Disfagia no Transtorno do Espectro Autista (TEA): uma revisão integrativa / Dysphagia in Autism Spectrum Disorder (ASD): An integrative review / Disfagia en el trastorno del espectro autista (TEA): una revisión integradora

Introdução: O Transtorno do Espectro Autista (TEA) é um distúrbio do neurodesenvolvimento caracterizado por déficits na comunicação social, alterações de sensibilidade e dificuldades alimentares.Objetivo: Realizar uma revisão integrativa das alterações de deglutição em indivíduos com TEA.Métodos: A pesquisa foi realizada por meio de uma busca por artigos nacionais e internacionais, utilizando descritores para a pesquisa, bem como critérios de inclusão e exclusão para a seleção da amostra final. A estratégia PPOT foi utilizada para definir critérios de elegibilidade, incluindo população (crianças e adultos), preditor (diagnóstico de TEA), desfecho (relato ou diagnóstico de disfagia oral, faríngea ou esofágica) e tipo de estudo (estudos observatórios). A busca foi realizada no período de junho a agosto de 2023, nas bases de dados: Pubmed, Scopus, Embase e Google Scholar. Resultados: Foram selecionados dez estudos com pacientes diagnosticados com TEA que relataram sintomas de disfagia orofaríngea e esofágica, além de queixas sobre ingestão alimentar. Os estudos sugerem que crianças com TEA podem apresentar algum problema de disfunções motoras orais, frequência alimentar inadequada, padrões alimentares obsessivos, apresentação específica de determinados alimentos, seletividade alimentar e dificuldades de processamento sensorial. Conclusão: Conclui-se que não há evidências científicas robustas sobre a presença de disfagia em pacientes com TEA. (AU)

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication, changes in sensitivity and eating difficulties. Objective: To carry out an integrative review of swallowing changes in individuals with ASD. Methods: The research was carried out through a search for national and international articles, using descriptors for the research, as well as inclusion and exclusion criteria for selecting the final sample. The PPOT strategy was used to define eligibility criteria, including population (children and adults), predictor (ASD diagnosis), outcome (report or diagnosis of dysphagia oral, pharyngeal or esophageal), and study type (observatory studies). The search was carried out from June to August 2023, in the databases: Pubmed, Scopus, Embase and Google Scholar. Results: Ten studies were selected with patients diagnosed with ASD who reported symptoms of oropharyngeal and esophageal dysphagia, in addition to complaints about food intake. Studies suggest that children with ASD may present problems with oral motor dysfunction, inadequate eating frequency, obsessive eating patterns, specific presentation of certain foods, food selectivity and sensory processing difficulties. Conclusion: It is concluded that there is no robust scientific evidence about the presence of dysphagia in patients with ASD. (AU)

Introducción: El Trastorno del Espectro Autista (TEA) es un trastorno del neurodesarrollo caracterizado por déficits en la comunicación social, cambios en la sensibilidad y dificultades alimentarias. Objetivo: Realizar una revisión integradora de los cambios en la deglución en individuos con TEA. Métodos: La investigación se realizó mediante una búsqueda de artículos nacionales e internacionales, utilizando descriptores para la investigación, así como criterios de inclusión y exclusión para la selección de la muestra final. La estrategia PPOT se utilizó para definir los criterios de elegibilidad, incluida la población (niños y adultos), el predictor (diagnóstico de TEA), el resultado (informe o diagnóstico de enfermedad oral, faríngea o esofágica) y el tipo de estudio (estudios observatorios). La búsqueda se realizó de junio a agosto de 2023, en las bases de datos: Pubmed, Scopus, Embase y Google Scholar. Resultados: Se seleccionaron diez estudios con pacientes diagnosticados de TEA que refirieron síntomas de disfagia orofaríngea y esofágica, además de quejas sobre la ingesta de alimentos. Los estudios sugieren que los niños con TEA pueden presentar problemas de disfunción motora oral, frecuencia inadecuada de alimentación, patrones alimentarios obsesivos, presentación específica de ciertos alimentos, selectividad alimentaria y dificultades en el procesamiento sensorial. Conclusión: Se concluye que no existe evidencia científica robusta sobre la presencia de disfagia en pacientes con TEA. (AU)

Abordaje de los trastornos del sueño en los trastornos del neurodesarrollo / Treatment of sleep disorders in neurodevelopmental disorders

Resumen Los trastornos del sueño son frecuentes en niños y afectan al desarrollo neurológico, con importante repercusión cognitiva, emocional y conductual. Existe una alta prevalencia de trastornos del sueño (TS) en los trastornos del neurodesarrollo (TND), como trastorno del espectro autista (TEA) y trastorno por déficit de atención con hiperactividad (TDAH). Los TS en población pediá trica tienen una prevalencia del 6-25%, mientras que en los niños con TND esta cifra asciende al 50-80%. En los TND se observa un incremento de las dificultades para conciliar el sueño, de los despertares nocturnos y de la somnolencia diurna. Así mismo, presentan alteracio nes del ritmo circadiano y trastornos respiratorios del sueño. Como consecuencia se produce una reducción de la alerta para las actividades diarias con incremento de trastornos conductuales, problemas emocionales y dificultades académicas asociadas a disfunciones eje cutivas y de memoria. La evaluación del sueño debe formar parte sistemática en la valoración clínica de los niños con TND, con el fin de realizar un diagnóstico y un tratamiento adecuados a cada caso, permitiendo mejorar la calidad de vida del niño y de su familia.

Abstract Sleep disorders are common in children and affect neurological development with important cognitive, emotional and behavioral repercussions. There is a high prevalence of sleep disorders (SD) in neurodevelop mental disorders (NDD) such as autism spectrum dis order (ASD) and attention-deficit hyperactivity disorder (ADHD). Sleep disorders in pediatric population have a prevalence of 6-25%, while in children with NDD this number rises to 50-80%. In NDDs, higher rates of dif ficulties in falling asleep, nocturnal awakenings and daytime sleepiness are observed. Disturbances in the circadian rhythm as well as respiratory sleep disorders are also observed. Consequently, there is a decrease in alertness for daytime activities with increased be havioral disorders, emotional problems and academic difficulties associated with executive and memory dys functions. Sleep assessment has to be a systemic part in the clinical evaluation of children with NDDs, so as to give a convenient diagnosis and treatment in each case, allowing to improve the quality of life of children and their families.

