Il presente lavoro di tesi affronta il tema della prevenzione del tumore alla mammella nell’ambito del contesto italiano. Con un primo studio ci si pone l’obiettivo di indagare le conoscenze, le rappresentazioni, le emozioni ed i comportamenti che donne del nord e del sud d’Italia hanno riguardo il concetto di prevenzione del tumore alla mammella. Nello specifico si vuole indagare se la cultura e il luogo di provenienza delle donne hanno un’influenza sulle loro rappresentazioni riguardo l’argomento di interesse. Questo obiettivo è stato perseguito con l’utilizzo di focus group condotti in Lombardia e in Campania. I risultati a questo studio hanno messo in luce notevoli differenze tra i due gruppi, in particolare rispetto alle conoscenze e alle pratiche preventive messe in atto. Con un secondo studio si vuole indagare un ampio campione (N= 2070) di donne lombarde che partecipano allo screening mammografico (programma preventivo offerto dal SSN). All’interno di tale campione si voglio individuare profili psicologici caratterizzanti le donne e i predittori dell’ansia pre-screening, una variabile frequente tra i soggetti che si sottopongono a mammografia preventiva. I risultati a questo studio evidenziano la presenza di tre profili psicologici (cluster) all’interno dei quali si suddivide il campione. Questi profili differenziano le donne e le motivazioni che le conducono a prendere parte al programma di screening. Sempre grazie alle analisi effettuate per soddisfare gli obiettivi del secondo studio è stato possibile determinare che bassa stabilità emotiva, bassa qualità di vita e basso ottimismo hanno influenza nell’incrementare i livelli di ansia in donne in attesa di sottoporsi a screening mammografico. / The present dissertation deals with the topic of breast cancer prevention in the Italian context. The first study of the research aimed to explore the knowledge, the representations, the emotions and the behaviors that northern and southern women have about breast cancer prevention. We want to investigate if cultural and contextual factors influence representations that women have about the topic of interest. We satisfied the objective of the first study conducting focus group in a northern and in a southern region of Italy. The outcome of this study highlighted differences between the two groups especially concerning women knowledge and their behaviors in regard to breast cancer prevention. The second study aimed to investigate a sample (N=2075) of Italian northern women that choose to take part in the national breast cancer screening. The specific objectives of this study were the identification of psychological profiles that characterize this sample and pre-screening anxiety predictors, a common variable among women waiting to have a mammogram. The results at this study highlighted three clusters that differentiated women and the reason why they decide to take part in the prevention program. Analysis performed for the second study identified low emotional stability, low quality of life and low optimism as pre-screening anxiety predictors.

Il presente studio intervento randomizzato è stato condotto su 140 donne assegnate - a seguito del parto - alla condizione di scrittura espressiva (EW) o alla condizione di scrittura neutra non-emotiva (NW). L’obiettivo era indagare gli effetti della scrittura espressiva sull’esperienza del parto sia sul funzionamento psicologico – sintomi depressivi e postraumatici da stress- (Studio 1a), sia sul funzionamento genitoriale - stress che la madre incontra nell’esercizio del suo ruolo e nell’interazione con il bambino – (Studio 2) al follow-up a tre mesi dal parto. Inoltre, sono state indagate le differenze individuali (moderatori) e i meccanismi psicologici- linguistici (mediatori) associati al cambiamento positivo a seguito della scrittura espressiva (Studio 1b). Gli studi hanno evidenziato che i sintomi depressivi e di intrusione connessi al trauma si riducevano nelle donne assegnate alla condizione EW nel confronto con la condizione NW e che a beneficiare dell’intervento erano le donne con sintomi acuti post-partum (Studio 1a). L’elaborazione cognitiva dell’esperienza stressante del parto attraverso le sessioni di scrittura è stata identificata come il meccanismo chiave, responsabile degli effetti benefici sulla sintomatologia depressiva postnatale (Studio 1b). Infine, il terzo studio ha identificato un effetto positivo della scrittura espressiva sulla qualità dell’interazione madre-bambino moderato da alcune caratteristiche individuali. / One hundred forty women participated in the present randomized intervention study. Right after giving birth women were assigned to the Expressive Writing (EW) intervention group or to the non-emotional neutral writing (NW) condition. The aim was to investigate the effects in the childbirth experience of expressive writing both on psychological functioning - depression and post-partum traumatic stress symptoms - (Study 1a), and on parental functioning - the stress experienced by mothers in their parental role and in the interaction with the newborn - (Study 2) at a three-month follow-up after delivery. Individual differences were investigated as moderators and psycholinguistic mechanisms as mediators associated with positive changes following expressive writing (Study 1b). Results indicate that depression and intrusive symptoms related to the trauma decreased in EW women compared to NW women, and that acute post-partum symptom women benefited the most (Study 1a). Cognitive elaboration of the childbirth traumatic experience taking place during writing sessions is the key mechanism responsible for the beneficial effects on postnatal depression symptoms (Study 1b). Finally, the third study indicated a positive effect of expressive writing on the quality of mother-child interaction. The effect resulted moderated by some individual characteristics.

