Language of mothers and fathers in interaction with their autistic children.

Introduction: Verbal language is one of the most immediate and significant means parents have to express affect and information to their children. Parental speech directed to children has been thoroughly examined in typical development. However, the characteristics of parental speech directed to children with neurodevelopmental disorders are far less well documented, and no recent studies have been carried out that involve autistic1 children and their fathers. Therefore, the present study aims to analyze and compare maternal and paternal speech directed to young autistic children, focusing on fathers' elements of speech in comparison with maternal language. Methods: N = 88 dyads participated in this study. 44 autistic children (41 males and 3 females) (chronological age: M = 40.01 months; SD = 11.96) in interaction with their fathers (paternal age M = 41.84 years; SD = 7.02) and the same 44 children in interaction with their mothers (maternal age M = 37.37 years; SD = 5.45). The language was verbatim transcribed using ELAN software (ELAN Version 6.4, 2022) and coded with an observational tool (Penman) for analyzing functions and referents of speech after reaching a satisfactory level of agreement between two independent transcribers. Results: No differences emerged considering the affective aspects of speech. However, mothers seem to direct more informative salient statements (W = 1,259; p = 0.02) and call the child's attention more often than fathers (W = 1,253.5; p = 0.02). Regarding referents of informative speech, fathers focused more on the child's internal states rather than mothers (W = 727; p = 0.04). Discussion: These results reveal that fathers seem to display a relationship-based approach focused on a non-intrusive style with few demands while talking with their children, providing a complementary role to mothers that allows complete and harmonious stimulation of all areas of child development.

Co-Design of a Virtual Reality Multiplayer Adventure Game for Adolescents With Autism Spectrum Disorder: Mixed Methods Study.

BACKGROUND: Virtual reality (VR) adventure games can offer ideal technological solutions for training social skills in adolescents with autism spectrum disorder (ASD), leveraging their support for multisensory and multiplayer interactions over distance, which may lower barriers to training access and increase user motivation. However, the design of VR-based game environments for social skills training is still understudied and deserves the deployment of an inclusive design approach to ensure its acceptability by target users. OBJECTIVE: We aimed to present the inclusive design process that we had followed to develop the Zentastic VR adventure game to foster social skills training in adolescents with ASD and to investigate its feasibility as a training environment for adolescents. METHODS: The VR game supports multiplayer training sessions involving small groups of adolescents and their therapists, who act as facilitators. Adolescents with ASD and their therapists were involved in the design and in an explorative acceptability study of an initial prototype of the gaming environment, as well as in a later feasibility multisession evaluation of the VR game final release. RESULTS: The feasibility study demonstrated good acceptability of the VR game by adolescents and an enhancement of their social skills from baseline to posttraining. CONCLUSIONS: The findings provide preliminary evidence of the benefits that VR-based games can bring to the training of adolescents with ASD and, potentially, other neurodevelopmental disorders.

Child-therapist interaction features impact Autism treatment response trajectories.

BACKGROUND: Identifying mechanisms of change in Autism treatment may help explain response variability and maximize efficacy. For this, the child-therapist interaction could have a key role as stressed by developmental models of intervention, but still remains under-investigated. AIMS: The longitudinal study of treatment response trajectories considering both baseline and child-therapist interaction features by means of predictive modeling. METHODS AND PROCEDURES: N = 25 preschool children were monitored for one year during Naturalistic Developmental Behavioral Intervention. N = 100 video-recorded sessions were annotated with an observational coding system at four time points, to extract quantitative interaction features. OUTCOMES AND RESULTS: Baseline and interaction variables were combined to predict response trajectories at one year, and achieved the best predictive performance. The baseline developmental gap, therapist's efficacy in child engagement, respecting children's timing after fast behavioral synchronization, and modulating the interplay to prevent child withdrawal emerged as key factors. Further, changes in interaction patterns in the early phase of the intervention were predictive of the overall response to treatment. CONCLUSIONS AND IMPLICATIONS: Clinical implications are discussed, stressing the importance of promoting emotional self-regulation during intervention and the possible relevance of the first period of intervention for later response.