A biomarker-based solution for the limited access to early diagnosis and assessment of autism / Una solución basada en biomarcadores para el acceso limitado al diagnóstico precoz y evaluación del autismo

Abstract With the upsurge of community uptake in popula tion-based early screening for autism, the main obstacle to increasing access to early treatment and intervention services is the extremely limited access to high quality diagnosis, specifically the shortage of expert clinicians. Diagnostic evaluation models deployed by academic cen ters of excellence, which typically require the investment of 6-10 hours by specialized multidisciplinary teams, is not a viable solution to the vast needs of communities, resulting in parents' "diagnostic odysseys" and delays, often of several years, for treatment, interventions and supports. Biomarker-based objective procedures for early diagnosis and assessment of autism are now available, clinically validated, and cleared for broad implementa tion by the US Food and Drug Administration (FDA). They are intended to increase access while maintaining high quality. Such solutions, however, will require change in entrenched models of diagnostic care, and aggressive prioritization of the needs of the community at large. If these innovations are successful, the number of children diagnosed in the first three years of life will double or triple. This will, in turn, require much greater inves tments in resources for treatment, including massive workforce training of providers capable of delivering community-viable caregiver-mediated interventions, and of early educators capable of serving autistic children in therapeutic inclusive preschool settings.

Resumen Con el aumento de la aceptación comunitaria de la detección temprana del autismo basada en la pobla ción, el principal obstáculo para aumentar el acceso al tratamiento temprano y a los servicios de intervención es el acceso extremadamente limitado a un diagnóstico de alta calidad, específicamente la escasez de médicos expertos. Los modelos de evaluación diagnóstica imple mentados por centros académicos de excelencia, que normalmente requieren la inversión de 6 a 10 horas por parte de equipos multidisciplinarios especializados, no son una solución viable para las vastas necesidades de las comunidades, lo que resulta en "odiseas diagnósti cas" y retrasos, a menudo de gran importancia, para los padres varios años, para tratamiento, intervenciones y apoyos. Los procedimientos objetivos basados en bio marcadores para el diagnóstico temprano y la evaluación del autismo ya están disponibles, clínicamente validados y aprobados para su amplia implementación por la Ad ministración de Alimentos y Medicamentos de EE. UU. (FDA). Su objetivo es aumentar el acceso manteniendo una alta calidad. Sin embargo, tales soluciones requeri rán cambios en los modelos arraigados de atención de diagnóstico y una priorización agresiva de las necesida des de la comunidad en general. Si estas innovaciones tienen éxito, el número de niños diagnosticados en los primeros tres años de vida se duplicará o triplicará. 51 Esto, a su vez, requerirá inversiones mucho mayores en recursos para el tratamiento, incluida la capacitación masiva de la fuerza laboral de proveedores capaces de brindar intervenciones comunitarias viables mediadas por cuidadores, y de educadores tempranos capaces de atender a niños autistas en entornos preescolares terapéuticos inclusivos.

Demanda de cuidado nutricional de crianças com transtorno do espectro autista em uma região de acesso remoto / Demandas de atención nutricional de niños con trastorno del espectro autista en una región de acceso remoto / Nutritional care demands of children with autism spectrum disorder in a remote access region

Introdução: O transtorno do espectro autista é uma condição neuropsiquiátrica que demanda atenção interdisciplinar e multiprofissional. A abordagem nutricional é necessária frente aos possíveis sintomas associados, como seletividade alimentar e alterações do hábito intestinal. Famílias residentes em locais de acesso limitado à serviços de saúde podem possuir dificuldades para o adequado acompanhamento. Objetivo: Relatar a experiência de atendimentos em nutrição realizados pela Liga Acadêmica de Nutrição e Saúde Coletiva a crianças com transtorno do espectro autista explorando as principais demandas identificadas e enfrentadas em uma região de acesso remoto. Metodologia: Abordagem descritiva, do tipo relato de experiência, de atendimentos realizados no município de Coari, interior do Amazonas. Os encontros foram realizados com vista a identificar demandas e refletir sobre a melhor maneira de auxiliar as crianças com essas comorbidades. Resultados: Foram atendidas 9 crianças, nem todas com o diagnóstico fechado. Seletividade alimentar, distúrbios gastrointestinais e excesso de peso foram desafios recorrentes. Nota-se a carência da percepção da importância do acompanhamento nutricional, em um cenário de relatos importantes sobre as dificuldades no acesso a medicações, por falta no município ou por ausência de recursos para aquisição, assim como terapias especializadas. Aspectos que se tornam ainda mais desafiadores frente à distância geográfica e carência de profissionais especializados e que realizem uma atenção multiprofissional. Conclusões: O acompanhamento nutricional adequado é essencial para atender às necessidades específicas e melhorar a qualidade de vida dessas crianças. Diante das limitações identificadas na região, são necessários esforços contínuos para desenvolver soluções que garantam uma assistência inclusiva e eficaz às crianças com transtorno do espectro autista no interior do Amazonas. A colaboração entre instituições, a conscientização da comunidade e o fortalecimento da rede de saúde local são cruciais para promover uma abordagem abrangente e de alta qualidade para essas crianças e suas famílias (AU).

Introduction: Autism spectrum disorder is a neuropsychiatric condition that demands interdisciplinary and multidisciplinary attention. Nutritional intervention is necessary in the face of possible associated symptoms, such as food selectivity and changes in bowel habits. Families living in places with limited access to health services may have difficulties in obtaining adequate support and follow-up.Objective: Reporting the experience of nutrition services provided by the Academic League of Nutrition and Public Health to children with autism spectrum disorder, exploring the main identified demands and challengesfaced in a remote access region. Methodology:Descriptive approach, experience of an report, of services provided in the municipality of Coari, in the interiorof Amazonas. The meetings were held with the aim identifying demands and reflecting on the best way to assistchildren with these comorbidities. Results: Ninechildren attended to, not all with a confirmed diagnosis. Food selectivity, gastrointestinal disorders and overweight were recurring challenges. There is a lack of perception of the importance of nutritional monitoring, in a scenario where there areimportant reportsofdifficulties in accessing medications, either due to lack of availability in the municipality or lack of resources for acquisition, as well as specialized therapies. Theseaspects become even more challenging given the geographical distance and scarcity of specialized professionals whocanprovide multidisciplinary care. Conclusions: Adequate nutritional monitoring is essential to meet the specific needs and improve the quality of life of these children. Given the limitations identified in the region, continuous efforts are needed to develop solutions that guarantee inclusive and effective assistance for children with autism spectrum disorder in the interior of Amazonas. Collaboration between institutions, community awareness, and strengthening the local health network are crucial to promoting a comprehensive, high-quality approach for these children and their families (AU).