La transizione alla genitorialità è da sempre considerato un periodo di criticità per la coppia, questo processo ha inizio già nella fase della gravidanza, in cui il rapporto a due comincia a modificarsi in direzione triangolare, rompendo l’originaria struttura diadica. E’ tuttavia importante che il processo di riorganizzazione della relazione, necessario all’acquisizione del ruolo genitoriale, salvaguardi gli aspetti coniugali, oltre ad includere quelli genitoriali: molte coppie, faticano ad alimentare o dimenticano lo spazio della coniugalità. In termini più generali, per quanto i partner possano essere consapevoli della necessità di far fronte ai cambiamenti, spesso risultano impreparati e, a volte, poco adattabili. In tal senso il periodo perinatale può essere vissuto come un evento potenzialmente molto stressante. Tale progetto si pone l’obiettivo di studiare i possibili percorsi della transizione alla genitorialità focalizzandosi sul benessere/malessere psicologico dei partner in relazione alla loro percezione della qualità della relazione di coppia. I risultati evidenziano differenti traiettorie di benessere/malessere psicologico nel periodo perinatale e una relazione tra la condizione psicologica dei partner e la loro percezione della qualità della relazione di coppia. / In the psychological literature the transition to parenthood has been always considered a critical period for the couples. This process should begin during the pregnancy, the period during which the couple’s relationship should develops from the original dyadic structure to a new triangular structure. It must be underlyned the importance of the process of “renovation” of the relationship. This process includes the acquisition of the parental role and protects relavant marital and parental aspects such as the feeding of the marital relationship. Despite couples’ awerness of the importance to cope with the changes that the transition entails, often result unprepared. In this sense the perinatal period can be seen as a potentially stressfull event. This dissertation aims to study the possible paths of transition to parenthood focusing on partener’s psychological well-being and distress in relation to their perception of the quality of the couple’s relationship. The results show different trajectories of psychological well-being and distress in the perinatal period and a relation between the couples’ psychological condition and their perception of the quality of couple’s relationship.

