Neuroplasticity-Based Targeted Cognitive Training as Enhancement to Social Skills Program: A Randomized Controlled Trial Investigating a Novel Digital Application for Autistic Adolescents

Objective: Few evidence-based social cognitive interventions are available to autistic youth as they navigate their complex, socially demanding teenage years. Building from pilot research using neuroplasticity-based targeted cognitive training, CICADAS (Care Improving Cognition for ADolescents on the Autism Spectrum), a digital application (app) designed to prime the brain for socio-affective learning, was developed. In a randomized active-controlled trial with 3 comparison arms, CICADAS was evaluated as a stand-alone program and as an augmentation to evidence-based PEERS (Program for the Education and Enrichment of Relationship Skills). Method: Recruiting from clinics providing PEERS, 62 adolescents (11-18 years old) with confirmed autism were enrolled. Adolescents scheduled to start PEERS were assigned using block randomization to PEERS + CICADAS (n = 22) and PEERS + Active Control (n = 21) groups. A third comparison group (n = 19) comprised adolescents who used the app as a stand-alone intervention (CICADAS only). In addition to in-app performance metrics, data were collected from social, behavioral, and cognitive assessments (self-report/parent-report measures) at preintervention (baseline), postintervention (16 weeks), and follow-up (32 weeks) sessions. Results: Significant effects of group, time, and group × time interaction were found on multiple measures collected longitudinally. For example, on the Pediatric Quality of Life Inventory, PEERS + CICADAS participants showed significant psychosocial health improvements (F = 6.862, p = .002) over the study timeline compared with trend level gains in the CICADAS only (F = 2.150, p = .122) and PEERS + Active Control (F = 1.917, p = .153) groups. Whereas all participants improved from baseline on the Social Responsiveness Scale, 2nd Edition (F = 11.038, p < .001), only the PEERS + CICADAS group gained significantly (F = 3.786, p = .026) on the social cognition subscale across all 3 time points. Conclusion: Our data demonstrate the potential of CICADAS as a stand-alone intervention and suggest that engaging with the adaptive app (vs static active control) conferred an additional advantage to autistic teens participating in PEERS. Plain language summary: Youth with autism have few options for social cognitive support. To address this gap, researchers developed Care Improving Cognition for ADolescents on the Autism Spectrum (CICADAS), an adaptive cognitive training app designed to prime the brain for social cognitive learning. This study tested CICADAS by pairing the digital app with the Program for the Education and Enrichment of Relationship Skills (PEERS), one of the few well-established group-based social skills programs. This study of 62 adolescents (11-18 years) with autism compared groups using CICADAS alone, PEERS alone, or the combination. Data collected pre-/post-intervention showed gains from CICADAS used alone, but particularly as an enhancement to PEERS. Results suggest the digital tool may be a useful stand-alone or augmenting program for improving social cognition in youth with autism. Clinical trial registration information: Care Improving Cognition for ADolescents on the Autism Spectrum (CICADAS); https://www.clinicaltrials.gov/study/NCT04562688