L'obiettivo generale di questa tesi è chiarire il modo in cui alcune variabili, prossimali e distali, influenzano lo sviluppo psicofisico del bambino all' interno di un campione di madri a rischio del progetto Scommettiamo sui giovani. Qualora i risultati descritti in questo lavoro confermassero i dati presenti in letteratura, la Provincia Autonoma di Trento potrebbe applicare sul territorio una serie di servizi rivolti alle madri a rischio e non, e attuare interventi di supporto alla genitorialità. L'organizzazione della tesi prevede una parte teorica introduttiva, la presentazione di quattro articoli scientifici, in corso di pubblicazione, riguardanti diverse aree di interesse (articolo 1: Le madri a rischio e il quoziente di sviluppo dei bambini; articolo 2: L'indice di attaccamento dei bambini in un campione di madri a rischio; articolo 3: Il parenting nei contesti di immigrazione; articolo 4: Valutazione preliminare dell'efficacia dell'intervento di supporto alla genitorialità a rischio in Trentino e un capitolo finale sulle conclusioni generali e sulle ricerche future.

Il presente lavoro ha lo scopo di studiare in dettaglio l’interazione genitore-bambino in famiglie con bambini con Disturbo dello Spettro Autistico (che verranno sintetizzati con l’acronimo ASD dalla definizione inglese “Autism Spectrum Disorder”). I disturbi dello spettro autistico sono disordini del neurosviluppo che alterando nei primi anni di vita la capacità di mettersi in relazione con gli altri, determinano gravi effetti cognitivi, affettivi e comportamentali. Le ricerche condotte negli ultimi decenni nell'ambito della psicologia dello sviluppo hanno evidenziato il ruolo centrale delle relazioni genitoriali nello sviluppo del bambino, sia in bambini con sviluppo tipico che con sviluppo atipico. Questo lavoro di tesi ha l’obiettivo di osservare alcuni aspetti peculiari dell’interazione genitore-bambino in bambini con disturbo dello spettro autistico, considerando come il deficit a livello del “cervello sociale” si ripercuote sullo strutturarsi e il mantenersi di questa relazione. Nel presente lavoro si collocano quattro studi. In particolar modo saranno analizzate nel primo studio le caratteristiche del gioco in diadi madre-bambino con ASD confrontandole con diadi madre-bambino in cui il bambino presenta la Sindrome di Down o lo sviluppo tipico al fine di evidenziare similitudini e differenze sia nelle abilità manifestate dalle madri sia per quelle espresse dai bambini. Nel secondo studio, verrà approfondito l’aspetto del gioco specificatamente in interazione madre-bambino e padre-bambino in famiglie con bambini con ASD, al fine di osservare se la capacità di gioco manifestate dal bambino si differenzino in base alla figura genitoriale con cui stanno interagendo e per evidenziare se madre e padre evidenziano delle caratteristiche peculiari in base al ruolo genitoriale rivestito. Il terzo studio, invece, si è concentrato sull’analisi dello scambio sincronico all’interno delle diadi madre-bambino con disturbo dello spettro autistico confrontandolo con interazioni con bambini con sviluppo tipico e sindrome di Down, con lo scopo di osservare più in dettaglio la struttura dello scambio diadico per evidenziare i contribuiti specifici di entrambi i membri della diade, mostrando come possano differire in base alla presenza o meno di una patologia. Infine nel quarto studio sarà osservata la disponibilità emotiva diadica all’interno di famiglie di bambini con disturbo dello spettro autistico, analizzando sia i comportamenti del bambino sia i comportanti delle due figure genitoriali.

