Background and Objectives: Toe walking (TW) is frequently observed in children with Autism Spectrum Disorder (ASD), yet its clinical significance and association with comorbid conditions remain poorly understood. This study aimed to examine the prevalence of TW in a large Italian cohort of children with ASD and to explore its association with ASD severity, sleep disturbances, feeding behaviors, and gastrointestinal symptoms. Materials and Methods: A total of 289 children with ASD and 289 typically developing controls (TDC), matched for age and sex, were evaluated in a multicentric observational study. TW was assessed during neurodevelopmental evaluations. Sleep quality was assessed using the Sleep Disturbance Scale for Children (SDSC), feeding behaviors via the Brief Autism Mealtime Behavior Inventory (BAMBI), and gastrointestinal symptoms through clinical reporting. Statistical analyses included Chi-square tests, Mann–Whitney U tests, Spearman correlations, and logistic regressions. Results: TW was significantly more prevalent in the ASD group (27.3%) than in TDC (5.5%, p < 0.0001). Within the ASD group, TW occurred in 50.5% of children with Level 3 severity but was absent in Levels 1 and 2 (p < 0.0001). Males exhibited TW more frequently than females. Children with TW had higher SDSC scores (ρ = 0.33, p < 0.0001), though no subscale independently predicted TW. Constipation was reported in 100% of children with Level 3 ASD and was strongly correlated with SDSC total scores (ρ = 0.58, p < 0.0001). The Disorders of Arousal (DA) subscale emerged as an independent predictor of constipation (β = 0.184, p = 0.019). Conclusions: TW in ASD appears to be a marker of greater neurodevelopmental severity and is associated with sleep disturbances and gastrointestinal dysfunction. These findings support the hypothesis that TW may reflect broader dysfunctions involving the gut–brain axis, sensory processing, and motor control. The routine clinical assessment of TW should include the evaluation of sleep and somatic symptoms to better understand the multisystemic nature of ASD phenotypes.

Munchausen Syndrome by Proxy (MSBP) is recognized as a form of child abuse in which a caregiver induces or fabricates illnesses in their child to gain medical and social attention. MSBP represents one of the most complex and insidious forms of child abuse, characterized by an ambiguous clinical presentation that poses significant challenges for physicians, psychiatrists, and social workers. However, this condition raises critical questions regarding its diagnosis, management, and forensic implications. Traditionally, MSBP has been framed as an individual pathological manifestation of the mother, overlooking the role of the healthcare and legal systems in its identification and management. In this article, we propose a critical reflection on MSBP, emphasizing how the issue is not merely a “parental failure” but rather a systemic failure of healthcare, social, and judicial institutions in recognizing, preventing, and effectively managing such cases.

Background: Violent TV series and streaming content are increasingly accessible to children, raising concerns about behavioral imitation and psychological effects. This study examined copycat behaviors and associated emotional and somatic symptoms among children who reported watching the age-restricted series Squid Game. Methods: In this observational study of 228 Italian primary school children (aged 8–11), 128 who had watched Squid Game formed the analytic sample. They were categorized into a Copycat Behavior (CB) group or a Non-Copycat Behavior (NCB) group based on self-reported imitation of scenes or games from the series. Parents completed the Child Behavior Checklist (CBCL). Group differences were assessed using Mann–Whitney U tests, and gender distribution was compared with Chi-square tests (α = 0.05). Results: Among viewers, 42 children (32%) engaged in imitation behaviors, typically reenacting game-based violent scenes with friends (52%), siblings (28%), or classmates (20%). Age and gender distributions did not differ between groups. The CB group scored slightly higher on the CBCL Somatic Complaints scale compared with the NCB group (M = 54.12 vs. 52.92; U = 1414.5, p = 0.033), although this difference was small. No significant differences emerged on other CBCL syndrome or broadband scales. Conclusions: Among children engaging in copycat behaviors exhibited a small, subclinical increase in somatic complaints. While causality cannot be inferred, the findings highlight the need to protect vulnerable children—particularly those prone to somatic distress—from unsupervised access to violent, age-inappropriate content. Media literacy for parents and educators, and longitudinal studies including non-viewers are recommended.

Background: Autism Spectrum Disorder (ASD) is characterized by social communication deficits, restricted/repetitive behaviors, sensory processing atypicalities, and impaired adaptive functioning. Neuropsychomotor Therapy of Early Development (TNPEE) integrates motor, cognitive, and socio-emotional domains, promoting functional skills, while Therapy in Aquatic Motor Activities (TAMA) targets motor and sensory engagement. This multicenter, 18-month study compared TNPEE, TAMA, and their combination, hypothesizing that TNPEE would drive core symptom and adaptive improvements, with TAMA providing complementary benefits. Methods: Seventy-seven children with Autism Spectrum Disorder (31.6% females) were recruited from four Italian centers (Palermo, Perugia, Sarno, Messina) and allocated to three groups: TAMA only, TNPEE combined with TAMA, and TNPEE only. Assessments included the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the Childhood Autism Rating Scale, Second Edition (CARS-2), Vineland Adaptive Behavior Scales, Sensory Processing Measure and HAARS at baseline, 6, 12, and 18 months. Results: By 18 months, children receiving TNPEE, alone or combined with TAMA, exhibited significant reductions in autism severity, significant improvements in adaptive functioning, and enhanced sensory processing. In contrast, the TAMA-only group demonstrated improvements in aquatic competence (HAARS) but no statistically significant changes in ASD severity or adaptive functioning. Conclusions: TNPEE was the intervention most consistently associated with improvements in ASD severity, adaptive functioning, and sensory processing, whereas TAMA alone showed a more limited impact on broader developmental outcomes.

