Risk of autism spectrum disorder in children with infantile epileptic spasms syndrome: a retrospective study in a single center in Brazil

Abstract Objective This study aimed to investigate the prevalence of autism spectrum disorder and its possible correlations with clinical characteristics in patients with infantile epileptic spasms syndrome in a single center in Brazil. Methods This retrospective cross-sectional study examined 53 children with the diagnosis of infantile epileptic spasms syndrome prior to an autism spectrum disorder assessment. Participants were divided into two groups based on the presence or absence of autism spectrum disorder. Available variables (sex, medications, median age at onset of infantile epileptic spasms syndrome, and presence of comorbidities) were compared using Mann-Whitney U or chi-square tests. Results Among the included patients, 12 (23 %) were diagnosed with autism spectrum disorder, corresponding to a relative risk of 0.29 (95 % confidence interval 0.174-0.492). The age at the first seizure ranged from 3 to 15 months, with a mean of 6.65 months. This age significantly differed between participants with autism spectrum disorder (10.58 months) and those without (5.43 months), p<0.001. Conclusion Children with infantile epileptic spasms syndrome have a higher risk of being diagnosed with autism spectrum disorder. Later age of onset and period of spasm occurrence might be predisposing risk factors.

Evaluación funcional de niños, niñas y adolescentes con diagnóstico de trastorno del espectro autista en Argentina: estudio multicéntrico TEA-CIFunciona / Functional assessment of children and adolescents with autism spectrum disorder in Argentina: ICF-ASD multicenter study

Introducción. El trastorno del espectro autista (TEA) se caracteriza por dificultades de comunicación social y comportamientos repetitivos y estereotipados. Además de la categoría diagnóstica, las actividades que los niños, niñas y adolescentes (NNyA) pueden realizar y la participación social son los aspectos principales por considerar desde el marco de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF), propuesta por la Organización Mundial de la Salud, para describir los estados de salud. En una investigación previa, elaboramos la primera versión de una herramienta pediátrica basada en la CIF llamada TEA-CIFunciona para evaluación funcional de NNyA con diagnóstico de TEA, que permitió captar características funcionales adaptadas a nuestro contexto cultural. Se propuso como objetivo posterior aplicar TEA-CIFunciona en formato multicéntrico para evaluar NNyA de diferentes regiones, revisar y actualizar la herramienta, e identificar barreras y facilitadores. Población y métodos. Se administró TEA-CIFunciona versión 1.0 a NNyA con diagnóstico confirmado de TEA (según criterios del DSM-5), menores de 16 años, en seguimiento en cinco centros de atención pediátrica del país. Resultados. Se obtuvo la versión 2.0 de TEA-CIFunciona con 34 categorías (10 funciones corporales, 15 actividades y participación, y 9 factores ambientales). Se elaboró el perfil funcional de la muestra completa (n = 308). Conclusiones. La versión actualizada de TEA-CIFunciona contribuye a estandarizar y a sistematizar la obtención de información necesaria para adecuar el seguimiento de los NNyA con TEA a nivel nacional. Además, permite identificar barreras por superar y facilitadores para generalizar

Introduction. Autism spectrum disorder (ASD) is characterized by difficulties in social communication and repetitive and stereotyped behaviors. In addition to the diagnostic category, the activities performed by children and adolescents and their social involvement are the main aspects to be considered according to the International Classification of Functioning, Disability, and Health (ICF) proposed by the World Health Organization to describe health status. In a previous study, we developed the first version of a pediatric tool based on the ICF called ICF-ASD for the functional assessment of children and adolescents with ASD to capture functional characteristics adapted to our cultural setting. Our subsequent objective was to apply the ICF-ASD in a multicenter format to assess children and adolescents from different regions, review, and update it, and identify barriers and facilitators. Population and methods. The ICF-ASD version 1.0 was administered to children and adolescents younger than 16 years with a confirmed diagnosis of ASD (as per DSM-5 criteria), who were receiving follow-up at 5 children's health centers across Argentina. Results. Version 2.0 of the ICF-ASD was obtained, which included 34 categories (10 under body function, 15 under activities and participation, and 9 under environmental factors). A functional profile was developed for the whole sample (n = 308). Conclusions. The updated version of the ICF-ASD helps to standardize and systematize the collection of necessary data for an adequate follow-up of children and adolescents with ASD at a national level. It also allows to identify barriers to overcome and facilitators to be generalized

