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Kawai H, Kishimoto M, Okahisa Y, Sakamoto S, Terada S, Takaki M. Initial Outcomes of the Safe and Sound Protocol on Patients with Adult Autism Spectrum Disorder: Exploratory Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4862. [PMID: 36981773 PMCID: PMC10049251 DOI: 10.3390/ijerph20064862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Sensory impairments are common features of autism spectrum disorder (ASD) and are associated with its social impairments. However, there is no established treatment for these impairments in adults with ASD. The Safe & Sound Protocol (SSP) is a listening program designed to improve social communication skills by reducing auditory hypersensitivity. We investigated the effectiveness of the SSP for adults with ASD. We administered the SSP to six participants with ASD aged 21-44 years old, and the effects were assessed using the Social Responsiveness Scale, Second Edition (SRS-2). Secondary outcomes were assessed using the Center for Epidemiological Studies Depression Scale (CES-D), State-Trait Anxiety Inventory (STAI), WHO Quality of Life 26 (WHOQOL-BREF), and Adolescent/Adult Sensory Profile (A/ASP). In this study, only the Social Awareness scale of the SRS-2 Family-Report showed a significant improvement after the intervention. In addition, it was significantly correlated with physical health of WHOQOL-BREF (r = -0.577, p = 0.012), state and trait anxiety of STAI (r = 0.576, p = 0.012; r = 0.708, p = 0.00009, respectively), and CES-D (r = 0.465, p = 0.05). In conclusion, the SSP has a partial effect on social impairments in adults with ASD, specifically on the Social Awareness subscale of the SRS-2.
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Affiliation(s)
- Hiroki Kawai
- Department of Neuropsychiatry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (H.K.)
| | - Makiko Kishimoto
- Department of Neuropsychiatry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (H.K.)
- National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Yuko Okahisa
- Department of Neuropsychiatry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (H.K.)
| | - Shinji Sakamoto
- Department of Neuropsychiatry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (H.K.)
| | - Seishi Terada
- Department of Neuropsychiatry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (H.K.)
| | - Manabu Takaki
- Department of Neuropsychiatry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan; (H.K.)
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Klymus TM, Ravchyna TV, Herus O, Kozak MY, Tiurina TG, Shkoliar MV, Marcucci G. USING THE SENSORY INTEGRATION TECHNIQUE FOR PEOPLE WITH AUTISM SPECTRUM DISORDERS DURING TRAINING AT THE CLIMBING SECTION. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:558-562. [PMID: 38069858 DOI: 10.36740/merkur202305116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Aim: To analyze the practical application of the sensory integration technique for individuals with autism spectrum disorder at a climbing section, and to investigate the impact of physical activity on improving their proprioceptive and vestibular systems. PATIENTS AND METHODS Materials and Methods: The method of included participant observation at the climbing classes with constant recording the behavior (desirable and undesirable) was used. The sensory screening (developed by J. Ayres) was applied for recording and determining the sensory systems of the people with ASD before the start of training and again after a month. The scale of Sensory Integration and Praxis Tests (SIPT) was used for assessing certain aspects of participants' sensory processing or perception according to the goals set during the climbing classes. RESULTS Results: The results of the research showed that the application of the sensory integration technique for individuals with ACD at a climbing section promoted the dynamics of changes in their sensory system during training considering the characteristics of their sensory system. The positive changes were observed in the way the people with ACD felt about their own bodies and their involvement in sports activities that in its turn made it possible to be active and develop their sensory system. It has been identified that while planning training for the people with ASD it is necessary to take into account sensory modulation (reading sensory signals) and apply exercises for stimulating sensory sensations that will improve the motor activity of persons with ASD, their social interaction, and safety, as well. CONCLUSION Conclusions: During training at the climbing section sensory information processing of the individuals with ASD have the impact on their body control, hand-eye coordination, and hand sensitivity during training. The improvement of sensory information processing in its turn enables people with ASD to master climbing.
