Parents of Children with Autistic Spectrum Disorder (ASD) as Co-therapists: The Therapists’ View

Studies on the evaluation by therapists of parental behavior towards their children with Autistic Spectrum Disorder(ASD)and towards the therapists of their children are scarce.They are necessary,however,for enabling parents to become co-therapists.The present study’s purpose was the evaluation by therapists of the behavior of parents towards their children,of their relationship to therapists,and therapy outcome.The sample consisted of 178 parents of 89 children(72 boys)with ASD,who underwent intensive early intervention at a day centre for developmental disabilities.The professional team completed a questionnaire,separately for the mother and father,evaluating the parental attitude towards their children and towards the therapists.The behavior of parents was less satisfactory than expected.The fathers had difficulties in understanding their child’s problems,and had unrealistic expectations;mothers’behavior towards their children and therapists was better than the fathers’.Mothers had difficulty mostly in the management of the child’s behavior,and did not do well with feeding.It might be difficult for every parent to become co-therapist.Understanding the child’s difficulties by the mother,adequate handling of feeding and homework,were statistically significant in the good outcome of therapy.

Auditory symptoms and autistic spectrum disorder:A scoping review and recommendations for future research

Introduction:Auditory symptoms in individuals with Autistic Spectrum Disorder(ASD)are well described within the neurodevelopmental literature,yet there is minimal mention of ASD in Otolaryngology literature.This is surprising considering the potential clinical and diagnostic implications of this link,and the potential for ASD to present to Otolaryngologists in the form of unexplained auditory symptoms.The aims of this literature review were to explore the intersection of auditory symptoms and ASD from the perspective of clinical Otolaryngology,and to outline a clinically focused research agenda based on emerging themes relevant to Otolaryngology.Methods:We searched Pubmed,Embase,Ovid and Cochrane library for studies until November 2021.Four authors independently reviewed 227 publications identified.39 were filtered into the final analysis.The PRISMA 2020 guidelines were followed.The heterogeneity of literature meant that a Systematic Review was not feasible.Included studies were therefore classified thematically,forming the basis of the scoping review.Results:Diagnostic theories for auditory symptoms in ASD include the entire auditory pathway and brain.There is a growing body of literature on auditory symptoms in ASD,suggesting that a primary diagnosis of ASD should be considered in patients presenting with otherwise unexplained auditory symptoms,and indicating a learning need for Otolaryngologists and audiologists,to whom these patients may present.Conclusion:We recommend a research agenda focusing on multidisciplinary collaboration,stakeholder engagement,responsible clinical screening,and clarification of pathophysiological mechanisms and terminology.

How different is early-onset childhood disintegrative disorder from autistic disorder with speech loss?

To examine the difference between early-onset (< age 3) childhood disintegrative disorder (CDD) and autistic disorder with speech loss (ADSL), 8 children with early-onset CDD (mean age = 7.6 years, SD = 3.8;6 males) were compared with 92 age and gender-ratio comparable children with ADSL (mean age = 6.8 years, SD = 4.1;70 males) on 24 variables not directly related to the key features of CDD (regression after normal development for at least the first 2 years after birth). Compared with the ADSL group, the early-onset CDD group had a tendency to have a higher rate of a psychosocial event before speech loss (SL) (early-onset CDD, 75.0% vs ADSL, 37.0%, p = 0.057;effect size (phi) = 0.211, p < 0.05);a significantly higher rate of fearfulness during SL (62.5% vs 4.3%, p = 0.000;phi = 0.551, p < 0.05);and a tendency to have a higher rate of epilepsy (25.0% vs 3.3%, p = 0.050;phi = 0.271, p < 0.05), a tendency to have a lower rate of the Childhood Autism Rating Scale-Tokyo Version (CARS-TV) total score ≥ 30 (75.0% vs 95.7%, p = 0.072;phi = 0.236, p < 0.05), and a significantly lower rate of CARS-TV item 2 (imitation) score ≥ 2 (50.0% vs 82.6%, p = 0.049;phi = 0.221, p < 0.05) on the first visit. The two groups did not exhibit any significant difference in the other 19 variables. The findings of no significant difference in the great majority and a significant difference in the small minority of the 24 variables between the two groups support integrating CDD into regressive autism spectrum disorder and studying CDD as its prototypical form.

