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Given the influence of parents’ qualities and dyadic characteristics on child developmental outcomes, recent findings strengthened the importance of involving caregivers during the intervention to increase dyadic syntonization levels and to extend the acquisition of competencies in naturalistic contexts. The Intersubjectivity Parental-Based Intervention (I-PBI) presented throughout this chapter is delivered involving caregivers in two different modalities: first, in the therapeutic setting, together with the child to support interactions within the dyad. Second, the focus is on the parental representation of the child and the caregivers in their role. Trained psychologists deliver the intervention after receiving specific licenses on developmental intervention models for children with autism spectrum disorder (ASD). Finally, the team is constantly supervised at least once every month by an expert psychotherapist. Unlike parent-mediated intervention and parent training, the I-PBI does not require home assignments or fidelity schedules, and the therapist entirely delivers the intervention. Throughout this chapter, the structure and therapeutic techniques of the intervention will be presented. Further, results considering the child’s developmental trajectories and changes in caregiver-child interaction will be discussed.

During play activities, children express behaviors, emotions, ways of thinking and learning, as well as social skills, desires, and fears. Differences in the play of children with ASD appear during the first year of life and remain during development. Impairment in symbolic play constitutes one of the most relevant clinical aspects observed during a clinical assessment in young children. However, caregiver involvement in child activities enhances the frequency, duration, and complexity of child play. Given the importance for children with ASD to maintain routines and stability, hospitalization constitutes a challenging moment since they are removed from their familiar environment. In this chapter, the focus will be on the characteristics of play of children with ASD during interaction with caregivers, and on the attention to be used in the context of hospitalization.

(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.

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.

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.

(1) Background: Parental involvement during intervention with children with Autism Spectrum Disorder (ASD) has been demonstrated to be fundamental for children&rsquo, 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&rsquo, 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&rsquo, s and caregivers&rsquo, affective quality and cognitive abilities.

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.

Background Emotional availability (EA) is a dyadic relationship construct that can be considered an index of emotional quality of parent-child interaction. Using this construct, some research showed that both parent and child components of EA reflect key aspects of the parent-child relationship, but there are few studies that investigated these aspects in families with children with Autism Spectrum Disorder (ASD). The present study addresses several specific issues about the emotional availability of parents of children diagnosed with Autism Spectrum Disorder (ASD). Method We observed free-play interactions of 40 children with ASD (chronological age = 41.6 months, SD = 12; M mental age = 30.9 months, SD = 13.3) playing separately with their mothers and fathers one by one. We coded each parent-child dyad using the Emotional Availability Scales (EAS, Biringen, 2008). Results Findings showed that mothers and fathers were equally emotionally available to their children. There were no differences between the two in parents’ EA scales nor in their associations with child level of functioning and severity of the symptoms. In addition, children showed similar mean levels of Responsiveness and Involvement in mother-child and father-child interactions. However, children’s emotional availability was associated to their cognitive functioning and the severity of their symptoms. Conclusions The emotional quality of dyadic interaction is equal in mother-child and father-child dyads in families of children with ASD. We discuss the clinical utility of the EA Scales for assessing relationship between parents and their children with ASD and we speculate the possible relevance of our findings on father-child relationship for future intervention studies involving fathers on par with mothers.

(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 &ldquo, as usual&rdquo, 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&ndash, 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.