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Affiliation(s)
| | - Tetyana V Ravchyna
- SEPARATE STRUCTURAL UNIT "TECHNICAL VOCATIONAL COLLEGE OF LVIV POLYTECHNIC NATIONAL UNIVERSITY", LVIV, UKRAINE
| | - Olha Herus
- LVIV POLITECHNIK NATIONAL UNIVERSITY, LVIV, UKRAINE
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Shahrudin FA, Dzulkarnain AAA, Hanafi AM, Jamal FN, Basri NA, Sidek SN, Yusof HM, Khalid M. Music and Sound-Based Intervention in Autism Spectrum Disorder: A Scoping Review. Psychiatry Investig 2022; 19:626-636. [PMID: 36059051 PMCID: PMC9441466 DOI: 10.30773/pi.2021.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/20/2022] [Indexed: 11/27/2022] Open
Abstract
To map the evidence from the relevant studies regarding the use of music and sound-based intervention for autism spectrum disorder (ASD) using a scoping review study design. Scoping review was conducted according to the inclusion criteria using Google Scholar, PubMed, CINAHL, MEDLINE, and Scopus. The review was accomplished in five steps: 1) identify the inclusion criteria, 2) search for relevant studies, 3) studies selection, 4) data extraction and charting, and 5) data analysis and presentation. Four major themes emerged from 39 studies that matched the inclusion criteria as follows: 1) forms of sound therapy discussing methods of sound therapy and stimulus used, 2) duration of the intervention explain in terms of listening time and total listening sessions, 3) clinical characteristics of the intervention exploring the main interest of sound therapy study in ASD, and 4) evidence for the intervention effectiveness looking into the positive, negative, and mixed findings of previous studies. Each theme was explored to identify the knowledge gaps in sound-intervention therapy. This review demonstrated the need for further studies to address several issues including identifying the effectiveness of sound-therapy intervention for ASD according to the individual sound types, the minimum duration for ASD sound-therapy intervention and more details on the use of technology, and clinical features of the sound-therapy intervention. These elements are important to further demonstrate the effectiveness of sound therapy intervention for ASD children.
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Affiliation(s)
- Fatin Amira Shahrudin
- Department of Audiology and Speech-Language Pathology, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Ahmad Aidil Arafat Dzulkarnain
- Department of Audiology and Speech-Language Pathology, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Ayu Madiha Hanafi
- Department of Audiology and Speech-Language Pathology, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Fatin Nabilah Jamal
- Department of Audiology and Speech-Language Pathology, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Nadzirah Ahmad Basri
- Department of Psychiatry, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
| | - Shahrul Na'im Sidek
- Department of Mechatronic Engineering, Kulliyyah of Engineering, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Hazlina Md Yusof
- Department of Mechatronic Engineering, Kulliyyah of Engineering, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Madihah Khalid
- Department of Curriculum and Instruction, Kulliyyah of Education, International Islamic University Malaysia, Kuala Lumpur, Malaysia
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Danesh AA, Howery S, Aazh H, Kaf W, Eshraghi AA. Hyperacusis in Autism Spectrum Disorders. Audiol Res 2021; 11:547-556. [PMID: 34698068 PMCID: PMC8544234 DOI: 10.3390/audiolres11040049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
Hyperacusis is highly prevalent in the autism spectrum disorder (ASD) population. This auditory hypersensitivity can trigger pragmatically atypical reactions that may impact social and academic domains. Objective: The aim of this report is to describe the relationship between decreased sound tolerance disorders and the ASD population. Topics covered: The main topics discussed include (1) assessment and prevalence of hyperacusis in ASD; (2) etiology of hyperacusis in ASD; (3) treatment of hyperacusis in ASD. Conclusions: Knowledge of the assessment and treatment of decreased sound tolerance disorders within the ASD population is growing and changing.
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Affiliation(s)
- Ali A. Danesh
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, FL 33431, USA;
- Department of Integrated Medical Sciences, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
- Correspondence:
| | - Stephanie Howery
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Hashir Aazh
- Department of Audiology, Tinnitus and Hyperacusis Specialty Clinic, Royal Surrey Hospital, Guildford GU2 7XX, UK;
| | - Wafaa Kaf
- Communication Sciences and Disorders Department, Missouri State University, Springfield, MO 65897, USA;
| | - Adrien A. Eshraghi
- Department of Otolaryngology and Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33146, USA;
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Scheerer NE, Boucher TQ, Bahmei B, Iarocci G, Arzanpour S, Birmingham E. Family Experiences of Decreased Sound Tolerance in ASD. J Autism Dev Disord 2021; 52:4007-4021. [PMID: 34524587 DOI: 10.1007/s10803-021-05282-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
Decreased sound tolerance (DST) is the most common sensory difficulty experienced by autistic individuals. Parents of 88 autistic children and young adults between the ages of 3 and 30 described coping strategies and physical and emotional responses used to deal with distressing sounds, and their impact on daily activities. Loud, sudden, and high-pitched sounds were most commonly endorsed as distressing, most often causing autistic children and young adults to cover their ears or yell, while producing stress, irritation, fear, and anxiety. Parents reported warning their child, providing breaks, or avoiding noisy settings as the most used coping strategies. Overall, findings indicate that DST leads to fewer opportunities for autistic children and young adults to participate at home, at school, and in the community. Further, results suggest hyperacusis, misophonia, and phonophobia, subtypes of DST, are present in autistic children and young adults.
