针刺治疗孤独症谱系障碍儿童便秘的效果

目的 观察针刺对孤独症谱系障碍(ASD)儿童便秘问题及核心症状的治疗效果。方法 2019年1月至2020年11月,黑龙江中医药大学附属第二医院康复中心收治50例ASD并发便秘患儿,随机分为针康组(n = 25)和药康组(n = 25)。针康组采用头针、体针结合康复训练法;药康组采用口服益生菌结合康复训练法;两组均进行便秘和核心症状的康复训练。便秘治疗8周,核心症状治疗12周。治疗前,治疗8周、12周后进行便秘疗效判定和便秘主症评分,并采用孤独症儿童行为量表(ABC)和孤独症治疗评估表(ATEC)对核心症状进行评估。结果 治疗前两组便秘主症评分、ABC评分和ATEC总分比较均无显著性差异(P > 0.05)。治疗8周,两组主症评分均显著降低(t > 5.473, P < 0.001);治疗12周,针康组便秘疗效和主症评分均优于药康组(Z = 2.848, t = -2.139, P < 0.05)。治疗8周后,两组ABC评分和ATEC总分均较治疗前显著降低(t > 7.139, P < 0.001),两组间比较均无显著性差异(P > 0.05);针康组ATEC行为评分明显降低(t = 3.849, P < 0.01),优于药康组(t = -2.643, P < 0.05),两组间其他项评分无显著性差异(P > 0.05);治疗12周,针康组ABC评分、ATEC总分及各项评分均低于药康组(|t| > 2.156, P < 0.05)。结论 针刺结合康复训练法可改善ASD儿童便秘问题,疗效较持久,也可改善孤独症的核心症状,均优于药物结合康复训练法。     

学龄前孤独症谱系障碍儿童相关危险因素的调查分析

目的:探讨学龄前儿童孤独症谱系障碍(ASD)患病的危险因素。方法:选取2019年4月至12月就诊的100例ASD患儿为ASD组,健康儿童100例为对照组。通过自编调查问卷的方式收集2组的ASD相关因素,进行组间比较;再选取有差异的指标进行Logistic回归分析,寻找ASD的危险因素。结果:ASD组的养育环境、母亲焦虑或抑郁、孕期经常使用电脑、母亲生育年龄、全面发育落后及婴幼儿睡眠障碍与对照组的差异有统计学意义(P0.05)。Logistic回归分析结果发现养育环境、母亲焦虑或抑郁、孕期经常使用电脑、母亲生育年龄较大、全面发育落后及婴幼儿睡眠障碍均为ASD的危险因素。结论:家庭养育环境、孕妇精神状态、孕期经常使用电脑、母亲生育年龄较大、儿童全面发育落后及睡眠障碍可能为ASD发病危险因素,需重视以上危险因素,实现早期筛查、诊断与干预。     

Effects of Exercise Interventions on Stereotypic Behaviours in Children with Autism Spectrum Disorder

Purpose:

The purpose of this systematic review was to synthesize evidence from studies examining the effect of exercise interventions on stereotypic behaviours in children with autism spectrum disorder (ASD).

Methods:

Only exercise-related physical therapy (PT) interventions were included. A multifaceted search strategy identified studies published between 1980 and 2007. Quality was assessed using the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) Study Quality Scale, the Clinical Relevance Tool for Case Studies, and the Quality, Rigour or Evaluative Criteria tool.

Results:

Seven studies (1982–2003) met our inclusion criteria; four of these used single-subject research designs, two were group studies, and one was a case study. Ages and behavioural characteristics of the children (N = 25) varied among the studies. Levels of evidence ranged from II to V (of a possible I–V). Study quality scores ranged from 2 to 5 (range: 0 to 7); mean = 3.9, mode = 5. Few studies in this area of PT practice have been published, and those identified scored low levels of rigour on the AACPDM criteria.

Conclusions:

Research suggests that exercise provides short-term reductions of stereotypic behaviours in children with ASD. Future research with stronger evidence levels, greater rigour, and longer-term outcome assessment is required to determine specific exercise parameters.     

