文章

Whitney Guthrie 等人

Robust evidence supports the efficacy of early autism intervention. Despite broad consensus that earlier intervention leads to better outcomes, evidence for this has been limited to correlational studies. This study examined timing effects of the Early Social Interaction (ESI) model, a parent-implemented intervention, using a complete crossover randomized controlled trial (RCT). Effects of Individual-ESI were compared when initiated at 18 or 27 months of age, and also contrasted with effects of the less intensive Group-ESI as an active control condition. Participants included 82 autistic toddlers who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order randomized. Blinded clinicians completed assessments at baseline (18 months of age), end of Condition 1 (27 months), and end of Condition 2 (36 months). Toddlers randomized to Individual-ESI at 18 months showed greater gains during treatment than those starting Individual-ESI at 27 months in receptive/expressive language, social communication, and daily living skills. This pattern was not observed for Group-ESI, demonstrating that timing effects were specific to Individual-ESI and ruling out maturation effects. This RCT demonstrated that earlier intensive, individualized intervention led to greater improvements, and suggests that even a narrow window of 18 versus 27 months may impact child outcomes.

强有力的证据支持早期自闭症干预的有效性。尽管人们普遍认为早期干预会带来更好的结果,但这方面的证据仅限于相关研究。本研究通过一项完全交叉随机对照试验(RCT),考察了由家长实施干预的早期社会互动(ESI)模式的时间效果。研究比较了个体-ESI 在幼儿 18 个月或 27 个月时启动的效果,并将其与强度较低的群体-ESI 作为积极对照条件的效果进行了对比。研究对象包括 82 名自闭症幼儿,他们分别接受了 9 个月的个体-ESI 和 9 个月的群体-ESI,时间/顺序随机安排。蒙眼临床医生分别在基线(18 个月大)、条件 1 结束(27 个月大)和条件 2 结束(36 个月大)时完成评估。与 27 个月时开始接受个体-ESI 的幼儿相比,18 个月时随机接受个体-ESI 的幼儿在接受/表达语言、社交沟通和日常生活技能方面的进步更大。在群体-ESI 中没有观察到这种模式,这表明时间效应是个体-ESI 所特有的,并排除了成熟效应。这项研究表明,更早的强化、个性化干预能带来更大的改善,并表明即使是 18 个月与 27 个月的狭窄窗口期也可能影响儿童的结果。

Zoë L. Hopkins; Nicola Yuill;Holly P. Branigan

In dialogue, speakers tend to imitate, or align with, a partner’s language choices. Higher levels of alignment facilitate communication and can be elicited by affiliation goals. Since autistic children have interaction and communication impairments, we investigated whether a failure to display affiliative language imitation contributes to their conversational difficulties. We measured autistic children’s lexical alignment with a partner, following an ostracism manipulation which induces affiliative motivation in typical adults and children. While autistic children demonstrated lexical alignment, we observed no affiliative influence on ostracised children’s tendency to align, relative to controls. Our results suggest that increased language imitation—a potentially valuable form of social adaptation—is unavailable to autistic children, which may reflect their impaired affective understanding.

在对话中,说话者倾向于模仿或配合对方的语言选择。较高程度的一致有助于交流,并可由从属目标激发。由于自闭症儿童有互动和交流障碍,我们研究了未能表现出附属语言模仿是否会导致他们的对话困难。我们测量了自闭症儿童与伙伴的词汇一致性,并采用了一种会诱发典型成人和儿童从属动机的排斥操作。虽然自闭症儿童表现出了词汇一致性,但与对照组相比,我们没有观察到从属关系对被排斥儿童的一致性倾向产生影响。我们的研究结果表明,自闭症儿童无法增加语言模仿–一种潜在的有价值的社会适应形式,这可能反映出他们的情感理解能力受损。

Ying Hao ;Yao Du; Saijun Zhang;Lin Sun; Gina Keene; Toshikazu Ikuta

This systematic review and meta-analysis evaluated the effectiveness of telehealth social communication intervention on language skills of children with autism spectrum disorder (ASD). Twenty-one studies were included, among which 17 were single subject experimental design (SSED). Language outcomes were categorized into five linguistic domains (phonology, morphology, syntax, semantics, and pragmatics), and meta-analysis was planned for each domain. Meta-analysis was only performed for pragmatic outcomes, due to the small number of studies that included outcomes in other domains. The results showed significant pre- to post-intervention improvement, thus supporting the use of telehealth social communication intervention to improve pragmatic skills among children with ASD. More diverse measures should be used to target linguistic domains beyond pragmatics. The predominant use of SSED warrants large-scale studies for robust evidence in the future.