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Affiliation(s)
- Nichole E Scheerer
- Brain and Mind Institute, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
| | - Troy Q Boucher
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Behnaz Bahmei
- Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada
| | - Grace Iarocci
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Siamak Arzanpour
- Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada
| | - Elina Birmingham
- Faculty of Education, Simon Fraser University, Burnaby, BC, Canada
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Prevalence of Decreased Sound Tolerance (Hyperacusis) in Individuals With Autism Spectrum Disorder: A Meta-Analysis. Ear Hear 2021; 42:1137-1150. [PMID: 33577214 DOI: 10.1097/aud.0000000000001005] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Hyperacusis, defined as decreased tolerance to sound at levels that would not trouble most individuals, is frequently observed in individuals with autism spectrum disorder (ASD). Despite the functional impairment attributable to hyperacusis, little is known about its prevalence or natural history in the ASD population. The objective of this study was to conduct a systematic review and meta-analysis estimating the current and lifetime prevalence of hyperacusis in children, adolescents, and adults with ASD. By precisely estimating the burden of hyperacusis in the ASD population, the present study aims to enhance recognition of this particular symptom of ASD and highlight the need for additional research into the causes, prevention, and treatment of hyperacusis in persons on the spectrum. DESIGN We searched PubMed and ProQuest to identify peer-reviewed articles published in English after January 1993. We additionally performed targeted searches of Google Scholar and the gray literature, including studies published through May 2020. Eligible studies included at least 20 individuals with diagnosed ASD of any age and reported data from which the proportion of ASD individuals with current and/or lifetime hyperacusis could be derived. To account for multiple prevalence estimates derived from the same samples, we utilized three-level Bayesian random-effects meta-analyses to estimate the current and lifetime prevalence of hyperacusis. Bayesian meta-regression was used to assess potential moderators of current hyperacusis prevalence. To reduce heterogeneity due to varying definitions of hyperacusis, we performed a sensitivity analysis on the subset of studies that ascertained hyperacusis status using the Autism Diagnostic Interview-Revised (ADI-R), a structured parent interview. RESULTS A total of 7783 nonduplicate articles were screened, of which 67 were included in the review and synthesis. Hyperacusis status was ascertained in multiple ways across studies, with 60 articles employing interviews or questionnaires and seven using behavioral observations or objective measures. The mean (range) age of samples in the included studies was 7.88 years (1.00 to 34.89 years). The meta-analysis of interview/questionnaire measures (k(3) = 103, nASD = 13,093) estimated the current and lifetime prevalence of hyperacusis in ASD to be 41.42% (95% CrI, 37.23 to 45.84%) and 60.58% (50.37 to 69.76%), respectively. A sensitivity analysis restricted to prevalence estimates derived from the ADI-R (k(3) = 25, nASD = 5028) produced similar values. The estimate of current hyperacusis prevalence using objective/observational measures (k(3) = 8, nASD = 488) was 27.30% (14.92 to 46.31%). Heterogeneity in the full sample of interview/questionnaire measures was substantial but not significantly explained by any tested moderator. However, prevalence increased sharply with increasing age in studies using the ADI-R (BF10 = 93.10, R2Het = 0.692). CONCLUSIONS In this meta-analysis, we found a high prevalence of current and lifetime hyperacusis in individuals with ASD, with a majority of individuals on the autism spectrum experiencing hyperacusis at some point in their lives. The high prevalence of hyperacusis in individuals with ASD across the lifespan highlights the need for further research on sound tolerance in this population and the development of services and/or interventions to reduce the burden of this common symptom.
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Williams ZJ, He JL, Cascio CJ, Woynaroski TG. A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms. Neurosci Biobehav Rev 2021; 121:1-17. [PMID: 33285160 PMCID: PMC7855558 DOI: 10.1016/j.neubiorev.2020.11.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
Atypical behavioral responses to environmental sounds are common in autistic children and adults, with 50-70 % of this population exhibiting decreased sound tolerance (DST) at some point in their lives. This symptom is a source of significant distress and impairment across the lifespan, contributing to anxiety, challenging behaviors, reduced community participation, and school/workplace difficulties. However, relatively little is known about its phenomenology or neurocognitive underpinnings. The present article synthesizes a large body of literature on the phenomenology and pathophysiology of DST-related conditions to generate a comprehensive theoretical account of DST in autism. Notably, we argue against conceptualizing DST as a unified construct, suggesting that it be separated into three phenomenologically distinct conditions: hyperacusis (the perception of everyday sounds as excessively loud or painful), misophonia (an acquired aversive reaction to specific sounds), and phonophobia (a specific phobia of sound), each responsible for a portion of observed DST behaviors. We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.