Autologous cord blood vs individualized supplements in autistic spectrum disorder:CORDUS study results

BACKGROUND Cellular therapies have started an important new therapeutic direction in autistic spectrum disorder(ASD),and the ample diversity of ASD pathophysiology and the different types of cell therapies prompt an equally ample effort to employ clinical studies for studying the ASD causes and cell therapies.Stem cells have yielded so far mixed results in clinical trials,and at patient level the results varied from impressive to no improvement.In this context we have administered autologous cord blood(ACB)and a non-placebo,material intervention repre-sented by an individualized combination of supplements(ICS)to ASD children.METHODS CORDUS clinical study is a crossover study in which both oral ICS and intravenous ACB were sequentially administered to 56 children;ACB was infused as an inpatient procedure.Treatment efficacy was evaluated pre-treatment and post-treatment at 6 months by an independent psychotherapist with Autism Treatment Evaluation Checklist,Quantitative Checklist for Autism in Toddlers and a 16-item comparative table score,after interviewing the children’s parents and therapists.Before and after each intervention participants had a set of blood tests including inflammatory,metabolic and oxidative markers,and the neuronal specific enolase.RESULTS No serious adverse reactions were noted during and after cord blood or supplement administration.ACB improved evaluation scores in 78%of children with age 3–7-years(n=28),but was much less effective in kids older than 8 years or with body weight of more than 35 kg(n=28;only 11%of children improved scores).ICS yielded better results than ACB in 5 cases out of 28,while in 23 kids ACB brought more improvement than ICS(P<0.05);high initial levels of inflammation and ferritin were associated with no improvement.Ample individual differences were noted in children's progress,and statistically significant improvements were seen after ACB on areas such as verbalization and social interaction,but not on irritability or aggressive behavior.CONCLUSION ACB has superior efficacy to ICS in ASD;high inflammation,ferritin,age and body weight predict less improvement;more clinical studies are needed for studying ACB efficacy in ASD.

Autism spectrum disorder:Review of literature and dental management

With an increase in the number of cases of autism spectrum disorder(ASD),dental professionals need to be aware of the different techniques required to ensure safe dental treatments for affected patients. The concerns and preferences of the parents and the medical and dental history of each patient should be considered. The aim of this article was to provide a comprehensive update on the medical and dental health of patients with ASD. A detailed search of the electronic database PubMed/Medline/Lilacs was performed for the terms"Autism", "Autistic", "Autism Spectrum Disorder", "ASD", "Dentistry" and"Dentist", in the period between 2006 and 2017. Systemic reviews, research articles, and literature reviews were included. Expert opinions, case series, and case reports were excluded from the search. A detailed family-centered approach based on the preferences and concerns of parents is an important foundation for appropriate individualized dental treatment of patients with ASD. In addition,the knowledge of disruptive behaviors and patient′s challenges may guide dental practitioners in improving treatment planning, oral management, and the overall oral health of patients with ASD.

Clinical and therapeutic implications of psychiatric comorbidity in high functioning autism/Asperger syndrome: An Italian study

The present study describes the occurrence of psychiatric comorbid disorders in a cohort of 86 high functioning autism (HFA)/Asperger syndrome (AS) patients, examined at Child Neurology and Psychiatry Unit of Tor Vergata University. 38 patients out of 86 (44.2%) presented one or more psychiatric comorbidities, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychotic symptoms. We compared our sample with the evidences from the scientific literature on psychiatric comorbidity in ASD patient, in particular in HFA/AS. In this paper we focus on the high frequency of comorbid psychiatric disorders in HFA/AS patients, such as mood disorders, Attention Deficit/Hyperactivity Disorder (ADHD), Tourette syndrome (TS), anxiety disorders, including obsessive-compulsive disorder (OCD), and psychosis, including schizophrenia. We analyzed rates of all psichiatric comorbidities diagnosed in a sample of HFA/AS subjects and we compared findings from our study with the evidences from the scientific literature on psychiatric comorbidity in ASD patients, in particular HFA/AS. We point out that comorbid psychiatric symptoms can be hardly diagnosed, because they could present atipically in ASDs then in general population. Furthermore, they could be masked by ASD core symptoms.

