Comunicação social no transtorno do espectro autista: adolescentes no contexto teatral / Social communication in autistic spectrum disorder: teenagers in a theater context / Comunicación social en el trastorno del espectro autista: los adolescentes en el contexto teatral

Introdução: O transtorno do espectro autista (TEA) é caracterizado por prejuízos persistentes na comunicação e interação social e por padrões restritos de interesses e de atividades. As manifestações do quadro são presentes em níveis variáveis entre indivíduos e podem ser evidenciadas à medida que as demandas sociais excedem o limite de suas habilidades. A hipótese é de que a exposição à atividade teatral geraria impactos na comunicação social. Objetivo: Comparar o desempenho em aspectos sociais e de linguagem antes e após realização de atividade teatral em um grupo de adolescentes com TEA. Método: Participaram do estudo12 indivíduos com diagnóstico multidisciplinar de TEA com média de 16,1 anos de idade, todos com comunicação predominantemente verbal, inseridos em atividade pedagógicas e/ou ocupacionais com frequência de participação na atividade teatral de pelo menos 75%. Foram avaliados pré e pós-atividade teatral os aspectos de compreensão verbal, realização de inferência e memória a partir do reconto de uma história e as respostas diante de um texto curto em formato de piada. Esses dados foram relacionados a variáveis de nível de inteligência e de habilidades adaptativas. Resultados: Houve relação entre desempenho em habilidades de linguagem e aspectos cognitivos e de habilidades adaptativas e essas relações mantiveram-se positivas pré e pós-atividade proposta. Conclusão: A hipótese inicial foi parcialmente confirmada e os resultados sugerem tendência de melhora da comunicação social nesse contexto. (AU)

Introduction: Autism spectrum disorder (ASD) is characterized by persistent impairments in communication and social interaction and by restricted patterns of interests and activities. The condition ́smanifestations are present at different levels between individuals and can be evidenced as social demands exceed the limits of their abilities. The hypothesis is that exposure to theatrical activity would generate social communication impacts. Objective: To compare performance in social and language aspects before and after performing a theatrical activity in a group of adolescents with ASD. Method: Twelve individuals with a multidisciplinary diagnosis of ASD with an average age of 16.1 years participated in the study, all with predominantly verbal communication, engaged in educational and/or occupational activities and with at least 75% of frequency in theatrical activities. The aspects of verbal comprehension, inference and memory from the retelling of a story and the answers to a short text in a joke format were evaluated before and after the theatrical activity. These data were related to variables of level of intelligence and adaptive abilities. Results: There was a relationship between performance in language skills and cognitive aspects and adaptive skills and those relationships remained positive before and after the proposed activity. Conclusion: The initial hypothesis was partially confirmed and the results suggest a trend towards improvement in social communication in this context. (AU)

Introducción: El trastorno del espectro autista (TEA) se caracteriza por deficiencias persistentes en la comunicación y la interacción social y por patrones restringidos de intereses y actividades. Las manifestaciones de la condición están presentes en distintos niveles entre individuos y pueden evidenciarse a medida que las demandas sociales superan los límites de sus capacidades. La hipótesis es que la exposición a la actividad teatral generaría impactos en la comunicación social. Objetivo:Comparar el desempeño en aspectos sociales y lingüísticos antes y después de realizar una actividad teatral en un grupo de adolescentes con TEA. Método: Participaron del estudio doce personas con diagnóstico multidisciplinario de TEAcon una edad promedio de 16,1 años, todas con comunicación predominantemente verbal, dedicadas a actividades educativas y / u ocupacionales con una frecuencia de participación en la actividad teatral de al menos 75%. Se evaluaron los aspectos de comprensión verbal, inferencia y memoria a partir del recuento de una historia y las respuestas a un texto breve en formato de broma antes y después de la actividad teatral. Estos datos se relacionaron con variables de nivel de inteligencia y habilidades adaptativas. Resultados: Hubo una relación entre el desempeño en las habilidades del lenguaje y los aspectos cognitivos y las habilidades adaptativas y estas relaciones se mantuvieron positivas antes y después de la actividad propuesta. Conclusión: La hipótesis inicial fue parcialmente confirmada y los resultados sugieren una tendencia hacia la mejora de la comunicación social en este contexto. (AU)

Recent research on neurodevelopmental disorders in children / 中国当代儿科杂志

Neurodevelopmental disorders (NDDs) in children are a group of chronic developmental brain disorders caused by multiple genetic or acquired causes, including disorders of intellectual development, developmental speech or language disorders, autism spectrum disorders, developmental learning disorders, attention deficit hyperactivity disorder, tic disorders, and other neurodevelopmental disorders. With the improvement in the research level and the diagnosis and treatment techniques of NDDs, great progress has been made in the research on NDDs in children. This article reviews the research advances in NDDs, in order to further improve the breadth and depth of the understanding of NDDs in children among pediatricians.

