In pursuance of the dichotomy mentioned in the last paragraph, we shall analyze, even only in a generic fashion, what the characteristics of healthy development are in those areas that we should be attentive to, and on the other hand, what is indicative of something that is not progressing as it should.

Multiple researchers have proposed that early signs of ASD-related impairments may first manifest within the motor system and present as a motor delay (Ozonoff et al., 2008; Esposito et al., 2009; Flanagan et al., 2012). Motor skills development is part of those areas indicative of harmonious and healthy development. Motor skills are deliberate movements that a baby makes to achieve an objective. These fall into two major areas: fine motor skills and gross motor skills.

A fundamental concept of developmental psychology is that of co-regulation, beginning from Thompson’s definition (Thompson, 1994), developed during the ‘90s, where regulation is underlined as a necessary mechanism for processes of the infant’s internal and external worlds. Furthermore, the concept of co-regulation positions the body at the center of the learning process of the baby who, from the very first months of life, identifies a specific attachment figure based on care received. The relationship with this figure has well known consequences for the development of the baby (Bowlby, 1988; Draghi-Lorenz, 2001; Moretti and Peled, 2004). In their conversations parents and children modulate and adjust to each other’s voices and vocalizations in a variety of ways, thus anticipating and regulating the cycle of emotions. It is also through voice that the child activates and engages with close family, also constructing an internal representation of the most affectively and psychologically significant external impacts. Scientific contributions have shown this hypothesis to be a proven scientific construct are truly diverse, and we have not been able to cite them all, as space does not permit, but only a few. Damasio and Carvalho (2013) more recently, showed that the cognitive and emotional spheres are constructed in stages and through the intersection between the child’s internal and external worlds, however, the Self is also constructed in this way (Wallon, 1947). Gaddini (1969) pointed out that in the first weeks of life the baby’s perception of the outside world passes through a series of bodily modifications. The first behaviors that the child enacts are purely imitative. Therefore, imitation is a precursor of the processes of adaptation of the Ego and, in the first stage, is used by the child to perceive/know and in the second stage to be. It is through the tonic dialog (Toledo, 2009) between mother and child that the child will develop a series of skills. Emotional involvement in the dyad is also fundamental to the repetition of those simple gestures, such as the protrusion of the tongue, which were previously only seen through an intra-individual perspective (Di Renzo, 2017). But this pas de deux, as other studies on prenatal life point out, is nothing more than the continuation of a rhythm already established during pregnancy. Trevarthen (2001) coined the term sinus rhythm to refer to the dialog that exists between mother and child during pregnancy. Co-regulation is the ability that is expressed at the dyadic level between caregiver and child to regulate and treat their emotions, ideas, and behaviors. It is a prerequisite of a healthy emotional and cognitive organization that manifests itself with the child’s ability to express himself and adapt to the context, filtering, and organizing inputs from the internal and external world, thanks to the attunement with the caregiver. This process, as we have previously pointed out, has its roots in pregnancy. The scientific literature has clearly highlighted how much these abilities are damaged in autistic children (Jahromi et al., 2012; Chan et al., 2018). ASD children have fewer positive and more negative adaptive strategies when compared to non-ASD children. Such difficulties. Moreover, they are related to higher levels of emotional dysregulation (anxiety, depression) and behavioral problems related to aggression (Mazefsky et al., 2014).

The first year of life is a time of development and learning about important matters which can give accurate signs of an atypical development trajectory, veering toward autism. Signs which may worry parents and/or pediatricians and specialists could relate to an inability to master a skill we have listed above, or with the emergence of repetitive and or excessive movements. This may sometimes also be encountered even in very young babies who are already presenting with motor stereotypies. We wish to summarize several signs which set off alarm bells for an atypical development which we can list as the following predisposing behaviors/conditions.

