Thinking flexibly: A cognitive remediation therapy–informed intervention for autistic youth

Autistic people are known to demonstrate greater difficulties with cognitive flexibility. These difficulties are associated with a range of poor outcomes, including elevated rates of anxiety and depression. Current intervention approaches fail to account for these specific mechanisms. In this study, we address this by piloting a new intervention which aims to specifically target cognitive inflexibility. The 'Thinking Flexibly' intervention has been co-designed with autistic youth based on previous work, including cognitive remediation therapy. Twenty autistic adolescents were recruited from clinical services and offered the eight-session intervention. Acceptability was assessed through participant drop-out and session completion. Participants (and their parents) also completed questionnaire measures of cognitive inflexibility, anxiety, depression and functional outcomes before and after the intervention. Our results indicated good acceptability with 19/20 participants completing the intervention and session attendance was high, with a single missed session. We found significant increases in flexibility across both parent- and self-report of a moderate effect. Participants reported significant reductions in symptoms of anxiety and depression. We conclude that 'Thinking Flexibly' is acceptable for use with autistic adolescents and shows promise as a standalone or adjunct therapy. Changes on outcome measures are promising and warrant further investigation in a larger trial.Lay abstractAutistic people often have greater difficulties with flexible thinking when compared to those without autism. People with difficulties in this area often appear to be 'stuck' in their style of thinking or in their way of behaving. This can have a negative impact on several areas of life, including on their mental health. In this study, we developed and tested an intervention designed to help autistic individual think flexibly. We showed that the intervention was acceptable (people were able to attend and complete the intervention) and some improvements in cognitive flexibility and mental health symptoms were reported.