基于基因组学的精准健康教育管理在癫痫共患孤独症谱系障碍患儿中的应用

目的:探讨基于基因组学的精准健康教育管理在癫痫共患孤独谱系障碍(ASD)患儿中的应用效果。方法:选取2018年1月—2022年7月郴州市第一人民医院儿童神经内科收治的64例患儿,将癫痫基因确诊的32例共患ASD患儿作为观察组,将原因未知的癫痫共患ASD患儿32例作为对照组。观察组利用家长课堂,融入基因组学知识,针对基因学表型、症状学和药物基因学,制定相应精准健康教育管理干预模式,对照组采用常规健康教育管理模式,评估两组患儿住院期间不良风险事件发生率、健康知识掌握程度、患儿干预依从性、癫痫的控制效果、儿童孤独症评定量表(CARS)评分和癫痫儿童生活质量量表评分。结果:观察组不良风险事件发生率为50.00%,低于对照组(96.88%);观察组对疾病知识掌握得分、服药依从性与康复治疗训练依从性、生活质量量表评分均高于对照组;观察组癫痫控制有效率为90.63%,高于对照组(68.75%);观察组患儿CARS评分低于对照组,差异均有统计学意义(P<0.05)。结论:将基因组学及家长课堂运用于癫痫共患ASD患儿的患者健康教育中,家属参与度高,依从性好,医患双方能利用致病基因表型特点有效避免诱因,规避不良风险。

与众不同:孤独症儿童的内感受特征

内感受指对自己身体内部状态及器官的感知,而非对外部刺激的感知(如视觉、听觉、触觉、味觉和嗅觉)。为探讨孤独症儿童的内感受特征,采用了心跳追踪任务,对比孤独症儿童与典型发育儿童内感受准确性的差异。结果显示,孤独症儿童的内感受呈现出独特模式,孤独症儿童在长时程的心跳追踪任务中表现出更稳定的内感受特征,这一特征可能与孤独症的社交障碍存在关联,为后续从内感受的角度深入探讨孤独症成因与干预手段提供了新的实证依据。

基于《脾胃论》探析孤独症病机及证治

基于李东垣《脾胃论》“脾胃衰而生百病”思想,探析孤独症与脾胃之间的病机联系,阐述“调节升降以滋脑髓、理气化痰以清九窍、濡养五脏以安五神、火郁发之以护元气”对孤独症治疗的指导作用。

Sex-biased single-cell genetic landscape in mice with autism spectrum disorder

Autistic spectrum disorder(ASD)is a male-biased,heterogeneous neurodevelopmental disorder that affects approximately 1%e2%of the population.Prenatal exposure to valproic acid(VPA)is a recognized risk factor for ASD,but the cellular and molecular basis of VPA-induced ASD at the single-cell resolution is unclear.Here,we aim to compare the cellular and molecular differences in the hippocampus between male and female prenatal mice with ASD at the single-cell transcriptomic level.The transcriptomes of more than 45,000 cells are assigned to 12 major cell types,including neurons,glial cells,vascular cells,and immune cells.Cell type-specific genes with altered expression after prenatal VPA exposure are analyzed,and the largest number of differentially expressed genes(DEGs)are found in neurons,choroid plexus epithelial cells,and microglia.In microglia,several pathways related to inflammation are found in both males and females,including the tumor necrosis factor(TNF),nuclear factor kappa B(NF-kB),toll-like receptor(TLR),and mitogen-activated protein kinase(MAPK)signaling pathways,which are important for the induction of autistic-like behavior.Additionally,we note that several X-linked genes,including Bex1,Bex3,and Gria3,were among the male-specific DEGs of neurons.This pioneering study describes the landscape of the transcriptome in the hippocampus of autistic mice.The elucidation of sexual differences could provide innovative strategies for the prevention and treatment of ASD.

孤独症谱系障碍儿童的睡眠问题及其相关因素研究

目的:研究孤独症谱系障碍(autism spectrum disorder,ASD)儿童的睡眠问题与其相关因素,为ASD共患睡眠问题的儿童提供防治依据。方法:选取2019年7月-2022年12月就诊于佛山市妇幼保健院儿童保健科的84例ASD儿童(ASD组),和同地区同时期84例年龄匹配的正常儿童进行对比。收集两组儿童的社会人口学资料调查表和儿童睡眠习惯问卷(children’s sleep habits questionnaire,CHSQ),通过t检验或卡方检验对两组儿童的基本情况及睡眠情况进行比较,再通过logistic回归分析模型对ASD儿童的睡眠情况相关因素进行分析。结果:ASD组儿童和对照组儿童存在睡眠问题的检出率分别为91.7%和81.0%,两者差异具有统计学意义(P≤0.05),说明ASD组的睡眠问题检出率更高。ASD组在CHSQ总分、异态睡眠、日间嗜睡方面评分高于对照组,且两组差异具有统计学意义(P值均≤0.05),说明ASD组儿童存在睡眠问题更多,特别是在异态睡眠和日间嗜睡方面。logistic分析结果显示,母亲孕期补充维生素D有益于改善ASD儿童的睡眠问题(OR=0.01,P≤0.05)。结论:ASD儿童相比于正常儿童更可能出现睡眠问题,母亲孕期是否补充维生素D可能与ASD儿童存在睡眠问题相关。