本系统综述和荟萃分析评估了远程医疗社会沟通干预对自闭症谱系障碍(ASD)儿童语言能力的影响。共纳入 21 项研究,其中 17 项为单人实验设计(SSED)。语言成果分为五个语言领域(语音学、形态学、句法学、语义学和语用学),并计划对每个领域进行元分析。由于包含其他领域结果的研究数量较少,因此只对语用结果进行了元分析。研究结果表明,干预前和干预后的效果都有明显改善,因此支持使用远程医疗社会沟通干预来提高 ASD 儿童的实用技能。除了语用能力之外,还应该使用更多样化的测量方法来测量语言领域。由于主要使用的是社会交往能力评估(SSED),因此今后需要进行大规模研究,以获得可靠的证据。

Adrian Hase ; Melanie Haynes ;Gregor Hasler

Deficits in socio-emotional reciprocity, in prosocial behavior and in developing social relationships are diagnostic criteria of autism spectrum disorder (ASD), usually assessed by self-report or observation. Simple social experiments developed by behavioral economists allow for quantification of ASD-related social behavior. In this study, we used such experiments to compare social-economic decision-making between ASD adolescents and neurotypical controls. Precisely, we analyzed social orienting and prosocial behavior in 17 adolescents with ASD (Asperger syndrome) and 24 matched neurotypical adolescents. We used a twocondition distribution game (possibility of punishment by fellow player versus no such possibility) and an impunity game to examine social orienting (distribution game) and prosocial behavior (both games). Participants with ASD exhibited less social orienting in the distribution game (p = 0.03, d = 0.61). In addition, there was a trend for ASD participants to behave in a more prosocial way than neurotypical participants in the impunity game (p = 0.08, d = 0.60), which was not the case in the no-punishment condition of the distribution game (p = 0.35, r = 0.17). These results demonstrate the potential of simple economic games to capture reduced social orienting in ASD. The unexpected finding of more prosocial behavior in adolescents with autism spectrum disorder than in neurotypical controls adds to the complexity of previously published results. We recommend metaanalytic efforts to determine average effect sizes across studies and elucidate the conditions for prosocial behavior in ASD to occur.

社会情感互惠、亲社会行为和发展社会关系方面的缺陷是自闭症谱系障碍(ASD)的诊断标准,通常通过自我报告或观察进行评估。行为经济学家开发的简单社会实验可以量化与 ASD 相关的社会行为。在本研究中,我们利用此类实验来比较 ASD 青少年和神经正常对照组之间的社会经济决策。确切地说,我们分析了 17 名患有 ASD(阿斯伯格综合症)的青少年和 24 名匹配的神经典型青少年的社会定向和亲社会行为。我们使用了一种双条件分配游戏(可能受到同伴惩罚与不可能受到惩罚)和一种有罪不罚游戏来研究社会定向(分配游戏)和亲社会行为(两种游戏)。患有 ASD 的参与者在分配游戏中表现出较低的社会导向性(p = 0.03,d = 0.61)。此外,与神经畸形参与者相比,ASD 参与者在有罪不罚游戏中的亲社会行为呈上升趋势(p = 0.08,d = 0.60),而在分配游戏的无惩罚条件下,情况并非如此(p = 0.35,r = 0.17)。这些结果表明,简单的经济游戏有可能捕捉到 ASD 社会定向力下降的情况。与神经畸形对照组相比,自闭症谱系障碍青少年的亲社会行为更多,这一意外发现增加了之前公布结果的复杂性。我们建议进行荟萃分析,以确定各项研究的平均效应大小,并阐明自闭症谱系障碍青少年亲社会行为发生的条件。

