Table 1.
Characteristics of the included studies.
| RANDOMIZED CONTROL TRIALS | ||||||||
|---|---|---|---|---|---|---|---|---|
| Study | Aim of the study | Design | Inclusion Criteria | Sample characteristics | Intervention | Outcome measures | Summary of results | Limitations |
| Bölte et al. (18) | Preliminary evaluation of the development of a computer-based program (using social cognition remediation) to test and to treat facial affect in autistic people. | RCT | Participants to have a diagnosis of autism or Asperger’s*. | n = 10 autistic people aged 16–40. | Computer-based program to test using social cognition remediation. | International Affective Picture System* and fMRI-scans. | The results indicated a statistically significant improvement in facial affect in the intervention group post the computer-based program. | Small sample size affected power and limited the generalizability of findings. Gender bias by only including male participants. |
| De Vries et al. (10) | To investigate the effect of a working memory flexibility-training compared to an active control condition. | RCT | Prior diagnosis of ASC, IQ ≥80* and absence of a seizure disorder. | n = 121 children. Diagnosed with ASC. | ‘Braingame Brian’: executive function training. 25 Group sessions. | Corsi-BTT, BRIEF, SSRT, N-Back task, Gender-emotion switch-task* | The trend toward improvement in working memory and cognitive flexibility. Not feasible for autistic children. | High attrition rate. Targeted isolated aspects of cognition with limited functional impact. Does not specify participants gender |
| Miyajima et al. (20) | To explore the effects of CRT using the frontal/executive program for ASC compared to treatment as usual (normal supportive psychotherapy). | RCT | Outpatients younger than aged 60 & ≥9 years of formal education. | n = 14 adult outpatients. Diagnosed with ASC. | CRT using the frontal/executive program—44 individual sessions. (2 sessions a week). | BACS-J, WCST, CPT, ScoRS-J, LASMI* | Intervention group improved in working memory, executive functioning, verbal fluency and planning. | Small sample size. No follow-up investigation to determine the persistence of the effect. |
| Eack et al. (19) | To examine the efficacy of CET for improving core cognitive (neurocognitive & social-cognitive) and employment outcomes in autistic adults. | RCT | Diagnosis of ASC, IQ ≥80*, adults aged 16-45 and young people aged 16–17. | n = 33 adult, 7 adolescent male outpatients. Diagnosed with ASC. | CET—60 h over 18 months. Individual and group sessions. | MCCB, WCST, MSCEIT, PERT, PEDT, PEAT, SCS* | CET significantly increased neurocognitive function & social cognition in comparison to the control group. | Small sample size affected power. Treatment conditions were not matched (hours of treatment). |
| NON-RANDOMIZED CONTROL TRIAL | ||||||||
| Study | Aim of the study | Design | Inclusion criteria | Sample characteristics | Intervention | Outcome measures | Summary of results | Limitations |
| Golan et al. (27) | To teach autistic adults to recognize complex emotions using interactive multimedia. Using social cognition remediation (SCR) to improve the theory of mind. | Non-randomized controlled | Diagnosis of ASC and not taking part in any other intervention. | n = 39 autistic adults (32 males and 7 females). 13 people in each condition. | SCR using the mind reading intervention. Individual and group sessions. | CAM, RME, RMV & RMF* | Significant improvements on measures of face and voice recognition following intervention. | Sample was not randomized. The use of computer-based tasks is different to real life. |
| Turner-Brown et al. (28) | To evaluate the efficacy of social cognition remediation to improve social-cognitive functioning in high functioning autistic adults. | Non-randomized controlled | Aged 18–55, ASC diagnosis, IQ ≥80. | n = 11 high functioning autistic adults | Group based Social Cognition and Interaction Training modified for autism. | FEIT, Hinting Task, SCSQ and SSPA* | Intervention group showed significant improvement in theory of mind & social communication skills. | Small sample size and the quasi-experimental nature of the design where the sample was not randomized. |
| CASE SERIES | ||||||||
| Study | Aim of the study | Design | Inclusion criteria | Sample characteristics | Intervention | Outcome measures | Summary of results | Limitations |
| Eack et al. (29) | To examine the feasibility and potential efficacy of CET in autistic adults. | Feasibility study | ASC diagnosis, cognitive and social disability, IQ ≥80. | n = 14 young autistic adults (12 males 2 females). | CET. 60 hours over 18 months. Individual and group sessions. | CSQ-8, NIMH MATRICS, WCST, CSSCEI, PERT, SCP* | Improvements in cognitive difficulties and social cognition. | Small sample size, limiting generalizability of the results. Gender bias. |