Autism Spectrum Disorder Screening and Early Action

Since its diagnostic inception, autism has garnered stigma and fear, often to the exclusion of action. Early detection and treatment of autism spectrum disorders have become crucial priorities of the National Institutes of Health. The primary care provider is the point of entry to the health care system for infants/children showing risk factors for autism spectrum disorders and/or symptoms of the disorder. Despite the existence of low-cost, well-tested developmental screening tools, many primary care providers rely solely on clinical judgment to ascertain developmental status. Current best screening practices were determined by a review of the literature. Key recommendations are highlighted.     

综合疗法对孤独症谱系障碍患儿的效果

目的 观察综合疗法对孤独症谱系障碍(ASD)患儿的临床效果。方法 2017年10月至2019年10月,60例ASD儿童随机分为对照组(n = 30)和治疗组(n = 30)。对照组给予康复训练和特殊教育。治疗组在此基础上根据辨证,给予针刺、推拿、中药治疗,共12周。治疗前后比较两组孤独症儿童行为量表(ABC)和孤独症治疗评价量表(ATEC)评分。结果 治疗前,两组ABC和ATEC评分无显著性差异(t < 1.426, P> 0.05)。治疗后,两组ABC和ATEC评分均显著降低(t > 5.46, P< 0.001),且治疗组明显低于对照组(|t| > 3.304, P< 0.01)。结论 综合疗法可改善ASD患儿的治疗效果,优于康复训练和特殊教育。     

犬辅助干预对孤独症家庭功能的影响

目的 系统评价犬辅助干预对孤独症家庭功能的影响。方法 检索建库至2021年2月Cochrane Library、PubMed、Web of Science、CNKI、中国生物医学文献数据库(CBM)、维普(VIP)、万方数据库关于犬辅助干预治疗孤独症的随机对照试验(RCT)研究。采用家庭评估量表(FAM-III-GS)评估家庭功能;采用儿童抑郁量表第二版(CDI-2)和Spence儿童焦虑量表(Spence Children's Anxiety Scale, SCAS)评估心理行为。根据Cochrane系统评价标准和澳大利亚循证护理中心(JBI)标准对纳入文献进行质量评估。应用RevMan 5.4软件进行Meta分析。结果 纳入4项RCT研究,共190例受试者。各项指标文献不足,不能进行Meta分析。两项研究显示,犬辅助干预有助于改善FAM-III-GS评分。结论 犬辅助干预可以改善孤独症家庭功能。     

The Experiences of Parents During Diagnosis and Forward Planning for Children with Autism Spectrum Disorder

Background For families of children diagnosed with autism spectrum disorder (ASD) getting a diagnosis is a traumatic experience on which future care and education plans for the child depend. In this paper parental experiences of diagnosis and forward planning for children with ASD are reported. Method This paper is part of a large cross‐sectional study conducted in Northern Ireland and the Republic of Ireland that assessed the needs and experiences of parents of children diagnosed with ASD. Questionnaires were designed and completed by 95 parents, reporting on 100 children, as well as 67 multi‐disciplinary professionals. Results Findings confirm that diagnostic and planning processes are extremely stressful for parents, that statutory diagnosis takes a long time, that care and education plans do not include full parental participation, and that reviews of plans do not consistently include intervention data. Conclusion Policy and practice implications of these findings are important for future revisions of diagnostic tools and manuals.     

孤独症谱系障碍儿童脑组织神经元和神经胶质细胞发育的研究进展

孤独症谱系障碍是一组发病于儿童发育早期的神经发育障碍性疾病,其具体的发病机制尚不清楚。神经元和神经胶质细胞发育异常是孤独症谱系障碍儿童的一个显著特点。本文综述神经元以及星形胶质细胞、小胶质细胞和少突胶质细胞在孤独症谱系障碍儿童脑组织中的发育情况。     

