Play therapy in children with autism: Its role, implications, and limitations

The Impact of a Music- and Movement-Based Intervention on Motor Competence, Social Engagement, and Behavior in Children with Autism Spectrum Disorder

BACKGROUND/OBJECTIVES

The main objective of this manuscript is to evaluate the effects of training, music, and movement intervention on motor functions, social engagement, and behaviors in autistic children.

METHODS

Twenty-one children with a diagnosis of mild autism spectrum disorder (ASD), with an age range of 5-to-13 years, were divided into two groups: the experimental group (n = 10) and the control group (n = 11). All participants were examined before (T0) and after the intervention (T1) to evaluate their motor functions (Bruininks-Oseretsky Motor Performance Test (BOT-2)), maladaptive behavior (RCS (Response to Challenge Scale)), and enjoyment and engagement (PACES (Physical Activity Enjoyment Scale)).

RESULTS

Statistical analysis showed that music and movement intervention significantly improved motor functions such as balance and bilateral coordination (p < 0.0001), social engagement (p = 0.002), and adaptive behaviors (p = 0.005) in children with ASD. Our research supports the feasibility of music and movement intervention and documents the interest in participating in children with ASD.

CONCLUSIONS

This study demonstrates the benefits of movement and music interventions and can be considered a useful way to manage autism spectrum disorders in the future.

The effectiveness of play therapy on depression and anxiety in hospitalized children with cancer: a systematic review

BACKGROUND

The presence of cancer and its treatment will induce anxiety and various effects, not only on a physical level but also on a psychological level. Play therapy can be used by children to articulate their emotions and foster proficient communication with healthcare professionals and caregivers. Play therapy emerges as a highly effective method for the management of illness in children diagnosed with cancer.

MATERIAL AND METHODS

A thorough search was conducted across multiple databases including PubMed, Web of Science, Scopus, Google Scholar, and Cochrane Library. Our review included only interventional studies published from inception to 1 March 2024 that investigated the impact of play therapy on depression and anxiety in hospitalized children with cancer. For each study, information was gathered regarding the study's objective, participant characteristics, conditions, intervention details, comparisons made, study duration, and outcome measures.

RESULTS

Following the retrieval of 2158 records, 12 studies were found to meet the eligibility criteria and were thus selected to include in the synthesis. Play therapy has been explored in several studies using interventions like cognitive-behavioral-based play therapy, family-based play therapy, group-based play therapy, virtual reality-based play therapy, and play therapy combined with other therapeutic approaches. Specifically, six studies investigated the effects of play therapy on anxiety, two studies on depression, and four studies on anxiety and depression.

CONCLUSION

Play therapy is highly recommended due to its simplicity, minimal requirement of tools and materials, ease of implementation, affordability, and suitability for hospitalized preschool and school-age children with cancer.

Selective Mutism in the Context of Autism and Bilingualism

CASE

Juan is a 5-year-old boy who has been followed by a developmental-behavioral pediatrician and pediatric neuropsychologist since being diagnosed with language delay and autism spectrum disorder at age 2 years. He is otherwise healthy and was born at term after a healthy pregnancy. His primary language is Spanish, and he has minimal interactions in English. His first words were at 20 months; they were not functional but rather words related to his interests such as "train." He began using 2 to 3-word phrases shortly after but only to request needs. He began speaking in complete sentences at age 4 years.A neuropsychological evaluation was conducted at age 2 years during which Juan demonstrated repetitive behaviors such as hand-flapping, toe-walking, body rocking, and head banging. He displayed sensory seeking behaviors such as rubbing items on his face and close visual inspection. He did not respond to his name and his use of eye contact was inconsistent. He demonstrated rigidity and difficulty transitioning between activities. He did not engage in social reciprocity, and his facial expressions were limited. Minimal spontaneous language was observed, and expressive language largely consisted of echolalia in both languages. Juan was diagnosed with autism spectrum disorder and applied behavior analysis, speech and language therapy, and occupational therapy were recommended.Developmental-behavioral follow-up over the next 2 years noted improvements in behavior, transitions, and social interactions. He participated in early childhood intervention and early childhood special education with significant advances for speech and language in English and Spanish, demonstrating a large vocabulary. At 4 years, parents noted Juan to have reluctance to speak in English. He stopped speaking in English entirely for 3 weeks, though he continued to speak in Spanish. When he resumed speaking in English, it was only with people he knew well (e.g., parents, teachers, babysitter). In clinic, he did not speak to the English-speaking developmental-behavioral pediatrician but spoke in short sentences to the Spanish-speaking neuropsychologist.A repeat neuropsychological evaluation completed at age 5 years revealed that Juan had stopped speaking in English completely, even among those previously deemed "safe." Results were consistent with average cognitive abilities with a strength in verbal skills. Juan's single-word vocabulary in Spanish was exceptionally high. He did not provide expressive responses in English, but his receptive English vocabulary was high average. He responded to English language with nonverbal gestures or spoken language in Spanish. Parents reported Juan to display increased anxiety accompanied by extreme school refusal, behavioral difficulties, and reluctance to leave the home.Given this information, what are your diagnostic considerations and treatment recommendations?