The teleNIDA: Early Screening of Autism Spectrum Disorder Through a Novel Telehealth Approach.

The COVID-19 pandemic has fast-tracked interest in telehealth methods to guarantee the continuity of care of children with Autism Spectrum Disorder (ASD). Store-and-forward telehealth approaches offer the opportunity to facilitate timely screening of ASD, allowing parents to record videos of their child's behaviors, subsequently shared with clinicians that provide an assessment remotely. This study aimed to examine the psychometric properties of a new telehealth screening tool, the teleNIDA, administered in home settings for remote observation of early signs of ASD in toddlers aged 18-30 months. Results showed good psychometric properties of the teleNIDA, as compared to the gold standard in-person assessment, and the predictive validity on the diagnosis of ASD at 36 months was demonstrated. This study supports the teleNIDA as a promising level 2 screening tool for ASD able to speed up diagnostic and intervention processes.

Play with Me: How Fathers and Mothers Play with Their Preschoolers with Autism.

(1) Background: Children can develop cognitive and social skills during play. Most research has focused on mothers, but the paternal features in interaction with children with autism spectrum disorder (ASD) are mainly unexplored. This study aimed to compare fathers' and mothers' interactive behaviors with their children with ASD to identify similarities and differences during playful exchanges. (2) Methods: A total of 72 mothers and 72 fathers of paired children with ASD (chronological age: M = 44.61 months; SD = 13.37) took part in this study. Data were collected during 10 min of video-recorded semi-structured interactions with mothers and fathers separately in interaction with their children. (3) Results: Mothers showed more symbolic play (W = 3537; p < 0.001) than fathers, who displayed higher levels of exploratory play (t(139.44) = −2.52; p = 0.013) compared to mothers. However, child cognitive functioning impacts maternal play but not the father's play characteristics. (4) Conclusions: Highlighting mother−child and father−child features may have important service delivery implications for implementing personalized parental-based interventions based on the strengths and weaknesses of both caregivers in a complementary system.

Interpersonal synchrony: Interaction variables and gender differences in preschoolers with ASD.

Background: Females with ASD tend to be under-recognized as they might present a different symptom manifestation, better social abilities, and masking behaviors. Since the main limitation of current literature on gender differences is represented by focusing on broad constructs, research needs to prioritize narrower constructs related to the subdomains of social abilities. Hence, the aim of this work was to explore gender differences in Interpersonal Synchrony of children with ASD. Method: N = 51 psychologist-child dyads, 25 females and 26 males participated in the study. An Observational Coding Scheme to study interaction features was applied to video-recorded sessions of the ADOS-2 administration. Results: Females presented more synchronous behaviors with shorter latencies. Their interplays were longer, more complex, more engaging and most frequently adequately concluded with respect to males. The complexity of interchanges, their total duration and the proportion of exchanges adequately terminated correlated with the Social Affect score, Personal-Social, and Language Quotients in females, but not in males. The success rate of psychologist proposals correlated with Language Quotient in both males and females. The number of exchanges positively correlated with the Performance Quotient in males. Despite females being significantly older than males, age-related differences did not emerge. Conclusions: Our findings suggest the importance of studying gender differences with respect to interaction variables. Females may present better IS abilities which, in turn, may promote social and language development. Further, our results suggested that successful interactions seem to rely more on social abilities in females, while males appeared to rely more on performance skills.

Explicit and implicit attachment representations in cognitively able school-age children with autism spectrum disorder: A window to their inner world.

The few studies available on quality of attachment in school-age children with autism spectrum disorder (ASD) exclusively used questionnaires assessing explicit attachment representations. Thus, in the current study we assessed both explicit and implicit attachment representations in 23 children with ASD (without intellectual disability), 22 with learning disabilities and 27 with typical development aged from 7 to 13 years. A self-reported measure on the quality of attachment to parents and a semi-structured interview were administered to the children. In addition, a developmental assessment of the child including measures of intelligence and social-communication impairment was conducted. Despite the lack of group differences on explicit attachment representations, we found that children with ASD showed higher rates of at-risk self-protective strategies and psychological trauma compared to the TD group. Children with SLD also showed a high level of at-risk implicit attachment representations than TD, albeit to a lesser extent compared to children with ASD. These results may be related to several factors associated with ASD impairment and developmental pathways, such as the atypical learning process which occur at interpersonal level, the difficulties in social information processing and reflective functioning. Our findings suggested that children with ASD may experience difficulties in the construction of balanced implicit attachment representations. Thus, a more comprehensive assessment of attachment including both implicit and explicit representations is recommended.