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Affiliation(s)
- Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 221 Eskind Biomedical Library and Learning Center, 2209 Garland Ave., Nashville, TN, 37240, United States; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States.
| | - Jason L He
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Strand Building, Strand Campus, Strand, London, WC2R 2LS, London, United Kingdom.
| | - Carissa J Cascio
- Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 2254 Village at Vanderbilt, 1500 21st Ave South, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
| | - Tiffany G Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
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Psychoeducational Interventions for Adults With Level 3 Autism Spectrum Disorder: A 50-Year Systematic Review. Cogn Behav Neurol 2020; 32:139-163. [PMID: 31517698 PMCID: PMC6749978 DOI: 10.1097/wnn.0000000000000201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is face validity to the expectation that adults with level 3 autism spectrum disorder (ASD–3) will benefit from a range of psychoeducational interventions. This paper reviews the empirical evidence supporting the effectiveness of these interventions, many of which are currently used in clinical settings. We reviewed 56 peer-reviewed studies of psychoeducational interventions for adults with ASD–3, written in English and since 1968, that met our criteria. The reviewing team included educators, clinicians, researchers, and a biostatistician. The available literature was limited, and most, if not all, of the studies presented some significant methodological limitations. When using Cochrane’s criteria to assess seven key outcome domains—activities of daily living, aggressive/destructive behaviors, emotional functioning, language/communication skills, self-injurious behaviors, stereotypy/mannerisms, and vocational skills—we found only moderately reliable evidence to support the effectiveness of interventions designed to improve emotional functioning in adults with ASD–3. The reliability of evidence relevant to the six other outcome domains was rated as low or very low. Based on this review, we suggest directions for future study of interventions for adults with ASD–3, including topics, subpopulations, and approaches that should be explored. We also propose some crucial changes in how future studies regarding this population should be designed, analyzed, and documented, while balancing clinical considerations with scientific/educational utility.
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Zhukova M, Talantseva O, Logvinenko T, Titova O, Grigorenko E. Complementary and Alternative Treatments for Autism Spectrum Disorders: A Review for Parents and Clinicians. КЛИНИЧЕСКАЯ И СПЕЦИАЛЬНАЯ ПСИХОЛОГИЯ 2020. [DOI: 10.17759/cpse.2020090310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Complementary and alternative therapy (CAT) methods for children with autism spectrum disorders (ASD) are widespread in European countries and the Russian Federation; however, their efficacy and safety is not routinely considered by parents and clinicians when recommended or used. The current narrative review presents the most widely known CAT interventions for children with ASD synthesizing data from meta-analyses, systematic reviews, and randomized controlled trials obtained from the PubMed database based on the safety-efficacy model. We have found that, of the reviewed CATs, only the melatonin intervention can be considered safe and effective for children with ASD with comorbid sleep problems. The methods that were classified as safe but had inconclusive efficacy are recommended to be implemented only when they do not interfere with front line treatment for ASD, Applied Behavior Analysis (ABA). Methods with the lack of current evidence for the efficacy such as auditory integration therapies, bioacoustic correction, sensory integration therapy, micropolarization, animal assisted therapy, and dietary interventions should not be recommended as alternative treatments and can only be used as complimentary to ABA-based interventions. We advise against the use of chelation, hyperbaric oxygen therapy, and holding therapy due their documented harmful psychological and physical effects. When considering CAT for ASD we recommend parents and clinicians use the criteria suggested by Lofthouse and colleagues [59]: only the therapies that are safe, easy, cheap, and sensible can be recommended and used, as opposed to therapies that are risky, unrealistic, difficult, or expensive that should not be recommended or utilized.
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Pfeiffer B, Stein Duker L, Murphy A, Shui C. Effectiveness of Noise-Attenuating Headphones on Physiological Responses for Children With Autism Spectrum Disorders. Front Integr Neurosci 2019; 13:65. [PMID: 31798424 PMCID: PMC6863142 DOI: 10.3389/fnint.2019.00065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 10/21/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the proof of concept of an intervention to decrease sympathetic activation as measured by skin conductivity (electrodermal activity, EDA) in children with an autism spectrum disorder (ASD) and auditory hypersensitivity (hyperacusis). In addition, researchers examined if the intervention provided protection against the negative effects of decibel level of environmental noises on electrodermal measures between interventions. The feasibility of implementation and outcome measures within natural environments were evaluated. Method: A single-subject multi-treatment design was used with six children, aged 8–16 years, with a form of Autism (i.e., Autism, PDD-NOS). Participants used in-ear (IE) and over-ear (OE) headphones for two randomly sequenced treatment phases. Each child completed four phases: (1) a week of baseline data collection; (2) a week of an intervention; (3) a week of no intervention; and (4) a week of the other intervention. Empatica E4 wristbands collected EDA data. Data was collected on 16–20 occasions per participant, with five measurements per phase. Results: Separated tests for paired study phases suggested that regardless of intervention type, noise attenuating headphones led to a significance difference in both skin conductance levels (SCL) and frequency of non-specific conductance responses (NS-SCRs) between the baseline measurement and subsequent phases. Overall, SCL and NS-SCR frequency significantly decreased between baseline and the first intervention phase. A protective effect of the intervention was tested by collapsing intervention results into three phases. Slope correlation suggested constant SCL and NS-SCR frequency after initial use of the headphones regardless of the increase in environmental noises. A subsequent analysis of the quality of EDA data identified that later phases of data collection were associated with better data quality. Conclusion: Many children with ASD have hypersensitivities to sound resulting in high levels of sympathetic nervous system reactivity, which is associated with problematic behaviors and distress. The findings of this study suggest that the use of noise attenuating headphones for individuals with ASD and hyperacusis may reduce sympathetic activation. Additionally, results suggest that the use of wearable sensors to collect physiological data in natural environments is feasible with established protocols and training procedures.
