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Highlights

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Both interventions reduced anxiety in children with ASD with no significant differences between the intervention groups.

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Physical exercise reduced anxiety at 12 and 16 weeks follow up.

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Physical exercise improved sleep at weeks 6 and 8.

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Physical exercise is a promising intervention in young children with ASD from underserved populations.

Abstract

Background

Anxiety is a frequent comorbidity in children with autism spectrum disorder (ASD). Physical exercise is a low cost and easy-to-access intervention with therapeutic benefits for reducing anxiety in adults and adolescents. There are currently no randomized controlled trials on the feasibility and efficacy of a physical exercise intervention to reduce anxiety in younger children with ASD.

Method

148 children (6-12 years old) with ASD were randomized into a clinical trial to evaluate the efficacy of an 8-week exercise protocol designed to reduce anxiety specifically in younger children with ASD. Participants were randomized to an exercise intervention group (N = 76) or sedentary activity LEGO/Minecraft group (N = 72). Both programs were administered 1-3 times weekly for 8 weeks. Anxiety was assessed via parent ratings with the Child Behavior Checklist DSM-5 anxiety subscale (CBCL DSM-5) at weeks 1, 3, 6, and 8 as well as follow up at weeks 12 and 16. Secondary outcome measures included child self-reported anxiety (Screen for Child Anxiety Related Disorders; SCARED), sleep (Child's Sleep Habits Questionnaire, CSHQ-ATN), physical activity level (Physical Activity Questionnaire, PAQ-C), and salivary cortisol measured at weeks 1, 3, 6, and 8.

Results

Parent-rated (CBCL DSM-5) and self-reported (SCARED) anxiety scores showed improvements at weeks 3, 6 and 8 in both groups with no significant differences between the physical exercise and sedentary activity (LEGO/Minecraft) groups. In addition, the CBCL DSM-5 anxiety scores decreased only in the physical exercise group at weeks 12 and 16 compared to baseline with no significant difference from LEGO/Minecraft group. Sleep also showed improvements during weeks 6 and 8 in the physical exercise group but not in the LEGO/Minecraft group with no significant differences between the groups. Physical activity level was significantly increased in the physical exercise group compared to the LEGO/Minecraft group at week 8. Salivary cortisol did not show any significant changes from weeks 1-8 or differences between groups.

Conclusion

Eight-week physical exercise and sedentary LEGO/Minecraft interventions reduced parent-rated and self-reported anxiety in 6-12-year-old underserved children with ASD with no significant difference between the intervention groups.

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The effects of a physical exercise program, LEGOR and Minecraft activities on anxiety in underserved children with autism spectrum disorder

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Both interventions reduced anxiety in children with ASD with no significant differences between the intervention groups. * Physical exercise reduced anxiety at 12 and 16 weeks follow up. * Physical exercise improved sleep at weeks 6 and 8. * Physical exercise is a promising intervention in young children with ASD from underserved populations.

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Impact of COVID-19 pandemic and school closure on the psychosocial well-beingof children & adolescents 

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Impact of COVID-19 pandemic and school closure on the psychosocial well-beingof children & adolescents 

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《新肺炎疫症對基層SEN家庭的影響》調查報告 

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《新肺炎疫症對基層SEN家庭的影響》調查報告 

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本會的特殊教育需要（SEN）兒童的媽媽於母親節發佈「新肺炎疫症對基層SEN家庭的影響」問卷調查報告，反映基層SEN兒童在疫症停課期間，針對SEN兒童的訓練和學習服務停頓，SEN兒童的規律生活被打斷，學習能力倒退，負面情緒和行為問題加劇。面對物資不足、支援不足、經濟困難等問題，照顧者和照顧對象在疫情下難以外出，雙方都被迫困在家中，照顧者情緒備受困擾，恐造成家庭悲劇。本會於2020年3月訪問了227名確診SEN兒童的家長，相關研究結果希望政府考慮在疫症新常態下，加強對基層清貧SEN兒童和照顧者的支援。

因新冠狀肺炎(COVID-19)疫症自2019年12月在中國湖北省武漢市爆發，其後疫症蔓延至全球各地，截至2020年5月9日，全球有187個國家（地區）傳出確診案例，病例數逾390萬餘人，超過27萬人喪命，致死率約7%[1] 。而本港共有確診/疑似個案1045宗，死亡個案有4宗，迄今為止全球感染人數和死亡人數均已超過2003年非典型肺炎（SARS）疫情，對香港的經濟無疑是雪上加霜，現時香港的旅遊、零售和飲食業等均受重創，而基層市民深受影響。

根據教育局定義SEN包括讀寫障礙、肢體傷殘、發展遲緩、聽障、視障、言語障礙和情緒問題。統計資料顯示(2018年)，全港共有1,027,100名18歲以下的兒童，確診SEN兒童 (學前和學齡) 至少有71,324人[2], 換言之6.9%兒童為確診SEN兒童，若加上懷疑個案，相關數字可能仍是低估。雖然自本年初，港府共推出三次共2,875億元的措施協助受影響的企業和市民，但未有針對兒童，尤其是針對特殊教育需要兒童和照顧者推出相關抗疫或支援措施。
2.1受訪SEN兒童超五成有注意力不足/過度活躍症，照顧者壓力俱增
是次調查中的SEN兒童全為基層兒童，有57.3%來自低收入家庭、32.2%為綜援家庭，而單親家庭和新移民家庭則各佔24.2%和14.1%。他們主要集中6-12歲兒童（佔57.3%）、其次為12-18歲兒童（21.6%），3-6歲兒童（18.5%），學前和18歲以上的兒童分別為2.2%和0.4%。他們當中的SEN類別最多的為注意力不足/過度活躍症（54.2%）、其次為言語障礙（佔35.2%）、讀寫障礙（28.6%）、情緒問題（23.8%）、自閉症（19.8%）、智力障礙（7%）、聽力障礙（4%）和肢體傷殘（0.9%），亦有11.9%的受訪者僅懷疑，無確診。
2.2居住劏房等不適切居所亦為壓力來源
居於劏房等不適切居所的受訪者，他們的居所都比較狹窄，過八成的SEN兒童居住面積不足200呎，更有51.4%的SEN兒童居於面積不足120呎的劏房內。但租金卻為$3,001-$5,000元（55.7%）、$5,001-$7,000元（佔27.1%）。居於出租私樓的基層兒童，其住屋環境明顯較居於公屋的學童差，家中環境，無論通風或衛生欠佳，照顧者均擔心留在劏房家中避疫未必安全。而照顧者當中亦有27.3%表示其情緒受到住屋問題的影響。

此外劏房擠迫，較多租住的SEN家長反應家中無書檯（17.6%）、沒有安裝上網（11.5%）、上網速度太慢（44.1%）或家中太吵，無法集中精神（41.4%），均反映租住不適切居所的SEN學生學習條件更差，這與家中租金負擔重，生活開支大，空間狹窄有密切關係。
2.3 清貧SEN學生難已應付網上教學
是次調查中，雖然所有學校都因防疫而停課，但74.4%的SEN兒童的學校均有佈置網上功課，54.6%的學校有網上教學，23.3%的學校要求學生自行列印習作做功課，僅39.2%學校派習作功課。對於基層學生來說，網上教學最大的阻礙源於家中的網絡和電腦問題。受訪者當中有44.1%覺得家中網速太慢，只有手機做功課、容量少/網速慢（38.3%）、無法列印習作（35.7%）、家中電腦太舊（33.9%）、不會做網上功課（33%）、家中無電腦/IPad（28.2%）、家中無書檯（17.6%）和家中無上網（11.5%）。可見若基層SEN兒童家中缺乏基本電腦和上網，或者擁有的電腦太慢亦阻礙網上學習，未能跟上學習進度。亦有受訪者表示家中只有一部電腦，若家中超過一名子女，不同學校的網上教學時間重疊，影響SEN子女的教學進度。