Sistema de juegos inclusivos para el desarrollo de la coordinación motriz en estudiantes con trastorno del espectro autista

La Educación Física ha demostrado ser una herramienta eficaz para desarrollar condiciones físicas y mentales en el ser humano. Sin embargo, aún las propuestas a favor de hacer realidad la educación inclusiva en estudiantes con trastorno del espectro autista no logra los niveles mundialmente esperados. Es por ello que en esta obra se plantea como objetivo diseñar un sistema de juegos inclusivos para el desarrollo de la coordinación motriz en estudiantes con trastorno del espectro autista, en la clase de Educación Física. Para lograr este propósito se emplearon como métodos fundamentales del nivel empírico la encuesta, la prueba pedagógica y la observación. Los resultados del diagnóstico apuntan a un deficiente conocimiento por parte de los docentes de Educación Física sobre el tratamiento de los estudiantes con este trastorno, por lo que se procede a la tarea de elaborar un sistema de juegos para el desarrollo de la coordinación motriz que gradualmente los incorpore a la socialización en el grupo, y un sistema evaluativo pertinente donde se pudieron apreciar resultados superiores cuantitativa y cualitativamente.

A Educação Física tem se mostrado uma ferramenta eficaz para desenvolver as condições físicas e mentais do ser humano. No entanto, mesmo as propostas a favor de tornar a educação inclusiva uma realidade para alunos com perturbação do espectro do autismo não atingem os níveis globalmente esperados. Por isso o objetivo deste trabalho é desenhar um sistema de jogos inclusivos para o desenvolvimento da coordenação motora em alunos com transtorno do espectro do autismo, na aula de Educação Física. Para atingir este propósito, o inquérito, o teste pedagógico e a observação foram utilizados como métodos fundamentais a nível empírico. Os resultados do diagnóstico apontam para pouco conhecimento por parte dos professores de Educação Física sobre o tratamento dos alunos com esse transtorno, por isso passam à tarefa de desenvolver um sistema de jogos para o desenvolvimento da coordenação motora que os incorpore gradativamente à socialização em o grupo, e um sistema avaliativo pertinente onde resultados superiores pudessem ser vistos quantitativa e qualitativamente.

Physical Education has proven to be an effective tool to develop physical and mental conditions in human beings. However, even the proposals in favor of making inclusive education a reality for students with autism spectrum disorder do not achieve the globally expected levels. That is why, the objective of this work is to design a system of inclusive games for the development of motor coordination in students with autism spectrum disorder, in the Physical Education class. To achieve this purpose, the survey, the pedagogical test and observation were used as fundamental methods at the empirical level. The results of the diagnosis point to poor knowledge on the part of Physical Education teachers about the treatment of students with this disorder, so it is proceed to the task of developing a system of games for the development of motor coordination that gradually incorporated them into socialization in the group, and a pertinent evaluative system where superior results could be seen quantitatively and qualitatively.

Programas de estimulación temprana para niños dentro del espectro autista durante la pandemia por COVID-19

Los programas de estimulación temprana son intervenciones dirigidas a niños con trastornos del desarrollo, como lo es el autismo, estos buscan favorecer la adaptación e integración social, así como mejorar habilidades cognitivas, comunicativas y emocionales. Sin embargo, la pandemia del COVID-19 fue un gran desafío para la continuidad y la efectividad de estos programas, debido a las restricciones de movilidad, el cierre de centros educativos y sanitarios, y el aumento del estrés familiar. En este artículo se revisan los principales estudios que evaluaron el impacto de la pandemia en los programas de estimulación temprana para niños dentro del espectro autista y las estrategias para adaptarlos al contexto actual. Metodología: se realizó una revisión bibliográfica de estudios publicados entre 2020 y 2023 en Scopus, Web of Science, Scielo, Latindex y Google Scholar. Aplicando ecuaciones de búsqueda elaboradas con los descriptores y operadores booleanos: "programas de estimulación temprana", "trastorno del espectro autista", "pandemia COVID-19". Se seleccionaron 29 trabajos que cumplieron con los criterios de inclusión como el aborde de programas de estimulación temprana para niños dentro del espectro autista, producto de investigación empírica o teórica sobre el tema. Los resultados coinciden con los de otras investigaciones que han analizado la misma temática. Se concluye que la pandemia afectó negativamente tanto la calidad como la efectividad de los programas de estimulación temprana, elevando la vulnerabilidad de los niños y niñas con TEA, y que es necesario desarrollar e implementar medidas específicas para garantizar el acceso y la atención adecuada a este colectivo vulnerable.

