Corrigendum: What happened to parents' views of school success for autistic children during the COVID-19 pandemic?

[This corrects the article DOI: 10.3389/fpsyt.2023.1211041.].

Effectiveness of Fabric Weaving Therapy for Children with Autism Spectrum Disorder: A Randomized Waitlist-Controlled Trial

Objectives: To evaluate the effectiveness of weaving therapy on clinical outcomes and quality of life of autistic children. Design: Randomized waitlist-controlled trial. Setting/Location: Developmental and Behavioral Pediatrics Clinic, Faculty of Medicine Ramathibodi Hospital. Subjects: Twenty-three autistic children. Interventions: Weaving therapy was performed weekly for 6 months (3 months for hospital-based intervention and 3 months for home-based intervention). Outcome measures: Childhood Autism Rating Scale-second edition (CARS-2) and Pediatric Quality of Life Inventory (PedsQL) were measured at preintervention, 3 and 6 months postintervention. Methods: Twenty-three autistic children, aged 7.8-16.6 years, were randomized into an intervention group (N = 11) and a 3-month waitlist period group (N = 12). Ten weaving sessions were performed by the children, along with their parents, weekly for 3 months in hospital, and continued at home for an additional 3 months. The weaving therapy was delayed for 3 months in the waitlist group, followed by a 6-month intervention as the intervention group. Results: There was significant improvement on CARS-2 (p < 0.01) and PedsQL scores (p < 0.01) in the intervention group after the first 3-month weaving therapy. Meanwhile, in the waitlist group, no significant difference was found on CARS-2 (p = 0.09) and PedsQL scores (p = 0.26) during no weaving period. After the waitlist group began weaving therapy for 3 months, the authors found a significant improvement on both CARS-2 and PedsQL scores (p < 0.01both). Between-group comparisons showed that the intervention group had significant improvement on CARS-2 (p = 0.002) and PedsQL (p < 0.001) after 3-month weaving comparing with the waitlist group. After all the 23 participants finished a 6-month weaving therapy, there was significant difference in CARS-2 (p < 0.001) and PedsQL scores (p < 0.001) between pre- and postintervention. Conclusions: These findings suggest that traditional Thai fabric weaving therapy, as an alternative and complementary intervention, appears to be an effective therapy in improving the clinical symptoms and quality of life among autistic children. Clinical Trial Registration number: TCTR20200420002.

Prelinguistic communication complexity predicts expressive language in initial minimally verbal autistic children

BACKGROUND

Prelinguistic communication complexity refers to the use of different communication forms such as eye gaze, gestures and vocalisations and the degree to which these forms are coordinated and how directed to a communication partner. To date, little is known about the relationship between prelinguistic communication complexity and expressive language in minimally verbal autistic children.

AIMS

To test the hypothesis that prelinguistic communication complexity predicts expressive language 12 months later in autistic children and explore whether there are any differences in specific prelinguistic intentional communicative behaviours that are related to later expressive language levels.

METHODS & PROCEDURES

This longitudinal study examined 37 minimally verbal autistic children (29-71 months old). The Communication Complexity Scale (CCS) was used to measure participants' prelinguistic communication behaviours, which were extracted from a semi-structured play interaction at Time 1. The Chinese Communicative Development Inventory (CCDI) was used to examine participants' expressive language at Time 1 and Time 2 (12 months later). According to Time 2 vocabulary size, participants were divided into two groups: Low CCDI, between 0 and 62 words, and High CCDI, more than 100 words. Linear regression was used to examine the relationship between early prelinguistic communication complexity and later expressive language. Binary logistic regression was used to determine which of the early communication behaviours were uniquely significantly related to later expressive language levels.

OUTCOMES & RESULTS

There was a significant positive relationship between prelinguistic communication complexity and expressive language 12 months later, even after controlling for age and concurrent language. Findings revealed a group difference in the frequency of gesture and vocalisation combinations between the Low and High CCDI groups at Time 1. Gesture-vocalisation combinations also predicted better expressive language levels at Time 2.

