Omid early intervention resource kit for children with autism spectrum disorders and their families

Omid early intervention resource kit containing information booklets on autism spectrum disorders (ASD) and related issues, five packs of tangible selected playthings and communication facilitating aids was developed and evaluated with 65 Iranian parents. Beside a pretest before the resource kit deliverance, parents in the control group took part in a two-day workshop. Parents in the control group were also visited at the middle of the study and re-evaluated three months after the resource kit usage. Post-testing comparison showed a statistically significant improvement for parents and their children in experimental group. Findings support usefulness of the resource kit as a practical approach to meeting the needs of parents after the diagnosis of ASD for their child in a country with scarce support and services.     

One-year follow-up of the outcome of a randomized controlled trial of a home-based intervention programme for children with autism and developmental delay and their families

Introduction There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems. The aim of the study was to determine whether a home‐based programme provided over 12 months resulted in sustained improvement in development and behaviour 12 months after the intervention ceased. The characteristics of the children and families who benefited most from the intervention were also studied. Method Randomized controlled trial. Participants A total of 59 children, aged 3–5 years, attending two early childhood intervention centres in Melbourne, Australia. Intervention Half of the subjects received an additional home‐based programme consisting of 40 weekly visits. Main outcome measures Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised, Preschool Behaviour Checklist, Bayley Behaviour Rating Scale and Behaviour Screening Questionnaire. All tests administered pre‐intervention, following the intervention and 12 months later. Secondary outcome measures Family stress, support and empowerment. Results Fifty‐four children completed the assessments 12 months after conclusion of the intervention. Compared with the control group, improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later (P= 0.007) while significant behavioural differences post intervention were not. Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non‐verbal areas. In contrast to the control group who deteriorated, language skills in the intervention group remained stable. Improvements were significantly associated with higher stress in the families. Conclusion Improvements following the provision of a home‐based programme to preschool children with developmental disabilities were sustained 1 year later. Children from highly stressed families appeared to benefit most, reinforcing the importance of involving families in early childhood intervention programmes.     

孤独症谱系障碍以家长为中介的超早期干预

孤独症谱系障碍是严重影响儿童发展的神经发育障碍性疾病,早期诊断早期干预是有效的手段已成为目前的临床共识。本文重点就目前国内外关于孤独症谱系障碍超早期干预的研究进展及其中家长参与的重要性和必要性作一介绍,以供相关专业人员参考。     

The transport mobility situation for children with autism spectrum disorders

In order to investigate the transport mobility situation for children with autism spectrum disorders, questionnaires from 1,631 parents were analysed. The results showed that almost 3 out of 4 parents were worried when their child was transported by school transport or by the Special Transport System. Transports in the family vehicle caused worry among almost half of the parents. The parents’ worries were justified by the fact that the children were not transported according to general safety recommendations. Moreover, it was common for the children to be transported with unfamiliar drivers, as well as with unknown passengers, which is known to be quite problematic. Transport mobility adaptation to this particular group of children with disabilities refers merely to implementation of knowledge and a specific, well-structured approach among the drivers towards the children during the ride, rather than to physical/mechanical adaptation of the vehicles.     

Improving social participation of children with autism spectrum disorder: Pilot testing of an early animal‐assisted intervention in Spain

Children with autism spectrum disorder (ASD) experience moderate to profound challenges in relation to the skills required for social participation. Animal‐assisted intervention (AAI) is increasingly used within early community care. However, the results of its early application in this population group are not known. This pilot study aimed to explore the feasibility of an early intervention based on the use of therapy dogs and to examine their impact on communication and social interaction skills. A within‐subject quasi‐experimental longitudinal design was used. The instruments for measuring results were the Assessment of Communication and Interaction Skills (ACIS) and Animal‐assisted Therapy Flow Sheet, both based on observation. A total of 19 children with confirmed or probable ASD (with mean age of 46.2 months), cared for in a Spanish therapeutic unit, participated in a median of nine AAI sessions, with a mean duration of 19.9 min per session. The total ACIS score increased significantly between the initial and final assessments of the study, with communication and social interaction skills improving with a large effect size. In the Animal‐assisted Therapy Flow Sheet instrument, statistically significant improvements were found in most of the items that evaluate the frequency of child–dog social relationships (look at the dog, touch it, talk to it and get involved in an activity with the animal) and child–therapist relationships (look at the therapist and talk to him/her); the effect sizes ranged from medium to large. In conclusion, the early application of an AAI is feasible and seems to improve communication and social interaction skills, both essential elements for social participation. The results suggest that this intervention may be a beneficial non‐pharmacological therapy as a complementary approach within community care for children with ASD in the early years of their life.     