Il presente programma di ricerca approfondisce l’uso dell’Expressive Writing (EW) con gli adolescenti a partire da tre studi, organizzati in modo sequenziale. Lo Studio 1 indaga l’efficacia e i fattori di moderazione dell’EW con gli adolescenti tramite meta-analisi. In particolare, è stata eseguita una review quantitativa degli studi sull’EW con partecipanti in età adolescenziale, attraverso i seguenti passaggi: ricerca sistematica e codifica degli studi; calcolo degli effect size; analisi dei moderatori. Lo Studio 2 confronta sperimentalmente sugli adolescenti gli effetti a breve e lungo termine di due tipi di istruzioni di scrittura, una convenzionale (EW) e l’altra orientata cognitivamente (CEW), elaborata sulla base dei risultati della meta-analisi. Le analisi sono state finalizzate a testare gli effetti della modificazione delle consegne di scrittura sul funzionamento emotivo e sociale degli adolescenti. Lo Studio 3 consiste in un’analisi secondaria dello Studio 2 ed esplora l’esito dell’intervento in funzione delle traiettorie di cambiamento dei meccanismi cognitivi (“Self-distancing”) rilevati negli scritti, tramite Group-Based Trajectory Modeling. I risultati degli studi sono discussi in funzione delle loro implicazioni teoriche e pratiche. / The present research program aims at evaluating the use of Expressive Writing (EW) with adolescents through three studies, organized in a progressive fashion. Study 1 investigates the efficacy and moderators of EW with adolescents through a meta-analysis. The study performed a quantitative review of the EW interventions with adolescent samples, according to the following steps: systematic literature search and coding of the studies; calculation of the effect size; analysis of the moderators. Study 2 experimentally compares the short- and long-term effects of the traditional writing condition (EW) to a cognitively-oriented EW condition (CEW) on a sample of adolescents. The analyses had the objective to test the effects of altering the writing instructions on social and emotional adjustment of participants. Study 3 consists in a secondary analysis of the written essays collected in Study 2 with the intent of examining the effects of the intervention as a function of the cognitive processes (“Self-distancing”) observed during the writing sessions by means of the Group-Based Trajectory Modeling. The findings are discussed on the basis of their theoretical and practical implications.

Nonostante il maltrattamento all’infanzia costituisca un’esperienza relazionale patogena, alcuni bambini maltrattati mostrano un itinerario di sviluppo resiliente. La tesi si focalizza sul possibile ruolo giocato da meaning-making e mindfulness skills nel funzionamento resiliente. Il primo obiettivo è stato esplorare la relazione tra meaning-making, mindfulness skills e benessere in bambini non maltrattati. Il secondo obiettivo è stato valutare meaning-making e mindfulness skills in minori maltrattati, per determinare se il funzionamento resiliente fosse in relazione con questi costrutti. Il terzo obiettivo è stato creare un intervento per minori maltrattati ospitati in comunità (MBYR), testandone la fattibilità. Lo studio 1 ha esplorato il meaning-making in bambini non maltrattati, non evidenziando alcuna relazione con le loro competenze e difficoltà. Lo studio 2 ha mostrato che le mindfulness skills correlavano negativamente con outcome avversi, ma positivamente con le competenze dei bambini. Lo studio 3 ha esplorato la relazione tra funzionamento resiliente, meaning-making e mindfulness skills in minori maltratti, evidenziando che il meaning-making era legato a livelli più bassi di qualità della vita, mentre le mindfulness skills erano in relazione con il funzionamento resiliente. Questi risultati hanno informato il razionale dell’MBYR, che ha significativamente ridotto i sintomi traumatici, aumentando mindfulness skills e competenze generali (studio 4). / Child maltreatment is a pathogenic relational experience representing one of the most difficult challenges to children’s healthy adaptation; nonetheless, some maltreated children develop resiliently. The thesis focuses on the possible role played by meaning-making and mindfulness skills in resilient functioning. The first aim was to investigate the relation between meaning-making, mindfulness skills, and wellbeing in nonmaltreated children. The second aim was to explore meaning-making and mindfulness skills in maltreated children and adolescents, to determine whether resilient functioning was related to these constructs. Finally, the third aim was to design an intervention for maltreated youths in residential care (MBYR) and to test its feasibility. Study 1 explored meaning-making in nonmaltreated children, showing that it was not related to their competencies and difficulties. Study 2 highlighted that mindfulness skills were negatively related to adverse outcomes and positively related to children’s competencies. Study 3 explored the relation between different domains of resilient functioning, meaning-making, and mindfulness skills in maltreated youths, showing that meaning-making was related to lower levels of quality of life, whereas mindfulness skills were related to resilient functioning. These results informed the rationale for the MBYR, which significantly reduced traumatic symptoms while enhancing mindfulness skills and general competencies (study 4).

