| Part I: A randomized controlled clinical study of peer-mediated interventions on the social interaction of children with autism spectrum disorderObjectivePeer-mediated intervention(PMI)is an intervention that systematically teaches normally developing peers to help children with Autism Spectrum Disorder(ASD)actively participate in social interactions,thereby enabling children with ASD to acquire appropriate social skills.Due to the large clinical heterogeneity of ASD children,this study was the first to use PMI to intervene in social interaction core issues in ASD children with different symptom levels.A randomized,single-blind,parallel-controlled design was used to explore and analyze the effectiveness of PMI on the core social interaction problems of children with ASD in a hospital setting,providing a new approach to clinical interventions for children with different symptom levels of ASD.Methods55 children aged 4-12 years were diagnosed with ASD by their physicians using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5)and randomly assigned to either the experimental or control group using the envelope method stratification.PMI was used in the experimental group and Early Intensive Behavioural Intervention(EIBI)based on Applied Behavioural Analysis(ABA)was used in the control group.Children with ASD in both groups received 2 months of intervention each for a total of 24 sessions,each session lasting 40 minutes.The rate of improvement in the social interaction performance of children with ASD before and after the intervention was used as the primary outcome indicator,assessed by the Social Responsiveness Scale(SRS),with the rate of improvement in autistic symptoms and various social subscales as secondary outcome indicators.Intra-group and inter-group comparisons were made between the two groups of children before and after the intervention.Results Fifty-five participants were recruited and analyzed,a total of 29 in the experimental group,18 mild to moderate and 11 severe,and a total of 26 in the control group,15 mild to moderate and 11 severe.After the intervention,social response scores decreased by 12.10±12.64 points in the experimental group,significantly more than in the control group(t=-3.918,P=0.000),with an effect size of-1.043;SRS scores decreased by 15.06±10.61 in the mild to moderate subgroup,also significantly more than in the control group(H=17.811,P=0.009),with an effect size of-1.642.At the same time,social communication scores decreased more significantly in the experimental group compared to the control group(t=-3.869,P=0.000),with a 95% confidence interval of-10.067 to-3.193.At the same time,social communication scores decreased more significantly in the experimental group compared to the control group(t=-3.869,P=0.000),with a 95% confidence interval of-10.067 to-3.193.Social motivation(H=16.894,P=0.011)and behavioral patterns of ASD(H=18.150,P=0.006)also decreased more significantly in the mild to the moderate subgroup of the experimental group compared to the control group.The decrease in scores was also more significant in the experimental group compared to the control group.ConclusionPeer-mediated intervention can trigger social motivation in children with mild to moderate ASD and reduce their maladaptive behaviour patterns,thereby effectively improving the overall social competence of children with ASD and facilitating effective social communication with others.Part II: The potential brain mechanism of peer-mediated interventions in preschool children with autism spectrum disorderObjectivePeer-mediated intervention is a complex intervention.In order to understand the potential neural-related mechanisms of the therapeutic components involved in the social interaction of children with ASD,using functional Near-Infrared Spectroscopy (f NIRS)hyperscanning and the eye-tracking glasses technology were used to observe and study the social task performance of preschool children with ASD in the natural environment,so as to explore the possible brain mechanism of PMI on the social interaction of ASD children and provide new ideas for accurate clinical intervention research.MethodsThree common social intervention components of PMI were used as target tasks,including static imitation(Task One,T1),dynamic imitation(Task Two,T2),and imitation rotation tasks(Task Three,T3).A total of 32 preschool children aged between 4 and 8 years old,together with their parents,eventually participated in the study.The three kinds of social imitation games were played in a naturalistic setting,and the completion and correctness rates of the two groups of children performing the social imitation tasks were compared by video recording and scoring.f NIRS was used to measure the cerebral hemodynamic changes in the region of interest of the children and their parents during the social task,and the relationship between the NIRS signals produced by the parent-child pairs in each task was calculated using Wavelet Transform Coherence(WTC)and interbrain neural synchronization values were obtained.Eye-tracking techniques were also used to assess the visual attention of both groups during the social task,including pre-first gaze duration,first gaze duration,mean gaze duration,total gaze duration,and the number of gaze counts.In addition,the role of the prefrontal cortex and visual attention in the different social interaction tasks was analyzed and compared and the correlation between social interaction behavior,visual attention,and interbrain neural synchronization of both sides of interaction was analyzed.Results(1)When comparing children with ASD and Typically Developing(TD)children,TD children had significantly better task completion and correctness rates than ASD children on the three imitation tasks of PMI(p<0.05).(2)In all three imitation tasks,children with TD focused on the blocks they built more than children with ASD(p<0.05)in terms of Average Fixation Duration(AFD),AFD of parental/mother’s hand,total Fixation Duration,and Fixation Count,with the Time to First Fixation significantly different in both groups of children’s tasks,with T2 taking the shortest time.(3)At T2,interbrain synchronization(IBS)was significantly lower in the frontal eye field(FEF)and medial prefrontal cortex(m PFC)of channel 3 and channel 7 of the brain for the ASD parent-child pairs than for the TD parent-child pairs.At T3,IBS in the right Dorsolateral Prefrontal Cortex(r DLPFC)was significantly lower in the ASD parental pair than in the TD parental pair.At T1,there was no significant difference in IBS between the two groups.The IBS of the two parental pairs between tasks showed that the TD parental pair had significantly higher IBS in channel 3,T2 than in T1;in channel 6,T3 had significantly higher IBS than in T1 and T2;in channel 7,T2 had significantly higher IBS than in T1 and T3;the ASD parental pair had significantly higher IBS in channel 3,T2 than in T1 and T3;in channel 9,the left dorsolateral prefrontal cortex(l DLPFC),the IBS of T2 was also significantly higher than that of T1.(4)Correlation analysis between task behavior and IBS showed that IBS values for channel 7 were significantly correlated with task correctness in T2 for ASD parent-child pairs;correlation analysis between eye tracking and IBS showed that IBS values for channel 7 for TD parent-child pairs were significantly and positively correlated with the total amount of time that TD children focused on their parent’s hand and significantly and negatively correlated with the total amount of time that they focused on their own blocks;correlation analysis between task behavior and eye tracking showed that the total amount of time that ASD children focused on their own blocks was significantly and positively correlated with task correctness in T3.ConclusionThere is a potential neurological correlation between the performance of interbrain synchrony in frontal eye movement(FEF),medial prefrontal(m PFC),and dorsolateral prefrontal cortex(DLPFC)brain regions and various visual attention indicators and social interactions in children with ASD,which can be potential indicators for the assessment and prognosis of social interaction in children with ASD,and dynamic imitation and turn-taking games are effective intervention components of PMI,helping to promote behavioral performance and visual attention in social situations for children with ASD. |
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