CONCLUSIONS & IMPLICATIONS

Our findings suggest that it may be beneficial to incorporate different complex communication behaviours into prelinguistic intervention targets for minimally verbal autistic children. The CCS hierarchies can be used as a reference for the intervention goals of minimally verbal autistic children. These findings highlight the importance of targeting gesture and vocalisation combinations when autistic children transition from single prelinguistic communication behaviours to multimodal behaviours.

WHAT THIS PAPER ADDS

What is already known on this subject Children use eye gaze, gestures and vocalisations to communicate with others before they learn spoken language. There is strong evidence suggest that the frequency of prelinguistic communication predicts later linguistic achievements in autistic children. However, less is known about whether prelinguistic communication complexity also predicts later language and which specific behaviours are most predictive of language outcomes. What this study adds Minimally verbal autistic children who exhibit more complex prelinguistic communication behaviours have better expressive language 12 months later. Gestures combined with vocalisations predict better expressive language in minimally verbal autistic children. What are the clinical implications of this work? When identifying intervention targets for minimally verbal autistic children, the clinicians may reference the prelinguistic communication behaviours from the CCS. The gesture and vocalisation combinations are the key behaviours when targets transit from single form to two-form behaviours.

An affective assessment: incarnate biases in picture captions for autistic children

Previous studies have explored cognitive disabilities experienced by autistic children between the ages of 2 and 5 who attend special schools. However, there is still debate regarding the onset, scope, and causes of these problems, particularly when considering incarnate biases that may arise from affective notions. Early affective issues could potentially be a key factor contributing to observing such biases in picture captions. In this study, we employed an affective approach-simultaneous observation and questionnaire-to investigate how incarnate biases impact picture caption activities. Specifically, we looked at the performances of autistic children across four grades: PreK, K1, K2, and K3. We found that autistic children across all grades demonstrated instances of incarnation-biased interpretations in picture captions, although K3 performed better than the other grades. Furthermore, their incarnate biases tended to be negative rather than positive in affection, depending on the level of activity involved. Ultimately, the sources of these incarnate biases may stem from three spheres: school, society, and family. Thus, it is essential to consider these factors when designing educational programs for children with autism. It highlights the potential dangers associated with negative biases in picture captions. Unlike previous studies that focused on identifying discrepancies in picture caption, our research suggests that over time, as we take into account the onset of incarnate biases from the three affective spheres discussed in this study, picture caption may improve among autistic children as their incarnate biases decrease.

Hablando at home: Examining the interactional resources of a bilingual autistic child

Daily language interactions predict child outcomes. For multilingual families who rear neurodiverse children and who may be minoritized for their language use, a dearth of research examines families' daily language interactions. Utilizing a language socialization framework and a case study methodology, 4,991 English and Spanish utterances from a 5-year old autistic child and his family were collected during naturally occurring interactions over 10 days. Utterances were analyzed for patterns of code-switching by speaker, activity setting, English or Spanish initial language, and code-switch function. Spanish was spoken in most activities. For reading, both languages were equally employed by the father. While participants used both languages across all activity settings, significant variations in code-switching type and function were observed by activity setting and speaker. We discuss implications for how home language resources can be integrated into autism interventions.

Association of Parental Support with Reduced Stereotypy in Children with Autism Spectrum Disorder: A Cross-Sectional Study

Background and Objectives: To analyze the influence of parental presence and use of risperidone on social interaction and apathy among patients with Autism Spectrum Disorder (ASD). Materials and Methods: Cross-sectional study in a reference center for patients with ASD in a city in northeastern Brazil. The research was carried out using a sociodemographic questionnaire, the Dimensional Apathy Scale, and the Social Communication Questionnaire (SCQ) with the domains of social interaction, language, stereotypy, and communication. The referred questionnaire was answered by the parents or guardians of the children with ASD according to the DSM V criteria. Data were analyzed via independent t-test using the SPSS software version 20. Results: Interviews were conducted with 51 parents/guardians of autistic children with a mean age of 8.8 years (±2.95) and a predominance of males, 34 (66.7%). Of this total, 49 (96.1%) of the children attended school; 40 (78.4%) children were on medication, of which 38 (74.5%) were on risperidone. Those children on risperidone had a higher score on the SCQ scale (p = 0.049) and on the domain of stereotyped behaviors (p = 0.033), which indicated greater impairment. Another statistically relevant variable was the presence of married parents, whereby children who did not have the presence of married parents had a higher average of stereotyped behaviors compared to those who had married parents. Conclusions: The results showed differences in the means of social interactions for children on risperidone, especially regarding stereotyped behaviors. However, it is not possible to state whether this difference was due to the use of risperidone or whether they used risperidone precisely because of these behaviors. Also important was that children who had the presence of married parents showed fewer stereotyped behaviors. There was no difference in apathetic behavior between children.

