Understanding Natural Approaches to Autism

Understanding Natural Approaches to Autism

When it comes to addressing the unique needs of individuals with autism, natural approaches have gained popularity over the past decade. These approaches encompass a range of therapies and interventions that focus on harnessing the benefits of nature and incorporating them into the lives of individuals on the autism spectrum. By understanding and exploring these natural approaches, we can better support individuals with autism in their development and overall well-being.

Natural Approaches for Autism

Natural approaches for autism encompass a variety of therapies and interventions that aim to improve the quality of life for individuals on the autism spectrum. These approaches often focus on utilizing nature and non-medical interventions to support the development of individuals with autism. Some examples of natural approaches include:

• Animal-Assisted Interventions: Programs that involve interacting with animals, such as therapeutic horseback riding or the use of service dogs, have shown positive effects on individuals with autism. These interventions can help improve social skills, communication, and emotional well-being.
• Music Therapy: Music has a unique ability to engage individuals with autism and can be used as a therapeutic tool. Music therapy involves using music-based activities to address various goals, such as improving communication skills, self-expression, and emotional regulation.
• Art Therapy: Art therapy provides individuals with autism a creative outlet to express themselves and explore their emotions. Through various art forms, individuals can enhance their communication skills, improve sensory integration, and develop self-awareness.

Benefits of Natural Approaches

Natural approaches offer several potential benefits for individuals with autism. These approaches often align with the preferences and strengths of individuals on the autism spectrum, making them more receptive to interventions. Some benefits of natural approaches include:

• Individualized and Integrated: Natural approaches can be tailored to meet the specific needs of each individual with autism. These interventions can be integrated into their daily routine, allowing for consistent support and progress. By incorporating natural approaches into their lives, individuals with autism can experience ongoing benefits across various domains of development.
• Addressing Core Symptoms: Natural approaches have the potential to address core symptoms of autism, such as communication difficulties and repetitive behaviors. By utilizing therapies like music, art, and animal-assisted interventions, individuals with autism may see improvements in their social skills, emotional regulation, and overall well-being.
• Enhancing Overall Well-being: Many natural approaches aim to improve the overall well-being of individuals with autism. For example, dietary interventions, such as gluten-free or casein-free diets, nutritional supplements, and probiotics, are believed to potentially alleviate symptoms and improve overall health in individuals on the autism spectrum. Additionally, mind-body therapies like acupuncture, massage therapy, meditation, and yoga can help manage symptoms such as anxiety, hyperactivity, and sensory sensitivities, promoting relaxation and stress reduction.

By embracing natural approaches to autism, we can unlock the potential for individuals on the autism spectrum to thrive and enhance their overall well-being. These approaches offer individualized support and address core symptoms, empowering individuals with autism to lead fulfilling lives.

Therapeutic Interventions for Autism

When it comes to addressing the unique needs of individuals with autism, there are various therapeutic interventions available. These approaches aim to support individuals in their development, communication, and overall well-being. Three popular therapeutic interventions for autism are animal-assisted interventions, music therapy, and art therapy.

Animal-Assisted Interventions

Animal-assisted interventions have gained recognition as a natural approach to supporting individuals with autism. Programs and services incorporating therapeutic horseback riding and the use of service dogs have seen significant growth in recent years.

The presence of animals can have a calming effect on individuals with autism, leading to improved social interaction, emotional regulation, and sensory integration. Interacting with animals can also promote the development of empathy, responsibility, and communication skills. Additionally, animal-assisted interventions provide opportunities for physical activity and outdoor engagement.

Music Therapy

Music therapy has shown promise in supporting individuals with autism. It involves the use of music and musical elements to address specific goals and needs. Music has a unique way of engaging individuals with autism, as it can capture their attention, promote self-expression, and facilitate communication.

Through music therapy, individuals with autism can develop social skills, improve emotional regulation, enhance cognitive abilities, and strengthen their sensory integration. Music therapists use various techniques, such as improvisation, singing, playing instruments, and songwriting, to tailor interventions to meet the specific needs of each individual.

Art Therapy

Art therapy provides individuals with autism a creative and expressive outlet to communicate and explore their emotions. It involves the use of various art forms, including drawing, painting, sculpting, and collage-making, as a means of self-expression and reflection.

