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: Parental involvement is currently recommended by Italian national guidelines on autism spectrum disorder (ASD) intervention. However, research on the impact of parent-mediated interventions on parental skills and children's outcomes in Italy is limited. This study evaluated the feasibility of delivering Parent-ESDM (Parent-mediated Early Start Denver Model), a well-supported Naturalistic Developmental Behavioral Intervention (NDBI) known to benefit parents' well-being and children's development, within an Italian healthcare service. : Twenty parent-child dyads participated in weekly 1 h Parent-ESDM sessions for 6 months. Spontaneous parent-child interactions were assessed at baseline, mid-intervention, and post-intervention to examine parents' use of NDBI strategies and changes in children's core ASD behaviors. : Throughout the intervention, parents acquired a good level of fidelity in the use of NDBI strategies and children obtained significant improvements in core ASD behaviors. : These preliminary findings support the feasibility of delivering a parent-mediated intervention within an Italian healthcare service. The positive trends observed provide a strong rationale for conducting controlled trials to more definitively evaluate this model and its potential adoption as a future standard practice.

Background Early prodromal signs of Autism Spectrum Disorder (ASD) can be detected within the first year of life, a period of heightened neuroplasticity. Pre-emptive, parent-mediated interventions delivered during this window may improve developmental outcomes and reduce ASD symptom severity, but evidence from adequately powered randomized trials in Europe remains limited. Early prodromal signs of Autism Spectrum Disorder (ASD) can be detected within the first year of life, a period of heightened neuroplasticity. Pre-emptive, parent-mediated interventions delivered during this window may improve developmental outcomes and reduce ASD symptom severity, but evidence from adequately powered randomized trials in Europe remains limited. Objectives The primary objective of this trial is to determine the efficacy of FIRRST (Fostering Infant Responsivity and Reciprocity – Support to Thrive), a parent-mediated pre-emptive telehealth intervention, in reducing ASD symptom severity in infants with ASD prodromes, as measured by change in Autism Diagnostic Observation Schedule–Second Edition (ADOS-2) Calibrated Severity Scores. Secondary objectives are to evaluate effects on infant developmental skills, caregiver–child interaction, parental well-being, neurophysiological markers, and cost-effectiveness. Methods This is a multicenter, single-blinded, randomized, parallel-group superiority trial conducted in Italy. A total of 132 infants aged 9–14 months with ASD prodromes will be recruited by clinicians at participating university hospital–based centers and randomly allocated (1:1) to FIRRST or a Parent Education control condition. Key inclusion criteria include risk-range scores on the Social Attention and Communication Surveillance–Revised (SACS-R); exclusion criteria include known genetic, neurological, or severe sensory impairments. Randomization will be stratified by age (< 12 vs ≥ 12 months), sex, and ASD symptom severity. FIRRST consists of weekly telehealth sessions delivered by trained licensed health professionals over 24 weeks. Outcomes will be assessed at baseline, post-intervention (24 weeks), and follow-up (48 weeks). Outcomes The primary outcome is change in ADOS-2 Calibrated Severity Scores from baseline to post-intervention. Secondary outcomes include developmental level (Griffiths-III), caregiver–child interaction (MONSI-CC), parental well-being (PSI-4), and neurophysiological measures derived from high-density electroencephalography. Safety outcomes include monitoring and descriptive reporting of adverse events. A cost-effectiveness analysis will be conducted from the healthcare system perspective. Trial registration ClinicalTrials.gov NCT06817746 . Registered on November 2024.

The capacity of the Child Behavior Checklist 1½–5 (CBCL 1½–5) to identify children with autism spectrum disorder (ASD) at 18 months was tested on 37 children clinically referred for ASD and 46 children at elevated likelihood of developing ASD due to having an affected brother/sister. At 30 months the clinically referred children all received a confirmatory diagnosis, and 10 out of 46 siblings received a diagnosis of ASD. CBCL 1½-5 profiles were compared with a group of matched children with typical development (effect of cognitive level controlled for). The capacity of the CBCL 1½-5 DSM Oriented-Pervasive Developmental Problems scale to differentiate correctly between children diagnosed with ASD and children with typical development appeared dependent on group ascertainment methodology.

Background/Objectives: Increasing scientific evidence supports the importance of early diagnosis of autism spectrum disorder (ASD), followed by timely intervention, in optimizing developmental trajectories. Despite these advances, achieving an early diagnosis remains challenging, and substantial delays in the diagnostic process continue to be reported worldwide. This study aimed to describe the clinical and sociodemographic characteristics associated with early referral to a telehealth parent-mediated intervention program for infants at high likelihood for ASD, under 18 months of age, with the broader goal of informing clinical services in the field of neurodevelopmental disorders. Methods: Infants were evaluated by a multidisciplinary team using standardized measures to assess autism risk, developmental functioning, adaptive behavior, and parental stress. Potential differences in age at access to the program were examined by comparing families who were referred before versus after 12 months of age. Results: Of the 78 families who expressed interest in the program, 69 consented and 60 met eligibility criteria (male/female ratio = 40/20; mean age = 10.0 months). Families were evenly distributed across Italy, and 66% of parents held a university degree. Self-referral accounted for 62% of cases. Higher parental concern was associated with earlier referral and children referred after 12 months of age showed significantly lower developmental and adaptive functioning scores. Conclusions: These findings support the feasibility of identifying prodromes of autism within the first year of life and highlight gaps in specialized services for infants at elevated likelihood in Italy. Maternal concern and self-referral drove early consultation, underscoring the need for improved pediatric training. Future studies should assess longitudinal population-based screening and the feasibility and long-term impact of timely interventions in routine care.

From early infancy onwards, young children appear motivated to engage reciprocally with others and share psychological states during dyadic interactions. Although poor reciprocity is one of the defining features of autism spectrum disorders (ASDs), few studies have focused on the direct assessment of real-life reciprocal behavior; consequently, our knowledge of the nature and the development of this core feature of autism is still limited. In this study, we describe the phenomenon of reciprocity in infant-caregiver interaction by analyzing family movies taken during the first year of life of 10 infants with ASD and 9 infants with typical development (TD). We analyzed reciprocal behaviors by means of a coding scheme developed for this purpose (caregiver-infant reciprocity scale (CIRS)). Infants with ASD displayed less motor activity during the first semester and subsequently fewer vocalizations, compared to TD infants. Caregivers of ASD infants showed in the second semester shorter periods of involvement and a reduction of affectionate touch. These results suggest that from the first months of life a nonsynchronic motor-vocal pattern may interfere in different ways with the development of reciprocity in the primary relationship between infants later diagnosed with ASD and their caregivers.

We examined the longitudinal relationship between sleep problems and behavioral problems at primary school in Italian children. We recruited a school-based sample of 227 children (age range 6–10 years) in schools located in Pisa (Italy). Parents completed the Sleep Disturbance Scale for Children (SDSC), and teachers completed the Strengths and Difficulties Questionnaire (SDQ) to evaluate children’s behavioral difficulties. We used a two-step robust regression approach to identify which aspects of sleep problems might affect children’s behavior at school. After removing socio-demographic effects, results indicated an association between an increase in sleep problems and the worsening of inattentive and hyperactive behavioral problems at school 1 year later. This association was particularly robust in children whose sleep problems had gotten worse over the year. We found no associations between child sleep problems and conduct problems in school settings. Schools may be a suitable arena in which to identify and prevent the development of severe externalizing behaviors through screening procedures and intervention for children’s sleep problems.