Autism and Mind-Body Therapies: A Systematic Review

The Physiological and Clinical-Behavioral Effects of Heart Rate Variability Biofeedback in Adolescents with Autism: A Pilot Randomized Controlled Trial

Adolescents with autism present lower levels of cardiac vagal modulation. It was hypothesized that Heart Rate Variability Biofeedback (HRVB) increases cardiac vagal modulation in adolescents with autism, resulting in positive effects on physiological and psychosocial parameters. It was also hypothesized that home-based HRVB training is feasible. In a single-blind, randomized sham-controlled pilot trial, adolescents with autism performed supervised HRVB (n = 24) or sham training (n = 20). Subsequently, half of the adolescents received HRVB training at home, whereas the other subset did not practice. Physiological, cortisol and behavioral data were collected during stress-provoking assessments before and after each training period. Supervised HRVB resulted in a late increase in cardiac vagal modulation in adolescents with autism. Heart rate increased and cortisol decreased significantly immediately after supervised HRVB, but none of these effects remained after follow-up. Following supervised HRVB, no significant change in psychosocial functioning was found. Home-based HRVB was feasible, adolescents reported lower symptoms of stress, but a significant decrease in compliance rate was found. HRVB is feasible and effective in adolescents with autism given the late-emerging increases in cardiac vagal modulation and decrease in stress symptoms. Replicating this study with a larger sample and further exploration of the working mechanisms of HRVB are recommended. ClinicalTrials.gov , NCT04628715.

Mindfulness Meditation Training Reduces Gaming Cravings by Reshaping the Functional Connectivity Between the Default Mode Network and Executive Control-Related Brain Regions

BACKGROUND

Internet gaming disorder (IGD) can lead to psychological problems and cause behavioral problems in individuals. Traditional interventions have been ineffective in treating IGD. Meanwhile, mindfulness meditation (MM) is an emerging method that has proven to be effective for treating psychiatric disorders. In this study, MM was used to intervene in IGD and to explore its neural mechanism.

METHODS

Eighty participants were recruited through advertisements. Eventually, 61 completed the 1-month training (MM group, n = 31; progressive muscle relaxation [PMR] group, n = 30), including a pretest, 8 training sessions, and a posttest. Regional homogeneity and degree centrality were calculated, and the tests (pre- and post-) and group (MM and PMR) analysis of variance was performed. The overlapping results were obtained as region of interest for functional connectivity (FC) analyses. Behavioral data and neurotransmitter availability maps were correlated with FC.

RESULTS

Compared with PMR, MM decreased the severity of addiction and game craving in IGD. Brain imaging results showed that the FC between and within the executive control and default mode networks/reward-related regions were enhanced. Significant negative correlations were observed between FC and dopamine receptor D2, dopamine transporter, and vesicular acetylcholine transporter. Significant positive correlations were observed between FCs and serotonin and aminobutyric acid receptors.

CONCLUSIONS

This study confirmed the effectiveness of MM in treating IGD. MM altered the default mode and enhanced top-down control over game cravings. These findings were revealed by the correlations between brain regions and behavioral and biochemical effects. The results show the neural mechanism of MM in reducing IGD and lay the foundation for future research.

Physical Activity for Anxiety for Autistic People: A Systematic Review

Clinical anxiety is a common comorbidity in autistic people. Due to the prevalence of anxiety in the autism population and the adverse effects it causes, there is a critical need to develop effective interventions which address anxiety symptoms for autistic people. Therefore, the purpose of this systematic review was to examine the effectiveness of the use of physical activity as an intervention to reduce anxiety in autistic people. Three databases PubMed, PsychInfo, and Cochrane RCTs, were searched utilizing key terms. PRISMA systematic search procedures identified 44 studies meeting predetermined inclusion criteria. Participant characteristics, the type of physical activity performed, the nature of the physical activity program/delivery, anxiety-related outcomes, and research methodology was evaluated for each study. Each paper included was appraised and scored for risk of bias using Cochrane Handbook for Systematic Reviews of Interventions risk of bias tool. Titles and abstracts of 44 articles were reviewed and 8 articles met inclusion criteria which evaluated interventions. Evidence from 8 studies suggests that yoga, a community-based football program, an app-assisted walking program, group exercise programs, and horseback riding interventions reduced anxiety for autistic people. The studies included in this systematic review provide strong-to-moderate evidence that physical activity can reduce anxiety for autistic children and adults. However, additional research is needed to identify which mode of physical activity is most beneficial for anxiety reduction. Further, future research should evaluate frequency, duration, and intensity and their effects on anxiety for autistic people.