Sam Perochon

Early detection of autism, a neurodevelopmental condition associated with challenges in social communication, ensures timely access to intervention. Autism screening questionnaires have been shown to have lower accuracy when used in real-world settings, such as primary care, as compared to research studies, particularly for children of color and girls. Here we report findings from a multiclinic, prospective study assessing the accuracy of an autism screening digital application (app) administered during a pediatric well-child visit to 475 (17–36 months old) children (269 boys and 206 girls), of which 49 were diagnosed with autism and 98 were diagnosed with developmental delay without autism. The app displayed stimuli that elicited behavioral signs of autism, quantified using computer vision and machine learning. An algorithm combining multiple digital phenotypes showed high diagnostic accuracy with the area under the receiver operating characteristic curve = 0.90, sensitivity = 87.8%, specificity = 80.8%, negative predictive value = 97.8% and positive predictive value = 40.6%. The algorithm had similar sensitivity performance across subgroups as defined by sex, race and ethnicity. These results demonstrate the potential for digital phenotyping to provide an objective, scalable approach to autism screening in real-world settings. Moreover, combining results from digital phenotyping and caregiver questionnaires may increase autism screening accuracy and help reduce disparities in access to diagnosis and intervention.

自闭症是一种与社交沟通障碍有关的神经发育疾病,早期发现自闭症可确保及时干预。与研究相比,自闭症筛查问卷在基层医疗机构等实际环境中使用时的准确性较低,尤其是对有色人种儿童和女童而言。在此,我们报告了一项多临床、前瞻性研究的结果,该研究评估了自闭症筛查数字应用程序(App)的准确性,该应用程序是在儿科健康检查期间对 475 名(17-36 个月大)儿童(269 名男孩和 206 名女孩)进行的,其中 49 名儿童被诊断为自闭症,98 名儿童被诊断为发育迟缓,但没有自闭症。该应用程序显示的刺激物可诱发自闭症的行为表现,并通过计算机视觉和机器学习进行量化。结合多种数字表型的算法显示出很高的诊断准确性,接收者工作特征曲线下面积 = 0.90,灵敏度 = 87.8%,特异性 = 80.8%,阴性预测值 = 97.8%,阳性预测值 = 40.6%。该算法在按性别、种族和民族划分的亚组中具有相似的灵敏度表现。这些结果表明,数字表型技术有可能为现实环境中的自闭症筛查提供一种客观、可扩展的方法。此外,将数字表型和照顾者问卷调查的结果结合起来可能会提高自闭症筛查的准确性,并有助于减少诊断和干预方面的差异。

Florence Y. N. Leung, Vesna Stojanovik, Cunmei Jiang, Fang Liu

 Cumulating evidence suggests that atypical emotion processing in autism may generalize across different stimulus domains. However, this evidence comes from studies examining explicit emotion recognition. It remains unclear whether domain-general atypicality also applies to implicit emotion processing in autism and its implication for real-world social communication. To investigate this, we employed a novel cross-modal emotional priming task to assess implicit emotion processing of spoken/sung words (primes) through their influence on subsequent emotional judgment of faces/face-like objects (targets). We assessed whether implicit emotional priming differed between 38 autistic and 38 neurotypical individuals across age groups as a function of prime and target type. Results indicated no overall group differences across age groups, prime types, and target types. However, differential, domain-specific developmental patterns emerged for the autism and neurotypical groups. For neurotypical individuals, speech but not song primed the emotional judgment of faces across ages. This speech-orienting tendency was not observed across ages in the autism group, as priming of speech on faces was not seen in autistic adults. These results outline the importance of the delicate weighting between speech- versus song-orientation in implicit emotion processing throughout development, providing more nuanced insights into the emotion processing profile of autistic individuals.