Brothers or sisters already on the autism spectrum: as has been shown in a wide range of scientific literature, where there is a brother or sister on the autism spectrum there is a possibility that he/she may also fall within the spectrum (Grønborg et al., 2013; Sandin et al., 2017). Recently it has been shown that the risk for unaffected families, as compared to the risk of occurrence of ASD is increased 8.4 times where there is an older brother with ASD and an increased risk of 17.4 times where there is an older brother with CA (childhood autism) (Hansen et al., 2019).

The presence of express atypical patterns of crying (higher fundamental frequency, shorter inter-bout pauses, fewer utterances) in response to social (Esposito et al., 2014) and non-social stressors (Sheinkopf et al., 2012). In addition, the cry of a baby with ASD is more difficult to decipher by a parent who finds it unexpected and inexplicable (Esposito and Venuti, 2008). It may also be very difficult to comfort these babies since cuddles and physical contact are not always well tolerated, and sometimes may be experienced as being invasive (Henderson, 2022).

Difficulties in gaze regulation and all such anticipatory gestures (Landa et al., 2007) which should develop within the first 6 months of life, through playing routines as well as through feeding (Boyd et al., 2010; Brisson et al., 2012) It is very important to follow the development of non-verbal forms of communication including fine motor acts such as pointing, as well as gross motor acts such as head turning for looking because gestural development is closely linked to language development (Iverson and Goldin-Meadow, 2005). Infants’ early rhythmic arm movements appeared to peak around the same time they began to babble (Erson and Wozniak, 2007). This relationship between early arm movements and babble onset was lacking in some infants who later developed ASDs as well as infrequent initiation of and response to joint attention cues of others (Yoder et al., 2009).

Motor-skills difficulties, delays in achieving motor milestones such as rolling, sitting, and crawling as well as atypical movement patterns such as movement asymmetries or abnormal reflexes (Bhat et al., 2012).

Cranial circumference, various scientific evidence has emphasized an accelerated increase in the circumference of the cranium taking place within the first 2 months of life with a significant surge in this increase from 3 to 5 months of life (Muratori et al., 2009).

Reciprocity, where reciprocity appears lacking in play, social, or sensory routines or simply during an interaction, such as a nappy change, or during mealtimes where the baby seems more interested in objects than in people and does not seem to understand the meaning of gestures (Schwartz et al., 2021).

An advancement of psychology in Italy could be about precisely this two questions: evaluation of the risk of autism or of atypical development and early intervention. Attention to these issues is spread unevenly in our country, despite the presence and effort of various health institutes that deal with them. One instrument useful in identifying the risk of developing a form of autism, or a similar atypia, within the first year of life, is as indicated on the grid. The so-called PREAUT (Olliac et al., 2017) grid can obtain a predictive VPP of 26% at 4 months which increases to 36% at 9 months. Furthermore, the PREAUT grid is repeatable at 4 and 9 months and the results are statistically correlated with CHAT (Allison et al., 2008) which is administered at 18 or 20 months (in particular, the key indicative, and practical items). By assessing children’s typical behaviors and play patterns, the CHAT scale is a screening tool for the likelihood of autism in children between the ages of 18 and 24 months (Robins and Dumont-Mathieu, 2006). It consists of five observation questions evaluating the child’s behavior and responses to examiner-initiated stimuli, as well as nine questions proposed to parents (items A), evaluating the child’s interest in social interactions, motor games, pretend play, pointing, and bringing an object to show it (B items: eye contact, pretend play, proto-declarative pointing, pointing comprehension, and construction of a tower of cubes). When a baby fails all five test items, they are deemed high risk. When an infant never points (proto-declarative score), neither their mother (A7) nor the examiner observes them, they are deemed “positive” with a medium risk (B4).