Mindfulness-based stress reduction for autistic adults: A feasibility study in an outpatient context

LAY ABSTRACT

Autistic adults report high stress levels and difficulties dealing with everyday stressors. Mindfulness-based stress reduction groups aim to help regulate stress responses. We asked 50 autistic adults, without intellectual disability, to participate in a study of mindfulness-based stress reduction. The group program was made accessible through clear group leader communication and good program predictability, as well as reduced exposure to disturbing sensory stimuli. The mindfulness and yoga based exercises from the original mindfulness-based stress reduction program were included. The participants were positive and would even recommend an autistic friend to participate in a mindfulness-based stress reduction group. They reported that mindfulness-based stress reduction could lower symptoms of stress and improved stress coping. We still need to investigate these effects further in larger studies. The findings of this work show that mindfulness-based stress reduction groups can be adapted for autistic adults and that the participants overall were positive to the intervention and the group format.

Nissl Granules, Axonal Regeneration, and Regenerative Therapeutics: A Comprehensive Review

Nissl granules, traditionally recognized for their pivotal role in protein synthesis within neuronal cell bodies, are emerging as intriguing components with far-reaching implications in the realm of regenerative therapeutics. This abstract encapsulates the essence of a comprehensive review, exploring the nexus between Nissl granules, axonal regeneration, and their transformative applications in regenerative medicine. The molecular intricacies of Nissl granules form the foundation of this exploration, unraveling their dynamic role in orchestrating cellular responses, particularly in the context of axonal regeneration. As we delve into the interplay between Nissl granules and regenerative processes, this review highlights the diverse mechanisms through which these granules contribute to neuronal repair and recovery. Beyond their conventional association with neurobiology, recent advancements underscore the translational potential of Nissl granules as therapeutic agents. Insights into their involvement in enhancing axonal regeneration prompt a reconsideration of these granules as key players in the broader field of regenerative medicine. The abstract encapsulates evidence suggesting that modulating Nissl granule-related pathways holds promise for augmenting tissue regeneration, extending their applicability beyond the confines of the nervous system. This review aims to serve as a valuable resource for medical professionals, researchers, and clinicians seeking to comprehend the multifaceted role of Nissl granules in regenerative therapeutics. By illuminating the intricate connections between Nissl granules, axonal regeneration, and therapeutic applications, this work aspires to catalyze further research and innovation, ultimately contributing to the evolution of regenerative strategies that harness the innate reparative capacities within cellular constituents.

The efficacy of mindfulness-based therapy for anxiety, social skills, and aggressive behaviors in children and young people with Autism Spectrum Disorder: A systematic review

Introduction

The purpose of this systematic review was to examine the efficacy of mindfulness-based interventions for improving anxiety, social skills, and aggressive behaviors in children and young people (CYP) with Autism Spectrum Disorder (ASD); summarize the results across clinic, home, and school contexts; and evaluate the quality of these interventions for clinical practice.

Methods

A search of the PsycINFO, Medline (Ovid), Web of Science, and Scopus databases was conducted in June 2021, and no date restrictions were applied. Inclusion criteria were quantitative or qualitative research implementing a mindfulness-based intervention for CYP aged 6–25 years with a diagnosis of ASD, Pervasive Development Disorder, or Asperger’s Syndrome.

Results

We identified 23 articles for inclusion including within subject pre- and post-testing, multiple baselines, and randomized control trials, among other research designs. Of these, a quality analysis conducted using an ASD research-specific risk of bias tool found over half (14) were of weak methodological quality, whereas only four and five were found to be of strong and adequate quality, respectively.

