نوع مقاله : مقاله پژوهشی

نویسندگان

• سارا روحانی ¹
• محمد نریمانی ²
• نادر حاجلو ³
• رضا فرضی زاده ⁴

¹ کارشناس ارشد روان‌شناسی کودکان استثنایی، دانشگاه محقق اردبیلی، اردبیل، ایران

² استاد ممتاز گروه روان‌شناسی، دانشگاه محقق اردبیلی، اردبیل، ایران

³ استاد گروه روان‌شناسی، دانشگاه محقق اردبیلی، اردبیل، ایران

⁴ دانشیار گروه فیزیولوژی ورزشی، دانشگاه محقق اردبیلی، اردبیل، ایران

چکیده

تدوین مدل درمانی مبتنی بر رشد عصب محور جهت درمان حداکثری اختلالات عصب-تحولی ضروری به نظر می‌رسد. این پژوهش با هدف تدوین و بررسی اثربخشی روش نوآورانه‌ی درمان مبتنی بر تکثیر انبوه عصبی بر شاخص‌های تحولی و علائم اوتیسم کودکان طیف اوتیسم انجام شده است. روش پژوهش از نوع کیفی و کمی است. در بخش پژوهش کیفی از روش تحلیل محتوای کیفی از نوع استقرایی و سپس روش دلفی برای طراحی مبانی نظری و طرح عملیاتی درمان استفاده شد. پس از آن با استفاده از روش آزمایشی با طرح پیش‌آزمون‌-پس‌آزمون‌ با گروه کنترل، تعداد 30 آزمودنی ۳ تا ۵ سال دارای اختلال طیف اُتیسم از طریق روش نمونه گیری در دسترس انتخاب و به صورت تصادفی در دو گروه 15 نفری آزمایش و کنترل جای دهی شدند. مداخله به میزان 36 جلسه، طی 3 ماه و در قالب جلسات 45 دقیقه‌ای اجرا شد. ابزار سنجش آزمون گارس 3 و ASQ II بود. داده‌ها با روش مانکووا تحلیل شد. یافته‌ها حاکی از نتایج مثبت در حیطه‌ی حل‌مسئله؛ حرکات درشت؛ برقراری ارتباط و علائم اتیستیک (0.01>P) بود، اما این تغییرات در متغیرهای حرکات ظریف و رفتارهای شخصی- اجتماعی؛ دیده نشد. این چنین استنباط می‌شود که روش درمان مبتنی بر تکثیر انبوه عصبی موجب رشد و گسترش کارکردهای رشد محور و پایه‌ای (کلان) می‌شود، اما تأثیر مستقیم آن در بازه‌ی زمانی 3 ماهه بر کارکردهای خرد که غالباً نیازمند آموختن از محیط هستند قابل مشاهده نیست.

کلیدواژه‌ها

• مداخله‌ی عصب محور
• اختلال طیف اوتیسم
• شاخص‌های تحولی
• درمان مبتنی بر تکثیر انبوه عصبی

عنوان مقاله [English]

Formulation and Effectiveness of Neuro Exuberant Proliferation Therapy on Developmental Indicators and Symptoms of Children with Autism Spectrum Disorder

نویسندگان [English]

• Sara Rouhani ¹
• Mohammad Narimani ²
• Nader Hajloo ³
• REZA Farzizadeh ⁴

¹ M.A. in Psychology of Exceptional Children, University of Mohaghegh Ardabili, Ardabil, Iran

² Distinguished Professor, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

³ Professor, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

⁴ Associate Professor, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

چکیده [English]