Early stimulation programs are interventions aimed at children with developmental disorders, such as autism, which seek to promote adaptation and social integration, as well as improve cognitive, communicative and emotional skills. However, the COVID-19 pandemic was a great challenge for the continuity and effectiveness of these programs, due to mobility restrictions, the closure of educational and health centers, and increased family stress. This article reviews the main studies that evaluated the impact of the pandemic on early stimulation programs for children within the autism spectrum and the strategies to adapt them to the current context. Methodology: a bibliographic review of studies published between 2020 and 2023 in Scopus, Web of Science, Scielo, Latindex and Google Scholar was carried out. Applying search equations created with Boolean descriptors and operators: "early stimulation programs", "autism spectrum disorder", "COVID-19 pandemic". 29 works were selected that met the inclusion criteria such as addressing early stimulation programs for children within the autism spectrum, product of empirical or theoretical research on the topic. The results coincide with those of other investigations that have analyzed the same topic. It is concluded that the pandemic negatively affected both the quality and effectiveness of early stimulation programs, increasing the vulnerability of boys and girls with ASD, and that it is necessary to develop and implement specific measures to guarantee access and adequate care for this vulnerable group.

Os programas de estimulação precoce são intervenções dirigidas a crianças com perturbações do desenvolvimento, como o autismo, que procuram promover a adaptação e a integração social, bem como melhorar as competências cognitivas, comunicativas e emocionais. No entanto, a pandemia da COVID-19 representou um grande desafio para a continuidade e eficácia destes programas, devido às restrições de mobilidade, ao encerramento de centros educativos e de saúde e ao aumento do stress familiar. Este artigo revisa os principais estudos que avaliaram o impacto da pandemia nos programas de estimulação precoce para crianças do espectro do autismo e as estratégias para adaptá-los ao contexto atual. Metodologia: foi realizada uma revisão bibliográfica de estudos publicados entre 2020 e 2023 nas bases Scopus, Web of Science, Scielo, Latindex e Google Scholar. Aplicando equações de busca criadas com descritores e operadores booleanos: "programas de estimulação precoce", "transtorno do espectro do autismo", "pandemia de COVID-19". Foram selecionados 29 trabalhos que atenderam aos critérios de inclusão como abordar programas de estimulação precoce para crianças do espectro do autismo, produto de pesquisas empíricas ou teóricas sobre o tema. Os resultados coincidem com os de outras investigações que analisaram o mesmo tema. Conclui-se que a pandemia afetou negativamente tanto a qualidade como a eficácia dos programas de estimulação precoce, aumentando a vulnerabilidade de meninos e meninas com TEA, e que é necessário desenvolver e implementar medidas específicas para garantir o acesso e cuidados adequados a este grupo vulnerável.

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).

Detecção precoce dos sinais de alerta de autismo em crianças na atenção primária à saúde sob a perspectiva das relações interpessoais / Early detection of warning signs of autism in children in primary care from the perspective of interpersonal relationships