Discussion

While the results of this systematic review suggest promising evidence for the use of mindfulness-based interventions to improve anxiety, social skills, and aggressive behaviors in CYP with ASD, results should be interpreted with caution due to the limitations resulting from the overall weak quality of the studies.

The review protocol was pre-registered on PROSPERO (CRD42021259125) and can be viewed at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259125

How to Make the Unpredictable Foreseeable? Effective Forms of Assistance for Children with Autism Spectrum Disorder (ASD) during the COVID-19 Pandemic

Symptomatology in patients with the diagnosis of autism spectrum disorder (ASD) is very heterogeneous. The symptoms they present include communication difficulties, behavior problems, upbringing problems from their parents, and comorbidities (e.g., epilepsy, intellectual disability). A predictable and stable environment and the continuity of therapeutic interactions are crucial in this population. The COVID-19 pandemic has created much concern, and the need for home isolation to limit the spread of the virus has disrupted the functioning routine of children/adolescents with ASD. Are there effective diagnostic and therapeutic alternatives to limit the consequences of disturbing the daily routine of young patients during the unpredictable times of the pandemic? Modern technology and telemedicine have come to the rescue. This narrative review aims to present a change in the impact profile in the era of isolation and assess the directions of changes that specialists may choose when dealing with patients with ASD.

Asperger Syndrome (AS): A Review Article

A variant of autism spectrum disorder (ASD) known as Asperger syndrome (AS) is characterized by severe issues with interpersonal, verbal, and nonverbal communication as well as restricted and repetitive patterns of behavior and activities. Although there is no known cause for ASD, various genetic as well as non-genetic risk factors that may act either alone or in combination to induce ASD have been identified. The occurrence of ASD has been increasing worldwide. Co-occurring neuropsychological diseases are frequently present as well. The premise for diagnosis is the observation of abnormal conduct, with diagnostic criteria emphasizing limitations in social interaction and communication as well as constrained, repetitive behavioral patterns, activities, or hobbies. The degree of the illness and the presence of intellectual impairment have a significant impact on the prognosis. Like autism, Asperger's can neither be prevented nor treated. There is no specific medical therapy that can effectively cure all of the symptoms of autism. However, medications may be used as adjuvant therapy for maladaptive behaviors and co-occurring mental problems. The treatment aims to reduce core impairments, increase functional ability, and reduce harmful behaviors that could limit functional skills. It is crucial to provide proper care, establish supportive networks for individuals who are affected and their families, and use effective therapies to enhance functioning and results.

Therapeutic Riding or Mindfulness: Comparative Effectiveness of Two Recreational Therapy Interventions for Adolescents with Autism

Therapeutic riding (THR) and HeartMath (HM) mindfulness-based interventions have promise for reducing stress in adolescents with autism spectrum disorder. In three 10-week periods, this study compared THR, HM, and control on salivary cortisol, self-reported stress, parent-reported social responsiveness, and heart-rate variability. This crossover design included 27 participants (12-21 years) randomly assigned to order of intervention. Findings suggest that HM and THR manualized protocols are equally beneficial in decreasing cortisol levels immediately following a session, but HM sessions had more impact on heart-rate variability. There was no significant effect on follow-up cortisol levels within a week after either intervention, but THR had more impact on decreasing some self-reported stressors.

Mindfulness-based interventions: an overall review

INTRODUCTION

This is an overall review on mindfulness-based interventions (MBIs).

SOURCES OF DATA

We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including 'mindfulness', 'meditation', and 'review', 'meta-analysis' or their variations.

AREAS OF AGREEMENT

MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions.

AREAS OF CONTROVERSY

Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations.

GROWING POINTS

Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed.

AREAS TIMELY FOR DEVELOPING RESEARCH

More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.

Barriers and facilitators to engaging individuals and families with autism spectrum disorder in mindfulness and acceptance-based therapies: a meta-synthesis

PURPOSE

Third-wave psychological therapies can benefit individuals and families living with autism spectrum disorder (ASD). To date, little is known about individuals' perceptions and experiences of therapy. This meta-synthesis aimed to capture participants' own reflections of mindfulness and acceptance-based therapies, including potential barriers and facilitators to therapy engagement.