Abstract
The formulation of a therapeutic model centered on neurology can be crucial for the effective treatment of neurodevelopmental disorders. This research investigates the development and evaluation of an innovative "Neuro-Exuberant Proliferation Therapy" as a treatment modality for symptoms and developmental indicators in children diagnosed with Autism Spectrum Disorder (ASD). A mixed-methods approach was employed. In the qualitative component, inductive qualitative content analysis was applied to formulate the theoretical foundations and operational plan of the therapy. In the quantitative phase, an experimental design with a pre-test-post-test control group was used to assess the treatment's effectiveness. A total of 30 participants aged 3-5 years with autism spectrum disorder were recruited through convenience sampling and randomly allocated into an experimental group and a control group, each with 15 individuals. The therapeutic intervention consisted of 36 sessions, each lasting 45 minutes, over a period of 3 months. The measurement tools used were the GARS-3 (Gilliam Autism Rating Scale) and the ASQ-II (Ages and Stages Questionnaires, Parent-Administered). Data were analyzed using the Mann-Whitney U test, revealing significant positive outcomes in the domains of problem-solving, gross motor skills, communication, and autistic symptoms (p < 0.01). However, these positive changes were not observed in the areas of fine motor skills and personal-social behaviors. It can be concluded that Neuro-Exuberant Proliferation Therapy has a positive impact on the development and reinforcement of broader, foundational (macro) functions. However, this intervention does not appear to have a significant direct effect on specific, learned (micro) functions within a 3-month period.
Keywords: Neuro-centered Intervention, Autism Spectrum Disorder, Developmental Indicators, Neuro Exuberant Proliferation Therapy
 
 
 
Extended Abstract

Introduction

Autism spectrum disorder is a neurodevelopmental disorder with a substantial prevalence rate and considerable potential for causing functional limitations. It is characterized by two primary features: persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behavior, interests, or activities (DSM-5). These symptoms pose significant challenges to the cognitive, communication, and social development of affected children (APA). The recent revisions in the DSM-5-TR emphasize the neurological underpinnings of autism spectrum disorder. Additionally, the theme chosen by the World Health Organization (WHO) for World Autism Awareness Day in both 2023 and 2024, which focuses on the necessity to transition toward a neurocentric approach, further underscores the significance of a neurological perspective in autism care.
It is crucial to recognize that autism spectrum disorder is primarily caused by defects in essential neurobiological processes such as neurogenesis, neuronal development, synapse formation, and synaptic plasticity, which disrupt the proper formation of layers of the cerebral cortex, as well as neural differentiation and signaling (Van Koten et al., 2008; Vegil et al., 2010; Parikshak et al., 2013; Gilbert & Manji, 2017). Among the various complications associated with children diagnosed with autism spectrum disorder, comorbid conditions such as depression, anxiety, attention deficit, hyperactivity, and sleep disturbances (Yang et al., 2022), along with cognitive-perceptual dysfunctions, executive dysfunction, and information processing difficulties, are commonplace (Weir et al., 2022). The collective accumulation of these functional and behavioral deficiencies culminates in increasingly divergent patterns of development from normative standards (Woznik et al., 2017). In examining autism spectrum disorder, two principal approaches come to light. The first approach focuses on addressing behavioral symptoms and remediating behavioral deficits via symptom-based interventions. Simultaneously, a neurodevelopmental perspective (which encompasses the researcher's viewpoint) prioritizes a developmental-oriented approach. Since development is intrinsically tied to the functionality of neuronal structures, transformation must originate from changes to those very structures (Chakraburty, 2021).
To effectively address this class of neurodevelopmental disorders through rehabilitation, it is imperative to identify interventions capable of instigating transformation in the neural development process and activating intrinsic self-repair mechanisms by harnessing the adaptive capabilities of the nervous system. Studies have revealed that certain techniques traditionally employed solely for educational purposes can also stimulate brain function and promote neurogenesis. Aerobic exercise is one such intervention that falls into this category. Aerobic exercise functions by activating the cardiovascular system and increasing heart rate while simultaneously pumping greater amounts of oxygen to the brain (Datta, 2019). Another highly effective intervention within the field of neurodevelopmental disorders is sports training. This is significant given that anomalies in the central oxytocinergic and serotonergic systems are recognized as a root cause behind the social-functional deficits exhibited by individuals diagnosed with autism spectrum disorder (Mohdi et al., 2013). It has been documented that sports training can help modulate this metabolism (Mohdi et al., 2013), which furthermore diminishes disruptive behaviors such as aggression.
The essence of this research revolves around the deliberate design of a therapeutic approach, coined as "Neuro-Exuberant Proliferation Therapy" by the researcher. This approach embodies a comprehensive, neurodevelopmental orientation, taking into account the dimensions and scope of the impairment and the unique individual variations of each child. By applying principles of play therapy, a targeted regimen of exercises is implemented to achieve desired transformational outcomes. The differentiation of the "Neuro-Exuberant Proliferation Therapy" method from traditional utilization of sports or mental exercises lies in its emphasis not only on employing the principle of synergy but also on directly targeting the activation of brain structures, fostering neurogenesis, and promoting neural network formation through behavioral interventions.
The execution model of "Neuro-Exuberant Proliferation Therapy" adheres to the mind's networking model, which pertains to the utilization of cognitive and executive functions. The exercises employed are designed to mimic the developmental stages of children's cognitive and executive functions. This modeling approach facilitates the activation of brain networks associated with cognitive tasks and decision-making. The foundational theory behind the Neuro-Exuberant Proliferation Therapy (NEPT) methodology is centered on the premise that the proliferation of beneficial neurons leads to the formation of developmental stages and milestones. Over time, this process leads to the elimination of non-useful neuronal pathways. From this perspective, exercises have been selected that are extensively researched and proven to yield significant neurodevelopmental advancements, specifically those categorized as "exuberant proliferation."