The determinants of compliance with an early intervention programme for high-risk babies in India

BACKGROUND: Early intervention is known to improve outcomes for babies at risk for growth and developmental problems. Such programmes usually have a prolonged course and require frequent contacts with the service providers. As a consequence of poverty, illiteracy and lack of communication facilities in developing countries, treatment adherence can suffer. METHODS: The present study is an analysis of a clinic-based early intervention programme for high-risk babies in a developing society in Goa, India. A sample of 152 neonates and their parents were offered an early intervention programme and followed up until their first birthday. The primary outcome under study was the uptake of the programme. Various socio-demographic, programmatic and infant-related variables that could affect compliance were examined. RESULTS: Compliance with the intervention programme was only moderate, with 59.2% of infants brought for three or more sessions. Higher maternal educational levels and proximity of the place of residence of the family to the early intervention clinic were significantly associated with better compliance. CONCLUSIONS: Early intervention programmes that go into homes have a greater chance of reaching high-risk infants, compared with those provided at a distant centre. Better-educated mothers are more likely to be convinced about the benefits of such inputs. The authors conclude with recommendations for future practice and research.     

The information and support needs of Iranian parents of children with autism spectrum disorders

Internationally, increasing numbers of children are being diagnosed with an autism spectrum disorder (ASD), but there is a dearth of studies outside more affluent countries as to parents’ understanding of this condition and the support they receive. Forty-three parents were recruited from schools and clinics in Tehran and interviewed individually using a structured interview schedule. Thematic content analyses identified a lack of parental understanding about autism and its causes, along with parents’ reactions to the diagnostic process and the dearth of information available to them. The majority of parents were dissatisfied with the professional assistance provided for their children and many lacked informal support from their families. The provision of accurate information through informal parent-to-parent support seems to be the most feasible means of assisting Iranian families to adjust to having a child with ASD within the family.     

Cluster randomized trial of a parent-based intervention to support early development of children in a low-income country

Background   Programmes that promote early psychological development of children in the developed world have been found to be beneficial. However, such programmes are rare in underprivileged parts of the developing world. We adapted one such parent-based programme (Learning Through Play) for a rural Pakistani population and aimed to study if: (1) it was acceptable to community health workers; (2) the programme led to an improvement, after a period of 6 months, in mothers' knowledge and attitudes about early infant development; (3) it led to a reduction in the levels of maternal mental distress in the post-natal period.
Methods   Using a cluster randomized design with villages as unit of randomization, 163 mothers from 24 villages in a rural sub-district of Rawalpindi, Pakistan, received the 'Learning Through Play' programme, whereas 146 mothers from 24 villages acted as controls. Twenty-four community health workers were trained to carry out the programme. Assessments were conducted using a specially developed 15-item Infant Development Questionnaire and the 20-item Self-Reporting Questionnaire (SRQ).
Results   Over 80% of the community health workers trained found the programme to be relevant and were able to integrate it into their routine work. There was a significant increase in mothers' knowledge and positive attitudes about infant development in the intervention group, compared with the control group. Women in the intervention group answered correctly 4.3 (95% CI 3.7–14.9, P  < 0.001) more questions than the control group. There was no difference in levels of mental distress measured by the SRQ.
Conclusions   The 'Learning Through Play' programme was successfully integrated into the existing health system and accepted by community health workers. The programme succeeded in improving the knowledge and attitudes of mothers about infant development.     