Parenting a Child with a Neurodevelopmental Disorder during the Early Stage of the COVID-19 Pandemic: Quantitative and Qualitative Cross-Cultural Findings.

Research during the COVID-19 pandemic has shown a strong relationship between child symptoms, parental stress, and mental health challenges. The pandemic has changed family routines, worsening child symptomatology and parental burden. The aim of this study was to investigate how the magnitude of the perceived changes in child externalizing behavior, parental stress, and discontinuity of therapy-from before to during the COVID-19 pandemic-affected parental mental health during the pandemic. Moreover, we sought to compare these aspects cross-culturally between European countries and the USA. To these purposes, we asked Italian, Spanish, and U.S. parents of children with neurodevelopmental disabilities (NDD) to complete an online survey. Quantitative results showed that increased parental stress may have contributed to a worsening in parental psychological distress, regardless of culture. Moreover, they suggested an indirect effect of child externalizing behaviors on parents' psychological distress via parental stress. Qualitative analyses highlighted that the lack, or discontinuity, of therapeutic activities may have been one of the key contributors to parenting burden during the COVID-19 pandemic. Finally, qualitative results highlighted resilience factors that could have decreased the risk of psychological problems during the pandemic, such as a strong sense of parental efficacy and the ability to adapt to changing family dynamics.

Family adjustment to COVID-19 lockdown in Italy: Parental stress, coparenting, and child externalizing behavior.

Evidence of psychological distress in families during COVID-19 outbreak are arising. However, the perceived changes in psychological adjustment during home confinement with respect to the period before the pandemic have not been addressed yet. Moreover, little is known about the role of coparenting and specific COVID-19 contextual variables on parental stress and children's behavioral difficulties in the Italian context. Using a cross-sectional survey, we collected data on 841 Italian parents of children aged 3-11 years with typical development during the home confinement (20th April-18th May). We analyzed levels of parental stress, coparenting, and child externalizing behaviors before and during the home confinement. Additionally, hierarchical regressions were performed to investigate predictors of parental stress and child externalizing behaviors during the lockdown. Results showed that parental stress (especially in mothers) and child externalizing behaviors increased during the lockdown period. Coparenting was a strong predictor of parental stress, together with being a mother, younger child age, less time dedicated to the child, and scarce feasibility of remote working. Besides, child externalizing behaviors were predicted by male gender, less parental time dedicated to the child, higher parental stress, and child distance learning workload. Our findings indicate a negative impact of COVID-19 lockdown in both parents and children, suggesting that positive coparenting and time dedicated to children may help to reduce the detrimental effect of pandemic restrictions on family adjustment.

Están surgiendo datos sobre el distrés psicológico en las familias durante el brote de la COVID-19. Sin embargo, aún no se han abordado los cambios percibidos en la adaptación psicológica durante el confinamiento. Este estudio tuvo como finalidad investigar los cambios en los niveles de estrés de los padres, las dificultades conductuales de los niños y la cocrianza antes y durante el confinamiento en el hogar. Además, analizamos los factores pronósticos de estrés por la crianza y las conductas de exteriorización de los niños durante el confinamiento. Utilizando una encuesta representativa, recogimos datos sobre 841 padres italianos durante el confinamiento en el hogar (desde el 20 de abril hasta el 18 de mayo). Analizamos los niveles de estrés de los padres, la cocrianza y las conductas de exteriorización de los niños antes y durante el confinamiento. Se realizaron regresiones jerárquicas para investigar los factores pronósticos de estrés de los padres y las conductas de exteriorización de los niños durante el confinamiento. El estrés de los padres (especialmente de las madres) y las conductas de exteriorización de los niños aumentaron durante el periodo de confinamiento. La cocrianza se mantuvo estable y fue un factor pronóstico fuerte del estrés de los padres, junto con ser madre, niños más pequeños, menos tiempo dedicado al niño y escasa viabilidad de trabajar virtualmente. Las conductas de exteriorización de los niños fueron pronosticadas por el género masculino, menos tiempo de los padres dedicado al niño, un mayor estrés de los padres y la cantidad de actividades de la enseñanza a distancia del niño. Nuestros resultados indican un efecto negativo del confinamiento por la COVID-19 tanto en los padres como en los niños e indican que la cocrianza positiva y el tiempo dedicado a los niños pueden contribuir a reducir el efecto perjudicial de las restricciones de la pandemia en la adaptación familiar.

