Neuroplasticity-Based Cognitive Training for Adolescents with Autism Spectrum Disorder: Preliminary Findings from a Computerized Intervention Program

Background: Autism Spectrum Disorder (ASD), a complex neurodevelopmental disorder, is characterized by persistent deficits in communication and interaction, and restrictive, repetitive patterns in behavior, interests, and activities. Many difficulties experienced by individuals with ASD have been attributed, in part, to deficits in cognitive functions necessary for goal directed behavior that is adaptive to the environment. Cognitive training methods in auditory and social/communication (SC) domains have emerged as a promising approach to improve functional impairments in multiple pathologies (e.g., Schizophrenia, Attention-Deficit/Hyperactivity Disorder; ADHD). In particular, computerized and adaptive brain-based programs have shown considerable potential as effective and accessible interventions. This approach has been applied effectively to address general cognitive deficits in chronic schizophrenia and in children and adolescents with ADHD. However, despite the likely utility of these methods for the treatment of cognitive deficits in autism, few trials have been implemented in the ASD population.

Objectives: Longitudinal studies of adults with ASD with and without intellectual disability have shown consistent and persistent deficits across cognitive, social, and vocational domains. Moreover, the cognitive and social skill deficits that are core features of ASD have been identified as major challenges to employment success for these adults, highlighting the critical need for evidence-based interventions as adolescents with ASD transition into adulthood. Thus, we aim to assess the efficacy of a novel, computerized, adaptive, brain-based targeted cognitive training (TCT) program designed to leverage neuroplasticity in a pilot sample of adolescents with ASD.

Methods: We enrolled 20 adolescents (6F; Age=14.9±1.4years) with a prior diagnosis of ASD and IQ ≥ 70 from local ASD clinics. We customized two web-based TCT modules (Auditory/SC) and participants were randomized to each group. Study procedures included: 1) Pre-Intervention Assessments; 2) 10-14 weeks of TCT including forty (25-45 minute) training sessions; and 3) Post-Intervention Assessments. The Auditory Module was designed to improve information processing speed and accuracy while engaging working memory and cognitive control under conditions of close attention and reward. The SC Module applied principles of implicit learning to improve processing and use of socially-relevant information. Exercises continuously adjusted difficulty level to user performance to maintain an approximately 80% correct performance rate. Correct trials were rewarded with points and animation.

Results: Data collection and recruitment is ongoing, but to date, five participants (1F; Age=14.6±0.5years) have completed the Auditory Module and four participants (2F; Age=15±1.4years) have completed the SC Module. We anticipate having a total of ten participants in each group by Spring 2019. Preliminary data show mean percentage improvement from baseline to best performance of 24% for the Auditory Group and 21% for the SC Group.

Conclusions: Preliminary results are promising and indicate overall improvement on training tasks across groups. Pre- and Post-Assessment sessions include functional neuroimaging and behavioral measures of social and cognitive functioning. We will compare neural, clinical, and cognitive changes between the baseline and outcome assessments to gauge the efficacy of the TCT programs as well as generalizability across training domains.