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阿斯伯格社交障碍治疗最有效和最前沿的研究
针对阿斯伯格综合征（现多归类于孤独症谱系障碍的高功能端）社交障碍的治疗，目前最核心的结论是：没有单一的“神药”或“魔法”，最有效的方案是“组合拳”——即结合社会技能训练、认知行为干预以及前沿的生物医学辅助手段。**
现有的科学证据表明，像侦探游戏一样的角色扮演训练、音乐治疗等非药物干预效果显著，而像催产素（Oxytocin）吸入、脑部磁刺激（TMS）等前沿生物技术正展现出令人兴奋的潜力，能帮助大脑“连线”以更好地理解他人眼中的世界。
以下为您详细拆解这些有效且前沿的治疗方向：
1. 把社交变成“破案游戏”：针对性的社会技能训练
对于许多阿斯伯格孩子来说，理解别人的言外之意就像破解密码一样困难。目前研究证实，把复杂的社交规则拆解成有趣的任务极其有效。
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“小侦探”训练营（Junior Detective Training Program）： 这是一项非常有趣的科学尝试。澳大利亚的研究人员设计了一个为期7周的“小侦探”项目，让49名阿斯伯格儿童参与。在这个项目里，孩子们不是在枯燥地听课，而是像侦探一样去观察线索。
- 具体做法：通过电脑游戏、小组活动，孩子们学习如何通过别人的表情、姿势来推测对方的心情。
- 效果数据：结果非常惊人！参加训练的孩子在社交技能上有了显著提升。更有意思的是，他们在训练结束5个月后，依然保持着这些进步 。这说明他们真的学会了这门“手艺”，而不仅仅是死记硬背。
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把生活搬上舞台（Socio-dramatic Intervention）： 人生如戏，全靠演技。对于社交障碍，通过戏剧表演来练习是一种很棒的方法。在一项针对青少年的研究中，研究者使用了名为“SDARI”的戏剧干预法。
- 具体做法：在一个夏令营里，孩子们通过戏剧游戏来练习现实生活中的互动。
- 效果：与没有参加的孩子相比，这些“小演员”在社交功能上有了明显的改善 。这就像是在排练生活中可能遇到的各种场景，等真的遇到了，就不慌了。
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音乐的魔力（Music Therapy）： 音乐不仅好听，还能作为社交的润滑剂。在一项涉及45名6到17岁孩子的实验中，研究者利用音乐表演和即兴创作来训练社交技能。
- 具体做法：孩子们在一起玩音乐，这要求他们必须互相配合、互相倾听。
- 效果：不管是学校老师的评分，还是孩子们自己的感觉，他们的社交能力都有了显著提高 。音乐让他们学会了如何与人“合拍”。
2. 生物医学的前沿探索：给大脑“加点油”
除了行为训练，科学家们正在探索直接作用于大脑的生物学方法，这些被称为“前沿”研究。
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“爱的荷尔蒙”——催产素（Oxytocin）： 你可能听说过催产素，它常被称为“拥抱激素”或“爱的荷尔蒙”，因为它能促进人与人之间的信任和依恋。科学家们发现，它可能是打开阿斯伯格人群社交大门的钥匙。
- 术语解释：催产素（Oxytocin） 是一种由大脑产生的激素。在这个场景下，你可以把它想象成一种“社交放大镜”，能帮助大脑更敏感地捕捉到别人的情感信号，比如眼神和微笑。
- 神奇的实验：
- 盯着眼睛看：阿斯伯格人群通常回避眼神接触。但在吸入催产素后，成年男性患者在与人互动时，看对方眼睛的时间显著增加了 。
- 信任游戏：另一项研究发现，吸入催产素后，患者在模拟游戏中更愿意信任别人，也会更多地关注面部表情中传递情感的眼睛区域 。这就像是给大脑戴上了一副“情感眼镜”，让他们能更清晰地看到别人的善意。
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经颅磁刺激（TMS）：给大脑特定区域“做按摩”： 这听起来有点像科幻电影，但实际上已经用于临床研究。
- 术语解释：经颅磁刺激（rTMS） 是一种不需要开刀的技术。科学家用一个线圈放在头皮上，产生磁场来刺激大脑里的神经细胞。你可以把它想象成隔着头皮给大脑里掌管社交的那个“懒惰”区域发微信，唤醒它开始工作。
- 研究发现：在一项针对28名成年患者的双盲实验（一种非常严格的科学实验方法）中，研究人员对他们大脑中负责社交判断的区域进行了两周的磁刺激。结果显示，接受真正刺激的患者，其社交障碍症状减轻了，而且在社交场合中的焦虑感也下降了 。在一个年轻女性的个案研究中，这种治疗也改善了她对他人的理解能力 。
3. 家长和环境的作用：不仅仅是孩子的事
研究还发现，治疗不仅仅是针对孩子或患者本人，改变周围的环境同样关键。
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家长培训+药物治疗： 虽然药物不能直接治愈阿斯伯格，但可以控制一些严重的行为问题。一项针对124名儿童的大型研究发现，如果把“利培酮”（一种治疗药物）和“家长培训”结合起来，效果比单吃药要好。