Introdução: os transtornos do espectro do autismo (TEA) são uma condição de início precoce, cujas dificuldades estão relacionadas à ausência ou limitações no uso da linguagem, na interação social e das atividades imaginativas, bem como padrões restritos/repetitivos de comportamento. Geralmente, as primeiras manifestações dos TEA aparecem antes dos 36 meses de idade, o que envolve a adoção de medidas de detecção precoce dos sinais de alerta já nesses primeiros meses de vida. No âmbito da Atenção Primária à Saúde (APS), práticas de Enfermagem podem ser empreendidas para a detecção precoce desses sinais de alerta, partindo-se da premissa de que o enfermeiro possui papel estratégico neste processo, cujas ações podem impactar positivamente na qualidade de vida e bem estar de crianças e de suas famílias. Objetivos: descrever a participação de enfermeiros no processo de detecção precoce dos sinais de alerta dos TEA em crianças de até três anos de idade, no âmbito da Atenção Primária à Saúde; e analisar as relações interpessoais enfermeiros e familiares dessas crianças no processo de detecção precoce dos sinais de alerta dos TEA. Método: estudo de abordagem qualitativa, descritivo, desenvolvido por meio de entrevistas semiestruturadas com enfermeiros de cinco unidades de Clínica da Família (CF) do município do Rio de Janeiro. Para tratamento dos dados foi utilizado o software IRaMuTeQ®. As interpretações e teorização foram orientadas pela aplicação da Teoria das Relações Interpessoais, de Hildegard Peplau. A pesquisa foi aprovada por Comitês de Ética em Pesquisa (Pareceres nº 5.370.466 e nº 5.443.956). Resultados: participaram 27 enfermeiros, com idades variando entre 25 e 50 anos (média de 36,3 anos). A área predominante de formação em especialização/residência foi a de Saúde da Família (22 enfermeiros). O tempo de graduação entre os entrevistados obteve média de 9,5 anos; o tempo de trabalho na CF obteve média de 2,9 anos; e o tempo de trabalho na assistência a crianças, com média de 7,2 anos. O corpus advindo das entrevistas foi processado por meio de classificação hierárquica descendente, cuja estruturação se deu em dois blocos temáticos e cinco classes. O bloco I (composto pela classe 2) reuniu 229 segmentos de texto (ST), o que representou 20,3% do corpus textual; e o bloco II (composto pelas classes 1, 3, 4 e 5) contemplou 866 ST, ou seja, 79,7% do corpus textual. A análise lexical foi estruturada a partir dessas cinco classes, que abordaram os seguintes temas: classe 2) as relações interpessoais nas consultas puericultura; classe 1) capacitação de enfermeiros para a detecção dos sinais de alerta dos TEA; classe 3) papéis dos enfermeiros na atenção a familiares de crianças com sinais de alerta dos TEA; classe 4) a comunicação e o vínculo na relação interpessoal terapêutica; e classe 5) o trabalho multidisciplinar na suspeição precoce dos TEA. Considerações Finais: a participação dos enfermeiros no processo de detecção precoce dos sinais de alerta dos TEA revelou-se essencial, estratégica e necessária, a despeito das dificuldades constatadas em relação às demandas de trabalho, problemas de fluxos de atendimento, demoras nos acompanhamentos subsequentes pelo sistema de regulação, desconhecimento sobre aplicabilidade de escalas e protocolos de avaliação, e ainda autorreconhecimento precário de seus papéis e questões relacionadas à treinamento e capacitação. As implicações para a Enfermagem estão centradas no fortalecimento das relações interpessoais família-criança-enfermeiro, com vistas a melhorar a qualidade de vida futura, proporcionando suporte adequado e oportuno desde os primeiros passos do desenvolvimento. A articulação do conhecimento técnico-científico com a sensibilidade humana pode ser compreendida como o caminho para uma prática de Enfermagem mais efetiva, libertadora e inclusiva.

Introduction: autism spectrum disorders (ASD) are an early-onset condition, whose difficulties are related to the absence or limitations in the use of language, social interaction and imaginative activities, as well as restricted/repetitive patterns of behavior. Generally, the first manifestations of ASD appear before 36 months of age, which involves adopting measures to detect early warning signs in the first months of life. Within the scope of Primary Health Care (PHC), Nursing practices can be undertaken for the early detection of these warning signs, based on the premise that nurses have a strategic role in this process, whose actions can positively impact quality of life and well-being of children and their families. Objectives: to describe the participation of nurses in the process of early detection of warning signs of ASD in children up to three years of age, within the scope of Primary Health Care; and analyze the interpersonal relationships between nurses and families of these children in the process of early detection of warning signs of ASD. Method: qualitative, descriptive study, developed through semi-structured interviews with nurses from five Family Clinic (CF) units in the city of Rio de Janeiro. The IRaMuTeQ® software was used to process the data. The interpretations and theorization were guided by the application of Hildegard Peplau's Theory of Interpersonal Relations. The research was approved by Research Ethics Committees (Opinions nº 5,370,466 and nº 5,443,956). Results: 27 nurses participated, with ages ranging between 25 and 50 years (average of 36.3 years). The predominant area of specialization/residency training was Family Health (22 nurses). The time since graduation among those interviewed had an average of 9.5 years; working time at CF averaged 2.9 years; and time working in childcare, with an average of 7.2 years. The corpus arising from the interviews was processed through descending hierarchical classification, which was structured into two thematic blocks and five classes. Block I (composed of class 2) brought together 229 text segments (ST), which represented 20.3% of the textual corpus; and block II (composed of classes 1, 3, 4 and 5) included 866 ST, that is, 79.7% of the textual corpus. The lexical analysis was structured based on these five classes, which addressed the following themes: class 2) interpersonal relationships in childcare consultations; class 1) training nurses to detect the warning signs of ASD; class 3) nurses' roles in caring for family members of children with warning signs of ASD; class 4) communication and bonding in the therapeutic interpersonal relationship; and class 5) multidisciplinary work in the early suspicion of ASD. Final Considerations: the participation of nurses in the process of early detection of warning signs of ASD proved to be essential, strategic and necessary, despite the difficulties observed in relation to work demands, problems with care flows, delays in subsequent follow-ups by the regulation system, lack of knowledge about the applicability of assessment scales and protocols, and also precarious self-recognition of their roles and issues related to training and qualification. The implications for Nursing are centered on strengthening family-child-nurse interpersonal relationships, with a view to improving future quality of life, providing adequate and timely support from the first steps of development. The articulation of technical-scientific knowledge with human sensitivity can be understood as the path to a more effective, liberating and inclusive Nursing practice.