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Affiliation(s)
- Beth Pfeiffer
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
| | - Leah Stein Duker
- USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States
| | - AnnMarie Murphy
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
| | - Chengshi Shui
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
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Impact of Auditory Integration Therapy (AIT) on the Plasma Levels of Human Glial Cell Line-Derived Neurotrophic Factor (GDNF) in Autism Spectrum Disorder. J Mol Neurosci 2019; 68:688-695. [PMID: 31073917 DOI: 10.1007/s12031-019-01332-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/25/2019] [Indexed: 01/14/2023]
Abstract
Neurotrophic factors, including the glial cell line-derived neurotrophic factor (GDNF), are of importance for synaptic plasticity regulation, intended as the synapses' ability to strengthen or weaken their responses to differences in neuronal activity. Such plasticity is essential for sensory processing, which has been shown to be impaired in autism spectrum disorder (ASD). This study is the first to investigate the impact of auditory integration therapy (AIT) of sensory processing abnormalities in autism on plasma GDNF levels. Fifteen ASD children, aged between 5 and 12 years, were enrolled and underwent the present research study. AIT was performed throughout 10 days with a 30-min session twice a day. Before and after AIT, Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), and Short Sensory Profile (SSP) scores were calculated, and plasma GDNF levels were assayed by an EIA test. A substantial decline in autistic behavior was observed after AIT in the scaling parameters used. Median plasma GDNF level was 52.142 pg/ml before AIT. This level greatly increased immediately after AIT to 242.05 pg/ml (P < 0.001). The levels were depressed to 154.00 pg/ml and 125.594 pg/ml 1 month and 3 months later, respectively, but they were still significantly higher compared with the levels before the treatment (P = 0.001, P = 0.01, respectively). There was an improvement in the measures of autism severity as an effect of AIT which induced the up-regulation of GDNF in plasma. Further research, on a large scale, is needed to evaluate if the cognitive improvement of ASD children after AIT is related or not connected to the up-regulation of GDNF.
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Platel H. [Music and neurodevelopment, the contribution of cognitive neurosciences]. SOINS. PÉDIATRIE, PUÉRICULTURE 2019; 40:8-11. [PMID: 30910079 DOI: 10.1016/j.spp.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research in cognitive neurosciences has developed significantly and has enabled the mechanisms of neuroplasticity to be studied in order to understand the effect of music practice. In children, this research concerns mainly the impact of music learning in the setting of a music conservatory. Moreover, recent studies have also sought to measure the clinical benefits of music interventions on hospital wards, providing a scientific basis to these practices.
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Affiliation(s)
- Hervé Platel
- Normandie Université, Unicaen, PSL ResearchUniversity, EPHE, Inserm U1077, Centre hospitalier universitaire de Caen, Neuropsychologie et imagerie de la mémoire humaine, Pôle des formations et de recherche en santé, 2 rue des Rochambelles, 14032 Caen cedex CS-14032, France.
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The association of auditory integration training in children with autism spectrum disorders among Chinese: a meta-analysis. Biosci Rep 2018; 38:BSR20181412. [PMID: 30429234 PMCID: PMC6294631 DOI: 10.1042/bsr20181412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/17/2022] Open
Abstract
Randomized controlled trials (RCTs) have reported an inconsistent relationship about the auditory integration training (AIT) in children with autism spectrum disorders (ASD) among Chinese. The current study was to investigate the efficacy of AIT for children with ASD compared with those in control group by using meta-analysis. Relevant trials published were identified by an electronic search of PubMed, CENTRAL, EMBASE, WanFang, CNKI, and SinoMed databases up to December 31, 2017. Outcome of interest included childhood autism rating scale (CARS), autism behavior checklist (ABC), intelligence quotient (IQ), and autism treatment evaluation checklist (ATEC). Standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated using a random-effect model. Thirteen RCTs with 976 children with ASD were included for analysis. The pooled SMD showed that children with ASD had significantly lower ABC scores [summary SMD = −0.58, 95%CI = −0.79 to −0.38] and ATEC scores [summary SMD = −0.75, 95%CI = −1.05 to −0.45] in AIT group compared with that in control group. The analysis of pooled statistics put forward AIT could increase the IQ score when compared with that in control group [summary SMD = 0.59, 95%CI = 0.41–0.77]. A negative association was found about CARS scores between AIT group and control group. No publication bias was found and no single study had essential effect on the pooled results. In conclusions, AIT can reduce the score of ABC and ATEC and can increase the IQ score among children with ASD in Chinese. Therefore, it is recommended for Chinese children with ASD to receive AIT.
