Impaired or atypical social perception and social cognition are fundamental to autistic spectrum disorders (ASD), and perhaps the leading source of difficulty for individuals with high-functioning autism or Asperger's syndrome who have social impairment with minimal, if any, other cognitive disturbances. There is, however, no effective current treatment for impaired social cognition in ASD. A promising approach toward treatment of ASD is intranasal administration of oxytocin, a hormone reported to have a powerful role in affiliative social behaviors in both humans and other mammals. There is also evidence that administration of oxytocin enhances social behaviors not only in typically developing people, but also people with ASD. Importantly, multiple oxytocin studies with typically developing and ASD participants report virtually no adverse effects in either group (i.e., this is a natural and safe substance). Another promising approach toward treatment of ASD is cognitive behavioral therapy (CBT), which refers to a class of interventions whose basic premise is that mental disorders are maintained by cognitive factors, and therefore treatment focuses on changing these factors through cognitive strategies (cognitive restructuring) and behavioral techniques (e.g., exposure, behavioral experiments, relaxation training, social skills training). Many well-controlled studies demonstrate that not only is CBT is more effective than placebo treatments and alternative behavioral treatments, but also at least as effective as psychopharmacology. Thus, there is extensive and high-quality scientific evidence that CBT can be highly effective, and at least as effective as medications. Several studies indicate that CBT can be effective for treating anxiety in children with ASD. These studies indicate that CBT appeared to help a large percentage of children enhance daily living skills, and that the benefits are sustained months after the treatment ends. It is remarkable, given the great evidence that CBT is effective in many disorders, that CBT appears effective in children with ASD, and that there is no scientifically supported treatment available to ASD adults to help them cope with social skills, that there is no clinical trial of whether CBT can help adults with ASD. We report pilot evidence that a form of CBT aimed at improving social skills in young adults with ASD shows promise. The objective of this clinical study will be to test if (1) CBT aimed at core social dysfunctions and (2) oxytocin administration prior to CBT sessions will enhance social function in young adults with ASD. This is important because it is now appreciated that a large number of individuals with ASD need to have optimal transitions to adult lives of employment and human relations, but there are no known treatments with young adults for the core social dysfunctions that characterize ASD and impede the typical growth of personal relations (family, friends, partners), independence, and employment that are fundamental for the transition from adolescence into adulthood. Our proposed approach stands to advance understanding of ASD and lead to improved outcomes for high-functioning individuals with autism. The results of these experiments may have far-reaching implications for treatment of autism. The demonstration that CBT and/or oxytocin can enhance social cognition can be used as a platform for increased clinical trials. Importantly, both CBT and oxytocin are safe, practical treatment approaches that could be rapidly disseminated to support young adults with ASD.
Interagency Autism Coordinating Committee (IACC)
Autism Research Database (AFD)