Introducción: El trastorno del espectro autista es una condiciónneuropsiquiátrica que requiere atención interdisciplinaria y multidisciplinaria. El enfoque nutricionales frente a losposibles síntomas, como selectividad alimentaria y alteraciones delhábitosintestinales. Las familias que viven en lugares con accesolimitado a los servicios de salud pueden tener dificultades para recibir un seguimiento adecuado. Objetivo: Reportar la experiencia de los servicios de nutrición brindados por la Liga Académica de Nutrición y Salud Pública a niños con trastorno del espectro autista, explorando las principales demandas identificadas y enfrentadas en una región de acceso remoto.Metodología: Enfoque descriptivo, relato de experiencia, de los servicios prestados en Coari, en el interior de Amazonas. Los encuentros se realizaron con el objetivo de identificar demandas y reflexionar sobre la mejor manera de ayudar. Resultados:Se atendieron 9 niños, no todos con diagnóstico confirmado. Selectividad alimentaria, trastornos gastrointestinales y exceso de peso fueron desafíos recurrentes. Se observa una falta percepción de la importancia del seguimiento nutricional, en un escenario de informes importantes sobre las dificultades en el acceso a medicamentos, debido a lafaltade suministro en el municipio o a la falta de recursos para su adquisición, así como terapias especializadas. Estosaspectos que se vuelven aún más desafiantes dada la distancia geográfica y falta de profesionales especializados que brinden una atención multidisciplinaria.Conclusiones: Un adecuado seguimiento nutricional es fundamental para satisfacerlas necesidades específicas y mejorar la calidad de vida de estos niños. Antelas limitaciones identificadas, se necesitan esfuerzos continuos para desarrollar soluciones que garanticen una atención inclusiva y efectiva estosniños en el interior de Amazonas. Colaboración entre instituciones, concientización comunitaria y fortalecimiento de la red de salud local son cruciales para promover un enfoque integral y de alta calidad para estos niños com trastorno del espectro autista y sus familias (AU).

Intervención psicoeducativa en familiares de educandos con trastornos del espectro autista

Fundamento: el trastorno del espectro autista es una entidad de origen neurobiológico, caracterizada por una variedad de signos y síntomas. Objetivo: elevar el nivel de conocimiento en familiares de educandos con trastorno del espectro de autismo. Métodos: se realizó un estudio cuasiexperimental, de intervención educativa en los nueve Servicios de Rehabilitación de las áreas de salud del municipio de Camagüey, durante los meses enero-diciembre de 2022. La muestra quedó constituida por 25 familiares que cumplieron con los criterios de elegibilidad. Para evaluar los resultados de la intervención se aplicó un cuestionario antes y después de desarrollada la intervención. Resultados: existió predominio del sexo femenino 23 (92 %), un rango de edad de 30-39 años 11 (44 %) y un nivel escolar de bachiller 13 (52 %). Antes de la intervención fue insuficiente el nivel de conocimiento general sobre el trastorno del espectro autista en un 68 %. En lo referente a la competencia emocional, alcanzó el 84 %, el tratamiento indicado el 84 %, y los métodos educativos el 60 %. Posterior a la estrategia se logró elevar el nivel de conocimiento general en el 100 %, el 92 % alcanzó el objetivo de la competencia emocional, el 100 % logró suficiencia sobre el tratamiento indicado y en el 92 % obtuvo mejoría en el conocimiento sobre los estilos educativos. Conclusiones: se logró elevar el nivel de conocimientos generales sobre el trastorno del espectro autista, la competencia emocional, cumplimiento del tratamiento neurosensorial y estilos educativos.

Background: autism spectrum disorder" is an entity of neurobiological origin, characterized by a variety of signs and symptoms. Objective: raise the knowledge level in relatives of students with autism spectrum disorder. Methods: a quasi-experimental study of educational intervention was carried out in the nine Rehabilitation Services of the Camagüey municipality health areas, from January to December 2022. The sample consisted of 25 family members who met the eligibility criteria. To evaluate the results of the intervention, a questionnaire was applied before and after the intervention was developed. Results: there was a predominance of the female sex 23 (92%), an age range of 30-39 years 11 (44%) and a high school level 13 (52%). Before the intervention, the level of general knowledge about autism spectrum disorder was insufficient by 68%. Regarding emotional competence, it reached 84%, the indicated treatment 84%, and educational methods 60%. After the strategy, it was possible to raise the level of general knowledge by 100%, 92% achieved the objective of emotional competence, 100% achieved sufficiency regarding the indicated treatment and 92% obtained improvement in educational styles knowledge. Conclusions: it was possible to raise the level of general knowledge about autism spectrum disorder, emotional competence, compliance with neurosensory treatment and educational styles.

Proposal of a screening instrument for autism spectrum disorder in children (Mini-TEA Scale) / Proposta de um instrumento de triagem para transtorno do espectro autista em crianças (Escala Mini-TEA)

Abstract Background Autism spectrum disorder (ASD) requires trained professionals for its adequate diagnosis. There is a shortage of such professionals in Brazil. Screening tools could identify priority cases. The only instrument for that in Brazilian Portuguese is employed for toddlers up to 2.5 years old. Objective The Mini-TEA scale was conceived and tested as a screening for children from 2.5 to 12 years old. Methods After local ethics committee's approval, this study was conducted from December 2022 to April 2023 in the Associação de Pais e Amigos dos Excepcionais, Passo Fundo/RS, of invitations to children's parents/relatives who were under evaluation for ASD and by local advertisement. Inclusion criteria were age from 2.5 to 12 years old; consent from the child's legal guardians. 75 children's parents/relatives were interviewed using the 15-item Mini-TEA scale. After that, children were evaluated for the diagnosis of ASD by a pediatric neurologist. Sensibility and specificity for ASD diagnosis along the Mini-TEA scores were measured. Experts and target population evaluated the validity/reliability of the Mini-TEA scale. The reproducibility of the scores was assessed about 40 days later. Results From the 75 participants, 28 received a diagnosis of ASD. Scores ≥ 10 on the Mini-TEA scale require further evaluation of the children (sensitivity 100%; specificity 68%). Content validity coefficient (CVC) rendered values > 0.80 (acceptable). Test-retest analyzes with the intraclass correlation coefficient (ICC) indicated excellent reliability (> 0.90). The time spent for applying the screening was about 10 minutes. Conclusion The Mini-TEA scale presents as an easy tool for screening ASD among children.

