The effect of cognitive rehabilitation therapy (CRT) on the executive functions of children with autism spectrum disorder (ASD)
DOI:
https://doi.org/10.22122/cdj.v7i3.408Keywords:
Cognitive Rehabilitation Therapy, Executive Function, High-Functioning Autism Spectrum DisorderAbstract
BACKGROUND: Executive functions (EF) impairments are considered as central deficits in autism spectrum disorder (ASD). The purpose of this study was to determine the effectiveness of cognitive rehabilitation therapy (CRT) on EFs of children with high-functioning ASD (HFA).
METHODS: This was a quasi-experimental study with a pretest-posttest design and control group. The study population included all children with HFA referred to the comprehensive Arman Shayan Rehabilitation Center in Tehran, Iran. Using the high-functioning Autism Spectrum Screening Questionnaire (ASSQ) and clinical diagnostic interviews by two clinical psychologists, 24 children with HFA were selected purposefully and were randomly assigned to experimental or control groups. Subjects in both groups completed the Behavior Rating Inventory of Executive Function (BRIEF) in pretest and posttest. The experimental group received 1-2 sessions (1 hour) per week of CRT for 6 months. Data analysis was performed using analysis of covariance (ANCOVA) in SPSS.
RESULTS: Data analysis showed that the use of CRT resulted in a significant difference between groups in terms of the total EFs score, which was 88.5%, as well as the components of inhibition (57%), orientation (46%), emotional control (42%), initiate (43%), working memory (55%), planning (56%), organizing (36%),and monitoring (36%).
CONCLUSION: CRT, as an evidence-based intervention, seems to be effective in improving neuropsychological functions in children with HFA.
References
Pugliese CE, Anthony L, Strang JF, Dudley K, Wallace GL, Kenworthy L. Increasing adaptive behavior skill deficits from childhood to adolescence in autism spectrum disorder: Role of executive function. J Autism Dev Disord 2015; 45(6): 1579-87.
de Vries M, Geurts H. Influence of autism traits and executive functioning on quality of life in children with an autism spectrum disorder. J Autism Dev Disord 2015; 45(9): 2734-43.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013.
Elsabbagh M, Divan G, Koh YJ, Kim YS, Kauchali S, Marcin C, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res 2012; 5(3): 160-79.
Carpenter LA, Boan AD, Wahlquist AE, Cohen A, Charles J, Jenner W, et al. Screening and direct assessment methodology to determine the prevalence of autism spectrum disorders. Ann Epidemiol 2016; 26(6): 395-400.
Jalil Abkenar SS, Razavi F, Ashori M. analytical investigation of autism spectrum disorders in diagnostic and statistical manual of mental disorders. Journal of Exceptional Education 2016; 16(141): 69-59. [In Persian].
Samadi SA, McConkey R. Screening for autism in Iranian preschoolers: Contrasting M-CHAT and a scale developed in Iran. J Autism Dev Disord 2015; 45(9): 2908-16.
Moradi H, Sohrabi M, Taheri H, Khodashenas E, Movahedi A. The effects of different combinations of perceptual-motor exercises, music, and vitamin D supplementation on the nerve growth factor in children with high-functioning autism. Complement Ther Clin Pract 2018; 31: 139-45.
Dijkhuis RR, Ziermans TB, Van Rijn S, Staal WG, Swaab H. Self-regulation and quality of life in high-functioning young adults with autism. Autism 2017; 21(7): 896-906.
Carpenter LA, Soorya L, Halpern D. Asperger's syndrome and high-functioning autism. Pediatr Ann 2009; 38(1): 30-5.
Sanders JL. Qualitative or quantitative differences between Asperger's disorder and autism? Historical considerations. J Autism Dev Disord 2009; 39(11): 1560-7.
Shipman DL, Sheldrick RC, Perrin EC. Quality of life in adolescents with autism spectrum disorders: Reliability and validity of self-reports. J Dev Behav Pediatr 2011; 32(2): 85-9.
Parvizi F, Lajevardi L, Alizadeh ZM, Ashaieri H. Comparing set-shifting in high functioning children with autism and normal ones (6 to 12 years). J Mod Rehabil 2012; 5(4): 15-20. [In Persian].
Rabinovici GD, Stephens ML, Possin KL. Executive dysfunction. Continuum (Minneap Minn) 2015; 21(3 Behavioral Neurology and Neuropsychiatry): 646-59.
Nejati V, Izadi-Najafabadi S. Comparison of executive functions in high-function autistic children and their typical matched peers. J Res Rehabil Sci 2012; 8(1): 28-39. [In Persian].
Kouklari EC, Tsermentseli S, Auyeung B. Executive function predicts theory of mind but not social verbal communication in school-aged children with autism spectrum disorder. Res Dev Disabil 2018; 76: 12-24.
Adams NC, Jarrold C. Inhibition in autism: Children with autism have difficulty inhibiting irrelevant distractors but not prepotent responses. J Autism Dev Disord 2012; 42(6): 1052-63.
Geurts HM, van den Bergh SF, Ruzzano L. Prepotent response inhibition and interference control in autism spectrum disorders: Two meta-analyses. Autism Res 2014; 7(4): 407-20.
Leung RC, Zakzanis KK. Brief report: Cognitive flexibility in autism spectrum disorders: A quantitative review. J Autism Dev Disord 2014; 44(10): 2628-45.
