Livia Fornasari

Virtual reality in autism: state of the art

Autism spectrum disorders are characterized by core deficits with regard to three domains, i.e. social interaction, communication and repetitive or stereotypic behaviour. It is crucial to develop intervention strategies helping individuals with autism, their caregivers and educators in daily life. For this purpose, virtual reality (VR), i.e. a simulation of the real world based on computer graphics, can be useful as it allows instructors and therapists to offer a safe, repeatable and diversifiable environment during learning. This mini review examines studies that have investigated the use of VR in autism.

Impaired configural body processing in anorexia nervosa: Evidence from the body inversion effect

Patients with anorexia nervosa (AN) suffer from severe disturbances of body perception. It is unclear, however, whether such disturbances are linked to specific alterations in the processing of body configurations with respect to the local processing of body part details. Here, we compared a consecutive sample of 12 AN patients with a group of 12 age-, gender- and education-matched controls using an inversion effect paradigm requiring the visual discrimination of upright and inverted pictures of whole bodies, faces and objects. The AN patients presented selective deficits in the discrimination of upright body stimuli, which requires configural processing. Conversely, patients and controls showed comparable abilities in the discrimination of inverted bodies, which involves only detail-based processing, and in the discrimination of both upright and inverted faces and objects. Importantly, the body inversion effect negatively correlated with the persistence scores at the Temperament and Character Inventory, which evaluates increased tendency to convert a signal of punishment into a signal of reinforcement. These results suggest that the deficits of configural processing in AN patients may be associated with their obsessive worries about body appearance and to the excessive attention to details that characterizes their general perceptual style.

Body Schema and Self-Representation in Patients with Bulimia Nervosa

OBJECTIVE Neuroimaging evidences in eating disorder (ED) patients document dysfunctional neural activity of the posterior parietal cortex, which is engaged in the representation of body schema. Yet a full neuropsychological investigation of body schema representation in ED patients is lacking. We examined mental imagery and body schema representation in patients with bulimia nervosa (BN) and binge eating disorder (BED). METHOD Consecutive samples of 15 BN patients and 15 BED patients were compared with two groups of 15 age-matched controls in tasks requiring body or object mental transformation. RESULTS BN, but not BED patients, were selectively impaired in the mental transformation of their own body, although this deficit was not correlated with measures of body dissatisfaction. In contrast, no patient group was impaired in the mental transformation of external objects. DISCUSSION Results showed altered self-body representation in BN, but not BED patients, as the neuropsychological consequences of posterior parietal cortex dysfunctions.

Psychopathological and personality traits underlie decision making in recent onset medication naïve anorexia nervosa: a pilot study.

The Iowa Gambling Task (IGT) analyzes the ability of participants to sacrifice immediate rewards in view of a long term gain. Anorexia Nervosa (AN) in addition to weight loss and body image disturbances is also characterized by the tendency to make decisions that may result in long-term negative outcomes. Studies that analyzed IGT performance in patients with AN were not consistent with each other. Fifteen adolescents with AN and 15 matched controls carried out IGT after being clinically and neuropsychologically evaluated. An interesting generalized estimating equation approach showed that four independent clinical variables, and not the group, explained IGT performances, such as blocks repetition, anxiety, psychogenic eating disorders and self transcendence. The impairment of decision making is not related to the diagnosis of AN, but it is driven by high levels of anxiety and self transcendence. Instead, some psychogenic eating disorders traits, related to illness severity, positively affected IGT performance in the whole sample. IGT impairment in AN found by prior studies could be related to these clinical features which are not always taken into account.

