Supporting the wellbeing of caregivers of children on the autism spectrum: A qualitative report on experiences of attending group dance movement psychotherapy.

Caregivers of children on the autism spectrum can carry a significant amount of practical, psychological, and social demands and responsibilities that are highly stressful. A group Dance Movement Psychotherapy (DMP) was offered to facilitate the wellbeing of caregivers. In this article, we explore the experiences of the therapeutic processes and outcomes of the intervention from the perspectives of caregivers, the therapist, and the researcher/co-facilitator. METHOD: Four clusters of caregivers of children on the autism spectrum (N = 20 Mean age = 39.25 years) took part in five group DMP sessions lasting 90 minutes delivered across two special educational needs settings. Twenty reflective focus groups took place in total, with each taking place at the end of each DMP session. Participants were invited to capture their experiences through arts-based drawings, while therapist and participating researcher/co-facilitator kept session-based notes and arts-based reflections. These arts-based and verbal data were grouped to generate themes. RESULTS: Six overarching themes emerged from the arts-based and verbal data with multiple subthemes that describe the contribution of DMP towards promoting caregivers' wellbeing and identified key challenges in implementing the intervention. These themes are: (1) Beholding within and around; (2) Reflecting and reinforcing strengths; (3) Exchanging views; (4) Looking back and carrying forward; (5) Core benefits; and (6) Challenges to engage in DMP. CONCLUSION: Caregivers talked about their experience of participating in the DMP groups as positive and acknowledged the helpful and challenging aspects of taking part in DMP intervention. They appreciated the creative and expressive nature of the intervention to promote their emotional and social wellbeing. The challenges identified in the study indicate that further awareness is needed within school environments about the contribution arts therapies can make towards establishing appropriate and sustainable interventions for caregivers.

Feasibility, acceptability, and effectiveness of school-based dance movement psychotherapy for children with emotional and behavioral difficulties.

Background: Schools have been increasingly employing dance movement psychotherapists to support children cope with daily worries and stress, express and understand their emotions, develop self-awareness and self-esteem. However, evidence on the impact of dance movement psychotherapy as a tool for prevention of mental health difficulties in childhood remains limited. Methods: Sixteen children (aged 7-9) with mild emotional and behavioral difficulties from two primary schools were randomly assigned to a Dance Movement Psychotherapy (DMP) intervention or to a waiting list, within a larger pilot cross-over randomized controlled study which aimed to (a) test whether all elements of study design can work together and run smoothly in a full-scale RCT; and (b) investigate the effectiveness of arts therapies in improving children's health related quality of life (HRQOL; EQ-5D-Y), wellbeing and life functioning (Child Outcome Rating Scale; CORS), emotional and behavioral difficulties (Strengths and Difficulties Questionnaire; SDQ), and duration of sleep (Fitbits). The therapeutic process was also evaluated through interviews with children, participant observations, the Children's Session Rating Scale (CSRS), and ratings of adherence to the therapeutic protocol. Results: The findings indicated that DMP led to improvements in children's life functioning, wellbeing, duration of sleep, emotional and behavioral difficulties, but not in quality of life. The improvements were maintained at the follow-up stages, up to 6 months post-intervention. Interviews with children also suggested positive outcomes, such as self-expression; emotional regulation; mastery and acceptance of emotions; improved self-confidence and self-esteem; reduced stress; and development of positive relationships. However, children would have preferred smaller groups and longer sessions. Conclusion: This study indicated that all outcome measures would be suitable for inclusion in a larger randomized controlled trial, though the EQ-5D-Y is not recommended as a stand-alone measure due to its lack of sensitivity and specificity for young participants. The adherence to the therapeutic protocol ratings differed between children and adults, highlighting the need to include children's voice in future research. Strategies are also proposed of how to conduct randomization of participants in ways that do not hinder the therapeutic process.

Qualitative and Arts-Based Evidence from Children Participating in a Pilot Randomised Controlled Study of School-Based Arts Therapies.

