training (23:01) – Sequentially targets lower- to higher-order cognitive domains. The training is socially designed and assists in developing basic and generalized problem-solving strategies for daily use. 

Social-cognitive group therapy (26:32) – Coaches (not therapists) help individuals solve problems and build skills for themselves. Training is done in small groups (6-8 members) to encourage social abilities.

Eack explains how CET robustly improved cognitive domains beyond other supports and treatments in individuals with schizophrenia (28:10). He stresses the positive trickle-down effects of social and personal behavior, noting the neural and social-cognitive similarities between autism and schizophrenia (29:55). A recent pilot study found that, when appropriately adapted to the autistic population, individuals were satisfied with participation and outcomes of an 18-month CET program (31:10). The speaker describes a preliminary study on the efficacy of CET in autistic adults, which revealed that it is possible to address social-cognitive difficulties in this population. Further, results showed significant downstream effects on social adjustments and ability to function within the community (33:28)

The presenter outlines inclusion criteria, study methods, and parameters for the first clinical trial of CET in adults with autism. Fifty-four participants were randomized into either a CET or enriched supportive therapy (EST) comparison and treated for 18 months (34:52). All individuals showed marked improvements in neuro- and social cognition, and CET had greater effect in both domains. The effect of CET was significantly more than that of EST on neurocognition but not on social cognition (38:16). The speaker states that results also showed that CET had the most advantageous effect on employment adjustment and the number of individuals employed (41:43). Therefore, he asserts that “treatments focusing on cognitive impairments may, in fact, have significant and very large downstream effects on employment and other important domains of adult functioning.” (42:05)

Eack summarizes the presentation and clinical results, noting the promising potential of CET in improved cognition and downstream functionality (43:05). He discusses preliminary MRI data, which suggests that as these changes occur, corresponding neuroplastic changes also occur (44:10). The speaker asserts his belief that CET is a new therapeutic avenue for supporting adaptive functioning for adults living with autism. He also notes the effectiveness of EST and posits that the benefits of individual support for education and emotion management may, themselves, confer massive benefits to adults living with this condition (45:00). Eack provides details for the second clinical trial (44:53) before opening the question and answer session (46:45)

Published: 11/07/2018

Shaun Eack, Ph.DDavid E. Epperson Professor Shaun M. Eack earned his Ph.D. in Social Work from the University of Pittsburgh. Eack’s primary interests include the development, implementation, and evaluation of psychosocial treatment methodologies to improve the care of people with schizophrenia and related disorders. He is also interested in the biopsychosocial factors that contribute to recovery and psychosocial outcomes among people with schizophrenia and related disorders, and how the elucidation of these factors can serve to aid novel treatment development efforts. In addition, Dr. Eack holds a broad interest in social work education and workforce development as they relate to the provision of care for persons with schizophrenia and other severe mental illnesses.

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