The autistic people Shaun Eack works with are often described as high functioning.
But that doesn't mean their lives are as fulfilling as they would like them to be. Half of them are unemployed, and the other half are underemployed, based on the kinds of jobs they should be able to hold, given their intellectual skills.
Many of them still live at home, dependent on their families for day-to-day support.
That is why the social work professor at the University of Pittsburgh is passionate about a new form of therapy that he thinks could help them move closer to normal thinking and social interaction.
Known as cognitive enhancement therapy, or CET, the technique was pioneered by Pitt researcher Gerard Hogarty for use with schizophrenia patients. It has shown documented improvement in test scores for that group, and now it is showing equally impressive early results in autistic individuals.
The CET approach combines computer exercises with group sessions involving six to eight people to work both on cognitive deficits and social impairments.
While the trial group for the therapy had above average intelligence scores, they also showed some thinking difficulties that are common in autism.
One stumbling block is slow processing speed. In social situations, where most of us make almost instantaneous interpretations of other people's facial expressions, body language and the social meanings of what is said, the slower reactions of autistic people can mark them as socially awkward.
If an autistic person is slow to react to a question, it can create an awkward pause; and if he can't detect when people's interest is flagging, he may talk on and on about his favorite topic.
To work on that issue, CET's computer exercises will train people to respond to a symbol when it appears on the screen by hitting the space bar, and give them feedback to help them speed up their reactions.
Another cognitive deficit for autistic people is a lack of flexibility.
One CET exercise dealing with that issue asks pairs of autistic people to put names of animals in two different categories, such as types of animals and what continent they live on. The therapists then ask them to put the same words into three categories, "and typically, they're like, 'But there's two categories. What do you mean three?' Rigidity is a big issue in autism spectrum disorders," the Pitt researcher said.
Social interactions are at the heart of CET's group sessions.
In one exercise, a participant is asked to compose an announcement of no more than 10 words telling his father that he has left his wallet at an airport restaurant. This grapples with two central issues in autism: difficulty being succinct, and trouble knowing how other people would hear a message.
"A lot of our folks have trouble with organization, and are often too verbose when talking," he said. "At the same time they have to be aware of the social context, so there are things you might not want to announce, such as the fact that there's a wallet at the restaurant."
Another major issue in group sessions is managing emotions.
He said many people with autism have an on-off switch for sensing their emotions. "What we've noticed with this group is that people have a real lack of awareness of their own emotions until suddenly, they become very aware. For them, it's like all of a sudden they're in meltdown mode.
"Autistic people are more sensitive to stress than you or I, and so, while missing the first bus is mildly stressful to us, it's a show-stopper for the day for people with autism."
After Pittsburgh went through a mild earthquake last year, he recalled, therapists had to send many of the autistic group members home because they were so upset.
The CET sessions train people to become more attuned to the early signs of emotional distress and to manage their reactions to things that upset them.
A pilot study of the CET technique with 14 young adults with autism showed significant improvement in tests on thinking ability and social awareness, and so far, a much larger trial comparing CET with a control group is seeing similar gains.
Patricia Howlin, a psychology professor at King's College London who is an expert on adults with autism, said that the experiments that are under way to compare CET to results in a control group will be vital to proving it is effective, but "there are so few interventions focused on adults that any research of this kind is to be welcomed."
Working as closely as he has with autistic adults has sensitized the Pitt professor's personal radar to signs of the disorder, and he can now more easily spot autistic tendencies in people he meets in public.
One group in which he has noticed those behaviors are some of the parents and other relatives of the people in his studies.
"Almost all of these [autistic] adults come here with their families, who are wonderful, supportive people, and many of them don't have a diagnosis, but when you talk to them, you can see aspects of the autism spectrum that have affected them personally, too.
"I am also routinely at Carnegie Mellon University and work with all kinds of people over there, and the autism spectrum is something that pops up a lot" when he observes professors and students there. "I think truly it is underrecognized in a lot of people."
He doesn't expect miracles from the CET approach, but he does think it could substantially improve the lives of autistic people.
"I wouldn't expect that the goal for many of our people would be to get them competitive employment; it would be to get them secure housing in an environment they feel comfortable in, that is not institutional, that allows them to be as much a part of the community as they are capable of.
"By all indications, it looks like CET is going to be an important part of that."
Mark Roth: email@example.com or 412-263-1130. Twitter @markomar. First Published October 8, 2013 8:00 PM