Analyzing the efficacy of improvisational music therapy as a treatment method for children with ASD

The field of CSD relies on evidence-based practice or the notion that all therapy and evaluation procedures are determined by clinical opinion or reliable research. Several studies have been conducted on the efficacy of music therapy as a treatment method for children with autism; however, this method is not widely practiced by speech-language pathologists. This literature review outlines the results, strengths and weaknesses of 14 studies on the efficacy of music therapy for children with ASD. The studies were an average of 20 weeks, with 1-3 sessions per week ranging from 30-60 minutes. The sessions were all conducted by music therapists and included both individual and group sessions. The studies revealed music therapy leads to significant improvement for children with ASD in the following areas: joint attention, eye gaze, turn-taking, selective attention, expressive language, Social-emotional reciprocity, motor skills, and emotional synchrony. The paper also includes relevant background information on why music therapy works especially well for children with ASD, and suggestions for practical clinical implementation and future research. The overarching goal of this paper is to encourage SLPs to explore the research that exists outside of play-based therapy in order to ensure the best possible treatment and outcomes for children with ASD.Communication Sciences and Disorder

ISLAMIC PSYCHOLOGY IN TREATING VICTIMS OF CHILD SEXUAL ABUSE (Family Therapy and Story Telling Therapy) IN TREATING VICTIMS OF CHILD SEXUAL ABUSE

The purpose of this study was to describe the changes experienced by the subjects after family therapy and storytelling therapy. This research used descriptive qualitative study with Curative Therapy methods and the Observational Analysis. Subjects of the research were two children in their middle childhood (6-8 years) who were chosen through purposive sampling, their families were included in the therapy, and live in Semarang. Islamic Psychological approach were applied through family therapy in the form of understanding of the nature of sexual identity of children, understanding puberty, giving family support, as well as doing of Islamic religious ritual by reviewing the interpretation on the Qur'an and Sunnah with the child and planting the moral and beliefs in the family. Those efforts were accompanied by storytelling therapy based on Islamic psychology approach, namely through the implementation of Islamic siroh through storytelling and role playing. The results shows that the impact of sexual violence to the subjects are reluctant to go to school, have a sense of inferiority, tend to withdraw from society, experience irritability and aggressiveness. When the subject and family participate in the therapy for 6 months, it can be seen that those children showed a noticeable progress in their behavior by getting back to school, showing their happiness, starting to play with their friends although the intensity was still less than usual. Another finding in the study is the formation of family cohesiveness. Treatment will continue until the next 1-2 years, and it is expected that it will become a habit in the family

Psychotherapeutic Techniques and Play Therapy with Children Who Experienced Trauma: A Review of The Literature

This research examined the use of Play Therapy with children who have experienced emotional, physical or psychological trauma. Past research supports other therapeutic modalities as being effective with children after a traumatic experience, though the validity of play therapy lacks comprehensive quantitative and qualitative support. Based on the concept that play is the natural language of children, this form of treatment is developmentally appropriate, specifically with children under the age of twelve. For the purposes of this research, trauma was categorized in to Type 1 (single occurrences) and Type 2 (recurring trauma). A review of the literature found that although there has been an increase in the use of play therapy, there are disparities in the suggested styles; directive versus child-centered. Though play therapy is becoming increasingly more validated, the field lacks longitudinal studies and research outside of the United States

Tumor-associated and immunochemotherapy-dependent long-term alterations of the peripheral blood NK cell compartment in DLBCL patients

Natural Killer (NK) cells are a key component of tumor immunosurveillance and thus play an important role in rituximab-dependent killing of lymphoma cells via an antibody-dependent cellular cytotoxicity (ADCC) mechanism. We evaluated the phenotypic and functional assets of peripheral blood NK cell subsets in 32 newly-diagnosed diffuse large B-cell lymphoma (DLBCL) patients and in 27 healthy controls. We further monitored long-term modifications of patient NK cells for up to 12 months after rituximab-based immunochemotherapy. At diagnosis, patients showed a higher percentage of CD56dim and CD16C NK cells, and a higher frequency of GrzBC cells in CD56dim, CD56bright, and CD16C NK cell subsets than healthy controls. Conversely, DLBCL NK cell killing and interferon g (IFNg) production capability were comparable to those derived from healthy subjects. Notably, NK cells from refractory/relapsed patients exhibited a lower “natural” cytotoxicity. A marked and prolonged therapy-induced reduction of both “natural” and CD16- dependent NK cytotoxic activities was accompanied by the down-modulation of CD16 and NKG2D activating receptors, particularly in the CD56dim subset. However, reduced NK cell killing was not associated with defective lytic granule content or IFNg production capability. This study firstly describes tumor-associated and therapy-induced alterations of the systemic NK cell compartment in DLBCL patients. As these alterations may negatively impact rituximab-based therapy efficacy, our work may provide useful information for improving immunochemotherapeutic strategies

