What Therapy for My Child? Features, Strengths, and Gaps to Fill for the Implementation of Early Autism Interventions

Scientific literature suggests the neurobiological value of early intervention for children at risk of ASD and of other neurodevelopmental disorders, because it is based on the promotion of brain plasticity mechanisms in an ecological, noninvasive, and evidence-based way. Moreover, several authors suggest the greatest efficacy of early rehabilitation programs, involving both the parents and the children, is to improve not only sensory-motor and cognitive outcomes but also child-parent interactions and the wellness of the familiar system. In this chapter, the neurobiological fundaments and features for the early intervention and the most recent early approaches for children at risk of ASD (behavioral, developmental, naturalistic developmental behavioral, and parent-mediated interventions) will be explained

Neurodevelopmental versus functional tics:A controlled study

BACKGROUND: An unprecedented increase in newly developed functional tics, mainly in young females, has been reported during the COVID-19 pandemic. We set out to complement existing case series with the largest controlled study to date on the clinical phenomenology of functional tics versus neurodevelopmental tics.METHODS: Data from 166 patients were collected at a specialist clinic for tic disorders during a three-year period overlapping with the COVID-19 pandemic (2020-2023). We compared the clinical features of patients who developed functional tics during the COVID-19 pandemic (N = 83) to patients with Tourette syndrome matched for age and gender (N = 83).RESULTS: Female adolescents and young adults accounted for 86% of the clinical sample of patients with functional tics, who were less likely to report a family history of tic disorders than their matched controls with Tourette syndrome. Co-morbidity profiles were significantly different: anxiety and other functional neurological disorders were more strongly associated with functional tics, whereas attention-deficit and hyperactivity disorder and tic-related obsessive-compulsive behaviors co-occurred more frequently with neurodevelopmental tics. Overall, absence of tic-related obsessive-compulsive behaviors (t = 8.096; p &lt; 0.001) and absence of a family history of tics (t = 5.111; p &lt; 0.001) were the strongest predictors of the diagnosis of functional tics. Compared to neurodevelopmental tics, functional tics were more likely to present acutely/subacutely at a later age (21 versus 7 years), without a clear rostro-caudal progression. Coprophenomena, self-injurious behaviors, and complex clinical manifestations such as blocking tics, throwing tics, and tic attacks, were all over-represented in the functional group.CONCLUSIONS: Our findings provide robust confirmation of both patient-related variables and tic characteristics contributing to the differential diagnosis between functional tics developed during the pandemic and neurodevelopmental tics reported by patients with Tourette syndrome.</p

Multisensory-Based Rehabilitation Approach: Translational Insights from Animal Models to Early Intervention

Multisensory processes permit combinations of several inputs, coming from different sensory systems, allowing for a coherent representation of biological events and facilitating adaptation to environment. For these reasons, their application in neurological and neuropsychological rehabilitation has been enhanced in the last decades. Recent studies on animals and human models have indicated that, on one hand multisensory integration matures gradually during post-natal life and development is closely linked to environment and experience and, on the other hand, that modality-specific information seems to do not benefit by redundancy across multiple sense modalities and is more readily perceived in unimodal than in multimodal stimulation. In this review, multisensory process development is analyzed, highlighting clinical effects in animal and human models of its manipulation for rehabilitation of sensory disorders. In addition, new methods of early intervention based on multisensory-based rehabilitation approach and their applications on different infant populations at risk of neurodevelopmental disabilities are discussed

The Western origins of mindfulness therapy in ancient Rome

Stoic philosophy has multiple parallels with cognitive behavioural therapy interventions. In their ancient texts, the Roman Stoics present a set of theoretical principles and behavioural strategies that are directly relevant to the clinical care of patients with a wide range of neuropsychiatric conditions. Mindfulness is a key component of the 'third wave' of modern psychotherapy that closely resembles the ancient Stoic practice of attention or 'concentration on the present moment'. Stoic mindfulness draws attention to one of the main principles driving both Stoicism and modern psychotherapy: the assumption that cognitive activity (reasoning) mediates emotions and behaviours. This principle can be traced back to Epictetus' Enchiridion, where he recognises that 'men are disturbed not by things, but by the views which they take of things'. It has been shown that cognitive behavioural therapies and mindfulness-based interventions directed at patients with neuropsychiatric disorders were originally developed as Stoic-inspired treatment interventions. Both Albert Ellis and Aaron Beck (the founders of rational emotive behaviour therapy and cognitive behavioural therapy, respectively) explicitly acknowledged the role of Stoicism as the philosophical precursor of their treatment approaches. The effective implementation of evidence-based guidelines would benefit from an increased awareness of the influence of the Stoic tradition of philosophical therapy on the treatment approaches currently in use in neuropsychiatry. [Abstract copyright: © 2023. The Author(s).

