Re-evaluation of systematic reviews of acupuncture and moxibustion for childhood autism / 中国针灸

OBJECTIVE@#To re-evaluate the systematic review/Meta-analysis of acupuncture and moxibustion for childhood autism (CA), aiming to provide decision-making basis for clinical diagnosis and treatment.@*METHODS@#The systematic review and/or Meta-analysis of acupuncture and moxibustion for CA were searched in PubMed, EMbase, Cochrane Library, SinoMed, CNKI and Wanfang databases. The retrieval time was from the database establishment to May 5th, 2022. PRISMA (preferred reporting items for systematic reviews and Meta-analyses) was used to evaluate the report quality, and AMSTAR 2 (a measurement tool to assess systematic reviews 2) was used to evaluate the methodological quality, bubble map was used to construct the evidence map and GRADE was used to evaluate the quality of evidence.@*RESULTS@#A total of 9 systematic reviews were included. The PRISMA scores ranged from 13 to 26. The report quality was low, and there was a serious lack in the aspects of program and registration, search, other analysis and funding. The main problems in methodology included not making prespecified protocol, incomplete retrieval strategy, not providing a list of excluded literatures, and incomplete explanation on heterogeneity analysis and bias risk. The evidence map showed that 6 conclusions were valid, 2 conclusions were possible valid and 1 conclusion was uncertain valid. The overall quality of evidence was low, and the main factors leading to the downgrade were limitations, followed by inconsistency, imprecision and publication bias.@*CONCLUSION@#Acupuncture and moxibustion has a certain effect for CA, but the quality of reporting, methodology and evidence in included literature need to be improved. It is suggested to perform high-quality and standardized research in the future to provide evidence-based basis.

Os impasses ao acesso à intersubjetividade: observações clínicas de um bebê com risco de evolução autística / Impases en el accesoa la intersubjetividad: observaciones clínicas de un bebé con riesgo de evolución autista / Challenge in accessing intersubjectivity: clinical observations of a baby with a risk of autism / Les impasses à l'accès à l'intersubjectivité: observations cliniques d'un bébé à risque d'autisme

O artigo aborda os impasses vividos por um bebê com risco de autismo em seu processo de subjetivação. Estudos afirmam que há bebês que, muito precocemente, recusam-se a estabelecer trocas com o objeto materno, impossibilitando que a mãe entre em um estado de identificação com seu bebê, o que colocaria em pauta que o autismo infantil não se limitaria apenas a uma falha materna, mas se trataria de uma patologia multifatorial. Quais intervenções clínicas seriam necessárias para que a mãe e o bebê possam juntos (re)escrever uma nova narrativa psíquica? Haveria um tipo de intervenção e de manejo clínico específico nos casos de bebês com risco de autismo? E como a psicanálise contemporânea, fundamentada pela leitura da intersubjetividade, nos ajudaria na compreensão da clínica da intervenção precoce?

Este artículo se propone abordar los impases experimentados por un bebé con riesgo autista en su proceso de subjetivación. Existen estudios sobre bebés que precozmente se niegan a establecer intercambios con el objeto materno, imposibilitando que la madre entre en identificación con él, poniendo sobre la mesa que el autismo infantil no se limitaría a una falla materna, sino que se trataría de una patología multifactorial. Se plantea, cuáles intervenciones clínicas son necesarias para que madre y bebé puedan (re)escribir una nueva narrativa psíquica, que posibilite un verdadero encuentro diádico. ¿Habría un tipo específico de intervención y manejo clínico en los bebés con riesgo de autismo? ¿Cómo el psicoanálisis contemporáneo, basado en la lectura de la intersubjetividad y de lo intrapsíquico, ayudaría a entender la clínica de la intervención precoz?

This article addresses the failures of a baby with a risk of autism to develop his subjectivation process. Recent studies show that some babies are not able to develop exchanges with their maternal object, which would show that children autism would not be limited to a failure of the mother to enter into a state of identification with her baby, but would be associated to a multifactorial pathology. In that respect, which clinical interventions would be necessary so that mother and baby can (re)write a new psychic narrative, enabling them to develop a genuine capability to meet together? Is there a type of clinical handling for babies with a risk of autism? How can contemporary psychoanalysis, with focus on intersubjectivity and inter-psychism, could help us to understand early intervention clinic?