Art therapy can help individuals with autism improve their self-awareness, emotional regulation, and social skills. Engaging in artistic activities allows individuals to express themselves non-verbally and explore their thoughts and feelings in a safe and supportive environment. Art therapists work closely with individuals, adapting interventions to their unique strengths and needs.

By integrating these therapeutic interventions into treatment plans, individuals with autism can benefit from the positive effects of animal-assisted interventions, music therapy, and art therapy. These natural approaches offer alternative avenues for communication, self-expression, and skill development, promoting overall well-being and enhancing the quality of life for individuals with autism.

Exercise and Autism

Engaging in regular exercise can have a positive impact on individuals with autism, benefiting their overall well-being. In this section, we will explore the effects of exercise on mood and cognitive function, the social benefits of physical activity, and the importance of physical health for individuals with autism.

Effects of Exercise on Mood and Cognitive Function

Exercise plays a significant role in improving mood and cognitive function in individuals with autism. According to Autism Speaks, regular physical activity can help improve mood, reduce anxiety, and enhance cognitive functioning. These benefits can lead to better focus, attention, and overall mental well-being.

By engaging in exercise, individuals with autism may experience a release of endorphins, often referred to as "feel-good" hormones. This can contribute to a more positive mood and a reduction in stress and anxiety levels. Moreover, exercise has been shown to enhance cognitive function, including attention, memory, and problem-solving skills. These improvements can have a significant impact on daily functioning and overall quality of life.

Social Benefits of Physical Activity

Physical activity also provides valuable opportunities for individuals with autism to enhance their social interactions and develop communication skills. Engaging in exercise with peers or participating in group activities can foster social connections and improve social skills.

Through exercise, individuals with autism can learn important social cues, practice turn-taking, and develop teamwork and cooperation skills. Group activities such as team sports or exercise classes create an environment that encourages social engagement, allowing individuals with autism to form meaningful connections with others. These social benefits can contribute to an improved sense of belonging and overall well-being.

Physical Health and Autism

In addition to the psychological and social benefits, regular exercise contributes to better overall physical health for individuals with autism. Addressing common health issues such as weight management and obesity is crucial for maintaining a healthy lifestyle. According to Autism Speaks, exercise can help individuals with autism manage their weight and reduce the risk of obesity-related complications.

It is important to tailor exercise programs to meet the individual needs and preferences of individuals with autism. By involving them in selecting the type of exercise they enjoy, there is a higher likelihood of increased participation and long-term adherence to physical activity routines [3]. This personalized approach ensures that individuals with autism can engage in physical activity that suits their interests and abilities, leading to greater enjoyment and overall well-being.

In summary, exercise offers numerous benefits for individuals with autism, including improved mood, enhanced cognitive function, better social interactions, and enhanced physical health. By incorporating regular physical activity into their routine and tailoring exercise programs to meet their specific needs, individuals with autism can unlock the potential for a healthier and more fulfilling life.

Dietary Approaches for Autism

When it comes to addressing autism, dietary approaches can play a significant role in supporting overall well-being and potentially alleviating certain symptoms. In this section, we will explore three dietary approaches that have shown promise in the context of autism: gut health, nutritional supplements, and essential oils for stress reduction.

Gut Health and Autism

There is a strong connection between gut health and brain health, and addressing gut health issues is an important aspect of treating autism. Promoting a healthy gut can potentially improve symptoms associated with autism. Probiotics, digestive enzymes, and fermented foods are often recommended to support gut health [4]. Probiotics, such as Lactobacillus and Bifidobacterium, have shown potential in improving gastrointestinal symptoms and bowel habits in individuals with autism spectrum disorder (ASD).

Nutritional Supplements

Supplements can play a role in supporting brain health and potentially improving symptoms associated with autism. Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have shown promise in reducing inflammation in the brain and improving symptoms such as hyperactivity and communication difficulties in children with ASD. Including omega-3 fatty acids in the diet through sources like fish oil or flaxseed oil may be beneficial for individuals with autism.

Essential Oils and Stress Reduction

Reducing stress and anxiety is important for individuals with autism, and certain essential oils have been explored for their potential calming effects. Essential oils like lavender or frankincense may help promote relaxation and reduce stress and anxiety levels. These oils can be used through aromatherapy or diluted for topical application. It's important to note that essential oils should be used with caution and under the guidance of a healthcare professional, especially when it comes to children with autism.