不断积累的证据表明,自闭症患者的非典型情绪处理可能会在不同的刺激领域普遍存在。然而,这些证据来自于对显性情绪识别的研究。至于自闭症患者的内隐情绪处理是否也会出现领域泛化的不典型性及其对现实世界社交沟通的影响,目前仍不清楚。为了探究这个问题,我们采用了一种新颖的跨模态情绪引物任务,通过影响随后对人脸/类似人脸的物体(目标)的情绪判断,来评估口语/唱歌词(引物)的内隐情绪加工。我们评估了不同年龄组的 38 名自闭症患者和 38 名神经畸形患者的内隐情绪引物是否因引物和目标物类型而有所不同。结果表明,不同年龄组、素材类型和目标类型之间没有整体的群体差异。然而,自闭症群体和神经症群体出现了不同的、特定领域的发展模式。对于神经症患者来说,在不同年龄段,语音而非歌曲会引发对人脸的情感判断。在自闭症群体中,不同年龄段的人并没有观察到这种语音导向的倾向,因为在自闭症成人中没有看到语音对人脸的引导作用。这些结果概述了在整个发育过程中,内隐情绪处理中语音导向与歌曲导向之间微妙权重的重要性,从而为了解自闭症患者的情绪处理特征提供了更细致入微的见解。

Tyler C. McFayden, Clare Harrop, Kyle Roell, Robert M. Joseph, Rebecca C. Fry & T. Michael O’Shea

Purpose

To evaluate sex differences in autistic traits in youth born extremely preterm (EP; 23–27 weeks) who were later diagnosed with autism spectrum disorder (ASD) at 10-years.

 

Method

A longitudinal cohort design from the Extremely Low Gestational Age Newborn Study (ELGAN) followed N = 857 EP infants from birth through 10-years. EP infants later diagnosed with ASD (N = 61, 20 females) participated in the study. Group differences were evaluated via inferential and Bayesian statistics (values > 1 suggest evidence for alternate hypothesis) on ASD screeners (M-CHAT at 2-years, SCQ and SRS-2 at 10-years), and gold-standard diagnostic measures (ADOS-2, ADI-R) at 10-years.

 

Results

Males scored significantly higher than females on measures of Social Affect from the ADOS-2, t(34.27)=-2.20, BF10 = 2.33, and measures of Repetitive and Restricted Behaviors from the ADI-R, t(40.52)=-2.85, BF10 = 5.26. Bayesian estimates suggested marginal evidence for sex differences in Nonverbal Communication, t(30.66)=-1.81, BF10 = 1.25, and Verbal Communication, t(24.64)=-1.89, BF10 = 1.39, from the ADI-R, wherein males scored higher than females. No statistically significant sex differences were identified on any of the ASD screeners at 2 (M-CHAT) or 10 years (SCQ). No significant sex differences were observed on any subscales of the SRS at 10 years.

目的

评估极早产儿(EP;23-27 周)青少年自闭症特征的性别差异,这些青少年在 10 岁时被诊断出患有自闭症谱系障碍(ASD)。

 

研究方法

采用极低妊娠年龄新生儿研究(ELGAN)的纵向队列设计,对 N = 857 名极度早产儿进行了从出生到 10 年的跟踪研究。后来被诊断为 ASD 的 EP 婴儿(N = 61,20 名女性)参与了研究。通过推论和贝叶斯统计(值 > 1 表明有证据支持另一假设)对 ASD 筛查指标(2 岁时的 M-CHAT、10 岁时的 SCQ 和 SRS-2)和 10 岁时的黄金标准诊断指标(ADOS-2、ADI-R)进行了群体差异评估。

 

结果

在ADOS-2的社交情感测量中,男性得分明显高于女性,t(34.27)=-2.20, BF10 = 2.33;在ADI-R的重复和受限行为测量中,男性得分明显高于女性,t(40.52)=-2.85, BF10 = 5.26。贝叶斯估计结果表明,ADI-R 的非语言沟通(t(30.66)=-1.81, BF10 = 1.25)和语言沟通(t(24.64)=-1.89, BF10 = 1.39)方面存在边缘性性别差异,其中男性得分高于女性。在 2 年(M-CHAT)或 10 年(SCQ)的任何 ASD 筛查指标上,均未发现明显的性别差异。10 年后,SRS 的任何分量表均未发现明显的性别差异。

