Importance Many studies have investigated impairments in cognitive domains in adults with autism spectrum disorder (ASD). Yet, to date, a comprehensive overview on the patterns of cognitive functioning is lacking. Objective To provide an overview of nonsocial and social cognitive functioning in various domains in adults with ASD, allowing for comparison of the severity of deficits between different domains. Data Sources A literature search performed in an academic medical setting was conducted using PubMed, PsycINFO, Embase, and Medline databases with the combination of the following free-text and Medical Subject Headings where applicable: [cogniti* OR neurocogniti* OR neuropsycholog* OR executive function* OR IQ OR intelligence quotient OR social cognition OR emotion perception OR affect perception OR emotion recognition OR attribution OR ToM OR mentalising OR mentalizing OR prosody OR social knowledge OR mind reading OR social cue OR social judgment] AND [autis* OR ASD OR Asperger OR Asperger’s OR PDD OR pervasive developmental disorder]. The search was further limited to studies published between 1980 (first inclusion of autism diagnosis in theDSM-III) and July 2018. Study Selection Studies included were published as a primary peer-reviewed research article in English, included individuals with ASD 16 years or older, and assessed at least 1 domain of neurocognitive functioning or social cognition using standard measures. Data Extraction and Synthesis Of 9892 articles identified and screened, 75 met the inclusion criteria for the systematic review and meta-analysis. Main Outcomes and Measures Hedgesgeffect sizes were computed, and random-effects models were used for all analyses. Moderators of between-study variability in effect sizes were assessed using meta-regressions. Results The systematic review and meta-analysis included 75 studies, with a combined sample of 3361 individuals with ASD (mean [SD] age, 32.0 [9.3] years; 75.9% male) and 5344 neurotypical adults (mean [SD] age, 32.3 [9.1] years; 70.1% male). Adults with ASD showed large impairments in theory of mind (g = −1.09; 95% CI, −1.25 to −0.92; number of studies = 39) and emotion perception and processing (g = −0.80; 95% CI, −1.04 to −0.55; n = 18), followed by medium impairments in processing speed (g = −0.61; 95% CI, −0.83 to −0.38; n = 21) and verbal learning and memory (g = −0.55; 95% CI, −0.86 to −0.25; n = 12). The least altered cognitive domains were attention and vigilance (g = −0.30; 95% CI, −0.81 to 0.21; n = 5) and working memory (g = −0.23; 95% CI, −0.47 to 0.01; n = 19). Meta-regressions confirmed robustness of the results. Conclusions and Relevance Results of this systematic review and meta-analysis suggest that adults with ASD show impairments in social cognitive domains and in specific nonsocial cognitive domains. These findings contribute to the understanding of the patterns of cognitive functioning in adults with ASD and may assist in the identification of targets for cognitive interventions.

Cognitive impairment is a central feature of schizophrenia and is associated with poor social and vocational outcomes.^1,2 Prospective studies demonstrate that cognitive deficits predate psychosis onset.^3-5 Ultrahigh-risk and first-episode psychosis studies find that in the short term, levels of cognitive dysfunction are stable or improving.^6-13 However, systematic evidence on the long-term cognitive outcome in first-episode psychosis is very limited.¹⁴ Several studies followed up first-episode psychosis cohorts for 10 years and mostly found stable cognitive performance.^15-18 Others reported declines in at least some cognitive functions.^17,19 Long-term outcomes may be different, and longer-term studies are needed to determine whether cognitive impairment in psychotic disorders is indeed progressive.

Background: There is an increasing interest in cognitive–behavioural therapy (CBT) interventions targeting negative symptoms in schizophrenia. To date, CBT trials primarily focused on positive symptoms and investigated change in negative symptoms only as a secondary outcome. To enhance insight into factors contributing to improvement of negative symptoms, and to identify subgroups of patients that may benefit most from CBT directed at ameliorating negative symptoms, we reviewed all available evidence on these outcomes.Method: A systematic search of the literature was conducted in PsychInfo, PubMed and the Cochrane register to identify randomized controlled trials reporting on the impact of CBT interventions on negative symptoms in schizophrenia. Random-effects meta-analyses were performed on end-of-treatment, short-term and long-term changes in negative symptoms.Results: A total of 35 publications covering 30 trials in 2312 patients, published between 1993 and 2013, were included. Our results showed studies’ pooled effect on symptom alleviation to be small [Hedges’ g = 0.093, 95% confidence interval (CI) −0.028 to 0.214, p = 0.130] and heterogeneous (Q = 73.067, degrees of freedom = 29, p < 0.001, τ² = 0.081, I² = 60.31) in studies with negative symptoms as a secondary outcome. Similar results were found for studies focused on negative symptom reduction (Hedges’ g = 0.157, 95% CI −0.10 to 0.409, p = 0.225). Meta-regression revealed that stronger treatment effects were associated with earlier year of publication, lower study quality and with CBT provided individually (as compared with group-based).Conclusions: The co-occurring beneficial effect of conventional CBT on negative symptoms found in older studies was not supported by more recent studies. It is now necessary to further disentangle effective treatment ingredients of older studies in order to guide the development of future CBT interventions aimed at negative symptom reduction.