Training parents to implement communication interventions for children with autism spectrum disorders (ASD): A systematic review

This review identifies procedures used to train parents to implement communication interventions to children with autism spectrum disorders. Systematic search procedures identified 11 studies that met predetermined inclusion criteria. Across studies, 60 parents were trained to implement Pivotal Response Training, Enhanced Milieu Teaching, Natural Language Paradigm, or Early Start Denver Model. The mean time spent training parents was 17 hours. Training procedures used most often included: (a) verbal instruction and/or instruction manuals, (b) in vivo practice, (c) role playing, (d) modeling by trainer, and (e) reviewing videos of intervention sessions. Improvements in parent ability to implement intervention and child communication were ubiquitous. However, a paucity of studies in which baseline parent behavior was measured, coupled with the absence of studies evaluating individual training procedures, precludes definitive statements regarding the most effective and efficient approach to parent training and, therefore, warrant future research.     

A survey of practice for clinicians working with children with autism spectrum disorders and feeding difficulties

Abstract

The aim of this study was to document information from allied health clinicians about children on their caseload with autism spectrum disorders and feeding difficulties. An electronic survey was disseminated to clinicians working with this group around Australia, where 150 responses were returned and 96 were able to be analysed. Variability in responses was observed for service delivery models, frequency of input, referral reasons, and intervention choices. The majority of respondents identified limited-to-average knowledge of feeding therapy options for this population. Clinician confidence was significantly correlated with perceived therapy success. Results of the survey suggest a need for clinical guidelines in the area to direct practice. Low levels of clinician confidence and perceived therapy success also highlight a need for ongoing research and training.     

孤独谱系障碍患儿情绪能力及其相关因素研究

目的:对比分析孤独谱系障碍(ASD)与正常儿童(TD)两组儿童情绪能力特征,并探讨其情绪能力特征与其面部表情识别正确率之间的相关性。方法:对31例符合美国精神障碍诊断和统计手册第5版(DSM-Ⅴ)诊断标准的ASD患儿和30例年龄、性别及智商匹配的正常儿童对照组,使用3—6岁儿童情绪能力量表评定两组儿童的情绪能力,并使用面部表情识别任务测试情绪识别能力。结果:两组儿童对情绪觉察辨识、情绪理解、情绪表达、情绪调节等情绪能力差异有显著性意义(P0.05);情绪察觉辨识、情绪理解、情绪表达、情绪调节与智商、表情识别正确率存在显著正相关(P0.05);儿童情绪能力与其年龄相关不显著(P0.05)。结论:与正常儿童相比,ASD患儿情绪察觉辨识、情绪理解、情绪表达、情绪调节等情绪能力较低,且其智力水平、对表情识别能力可正向预测其情绪能力。     

自闭症儿童早期大脑过度发育的sMRI研究

目的利用结构磁共振成像(structural MRI,sMRI)提取的区域特征来研究自闭症患者的大脑发育异常情况。材料与方法收集59例年龄2~4岁的自闭症儿童和50名年龄4~10岁的正常儿童的结构磁共振数据,利用freesurfer软件提取大脑皮层厚度、灰质和白质区域体积以及从预定义的感兴趣区域(region of interest,ROI)提取的若干皮层下结构等区域特征,最后经统计分析方法计算两组的差异。结果通过对150项脑皮层与体积指标进行t检验组分析,发现自闭症患儿与正常对照组在其中66项上存在显著差异(P<0.05),与年龄较大的正常发育中的儿童相比,自闭症儿童的大脑表现出明显的过度生长模式,特别是在顶叶、枕叶、额叶、颞叶和楔前叶等区域。结论本研究证实自闭症儿童存在大脑结构过度发育现象,增加的大脑尺寸是自闭症患儿早期大脑发育的重要结构特征,这将为自闭症的早期诊断和病情评估提供了有力工具。     

自然情境下的结构化教学模式对孤独症谱系障碍儿童康复的初步应用

目的：研究自然情境下的结构化教学模式对孤独症谱系障碍(ASD)儿童的影响。方法：将40例ASD儿童随机分为对照组和观察组各20例。对照组接受常规康复治疗,观察组在此基础上接受自然情境下的结构化教学模式治疗。治疗前后分别采用儿童期孤独症评定量表(CARS)、孤独症治疗评估量表(ATEC),儿童功能独立性评定量表(WeeFIM)进行评估。结果:治疗后,2组CARS、ATEC评分均较治疗前明显降低（P<0.01),且观察组CARS、ATEC的语言、社交、感知觉及总分均低于对照组（P<0.05);治疗后,2组WeeFIM评分较治疗前明显升高（P<0.01),且观察组WeeFIM的认知功能评分及总分均高于对照组（P<0.01)。结论:自然情境下的结构化教学模式可以有效改善ASD患儿的语言、社交和认知功能。     