What happened to parents' views of school success for autistic children during the COVID-19 pandemic?

Background

The educational views of parents with autistic children directly impacts their children's academic success. However, little research has been done on how the COVID-19 pandemic impacted parents' academic and social views.

Aim

This study analyzes parents' views of school success for their autistic children in the context of the COVID-19 pandemic and examines the relationships among pandemic stress, parental involvement, and parents' views of school success for autistic children in mainland China.

Methods

In this study, 713 parents of autistic children completed measures assessing their pandemic stress, parental involvement, and views of school success; linear regression and structural equation modeling were used to analyze the data.

Results

Parents' views of school success were influenced by factors such as parents' level of education, household income, parents' gender, and children's age. The effects of pandemic stress on views of school success for parents of autistic children are complex: physical and mental reaction has a negative direct effect on views of school success, a positive indirect effect mediated by parental involvement, and a net positive effect; risk perception and concern has a negative indirect effect; and both the direct and indirect effects of pragmatic hopefulness are positive. Education policymakers and practitioners need to seriously and carefully assess these results' implications for modern, inclusive education.

Geographic Variation in Preventable Hospitalizations among US Children with Autism

There is a limited amount of research on geographic differences in preventable hospitalizations for ambulatory care sensitive conditions (ACSCs) among children with autism. The purpose of this study was to examine US regional differences in potentially preventable hospital admissions for pediatric inpatients diagnosed with autism. Hospital discharge data for six pediatric preventable conditions were obtained from the 2016-2019 National Inpatient Sample (NIS) under the US Agency for Healthcare Research and Quality. Geographic differences in preventable hospitalizations for children with autism were examined by US census regions and divisions. Multiple logistic regression analyses were conducted to examine child and clinical characteristics associated with ACSCs hospitalization across four US regions; the dependent variable was the likelihood of ACSCs hospitalization. Additionally, this study further explored the variation in preventable hospitalization among racial and ethnic groups for each region or division. Of the 138,305 autistic inpatients aged 2-17 years, about 10% had a primary diagnosis related to ACSCs. The results showed that the highest proportion of preventable hospitalizations for autistic children occurred in the middle Atlantic division of the northeast region. Racial differences were observed across all US regions, particularly in the northeast and south regions. Black children with autism were more likely to be hospitalized for ACSCs compared to White children with autism in three of the four US regions. Our results highlight the significant racial disparities in potentially avoidable hospitalizations among US children with autism. Examining geographic and racial differences in potentially avoidable hospitalizations could inform policy and practice while gaining a better understanding of pediatric patients with autism and where their families access health services. The findings of this study may help policymakers to identify where intervention is needed to tackle health inequities in the accessibility to quality primary care in the US. Further studies with more detailed investigation are recommended to better understand the mechanisms underlying these disparities, and to formulate effective regional policy and clinical practices while considering the unique needs and challenges of underserved children with autism.

Maternal Variability of Amplitudes of Frequency Fluctuations Is Related to the Progressive Self-Other Transposition Group Intervention in Autistic Children

