The unmet need for CRT in children on the autism spectrum: A Zambian perspective

by Bained Nyirongo, Med Special Needs Education, National Sign language coordinator, Lecturer, and PhD research fellow at The University of Zambia

Children on the autism spectrum commonly display impulsive behaviours that negatively affect their academic performance and general quality of life. For instance, parents avoid going shopping with their children on the autism spectrum because they fear that the child will react impulsively and pick up items that are not within the family’s budget, attracting unwelcome attention from others. This behaviour lowers parental self-esteem and is considered embarrassing by many of them.

However, in my home country of Zambia, there is a paucity of evidence-based interventions to help children on the autism spectrum establish inhibitory control skills. There is considerable evidence that cognitive remediation therapy (CRT) is effective in promoting cognitive skills in adults with severe mental health conditions. CRT has also already been tested on African soil - in Tunisia - with neurodiverse children. This sparked my motivation to gain an understanding of CRT with the aim of implementing this intervention with autistic children in the Zambian context.

I enrolled on a CIRCuiTS™ CRT training course at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. The training, which takes place in a virtual “Village”, was motivating and engaging. This is because CIRCuiTS™ makes cognitive task practice relevant to the environments in which children play on a daily basis. It is also contextual and culturally appropriate for children.

The next step was to plan a study to investigate whether providing CRT to school-going children on the autism spectrum will help them to manage their impulsive behaviour and improve their thinking skills. In my current study, I am proposing that CRT will be able to improve inhibition skills in children on the autism spectrum in Zambia. This will be a new interventional approach for such children in Zambian schools.

To test the effectiveness of CRT for children on the autism spectrum, the study will take the following steps:

1. All children in special units and grade three classes will undergo autism screening and assessment by a clinician (a medical doctor)

2. All children identified as being on the autism spectrum will be offered 10 weeks of CRT.

3. The child’s class teacher, parents, clinician and myself will work together to support the delivery of CRT.

4. The children will be assessed before and after CRT with measures of executive function and adaptive functioning skills.

5. Lastly, I will collect parents’/caregivers’ perceptions on CRT as an intervention for improving executive function, particularly inhibitory control skills, in children on the autism spectrum.

I will focus primarily on the following outcomes to determine the effectiveness of CRT in children on the autism spectrum:

1. Improvement in executive function, particularly inhibition skills, by using the inhibitory version of the pencil tapping task before and after exposure to CRT.

2. Improvement in adaptive functioning skills as measured with the adaptive functioning skills test, which will be administered to the children before and after exposure to CRT.

3. A comparison of the pre-test and post-test results to establish whether there is a statistically significant difference in inhibition and adaptive functioning skills in children on the spectrum.

I strongly believe that CRT will help these children improve both their response inhibition and thinking skills. In turn, this may enhance their daily quality of life because, as we know, the ability to regulate behaviour and think clearly is essential for living a fulfilling and productive life.

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