Cet article aborde les entraves d'un bébé à risque autistique à développer son processus de subjectivation. Des études récentes montrent que certains bébés ne sont pas capables de développer des échanges avec leur objet maternel, ce qui montrerait que l'autisme infantile ne se limiterait pas seulement à un échec de la mère d'entrer dans un état d'identification avec son bébé, mais qu'il s'agirait d'une pathologie multifactorielle. Ainsi, quelles interventions cliniques seraient nécessaires pour que mère et bébé puissent (ré)écrire ensemble un nouveau récit psychique, qui leur permettrait de développer une véritable capacité à se rencontrer ? Y aurait-il un type de prise en charge clinique spécifique aux bébés à risque d'autisme? Comment la psychanalyse contemporaine, centrée sur l'intersubjectivité et l'inter-psychisme, peut nous aider à comprendre la clinique d'intervention précoce?

Comparison of the Autism Diagnostic Observation Schedule and Childhood Autism Rating Scale in the Diagnosis of Autism Spectrum Disorder: A Preliminary Study

OBJECTIVES: We examined the agreement between the Autism Diagnostic Observation Schedule (ADOS) and the Childhood Autism Rating Scale (CARS) in the diagnosis of autism spectrum disorder. METHODS: The ADOS and CARS scores of 78 children were retrospectively collected from a chart review. A correlation analysis was performed to examine the concurrent validity between the two measures. Using the receiver operating characteristic (ROC) curve, we determined the optimal cut-off score of the CARS for identifying autism spectrum disorder. RESULTS: The CARS score was significantly correlated with the ADOS score (r=0.808, p < 0.001). Taking ADOS as the ideal standard, the optimal cut-off scores of CARS for identifying autism and autism spectrum were 30 and 24.5, respectively. CONCLUSION: We determined the optimal cut-off scores of CARS for screening and diagnosing autism spectrum disorder.

Clinical Study on Interactive Scalp Acupuncture Therapy for Autism Spectrum Disorders / 上海针灸杂志

Objective To investigate the clinical efficacy of interactive scalp acupuncture therapy for autism spectrum disorders (ASD).Methods Eighty-three ASD patients were randomized to a treatment group (43 cases) and a control group (40 cases).The treatment group received interactive scalp acupuncture therapy (scalp acupuncture first and music education therapy during needle retention) and the control group,music education therapy alone.The Childhood Autism Rating Scale (CARS) score,the Autism Behavior Checklist (ABC) score and the Gesell Development Quotient (DQ) scores were recorded in the two groups before and after treatment.Results There were statistically significant pre-/post-treatment differences in the CARS,ABC and DQ (social adaptation and individual sociality) scores in both groups (P＜ 0.01).There were statistically significant post-treatment differences in the CARS,ABC and DQ scores between the treatment and control groups (P＜0.05).Conclusion Interactive scalp acupuncture therapy plus music education therapy can relieve the clinical symptoms and improve social and cognitive abilities in ASD patients.

Reliability, validity and cut-off value of the childhood autism spectrum test / 中华实用儿科临床杂志

Objective To explore the applicability of the childhood autism spectrum test (CAST) of children in Mainland China according to autism screening,in order to provide the effective reference for the identification and diagnosis of autism spectrum disorders of children.Methods Two hundreds and fifty-two typical developing children,and 61 autistic children who were confirmed by psychological clinic of Child Healthcare Clinic,Shenzhen Luohu District Maternal and Child Health Care Hospital who were conformed with diagnosis standards of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition(DSM-5) by using CAST Chinese version were assessed,and the reliability and validity analysis were made on the CAST scale.The receiver operating characteristic curve was drew to determine the optimal threshold value,and the sensitivity,specificity and positive predictive value were calculated.Results CAST Chinese version had good reliability,Cronbach's α was 0.880.Split-half reliability coefficient r was 0.821,and the whole scale calibration reliability coefficient was 0.902.There was statistically significant difference between items and the total score(P＜0.05).The consistency between the CAST ≥4 years old children and diagnosis standards of DSM-5 reached 0.884(P=0.000).The consistency 3-＜4 years old children and diagnosis standards of DSM-5 reached 0.867 (P=0.000).Among the screening of the children who were ≥4 years old,the cut off was 15 scores that the sensitivity and specificity were best.With the children of 3-＜4 years old,a designated cut-point should be 17 scores.Conclusions There are good reliability and validity of CAST,which can be used to mainland China,as well as to screen autistic children more than 3 years old.