現時本港教育均強調電子學習，學生亦需完成網上功課或於網上搜集資料。但本次疫情期間，卻突顯基層學生家中缺乏電腦、電腦殘舊或者上網速度慢的詬病，亦從另一方面顯示社會多年來提及的縮窄學習上的數碼差距，並未有透過政府推出為綜援學生提供的上網費津貼或關愛基金援助項目-資助清貧中小學生購買流動電腦裝置項目得到改善。
2.4 兩成SEN兒童有託管需要，但近五成學校不提供託管服務
值得留意的是，受訪的SEN兒童的照顧者有22%表示需要託管服務，但他們當中有46.9%家長表示學校不提供託管服務，亦有44.9%的家長表示不清楚。在防疫期間，教育局主要宣佈各學校停課，亦呼籲學童停課不停學，鼓勵學校進行網上教學，雖然有建議學校開放校園，為有需要回校的學童提供支援等措施。但調查結果顯示亦有一定比例的學校未有為有需要回校的學童提供支援，甚至不知道學校是否有學童回校支援措施。

對於基層SEN兒童的家長來說，疫情期間仍有一份可維持生計的工作已屬難得，但如果因照顧SEN子女而無法工作，將有機會讓赤貧家庭陷入綜援網。此外即使家中有照顧者，但停課期間讓家長時間照顧兒童已屬因難，再加上要照顧有SEN的兒童（如專注力不足/過度活躍症或自閉症兒童），無疑對家長來說更是雪上加霜。可見學校為有需要的學生提供返校支援或託管服務極為重要。
2.5 絕大部分針對SEN的支援服務受疫情影響嚴重
是次調查中，在疫情前最多SEN學生參加的服務為醫院覆診（44.9%）、小學或中學提供的興趣班和學習班（38.9%）、學校提供的治療性服務（如情緒、行為小組和訓練等）30%和坊間或社區提供的興趣班和學習班（29%）。疫情發生後，幾乎所有服務均受影響，特別是於學校或坊間舉行的興趣班、學習班和治療性服務等。值得留意的是醫院覆診和排期評估服務亦受影響。而相關支援服務，對改善SEN學生情緒和行為等均有重要意義，若SEN學生在停課期間常期留在家中，缺乏與朋輩師長的互動，亦缺乏適當運動，對SEN學生均有負面影響。

雖然根據教育局建議，學校要做到停課不停學，除了網上學習支援外，在控制適當人數的前提到，教育局應要求各學校在疫症期間，分時段給SEN學生提供支援服務，特別優先予出現嚴重負面情緒和行為的SEN兒童。

而根據社會福利署建議，政府宣佈在實施針對性措施減低社交接觸和採取預防感染措施的前提下，受資助的幼兒中心、庇護工場及展能中心等均停止服務，但各中心會按情況開放予有特別需要的服務使用者；而綜合家庭服務中心和綜合服務中心只提供個案服務；殘疾人士社交及康樂中心、綜合青少年服務中心、社區中心等大部分受資助單位的中心均不對外開放，但維持有限度服務，但不提供小組和活動性服務，服務單位內供公眾人士使用的地方(如資源角、遊戲角等)暫停使用。而本港絕大多數的非牟利社福機構均會參考社署的指引。社署應該建議各中心在疫症期間，在避免人群聚集的安全前提下，分時段分人數安排SEN兒童前往參加支援服務。
2.6 最擔心缺乏抗疫物資和子女問題
是次調查中，SEN兒童的照顧者當中有99.6%的家長情緒都受到很大影響或一定影響。95.1%的受訪者表示他們在疫症期間，均覺得照顧SEN子女更困難。而他們在疫情期間也擔憂不夠抗疫物資，例如口罩（81.1%）、照顧SEN子女（78.9%）、家庭經濟（76.7%）和怕感染（74.4%）。

是次疫情爆發，口罩等抗議物資嚴重不足，不少藥房或商鋪大幅抬高抗疫物品售價謀取暴利，如索價$300-200元一盒口罩，沒有經濟能力的基層市民根本無法負擔購買抗疫物資。當局應考慮將涉及基本生活所的商品，納入法例之列，如將口罩納入《儲備商品條例》之中，並維持不少於三個月甚至半年的供應，避免出現炒風。或者效仿澳門，市民可憑身份證，每人每次購買一定數量的成人和兒童口罩，避免公眾出現極大恐慌和不安。

在SEN子女停課期間，讓照顧者最困擾的SEN子女問題為功課問題（87.7%）、情緒（80.2%）、網上功課（74.9%）、子女行為（68.3%）、與子女的相處矛盾（65.2%）、子女社交問題（51.1%）和子女的覆診（41.4%）。雖然疫情期間通過停課，避免市民外出感染病毒的政策無可厚非，但卻亦引發SEN子女學業、情緒和行為，與父母衝突等負面影響。當局應在疫情緩和時，為避免聚集人數過多，分時段分流規定SEN子女和照顧者提供支援服務。
2.7 照顧者身心疲憊，超過八成在最近兩個月有自殺念頭
是次調查中有22.9%的受訪者需要服用精神科藥物（如安眠藥），更有超過八成（83.3%）的照顧者表示最近兩個月有自殺念頭，可見照顧者的精神已處於崩潰邊緣，極需支援。停課，抑或針對SEN兒童的訓練和學習服務停頓，SEN兒童的規律生活被打斷，學習能力倒退，負面情緒和行為問題加劇。面對物資不足、支援不足、經濟困難等問題，照顧者和照顧對象在疫情下難以外出，雙方都被迫困在家中，恐造成家庭悲劇。

將抗疫物資綱入《商品條例》之中，訂立不少於3個月的社會需求儲備；

為基層SEN家庭提供額外津貼（包括居住劏房的租金津貼、SEN子女照顧津貼）等；

為基層學生提供針對恒常網上學習的電子設備（特別是電腦和寬頻上網），確保每一名清貧學生在疫情中或疫情後都可參與電子學習當中；

學校和社福機構分時段給SEN子女預約回校做功課、參加有限度訓練和支援服務；為照顧者提供針對SEN兒童的暫託服務，舒緩照顧者的照顧壓力。

讓參加幼稚園「資助學前康復服務」（特別是特殊幼兒中心）、幼稚園「到校學前康復服務試驗計劃」幼稚園「為輪候資助學前康復服務的兒童提供學習訓練津貼」服務的SEN學生可選擇延長服務一年。

[1] https://udn.com/news/story/120944/4299961

[2] 在公營中、小學就讀的SEN學生情況

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母親節 -《新肺炎疫症對基層SEN家庭的影響》調查報告 同心抗疫 支援SEN家庭 新聞稿 - SoCO

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本會的特殊教育需要（SEN）兒童的媽媽於母親節發佈「新肺炎疫症對基層SEN家庭的影響」問卷調查報告，反映基層SEN兒童在疫症停課期間，針對SEN兒童的訓練和學習服務停頓，SEN兒童的規律生活被打斷，學習能力倒退，負面情緒和行為問題加劇。面對物資不足、支援不足、經濟困難等問題，照顧者和照顧對象在疫情下難以外出，雙方都被迫困在家中，照顧者情緒備受困擾，恐造成家庭悲劇。本會於2020年3月訪問了2...

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支持自閉症者度過新冠肺炎下的不穩定時期 

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The more the brain is exercised, the stronger and more connected it becomes. The connections occur across the brain's grey and white matter. Grey matter is neural tissue that includes regions of the brain involved in muscle control, sensory perception (e.g., seeing, hearing), memory, emotions, speech, decision-making and self-control. White matter connects grey matter regions together.

That's the science. Here's how it plays out in the world of things, from learning a new language to navigating a new city:

Learning another language increases density in grey matter and strengthens white matter.

London taxi cab drivers have greater grey matter volume in mid-posterior hippocampus in comparison to London bus drivers.

Stroke survivors who engage in repetitive, increasingly challenging exercises can regain motor function.

Thought alone is associated with neuroplastic gains. Some aging piano performers prepare for concerts primarily through visualization instead of physical practice. Both approaches show the same motor mapping in an fMRI scan.

Regular mindfulness practice improves attention, memory and emotional regulation, increasing gray matter in parts of the brain that are responsible for these functions.,,

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The more the brain is exercised, the stronger and more connected it becomes. The connections occur across the brain's grey and white matter. Grey matter is neural tissue that includes regions of the brain involved in muscle control, sensory perception (e.g., seeing, hearing), memory, emotions, speech, decision-making and self-control.

