Prospective,Blinded Exploratory Evaluation of the PlayWisely Program in Children with Autism Spectrum Disorder

The purpose of the study was to explore a low-cost intervention that targets an increasingly common developmental disorder. The study was a blinded, exploratory evaluation of the PlayWisely program on autism symptoms and essential learning foundation skills (attention, recognition, and memory skills) in children with a diagnosis of autism, autism spectrum disorder (ASD), pervasive developmental disorder – not otherwise specified (PDD-NOS), and Asperger syndrome (AS). Eighteen children, 1 to 10 years of age, were evaluated using the Childhood Autism Rating Scale, Second Edition (CARS2); the PlayWisely Interactive Test of Attention, Recognition, and Memory Skills; Autism Treatment Evaluation Checklist (ATEC), and the Modified Checklist for Autism in Toddlers (M-CHAT). There were significant treatment effects for the PlayWisely measure on the Yellow Sets that examine recognition; Purple Sets that examine brain region agility and early memory skills; Blue Sets that examine phonemic awareness and recognition; and for the Total Sets, with a similar trend toward improvement in the Green Sets that examine perception and Red Sets that examine attention. No other measures reached statistical significance. The results suggest that PlayWisely can improve recognition, brain region agility, phonemic awareness, letter recognition, and early memory skills in ASD. It was observed by the parents, coaches, and study investigators that the children who were less than 3 years of age showed improvements in autism symptoms; however, the group was too small to reach statistical significance. Future studies are needed to see if this intervention can mitigate autism symptoms in very young children with ASD.     

孤独症谱系障碍的遗传基础与神经机制

孤独症谱系障碍(autism spectrum disorder,ASD)是一种神经精神障碍,主要表现为社会交往障碍、交流障碍以及局限性的兴趣和重复刻板的行为模式三个主要核心症状．本文介绍了ASD的遗传基础和神经机制的最新研究进展．ASD具有较高的遗传率,且ASD个体的5-羟色胺和睾丸激素都较高．神经影像学研究发现,ASD个体的杏仁核、扣带回、梭状回、镜像神经元和前额叶等大脑区域在结构和功能上都与正常发育个体存在差异,但在个别区域激活模式的差异方向上仍存在不一致的地方．此外,功能连接的研究结果也证实了ASD个体连接不良的假设．未来的研究应该更多地着眼于如何利用这些基础研究成果为临床上提出有效的治疗和训练方式．     

应用行为分析联合感觉统合训练对孤独症谱系障碍儿童行为、发育、睡眠障碍的影响

摘要 目的：评价应用行为分析（ABA）联合感觉统合训练对孤独症谱系障碍（ASD）儿童行为、发育以及睡眠障碍的影响。方法：选入我院2021年1月~2023年1月收治的ASD儿童62例,随机分为对照组和观察组,各31例。两组均予以ABA疗法,观察组在此基础上接受感觉统合训练。评价两组的行为、发育及睡眠情况等,并进行统计比较。结果：观察组治疗总有效率87.10%,显著高于对照组的61.29%（P＜0.05）;两组治疗后ABC和ATEC量表的各项得分及总分均较治疗前减少,而观察组减少幅度更大,与对照组差异显著（P＜0.05）;与治疗前比较,两组治疗后Gesell量表各项得分明显升高（P＜0.05）,而观察组升高幅度显著大于对照组（P＜0.05）;两组治疗前CSHQ的各项评分及总分无明显差异（P＞0.05）,而治疗后,与对照组相比,观察组CSHQ各项评分及总分均较低（P＜0.05）。结论：ABA疗法联合感觉统合训练能够减轻ASD患儿的疾病症状,改善行为状态及睡眠质量,促进患儿发育,提高临床疗效。     

Pet Dogs Improve Family Functioning and Reduce Anxiety in Children with Autism Spectrum Disorder

