Abstract
BackgroundAutism spectrum condition (ASC) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors. Cognitive remediation (CR) interventions are frequently used to address cognitive characteristics and improve cognitive and general functioning. However, the evidence is limited for ASC. This systematic review is the first to provide a narrative synthesis of all studies of CR interventions and ASC. The review aimed to delineate the development of research in this area in both adolescents and adults, with implications for clinical practice and future research.MethodThe review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) statement. The literature was reviewed using the PubMed, PsycINFO, Web of Science, Scopus and Embase from inception to 1st April 2020. Out of 1,503 publications, a total of 13 papers were identified as being relevant for the review.ResultsThe 13 studies meeting the inclusion criteria were: four randomized control trials (RCTs); two non-randomized control trials, four case series, two feasibility studies and one case study. A narrative synthesis of the data suggested that CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. RCTs supported the efficacy of CR interventions in improving social cognition and executive functioning. Non-randomized control trials provided evidence for the effectiveness of social cognition remediation interventions in ASC. Case series and a case study have also supported the feasibility of CR interventions, including reflections on their adaptation for ASC populations and the positive feedback from participants.ConclusionsCR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. However, the generalizability of the included empirical studies was hampered by several methodological limitations. To further strengthen understandings of the effectiveness of CR interventions for ASC, future RCTs are needed with larger sample sizes in exploring the long-term effectiveness of CR interventions, using age-appropriate valid and reliable outcome measures. They should also consider the heterogeneity in neuropsychological functioning in ASC and the mediating and moderating mechanisms of the CR intervention for ASC.
Highlights
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterized by differences in reciprocal social interaction, communication, language, and restricted and repetitive behaviors [1]
The results suggest Cognitive remediation (CR) interventions are potentially effective in improving social cognition and cognitive functioning in Autistic Spectrum Condition (ASC)
The various interventions and outcome measures used in the identified studies prevented a meta-analysis, limiting our ability to draw conclusions around efficacy or to assess the risk of bias. This is the first paper that presents a narrative synthesis of all studies of CR interventions in ASC, and the first paper delineating its research development from single case studies to RCTs
Summary
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterized by differences in reciprocal social interaction, communication, language, and restricted and repetitive behaviors [1]. ASC is associated with a spectrum of manifestations and behaviors that affect individuals in different ways These surface differences are theorized to be underpinned by a common cognitive profile: inflexibility of thinking and heightened attention to detail [5, 6]. ASC is characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors [7]. A recent systematic review and meta-analysis aimed to systematically map non-social and social cognitive functioning in autistic adults [8]. Autism spectrum condition (ASC) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors. The review aimed to delineate the development of research in this area in both adolescents and adults, with implications for clinical practice and future research
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