NONAKA SHUNSUKE

Backgrounds: Hikikomori, a severe form of social withdrawal, is increasingly a serious mental health issue worldwide. Hikikomori is comorbid with various psychiatric conditions including depression, social anxiety and suicidal behaviors. Family support is encouraged as a vital first step, however evidence-based programs have yet to be established. Mental Health First Aid (MHFA) is one of the most well-validated educational programs encouraging lay people such as family members, to support close persons suffering from various psychiatric conditions such as depression, anxiety and suicidal behaviors. Methods: We newly developed an educational program for family members of hikikomori sufferers mainly based on MHFA and 'Community Reinforcement and Family Training (CRAFT)' with role-play and homework. As a single-arm trial, 21 parents (7 fathers and 14 mothers) living with hikikomori sufferers participated in our program with five once-a-week sessions (2 h per session) and six monthly follow-ups, and its effectiveness was evaluated using various self-rated questionnaires. Results: Perceived skills toward a depressed hikikomori case vignette, stigma held by participants, and subscales of two problematic and one adaptive behaviors of hikikomori sufferers were improved throughout the sessions and follow-ups. In addition, positive behavioral changes of hikikomori sufferers such as improved social participation were reported by participants. Limitations: Single-arm design and evaluation using self-rated questionnaires are the main limitations of the present study. Conclusions: Our newly developed program has positive effects on family members in their contact and support of hikikomori sufferers. Future trials with control groups are required to validate the effectiveness of this program.

【背景】自閉スペクトラム症(Autism Spectrum Disorder:ASD)児の不安症状に対する認知行動療法の有効性はこれまで示されているが、教師が学校で実施できるプログラムはまだ確立されていない。【目的】ASD児向けの小学校で実施可能な不安軽減プログラムを開発し、まず小集団での実施可能性を検討し(研究1)、次に学校で教師が実施可能かどうかを検討する(研究2)。【方法】ASDの認知特性を考慮して認知的および行動的介入を含むプログラム10回分を開発し、ASDを有する男児3名(8〜11歳)の集団に対して臨床心理士が実施し、出席率や親の報告によって実施可能性を検討した(研究1)。次いで、小学校通級指導教室において教師によるプログラム実施の忠実性を調べ、5年生男児3名には事後に理解度を、そして児童と担任教師の両者には事後に社会的妥当性に関する質問に回答してもらった(研究2)。【結果】研究1では100%の出席率と肯定的な感想が得られた。研究2では、高い忠実性が確認され、児童の理解度は終了後3ヵ月時点でも高い水準で維持されていた。児童、教師による社会的妥当性の回答はおおむね良好であったが、授業の準備にかかる教師への負担が大きいことが示唆された。【結論】同プログラムはASD児に理解可能で集団参加が可能であり、教師が事前研修とサポートがあれば実施可能であることが確認された。今後は、同プログラムのASD児の不安軽減に対する有効性が検証される必要がある。(著者抄録)

The acoustic startle response (ASR) and its modulations are useful neurophysiological measurements in translational research. In particular, prepulse inhibition (PPI) of ASR is considered a candidate endophenotype of psychiatric diseases. However, findings from previous studies of PPI in autism spectrum disorders (ASD) have been inconsistent. Recently, we reported larger ASR magnitude to weak stimuli and prolonged peak startle latency in children with ASD. An atypical profile of ASR in ASD might therefore explain the inconsistent results in previous PPI studies. In addition, the relationship of ASR modulations to clinical characteristics of ASD is not known well. Thus, we investigated PPI with several prepulse intensities and its relationship to autistic traits and other emotional - behavioral problems in children with ASD and with typical development. Although, no significant difference for PPI or habituation was observed in ASD children compared to controls, habituation and PPI at relatively weak prepulse were negatively related to several autistic traits subscales and other emotional - behavioral problems, when considering all children. The comprehensive investigation of ASR and its modulation, including the magnitude of startle responses to weak stimuli peak startle latency, habituation, and PPI, might increase understanding of the neurophysiological impairments underlying ASD and other mental health problems in children.