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感知肌能訓練（特殊教育需要)學習綱要 - 第四章 - 感知肌能訓練課程策略

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Impact of COVID-19 on Youth With ADHD: Predictors and Moderators of Response to Pandemic Restrictions on Daily Life

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Impact of COVID-19 on Youth With ADHD: Predictors and Moderators of Response to Pandemic Restrictions on Daily Life

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Impact of the COVID-19 Pandemic on Children with ASD and Their Families: An Online Survey in China.

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Impact of the COVID-19 Pandemic on Children with ASD and Their Families: An Online Survey in China.

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Impact of the COVID-19 Pandemic on Children with ASD and Their Families: An Online Survey in China. | Psychol Res Behav Manag;14: 289-297, 2021. | MEDLINE

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Impact of the COVID-19 Pandemic on Children with ASD and Their Families: An Online Survey in China.

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https://www.psychology.hku.hk/sleep/SleepEducation/ControlOfSleep.html

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Improving executive function of children with ASD through cycling skill acquisition

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Improving executive function of children with ASD through cycling skill acquisition

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Improving executive function of children with ASD through cycling skill acquisition

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【體路專欄】在之前的文章裏，作者指出定期的運動訓練有助改善自閉症兒童的睡眠效率，減少刻板行為，增強情緒控制的能力，社交能力及認知能力，以及解釋了一些定期運動訓練在自閉症小孩身心發展的迷思。在文章刊登後，有些讀者電郵給作者時，不約而同的問了一個問題: 云云眾多的運動，什麼運動對自閉症兒童最為有用 ?

在解答這個問題之前，我們要先了解對象是什麼，即是說：什麼運動對自閉症兒童「的什麼」最為有用？因為不同的對象，有著不同的答案。

例如，什麼運動對自閉症兒童的睡眠最為有用 ? 我會回答：沒有特定的運動。從科研實證而言，只要能維持每天運動30分鐘或以上，就能改善自閉症兒童的睡眠質素。如有人問，有什麼運動對減少自閉症兒童的刻板行為最為有用？我會回答，視乎是什麼刻板行為。如果是有關手部的刻板行為，例如不斷的拍手，不斷的「捽」手，那麼，就以往的科研結果顯示，給孩子們拍拍球，持拍擊球會比較有效；如果是有關整個身體的刻板行為，例如不斷地搖擺身體，那麼就給孩子一些能運用全身肌肉的運動最為有效，例如游水、跑步、跳舞。如有人再問，有什麼運動能改善自閉症兒童的認知能力 ? 那我會回答，做一些需要運用腦筋的運動( cognitively engaging exercise) 比較有效。

最近，作者的研究團隊從運動對改善自閉症小朋友的認知能力作出更進一步的研究。在研究中，作者共招收了62名被診斷患有 ASD 的兒童（50 名男性和 12 名女性，Mage = 9.89±1.53 歲，Mheight = 1.43 ± 0.15 m，Mweight = 44.69 ± 11.96kg）。他們被隨機分為三組：1) 學習單車組; 2) 健身單車組; 3) 慢步組 (活動控制組)。研究為期兩星期，學習單車組需在十堂內（每堂約50分鐘）學習怎樣踏兩輪單車，而健身單車組則需在十堂內（每堂約30分鐘）踏健身單車，至於慢步組則需在兩星期內每天慢行30分鐘。研究團隊在研究前後一星期內收集了他們認知能力的數據。結果顯示，學習單車組在各項認知能力評估中（計劃、工作記憶、靈活性和抑制）都有顯著的改善，而十分驚訝地，其餘兩組均沒有明顯的改善。研究團隊認為，如欲透過運動改善小朋友的認知能力，最佳的選擇便是學習一種新的運動技能。因為在學習過程中，學習者必須運用其認知能力，從而鍛鍊認知能力。

References

Bass, M. M., Duchowny, C. A., et al. (2009). The effect of therapeutic horseback riding on social functioning in children with autism. Journal of Autism Developmental Disorder; 39: 1261.

Brand, S., Jossen, S., Holsboer-Trachsler, E. et al. (2015). Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders - a pilot study. Neuropsychiatric Disease and Treatment; 11:1911-20.

Bremer, E., Crozier, M., et al. (2016). A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism; 20: 899-915.

Pan, C.Y., Chu, C.H., Tsai, C. L, et al. (2017). The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder. Autism;2: 190-210.

Tse, A. C. Y., Anderson, D., Liu, H. L. & Tsui, S. L. S. (2021). Improving executive function of children with ASD through cycling skill acquisition. Medicine & Science in Sports & Exercise, 53, 1417-1424.

Tse, A. C. Y. (2020). Brief report: Impact of a physical exercise intervention on emotion regulation and behavioral functioning in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50, 4191-4198.

Tse, A. C. Y., Lee, P.H., Chan, K.K.S., Edgar, B.V., Wilkinson-Smith, A., & Lai, W.H.E (2019). Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: a randomized controlled trial. Autism, 23, 1699-1710.

作者：謝采揚博士
現為香港教育大學健康及體育系副教授及署理系主任

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運動心理學淺談（59）：什麼運動對自閉症兒童最為有用 ? - 體路 Sportsroad

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【體路專欄】在之前的文章裏，作者指出定期的運動訓練有助改善自閉症兒童的睡眠效率，減少刻板行為，增強情緒控制的能力，社交能力及認知能力，以及解釋了一些定期運動訓練在自閉症小孩身心發展的迷思。在文章刊登後，有些讀者電郵給作者時，不約而同的問了一個問題: 云云眾多的運動，什麼運動對自閉症兒童最為有用 ? 在解答這個問題之前，我們要先了解對象是什麼，即是說：什麼運動對自閉症兒童「的什麼」最為有用？因為不同的對象，有著不同的答案。 例如，什麼運動對自閉症兒童的睡眠最為有用 ? 我會回答：沒有特定的運動。從科研實證而言，只要能維持每天運動30分鐘或以上，就能改善自閉症兒童的睡眠質素。如有人問，有什麼運動對減少自閉症兒童的刻板行為最為有用？我會回答，視乎是什麼刻板行為。如果是有關手部的刻板行為，例如不斷的拍手，不斷的「捽」手，那麼，就以往的科研結果顯示，給孩子們拍拍球，持拍擊球會比較有效；如果是有關整個身體的刻板行為，例如不斷地搖擺身體，那麼就給孩子一些能運用全身肌肉的運動最為有效，例如游水、跑步、跳舞。如有人再問，有什麼運動能改善自閉症兒童的認知能力 ? 那我會回答，做一些需要運用腦筋的運動( cognitively engaging exercise) 比較有效。 最近，作者的研究團隊從運動對改善自閉症小朋友的認知能力作出更進一步的研究。在研究中，作者共招收了62名被診斷患有 ASD 的兒童（50 名男性和 12 名女性，Mage = 9.89±1.53 歲，Mheight = 1.43 ± 0.15 m，Mweight = 44.69 ± 11.96kg）。他們被隨機分為三組：1) 學習單車組; 2) 健身單車組; 3) 慢步組 (活動控制組)。研究為期兩星期，學習單車組需在十堂內（每堂約50分鐘）學習怎樣踏兩輪單車，而健身單車組則需在十堂內（每堂約30分鐘）踏健身單車，至於慢步組則需在兩星期內每天慢行30分鐘。研究團隊在研究前後一星期內收集了他們認知能力的數據。結果顯示，學習單車組在各項認知能力評估中（計劃、工作記憶、靈活性和抑制）都有顯著的改善，而十分驚訝地，其餘兩組均沒有明顯的改善。研究團隊認為，如欲透過運動改善小朋友的認知能力，最佳的選擇便是學習一種新的運動技能。因為在學習過程中，學習者必須運用其認知能力，從而鍛鍊認知能力。 References Bass, M. M., Duchowny, C. A., et al. (2009).