While dietary approaches can be beneficial for individuals with autism, it's crucial to consult with a healthcare professional or registered dietitian before implementing any significant dietary changes or introducing supplements. They can provide personalized guidance and ensure that the chosen approach is safe and appropriate for the individual's specific needs. By addressing gut health, incorporating nutritional supplements, and exploring the potential benefits of essential oils, individuals with autism may find support in managing their symptoms and promoting overall well-being.

Behavioral Therapies for Autism

When it comes to addressing the challenges associated with autism, behavioral therapies play a crucial role in promoting positive development and enhancing the quality of life for individuals on the autism spectrum. In this section, we will explore three prominent behavioral therapies: Applied Behavior Analysis (ABA), Occupational Therapy, and Naturalistic Developmental Behavioral Interventions (NDBIs).

Applied Behavior Analysis (ABA)

Applied Behavior Analysis (ABA) is a widely recognized and evidence-based approach that focuses on understanding and modifying behavior. It involves breaking down skills and behaviors into smaller components and using positive reinforcement to encourage desired behaviors while reducing challenging behaviors. ABA interventions are highly individualized and tailored to the specific needs of each person with autism.

ABA therapy utilizes a variety of techniques, such as discrete trial training, pivotal response training, and verbal behavior interventions. These interventions aim to improve communication, social skills, self-care abilities, and reduce challenging behaviors. The therapy is typically implemented in one-on-one sessions with a trained ABA therapist, but it can also be incorporated into classroom settings or daily routines.

Occupational Therapy

Occupational Therapy (OT) is another important behavioral therapy for individuals with autism. OT focuses on helping individuals develop the skills necessary for daily living and participating in meaningful activities. Occupational therapists work with individuals with autism to improve their fine motor skills, sensory processing, self-regulation, and social interaction abilities.

Through a combination of structured activities, sensory integration techniques, and play-based approaches, occupational therapy aims to enhance an individual's independence and functional skills. OT sessions may involve activities such as writing, dressing, playing with sensory materials, and engaging in social interactions. The therapist customizes the interventions to address the specific needs and goals of each individual.

Naturalistic Developmental Behavioral Interventions (NDBIs)

Naturalistic Developmental Behavioral Interventions (NDBIs) represent a more recent approach in the field of autism treatment. NDBIs are implemented in natural settings, involve shared control between the child and therapist, and utilize natural contingencies [6]. These interventions are based on the principles of applied behavior analysis and developmental sciences, merging the two disciplines to create a comprehensive approach.

NDBIs are delivered in natural and interactive social contexts, such as play and daily routines. They involve child-directed teaching strategies, utilizing materials and activities that are preferred by the child. By focusing on the child's interests and creating a supportive environment, NDBIs aim to teach developmentally appropriate skills and promote positive social interactions.

It's important to note that each individual with autism has unique strengths and challenges, and therefore, the choice of behavioral therapy should be based on their specific needs. Applied Behavior Analysis, Occupational Therapy, and Naturalistic Developmental Behavioral Interventions are all valuable approaches that can make a positive impact on the lives of individuals with autism.

Complementary and Alternative Therapies for Autism

In addition to traditional therapies, there are several complementary and alternative approaches that are being explored for the management of autism spectrum disorder (ASD). These approaches include dietary interventions, mind-body therapies, and sensory-based therapies.

Dietary Interventions

Dietary interventions are one of the commonly used complementary approaches for individuals with autism. Some of the dietary interventions include:

• Gluten-free diet: This involves eliminating foods that contain gluten, a protein found in wheat and other grains. It is believed that gluten may contribute to gastrointestinal issues and behavioral symptoms in some individuals with ASD.
• Casein-free diet: Casein is a protein found in milk and dairy products. Eliminating casein from the diet is thought to alleviate gastrointestinal problems and improve behavior in individuals with ASD.
• Nutritional supplements: Nutritional supplements such as omega-3 fatty acids, vitamin B6, magnesium, and various vitamins and minerals are often used as complementary treatments for autism. These supplements are believed to potentially alleviate symptoms of autism and improve overall health.
• Probiotics: Addressing gut health is considered important in treating autism. Probiotics, which are beneficial bacteria, can aid in promoting a healthy gut and potentially improve symptoms of autism.