(1) Background: There is limited evidence on the impact of arts therapies as a tool for the prevention of mental health difficulties in childhood. This pilot randomised controlled study aimed to investigate the impact of arts therapies on children's mental health and well-being; the qualitative and arts-based evidence is presented in this article. (2) Methods: Sixty-two children (aged 7-10) with mild emotional and behavioral difficulties were recruited across four primary schools and were randomly assigned to either art therapy, music therapy, dance movement therapy, or dramatherapy. All children were interviewed individually after their participation in arts therapies. (3) Results: Children verbally and artistically expressed that they experienced positive changes in their mental health and well-being, such as improved self-expression, safety, empowerment, hope, and optimism for the future. The arts were particularly important for expressing complex emotions and feelings that cannot be easily verbalised. Recommendations are provided to improve the quality of group arts therapies in future interventions, such as through smaller groups, longer sessions, and strategies to protect the therapeutic environment. (4) Conclusions: This study embraced all arts therapies as one research domain and set children's verbal and non-verbal responses at the heart of outcome evaluation. This article highlights the importance of incorporating qualitative and arts-based methods to capture changes in children's mental health well-being in future experimental studies.

A Systematic Review of the Contribution of Dance Movement Psychotherapy Towards the Well-Being of Children With Autism Spectrum Disorders.

Background: The present review provides an original examination of published literature on the use of Dance Movement Psychotherapy (DMP) as an intervention for children with an Autism Spectrum Disorder (ASD). Method: The review was systematically conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A protocol consisting of four phases: identification; screening and selection; data extraction and synthesis; quality assurance was developed and registered with the PROSPERO. A search strategy was developed using population and intervention as the key concepts and ten databases were searched between 6.1.2018 to 4.4.2018 and 10.07.2021 to 20.07.2021. The intervention characteristics were extracted based on the TIDieR template for intervention description and replication checklist. Quality assessment and level of evidence of all the included studies were evaluated using the Mixed Methods Appraisal Tool (MMAT) and the Centre for Evidence-Based Medicine (CEBM) for treatment criteria. Results: Nine research studies with a total of 133 participants were identified through a systematic search process. There was only one mixed-methods study with the component of randomisation found during the literature search. Collected information was synthesised in relation to (a) ways in which dance movement psychotherapists work with children; (b) data collection methods and findings. Results from the reviewed literature suggest that DMP can potentially promote various aspects of well-being in children with ASD. Eight out of nine studies mentioned the effects of DMP on improving different social and communication skills. However, results from quality assessments and synthesised outcomes indicate that research in DMP is still in its infancy. Conclusions: We conclude that further large-scale, high-quality studies are required to generate further evidence that explains the processes involved in DMP, the effectiveness of DMP, the relationship between therapeutic factors of DMP, and research findings for children on the autism spectrum. Systematic Review Protocol Registration: PROSPERO, identifier: CRD42018087912.

A Dance Movement Psychotherapy Intervention for the Wellbeing of Children With an Autism Spectrum Disorder: A Pilot Intervention Study.

BACKGROUND: Sustaining the wellbeing for children with an autism spectrum disorder (ASD) can be highly demanding. Dance Movement Psychotherapy (DMP), a form of psychotherapy with a non-verbal character, may present as a relevant intervention option for this group of children. METHODS: A protocol-based group DMP intervention was developed and implemented in two special educational needs schools in the North West of England. We aimed to investigate the effects of DMP on children with ASD using the Social Communication Questionnaire (SCQ) and Strengths and Difficulties Questionnaire (SDQ). Twenty-six children aged between 8 and 13 years (mean age = 10.65 years) with ASD were randomly allocated to DMP and a control group with standard care, following a crossover research design. RESULTS: Results showed no significant carryover or period effects for either the SCQ or SDQ (p > 0.05). A significant intervention effect was found only for SCQ (p = 0.005) but not for SDQ (p > 0.05). ANCOVAs were performed on the data before the crossover to test for differences in SCQ and SDQ scores between the DMP intervention and control groups while controlling for pre-intervention scores. Those in the DMP intervention group presented significantly lower SCQ scores following the intervention period than those in the control group (p = 0.001). No significant differences in post-intervention SDQ scores were found between DMP intervention and control groups (p = 0.2). However, minimal clinically important differences (MCID) were reached for both SCQ and SDQ measures before crossover for those in the DMP intervention group. Moreover, repeated measures ANOVAs performed on SCQ and SDQ measures following crossover were significant, with the change in both SCQ (p = 0.001) and SDQ (p = 0.009) pre-and post-intervention being significantly greater for those in the DMP intervention than the control group. CONCLUSION: The pilot DMP intervention has shown promising results on the social and emotional wellbeing of children with ASD irrespective of whether they preferred verbal or non-verbal mode of communication. Limitations and appropriateness of the research methods implemented in this study for their use in a large RCT are discussed in detail. Overall, our findings highlight the value of creative therapies for improving the lives of young vulnerable groups.