Working on Cognitive Functions in a Fully Digitalized Multisensory Interactive Room: A New Approach for Intervention in Autism Spectrum Disorders.

The feasibility of working on cognitive functions with children and adults with Autism Spectrum Disorders (ASD) inside Multisensory Interactive Rooms (MIRs) has been poorly investigated, even if sensory atypicalities are common in ASD and usual intervention rooms could represent a challenging sensory setting for patients with ASD. We hypothesized that the possibility to calibrate the sensory stimulation offered by this type of environment, able to promote a positive emotional state in patients with ASD, can consequently favor the interaction with the therapist and the motivation towards activities targeting cognitive functions. High- and low-functioning children and low-functioning adolescents/adults underwent five sessions in a fully digitalized MIR, working on sustained attention, selective attention, association, single inhibition, receptive communication, verbalization, and turn. We developed specific protocols calibrated for sensory stimulation and difficulty level based on the characteristics of the participants. We found statistically significant improvements in all functions, except association, in the children's group. Therefore, a fully digitalized MIR seems suitable for intervention on cognitive functions in ASDs, but further investigations are needed to better address possible differences related to age and functioning level.

Effects of Cognitive Training Programs on Executive Function in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review.

BACKGROUND: Autism Spectrum Disorder is often associated with deficits in executive functions (EFs), which is contributing significantly to individuals with ASD's difficulties in conducting an independent life, particularly considering social skills. Technologies offer promising opportunities to structure EF intervention programs for children on the autistic spectrum. METHODS: This study aimed to review the effectiveness of randomized controlled trials or quasi-experimental studies of EF interventions delivered to children and young people (up to 23 years old) with a diagnosis of ASD. A special focus was dedicated to document the effectiveness of computerized and non-computerized cognitive training on (1) EFs and on (2) ASD symptomatology and social skills. Of 2601 studies retrieved, 19 fulfilled the inclusion criteria. RESULTS: Most of the interventions identified were effective in enhancing EFs and reducing symptoms in children and young people with ASD. Limited evidence is available on their generalization to untrained skills (i.e., social abilities) as well as long-term effects. CONCLUSIONS: There is growing evidence for overall effectiveness of EF training, particularly when computerized. However, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and a small samples of included studies.

Father-Child Interactions in Preschool Children with ASD: A Systematic Review.

Studies on parental interaction in the context of ASD has mainly focused on mothers, even if fathers and their children seem to form close and supportive relationships that may have unique effects on child development. Given the impact of ASD symptoms on a child's ability to interact with significant others, recent findings strengthen the importance of including caregivers during treatment to guarantee a better adaptation to the child's impairments. Despite this, fathers are scarcely involved, and interventions seem to not be tailored to their interactive characteristics and needs. For this reason, a systematic review was conducted to investigate fathers and children with ASD behaviors during interaction. This review found 12 observational studies that identified social, cognitive, and affective interactive modalities in father-child dyads through three psychology-focused journal databases: PubMed, PsycINFO and Scopus. The significant variation in both sample size and in the measures used to assess dyadic outcomes limits the ability of this work to make robust recommendations for intervention. Despite this, the results revealed characteristic behaviors of this dyad that consequently allow specific targets to be worked on during intervention. In fact, from fathers' individual strengths and weaknesses, it is possible to implement interventions that are complementary with maternal characteristics from the perspective of personalized and optimized treatment.