ABSTRACT

There is increasing evidence to suggest that dogs are beneficial for children with Autism Spectrum Disorder (ASD) in therapy sessions, and anecdotal reports suggest that dogs may have wider benefits, in a family setting. This study investigated the effect of dog ownership on family functioning and child anxiety. Using a validated scale of family strengths and weaknesses (Brief Version of the Family Assessment Measure-III [General Scale]), we compared parents of children with ASD who had recently acquired a pet dog (n=42, Intervention group) with a similar group of parents not acquiring a dog (n=28, Control group) at matched time points. A sub-population (n =14 acquiring a dog, n=26 controls) completed a parental-report measure of child anxiety (Spence Children's Anxiety Scale). The primary carer completed the scales via telephone at Baseline (up to 17 weeks before acquiring a dog), Post-intervention (3–10 weeks after acquisition), and Follow-up (25–40 weeks after acquisition). Over time, scores for family functioning showed significant improvements (reduced family weaknesses, increased strengths) in the dog-owning compared with the non-dog owning group. In comparison with the non-dog owning group, anxiety scores in the dog-owning group reduced by a greater percentage, most notably in the domains of Obsessive Compulsive Disorder (26% greater decrease), Panic Attack and Agoraphobia (24%), Social Phobia (22%), and Separation Anxiety (22%). The results illustrate the potential of pet dogs to improve whole family functioning and child anxiety.     

Toward Innovative,Cost-Effective,and Systemic Solutions to Improve Outcomes and Well-Being of Military Families Affected by Autism Spectrum Disorder

The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit.     

孤独症谱系障碍儿童早期神经发育水平和智能特征分析

目的:探讨孤独症谱系障碍(Autism spectrum disorder,ASD)儿童早期神经发育水平及智能分区特征,为提高ASD的早期识别和诊断提供理论依据.方法:运用Gesell发育评估量表对18月龄至48月龄以内的27例ASD患儿和30例发育迟缓(Mental retardation,MR)患儿的发育商(Dev...     

孤独症谱系障碍儿童听觉脑干反应特征分析

摘要 目的：探讨孤独症谱系障碍(autism spectrum disorder,ASD)儿童听觉脑干反应(auditory brainstem response,ABR)各波潜伏期和波间期特征与ASD行为表型间的关联。方法：对2019年7月-2020年12月来我科就诊的26例明确诊断的2~6岁ASD儿童的患儿进行声导抗,听性脑干反应,畸变产物耳声发射及多频稳态听觉诱发电位测试,以38例正常儿童为对照组,进行同样的测试,并对其测试结果进行统计分析。分析ASD儿童左右耳各波潜伏期,波间期特征及与ASD临床表型的关联。结果：ASD儿童左右耳Ⅰ,Ⅲ,Ⅴ波潜伏期分别为(1.42±0.09)ms,(3.67±0.09)ms,(5.65±0.13)ms;(1.45±0.11)ms,(3.69±0.08)ms,(5.62±0.15)ms。ASD组的右耳I,III波的潜伏期均值大于正常组 (P 值均＜0.05);ASD儿童两组间左耳III-V,右耳III-V,右耳I-V的波间期分别是(1.97±0.07)ms,(1.93±0.10)ms,(4.15±0.14)ms;ASD组的左耳III-V,右耳III-V,右耳I-V波间期均小于正常组(P 值均＜0.05);ASD组中小于等于3岁组与大于3岁组间ABR波间期差异不具有统计学意义。关联性分析发现,ASD儿童语言能力与右耳III波潜伏期,右耳最小阈值V波潜伏期负相关;社会行为能力与右耳I-III波间期负相关;社会生活能力与左耳最小阈值V波潜伏期负相关;而ABC评分与ASD儿童右耳III波潜伏期,左耳I-III波间期,右耳I-III波间期正相关。结论：ASD儿童存在异常的听觉脑干反应特征,且异常程度与 ASD 儿童语言,社会行为能力,社会生活能力的严重程度存在明显关联。     

Marble Burying and Nestlet Shredding as Tests of Repetitive,Compulsive-like Behaviors in Mice

Obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASD) are serious and debilitating psychiatric conditions and each constitutes a significant public health concern, particularly in children. Both of these conditions are highlighted by the repeated expression of meaningless behaviors. Individuals with OCD often show checking, frequent hand washing, and counting. Children with ASDs also engage in repetitive tapping, arm or hand flapping, and rocking. These behaviors can vary widely in intensity and frequency of expression. More intense forms of repetitive behaviors can even result in injury (e.g. excessive grooming, hand washing, and self-stimulation). These behaviors are therefore very disruptive and make normal social discourse difficult. Treatment options for repetitive behaviors in OCD and ASDs are somewhat limited and there is great interest in developing more effective therapies for each condition. Numerous animal models for evaluating compulsive-like behaviors have been developed over the past three decades. Perhaps the animal models with the greatest validity and ease of use are the marble burying test and the nestlet shredding test. Both tests take advantage of the fact that the target behaviors occur spontaneously in mice. In the marble burying test, 20 marbles are arrayed on the surface of clean bedding. The number of marbles buried in a 30 min session is scored by investigators blind to the treatment or status of the subjects. In the nestlet shredding test, a nestlet comprised of pulped cotton fiber is preweighed and placed on top of cage bedding and the amount of the nestlet remaining intact after a 30 min test session is determined. Presently, we describe protocols for and show movie documentation of marble burying and nestlet shredding. Both tests are easily and accurately scored and each is sensitive to small changes in the expression of compulsive-like behaviors that result from genetic manipulations, disease, or head injury.     

感觉统合训练结合常规康复训练对痉挛型脑瘫患儿平衡控制及运动功能的影响

目的:探讨感觉统合训练结合常规康复训练对痉挛型脑瘫患儿平衡控制及运动功能的影响。方法:选取2016年1月到2017年12月期间成都市妇女儿童中心医院康复科收治的痉挛型脑瘫患儿80例为研究对象,根据随机数字表法将80例患儿分为对照组(40例)和观察组(40例)。对照组患儿采用常规康复训练进行治疗,观察组患儿采用感觉统合训练结合常规康复训练进行治疗。比较两组脑瘫患儿的平衡控制功能、步态、粗大运动功能测试量表-88(GMFM-88)D区和E区的评分。结果:治疗3个月后两组患儿的Rivermead活动指数、Berg平衡量表得分均明显升高,且观察组患儿的Rivermead活动指数、Berg平衡量表得分高于对照组(P0.05)。治疗3个月后两组患儿的步行足长、步速明显增加,步宽明显减小(P0.05),且观察组患儿步行足长、步速大于对照组,步宽小于对照组(P0.05)。治疗3个月后两组患儿的GMFM-88 D区、GMFM-88 E区得分均分别明显升高(P0.05),且观察组患儿的GMFM-88 D区、GMFM-88 E区得分均分别高于对照组(P0.05)。结论:感觉统合训练结合常规康复训练可有效改善痉挛型脑瘫患儿的平衡控制功能、步态以及粗大运动功能。     

调任通督针刺法联合感觉统合训练对注意缺陷多动障碍患儿注意力和脑动脉血流速度的影响

摘要 目的：观察感觉统合训练联合调任通督针刺法对注意缺陷多动障碍（ADHD）患儿注意力和脑动脉血流速度的影响。方法：纳入东莞市中医院2020年1月到2021年1月期间收治的ADHD患儿100例,入组患儿按门诊号单双数分为对照组（单数,感觉统合训练）和研究组（双数,调任通督针刺法联合感觉统合训练）,各为50例,两组患儿均干预3个月。观察并对比两组疗效、中医证候总积分、注意力、脑动脉血流速度、Conners父母评症状量表（PSQ）、联合型瑞文测验 (CRT) 评分。结果：研究组的临床总有效率明显高于对照组（P<0.05）。干预3个月后,两组注意力情况：错误数、漏报数较干预前减少,反应时间较干预前缩短,且研究组的变化程度大于对照组（P<0.05）。研究组患儿干预3个月后双侧中动脉（MCA）、前动脉（ACA）、后动脉（PCA）的血流速度均较干预前增快,且高于同时期的对照组患儿（P＜0.05）。干预3个月后,两组PSQ评分、中医证候总积分下降,CRT评分升高,且研究组的变化程度大于对照组（P<0.05）。结论：调任通督针刺法联合感觉统合训练可有效改善ADHD患儿注意力,促进临床症状改善,调节脑血流速度,临床应用价值较好。