LEGO®-Based Therapy in School Settings for Social Behavior Stimulation in Children with Autism Spectrum Disorder: Comparing Peer-Mediated and Expert Intervention

BACKGROUND

LEGO®-based therapy is a social development protocol that uses LEGO® activities to support the development of a wide range of interaction skills, enhancing prosocial behaviors and mitigating the challenges associated with mental health difficulties and behavioral issues commonly observed in children with autism spectrum disorder (ASD).

OBJECTIVES

This study aimed to explore the effects of LEGO®-based therapy on the social behavior and mental health of children with ASD, comparing stimulation mediated by expert and stimulation mediated by non-autistic peers. This study was approved by the Ethical Committee at Mackenzie Presbyterian University, ensuring adherence to ethical standards throughout the research process.

METHODS

This study involved 18 children with ASD, levels 1 or 2, with an intelligence quotient (IQ) above 70, and three typically developing peers, intelligence quotient (IQ) above 80, aged between 5 and 8 years old, of both sexes. Participants were randomized into three groups for stimulation (stimulation mediated by expert, by a non-autistic peer and control group). The measures were the Wechsler Abbreviated Scale of Intelligence, the Strengths and Difficulties Questionnaire (parent and teacher versions), the Inventory of Difficulties in Executive Functions, Regulation, and Aversion to Delay-Child Version, the Developmental Coordination Disorder Questionnaire, the Autism Behavior Checklist, and the Autistic Behavior Inventory.

RESULTS

After 14 sessions of 45 min in school settings, the participants of both groups (mediated by experts and non-autistic children) showed significant gains on social behavior. A statistically significant difference was observed between baseline sessions and probes (χ2 (5) = 25.905, p < 0.001). These gains were maintained in both follow-up points, 30 and 90 days after the completion of the stimulation sessions. Additionally, maladaptive behavior showed a significant decline when compared pre- and post-intervention. These improvements were sustained during follow-up assessments at 30 and 90 days.

CONCLUSIONS

The results suggest that a structured intervention combined with peer-mediated stimulation may be an effective method for promoting adaptive and prosocial behaviors in children with ASD.

Decoding the genetic landscape of autism: A comprehensive review

BACKGROUND

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by heterogeneous symptoms and genetic underpinnings. Recent advancements in genetic and epigenetic research have provided insights into the intricate mechanisms contributing to ASD, influencing both diagnosis and therapeutic strategies.

AIM

To explore the genetic architecture of ASD, elucidate mechanistic insights into genetic mutations, and examine gene-environment interactions.

METHODS

A comprehensive systematic review was conducted, integrating findings from studies on genetic variations, epigenetic mechanisms (such as DNA methylation and histone modifications), and emerging technologies [including Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas9 and single-cell RNA sequencing]. Relevant articles were identified through systematic searches of databases such as PubMed and Google Scholar.

RESULTS

Genetic studies have identified numerous risk genes and mutations associated with ASD, yet many cases remain unexplained by known factors, suggesting undiscovered genetic components. Mechanistic insights into how these genetic mutations impact neural development and brain connectivity are still evolving. Epigenetic modifications, particularly DNA methylation and non-coding RNAs, also play significant roles in ASD pathogenesis. Emerging technologies like CRISPR-Cas9 and advanced bioinformatics are advancing our understanding by enabling precise genetic editing and analysis of complex genomic data.

CONCLUSION

Continued research into the genetic and epigenetic underpinnings of ASD is crucial for developing personalized and effective treatments. Collaborative efforts integrating multidisciplinary expertise and international collaborations are essential to address the complexity of ASD and translate genetic discoveries into clinical practice. Addressing unresolved questions and ethical considerations surrounding genetic research will pave the way for improved diagnostic tools and targeted therapies, ultimately enhancing outcomes for individuals affected by ASD.

