Brief report: is cognitive rehabilitation needed in verbal adults with autism? Insights from initial enrollment in a trial of cognitive enhancement therapy.

The team enrolled 28 verbal adults with autism. All had IQ scores in the normal range.

Each adult took a full battery of thinking tests. The tests measured speed, flexibility, and social-cognition.

Even with normal IQ, every adult showed clear deficits. They were slow, rigid, and missed social cues.

The gaps were wide enough that the authors asked, 'Should we add brain training for this group?'

Greene et al. (2019) extend the story. They show gifted autistic kids soar in school when given enrichment and mental-health supports. Together the papers draw one line: high IQ does not protect you from cognitive holes at any age.

Marsack-Topolewski et al. (2025) seem to disagree. They found autistic adults adapt to new speech sounds just like neurotypicals. The clash fades when you see the tasks: speech tweaking is low-level, while M et al. tested higher-order control.

Reed (2023) backs the target. His data show autistic children shift rules slower after verbal hints, matching the flexibility deficit seen here.

If your client talks in full sentences and scores average on IQ, do not assume thinking skills are intact. Screen processing speed, set-shifting, and social reasoning. Add brief drills or apps that target these areas. Pair the training with mental-health check-ins, just like the twice-exceptional kids in Greene et al. (2019). A ten-minute cognitive warm-up could save hours of frustration later.