Two-year follow-up of 90 children with autism spectrum disorder receiving intensive developmental play therapy (3i method).

BACKGROUND: The Intensive, Interactive, and Individual (3i) intervention approach aims to decrease the severity of autism spectrum disorder (ASD) using intensive developmental play therapy (3i). We performed a retrospective study of 90 children who were enrolled for 2 years in the 3i approach to assess changes and predictors of changes in ASD severity at follow-up (FU). METHODS: The ASD severity of all patients (N = 119) who began 3i intervention between 2013 and 2018 was systematically measured using the childhood autism rating scale (CARS) and autism diagnosis interview-revised (ADI-R). Among them, 90 patients (mean age 5.6 ± 3.7 years) had a second assessment at the 2 year FU. CARS and ADI-R scores after 2 years of 3i intervention were compared to baseline scores using paired student's t-tests. We used multiple linear regression models to assess the weight of baseline variables (e.g., age, oral language, sex, treatment intensity) on changes at the 2 year FU. RESULTS: Mean CARS and ADI-R subscores (interaction, communication, repetitive behaviour) decreased significantly by 20, 41, 27.5 and 25%, respectively (effect sizes: d > 0.8). Moreover, 55 and 46.7% of participants switched to a lower category of ASD severity based on the CARS scale and ADI-R interview, respectively. Multiple linear models showed that (i) a higher treatment intensity (more than 30 h per week) was significantly associated with a greater decrease (improvement) in the ADI-R interaction score; (ii) patients categorized as verbal subjects at baseline were associated with a better outcome, as ascertained by the CARS, ADI-R interaction and ADI-R communication scores; and (iii) older patients were significantly associated with a greater decrease in the ADI-R interaction score. However, we found no impact of sex, severity of ASD or comorbidities at baseline. CONCLUSION: This study performed on 90 children suggests that 3i therapy may allow for a significant reduction in ASD severity with improvements in interaction, communication, and repetitive behaviours. A study using a control group is required to assess the efficacy of 3i play therapy compared to other interventions.

[Effects of pony-assisted therapy on the behavior of older people with neurocognitive disorders living in nursing homes]. / Effets de la thérapie assistée par le poney sur le comportement des personnes âgées ayant des troubles neurocognitifs vivant en Ehpad.

CONTEXT: Experienced in psychomotricity in two nursing homes, pony-assisted therapy shows first positive effects on psycho-behavioral symptoms. Recognized in the field of disability and psychiatry, this form of therapy is not developed in gerontology. OBJECTIVES: To measure the effects of this therapy on the behavior of elderly people with neurocognitive disorders living in long-term care and especially on the involvement in this activity. Anxiety and apathy were chosen as the measurement criteria. METHODS: An intervention study with an experimental cross-study design was conducted over two months for 23 subjects. An intervention group was studied during a period with TAP and a period without TAP. Another group without intervention was also studied. All participants were assessed before and after intervention with the NPI-R scale. The engagement during two TAP sessions and one animation time was also evaluated with the ECPAI scale. RESULTS: In the crossover study, positive engagement is more important in participant/pony interaction than in participant/facilitator interaction (p<0.01). The ECPAI score reflecting apathetic behavior was significantly decreased during interaction with the animal than in the interaction with the facilitator in patients undergoing therapy (p<0.01). The ECPAI score reflecting engagement is greater in pony interaction for participants in therapy than in the control group in facilitator interaction (p<0.01). There is no significant change in the scores for the anxiety and apathy items on the NPI-R scale. CONCLUSION: TAP participates in the positive engagement of the elderly people in the interaction with the animal. These results are consistent with the conclusions of the studies on animal mediation and confirm the clinical observations collected. TAP could work by improving self-esteem and valuing all of the person's preserved abilities.

Clinical outcomes of interactive, intensive and individual (3i) play therapy for children with ASD: a two-year follow-up study.