Quantifying the Child-Therapist Interaction in ASD Intervention: An Observational Coding System.

BACKGROUND: Observational research plays an important part in developmental research due to its noninvasiveness. However, it has been hardly applied to investigate efficacy of the child-therapist interaction in the context of naturalistic developmental behavioral interventions (NDBI). In particular, the characteristics of child-therapist interplay are thought to have a significant impact in NDBIs in children with autism spectrum disorder (ASD). Quantitative approaches may help to identify the key features of interaction during therapy and could be translated as instruments to monitor early interventions. METHODS: n = 24 children with autism spectrum disorder (ASD) were monitored from the time of the diagnosis (T0) and after about one year of early intervention (T1). A novel observational coding system was applied to video recorded sessions of intervention to extract quantitative behavioral descriptors. We explored the coding scheme reliability together with its convergent and predictive validity. Further, we applied computational techniques to investigate changes and associations between interaction profiles and developmental outcomes. RESULTS: Significant changes in interaction variables emerged with time, suggesting that a favorable outcome is associated with interactions characterized by increased synchrony, better therapist's strategies to successfully engage the child and scaffold longer, more complex and engaging interchanges. Interestingly, data models linked interaction profiles, outcome measures and response trajectories. CONCLUSION: Current research stresses the need for process measures to understand the hows and the whys of ASD early intervention. Combining observational techniques with computational approaches may help in explaining interindividual variability. Further, it could disclose successful features of interaction associated with better response trajectories or to different ASD behavioral phenotypes that could require specific dyadic modalities.

Paternal speech directed to young children with Autism Spectrum Disorders and typical development.

BACKGROUND: Few studies have investigated the characteristics of father language directed to typically developing children (TD), and father speech directed to children with Autism Spectrum Disorders (ASD) is largely under investigated. Considering the importance of involving fathers of children with ASD in research and clinical practice, the main purpose of this study was to investigate paternal speech directed to children with ASD compared to that of fathers of TD children. METHODS: To this aim, we coded multiple functional aspects of speech during 10-min naturalistic dyadic play interactions between fathers and their preschool children with ASD (n = 20) and with TD (n = 20). RESULTS: Results showed that fathers of children with ASD displayed a peculiar child-directed language that seems to reflect the effort to provide enhanced scaffolding and reduced demands while sustaining a challenging social interaction. Specifically, fathers of children with ASD used more descriptions, fewer questions in general but more questions about child internal states. Moreover, fathers adapted aspects of their information-salient speech to the severity of child impairments. CONCLUSIONS: Our findings support the importance to include fathers in early developmental intervention programs for children with ASD, by underlying fathers' spontaneous adaptation to their children's needs.

Psychological impact of Covid-19 pandemic in Italian families of children with neurodevelopmental disorders.

Research on the psychological impact of the COVID-19 pandemic highlighted negative effects on the general population and particularly on parents. However, little is known about families of children with Neurodevelopmental Disorder (NDD). The present study investigated parental stress, coparenting, and child adjustment in Italian families with children with NDD (N = 82) and typical developing children (TD, N = 82) during lockdown, using an online survey. Results of quantitative analyses showed a significant increase in parental stress and child externalizing behaviors, but not of coparenting. Parental stress is predicted by externalizing behaviors, and coparenting acted as a moderator in the relationship between the change in the amount of time spent with the children before and during lockdown and parental stress. In children with NDD, the decrease in therapeutic/rehabilitation support predicted higher externalizing behaviors. Qualitative analysis showed that beyond the difficulties and worries arising during lockdown, most of the parents appreciated the opportunity of spending more time with their children and strengthening the parent-child relationship. In conclusion, our results point out the importance of ensuring continuity of care for children with NDD (e.g. telehealth) during home confinement and of providing psychological support for parents.

Emotional Availability and Play in Mother-Child Dyads with ASD: Changes during a Parental Based Intervention.