Questa sintesi conclusiva del percorso di dottorato ruota attorno al costrutto di fragilità, attualmente definita come una condizione disfunzionale dinamica di natura multi-sistemica, associata a un aumentato rischio di conseguenze negative quali istituzionalizzazione, ospedalizzazione e morte. Come illustrato tramite gli studi inclusi nella presente tesi, le osservazioni empiriche e l’esperienza in ambito clinico hanno sistematicamente evidenziato l’assenza di strumenti di screening cognitivo nella fragilità che presentino sistematicamente valore clinico e validità trasversalmente a diverse tipologie di pazienti o utenti fragili, affetti da disturbi neurologici e cognitivi o che presentino profili di rischio psicosociale. Nei capitoli empirici sono stati riportati tre studi che hanno riguardato, il primo, la valutazione del potenziale clinico di un nuovo test di screening cognitivo, il CASP, somministrabile anche a persone affette da afasia. Questo è stato comparato con strumenti classici come il MMSE e il MoCA. Nel secondo studio è stato sviluppato e testato un protocollo di valutazione della fragilità cognitiva e psicosociale nella malattia cronica, ideato per essere inclusivo anche nel suo utilizzo con pazienti migranti. Infine, il terzo studio, oltre a mirare – come i precedenti – all’arricchimento della cassetta di attrezzi del neurospicologo, si è focalizzato sull’integrazione del testing neuropsicologico classico con le potenzialità della neuroinformatica, avendo come obiettivo lo sviluppo di un approccio di screening multi-componenziale e di un sistema di machine learning per finalità diagnostiche nell’ambito dell’invecchiamento fisiologico e patologico, che non fosse una mera digitalizzazione di test neuropsicologici tradizionali. / This final synthesis of the PhD program revolves around the construct of fragility, currently defined as a dynamic dysfunctional condition of a multi-systemic nature, associated with an increased risk of negative consequences such as institutionalization, hospitalization and death. As illustrated through the studies included in this thesis, empirical observations and experience in the clinical setting have systematically highlighted the absence of cognitive screening tools in frailty that systematically present clinical value and validity across different types of patients or frail users, suffering from neurological and cognitive disorders or with psychosocial risk profiles. Three studies have been reported in the empirical chapters which concerned, the first, the evaluation of the clinical potential of a new cognitive screening test, CASP, which can also be administered to people with aphasia. This has been compared with classical instruments such as the MMSE and the MoCA. In the second study, a protocol for assessing cognitive and psychosocial frailty in chronic disease was developed and tested, designed to be inclusive also in its use with migrant patients. Finally, the third study, in addition to aiming - like the previous ones - at the enrichment of the neurospychologist's toolbox, focused on the integration of classical neuropsychological testing with the potential of neuroinformatics, aiming at the development of a screening approach. multi-component and a machine learning system for diagnostic purposes in the field of physiological and pathological aging, which was not a mere digitization of traditional neuropsychological tests.

Autism Spectrum Disorder (ASD) is a condition that carries high costs for families and the healthcare system, requiring extensive management both in terms of diagnosis and treatment. The implementation of AI-based systems in clinical practice represents a possible supportive solution that can help clinicians by providing more systematic meth- ods to monitor child behavior. The main advantage over more traditional observational approaches is to offer quantitative and refined analysis solutions that can be ecological at the same time. The relevance of AI in clinical applications can have a role both in the challenge of early detection and in designing intervention programs better tai- lored to the specific functioning of children with ASD. The research project presented in this dissertation focused on developing AI-based systems for fine-grained analysis of autism-related social behaviors and their validation in concrete clinical environments. Specifically, in Chapter 2, our first study is presented, which targets on implementing a computational phenotyping system to address the need for new early markers of the condition. Through fine-grained analytics of facial dynamics in videos, we identified a set of features that distinguished young (6-12 months) infants with ASD (18 ASD, 15 non-ASD) during unconstrained at-home interactions. In Chapters 3 and 4, we introduce EYE-C, a Behavior Imaging model for robust analysis of eye contact episodes in eco- logical therapist-child interactions. The system was validated in the clinical setting for personalized early intervention. First, we investigated the influence of extracted features in categorizing spectrum heterogeneity across a sample of 62 preschool (<6 years) chil- dren with ASD. Further, we tested our metrics as predictors of early intensive treatment outcomes in a sub-sample of 18 subjects with ASD. The project aims to demonstrate the feasibility of effective computational systems that are robust to the high variability of unstructured interactions, with emphasis on the applicative value in real-world scenar- ios. Even though based on limited sample sizes, the work presented may offer interesting insights into the perspective of integrating AI into clinical practice. The research project was funded by an FBK scholarship and developed in a double in- ternship at ODFLab (University of Trento) and the FBK Data Science for Health (DSH) research unit.

