Oltre il sintomo: riconoscere precocemente la comorbidità neuropsichiatrica in Pediatria

Neuropsychiatric conditions frequently coexist with physical health problems in children and adolescents, yet they may remain unrecognised when presenting symptoms are interpreted in isolation. The paediatrician, particularly in primary care, is in a privileged position to identify early warning signs through longitudinal observation and knowledge of the child’s overall functioning. This article illustrates three common clinical presentations - a child who does not speak, a child who eats excessively and a child with recurrent physical symptoms - to highlight how apparently isolated complaints may represent early manifestations of autism spectrum disorder, attention-deficit/hyperactivity disorder, or anxiety disorders. Rather than focusing exclusively on the presenting symptom, an integrated assessment of communication, behaviour, emotional regulation, eating patterns, somatic complaints and functional impairment may facilitate early recognition and timely referral to Child and Adolescent Neuropsychiatry. The article also emphasises the importance of avoiding both diagnostic overshadowing and excessive medical investigation, while maintaining appropriate attention to underlying physical conditions. An integrated and multidisciplinary approach may improve early identification, treatment and long-term outcomes for children and their families.