融合共同体视角下我国孤独症儿童心理康复路径研究

孤独症儿童康复过程中心理状态、认知情绪、社会交往等方面都会面临较大的挑战,在融合教育过程中,作为施教主体的学校来说,一方面要通过跟岗培训方式让校内老师迅速承担起特殊儿童的教育工作,一方面更需要借助外部力量来更好地填补学校教育的不足或缺失。本文通过案例分析,尝试提出一种全新的融合教育共同体策略,根据共同体的理论基础,提出学校和社会融合、家庭和社区融合、学校和机构融合、家庭和机构融合、家庭和医院的多方融合教育共同体的帮扶路径,以有效助推孤独症儿童心理康复。

Mirror system based therapy for autism spectrum disorders

This paper reviews the present theories and empirical research of autisms’cognitive research and mir-ror systems and introduces a new hypothesis about the causes of autism spectrum disorders(ASD):autistic mir-ror neuron dysfunction hypothesis.ASD subjects show obvious lack of the activation of the mirror system during the task of observation or emotional cognition.It is sig-nificant to investigate the mirror system for revealing the causes of autism and it is also helpful for developing new ways to diagnose or treat this disorder.

针刺治疗中风慢性期中重度吞咽障碍临床研究

目的 :评价针刺治疗中风慢性期吞咽障碍临床疗效和安全性。方法 :采用针刺风府、人迎、廉泉、百劳治疗 ,随机设立康复对照组。 结果 :根据床边吞咽功能评价量表评价 :针刺组治愈率31 7% ,有效率 6 1 6 % ,总有效率 93 3% ;针刺组疗效明显优于对照组 (P <0 0 1) ;针刺组起效快 ,且疗效与病程长短无关 ;针刺组假性球麻痹疗效优于球麻组。根据电视荧光吞咽功能评价 :针刺组治愈率 2 5 0 % ,有效率 6 0 0 % ,总有效率 85 0 % ;

电针配合行为疗法对孤独症患儿行为能力及智能的影响

目的:探寻治疗孤独症的有效疗法。方法:将60例孤独症患儿随机分为电针行为疗法组(30例)和行为疗法组(30例)。两组均进行常规行为疗法,电针行为疗法组在此基础上穴取百会、四神聪、神庭、本神、印堂、脑户、脑空、内关及头针语言一区、语言二区、语言三区进行电针。观察两组疗效及治疗前后分别进行图片词汇量表(PPVT)、孤独症行为能力的测试。结果:电针行为疗法组总有效率为86.7%,优于行为疗法组的56.7%(P<0.05)。电针行为疗法组在感觉、交往、躯体、自理能力方面均较治疗前有显著性提高(P<0.05),且在感觉、躯体及自理因子方面优于行为疗法组(P<0.05)。两组PPVT治疗后分值无明显改善(P>0.05)。结论:电针行为疗法组可以明显改善孤独症的临床症状,但对智能改善不明显。

针刺治疗中风慢性期中重度吞咽障碍机理探讨

目的:探讨针刺风府、人迎、廉泉、百劳治疗中风吞咽障碍的机理。方法:测定针刺前、后5分钟和疗前、疗后的吞咽相关肌肉肌电图和脑干诱发电位。结果:真性球麻痹患者疗后环甲肌振幅、时限及舌肌时限较疗前降低。假性球麻痹患者疗前、疗后各项指标变化差异无显著意义。结论:对于假性球麻痹吞咽障碍,针刺主要是调节皮质和脑干网状结构当中的吞咽中枢对于吞咽反射的控制作用,协调吞咽诸肌的运动;而对于真性球麻痹障碍,针刺的作用主要是直接促使损伤的周围神经恢复,从而起到治疗效应。

