Pilot study: cognitive remediation for executive dysfunctions among children with Asperger's syndrome ages 11-16

Scope: This preliminary study investigated the potential social and executive function benefits of cognitive remediation for children with Asperger’s Syndrome (AS). Purpose: Children and adolescents with AS experience clinical levels of social isolation and peer rejection due to limited social functioning skills. A prominent theory of executive dysfunction suggests that enhancement of frontal executive abilities may improve the quality of social functioning if it were followed by some social skills training. Methodology: A 20 week cognitive remediation intervention (Frontal Executive Program-FEP) followed by a 10 week social skills program (Adolescent Social Perceptual Emotional and Communication Training – ASPECT as Treatment as Usual-TAU) was trialled on 20 children (ages 11-16) diagnosed with AS. Half of subjects receiving both programs were compared to the other half who received the social skills program only. All subjects received baseline and post-treatment assessments in intelligence, executive function, mental health, social problems, autistic mannerisms and social communication function. Results: Compared to standardised data children with AS have greater deficits in cognitive flexibility, planning/problem solving, and verbal working memory. Verbal working memory deteriorates with age during early adolescence. Verbal fluency is better with increased intelligence. The 20 week FEP intervention made large and clinically meaningful treatment gains on cognitive abilities and reductions on psychosocial and autistic symptoms. The 10 week TAU intervention made medium treatment reductions on psychosocial and autistic symptoms. When compared to a control group matched in age, IQ, gender, and AS diagnosis, the combined FEP+TAU intervention made medium gains on cognitive abilities and autistic symptoms. Conclusions/Implications: Cognitive deficits can be enhanced with the FEP cognitive remediation. Autistic symptoms can be reduced below sub-clinical levels if the TAU is followed after the FEP intervention. Social skills interventions among young AS individuals are most effective when cognitive deficits are first improved.