Resumo Antecedentes O transtorno do espectro autista (TEA) requer profissionais treinados para o diagnóstico, escassos no Brasil. Instrumentos de triagem poderiam identificar casos prioritários para avaliação. O único em português brasileiro é empregado para crianças até 30 meses de idade. Objetivo A escala Mini-TEA foi concebida e testada como triagem para crianças entre 2,5 e 12 anos. Métodos Estudo foi conduzido de dezembro de 2022 a abril de 2023 na Associação de Pais e Amigos dos Excepcionais (APAE) de Passo Fundo/RS, após a aprovação bioética local. O recrutamento consistiu em convite aos familiares de crianças que estavam sendo avaliadas para TEA e por divulgação local. Os critérios de inclusão foram idade entre 2,5 e 12 anos e consentimento do guardião legal. Familiares de 75 crianças foram entrevistados com a escala Mini-TEA (15 itens). Depois, as crianças foram avaliadas para o diagnóstico de TEA por neuropediatra. A sensibilidade e a especificidade do diagnóstico de TEA com os escores da Mini-TEA foram mensuradas. A validade e a confiabilidade da escala Mini-TEA foram avaliadas por experts e pela população alvo. A reprodutibilidade dos escores foi medida após ± 40 dias. Resultados Dos 75 participantes, 28 receberam diagnóstico de TEA. Escores ≥ 10 na escala Mini-TEA requerem avaliação das crianças (sensibilidade 100%; especificidade 68%). O coeficiente de validação de conteúdo (CVC) rendeu valores > 0,80 (aceitável). Análises de teste-reteste com coeficiente de correlação intraclasse (ICC) indicou excelente confiabilidade (> 0,90). O tempo gasto para a triagem foi cerca de 10 minutos. Conclusão A escala Mini-TEA constitui ferramenta breve e fácil para triagem de TEA em crianças.

Percepção de cuidadores de pré-escolares com TEA sobre seu comportamento e desempenho ocupacional durante a pandemia da COVID-19 / Perception of caregivers of preschool children with ASD on their behavior and occupational performance during the COVID-19 pandemic

Resumo Introdução Crianças com Transtorno do Espectro Autista (TEA) podem apresentar questões comportamentais, no processamento sensorial, na cognição e na linguagem, que afetam seu desempenho ocupacional, necessitando de acesso a serviços escolares, terapêuticos e de saúde. O acesso a esses serviços esteve restrito durante a pandemia de COVID-19, tornando essa população particularmente ainda mais vulnerável às restrições sociais impostas à época. Objetivo Descrever a percepção dos pais cuidadores de pré-escolares com TEA acerca do comportamento e desempenho ocupacional de seus filhos durante a pandemia da COVID-19. Método Estudo transversal, descritivo, quantitativo e qualitativo baseado em entrevistas com 60 cuidadores de pré-escolares com TEA. Os participantes responderam à seguinte pergunta: Você está notando alguma diferença no comportamento e desempenho da criança durante a pandemia? Para caracterização das crianças, foram utilizados o Sistema de Classificação de Funcionalidade no Autismo: Comunicação Social (ACSF:SC), o Inventário de Avaliação Pediátrica de Incapacidade - Teste Adaptativo de Computador (PEDI-CAT) e o Perfil Sensorial 2 (SP-2). Todas as entrevistas foram anotadas e 15 delas foram gravadas e transcritas. O material foi submetido à análise temática de conteúdo. Resultados Foram entrevistadas 43 mães, 15 casais e dois pais de crianças com TEA. Das 60 crianças, 46 (76,7%) eram meninos, com idade de 3 a 5 anos (53,6 ±10,18 meses). Os cuidadores perceberam mudanças no comportamento e desempenho ocupacional, com prevalência de relatos de piora. Houve aumento nas estereotipias, rigidez e hiperfoco, bem como menor engajamento nas atividades cotidianas. A presença dos cuidadores beneficiou algumas crianças, mas há relato de estresse, especialmente por parte das mães. Conclusão Houve variação nos relatos, com maior tendência à piora no comportamento e desempenho ocupacional das crianças com TEA.

Abstract Introduction Children with Autism Spectrum Disorder (ASD) face behavioral, sensory processing, cognitive, and language challenges that affect their ability to perform activities of daily living (ADL) and necessitate access to educational, therapeutic, and health services. The COVID-19 pandemic limited access to these essential services, exacerbating the challenges faced by this vulnerable population due to imposed social distancing measures. Objective To explore the perceptions of parent caregivers of preschoolers with ASD regarding their children's behavior and performance in ADL during the COVID-19 pandemic. Method This cross-sectional, descriptive study utilized both quantitative and qualitative approaches, interviewing 60 caregivers of preschoolers with ASD. Participants were asked about any observed changes in their child's behavior and ability to engage in ADL during the pandemic. Child characterization involved the Autism Classification System of Functioning: Social Communication (ACSF:SC), the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT), and the Sensory Profile 2 (SP-2). Interviews were documented, with 15 recorded and transcribed for thematic content analysis. Results Participants included 43 mothers, 15 couples, and two fathers, totaling 60 children, of whom 46 (76.7%) were boys aged between 3 and 5 years (mean age 53.6 ±10.18 months). Caregivers reported changes in behavior and performance in ADL, predominantly noting deterioration. Increases in stereotypic behaviors, rigidity, and hyperfocus were observed, along with decreased participation in ADL. While the presence of caregivers benefited some children, it also led to reported stress, particularly among mothers. Conclusion The study found a predominant trend of deteriorating behavior and performance in ADL among children with ASD during the pandemic, based on caregiver reports.

Effects of dialogic reading for comprehension (LuDiCa) on the social interaction of autistic adolescents and their peers

Abstract Background In today's contemporary world, relationships take a prominent role in the lives of adolescents. However, challenges related to mutual understanding and a lack of inclusive environments can often lead to autistic teens feeling excluded. Objective In order to assess the impact of naturalistic interventions on interpersonal relationships, we conducted an experimental test utilizing Dialogic Reading for Comprehension (LuDiCa) in online reading circles with groups comprising both autistic and neurotypical adolescents. Our focus was on exploring its relevance for enhancing social interaction, particularly in terms of conversational acts, sharing experiences, initiations, and questions. Methods Five autistic and five neurotypical students between 11 and 15 years old from a public school in Brasilia, Federal District, participated. We paired groups A and B (made up of trios of teenagers) and groups C and D (made up of pairs) in a multiple baseline design per reading group, in which all groups went through the baseline conditions (BL), intervention (LuDiCa) and maintenance. Results LuDiCa increased the frequency of conversational acts of both autistic participants and neurotypical peers. In addition, the intervention favored initiations, questions, and sharing experiences, through the shared activity of reading and talking about a work of fiction. Participants rated the intervention in relation to the platform, the book, the reading facilitator, and interaction with peers. We discuss the potential of the facilitator's role in favoring interactions and the potential of LuDiCa as a joint activity for the engagement of adolescents. We also include suggestions for future research focused on the online context and discuss some limitations of the LuDiCa intervention. Conclusion In summary, our study offers initial experimental evidence demonstrating the positive impact of LuDiCa on social interaction behaviors among both autistic and neurotypical adolescents within an inclusive setting.

