Autism, from early diagnosis to treatment: an uphill road for 500,000 children

Early diagnosis, evidence-based interventions, transition to adulthood and social and work inclusion. These are the 'bullet points' that emerge when we talk about autism, from its onset to its continuing to pose questions to clinicians, families and those who govern and manage health and social care, throughout the life course of the person who, with varying degrees of intensity, falls within the broad 'spectrum' redrawn by the latest diagnostic and statistical manual of mental disorders (Dsm-5).

For Italia, the good news is the ability to ascertain the presence of the disorder earlier than the average reported in the international literature: around three years as opposed to the 49 months needed in other countries. This is a very important element: early detection of signs of risk is a crucial step to initiate interventions capable of significantly affecting developmental trajectories and directing the diagnostic pathway. An efficiency that can be seen in the numbers, and in fact the estimated prevalence of this condition is one child in 77, with a higher incidence in males, for a total of about 500 thousand people. As Elisa Fazzi, president of the Society of Neuropsychiatry of Childhood and Adolescence (Sinpia), explained on the occasion of World Autism Awareness Day on 2 April, 'the increase in cases should not be interpreted solely as a real increase, but rather as the result of several factors, including the broadening of diagnostic criteria, greater awareness, and the improvement of screening and early diagnosis tools'. But it is Fazzi herself who presents the other side of the coin: 'This trend puts the system under pressure and makes it even more urgent to ensure adequate and timely responses throughout the country, providing services with the necessary resources'.

The problem, therefore, is the response - both in terms of funding and the organisation of care provision - which to a large extent is still lacking and is extremely differentiated throughout the country: there are still great inequalities in territorial access, waiting times, and multidisciplinary care, also due to the lack of personnel and facilities, which Sinpia itself, as well as the patients' families' associations, have been highlighting for some time.

The structured offer of services is dramatically lacking, especially in some areas of Italia such as the South and the Islands, even though steps are being taken to implement it: the announcement of a new collaboration agreement between the Ministry of Health and the Higher Institute of Health, which will benefit from 10 million euros made available by the Autism Fund 2025-2026, has just been made. And which will be earmarked precisely to strengthen the autism network, to increase the number of early diagnoses, and to make people's life project more and more structured, in line with legislative decree 62 of 2024 implementing the disability reform, with the intention of maximising the full expression of people's potential. "All the Regions," warns Maria Luisa Scattoni, coordinator of the National Autism Observatory, "have been involved in the implementation of dedicated services and teams specialised in the management of behavioural emergencies, both in childhood and adulthood.
A need for which 67 professionals of the National Health Service have been trained - in the use of evidence-based techniques -: they will operate in public centres to guarantee dedicated interventions and disseminate specific skills. A breath of fresh air: the lack of specialised personnel is also one of the main critical issues in this field.

The life project is the bet that holds together the need to protect the transition to adulthood and the 'After Us'. the Regions are called upon to develop customised pathways based on the person's needs, preferences, and level of functioning," Scattoni continues. "The pathways will concern the areas of health, learning, work, and living in an integrated manner, and the activation of Autism Functional Units in the services of child neuropsychiatry and adult psychiatry is also envisaged, with the functions of evaluating, planning, and monitoring customised pathways.