Mind-Body Therapies

Mind-body therapies focus on the connection between the mind and body, aiming to promote relaxation, reduce stress, and improve overall well-being. Some of the mind-body therapies used in individuals with autism include:

• Acupuncture: This ancient Chinese practice involves the insertion of thin needles into specific points on the body. Acupuncture is believed to promote balance and improve overall health.
• Massage therapy: The use of massage techniques can help individuals with autism manage symptoms such as anxiety, hyperactivity, and sensory sensitivities.
• Meditation: Meditation techniques, such as mindfulness meditation, can help individuals with autism to reduce stress, improve focus, and enhance self-awareness.
• Yoga: Yoga combines physical postures, breathing exercises, and meditation. It can help individuals with autism improve flexibility, balance, and body awareness while promoting relaxation and reducing anxiety.

Sensory-Based Therapies

Sensory-based therapies aim to help individuals with autism better process sensory information and improve their responses to sensory stimuli. Some of the sensory-based therapies used in autism include:

• Sensory integration therapy: This therapy approach focuses on addressing sensory challenges often seen in individuals with ASD. It involves providing structured sensory experiences to help individuals better process and respond to sensory information.
• Occupational therapy: Occupational therapists can work with individuals with autism to develop strategies for managing sensory sensitivities and improving daily functioning.
• Other sensory-based interventions: These may include activities such as deep pressure therapy, use of weighted blankets, or sensory diets tailored to individual needs.

While complementary and alternative therapies can be used alongside traditional treatments, it's important to consult with healthcare professionals and experts in the field of autism to determine the appropriateness and effectiveness of these approaches for each individual.

Research on Natural Approaches for Autism

To better understand the effectiveness of natural approaches for autism, various research studies have been conducted. In this section, we will explore three key areas of research: therapeutic diets, comprehensive nutritional and dietary interventions, and naturalistic developmental behavioral interventions (NDBIs).

Effectiveness of Therapeutic Diets

One area of research focuses on the impact of therapeutic diets on individuals with autism spectrum disorder (ASD). A comprehensive study published in the PubMed Central examined the effects of a 12-month treatment involving a comprehensive nutritional and dietary intervention. The study involved 67 children and adults with ASD, along with 50 non-sibling neurotypical controls of similar age and gender.

The results of this study showed significant improvements in various areas for the treatment group. Nonverbal intellectual ability increased by an average of +6.7 ± 11 IQ points, compared to a decrease of -0.6 ± 11 IQ points in the non-treatment group. Additionally, the treatment group displayed greater improvements in autism symptoms and developmental age, based on semi-blinded assessments.

The study also found that individuals in the treatment group had notable increases in essential nutrients such as EPA, DHA, carnitine, and various vitamins, indicating positive impacts on nutritional factors.

Comprehensive Nutritional and Dietary Interventions

In the same study mentioned above, the comprehensive nutritional and dietary intervention showed significant positive outcomes. Parents of the participants reported improvements in various areas, including nutritional status, non-verbal IQ, autism symptoms, and other symptoms associated with ASD.

The findings suggest that a comprehensive nutritional and dietary intervention can be effective in enhancing the overall well-being of individuals with ASD. It highlights the potential benefits of adopting a personalized approach that considers the unique nutritional needs of each individual.

Naturalistic Developmental Behavioral Interventions (NDBIs)

Naturalistic developmental behavioral interventions (NDBIs) are another area of research that explores natural approaches for autism. NDBIs focus on promoting developmental progress and reducing autism symptoms through natural and play-based interactions. These interventions aim to enhance social communication, language skills, and overall development.

Research studies have shown promising results for NDBIs, indicating improvements in social skills, language abilities, and adaptive behaviors in children with ASD. These interventions often involve incorporating the child's interests and using strategies that are developmentally appropriate.

By exploring the effectiveness of therapeutic diets, comprehensive nutritional and dietary interventions, and naturalistic developmental behavioral interventions, researchers are uncovering valuable insights into natural approaches for autism. While further research is needed to fully understand the long-term effects and individual variations, these studies provide evidence of the potential benefits of these approaches in improving the lives of individuals with autism.