Effect of electroacupuncture at Tinghui (GB 2) and Benshen (GB 13) on abnormal auditory response in children with autism spectrum disorder / 中国针灸

OBJECTIVE@#To compare the effect of electroacupuncture at Tinghui (GB 2) and Benshen (GB 13) combined with routine rehabilitation training and simple routine rehabilitation training on abnormal auditory response in children with autism spectrum disorder (ASD).@*METHODS@#A total of 70 children with ASD were randomly divided into an observation group and a control group, 35 cases in each group. The control group was given routine rehabilitation training. On the basis of the treatment in the control group, the observation group was given electroacupuncture at Tinghui (GB 2) and Benshen (GB 13), disperse-dense wave, frequency in 2 Hz/10 Hz, 20 min each time, and 1 day off after 6 days of treatment. Both groups were treated for 12 weeks. The incidence of abnormal auditory response, the scores of childhood autism rating scale (CARS) and autism behavior checklist (ABC) were compared between the two groups before and after treatment.@*RESULTS@#After treatment, the total incidences of abnormal auditory response in the two groups and the incidences of dull and hypersensitive auditory response in the observation group were lower than those before treatment (P<0.05). The total incidence of abnormal auditory response and the incidence of hypersensitive auditory response in the observation group were lower than those in the control group (P<0.05). After treatment, CARS and ABC scores of both groups were lower than those before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05).@*CONCLUSION@#Electroacupuncture at Tinghui (GB 2) and Benshen (GB 13) combined with routine rehabilitation training can reduce the incidence of abnormal auditory response and improve the core symptoms in children with ASD, and the clinical effect is better than the simple routine rehabilitation training.

Clinical observation on syndrome-differentiation acupuncture combined with rehabilitation training for autism spectrum disorder / 中国针灸

OBJECTIVE@#To compare the clinical efficacy and safety between syndrome-differentiation acupuncture combined with rehabilitation training and simple rehabilitation training for children with autism spectrum disorder (ASD).@*METHODS@#A total of 60 children with ASD were randomly divided into an observation group and a control group, 30 cases in each group. In the control group, routine rehabilitation training was applied; in the observation group, syndrome-differentiation acupuncture (the main points were Baihui [GV 20], Dingshenzhen, Niesanzhen, etc., the supplementary acupoints were selected according to syndrome-differentiation) combined with rehabilitation training were applied, all the treatments were given once a day, 5-day continuous treatment with 2-day interval, 12 weeks were required. Before treatment and after 6, 12 weeks of treatment, the autism treatment evaluation checklist (ATEC), childhood autism rating scale (CARS) and autism behavior checklist (ABC) scores were observed, the therapeutic effect and safety were evaluated in the two groups.@*RESULTS@#After 6 and 12 weeks of treatment, except for the sensory perception score after 6 weeks of treatment in the control group, the item scores and total scores of ATEC, CARS scores and ABC scores were decreased compared with those before treatment in the two groups (P<0.05). After 6 weeks of treatment, the social score and total score of ATEC, CARS score in the observation group were lower than those in the control group (P<0.05); after 12 weeks of treatment, the item scores and total score of ATEC, CARS score and ABC score in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 80.0% (24/30), which was higher than 56.7% (17/30) in the control group (P<0.05). There was no serious adverse reactions in the two groups, and there was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05).@*CONCLUSION@#Syndrome-differentiation acupuncture combined with rehabilitation training could improve the core symptoms in children with ASD, especially sensory perception and social ability, and with good safety, which is superior to simple rehabilitation training.

Tratamientos alternativos y/o complementarios en pacientes con trastorno del espectro autista / Alternative and/or complementary treatments in patients with autism spectrum disorder

El Trastorno del Espectro Autista (TEA) es una condición que afecta el neurodesarrollo caracterizada por presentar alteraciones en la comunicación, conducta y en las interacciones sociales, y que afecta el funcionamiento del individuo a lo largo de su vida. Los tratamientos recomendados por la evidencia científica incluyen un enfoque interdisciplinario que combina intervenciones educativas, terapias psicológicas/conductuales, terapia del habla y el lenguaje, terapia ocupacional/física y tratamientos médicos. Para muchas familias, barreras económicas y geográficas limitan el acceso a los tratamientos específicos. Este y otros motivos llevan a incorporar tratamientos alternativos y/o complementarios. El Centro Nacional de Medicina Complementaria y Alternativa (NIH-EEUU) define los Tratamientos Alternativos Complementarios (TAC) como "un grupo de diversos sistemas médicos y de cuidados de la salud; prácticas y productos que generalmente no son considerados parte de la medicina convencional". La prevalencia del uso de TAC en personas con TEA está entre las más altas respecto a otras patologías y a otros trastornos del desarrollo, con porcentajes entre 52% y 95%. Su uso debe ser preguntado en las consultas de seguimiento, y debe discutirse sobre riesgos, beneficios y costos. La cantidad y el tipo de intervención que reciben niños, niñas, adolescentes (NNyA) y adultos con TEA varían enormemente en todo el mundo e incluso dentro de un mismo país y región. El pronóstico del TEA es mejorado cuando el diagnóstico es oportuno y temprano y el abordaje educativo terapéutico es iniciado y orientado a aspectos funcionales y centrados en la familia. (AU)

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by alterations in communication, behavior, and social interactions that affect the individual's functioning throughout life. Evidence-based treatments include an interdisciplinary approach that combines educational interventions, psychological/behavioral therapies, speech and language therapy, occupational/physical therapy, and medical treatments. For many families, economic and geographic barriers limit access to specific treatments. This and other reasons have led to the incorporation of alternative and/or complementary treatments. The National Center for Complementary and Integrative Health (NCCIH - USA) defines complementary alternative medicine (CAM) as "a group of diverse medical and health care systems, practices and products that are not generally considered part of conventional medicine". The prevalence of the use of CAM in people with ASD is among the highest compared to other diseases and developmental disorders, with percentages ranging from 52% to 95%. Their use should be considered in follow-up visits, and risks, benefits, and costs should be discussed. The amount and type of intervention received by children, adolescents, and adults with ASD varies greatly around the world and even within the same country and region. The prognosis of ASD is improved with timely diagnosis and early, family-centered and functionally oriented educational and therapeutic approaches