People with Autism Spectrum Disorder (ASD) have difficulties in dealing with social interaction (DSM V, 2013). From long time, it has been reported deficit in recognizing gaze, face and intentions of others. Besides that, in the last decade numerous finds have showed an impairment in coding the human body movements. During my PhD I have explored the ability in recognizing the emotional valence of human movements in people with ASD and with typical development. In order to understand developmental changes, I have initially compared this ability between children and adults. In order to understand the role of intelligence, I have included people with high and low functioning ASD, either in children and adults samples. In the first study, we compared TD children and children with ASD with different level of functioning to investigate i) whether the difficulties in ASD population were associated to emotion comprehension or related to a more basic visual processing of biological motion, and ii) to explore whether this ability improves according to the age and to the non-verbal IQ. To this purposes, we presented point-light (PLDs) and full-light (FLDs) version of human movements with three different emotional valence (Happy, Fearful, Neutral). Our main findings showed that: -TD children were more accurate in recognizing the emotional content of body movements when the shape of the body was visible (i.e. FLDs), compared to the view of pure motion information (i.e. PLDs), but there were no differences in RT across display conditions. This result suggests that school-aged children are able to correctly identify the emotional valence of dynamic bodily expression, also when the form information is minimized by presenting PLDs. -According to the emotional content, we found that the valence had an effect on the performance of TD children. In particular, TD children recognized happy bodily expressions with lower accuracy than fearful and neutral movements. Besides, fearful movements were identified more rapidly. We hypothesized that, from an evolutionary point of view, it is more important to recognize fearful signals when they are far from us. Body movements are particularly relevant to convey other people’s state and intentions from a distance, hence bodies are preferential channels to convey fearful signals. -Comparing typical and atypical children, we found that TD were more accurate and more rapid than children with ASD in recognizing the emotional valence of body movements. Moreover, children with HF ASD outperformed children with LF ASD and their performance was significantly predicted from age and nonverbal IQ. This results suggest that the nonverbal abilities have a role in body movement comprehension, probably underpinning the development of compensatory mechanisms which improve with age. -Compared to TD children, children with ASD were impaired not only in understanding the emotional expressions, but also in recognizing the neutral actions. Irrespectively to their IQ level, children with ASD did not benefit from the richness of visual information, and their ability to recognize BM did not change according to the emotional valence. This finding suggests that the difficulty encountered by individuals with ASD in social interaction could be more generally related to biological motion elaboration, rather than being specific for the emotions comprehension. Hence, the lack in emotion recognition in ASD seems to be attributable to a deficit in elaborating motion cues rather than emotional information. To interpret the body movements, children with ASD may adopt compensatory mechanisms, which acquisition seems to be mediated by the nonverbal IQ and improving with age. If this was the case, we should expect an improvement in the ability of recognizing the BM in adults with ASD, with respect to children with ASD, and this improvement should have been correlated with the non-verbal IQ level. To explore this hypothesis, we run a second experiment, were we asked to a group of TD adults, a group of adults with high functioning Autism matched for age and non-verbal IQ, and a group of adults with low functioning Autism matched for age, to performed the same BM recognition task that children did in our first experiment. Results with adults confirmed what we found in children: the emotional valence and the richness of visual information did not modulate the Accuracy and the velocity in recognizing the BM stimuli in ASD, suggesting that the whole body movement is elaborated differently in ASD than in TD adults and that the impairment in ASD is more related to the processing of body movement, rather than being specific for the emotion comprehension. In a third study, we explored the developmental changes in the ability of recognizing the emotional meaning of human whole-body movements from childhood to adulthood. To this aim, we compared the performance between children and adults in each group of Functioning. Results showed that TD adults were more accurate and faster than TD children; FLDs were recognized with higher accuracy and quicker than PLDs; and fearful and neutral movements were recognized significantly better than happy ones. In participants with ASD, adults were significantly more accurate than children, but