Yanru Chen & Laudan B. Jahromi

Children with autism spectrum disorder often demonstrate self-regulation challenges and academic difficulties. Although self-regulation has been well documented as an important factor for academic achievement in neurotypical children, little is known about how it is related to academic learning in autistic children, especially during preschool, a critical developmental period for both emergent academic skills and self-regulatory abilities. It is also unclear whether school engagement or autism characteristics influence the relation between self-regulation and academic learning in autistic children during preschool. Thirty-two autistic preschoolers participated in this study. Direct measures and parent reports were used to measure three dimensions of self-regulation, including executive function, effortful control, and emotion regulation. Classroom-based data from multiple academic programs were used to reflect their average rates of achieving new literacy and mathematics learning goals. Teachers reported the participants’ levels of school engagement, and their autism characteristics were measured directly. Emotion regulation was significantly linked to the rate of meeting literacy learning goals in autistic preschoolers, whereas multiple executive function skills, including inhibitory and attentional control and working memory, were associated with their mathematics learning rate. Emotion regulation demonstrated a stronger association with literacy learning when autistic children were more engaged in classroom activities. Levels of autism characteristics did not mediate or moderate the association between self-regulation and academic learning. Future interventions and teaching should consider fostering self-regulation and facilitating school engagement for autistic preschoolers besides targeting their learning performance on specific academic content to promote their current and future academic success.

患有自闭症谱系障碍的儿童常常表现出自我调节方面的挑战和学业困难。尽管自我调节作为神经畸形儿童学业成绩的重要因素已被充分证明,但人们对自闭症儿童的自我调节与学业学习之间的关系却知之甚少,尤其是在学龄前阶段,因为学龄前阶段是学习技能和自我调节能力发展的关键时期。学校参与或自闭症特征是否会影响学龄前自闭症儿童自我调节与学业学习之间的关系,目前也尚不清楚。32 名学龄前自闭症儿童参与了本研究。研究采用直接测量法和家长报告来测量自我调节的三个维度,包括执行功能、努力控制和情绪调节。来自多个学术项目的课堂数据被用来反映他们实现新的识字和数学学习目标的平均比率。教师报告了参与者的学校参与程度,并直接测量了他们的自闭症特征。情绪调节与自闭症学龄前儿童达到识字学习目标的比率有明显联系,而多种执行功能技能(包括抑制和注意力控制以及工作记忆)则与他们的数学学习比率有关。当自闭症儿童更多地参与课堂活动时,情绪调节与识字学习的关系更为密切。自闭症特征的水平并不能调节或缓和自我调节与学业学习之间的关系。未来的干预和教学除了针对自闭症学龄前儿童在特定学业内容上的学习表现外,还应考虑培养他们的自我调节能力和促进他们参与学校活动,以促进他们当前和未来的学业成功。

Ana Belen Lopez-Rodriguez, Carol L. Murray, John Kealy, Clodagh Towns, Andrew Roche, Arshed Nazmi, Michelle Doran, John P. Lowry & Colm Cunningham

Background

Autism spectrum disorders (ASD) are predominantly neurodevelopmental and largely genetically determined. However, there are human data supporting the idea that fever can improve symptoms in some individuals, but those data are limited and there are almost no data to support this from animal models. We aimed to test the hypothesis that elevated body temperature would improve function in two animal models of ASD.

Methods

We used a 4 h whole-body hyperthermia (WBH) protocol and, separately, systemic inflammation induced by bacterial endotoxin (LPS) at 250 µg/kg, to dissociate temperature and inflammatory elements of fever in two ASD animal models: C58/J and Shank3B- mice. We used one- or two-way ANOVA and t-tests with normally distributed data and Kruskal–Wallis or Mann–Whitney with nonparametric data. Post hoc comparisons were made with a level of significance set at p < 0.05. For correlation analyses, data were adjusted by a linear regression model.