Benefícios da orientação familiar nas dificuldades comunicativas de crianças com transtornos do espectro do autismo: revisão integrativa da literatura / Benefits of family guidance in communicative difficulties in children with autism spectrum disorder: an integrative literature review / Beneficios de la orientación familiar en las dificultades comunicativas en niños con trastornos del espectro autista: una revisión integradora de la literatura

Introdução: A terapia indireta é uma abordagem de intervenção terapêutica na qual se realizam orientações familiares e um treinamento dos cuidadores para que o entendimento da mesma seja ampliado. Este tipo de intervenção é relevante porque são os familiares as pessoas mais próximas das crianças, e, por meio das orientações, aprimoram o elo e a interação para o amadurecimento da comunicação funcional da criança. Objetivo: Analisar achados acerca dos benefícios da orientação familiar nas dificuldades comunicativas de crianças com diagnóstico de Transtorno do Espectro do Autismo. Estratégia de pesquisa: Levantamento na literatura publicada nas línguas inglesa, portuguesa e espanhola. Foram incluídos artigos originais publicados na íntegra no período de janeiro de 1999 a novembro de 2019, com grau de recomendação A, B e C e níveis de evidência 1, 2, 3 4, segundo o Oxford Centre. Resultados: Foram encontrados 934 artigos, 55 excluídos por duplicata e 31 foram selecionados para leitura na íntegra. Destes, 15 foram considerados para análise do estudo. Discussão: A terapia indireta, por meio da orientação familiar, no processo de reabilitação de crianças no espectro aponta que o trabalho de promoção do desenvolvimento das habilidades comunicativas de crianças com TEA promove ganhos na comunicação. Também, mostram que uma intervenção indireta aumenta a capacidade de reflexão e autocrítica dos cuidadores. Conclusão: O processo terapêutico indireto de crianças com diagnóstico de TEA, fornece mudanças positivas no processo de desenvolvimento de linguagem dessas crianças e existe uma relação direta e positiva entre orientação familiar e dificuldade comunicativa dessas crianças.

Introduction: Indirect therapy is a therapeutic intervention approach in which family orientations and training of caregivers are carried out so that their understanding is broadened. This type of intervention is relevant because family members are the people closest to the children, and, through the guidelines, they improve the link and the interaction for the maturation of the child's functional communication. Objective: To analyze findings about the benefits of familiar orientations, in the communicative difficulties of children diagnosed with ASD. Research strategy: Survey of national and international literature, published in English, Portuguese and Spanish. Original articles published in full from January 1999 to November 2019 were included, with degree of recommendation A, B and C and levels of evidence 1, 2, 3 4, according to the Oxford Center. Results: 934 articles were found, 55 excluded by duplicate and 31 were selected for reading in full. Of these, 15 were considered for analysis of the study. Discussion: Indirect therapy, through family guidance, in the process of rehabilitation of children on the spectrum points out that the work of promoting the development of the communicative skills of children with ASD promotes gains in communication. They also show that an indirect intervention increases the caregivers' capacity for reflection and self-criticism. Conclusion: The indirect therapeutic process of children diagnosed with ASD provides positive changes in the language development process of these children and there is a direct and positive relationship between family orientation and communicative difficulties in these children.

Introducción: La terapia indirecta es un enfoque terapéutico en el que se realizan orientaciones familiares y la formación de los cuidadores para ampliar su comprensión. Este tipo de intervención es relevante porque los familiares son las personas más cercanas a los niños y, a través de las pautas, mejoran el vínculo y la interacción para la maduración de la comunicación funcional del niño. Objetivo: Analizar los hallazgos sobre los beneficios de la orientación familiar en las dificultades comunicativas de los niños diagnosticados con TEA. Estrategia de investigación: Encuesta de literatura nacional e internacional, publicada en inglés, portugués y español. Se incluyeron artículos originales publicados íntegramente desde enero de 1999 hasta noviembre de 2019, con grado de recomendación A, B y C y niveles de evidencia 1, 2, 3 4, según el Centro de Oxford. Resultados: Se encontraron 934 artículos, 55 excluidos por duplicado y 31 seleccionados para lectura completa. De estos, 15 fueron considerados para el análisis del estudio. Discusión: La terapia indirecta, a través de la orientación familiar, en el proceso de rehabilitación de los niños en el espectro señala que el trabajo de promover el desarrollo de las habilidades comunicativas de los niños con TEA promueve ganancias en la comunicación. Conclusión: El proceso terapéutico indirecto de los niños diagnosticados con TEA proporciona cambios positivos en el proceso de desarrollo del lenguaje de estos niños y existe una relación directa y positiva entre la orientación familiar y las dificultades comunicativas en estos niños.

