Diagnosis of autism spectrum disorder (ASD) before the age of three years is a challenge. Analyzing the present practice may help reaching that goal. Aim: To investigate developmental abnormalities and diagnostic pathway of ASD patients in pediatric practice. Methods: Retrospective cross-sectional study of 192 children aged 13 months to 17 years 11 months (average 4 years 9 months), investigated in an outpatient and hospital setting from January 2015 to June 2018 by a semi-structured history and clinical examination, and diagnosed with ASD by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Results: Behavioral peculiarities were detected in the history of the first two years of life in 74.8% of the subjects. The first developmental abnormalities were noticed by the parents at ages from 8 to 36 months (mean 15.6 months) and were predominantly in speech (in 94.6%) and non-verbal communication (11.3%). Developmental regression was reported in 42.1% of the patients occurring between the ages of 6 and 50 months (mean 17.9 months), affecting most commonly speech (88.4% of cases), non-verbal communication (29.2%), and behavior (12.8%). By history, the first manifestations of ASD were noticed at ages from 8 months to 84 months (mean 18.5 months), and were disorders of expressive speech (in 66.7% of cases), receptive speech (in 45.8%), non-verbal communication (35.4%), behavior (27.6%), play (8.9%), socialization (5.7%), and joint attention (2.1%). The most common motive for specialized consultation was delay in language development—in 84.6% of children. The age of ASD diagnosis varied between 12 and 132 months (mean 39.7 months), and the time period between first ASD manifestations and diagnosis was in the range of 0 to 79 months (mean 23.3 months). Many symptoms of abnormal social communication, unnoticed by parents, were detected objectively in more than 95% of the cases—absent or rare spontaneous or reciprocal smile; lack of sharing of interest or affect; abnormal eye contact; lack of finger pointing; lack of gaze to a pointed object; poor facial expressions; lack of imaginary play, etc. Conclusions: Almost two years are needed for diagnosing abnormal development in other domains besides speech in ASD patients. Diagnosis before the age of three years can be achieved by focusing parents’ and pediatricians’ attention on social communication and behavior in patients with speech delay or developmental regression.

Background: Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising neuromodulation technique for enhancing motor recovery in children with hemiplegic cerebral palsy. However, long-term effects of repeated rTMS courses remain unclear, as existing studies have focused primarily on short-term outcomes following a single treatment course, with limited data on whether benefits decline, persist, or can be restored by a second course. Objective: To investigate the immediate and sustained neurophysiological and functional effects of two courses of low-frequency rTMS applied to the contralesional motor cortex in children with hemiplegic CP. Methods: Fifteen children (mean age 9.5 ± 2.8 years; GMFCS I-II, MACS I-II) received two courses of 1 Hz rTMS separated by 3 months. Each course consisted of 10 daily sessions at 90% resting motor threshold, targeting the contralesional motor cortex. Assessments at six time points included neurophysiological parameters (motor threshold MT; motor evoked potentials (MEP) latency and amplitude; cortical silent period, CSP) and functional tests (Finger Tapping, FT; Box and Blocks, BB; Melbourne Assessment, MA; Timed Up and Go, TUG; 1-Minute Walk Test, Berg Balance Scale, BBS). Results: Following the first rTMS course, MT decreased by 32% (upper limb) and 29% (lower limb); MEP latency shortened by 12 and 9%, respectively; MEP amplitude increased by 17 and 18%; and CSP decreased by 31 and 34% (all p < 0.001). Functional improvements consisted of 12% increase in FT and 8.5% in BB, 16% faster TUG, 16% greater 1-min walking distance, and 6.5% improved balance in BBS (all p < 0.001). During 3-month follow-up, effects gradually declined but remained significantly better than baseline. The second rTMS course produced similar magnitude improvements, restoring parameters to first-course post-treatment levels. No significant difference was found between neurophysiological and functional parameters 1 month after the first and 1 month after the second course, with the exception of progressive prolongation CSP. Conclusion: Repeated courses of low-frequency rTMS were associated with reproducible within-subject improvement in neurophysiological and functional measures in children with hemiplegic cerebral palsy. These effects appeared to partially decline over 3 months, and a second course was associated with restoration of treatment benefits without generating further major cumulative gains.