Telepractice: Increase in communication skills in adolescents with autistic spectrum disorder (ASD)
Telepractice: Increase in communication skills in adolescents with autistic spectrum disorder (ASD)
Funded by Cassa di Risparmio di Torino (CRT)
P.I.: Prof.ssa Francesca M. Bosco
Autistic individuals often show specific impairments in pragmatic communication, such as difficulties understanding indirect speech acts, figurative language, and using gestures or prosody appropriately (Loukusa & Moilanen, 2009; Angeleri et al., 2016). These deficits impact social functioning and quality of life, especially in adolescence (Brizio et al., 2015). Despite the growing use of telepractice in clinical contexts (Cason & Cohn, 2014), validated tools for remote assessment and intervention in pragmatics are still lacking. This project aims to address this gap by adapting two existing tools—the ABaCo (Angeleri et al., 2015) and the Cognitive Pragmatic Treatment for Adolescents (@CPT; Gabbatore et al., 2022)—for use via telepractice.
Telepractice offers key advantages over traditional face-to-face services, including increased accessibility for families in underserved areas, reduced transportation costs, and improved treatment continuity (Antezana et al., 2017). Despite growing interest, current protocols in Italy lack validated tools specifically targeting pragmatic communication difficulties in autistic adolescents. The ABaCo battery has proven effective in assessing pragmatic skills in ASD (Angeleri et al., 2016), and the A-CPT has shown positive outcomes in face-to-face settings (Gabbatore et al., 2022). This project aims to adapt both tools for telepractice use, addressing unmet clinical needs. It responds to national and regional health strategies (e.g., PNRR, Regione Piemonte’s POR), which recognize telemedicine as essential for improving care pathways in ASD.
The project addresses a critical gap in clinical and research practice: the absence of validated tools for assessing and improving pragmatic communication skills in autistic adolescents via telepractice. To respond to this need, two empirical studies will be conducted in collaboration with regional clinical centers (e.g., Centro Riabilitazione Ferrero in Alba and Centro Autismo e Sindrome di Asperger in Mondovì).
The first study focuses on adapting the Assessment Battery for Communication (ABaCo; Angeleri et al., 2015) into a telepractice-compatible version (e-ABaCo), and evaluating its reliability in remote administration. ABaCo is a validated tool that assesses pragmatic abilities across five expressive channels: linguistic, extralinguistic, paralinguistic, contextual, and conversational. It includes both comprehension and production tasks using short video clips and examiner-participant interactions.
The study will involve 45 adolescents, aged 12–18, with and without autism. Participants will be divided into three groups:
ASD Tp (n = 15): adolescents with ASD assessed via e-ABaCo (telepractice)
ASD FtF (n = 15): adolescents with ASD assessed via standard face-to-face ABaCo
CG FtF (n = 15): neurotypical controls assessed via face-to-face ABaCo
All participants will be matched for age, gender, and non-verbal IQ (Raven's Standard Progressive Matrices; Picone et al., 2017). Inclusion criteria include preserved language skills (BVN 12–18 Token Test) and a formal ASD diagnosis based on DSM-5 criteria (APA, 2013).
Hypotheses:
No significant difference is expected between the ASD Tp and ASD FtF groups, supporting the equivalence of remote and in-person administration.
Both ASD groups are expected to score lower than the control group, confirming the clinical sensitivity of the tool.
The study will demonstrate the feasibility and diagnostic validity of e-ABaCo, with the goal of making it available to clinical services across the Piedmont region.
The second study evaluates the effectiveness of a remote version of the Cognitive Pragmatic Treatment for Adolescents (@CPT), adapted from the validated face-to-face A-CPT protocol (Gabbatore et al., 2022). The training consists of 15 weekly 90-minute sessions delivered via videoconferencing platforms (e.g., WebEx, Google Meet) in small groups (4–5 participants). Each session includes comprehension tasks (e.g., video-based analysis of communicative breakdowns), production tasks (e.g., role-plays), and homework assignments to generalize learned skills.
Thirty autistic adolescents will be recruited and randomly assigned to two groups:
@CPT Group (n = 15): will receive both Treatment As Usual (TAU) and the @CPT program
Control Group (n = 15): will receive only TAU (e.g., recreational activities)
Participants will be assessed at three time points: pre-training (T0), post-training (T1), and follow-up (T2, 3 months later). Pragmatic abilities will be evaluated using e-ABaCo (with equivalent forms A/B), and cognitive functions will be assessed via the BVN 12–18 (Gugliotta, 2023).
Hypotheses:
The @CPT group will show significant improvements in pragmatic skills at T1, maintained at T2.
No change is expected in cognitive test scores, confirming the specificity of the intervention.
The control group is not expected to improve, supporting the treatment’s efficacy.
A pilot study (Traetta et al., 2023) has already demonstrated promising results, with significant gains in both pragmatic comprehension and production. This larger controlled study will provide robust evidence for the effectiveness of @CPT in telepractice and support its implementation in clinical settings.
The project will be implemented in collaboration with the Centro di Riabilitazione Ferrero (Alba), which has supported previous research on A-CPT and @CPT (Gabbatore et al., 2022; Traetta et al., 2023). If funded, the initiative will be extended to other clinical centers across Piedmont. Directors of public and private facilities will be contacted via email or phone, followed by meetings to present the project. Professionals working with eligible adolescents will be involved in participant recruitment and family communication. Additionally, updates and calls for participation will be disseminated through the social media channels of the Mente e Cervello association, coordinated by the PI. The project is conducted in collaboration with Associazione Mente e Cervello (http://www.mentecervello.it/)
The success of the initiative will be assessed through both quantitative measures and dissemination activities at local, national, and international levels. The core of the evaluation strategy involves the application of repeated-measures ANOVA with Bonferroni post-hoc corrections, ensuring statistical robustness in comparing pre-, post-, and follow-up scores. These analyses will verify both the reliability of e-ABaCo and the effectiveness of the @CPT intervention.
In addition to empirical validation, the project will emphasize community impact and knowledge transfer. As done in previous projects, findings will be shared through: Articles in local newspapers (e.g., Gazzetta d’Alba); Public workshops involving families and local care centers (e.g., Ferrero Center workshop); Conference presentations (e.g., Experimental Pragmatics Conference, 2025); Submissions of at least two articles to high-impact international journals such as the Journal of Telemedicine and Telecare and the Journal of Autism and Developmental Disorders.
Phase 1 (Jan–Mar 2025) Adaptation of ABaCo and A-CPT for telepractice (e-ABaCo and @CPT), including remote usability tests via platforms like Webex or Google Meet.
Phase 2 (Mar–Apr 2025) Recruitment of eligible participants through clinical centers, based on inclusion and exclusion criteria.
Phase 3 (Apr 2025–Mar 2026) Pseudo-randomized group assignment and baseline assessment (T0). Training group completes @CPT; both groups are assessed at post-test (T1) and 3-month follow-up (T2).
Phase 4 (Nov 2025–May 2026) Data entry, cleaning, and preliminary statistical analyses across T0, T1, and T2.
Phase 5 (Dec 2025–Jun 2026) Final data analyses, manuscript preparation, and presentation of results at conferences and in peer-reviewed journals.
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