Developmental Dyslexia (DD) is one of the most common neurodevelopmental disorders across cultures. Children affected by DD struggle to read fluently and/or correctly, despite normal intelligence, the absence of other psychological or neurological symptoms, and standard reading education. Not only does this condition affect academic achievement, but it is also associated with a number of other negative consequences across the lifespan, such as an enhanced risk of psychological distress and mental health problems. Despite considerable efforts to identify the underlying cause of dyslexia, agreement on a single interpretation has not yet been reached. DD is commonly described as a languagerelated disorder, with compromised phonological abilities being considered as the core deficit. Nonetheless, a growing body of evidence supports multifactorial models: reading is a complex cognitive process, involving not only phonological skills, but also auditory sensory processes, visual-spatial abilities, attention and memory. In this regard, various studies have documented a relationship between dyslexia and deficits in the Executive Functions (hereafter EFs), which can be defined as a cluster of general-purpose control mechanisms that modulate various cognitive sub-processes. However, the relationship between cognitive correlates and reading impairments is still a controversial issue. The present project aims to analyse the fundamental characteristics and the efficacy of different rehabilitation methods for Developmental Dyslexia. Although the neurocognitive causes of DD are still hotly debated, researchers agree that the main challenge is the remediation, that is, how to improve children’s reading fluency and accuracy. The most common approach has been to devise sophisticated remediation programs that train sub-skills of reading, especially phonological skills and auditory perception. Despite the promising results, the improvements in these sub-skills do not automatically transfer in better reading abilities in all subjects (especially regarding reading fluency), thus giving rise to the issue related to "non-responders" or "poor responders". Since the present data gives firm indications of the need to individualize intervention based on neuropsychological testing, the aim of this project is to investigate the efficacy of new types of treatment based on a multifactorial, probabilistic, model of the disorder. Consequently, this project consisted of two parts: specifically, in the first study, we compared phonological-based treatment with computerized cognitive training of the executive functions (e.g., attention, working memory, planning, inhibition). The results of this study clearly pointed out an advantage both in terms of improvements in EFs and literacy skills for the group who undertook the Integrated training, i.e., the group that underwent 12 hours of Cognitive training prior to 12 hours of Phonological-based treatment. Next, the second study aimed to explore the efficacy of a video game Skies of Manawak purposefully designed to train several EFs. Indeed, it has been showed that the existing treatments are not sufficiently captivating and motivating and, thus, we developed a tool ex novo in order to obtain overall improvement and higher chances of transfer to untrained tasks. Our goal was to investigate whether playing this video game may enhance EFs following intervention, and whether these improvements transfer to important literacy skills in typically developing (Study 2 – Part A) and dyslexic children (Study 2 – Part B). All children underwent 12 hours of training, distributed over 6 weeks, either on Skies of Manawak or on a control computerized activity (Scratch). Assessments upon training completion indicated greater improvements in executive functioning and reading efficiency after Skies of Manawak than after the control training in both studies. Interestingly, the advantage in reading skills was maintained in a follow-up test 6 months later and seemed to generalize to academic performance (i.e., Italian marks). Overall findings highlighted promising effects of the training programs on children’s cognition, making way for future studies investigating the underlying brain mechanisms and the factors leading to treatment success.

Despite a large body of research has investigated child attachment during middle childhood, only a limited number of studies has focused on children with Autism Spectrum Disorder. Additionally. The few studies available on this topic have exclusively used self-reported measures to assess quality of attachment, overlooking the role of internal representations, which are considered to play a fundamental role since attachment is internalized. Therefore, no studies examined the way in which child attachment representations are associated with child diagnosis, parenting and caregiving environment in ASD. In the first study, we assessed attachment representations in children with ASD, Learning Disabilities (LD) and Typical development (TD). In particular, we investigated possible group differences on perceived attachment to parents, self-protective strategies and quality of attachment implicit representations using the Dynamic Maturational Model of Attachment and Adaptation (DMM). The Study 2 focused on the caregiving environment and its influence on child attachment implicit representations. To this aim, we assessed parenting stress and parental style in mothers and fathers of children with ASD and TD, examining whether parents of children with ASD differ from those of matched TD group. Secondly, we examined which caregiving environment dimensions contribute significantly in predicting at-risk attachment representations, assessing separately the contribution of maternal and paternal parenting stress and parental interactive social style. In the third study maternal and paternal attachment style were assessed to test the hypothesis of attachment continuity across generations. Firstly, we investigated