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Villasenor RF, Smith SL, Jewell VD. A systematic review of sound-based intervention programs to improve participation in education for children with sensory processing and integration challenges. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2018. [DOI: 10.1080/19411243.2018.1432444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Sarah L. Smith
- Creighton University, Occupational Therapy Department, Omaha, NE, USA
| | - Vanessa D. Jewell
- Creighton University, Occupational Therapy Department, Omaha, NE, USA
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Al-Ayadhi L, Alhowikan AM, Halepoto DM. Impact of Auditory Integrative Training on Transforming Growth Factor-β1 and Its Effect on Behavioral and Social Emotions in Children with Autism Spectrum Disorder. Med Princ Pract 2018; 27:23-29. [PMID: 29298441 PMCID: PMC5968258 DOI: 10.1159/000486572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 01/03/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore the impact of auditory integrative training (AIT) on the inflammatory biomarker transforming growth factor (TGF)-β1 and to assess its effect on social behavior in children with autism spectrum disorder (ASD). SUBJECTS AND METHODS In this cross-sectional study, 15 patients (14 males and 1 female) with ASD aged 3-12 years were recruited. All were screened for autism using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Plasma levels of TGF-β1 were measured in all patients using a sandwich enzyme-linked immunoassay (ELISA) immediately and 1 and 3 months after the AIT sessions. Pre- and post-AIT behavioral scores were also calculated for each child using the Childhood Autism Rating Scale (CARS), the Social Responsiveness Scale (SRS), and the Short Sensory Profile (SSP). Data were analyzed using the Statistical Package for the Social Sciences (SPSS 21.0 for Windows). RESULTS Plasma levels of TGF-β1 significantly increased to 85% immediately after AIT (20.13 ± 12 ng/mL, p < 0.05), to 95% 1 month after AIT (21.2 ± 11 ng/mL, p < 0.01), and to 105% 3 months after AIT (22.25 ± 16 ng/mL, p < 0.01) compared to before AIT (10.85 ± 8 ng/mL). Results also revealed that behavioral rating scales (CARS, SRS, and SSP) improved in terms of disease severity after AIT. CONCLUSION Increased plasma levels of TGF-β1 support the therapeutic effect of AIT on TGF-β1 followed by improvement in social awareness, social cognition, and social communication in children with ASD. Furthermore, TGF-β1 was associated with severity in all scores tested (CARS, SRS, and SSP); if confirmed in studies with larger sample sizes, TGF-β1 may be considered as a marker of ASD severity and to assess the efficacy of therapeutic interventions.
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Affiliation(s)
- Laila Al-Ayadhi
- Autism Research and Treatment Centre, King Saud University, Riyadh, Saudi Arabia
| | | | - Dost Muhammad Halepoto
- Autism Research and Treatment Centre, King Saud University, Riyadh, Saudi Arabia
- *Dost Muhammad Halepoto, Faculty of Medicine, King Saud University, PO Box 2925, Riyadh 11461 (Saudi Arabia), E-Mail
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Schoen SA, Miller LJ, Sullivan J. A Pilot Study of Integrated Listening Systems for Children With Sensory Processing Problems. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2015. [DOI: 10.1080/19411243.2015.1055418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sturmey P. Treatment of psychopathology in people with intellectual and other disabilities. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:593-600. [PMID: 23072950 DOI: 10.1177/070674371205701003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the psychosocial, pharmacological, and other treatments of psychopathology in people with intellectual disabilities (IDs), autism, and other developmental disabilities (DDs). METHOD Systematic reviews and meta-analyses of psychosocial, pharmacological, and other treatments for people with DDs are reviewed. RESULTS There is strong evidence for applied behaviour analysis (ABA) and other behavioural treatments of some forms of psychopathology. There is little good evidence to support the effectiveness of cognitive-behavioural therapy, cognitive therapy, sensory interventions, and other forms of psychosocial interventions. Recently, more randomized controlled trials (RCTs) of psychopharmacology have been published, especially with people with autism spectrum disorders. Most RCTs were for externalizing behaviour problems, rather than for psychopathology. These RCTs offer only preliminary support for the effectiveness of pharmacotherapy. No evidence was found for the effectiveness of other biological treatments. CONCLUSIONS Current research supports the use of ABA and other behavioural interventions for some forms of psychopathology. Evidence for the effectiveness of other interventions is limited or absent.
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Affiliation(s)
- Peter Sturmey
- Department of Psychology, City University of New York, Flushing, New York, NY, USA.