Supporting parents of children with autism spectrum disorders to become informed consumers of evidence on speech pathology practice

The aim of this pilot study was to evaluate the effectiveness of an intervention program designed to help parents of children with autism spectrum disorders (ASD) to become informed consumers of evidence for speech pathology services. The program comprised an interactive workshop and the provision of written materials aimed at increasing the participants’ knowledge of evidence-based practice (EBP) principles and confidence discussing EBP with their children's speech pathologists. Using a repeated measures within-group design (pre/post) and mixed methods of analysis, the results indicate that the participants’ knowledge and confidence increased following their participation in the program. Qualitative analysis revealed that parents differed with regard to which component (workshop or written information) was most helpful. The results provide preliminary evidence to support the further development and testing of intervention programs aimed at supporting parents of children with ASD to become informed consumers of evidence-based speech pathology services.     

Parent implemented early intervention for young children with autism spectrum disorder: a systematic review

BACKGROUND: Recent estimates concerning the prevalence of autism spectrum disorder (ASD) suggest that at least one in 200 children is affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children. METHODS: This research review focused on interventions for children aged 1-6 years, and was carried out using systematic methodology: a comprehensive search of psychological, educational and biomedical databases, as well as bibliographies and reference lists of key articles, contact with experts in the field, and hand search of key journals. Only studies which involved a concurrent element of control were included. RESULTS: The review found very few studies that had adequate research design from which to draw conclusions about the effectiveness of parent-implemented early intervention. Both randomized and controlled studies tended to suggest that parent training leads to improved child communicative behaviour, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression. CONCLUSION: It seems that parent training can successfully contribute to intervention for young children with ASD. However, the review highlights the need for improved research in this area.     

Developing the “Skippu‐Mama” program for mothers of children with autism spectrum disorder

The “Skippu‐Mama” peer support program was developed to improve quality of life and reduce parental stress in mothers of children with autism spectrum disorders. The program was designed to improve these variables by refreshing and healing participants’ minds and bodies. Twenty‐four mothers of 26 children diagnosed with ASD in Japan were included in the study and completed measures of quality of life and parental stress before, during, and after participation in the Skippu‐Mama program. Our results demonstrated that time was a significant main effect. Further, multiple comparisons with Bonferroni corrections indicated a significant increase in World Health Organization Quality of Life 26 scores three months into the program and at its conclusion six months after commencement. Overall, the Skippu‐Mama program improved the quality of life of mothers of children with ASD, and we believe that the intervention's focus on both individual and family variables may be especially effective in this population.     

学龄前孤独症谱系障碍儿童健康体适能水平及影响因素

摘要目的：初步研究学龄前孤独症谱系障碍（autism spectrum disorder, ASD）儿童健康体适能水平,探讨ASD儿童健康体适能的影响因素,为其全面康复治疗和家庭运动指导提供参考。方法：选取ASD组儿童50例和正常组儿童50例,健康体适能水平采用身体质量指数、20m往返跑距离、网球掷远距离、立定跳远距离、等长俯卧撑时长、单脚站时长平均值、坐位体前屈距离7个指标,收集整理ASD儿童的影响因素情况。分析学龄前ASD儿童与正常儿童之间的健康体适能水平差异,采用多元线性回归模型分析性别、BMI、平均每天睡眠时间、平均每天久坐时间、平均每天TPA时间、平均每天MVPA时间、母亲文化水平、父亲文化水平、家庭收入、儿童主要看护人年龄对学龄前ASD儿童健康体适能影响。结果：组间对比分析结果显示ASD组网球掷远距离低于正常组（P<0.05）,20m往返跑距离、等长俯卧撑时长和单脚站时长平均值显著低于正常组儿童（P<0.001）,差异存在显著性意义。两组BMI、立定跳远距离和坐位体前屈距离成绩差异无显著性意义（P>0.05）。多元线性回归模型分析显示平均每天睡眠、总体力活动（total physical activity, TPA）、中高强度体力活动（moderate to vigorous intensity physical activity, MVPA）时间对20m往返跑距离有良好拟合作用（20m往返跑距离=﹣9.561+1.048×平均每天睡眠时间+0.076×均每天TPA时间+0.066×平均每天MVPA时间）;平均每天TPA时间对等长俯卧撑时长有良好拟合作用（等长俯卧撑时长=﹣87.625+0.428×平均每天TPA时间）;平均每天TPA、MVPA时间对单脚站时长平均值有良好拟合作用（单脚站时长平均值=6.627+0.094×平均每天总身体活动时间+0.071×平均每天中高强度活动时间）。结论：学龄前ASD儿童的心肺适能、运动适能、上肢肌肉适能低于正常儿童,综合康复干预方案应适当加入体适能训练。学龄前ASD儿童睡眠时间越长、TPA时间越长、MVPA时间越长可能心肺适能、运动适能越好,应增强学龄前ASD儿童睡眠时间和中高强度体力活动的有效时长。     