Yoga com histórias para crianças com transtorno do espectro autista: regulação emocional mediada pela internet / Yoga with stories for kids with autism spectrum disorder: internet mediated emotion regulation / Yoga avec des histoires pour les enfants atteints de troubles du spectre autistique: régulation des émotions via internet / Yoga con historias para niños con trastorno del espectro autista: regulación de las emociones mediada por internet

Este estudo de caso mediado pela internet objetivou avaliar possíveis relações entre contação de histórias associada a exercícios de yoga e autorregulação de crianças com transtorno do espectro autista. Para tanto, pais e cuidadores foram instruídos a utilizar vídeos de contação de histórias, vídeos com demonstração de rotinas de exercícios de yoga e formulários de avaliação, totalizando três encontros. Relações entre controle por contingências e governo por regras foram investigadas. Verificamos resultados positivos nos dois casos estudados, um deles mediado pelos pais da criança e outro pela acompanhante terapêutica. Em conclusão, o envolvimento de pessoas de referência no treino de autorregulação demonstrou gerar efeitos positivos no comportamento das crianças e nas relações interpessoais estabelecidas. Estudos futuros poderão se valer do delineamento testado e do material interventivo para alcançar um maior número de crianças com desenvolvimento atípico e típico

This internet-mediated case study aimed to evaluate possible relationships between storytelling associated with yoga exercises and self-regulation of children with Autism Spectrum Disorder. To this end, parents and caregivers were instructed to use storytelling videos, videos with demonstration of yoga exercise routines and evaluation forms in a total of three meetings. Relationships between contingency-shaped and rule-governed behavior were investigated. We found positive results in the two cases studied, one mediated by the child's parents and the other by the therapeutic companion. In conclusion, the involvement of relevant people in self-regulation training has been shown to generate positive effects on children's behavior and also on established interpersonal relationships. Future studies may use the tested design and intervention material to reach a greater number of children with atypical and typical development

Cette étude de cas médiatisée par Internet visait à évaluer les relations possibles entre la narration associée aux exercices de yoga et l'autorégulation d'enfants atteints de troubles du spectre autistique. À cette fin, les parents et les soignants ont été invités à utiliser des vidéos de narration, des vidéos avec démonstration de routines d'exercices de yoga et des formulaires d'évaluation dans un total de trois réunions. Les relations entre les comportements contingents et régis par des règles ont été étudiées. Nous avons trouvé des résultats positifs dans les deux cas étudiés, l'un médiatisé par les parents de l'enfant et l'autre par le compagnon thérapeutique. En conclusion, il a été démontré que l'implication des personnes concernées dans la formation à l'autorégulation a des effets positifs sur le comportement des enfants et sur les relations interpersonnelles établies. Les études futures peuvent utiliser la conception testée et le matériel d'intervention pour atteindre un plus grand nombre d'enfants au développement atypique et typique

Este estudio de caso mediado por Internet tuvo como objetivo evaluar las posibles relaciones entre la narración asociada con los ejercicios de yoga y la autorregulación de los niños con trastorno del espectro autista. Con este fin, se instruyó a los padres y cuidadores a utilizar videos narrativos, videos con demostración de rutinas de ejercicios de yoga y formularios de evaluación en un total de tres reuniones. Se investigaron las relaciones entre el comportamiento en forma de contingencia y el regido por reglas. Encontramos resultados positivos en los dos casos estudiados, uno mediado por los padres del niño y otro por el acompañante terapéutico. En conclusión, se ha demostrado que la participación de personas relevantes en la formación de autorregulación genera efectos positivos en el comportamiento de los niños y también en las relaciones interpersonales establecidas. Los estudios futuros pueden utilizar el diseño probado y el material de intervención para llegar a un mayor número de niños con un desarrollo típico y atípico

Effect of parent-child cooperative music therapy on children with autism spectrum disorder and their mothers: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To study the effect of parent-child cooperative music therapy on the core symptoms of children with autism spectrum disorder (ASD) and their mothers.@*METHODS@#In this prospective study, 112 children with ASD and their mothers were divided into a music therapy group and an applied behavior analysis (ABA) group using a random number table (n=56 each). The children in the ABA group were treated with ABA, and those in the music therapy group were given parent-child cooperative music therapy in addition to the ABA treatment. The duration of intervention was 8 weeks for both groups. Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC), Parenting Stress Index-Short form (PSI-SF), Family APGAR Index, and Herth Hope Index (HHI) were used to evaluate the core symptoms of children with ASD and the parenting stress, family APGAR index, and hope level of mothers before and after intervention.@*RESULTS@#A total of 100 child-mother dyads completed the whole study, with 50 child-mother dyads in each group. After intervention, the children in the music therapy group had significantly lower total score of ABC scale and scores of sensation, social interaction, and somatic movement, as well as a significantly lower total score of CARS than those in the ABA group (P<0.05). After intervention, compared with the mothers in the ABA group, the mothers in the music therapy group had significantly higher total score of PSI-SF and score of parent-child dysfunctional interaction, significantly higher total score of HHI and scores of each dimension, and significantly higher total score of APGAR and scores of cooperation and intimacy (P<0.05).@*CONCLUSIONS@#Parent-child cooperative music therapy combined with ABA can alleviate the core symptoms of children with ASD, reduce the parenting stress of their mothers, and improve family APGAR index and hope level.

The effectiveness of early parental coaching in the autism spectrum disorder

Abstract Objective Analysis of the effectiveness of early Parental Coaching in the Autism Spectrum Disorder. Method Randomized, controlled and blinded clinical trial to analyze parent-child interaction videos. Results The sample consisted of 18 children being followed up at the Autism Outpatient Clinic of a Neuropediatric Center in southern Brazil diagnosed with Autism Spectrum Disorder, between 29 and 42 months of age, randomly allocated to two groups: the Study Group (SG; n = 9), which received Parental Coaching performed by a professional certified by the Early Start Denver Model; and the Control Group (CG; n = 9), which was in a routine follow-up, without treatment and training of parents by a trained professional. The parents of the SG were willing to attend weekly meetings and to apply the instructional techniques at home with their children. It took 12 weeks and an average of 2 h per meeting. Conclusions The learning rate for comprehensive development skills in the Early Start Denver Model checklist, such as receptive communication, expressive communication, social capacity, imitation, cognition, games, fine motor skills, gross motor skills, behavior, and personal independence was significantly higher in the SG, as well as the strategies and the quality of interaction between parents and children. Thus, Parental Coaching presents as a possibility of early intervention in children with Autism Spectrum Disorder.