MATERIALS AND METHODS

Database searches identified 10 independent studies targeting caregivers (N_studies = 3), dyadic parent-child interventions (N_studies = 6), or adults with ASD (N_studies = 1). Studies were subject to quality assessment and thematically analysed.

RESULTS

Caregivers highlighted a need to adapt the length and frequency of daily mindfulness practice around busy lifestyles. Adults with ASD also identified therapy barriers, although these data were less robust. Children with ASD focused on therapy benefits.

CONCLUSIONS

All three participant groups commented on the importance of mindfulness as a method to enhance self-awareness, self-regulation and self-care. Peer support provided in group-based therapy was also seen as beneficial. Future research should examine the application of mindfulness therapies to adults with ASD, with little currently known about this cohort's therapy experiences. Whether traditional mindfulness approaches can be effectively modified to accommodate ongoing, cumulative daily demands these families experience also requires investigation.Implications for rehabilitationIndividuals with autism spectrum disorders (ASD) and their caregivers often experience high levels of anxiety and stress.Mindfulness and acceptance-based therapies can enhance an individual's self-awareness and self-regulation, thereby reducing distress - with benefits extending to familiesGroup-based therapy is an important adjunct to the support of caregivers developing mindfulness-awareness.

The efficacy of meditation-based mind-body interventions for mental disorders: A meta-review of 17 meta-analyses of randomized controlled trials

There is increasing interest in the potential efficacy of meditation-based mind-body interventions (MBIs) within mental health care. We conducted a systematic metareview of the published randomized control trial (RCT) evidence. MEDLINE/PubMed, PsycARTICLES and EMBASE were searched from inception to 06/2020 examining MBIs (mindfulness, qigong, tai chi, yoga) as add-on or monotherapy versus no treatment, minimal treatment and passive and active control conditions in people with a mental disorder. The quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the methodological quality of the RCTs using AMSTAR-Plus. Sixteen (94%) of 17 meta-analyses had good overall methodological quality. The content validity of the included RCTs was considered good in 9 (53%) meta-analyses. In meta-analyses with good methodological quality (AMSTAR 8≤) and content validity (AMSTAR+ 4≤), large effect sizes (0.80 or higher) were observed for mindfulness in schizophrenia and in ADHD, a moderate (0.50 ≤ 0.80) effect size for mindfulness in PTSD and a small (0.20 < 0.50) effect size for yoga in schizophrenia No serious adverse events were reported (n RCTs = 43, n in the MBI arms = 1774), while the attrition rates were comparable with the rates in passive and active control conditions. Our meta-review demonstrates that mindfulness and to a lesser extent yoga may serve as an efficacious supplement to pharmacotherapy, and psychotherapy and can be complementary in healthy lifestyle interventions for people with mental disorders. Meta-analytic evidence of high methodological quality and content validity of included trials is currently lacking for qigong and tai chi.

Group Virtual Mindfulness-Based Intervention for Parents of Autistic Adolescents and Adults

Mindfulness-based approaches have been shown to be effective in improving the mental health of parents of youth and adults with autism and other developmental disabilities, but prior work suggests that geography and caregiving demands can make in-person attendance challenging. The purpose of this study was to evaluate the feasibility, acceptability and preliminary outcomes of a mindfulness-based group intervention delivered to parents virtually. It was feasible to deliver this manualized intervention. Twenty-one of 39 parents completed the intervention and completers reported high satisfaction ratings. Parents reported reduced levels of distress, maintained at 3-month follow-up, and increased mindfulness. Changes reported following intervention were similar to changes reported in a prior study of parents competing an in person mindfulness group.

Dance promotes positive benefits for negative symptoms in autism spectrum disorder (ASD): A systematic review

BACKGROUND

Autism spectrum disorder (ASD) is characterized as a neurodevelopmental disorder with stereotyped and repetitive behaviors. Dance practice can elicit esthesia to stimulate the communication process through the notion of the phenomenal body that is recognized in an expressive and symbolic space.