- 效果数据：接受这种“组合疗法”的孩子，在社交适应能力上的得分显著更高 。这说明，当家长学会了如何引导孩子，配合医生的治疗，孩子的进步会快得多。
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社会故事（Social Stories）： 这是一种通过写简短故事来教孩子社交规则的方法。比如写一个故事叫《怎么排队》，告诉孩子为什么要排队、排队时该做什么。
- 现状：虽然这种方法很流行且容易操作，但目前的科学证据显示它的效果“因人而异”，很不稳定 。它可能是一个不错的辅助工具，但不应作为唯一的治疗手段。
4. 社交背后的认知机制：理解“为什么”
要治疗社交障碍，得先明白阿斯伯格人群为什么会有社交困难。
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眼神和注意力的差异： 普通人在看魔术表演时，会盯着魔术师的脸看他的眼神暗示。但一项利用眼动仪（追踪眼球运动的机器）的研究发现，阿斯伯格孩子看魔术师脸的时间更短，他们更多地盯着物体看。不过，有趣的是，一旦有人告诉他们魔术的秘密，他们的观察方式就会发生改变 。这提示我们，明确的解说和信息告知可以帮助他们建立更好的观察策略。
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共同注意（Joint Attention）： 这是指“我和你一起看同一个东西”的能力。研究发现，在游戏互动中，如果有一个熟悉的成年人（比如言语治疗师或妈妈）在场引导，孩子展现出“共同注意”的频率会增加 。这再次强调了在自然的游戏情境中进行干预的重要性。
总结
对于阿斯伯格社交障碍的治疗，最有效的策略是“多管齐下”：
- 实战演练：参加“小侦探”培训或戏剧表演，在模拟中学习破译社交密码。
- 生物辅助：关注催产素、脑磁刺激等前沿技术，它们可能从生理层面改善大脑的社交连接。
- 环境支持：家长接受培训，学会如何引导，同时利用音乐、游戏等自然媒介。
科学在这条路上正在飞速进步，每一个微小的尝试和数据，都在为这些独特的大脑铺设通往社交世界的桥梁。
References
1Social Stories for children with disabilities.PubMed
Georgina Reynhout, Mark Carter
J Autism Dev Disord. 2006 May;36(4):445-69. doi: 10.1007/s10803-006-0086-1.
A review of the empirical research literature on Social Stories is presented, including a descriptive review and single-subject meta-analysis of appropriate studies. Examination of data suggests the effects of Social Stories are highly variable. Interpretations of extant studies are frequently confounded by inadequate participant description and the use of Social Stories in combination with other interventions. It is unclear whether particular components of Social Stories are central to their efficacy. Data on maintenance and generalization are also limited. Social Stories stand as a promising intervention, being relatively straightforward and efficient to implement with application to a wide range of behaviors. Further research is needed to determine the exact nature of their contribution and the components critical to their efficacy.
2Psychiatric hospitalization among children with autism spectrum disorders.PubMed
David S Mandell
J Autism Dev Disord. 2008 Jul;38(6):1059-65. doi: 10.1007/s10803-007-0481-2. Epub 2007 Nov 2.