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【體路專欄】自閉症譜系障礙（ASD）是一種神經發育障礙，在兒童早期就很明顯，並且患病率不斷上升。據報導，香港最新的ASD患病率是1.5%（香港自閉症聯盟，2019），而且這比率預計會提高。患有自閉症的兒童表現出持續的社交溝通和社交障礙，以及受限和重複的行為、興趣或活動（美國精神病學協會，2016）。除了這些核心症狀外，還經常出現情緒和行為上的困難，例如攻擊性和發脾氣（Jahromi等人，2012；Jahromi等人，2013；Samson等人，2015）。例如，Maskey及其同事（2013）報告說，一些自閉症兒童在經歷消極或過分激動的情緒時會表現出攻擊性行為，例如攻擊性行為和自我傷害行為（Maskey等人，2013）。Chandler及其同事（2016）發現，高程度的破壞性行為，自我吸收和過度活躍與ASD幼兒的情緒問題相關（Chandler等人2016）。這些情緒和行為問題對日常工作構成了嚴峻挑戰，因為它們可能導致不良的社會發展（Baker，2008）、抑鬱症（Mazefsky等人2013）和焦慮症狀（Kim等人2000）。此外，這些問題與ASD兒童較高的父母壓力和家庭困擾密切相關（請參見Yorke等人2018年的評論）。

現時有兩種類型的干預措施用於解決ASD兒童的情緒問題：應用行為分析（Mohammadzaheri等，2014）和認知行為療法（Scarpa and Reyes，2011）。這些干預措施已顯示出其對ASD兒童情緒和行為問題的有效性（有關綜述，請參見Ung等，2015）。在過去，有很多研究顯示，運動有助改善正常兒童的情緒行為問題（Fox 1999；Ishii等人2016；Penedo和Dahn 2005；Telles等人2013）。例如，Telles及其同事（2013）進行了一項隨機對照試驗，研究「瑜伽」和「慢跑」對健康兒童身體健康，認知功能和情緒健康的影響。結果顯示，瑜伽和慢跑均可提高體力、注意力和自尊心。Ishii及其同事（2016）進行了一項大規模的問卷調查，研究定期運動對兒童情緒和行為的影響。結果顯示，定期鍛煉與改善自我效能以及減少情緒和行為問題密切相關（Ishii等，2016）。考慮到運動可改善兒童的情緒和行為功能，科學家亦認為ASD兒童也可能從中受益。事實上，一些研究亦提供了證據，顯示運動可能有益於ASD兒童的社交功能。例如，Levinson和Reid（1993）研究五週運動干預（一天走路15分鐘，另一天慢跑15分鐘）對三名ASD兒童刻板印象行為的有效性。結果顯示，五週後他們的刻板印象行為大大減少（Levinson＆Reid，1993）。Rosenthal-Malek和Mitchell（1997）也作了相類似的研究，其研究亦發現10節（一週兩節）的20分鐘的慢跑可以顯著減少ASD兒童的自我刺激行為。此外，兩次系統性評價（例如Bremer等人，2016； Petrus等，2008）亦顯示，運動可以有效地改善ASD兒童社交行為功能。但是，先前的研究都沒有直接調查運動對ASD兒童情緒功能的影響。

本人團隊去年年初進行了一項研究，目的是研究運動（中度至劇烈的強度慢跑）對自閉症兒童情緒和行為功能的影響。使用慢跑活動是因為此項運動易於管理，並且不需要昂貴的資源。我們把27名8-12歲被診斷患有自閉症的兒童隨機分為運動組（15名兒童）或對照組（12名兒童）。運動組接受了為期12週的慢跑干預 （每星期三次）。兒童父母在研究前後填寫了「情緒調節檢量表」和 「兒童行為檢量表」。結果指出，運動組無論在情緒調節方面或是在行為方面均有顯著改善（例如不易發脾氣，有耐性），並在行為問題的減少。

本人認為，運動（尤其有氧運動）之所以有助改善情緒，是因為運動的性質本生具有要求參與者克服疲勞，或包容自己可能跑得比其他人慢等的負面情緒。在運動過程中，自閉症兒童可能體會自己能力的改變，或增強了自我認知能力或提高自我成就的，因而漸漸地懂得放鬆自己或包容別人（Bernstein and McNally 2017）。另一個可能的解釋可能是在提升神經生理機制層面，例如神經營養因子的釋放和合成（Ferris等，2007； Voss等，2011）或神經遞質的釋放（例如，血清素，去甲腎上腺素，多巴胺）。現時本人正致力於研究不同的運動對情緒認知機制方面的研究，期望在下一次給讀者一點建議： 例如應做什麼運動，多少運動的時間，怎麼樣的運動強度，才能有效地幫助改善自閉症兒童的情緒及認知能力。

參考文獻：

Autism Hong Kong. Global Autism Population. http://www.autism.hk/2019/asd-pop.htm. Accessed on 19 th August, 2020

Baker, J.（2008）. No more meltdowns: Positive strategies for managing and preventing out-of-control behavior. Arlington, TX: Future Horizons.

Bernstein, E. E., & McNally, R. J.（2017）. Acute aerobic exercise helps overcome emotion regulation deficits. Cognition & Emotion, 31, 834-843.

Bremer, E., Crozier, M., & Lloyd, M.（2016）. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism, 20, 899-915.

Centre for Disease Control and Prevention, HKSAR（2012）. Identified prevalence of autism spectrum disorder. https://www.cdc.gov/ncbddd/autism/data.html. Accessed 28th May 2019

Chandler, S., Howlin, P., Simonoff, E., O'Sullivan, T., Tseng, E., Kennedy, J., et al.（2016）. Emotional and behavioural problems in young children with autism spectrum disorder. Developmental Medicine & Child Neurology, 58, 202-208.

Ferris, L. T., Williams, J. S., & Shen, C. L.（2007）. The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function. Medicine & Science in Sports & Exercise, 39, 728-734.

Fox, K. R.（1999）. The influence of physical activity on mental well-being. Public Health Nutrition, 2, 411-418.

Ishii, K., Shibata, A., Adachi, M., & Oka, K.（2016）. Association of physical activity and sedentary behavior with psychological well-being among Japanese children: A two-year longitudinal study. Perceptual and Motor Skills, 123, 445-459.

文：謝采揚博士

香港教育大學健康與體育學系助理教授

香港運動心理學會成員

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運動心理學淺談（35）：運動有助改善自閉症兒童的情緒 - 體路 Sportsroad

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【體路專欄】自閉症譜系障礙（ASD）是一種神經發育障礙，在兒童早期就很明顯，並且患病率不斷上升。據報導，香港最新的ASD患病率是1.5%（香港自閉症聯盟，2019），而且這比率預計會提高。患有自閉症的兒童表現出持續的社交溝通和社交障礙，以及受限和重複的行為、興趣或活動（美國精神病學協會，2016）。除了這些核心症狀外，還經常出現情緒和行為上的困難，例如攻擊性和發脾氣（Jahromi等人，20...

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【體路專欄】根據2016年世界衛生組織數字顯示，自閉症譜系障礙 (Autism Spectrum Disorder, 簡稱ASD) 是一種兒童早期表現出來的神經發育障礙，近年來發病率迅速上升。據香港特區疾病預防控制中心2012年的報導，在香港患有ASD的兒童患病率為14.6%，這趨勢預計將繼續上升。治療自閉症患兒的主要挑戰之一是克服他們的重複行為和發聲行為，這被美國精神病學協會稱為「刻板行為」。「刻板行為」一般被定義為無意識、重複、不適應和不恰當的行為。「刻板行為」的例子包括任何或所有身體部位的動作 (例如，身體搖擺和跳)、手的動作 (例如，用手拍打，揮手和無情境地指著)、操控物件 (如旋轉或翻轉物件，或將物件排成一條線)和機械重複的聲音 (例如，認不出來的聲音和短語重複)。這些行為已被證明會干擾兒童的社交、溝通和技能獲取。此外，報導亦指出當兒童出現刻板行為，被同齡人孤立和排斥的風險會更高。考慮到這些負面的行為影響，開發有效的干預措施來緩解這一人群的刻板行為是很重要的。現時有大量的證據表明運動有可能是減少ASD兒童的刻板行為的有效治療方法。

本人的研究試圖通過針對性的運動來改善ASD兒童的刻板行為。本人成功邀請了三十名患有ASD的兒童, 他們均有表現出「拍手」及「搖擺身體」的刻板行為。在研究中， 他們被要求參與控制 (故事) 及實驗 (拍球類運動) 兩種組別。實驗組別包括15分鐘的擊球時間，在這段時間裡，孩子們會被要求盡可能擊打一個塑料球, 次數愈多愈好。

