研究目的：孤独症是一种在幼儿早期发病的神经发育障碍，核心症状是社会交往障碍、刻板行为、兴趣或活动范围狭窄。共同注意是利用手势和眼神交流等协调他人的注意，以分享对感兴趣的物体或事件的体验。孤独症儿童共同注意障碍导致其难以获得社交发展所需的基础功能。以往共同注意研究多聚焦于3岁前孤独症儿童，对学龄期儿童关注不够，学龄期孤独症儿童应答性共同注意是否发育完善及干预是否具有价值存在争议。共同注意干预方法和手段仍需进一步扩展，其可能的作用机制有待进一步明确。此外，研究证实运动是具有循证依据的干预方法，可以改善孤独症认知与行为问题、促进脑智发育。但共同注意方面，运动干预共同注意研究很少，尚未见到小篮球运动对孤独症儿童共同注意的干预。此外，运动对共同注意的作用机制尚不明确，缺乏科学证据的支持。本研究旨在探讨孤独症儿童共同注意表现特征，进一步验证学龄期孤独症儿童应答性共同注意是否发育完善；开展小篮球运动对孤独症儿童共同注意的干预实验，检验学龄期共同注意干预是否依然有效；此外，进一步分析小篮球运动对孤独症儿童共同注意和大脑静息态功能连接的影响，揭示小篮球运动对孤独症儿童共同注意影响的认知神经机制。

研究方法：（1）研究一采用比较研究设计，考察孤独症儿童共同注意表现特征。共同注意社会性特征方面，面向4~12岁孤独症儿童和正常儿童发放共同注意量表；孤独症组有效问卷84份，正常儿童组有效问卷104份。共同注意眼动特征方面，对6~12岁孤独症儿童、正常儿童进行共同注意眼动任务测查。两组儿童共同注意量表指标、眼动任务指标分别进行独立样本t检验。（2）研究二为相关研究设计，分别考察共同注意社会性特征与症状、共同注意眼动特征与症状之间的关系。（3）研究三为干预研究，探索小篮球运动干预对孤独症儿童共同注意的作用。研究包括4个实验，均招募4~12岁孤独症儿童，实验组在常规康复训练的基础上，进行12周中等强度小篮球运动干预；对照组常规康复、学习、生活等与以往保持不变。实验1：实验组22人、对照组26人，干预前后分别完成共同注意量表考察；实验2：实验组23人、对照组33人，干预前后分别完成共同注意眼动任务；实验3：实验组23人、对照组33人，干预前后分别完成共同注意静态线索眼动任务；实验4：实验组11人、对照组10人，干预前后分别完成多目标追踪任务。4个实验均采用广义估计方程进行数据分析。（4）研究四为认知神经机制研究，探索小篮球运动干预对孤独症儿童共同注意影响的可能的认知神经机制。招募4~12岁孤独症儿童，实验组16人、对照组11人，干预前后进行共同注意眼动任务测查与磁共振扫描。对干预前后两组眼动指标变化情况、大脑静息态功能连接变化情况进行独立样本t检验；对干预前后眼动任务指标变化情况与大脑静息态功能连接变化情况进行相关分析。

研究结果：（1）研究一，孤独症儿童与正常儿童共同注意存在显著差异。共同注意社会性特征方面，两组共同注意总分、亲社会性维度和非社会性维度方面统计学差异极其显著（p <0.001）。孤独症组共同注意总分、亲社会性得分明显低于正常儿童组；孤独症组非社会性表现显著高于正常儿童组。共同注意眼动特征方面，孤独症儿童与正常儿童在AOI注视时间、AOI注视次数、AOI访问时间、AOI访问次数、首次注视正确次数、首次注视正确次数比非正确次数、视屏时间统计学差异均极其显著（p <0.001），孤独症组上述指标表现均明显低于正常儿童组； 孤独症组的线索首次注视时间则明显高于正常儿童组（p =0.03）。（2）研究二，共同注意社会性特征，亲社会维度与症状中度负相关（r=-0.41，p =0.04），共同注意总分与症状中度负相关（r=-0.40，p =0.04）；共同注意眼动特征，AOI注视次数与症状中度负相关（r=-0.45，p =0.02），AOI注视时间与症状强相关（r=-0.52，p =0.007），AOI访问时间与症状强相关（r=-0.54，p =0.005）。（3）研究三，12周中等强度小篮球运动对共同注意干预结果。实验1：两组在共同注意亲社会维度方面交互作用显著（p =0.04），干预后实验组升高、对照组下降。实验2：共同注意眼动特征，干预前后，两组在AOI注视时间上，时间与组别交互作用统计学差异极其显著（p <0.001），干预后实验组显著上升、对照组略下降；AOI访问时间，时间与组别交互作用显著（p =0.01）；首次注视正确次数、首次注视正确次数与错误次数比，时间与组别交互作用极其显著（p <0.001）。实验3：共同注意静态线索追踪，两组在AOI-1注视次数方面，时间与组别交互作用显著（p =0.04），两组成绩均有下降，但对照组下降更明显。 实验4：共同注意动态线索追踪，干预前后，两组一球正确率时间与组别交互作用显著（p =0.01），运动干预后实验组提高、对照组下降。（4）研究四，两组首次注视正确次数方面，干预前后差异非常显著（p =0.008），干预后实验组首次注视正确物体次数增多、对照组则出现下降；首次注视正确率，两组干预前后变化差异显著（p =0.01），干预后实验组首次注视正确率提高、对照组则出现下降。干预前后，两组儿童大脑静息态功能连接变化显著差异脑区为岛盖部额下回、中扣带回、额中回。干预后实验组左侧前扣带回与右侧岛盖部额下回功能连接减弱，且两者之间功能连接减弱与共同注意首次注视正确次数增多呈显著负相关（r=-0.55，p =0.04）；对照组未发现上述脑区静息态功能连接变化与行为变化之间的显著相关性（r=-0.18，p =0.64）。  