Efectividad de la terapia cognitivo conductual para trastorno obsesivo compulsivo en pacientes con trastorno del espectro autista: Artículo de revisión / Effectiveness of cognitive behavioral therapy for obsessive compulsive disorder in patients with autism spectrum disorde: Review article

La terapia cognitivo conductual (TCC), es el tratamiento de elección para el trastorno obsesivo compulsivo (TOC), principalmente la exposición con prevención de respuesta (EPR). En pacientes que presentan TOC co-ocurrente con trastorno del espectro autista (TEA) se cree que la TCC tendría un menor efecto debido al empobrecimiento de la comprensión de las propias emociones y de la rigidez cognitiva de estos pacientes. A través de la siguiente revisión se busca evaluar la efectividad de la TCC en pacientes que tengan TOC en asociación a TEA en niños, adolescentes y adultos. Métodos: Se realizó una búsqueda de artículos, de los últimos 10 años, que abordasen la efectividad de la TCC en niños, adolescentes o adultos con TOC y TEA en conjunto. Resultados: A pesar de que no todos los estudios concuerdan en sus resultados, la mayoría de éstos, indican que hay efectividad en la TCC en disminuir la sintomatología del TOC en pacientes con TEA co-ocurrente tanto en niños como en adolescentes y adultos. Existen terapias de TCC con ciertas adaptaciones que mejorarían los resultados de estos pacientes al personalizar su tratamiento, por lo que se incentiva al mayor desarrollo de este tipo de terapias. Conclusión: Los estudios revisados respaldan que a pesar de la rigidez que presentan los pacientes con TEA co-ocurrente, la TCC es efectiva para tratar TOC en niños, adolescentes y adultos, especialmente al realizar adaptaciones de esta.

The treatment of choice for obsessive compulsive disorder (OCD) is cognitive behavioral therapy (CBT), mainly exposure with response prevention (ERP). In patients with OCD co-occurring with autism spectrum disorder (ASD), it is believed that CBT should have a lesser effect due to the impoverishment of the understanding of their own emotions and the cognitive rigidity of these patients. The following review seeks to evaluate the effectiveness of CBT in patients who have OCD in association with ASD in children, adolescents and adults. Methods: A search was carried out for articles, from the last 10 years, that addressed the effectiveness of CBT in children, adolescents or adults with OCD and ASD together. Results: Although not all studies agree on their results, most of these indicate that CBT is effective in reducing OCD symptoms in patients with co-occurring ASD in children, adolescents and adults. There are CBT therapies with certain adaptations that would improve the results of these patients by personalizing their treatment, which is why the further development of this type of therapy is encouraged. Conclusion: The reviewed studies support that despite the rigidity that patients with co-occurring ASD present, CBT is effective to treat OCD in children, adolescents and adults, especially when making adaptations to it.

Estratégias para o transtorno do espectro autista: interação social e intervenções terapêuticas / Strategies for autism spectrum disorder: social interaction and therapeutic interventions

OBJETIVO: Identificar os fatores que dificultam as intervenções terapêuticas motoras em crianças com transtorno do espectro autista. MÉTODOS: Foram utilizadas as bases de dados PubMed, Web of Science, Scopus e LILACS. Uma pesquisa de literatura cinzenta foi conduzida com acadêmico do Google. PRISMA foi usado, bem como a análise de risco de viés adaptada do Cochrane Manual para ensaios clínicos e, para outros estudos, foi utilizada a lista de verificação Downs e Black. RESULTADOS: Dezessete artigos científicos foram incluídos na análise de síntese qualitativa sobre estratégias para interação social e motora em pacientes com transtorno do espectro autista. Quatorze artigos científicos alcançaram pontuações aceitáveis na escala de Downs e Black, e três ensaios clínicos indicaram domínios satisfatórios. Pessoas com transtorno do espectro autista apresentaram percentuais acima de 30%, com dificuldades de comportamentos sociáveis, de aprendizagem e de comunicação. O diagnóstico adequado e a preconização de um plano de tratamento para o desenvolvimento da motricidade são estratégias fundamentais e de ordem prioritária, uma vez que possibilitarão uma análise quantitativa ao longo da vida do autista, assim como proporcionarão uma maior viabilidade de análise das habilidades cognitivas. CONCLUSÃO: A dificuldade de comportamento social do indivíduo com transtorno do espectro autista pode ser o ponto-alvo nas suas limitações de aprendizagem motora. Portanto, a concepção metodológica com a prática de imitação, associada a uma dinâmica prazerosa do exercício rítmico, é a melhor sugestão para contemplar o direcionamento das pesquisas contemporâneas, uma vez que, quando prevalece a inter-relação entre interação social, aprendizagem motora e percepções sensoriais, os desfechos são mais significativos para essas crianças.