結果顯示，在拍球類運動後，兒童拍手的刻板行為明顯減少，而身體搖擺的刻板行為則沒有變化。就此結果的解釋，研究團隊相信可能與刻板印象的理論操作性有關。該理論指出，刻板行為是用來滿足其某種感官需要。因此，通過提供替代的感官刺激(如拍球類運動)，就可以減少刻板行為 (如拍手行為)。基於這一理論，研究團隊相信，觀察到被測試的兩種刻板行為的相似生物力學，可能會產生相似的內部預約效果，以滿足感官需求，結果減少了拍手的刻板行為。相比之下，由於身體搖擺的刻板行為 (全身運動) 的生物力學與擊球動作所需要的生物力學不同，這種刻板動作所提供的感官刺激可能與該運動的不相匹配，因此不能從該運動中獲得任何益處。但總括來說，這些結果不僅證實了許多運動干預對刻板印象的正面影響，而且進一步表明，體育鍛鍊應該與刻板印象的生物力學相匹配，以產生令人滿意的行為效益。

參考文獻：

American Psychiatric Association (2016). Diagnostic and statistical manual of mental disorders: DSM-5 Washington, DC: American Psychiatric Association.\ Bahrami, F., Movahedi, A., Marandi, S. M., & Abedi, A. (2012). Kata techniques training consistently decreases stereotypy in children with autism spectrum disorder. Research in Developmental Disabilities, 33, 1183-1193.

Centres for Disease Control and Prevention, HKSAR (2012). Identified prevalence of autism spectrum disorder. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html

Church, C., Alisanski, S., & Amanullah, S. (2000). The social, behavioral, and academic experiences of children with asperger syndrome. Focus on Autism and Other Developmental Disabilities, 15, 12-20.

Jones, R. S. P., Wint, D., & Ellis, N. C. (1990). The social effects of stereotyped behaviour. Journal of intellectual disability research, 34, 261-268.

Lanovaz, M. J., Robertson, K. M., Soerono, K., & Watkins, N. (2013). Effects of reducing stereotypy on other behaviors: A systematic review. Research in autism spectrum disorders, 7, 1234-1243.

Lancioni, G. E., Singh, N. N., O'Reilly, M. F., & Sigafoos, J. (2009). An overview of behavioral strategies for reducing hand-related stereotypies of persons with severe to profound intellectual and multiple disabilities: 1995-2007. Research in Developmental Disabilities, 30, 20-43.

Lovaas, I., Newsom, C., & Hickman, C. (1987). Self-stimulatory behavior and perceptual reinfourcement. Journal of Applied Behavior Analysis, 20, 45-68.

MacDonald, R., Green, G., Mansfield, R., Geckeler, A., Gardenier, N., Anderson, J., . . . Sanchez, J. (2007). Stereotypy in young children with autism and typically developing children. Research in Developmental Disabilities, 28, 266-277.

Ming, X., Brimacombe, M., & Wagner, G. C. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain and Development, 29, 565-570.

Organization, W. H. (2016, March 2016). Questions and answers about autism spectrum disorders (ASD). Retrieved from http://www.who.int/features/qa/85/en/

Shriberg, L. D., Paul, R., McSweeny, J. L., Klin, A., Cohen, D. J., & Volkmar, F. R. (2001). Speech and prosody characteristics of adolescents and adults with high-functioning autism and asperger syndrome. Journal of Speech, Language, and Hearing Research, 44, 1097-1115.

Turner, M. (1999). Annotation: Repetitive behaviour in autism: A review of psychological resea

文：謝采揚博士

香港教育大學健康與體育學系助理教授

香港運動心理學會成員

香港運動心理學會 (HKSSEP) 作為本地唯一的專業學會，致力推廣具科學論証的運動心理知識及結合應用經驗，亦希望成為學術及前線同行的溝通平台，共同發展運動心理專業。HKSSEP由在本地大學中從事科研的運動心理學學者，及在不同前線機構 (如香港體育學院等) 的運動心理專家成立及主理。今後我們希望透過體路的平台，繼續跟廣大讀者交流，歡迎在我們的 Facebook專頁 留言。

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運動心理學淺談（25）：選擇適當的體力活動來減少自閉症兒童的刻板行為 - 體路 Sportsroad

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【體路專欄】根據2016年世界衛生組織數字顯示，自閉症譜系障礙 (Autism Spectrum Disorder, 簡稱ASD) 是一種兒童早期表現出來的神經發育障礙，近年來發病率迅速上升。據香港特區疾病預防控制中心2012年的報導，在香港患有ASD的兒童患病率為14.6%，這趨勢預計將繼續上升。治療自閉症患兒的主要挑戰之一是克服他們的重複行為和發聲行為，這被美國精神病學協會稱為「刻板行為」。「刻板行為」一般被定義為無意識、重複、不適應和不恰當的行為。「刻板行為」的例子包括任何或所有身體部位的動作 (例如，身體搖擺和跳)、手的動作 (例如，用手拍打，揮手和無情境地指著)、操控物件 (如旋轉或翻轉物件，或將物件排成一條線)和機械重複的聲音 (例如，認不出來的聲音和短語重複)。這些行為已被證明會干擾兒童的社交、溝通和技能獲取。此外，報導亦指出當兒童出現刻板行為，被同齡人孤立和排斥的風險會更高。考慮到這些負面的行為影響，開發有效的干預措施來緩解這一人群的刻板行為是很重要的。現時有大量的證據表明運動有可能是減少ASD兒童的刻板行為的有效治療方法。 本人的研究試圖通過針對性的運動來改善ASD兒童的刻板行為。本人成功邀請了三十名患有ASD的兒童, 他們均有表現出「拍手」及「搖擺身體」的刻板行為。在研究中， 他們被要求參與控制 (故事) 及實驗 (拍球類運動) 兩種組別。實驗組別包括15分鐘的擊球時間，在這段時間裡，孩子們會被要求盡可能擊打一個塑料球, 次數愈多愈好。 結果顯示，在拍球類運動後，兒童拍手的刻板行為明顯減少，而身體搖擺的刻板行為則沒有變化。就此結果的解釋，研究團隊相信可能與刻板印象的理論操作性有關。該理論指出，刻板行為是用來滿足其某種感官需要。因此，通過提供替代的感官刺激(如拍球類運動)，就可以減少刻板行為 (如拍手行為)。基於這一理論，研究團隊相信，觀察到被測試的兩種刻板行為的相似生物力學，可能會產生相似的內部預約效果，以滿足感官需求，結果減少了拍手的刻板行為。相比之下，由於身體搖擺的刻板行為 (全身運動) 的生物力學與擊球動作所需要的生物力學不同，這種刻板動作所提供的感官刺激可能與該運動的不相匹配，因此不能從該運動中獲得任何益處。但總括來說，這些結果不僅證實了許多運動干預對刻板印象的正面影響，而且進一步表明，體育鍛鍊應該與刻板印象的生物力學相匹配，以產生令人滿意的行為效益。 參考文獻： American Psychiatric Association (2016). Diagnostic and statistical manual of mental disorders: DSM-5 Washington, DC: American Psychiatric Association.\ Bahrami, F., Movahedi, A., Marandi, S. M., & Abedi, A.

