**3. A Telemedicine Working Model for Intervention**

The telemedicine working model for intervention that has been developed was aimed at both preschoolers and older children (see Figure 2).

**Figure 2.** Working model for intervention.

For preschoolers, two sessions of 30 min each per week are expected. During these sessions, a parent-mediated remote intervention, guided by therapist, is carried out. The therapist may suggest to the parents the socio-communicative strategies aimed at improving the child's initiative. The two sessions (with parent–child and therapist remotely connected) are video recorded. During the week, another session of 60 min (remotely) is added to the two described before with the purpose of discussing with the parents the key points of the child's intervention (without the child). The therapist, in the discussion with the parents, can use parts of the recorded sessions made during the week.

For the preschoolers, the adopted intervention models are the so-called Naturalistic Developmental Behavioral Interventions (NDBI) [38]. The NDBI are evidence-based intervention models; they are based both on behavioral learning and on developmental sciences. The Early Start Denver Model [39,40] (with certified therapists from University of California (UC)-Davis) and DIR/Floor-Time [41] (with certified therapist from Interdisciplinary Council on Development and Learning (ICDL)) are remotely implemented. Remote parenting coaching, to provide parents/caregivers with tools and strategies to teach and engage their child through play and everyday routines, such as mealtimes, bathing, and dressing, is provided [42].

Therapists are supervised by an experienced psychologist in the field of early intervention.

For school-aged children, two 30 min online speech and communication therapy sessions are suggested per week. If necessary, the support of a parent is requested. The efficacy of speech and communication therapy delivered via telemedicine has been well documented [43]. During speech and communication therapy, the therapist and child are remotely connected, and they can interact in real time through audio and video with images and learning materials [43]. One session of 60 min every two weeks with parents is provided (without the child) to share the child's improvements and difficulties, as well as to suggest practical advice for the parents to perform at home.

For high-functioning children, it is established to continue the psychoeducational interventions, psychological support, and psychotherapy; however, the duration was modified to 30 min a week instead the original 60 min of in-person therapy. The high psychiatric vulnerability and/or comorbidity of children with ASD is widely documented. Among them, anxiety disorder is one of the most reported [44]. Psychiatric comorbidities could contribute to a depletion of development, especially in adolescence. The alert state caused by the COVID-19 pandemic could be a difficult event to mentalize for children with ASD. For this reason, if the children were engaged in psychotherapy before the COVID-19 alert, it is important that they continue the therapy in online video or audio mode with the same weekly appointments. Continuing therapy could reduce anxiety, control mood, and offer children a private space to talk to a specialist [1].

One session of 60 min every two weeks with parents is also provided (without the child).

For patients who do not have the adequate autonomy to carry out online therapy, the intervention takes place exclusively in the form of one or two 30 min sessions a week for remote parent coaching.

During remote parent coaching, parents are invited to (1) share a home video (10–15 min) with therapists related to the child's behavior during structured sessions in a home setting or during free play and (2) discuss with therapists individualized strategies and methods of intervention for their child.