The self-to-other model of empathy (SOME) states that a key reason for the empathic deficiency in autistic individuals is the imbalance of the self-other switch. The existing interventions of theory of mind contain training of self-other transposition ability but combined with other cognitive trainings. The self-other distinction brain areas of autistic individuals have been revealed, but the brain areas of the self-other transposition ability and its intervention have not been investigated. There are normalized amplitudes of low-frequency fluctuations (mALFFs) within 0.01-0.1 Hz and many normalized amplitudes of frequency fluctuations (mAFFs) within 0-0.01, 0.01-0.05, 0.05-0.1, 0.1-0.15, 0.15-0.2, and 0.2-0.25 Hz. Therefore, the current study established a progressive self-other transposition group intervention to specifically and systematically improve autistic children's self-other transposition abilities. The transposition test with a three mountains test, an unexpected location test, and a deception test was used to directly measure autistic children's transposition abilities. The Interpersonal Responsiveness Index Empathy Questionnaire with perspective-taking and fantasy subscales (IRI-T) was used to indirectly measure autistic children's transposition abilities. The Autism Treatment Evaluation Checklist (ATEC) was used to measure autistic children's autism symptoms. The experiment was designed with two (intervention: experimental group vs. control group) independent variables and two (test time: pretest vs. posttest or tracking test) × three (test: transposition test vs. IRI-T test vs. ATEC test) dependent variables. Furthermore, it used eyes-closed resting-state functional magnetic resonance imaging to investigate and compare the relevant maternal mALFFs and average energy rank and energy rank variability of mAFFs of autistic children's transposition abilities, autism symptoms, and intervention effects. The results showed the following: (1) There were many improvements (pretest vs. posttest or tracking test) greater than chance 0 in the experimental group, such as the three mountains, lie, transposition, PT, IRI-T, PT tracking, cognition, behavior, ATEC, language tracking, cognition tracking, behavior tracking, and ATEC tracking improvements. However, there was no improvement greater than chance 0 in the control group. (2) The maternal mALFFs and maternal average energy rank and energy rank variability of mAFFs could predict the autistic children's transposition abilities, autism symptoms, and intervention effects with some overlap and some difference in maternal self-other distinction, sensorimotor, visual, facial expression recognition, language, memory and emotion, and self-consciousness networks. These results indicated that the progressive self-other transposition group intervention successfully improved autistic children's transposition abilities and reduced their autism symptoms; the intervention effects could be applied to daily life and last up to a month. The maternal mALFFs, average energy rank, and energy rank variability of mAFFs were three effective neural indictors of autistic children's transposition abilities, autism symptoms, and intervention effects, and the average energy rank and energy rank variability of mAFFs were two new neural indictors established in the current study. The maternal neural markers of the progressive self-other transposition group intervention effects for autistic children were found in part.

Occupational therapy assessment and interventions for young autistic children in South Africa

Background

Occupational Therapy is among the top interventions for autistic children, hence the need for equitable and effective services in the public and private health and education sectors. Ongoing research into the therapies for autism spectrum disorders in different contexts is also required.

Objectives

To explore and describe occupational therapists' assessment and intervention for autistic children in South Africa.

Methods

A descriptive qualitative research design using semi-structured interviews to gather data from purposively recruited OTs (n=20). Data were audio-recorded, transcribed and analysed thematically, and compared across three sectors public health, special needs schools and private practice.

Results

South African practice across all three sectors was similar to international patterns of informal play-based assessment, sensory processing and Ayres Sensory Integration (ASI®) treatment. Developmental frameworks guided specific approaches. Strong team collaboration was present across sectors, with some transdisciplinary teamwork and co-treatment. Undergraduate and postgraduate training opportunities were, however limited.

Conclusions

Occupational therapy assessments had diagnostic value. Informal tools such as developmental checklists were found to have clinical utility, whilst standardised tools were most commonly used to assess sensory processing and visual perception. Recommendations included incorporating ASI® into undergraduate curricula and postgraduate training opportunities with multidisciplinary input to develop ASD professionals in South Africa. It is imperative to advocate for services in under-resourced rural areas and marginalised communities that lack financial and social resources. Occupational therapists need to find new ways of working collaboratively across sectors to ensure effective and comprehensive services in public health and special schools.

"Music Therapy Was Never on the Table": Perspectives of Parents of Young Autistic Children

Parent coaching of music interventions is emerging as a viable model for families with young autistic children, yet recruitment difficulties have been apparent in previous studies. Understanding parent perspectives of early intervention services is critical to ensure that interventions are acceptable, feasible, and effective for all family members. In order to understand possible parental resistance to this type of parent education, we explored perspectives regarding music therapy, research, and parent coaching in parents of young autistic children. Fourteen parents attended virtual focus groups to discuss their experiences. We used a descriptive phenomenological approach to uncover the essence of their experience. Our findings indicate that, contrary to our preconceptions, participants did not show negative dispositions towards music therapy, research, or parent coaching. Instead, most participants had very little or no knowledge of music therapy services. They had limited experience with research in general, and only two participants had experienced music therapy directly. Several participants had varying amounts of experience with parent participation or parent coaching outside of music therapy and shared positive experiences with it. Parents seemed willing and eager to learn music strategies to support their children and saw value in the use of music for their child's development. First-contact providers (i.e., early interventionists and diagnosticians) and social media seem influential in parents' decision-making as they navigate early intervention services soon after diagnosis. Music therapy organizations are encouraged to design targeted efforts to make information on music therapy available through these sources.

