自闭症谱系障碍社交动机理论：机制及干预探索

自闭症谱系障碍(Autism Spectrum Disorder, ASD)表现为社会交往困难以及重复刻板兴趣或行为。社交动机理论提出ASD个体是由于社交动机缺乏导致的社交障碍。目前该理论缺乏理论元素及结构关系的系统论证, 及基于此理论的低龄ASD儿童群体的研究证据。本研究拟采用心理实验法、眼动及近红外脑成像技术, 探索低龄ASD儿童早期社交奖赏、社交定向异常眼动标记及眶额叶脑区活动的神经机制。此外, 通过音乐奖赏强化学习的干预方式改善该理论的核心元素(社交奖赏), 观测能否改善ASD儿童的社交动机。本研究的开展有望对该理论进行系统验证, 并形成改善社交行为的潜在干预方案。     

Structural connectivity between the hippocampus and cortical/subcortical area relates to cognitive impairment in schizophrenia but not in mood disorders

Cognitive impairment in schizophrenia and other psychiatric disorders is a challenge to be overcome in order to maintain patients' quality of life and social function. The neurological pathogenesis of cognitive impairment requires further elucidation. In general, the hippocampus interacts between the cortical and subcortical areas for information processing and consolidation and has an important role in memory. We examined the relationship between structural connectivity of the hippocampus and cortical/subcortical areas and cognitive impairment in schizophrenia, major depressive disorder and bipolar disorder. Subjects comprised 21 healthy controls, 19 patients with schizophrenia, 20 patients with bipolar disorder and 18 patients with major depressive disorder. Diffusion-weighted tensor images data were processed using ProbtrackX2 to calculate the structural connectivity between the hippocampus and cortical/subcortical areas. Cognitive function was assessed using the Brief Assessment of Cognition in schizophrenia composite score. Hippocampal structural connectivity index was significantly correlated with composite score in the schizophrenia group but not in the healthy control, major depressive disorder or bipolar disorder groups. There were no statistically significant differences in hippocampal structural connectivity index between the four groups. Structural connectivity between the hippocampus and cortical/subcortical areas is suggested to be a pathophysiological mechanism of comprehensive cognitive impairment in schizophrenia.     

EXPERIMENTAL ANALYSIS AND TREATMENT OF MULTIPLY CONTROLLED SELF-INJURY

A functional analysis of the self-injurious behavior (SIB) of 3 adults with profound developmental disabilities showed that each engaged in SIB in more than one assessment condition. Such outcomes may result from a failure to isolate the variable maintaining SIB, or they may reflect multiple sources of control over SIB. In order to identify more clearly the determinants of SIB, each subject was exposed to a series of treatments appropriate to one or both of the apparent functions of SIB. These treatments, applied sequentially on baselines appropriate to each behavioral function, identified the maintaining variables for SIB through differential outcomes across baselines. Results indicated that the SIB of 2 subjects was multiply controlled, confirming the outcomes of the functional analysis. However, the SIB of the 3rd subject was eliminated using a treatment designed for a single function, suggesting spurious results of the original assessment. Alternative interpretations of undifferentiated assessment data are discussed, as are analysis and treatment issues related to multiply determined behavior disorders.     

FUNCTIONAL COMMUNICATION TRAINING WITH AND WITHOUT EXTINCTION AND PUNISHMENT

Functional communication training has been reported to be a promising treatment for severe behavior problems. In this study, functional communication training alone and combined with extinction and/or punishment was evaluated for 4 clients with severe retardation, behavior problems, and communication deficits. The participants were inpatients on a hospital unit for treatment of severe behavior disorders. They received individualized interventions based on functional assessment that included reinforcement of a communication response with the same function as their destructive behavior. Results showed that for some patients, functional communication training was not sufficient to produce clinically significant reductions in destructive behavior, and the combination of training plus punishment produced the largest and most consistent reductions.     

HYPOTHESIS-BASED INTERVENTIONS FOR TANTRUM BEHAVIORS OF PERSONS WITH DEVELOPMENTAL DISABILITIES IN SCHOOL SETTINGS

We conducted a functional assessment of problem behaviors of 2 students with developmental disabilities in their classroom environments. Results of the assessments showed that although there were more tantrums in demand than in no-demand conditions, the function of the behavior was to gain attention (positive reinforcement) rather than to avoid or escape demands (negative reinforcement); demand conditions apparently served a discriminative function for the availability of attention. Therefore, intervention was based on the positive reinforcement hypothesis, resulting in a substantial reduction of tantrums for both subjects.     

Treatment of escape-maintained aberrant behavior with escape extinction and predictable routines

We evaluated the effects of two daily activity schedules on 2 participants' rates of aberrant behavior and their compliance. Functional analysis identified the operant function of the participants' aberrant behaviors to be escape from tasks. Participants were taught to use stimuli contained in daily schedules, and were tested based on a modified stimulus-equivalence model that consisted of flash cards and activity schedules comprised of words or photographs that corresponded to the participants' daily activities. On pretests, the participants demonstrated simple and conditional discriminations with the photographs but not with the printed stimuli. A time-delay procedure was used to teach the participants to name the flash cards. Following training, the printed activity schedules corresponded to lower rates of problem behavior and higher rates of compliance than the photographic activity schedules. Performance on posttests indicated the establishment of functional classes of stimuli involving the flash cards and activity schedules even though this type of correspondence was not directly trained.     

ANALYSIS OF A HIGH-PROBABILITY INSTRUCTIONAL SEQUENCE AND TIME-OUT IN THE TREATMENT OF CHILD NONCOMPLIANCE

This study evaluated the effectiveness of high-probability requests and time-out as treatments for noncompliance that appeared to be maintained by contingent attention in 2 developmental normal children. The introduction of high-probability requests increased compliance for 1 child but not the other. Time-out was effective with both children, and improvements in compliance were maintained at an 8-week follow-up.     

REDUCING ESCAPE BEHAVIOR AND INCREASING TASK COMPLETION WITH FUNCTIONAL COMMUNICATION TRAINING,EXTINCTION AND RESPONSE CHAINING

The effects of functional communication training, extinction, and response chaining on 3 subjects' escape-maintained aberrant behavior were evaluated using a multielement design. Functional communication training consisted of teaching subjects a verbal response that was functionally equivalent to their aberrant behavior. Subjects initially were allowed to escape from a task contingent on the trained verbal response. In subsequent treatment phases, escape was contingent on the trained verbal response plus the completion of the specified number of steps in the task (response chaining). The number of steps was increased until a subject completed the task to obtain a break. Results showed that the treatment reduced rates of aberrant behavior and that the chaining procedure was effective in decreasing the availability of escape.