Use of the STAR PROCESS for Children with Sensory Processing Challenges

Background: This study examined the effectiveness of the STAR PROCESS, an intensive, short-term intervention that combines principles of sensory integration, relationship-based therapy, and parental-therapist collaboration for children with sensory processing challenges. Method: A nonconcurrent multiple baseline, repeated measures design was used. Four boys, aged 5 years 0 months to 7 years 9 months, participated in this study. The mean length of intervention was 22 sessions delivered 3 to 5 times per week. A behavioral coding system was used to measure change in four areas: play level, positive affect, joint attention, and novel use of equipment. The theory of change reflects the use of multisensory experiences in combination with parent participation to impact outcomes. Results: Improvement was noted in play level in all of the participants. Multisensory experiences and parent participation were associated with these changes in two participants. Discussion: The study results suggest a feasible methodology to study occupational therapy interventions. The behavioral coding system was sensitive to change. Play abilities changed in all four children. Preliminary support was provided for the theory of change combining multisensory experiences with parent participation. Conclusion: A targeted treatment approach that emphasizes parents as play partners in a multisensory environment shows promise in remediating these deficits

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

Background/aim. In South Africa, contextual factors have been identified as barriers to outdoor, unstructured play. The human immunodeficiency virus (HIV) and resulting progressive HIV encephalopathy (PHE) is a pandemic in this area, associated with development delays that are not addressed by highly active antiretroviral treatment (HAART). This study aimed to describe the playfulness in children with HIV and PHE on HAART living in challenging socioeconomic areas in South Africa aged 6 months to 8 years and to evaluate the feasibility and preliminary effectiveness of a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for improving play. Methods. A feasibility randomized control trial allowed for comparison of PICIHBI and conventional one-on-one occupational therapy interventions. Children were filmed playing pre-, mid-, and postintervention, using the Test of Playfulness (ToP) to assess playfulness. The PICIHBI comprised of 10 monthly sessions facilitated by an occupational therapist, involving group discussions with caregivers and periods of experiential play. Results. Twenty-four children with HIV and/or PHE were randomized into one of the two intervention groups. Overall, the group (n = 24) had a median score of 0 (lowest item score) on nine of 24 ToP items and only had a median score of 3 (highest score) on two items. Pre- to postintervention overall ToP scores improved marginally for the PICIHBI group (n = 12) and the conventional group (n = 12). Between-group differences were not significant. The PICIHBI group demonstrated a significant increase in one ToP item score at midassessment. No significant ToP item changes were found in the conventional group. Conclusion. Children with HIV were found to have the most difficulty on ToP items relating to the play elements of internal control and freedom from constraints of reality. The PICIHBI did not significantly improve children’s play and was not more effective than the conventional intervention. Considerations for feasibility and effectiveness, including barriers to attendance, are discussed

Thrombotic Thrombocytopenic Purpura, Moschcowitz Syndrome

The authors present a case of a 16-year-old boy, who was referred to the hospital due to thrombocytopenia, anemia, proteinuria and hyperbilirubinemia. Based on the clinical picture and the laboratory data, thrombotic thrombocytopenic purpura (TTP) was diagnosed. The adequate therapy was immediately started. TTP is quite a rare entity. The etiology and the pathogenesis are not well defined. The authors summarize the different pathomechanisms, which may play a role in the development of TTP. Similarity to the hemolytic uremic syndrome (HUS), therapeutic possibilities, prognosis and the outcome are also discussed. The importance of the early diagnosis of TTP in childhood, and life-saving effect of the adequate treatment are emphasized

IL-2 Therapy Diminishes Renal Inflammation and the Activity of Kidney-Infiltrating CD4+ T Cells in Murine Lupus Nephritis