Literature Review

The meta-analysis conducted by Delani (2021) reveals that employing aerobic exercise, particularly at high intensity, is highly effective in mitigating the symptoms associated with autism spectrum disorder. Some observed effects of this intervention include a reduction in stereotyped behaviors and repetitive movements, as well as improvements in sleep pattern regularity and attention span. According to Delani (2021), these findings have the potential to substantially influence the design of therapy programs and the organization of special education in schools. Additionally, recent research by Jackson et al. (2022) highlights that performing aerobic exercises synergistically can yield even more substantial positive effects.
It has also been observed that when these exercises are performed intermittently at a high intensity and at a moderately to intensely challenging level, they can lead to significant enhancements in cognitive flexibility and social performance among individuals (Mamari et al., 2017). Sensory integration plays a pivotal role in the effectiveness of these interventions. Researchers have observed that the successful integration of sensory inputs, encompassing the proprioceptive (body position), vestibular (balance and movement), and interoceptive (internal bodily sensations) systems, has a profound impact during combined exercise training. This integrated sensory input is critical for developing the skills necessary for participating in a broad spectrum of daily activities (Miller et al., 2014).

Methodology

The research employed a mixed-methods approach, being both fundamental and applied in nature. To design and assess the desired intervention, the Goodman Delphi method (1987) was utilized. In the first step, the "pre-clinical stage," an extensive review of scientific databases was conducted using the keywords "Neurodevelopment," "Autism," and "Proliferation." A total of 103 studies demonstrating the highest reported rates of neurodevelopmental progress in children diagnosed with neurodevelopmental disorders, particularly autism spectrum disorder, were identified and collected for reference.
The review process, specifically the second step in the research methodology, involved the selection of 15 meta-analysis studies that comprehensively assessed recent research and included larger sample sizes with input from a broad group of expert researchers. The theoretical foundations and main aspects of the desired treatment method were extracted from these studies, in accordance with neurological functions and aligned with relevant specialized texts. The initial treatment plan was subsequently developed under the supervision of psychology professors. The principles, techniques, and theoretical and functional areas considered by the author in designing the chosen treatment method were presented to relevant field experts. These experts evaluated the components and provided feedback, which the author incorporated into the final intervention.