(1) Background: Parental involvement during intervention with children with Autism Spectrum Disorder (ASD) has been demonstrated to be fundamental for children's developmental outcomes. However, most research focused on child gains especially considering cognitive functioning and symptoms severity, whereas parental and dyadic changes during intervention need further investigation. (2) Methods: 29 mothers in interaction with their preschool children with ASD were analyzed through two standardized behavioral and observational measures to evaluate the dyadic Emotional Availability (EA) and play skills before (T1) and after (T2) a parental-based intervention. (3) Results: Results revealed mothers increased affective quality and major awareness in understanding the signals produced by the child, that in turn was more responsive, involving also using more complex play strategies. Interestingly, the role of specific factors able to predict parental characteristics was investigated, pointing out the important contribution of mothers' perceptions of having a difficult child and child language communicative abilities. (4) Conclusions: the study enhances knowledge about child and caregiver variables that impact on dyadic outcomes, identifying important target areas to be addressed during intervention. Further, our results suggest that a parental-based intervention supports and facilitates improvements in both children's and caregivers' affective quality and cognitive abilities.

Changes in Developmental Trajectories of Preschool Children with Autism Spectrum Disorder during Parental Based Intensive Intervention.

(1) Background: Research highlights the positive effects of early intensive intervention with parent and school involvement for preschool children with Autism Spectrum Disorder (ASD) on general developmental outcomes and social skills in randomized controlled trials. However, given the inter-individual variability in the response to treatment, it is necessary to investigate intervention effects in terms of mediators and moderators in order to explain variability and to highlight mechanisms of change. (2) Methods: 25 children in the experimental group were exposed to early intensive intervention and 14 children in the control group were subjected to "as usual" intervention. The initial assessment was obtained at the time of diagnosis (T1) and the follow-up assessment was conducted after 15 months of intervention (T2) in both groups. (3) Results: Participants in the experimental group achieved more prominent gains in both cognitive and socio-interactive skills. The role of specific factors able to predict general quotient and language quotient after intervention were investigated, pointing out the contribution of personal-social and performance abilities. (4) Conclusions: The findings support the importance of parental involvement in targeting ASD core symptoms. Further, results informed our understanding of early predictors in order to identify specific elements to be targeted in the individualized intervention design.

An Investigation of Attention to Faces and Eyes: Looking Time Is Task-Dependent in Autism Spectrum Disorder.

A defective attention to faces and eyes characterizes autism spectrum disorder (ASD), however, the role of contingent information - such as the task instructions - remains still unclear. Our study aimed to investigate the face-orienting response and the subsequent attentive selection in the presence of varying task instructions in individuals with atypical and typical development. Twenty young adults with ASD and 24 young adults with typical development participated in our eye-tracking study. The participants received one of three different instructions at the beginning of each trial and watched scenes of a social interaction. The instructions asked either to find an object (visual-search, VS), to identify which actor was paying attention to the conversation (gaze-reading, GR), or to simply watch the video (free-viewing, FV). We found that the groups did not differ in terms of proportion of first fixations to the face. Nonetheless, average looking time and proportional looking time to faces differed across groups. Furthermore, proportional looking time to faces was task-dependent in the ASD group only, with maximum proportion in the GR and minimum in the VS condition. This result cannot be explained by a lack of an initial bias to orient to the face, since the face-orienting tendency was similar in the ASD and the control group.

Mother-Child Play: A Comparison of Autism Spectrum Disorder, Down Syndrome, and Typical Development.

The purpose of the present study was to analyze mother-child collaborative play in children with Autism Spectrum Disorders (ASD) compared to children with Down Syndrome (DS) and typical developing children (TD). Children with ASD are often described as having deficient play skills, particularly in the symbolic domain. Caregivers' involvement in child play activities increases the structural complexity of playing in both typically developing children and children with disabilities. Participants included 75 mothers and their children with ASD (n = 25), with down syndrome (n = 25) and with typical development (n = 25). Mother-child play sessions were analyzed using a coding system for exploratory and symbolic play. Results indicated that children with ASD showed more exploratory play compared to children in the other groups. No significant differences emerged between the three groups for child symbolic play or for mother play. These findings are discussed in relation to the debate about functional and symbolic play in children with ASD and in relation to the importance of setting and age for play assessment.