Chiara Failla1,2†Paola Chilà1,3†Noemi Vetrano1,4Germana Doria1,3Ileana Scarcella1,3Roberta Minutoli1,3*Stefania Gismondo1Giovanni Pioggia1†Flavia Marino1†

Background and aimsGiulia, an 11-year-old girl diagnosed with ligyrophobia, has been experiencing intense anxiety related to loud noises since the age of two. This case report aims to explore the efficacy of Third-Wave Cognitive Behavioral Therapy, specifically Acceptance and Commitment Therapy (ACT), in addressing Giulia’s anxiety and avoidance behaviors. The primary goal is to examine the impact of ACT on reducing ligyrophobic symptoms and enhancing psychological flexibility.MethodsThe therapeutic intervention spanned 24 sessions and was divided into two phases. The initial phase focused on emotional competence using characters from the movie “Inside Out,” aiding Giulia in recognizing and understanding her emotions. The subsequent phase targeted the six processes of psychological inflexibility identified in ACT, fostering increased flexibility.ResultsThroughout the intervention, Giulia demonstrated significant improvements in anxiety symptoms, as evidenced by a decrease in Subjective Units of Distress (SUD) scores. Avoidance behaviors also diminished, and Giulia exhibited enhanced mindfulness skills. She became more cognizant of her emotional experiences and more certain of her personal ideals as a result of the therapy. Giulia’s active participation and commitment to exposure exercises led to a substantial reduction in ligyrophobic reactions.DiscussionThe successful application of ACT in Giulia’s case suggests that targeting psychological inflexibility through mindfulness and values clarification can be effective in treating ligyrophobia in children. The integration of metaphors and creative exercises proved valuable in engaging Giulia and fostering therapeutic progress. The findings underscore the importance of a tailored, third-wave therapeutic approach in addressing specific phobias in pediatric populations.

BackgroundReceptive language, the ability to comprehend and respond to spoken language, poses significant challenges for individuals with Autism Spectrum Disorder (ASD). To support communication in autistic children, interventions like Lovaas’ simple-conditional method and Green’s conditional-only method are commonly employed. Personalized approaches are essential due to the spectrum nature of autism. Advancements in technology have opened new avenues for personalizing therapeutic interventions. This single case study compares traditional and technology-based learning sets in a receptive labeling teaching program using Green’s method.MethodsAn alternating treatments design assessed the number of sessions required to achieve mastery in receptive identification of stimuli presented on flashcards or tablets. The study involved a six-year-old Italian child with ASD named Pietro. Initial assessment using the Verbal Behavior Milestone Assessment and Placement Program (VB-MAPP) determined Pietro’s strengths and weaknesses. Six stimuli were selected and divided into two sets: traditional and technology-based. Sessions were semi-randomly alternated, and the teaching procedures remained constant across conditions. In the traditional condition, sessions were conducted twice a week, using flashcards. Correct responses received immediate social reinforcement. In the technological condition, the same stimuli were presented on a tablet via PowerPoint slides.ResultsPietro achieved mastery more quickly with flashcard instruction than with tablet instruction. Learning was exponential in the traditional condition and linear in the digital condition. Follow-up assessments three weeks post-treatment showed no differences in the generalization and maintenance of skills between the two modalities.DiscussionThe findings indicate that the format of stimulus delivery affects the learning process, with traditional flashcards leading to faster mastery in this case. Individual motivation appears crucial, suggesting that Pietro’s learning history influenced his performance. Personalized approaches remain vital in autism interventions. Further research is needed to determine if these differences extend to other skills or contexts.ConclusionWhile technology-based interventions offer new opportunities, they are not universally more effective than traditional methods. Careful consideration of individual differences, especially motivational factors, is essential in designing effective autism intervention programs.

Information and communication technologies (ICTs) have become more widely used in the past years to help people with autism spectrum conditions (ASC). Serious games embedded into computers or tablets, as well as social robots, are the most employed ICT-related tools that are appealing to and appropriate for autistic children. The goal of ICT applications is to enhance behavioral abnormalities associated with ASC while also creating an interactive link between one person and one computer. Comparatively, to human-based therapy, ICT tools aid to inspire autistic children by providing predictability and regularity of tasks. Regaining social skills is the primary behavioral goal for which ICT tools have been designed and implemented. In the past several years, many studies have been created to show how effective it is at improving targeted behaviors. However, only a small number of researchers have used an RCT approach to evaluate its effectiveness. In this systematic review, we only included RCT studies where ICT technologies were used to help children with ASC in improving their social skills. Only 14 RCT studies satisfied the criteria and 12 described significant improvements, showing how the use of technology in educational contexts produced better improvement in developing several social skill facets with respect to the traditional face-to-face approach. Some studies used interventions and outcome measures focused on the core ASC symptoms, but many others addressed neurocognitive functions directly, like social cognition or emotional regulation, while other more general functions such as language or adaptive behaviors. We propose a classification based on processes and outcome measures to foster future research in this specific area of research. The behavioral intervention mediated by technological tools such as computer-based, tablet, and social robotics, undoubtedly provides a comfortable environment that promotes constant learning for people with ASC. Evidence provided in this review highlights the translational potential of this field of study in primary care practice and educational settings.

In many therapeutic settings, remote health services are becoming increasingly a viable strategy for behavior management interventions in children with autism spectrum disorder (ASD). However, there is a paucity of tools for recovering social-pragmatic skills. In this study, we sought to demonstrate the effectiveness of a new online behavioral training, comparing the performance of an ASD group carrying out an online treatment (n°8) with respect to a control group of demographically-/clinically matched ASD children (n°8) engaged in a traditional in-presence intervention (face-to-face). After a 4-month behavioral treatment, the pragmatic skills language (APL test) abilities detected in the experimental group were almost similar to the control group. However, principal component analysis (PCA) demonstrated that the overall improvement in socio-pragmatic skills was higher for ASD children who underwent in-presence training. In fact, dimensions defined by merging APL subscale scores are clearly separated in ASD children who underwent in-presence training with respect to those performing the online approach. Our findings support the effectiveness of remote healthcare systems in managing the social skills of children with ASD, but more approaches and resources are required to enhance remote services.

Mindfulness is one of the most popular psychotherapeutic techniques that help to promote good mental and physical health. Combining mindfulness with immersive virtual reality (VR) has been proven to be especially effective for a wide range of mood disorders for which traditional mindfulness has proven valuable. However, the vast majority of immersive VR-enhanced mindfulness applications have focused on clinical settings, with little evidence on healthy subjects. This narrative review evaluates the real effectiveness of state-of-the-art mindfulness interventions mediated by VR systems in influencing mood and physiological status in non-clinical populations. Only studies with an RCT study design were considered. We conclude that most studies were characterized by one single meditation experience, which seemed sufficient to induce a significant reduction in negative mood states (anxiety, anger, depression, tension) combined with increased mindfulness skills. However, physiological correlates of mindfulness practices have scarcely been investigated. The application of VR-enhanced mindfulness-based interventions in non-clinical populations is in its infancy since most studies have several limitations, such as the poor employment of the RCT study design, the lack of physiological measurements (i.e., heart rate variability), as well as the high heterogeneity in demographical data, technological devices, and VR procedures. We thus concluded that before applying mindfulness interventions mediated by VR in clinical populations, more robust and reliable methodological procedures need to be defined.