重复经颅磁刺激联合抗抑郁药对抑郁症首次发病患者的早期疗效及认知功能的影响

目的:探讨重复经颅磁刺激(rTMS)联合抗抑郁药物对抑郁症首次发病患者的早期疗效及认知功能的影响。方法:选择符合《美国精神障碍诊断统计手册第四版(DSM-IV)》抑郁发作诊断标准,年龄为18~45岁的60例首发抑郁症患者。随机分为研究组和对照组,两组均服用氢溴酸西酞普兰片20 mg/d,研究组加用2周rTMS真性刺激,以10 Hz、90%运动阈值刺激患者左前额叶背外侧;对照组加用2周rTMS伪刺激治疗。采用汉密顿抑郁量表(HAMD)测评患者治疗前后的疗效;采用威斯康星卡片分类测验(WCST)和持续操作测验(CPT)评估治疗前后的认知功能。结果:①治疗2周后,研究组有效率高于对照组(57%vs29%,P<0.05)。②治疗后两组患者HAMD总分明显下降,2周时研究组的HAMD总分低于对照组(15.36±1.73vs17.43±2.44,P<0.01)。③在WCST测验中,治疗后研究组分类数增加(P<0.05),并且好于对照组(P<0.05),其他指标无统计学差异。在CPT测验中各项指标均无统计学差异。④经rTMS治疗后患者未见严重的不良事件发生。结论:10 Hz rTMS辅助氢溴酸西酞普兰片治疗抑郁症,能增强患...

针刺治疗脑卒中后抑郁失眠临床疗效评价

目的 :对针刺治疗脑卒中后抑郁失眠症的临床疗效进行系统评价。方法 :将入选的 6 4例患者随机分为两组 ,治疗组 34例 ,采用“三才”配穴、联合针法相结合治疗 ;对照组 30例 ,采用口服安定类药物治疗。将两组的疗效进行对比观察及评价。结果 :治疗组治疗中风后抑郁症总有效率为79 4 % ,其失眠症的总有效率达 97 0 % ;药物对照组仅为 4 0 0 %与 73 3% ,两组间差异存在着非常显著性意义 (P <0 0 0 1,P <0 0 1)。结论 :“三才”配穴、联合针法相结合治疗脑卒中后抑郁失眠疗效显著 。

儿童孤独症量表评定的信度、效度分析

目的探讨儿童孤独症评定量表(CARS)、孤独症儿童行为检查表(ABC)、孤独症治疗评定量表(ATEC)三种孤独症评定量表的信度、效度及三者之间的相关性.方法采用CARS、ABC、ATEC三种量表对门诊孤独症儿童43例进行评定,采用CARS量表对31例非孤独症儿童进行评定.结果CARS量表信度系数α为0.735;CARS量表15个评定项目均具有鉴别诊断意义,均P＜0.01;CARS量表总分与15个评定项目之间的相关系数在0.569～0.935之间,15个评定项目之间的相关系数在0.2780.808之间;CARS量表总分与ABC全量表分的相关系数为0.502;与ABC量表5个因子分的相关系数为0.449,0.420,0.178,0.328和0.360.CARS量表总分与ATEC总分相关系数为0.572;CARS量表总分与ATEC量表的4个分量表的相关系数为0.514,0.412,0.517和0.245.临床诊断与CARS量表的阳性率为97.7%,ABC量表的阳性率为81.4%,ATEC行为量表有81.8%达60%～90%区间(中-重度).结论CARS,ABC和ATEC三种孤独症评定量表可以从不同的评定角度在孤独症的临床诊治中提供有效的帮助,适合于临床应用.

针刺膻中穴治疗产后缺乳：多中心随机对照研究

目的:研究针刺膻中穴治疗产后缺乳的临床作用,为腧穴主治提供临床依据。方法:本课题采用北京妇产医院、北京妇幼保健院、海淀妇幼保健院3个临床中心单盲随机对照研究方法,将276例乳汁不足的产妇随机分为针刺组与中药组。针刺组针刺膻中穴;中药组采用传统中药通乳汤治疗。观察乳房充盈程度、泌乳量、泌乳素及新生儿体重、人工喂养次数、人工喂养容量、婴儿小便次数、哭闹时间长短等指标,对照比较治疗产后缺乳的临床疗效。结果:针刺组与中药组均能有效改善缺乳状态,乳房充盈程度、泌乳量及新生儿体重、人工喂养次数、人工喂养容量、婴儿小便次数等指标,2组治疗前后差异均有统计学意义,2组之间差异无显著性意义。针刺组治疗前后泌乳素无改变。结论:针刺膻中穴能有效促进乳汁的分泌,效果与传统中药相当。