While notable advances have been made, effective interventions for people with autism spectrum disorder (ASD) are limited to specialized early childhood programs and pharmacological interventions for associated symptoms. Developing effective treatments for core social impairments is a pressing challenge for the field. In typical development, poor social abilities in childhood are associated with negative long-term outcomes. In ASD, recent reports suggest young adults with average or better cognitive skills may in fact be at greater risk for social isolation, un-employment, and psychiatric illnesses; underscoring the need for improved interventions targeting higher-level social impairments in ASD.
This study seeks to evaluate a novel pharmacological augmentation of a behavioral intervention for core social information processing deficits. The study represents an early step towards the development of personalized treatments for this complex condition, building upon data from a randomized, comparative study of Seaver-NETT (Nonverbal synchrony, Emotion recognition, and Theory of mind Training), a social cognitive skills training group. Participation in Seaver-NETT is associated with improvements in nonverbal communication and emotional awareness. However, treatment effects were not seen in neuropsychological measures of social cognition or at a three-month follow-up assessment.
Changes in social behavior are naturally linked to changes in cognitive processes in typical development. However, the Seaver-NETT study supports existing research indicating a weaker link between behavior and cognition during socialization in ASD. Generalization and maintenance is also a lingering concern for existing socialization interventions. We hypothesize that the efficacy and durability of interventions for higher-level social deficits will require normalization of social learning processes, involving changes in both behavior rehearsal and social cognition.
This study seeks to capitalize on medication studies of promising cognitive enhancers, such as the neuropeptide oxytocin, for neurodevelopmental disorders. Single-dose oxytocin administration is associated with improvements in social cognitive processes such as social attention and emotion recognition in clinical populations including ASD. In this proof-of-principle study, we will evaluate if targeted augmentation during Seaver-NETT may boost social cognitive effects, facilitate social learning, and increase the likelihood that changes in social-communication behaviors from Seaver-NETT are maintained.
The study will enroll pre-adolescents with ASD into a 12-week social skills group with oxytocin administered prior to each session and prior to homework sessions. We will study if the augmentation model is associated with changes in social cognition and social behavior, and ultimately social learning. The study will also explore outcomes on several novel measures of social cognition, group dynamics, and social relationships. These measures will be helpful in designing future studies testing if and how this new treatment approach may improve core social impairments in ASD. Additionally, the study supports a broader research program seeking to develop integrated behavioral-pharmacological interventions that can be individualized to accommodate developmentally-specific, and diverse expression of core impairments in this heterogeneous disorder.