Introducción: los trastornos del espectro autista (TEA) son una condición de aparición temprana, cuyas dificultades están relacionadas con la ausencia o limitaciones en el uso del lenguaje, la interacción social y las actividades imaginativas, así como con patrones de conducta restringidos/repetitivos. Generalmente, las primeras manifestaciones del TEA aparecen antes de los 36 meses de edad, lo que implica adoptar medidas para detectar signos precoces de alerta en los primeros meses de vida. En el ámbito de la Atención Primaria de Salud (APS), se pueden emprender prácticas de enfermería para la detección temprana de estos signos de alerta, partiendo de la premisa de que el enfermero tiene un papel estratégico en este proceso, cuyas acciones pueden impactar positivamente la calidad de vida y el bienestar. ser de los niños y sus familias. Objetivos: describir la participación del enfermero en el proceso de detección temprana de signos de alerta de TEA en niños de hasta tres años de edad, en el ámbito de la Atención Primaria de Salud; y analizar las relaciones interpersonales entre enfermeras y familias de estos niños en el proceso de detección precoz de signos de alerta del TEA. Método: estudio cualitativo, descriptivo, desarrollado a través de entrevistas semiestructuradas con enfermeros de cinco unidades de Clínica de la Familia (CF) de la ciudad de Río de Janeiro. Para procesar los datos se utilizó el software IRaMuTeQ®. Las interpretaciones y teorización estuvieron guiadas por la aplicación de la Teoría de las Relaciones Interpersonales de Hildegard Peplau. La investigación fue aprobada por los Comités de Ética en Investigación (Dictamen nº 5.370.466 y nº 5.443.956). Resultados: Participaron 27 enfermeros, con edades comprendidas entre 25 y 50 años (promedio de 36,3 años). El área de formación de especialización/residencia predominante fue Salud de la Familia (22 enfermeros). El tiempo de egreso entre los entrevistados tuvo un promedio de 9,5 años; el tiempo de trabajo en CF fue de 2,9 años en promedio; y tiempo trabajado en guarderías, con una media de 7,2 años. El corpus surgido de las entrevistas fue procesado mediante clasificación jerárquica descendente, la cual se estructuró en dos bloques temáticos y cinco clases. El bloque I (compuesto por la clase 2) reunió 229 segmentos textuales (ST), que representaron el 20,3% del corpus textual; y el bloque II (compuesto por las clases 1, 3, 4 y 5) incluyó 866 ST, es decir, el 79,7% del corpus textual. El análisis léxico se estructuró a partir de estas cinco clases, las cuales abordaron los siguientes temas: clase 2) relaciones interpersonales en las consultas de puericultura; clase 1) formación de enfermeras para detectar las señales de alerta del TEA; clase 3) funciones de las enfermeras en el cuidado de familiares de niños con signos de advertencia de TEA; clase 4) comunicación y vinculación en la relación interpersonal terapéutica; y clase 5) trabajo multidisciplinar en la sospecha temprana de TEA. Consideraciones finales: la participación de los enfermeros en el proceso de detección temprana de signos de alerta de TEA resultó esencial, estratégica y necesaria, a pesar de las dificultades observadas en relación a las demandas laborales, problemas con los flujos de cuidados, retrasos en los seguimientos posteriores por parte de los sistema de regulación, desconocimiento sobre la aplicabilidad de escalas y protocolos de evaluación, y también precario reconocimiento de sus roles y cuestiones relacionadas con la formación y la cualificación. Las implicaciones para la Enfermería se centran en fortalecer las relaciones interpersonales familia-niño-enfermero, con miras a mejorar la calidad de vida futura, brindando apoyo adecuado y oportuno desde los primeros pasos del desarrollo. La articulación del conocimiento técnico-científico con la sensibilidad humana puede entenderse como el camino hacia una práctica de Enfermería más eficaz, liberadora e inclusiva.