孤独症谱系障碍幼儿家庭干预的管理

孤独症谱系障碍是一类起病于发育早期的神经发育障碍性疾病,临床上对ASD早识别、早发现和早干预能极大的改善ASD儿童的预后已有共识,在ASD早期干预过程中家庭干预的作用日渐引起重视,并逐渐成为目前国际ASD早期干预的研究热点.本文就科学管理和评估孤独症幼儿家庭干预实践中可能涉及的方面展开了探讨.     

孤独症谱系障碍儿童睡眠障碍的评估和干预

睡眠障碍是孤独症谱系障碍(ASD)儿童最常见的共患障碍之一,不仅与ASD儿童核心症状存在显著相关,还会影响患儿的功能水平、生活质量以及干预康复效果,给父母造成巨大养育压力和经济负担。国际上已将睡眠障碍,特别是失眠纳入到ASD的综合诊治之中,但国内相关工作开展滞后,儿科专业人员对ASD儿童睡眠障碍的诊治能力有待提升。 因此,本研究将介绍ASD儿童睡眠障碍的评估和干预方法,为临床和研究工作提供依据。     

儿童神经发育异常的早期干预

随着早期识别神经发育异常能力的提高,医生们对早期干预的信息需求上升。本文包括了早期干预的神经发育背景、开始干预的时间、主要干预方法和治疗结果的预测因素。并强调,在临床的实践建议下将父母干预和临床干预相结合,可以最大限度地提高患儿的预后。     

脑瘫患儿早期诊断和早期干预的探讨

目的：探讨对脑瘫患儿进行早期诊断、早期干预的措施和方法。方法选择铜川职业技术学院校外实训基地铜川市人民医院,2010年7月至2013年7月收治的94例脑瘫患儿为研究对象,根据患病年龄大小将其分为甲组（出生至6个月）、乙组（7个月至1岁）和丙组（1岁至5岁）。对3组的临床资料进行回顾性分析,并对3组患儿进行综合性康复治疗,治疗1个疗程后进行疗效评价。结果3组进行治疗后,甲组和乙组有效率均高于丙组（χ2值分别为10．333和4．585,P＜0．05）;甲组治疗效果为“优”者较之丙组的比率高（χ2＝5．905,P＜0．05）,丙组治疗效果为“差”者的比率高于甲组（χ2＝4．026,P＜0．05）。3组经过治疗后,甲组家属对治疗结果满意率高于丙组（χ2＝8．952,P＜0．05）,而丙组家属对治疗结果不满意率高于甲组（χ2＝7．891,P＜0．05）。结论对脑瘫患儿进行早期诊断,实施早期干预,能够使患儿病情得到有效康复,明显减少患儿和家属身心痛苦。     

Medical care experiences of children with autism and their parents: A scoping review

Children with autism spectrum disorder (ASD) and their families may benefit from the provision of additional supports in health care settings, particularly when preparing for and attending medical appointments. This review examined literature that describes experiences in medical care settings from the perspective of patients under age 18 with ASD and their caregivers. A scoping review was conducted to examine the experiences of children with ASD and their families in medical care settings. Twenty‐nine studies meeting inclusion criteria were identified and reviewed. The review indicated a number of challenges (e.g., parent‐reported problems in parent‐provider communication and overwhelming environments) as well as factors that facilitate positive experiences (e.g., providing positive reinforcement and explaining exam steps) during medical appointments. Children with ASD and their families are faced with many challenges while receiving care in medical settings. The present review identified many challenges families face, as well as facilitators of positive experiences. Understanding the unique experiences of patients with ASD and their parents will help to improve experiences in medical care settings for children, caregivers, and health care providers.     

Difficulties for mothers in using an early intervention service for children with cerebral palsy in Bangladesh

Given the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers' attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child's sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed.     