| Hajri et al. (30) | To investigate whether CRT improves cognitive function in autistic children. | Cross-sectional | ASC diagnosis, cognitive difficulties*, on stable dose/type of medication. | n = 16 autistic children, aged 6-21 with regular school curriculum. | Individual CRT 22 sessions (one session per week). | CPM, VSFT, PFT, SF, DST, CARS* | CRT showed significant positive effects on neurocognition. | Small N. No follow-up investigation to determine the long-term persistence of the effect. Does not specify participants gender. |
| Tchanturia et al. (31) | To examine the treatment response of group CRT in anorexia nervosa patients with high or low autistic traits. | Cross-sectional | Adults with a diagnosis of anorexia nervosa. | n = 35 adult inpatients with AN diagnosis. | Group CRT 6 once-weekly sessions. | Motivational ruler, DFlex, patient feedback questionnaire* | No improvements following CRT for patients with high autistic traits. | 23% of participants were only assessed for ASC with self-report questionnaires. |
| Hajri et al. (32) | To evaluate CRT’s effectiveness for autistic children on executive functions, clinical symptoms & education. | Cross-sectional | ASC diagnosis, cognitive difficulties*, on stable dose/type of medication. | n = 16 autistic children and adolescents, aged 6–21 with regular school curriculum. | Individual CRT adapted for young autistic people, once weekly. | CPM, HSCT, ROCF, CARS | Significant improvement in intellectual abilities, executive functions and clinical symptoms following CRT | Small sample size. No control group. Does not specify participants gender. |
| Okuda et al. (33) | To investigate the effectiveness and feasibility of CRT for ASC individuals. | Single-group pilot study | ASC diagnosis, aged 18–50, IQ ≥80. | n =16 female outpatients (4 adolescents and 12 adults). | Individual CRT, 10 sessions (weekly or biweekly). | Brixton, TMT, ST, WCST, ROCF, CFS* | Increase in patient’s central coherence following CRT, but not statistically significant. | Small sample size which results in a lack of power to detect statistical differences. |
| Dandil et al. (34) | To examine the difference in the effects of individual CRT for patients with AN and high autistic features (HAF). | Cross-sectional | Adult females with a diagnosis of AN and completed the AQ-10*. | n = 99 adult female inpatients diagnosed AN. (59 with HAF). | Individual CRT, 10 sessions (weekly or biweekly). | ROCF, Brixton SAT, DFlex* | HAF patients showed improvement in cognitive flexibility but not central coherence. | Participants were only assessed using ASC screening tools and not the full ASC diagnostic measures. |
| SINGLE CASE STUDY | ||||||||
| Study | Aim of the study | Design | Inclusion criteria | Sample characteristics | Intervention | Outcome measures | Summary of results | Limitations |
| Dandil et al. (35) | To investigate the feasibility of individual CRT for a complex single case study of anorexia nervosa (AN) and ASC. | Case study | Diagnosis of ASC and anorexia nervosa. | n = 1 inpatient autistic female aged 21 diagnosed with AN. | Individual CRT 13 sessions (twice a week). | DFlex, ROCF, Motivational ruler, Brixton SAT * | CRT indicated improvements in cognitive flexibility and central coherence. | Single case study, therefore, hard to generalise to a larger population. |
*Diagnosis of ASC = (1, 36, 37), IQ, Intelligence Quotient (38); Cognitive difficulties, The Cognitive Styles and Social Cognition Eligibility Interview (39); AQ-10, The 10-Item Autism Spectrum Quotient (40); Corsi-BTT, The Corsi block tapping task (41); BRIEF, Behavioral Rating Inventory of Executive Functioning (42); SSRT, The stop-signal reaction time (43); N-back task (44, 45), Gender-emotion switch-task (46). BACS-J, The Brief Assessment of Cognition in Schizophrenia- Japanese version (47); CPT, Continuous Performance Test (48); SCoRS-J, Schizophrenia Cognition Rating Scale-Japanese version (48); LASMI, Life Assessment Scale for the Mentally Ill (49); MCCB, MATRICS Consensus Cognitive Battery (50); MSCEIT, The Mayer–Salovey–Caruso Emotional Intelligence Test (51); CAM, Cambridge Mindreading Face-Voice Battery (52); RME, Reading the Mind in the Eyes (53); RMV, Reading the Mind in the Voice task (54); RMF, Reading the mind in the films (55); FEIT, The Face Emotion Identification Test (56); The Hinting Task (57); SCSQ, Social Communication Skills Questionnaire (58); SSPA, Social Skills Performance Assessment (59); CSQ-8, Client Satisfaction Questionnaire-8 (60); NIMH MATRICS, Consensus Cognitive Battery (50); WCST, Wisconsin Card Sorting Test (61); CSSCEI, Cognitive Style and Social Cognition Eligibility Interview (39); PERT, Penn Emotion Recognition Test-40 (62); PEDT, Penn Emotion Discrimination Task (63); PEAT, Penn Emotional Acuity Test (64); SCS, the Social Cognition Profile (39); CPM, Raven Progressive Matrices (CPM); (65); VSFT, Verbal and Semantic Fluency Tests (66); PFT, phonemic fluency task (67); SF, Semantic Fluency (68); DST, Digit-span task (69); CARS, Childhood autism rating scale (70, 71); HSCT, Hayling Sentence Completion Task (72); TMT, Trail making test (73); ST, Stroop Test (74); CFS, Cognitive Flexibility Scale (75); DFlex, The Detail and Flexibility Questionnaire (76); ROCF, The Rey–Osterrieth Complex Figure (77); Brixton SAT, The Brixton Spatial Anticipation Test (72).