This study examined predictors of psychiatric hospitalization among children with autism spectrum disorders (ASD). Data were collected from 760 caregivers of children with ASD. Cox regression was used to determine factors associated with hospitalization. Almost 11% were hospitalized. Youth in single parent homes were more likely to be hospitalized (OR = 2.54), as were youth diagnosed at a later age (OR = 1.10). Engaging in self-injurious behavior (OR = 2.14), aggressive behavior (OR = 4.83), and being diagnosed with depression (OR = 2.48) or obsessive compulsive disorder (OR = 2.35) increased the odds of hospitalization. Risk for hospitalization increased with age and over time. The results suggest early diagnosis and community-based interventions for aggressive and self-injurious behaviors may reduce hospitalizations.
3A multi-component social skills intervention for children with Asperger syndrome: the Junior Detective Training Program.PubMed
Renae Beaumont, Kate Sofronoff
J Child Psychol Psychiatry. 2008 Jul;49(7):743-53. doi: 10.1111/j.1469-7610.2008.01920.x. Epub 2008 Jul 1.
BACKGROUND: The study aimed to investigate the effectiveness of a new multi-component social skills intervention for children with Asperger syndrome (AS): The Junior Detective Training Program. This 7-week program included a computer game, small group sessions, parent training sessions and teacher handouts. METHOD: Forty-nine children with AS were recruited to participate and randomly assigned to intervention (n = 26) or wait-list control (n = 23) conditions. RESULTS: Relative to children in the wait-list group, program participants showed greater improvements in social skills over the course of the intervention, as indicated by parent-report measures. Teacher-report data also confirmed that children receiving the intervention made significant improvements in social functioning from pre- to post-treatment. Treatment group participants were better able to suggest appropriate emotion-management strategies for story characters at post-intervention than at pre-intervention, whereas control participants were not. However, there was no difference in the improvements made by children in the intervention and control conditions on facial expression and body-posture recognition measures. Follow-up data suggested that treatment gains were maintained by children at 5-months post-intervention. CONCLUSIONS: The Junior Detective Training Program appeared to be effective in enhancing the social skills and emotional understanding of children with AS. Limitations and suggestions for future research are discussed.
4The effect of a music therapy social skills training program on improving social competence in children and adolescents with social skills deficits.PubMed
Lori F Gooding
J Music Ther. 2011 Winter;48(4):440-62. doi: 10.1093/jmt/48.4.440.
Three separate studies were conducted in school, residential and after-school care settings to test the effectiveness of a music therapy-based social skills intervention program on improving social competence in children and adolescents. A total of 45 children (n = 12; n = 13; n = 20) aged 6-17 years with social skills deficits participated in a group-based five session intervention program. The same curriculum, adapted to be age appropriate, was used at all 3 sites. Specific deficits within the social skills areas of peer relations and self-management skills were targeted. Active interventions like music performance, movement to music and improvisation were used. Cognitive-behavioral techniques like modeling, feedback, transfer training and problem solving were also incorporated. Data on social functioning were collected before, during, and after the music therapy intervention from participants, appropriate adult personnel and via behavioral observations. Results indicated that significant improvements in social functioning were found in (a) school participant pre and post self-ratings, (b) researcher pre and post ratings of school participants, (c) case manager's pre and post treatment ratings for the residential participants, (d) after-school care participants' pre and post self-ratings, and (e) behavioral observations at all three settings. Additional changes, although not significant, were noted in teacher ratings, residential participant self- and peer ratings, and after-school case manager ratings. Results from these studies suggest that the music therapy intervention was effective in improving social competence in children and adolescents with social deficits. More research is warranted to provide additional guidance about the use of music therapy interventions to improve social functioning.
5Substance use disorder in Asperger syndrome: An investigation into the development and maintenance of substance use disorder by individuals with a diagnosis of Asperger syndrome.PubMed
Thomas Clarke, Anna Tickle, Alinda Gillott
Int J Drug Policy. 2016 Jan;27:154-63. doi: 10.1016/j.drugpo.2015.06.003. Epub 2015 Jun 29.
