Computer based training of executive functions in children with an autism spectrum disorder.

There is an urgent need for effective interventions for children with autism.
As for now, most intervention studies in autism focus directly on teaching of
social and communicative skills, but are unsuccessful (Charman & Howlin, 2003).
Training fundamental abilities such as executive functions (EF) might be
susceptible for success. In developmental disorders related to autism,
attention deficit/hyperactivity disorder (AD/HD) in particular, executive
function interventions have been shown to generalize to domains that were not
specifically targeted during the intervention (Klingberg et al., 2005; Prins et
al., 2008). The current proposal concerns a randomized clinical trial to study
the efficacy of two executive function interventions, working memory training
and a cognitive flexibility training, in children with autism.

The objective of the study is to improve the trained as wel as other executieve
functions. Also the aim of this study is that these functions will improve in
everyday life and generalize to other domains, resulting in improvement in
behavior, decrease of symptoms and improvement in quality of life.

Children will be tested on 4 testing sessions. While the children are tested,
the parent will be interviewed or asked to fill out questionnaires.
The first testing session (T1) a short intelligence measurement and a theory of
mind (ToM) task will be adminstered to the children. The Autisme Diagnostic
Interview Revised (ADI-R) will be administered to parents. The ADI-R will be
administered to confirm the Autism Spectrum Disorder (ASD) diagnosis.
In testing session 2 (T2), 3 (T3), and 4 (T4) the children will perform EF
tasks on the computer and the parent will fill out questionnaires. The training
will take place between sessions 2 and 3. The EF tasks are all
neuropsychological tasks to measure WM, CogF and respons inhibition with good
validity. These tasks will be adapted to make them more attractive to
children. The parent's questionnaires include different aspects of behavior
(executive functioning, behavioral problems, social behavior, quality of life).
T4 will take place 6 weeks after finnishing the training.

In short, 102 children with autism, 8 to 12 years of age, and an estimated IQ
above 80 will participate in a randomized controlled clinical trial. Children
will be randomly assigned to one of three different conditions; WM training,
CogF training or no training. The children will play the game, in which these
training conditions are embedded. The total number of training sessions is 25,
with a fixed duration of 40 minutes each session. Children are asked to play
the game 4-5 times a week for a period of 6 successive weeks, until they have
finished all sessions. During each session the participants play the computer
game which contains several levels of difficulty. In each session there are two
training blocks for each EF. In the Working Memory (WM) training condition, the
WM will be trained twice each session, for about 5 minutes each block (10
minutes per session). The training blocks will adapt in difficulty to
performance of the child, so that each training block will be somewhat more
difficult than the former and WM is actually being trained. The Cognitive
flexibility (CogF) training will have a similar set up and duration as the WM
training, provided that CogF is being trained. The non-EF training is similar
to the WM and CogF training, but the training blocks will be replaced by non-EF
tasks. These tasks will be similar to the EF training tasks, but the EF
training element is now excluded; the level is and will remain very low, so no
EF is actually being trained. This condition will however apply to fastness of
reaction, attention and concentration.

Four testing sessions (with an avarage of 70 minutes per session) for parents
and child. 6 weeks of training, 25 sessions taking 40 minutes each (avarage of
4 times a week). There are no risks.