Other Natural Remedies for Autism

In addition to the various therapeutic interventions and dietary approaches, there are other natural remedies that have been explored for their potential benefits in managing autism spectrum disorder (ASD). These remedies include medical cannabis, probiotics, omega-3 fatty acids, herbal remedies, vitamin D3, and melatonin.

Medical Cannabis

Medical cannabis, specifically cannabidiol (CBD), has gained attention as a potential treatment for ASD. It has been shown to alleviate anxiety and aggression, improve sleep quality, and reduce seizure frequency in individuals with ASD [5]. However, it's important to note that the use of medical cannabis for autism is still a topic of ongoing research and discussion, and it should only be considered under the guidance of a medical professional.

Probiotics and Gut Health

Probiotics, such as Lactobacillus and Bifidobacterium, have been studied for their potential benefits in individuals with ASD. These beneficial bacteria can help improve gastrointestinal symptoms and bowel habits in individuals with ASD, who often experience gastrointestinal issues. However, further research is needed to better understand the specific strains and dosages that may be most effective.

Omega-3 Fatty Acids and Neuroinflammation

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been studied for their potential benefits in children with ASD. These fatty acids can help reduce inflammation in the brain, which may contribute to the improvement of symptoms such as hyperactivity and communication difficulties [5]. Including dietary sources of omega-3 fatty acids or considering supplementation under medical supervision may be beneficial.

Herbal Remedies and Neuroprotection

Herbal remedies, used in conjunction with conventional therapy, may improve outcomes for individuals with ASD. Certain herbs, such as ginger, green tea, soybean, turmeric, almonds, and ginkgo, possess neuroprotective properties that may support brain health. However, it's important to consult with a healthcare professional before incorporating herbal remedies into an individual's treatment plan to ensure safety and appropriateness.

Vitamin D3 and Immune Function

Vitamin D3 deficiency is common among children affected by autism. Supplementation with vitamin D3 may improve core symptoms by supporting brain development, neurotransmitter balance, antioxidant ability, and immune function. It is recommended to have vitamin D levels assessed through blood tests and consult with a healthcare professional for appropriate supplementation.

Melatonin for Sleep Quality

Many individuals with ASD experience sleep difficulties. Melatonin supplements can help improve sleep quality, reduce irritability, and decrease anxiety associated with ASD symptoms. However, it's important to consult with a healthcare professional before starting melatonin supplementation to determine the appropriate dosage and timing.

While these natural remedies show promise, it's crucial to approach them with caution and seek guidance from healthcare professionals who specialize in autism. Each individual with ASD is unique, and what works for one person may not work for another. Integrating these natural remedies into a comprehensive treatment plan that includes behavioral therapies, dietary modifications, and other evidence-based interventions can help maximize the potential benefits for individuals with autism.

Physical Activity and Autism

Engaging in regular physical activity has shown numerous benefits for individuals with autism spectrum disorder (ASD). This section will explore the advantages of physical activity for ASD, including improvements in motor skills and cognition, as well as the positive impact of dance on social function.

Benefits of Physical Activity for ASD

Physical activity has been found to reduce maladaptive behaviors in individuals with ASD. Several studies, including meta-analyses, have demonstrated the positive effects of physical activity on social skills and behavior in children and adolescents with ASD [7]. Engaging in activities such as martial arts has been particularly beneficial for individuals on the autism spectrum.

In addition to the social benefits, physical activity plays a significant role in improving overall health and well-being for individuals with ASD. It helps manage weight, improves cardiovascular fitness, and enhances coordination and motor skills. Furthermore, physical activity provides an outlet for individuals with ASD to channel their energy, reduces anxiety, and promotes a sense of calm and relaxation.

Improving Motor Skills and Cognition

Motor skill deficiencies are commonly associated with ASD, and physical activity has been shown to improve motor skills and cognition in children with ASD. Regular participation in physical activities that involve coordination and movement can help enhance motor planning, balance, and motor control. These improvements not only contribute to better physical abilities but also have a positive impact on cognitive function and academic performance.

While children with ASD may have lower levels of physical activity compared to their typically developing peers, tailored physical activity programs can help bridge this gap. By providing opportunities for structured and enjoyable physical activities, individuals with ASD can develop their motor skills, boost self-confidence, and experience the joy of movement.

