**2. Intersubjectivity parental-based intervention (I-PBI)**

With this chapter, we want to present and describe an intervention plan that has been implemented in the Laboratory of Observation, Diagnosis, and Education (ODFLab) of the Department of Psychology and Cognitive Science, University of Trento (Italy). ODFLab is a clinical and research laboratory specialized in the multimethod assessment and evidence-based intervention programs for individuals with typical and atypical neurodevelopment. Specifically, the ODFLab is a national reference center for assessment and intervention for autism spectrum disorders (ASDs) and learning disabilities (LD). In the context of ASD, ODFLab implements an "Intersubjectivity Parental-Based Intervention" (I-PBI), which combines empirically validated scientific principles with guidelines following the Italian Health System [6, 27, 28]. This intervention integrates developmental and relationship-based principles with behavioral ones, taking inspiration from the elements of the American Early Start Denver Model [29, 30]. In addition, the I-PBI emphasizes the fundamental role of reciprocity between caregiver and child, supporting intersubjective exchanges and promoting the child's intentionality during interactions. The purpose of the intervention is to increase the intersubjectivity within the dyad, providing the child with the

#### *An Intersubjectivity Parental-Based Intervention (I-PBI) for Preschoolers with ASD DOI: http://dx.doi.org/10.5772/intechopen.108672*

relational experience to reach several stages of development. The intervention allows children with atypical development to establish empathy relations with the parent and acquire essential primary communication skills. Furthermore, given possible caregivers-child maladaptive interactive circuits in dyads with children with ASD, the I-PBI involves caregivers in the therapeutic setting to allow parents to learn appropriate strategies to deal with their children. In addition, parents play a fundamental role in the generalization of child competencies. In fact, through parental involvement, caregivers may effectively use the acquired strategies in more naturalistic contexts (e.g., home). The intervention is adapted following the child's age, specific interests, and individual functional profiles. Further, intervention goals are constantly changed and revised depending on the child's developmental improvements. Moreover, unlike parent-mediated intervention and parent training, parental involvement does not require home assignments or fidelity schedules, and the therapist delivers the intervention entirely. In fact, during these weekly sessions, parents are not delivering the intervention, and therapists remain the key figures, structuring activities and creating opportunities for the caregivers and the child to interact and play together. Thanks to this, caregivers may have the opportunity to experience more functional interactions with their child characterized by more adequate proposals and significant awareness of the child's difficulties. This may lead to increased dyadic pleasure, increased parents' self-efficacy, and significant motivation to interact with their children while reducing stress and frustration. This intervention also refers to the highly validated Preschool Autism Communication Trial - PACT [9] procedure aimed to enhance parental sensitivity and responsiveness, and consequently, being beneficial in terms of more pronounced parental synchronous response to the child, child initiations with adults, and joint attention between parent and child. Considering the child, the intervention is based on three different levels: (1) Relationship, consisting of specific intervention on parent-child interaction; (2) Behavior, through learning adaptive modalities in the interaction with others by using alternative augmentative communication (CAA) and use of images or sounds in order to structure sequential organization of activities; (3) Development, consisting of individual rehabilitative interventions such as music therapy, psychomotricity, cognitive activation, speech therapy, and occupational therapy. Every intervention should be planned considering individual and specific characteristics. However, some primary indications are divided into four phases that would adapt to each child.

**Phase 1 – Intensive Intervention:** after diagnosis, the intervention should be intensive and highly structured, consisting of 6/8 hours per week (3/4 hours for individual rehabilitation and 3/4 involving parents during intervention). Further, meetings with parents alone are provided during this phase. The intensive intervention should last a minimum of 6 months, depending on each case. Generally, this first phase can be considered concluded when the adult can interact appropriately with the child and contain him/her.

**Phase 2 – Consolidation of Intervention:** this phase consists of a maximum of 4 hours of intervention per week in a group of peers to develop social play skills. However, during this phase, parents are supported by a psychotherapist or a psychologist through meetings every 2/3 weeks.

**Phase 3 – "Conclusion" of Intervention:** there is no actual conclusion of the intervention, and support for families is always present. When children acquire suitable and sufficient abilities, they may receive other direct interventions in specific moments, such as challenging situations or essential transitions in life.

## **2.1 Parental intervention**

Considering parents, there are several phases below described in detail. **Phase 1 – Parent-Child Interaction:** during this phase, the intervention setting is not highly structured to offer spontaneous and ecological interactions that are easily replicable at home or other contexts. The main goal of parent involvement in a therapy room is teaching adults to detect and promptly respond to the child's cues, decreasing the child's frustration and anxiety. During the first phase, especially during the first meetings, the therapist has a leading role in dealing with the child to comprehend which ways are appropriate and well accepted by the child, reactivating a synchronic interactive exchange. The therapist uses specific techniques to create an appropriate context within the dyad and help parents get closer to their children. The main focus of the intervention is the parent-child interaction and, in particular, the promotion of a synchronic and responsive interaction that acts as a framework for the child's development. Therefore, working on identifying dysfunctional interactive patterns is fundamental to understanding how to replace them with more adequate and effective interactive methods. Improvements in relationship quality imply constant support to the parents to help them acquire the ability to maintain a balance between the child's exploration and structured activities, respecting the timing and the methods of a child that follows different evolutionary paths. The main intervention objectives are:


#### *An Intersubjectivity Parental-Based Intervention (I-PBI) for Preschoolers with ASD DOI: http://dx.doi.org/10.5772/intechopen.108672*

**Phase 2 – Parental Representation:** during this phase, every 2–3 weeks, parents meet another therapist, and through video recording technology, they discuss interactive moments with their children. The intervention provides specific work on parents' representations to build a more truthful image of the child and themselves as parents, enhancing their ability to reflect on their own and the child's behaviors. In addition, during these meetings, parents have the opportunity to share and discuss their difficulties, hopes, and worries. The intervention provides specific work on parents' representations to build a more truthful image of the child and themselves as parents, enhancing their ability to reflect on their own and the child's behaviors.

The meeting is divided into two phases: an initial one that follows the classic clinical interview method and a more structured one that involves video analysis. During the first phase, parents can talk freely about previous weeks' events. The therapist intervenes to share and process painful feelings and to support positive affects when the parents tell pleasant episodes connected to the relationship with the child. In addition, the therapist gives several concrete suggestions on supporting and managing certain aspects of the child's development. The therapist has previously selected clips of interaction that are first watched together and then commented on. The psychotherapist guides the parent in observing their behaviors' effects on the child (e.g., respecting the child's timing leads the child to respond to a request; or a too high-pitched voice causes the child's withdrawal behaviors). These events are of such a short duration that, generally, no attention is paid to them during the flow of the interaction. However, observing, evaluating, and discussing their presence are fundamental for truthful caregivers' representations.

Finally, parents are guided in the comprehension of their behavior through questions about feelings considering themselves and the child to promote their reflective function.

In summary, the therapist's objectives in this phase are:


**Phase 3 – Parent's group**: in this phase, different parents of same-aged children discuss their difficulties and worries, support each other, and share thoughts and ideas about parenting. Thanks to the confrontation with families of children in the same condition, parents may feel understood in their difficulties and less alone.

### **3. Highlights**

To sum up, the I-PBI focuses on:


Trained psychologists deliver the intervention after receiving specific licenses on developmental intervention models for children with ASD. Finally, the team is constantly supervised at least once every month by an expert psychotherapist.
