Autism and Wellbeing

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. 

Cognitive Enhancement Therapy

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). 

CET and employment

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). 

Conclusion

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).