Functional tics:Expanding the phenotypes of functional movement disorders?

Background and purpose: Until the outbreak reported during the COVID-19 pandemic, functional tics were considered to be a relatively rare clinical phenotype, as opposed to other functional movement disorders such as functional tremor and dystonia. To better characterize this phenotype, we compared the demographic and clinical characteristics of patients who developed functional tics during the pandemic and those of patients with other functional movement disorders. Methods: Data from 110 patients were collected at the same neuropsychiatry centre: 66 consecutive patients who developed functional tics without other functional motor symptoms or neurodevelopmental tics and 44 patients with a mix of functional dystonia, tremor, gait, and myoclonus. Results: Both groups were characterized by female sex preponderance (70%–80%) and (sub)acute onset of functional symptoms (~80%). However, patients with functional tics had a significantly earlier age at onset of functional symptoms (21 vs. 39 years). Exposure to relevant social media content was reported by almost half of the patients with functional tics, but by none of the patients with other functional movement disorders. Comorbidity profiles were similar, with relatively high rates of anxiety/affective symptoms and other functional neurological symptoms (nonepileptic attacks). Conclusions: Patients who developed functional tics during the pandemic represent a phenotypic variant of the wider group of patients with functional movement disorders, associated with younger age at onset and influenced by pandemic-related factors, including increased exposure to specific social media content. Diagnostic protocols and treatment interventions should be tailored to address the specific features of this newly defined phenotype

Multisensory Processes and Brain Plasticity in Typical Development and in Children with Neurodevelopmental Disabilities

The general aim of this PhD thesis is to study and analyze Multisensory Processes (MP) in typical and atypical development, within a model of therapeutic intervention for children. In accordance with the outlines of this thesis, MP could be considered a keystone for the enhancement of brain plasticity even in the presence of congenital or acquired neurological disorders. The current literature underlines the crucial role of early intervention for improving the long-term outcome of children at-risk for neurodevelopmental disability (Blauw-Hospers, Dirks, Hulshof, Bos, & Hadders-Algra, 2011; Cioni, D'Acunto, & Guzzetta, 2011; Guzzetta et al., 2009; Sgandurra et al., 2016), but a considerable line of research also supports the idea that it is possible, even in adulthood, to improve the performance of patients with chronic neurosensory deficits, in particular with cerebral visual disorders by using therapeutic strategies based on multisensory integration (Bolognini, Rasi, Coccia, & Ladavas, 2005; Dundon, Bertini, Ladavas, Sabel, & Gall, 2015; Keller & Lefin-Rank, 2010; Targher, Occelli, & Zampini, 2012). During my PhD course, I focused on the topic of multisensory perception and whether it facilitates adaptation to the environment in subjects with neurological disorders. In the first study, the aim was to explore the effects of an early multisensory intervention, based on body massage, on the development of visual function in infants with genetic neurodevelopmental disabilities, specifically with Down syndrome (DS). The results showed that the Environmental Enrichment protocol, based on multisensory infant massage, affects the maturation of visual functions in human infants with DS, as has already been demonstrated in preterm infants (Guzzetta et al., 2009). The infants in the Experimental Group showed an accelerated development in visual acuity up to at least 12 months and also stereopsis had an earlier onset, compared to Controls. The second study focused on the implementation of a multisensory stimulation training programme in children and adults with visual field defect, after brain injury. This type of rehabilitation approach was first implemented by Bolognini and collaborators with adult patients (Bolognini, Rasi, Coccia, et al., 2005). At the beginning of this chapter, its use with children with acquired visual field defects is described. The results confirm the amelioration in visual target detection and visual search abilities in children. Subsequently, the audiovisual stimulation training was performed with a new tool, which was designed to be implemented at home through a telerehabilitation programme. The impact of this intensive multisensory stimulation on patients was investigated by studying the improvement in behavioural tasks, and by analyzing a potential change in brain activity at fMRI, before and after training. The results were positive and suggested new hypotheses on the neurofunctional mechanisms underlying plasticity and multisensory integration. The third study aimed mainly to study how multisensory integration skills (specifically visuo-haptic integration) influence recognition of everyday objects in typically developing children and whether the developmental trajectory of this multisensory modality differs from unisensory modalities in typical preschool and school-aged children. According to our results, 4-5 year-old children are already able to benefit from multisensory integration in object recognition tasks and the results show important differences between unimodal and bimodal sensory abilities, but this process appears to be very complex and long, indeed it continues to develop during the entire school period. The introduction of this PhD thesis briefly presents the scientific literature on the development of MP both in typical children and in the presence of visual disorders

