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.