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Command & Control Cognitive Training: Executive Functioning Intervention for Teens & Young Adults with ASD Pilot Study
Individuals with ASD are rapidly developing into teens and young adults (Lord & Bishop, 2010) and are in need of functional cognitive skills necessary for positive livelihood (Duncan & Bishop, 2013;) those with these skills demonstrate increased vocational and educational outcomes (Taylor & Mallick, 2014). Executive functioning (EF) skills are the cognitive skills most frequently impacted in autism spectrum disorders (Kenworthy, Yerys, Anthony, & Wallace, 2008). EF skills have been found to be associated with reduced adaptive functioning (Gilotty, Kenworthy, Sirian, Black, & Wagner, 2002) and greater ASD symptoms (Kenworthy, Black, Harrison, Della Rosa, &Wallace, 2009). Many EF abilities improve through childhood and adolescence but mature more slowly and often remain impaired into adulthood in individuals with ASD peers without direct intervention (Rosenthal, 2013).
Objectives:
This study developed a novel treatment, Command & Control Cognitive Training, which is an innovative manualized small group executive functioning curriculum. A pilot study was conducted to obtain estimates of effects of outcomes which include executive functioning skills for teens and young adults with ASD.
Methods:
A total of 14 individuals with ASD (10 teens, 15= yrs, 4 young adults, μ=23 yrs) participated in an open trial pilot study of the Command & Control Cognitive Training program. Command & Control was delivered weekly for 90 minutes via active group participation. In addition, there was a weekly 30 minute parent education component conducted simultaneously with the participant group. The program involves 12 sessions over 3 months with an engaging “tech/gaming focused” curriculum teaching the participants “Commands” which were the following executive functioning skills: sustained attention, cognitive shifting, cognitive flexibility, problem solving, inhibition, goal-oriented thinking, and organization and “Controls” which were specific strategies to use for each construct (i.e. Tune in, Eliminate Distractions for sustained attention). Pre and post assessments included a battery of standardized measures: 1. Behavior Rating Inventory of Executive Function (BRIEF & BRIEF-A), 2. Social Responsiveness Scale-2 (SRS-2) and 3. Satisfaction questionnaire. Participants and parent informants completed each measure. The participants were diverse with about half female (43%) and diverse race/ethnicity (35%). Some were involved with various social services: 57% disability services, 71% special education, and 57% receiving therapy (29% mental health, 50% speech, 43% occupational).
Results:
Analyses consisted of paired-sample t-tests and Cohen’s d effect sizes to estimate intervention effects. Preliminary findings reveal small to large positive effects per participant and parent report on the BRIEF/BRIEF-A. This may be a reflection of the effectiveness of the intervention. Small to large positive effects were also found on the SRS-2 subscales per parent report and minimal effects for participants (Refer to Tables). Program satisfaction was very high (8.5 participant and 9.3 parent, out of 10).
Conclusions:
This study demonstrates that the engaging “tech/gaming” focused executive functioning intervention, Command & Control Cognitive Training, was well received and demonstrated initial positive outcomes and overall satisfaction. Using small groups to teach EF skills to teens and adults shows promise.