Results

Only LPS induced inflammatory signatures in the brain while only WBH produced fever-range hyperthermia. WBH reduced repetitive behaviours and improved social interaction in C58/J mice and significantly reduced compulsive grooming in Shank3B- mice. LPS significantly suppressed most activities over 5–48 h.

Limitations

We show behavioural, cellular and molecular changes, but provide no specific mechanistic explanation for the observed behavioural improvements.

Conclusions

The data are the first, to our knowledge, to demonstrate that elevated body temperature can improve behavioural signs in 2 distinct ASD models. Given the developmental nature of ASD, evidence that symptoms may be improved by environmental perturbations indicates possibilities for improving function in these individuals. Since experimental hyperthermia in patients would carry significant risks, it is now essential to pursue molecular mechanisms through which hyperthermia might bring about the observed benefits.

 

自闭症谱系障碍(ASD)主要是神经发育性疾病,而且在很大程度上是由基因决定的。然而,有数据支持发烧可以改善某些人的症状这一观点,但这些数据是有限的,而且几乎没有动物模型的数据支持这一观点。我们旨在验证体温升高可改善两种 ASD 动物模型功能的假设。

 

实验方法

我们使用 4 小时全身热疗(WBH)方案,并分别使用 250 微克/千克细菌内毒素(LPS)诱导的全身炎症,来区分两种 ASD 动物模型的体温和发热的炎症因素: C58/J和Shank3B-小鼠。对于正态分布的数据,我们使用了单因子或双因子方差分析和 t 检验;对于非参数数据,我们使用了 Kruskal-Wallis 或 Mann-Whitney 检验。事后比较的显著性水平设定为 p < 0.05。对于相关性分析,数据通过线性回归模型进行调整。

 

研究结果

只有 LPS 能诱发大脑炎症特征,而只有 WBH 能产生发热范围的高热。WBH 可减少 C58/J 小鼠的重复行为,改善其社会交往,并显著减少 Shank3B- 小鼠的强迫性梳理行为。LPS 在 5-48 小时内明显抑制了大多数活动。

 

局限性

我们展示了行为、细胞和分子变化,但没有对观察到的行为改善提供具体的机理解释。

研究结论

据我们所知,这些数据首次证明体温升高可以改善两个不同的 ASD 模型的行为体征。鉴于自闭症的发育性质,环境干扰可改善症状的证据表明,有可能改善这些人的功能。由于在患者身上进行实验性热疗会有很大风险,因此现在有必要研究热疗可能带来所观察到的益处的分子机制。

Keith Mcallister, Barry Maguire

Abstract    

There is a growing consensus that an appropriate classroom environment will aid the performance of the pupil with autism spectrum disorder (ASD). There are, however, very few design guidelines available when considering ASD and the school environment. Such guidelines that do exist tend only to be in general terms. Therefore, this article seeks to highlight design considerations specifically for the ASD-friendly Key Stage 1 (age five to eight) classroom. It will first highlight some of the challenges for those with autism spectrum disorder in a school environment and the triad of challenges faced by architects and designers when considering ASD-friendly classroom design. It will then go on to describe the findings and results of a two-year study carried out in conjunction with the ASD teaching staff of Northern Ireland’s Southern Education and Library Board. These consist of 16 specific design considerations for the Key Stage 1 ASD-friendly classroom applicable to all classrooms for pupils between five and eight years of age.

一个合适的课堂环境将有助于自闭症谱系障碍( ASD )学生的表现,这已成为越来越多的共识。然而,在考虑ASD和学校环境时,可用的设计指南非常少。这种确实存在的准则往往只是笼统的。因此,本文试图突出针对ASD友好型关键阶段1 (年龄5 ~ 8岁)课堂的设计考虑。它将首先强调在学校环境中自闭症谱系障碍患者面临的一些挑战,以及建筑师和设计师在考虑ASD友好型教室设计时面临的三重挑战。然后将继续描述与ASD教学结合进行的为期两年的研究的发现和结果,包括适用于所有5 ~ 8岁学生教室的关键阶段1 ASD友好型教室的16项具体设计考虑。

图1:教师设计的针对孤独症友好型教室模型