Background: Emotional well-being and happiness have received little attention in the field of autism. When we focus on well-being, we often do so from a negative perspective, that is, the lack of functioning that is assumed to play a key role in ensuring a good quality of life. The leisure-rehabilitation programs offered to children and adolescents with autism convey different kind of psychological responses and have an intrinsic power to influence the emotional pattern in different ways.

Objectives: To define how different types of rehabilitation programs can be expected to influence the psychological response di children and adolescent affected by autism.

Methods: We applied the Delphi procedure during a workshop with 18 expert therapists (12 females- 6 males), with at least 10 years’ experience in pediatric neuropsychiatric rehabilitation, specifically in autism. A two-round Delphi study was conducted in accordance with the Guidance on Conducting and REporting DElphi Studies (CREDES) with the aim of achieving consensus regarding the appropriateness of 12 types of leisure-rehabilitation activities ( Dance therapy, Dramatherapy, Exercising in the gym, Exercising in the swimming pool, Individual sports, Team sports, Indoor climbing, Music play, Outdoor visits to common life environments, Outdoor visits to museums, Outdoor visits to parks and gardens, Writing your life story) in inducing seven types of psychological responses: Emotional engagement, Social engagement, Cognitive engagement, Physical engagement, Just fun, Sense of adventure, Sense of novelty.
Each participant could vote from 0 (complete lack of appropriateness) to 10 (maximum of appropriateness), where 5 means doubtful. Kappa statistics tested interrater reliability.

Results: We observed as expected an improvement of agreement with the second Delphi round ( mean K from 0.36 to 0.39). The activities with the highest potential for each psychological response were indoor climbing for physical engagement, for sense of adventure and for sense of novelty; team sports for social engagement and for fun, dramatherapy for emotional engagement, writing your life story for cognitive engagement. The top five activities with the highest overall impact (mean overall score > 7) were in decreasing order: indoor climbing, team sports, outdoor visits to common life environments, exercising in the swimming pool, and dramatherapy.

Conclusions: The analysis of judgement made through a Delphi method showed that the twelve leisure-rehabilitation activities may act in different way on seven types of psychological responses. This varied potential allows modulating in clinical practice the combination of activities to the specific needs of the subject in the best way maximizing the potential benefit of rehabilitation.

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Autism Research Unit, Villa Santa Maria SCS, Tavernerio, Como, Italy