BACKGROUND: Recent research has suggested that the prevalence of problematic substance use within the Asperger syndrome population has previously been underestimated. Furthermore, there is some indication that problematic substance use might take place to manage the traits of Asperger syndrome; however this possibility has yet to be examined in detail. This study aimed to address this omission by exploring individuals' perceptions of their substance use in relation to their diagnosis of Asperger syndrome. METHODS: Eight participants were recruited from either a specialist Asperger syndrome service or a drug and alcohol service. Participants were interviewed regarding their views of which factors led to their development and maintenance of problematic substance use, specifically in relation to their experience of having been diagnosed with Asperger syndrome. Thematic analysis was conducted on the interview transcripts. RESULTS: Six main themes were identified: self-medication; social facilitation; discrepancy between need and support; defining problematic substance use; substance use of peers, and recreational use of substances. The two themes of social facilitation and self-medication are focused on within this paper as they most closely reflect the more prominent bodies of literature in relation to the research aim. CONCLUSIONS: Participants reported that substances were used to act as a social facilitator to compensate for social deficits by increasing confidence in social settings and increasing participants' ease with which they communicate. The self-medication of psychological distress was reported and was associated with depression, anxiety and sleep difficulties. The study ends with a reflection on the method of data collection, the implications for clinical practice and suggestions for future research.
6A double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder.PubMed
Peter G Enticott, Bernadette M Fitzgibbon, Hayley A Kennedy, et al.
Brain Stimul. 2014 Mar-Apr;7(2):206-11. doi: 10.1016/j.brs.2013.10.004. Epub 2013 Oct 27.
BACKGROUND: Biomedical treatment options for autism spectrum disorder (ASD) are extremely limited. Repetitive transcranial magnetic stimulation (rTMS) is a safe and efficacious technique when targeting specific areas of cortical dysfunction in major depressive disorder, and a similar approach could yield therapeutic benefits in ASD, if applied to relevant cortical regions. OBJECTIVE: The aim of this study was to examine whether deep rTMS to bilateral dorsomedial prefrontal cortex improves social relating in ASD. METHODS: 28 adults diagnosed with either autistic disorder (high-functioning) or Asperger's disorder completed a prospective, double-blind, randomized, placebo-controlled design with 2 weeks of daily weekday treatment. This involved deep rTMS to bilateral dorsomedial prefrontal cortex (5 Hz, 10-s train duration, 20-s inter-train interval) for 15 min (1500 pulses per session) using a HAUT-Coil. The sham rTMS coil was encased in the same helmet of the active deep rTMS coil, but no effective field was delivered into the brain. Assessments were conducted before, after, and one month following treatment. RESULTS: Participants in the active condition showed a near significant reduction in self-reported social relating symptoms from pre-treatment to one month follow-up, and a significant reduction in social relating symptoms (relative to sham participants) for both post-treatment assessments. Those in the active condition also showed a reduction in self-oriented anxiety during difficult and emotional social situations from pre-treatment to one month follow-up. There were no changes for those in the sham condition. CONCLUSION: Deep rTMS to bilateral dorsomedial prefrontal cortex yielded a reduction in social relating impairment and socially-related anxiety. Further research in this area should employ extended rTMS protocols that approximate those used in depression in an attempt to replicate and amplify the clinical response.
7Gaze and visual search strategies of children with Asperger syndrome/high functioning autism viewing a magic trick.PubMed
Annette Joosten, Sonya Girdler, Matthew A Albrecht, et al.
Dev Neurorehabil. 2016;19(2):95-102. doi: 10.3109/17518423.2014.913081. Epub 2014 May 27.
OBJECTIVE: To examine visual search patterns and strategies used by children with and without Asperger syndrome/high functioning autism (AS/HFA) while watching a magic trick. Limited responsivity to gaze cues is hypothesised to contribute to social deficits in children with AS/HFA. METHODS: Twenty-one children with AS/HFA and 31 matched peers viewed a video of a gaze-cued magic trick twice. Between the viewings, they were informed about how the trick was performed. Participants' eye movements were recorded using a head-mounted eye-tracker. RESULTS: Children with AS/HFA looked less frequently and had shorter fixation on the magician's direct and averted gazes during both viewings and more frequently at not gaze-cued objects and on areas outside the magician's face. After being informed of how the trick was conducted, both groups made fewer fixations on gaze-cued objects and direct gaze. CONCLUSIONS: Information may enhance effective visual strategies in children with and without AS/HFA.
8Effects of risperidone and parent training on adaptive functioning in children with pervasive developmental disorders and serious behavioral problems.PubMed
Lawrence Scahill, Christopher J McDougle, Michael G Aman, et al.
J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):136-46. doi: 10.1016/j.jaac.2011.11.010. Epub 2011 Dec 23.
