Impairments in social cognition and social functioning are defining features of autism (American Psychiatric Association 2000
; Baron-Cohen and Wheelwright 2003
; Orsmond et al. 2004
). Social-cognitive deficits include difficulties with emotion perception and theory-of-mind (ToM), whereas social functioning deficits include problems interacting with others and developing positive social relationships. Such impairments emerge during early childhood and persist into adulthood, even for those with high-functioning autism (HFA), which includes individuals with Asperger syndrome, autism, or PDD-NOS with average intellectual ability. Individuals with HFA often desire social contact with peers, yet have poor friendships due to limited social-emotional understanding. This difference between social interests and skills often leads to social isolation, social rejection, and increased loneliness (Bauminger and Kasari 1999
; Orsmond et al. 2004
Adaptive social skills are impaired relative to cognitive skills in adults with HFA (Klin et al. 2006
). In other words, social deficits outweigh cognitive deficits, implying that “high functioning” in cognitive terms does not equate with “high functioning” in social terms. This discrepancy between cognitive and social skills may affect the ability of adults with HFA to secure employment and live independently (Klin et al. 2006
; Tantam 1991
). Clearly, adults with HFA would benefit from an intervention that directly targets social-cognitive functioning by teaching skills needed to build positive social relationships.
Interventions that target social cognition and social skills in autism have shown positive, but often limited, effects (Bauminger 2002
; Gevers et al. 2006
; Hadwin et al. 1996
; Ozonoff and Miller 1995
). These studies have utilized a variety of techniques, including cognitive behavior therapy, video modeling, and peer modeling to teach a range of social cognitive and social interaction skills. In general, participants have been children or adolescents, and results have indicated improvements in specific targeted areas, with little generalization of skills outside the therapy setting. These interventions include three group therapy programs (Bauminger 2007
; Hadwin et al. 1997
; Ozonoff and Miller 1995
). Both Hadwin et al. and Ozonoff and Miller targeted specific components of social cognition (e.g., theory of mind or emotion recognition) in addition to social skills. Bauminger (2007)
recently tested a group intervention that targets several components of social cognition. However, this intervention includes a year of group intervention that follows a year of individual intervention. While these programs are promising for targeting social cognition and skill, none has included adult participants. Thus, little research has directly targeted social cognition and “real-world” social-functioning in adults with HFA.
Social Cognition and Interaction Training (SCIT; Roberts et al. 2004
), is a group intervention that was originally designed for adults with psychotic disorders to improve social cognition, social skills, and community functioning (Couture et al. 2006
). This program targets several components of social cognition, including emotion recognition, theory of mind, and attributions as well as social interaction skills. In a pilot study, Penn et al. (2005)
found that SCIT was associated with improved performance in ToM and attributional style in a sample of inpatients with psychosis. Combs et al. (2007)
demonstrated that individuals with psychosis who received SCIT showed greater improvement in emotion perception, ToM, attributions, and social functioning than individuals who participated in a coping skills group.
SCIT may be a useful starting point for adapting a treatment for autism. Individuals with schizophrenia and those with autism have similarities with respect to social-cognitive functioning (Couture et al. 2005
), visual scanpaths (Sasson et al. 2007
), and neural activation during social cognitive tasks (Pinkham et al. in press
). Specifically, Couture et al. (2005)
found no differences between these two groups on measures of emotion perception and theory of mind. Recently, Pinkham et al. (in press)
found that individuals with HFA and those with paranoid schizophrenia showed similar patterns of neural activations while rating the “trustworthiness” of faces. Finally, Sasson et al. (2007)
found similarities between visual scanpaths when viewing social scenes and identifying emotions displayed between the two groups. These similarities in social-cognitive functioning between individuals with autism and schizophrenia, combined with the success of the SCIT for use with individuals with schizophrenia, suggest that SCIT may be a valuable tool to treat social-cognitive deficits in high-functioning adults with autism.
The goal of this study was to examine the feasibility of a version of SCIT modified for individuals with autism (coined “SCIT-A”) for adults with HFA, and to investigate its impact on social-cognition and social functioning relative to treatment as usual (TAU). We hypothesized that individuals who received SCIT-A would show greater improvements in social cognition and social functioning relative to individuals who received TAU.