Effects of Cognitive Training Programs on Executive Function in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review

Abstract

Background. Autism Spectrum Disorder is often associated with deficits in executive functions (EFs), which is contributing significantly to individuals with ASD’s difficulties in conducting an independent life, particularly considering social skills. Technologies offer promising opportunities to structure EF intervention programs for children on the autistic spectrum. Methods. This study aimed to review the effectiveness of randomized controlled trials or quasi-experimental studies of EF interventions delivered to children and young people (up to 23 years old) with a diagnosis of ASD. A special focus was dedicated to document the effectiveness of computerized and non-computerized cognitive training on (1) EFs and on (2) ASD symptomatology and social skills. Of 2601 studies retrieved, 19 fulfilled the inclusion criteria. Results. Most of the interventions identified were effective in enhancing EFs and reducing symptoms in children and young people with ASD. Limited evidence is available on their generalization to untrained skills (i.e., social abilities) as well as long-term effects. Conclusions. There is growing evidence for overall effectiveness of EF training, particularly when computerized. However, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and a small samples of included studies.

Cognitive deficits in children with autism spectrum disorders: Toward an integrative approach combining social and non-social cognition

“…Another interesting recent systematic review carried out by Pasqualotto et al in 2021 investigated the effectiveness of EF studies in children and young people (up to 23) with ASD ( 12 ). Nineteen studies were included, involving either computerized or non-computerized trainings.…”

“…A large body of evidence has supported the association between executive processes and social cognition abilities ( 12 ). The latter require, among other factors, self-mentoring skills and response initiation, which are impaired in patients with ASD ( 30 ).…”

“…Although CR studies in children and adolescents with ASD are still new, the available evidence suggests that it could be a potential efficient approach ( 12 ). Research studies involving CR interventions targeting both neurocognitive and social cognition are lacking.…”

What Underlies Autism Spectrum Disorder?

“…There are basically 3 main hypotheses that have been elaborated so far to explain the core symptoms of autism: each of them helps to interpret some of the symptoms that characterize this condition, but not all. Here the reference is made to the possible dysfunction of the theory of mind, 8 , 9 of the executive functions, 10 , 11 and of the central coherence. 12 , 13 …”

“…Executive functions, therefore, appear to be widely involved in social cognition skills and adaptive behavior, and their impairments may explain some autism core features. 10 , 11 …”