研究结论：（1）4~12孤独症儿童存在共同注意障碍，在共同注意社会性特征及眼动特征方面均有表现。（2）孤独症共同注意社会性特征和眼动特征指标均与孤独症核心症状评分直接相关，提示共同注意对孤独症具有重要意义。（3）12周中等强度小篮球运动干预可以有效改善孤独症儿童共同注意能力。（4）12周中等强度小篮球运动干预对孤独症儿童共同注意有积极影响，其可能的认知神经机制是小篮球运动干预后孤独症儿童大脑左侧前扣带回与右侧岛盖部额下回功能连接强度减弱。

Objective: Autism is a neurodevelopmental disorder that occurs in early childhood, characterized by core symptoms such as social interaction disorders, stereotypical behaviors, and narrow interests or activities. Joint attention, which involves coordinating one's attention with others through gestures and eye contact to share experiences of objects or events of interest, is crucial for social development.Children with autism have a joint attention disorder that makes it difficult for them to acquire the basic functions that required for social development. While previous research on joint attention has mainly focused on children with autism under the age of three, less attention has been given to school-aged children, and there are controversies regarding whether responsive joint attention development and intervention are still effective during this period. Intervention methods and approaches for joint attention still need further development, and the potential mechanisms of action require clarification. Additionally, evidence has shown that exercise is an evidence-based intervention that can improve cognitive and behavioral problems related to autism and promote brain development.However, in terms of joint attention, there is little research on exercise intervention for joint attention, and there has not been any intervention of mini-basketball on joint attention in children with autism.In addition, the mechanism of the effect of exercise on joint attention is not yet clear, and there is a lack of scientific evidence to support it. This study aims to investigate the characteristics of joint attention performance in children with autism, to verify whether responsive joint attention is still developing during the school-aged period, to conduct a basketball intervention experiment to examine whether joint attention intervention is still effective during this period, and to further analyze the effects of basketball intervention on joint attention and functional connectivity in the brain of children with autism, and to elucidate the cognitive and neural mechanisms underlying the effects of basketball intervention on joint attention in children with autism.

Methods:

The research methods consist of 4 parts: (1) A comparative research design was used to examine the characteristics of joint attention in children with autism. A joint attention questionnaire was administered to children with autism and typically developing children aged 4-12, with 84 valid questionnaires in the autism group and 104 in the control group. A joint attention eye-tracking task was conducted with autistic children and typically developing children aged 6-12. Independent sample t-tests were used to compare the joint attention questionnaire and eye-tracking task scores between the two groups. (2) A correlation research design was used to investigate the relationship between joint attention characteristics and symptoms in children with autism. (3) A mini-basketball intervention study was conducted to explore the effects of mini-basketball intervention on joint attention in children with autism. Including 4 experiments, all recruited children with autism aged 4-12. The experimental group received 12 weeks of mini-basketball intervention on the basis of routine rehabilitation training. The routine rehabilitation, learning, and daily life of control group remained the same as before. Experiment 1: 22 participants in experimental group and 26 participants in control group.All of them completed the Joint  Attention Scale before and after intervention. Experiment 2: 23 participants in experimental group and 33 participants in control group.All of them completed the common attention eye movement task before and after the intervention. Experiment 3: The experimental group consisted of 23 autistic childern and the control group consisted of 33 autistic childern, who completed the task of joint attention static cue eye movement before and after the intervention. Experiment 4: 11 participants in experimental group and 10 participants in control group.All of them completed multi-objective tracking tasks before and after intervention. All 4 experiments used generalized estimation equations for difference testing. (4) A cognitive and neural mechanism study was conducted to explore the possible cognitive and neural mechanisms underlying the effects of mini-basketball intervention on joint attention in children with autism. Recruit the children with age 4~12, 16 participants in experimental group and 11 participants in control group. Conduct joint attention eye movement task tests and magnetic resonance imaging before and after intervention. Independent sample t-tests were used to compare changes in eye movement indicators and brain resting state functional connectivity before and after intervention in both groups. Analyze the correlation between changes in eye movement task indicators and changes in brain resting state functional connectivity.

