Much of the treatment for autism spectrum disorders has focused exclusively on early intervention and childhood treatment programs. These programs are quite helpful for individuals and families as they move through the educational system and provide children with autism spectrum disorders specialized treatment programs to improve their lives. Unfortunately, when children reach the age of 18 (or in some cases 21), many of the services that were available and appropriate for them at a younger age come to an end. Equally unfortunate is the fact that little to no evidence-based treatments exist to help adults with autism spectrum disorders as they transition and continue into adulthood.
As anyone with an autism spectrum disorder will tell you, the difficulties that autism, Asperger’s syndrome, and pervasive developmental disorder present to people with these conditions do not end at age 18. Adulthood presents its own array of unique challenges as individuals are attending college, trying to build friendships, and attempting to advance successful careers that build on their talents. For many, this time is fraught with the challenges of over-stimulation, fitting in, and shifting toward independence that come from the busy and demanding world of adult life. Many have argued that it is precisely at this time when individuals with autism spectrum disorders need help the most. Still, scientifically-validated treatments for adults with these conditions are almost completely absent.
Recent research has identified difficulties in thinking or cognition as key contributors to disability in adults with autism spectrum disorders. Studies have demonstrated that, despite frequent cognitive talents, many individuals with these conditions experience a slowing in speed of processing, difficulty with planning, and reduced mental stamina. These problems are combined with core impairments in social cognition, which are characterized by an inability to identify non-verbal cues, take the perspective of others, and understand the broader context of social situations. In addition to problems in social and non-social cognition, many adults with autism spectrum disorders experience significant difficulty in managing stress and emotions, and frequently experience what some have termed “meltdowns.” Problems that may seem trivial to others are magnified to the adult with autism, shifting to new environments and situations often produce high negative emotional reactions, and many lack the skills needed to cope with the very real stress of adult life.
Not surprisingly, individuals who experience these problems in cognition and emotion (regardless of whether they have an autism spectrum disorder), find it exceedingly difficult to succeed as adults. Mental stamina and ability to quickly process information are critical to keeping up at work and school. The ability to understand social contexts and take the perspective of others provides the foundation for succeeding in interpersonal situations and making friends. Further, nearly every aspect of one’s life can be disrupted by emotional meltdowns, which can also lead to a great deal of stigma. Unfortunately, interventions designed to directly treat problems in cognition and emotion management with autism spectrum disorders have yet to be developed and scientifically validated.
Recognizing the great need for the treatment of these problems in adults with autism spectrum disorders, the University of Pittsburgh Autism Center of Excellence has begun the Perspectives Program. With funding from the National Institute of Mental Health, the Pennsylvania Department of Human Services, and Autism Speaks, the Perspectives Program is aimed at pioneering new interventions to help adults with autism spectrum disorders develop the cognitive, social, and emotional abilities needed to succeed in adulthood. The focus is placed particularly on psychosocial interventions, which include non-drug therapeutic strategies to target the core symptoms of autism.
Currently, the Perspectives Program is working on testing two new and very promising interventions for adults with autism spectrum disorders known as Cognitive Enhancement Therapy and Enriched Supportive Therapy. These psychosocial research interventions provide support and are designed to improve cognition, social functioning, problem-solving, stress management, and other skills needed for individuals to succeed in adulthood.
Cognitive Enhancement Therapy aims to help adults with problems they experience in thinking, planning, and socialization, which are extremely important for adult activities like completing college, finding a job or getting a promotion. Participants begin this treatment with cognitive training to improve thinking and planning using computer software programs. They also participate in a small “social-cognitive” group to learn about their condition and how to act wisely in social situations by developing the abilities needed to understand another person’s perspective, evaluate social contexts, and be foresightful.
Enriched Supportive Therapy uses individual therapy to help adults learn about their condition, manage their emotions and stress, improve their social skills, and cope with everyday problems. Since adult life can be particularly challenging, both emotionally and socially, for individuals with autism spectrum disorders, this treatment focuses on helping individuals meet and overcome these challenges so that they can succeed in adulthood. In the treatment, the management of emotion and arousal is vital. Participants learn about the impact of stress on their lives, how to identify their own early cues of distress, and how to apply effective coping strategies. Ultimately, these activities are targeted toward improving interpersonal functioning, as well as life success and achievement.
The Perspectives Program is one of the first of its kind to develop and test new interventions specifically for adults with autism spectrum disorders. It is expected that this program will be a resource for individuals and families in the Pittsburgh community who live with an autism spectrum disorder. It is also expected that through the testing of these two novel treatments, the relative benefits of cognitive, supportive, and emotional interventions for adults with autism spectrum disorders will be firmly established. Eventually, it is hoped that by providing this evidence, such treatments will become a standard of care and routinely available to help adults with these conditions maximize their strengths and lead successful and fulfilling lives.
Individuals interested in participating in the Perspectives Program are encouraged to contact the University of Pittsburgh Autism Center of Excellence by telephone, 1-866-647-3436 (toll free), or e-mail, autismrecruiter@upmc.edu. For more information, visit https://www.cefar.pitt.edu/perspectives-program-intervention-for-adults/.
