ASSESSMENT OF A LONG-TERM DEVELOPMENTAL RELATIONSHIP-BASED APPROACH IN CHILDREN WITH AUTISM SPECTRUM DISORDER.

90 Italian children (72 boys, 18 girls) with a diagnosis of infantile autism (age range = 2.5-16.5 yr.) were assessed with a non-verbal intelligence test (Leiter-R). The test was repeated 3 times in four years. The measures used were IQ and Fluid Reasoning (FR), as evaluation of inductive and deductive reasoning, and the Autism Diagnostic Observation Schedule (ADOS), indicative of the severity of autistic symptoms at the beginning and at the end of therapy. The increase in the average IQ and FR scores at retests demonstrates the effectiveness of a treatment that emphasizes the centrality of the relationship-based approach. Moreover, the FR score at intake was predictive of a significant decrease of ADOS scores after four years of treatment, and of the increase in IQ observed in later evaluations. The data support the hypothesis that a relationship-based intervention allows cognitive improvement regardless of the autism severity expressed in the ADOS score.

Babies under 1 year with atypical development: Perspectives for preventive individuation and treatment.

A baby's first year of life is a time of immense development and cerebral plasticity. Following today's research and clinical observation, the period of the first year of life provides a new challenge inasmuch it is presently clear that it is possible to identify developmental anomalies in this window of time. Effecting early screening procedures could prove very useful, especially where we find genetic vulnerabilities in brothers and sisters of autistic subjects. Interventions of this kind, already practiced by some Public Health systems, can mean taking early action and primary protective measures with significant impacts not only on the subjects (babies and family members) concerned, but also on the public purse. It is, therefore, essential to provide for specific professionalized procedures for psychologists, pediatricians and neuropsychologists to be introduced through personnel highly specialized in interventions during the first year of life.

Dreams and COVID-19.

This work originates from reflections on the observation of recurring themes in dreams of patients in psychoanalytic treatment during the most restrictive lockdown period in Italy (March - May 2020). The authors focus on the peculiar dialogic state between consciousness and the unconscious that arose following a collective event such as that of the pandemic, which determined the activation of complex personal nuclei, compensatory effects of the unconscious psyche and new perspective functions. These latter aspects are interpreted with reference to the contributions of Erich Neumann, bringing a new psychological vision of the relationship between Man and Nature in relation to catastrophic events.

Ce travail a pour point de départ nos réflexions sur l'observation de thèmes récurrents dans les rêves de patients en traitement psychanalytique durant la période de confinement le plus strict en Italie (de mars à mai 2020). Les auteurs se concentrent sur l'état dialogique singulier entre la conscience et l'inconscient, qui survient à la suite d'un événement collectif tel la pandémie, et qui détermine l'activation de noyaux personnels complexes, les effets compensatoires de la psyché inconsciente et les fonctions de nouvelle perspective. Ces derniers aspects sont interprétés en référence aux apports d'Erich Neumann, amenant une nouvelle vision psychologique de la relation entre l'Homme et la Nature en lien avec des événements catastrophiques.

El presente trabajo se origina a partir de reflexiones basadas en la observación de temas recurrentes en sueños de pacientes en tratamiento psicoanalítico durante el período de cuarentena de mayor restricción en Italia (Marzo-Mayo 2020). Los autores focalizan en el estado dialógico peculiar entre la consciencia y el inconsciente que emergió a partir de un evento colectivo como el de la pandemia, el cual determinó la activación de núcleos de complejos personales, efectos compensatorios de la psique inconsciente y nuevas funciones. Estos últimos aspectos son interpretados con referencia a las contribuciones de Erich Neumann, ofreciendo una nueva visión psicológica de la relación entre el Hombre y la Naturaleza con relación a los eventos catastróficos.

"My Life in the Hospital": Narratives of Children With a Medical Condition.