Visual scanning of social stimuli in preterm and autism spectrum disorder children / Varredura visual de estímulos sociais em crianças prematuras e com transtorno do espectro autista

ABSTRACT Objective: To evaluate the pattern of eye-gaze of preterm (PT), autism spectrum disorder (ASD) and neurotypical (Ty) children. Methods: A cross-sectional study with eight preterm (born with ≤2000 g weight), nine ASD and five Ty male children, between six and nine years old, was performed. The eye gaze was evaluated presenting a board with a couple in social interaction, and a video with four children playing with blocks, projected in a screen computer, successively, evaluating the time that the children looked at each stimulus. Results: Although all the groups focus on the central social figure with no significant differences, ASD presented significant differences in time fixation of the objects (p=0.021), while premature children fixated more time in the central social interaction than in the whole scene than typical children. Conclusions: Although this study found noteworthy differences in the eye-gaze patterns among the three groups, additional research with a more extensive participant pool is necessary to validate these preliminary results.

RESUMO Objetivo: Avaliar o padrão de fixação visual de crianças nascidas prematuras (PT), com transtorno do espectro do autismo (TEA/ASD) e neurotípicas (Ty). Métodos: Estudo transversal incluindo oito meninos prematuros (nascidos com peso ≤2000 g), nove TEA e cinco Ty, com idade entre 6 e 9 anos. A varredura visual foi avaliada apresentando-se imagem de casal em interação social e vídeo com crianças brincando. A figura e o vídeo foram projetados em tela de computador, sucessivamente, sendo avaliado o tempo de fixação para cada estímulo. Resultados: Apesar de os três grupos de crianças focarem o olhar na figura social central sem diferenças significativas, crianças com TEA apresentaram diferenças significativas no tempo de fixação em objetos (p=0,021), enquanto prematuros fixaram o olhar mais tempo na interação social central do que na cena como um todo. Conclusões: Embora tenham sido notadas algumas diferenças significativas nos padrões de olhar para os três grupos, é necessário realizar mais pesquisas com uma amostra maior para confirmar esses resultados iniciais.

Características de niños con trastorno del espectro autista en rehabilitación pediátrica de un hospital de referencia en Perú / Characteristics of children with autism spectrum disorder in pediatric rehabilitation at a referral hospital in Peru

RESUMEN Objetivo. El trastorno del espectro autista (TEA) se caracteriza por alteraciones en el desarrollo, dificultades de interacción social y comunicación, y patrones restrictivos y repetitivos de conducta. A pesar de su alta prevalencia, pocos estudios se han realizado en ambientes de rehabilitación. El objetivo del estudio fue describir las características de los niños con TEA atendidos en el Servicio de Rehabilitación Pediátrica del Hospital Rebagliati (SRP-HNERM). Materiales y métodos. Estudio descriptivo transversal. Se revisaron las historias clínicas de niños menores de 14 años con diagnóstico previo de TEA atendidos en el SRP-HNERM durante el 2022. Resultados. Se evaluaron a 120 niños con TEA. La mediana de edad fue de cinco años. La mayoría recibía educación regular, pero solo para el 9,8% fue inclusiva. La media de edad de diagnóstico fue de 3,83 años. El 78,4% no tenía certificado de discapacidad y el 77,5% tenía evaluación psicológica incompleta. La mediana del tiempo transcurrido desde las últimas sesiones de terapia física, ocupacional y de lenguaje fue de 3, 8 y 3,5 meses respectivamente. Conclusión. La media de edad de diagnóstico de TEA fue mayor de tres años y más del 75% de los pacientes no contaban con un certificado de discapacidad ni con una evaluación psicológica completa. La mediana del tiempo desde las últimas sesiones de terapias de rehabilitación fue de tres meses o más. Estos hallazgos resaltan la necesidad de potenciar el diagnóstico temprano, la educación inclusiva y la evaluación y posterior certificación de la discapacidad, así como de establecer intervenciones más oportunas.

ABSTRACT Objective. Autism spectrum disorder (ASD) is characterized by developmental disorders, difficulties in social interaction and communication, and restrictive and repetitive patterns of behavior. Despite its high prevalence, few studies have been conducted in rehabilitation settings. This study aimed to describe the characteristics of children with ASD from the Pediatric Rehabilitation Service of the Rebagliati Hospital (SRP-HNERM). Materials and methods. Cross-sectional descriptive study. We reviewed the medical records of children under 14 years of age previously diagnosed with ASD from the SRP-HNERM during 2022. Results. A total of 120 children with ASD were evaluated. The median age was 5 years. Most received regular education, but it was inclusive only for 9.8%. The mean age at diagnosis was 3.83 years. We found that 78.4% had no disability certificate and 77.5% of the participants had incomplete psychological evaluation. The median time since the last physical, occupational and speech therapy sessions was 3, 8 and 3.5 months respectively. Conclusion. The mean age at diagnosis of ASD was older than three years, and more than 75% of the patients had neither a disability certificate nor a complete psychological evaluation. The median time since the last rehabilitation therapy sessions was three months or more. Our findings highlight the need to improve early diagnosis, inclusive education and evaluation and subsequent certification of disability, as well as to establish timely interventions.

Cognitive and social adaptation in autism spectrum disorder: A prospective cohort study

ABSTRACT BACKGROUND: During development, children face a number of demands and cognitive, behavioral, and social challenges necessary for growth. Cognitive skills make individuals competent and allow them to interact with their environment. OBJECTIVE: To identify the cognitive skills that promote better social insertion in children with autism spectrum disorder within 12 months. DESIGN AND SETTING: Prospective cohort study METHODS: In this study, 21 children aged 3-12 years were assessed, and their mothers were interviewed. Children were enrolled in regular or special autistic schools. Twelve months after the first assessment, the same children participated in the second assessment. In individual interviews, mothers provided data by answering the Vineland Adaptive Behavior Scale. Each child was assessed individually using the fourth edition of the Stanford Binet Intelligence Scale 4th Edition. RESULTS: In the first assessment, the Stanford Binet areas and total scores correlated with the communication domains, daily life abilities, socialization, and total score of the Vineland Scale. After 12 months, a correlation was observed between the Stanford Binet areas and the total and communication domains, daily life abilities, socialization, motor abilities, and total score on the Vineland Scale. CONCLUSION: Logic mathematics and memory promote better social insertion in children with autism spectrum disorder. General cognitive ability promotes communication.