OBJECTIVE: Children with Pervasive Developmental Disorders (PDDs) have social interaction deficits, delayed communication, and repetitive behaviors as well as impairments in adaptive functioning. Many children actually show a decline in adaptive skills compared with age mates over time. METHOD: This 24-week, three-site, controlled clinical trial randomized 124 children (4 through 13 years of age) with PDDs and serious behavioral problems to medication alone (MED; n = 49; risperidone 0.5 to 3.5 mg/day; if ineffective, switch to aripiprazole was permitted) or a combination of medication plus parent training (PT) (COMB; n = 75). Parents of children in COMB received an average of 11.4 PT sessions. Standard scores and Age-Equivalent scores on Vineland Adaptive Behavior Scales were the outcome measures of primary interest. RESULTS: Seventeen subjects did not have a post-randomization Vineland assessment. Thus, we used a mixed model with outcome conditioned on the baseline Vineland scores. Both groups showed improvement over the 24-week trial on all Vineland domains. Compared with MED, Vineland Socialization and Adaptive Composite Standard scores showed greater improvement in the COMB group (p = .01 and .05, and effect sizes = 0.35 and 0.22, respectively). On Age Equivalent scores, Socialization and Communication domains showed greater improvement in COMB versus MED (p = .03 and 0.05, and effect sizes = 0.33 and 0.14, respectively). Using logistic regression, children in the COMB group were twice as likely to make at least 6 months' gain (equal to the passage of time) in the Vineland Communication Age Equivalent score compared with MED (p = .02). After controlling for IQ, this difference was no longer significant. CONCLUSION: Reduction of serious maladaptive behavior promotes improvement in adaptive behavior. Medication plus PT shows modest additional benefit over medication alone. Clinical trial registration information-RUPP PI PDD: Drug and Behavioral Therapy for Children With Pervasive Developmental Disorders; http://www.clinicaltrials.gov; NCT00080145.
9A Group-Administered social Skills Training for 8- to 12- Year-Old, high-Functioning Children With Autism Spectrum Disorders: An Evaluation of its Effectiveness in a Naturalistic Outpatient Treatment Setting.PubMed
Anne Deckers, Peter Muris, Jeffrey Roelofs, et al.
J Autism Dev Disord. 2016 Nov;46(11):3493-3504. doi: 10.1007/s10803-016-2887-1.
A social skills training (SST) for high-functioning children with autism spectrum disorders (ASD) was evaluated in an outpatient setting using a combined between- and within-subject design in which SST and a waiting list condition were compared. According to parents and teachers, the SST produced greater improvement of social skills than the waiting list, and these effects were maintained at 3 months follow-up. No between-group effects were found for loneliness, although in general scores on this outcome measure decreased from pre- to follow-up. The effects of SST were unaffected by social anxiety, ADHD symptoms, Theory of Mind, or desire for social interaction. Altogether, SST seems an effective intervention for high-functioning children with ASD that can be applied in daily clinical practice.
10Brief report: individual social-multi-modal intervention for HFASD.PubMed
Nirit Bauminger
J Autism Dev Disord. 2007 Sep;37(8):1593-604. doi: 10.1007/s10803-006-0245-4. Epub 2006 Oct 27.
This research is the first part of a 2-year cognitive-behavioral-ecological (CB-E) social skills training for high-functioning children with autism spectrum disorder (HFASD). Current study examined efficacy of an individual CB-E intervention in facilitating children's dyadic interactions (immediately after treatment and 4 months later) and their social cognition capabilities (e.g., emotion understanding and recognition, social problem solving). Participants were 19 HFASD children aged 7 years and 7 months to 11 years and 6 months. Results demonstrated improvement in children's social cognition and positive dyadic interaction and decrease in children's low-level social interaction behavior. Long-term evaluation revealed maintenance of improvement. Progress in children's cooperation, self-control, and assertiveness was reported by their teachers. Discussion focused on CB-E intervention efficacy in promoting integral social functioning for HF children with ASD.
11Genetic heterogeneity between the three components of the autism spectrum: a twin study.PubMed
Angelica Ronald, Francesca Happé, Patrick Bolton, et al.
J Am Acad Child Adolesc Psychiatry. 2006 Jun;45(6):691-699. doi: 10.1097/01.chi.0000215325.13058.9d.