Trastorno del espectro autista y función ejecutiva / Autism spectrum disorder and executive functions

Introducción: las alteraciones en la función ejecutiva, especialmente en flexibilidad cognoscitiva, planeación,control inhibitorio y memoria de trabajo constituyen un elemento cardinal dentro las manifestaciones deltrastorno del espectro autista (TEA).Objetivo: el objetivo de este trabajo fue evaluar el desempeño de las pruebas de función ejecutiva en unapoblación de pacientes con trastorno del espectro autista (TEA).Materiales y métodos: se realizó un estudio observacional en niños de una institución de rehabilitación. Seevaluó el desempeño en las subpruebas de la evaluación neuropsicológica infantil, el puntaje de CARS (ChildhoodAutism Rating Scale) y otras variables, mediante un análisis de correlación de Spearman. El estudio fueaprobado por el Comité de Ética en Investigación y se obtuvo consentimiento de los padres.Resultados: se evaluaron ocho niños con edad promedio de 8,9 años (6,1-13,7) y puntaje CARS entre 32 y 46.Se encontró mejor desempeño en habilidades gráficas y menor fluidez gráfica y verbal y de flexibilidad cognitiva.La edad tuvo correlación directa con el puntaje en memoria de trabajo y con la capacidad de planeación.Un puntaje de CARS alto se correlacionó con bajo rendimiento en flexibilidad cognitiva, memoria de trabajoy fluidez gráfica no semántica.Conclusión: los niños con TEA son susceptibles de presentar alteraciones significativas en tareas relacionadascon las funciones ejecutivas, lo que puede explicar la tendencia a la perseveración, incapacidad de cambio decriterio y conductas estereotipadas. Esta disfunción se correlaciona con la severidad del autismo y varía segúnla edad. Aunque esta alteración no es un fenómeno que se presente exclusivamente en el TEA, constituye unelemento a tener en cuenta al momento de evaluar estos niños.

Introduction: executive function disturbances, especially in cognitive flexibility planning, inhibitory control and working memory constitute a cardinal element within the manifestations of autism spectrum disorder (ASD).Objective: the aim of this research was to evaluate the performance of executive function tests in children with ASD.Materials and methods: an observational study was conducted in children attending a rehabilitation institution. An analysis between the performance of the Childhood Neuropsychological assessment subtests, scores of CARS (Childhood Autism Rating Scale) and other variables was performed by a Spearman correlation test. The study was approved by the Institutional Ethics Committee and parental consent was obtained.Results: we evaluated eight children with a mean age of 8.9 years (min: 6.1, max: 13.7) and CARS score between 32 and 46. Better performance was found in graphical abilities, less in graphical and verbal fluency and in cognitive flexibility. Age was directly correlated with scores on working memory and planning. A high CARS score was correlated with poor performance on cognitive flexibility, working memory and non-semantic graphic fluency.Conclusion: children with ASD are prone to show disturbances in executive functions related tasks which may explain the inflexible adherence to routines, the persistence of stereotypical behaviors and the perseveration observed in ASD patients. This dysfunction correlates with the severity of autism and varies with age. Although this condition is not present exclusively in ASD, it is a factor to consider when evaluating children with autism.

Autismo e parentalidade / Autism and parenting / El autismo y la parentalidad

As patologias autísticas são complexas e requerem uma atenção especifica para cada criança. Na organização que preside os tratamentos, a Psicoterapia Institucional tem uma grande importância devido à sua larga experiência com as psicopatologias graves como o autismo e a psicose. No projeto terapêutico da criança, a implicação e o papel dos pais são determinantes para sua orientação e indispensáveis para dar-lhe sentido. Contudo, por razões distintas, alguns pais podem desenvolver sentimentos negativos frente aos profissionais, que devem ser considerados.