Evaluation of the efficacy and safety of cannabidiol-rich cannabis extract in children with autism spectrum disorder: randomized, double-blind, and placebo-controlled clinical trial

Abstract Objective Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction and by restricted and repetitive patterns of behavior. Some studies have shown that substances derived from Cannabis sativa improve the quality of life of children with ASD without causing serious adverse effects, thus providing an alternative therapeutic option. The objective of this study was to evaluate the efficacy and safety of a cannabis extract rich in cannabidiol (CBD) in children with ASD. Methods In this randomized, double-blind, placebo-controlled clinical trial, 60 children, aged from 5 to 11 years, were selected and divided into two groups: the treatment group, which received the CBD-rich cannabis extract, and the control group, which received the placebo. They both used their respective products for a period of 12 weeks. Statistical analysis was done by two-factor mixed analysis of variance (two-way ANOVA). Results Significant results were found for social interaction (F1,116 = 14.13, p = 0.0002), anxiety (F1,116 = 5.99, p = 0.016), psychomotor agitation (F1,116 = 9.22, p = 0.003), number of meals a day (F1,116 = 4.11, p = 0.04), and concentration (F1,48 = 6.75, p = 0.01), the last of which was only significant in mild ASD cases. Regarding safety, it was found that only three children in the treatment group (9.7%) had adverse effects, namely dizziness, insomnia, colic, and weight gain. Conclusion CBD-rich cannabis extract was found to improve one of the diagnostic criteria for ASD (social interaction), as well as features that often co-exist with ASD, and to have few serious adverse effects.

Breastfeeding and autism spectrum disorder: case-control study / Transtorno do espectro do autismo e aleitamento materno: estudo de caso controle

Abstract Objectives: to evaluate the association between breastfeeding and Autism Spectrum Disorder (ASD) in children and adolescents. Methods: this is a case-control study carried out in the north of the state of Minas Gerais, Brazil, which included 248 children and adolescents diagnosed with ASD (case group) and 886 children and adolescents without a diagnosis of ASD (control group).Interviews were conducted with the mothers of children and adolescents and a semi-structured questionnaire was used to collect data. For data analysis, a multiple logistic regression model was adopted. The magnitude of associations was estimated by the odds ratio (OR). Three multiple models were fitted: Model 1: presence or absence of breastfeeding; Model 2: duration of breastfeeding; Model 3: duration of exclusive breastfeeding. Results: ASD was associated with the absence of breastfeeding in the three adjusted models: Model 1: OR=2.1, CI95%=1.1-4.1; Model 2: OR=2.3, CI95%=1.2-4.5; Model 3: OR=2.3, CI95%=1.2-4.5. Conclusions: individuals with ASD were more likely to have not received breastfeeding, however, due to the nature of case control studies, it cannot be stated that breastfeeding prevents ASD. Conducting a cohort study may clarify this relationship.

Resumo Objetivos: avaliar a associação entre aleitamento materno e Transtorno do Espectro do Autismo (TEA) em crianças e adolescentes. Métodos: trata-se de um estudo caso-controle realizado no norte de Minas Gerais, Brasil, que incluiu 248 crianças e adolescentes com diagnóstico de TEA (grupo caso) e 886 crianças e adolescentes sem diagnóstico de TEA (grupo controle). Foram realizadas entrevistas com as mães das crianças e adolescentes e utilizado um questionário semiestruturado para coleta dos dados. Para análise dos dados foi adotado modelo de regressão logística múltipla. A magnitude das associações foi estimada pela Odds Ratio (OR). Três modelos múltiplos foram ajustados: Modelo 1: presença ou ausência de aleitamento materno; Modelo 2: duração do aleitamento materno; Modelo 3: duração do aleitamento materno exclusivo. Resultados: o TEA foi associado à ausência de aleitamento materno nos três modelos ajustados: Modelo 1: OR=2,1, IC95%=1,1-4,1; Modelo 2: OR=2,3, IC95%=1,2-4,5; Modelo 3: OR=2,3, IC95%=1,2-4,5. Conclusões: os indivíduos com TEA tiveram maiores chances de não terem recebido aleitamento materno, no entanto, devido à natureza dos estudos de caso-controle, não se pode afirmar que o aleitamento materno previna o TEA. A realização de um estudo de coorte poderá esclarecer essa relação.

Repercussões psicossociais da pandemia da covid-19 para mães de crianças com transtorno do espectro autista / Psychosocial repercussions of the covid-19 pandemic for mothers of children with autism spectrum disorder / Repercusiones psicosociales de la pandemia de covid-19 en las madres de niños con trastorno del espectro autista

RESUMO Objetivo: compreender as repercussões psicossociais da pandemia da COVID-19 para mães de crianças com Transtorno do Espectro Autista. Método: estudo qualitativo, com a participação de 22 mães. Os dados foram coletados de maio a julho de 2022, no interior da Paraíba, Brasil, por meio de uma Dinâmica de Criatividade e Sensibilidade. A análise deu-se através do referencial teórico-analítico da análise de discurso francesa. Resultados: medo, ansiedade, angústia, preocupações assumiram um lugar central no movimento dialógico das mães. Diante das demandas e reconfigurações na rotina, houve uma sobrecarrega física, emocional e psicológica, com repercussões na vida materna. A solidão pôde ser evidenciada pela frágil ou inexistente rede de apoio durante o período pandêmico. Conclusão: o estudo pode subsidiar a reflexão sobre as repercussões da pandemia na vida de mães de crianças com autismo e viabilizar a elaboração de ações que priorizem a saúde mental, auxiliando-as na superação de momentos de adversidades.

ABSTRACT Objective: to understand the psychosocial repercussions of the COVID-19 pandemic for mothers of children with Autism Spectrum Disorder. Method: a qualitative study, with participation of 22 mothers. The data were collected from May to July 2022 in the inland of Paraíba, Brazil, through the Dynamics of Creativity and Sensitivity. The analysis took place through the theoretical-analytical framework of French discourse analysis. Results: fear, anxiety, anguish and concerns assumed a central place in the mothers' dialogical movement. Faced with the demands and reconfigurations in the routine, there was physical, emotional and psychological overload, with repercussions on maternal life. Loneliness can be seen in the weak or non-existent support network during the pandemic. Conclusion: the study can support reflection on the repercussions of the pandemic on the lives of mothers of children with autism and enable the development of actions that prioritize mental health, helping them to overcome moments of adversity.