Wang Y, Zhang YB, Liu LL, Cui JF, Wang J, Shum DH, et al. A meta-analysis of working memory impairments in autism spectrum disorders. Neuropsychol Rev 2017; 27(1): 46-61.
Keshavan MS, Vinogradov S, Rumsey J, Sherrill J, Wagner A. Cognitive training in mental disorders: Update and future directions. Am J Psychiatry 2014; 171(5): 510-22.
Philip RC, Dauvermann MR, Whalley HC, Baynham K, Lawrie SM, Stanfield AC. A systematic review and meta-analysis of the fMRI investigation of autism spectrum disorders. Neurosci Biobehav Rev 2012; 36(2): 901-42.
Miyajima M, Omiya H, Yamashita K, Miyata T, Yambe K, Matsui M, et al. The effects of cognitive remediation therapy using the frontal/executive program for autism spectrum disorder. Int J Psychiatry Med 2016; 51(3): 223-35.
Eack SM, Greenwald DP, Hogarty SS, Bahorik AL, Litschge MY, Mazefsky CA, et al. Cognitive enhancement therapy for adults with autism spectrum disorder: Results of an 18-month feasibility study.
J Autism Dev Disord 2013; 43(12): 2866-77.
van Passel B, Danner U, Dingemans A, van Furth E, Sternheim L, van Elburg A, et al. Cognitive remediation therapy (CRT) as a treatment enhancer of eating disorders and obsessive compulsive disorders: study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16(1): 393.
Matsui M, Arai H, Yonezawa M, Sumiyoshi T, Suzuki M, Kurachi M. The effects of cognitive rehabilitation on social knowledge in patients with schizophrenia. Appl Neuropsychol 2009; 16(3): 158-64.
Katsumi A, Hoshino H, Fujimoto S, Yabe H, Ikebuchi E, Nakagome K, et al. Effects of cognitive remediation on cognitive and social functions in individuals with schizophrenia. Neuropsychol Rehabil 2017; 1-13.
Buissonničre-Ariza VL, Schneider SC, Storch EA. Cognitive remediation of executive functioning in youth with neuropsychiatric conditions: Current knowledge on feasibility, effectiveness, and personalization. Expert Rev Precis Med Drug Dev 2017; 2(2): 133-44.
Kasechi M, Behnia F, Mirzaei H, Rezafiani M, Farzi M. Validity and reliability of Persian version of high-functioning autism spectrum screening questionnaire age 7-12. Pajouhan Scientific Journal 2013; 12(1): 45-54. [In Persian].
Maleki S, Alizadeh Zarei M. Correlation between executive function behaviors and educational achievement of children with developmental coordination disorder. Middle East J Rehabil Health Stud 2016; 3(3): e37378. [In Persian].
Demehri F. Considering the effectiveness of psychosocial intervention on inhibition and emotion regulation in children with high functioning autism spectrum disorder. Journal of Exceptional Education 2017; 17(147): 41-8. [In Persian].
Eack SM, Hogarty SS, Greenwald DP, Litschge MY, Porton SA, Mazefsky CA, et al. Cognitive enhancement therapy for adult autism spectrum disorder: Results of an 18-month randomized clinical trial. Autism Res 2018; 11(3): 519-30.
Marceau EM, Berry J, Lunn J, Kelly PJ, Solowij N. Cognitive remediation improves executive functions, self-regulation and quality of life in residents of a substance use disorder therapeutic community. Drug Alcohol Depend 2017; 178: 150-8.
Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. Am J Psychiatry 2011; 168(5): 472-85.
Glenthoj LB, Hjorthoj C, Kristensen TD, Davidson CA, Nordentoft M. The effect of cognitive remediation in individuals at ultra-high risk for psychosis: A systematic review. NPJ Schizophr 2017; 3: 20.
McGurk SR, Twamley EW, Sitzer DI, McHugo GJ, Mueser KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry 2007; 164(12): 1791-802.
Fan Q, Liao L, Pan G. The Application of Cognitive Remediation Therapy in the treatment of mental disorders. Shanghai Arch Psychiatry 2017; 29(6): 373-5.
Thorsen AL, Johansson K, Loberg EM. Neurobiology of cognitive remediation therapy for schizophrenia: A systematic review. Front Psychiatry 2014; 5: 103.
Brockmeyer T, Walther S, Ingenerf K, Wild B, Hartmann M, Weisbrod M, et al. Brain effects of
computer-assisted cognitive remediation therapy in anorexia nervosa: A pilot fMRI study. Psychiatry Res Neuroimaging 2016; 249: 52-6.
Eack SM, Hogarty GE, Cho RY, Prasad KM, Greenwald DP, Hogarty SS, et al. Neuroprotective effects of cognitive enhancement therapy against gray matter loss in early schizophrenia: Results from a 2-year randomized controlled trial. Arch Gen Psychiatry 2010; 67(7): 674-82.
Penades R, Pujol N, Catalan R, Massana G, Rametti G, Garcia-Rizo C, et al. Brain effects of cognitive remediation therapy in schizophrenia: A structural and functional neuroimaging study. Biol Psychiatry 2013; 73(10): 1015-23.
McIntyre RS, Cha DS. Cognitive impairment in major depressive disorder: Clinical relevance, biological substrates, and treatment opportunities. Cambridge, UK: Cambridge University Press; 2016.
Penades R, Boget T, Catalan R, Bernardo M, Gasto C, Salamero M. Cognitive mechanisms, psychosocial functioning, and neurocognitive rehabilitation in schizophrenia. Schizophr Res 2003; 63(3): 219-27.