*4.2. The Narration from the Students*

The participants of the filmmaking course were also elated to be part of the programme. The course provided a space for these young individuals to explore their creativity and discover their strengths, ultimately leading to a sense of empowerment. Through their words, we see how the magic of filmmaking can transcend barriers and inspire young minds to pursue their dreams.

Federico, a 13-year-old with a diagnosis of OCD and tic disorder says:

*"It is impossible to describe in a few words the magic emotions that I experienced during the course. All of us learned new abilities. We felt like professionals, and we had the responsibility to use complex equipment. But above all, we felt like a big family. Unfortunately, it's all over, but everything we have done is still within us, in a special place in our heart. After this course I've decided that when I grow up, I'll work in the movie industry".*

Alessio, a 12-year-old with dyslexia and autism spectrum disorder commented on the filmmaking experience. Even if the text is ungrammatical and full of errors, the meaning is clearly understandable:

*"We don't know if this was a sign of destiny or if we are made to do things that giants do, but no one can express the emotions of this project. (In the sense that it is difficult to describe them). This project was beautiful (Arianna's thread). From this experience, I* *understood that each of us has skills. Participating in a movie set with all the other kids was an incredible adventure. I hope more similar things are done. Anyone who has yet to experience it cannot understand."* (Figure 2. Alessio's chat screenshot)

**Figure 2.** Alessio's chat screenshot.

#### **5. Discussion**

This pilot study aimed to explore the benefits of filmmaking therapy for individuals diagnosed with psychiatric or neurodevelopmental disorders in a consecutive sample of children and adolescents. This research is motivated by finding alternative and innovative ways to help children and adolescents with neuropsychiatric disorders in managing life challenges.

In this work, we measured the benefits of a filmmaking course by applying standardized scales widely used in the clinical assessment of developmental age. A systematic outcome measure was carried out pre- and post-programme in the context of a specialized mental health care team.

One of the strengths of this study is that it proves the effectiveness of filmmaking projects on children and adolescents affected by various psychiatric disorders, unlike previous studies that had enrolled patients affected by specific disorders such as ASD [11]. The study shows how an inclusive group offers to participants the opportunity to share their different skills and in a highly cooperative environment. It may improve creativity and self-expression, giving the participants a platform to share their perspectives with others. In fact, through storytelling, participants could learn how to convey emotions, communicate ideas, and engage their audience. Moreover, this requires effective communication between team members, and they learn how to explain their ideas clearly and persuasively and how to listen and constructively respond to others.

A second strength of the project Is that It allows the participants to create the stories and, therefore, to express their inner thoughts. The participants had the opportunity to translate their ideas and feelings into cinematic language, one of the most powerful and complete means of expression. They could learn to empathize with their characters and explain their message in a way that resonates with their audience.

The increase in the number of participants with high self-esteem we have noticed suggests that some of them changed the opinion they have of themselves. Improving the self-esteem or confidence of children and adolescents with psychiatric diseases is one of the main goals of educational interventions, with the purpose to avoid common behaviours, such as avoiding social situations and new and challenging experiences. In accordance with this result, the reduction in withdrawn/depression problems, measured by the Youth Self-Report scale, suggests a positive effect on the internalizing symptoms found in many psychiatric disorders.

Another important result was the decrease in social problems. Filmmaking requires collaboration and teamwork, as different people with different skills and perspectives come together to create a final product. Moreover, the "Social awareness" and the "Social motivation subscale", measured by the Social Responsiveness Scale, increased in all participants. Given that some of the patients were diagnosed as having ASD and that the SRS also offered a reasonable interpretation of characteristics regarding the improvement of reciprocal social interaction [22], we can expect a positive outcome of the course on social abilities, even in participants affected with ASD. Our data suggest that, as shown in previous studies focused exclusively on children with ASD [11], film production promotes the development of social skills in participants with diverse psychiatric diseases. In this way, participants learn to communicate effectively, listen actively, and provide constructive feedback. These skills are critical in any social setting and could help them develop empathy, respect, and cooperation. In addition, this could stimulate people to appreciate different perspectives and opinions, which is an essential component of social-emotional intelligence.

Our data also suggest that filmmaking could be a powerful tool for children and adolescents, providing creative expression, communication, collaboration, social awareness, and problem-solving opportunities. In fact, the thought problems and rule-breaking behaviours significantly decreased after the course.

Filmmaking is a complex and challenging creative endeavour that requires the use of a variety of cognitive skills and executive functions (EF) (motor response inhibition, working memory, sustained attention, response variability, and cognitive switching), which are mental control processes needed to carry out goal-directed behaviours and are fundamental to successful daily functioning across the lifespan [32]. Efs refer to a family of top-down mental processes needed to concentrate and pay attention when acting automatically or relying on instinct or intuition would be ill-advised, insufficient, or impossible [33–35]. Therefore, Efs are particularly important in children because they support the complex behaviours necessary for successful social interactions [36]. Deficient executive functioning has been implicated in social skills problems for many clinical populations of children. Moreover, EF impairment is commonly observed in many neurodevelopmental disorders, particularly autism spectrum disorder and attention-deficit/hyperactivity disorder. It has been estimated that 41% to 78% of individuals with ASD exhibit executive dysfunctions [37], and around 89% of children with ADHD were classified as impaired on at least one executive function component [38].

Lack of executive functioning was also detected in externalizing disorders (oppositional defiant disorders and conduct disorders) and some mood disorders (major depression, bipolar disorder). However, there are some variations in effect sizes. Apart from the classical "cold" EF, other mechanisms, including the so-called "hot" EF, i.e., motivational dysfunction, delay aversion, sensitivity to reward and punishment, and emotional processing, could be involved.