OBJECTIVE

To conduct a systematic review to identify how dance promotes positive benefits for the negative symptoms in ASD.

METHOD

We formulated the research question based on PICO: "What is the influence of dance on negative symptoms in individuals with autism spectrum disorder?". Databases were searched in March 2019 and included PubMed, Science Direct, Scopus, PsycInfo and Web of Science.

RESULTS

We identified 9,350 studies of which five were selected for our review (a total of 266 individuals). All included studies showed an influence of dance on negative symptoms, including empathy, emotional expression, body awareness, behavior, and psychological wellbeing that impact on social reciprocity, and consequently the communication process, in ASD.

CONCLUSIONS

Dance practice may contribute to body awareness and social involvement using techniques that provide mirroring, synchronization, rhythm, and reciprocity in adults with normal to high-functioning ASD.

Identification, Evaluation, and Management of Children With Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions.  This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.

The effect of six weeks of Tai Chi Chuan training on the motor skills of children with Autism Spectrum Disorder

OBJECTIVES

Autism Spectrum Disorder (ASD) is related to a dysfunction of central nervous system that most frequently appears at the age of three years old. There is no certain cure for this disorder; however, decreasing complications can produce positive life changes. Increasing physical activity is an appealing method for reducing behavioral disorders in ASD. Since Tai Chi Chuan training improves focus, attention to internal cues and balance, it seems to be an effective system for autistic children.

MATERIALS & METHODS

18 children with ASD in the age range between 6-12 years old were divided randomly into experimental and control groups. The experimental group participated in a six-week program of Tai Chi Chuan consisting of 18 sessions, limited to 60 min each. To assess motor skills, an M-ABC test was used during pre- and post-assessment. In order to analyze the data, dependent and independent T tests were used (with significance level of 0.05).

RESULTS

Results showed a significant difference in the subscales of ball skills and balance performance (P < 0.05) and no significant difference in the manual agility scale (P > 0.05) between the two groups.

CONCLUSION

According to the results, it may be concluded that forms of Tai Chi Chuan improve balance and motion coordination. Moreover, this training consists of slow motion workouts with strongly focused attention, which may lead to developed control of body motions with harmony and discipline. Therefore, Tai Chi Chuan training seems to be a helpful therapeutic program to reduce motor limitations, and these benefits can be transferred to daily life in autistic children.

Psychosocial Treatments Targeting Anxiety and Depression in Adolescents and Adults on the Autism Spectrum: Review of the Latest Research and Recommended Future Directions

PURPOSE OF REVIEW

This synthesis of treatment research related to anxiety and depression in adolescents and adults with autism spectrum disorder (ASD) focuses on the scientific support for various forms of psychosocial interventions, useful adaptations to standard interventions, and engagement of candidate therapeutic mechanisms.

RECENT FINDINGS

There is considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) to treat co-occurring problems with anxiety, but there has been relatively little research on treatment of co-occurring depression. Multiple mechanisms of treatment effect have been proposed, but there has been little demonstration of target engagement via experimental therapeutics. Comorbidity between ASD and anxiety and/or mood problems is common. Although there is evidence for the use of CBT for anxiety, little work has addressed how to effectively treat depression. There is emerging support for alternative treatment approaches, such as mindfulness-based interventions. We encourage rigorous, collaborative approaches to identify and manipulate putative mechanisms of change.

Psychosocial interventions for internalizing disorders in youth and adults with ASD

Internalizing disorders are common in individuals with ASD. Psychosocial interventions targeting these disorders in the ASD population have burgeoned in the last decade. Cognitive-behavioural therapy, modified for ASD, is the most frequently investigated model, although other interventions, including behaviour therapy, third-wave interventions, models targeting transdiagnostic constructs, and alternative interventions and treatment delivery methods are now emerging. This review provides a summary of the efficacy of these interventions in treating internalizing disorders in youth and adults with ASD. The barriers to accessing these treatments, which are experienced by many individuals with ASD and their families, as well as future research directions, are also discussed.