RESUMEN Objetivo: comprender las repercusiones psicosociales de la pandemia de COVID-19 en las madres de niños con Trastorno del Espectro Autista. Método: estudio cualitativo, con la participación de 22 madres. Los datos fueron recolectados de mayo a julio de 2022, en el interior de Paraíba, Brasil, mediante una Dinámica de Creatividad y Sensibilidad. El análisis se realizó siguiendo el marco teórico-analítico del análisis del discurso francés. Resultados: el miedo, la ansiedad, la angustia y las preocupaciones ocuparon un lugar central en el movimiento dialógico de las madres. Ante las exigencias y reconfiguraciones de la rutina, las madres sufrieron una sobrecarga física, emocional y psicológica que afectó su vida. La soledad se puede ver en la débil o nula red de apoyo que tuvieron durante la pandemia. Conclusión: el estudio puede contribuir a la reflexión sobre las repercusiones de la pandemia en la vida de las madres de niños con autismo y posibilitar el desarrollo de acciones que prioricen la salud mental que las ayuden a superar momentos de adversidad.

The challenges for early intervention and its effects on the prognosis of autism spectrum disorder: a systematic review / Os desafios para a intervenção precoce e seus efeitos no prognóstico do transtorno do espectro autista: uma revisão sistemática

ABSTRACT. Autism spectrum disorder (ASD) is expressed with neurobehavioral symptoms of different degrees of intensity. It is estimated that, for every three cases detected, there are two cases that reach adulthood without treatment. Objective: To establish what challenges are still present in the implementation of early intervention (EI) and its effects on the prognosis of ASD. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) methodology was carried out in the PubMed and ScienceDirect databases in January 2023. The search keywords were "autism spectrum disorder", "early intervention" and "prognosis". Results: Sixteen studies were included, two randomized and 14 non-randomized. Knowledge about the signs of ASD, diagnostic and therapeutic methods, age at the start of treatment, and socioeconomic factors were the main challenges encountered in the implementation of the EI. Conclusion: EI is capable of modifying the prognosis of ASD and challenges in its implementation persist, especially in developing regions with low socioeconomic status.

RESUMO. O transtorno do espectro autista (TEA) expressa-se com sintomas neurocomportamentais de diferentes graus de intensidade. Estima-se que, para cada três casos detectados, existam dois casos que atingem a idade adulta sem tratamento. Objetivo: Estabelecer quais são os desafios ainda presentes na implementação efetiva da intervenção precoce (IP) e quais são os seus efeitos no prognóstico do TEA. Métodos: Revisão sistemática com a metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) foi realizada nos bancos de dados PubMed e ScienceDirect em janeiro de 2023. As palavras-chave da pesquisa foram "autism spectrum disorder", "early intervention" e "prognosis". Resultados: Dezesseis estudos foram incluídos, sendo dois randomizados e 14 não randomizados. O conhecimento sobre os sinais do TEA, os métodos diagnósticos e terapêuticos, a idade de início de tratamento e os fatores socioeconômicos foram os principais desafios encontrados na implementação da IP. Conclusão: A IP é capaz de modificar o prognóstico do TEA e os desafios em sua implementação ainda afetam, principalmente, regiões em desenvolvimento e de baixo status socioeconômico.

O que dizem familiares de autistas sobre o trabalho desenvolvido pelos CAPSi? / What do family members of autistic people say of the work carried out by the CAPSi?

Resumo A política de saúde mental infantojuvenil, implantada no Brasil no início do século XXI, estabeleceu os Centros de Atenção Psicossocial Infantojuvenis (CAPSi) como equipamentos estratégicos para priorizar os casos de maior complexidade, com destaque para os autistas. Este estudo visa cotejar duas fontes de informação sobre a percepção de familiares de autistas acerca do trabalho desenvolvido pelos CAPSi: a primeira foi colhida em pesquisa de 2011, que utilizou grupos focais; e a segunda, a partir da literatura produzida sobre o tema nos 10 anos seguintes. As narrativas foram organizadas em quatro eixos temáticos: percepção sobre os efeitos do trabalho psicossocial; compartilhamento de informações; percepção sobre os processos de cuidado; e demandas e reivindicações. A despeito da heterogeneidade entre os estudos, os resultados indicaram que o trabalho dos CAPSi produz efeitos positivos, principalmente em relação à socialização. Contudo, essa percepção não é acompanhada de melhor entendimento do quadro clínico e dos processos de cuidado. O valor do tratamento é frequentemente atribuído à atitude pessoal dos profissionais, indicando a ausência de compartilhamento e participação dos familiares. Esses aspectos devem instigar os CAPSi a envolver os familiares como parceiros do cuidado, dando atenção especial à transmissão da lógica psicossocial, suas estratégias e direção do cuidado.

Abstract The child and adolescent mental health policy, implemented in Brazil from the beginning of the 21st century, established the Centros de Atenção Psicossocial Infantojuvenis (CAPSi - Psychosocial Care Centers for Children and Adolescent) as strategic services to prioritize more complex cases, with emphasis on autism. This study aims to compare two sources of information on the perception family members of autistic people regarding the work carried out by CAPSi: the first was collected in a 2011 survey, which used focus groups; and the second, from the literature produced on the subject in the following 10 years. The family member's narratives were organized into four thematic axes: perception of the effects of psychosocial care; information sharing; perception about care processes; and demands and claims. Despite the heterogeneity between the studies, the results indicated that the work of the CAPSi produces positive effects, especially regarding socialization. However, this perception is not accompanied by a better understanding of the clinical picture and care processes. The value of treatment is often attributed to the personal attitude of professionals, indicating the lack of sharing and participation by family members. These aspects should encourage the CAPSi to involve family members as partners in care, particularly valuing the transmission of the psychosocial reasoning, its strategies and direction of care.