An acquired deficiency of interleukin-2 (IL-2) and related disturbances in regulatory T cell (Treg) homeostasis play an important role in the pathogenesis of systemic lupus erythematosus (SLE). Low-dose IL-2 therapy was shown to restore Treg homeostasis in patients with active SLE and its clinical efficacy is currently evaluated in clinical trials. Lupus nephritis (LN), a challenging organ manifestation in SLE, is characterized by the infiltration of pathogenic CD4+ T cells into the inflamed kidney. However, the role of the Treg-IL-2 axis in the pathogenesis of LN and the mode of action of IL-2 therapy in the inflamed kidneys are still poorly understood. Using the (NZB × NZW) F1 mouse model of SLE we studied whether intrarenal Treg are affected by a shortage of IL-2 in comparison with lymphatic organs and whether and how intrarenal T cells and renal inflammation can be influenced by IL-2 therapy. We found that intrarenal Treg show phenotypic signs that are reminiscent of IL-2 deprivation in parallel to a progressive hyperactivity of intrarenal conventional CD4+ T cells (Tcon). Short-term IL-2 treatment of mice with active LN induced an expansion the intrarenal Treg population whereas long-term IL-2 treatment reduced the activity and proliferation of intrarenal Tcon, which was accompanied by a clinical and histological amelioration of LN. The association of these immune pathologies with IL-2 deficiency and their reversibility by IL-2 therapy provides important rationales for an IL-2-based immunotherapy of LN.DFG, SFB 650, Zelluläre Ansätze zur Suppression unerwünschter Immunreaktionen - From Bench to Bedsid

The Non-linear Trajectory of Change in Play Profiles of Three Children in Psychodynamic Play Therapy

Aim: Even though there is substantial evidence that play based therapies produce significant change, the specific play processes in treatment remain unexamined. For that purpose, processes of change in long-term psychodynamic play therapy are assessed through a repeated systematic assessment of three children's "play profiles," which reflect patterns of organization among play variables that contribute to play activity in therapy, indicative of the children's coping strategies, and an expression of their internal world. The main aims of the study are to investigate the kinds of play profiles expressed in treatment, and to test whether there is emergence of new and more adaptive play profiles using dynamic systems theory as a methodological framework. Methods and Procedures: Each session from the long-term psychodynamic treatment (mean number of sessions = 55) of three 6-year-old good outcome cases presenting with Separation Anxiety were recorded, transcribed and coded using items from the Children's Play Therapy Instrument (CPTI), created to assess the play activity of children in psychotherapy, generating discrete and measurable units of play activity arranged along a continuum of four play profiles: "Adaptive," "Inhibited," "Impulsive," and "Disorganized." The play profiles were clustered through K-means Algorithm, generating seven discrete states characterizing the course of treatment and the transitions between these states were analyzed by Markov Transition Matrix, Recurrence Quantification Analysis (RQA) and odds ratios comparing the first and second halves of psychotherapy. Results: The Markov Transitions between the states scaled almost perfectly and also showed the ergodicity of the system, meaning that the child can reach any state or shift to another one in play. The RQA and odds ratios showed two trends of change, first concerning the decrease in the use of "less adaptive" strategies, second regarding the reduction of play interruptions. Conclusion: The results support that these children express different psychic states in play, which can be captured through the lens of play profiles, and begin to modify less dysfunctional profiles over the course of treatment. The methodology employed showed the productivity of treating psychodynamic play therapy as a complex system, taking advantage of non-linear methods to study psychotherapeutic play activity

The Curative Power of Play: The Voices of Therapists around the World

It is important for all therapists to be culturally sensitive to children and their eco-systems as well as to be aware of the current trends and the changing application of play as a healing agent. The focus of this study is on the development of a current description of play by therapists from a global perspective through a thematic analysis of focus groups resulting in an explanation of how play contributes to healing and the practice of therapy. In this study, the naturalistic method of qualitative research (Bowers, 2009; Lincoln & Guba, 1985) was applied to the study of play around the world, resulting in a new description of “play”. The analyses of focus group meetings in Morocco, Singapore, Hong Kong, Canada and Europe resulted in the emergence of 8 themes: productivity through play, contribution to development, facilitation of the relationship through play, honouring diversity, collaboration between children and caregivers, stimulation through technology-based play, relaxation provided by play, and the devaluation of play. These themes, which are presented through the “voices of the participants”, together with the literature review, serve to enrich the changing description of play. With participants from all continents, a current global perspective highlights the changes that play, both as a concept and as a healing agent, has undergone and will continue to do so. New information emerged suggesting that technology has become a worldwide focus for children but has a paradoxical effect on their relationships