Caregivers’ Burden of School-Aged Children with Neurodevelopmental Disorders: Implications for Family-Centred Care

Caregivers of children with neurodevelopmental disorders play a central role during the rehabilitation and education processes, but they have an increasing risk of psychosocial problems even if the literature is not so agreed upon the specific and predisposing factors to that. The aim of this study was to examine possibly differences of burden levels in an Italian sample of principal caregivers of children with different kinds of neurodevelopmental disorders and to investigate the possible links between some clinical and sociodemographic variables and the levels of caregiver’s burden. 105 caregivers of school-aged children with neurodevelopmental disorders were included in the study and completed three online questionnaires (General Questionnaire, Caregiver Burden Inventory, Zarit Caregiver Burden Scale). Results highlighted that about the half of caregivers show from moderate to high levels of stress, but parents of children with Autism Spectrum Disorder and Intellectual Disability show greater difficulties than parents of children with Attention-Deficit Hyperactivity Disorder, Language and/or Learning Disorder, and Developmental Coordination Disorder. Moreover, it was evident a negative correlation between the burden levels and the age of children, but also a direct correlation between the burden levels and the weekly hours of rehabilitation. These findings show that severity of caregiver’s burden is dependent by the type of neurodevelopmental disorder and suggest that an ecological and family-centred approach is necessary to guarantee the life health developmental course of these children

Multisensory-Based Rehabilitation Approach: Translational Insights from Animal Models to Early Intervention

Multisensory processes permit combinations of several inputs, coming from different sensory systems, allowing for a coherent representation of biological events and facilitating adaptation to environment. For these reasons, their application in neurological and neuropsychological rehabilitation has been enhanced in the last decades. Recent studies on animals and human models have indicated that, on one hand multisensory integration matures gradually during post-natal life and development is closely linked to environment and experience and, on the other hand, that modality-specific information seems to do not benefit by redundancy across multiple sense modalities and is more readily perceived in unimodal than in multimodal stimulation. In this review, multisensory process development is analyzed, highlighting clinical effects in animal and human models of its manipulation for rehabilitation of sensory disorders. In addition, new methods of early intervention based on multisensory-based rehabilitation approach and their applications on different infant populations at risk of neurodevelopmental disabilities are discussed

Development and implementation of a new telerehabilitation system for audiovisual stimulation training in hemianopia

Telerehabilitation, defined as the method by which communication technologies are used to provide remote rehabilitation, although still underused, could be as efficient and effective as the conventional clinical rehabilitation practices. In the literature, there are descriptions of the use of telerehabilitation in adult patients with various diseases, whereas it is seldom used in clinical practice with child and adolescent patients. We have developed a new audiovisual telerehabilitation (AVT) system, based on the multisensory capabilities of the human brain, to provide a new tool for adults and children with visual field defects in order to improve ocular movements toward the blind hemifield. The apparatus consists of a semicircular structure in which visual and acoustic stimuli are positioned. A camera is integrated into the mechanical structure in the center of the panel to control eye and head movements. Patients can use this training system with a customized software on a tablet. From hospital, the therapist has complete control over the training process, and the results of the training sessions are automatically available within a few minutes on the hospital website. In this paper, we report the AVT system protocol and the preliminary results on its use by three adult patients. All three showed improvements in visual detection abilities with long-term effects. In the future, we will test this apparatus with children and their families. Since interventions for impairments in the visual field have a substantial cost for individuals and for the welfare system, we expect that our research could have a profound socio-economic impact avoiding prolonged and intensive hospital stays

Development of visuo-haptic transfer for object recognition in typical preschool and school-aged children

Object recognition is a long and complex adaptive process and its full maturation requires combination of many different sensory experiences as well as cognitive abilities to manipulate previous experiences in order to develop new percepts and subsequently to learn from the environment. It is well recognized that the transfer of visual and haptic information facilitates object recognition in adults, but less is known about development of this ability. In this study, we explored the developmental course of object recognition capacity in children using unimodal visual information, unimodal haptic information, and visuo-haptic information transfer in children from 4 years to 10 years and 11 months of age. Participants were tested through a clinical protocol, involving visual exploration of black-and-white photographs of common objects, haptic exploration of real objects, and visuo-haptic transfer of these two types of information. Results show an age-dependent development of object recognition abilities for visual, haptic, and visuo-haptic modalities. A significant effect of time on development of unimodal and crossmodal recognition skills was found. Moreover, our data suggest that multisensory processes for common object recognition are active at 4 years of age. They facilitate recognition of common objects, and, although not fully mature, are significant in adaptive behavior from the first years of age. The study of typical development of visuo-haptic processes in childhood is a starting point for future studies regarding object recognition in impaired populations