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Growing Pains: How Psychologists Can Help to Meet the Clinical Needs of Clients With Autism Spectrum Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2011.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fey ME, Richard GJ, Geffner D, Kamhi AG, Medwetsky L, Paul D, Ross-Swain D, Wallach GP, Frymark T, Schooling T. Auditory Processing Disorder and Auditory/Language Interventions: An Evidence-Based Systematic Review. Lang Speech Hear Serv Sch 2011; 42:246-64. [DOI: 10.1044/0161-1461(2010/10-0013)] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose
In this systematic review, the peer-reviewed literature on the efficacy of interventions for school-age children with auditory processing disorder (APD) is critically evaluated.
Method
Searches of 28 electronic databases yielded 25 studies for analysis. These studies were categorized by research phase (e.g., exploratory, efficacy) and ranked on a standard set of quality features related to methodology and reporting.
Results
Some support exists for the claim that auditory and language interventions can improve auditory functioning in children with APD and those with primary spoken language disorder. There is little indication, however, that observed improvements are due to the auditory features of these programs. Similarly, evidence supporting the effects of these programs on spoken and written language functioning is limited.
Conclusion
The evidence base is too small and weak to provide clear guidance to speech-language pathologists faced with treating children with diagnosed APD, but some cautious skepticism is warranted until the record of evidence is more complete. Clinicians who decide to use auditory interventions should be aware of the limitations in the evidence and take special care to monitor the spoken and written language status of their young clients.
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Affiliation(s)
- Marc E Fey
- University of Kansas Medical Center, Kansas City, MO, USA.
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Biological changes in auditory function following training in children with autism spectrum disorders. Behav Brain Funct 2010; 6:60. [PMID: 20950487 PMCID: PMC2965126 DOI: 10.1186/1744-9081-6-60] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 10/16/2010] [Indexed: 11/10/2022] Open
Abstract
Background Children with pervasive developmental disorders (PDD), such as children with autism spectrum disorders (ASD), often show auditory processing deficits related to their overarching language impairment. Auditory training programs such as Fast ForWord Language may potentially alleviate these deficits through training-induced improvements in auditory processing. Methods To assess the impact of auditory training on auditory function in children with ASD, brainstem and cortical responses to speech sounds presented in quiet and noise were collected from five children with ASD who completed Fast ForWord training. Results Relative to six control children with ASD who did not complete Fast ForWord, training-related changes were found in brainstem response timing (three children) and pitch-tracking (one child), and cortical response timing (all five children) after Fast ForWord use. Conclusions These results provide an objective indication of the benefit of training on auditory function for some children with ASD.
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Kamp-Becker I, Duketis E, Sinzig J, Poustka L, Becker K. Diagnostik und Therapie von Autismus-Spektrum-Störungen im Kindesalter. KINDHEIT UND ENTWICKLUNG 2010. [DOI: 10.1026/0942-5403/a000019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bei Autismus-Spektrum-Störungen (ASD) handelt es sich um komplexe Störungsbilder, die gerade im Kindesalter aufgrund der vielfältigen Differentialdiagnosen einer multidisziplinären und mehrschrittigen Diagnostik bedürfen. Eine Früherkennung autistischer Störungen ist ab dem zweiten Lebensjahr möglich. Standardisierte Verfahren verbessern die diagnostische Validität, erfordern jedoch eine fundierte kinder- und jugendpsychiatrische Expertise. Generell ist in der Behandlung ein ganzheitlicher, die Gesamtentwicklung des Kindes mit ASD umfassender Therapie- und Förderansatz zu verfolgen. Früh beginnende, intensive, verhaltenstherapeutische Interventionen unter Einbezug der Eltern haben sich als wirksam erwiesen. Die pharmakologische Behandlung von begleitenden Auffälligkeiten kann als ergänzende Maßnahme sinnvoll sein, da das Ansprechen auf pädagogische und psychotherapeutische Maßnahmen hierdurch verbessert werden kann.
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Affiliation(s)
- Inge Kamp-Becker
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie der Philipps-Universität Marburg
| | - Eftichia Duketis
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Johann Wolfgang Goethe-Universität Frankfurt am Main
| | - Judith Sinzig
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität Köln
| | - Luise Poustka
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit Mannheim
| | - Katja Becker
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie der Philipps-Universität Marburg
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Polatajko HJ, Cantin N. Exploring the Effectiveness of Occupational Therapy Interventions, Other Than the Sensory Integration Approach, With Children and Adolescents Experiencing Difficulty Processing and Integrating Sensory Information. Am J Occup Ther 2010; 64:415-29. [DOI: 10.5014/ajot.2010.09072] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
This literature review was completed as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association to explore the effectiveness of occupational therapy interventions with children and adolescents experiencing difficulty processing and integrating sensory information. This part of the review focused on interventions other than the sensory integration approach. Twenty articles (reporting on 21 studies) met the inclusion criteria. This systematic review found that children with difficulty processing and integrating sensory information and difficulties with the performance of daily occupations can benefit from intervention. However, the great variability that characterizes this literature in terms of populations, interventions, and study quality precludes the formation of any firm conclusions regarding specific approaches. There is an urgent need for well-controlled studies examining the effectiveness of frequently used pediatric occupational therapy interventions with well-defined, homogeneous populations on outcomes that target participation in everyday life.