OBJECTIVE: To identify the factors that hinder motor therapeutic interventions in children with autism spectrum disorder. METHODS: The PubMed, Web of Science, Scopus, and LILACS databases were used. A Grey Literature search was conducted with a Google scholar. PRISMA was used, as well as the risk analysis of bias adapted from the Cochrane Manual for clinical trials and, for other studies, the Downs and Black checklist was used. RESULTS: Seventeen scientific articles were included in the qualitative synthesis analysis on strategies for social and motor interaction in patients with autism spectrum disorder. Fourteen scientific articles achieved acceptable scores on the Downs and Black scale, and three clinical trials indicated satisfactory domains. People with autism spectrum disorder showed percentages above 30%, with difficulties in sociable behavior, learning, and communication issues. Adequate diagnosis and advocacy of a treatment plan for the development of motor skills are fundamental and priority strategies since they will enable a quantitative analysis throughout the life of the autistic person, as well as providing greater viability for the analysis of cognitive skills. CONCLUSION: The difficulty of social behavior of the individual with autism spectrum disorder may be the target point in his motor learning limitations. Therefore, the methodological conception with the practice of imitation, associated with a pleasurable dynamic of rhythmic exercise, is the best suggestion to contemplate the direction of contemporary research, since when the interrelation between social interaction, motor learning, and sensory perceptions prevails, outcomes are more significant for these children.

Trastorno del Espectro Autista (TEA) en el primer nivel de atención: cómo estamos, dónde estamos? Relato de nuestra experiencia en el CESAC 5 / Autism Spectrum Disorder (ASD) in the first level of care: how are we, where are we? Report of our experience at CESAC 5

Los trastornos del desarrollo conforman la "nueva morbilidad" y su identificación oportuna facilita planear los apoyos específicos que pueden favorecer el pronóstico de estos pacientes. El objetivo de este proyecto es brindar información acerca del abordaje de los pacientes con diagnóstico de TEA en el primer nivel de atención, mediante la descripción de diferentes variables a través de la evaluación de sus historias clínicas. Se analizaron 35 historias clínicas y se obtuvieron los siguientes resultados. 85,7% sexo masculino con un promedio de edad de 8,1 años. El 48,57% poseían obra social. 14,29% fueron nacidos pretérmino. 8,57% presentaron síndrome genético/cromosómico asociado al autismo. 22.86% presentaban hermano con mismo diagnóstico. Retraso madurativo o discapacidad intelectual en el 22,8%. Edad de diagnóstico media de 45.05 meses, (DE 17.13). En el 65,71% de las HC no se consignaba si el familiar presentaba alguna preocupación con respecto al desarrollo. En el 40% de las HC figura alteración en la comunicación/ ausencia o retraso del lenguaje, como motivo de preocupación/ derivación. El 91,43% se realizó el diagnostico por el equipo especializado en el Hospital Garrahan. El 85,71% realiza o realizó tratamiento, 71,43% en un centro público. El 88,57% se encontraba escolarizado. 51,43% en escuela especial. El 68,57% tenían certificado de discapacidad. El 28,57% se encontraban en tratamiento psicofarmacológico. El análisis de las HC nos permitió acercarnos a describir nuestra población, con características de diagnóstico y seguimiento que se ajustan en mayor medida a la descripta en la bibliografía, pese a tratarse de una población con un bajo nivel socio económico (AU)

Developmental disorders are the "new morbidity" and their timely identification enhances the planning of specific support measures that may improve the prognosis of these patients. The aim of this project is to provide information on the approach of patients diagnosed with ASD at the first level of care, by describing different variables obtained from medical records (MR). Thirtyfive MR were analyzed and the following results were obtained: 85.7% were male and mean age was 8.1 years. Overall, 48.57% had a health insurance; 14.29% were born preterm; 8,57% had a genetic/chromosomal syndrome associated with autism; 22.86% had a sibling with the same diagnosis. Developmental delay or intellectual disability was observed in 22.8%. Mean age at diagnosis was 45.05 months (SD 17.13). In 65.71% of the MR it was not clear if the caregiver was worried about the development of the child. In 40% of the MR, communication disturbances or absence of language/language delay were mentioned as the reason for worry or referral. In 91.43% the diagnosis was made by the specialized team at Garrahan Hospital. Overall, 85.71% underwent or is undergoing treatment, of whom 71.43% at a public center. Of all the children, 88.57% was attending school, 51.43% of whom at a special school; 68.57% had a disability certificate; 28.57% received psychopharmacological treatment. Analysis of the MR allowed us to describe our population, with diagnostic and follow-up features that mostly agree with the findings reported in the literature, in spite of the low socio-economic level of the families (AU)

Oficinas terapêuticas para meninos e meninas com Transtorno do Espectro do Autismo: estratégias e possibilidades durante a pandemia de COVID-19 / Talleres terapéuticos para niños y niñas con Trastorno del Espectro Autista: estrategias y posibilidades durante la pandemia de COVID-19 / Therapeutic groups for boys and girls with Autism Spectrum Disorder: strategies and possibilities during the COVID-19 pandemic / Ateliers thérapeutiques pour les enfants atteints de trouble du spectre autiste: stratégies et possibilités pendant la pandémie COVID-19

A chegada dos primeiros casos de COVID-19 ao Uruguai vem acompanhada do decreto de emergência sanitária. Isso interrompe o funcionamento de um dispositivo institucional para meninos e meninas com autismo, que atualmente é composto por oficinas terapêuticas coordenadas por estudantes da Faculdade de Psicologia da Universidade da República. Relatos de dois grupos de expressão plástica e um de música são apresentados e as ações implementadas para dar continuidade ao processo terapêutico na virtualidade são brevemente descritas. A seguir, são discutidas as estratégias utilizadas a partir dos eixos continuidade do tratamento, aliança terapêutica, transferência e técnica. Por fim, são tiradas conclusões sobre a realização das oficinas na modalidade virtual como forma de promover a continuidade do atendimento clínico