A pilot cross-over randomised controlled trial of child-focused process and outcome evaluation of arts therapies at primary mainstream schools: study protocol.

Background: Arts therapies are increasingly being adopted within schools to alleviate and prevent a wide range of children's difficulties. Such therapies help to facilitate personal change and growth through arts media; visual arts, music, drama, dance and movement.Methods: This study aims to investigate the child-focused process and outcomes of an arts therapies intervention through child-reported questionnaires, interviews, participant observations, arts-work and biomarkers. The participants are 64 primary school children with mild emotional and behavioural difficulties.Expected results: To explore a) whether all components of the study (i.e. recruitment, randomisation, follow-up) can work together in a larger trial; b) the children's evaluations of arts therapies;c) the impact on children's wellbeing, quality of life and sleep; d) the sample size calculations and cost evaluations for future research. This is the first study to embrace all arts therapies as one research domain with a clear focus on children's verbal, non-verbal and physical responses.

An Investigation of the Effectiveness of Arts Therapies Interventions on Measures of Quality of Life and Wellbeing: A Pilot Randomized Controlled Study in Primary Schools.

BACKGROUND: Over the last decades there has been a change in the way schooling is perceived recognizing that children's learning is closely linked to children's health. Children spend most of their time at school, which is often the place where problems are identified and interventions are offered, not only for treatment but also prevention. Embedding arts therapies into the educational system may help address children's emerging needs and have a positive impact on their wellbeing. METHODS: A pilot cross-over randomized controlled design was employed to investigate the effectiveness of an arts therapies intervention on a series of child- and teacher-reported outcome measures, specifically, health related quality of life (assessed using a HRQOL scale; EQ-5D-Y), wellbeing and life functioning (assessed using the child outcome rating scale; CORS), emotional and behavioral difficulties (assessed using the strengths and difficulties questionnaire; SDQ), as well as duration of sleep (assessed using Fitbits). Sample size calculations for future large-scale studies were also performed, and the sustained impact of the intervention was evaluated at 3, 6, and 12 months follow-up. The pluralistic theoretical and therapeutic framework of this intervention was informed by a systematic review on school-based arts therapies interventions and is presented in detail in the study protocol. Participants were 62 children with mild emotional and behavioral difficulties. RESULTS: Improvements in HRQOL and CORS were greater in those engaged in the arts therapies intervention than the control groups and were maintained at the follow-up stages. Significant improvements were only found for duration of sleep (P = 0.002) and SDQ (P = 0.008). Minimal clinically important differences (MCIDs) as defined in the published protocol were found for CORS, SDQ and duration of sleep, but not HRQOL. DISCUSSION: Findings indicate that the arts therapies interventions were having a clinically significant effect on life functioning, duration of sleep, emotional and behavioral difficulties. Findings also indicate a small effect size for health related quality of life, suggesting the intervention was having a small positive effect on this outcome measure. The study indicates that all outcome measures assessed here would be suitable for inclusion in a larger randomized controlled study utilizing these arts therapies interventions, and that a sample size of 225 participants would be required if these outcome measures were used.

The Pragmatics of Pragmatic Language and the Curse of Ambiguity: An fMRI Study.