BACKGROUND: The outcomes of psycho-educational interventions for Autism Spectrum Disorders (ASDs) comorbid with severe to moderate intellectual disability (ID) are insufficiently documented. In this prospective study, we examined a developmental individual, interactive and intensive approach, called the '3i method', which is based on play therapy. METHODS: Twenty DSM-IV-TR ASD subjects (mean chronological age 63.8 ± 37.8 months; mean developmental age 19.5 ± 6.6 months) were included and followed the 3i method for 24 months. Developmental and behavioural skills were assessed at baseline and after 24 months using the VABS, PEP-R and Nadel Imitation scale. Autism severity was evaluated using the Child Autism Rating Scale (CARS) and the Autism Diagnostic Interview (ADI-R). RESULTS: After 2 years of the 3i method, our 3 primary outcome variables significantly increased (VABS developmental age of socialization increased by 83%, age of communication by 34%, and Nadel Imitation score by 53%). Almost all VABS and PEP-R domains significantly improved. Additionally, increases in the VABS socialization score were positively correlated with the total number of treatment hours and CARS score; all ADI-R areas significantly decreased; and diagnoses had changed in 47.5% of the subjects (37% for PDD-NOS and even 10.5% for ID without PDD). CONCLUSION: Children who followed the 3i method for 2 years had significantly improved behavioural and developmental skills and showed a clear decrease in autism severity. These results suggest that the 3i method may be useful for autistic children by improving their daily interactions with their social environment. TRIAL REGISTRATION: was retrospectively registered on May 20th, 2014 by the French Agency for drug and health (ANSM) under number ID-RCB 2014-A00542-45, reference: B148558-31.

Microbiota-mitochondria inter-talk: consequence for microbiota-host interaction.

New discoveries in metagenomics and clinical research have highlighted the importance of the gut microbiota for human health through the regulation of the host immune response and energetic metabolism. The microbiota interacts with host cells in particular by intermingling with the mitochondrial activities. This mitochondria-microbiota cross-talk is intriguing because mitochondria share many common structural and functional features with the prokaryotic world. Several studies reported a correlation between microbiota quality and diversity and mitochondrial function. The mitochondrial production of reactive oxygen species (ROS) plays an important role during the innate immune response and inflammation, and is often targeted by pathogenic bacteria. Data suggest that excessive mitochondrial ROS production may affect ROS signaling induced by the microbiota to regulate the gut epithelial barrier. Finally, the microbiota releases metabolites that can directly interfere with the mitochondrial respiratory chain and ATP production. Short chain fatty acids have beneficial effects on mitochondrial activity. All these data suggest that the microbiota targets mitochondria to regulate its interaction with the host. Imbalance of this targeting may result in a pathogenic state as observed in numerous studies. The challenge to find new treatments will be to find strategies to modulate the quality and diversity of the microbiota rather than acting on microbiota metabolites and microbiota-related factors.

Physiological correction of lingual dysfunction with the "Tongue Right Positioner": Beneficial effects on the upper airways.

Several studies have demonstrated the beneficial role of functional tongue therapy in stabilizing treatments for dental malocclusion and treating sleep-disordered breathing (SDB). The aim of this retrospective study was to evaluate the effect on the upper airways of the Tongue Right Positioner device (TRP) used for the correction of atypical swallowing. We analyzed lateral headfilms of 94 orthodontic patients aged between 11 and 17, before the start of treatment and after establishment of mature swallowing, treated with the TRP (TRP group) or by reeducation exercises (control group). In the TRP group, the establishment of mature swallowing occurs twice as fast as in the control group. This led to thinning of the floor of the mouth (-8.38%, P<0.001) linked to anteroposterior enlargement of the pharynx (+10.48%, P<0.01), both probably due to an increase in genioglossal and styloglossal muscle tone and correction of cranio-cervical posture (+2.52%, P<0.01). These results are not dependent on the type of orthodontic treatment. They suggest that the TRP could be used in the treatment of SDB.