The first comprehensive, systematic review and meta-analysis of adults with autism shows that despite having an intact IQ, these adults have medium to large impairments in four key social- and non-social cognitive domains: theory of mind, emotion perception and knowledge, processing speed, and verbal learning and memory.
The results may help create a roadmap for treating autism in adults, a population that is less studied and understood than children with the condition.
The meta-analysis was conducted by the Seaver Autism Center for Research and Treatment at the Icahn School of Medicine at Mount Sinai in collaboration with City University London and published Wednesday, January 2, in JAMA Psychiatry.
Autism is characterized by persistent deficits in social communication and social interaction along with restricted, repetitive patterns of behavior, interests, or activities. While autism affects functioning in many domains throughout an individual's lifespan, research and treatment efforts have largely been dedicated to children. A critical question that has remained largely unaddressed is whether there are cognitive domains that are more severely impaired than others. Despite the efforts of individual studies to increase the understanding of cognitive deficits in adults with autism, sample sizes were often small, yielding inconsistent findings.
To directly compare the relative severity of impairments across cognitive domains in adults, Mount Sinai researchers aggregated all available autism literature and conducted a systematic review and analysis. Specifically, researchers from the Seaver Autism Center conducted a systematic review and meta-analysis of autism-related studies published in the PubMed, PsychINFO, EMBASE, and MEDLINE databases between 1980 (first inclusion of autism diagnosis in the DSM-III (The Diagnostic and Statistical Manual of Mental Disorders) and July 2018. Studies were included if they were published as a primary peer-reviewed research paper in English, included individuals with autism aged 16 or over, and assessed at least one domain of neurocognitive functioning or social cognition using standard measures. The meta-analysis included 75 studies and a combined sample of 3,361 individuals with autism and 5,344 neurotypical adults.
"Our findings have important implications for cognitive interventions in adults with autism. Current interventions for these individuals are primarily focused on improving individual adaptive social skills and social functioning," says Tjasa Velikonja, PhD, a postdoctoral research fellow at the Seaver Autism Center and first author of the paper. "While our results support the key social cognitive theories of autism treatments, they also highlight the importance of a broader approach when studying cognition and support interventions that also include non-social cognitive domains."
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The study was funded by the Beatrice and Samuel A. Seaver Foundation, the Netherland Organization for Scientific Research and the Brain and Behavior Foundation.
About the Seaver Autism Center for Research and Treatment at Mount Sinai?
The Seaver Autism Center for Research and Treatment at Mount Sinai conducts progressive research studies aimed at understanding the multiple causes of autism spectrum disorder (ASD). The multidisciplinary team is composed of experts in the fields of genetics, molecular biology, model systems, neuroimaging, biomarkers, diagnosis, and experimental therapeutics who are dedicated to discovering the biological causes of ASD. The Center strives to develop innovative diagnostics and treatments for integration into the provision of personalized, comprehensive assessment and care for people with ASD. The Seaver Autism Center was founded through the generous support of the Beatrice and Samuel A. Seaver Foundation. For more information, visit http://www.seaverautismcenter.org.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system encompassing (with the addition of South Nassau Communities Hospital) eight hospital campuses, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.
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Journal
JAMA Psychiatry