A case study on the effect of light and colors in the built environment on autistic children's behavior

BACKGROUND

The importance of strategies and services by caregivers and family members substantially impact the psychological and emotional wellbeing of autistic children. The rapid research developments in clinical and non-clinical methods benefit the features of autistic children. Among various internal and external factors, the influence of the built environment also impacts the characteristics of autistic children. This study investigates primarily the psychological effect of light and colors on the mood and behavior of autistic children to identify the most favorable and preferred indoor lights and color shades.

METHODS

A questionnaire survey was conducted at an autism center among autistic children and their parents. This study included autistic children aged between 6 and 16 (45 males, 42 females, mean age 8.7 years, standard deviation 2.3). Eighty-seven participants were involved in the survey to determine the sensory perceptions, intolerance, preferences, and sensitivities of children with an autism spectrum disorder toward colors and lighting. The margin of error at the statistical analysis's 95% confidence level is ± 0.481.

RESULTS

As per this case report, the children have various color preferences and respond differently to different shades. Different hues have varying effects on autistic children, with many neutral tones and mellow shades proven to be autistic-friendly with their calming and soothing effect, while bright, bold, and intense colors are refreshing and stimulating. The stimulus of bright-lighting causes behavioral changes in autistic children prone to light sensitivity.

CONCLUSION

The insights gained from this interaction with parents and caretakers of autistic children could be helpful for designers to incorporate specific autistic-friendly design elements that make productive interior spaces. A complete understanding of the effect of factors like color and lighting on the learning ability and engagement of autistic children in an indoor environment is essential for designers and clinicians. The main findings of this study could be helpful for a designer and clinicians to address designing an autism-friendly built environment with a color palette and lighting scheme conducive to their wellbeing and to maximize their cognitive functioning.

Face-viewing patterns predict audiovisual speech integration in autistic children

Autistic children show audiovisual speech integration deficits, though the underlying mechanisms remain unclear. The present study examined how audiovisual speech integration deficits in autistic children could be affected by their looking patterns. We measured audiovisual speech integration in 26 autistic children and 26 typically developing (TD) children (4- to 7-year-old) employing the McGurk task (a videotaped speaker uttering phonemes with her eyes open or closed) and tracked their eye movements. We found that, compared with TD children, autistic children showed weaker audiovisual speech integration (i.e., the McGurk effect) in the open-eyes condition and similar audiovisual speech integration in the closed-eyes condition. Autistic children viewed the speaker's mouth less in non-McGurk trials than in McGurk trials in both conditions. Importantly, autistic children's weaker audiovisual speech integration could be predicted by their reduced mouth-looking time. The present study indicated that atypical face-viewing patterns could serve as one of the cognitive mechanisms of audiovisual speech integration deficits in autistic children. LAY SUMMARY: McGurk effect occurs when the visual part of a phoneme (e.g., "ga") and the auditory part of another phoneme (e.g., "ba") uttered by a speaker were integrated into a fused perception (e.g., "da"). The present study examined how McGurk effect in autistic children could be affected by their looking patterns for the speaker's face. We found that less looking time for the speaker's mouth in autistic children could predict weaker McGurk effect. As McGurk effect manifests audiovisual speech integration, our findings imply that we could improve audiovisual speech integration in autistic children by directing them to look at the speaker's mouth in future intervention.

Robot applications for autism: a comprehensive review

PURPOSE

Technological advances in robotics have brought about exciting developments in different areas such as education, training, and therapy. Recent research has suggested that the robot can be even more effective in rehabilitation, therapy, and education for individuals with Autism Spectrum Disorder (ASD). In this paper, a comprehensive review of robotic technology for children with ASD is presented wherein a large number of journals and conference proceedings in science and engineering search engines' databases were implicated.