Autistic disorders are complex and require a specific treatment for each child. For the organization that presides over the care, Institutional Psychotherapy movement is important because of its vast experience with severe psychopathology, such as autism and psychosis. In the treatments proposed to the child, the place of parents is crucial in terms of guidance and essential to reassign sense. However, for various reasons, some parents may develop negative feelings in the presence of professionals that should be considered.

Las patologías del autismo son complejas y se necesitan de una atención específica para cada niño. En la organización que ofrece atención, es importante el movimiento de la Psicoterapía Institucional debido a su larga experiencia con las psicopatologías graves, tales como el autismo y las psicosis. En los tratamientos propuestos al niño, el lugar de los padres resulta crucial en términos de orientación y es indispensable por reasignarles sentido. Sin embargo, por muchas razones, algunos padres pueden desarrollar, en los profesionales, sentimientos negativos que deben considerarse.

Autismo infantil. Uma breve discussão sobre a clínica e o tratamento / Autism in childhood ? a brief discussion on its clinic and therapy

No presente artigo é realizada uma discussão sobre autismo infantil, enfatizando sua epidemiologia, etiologia, patogênese, manifestações clínicas, diagnóstico e tratamento.

RESEARCH OF GENETIC POLYMORPHISM OF 5-HTT IN CHILDHOOD AUTISM / 药物分析学报

Objective To reveal the relationship between the 5-HTTLPR and the Chinese Han nationality children with CA, compared the distribution of the 5-HTTLPR between the Han Chinese children with CA and healthy Han Chinese children ,and analyzed the association between the 5-HTTLPR and clinical symptoms of the Han Chinese children with CA. Methods Genomic DNAs of fifty subjects including 25 autistic children and 25 controls were extracted from blood samples. PCR amplification using Oligonucleotide primers flanking 5-HTTLPR was performed. Results ① Three kinds of alleles including the S (short) allele, the L (long) allele and the VL allele were found , and the 5-HTTLPR genotypes shown were S/S, L/L, S/L and L/VL. ② Allele frequencies did not differ significantly in patient groups in comparison with the control sample. No significant difference was identified between the observed 5-HTTLPR genotype distribution of the patient groups and control group. ③ The distribution of homozygous and heterozygous subjects between the two groups differed significantly. ④ The genotypes of the 5-HTTLPR polymorphism correlated significantly with the Body Movement Factor. ⑤ The allele frequency of healthy Han Chinese population and that of healthy Japanese population were similar. The frequency of S allele in not only autistic subjects but also healthy children in this study was considerably more than that in Caucasians and the frequency of L allele in our subjects decreased correspondingly. Conclusion ① A significant difference in the allele frequency between the Han Chinese and Caucasian populations was found. ② The genotypes of the 5-HTTLPR polymorphism correlated significantly with the Body Movement Factor of the patients. ③ The homozygote and the L allele were positively relevant to CA and they might be the risk factors of CA. The heterozygote and the S allele were negatively relevant to CA and they might be the protective factors of CA.

Risk Factors of Childhood Autism and its Manifestation in E arly Stage / 中国心理卫生杂志

Objective:To probe into risk factors and early manifestati on of childhood autism Method:49 children with autism (DSM-IV cri t eria) and 32 normal children matched by sex and age were investigated retrospect ively about risk factors in pregnant and perinatal period, and phenomenon in dev elopment Results:Children with autism had more risk factors dur i ng their mother's pregnancy and perinatal period than control Most parents of a utistic children found the abnormality in the development of their child at age 2 or so Conclusion:Early identification of childhood autism is possible

The Development of a Screening Checklist for Childhood Autism / 中国心理卫生杂志

Objective: To work out a screening checklist for childhood autism and explore its reliability and validity. Methods: Items were selected based on the knowledge of clinical manifestation and diagnostic criteria of childhood autism. The autism diagnostic interview-revised version was used to refine the draft. Three groups (childhood autism, mental retardation and normal control) were used to test the reliability and validity of the new screening tool. Results: The checklist had satisfying reliability including good inter-rater reliability, test-retest reliability, split half reliability and internal consistency. The differential validity of the checklist and the differential diagnostic validity of the items were good, so as the construct validity and the criterion validity. The cut-off point for screening and diagnosis were 21 and 24 respectively. Conclusion: The childhood autism checklist has good reliability and validity, and fit for the situation of Chinese children with the disorder.