Effect of L1-79 on Core Symptoms of Autism Spectrum Disorder: A Case Series

PurposeThis study examines the effects of the tyrosine hydroxylase inhibitor L1-79, a racemic formulation of α-methylparatyrosine, in patients with autism spectrum disorder (ASD) in a prospective case series. The l-isomer formulation of α-methylparatyrosine, metyrosine, is approved for the management of patients with pheochromocytoma.MethodsSix male and 2 female patients aged 2.75 to 24 years with ASD were treated for 8 weeks at L1-79 doses ranging from 90 to 400 mg thrice daily. Assessments at weekly intervals included the Aberrant Behavior Checklist–Community (ABC-C), Connor's Parent Rating Scale (CPRS), and Clinical Global Impressions (CGI) scale. The Autism Diagnostic Observation Schedule (ADOS) was administered at baseline and week 10.FindingsThe ABC-C and CPRS scores improved between baseline and end of study for 7 of 8 participants; most participants' assessment scores decreased. At week 8, the CGI efficacy index was 05 for 6 of 8 participants, indicating modest improvement with at least partial resolution of symptoms and no medication adverse effects, and 09 for 2 participants, indicating minimal improvement and no change in status or care needs, without adverse effects. The mean ADOS scores improved by ≥31% for 4 of the 6 participants tested, with 1 patient experiencing a 47% improvement. Seven of the 8 participants previously taking psychotropic medications were stable without their legacy medications while receiving L1-79, and 1 patient resumed a single legacy medication at a lower dose. Three adverse events were reported; symptoms were mild and resolved without change in therapy.ImplicationsThese results suggest L1-79 may be a tolerable and effective treatment for the core symptoms of ASD, which must be confirmed with double-blind studies.     

基于ICF-CY的适应性韵律体操活动对低功能孤独症谱系障碍儿童的效果

探讨基于《国际功能、残疾和健康分类(儿童青少年版)》(ICF-CY)的适应性韵律体操对低功能孤独症谱系障碍(ASD)儿童基本动作发展的效果。     

中医推拿干预孤独症谱系障碍患儿的临床观察

目的:观察中医推拿结合行为干预对孤独症谱系障碍(Autism Spectrum Disorder,ASD)患儿干预的临床疗效。方法:选择长沙市星学园教育发展中心符合入选标准的孤独症谱系障碍患儿44例,随机分为观察组(22例),对照组(22例),对照组予以行为干预,观察组在行为干预的基础上采用中医推拿。以30次为1个周期,共进行1个周期干预,以儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)和儿童孤独症行为量表(Autism Behavior Checklist,ABC)进行疗效判定。结果:干预后,观察组与对照组的CARS、ABC均较干预前下降(P<0.05),观察组优于对照组(P<0.05),观察组总有效率95.45%,对照组总有效率72.72%。结论:推拿干预孤独症谱系障碍或仅进行行为干预均能改善ASD患儿的临床症状,但是中医推拿结合行为干预的临床疗效优于单纯的行为干预。     

Siblings and Family Environments of Persons With Autism Spectrum Disorder: A Review of the Literature

OBJECTIVES: The purpose of this literature review is to summarize studies on siblings of individuals with autism spectrum disorders (ASD) in four major areas, to identify gaps in the literature, and to propose future directions for research of siblings of persons with ASD. DESIGN AND METHODS: A systematic review of research published within the past 10 years in peer review journals includes investigations on siblings' and parental characteristics, as well as sibling behaviors, relationships, and adaptation. Twelve studies are synthesized to include purpose, findings, and discussion relating it to previous work. RESULTS: Siblings are influenced by the context of their families that are impacted by biological, psychological, sociological, and ecological factors. Research studies are primarily exploratory and no intervention studies are identified. CONCLUSION: The literature review of parental and sibling characteristics, relationships, and adaptation support intervention measures for siblings and family members of persons with autism. Assessment of siblings is necessary to identify those who may be at risk for future adjustment problems and maladaptive behaviors.     

Factors for Assisting Adolescents with Autism Develop Health Self-Management

Although nurses provide much of the health care for adolescents with special health needs, the nursing literature has focused limited attention on these adolescents’ health transitions, particularly in adolescents with autism spectrum disorder (ASD). As many as 95% of individuals with ASD have co-occurring health conditions. Despite their need to develop health self-management skills as they transition to adulthood, only 14% of adolescents with ASD receive health transition planning. One barrier to such planning is a limited understanding of concepts and relationships within health care transitions. We propose a model for adolescent health self-management to guide researchers, nurses, other health care professionals, and policy makers in facilitating this transition.