Promoting secure attachment: evaluation of the effectiveness of an early intervention pilot programme with mother-infant dyads in Santiago, Chile

Background Research indicates that the early attachment patterns of babies could influence their socio‐emotional development and prevent the emergence of problematic behaviours in the child later in life. Many studies in the field of early attachment interventions have promoted a secure attachment bond between mother and infant. The purpose of this study was to evaluate the effectiveness of an early pilot intervention programme designed to promote a secure attachment bond in mother‐infant dyads belonging to a population seeking regular treatment at urban health centres in Santiago, Chile. Methods Primipara mothers were randomly assigned to two intervention conditions: a secure attachment promotion programme (experimental group = 43) or an educational talk (control group = 29). The Strange Situation Assessment was used to collect data on the attachment patterns of babies. Results The results show that after the intervention, there were more babies with secure attachment in the experimental group than in the control group. Conclusions These findings represent a preliminary step towards evaluating interventions aimed at promoting secure attachment in Chilean mother–child dyads. While the effect of the intervention is not significant, the effect size obtained is respectable and consistent with other meta‐analytic findings.     

Facilitating factors and barriers to the implementation of intensive home-based behavioural intervention for young children with autism

BACKGROUND: Although international interest in intensive home-based early behavioural intervention for children with autism is increasing, there is little or no published research on the experiences of families conducting these programmes. METHODS: One hundred and forty-one UK parents conducting Lovaas-style interventions with their young child with autism were asked to identify factors that acted as facilitative factors and barriers to the implementation of these programmes. Parents responded to written questions contained within a questionnaire survey, and their responses were subjected to a content analysis procedure. RESULTS: Several of the facilitative factors and barriers were found to be similar. For example, a supportive therapy team was the most frequently cited facilitative factor, and problems recruiting and maintaining a suitable team was the most frequently reported barrier. Other factors seemed to be more independent constructs. For example, an important barrier was the lack of time and personal energy, but plenty of time and energy was not cited as a facilitative factor. CONCLUSIONS: The practical implications of these results for families and for services supporting families engaged in intensive early behavioural intervention are discussed. In addition, more general implications for the designers of behavioural intervention programmes are identified.     

孤独症谱系障碍儿童综合干预年龄及持续时间对治疗效果影响的探讨

目的 通过分析孤独症谱系障碍(ASD)儿童综合干预开始的年龄及持续时间对治疗效果的影响,以期为ASD儿童综合干预开始年龄及持续时间、改善ASD儿童生活质量提供理论参考依据。方法 对符合《美国精神障碍诊断与统计手册》(第4版)(DSM-Ⅳ) ASD诊断标准的221名儿童进行以应用行为分析-语言行为教学为主的综合干预治疗,采用自身前后对照研究。使用孤独症谱系障碍儿童行为检查量表(ABC)进行综合干预治疗效果分析。结果 综合干预后ABC量表感觉、交往、运动、语言、自理因子分及总分均较综合干预前下降(P<0.000 1),且开始综合干预年龄越小、综合干预的持续时间越长,ABC量表各因子分及总分的变化越大(P<0.000 1)。结论 开始综合干预年龄越小、综合干预持续时间越长,ASD儿童感觉、交往、运动、语言、自理能力改善越好。     

孤独症儿童心理理论特征及临床干预的研究进展

心理理论发展的缺损或滞后是导致孤独症谱系障碍(ASD)患儿社交障碍的重要原因之一,这使得ASD患儿缺乏恰当的社会交往技能,无法正常地与人交流,更难以融入家庭、学校、社区等。通过ASD患儿的心理理论能力进行干预训练可以促进他们的社会交往能力的发展。现有的干预训练内容大致包括以下几项:对错误信念理解的干预训练,以正常儿童心理理论发展顺序为参照的多心理理论成分训练,将心理理论能力与社会交往能力相结合的干预训练。已有研究分析,对未来的干预训练更应注重心理理论技能干预的泛化和针对不同层次的ASD儿童设置差异化的干预方案。