Screening of children attending well baby clinic for risk of autism using modified checklist for autism in toddlers in a pediatric tertiary care Centre in Chennai

Background: Autism spectrum disorder is a common neurodevelopmental disorder with core deficits in social communication, interaction, and restrictive/repetitive behavior. Early intervention provides opportunity for good functional outcome. The study aimed to screen children attending well baby clinic for risk of autism using modified checklist for autism in toddlers (MCHAT) questionnaire.Methods: This descriptive cross-sectional study was conducted on 302 children attending the pediatric well baby clinic. The children aged 16-30 months who met the inclusion criteria were screened for risk of autism using MCHAT.Results: 20 out of 302 children failed the MCHAT screening, 6.6% of the children were found to be at risk of autism. Boys: girls� ratio was 2:1. Advanced parental age and higher socioeconomic status were found to have significant association with the risk of autism. 70% of children in the at-risk group were first born, 70% of children who failed the MCHAT screen were from a nuclear family.Conclusions: All toddlers attending the well-baby clinic should be screened for autism by pediatricians. MCHAT is a simple easy to use validated tool to screen for autism in a busy pediatric OPD. Timely referral for comprehensive assessment and intervention can help to improve the outcome in children with autism.

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.

Research progress in early start denver model for treatment of autism spectrum disorder / 吉林大学学报(医学版)

Early start denver model(ESDM)is a comprehensive early intervention approach for the children with autism spectrum disorder(ASD)between 12-month-old-36-month-old.The model is built upon the theoretical foundations of applied behavior analysis,denver model(DM),and pivotal response treatment,and it is one of the naturalistic developmental behavioral interventions.Compared with the other early intervention methods,ESDM is not limited by the environment of intervention;it encompasses all the areas of development during teaching practice and has been widely adopted for the early intervention of the children with ASD,and achieves the satisfactory therapeutic effect.The ESDM typically uses an intensive one-on-one intervention approach,but variabilities have emerged in its practical application,such as group ESDM(G-ESDM),parent-implemented ESDM(P-ESDM),and peer-mediated ESDM.In particular,G-ESDM and P-ESDM have provided the learning opportunities for more families,showing a broad application prospect.This study reviews the theoretical foundations,teaching models,and the effects of various intervention modalities of the ESDM in the treatment of ASD;combined with the domestic and international research findings,this study offers a reference for further studies on the mechanism of ESDM intervention for ASD.

Progress on immune dysfunction in autism spectrum disorder / 国际儿科学杂志

Autism spectrum disorder（ASD）is a serious neurodevelopmental disorder，with deficits in social and language communication，rigid behaviors，limited interests and activities. At present，research on the pathogenesis of ASD involving immunity has been making progress worldwide. In terms of cytokines（such as IL-1β，IL-8，IL-17，etc.）and ASD animal models，it has been found that the onset of ASD is associated with nervous system immune dysfunction，which may lead to synaptic function impairment. The purpose of this review is to describe the recent research on ASD and immune dysfunction to provide ideas for exploring the etiology，pathogenesis and potential therapeutic measures of ASD.

Application of arterial spin labeling techniques in autism spectrum disorder with or without global developmental delay / 实用放射学杂志

Objective To measure and compare the cerebral blood flow(CBF)of children with autism spectrum disorder(ASD),global developmental delay(GDD),and ASD with GDD groups via arterial spin labeling(ASL)technique,and to evaluate the diag-nostic value of CBF values.Methods ASL images of ASD,GDD,and ASD with GDD groups of children were firstly acquired,and the CBF values of frontal lobe,temporal lobe,parietal lobe,occipital lobe,striatum and thalamus region of interest(ROI)were fur-ther measured,respectively.One-way analysis of variance or Kruskal-Wallis H test was used to compare the differences in CBF values among these three groups,and the receiver operating characteristic(ROC)curve was used to analyze the efficacy of CBF values in distinguishing ASD with GDD from without GDD.Results ASD with GDD had significantly lower CBF values in the left and right frontal lobes than those with ASD or GDD alone,and the differences were statistically significant(P<0.05).The CBF values in the left and right frontal lobes effectively distinguished ASD with GDD from without GDD[area under the curve(AUC)>0.7].Conclusion ASL technique can noninvasively assess CBF in children with or without GDD,helping to understand the pathophysiology of ASD with GDD and improving diagnostic accuracy.