Creating a film involves many stages, from writing the script to planning the shots, filming, and editing. These stages require using a range of cognitive skills, including all the critical components of executive functioning.

Planning and organization are fundamental, from writing the script to scheduling the shoot and arranging locations and equipment. Filmmakers need to remember many details, such as camera angles, lighting, and sound while filming. It requires working memory, which is remembering information while using it to complete a task. Additionally, filming requires sustained attention to detail and the ability to switch focus between different aspects of the production. On the other hand, during the production schedule, it could be common to deal with unexpected changes, such as finding creative solutions to technical issues. It could help to improve the executive function of problem solving, which is the ability to identify and solve problems creatively and efficiently. Moreover, making decisions throughout the production process, such as selecting the location, choosing camera angles, and deciding on the best takes to use in the final edit, could enhance the decision-making steps.

During their work, participants had to be flexible and adapt to the changes in the group and the environment, maintain concentration by reducing external interference and distractions, and tolerate denials, frustrations, and routine changes.

In conclusion, participants could learn how to analyse situations, identify potential problems, and develop creative solutions. Consequently, this suggests that filmmaking, in the same way as other psychosocial interventions, could positively affect some executive functions. In the case of ADHD subjects, this can lead to the reduction in hyperactivity and inattention. This was not recorded in our work, due to the short time of the project and to the lack of psychometric assessments specifically for cognitive functions. We could hypothesize that more prolonged work might improve these outcomes.

Last but not least, thanks to this experience, which requires technology and media tools, participants could learn how to use cameras, edit software, and use other tools to create a final digital product. Some of the participants were inspired by the project to work in the cinema field in the future. This is another important result for adolescents having difficulty in designing their personal, social, and educational development.

The study had some potential limitations, represented by the small size of the sample and the absence of a control group, that limit the generalizability of the findings. In addition, it was conducted with limited time and resources, which can reduce the ability to collect detailed data. However, on the other hand, pre- and post-test comparisons were tested, and different statistically significant results were found. The group encompassed subjects with different and multiple diagnoses, and most participants affected by neurodevelopmental disorders show co-occurring psychiatric symptoms. However, the group was rather homogeneous since the participants shared neuropsychological and affective profiles and developmental trajectories. Additional research is needed in order to explore the effect of this kind of intervention on separate groups. Considering that the sample was not so wide, this was a denotative result, and with a larger sample, more significant results would emerge. More extensive studies will be necessary to test and refine research methods, procedures, and instruments. Larger patient samples and a systematic collection of standardized outcome measures are also needed. As more research is conducted in this area, we will better understand the benefits and limitations of this project as a therapeutic intervention.

#### **6. Conclusions**

This is a pilot study, but the preliminary results demonstrate that a filmmaking programme can result in measurable changes in emotional, behavioural, and social domains in children and adolescents with psychiatric or neurodevelopmental disorders. The projects that involve movies or videos could help develop new skills, increase awareness, and offer new ways of thinking about specific problems in various patient populations. Projects like this may also encourage children and adolescents with psychiatric disorders to develop skills in their personal and academic lives, explore their passions, and engage with the world around them.

Findings from this research project can offer an empirical basis for the effectiveness of a structured filmmaking method to be replicated in broader contexts (e.g., school and communities) in promoting children's psychological well-being.

In conclusion, the filmmaking programme proved to be a valid and complete psychosocial intervention to promote mental well-being in general and to strengthen specific weaknesses in young patients suffering from a psychiatric disorder.

**Supplementary Materials:** The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/healthcare11121695/s1. Supplementary File S1: All scales we used for testing our sample are reported in this supplementary section. 1. Rosenberg Self Esteem Scale (RSE); 2. Youth Self-Report scale (YSR); 3. Social Responsiveness Scale (SRS); 4. Revised Conners' Parent Rating Scale (CPRS-R).

**Author Contributions:** Conceptualization, A.G., M.G. and L.B.; methodology, M.I. and L.B.; software, M.I., C.C. and L.V.; validation, L.V. and M.R. (Michele Roccella); formal analysis, M.I. and

L.B.; investigation, M.B., L.F. and M.R. (Micaela Rizzi); resources, C.S.A. and F.L.; data curation, C.C. and L.V.; writing—original draft preparation, M.B. and L.F.; writing—review and editing, C.C., A.G. and M.I.; visualization, C.S.A.; supervision, A.G. and M.G.; project administration, M.R. (Michele Roccella). All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding. Participation in the filmmaking program was voluntary, without a reward system or financial or educational incentives.

**Institutional Review Board Statement:** The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Psychological Research and Intervention Center (CeRIP), University of Messina, code number n. 0032071 [UOR: SI001165-Classif. III/11].

**Informed Consent Statement:** Written informed consent was obtained from all subjects involved in the study. All caregivers received a full explanation of the study methods and purposes.

**Data Availability Statement:** The data presented in this study are available on request from the corresponding author. The data are not publicly available for privacy reasons due to the presence of sensitive information about the participants.

**Acknowledgments:** Special thanks go to Alessandro Zuddas, a great man and scientist who prematurely died, leaving a great void between scientific communities worldwide. He firmly believed in the usefulness of this course purpose to adolescents. His enthusiasm, knowledge, and passion have been an inspiration. We thank the AIFA APS association (Italian Association of ADHD Families), the Asperger Group ONLUS, (CuoreMenteLab), and the Buona Spa Società Benefit for support in organizational management.

**Conflicts of Interest:** The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