not faster. Also, we did not find any difference between displays or emotional categories. This results suggest that the understanding of body movements in individuals with ASD improve with age but the mechanism underpinning this ability works differently. In a fourth experiment we investigate whether the impairment in understanding social relevant signals in individuals with high functioning autism (HF ASD) was restricted to body movements or widespread to other social cues, such as facial expressions. Also, we investigated the role of movement in perceiving bodily expressions. To this aim, we explored whether there was a difference in recognizing the body expressions represented by dynamic or static stimuli. Finally, we investigated whether the vision of the body form, compared to the sight of pure motion information, could influence the identification of the emotional content of body movements. We did not found any group differences in accuracy, but there was a group difference in RTs specific for dynamic stimuli (TD were significantly faster than ASD in recognizing PLDs, and marginally in FLDs). These results suggest that HF ASD adopt compensatory mechanism to understand the meaning of facial and bodily expression that allow them to correctly recognize the emotional valence conveyed by face and body movements. However, this mechanism has a cost in terms of rapidity. In particular, ASD seems to need more time to identify dynamic body stimuli but not images of body expressions, suggesting a deficit in processing the actual body motion. In particular, the comprehension of happy body movements result difficult and time consuming. Indeed, happiness was better recognized from facial expressions and was harder to be identified when expressed by body movements. In the fifth experiment we used TMS-adaptation paradigm to explore the existence of a neural system specialized for the elaboration of emotional body movements. We first behaviourally investigated the existence of an adaptation for emotional PLDs. TD adult participant were adapted with point-light video clips depicting fearful, happy or neutral actions and then asked to recognize point-light with same/different emotional content. Results showed an adaptation after-effect only for incongruent stimuli, suggesting the existence of a neural mechanism for perceiving the body emotion specifically. Subsequently, in a TMS experiment we explore the possible brain location of this mechanism. The sites we stimulated are nodes of the neural network responsible for the human motion understanding, and they are reported to be abnormally activated in ASD. We found a reversed after-effect following TMS over aIPS, while the adaptation was still present after stimulation over pSTS and the control site. These results demonstrate that aIPS contains neurons that specifically code for the emotional body expressions, suggesting that the difficulties encountered by individuals with ASD in understanding the emotional signal during social interaction might rely to deficit in this mirror area.

Autism Spectrum Disorder (ASD) is characterized by difficulties in social communication and restricted, repetitive patterns of behavior and interests (American Psychiatric Association, 2013). These key characteristics of autism each create a number of difficulties for individuals with autism and also their parents. It is well established that parenting a child with ASD is stressful, impacting on mental health and overall quality of life (Baker-Ericzn, Brookman-Frazee, & Stahmer, 2005; Davis & Carter, 2008; Eisenhower, Baker, & Blacher, 2005; McStay, Dissanayake, Scheeren, Koot, & Begeer, 2013). However, there are some doubts or gaps in the literature of parenting children with ASD which we addressed in this thesis. Two main goals of this thesis were: a) examining well-being of parents of children with ASD, b) focusing on the parents’ responses to cries of infants with ASD and typical development, considering two types of responses: emotional and physiological. Therefore, this thesis is composed of two parts. The first part in which we aimed to examine well-being of parents of children with ASD has been divided into two sections. The first one dealt with similarities and differences between mothers and fathers in terms of parenting stress, parental mental health and attitude (Chapter 2). Results indicated that mothers of children with ASD reported higher level of depression than fathers and considerable percentages of both mothers and fathers had scores above the clinical cut-points of stress showing that they experience clinically significant levels of parenting stress. Moreover, in terms of parental attitude, mothers engaged with their children in more social exchange than fathers do. 8 The final chapter in Part 1 (Chapter 3) evaluated whether maternal well-being and sense of competence are affected by the outcomes of children receiving intervention. The results suggested that child and family factors, including mothers’ age, were linked to maternal well-being. However treatment-related changes in children’s communication, and parenting satisfaction contributed to well-being above and beyond other factors. A mediation analysis indicated that mothers whose children make treatment