Effect of enriched environment combined with acupuncture at head points on behavior in rats with autism spectrum disorder / 中国康复理论与实践

ObjectiveTo observe the effect of enriched environment (EE) combined with acupuncture at head point (HA) on behavior in rats with autism spectrum disorder. MethodsHealthy female Wistar rats were given peritoneal injection of sodium valproate at 12.5 days of gestation. Twenty-four male offspring rats were randomly selected and then randomly divided into model group (n = 6), EE group (n = 6), HA group (n = 6) and EE combined with HA group (the combined group, n = 6). Six male offspring rats born from female mice injected with the same amount of saline intraperitoneally were as control group. After four weeks of treatment, all the five groups were tested with three-chamber test and marble burying test, and the sociability index, the social novelty index and the number of buried marbles were recorded. The levels of interleukin (IL)-1β and IL-6 in peripheral blood were determined by enzyme-linked immunosorbent assay (ELISA). ResultsAfter treatment, compared with the model group, the sociability index and the social novelty index improved (P < 0.05), the number of buried marbles reduced (P < 0.05), and the levels of IL-6 and IL-1β in peripheral blood decreased in EE group, HA group and the combined group (P < 0.05); while the combined group was the best (P < 0.01). ConclusionBoth EE or acupuncture at HA could improve behavioral symptoms, and reduce the expression of inflammatory factors in rats with autism spectrum disorder. The combination of the two methods showed the best result.

Characteristics of interbrain synchrony during interactions among individuals with autism spectrum disorder: a scoping review / 中国康复理论与实践

ObjectiveTo review the characteristics of interbrain synchrony between individuals with autism spectrum disorder (ASD) and healthy individuals during interactions. MethodsResearches on interbrain synchrony during interactions in individuals with ASD were retrieved from databases such as PubMed, Web of Science, Scopus and CNKI in November, 2023. Researches were screened and the relevant data were extracted. The quality of the methodology was evaluated using critical appraisal tool for analytic cross sectional study. ResultsFive researches were returned, publicated mainly from 2020 to 2023, including 130 individuals with ASD. Interbrain synchrony was lower during the interaction task in the individuals with ASD compared with the healthy, mainly involving the prefrontal and temporo-parietal joint regions; as well as the interbrain synchrony of theta, alpha and beta bands of electroencephalography. There was difference in interbrain synchrony between genders in individuals with ASD; furthermore, abnormal interbrain synchrony in individuals with ASD associated with social impairment. ConclusionInterbrain synchrony deficits may be a potential neural mechanism for social impairment in individuals with ASD, and the abnormalities mainly happen in the brain areas related with mirror nervous system and theories of mind network.

Evaluation of Animal Model of Autism Spectrum Disorders Based on Characteristics of Clinical Symptoms of Traditional Chinese and Western Medicine / 中国实验方剂学杂志

ObjectiveBased on the new method of animal model evaluation， this paper summarized and analyzed the characteristics of traditional Chinese medicine（TCM） and Western medicine syndromes in existing autism spectrum disorder（ASD） animal models， and put forward suggestions for improvement. MethodRelevant literature on ASD animal models in China National Knowledge Infrastructure（CNKI） and PubMed were searched. According to the diagnostic standards of traditional Chinese and western medicine， core symptoms and accompanying symptoms were assigned values， and the clinical consistency of the models was comprehensively evaluated. ResultMost ASD model experimental animals were rodents， and the modeling methods included genetic and non-genetic. Domestic research focused on biochemical induction， while foreign research used genetic models more commonly. Among all models， valproic acid induction had the highest clinical consistency， followed by the neuroligin 4（NLGN4） and contactin associated protein like 2（CNTNAP2） gene knockout models. Most modeling methods could meet the characteristics of surface validity and structural validity， but did not clearly distinguish TCM syndromes. Currently， there is no model that has a high degree of clinical agreement between TCM and western medicine at the same time. ConclusionThe existing ASD animal models are mostly constructed under the guidance of western medicine， which lacks the characteristics of TCM syndromes. And the selection of evaluation indicators of western medicine is relatively single， without specifying the types of TCM syndromes. It is recommended to apply TCM intervention factors during the process of model preparation， to improve the evaluation indicators of traditional Chinese and western medicine， and to emphasize the study of on non-human primates， so as to lay a solid foundation for future experiments.

Effect of response interruption and redirection as a behavioral intervention on vocal stereotypy in children with autism spectrum disorder: a scoping review / 中国康复理论与实践

ObjectiveTo review the effect of response interruption and redirection intervention on vocal stereotypy in children with autism spectrum disorder (ASD). MethodsLiteratures on response interruption and redirection intervention for vocal stereotypy in children with ASD were retrieved from databases of EBSCO, PubMed, Web of Science, CNKI, and Wanfang data. The information of the literatures was extracted to conduct a scoping review. ResultsA total of 16 English literatures were included. All researches employed a single-subject time series study design. A total of 41 children with ASD were involved. Significant differences were found in levels of basic verbal functioning of children with ASD. Vocal stereotypy was characterized by both verbal and nonverbal forms. Most of the reviewed researches used experimental functional assessment to analyze the function of vocal stereotypy. In most cases, the function of vocal stereotypy was automatic reinforcement. Iwata et al.'s paradigm was dominantly adopted in performing experimental functional assessment across researches. Other related paradigms developed based on Iwata et al.'s paradigm to make operating process more concise were also used for experimental functional assessment in reviewed researches. Response disruption and redirection was often conducted in individualized setting, with a few researches conducted in special education classes. The time and frequency of interventions varied widely across subjects due to the levels of impairment in vocal stereotypy and other behaviors. According to a comparison of the effects of traditional response interruption and redirection and its morphing procedures, it was found that changing the content of the redirection task, reducing the number of redirection tasks, and varying the duration of execution did not impact the improvement of vocal stereotypy. Based on the comparisons of response interruption and redirection with matched stimuli, response cost, verbal manipulation training, and medication, it was found that both response interruption and redirection and other methods (except for medication) could reduce vocal stereotypy and promote the emergence of appropriate behaviors in children with ASD. Combining response interruption and redirection with other techniques, such as stimulus matching and response costs, yielded more favorable improvement of vocal stereotypy in children with ASD. ConclusionASD children with vocal stereotypy show different levels of functional language, and vocal stereotypy is generally characterized by both verbal and nonverbal formats. The function of vocal stereotypy is mostly automatic reinforcement. Response interruption and redirection as a behavioral intervention is mostly conducted in individualized setting, and the time and frequency of interventions depend on the levels of vocal stereotypy and other behaviors problems. Changing the content and number of redirection instructions does not significantly influence the improvement of vocal stereotypy in children with ASD. Other intervention methods such as matching stimulus and response cost are able to reduce vocal stereotypy in children with ASD, but response interruption and redirection used in conjunction with these methods show more favorable improvements. Response interruption and redirection interventions can not only reduce vocal stereotypy in children with ASD, but also increase appropriate vocalizations, task engagement and command obedience.