Examining the Link Between Social Affect and Visual Exploration of Cute Stimuli in Autistic Children

Baby schema refers to physical features perceived as cute, known to trigger attention, induce positive emotions, and prompt social interactions. Given the reduced visual attention to social stimuli observed in individuals on the autism spectrum, the current study examines whether the sensitivity to baby schema is also affected. We expected that the looking time towards cute-featured stimuli would vary with symptom severity levels and would be associated with social affect. Ninety-four children (31 typically developing; 63 diagnosed with autism spectrum disorder - ASD) aged 20-83 months (M = 49.63, SD = 13.59) completed an eye-tracking visual exploration task. Autistic participants were separated into two groups based on symptom severity: children with high autism severity symptoms (HS ASD; N = 23) and low-moderate autism symptoms (LMS ASD; N = 40). Animals and neutral objects were simultaneously presented on the screen along with either human babies (condition 1) or adults (condition 2). The results indicated that visual attention oriented to cute-featured stimuli varied with autism symptom severity: only LMS and TD groups spend more time looking at cute-featured stimuli (babies; animals) than neutral objects. Moreover, children with higher severity in the social affect domain spent less time on the stimuli depicting cute than non-cute stimuli. These findings suggest that autism symptom severity and social skills are linked to variations in visual attention to cute stimuli. Implications of baby schema sensitivity are discussed in relation to the development of social competencies and play, responsiveness to robot-based interventions, as well as appraised relevance in autistic children.

Metabolomic changes in children with autism

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication and repetitive behaviors. Metabolomic profiling has emerged as a valuable tool for understanding the underlying metabolic dysregulations associated with ASD.

AIM

To comprehensively explore metabolomic changes in children with ASD, integrating findings from various research articles, reviews, systematic reviews, meta-analyses, case reports, editorials, and a book chapter.

METHODS

A systematic search was conducted in electronic databases, including PubMed, PubMed Central, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, LISA, and NLM catalog up until January 2024. Inclusion criteria encompassed research articles (83), review articles (145), meta-analyses (6), systematic reviews (6), case reports (2), editorials (2), and a book chapter (1) related to metabolomic changes in children with ASD. Exclusion criteria were applied to ensure the relevance and quality of included studies.

RESULTS

The systematic review identified specific metabolites and metabolic pathways showing consistent differences in children with ASD compared to typically developing individuals. These metabolic biomarkers may serve as objective measures to support clinical assessments, improve diagnostic accuracy, and inform personalized treatment approaches. Metabolomic profiling also offers insights into the metabolic alterations associated with comorbid conditions commonly observed in individuals with ASD.

CONCLUSION

Integration of metabolomic changes in children with ASD holds promise for enhancing diagnostic accuracy, guiding personalized treatment approaches, monitoring treatment response, and improving outcomes. Further research is needed to validate findings, establish standardized protocols, and overcome technical challenges in metabolomic analysis. By advancing our understanding of metabolic dysregulations in ASD, clinicians can improve the lives of affected individuals and their families.

Assisted Robots in Therapies for Children with Autism in Early Childhood

Children with autism spectrum disorder (ASD) have deficits that affect their social relationships, communication, and flexibility in reasoning. There are different types of treatment (pharmacological, educational, psychological, and rehabilitative). Currently, one way to address this problem is by using robotic systems to address the abilities that are altered in these children. The aim of this review will be to analyse the effectiveness of the incorporation of the different robotic systems currently existing in the treatment of children up to 10 years of age diagnosed with autism. A systematic review has been carried out in the PubMed, Scopus, Web of Science, and Dialnet databases, with the following descriptors: child, autism, and robot. The search yielded 578 papers, and nine were selected after the application of the PRISMA guideline. The quality of the studies was analysed with the PEDRo scale, and only those with a score between four and six were selected. From this study, the conclusion is that the use of robots, in general, improves children's behaviour in the short term, but longer-term experiences are necessary to achieve more conclusive results.

Effectiveness of DIR/Floor Time Play Therapy in Social Skills and Emotion Regulation of Children with Autism Spectrum Disorder

Background: Children with autism spectrum disorder (ASD) and their families need to use rehabilitation services to improve their functions in social interactions and communication skills. Objectives: The present study aimed to investigate the effectiveness of DIR/floor time play therapy in the social skills and emotion regulation of children with ASD. Methods: The present study was a quasi-experimental with a pretest/posttest design. The statistical population included all the autistic children visiting Golhay-e Behesht Autism Center in Qom, Qom Province, Iran. The convenience sampling method was employed to select 30 participants, who were randomly assigned to an experimental group (n = 15) and a control group (n = 15). The experimental group received the DIR/floor time play therapy intervention for 23 twenty-minute sessions. The research instrument included Bellini’s Social Skills Profile Questionnaire and Emotion Regulation Checklist. Descriptive statistics and the repeated measures ANOVA were adopted for data analysis in SPSS 22. Results: According to the results, the DIR/floor time play therapy method improved emotion regulation components (i.e., instability/negativity and emotion regulation) and the indices of social skills (i.e., social interaction, social participation, and detrimental behavior). The results lasted until the follow-up step (P < 0.001). Conclusions: The DIR/floor time play therapy method caused positive changes to emotion regulation and social skills in autistic children. Therefore, it can be an effective intervention in children with ASD.