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Affiliation(s)
- Helene J. Polatajko
- Helene J. Polatajko, Doctoral, OT(C), OT Reg. (Ont.), FCAOT, is Professor, Department of Occupational Therapy, Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G 1V7 Canada;
| | - Noemi Cantin
- Noemi Cantin, OT Reg. (Ont.), is Doctoral Candidate, Department of Rehabilitation Science, Faculty of Medicine, University of Toronto, Ontario, Canada
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25
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Seida JK, Ospina MB, Karkhaneh M, Hartling L, Smith V, Clark B. Systematic reviews of psychosocial interventions for autism: an umbrella review. Dev Med Child Neurol 2009; 51:95-104. [PMID: 19191842 DOI: 10.1111/j.1469-8749.2008.03211.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM A wide range of psychosocial interventions for the treatment of individuals with autism-spectrum disorders (ASDs) have been evaluated in systematic reviews. We conducted an umbrella review of systematic reviews of the effectiveness of psychosocial interventions for ASD. METHOD Comprehensive searches were conducted in 25 bibliographic databases, relevant journals and reference lists up to May 2007. Studies included were systematic reviews on any psychosocial intervention for individuals with ASDs. Two reviewers independently assessed study relevance and quality. RESULTS Thirty systematic reviews were included. The majority of reviews evaluated interventions based on behavioural theory (n=9) or communication-focused (n=7) therapies. Positive intervention outcomes were reported in the majority of the reviews. Methodological quality of the reviews was generally poor. INTERPRETATION The reviews reported positive outcomes for many of the interventions, suggesting that some form of treatment is favourable over no treatment. However, there is little evidence for the relative effectiveness of these treatment options. Many of the systematic reviews had methodological weaknesses that make them vulnerable to bias. There is a need for further systematic reviews that adhere to strict scientific methods and for primary studies that make direct comparisons between different treatment options.
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Affiliation(s)
- Jennifer Krebs Seida
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
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Levy SE, Hyman SL. “Complementary and Alternative Medicine Treatments for Children with Autism Spectrum Disorders”. Child Adolesc Psychiatr Clin N Am 2008; 17:803-20, ix. [PMID: 18775371 PMCID: PMC2597185 DOI: 10.1016/j.chc.2008.06.004] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Complementary and alternative medical (CAM) treatments are commonly used for children with autism spectrum disorders. This review discusses the evidence supporting the most frequently used treatments, including categories of mind-body medicine, energy medicine, and biologically based, manipulative, and body-based practices, with the latter two treatments the most commonly selected by families. Clinical providers need to understand the evidence for efficacy (or lack thereof) and potential side effects. Some CAM practices have evidence to reject their use, such as secretin, whereas others have emerging evidence to support their use, such as melatonin. Most treatments have not been adequately studied and do not have evidence to support their use.
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Affiliation(s)
- Susan E. Levy
- Clinical Professor of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia
| | - Susan L. Hyman
- Associate Professor of Pediatrics, University of Rochester School of Medicine, Golisano Children's Hospital at Strong
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Complementary and alternative medical therapies for attention-deficit/hyperactivity disorder and autism. Pediatr Clin North Am 2007; 54:983-1006; xii. [PMID: 18061787 DOI: 10.1016/j.pcl.2007.09.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders. The use of these therapies is well documented, yet the evidence of the safety and efficacy of these treatments in children is limited. This article describes the current evidence-based CAM therapies for ADHD and autism, focusing on nutritional interventions; natural health products, including essential fatty acids, vitamins, minerals, and other health supplements; biofeedback; and reducing environmental toxins. The CAM evidence in ADHD is addressed, as is the CAM literature in autism.
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Abstract
Pediatricians have an important role not only in early recognition and evaluation of autism spectrum disorders but also in chronic management of these disorders. The primary goals of treatment are to maximize the child's ultimate functional independence and quality of life by minimizing the core autism spectrum disorder features, facilitating development and learning, promoting socialization, reducing maladaptive behaviors, and educating and supporting families. To assist pediatricians in educating families and guiding them toward empirically supported interventions for their children, this report reviews the educational strategies and associated therapies that are the primary treatments for children with autism spectrum disorders. Optimization of health care is likely to have a positive effect on habilitative progress, functional outcome, and quality of life; therefore, important issues, such as management of associated medical problems, pharmacologic and nonpharmacologic intervention for challenging behaviors or coexisting mental health conditions, and use of complementary and alternative medical treatments, are also addressed.
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