gains in communication skills experience a reduction in their level of negative well-being as a consequence of increased parental sense of competence with regards to parenting satisfaction. The second part of the thesis aimed to evaluate emotional and physiological responses of parents of children with ASD during infant crying. This part begins by laying out the theoretical dimensions of the research, and then proceeds as follows: a) the first experiment was concerned with the preparation and validation the cry episodes as unpleasant acoustic stimuli (Chapter 4); b) the second one examined emotional and physiological responses of non-parents adults while listening of infant crying (Chapter 5); c) the last experiment focused on parents of children with ASD and parents of typically developing children, examining their emotional and physiological responses during the listening of crying of children with ASD and of typically developing (TD) children (Chapter 6). Findings from Chapter 4 indicated that all cry episodes, regardless of the types (e.g., cries of children with ASD or cries of typically developing children) were perceived as unpleasant by non-parents adults. The following study in Chapter 5 showed that cries of children with ASD (ASD cry) were reported more stressed, aroused and less pleasant compare to cries of typically developing children (TD cry) by non-parents adults; however, similar pattern was not seen in the physiological responses of listeners. Results 9 from the final experiment (Chapter 6) showed that parents of children with ASD and parents of TD children were not differentiated in their self-reports of stress, arousal and valence levels for ASD cry and TD cry. However, their physiological responses showed that parents of children with ASD have higher heart rate than parents of TD children during ASD cry and TD cry. Moreover, the analysis on the comparisons between ASD cry and TD cry suggested both parents perceived ASD cry more stressful, aroused and less pleasant, but physiological responses of parents of children with ASD did not show the differences between ASD cry and TD cry. The overall structure of the thesis takes the form of seven chapters, including a general introduction (Chapter 1). The importance of those findings for future theoretical and clinical work is considered in detail in the end of related chapters and in the general discussion chapter (Chapter 7).

In the last two decades several studies have been trying to explore a possible role for gut microbiota in Autism Spectrum Disorders (ASD), supported by the high incidence of gastrointestinal disorders among ASD children and by the now well recognized existence of the brain-gut-microbiota axis (the complex system of bidirectional interactions between central nervous system, gastrointestinal tract and microorganisms inhabiting the gut). Nevertheless, results about alterations in gut microbiota composition and/or activity in ASD are to date strongly contrasting. A possible explanation could be that these studies tend to treat ASD as a unique pathology, whereas it includes different cognitive-behavioural phenotypes. Moreover, they do not consider factors which are important for children’s gut flora development, such as type of delivery, nutritional history (e.g. formula milk during lactation) and medical history (e.g. antibiotics intake) as well as factors that may affect the present composition of microbiota, such as the current diet (e.g. the strong food selectivity that often occurs in ASD children) and the presence of gastrointestinal disorders. In this study, I developed an interview to parents to assess whether there are differences related to the above mentioned aspects between ASD children and typically developing children and among ASD themselves, considering differences in cognitive level and severity of autistic traits. I also explored the use of special diets such as gluten-, lactose and casein free diets, the reasons for their adoption and the possible benefits for the child. Moreover, I decided to include in this interview also a section dedicated to parental difficulties in managing mealtime in order to collect information useful to plan future interventions. I found differences between ASD- and typical children in the incidence of gastrointestinal disorders and food selectivity. Especially, some children initially eat everything and then switch to a more and more restricted diet. This could be considered an early symptom of the pathology. I also found an association between gastrointestinal disorders and severity of autistic traits. Furthermore, I collected faecal samples from ASD families (two parents, an ASD child and a typically developing sibling) and analysed them with metaproteomics and bioinformatics techniques in order to assess microbiota activity and evaluate it in light of ASD phenotype, nutritional habits, gastrointestinal disorders and genetic proximity. Demonstrating the existence of a different microbiota composition in ASD or at least in a subgroup could allow to identify a biomarker of a possible development of ASD and to design preventive interventions, even through probiotics intake. Moreover, it could help to better understand the molecular mechanism underlying this pathology.