Background. Autism Spectrum Disorder (ASD) is a neurodevelopmental condition marked by social-communication difficulties, restricted interests, and motor coordination challenges. In recent years, structured physical activity programs — particularly martial arts — have gained attention as promising complementary interventions for youth with ASD. Objectives. This scoping review aimed to map and synthesize empirical evidence on martial arts interventions for individuals aged 6–18 years with ASD. Materials and methods. A systematic search of PubMed, Scopus, and Web of Science databases was conducted between January and March 2025. Results. After screening 89 records and applying rigorous eligibility filters (regarding study design, diagnosis, age range, and sample size ≥10), only two studies were included. Both studies reported statistically significant improvements in motor coordination and balance following structured martial arts programs, specifically karate kata (n = 30) and Tai Chi Chuan (n = 18). However, methodological limitations such as a lack of blinding and small sample sizes were noted. Broader literature supports additional benefits of martial arts on social engagement, executive function, emotional regulation, and parental outcomes, although the two included trials did not capture these effects. Conclusions. Despite the limited number of eligible RCTs, current evidence suggests that martial arts interventions may offer meaningful benefits across multiple developmental domains in children and adolescents with ASD. Further well-designed and rigorous trials are needed to confirm and expand these findings.

Background: Autism Spectrum Disorder (ASD) can be conceptualized not as a static condition but as a dynamic disorder of developmental regulation, in which neuroplastic potential is translated into functional gains only through structured, experience-dependent therapeutic input. Neuropsychomotor Therapy of Early Development (TNPEE) and Therapy in Aquatic Motor Activities (TAMA) have shown differential efficacy in children with ASD, but whether chronological age moderates the magnitude of therapeutic response—or whether the characteristics of the intervention itself are the stronger determinant of outcome—has not been systematically examined. Methods: This was a non-randomized, exploratory secondary stratified analysis of a multicenter 18-month longitudinal cohort (N = 77 children with ASD, age 4–12 years) allocated to three groups: TAMA only, TNPEE combined with TAMA (TAMA+TNPEE), or TNPEE only. Participants were stratified into a younger (≤6 years, n = 16; TAMA n = 8, TAMA+TNPEE n = 3, TNPEE n = 5) and an older (>6 years, n = 61; TAMA n = 18, TAMA+TNPEE n = 22, TNPEE n = 21) subgroup. Adaptive functioning was assessed with the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline and 18 months. Between-stratum comparisons used the Mann–Whitney U test; Spearman rank correlations and ANCOVA models with Age × Treatment interaction terms were used to test age moderation within a neuroplasticity-recruitment framework. Results: In the TAMA-only group, younger children showed significantly smaller adaptive gains than older children across the Composite (2.22 ± 1.14 vs. 3.53 ± 0.76, p = 0.012), Communication (p = 0.041), and Socialization (p = 0.016) subscales, with significant positive Spearman correlations between age and adaptive gains (r = 0.397–0.437). Simple slope analysis confirmed a significant age effect within the TAMA group (b = 0.231, SE = 0.083, p = 0.010) but not in the TNPEE (b = 0.133, p = 0.157) or TAMA+TNPEE (b = 0.135, p = 0.198) groups. The formal Age × Treatment interaction term in the ANCOVA did not reach statistical significance (all p > 0.18). As this interaction test is the formal statistical test of differential age moderation, the simple-slope pattern above should be regarded as exploratory rather than confirmatory. Treatment group accounted for the large majority of variance in adaptive gains (partial η² = 0.78–0.95), whereas age explained only a small proportion of outcome variability. ASD severity level transitions were comparable across age strata in TNPEE-based groups. Conclusions: In this exploratory secondary analysis, TNPEE-based interventions were associated with adaptive gains that did not differ significantly by age across the 4–12 year age range, whereas aquatic therapy alone showed an age-dependent pattern favoring older children. These findings are hypothesis-generating and consistent with a neuroplasticity-recruitment model in which therapeutic architecture—rather than chronological age alone— may be associated with how effectively latent plastic potential is translated into developmental gains, although the non-significant Age × Treatment interaction and the small, imbalanced subgroups (including n = 3 in the youngest TAMA+TNPEE stratum) mean these findings require confirmation in adequately powered, prospectively designed studies, with implications for clinical decision-making regarding therapy timing and design.