Pediatric hospitalization is a common experience that may increase children's sense of isolation and impinge on their social-emotional wellbeing. Educators and medical practitioners could minimize these negative effects of hospitalization if they were able to listen to the voices of the children and, therefore, better meet their needs. This qualitative study provides an overview of how children with a medical condition actively construct and organize their thoughts and feelings about illness, life in hospital, and relationships. We extrapolated from a collection of children's narratives from a previous more comprehensive study (consisting of 379 narratives from children in 29 public hospitals across Italy, age range 3-14 years). Narratives grouped under the headings "Me and my illness" or "Me and the others" were selected and analyzed using interpretative phenomenological analysis (IPA) to identify the richness and complexity of children's experience. Results showed that children's description of their illness was affected both by cognitive and social factors. For children, the concept of feeling ill or well is not linked only to the fact that they are in hospital for a medical condition; rather, it is influenced by their ability to form relationships with others, play, be active, and feel alive within the hospital environment. Listening to narratives can deepen our understanding of children's illness-related experiences and how they make sense of their situation. A set of practice implications are presented to help health professionals and educators to improve their listening capabilities and better prevent adverse pediatric hospitalization outcomes.

Attunement and Paternal Characteristics in Care Relationships in the Presence of Children Diagnosed with Autism.

Parents of children with autism spectrum disorder (ASD) have to address various challenges mainly due to their children's atypia related to communication, emotion regulation and behaviors, arising also within the relationship with their caregivers. Several studies have pointed out that children with ASD can exhibit many difficulties regarding initiating and maintaining meaningful relationships with others. To date, little research has explored the interactions between children with ASD and their fathers, focusing more on mothers. In the context of parent-child interactions in the presence of autism, recent studies have highlighted the importance of parental attunement but there is little research considering solely the affective-bodily dimension. Therefore, the aim of the present study was to explore the parental attunement in fathers of children with ASD observed during play interactions and to investigate the relationship between paternal attunement and the perception of their psychological characteristics related to care relationships. The results highlight that fathers who describe themselves as better in affective care and sensitivity toward others more likely have an absence of paternal attunement during play interactions. The data presented are discussed in the light of intervention hypotheses, aimed at improving the relationship between fathers and children with autism.

Prognostic factors and predictors of outcome in children with autism spectrum disorder: the role of the paediatrician.

BACKGROUND: Autism spectrum disorder is a complex condition with wide variation in type and severity that involves persistent challenges in social interaction, speech and nonverbal communication, restricted/repetitive behaviours and adaptive behaviours. In recent years, research has deepened the study of the predictive factors of optimal outcome, intended as indicators of positive trajectory in children with a previous diagnosis of autism who, after a therapeutic path, show a significant reduction in the "core" symptoms of autism and a positive evolution in social, adaptive, affective, and relational skills. METHODS: The study included 40 children aged 21 to 66 months, enrolled between 2015 and 2016 for an autism spectrum disorder clinical suspicious. Children were re-evaluated after at least 2 years of therapy and they were divided into two groups: the ASD-ASD group included children with a confirmed diagnosis of ASD, and the ASD-OO comparison group included children who no longer met the criteria for an autism classification. The aim of this retrospective study was to investigate the presence of cognitive, emotional and relational predictors capable of predicting the presence of optimal outcome in with a diagnosis of autism; the predictors taken into consideration were the intelligence quotient, the play, the emotional contagion and the understanding of other's intentions. In this way, it is possible to support clinicians in defining a more complete diagnostic framework of autism, using assessment tools that can be administered quickly and therefore suitable for short observation sessions in paediatric patients. RESULTS: The findings showed that 15 out of 40 children, after at least for 2 years, no longer fell into the diagnostic ASD category based on the ADOS-2, DSM-5 and clinical criteria. The children in the ASD-OO group initially had a higher IQ than those in the ASD-ASD group, lower severity of autistic symptoms, greater understanding of intentions, more emotional contagion, and better quality of play. The results suggest that the initial coexistence of skills in these areas at the time of the first diagnostic assessment may allow us to predict the possibility of achieving optimal outcome after 2 years of therapy. CONCLUSIONS: The data of this study highlight the importance of considering, during assessment, intelligence quotient, play, emotional contagion, and understanding of the intentions of others as potential prognostic predictors that can become useful tools for clinicians and paediatricians. This allows us to focus attention, in both the diagnostic and prognostic phases, on emotional-relational variables that can support the clinician in defining a more complete diagnostic framework and in planning a more personalized therapeutic path.