whether parents of children of ASD reported higher level of attachment-related avoidance/anxiety compared to their TD counterpart. Next, the associations between attachment style of both mothers and fathers and quality of child attachment representations was tested, by examining the moderation effect of child ASD diagnosis. The Study 4 investigated the role of other potential child attachment predictors. Due higher co-occurrence of ASD and difficulties in identifying, describing and distinguishing one’s own feelings, the predictive effect of alexithymia on child explicit attachment representations was tested. Moreover, we also examined whether children with ASD reported higher level of alexithymia compared to controls. The Study 1 showed that children with ASD are able to develop secure and coherent attachment implicit representations, albeit with a lesser extent compared to typically developing children. They were able to engage the attachment interview, confirming the suitability of this method in this clinical sample. Importantly, children with ASD showed high-risk attachment implicit representations and greater presence of unresolved trauma and modifiers, despite no differences emerged on perceived attachment to parents. The lack of group difference on perceived attachment suggested that implicit and explicit attachment representations of children with ASD originate from different sources of information. It is plausible that low reflective functioning, impaired metacognition as well as altered psychobiological processes of children with ASD contributed to attachment maladaptive information processing. Secondly, we replicated the well-established finding of higher parenting distress in parents of children with ASD compared to controls also in fathers. Moreover, the Study 2 documented less didactic and limit/setting style in parents of children with ASD. In accordance to a bidirectional perspective, these parenting behaviors were interpreted as parental functional responses to adapt to child unusual social-communication. Interestingly, data revealed a significant effect of maternal parenting stress and social exchange style on child attachment implicit representations. Thus, the study supports the coexistence of both child-driven and parent-driven effects in the context of parent-child relationship in ASD. Similarly, the Study 3 documented that children with ASD who have an insecurely attached primary caregiver showed at-risk attachment implicit representations. In other words, the continuity of attachment security across generations revealed a clear effect in ASD, suggesting that these children may be more susceptible to this mechanism compared to controls. In addition, parents of children with ASD reported higher attachment-related avoidance in comparison to their TD counterpart. This difference could be associated to the significant couple adjustment associated to the impact of rear a child with ASD. In addition, the Study 4 showed that alexithymia, but not ASD predicts perceived attachment to parents highlighting the different nature of attachment explicit and implicit representation. Moreover, our results confirmed higher co-occurrence of alexithymia and ASD also in school-age, extending literature on adulthood. Our findings pointed out that children with ASD (without intellectual disability) showed higher rates of at-risk self-protective strategies (attachment pattern). These results may be related to several factors associated with ASD symptoms, such as the more frequent disruptions of interpersonal exchanges with the caregiver across development, the difficulties in social information processing and reflective functioning. The higher exposure to adverse childhood experience (e.g. bullying), may explained the higher occurrence of unresolved trauma in these children. Up to date, to the best of our knowledge, these are the first studies on group differences and parental predictors of attachment implicit representations in school-age children with ASD. Therefore, these studies brought initial data to ASD literature on attachment representations, suggesting that these children are at increased risk of developing maladaptive information processing. Limitations of the studies and clinical implications are discussed.

Understanding what constitutes typical adult processing of infant cues and the potential individual variations associated with it is an important early step in comprehending how caregiving practices arise. By adopting a multi-method approach, the present work aimed to enrich the knowledge on adults’ cognitive and electrophysiological responses to infant cues, by focusing on the role of the adults’ sex, the perceived quality of early care from caregivers, and the actual involvement in childcare. Four studies were presented to cover different perspectives on adults’ responses to infant cues, from cognition to electrophysiology and parental behaviors. Methodologies encompassed cognitive experimental tasks, EEG, standardized observations, and self-reported measures. Samples included non-parents, different-sex parents, and same-sex parents. Overall, the present work responded to the recent interest in understanding adults’ responses to infant cues going beyond a heteronormative perspective. Our findings reinforced the argument that differences between males and females, if present in the response to infant stimuli, might not always be biologically determined, but reinforced by societal norms. In addition, we supported the relevance of accounting for both past and current experiences of care when investigating the adults’ cognitive and electrophysiological responses to infant cues. Eventually, we started to gain some knowledge on the neurophysiological correlates of sensitive caregiving in different family contexts. On the whole, considering the complexity of plural family models, we hopefully contributed to socializing the idea that there are different ways of conceiving and understanding parenting nowadays.