MATERIALS AND METHODS

A search for related literature was conducted in three search engines' databases, Web of Science, Scopus, and IEEE Xplore. Thematic keywords were used to identify articles in the recent ten years in titles, keywords, and abstracts. The retrieved articles were filtered, analysed, and evaluated based on specific inclusion and exclusion criteria.

RESULTS

A total of 208 studies were retrieved, while 166 met the inclusion criteria. The selected studies were reviewed according to the type of robot, the participants, objectives, and methods. 68 robots were used in all studies, NAO robot was used in 30.5% of those studies. The total number of participants in all studies was 1671. The highest percentage of the studies reviewed were dedicated to augmenting the learning skills.

CONCLUSIONS

Robots and the associated schemes were used to determine their feasibility and validity for augmenting the learning skills of autistic children. Most of the studies reviewed were focused on improving the social communication skills of autistic children and measuring the extent of robot mitigation of stereotyped autistic behaviours.Implications for rehabilitationSocial robots are not considered as promising tools to be utilized for rehabilitation of autistic children only, but also has been used for children and young people with severe intellectual disability.Rehabilitation for individuals with ASD using robots can augment their cognitive and social skills, but further studies should be conducted to clarify its effectiveness based on other factors such as sex, age and IQ of the participates.Robotic-based rehabilitation is not limited to the physical robots only, but virtual robots have been used also, whereas each of which can be used individually or simultaneously. However, further study is required to assess the extent of its efficiency and effectiveness for both cases.

Objects as Communicative Mediators in Children With Autism Spectrum Disorder

In recent years, the socio-material perspective has informed an important interdisciplinary debate concerning the role of the physical world (i.e., the objects) in human psychological development. Several studies in the field of developmental psychology showed positive achievements in explaining the relationship between the subject and the social context through a socio-material approach, in particular in the early development. The importance of objects was also recognized in children with autism spectrum disorder (ASD), showing that these children are characterized by alterations in the use of the objects from early development. Some studies highlighted that objects could be a facilitator in the interactions between children with ASD and peers. However, the role of objects was not sufficiently investigated in interactions between children with ASD and adults. The main purpose of the present study was to investigate in children with ASD the communicative function that the activities with objects assume in the interactions with adults, highlighting the mediator role of objects in these interactions. More generally, this study also aims to highlight the relevance of adopting a socio-material perspective to explore some neglected aspects of the psychological activity of children with ASD. To test this hypothesis, we conducted an extensive exploratory study, collecting data from a sample of 3-year-old (N = 18; F = 3) and 4-year-old (N = 26; F = 3) with ASD. Children were observed in a free-play situation with an adult. They were free to choose an object from a predefined set. Through quantitative data, we have described the general characteristics of the manipulation of objects; through qualitative data, we aimed to capture and describe, in microgenetic sequences, some characteristics of children's activities, defined as socio-material. The analysis of the socio-material activities suggested the role of objects as mediator of the interactions between children with ASD and adults.

Animal-Assisted Activity for Children with Autism Spectrum Disorder: Parents' and Therapists' Perception

Autism spectrum disorder (ASD), characterized by communication and social interaction difficulties, might be positively influenced by animal-assisted activity (AAA). The aim of this study was to investigate the parents' and therapists' perception to behavior in children with ASD after they underwent AAA. The study was performed in a specialized therapeutic center in Curitiba, South of Brazil. A total of 15 children (14 boys and 1 girl), aged 5.6 ± 1.6 years, diagnosed with ASD, underwent at least 10 weekly 30-min AAA sessions. Three trained dogs were used in total, and there were two dogs in each session. Children were free to interact with dogs and among themselves, in groups of 11.2 ± 2.2 children per session, in the presence of therapists, the researcher, and a veterinarian observing the dogs and ensuring safety. The parents and therapists completed two questionnaires on their perception of the children's behavior before and after AAA. A total of 18 visits were necessary to complete the 10 sessions for each of the 15 children. According to the therapists' perception, AAA increased positive gestures and facial expression in children (p = 0.010) and improved peer interaction. Even though there was a 50% reduction in the parents' feedback at the end of the study, according to their perception there was a reduction in self-aggression and repetitive stereotyped movements, as well as an improvement in speech communication and creativity. This study demonstrated the positive effects of the AAA on the social behavior of children with ASD.