学龄前孤独症谱系障碍患儿屏幕暴露情况与睡眠问题的调查

目的 探讨学龄前孤独症谱系障碍(ASD)患儿屏幕暴露情况与睡眠问题,并对两者在该群体中的关系进行初步探讨.方法 使用自制的《屏幕使用情况问卷》和《中文版儿童睡眠习惯问卷》对101例学龄前ASD患儿屏幕暴露及睡眠状况展开评估,应用Logistic回归分析探讨两者关系.结果 学龄前ASD患儿屏幕暴露超时(>1 h/d)检出...     

Capitalizing on technology for developing communication skills in autism spectrum disorder: a single case study

Purpose: In this case study, we discuss the application of a patient-centred clinical approach that led to the use of an assisted communication platform to combat severe communicative deficit in a child with autism spectrum disorder (ASD).

Methods: Initial assessment at four years of age revealed that the patient had rudimentary communication skills, with significant sensory integration dysfunction manifested as oral, olfactory, and tactile seeking behaviours; self-stimulatory behaviour; and complete dependence on caregiver for activities of daily living. Intensive, multi-disciplinary intervention resulted in minimal improvement in communicative skills and sensory seeking over six months. Subsequently, a tailor-made picture-assisted communication training with the mother as the communication facilitator was adopted. This approach was abandoned due to the patient’s poor response and mother’s low acceptance of picture-based interaction. A preference for printed material was observed in the patient. Accordingly, further management was focused on employing a computer-based interactive platform that the patient was taught to use over the course of a few months as a part of augmentative and alternative communication (AAC) intervention program. This resulted in a remarkable improvement in the child’s skills that now allowed for a better intentional communication of his thoughts and needs.

Conclusions: This study highlights the importance of revisiting conventional rehabilitation strategies for communicative deficits and tailoring them according to the patient’s needs and preferences. It also emphasises that besides excellent observation skills, clinicians must be willing to consider technology based approaches in patients responding poorly to traditional approaches in order to develop effective interventional programmes.

• Implication for Rehabilitation

• The current study highlights the importance of exploring the application of technology based intervention for building communication skills in the early stages of rehabilitation for persons with communicative deficit.

• It also emphasises the need for excellent observation skills among clinicians so that the peculiar interests of children with ASD may be applied in designing training programmes to overcome communication barriers.

• Additionally, clinicians should familiarise themselves with the latest assistive technology-based rehabilitation approaches and be willing to explore newer approaches if traditional ones fail to yield satisfactory outcomes.

• Use of technology-based interventions to reduce dependence among persons with disability would be beneficial, both socially and economically, in developing countries with limited resources.

     

Social communication intervention effects vary by dependent variable type in preschoolers with autism spectrum disorders

Abstract

Individuals with autism spectrum disorders (ASDs) have difficulty communicating in ways that are primarily for initiating and maintaining social relatedness (i.e., social communication). We hypothesized that the way researchers measured social communication would affect whether treatment effects were found. Using a best evidence review method, we found that treatments were shown to improve social communication outcomes approximately 54% of the time. The probability that a treatment affected social communication varied greatly depending on whether social communication was directly targeted (63%) or not (39%). Finally, the probability that a treatment affected social communication also varied greatly depending on whether social communication as measured in (a) contexts very similar to treatment sessions (82%) or (b) contexts that differed from treatment on at least setting, materials, and communication partner (33%). This paper also provides several methodological contributions.     