In pragmatic language, there is an intentional distinction between the literal meaning of what is said, and what the speaker actually means. Previous neuroimaging investigations of pragmatic language have contrasted it with literal language; however, such contrasts may have been confounded by the higher levels of ambiguity in pragmatic language. Here, we used functional magnetic resonance imaging (fMRI) to compare pragmatic sentences (specifically requiring the interpretation of nonliteral meaning in the form of hints) with unintentionally ambiguous scenarios. Analysis showed that ambiguous language activated brain areas recognized to play a role in generating a theory of mind (ToM) that have previously been argued to support understanding of pragmatic language, specifically medial prefrontal cortex (mPFC), posterior cingulate cortex (PCC), and temporoparietal junction (TPJ). In contrast, the pragmatic scenarios drew on anterior temporal, superior parietal lobule, in addition to precuneus. While no effect of gender was found for unintentionally ambiguous stimuli, females showed greater activity than males within mPFC and inferior frontal gyrus (IFG) for pragmatic scenarios - regions thought to be involved in cognitive and affective empathy, respectively. Findings suggest that while areas underpinning ToM are sufficient to support meaning derivation in the context of ambiguity, reasoning about pragmatic intent is more reliant on access to self-referential memory.

A functional Magnetic Resonance Imaging study of patients with Polar Type II/III complex shoulder instability.

The pathophysiology of Stanmore Classification Polar type II/III shoulder instability is not well understood. Functional Magnetic Resonance Imaging was used to measure brain activity in response to forward flexion and abduction in 16 patients with Polar Type II/III shoulder instability and 16 age-matched controls. When a cluster level correction was applied patients showed significantly greater brain activity than controls in primary motor cortex (BA4), supramarginal gyrus (BA40), inferior frontal gyrus (BA44), precentral gyrus (BA6) and middle frontal gyrus (BA6): the latter region is considered premotor cortex. Using voxel level correction within these five regions a unique activation was found in the primary motor cortex (BA4) at MNI coordinates -38 -26 56. Activation was greater in controls compared to patients in the parahippocampal gyrus (BA27) and perirhinal cortex (BA36). These findings show, for the first time, neural differences in patients with complex shoulder instability, and suggest that patients are in some sense working harder or differently to maintain shoulder stability, with brain activity similar to early stage motor sequence learning. It will help to understand the condition, design better therapies and improve treatment of this group; avoiding the common clinical misconception that their recurrent shoulder dislocations are a form of attention-seeking.

The neural correlates of theory of mind and their role during empathy and the game of chess: A functional magnetic resonance imaging study.

Chess involves the capacity to reason iteratively about potential intentional choices of an opponent and therefore involves high levels of explicit theory of mind [ToM] (i.e. ability to infer mental states of others) alongside clear, strategic rule-based decision-making. Functional magnetic resonance imaging was used on 12 healthy male novice chess players to identify cortical regions associated with chess, ToM and empathizing. The blood-oxygenation-level-dependent (BOLD) response for chess and empathizing tasks was extracted from each ToM region. Results showed neural overlap between ToM, chess and empathizing tasks in right-hemisphere temporo-parietal junction (TPJ) [BA40], left-hemisphere superior temporal gyrus [BA22] and posterior cingulate gyrus [BA23/31]. TPJ is suggested to underlie the capacity to reason iteratively about another's internal state in a range of tasks. Areas activated by ToM and empathy included right-hemisphere orbitofrontal cortex and bilateral middle temporal gyrus: areas that become active when there is need to inhibit one's own experience when considering the internal state of another and for visual evaluation of action rationality. Results support previous findings, that ToM recruits a neural network with each region sub-serving a supporting role depending on the nature of the task itself. In contrast, a network of cortical regions primarily located within right- and left-hemisphere medial-frontal and parietal cortex, outside the internal representational network, was selectively recruited during the chess task. We hypothesize that in our cohort of novice chess players the strategy was to employ an iterative thinking pattern which in part involved mentalizing processes and recruited core ToM-related regions.

Investigation of the Association Between Motor Stereotypy Behavior With Fundamental Movement Skills, Adaptive Functioning, and Autistic Spectrum Disorder Symptomology in Children With Intellectual Disabilities.

Motor stereotypy behaviors are patterned, coordinated, repetitive behaviors that are particularly evident in those with an autistic spectrum disorder and intellectual disabilities. The extent to which motor stereotypy behavior severity is associated with motor skills and maladaptive behavior, measures of adaptive functioning, along with fundamental movement skills and degree of autistic spectrum disorder symptomology is assessed in this preliminary report. Twelve participants, aged 7 to 16 years, with a reported motor stereotypy behavior and either mild or severe intellectual disability comprising developmental or global delay took part in the study. Spearman rho correlational analysis showed that severity of motor stereotypy behavior was significantly positively correlated with autistic spectrum disorder symptomology ( P = .008) and maladaptive behavior ( P = .008) but not fundamental movement skills ( P > .05). An increase in fundamental movement skills score was associated with a decrease in autistic spectrum disorder symptomology ( P = .01) and an increase in motor skills ( P = .002). This study provides evidence showing a significant relationship between motor stereotypy behavior severity with degree of autistic spectrum disorder symptomology and maladaptive behavior.

