Personalized approach to cognitive remediation for people with schizophrenia and autism

People with schizophrenia (PSCZ) and autism spectrum disorders (PASD) suffer from cognitive impairment. Cognitive remediation (CR) interventions aim to enhance cognition, but the approach is often not customized to meet the participants' needs. The Neuropsychological Educational Approach to Remediation - Medalia 2002 (NEAR)- enhances intrinsic motivation. Here participants are choosing cognitive goals according to their cognitive profile, and their training is adjusted accordingly. The aims of this study were 1. To demonstrate patient progress with NEAR for schizophrenia and autism 2. To see if adapted cognitive objectives before the NEAR program, with selected cognitive functions, improved specific clinical, functional and neuropsychological outcomes.

Fifty-one PSCZ and 17 PASD performed 30-biweekly-group-sessions with selected goals and pre/post program assessments for symptomatology, autonomy, self-esteem, quality-of-life, apathy, attention, working and verbal memory, and inhibition.

PSCZ improved overall, but PASD only improved for self-esteem, attention, and long-term recall. Within the Total Group (PTG), comparing Trained (T) and Non-trained (NT) showed increased performance: for "speed", in executive and verbal learning; for "attention", in attention, verbal learning and executive functions; for "working memory", in Digit span backward, verbal learning and executive functions; for "verbal learning", in verbal recall, attention and executive functions; for "executive", in attention, verbal learning, executive performances.

Participants with schizophrenia progressed after NEAR in clinical, functional and cognitive aspects, as well as self-esteem, attention and verbal memory dimensions in autism. The good matches between goals and observed change can optimize adherence and satisfaction to this therapy.