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

<h2>ABSTRACT</h2><h3>OBJECTIVE</h3> 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 (NB-TCT), we developed CICADAS (Care Improving Cognition for ADolescents on the Autism Spectrum), a digital application designed to prime the brain for socio-affective learning. In a randomized active-controlled trial with 3 comparison arms, we evaluated CICADAS as a stand-alone program and as an augmentation to evidence-based PEERS (Program for the Education and Enrichment of Relationship Skills). <h3>METHOD</h3> Recruiting from clinics delivering PEERS, we enrolled sixty-two adolescents (11-18 years) with confirmed autism. Individuals scheduled to start PEERS were block-randomized into PEERS+CICADAS (N=22) and PEERS+Active Control (N=21) groups. A third comparison group (N=19) comprised individuals who would use the app as a stand-alone intervention (CICADAS-Only). In addition to in-app performance metrics, we collected data from social, behavioral, and cognitive assessments (self-report/parent-report measures) at Pre-Intervention (Baseline), Post-Intervention (16-weeks), and Follow-Up (32-weeks) sessions. <h3>RESULTS</h3> We found significant effects of GROUP, TIME, and GROUP X TIME on multiple measures collected longitudinally. For example, on the Pediatric Quality of Life Inventory, PEERS+CICADAS participants showed significant Psychosocial Health improvements (<i>F=</i>6.862, <i>p=.002</i>) over the study timeline compared to trend-level gains in the CICADAS-Only (<i>F=</i>2.150, <i>p=</i>.122) and PEERS+Active Control (<i>F=</i>1.917, <i>p=</i>.153) groups. While all participants improved from baseline on the Social Responsiveness Scale, 2nd Edition (<i>F=</i>11.038, <i>p<.001</i>), only the PEERS+CICADAS group gained significantly (<i>F=</i>3.786, <i>p=</i>.026) on the Social Cognition subscale across all three time-points. <h3>CONCLUSION</h3> Our data demonstrates the potential of CICADAS as a stand-alone program and suggests that engaging with the adaptive app (versus static Active Control) conferred an additional advantage to autistic teens participating in PEERS.