Different association between intentionality competence and prefrontal volume in left- and right-handers.

Intentionality is the ability to explain and predict the behaviour of others by attributing to them mental states, and is thus important for social cognition. Prefrontal cortex (PFC) including orbital and dorsal regions is implicated in a range of social and metacognitive executive functions (EFs). We investigate, for the first time, in 39 left-handers and 43 right-handers the effect of handedness on the relationship between intentionality and (i) PFC volume using stereology and (ii) grey matter (GM) volume within six a priori regions of interest using voxel-based morphometry (VBM). Although no association was found between degree of handedness and intentionality competence (p = .17), handedness groups differ significantly in the relationship between intentionality and PFC volume. Right-handers with handedness score =+75 (based on a range from -100 to +100) show a significant positive correlation between intentionality and orbital PFC volume (p = .01), while no significant correlation is observed for dorsal PFC volume (p = .82); and left-handers with handedness score =-75 show a significant positive correlation between intentionality and dorsal PFC volume (p = .02) while no significant correlation is observed for orbital PFC volume (p = .44). VBM results showed significantly greater GM volume correlated with intentionality in right-handers compared to left-handers (family-wise error - FWE, p < .05) in right temporo-parietal junction and superior temporal sulcus. Correlations between GM volume and intentionality were found across all subjects (FWE, p < .05) in bilateral middle frontal gyrus, superior temporal sulcus and right inferior frontal gyrus, superior frontal gyrus and precuneus. Overall, the findings suggest that the neuroanatomy underlying intentionality competence is influenced by handedness and that different methodological approaches can and should be considered in conjunction when investigating neuroanatomical correlates of psychological functioning.

Sulcal morphology and volume of Broca's area linked to handedness and sex.

We investigated the effect of handedness and sex on: (i) sulcal contours defining PO and PTR and (ii) volume estimates of PO and PTR subfields in 40 left- and 42 right-handers. Results show an effect of handedness on discontinuity of the inferior frontal sulcus (IFS: P<0.01). Discontinuity of IFS was observed in: 43% left- and 62% right hemispheres in right-handers and in 65% left- and 48% right-hemispheres in left-handers. PO volume asymmetry was rightward in left-handed males (P=0.007) and females (P=0.02), showed a leftward trend in right-handed males (P=0.06), and was non-asymmetrical in right-handed females (P=0.96, i.e. left- and right-hemisphere PO volumes did not differ significantly). PO volume asymmetry in males differed significantly between handedness groups (P=0.001). Findings indicate a high degree of variability in the sulcal contours of PO and PTR and volume asymmetry of PO: the factors sex and handedness can explain some of this variability.

Orbital prefrontal cortex volume predicts social network size: an imaging study of individual differences in humans.

The social brain hypothesis, an explanation for the unusually large brains of primates, posits that the size of social group typical of a species is directly related to the volume of its neocortex. To test whether this hypothesis also applies at the within-species level, we applied the Cavalieri method of stereology in conjunction with point counting on magnetic resonance images to determine the volume of prefrontal cortex (PFC) subfields, including dorsal and orbital regions. Path analysis in a sample of 40 healthy adult humans revealed a significant linear relationship between orbital (but not dorsal) PFC volume and the size of subjects' social networks that was mediated by individual intentionality (mentalizing) competences. The results support the social brain hypothesis by indicating a relationship between PFC volume and social network size that applies within species, and, more importantly, indicates that the relationship is mediated by social cognitive skills.

Association between language and spatial laterality and cognitive ability: an fMRI study.

