Step-by-step program: mentalization-based intervention for autistic children and their families

Purpose Autism spectrum disorder (ASD) presents challenges for public health systems due to its heterogeneity and complexity. The Step-by-Step Program was developed as an innovative, community-based mentalization-based intervention for autistic children aged 5–7 and their families. This study aims to evaluate the feasibility of implementing this program within existing systems of care and to examine its preliminary effects. Design/methodology/approach An open trial was conducted with 16 autistic children and their families who participated in the Step-by-Step Program, a two-year intervention integrating weekly group therapy for children with alternating multi-family and parent sessions. Outcome measures included standardized assessments of child emotional and behavioral functioning, autism symptom profiles and parental satisfaction. Data were collected at baseline, midpoint, endpoint and one-year follow-up. Findings Findings indicated high feasibility, treatment adherence and strong family satisfaction ratings. Children demonstrated significant improvements in social communication, symbolic play, flexibility and emotional/behavioral regulation. These gains were not only maintained but further consolidated at the one-year follow-up. Families also reported reduced stress and increased capacity for understanding and supporting their child’s development. Research limitations/implications This pilot study supports the feasibility and preliminary effectiveness of the Step-by-Step program; however, several limitations should be considered. The open, uncontrolled design precludes causal attribution of observed changes to the intervention rather than to time or nonspecific therapeutic effects. This limitation will be addressed in future randomized controlled trials, for which the present findings provide essential pilot data. Additionally, due to the COVID-19 pandemic, the final three months of treatment were delivered via telehealth, although outcome assessment and treatment procedures were maintained. Finally, parental perceptions of children’s mentalizing abilities were not assessed. Future studies should include measures of parental reflective functioning, a key treatment target of mentalization-based therapy for children. Practical implications This is a pilot study that describes the development and implementation of the mentalization-based treatment for autistic children in the context of the community mental health case system in Catalonia, Spain. Social implications The Step-by-Step Program appears to be a promising, feasible and effective early intervention model for autistic children and their families. Its integration into community mental health services suggests potential for sustainable, family-centered approaches that enhance social development and well-being. Originality/value The authors believe that the innovative aspects of this study include the adaptation of mentalization-based therapy for autism, long-term treatment and implementation in the local Catalone system of care.