口肌训练结合语言认知训练对孤独症谱系障碍儿童语言康复的效果评价 刘丹

【】目的：研究口肌训练结合语言认知训练对孤独症谱系障碍儿童语言康复的效果。方法：选择来自我院2013年9月到2016年9月孤独症谱系障碍患儿30例。30例孤独症谱系障碍患儿随机分为口肌组和联合组。口肌组给予单纯口肌训练,联合组进行口肌训练结合语言认知训练。比较两组患儿孤独症谱系障碍治疗总有效率;总治疗时间;治疗前和治疗后患儿简易口部运动量表中舌口部、唇口部和下颌口部运动功能评分的差异。结果：联合组相较于口肌组孤独症谱系障碍治疗总有效率更高,P＜0.05;联合组相较于口肌组总治疗时间更短,P＜0.05;治疗前两组简易口部运动量表中舌口部、唇口部和下颌口部运动功能评分相似,P＞0.05;治疗后联合组相较于口肌组简易口部运动量表中舌口部、唇口部和下颌口部运动功能评分改善更显著,P＜0.05。结论：口肌训练结合语言认知训练对孤独症谱系障碍儿童语言康复的效果确切,看有效促进患儿语言功能康复,改善其口部肌肉功能和表达能力,缩短疗程,值得推广。     

不同气质类型孤独症谱系障碍儿童的行为问题与其家庭环境的研究

目的:比较不同气质类型孤独症谱系障碍(autism spectrum disorders,ASD)儿童的行为问题及家庭环境差异,深入探讨ASD儿童气质类型及家庭环境对其行为问题的影响,为ASD儿童临床诊断和早期家庭干预提供新思路.方法:选取2018年12月-2019年11月在佳木斯大学附属第三医院住院及门诊明确诊断的3...     

Investigating requests for information in children with autism spectrum disorders: Static versus dynamic assessment

This study investigated the use of static assessment (SA) and dynamic assessment (DA) methodologies for examining the production of requests for information (RI) by children with autism spectrum disorders (ASD) and typically developing peers (TDP) within their school environment. Following an initial SA observation session, the effects of manipulating contextual and linguistic variables to facilitate the production of RI were systematically investigated across three DA sessions. The contextual variables included object/activity choice and physical setting (e.g., treatment room versus classroom). The linguistic variables included prompting of RI production in an attempt to enhance performance. Independent and paired t-test comparisons revealed statistically significant differences in production of RI between the TDP group and children with ASD. The environmental variables of object/activity choice and linguistic prompting appeared to influence performance for a subgroup of children with ASD. Clinical implications related to the importance of assessing performance using both static and dynamic methodologies are discussed.     

Preparing for the future: a review of tools and strategies to support autonomous goal setting for children and youth with autism spectrum disorders

Purpose: Despite recognized benefits, current clinical practice rarely includes direct input from children and youth with autism spectrum disorder (ASD) in setting rehabilitation goals. This study reviews tools and evidence-based strategies to assist with autonomous goal settings for children and youth with ASD. Method: This study included two components: (1) A scoping review of existing tools and strategies to assist with autonomous goal setting in individuals with ASD and (2) a chart review of inter-disciplinary service plan goals for children and youth with ASD. Results: Eleven data sources, evaluating five different tools to assist with autonomous goal setting for children and youth with ASD, were found. Three themes emerged from the integration of the scoping review and chart review, which are discussed in the paper: (1) generalizability of findings, (2) adaptations to support participation and (3) practice implications. Conclusions: Children and youth with ASD can participate in setting rehabilitation goals, but few tools to support their participation have been evaluated, and those tools that do exist do not align well with current services foci. Visual aids appear to be one effective support, but further research on effective strategies for meaningful engagement in autonomous goal setting for children and youth with ASD is warranted.

• Implications for rehabilitation

• Persons with ASD are less self-determined than their peers.

• Input into one’s own rehabilitation goals and priorities is an important component of self-determination.

• Few tools exist to help engage children and youth with ASD in setting their own rehabilitation goals.

• An increased focus on identifying, developing and evaluating effective tools and strategies to facilitate engagement of children and youth with ASD in setting their own rehabilitation goals is warranted.

     

医教结合康复训练干预对孤独症谱系障碍儿童发育水平及社会生活能力的影响

目的 探讨医教结合康复训练干预在孤独症谱系障碍（autism spectrum disorder,ASD）患儿中的应用效果。方法 选择2019年6月-2021年1月于笔者所在医院就诊的ASD患儿72例,将2019年6月-2020年3月就诊的36例患儿设为对照组,接受常规康复训练;将2020年4月-2021年1月就诊的36例患儿设为观察组,接受医教结合康复训练。比较2组干预前、干预6个月后Gesell发育量表（Gesell developmental scale）、婴儿-初中学生社会生活能力量表（简称S-M量表）、社会沟通能力问卷（social communication questionnaire,SCQ）评分。结果干预6个月后,观察组Gesell量表中语言、个人社交、大运动、精细运动、适应性行为等维度评分均高于对照组（P<0.001）,S-M量表和SCQ量表评分也高于对照组（t=10.688,P<0.001;t=3.905,P<0.001）。结论 医教结合康复训练干预能够有效改善ASD儿童发育水平,提高其社会生活与沟通能力。