OBJECTIVE: This study investigated the etiology of autistic-like traits in the general population and the etiological overlap between the three aspects of the triad of impairments (social impairments, communication impairments, restricted repetitive behaviors and interests) that together define autism spectrum disorders. METHOD: Parents of 3,400 8-year-old twin pairs from the Twins Early Development Study completed the Childhood Asperger Syndrome Test, a screening instrument for autism spectrum symptoms in mainstream samples. Genetic model-fitting of categorical and continuous data is reported. RESULTS: High heritability was found for extreme autistic-like traits (0.64-0.92 for various cutoffs) and autistic-like traits as measured on a continuum (0.78-0.81), with no significant shared environmental influences. All three subscales were highly heritable but showed low covariation. In the genetic modeling, distinct genetic influences were identified for the three components. CONCLUSIONS: These results suggest the triad of impairments that define autism spectrum disorders is heterogeneous genetically. Molecular genetic research examining the three components separately may identify different causal pathways for the three components. The analyses give no indication that different genetic processes affect extreme autistic impairments and autistic impairments as measured on a continuum, but this can only be directly tested once genes are identified.
12The challenge of adolescents and adults with Asperger syndrome.PubMed
Digby Tantam
Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):143-63, vii-viii. doi: 10.1016/s1056-4993(02)00053-6.
Despite the rapid growth of interest in Asperger disorder in children, there continues to be a lack of awareness of the diagnosis and its implications for adolescents and adults. The reasons for this lack of awareness lie in the history of the disorder and in the historical development of mental health services. Because, as Santayana wrote, "Those who cannot remember the past are condemned to repeat it," this article reprises some of the history given elsewhere in this issue, but in a highly partial way, to bring out what the author believes to be the historically grounded prejudices that are the first challenge to anyone wanting to help adolescents and adults with Asperger syndrome.
13Brief report: group social-multimodal intervention for HFASD.PubMed
Nirit Bauminger
J Autism Dev Disord. 2007 Sep;37(8):1605-15. doi: 10.1007/s10803-006-0246-3. Epub 2006 Oct 27.
Current study is the second part of a 2-year cognitive-behavioral-ecological (CB-E) intervention for high-functioning (HF) children with autism spectrum disorder (ASD). We examined the utility of a group-centered intervention on children's ability to interact cooperatively with peers during structured and non-structured social situations. Direct (e.g., social problem solving) and indirect (theory of mind; executive function) treatment effects on social cognitive capabilities were also examined. Participants were 26 preadolescent HF children with ASD. Study results demonstrated direct and indirect treatment effects on social cognition and mixed results regarding children's social interaction capabilities. Although children's cooperative capabilities within the intervention group improved, dyadic, and group social interactions during school recess did not. Discussion focused on the utility of such group-intervention in increasing social functioning.
14Development of autistic children based on maternal responses to the Autism Behavior Checklist.PubMed
Ana Carina Tamanaha, Jacy Perissinoto, Brasilia Maria Chiari
Pro Fono. 2008 Jul-Sep;20(3):165-70. doi: 10.1590/s0104-56872008000300005.
BACKGROUND: language and speech-language intervention. AIM: to evaluate the development process of autistic children, in a direct and indirect intervention context based on the responses of mothers to the Autism Behavior Checklist. METHOD: the research sample consisted of 11 mothers of children diagnosed, according to the criteria established by the DSM IVtr (APA, 2002), with autism (six) and with Asperger Syndrome (five) and who were seen at the Investigation Laboratory of Global Developmental Disorders of the Federal University of São Paulo. These children were randomly divided into two groups: Six were receiving both direct and indirect intervention (TG), and five were receiving indirect intervention exclusively (OG). The Autism Behavior Checklist (Krug et al., 1993) was used, adapted to the Portuguese language by Marteleto (2003). This behavior checklist (57 items) allows the detailed description of non-adaptable characteristics regarding the following areas: sensory, use of the body and object, Language, Psycho-social and Relational. The questionnaire was filled in during an interview on three occasions: at the beginning of intervention, after six months and at the end of 12 months. RESULTS: after statistical analysis it was observed that there was a greater development in the total scores and in the areas of language, psycho-social and relational for the TG. This suggests a greater development pattern during the studied period for this group. CONCLUSION: the mothers of both groups observed behavioral changes. The better scores observed for the TG is probably related to the effectiveness of direct intervention, and not to the lack of attention of parents in the OG in recognizing behavioral changes in their children.