La llegada de los primeros casos de COVID-19 en Uruguay es acompañada del decreto de emergencia sanitaria. Esto interrumpe el funcionamiento de um dispositivo institucional para niños y niñas con autismo, que se compone en este momento por talleres terapéuticos coordinados por estudiantes de Facultad de Psicología de la Universidad de la República. Se presentan relatos de dos grupos de expresión plástica y uno de música y se describen brevemente las acciones implementadas para continuar el proceso terapéutico en el mundo virtual. En seguida, se discuten las estrategias utilizadas a partir de los ejes continuidad del tratamiento, alianza terapéutica, transferencia y técnica. Por último, se extraen conclusiones sobre la realización de los talleres en modalidad virtual como forma de propiciar la continuidad de la atención clínica

The arrival of the first cases of COVID-19 in Uruguay is accompanied by the decree of sanitary emergency. This interrupts the operation of an institutional device for boys and girls with autism, which is currently made up of therapeutic groups coordinated by students from the Faculty of Psychology of the University of the Republic. Reports of two groups of plastic expression and one of music are presented and the actions implemented to continue the therapeutic process virtually are briefly described. Next, the strategies used are discussed based on the continuity of treatment, therapeutic alliance, transference and technique. Finally, conclusions are drawn about the virtual groups as a way to promote the continuity of clinical care

L'arrivée des premiers cas de COVID-19 en Uruguay s'accompagne du décret d'urgence sanitaire. Cela interrompt le fonctionnement d'un dispositif institutionnel pour garçons et filles autistes,qui est actuellement composé d'ateliers thérapeutiques coordonnés par des étudiants de la Faculté de psychologie de l'Université de la République. Des rapports de deux groupes d'expression plastique et un de musique sont présentés et les actions mises en œuvre pour poursuivre le processus thérapeutique de manière virtuelle sont brièvement décrites. Ensuite, les stratégies utilisées sont discutées en fonction de la continuité du traitement, de l'alliance thérapeutique, du transfert et de la technique. Enfin, des conclusions sont tirées sur la tenue des ateliers en mode virtuel comme moyen de favoriser la continuité des soins cliniques

Diagnóstico diferencial ante la sospecha de TEA / Differential diagnosis of suspected ASD

Ateneo de la Residencia de Psicopedagogía del Hospital General de Agudos Ramos Mejía, de la Ciudad de Buenos Aires, que describe las acciones realizadas por el Equipo del hospital, que forma parte de la red de centros públicos de salud que participan del Programa de Orientación Temprana y Concientización en Trastornos del Neurodesarrollo y en el Espectro Autista (PROTECTEA). Se detallan la conceptualización y características del Trastorno del Espectro Autista, su diagnóstico específico, y su diferenciación del diagnóstico de Trastorno del Lenguaje, y de la Comunicación Social.

Effects of parent-child painting and creative crafting therapy on preschool children with autism spectrum disorder and their mothers: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVES@#To study the effects of parent-child painting and creative crafting therapy on the core symptoms of preschool children with mild-to-moderate autism spectrum disorder (ASD) and the parenting stress and hope level of their mothers.@*METHODS@#A total of 56 preschool children with mild-to-moderate ASD and their mothers were divided into an experimental group and a control group using the block randomization method, with 28 pairs in each group. The subjects in the control group received an applied behavior analytic intervention and those in the experimental group received parent-child painting and creative crafting therapy in addition to the intervention in the control group. The intervention time was 20 weeks for both groups. Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), Parenting Stress Index-Short Form (PSI-SF), and Herth Hope Index (HHI) were used to evaluate the core symptoms of children and the parenting stress and hope level of their mothers before and after 20 weeks of intervention.@*RESULTS@#Forty-nine child-mother pairs completed the study (25 pairs in the intervention group and 24 pairs in the control group). The children in the experimental group had significantly lower scores of social interaction, language, social communication, and social motivation and total scores of ABC and SRS compared with those in the control group (@*CONCLUSIONS@#The combination of applied behavior analytic intervention with parent-child painting and creative crafting therapy can more effectively improve the core symptoms and social interaction of preschool children with mild-to-moderate ASD, reduce the parenting stress of mothers and improve their hope level.

Effect of probiotics combined with applied behavior analysis in the treatment of children with autism spectrum disorder: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVES@#To study the effect of probiotics combined with applied behavior analysis (ABA) in the treatment of children with autism spectrum disorder (ASD).@*METHODS@#A total of 41 children with ASD who attended the Affiliated Hospital of Jiangsu University from May 2019 to December 2020 were enrolled and randomly divided into an observation group with 21 children and a control group with 20 children. The children in the observation group were given oral probiotics combined with ABA intervention, while those in the control group were given ABA intervention alone. The treatment outcomes were compared between the two groups. Autism Treatment Evaluation Checklist (ATEC) was used to evaluate the severity of behavioral symptoms in both groups before intervention and at 3 months after intervention. The fecal samples were collected to analyze the difference in intestinal flora between the two groups based on 16s rRNA high-throughput sequencing.@*RESULTS@#Before intervention, there was no significant difference in the ATEC score between the observation and control groups (@*CONCLUSIONS@#Probiotics may improve the effect of conventional ABA intervention in children with ASD by regulating intestinal flora.