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【體路專欄】在以往的三篇文章裏，筆者提及定期的運動訓練有助改善自閉症兒童的睡眠效率，減少刻板行為，增強情緒控制的能力，社交能力及認知能力，以上的資訊亦得到不同的研究所支持 （Baas et al., 2009; Brand et al., 2015; Bremer et al., 2016; Pan et al., 2016; Tse et al., 2021, 2020）。

顯然地，定期的運動訓練對於自閉症小孩的身心發展有着莫大的好處。 然而，筆者想強調，這些好處均需要長時間及定時的運動才能顯現出來，運動並不能替代小朋友現時的各種治療（例如：情緒行為治療，認知訓練，言語治療，物理治療)。各種針對性治療，治療師都具備有認可的專業資格，而治療的方法，亦有不同的專業認證。所以，筆者斗膽的說，運動只能作為輔助治療或預防醫學的工具。

最近，筆者及研究團隊從運動對改善自閉症小朋友睡眠質素作出更進一步的研究[1] 。在此研究中，作者運用了四個不同組別：1）運動組； 2）攝取褪黑激素補充劑組； 3）合併組（運動及褪黑激素補充劑）及 4）控制組（沒有運動及沒有褪黑激素補充劑）。研究為期12星期，運動組需要在此期間每天運動30分鐘，褪黑激素組則需要每天睡眠前20分鐘攝取5mg的褪黑激素補充劑，合併組則既要每天運動30分鐘，亦要每天攝取褪黑激素補充劑。

研究團隊在研究前後收集了他們有關睡眠質素的數據。結果顯示，運動組，褪黑激素組及合併組的睡眠質素均有明顯的改善，而在這三組之中，合併組在睡眠質素方面的改善是最大的，而褪黑激素組在睡眠質素方面的改善亦較運動組為好。這個例子再一次證明長時間的定期運動訓練對自閉症小童的身心發展是有好處的，而從褪黑激素補充劑組別的表現我們可以知道，運動的效用不及藥物的即時效用。總括而言，作者認為，定期運動訓練不能替代藥物，其只能作為輔助的治療。

[1] 此研究仍在文獻中審核

文：謝采揚博士
香港教育大學健康及體育系副教授

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運動心理學淺談（48）：定期運動訓練在自閉症小孩身心發展的迷思 - 體路 Sportsroad

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【體路專欄】在以往的三篇文章裏，筆者提及定期的運動訓練有助改善自閉症兒童的睡眠效率，減少刻板行為，增強情緒控制的能力，社交能力及認知能力，以上的資訊亦得到不同的研究所支持 （Baas et al., 2009; Brand et al., 2015; Bremer et al., 2016; Pan et al., 2016; Tse et al., 2021, 2020）。 顯然地，定期的運動訓練對於自閉症小孩的身心發展有着莫大的好處。 然而，筆者想強調，這些好處均需要長時間及定時的運動才能顯現出來，運動並不能替代小朋友現時的各種治療（例如：情緒行為治療，認知訓練，言語治療，物理治療)。各種針對性治療，治療師都具備有認可的專業資格，而治療的方法，亦有不同的專業認證。所以，筆者斗膽的說，運動只能作為輔助治療或預防醫學的工具。 最近，筆者及研究團隊從運動對改善自閉症小朋友睡眠質素作出更進一步的研究[1] 。在此研究中，作者運用了四個不同組別：1）運動組； 2）攝取褪黑激素補充劑組； 3）合併組（運動及褪黑激素補充劑）及 4）控制組（沒有運動及沒有褪黑激素補充劑）。研究為期12星期，運動組需要在此期間每天運動30分鐘，褪黑激素組則需要每天睡眠前20分鐘攝取5mg的褪黑激素補充劑，合併組則既要每天運動30分鐘，亦要每天攝取褪黑激素補充劑。 研究團隊在研究前後收集了他們有關睡眠質素的數據。結果顯示，運動組，褪黑激素組及合併組的睡眠質素均有明顯的改善，而在這三組之中，合併組在睡眠質素方面的改善是最大的，而褪黑激素組在睡眠質素方面的改善亦較運動組為好。這個例子再一次證明長時間的定期運動訓練對自閉症小童的身心發展是有好處的，而從褪黑激素補充劑組別的表現我們可以知道，運動的效用不及藥物的即時效用。總括而言，作者認為，定期運動訓練不能替代藥物，其只能作為輔助的治療。 [1] 此研究仍在文獻中審核 文：謝采揚博士 香港教育大學健康及體育系副教授

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【體路專欄】自閉症是一種複雜的神經發展障礙症，病徵普遍於患者年幼時出現，其包括社交互動障礙，語言溝通問題及刻板行為。我在前文提及，除了傳統的干預活動（例如：早期強化行為干預，行為治療分析，言語治療及感官統合療法），定期的運動訓練亦有助改善自閉症兒童的對自閉症兒童的發展有莫大的好處，例如提升睡眠效率 (Brand et al., 2015)，減少刻板行為 (Bremer et al., 2016)，增強社交能力 (Baas et al., 2009) 及認知能力 (Pan et al., 2016) 。當時文章一出，立刻引來家長們的追問，那要怎樣開始，做什麼運動，做多少運動才能產生這些效果。

首先，我想在此說一聲，我十分欣賞及尊敬這些家長，因為這些問題都是好問題，而且這亦代表他們願意花時間及精神培養小朋友的運動習慣。這已是一個很多的開始呢。言歸正傳，本人從事研究工作，現在讓我嘗試把自己及前人的研究，提供一些意見，供各位參考。

首先要怎樣開始令他們做運動，這是一個十分令人頭痛的問題，因為大部分的自閉症兒童都不願做運動。如果他們不想的時候，要改變他們是殊不容易的。無可否認，是困難的，但不是做不到。其實，他們也是普通的小朋友，只要知道他們為什麼不願意做運動，解決這些「不願意」，問題很多時便會迎刃而解。舉例說，我在工作見過不少的兒童，他們很多時不願意做是因爲他們根本聽不明指示，或做不到所需要的技巧，而這些可能是因為他們本身的身體協調能力不足而導致。所以，要解決這問題，我們便需要用一些非常簡單易明的指示(例如圖像)，及制訂簡單的運動目標，鼓勵他們多一些（例如利用圖表，儲值式的獎勵他們喜愛的事物），甚至陪他們做運動。另外，亦可以與一些機構或學校建議給小朋友多一些運動時間。以我所知，現時有至少一間特殊學校在推行「全民晨操」的活動，即是在每天上課前，要同學圍繞學校步行幾個圈。以我觀察，那間學校的學生在步行完後上堂，無論在情緒方面，專注方面都是有改善的。而最重要的是，大部分學生也因而產生興趣。不過，要培養他們對運動的興趣，家長們是要有很大的耐性，不能過於心急。

第二個問題是：要做多少運動才能改善他們的睡眠質素，認知能力，刻板行為等問題。這個問題最主要是取決於兒童本身的體能。而根據過往的研究(Center of Disease Control and Prevention, USA, 2019)，大部份都是要達致中至強度水平的運動。所謂中至強度水平的運動，是心跳要達致65%或以上的最高心跳率。而最高心跳率，大約為220減年紀。舉個例子：因我現在的歲數為20歲，那我的最高心跳就約為220-20等於200。如果要我達致中強到水平的運動，我的心跳就最少要是200乘65%=143。不過有研究顯示，大部份自閉症兒童的身體健康水平比普通兒童較低，所以有些研究認為(Pan et al., 2017)，只要一些運動能令自閉症兒童的心跳達致他們最高心跳率的50% ，也可以視作中至強度水平。

最後就是要做什麼的運動。根據之前的科學研究結果(Lang, 2010)：跑步，游水，騎馬，武術，舞蹈，這些運動都能提高自閉症兒童的生活水平。另外，我認為，亦需要考慮其目標。如果家長是希望小朋友能透過運動改善他們的睡眠質素，那可能就需要做多一些帶氧運動。又例如家長希望能透過運動改善小朋友的認知能力，可能便需要做多一些要動腦筋的運動（如學習一樣新的運動技能:球類運動）。不過，容我這樣說，家長不必想得太多。任何運動，只要是定期的，適量的，有興趣的，那就可以了。最後，我想澄清一點，現時並沒有證據證明運動可以取代其他治療。根據本人的研究及其他研究，我只能說，運動現時只能作為一種輔助治療。能否取代其他資料，還需要進一步的科研工作。希望大家留意。

文：謝采揚博士
香港教育大學健康及體育系助理教授
香港運動心理學會副主席（宣傳及出版）

References
Brand S, Jossen S, Holsboer-Trachsler E, et al. Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders - a pilot study. Neuropsychiatr Dis Treat 2015;11:1911-20.

Bremer E, Crozier M, et al. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism 2016; 20:899-915.

Bass MM., Duchowny CA, et al. The effect of therapeutic horseback riding on social functioning in children with autism. J Autism Dev Disord;2009;39: 1261.

Centres of Disease Control and Prevention. Measuring Physical Activity Intensity: Target Heart Rate and Estimated Maximum Heart Rate. 2015; https://www.cdc.gov/physicalactivity/basics/index.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fphysicalactivity%2Fbasics%2Fmeasuring%2Findex.html. Accessed 17th January, 2019.

Lang R, Koegel LK, Ashbaugh K, Regester A, Ence W, Smith W. Physical exercise and individuals with autism spectrum disorders: A systematic review. Res Aut Spectr Disord. 2010;4(4):565-576.

