Adaptation of the NEAR Cognitive Remediation Method to Child and Adult Autism by Including Social Scenarios and Skills

Study Overview
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Brief Summary
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The investigators currently provide the NEAR method (neuropsychological educational approach to cognitive remediation) for people with neurocognitive difficulties, without distinguishing between ASD and schizophrenia. However, the NEAR method does not address social cognition in the stimulated functions. The aim of this study is to add social scenarios to this neurocognitive method in order to improve not only neurocognitive functions, but also social cognition. Thus, NEAR would be in this adapted form a method that could be completely adapted to autism spectrum disorders in preadolescents and adults. The study will include participants aged 13-40 years, with a diagnosis of ASD. The NEAR TSA method will include 32 sessions: one session (90-120 min, with one or two breaks) per week for 32 weeks (8 months), for minor participants. two sessions (90 minutes each, with no breaks) per week for 16 weeks (4 months), for adult participants. The method includes 30 minutes of computerized exercises, 15 minutes of discussion on the exercises performed and the strategies applied, and the rest of the time for bridging groups. Three evaluation are proposed: an initial clinical and functional evaluation (T1), before the beginning of the program, a second clinical, functional and neuropsychological evaluation (T2), within one month since the end of the program a third clinical, functional and neuropsychologica evaluationl (T3), three months after the end of the program.

Detailed Description
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Inclusion age:two samples: 13 to 15 years old and 16 to 40 years old the clinical evaluation (T1,T2, T3) includes: global functional assessment; questionnaires for children and adults including the self esteem questionnaire, quality of life (who_QOL Bref), social responsiveness scale, conversational skills (CCC-2 for children; Pomini Scale for adults), intrinsic motivational scale (Medalia), Satisfaction scale (CSQ8). The Neuropsychological evaluation (T1, T2, T3) includes: WISC5 (children), WAIS 4 (adults), stroop test, D2-R, Child memory scale or Wechsler Memory scale for adults, Brief, color trail test, verbal fluency. Near TSA is a group cognitive remediation method, including one weekly session for children or 2 weekly sessions for adults with 30 mn of neuropsychological exercices, 15 mn of discussion about exercices and strategies, and 30 mn of bridging groups including social scritps.

Official Title
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NEAR-TSA : Adaptation of the NEAR (Neuropsychological and Educational Approach of Cognitive Remediation) Cognitive Remediation Method to Child and Adult Autism by Including Social Scenarios and Skills

Conditions
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Autism Spectrum Disorder

Intervention / Treatment
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* Other: NEAR-TSA


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with a diagnosis Autism Spectrum Disorder (ASD) - (DSM5) Attending one of the outpatient units participating in the research Diagnosis confirmed by the ADI (Autism Diagnostic Interview) with at least one parent present; or by the ADOS (Autism Diagnosis Observation Schedule) Score of at least 7 on the WISC5 (children) or WAIS4 (adults) comprehension subtest Patient whose neuropsychological evaluation shows neurocognitive impairment as assessed by the neuropsychologist Level of comprehension and communication allowing to understand the instructions of the exercises presented on the screen. For children, persons who can attend a non-specialized school If the patient is being treated with a psychotropic drug: stability of treatment for more than one month. Exclusion Criteria: Previously known diagnosis of intellectual disability Misunderstanding of questions or instructions given during the diagnostic interview Proven neurological pathology Persons treated with electroconvulsive therapy within the last 6 months Uncorrected sensory perception disorder Patient participating in another research study with an exclusion period still in progress at inclusion Treatment with daytime anxiolytics, and treatment with anticholinergic correctors Pregnant or breastfeeding woman Participants who have had cognitive remediation in the last two years Specific exclusion criteria for the adult group: - heterogeneous levels of development highlighted in the diagnostic workup including an examination of cognitive functions Specific exclusion criteria for the children group: - out-of-school children

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: NEAR TSA<br>Neuropsychological and Educational Approach of Cognitive Remediation, adapted for autism (NEAR-TSA) | Other: NEAR-TSA<br>* Neuropsychological and Educational Approach of Cognitive Remediation adapted to autism 32 sessions spread over 4 to 8 months (1 session per week for minors, 2 sessions per week for adults), lasting 90 to 120 minutes<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance | number of sessions correctly completed/number of sessions planned | At the end of the intervention (Month 4 for adults participants, Month 8 for minor participants) | 
| Enrollment rate | number of subjects recruited/number of subjects selected | at the end of the inclusion period (up to 24 months after the start of the research) | 
| Retention rate | Number of subjects in post evaluation (T2)) / number of subjects recruited | At T2 (between Mont 4 and Month 5 for adults participants ; between Month 8 and Month 9 for minor participants) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neuropsychological assessment: attentional performance | D2-R test | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 
| Neuropsychological assessment : processing speed | D2 test | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 
| Neuropsychological assessment : flexibility (1) | Color Trail Test (raw score) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the session | 
| Neuropsychological assessment : flexibility (2) | verbal fluency test (raw score and z-score) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the session | 
| Neuropsychological assessment : flexibility (3) | Stroop test (raw score and z-score) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the session | 
| Neuropsychological assessment : working memory | Child memory scale for minor <16 years, Wechsler's memory scale for other participants | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 
| Functional assessment: quality of life | World Health Organization Quality of Life-BREF (WHO QOL-BREF) (26 items rated on a 5-level scale (score from 1 to 5)) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 
| Functional assessment : conversational skills | CCC-2 (Children's Communication Check list) for minors <16 years (Raw Score, Scaled Score, Percentile) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 
| Functional assessment : conversational skills (2) | Pomini's Conversational Skills Scale (1999) for other participants (16 items, score from 0 to 3 for each ; maximum total score : 48) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 
| Functional assessment: self-esteem | Rosenberg's Self-Esteem Scale (10 items, score from 1 to 4 for each - total score between 10 and 40) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 
| Functional assessment: global functioning | Global assessment of functioning scale (total score between 0 and 100) | before the start of the NEAR TSA sessions, within one month of the end of the sessions and 3 to 4 months after the end of the sessions | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Autism Spectrum Disorder, Cognitive remediation, Children, Adults