Background & Objectives: Autism Spectrum Disorder (ASD) is a neural– evolutionary syndrome, i. e., among the most significant Disorders in childhood. In other words, Autism indicates an evolutionary disability which affects verbal and non– verbal communication, as well as social interactions. Moreover, this Disorder usually manifests before the age of three years, and has undesirable effects on educational functioning. Playing music is a multi– sensory process which involves motor planning, preparation, and execution systems in individuals. Purposeful musical– motor activities make children with ASD to shift focus from their inner world to their surrounding environment; subsequently, they create a mutual relationship with the community and social acceptance in children with ASD. The present study aimed to investigate the effects of musical– motor activities on Autism symptoms in children with High– Functioning Autism (HFA) Disorder. Methods: This was a quasi– experimental study with a pretest– posttest and a control group design. In total, 22 children with HFA Disorder and the mean± SD age of 8. 5± 1. 5 years and the mean± SD IQ score of 89. 36± 2. 31 were selected as study participants. Moreover, they were randomly divided into three groups, as follows: exercise intervention with music (7 children, 5 boys and 2 girls), exercise intervention without music (7 children, 6 boys and 1 girl), and the control group, including music (8 children, 6 boys and 2 girls). The study participants in the exercise intervention with music and non– music groups, practiced in a 12– week program of three sessions per week; each session lasted from 45 to 60 minutes. The Orff music was used in this study ) guitar, tombak, xylophone, Flute, drum, metallophone, improvisation, singing, blows with the body, nursery rhymes and consistent with music therapist(. The exercise intervention program included 5 to10 minutes of warm– up )walking, hand and foot stretching, & reviewing the learned movements), 35 to 45 minutes of main practice, that included 20 to 25 minutes of gymnastic fundamental movements (walking, jumping, static and dynamic balance, rabbit, flamingo, cat, crabs, dog, cow, kangaroo, hopping, bridge on shoulders, push– up, & movement on trampoline(, 10 minutes of practice with ball (catching, throwing & dribble), and 10 minutes of rhythmic movements (hands and feet creative and rhythmic movements). additionally 5 to 7 minutes was considered for cool– down, including stretching movements and relaxation. Moreover, the Garss– 2 Measurement Scale (Gilliam) was used for collecting data concerning Autism symptoms in children with HFA Disorder. The obtained data were analyzed in SPSS. Furthermore, we implemented Levene's test, Analysis of Covariance (ANCOVA), Analysis of Variance (ANOVA), and Bonferoni test at a significance level of 0. 05 for data analysis. Results: Results indicated that two groups of exercise intervention with music and without music performed better in stereotyped behavior, communication skills, and social interactions, compared to the control group. Besides, there was a significant difference between the two experimental groups in terms of stereotyped behavior (p<0. 001), communication skills (p<0. 001), and social interactions (p<0. 001). Conclusion: According to the current research findings, musical– motor activities were effective in the control and improvement of stereotyped behavior, communication difficulties, and social interactions in children with HFA Disorder; these progresses were achieved through providing sensory feedback and replacing similar mechanisms. Rhythmic games, as well as rhythmic and creative movements lead to the control and improvement of stereotyped behavior, social interactions, and communication skills in musical– motor activities. Therefore, musical– motor interventions could be used to control and reduce the symptoms of Autism and should be considered in designing training programs for this population.

Background and purpose: Autism spectrum Disorder (ASD) is a neurodevelopmental Disorder associated with problems in social interaction. The aim of this study was to compare the effectiveness of puppet psychodrama and pantomime on social interaction in children with ASD. Materials and methods: We performed a quasi-experimental study in 7-11 year-old children (n=45) with high functioning ASD. They were selected from the Welfare Centers of Tehran, Isfahan, Guilan, and Mashhad Provinces in 2020-2021 school year using convenience sampling. The participants were assigned into two experimental groups (puppet psychodrama or pantomime) and one control group (n=15 per group). The two experimental groups separately participated in 20 virtual sessions (twice a week,15 minutes per session) and received puppet psychodrama or pantomime, while the control group only participated in mainstream programs of the Center. The social interaction of all participants were evaluated using the Autism Social Skills Profile before and after the intervention and after eight weeks. Descriptive indices were used and Chi-square, Shapiro-Wilk test, Mauchly’, s sphericity test, and the Repeated measures ANOVA were applied for data analysis. Results: The eta-quotients showed that both puppet psychodrama and pantomime significantly changed social interaction (88% and 78%, respectively) and its components, including social reciprocity (88% and 78%, respectively), social participation (89% and 81%, respectively), and detrimental social behavior (87% and 76%, respectively) (both P<0. 001). The puppet psychodrama compared to pantomime led to 37% of variation in social interaction. The findings indicated that the control group did not change significantly over time (P>0. 05). Conclusion: Considering the effectiveness of puppet psychodrama, it can be used as an alternative method along with other family-oriented interventions and prevent the consequences of social interaction problems.

Letter to the Editor With interest, we read the review article by Ahmadabadi et al. on Autism spectrum Disorders (ASDs) in inborn errors of metabolism (IEM) (1). They reviewed 37 studies, and found that IEMs underlie autistic features in <5% of the patients, and that there is growing evidence on the association between ASDs and mitochondrial Disorders (MIDs), including mitochondrial encephalopathy, lactic acidosis, stroke-like episodes (MELAS) syndrome, and respiratory chain complex III/IV deficiency (1). The authors concluded that the syndromic Autism, a strong family history, or consanguinity suggest IEM (1). However, we have raised the following comments and concerns: We disagree with the idea that mitochondrial Disorders (MIDs) have only two points of onset as they can occur at any age, and their broad variability, even in a family, results from the peculiarities of mitochondrial genetics. Due to mutations in mtDNA-located genes, MIDs are maternally transmitted, and the underlying mtDNA mutations may not occur in each mtDNA copy (heteroplasmy). Moreover, mtDNA copy number may considerably vary from one mitochondrion to another mitochondrion, particularly if the mutation is located in a nuclearly-encoded gene. MIDs frequently manifest in the central nervous system (CNS), and the CNS manifestations may include psychiatric or neurological diseases or both. The psychiatric diseases range from mild cognitive impairment and personality change to delirium and psychosis. Autism has been frequently reported in MIDs (2) and may or may not be associated with cerebral morphological alterations. We also disagree that ASD occurs only in MELAS and complex-III/ IV deficiency (1). ASD has also been reported in a patient carrying the mtDNA variant m. 8363G>A, whose sister was carrying the same variant and presented with Leigh syndrome (3), as well as in two Korean siblings carrying the variant c. 790C>T in TFB2M (4). In a study on 60 ASD patients, single mtDNA deletions were detected in 16. 6% of the patients (5). In the same study, the ten patients with mtDNA deletions also carried single nucleotide variants (SNVs) in ASD-associated genes (5). In a study on 95 ASD patients, the mtDNA content decreased in the ASD patients, and 49 putative pathogenic mtDNA variants were detected (6). In a study on 10 families with ASD, whole-exome sequencing revealed the variants of interest (VOIs) in the ND5 gene in one family and VOIs in ATP6 and NDUFS4 in another family (7). In a study on 24 Iranian ASD patients, mtDNA mutations 16126T>C, m. 14569G>A, and m., 1811A>G, all of which were located in non-coding regions, showed a significant relationship with ASD (8). In general, there is ample evidence indicating that the IEM, which is most frequently associated with ASD, is MID. According to the literature, the mtDNA variants but not the nDNA variants have been more frequently associated with ASD. Patients with an ASD should be first examined in terms of the presence or absence of MID.