Play-based Intervention Models for Improving Verbal and Nonverbal Social Communication Skills in Children with Autism Spectrum Disorder / 听力学及言语疾病杂志

The social communication impairment is one of the core impairments of children with autism spec-trum disorder(ASD).This paper introduced five play-based intervention models that can improve social communica-tion skills of children with ASD.Guided by the concept of precision rehabilitation,practitioners who master these methods may effectively tailor interventions to different cases,by integrating personalized therapy for prescriptive treatment,may ensure healthy mind and body development of children with ASD while solving social communication problems,thus provide practice reference for parents of children with ASD,researchers and clinical educators in China.

The Characteristics of Auditory Brainstem Response Waveform in Autistic Children with Normal Hearing / 听力学及言语疾病杂志

Objective To investigate the effect of auditory brainstem response(ABR)in clinical detection and severity assessment of autism spectrum disorder(ASD)in children with normal hearing.Methods ① A total of 55 autistic children(110 ears)with normal hearing and 55 children(110 ears)with typical development(TD)who did not differ in sex composition ratio and average monthly age were divided into four sub-groups according to age:≤24 months group(22 ears),25～36 months group(40 ears),37～48 months group(28 ears)and＞48 months group(20 ears).The ABR latencies and interpeak latencies were compared between ASD children and age-matched TD children.② ASD children were graded by severity according to the Diagnostic and Statistical Manual of Mental Dis-orders(DSM-V),and the correlations between the ABR latencies and interpeak latencies in autistic children with normal hearing and the severity grading were studied.Results ① No statistically significant differences in ABR wave latencies and interpeak latencies were found in autistic children with normal hearing under 24 months of age compared to age-matched TD children(P＞0.05).② Compared with children with TD,autistic children with nor-mal hearing at 25～36 months of age had significantly longer wave Ⅲ latencies and the interpeak latencies of Ⅰ-Ⅲ andⅠ-Ⅴ;the significantly longer wave Ⅲ,Ⅴ latencies,the interpeak latencies of Ⅰ-Ⅲ,Ⅲ-Ⅴ and Ⅰ-Ⅴ in autistic chil-dren with normal hearing at 37～48 months of age.Autistic children with normal hearing in the＞48 months group had significantly longer wave Ⅴ latencies and interpeak latencies of Ⅲ-Ⅴ,Ⅰ-Ⅴ than age-matched TD children(P＜0.05).③ The higher the ASD severity grading the longer the wave Ⅲ and V latencies and the longer interpeak latencies of Ⅰ-Ⅲ,Ⅲ-Ⅴ,and Ⅰ-Ⅴ(P＜0.05).Conclusion Differences in the level of auditory brainstem pathway de-velopment emerged at 25 months of age,and autistic children with normal hearing had significantly lower levels of auditory brainstem development than age-matched TD children.There were correlations between the latencies and interpeak latencies of ABR in autistic children with normal hearing and the severity grading.

Research Progress on Auditory Evoked Potential in Children with Autism Spectrum Disorder / 听力学及言语疾病杂志

Children with autism spectrum disorder usually response abnormally to auditory stimuli.Previous studies of their auditory functions mostly adapted objective electrophysiology tests,including auditory brainstem re-sponse and a series of cortical auditory evoked potentials.Combining the test results of these studies suggests that children with autism spectrum disorder have varying degree of central auditory processing impairment compared to typically developmental children.