Parenting stress and affective symptoms in parents of autistic children

We examined parenting stress and mental health status in parents of autistic children and assessed factors associated with such stress. Participants were parents of 188 autistic children diagnosed with DSM-IV criteria and parents of 144 normally developing children. Parents of autistic children reported higher levels of stress, depression, and anxiety than parents of normally developing children. Mothers of autistic children had a higher risk of depression and anxiety than that did parents of normally developing children. Mothers compared to fathers of autistic children were more vulnerable to depression. Age, behavior problems of autistic children, and mothers' anxiety were significantly associated with parenting stress.

The Place of Complementary Medicine in the Treatment of Autistic Children

OBJECTIVES

The purpose of this study is to achieve a vision for autistic children and their parents aimed at generating interest in ideas such as "Sanitas Per Aquam" (SPA), massage and music therapy, which has begun to have widespread use and to attract attention.

METHODS

This cross-sectional, descriptive study was carried out with autistic children and their parents from February to April 2015 in Muğla, Turkey. The study was began by interviewing experts in the field and by developing a suitable assessment questionnaire. In order to direct the flow of conversation between the researchers and the autisitc children and their parents, the researchers conducted semi-structured face to face interviews in a form that had been determined by using reports in the literature and the opinions of experts in the field.

RESULTS

Forty two boys (84%) and eight girls (16%) with autism participated in our study. Children in the 0 ─ 7 age group spent long time in the bathroom (P = 0.001). Boys liked to be hugged more than girls (P = 0.01). Children ages 0 ─ 7 years liked bright lighting while those 15 years of age and older liked gloomy lighting (P = 0.009). Except for these statistically significant sex- and age-related differences, no other statistically significant differences were noted in the parameters of this study. Although the result was not statistically significant, more children with mild autism disorder obeyed commands like inhale or exhale (P = 0.051).

CONCLUSION

Treatment for autism spectrum disorders is not yet fully possible, so many studies are being done to alleviate some symptoms and to improve the quality of life for individuals with autism and their families. As a result of our study, whether touching the areas the children want touched and listening to their favorite music are required to stimulate the brain remain as questions in our minds.

Assessing and improving child care: a personal appearance index for children with autism

An index of children's physical appearance and personal care was developed and used to assess youngsters with autism who lived (a) at home, (b) in an established group home, (c) in new group homes, and (d) in a large institution. Subsequently, a multiple baseline design across participants documented major changes in personal appearance and cleanliness when children moved from an institution to community-based, family-style group homes. Finally, data-based feedback generated by the appearance index was used as a training tool enabling group home staff to further improve child appearance. This research demonstrates how an evaluation instrument can be used to obtain comparative data, measure some effects of different residential placements, and provide ongoing feedback to caregivers to promote high standards of personal care among persons with severe developmental disabilities.

A program for increasing manual signing by autistic and profoundly retarded youth within the daily environment

A program was implemented to increase the manual signing of five profoundly retarded and four autistic youth within their daily environment. Each participant was nonvocal or minimally vocal. The program was based on modified incidental teaching strategies and was implemented by direct care personnel under supervision in an institutional setting. Specific components included rearranging the physical environment to prompt signing, altering routine staff-resident interactions to prompt, manually guide and/or reinforce signing; and conducting mini-training sessions. Additionally, staff modeled signs intermittently throughout the day. The program was sequentially implemented during two staff work shifts on each of two resident living modules. Observations conducted at four separate time periods during the day indicated that significant increases in signing occurred for all participating youth and that the increases generally maintained during follow-up checks at 5 and 17 weeks. Differential effects of the increased signing on frequency of vocalizations were noted across residents. A staff acceptability survey indicated favorable staff reports on the usefulness of signing to communicate with the youth. Results are discussed regarding the significance of manual signing for seriously developmentally disabled persons and the importance of ensuring that signing skills are used in the daily environment and not exclusively in formal training sessions. Also, areas for continued research are noted in terms of more refined analyses of client skills and subsequent progress in manual communication programs.