Dance and Social Function

Dance has been found to have a positive effect on symptoms associated with ASD. Engaging in dance activities has been shown to improve social involvement, behavior, communication skills, body awareness, and mental health in individuals with ASD [7]. Meta-analyses have demonstrated moderate positive effects of physical activity interventions, including dance, on social function in individuals with ASD.

Dance provides a unique platform for individuals with ASD to express themselves creatively, connect with others, and develop social skills. The rhythm, coordination, and synchronization involved in dance activities can enhance social interaction, nonverbal communication, and emotional expression. Moreover, dance offers a supportive and inclusive environment where individuals with ASD can feel a sense of belonging and acceptance.

Parental Involvement in Physical Activity

Parental involvement plays a crucial role in physical activity-based interventions for individuals with ASD. Parents have a significant impact on the engagement and participation of their children in physical activity. By actively encouraging and facilitating their involvement, parents can create a supportive environment that promotes regular physical activity for individuals with ASD.

To optimize the benefits of physical activity for individuals with ASD, it is essential to individualize the programs based on their specific needs and preferences. Different sports and activities may be more effective for different individuals. Considering the preferences and capabilities of each person ensures that the physical activity program is tailored to their unique requirements, maximizing engagement and enjoyment.

By embracing physical activity, individuals with ASD can experience a range of benefits that contribute to their overall well-being. Improved motor skills, cognitive function, and social interaction are just some of the advantages that physical activity offers. Through parental involvement and individualized programs, individuals with ASD can unlock their potential and thrive in the realm of physical activity.

Parental Involvement in Physical Activity

When it comes to physical activity for individuals with autism spectrum disorder (ASD), parental involvement plays a crucial role in ensuring positive outcomes. Parents have the opportunity to actively support and encourage their children with ASD to engage in physical activity, which can have numerous benefits for their overall well-being.

Importance of Parental Involvement

Research has shown that parental involvement positively impacts the participation and engagement of individuals with ASD in physical activity programs. Parents serve as role models and can provide the necessary support and motivation for their children. By actively encouraging and participating in physical activities with their children, parents create a supportive and inclusive environment that fosters engagement and enjoyment.

Involvement in physical activity can also strengthen the parent-child relationship. It provides an opportunity for shared experiences, bonding, and quality time together. Additionally, parental involvement helps to instill a sense of confidence and accomplishment in individuals with ASD, as they witness their parents' belief in their abilities.

By actively participating in physical activities alongside their children, parents can also address any challenges or concerns that may arise during the activity. They can provide guidance and assistance when needed, ensuring a safe and enjoyable experience for their child.

Individualizing Physical Activity Programs

When implementing physical activity programs for individuals with ASD, it is important to consider their unique needs and preferences. Each person with ASD is different, and their abilities and interests may vary. Therefore, it is crucial to individualize physical activity programs to target their specific needs.

Parents can work closely with professionals, such as therapists or educators specializing in ASD, to develop tailored physical activity plans. These plans should take into account the child's strengths, challenges, and sensory preferences. By understanding the specific needs of their child, parents can choose suitable activities and sports that align with their interests and capabilities.

Moreover, parents can explore a variety of physical activities to find the ones that resonate most with their child. Some individuals with ASD may find traditional team sports challenging but may thrive in individual activities like swimming, martial arts, or dance. By providing a range of options, parents can help their children discover enjoyable ways to engage in physical activity.

It is important for parents to create a supportive and encouraging environment where their child feels comfortable and motivated to participate in physical activities. Celebrating achievements, setting realistic goals, and providing positive reinforcement can further enhance the child's enthusiasm and commitment to regular physical activity.

By actively involving themselves in the physical activity journey of their child with ASD, parents can make a significant impact on their overall well-being, social development, and motor skills. Through their support, encouragement, and individualized approach, parents can help their children embrace physical activity as an enjoyable and beneficial part of their lives.

References

• [1]: https://www.verywellhealth.com/complementary-and-alternative-therapies-for-autism
• ‍[2]: https://www.autismspeaks.org/expert-opinion/autism-exercise-benefits
• ‍[3]: https://draxe.com/health/autism-natural-treatment/
• ‍[4]: https://lyphe.com/natural-remedies-for-autism/
• ‍[5]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513196/
• ‍[6]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642468/‍