Pan CY, Chu CH, Tsai CL, et al. The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder. Autism 2017;2: 190-210.

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運動心理學淺談（15）：如何令自閉症兒童開始做運動？ - 體路 Sportsroad

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【體路專欄】自閉症是一種複雜的神經發展障礙症，病徵普遍於患者年幼時出現，其包括社交互動障礙，語言溝通問題及刻板行為。我在前文提及，除了傳統的干預活動（例如：早期強化行為干預，行為治療分析，言語治療及感官統合療法），定期的運動訓練亦有助改善自閉症兒童的對自閉症兒童的發展有莫大的好處，例如提升睡眠效率 (Brand et al., 2015)，減少刻板行為 (Bremer et al ...

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【體路專欄】根據世界衛生組織的定義，自閉症是一種複雜的神經發展障礙症，病徵普遍於患者年幼時出現，其包括社交互動障礙，語言溝通問題及刻板行為，當中有部份患者亦會有睡眠障礙症。針對以上各種症狀，現時坊間的療法包括早期強化行為干預，行為治療分析，言語治療及感官統合療法，部份情況較為嚴重的患者則需要定期服用處方藥物。雖然這些療法的功效在醫學及科研領域上都得到證明。然而，這些療法都需要大量的人力物力，所花的金錢亦不輕。因此有很多患者家庭在中途放棄了治療，而有些家庭則在等候公立治療服務中，無意間令患者失去了治療的黃金時間。

近年來，有很多科學研究顯示，定期的運動訓練對自閉症兒童的發展有莫大的好處，例如提升睡眠效率（Brand et al., 2015），減少刻板行為（Bremer et al., 2016），增強社交能力（Baas et al., 2009）及認知能力（Pan et al., 2016），而所涉及的運動則包括跑步，游水，騎馬及武術。由於運動本身對兒童的腦部及身心發展有很大的幫助，而運動的成本及所需要的器材亦相對地較輕。因此，我相信運動可以作為自閉症兒童的一種輔助療法。

最近，我在工作上進行了多項針對自閉症兒童運動的研究。結果發現，運動除了對睡眠健康及動作協調有正面的幫助外，運動對刻板行為亦有一個針對性的關係。例如：若果要減少兒童的刻板的手部動作，就需要做有關手部的運動 （如拍籃球）; 若果要針對兒童本體的刻板行為（如重復搖動身體），則可能需要做一些有關整個身體的運動（如游水或跑步）。由於有關研究仍在實驗階段，其結果及原理有待進一步的驗證和確認才能肯定。不過，運動對兒童身心發展的好處是肯定的，因此我覺得多做也是無傷大雅。

最後，當我在學校進行家長講座時，常被問到怎樣去提升自閉症兒童做運動的動機或陪養他們的興趣。我認同這是一個十分現實的問題。的確要令這群小孩養成做運動習慣並不容易。不過，綜合這幾年對待這類小朋友的經驗，我想最有效的方法，就是要用極大的耐心去鼓勵他們，例如與他們一起做運動，或用一些表象的方法去指示他們去做運動，如利用圖畫，或他們喜愛的某種語音等。並用圖象去記錄小孩的進步。「起步」永遠是困難，但只是堅持，我深信家長們會成功的。

文：謝采揚博士
香港運動心理學會的副會長（宣傳)
香港教育大學健康及體育系講師

香港運動心理學會（HKSSEP）作為本地唯一的專業學會，致力推廣具科學論証的運動心理知識及結合應用經驗，亦希望成為學術及前線同行的溝通平台，共同發展運動心理專業。HKSSEP由在本地大學中從事科研的運動心理學學者，及在不同前線機構（如香港體育學院等）的運動心理專家成立及主理。今後我們希望透過體路的平台，繼續跟廣大讀者交流，歡迎在我們的 Facebook專頁 留言。

References

Brand S, Jossen S, Holsboer-Trachsler E, et al. Impact of aerobic exercise on sleep and motor skills in children with autism spectrum disorders - a pilot study. Neuropsychiatr Dis Treat 2015;11:1911-20.

Bremer E, Crozier M, et al. A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism 2016; 20:899-915.

Bass MM., Duchowny CA, et al. The effect of therapeutic horseback riding on social functioning in children with autism. J Autism Dev Disord;2009;39: 1261.

Pan CY, Chu CH, Tsai CL, et al. The impacts of physical activity intervention on physical and cognitive outcomes in children with autism spectrum disorder. Autism 2017;2: 190-210.

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運動心理學淺談（7）：運動有助治療自閉症 - 體路 Sportsroad

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【體路專欄】根據世界衛生組織的定義，自閉症是一種複雜的神經發展障礙症，病徵普遍於患者年幼時出現，其包括社交互動障礙，語言溝通問題及刻板行為，當中有部份患者亦會有睡眠障礙症。針對以上各種症狀，現時坊間的療法包括早期強化行為干預，行為治療分析，言語治療及感官統合療法，部份情況較為嚴重的患者則需要定期服用處方藥物。雖然這些療法的功效在醫學及科研領域上都得到證明。然而，這些療法都需要大量的人力物力，...

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The effect of therapeutic horseback riding on social functioning in children with autism.

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The effect of therapeutic horseback riding on social functioning in children with autism.

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Validity of the Postrotary Nystagmus Test for Measuring Vestibular Function

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The Role of Eye Gaze During Natural Social Interactions in Typical and Autistic People

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Social Referencing Gaze Behavior During a Videogame Task Eye Tracking Evidence from Children With and Without ASD

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Social Referencing Gaze Behavior During a Videogame Task Eye Tracking Evidence from

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Effects of Vestibular Stimulation on Spontaneous Use of Verbal Language in Developmentally Delayed Children

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Abstract. The relationship between vestibular stimulation and language development in a group of five primary trainable mentally deficient and five developmentally retarded preschoolers was studied. Subjects received vestibular stimulation prior to a free play situation and were monitored for spontaneous recognizable language use.

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What are the building blocks necessary to develop the ability to cross the body’s mid-line?

Bilateral integration skills (using both sides of the body at the same time).

Core stability and trunk rotation: The muscles of the trunk that helps to stabilizing the body so the arms and legs can be moved with control.

Hand dominance: The consistent use of one hand or foot most often  that allows refine movement control to develop.

Planning and sequencing: The ability to follow multi-step instructions to achieve a defined outcome or end point.

Body awareness: The information that muscles and joints send to our brain that tells us about our body position.

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Crossing the Body’s Midline - Kid Sense Child Development

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Occupational Therapy helps children with crossing the body’s midline by developing: manipulation, hand dominance, finger strength, & bilateral integration.

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Affects on children who do not develop the bilateral skill

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Affects on children who do not develop the bilateral skill

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When a child has difficulty crossing midline, it can affect his/her ability to read.
While the child is moving his/her eyes from left to right across the page, the eyes will stop at midline to blink and refocus; however, when this happens, the child will very frequently lose his/her place on the line and become confused as to where they left off.

It also affects handwriting, as diagonal lines cross the midline, and the child may need to stop in the middle of the page to switch hands when writing from left to right.

Many self care and daily living skills require crossing midline. For example, perfecting the skill of putting socks or shoes on requires one hand to cross over to the other side of the body.

Children who have difficulty crossing midline may appear ambidextrous because they are often observed using both hands, but they actually have a hidden neuroprocessing issue. Both sides of their brains are not communicating, resulting in decreased coordination, decreased motor control of movements and difficulties achieving higher level skills. Often, these children end up with two unskilled hands.

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What is "crossing the midline"?

By the age of 3 or 4 years old, a child should have mastered the bilateral skill (using both sides of the body together) called "crossing the midline". This is the ability to move one hand, foot, or eye into the space of the other hand, foot or eye. We cross midline when we scratch an elbow, cross our ankles, and read left to right. Crossing the midline of your body helps build pathways in the brain and is an important prerequisite skill required for the appropriate development of various motor and cognitive skills. Children who have difficultly crossing the body's midline often have trouble with skills such as reading, writing, completing self care skills and participating in sports & physical activities. These skills require a type of coordination that comes from experience with "cross-lateral motion," which is movement involving the left arm and right leg, or the right arm and left leg at the same time.

