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作者：

Jane Shkel, Alicia Geng, Elise Pilchak, Maria Estefania Millan, Jessica M. Schwartzman, Rachel Schuck, Maria Victoria Bundang, Agatha Barnowski, Devon M. Slap, Sydney Stratford, Antonio Y. Hardan, Jennifer M. Phillips & Grace W. Gengoux

摘要：

Despite the popularity of social skills groups, there remains a need for empirical investigation of treatment effects, especially when targeting pivotal aspects of social functioning such as initiations to peers. The goal of the present study was to conduct a randomized controlled trial of a 12-week social intervention (SUCCESS), which combined an inclusive social group with a parent education program. Twenty-five 4- to 6-year-olds with Autism Spectrum Disorder (ASD) were randomized to SUCCESS (N = 11) or to treatment as usual (N = 14). Combining a peer group model with a parent training program, the SUCCESS intervention used naturalistic behavioral techniques (e.g., environmental arrangement, natural reinforcement) to increase social initiations to peers. After 12 weeks, children participating in the SUCCESS program made more frequent initiations to peers than children in the treatment-as-usual group, including more prompted and unprompted initiations to request. Additional gains in clinician-rated social functioning were observed in children randomized to SUCCESS, while differential treatment effects were not detected in parent-rated measures. However, lower baseline social motivation was associated with greater parent-reported initiation improvement. This study provides preliminary support for the efficacy of a naturalistic, behavioral social skills intervention to improve peer initiations for children with ASD. The findings suggest that using a motivation-based social skills group was effective in increasing both prompted and spontaneous initiations to peers, and highlights the need for further research into the role of baseline social motivation in predicting social skills treatment response.

尽管社交技能小组很受欢迎，但仍需要对治疗效果进行实证调查，尤其是在针对社会功能的关键方面时，例如对同伴的启蒙。本研究的目的是进行一项为期 12 周的社会干预 （SUCCESS） 的随机对照试验，该试验将包容性社会群体与家长教育计划相结合。25 名患有自闭症谱系障碍 （ASD） 的 4 至 6 岁儿童被随机分配到 SUCCESS （N = 11） 或常规治疗组 （N = 14）。SUCCESS干预将同伴群体模型与家长培训计划相结合，使用自然主义行为技术（例如，环境安排，自然强化）来增加对同伴的社交启蒙。12 周后，参与 SUCCESS 计划的儿童比常规治疗组的儿童更频繁地向同龄人发起，包括更多提示和无提示的请求。在随机分配到SUCCESS的儿童中观察到临床医生评定的社会功能有额外的增益，而在父母评定的措施中未检测到差异治疗效果。然而，较低的基线社会动机与父母报告的启动改善更大有关。本研究为自然主义、行为社交技能干预改善 ASD 儿童同伴启动的功效提供了初步支持。研究结果表明，使用基于动机的社交技能小组可有效增加对同龄人的提示和自发启动，并强调需要进一步研究基线社会动机在预测社交技能治疗反应中的作用。

Hung, L.Y., Margolis, K.G. Autism spectrum disorders and the gastrointestinal tract: insights into mechanisms and clinical relevance. Nat Rev Gastroenterol Hepatol 21, 142–163 (2024).

Abstract

Autism spectrum disorders (ASDs) are recognized as central neurodevelopmental disorders diagnosed by impairments in social interactions, communication and repetitive behaviours. The recognition of ASD as a central nervous system (CNS)-mediated neurobehavioural disorder has led most of the research in ASD to be focused on the CNS. However, gastrointestinal function is also likely to be affected owing to the neural mechanistic nature of ASD and the nervous system in the gastrointestinal tract (enteric nervous system). Thus, it is unsurprising that gastrointestinal disorders, particularly constipation, diarrhoea and abdominal pain, are highly comorbid in individuals with ASD. Gastrointestinal problems have also been repeatedly associated with increased severity of the core symptoms diagnostic of ASD and other centrally mediated comorbid conditions, including psychiatric issues, irritability, rigid–compulsive behaviours and aggression. Despite the high prevalence of gastrointestinal dysfunction in ASD and its associated behavioural comorbidities, the specific links between these two conditions have not been clearly delineated, and current data linking ASD to gastrointestinal dysfunction have not been extensively reviewed. This Review outlines the established and emerging clinical and preclinical evidence that emphasizes the gut as a novel mechanistic and potential therapeutic target for individuals with ASD.

孤独症谱系障碍（ASDs）被认为是中枢神经发育障碍，核心障碍俄日为社会互动、沟通和重复行为。对ASD是一种中枢神经系统（CNS）介导的神经行为障碍的认识，导致ASD的大多数研究集中在中枢神经系统上。然而，由于ASD的神经机制性质和胃肠道中的神经系统（肠神经系统），胃肠道功能也可能受到影响。因此，胃肠道疾病，特别是便秘、腹泻和腹痛，在ASD患者中高度共病也就不足为奇了。胃肠道问题也多次与ASD诊断的核心症状和其他中枢介导的共病条件的严重程度增加有关，包括精神问题、易怒、刚性强迫性行为和攻击性。尽管ASD中胃肠道功能障碍及其相关的行为共病的发病率很高，但这两种情况之间的具体联系尚未被明确描述，目前ASD与胃肠道功能障碍之间的联系数据尚未得到广泛的回顾。这篇综述概述了已确定的和新兴的临床、临床前证据，强调将肠道作为ASD个体的一个新的机制和潜在的治疗靶点。