The PREAUT grid can be a useful guide for psychologists, neuropsychiatrists and other professionals involved in the early identification of atypical development. The PREAUT grid was created using clinical data from therapeutic treatment with at-risk children and observation of family films of children with autism. The researchers group proposed the theory that, in contrast to healthy children, children at risk of developing ASD may be hampered by their intrinsic drive to interact and be a source of joy for those they interact with. The PREAUT grid assesses a child’s capacity for synchronous and spontaneous play and joyous interactions. The PREAUT grid’s items, such as: Does the baby gaze at the examiner or mother (or her replacement) voluntarily or just when asked? have been developed to combat a lack of social initiative: in reality, the more a youngster participates in an interaction spontaneously and actively, the better is the Preaut score.

In France, were the grid is born, it is used by the doctor while the baby is having his or her routine appointment with the mother (or her replacement) at in the fourth and ninth month of baby.¹

However, a psychological intervention at less than 1 year of life could be an intervention with a dual purpose. Thus, the psychologist may be able to facilitate co-regulation mechanisms between the baby and the caregiver as well as being able to work directly on the baby’s difficulties. It is certainly important that the psychologist be trained in specific methodologies for early intervention. Intervening as early as possible can improve the quality of life not only of the baby, but also of the family or caregivers. Studies have shown that interventions initiated after diagnosis within the first 3 years of life result in improved outcomes as compared to any interventions carried out subsequently (Vivanti et al., 2014). In any event, in the Italian context it is not easy to access the appropriate treatment when required during the window of neuronal plasticity. There is a long waiting list to access public services and not everyone is able to afford private treatment. Only a few have available financial resources and the majority will have to rely on public services. Nevertheless, it is vital to consider early intervention, but this also involves caregivers to provide them with techniques and strategies which they can use at home, as well as in nurseries attended by young children. In this way it would be advisable to train various persons, as well as therapists, who would be able to interact with the baby applying principles taught during dedicated training.

Early referral to successful therapy serves as a main means of preventing or delaying the full emergence of autism and the severe difficulties it is associated with. In order to have tested treatments available for identified newborns, early detection science demands that early treatment science evolve concurrently (Rogers et al., 2014). For precisely this reason, in this article we propose our intervention based on the ESDM (Early Start Denver Model) in various practical situations which will make training parents and school staff possible as well as providing for interventions for the child itself. ESDM is an intervention for effective (Dawson et al., 2010) developmental support for babies diagnosed with, or at risk of, ASD at the pre-school stage. As well as being a useful evaluation tool in the context of research (experimental efficacy), various studies in the Italian context have shown clinical efficacy (Devescovi et al., 2016; Colombi et al., 2018).

ESDM treatment is a comprehensive, manualized intercession program for children with ASD between the ages of 12 and 60 months (Dawson et al., 2010; Laister et al., 2021) is an approach based on techniques of Naturalistic Developmental Behavioral Intervention (NDBI).

Schreibman et al. (2015) this strategy envisions learning taking put inside naturalistic treatment settings that use the child’s inclinations and play exercises (Vivanti and Stahmer, 2020). Within the ESDM, there’s no outside reinforcement, but the joint and naturalistic exercises are intrinsically fulfilling for the child.

ESDM has also been scientifically validated with children under the age of 1 year who presented a series of behavioral atypia attributable to autism. Specifically, Rogers et al. (2014) described an ESDM intervention with seven symptomatic infants between the ages of 7 and 15 months with a 12-week low-intensity therapy. After treatment was over, parents kept up skills they had learned during the intervention and treated children at 36 months, had much lower rates of ASD than a similarly symptomatic group who did not enroll in the treatment study.

ESDM is shown to be a tool adaptable to needs, in as much as it can be used with a child, with a child and a parent (Parent-ESDM) (Rogers et al., 2012), in the school setting and electronically. In research by Dawson et al. (2010) it was shown how a group of 24 babies which received EDSM treatment for 20 h per week on a 1:1 basis in combination with methodologies for the parents, showed substantial improvement in most developmental areas 2 years after the intervention in comparison with children who had received other types of therapy of similar intensity. It is possible to involve parents effectively with ESDM therapy and similarly these strategies can be used at school through small-group interventions.