Investigating the development of temperament and character in school-aged children using a self-report measure

BACKGROUND Developmental studies of temperament and character dimensions are crucial for a better understanding of how genetic and environmental factors interact in shaping individual personality. However, although several studies have been conducted in adults, a few studies have addressed the evaluation of temperament and character in children. Here, we tested the suitability of self-report evaluation and the developmental trend of temperament and character dimensions among school-aged children using an Italian version of the junior Temperament and Character Inventory (jTCI). METHODS The jTCI was completed by 572 Italian children (292 girls and 280 boys) aged 8 to 12 years. We evaluated the internal consistency of the 7 jTCI scales at each age, the intercorrelations between the scales, and the factorial model of the questionnaires. Furthermore, we tested the differences between the development of the temperament and character dimensions in girls and boys. RESULTS Although the data from 8-year children showed unacceptably low internal consistency, better reliability was observed for older children. Intercorrelations and factor analysis partially confirmed the hypothesized structure of the jTCI items, with problems observed for some items of the Novelty Seeking, Harm Avoidance, Reward Dependence (RD), and Self-Directedness scales. Furthermore, in keeping with previous studies, girls presented lower scores in Novelty Seeking and higher RD, Self-Directedness, and Cooperativeness scales than did boys, with the between-sex difference in RD becoming larger at older ages. CONCLUSIONS Although the use of the self-administered jTCI in clinical settings should be cautious, it may serve as a useful complementary instrument to describe the development of personality in childhood.

Twelve months of TEACCH-oriented habilitation on an Italian population of children with autism

Abstract Autism is a severe disorder and it is important to implement targeted interventions designed on the strengths and needs of affected children in order to improve their daily life. In this sense, the TEACCH program (Treatment and Education of Autistic and related Communication handicapped CHildren) may be useful in autism. A longitudinal study was conducted in Italy to evaluate the effectiveness of our treatment and the best age to start a low-intensive TEACCH-oriented intervention. Twenty-eight children with autism were treated twice a week following the guidelines inspired by the TEACCH intervention. Developmental abilities were rated at baseline and after six and 12 months with the Psychoeducational Profile-Revised (PEP-R) scale. Developmental abilities significantly improved during the first 6 months with progressive amelioration throughout the 12-month follow-up period, particularly for children under 40 months of age. Specifically perception, motor skills, and cognition improved only in patients who begun the program before 60 months of age. This study shows that early low-intensive TEACCH habilitation is effective in improving developmental abilities in autism even after 6 months, particularly in patients at the very early stages of the disease. It is therefore crucial to begin the habilitation program in autism at the very early stage of the illness in order to maximize the effectiveness of the treatment.

Normative data and effects of age and gender on temperament and character dimensions across the lifespan in an Italian population: A cross-sectional validation study

BACKGROUND The short version of the Temperament and Character Inventory (TCI-125) has been employed for the study of personality traits in both clinical and normal populations. However, to the best of our knowledge, no studies explored the psychometric properties of this instrument in healthy individuals across the lifespan. We here provide the Italian normative data and present the personality features according to age and gender in a sample of healthy individuals. METHODS A cross-sectional study was carried out in a total of 1430 Italian healthy individuals ranging from 13 to 67 years (59.3% females). We evaluated the factorial model of the TCI-125, explored the internal consistency of the scales and carried out univariate analyses of variance for the investigation of age and gender differences in temperament and character dimensions. RESULTS Confirmatory factor analysis only partially confirmed the factor structure, with some Reward Dependence, Self-Directedness, and Cooperativeness items showing poor fit. Overall we found acceptable internal consistencies for all the dimensions of the TCI-125 across all age groups, except for Reward Dependence, Persistence, and Novelty Seeking, which showed unsatisfactory internal consistency in younger age groups. Furthermore, we found significant age differences in most temperament and all character dimensions. Finally, in specific age groups we also observed significantly lower scores in males compared to females in Harm Avoidance, Reward Dependence and all character dimensions except for Self-Directedness, on which males scored higher than females. CONCLUSIONS Although this study only partially confirmed the factor structure of the TCI-125 and suggested limited homogeneity for some temperament scales, overall our results supported the reliability of the TCI-125, which can therefore be considered a useful tool for exploring personality traits in both clinical and normal samples. Moreover, this study suggested the need of using this instrument with caution in adolescents.