Results:

(1) Study 1: There is a significant difference in joint attention between autistic children and normal children. In terms of social characteristics of joint attention, there was a statistically significant difference between the two groups in terms of total score of joint attention, prosocial dimension, and unsocial dimension (p <0.001). The total score of joint attention and prosocial behavior in the autism group were significantly lower than those who in the normal children group; The unsocial performance of the autism group was significantly higher than those who in the normal children group. In terms of joint attention to eye movement characteristics, there were extremely significant differences (p <0.001) between children with autism and normal children in terms of AOI fixation time, AOI fixation frequency, AOI visit time, AOI visit frequency, first fixation correct frequency, first fixation correct frequency compared to incorrect frequency, and screen time. The performance of the above indicators in the autism group was significantly lower than that in the normal children group; The first fixation time of cues in the autism group was significantly higher than that in the normal children group ((p =0.03).

(2) Study 2: In terms of social characteristics of joint attention, the prosocial dimension was moderately negatively correlated with symptoms (r=-0.41, p =0.04), and the total score of joint attention was moderately negatively correlated with symptoms (r=-0.40, p =0.04). In terms of joint attention with eye movement characteristics, AOI fixation frequency was moderately negatively correlated with symptoms (r=-0.45, p =0.02); AOI fixation time is strongly correlated with symptoms (r=-0.52, p =0.007), and AOI visi time is strongly correlated with symptoms (r=-0.54, p =0.005).

 (3) Study 3: The effect of 12 week mini-basketball exercise on joint attention intervention. Experiment 1: There was a significant interaction between the two groups in terms of prosocial dimension of joint attention (p =0.04). After intervention, scores with experimental group  increased and control group decreased. Experiment 2: In terms of eye movement characteristics with joint attention, there was a statistically significant difference in AOI fixation time between the two groups in time and group interaction (p <0.001). After intervention, experimental group showed a significant increase, while control group showed a slight decrease. The terms of AOI visit time, there was a significant interaction between time and group(p =0.01). The interaction between time and group was extremely significant (p <0.001) in terms of the correct number of first fixations,and  the ratio of correct first fixations to incorrect first fixations. Experiment 3: This study is about static clue tracking of joint attention. Before and after intervention, the two groups had a significant between time and group interaction in terms of  AOI-1 fixation frequency (p =0.04). Both groups showed a decrease in performance, but the control group showed a more significant decrease. Experiment 4: This study is about dynamic clue tracking of joint attention. Before and after intervention, the two groups had a significant between time and group interaction in terms of one ball accuracy(p =0.01). After exercise intervention, the experimental group improved while the control group decreased.

 (4) Study 4: There was a significant difference in the correct number of first fixations between the two groups before and after intervention (p =0.008). After intervention, the number of correct first fixations increased in the experimental group, while decreased in the control group. The first fixation accuracy rate showed a significant difference between the two groups before and after intervention (p =0.01). After intervention, the first fixation accuracy rate in  experimental group increased, while it decreased in control group. Before and after intervention, there was a significant difference in the changes in resting state functional connectivity between the two groups of children. The brain regions were the insular inferior frontal gyrus, middle cingulate gyrus, and middle frontal gyrus. After intervention, the functional connection between the left anterior cingulate gyrus and the right inferior frontal gyrus of the insula in the experimental group decreased, and there was a significant negative correlation between the decreased functional connection and the increase in the correct number of first fixation of joint attention (r=-0.55, p =0.04); No significant correlation was found between changes in resting state functional connectivity and behavioral changes in the control group (r=-0.18, p =0.64).

Conclusion:

(1) Children with autism from 4 to 12 have joint attention disorders, which are manifested in social and eye movement characteristics. (2) The social and eye movement characteristics indicators of joint attention in autism are directly related to the autism symptom score, indicating that joint attention is very important for autism. (3) 12 weeks of mini-basketball exercise intervention can effectively improve the joint attention ability of autistic children. (4) The 12 week mini-basketball exercise intervention has a positive impact on joint attention in children with autism, and the possible cognitive neural mechanism is that after the mini-basketball exercise intervention, the functional connection strength between the left anterior cingulate gyrus and the right inferior frontal gyrus of the insula.