Mother child relationship is the first and the most important social relationship as it has implications on psychological and neural development of the individual. Here we investigated mother child relationship focusing on different aspects and using a combination of behavioural and neuroimaging techniques. In the first study we addressed the association between brain connectivity and interpersonal competences which are at the basis of every social interaction including the ones involved in mother-child relationship. Several studies suggests that higher White Matter (WM) integrity - an index of increased brain connectivity - , is associated with better cognition and behavioural performance. To test the hypothesis that higher WM integrity is associated with higher interpersonal competence we used Diffusion Tensor Imaging (DTI), a neuroimaging technique which allows to study in vivo the anatomy of boundless of axons conveying information in the brain. Then we correlated this information with a self-reported measure of interpersonal competences: the Adolescent Interpersonal Competence Questionnaire (AICQ). Results indicate that Interpersonal competence is associate with higher WM integrity in several major tracts of the right hemisphere, in specific the uncinate fasciculus, the cingulum, the forceps minor, the infero-fronto occipital fasciculus, the inferior longitudinal fasciculus, and the superior longitudinal fasciculus. These results provide the first direct analysis of the neuroanatomical basis of interpersonal competencies and young adult self-reported skills in social contexts. In the second work we used the same paradigm to test one of the main assumption of the attachment theory which states that social skills highly depends on the quality of attachment relationship. Results show higher integrity in four white matter association fibers in the left hemisphere: Uncinate Fasciculus, Cingulum, Superior Longitudinal Fasciculus and Inferior Fronto Occipital Fasciculus. This result supports the idea that the quality of the attachment relationship influences the emotional and social life of the individual from childhood to adulthood. Furthermore, the research represents an explorative approach to the study of mother-child relationship in healthy population, demonstrating the feasibility of using neuroimaging tools coupled with clinical investigations. Together those studies show that efficient structural connectivity is linked with secure attachment, improved social cognition and cognitive ability. Similarities and differences emerged in these studies will be discussed at the end of Chapter 3 in particular regarding left and right hemisphere specialization. In the second part of the thesis we switched the focus on parenting behaviour. Evidence from the literature suggest an association between Axonal Integrity measured with FA and functional connectivity measured with TMS in two region involved in preparing ad executing actions: premotor and motor cortex. Moreover neuroimaging reveals that infant cries activate parts of the premotor cortical system. In line with this evidence we linked parenting and brain functional connectivity conducting a study on motor cortex excitability in response of infant cries. We used event-related transcranial magnetic stimulation (TMS) to investigated the presence and the time course of modulation of motor cortex excitability in young adults who listened to infant cries. TMS was delivered from 0 to 250 ms from sound onset in six steps of 50 ms in 10 females and 10 males. Motor Evoked Potentials (MEPs) were recorded from the biceps brachii (BB) and interosseus dorsalis primus (ID1) muscles. Results indicate an excitatory modulation of MEPs at 100 ms from the onset of the infant cry specific to females and to the ID1 muscle. This modulation is considered as automatic response to natural cry as it was not present in response of control sounds and the effect is found at 100-ms latency which make this modulation not compatible with a voluntary reaction to the stimulus but suggests an automatic, bottom-up audiomotor association. These results indicate that the brains of adult females appear to be tuned to respond to infant cries with automatic motor excitation. This effect may reflect the greater and longstanding burden on females in caregiving infants. The second part of the thesis continue with a study addressing the natural condition in which baby cries arise when the parent is not attending for infant stimulation. In this study we investigated how infant crying, compared to control sounds, captures adults’ attentive resources. Participants were all nulliparous women and men, we investigated the effects of different sounds on cerebral activation of the default mode network (DMN) while listeners engaged in two different kind of tasks: one designed to activate the DMN ( self-referential decision task) and one designed to deactivate the DMN (syllabic counting tasks). We found a strong deactivation of DMN in woman during baby cry which suggest a shift of attention from self-referential thinking toward the baby cry stimuli. In men we found instead a weaker deactivation of DMN during woman cry while their attention was directed toward an external task and simultaneously a sudden woman crying arise. Gender differences found in our studies and in the literature will be discussed. In the third part of the thesis we investigated the ability to discriminate synchrony and asynchrony during interaction between mother and child with typical or atypical development. We tested two kind of population: in the first study we compared parents of children with Autism Spectrum Disorder (ASD) to parents of children with Typical Development (TD). In the second study we used the Autistic Quotient questionnaire to divide the sample in two groups according with their autistic traits. The relevance of this task is due to the extreme importance to promptly individuate cues of abnormal social behavior in those cases in which the child might shows deficit in the social development. We hypothesized that individual related with a child with ASD or an individual with high autistic traits, might show similar social difficulties as the individual with ASD finding more challenging to detect cue of appropriate or unappropriated social behavior. To test this hypothesis we asked parents of children with ASD and parents of children with TD to judge video of interactions between mothers and child with ASD and mothers and child with TD. Each video were 20s long and depicted either a synchrony or asynchrony interaction, as categorized by an expert clinician. Contrary to our initial hypothesis results indicate that parents of children with ASD are as accurate as parents of children with TD in discriminating synchrony and asynchrony interaction with ASD, however they are less accurate than parents of children with TD in judging interaction with TD. In the second study by testing individual with higher autistic traits (HAQ group) versus lower autistic traits (LAQ group) we confirmed this trend. Using the same paradigm we found that both groups were less accurate during asynchrony interaction. However HAQ was more accurate in judging synchrony interaction with ASD while LAQ was more accurate in judging synchrony interaction with TD. This result indicate a facilitation effects in understanding interaction which include people that share similar characteristic with the observer disconfirming the hypothesis that people with higher autistic traits would have more difficulties in understanding social interactions and pointing the attention on other factors which might contribute during this process. A discussion on the need of further investigation using neuroimaging techniques to understand similarities and differences on neural processing of social interactions is provided at the end of Chapter 4.