Corrigendum: Parental Attunement, Insightfulness, and Acceptance of Child Diagnosis in Parents of Children With Autism: Clinical Implications.

[This corrects the article DOI: 10.3389/fpsyg.2020.01849.].

Parental perception of stress and emotional-behavioural difficulties of children with autism spectrum disorder and specific language impairment.

Background and aims: The daily challenges of caring for a child with autism spectrum disorder affect many areas of everyday life and parental well-being, as well as parents' ability to manage the needs of the family and the child concerned. A better understanding of parents' perception of their child's characteristics can allow better support for them and individualize intervention protocols in a more accurate way. The main objective of this study is the evaluation of the perception of stress by parents of children with autism compared to parents of children with specific language impairment. Methods: The parents of 87 children aged between 2 and 6 years were included in this study, 34 children with a specific language impairment diagnosis and 53 children with an autism spectrum disorder diagnosis (ASD) or at risk of developing it. They were asked to complete a self-report on perceived stress and rating scales on adaptive/problematic behaviours, executive functions and sensory profile of the child. Results: The results reveal that parents of ASD children, compared to the control group, showed significantly higher levels of stress, mainly due to the difficulty of managing unexpected events, the feeling of loss of control over one's life and the fear of not being able to cope with the adversities they were experiences. The most critical area, both for ASD and control group, concern the executive function related to emotional reactions. Conclusions: Thus, we argue that the difficulties in self-control, sensory modulation and emotional regulation, represent an element of stress for parents of children with developmental disorders.Implications: Regarding the difficulties of children with ASD, supporting the ways in which caregivers adapt to the signals of children is an important strategy, which has now become a key element of treatments for autism mediated by parents.

Parental Attunement, Insightfulness, and Acceptance of Child Diagnosis in Parents of Children With Autism: Clinical Implications.

Early parent-child relationships are an important factor influencing many domains of child development, even in the presence of autism. In this study, we investigated the associations between parent-child attunement during play, parental insightfulness, and parental acceptance of their child's diagnosis of an autism spectrum disorder. A sample of 50 parents (26 mothers and 24 fathers) of 26 children aged between 24 and 58 months were videotaped during parent-child play interactions and then interviewed about what they thought had gone through their child's head during the play interaction, and about their feelings and thoughts about their child's diagnosis. Play interactions were evaluated using a coding protocol to assess parental attunement. The results showed that parents who were more able to accept their child's diagnosis and to see things from their child's perspective were more likely to also be attuned during play interactions with their children. These findings highlight the importance of studying the parental ability of insightfulness and acceptance of their child diagnosis of ASD for the implementation of intervention programs for supporting parental attunement and improving the interactions between the parents and the children with autism spectrum disorders.

Parent-Reported Behavioural Changes in Children With Autism Spectrum Disorder During the COVID-19 Lockdown in Italy.

Autism Spectrum Disorders (ASD) are characterized by impairments in social interaction and reciprocal communication. During a pandemic, when social distancing becomes mandatory for all, both parents and children are not supported in-person by their therapists and cannot participate in usual therapies. This study reports the main clinical changes experienced by parents of children with during the first month of lockdown during the COVID-19 pandemic in Italy. Using standardized questionnaires, the families of 63 ASD children were interviewed in February and April 2020. Findings showed an increase in restricted and repetitive behaviours in about 30% of the sample; also, motor restlessness and sleep disturbances increased, with greater irritability and mood dysregulation. On the other hand, no changes emerged in personal self-care autonomies, in taste/smell sensitivity, and in auto or other-directed aggression. Despite the undeniable negative impact that lockdown can have on the psychosocial well-being of children, having maintained a continuity in supporting families, parental counselling (even if online and not in-person) helped families to redefine the meanings of behavioural changes of their children and to understand their adaptive functionality.