15How do individuals with Asperger syndrome respond to nonliteral language and inappropriate requests in computer-mediated communication?PubMed
Gnanathusharan Rajendran, Peter Mitchell, Hugh Rickards
J Autism Dev Disord. 2005 Aug;35(4):429-43. doi: 10.1007/s10803-005-5033-z.
Computer-mediated communication in individuals with Asperger syndrome, Tourette syndrome and normal controls was explored with a program called Bubble Dialogue (Gray, Creighton, McMahon, and Cunninghamn (1991)) in which the users type text into speech bubbles. Two scenarios, based on Happé (1994) were adapted to investigate understanding of figure of speech and sarcasm, and a third, developed by ourselves, looked at responses to inappropriate requests (lending money and disclosing home address on a first meeting). Dialogue transcripts were assessed by 62 raters who were blind to the clinical diagnoses. Hierarchical linear modelling revealed that rated understanding of a figure of speech was predicted mainly by verbal ability and executive ability, as well as by clinical diagnosis, whereas handling inappropriate requests was predicted by age, verbal ability, executive ability and diagnosis. Notably, the Tourette comparison group showed better understanding than the Asperger group in interpreting a figure of speech and handling inappropriate requests, and differences between these groups were possibly attributable to individual differences in executive ability. In contrast, understanding sarcasm was predicted by age but not by either verbal ability, executive ability or clinical diagnosis. Evidently, there is a complicated relation between Asperger syndrome, verbal ability and executive abilities with respect to communicative performance.
16Socio-dramatic affective-relational intervention for adolescents with asperger syndrome & high functioning autism: pilot study.PubMed
Matthew D Lerner, Amori Yee Mikami, Karen Levine
Autism. 2011 Jan;15(1):21-42. doi: 10.1177/1362361309353613. Epub 2010 Oct 5.
This study examined the effectiveness of a novel intervention called 'socio-dramatic affective-relational intervention' (SDARI), intended to improve social skills among adolescents with Asperger syndrome and high functioning autism diagnoses. SDARI adapts dramatic training activities to focus on in vivo practice of areas of social skill deficit among this population. SDARI was administered as a six-week summer program in a community human service agency. Nine SDARI participants and eight age- and diagnosis-group matched adolescents not receiving SDARI were compared on child- and parent-report of social functioning at three week intervals beginning six weeks prior to intervention and ending six weeks post-intervention. Hierarchical Linear Modeling (HLM) was used to estimate growth trends between groups to assess treatment outcomes and post-treatment maintenance. Results indicated significant improvement and post-treatment maintenance among SDARI participants on several measures of child social functioning. Implications for practice and research are discussed.
17Joint attention ability in children with autistic spectrum disorders.PubMed
Camila Gioconda de Lima e Menezes, Jacy Perissinoto
Pro Fono. 2008 Oct-Dec;20(4):273-9. doi: 10.1590/s0104-56872008000400012.
BACKGROUND: joint attention in children with autistic spectrum disorders. AIM: to evaluate joint attention ability in subjects with autistic spectrum disorders in different contexts and with different interlocutors. METHOD: twenty subjects with ages between four and twelve years, diagnosed with autism or asperger syndrome (DSM-IV-TR, 2002) by a multidisciplinary team, with no associated disorders, and who were enrolled in language therapy for at least six months were assessed. The Symbolic Maturity Assessment Test was used to evaluate joint attention behaviors. An adaptation that included the Semi-Structured Play situations was carried out for this research. For all of the studied situations (free play; semi-structured play with speech and language therapist and the caregiver; imitation) the following joint attention behaviors were observed: alternate, point, show (by child's initiative or in response to adult's action) and look at adult's action (response behavior). The last included the differentiation of the ways by which the adult drew the child's attention (talking; gesturing; or both). RESULTS: the different situations changed the way these subjects shared attention. The adult's intervention proved to be effective in triggering an increase in the occurrence of joint attention behaviors, mainly in response to the adult. No differences were found between interlocutors (speech therapist and mother) in semi-structured situations, probably because both interlocutors synchronized their behaviors with the children. CONCLUSION: the evaluation of joint attention behaviors in play contexts was effective and the interference of a known adult was reflected in the increase of the occurrence of these behaviors in semi-structured and imitation situations.