The interaction between language and spatial laterality and its association with cognitive ability was explored in a group of 42 right-handers and 40 left-handers using functional magnetic resonance imaging. Cognitive ability measures including working memory, verbal comprehension and perceptual organisation were assessed using the Wechsler Adult Intelligence Scale (version III). Left-handers show lower working memory scores than right-handers. Increased rightward language laterality is also associated with decreased working memory performance, which we suggest is related to the involvement of the left inferior frontal gyrus in subvocal rehearsal during working memory tasks. The interaction between language and spatial laterality is associated with performance on verbal comprehension and perceptual organisation, such that when language and spatial laterality are dissociated between the hemispheres a significant increase in verbal comprehension and perceptual organisation performance is found. There is a decrease in performance on the verbal comprehension and perceptual organisation subtests when language and spatial processing are associated to the same hemisphere (i.e. both lateralised to the right hemisphere or both lateralised to the left). This interaction is interpreted in relation to the 'hemispheric crowding' hypothesis, which proposes increased cognitive ability when language and spatial laterality are dissociated.

Orbital prefrontal cortex volume correlates with social cognitive competence.

Intentionality, or Theory of Mind, is the ability to explain and predict the behaviour of others by attributing to them intentions and mental states and is hypothesised to be one of several social cognitive mechanisms which have impacted upon brain size evolution. Though the brain activity associated with processing this type of information has been studied extensively, the neuroanatomical correlates of these abilities, e.g. whether subjects who perform better have greater volume of associated brain regions, remain to be investigated. Because social abilities of this type appear to have evolved relatively recently, and because the prefrontal cortex (PFC) was the last brain region to develop both phylogenetically and ontogenetically, we hypothesised a relationship between PFC volume and intentional competence. To test this, we estimated the volume of four regional prefrontal subfields in each cerebral hemisphere, in 40 healthy adult humans by applying stereological methods on T(1)-weighted magnetic resonance images. Our results reveal a significant linear relationship between intentionality score and volume of orbital PFC (p=0.01). Since this region is known to be involved in the processing of social information our findings support the hypothesis that brain size evolution is, at least in part, the result of social cognitive mechanisms supporting social cohesion.

Anthelmintic constituents of Clonostachys candelabrum.

Five diastereomeric polyketide glycosides, roselipins 3A-3E (1-5), have been isolated from the acetone extract of Clonostachys candelabrum on the basis of their positive anthelmintic activity. The structures of these compounds were elucidated by comparison of their NMR and MS data to those of previously reported roselipins and related structures, and were confirmed by 2D-NMR spectral analysis. Known compounds linoleic acid (6) and aurantiogliocladin (7) were also isolated as active anthelmintic components, although much less potent than the roselipins.

Anthelmintic macrolactams from Nonomuraea turkmeniaca MA7381.

A new macrolactam, fluvirucin B0 (1), and two known macrolactams, Sch 38516/fluvirucin B1 (2) and Sch 39185/fluvirucin B3 (3), have been isolated from an acetone extract of a strain of Nonomuraea turkmeniaca. These compounds were isolated by bioassay-guided fractionation as part of our search for new anthelmintics. The structures of these compounds were elucidated by comparison of their NMR and MS data to those of previously reported fluvirucins, and confirmed by 2D-NMR. 1approximately 3 exhibited in vitro activity (EC90 <1.0 approximately 1.7 microg/ml) against Haemonchus contortus larvae, but were ineffective in reducing worm counts in vivo against Heligmosomoides polygyrus in mice at 50 mg/kg dosed intramuscularly.

Noreupenifeldin, a tropolone from an unidentified ascomycete.

Noreupenifeldin ( 2), a new monotropolone derivative of the bistropolone eupenifeldin ( 1), was isolated from an unidentified ascomycete by bioassay-guided fractionation as part of our search for new anthelmintics. The structure of 1 was confirmed by comparison with literature data. The structure of 2 was elucidated from MS and 1D and 2D NMR data. Compounds 1 and 2 are diastereomers of pycnidione ( 3) and epolone A ( 4), respectively. Compounds 1- 3 were evaluated for their anthelmintic activity against the parasitic worm Hemonchus contortus. Compounds 1 and 3 exhibited modest in vitro activity, showing EC 90 50 and 83 microg/mL, respectively, in reducing motility of L3 larvae of H. contortus. Compound 2 was inactive, indicating that the second tropolone moiety is required for activity.