Response to Published Article – “Migration Status and Severity of Autism Spectrum Disorder: A Retrospective Study at Two Specialist Centers in Northern Italy”

To the Editor, We commend Centomo et al. for their timely and insightful study, “Migration Status and Severity of Autism Spectrum Disorder: A Retrospective Study at Two Specialist Centers in Northern Italy” (Archives of Medicine and Health Sciences, 2025;13:331-334), which highlights migration as a significant environmental correlate of autism spectrum disorder (ASD) severity. Their finding that immigrant children, particularly those from Asian and African origins, exhibit higher ASD severity provides valuable evidence in the context of increasing global migration and neurodevelopmental diversity.[1] While DSM-5-TR severity levels offer a standardized diagnostic benchmark, they may not fully capture a child’s functional participation in daily life. From an occupational therapy perspective, severity should also be understood through the lens of participation, encompassing play, social interaction, communication, and self-care, which better reflects lived experience and adaptive behavior.[2] This occupational framing bridges diagnostic criteria with functional reality and aligns with calls for ecologically valid outcome measures in neurodevelopmental research. Migration can disrupt occupational engagement for both children and their families. Stressors such as language barriers, cultural incongruence, disrupted routines, and reduced access to early intervention can limit opportunities for participation and development.[3,4] As Centomo et al. suggest, migration-related maternal stress may be an important contextual factor contributing to ASD severity.[1] An occupational interpretation complements this view by showing how stress and deprivation manifest through diminished co-occupations such as caregiving, shared play, and regulation routines that are foundational to socialcommunicative growth. Evidence indicates that such disruptions may exacerbate functional challenges in children with ASD, particularly in newly settled immigrant families.[5] Importantly, the greater ASD severity observed among immigrant children may therefore partially reflect contextual and occupational deprivation, rather than intrinsic neurobiological differences alone. Interventions that address maternal well-being, restore family routines, and enhance participation can mitigate functional severity, even within the same diagnostic level. Occupational therapists are well-positioned to support culturally responsive, family-centred care for immigrant families, fostering adaptive routines, strengthening parental self-efficacy, and promoting inclusive participation in daily life.[6] Centomo et al. acknowledged limitations including their retrospective design, clinic-based sampling, and the lack of certain sociodemographic covariates (e.g., parental education, reason for migration).[1] These constraints highlight the need for future interdisciplinary research integrating migration status, diagnostic severity, and occupational participation outcomes. Prospective studies combining neuropsychiatric and occupational science approaches could clarify how environmental context shapes ASD presentation and functional impact.[7] Migration should thus be viewed not merely as a biological or environmental risk factor, but as a contextual modifier of occupational engagement. Incorporating participation- and occupation-based measures into future ASD research would yield a more holistic understanding of severity and support equitable, function-oriented intervention strategies for migrant families. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.