18Oxytocin increases eye contact during a real-time, naturalistic social interaction in males with and without autism.PubMed
B Auyeung, M V Lombardo, M Heinrichs, et al.
Transl Psychiatry. 2015 Feb 10;5(2):e507. doi: 10.1038/tp.2014.146.
Autism spectrum conditions (autism) affect ~1% of the population and are characterized by deficits in social communication. Oxytocin has been widely reported to affect social-communicative function and its neural underpinnings. Here we report the first evidence that intranasal oxytocin administration improves a core problem that individuals with autism have in using eye contact appropriately in real-world social settings. A randomized double-blind, placebo-controlled, within-subjects design is used to examine how intranasal administration of 24 IU of oxytocin affects gaze behavior for 32 adult males with autism and 34 controls in a real-time interaction with a researcher. This interactive paradigm bypasses many of the limitations encountered with conventional static or computer-based stimuli. Eye movements are recorded using eye tracking, providing an objective measurement of looking patterns. The measure is shown to be sensitive to the reduced eye contact commonly reported in autism, with the autism group spending less time looking to the eye region of the face than controls. Oxytocin administration selectively enhanced gaze to the eyes in both the autism and control groups (transformed mean eye-fixation difference per second=0.082; 95% CI:0.025-0.14, P=0.006). Within the autism group, oxytocin has the most effect on fixation duration in individuals with impaired levels of eye contact at baseline (Cohen's d=0.86). These findings demonstrate that the potential benefits of oxytocin in autism extend to a real-time interaction, providing evidence of a therapeutic effect in a key aspect of social communication.
19Promoting social behavior with oxytocin in high-functioning autism spectrum disorders.PubMed
Elissar Andari, Jean-René Duhamel, Tiziana Zalla, et al.
Proc Natl Acad Sci U S A. 2010 Mar 2;107(9):4389-94. doi: 10.1073/pnas.0910249107. Epub 2010 Feb 16.
Social adaptation requires specific cognitive and emotional competences. Individuals with high-functioning autism or with Asperger syndrome cannot understand or engage in social situations despite preserved intellectual abilities. Recently, it has been suggested that oxytocin, a hormone known to promote mother-infant bonds, may be implicated in the social deficit of autism. We investigated the behavioral effects of oxytocin in 13 subjects with autism. In a simulated ball game where participants interacted with fictitious partners, we found that after oxytocin inhalation, patients exhibited stronger interactions with the most socially cooperative partner and reported enhanced feelings of trust and preference. Also, during free viewing of pictures of faces, oxytocin selectively increased patients' gazing time on the socially informative region of the face, namely the eyes. Thus, under oxytocin, patients respond more strongly to others and exhibit more appropriate social behavior and affect, suggesting a therapeutic potential of oxytocin through its action on a core dimension of autism.
20Deep repetitive transcranial magnetic stimulation associated with improved social functioning in a young woman with an autism spectrum disorder.PubMed
Peter G Enticott, Hayley A Kennedy, Abraham Zangen, et al.
J ECT. 2011 Mar;27(1):41-3. doi: 10.1097/YCT.0b013e3181f07948.
OBJECTIVES: There are currently no biomedical treatments targeting the core symptoms of autism spectrum disorders (ASDs). Considering evidence for cortical dysfunction in ASD, repetitive transcranial magnetic stimulation (rTMS) has been discussed as a potential therapeutic technique. METHODS: We describe the application of a new type of rTMS, deep rTMS, to the bilateral medial prefrontal cortex in a young woman with a high-functioning ASD. High-frequency rTMS was applied for 15 minutes each consecutive weekday for an 11-day period (9 treatments in total). Self-reported assessments were conducted before the first rTMS session, immediately after the last rTMS session, and 1-month after the last rTMS session. RESULTS: Self-reported assessments revealed a number of improvements after deep rTMS. These were primarily in the domain of social relating and interpersonal understanding and were corroborated by family members. CONCLUSIONS: Deep rTMS in ASD may serve to remediate aspects of cortical dysfunction (as standard rTMS seems to do in depression and schizophrenia) and provides a potential new avenue for the development of a biomedical treatment of impaired social relating in ASD.