4 Discussion
In the present study, we described an intervention using Dohsa-hou for a girl with Kabuki syndrome associated with ASD and examined the changes during and after the intervention. Reciprocal interaction improved in her daily life, as well as in Dohsa-hou and play sessions. Regarding joint attention, changes were observed in the sharing of intentions during the sessions with the therapist, but no clear improvement was observed in daily life.
In the early stages of the Dohsa-hou intervention, Sara was not able to pay attention to her own body or the intention of the therapist in the interaction. As the session progressed, she became aware of the therapist’s intentions and was able to share her intentions in the sessions. This process involved paying attention to her own body movements through physical experience and noticing the therapist’s support (i.e., intentions) in the process. Through the process, there was a preceding change in the way she interacted with the therapist during the treatment sessions. Then, the changes in reciprocal relationships with others were observed in daily life. Shared intention and change in interactions through joint action coordination could be therapeutic factors that lead to reciprocal interpersonal relationships in ASD as suggested in recent literature. 34, 35Therefore, interventions, such as Dohsa-hou and/or psychomotor therapy can be helpful for this population.12 As ASD are associated with certain cases of rare genetic disorders including Kabuki syndrome, 36-38 such an approach would be a viable treatment option for these children with the disorders.
In this study, we only evaluated patient functioning; however, parental burden is also important for management of the families.39, 40 Because no curative treatment is available for the disease, further research is required to establish adequate management practice for patients and families.
There are a few issues to be considered in this study. Kabuki syndrome is usually associated with less severe intellectual disability (i.e., mild to moderate),41 but the participants in this study had both severe intellectual disability and ASD. The process and quality of interaction may be affected by patient’s functioning. Although joint attention was established with a specific person (i.e., the therapist), it did not generalize to other relationships. However, the Joint Attention Behavior Scale is a measure of disability and may not be appropriate for detecting therapeutic changes.
In conclusion, we described Dohsa-hou intervention for a girl with Kabuki syndrome, who has ASD and intellectual disability, that resulted in changes in her interaction with others and sharing of intentions. These changes may have been accompanied by changes in interaction with the therapist during the Dohsa-hou and play sessions. The Dohsa-hou could be a treatment option for ASD associated with genetic disorders.