Results

The comparative analysis of the average scores of the subjects in the experimental group between the pre-test and post-test phases demonstrates a favorable progression in the attributes linked to communication, gross motor skills, and problem-solving abilities. The findings indicate a significant impact of the intervention strategy on these three specific factors.
The research data reveal statistically significant improvements in the problem-solving (p = 0.000), communication (p = 0.008), and gross motor skills variables. These three factors also exhibit substantial effect sizes of 43%, 27%, and 26%, respectively. Notably, the personal-social skills and fine motor skills variables, while showing change, were not statistically significant (p = 0.427 and p = 0.221, respectively) and did not demonstrate substantial effects within the three-month study period.
Table 1- The results of multivariate analysis of covariance of ASQ scales




Eta Squared


Level of Significance


F


Mean Square


Degree of Freedom


Sum of Squares


Source




0.269


0.008


8.458


246.637


1


246.637


Communicating




0.256


0.009


7.896


157.877


1


157.877


Gross Movements




0.064


0.221


1.586


4.948


1


4.948


Subtle Movements




0.430


0.000


17.334


161.24


1


161.24


Problem Solving




0.028


0.427


0.653


8.854


1


8.854


Personal-Social Skills




The GARS-3 test scores of the experimental group show considerable improvement between the pre-test and the post-test assessment across all dependent variables. According to the results obtained during the post-test phase, the NEPT method was found to be effective in addressing symptoms related to repetitive and stereotyped behaviors (67%), social interactions (57%), social communication (57%), and emotional reactions (67%). The overall efficacy of the therapy on the total symptoms of autism is estimated at 86%.
Table 2- Mancova test results of GARS-3 Gilliam autism scales




Eta Squared


Level of Significance


F


Mean Square


Degree of Freedom


Sum of Squares


Source




0.674


0.000


47.507


51.252


1


51.252


Stereotyped Behaviors




0.567


0.000


30.091


17.696


1


17.696


Social Interactions




0.570


0.000


30.531


5.936


1


5.936


Social Communication




0.675


0.000


47,860


11.418


1


11.418


Emotional Reactions




0.865


0.000


147.814


392.869


1


392.869


All Symptoms of Autism





Discussion

The findings align with several preceding meta-analytical studies pertaining to stereotypic behaviors, obsessive interests, and emotional reactions (Elliott et al., 1994; Seliberti et al., 1997; Long et al., 2010; Delaney, 2021). However, certain other investigations, such as Linderman et al. (1999), display conflicting results. These discrepancies can be attributed to various factors, including the age of the children at intervention, session quality, the combination of exercises, the level of the child's engagement in activities, and the number of sessions provided.
Studies conducted by Schaff et al. (2014), Basu et al. (2017), and Hong et al. (2020) corroborate the findings of this research. These researchers highlight that aerobic exercise leads to increased levels of brain-derived neurotrophic factor (BDNF), which supports the expansion of neural networks. This process results in modified behavioral patterns through heightened flexibility and the formation of new neural connections (Lees & Hopkins, 2013; Mandelsi et al., 2018; Arida et al., 2021).
Numerous meta-analyses, including those conducted by Liao et al. (2015), Basu et al. (2017), Hong et al. (2020), Jia et al. (2022), and Li et al. (2023), affirm the overall positive influence of aerobic exercise on cognitive performance, tasks related to the prefrontal cortex, and its beneficial impact on emotional states, mood, and emotional regulation. This positive effect can be attributed to the mechanisms of action of brain-derived neurotrophic factor (Caro et al., 2003) and nerve growth factors.

Conclusion

It can be stated that the NEPT method, as an initial behavioral intervention with a neurodevelopmentally oriented approach, has demonstrated considerable effects on developmental factors. Emphasizing the importance of development, rehabilitation must transcend survival and focus on nurturing growth. The NEPT method has the potential to spark a profound transformation in the realm of rehabilitation by shifting the focus from survival to comprehensive development.

کلیدواژه‌ها [English]

• Neuro-centered intervention
• autism spectrum disorder
• developmental indicators
• neuro exuberant proliferation therapy