Reliability and normative data of the Perceptual Aberration Scale in an Italian juvenile general population sample.

Psychometric tools, such as the Perceptual Aberration Scale (PAS), have been developed to identify people at risk to develop psychosis. This paper aims at providing an Italian version of the Perceptual Aberration Scale and its normative data for the general juvenile Italian population. The Italian version of the PAS was produced using three independent translators. It was administered to 1089 non-clinical participants, stratified into three age-groups, i.e., 8-13, 14-17 and 18-24. The Italian version of the PAS displayed good internal consistency in each age-group evaluated (i.e. Alpha Coefficients: 0.90 for the 8-13 age-group, 0.84 for the 14-17 age-group, and 0.87 for the 18-24 age-group) and the assumption of unidimensionality was corraborate. Furthermore, normative data for the three groups were collected (i.e. cut-offs: 25 for the 8-13 age-group, 21 for the 14-17 age-group and 20 for the 18-24 age-group) and an age-related difference, as the 18-24 group scored lower than the younger groups, was found. The Italian version of the PAS proved to be a reliable psychometric tool to investigate perceptual aberration during childhood, adolescence and young adulthood.

Normative data of the Magical Ideation Scale from childhood to adulthood in an Italian cohort

The assessment of schizotypy allows to identify people at risk to develop psychosis. For this purpose, psychometric tools have been developed, such as the Magical Ideation Scale (MIS). This scale investigates attenuated forms of thought transmission experiences, thought withdrawal and aberrant beliefs, related to positive schizotypy. This study aims at providing an Italian version of the MIS and its normative data in the general population from childhood to adulthood, being the first study evaluating subjects under 17year-old. The Italian MIS version was translated by three independent operators and administered to 1378 non-clinical participants, stratified into four age groups (i.e., 8-13, 14-17, 18-24 and 25-34). The unidimensionality of the scale was supported, and its internal consistency was satisfactory (i.e., ordinal Cronbachs αs ranging from 0.86 to 0.90 in different age groups), as well as test-retest reliability (i.e., 1-month ICC of 0.82 in a retested sub-sample). Normative data for the age groups were provided. Specific gender and age-related differences in MIS score were found, i.e. females scored higher than males in the 25-34 age group, which in general, as a group, scored lower than all the other age groups. This study provided evidence of reliability for the Italian version of the MIS in childhood and adolescence, for the first time, as well as in adulthood, showing specific gender and age effects in the early adult cohort.

Deficit di regolazione emotiva in età evolutiva: analisi dei profili di funzionamento in un campione clinico italiano

Il processo di autoregolazione emotiva riveste un ambito d’interesse nello studio della psicopatologia, in particolare in eta evolutiva in quanto un deficit di auto-regolazione puo essere implicato sia in disturbi internalizzanti sia esternalizzanti. Alcuni ricercatori hanno operazionalizzato questo costrutto clinico utilizzando tre scale della CBCL -Child Behavior Check List per misurarlo: ansia/depressione, attenzione, comportamento aggressivo. Tali scale sono state utilizzate anche per identificare livelli piu severi di disregolazione emotiva che definiscono il Dysregulation Profile. Possibili outcome clinici sono stati individuati in difficolta nella regolazione dell’umore, nella gestione dei pensieri/preoccupazioni, nella regolazione del comportamento, nella regolazione cognitiva. In considerazione di queste premesse, il presente lavoro si pone l’obiettivo di studiare, in un campione clinico italiano di 1.224 soggetti in eta evolutiva, i livelli di disregolazione emotiva (CBCL-DESR e CBCL-DP) in funzione delle categorie di inquadramento diagnostico secondo DSM-IV. I risultati di questo studio esplorativo mostrano la presenza di pattern di disregolazione in un’ampia parte del campione clinico in esame, e di grave disregolazione soprattutto nei soggetti con quadro clinico piu grave.