Establishing a "worker hand" and a "helper hand" is a sign that the brain is maturating and lateralization is occurring, and is strongly correlated with the ability to cross the midline. Both sides of the brain need to talk to each other for the "worker hand" and the "helper hand" to work together and compliment each other. Coordinating both sides of the body can be difficult for the child who avoids crossing midline. Often, these children have not yet established a hand preference, sometimes using their left and sometimes using their right to draw, color, write, eat, and throw.

Affects on children who do not develop the bilateral skill:

Furthermore, when a child has difficulty crossing midline, it can affect his/her ability to read. While the child is moving his/her eyes from left to right across the page, the eyes will stop at midline to blink and refocus; however, when this happens, the child will very frequently lose his/her place on the line and become confused as to where they left off. It also affects handwriting, as diagonal lines cross the midline, and the child may need to stop in the middle of the page to switch hands when writing from left to right. Many self care and daily living skills require crossing midline. For example, perfecting the skill of putting socks or shoes on requires one hand to cross over to the other side of the body.

Children who have difficulty crossing midline may appear ambidextrous because they are often observed using both hands, but they actually have a hidden neuroprocessing issue. Both sides of their brains are not communicating, resulting in decreased coordination, decreased motor control of movements and difficulties achieving higher level skills. Often, these children end up with two unskilled hands.

Activities to help develop the ability to cross the midline:

To help develop efficient crossing of the midline, provide children with a variety of two-handed (bilateral) activities. Try some of the below activities to help build more pathways in the brain and to develop the ability to cross the midline, improve coordination, and improve overall functional performance on a daily basis.

Right brain/left brain teasers-

a. Pop bubbles with only one hand (they will have to reach across their body to pop the bubbles floating on the opposite side).

b. Reach for bean bags, balls, stuffed animals, or other objects across midline, then throwing at a target.

c. Draw large figure eights (the infinity sign or an 8 turned on its side) on paper, on the floor with a finger, in the air with a finger, or drive a matchbox car around a figure eight pattern.

d. Let the child play with sand, scooping sand from one side of the body and putting it into a bucket on the opposite side of the body without switching hands.

e. Let the child pretend to drive a car with a ball in his/her hands to use as a steering wheel and encourage the crossing of his/her arms as he/she turns the 'steering wheel' OR to make this similar in style to most of the others-pretend to drive a car with a ball in both hands to use as a steering wheel and cross both arms while turning the "steering wheel".

f. Play flashlight tag. In a dimmed room, lie on your backs and have the child follow your flashlight beam projected on the wall with his own flashlight.

g. Touch the opposite elbow and knee.

h. Cross one foot over the other while walking sideways.

i. Do "grapevine" walks.

j. Knee slap walk- Walk around raising each knee while touching/slapping it with the opposite hand (or elbow). Change it to a skip while touching the opposite knee as it comes up.

k. Windmill-stand with feet spread apart and arms extended out to the sides. Bend over at waist and tap right hand to left foot. Stand back up and then bend and tap left hand to right foot.

l. Point your left finger out and put your right thumb up. Switch them, and switch, and switch, and switch...

m. Hold your nose, then cross the other hand over and grab your opposite ear. Slap your thighs and switch your hands...switch, slap, switch, slap...

n. Write your name in the air while rotating your foot in a circle clockwise.

o. Wash the car and make sure the arms cross midline while scrubbing.NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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Help Your Child Develop the "Crossing the Midline" Skill - North Shore Pediatric Therapy

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By the age of 3 or 4 years old, a child should have mastered the bilateral skill (using both sides of the body together) called crossing the midline.

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bilateral movements

trunk rotation

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Are you wondering what crossing the midline is all about?

When Occupational Therapists and other professionals talk about "midline crossing", the midline they are referring to is an imaginary line drawn from the head to the feet that separates the left and the right halves of the body.

Crossing this midline means that a body part (eg hand or foot) is able to spontaneously move over to the other side of the body to work there.

Click on the quick links below to find the information you need on this page:

How Midline Crossing Develops

Bilateral movements and interaction with the environment are therefore important factors in helping a child develop the skill of crossing the midline.

Young children may tend to use the left hand on the left side of the body and the right hand on the right side of the body as they play. However, as body scheme, left-right discrimination and spatial perception continue to develop between the ages of 4 - 8 years, the ability to spontaneously cross the midline also continues to develop.

There is usually a lot of maturation in this skill between the ages of 6 and 8 years old, and the skill is usually fully integrated by the ages of 8-9 years.

Factors Affecting Midline Crossing

Spending too much time in baby gear (car seats, bouncers), having too much screen time, or growing up in a deprived situation can affect how a baby interacts with the environment, and may limit opportunities for bimanual reaching and crossing the midline.

However, there is another vital factor in crossing the midline, and that is trunk rotation. If a child avoids rotating the trunk owing to poor core stability, and/or moves the trunk stiffly as a unit, then this may affect the child's ability to freely cross the midline.

You can see this in action in the photos below of a child throwing to a target off to her side:

Many kids shift their body subtly to avoid rotating their trunks and therefore avoiding crossing their midline. It usually takes a trained eye to see when they are doing this, so please do take your child for an assessment if you are all concerned about a weak core and/or poor trunk rotation and/or avoiding midline crossing.

The Benefits of Crossing The Midline

Children need to develop a strong preferred hand for tool use (cutting with scissors, drawing with a crayon etc) by the time they start formal schooling.

The ability to spontaneously cross the midline plays an important role in developing a strong preferred hand, by enabling the preferred hand to practice on both sides of the body as it crosses over the midline.

If a child avoids crossing the midline, and uses the left hand on the left side of the body and the right hand on the right side of the body, then both hands will tend to get equal practice at developing fine motor skills, and the child's true handedness may be apparently delayed. This may affect future handwriting skills.

When Kids Have Trouble Crossing the Midline

Some children may struggle to easily cross the body midline. When a child shows hesitancy in reaching, stepping or looking across the midline of the body, this is known as midline crossing inhibition.

Sometimes this delay can be seen when a child hesitates or is clumsy during gross motor tasks which require the arm or leg to cross over to the other side.

Some children with delayed midline crossing skills may display some "compensatory mechanisms" in school that make writing really awkward for them. Have a look at the kids pictured below:

These girls below have shifted their work over to the side to avoid crossing their midline while they work.

Kids who avoid crossing their midline just seem to take up more desk space as they shift their bodies, their chairs and their work to keep their writing hand on the same side of the body!

How to Help Your Child Cross the Midline

There are so many easy ways that you can help your child developing midline crossing skills:

Support Your Child's Bilateral Coordination Skills

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For those who like to dig deeper, this section below is for you!

Getting Technical: Midline Crossing and the Brain

The brain is divided into two sides, called the left and right hemispheres.

There is a mass of tissue between the two hemispheres, called the corpus callosum. The corpus callosum contains nerve fibers that allow the two hemispheres to communicate with each other in order to coordinate learning and movement.

A lack of midline crossing may indicate that the left and right sides of the brain (the left and right hemispheres) are not communicating well across the corpus callosum.

When a hand works in the space on the same side of the body ( the ipsilateral space), only one brain hemisphere is used. When the hand or leg crosses over to complete a task on the opposite side of the body ( the contralateral space), then both hemispheres of the brain are used. This requires more processing time owing to the communication/interaction between the hemispheres. These movements into contralateral space may also greater neurological organization than movements that don't cross the midline.

Smits-Engelsman et al (2004) found that when doing activities that require midline crossing, younger children were found to make more errors and usually needed more time to complete the task than older children did.

It was suggested that the reason for the errors was the additional processing and neurological organization required to complete the tasks - the more mature brains were able to process and carry out the contralateral tasks more efficiently than the younger brains.

References
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Why is crossing the midline such a big issue? Find out more about why it is important and how to help your child.

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甚麼是「跨越身體中線」，對嬰兒發展有什麼重要？

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甚麼是「跨越身體中線」，對嬰兒發展有什麼重要？

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Child Development Centre - Igniting Learning Journeys

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「跨越中線」是指一邊的肢體越過身體中線的動作。在身體建立中線之前，孩子活動時通常會只利用一邊的肢體。例如：用右手拿起放在右邊的物件。

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【史楚普效應】Stroop Effect | ストループ効果 | 斯特魯普效應 | 司楚卜效應 | 心口不一