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).
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.
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).
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).
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.