Espaço que a criança e adolescente com diagnóstico de Transtorno do Espectro Autista ocupa na rede de atenção psicossocial: revisão integrativa da literatura / The place children and adolescents diagnosed with Autistic Spectrum Disorder occupy in the psychosocial care network: integrative literature review / Espacio que el niño y el adolecente diagnosticado con trastorno del espectro autista ocupan en la red de atención psicosocial: Revisión integrativa de la literatura

O autismo vem sendo alvo de diversos debates e discussões, principalmente em torno das formas como este público deve ser contemplado diante das ações e dos serviços oferecidos pelo SUS. Entretanto, nota-se que ainda não está definido quais os espaços específicos para esta população dentro da linha de cuidado e qual a função de cada espaço na rede de atenção psicossocial. É nesse contexto de indefinições que esta pesquisa, através de uma revisão integrativa de literatura, objetiva compreender e discutir qual o espaço que a criança e o adolescente com transtorno do espectro autista ocupam na rede de atenção psicossocial, afim de contribuir com a clínica do autismo no contexto da saúde pública. As fontes de pesquisas utilizadas foram artigos, publicados entre 2014 e 2019, encontrados no Portal Capes através dos descritores "autismo" e "saúde mental". Os resultados sugerem a necessidade do estabelecimento de objetivos e critérios mais específicos para cada ponto de atenção, visto que está havendo a sobreposição de atendimentos para algumas pessoas ou até mesmo a falta dele para outras. Sendo assim, apesar de haver um claro avanço dentro da política de saúde mental voltada a este público, ainda há algumas lacunas que precisam ser mais bem definidas.

Autism has been the subject of several debates and discussions, especially concerning the ways this public should be contemplated in view of the actions and services offered by SUS. However, it is noticeable that this population has no defined place in the system, the psychosocial care network. It is in this context of in definition that this research, through an integrative literature review, aims to understand and discuss where children and adolescents with autistic spectrum disorder could be placed and deserve to be in the psychosocial care network in order to contribute to the caring for autism in the context of public health. The sources of research used were articles published between 2014 and 2019, found in the Portal Capes through the descriptors "autism" and "mental health". The results suggest the need to establish more specific objectives and criteria for each issue, as care is being overlapped for some people or even lacking for others. Therefore, although there is a clear advance in the mental health policy aimed at this public, there are still some gaps that need to be better defined.

El autismo ha sido objeto de varios debates y discusiones, especialmente en torno a las formas en que este público debe contemplarse ante las acciones y servicios que ofrece el SUS. Sin embargo, se destaca que aun no está definido cuales son los espacios específicos para esta población dentro de la línea de cuidado y cual es la función de cada espacio en la red de atención psicosocial. Es en este contexto de indefinición que esta investigación, a través de una revisión de literatura integrativa, tiene como objetivo comprender y discutir qué espacio ocupan los niños y adolescentes con trastorno del espectro autista en la red de atención psicosocial con el fin de contribuir con la clínica de autismo, en el contexto de la salud pública. Las fuentes de investigación utilizadas fueron os artículos publicados entre 2014 y 2019, que se encuentran en el Portal Capes a través de los descriptores "autismo" y "salud mental". Los resultados sugieren la necesidad de establecer objetivos y criterios más específicos para cada punto de atención, ya que hay una superposición de atención para algunas personas o incluso la falta de atención para otras. Por tanto, si bien existe un claro avance en la política de salud mental dirigida a este público, aún existen algunas lagunas que se necesitan definir mejor.

A comunicação de um adulto diagnosticado no Transtorno do Espectro do Autismo: relato de caso / The communication of an adult diagnosed in Autism Spectrum Disorder / La comunicación de un adulto diagnosticado en el Trastorno del Espectro Autista

Alterações na comunicação compõem uma das maiores dificuldades de pacientes diagnosticados no Transtorno do Espectro do Autismo (TEA), sendo que a intervenção precoce é considerada a melhor opção de tratamento, visando a obter bons resultados. Porém, há indicações na literatura de que o trabalho terapêutico com adolescentes e adultos pode ter resultados semelhantes .Objetivo identificar e descrever os avanços no desempenho comunicativo de um adulto com TEA, após 2 meses de atendimento fonoaudiológico Método: estudo qualitativo, do tipo estudo de caso de um adulto diagnosticado no Transtorno do Espectro do Autismo atendido em grupo por meio do dispositivo terapêutico Oficina de Cozinha Resultados: modificação na alternância de olhares, transposição de ecolalias mediatas, substituição de ações congeladas por palavras, algumas marcações de tempo. Conclusão: os resultados indicam que o paciente deu entrada no jogo intersubjetivo, condição para adequadas atitudes comunicativas, que já podem ser observadas.

The therapeutic work with the communication of an adult diagnosed in Autism Spectrum Disorder (ASD). Objective: To identify and describe the advances of the communicative performance of an adult with ASD after 2 months of therapeutic care in speech therapy. Method: a qualitative case report study of an adult diagnosed with Autism Spectrum Disorder treated in a group through the Kitchen Workshop therapeutic device. Results: change in look alternation, transposition of mediate echolalia, substitution of frozen actions by words, and some marking time. Thus, it is possible to assume the subject's entry into the intersubjective game.

El trabajo terapéutico con la comunicación de un adulto diagnosticado en el Trastorno del Espectro Autista (TEA). Objetivo: identificar y describir los avances de un adulto con TEA en su desarrollo comunicativo después de 2 meses de atención terapéutica logopédica. Método: estudio cualitativo de informe de caso de un adulto diagnosticado con trastorno del espectro autista tratado en un grupo a través del dispositivo terapéutico Taller de cocina. Resultados: cambio en la alternancia de la apariencia, transposición de la ecolalia media, sustitución de acciones congeladas por palabras, además de algunas marcaciones de tiempo. Por lo tanto, es posible asumir su entrada en el juego intersubjetivo.