Efficacy of esketamine combined with propofol for colonic transendoscopic enteral tubing in pediatric patients with autism / 中华麻醉学杂志

Objective:To evaluate the efficacy of esketamine combined with propofol for colonic transendoscopic enteral tubing (TET) in pediatric patients with autism.Methods:Sixty pediatric patients with autism of both sexes, aged 3-12 yr, weighing 15-45 kg, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who underwent painless transendoscopic enteral tubing (TET) from October 2022 to August 2023, were selected and divided into 2 groups ( n=30 each) by a random number table method: normal saline + propofol group (group NP) and esketamine + propofol group (group EP). In group NP, normal saline 10 ml was intravenously injected, and 30 s later propofol 2.0 mg/kg was given. In group EP, esketamine 0.3 mg/kg (diluted to 10 ml in normal saline) was intravenously injected, and 30 s later propofol 2.0 mg/kg was given. TET was performed when the Modified Observer′s Assessment of Alertness/Sedation Scale score ≤2. Propofol 0.5-1.0 mg/kg was added if the sedation depth was not enough, and the Modified Observer′s Assessment of Alertness/Sedation Scale score was maintained ≤2 until the end of surgery. The degree of body movement during TET was observed and recorded. The injection pain during induction, total consumption of propofol, operation time, spontaneous emergence time, and completion of operation were recorded. Adverse reactions such as respiratory depression, nausea and vomiting, hypotension, bradycardia, and postoperative agitation were recorded during operation and in the emergence period. Results:Compared with group NP, the degree of intraoperative body movement was significantly lighter, the total consumption of propofol and incidence of injection pain and intraoperative hypotension were significantly lower, and no significant change was found in the spontaneous emergence time and incidence of adverse reactions during recovery in group EP ( P<0.05). Conclusions:Esketamine (0.3 mg/kg) combined with propofol (2.0 mg/kg) can be safely and effectively used for colonic TET in pediatric patients with autism, and esketamine does not increase the risk of adverse reactions during resuscitation in a resuscitation strategy without early awakening.

Survey on autism knowledge of child health care professionals in primary health care institutions in Guangzhou / 中华全科医师杂志

Objective:To evaluate the knowledge of autism among child health care professionals in primary health care institutions.Methods:The study was a cross-sectional survey. An online questionnaire survey was conducted from February to March 2023 in primary health care institutions in Guangzhou to investigate the knowledge on autism among medical staff engaged in children′s health services and the influencing factors.Results:A total of 341 questionnaires were returned and 312 questionnaires were valid with a recovery rate of 91.5%. The age of 312 respondents was (35.9±7.9) years, of which 303 (97.1%) were female. One hundred and fifty-two (48.7%) child health care professionals in primary health care institutions had received specialist training in assessing the psychological and behavioral development of children, and only 139 (44.6%) reported that they were aware of the"five no"principle for early identification of autism. The questionnaire scores were 88.1% pass (275/312) and 53.2% excellent (166/312). The three questions with low accuracy were: autism can be cured with drugs, autism has a genetic basis and rehabilitation training has no effect, and the accuracy for these questions was 42.6% (133/312), 52.2% (163/312) and 70.2% (219/312), respectively. The passing of autism-related knowledge was positively associated with receiving relevant training ( OR=2.585, 95% CI:1.200-5.569), and the excellence was positively associated with the highest education ( OR=1.939, 95% CI:1.220-3.083) and receiving relevant training ( OR=2.016, 95% CI:1.247-3.260). Conclusions:There is a need for more professional training in autism knowledge among child health care professionals in primary health care institutions.

Supplementing applied behavioral analysis with speech-language therapy better improves the language ability of children on the autism spectrum / 中华物理医学与康复杂志

Objective:To observe any effect of supplementing applied behavior analysis with speech-and-language therapy in improving the language ability of children on the autism spectrum.Methods:A total of 60 children with an autism spectrum disorder were divided at random into an experimental group ( n=30) and a control group ( n=30). The control group accepted 3 hours of applied behavior analysis 5 days per week for 3 consecutive months. Over the same period the experiment group accepted 1.5 hours of applied behavior analysis and 1.5 hours of speech-language therapy. Before and after the intervention, sign-significate relations (S-S) and the language retardation examination were used to evaluate the language comprehension, expression, oral communication, the complexity of oral expression content, and the vocabulary of comprehension and expression of the two groups. Results:After the intervention, comprehension and expression in each stage of the S-S had improved significantly in both groups, but the average comprehension and language expression of the experimental group was significantly better than that of the control group. Oral communication improved significantly in both groups but complexity and the vocabulary used had improved significantly more in the experimental group.Conclusion:Supplementing applied behavioral analysis with speech-language therapy can improve the language ability of children on the autism spectrum significantly better than behavioral analysis alone.