The Parasomnias.

Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.

Sleep habits and sleep disorders in Italian children and adolescents: a cross-sectional survey.

STUDY OBJECTIVES: The aim was to describe sleep habits and epidemiology of the most common sleep disorders in Italian children and adolescents. METHODS: This was a cross-sectional study in which parents of typically developing children and adolescents (1-18 years) completed an online survey available in Italy, gathering retrospective information focusing on sleep habits and disorders. RESULTS: Respondents were 4,321 typically developing individuals (48.6% females). Most of our sample did not meet the age-specific National Sleep Foundation recommendations for total sleep duration (31.9% of toddlers, 71.5% of preschoolers, 61.6% of school-age children, and 41.3% of adolescents). Napping was described in 92.6% of toddlers and in 35.2% of preschoolers. Regarding geographical differences, children and adolescents of northern Italy showed more frequent earlier bedtimes and rise times than their peers of central and southern Italy. The most frequently reported sleep disorder in our sample was restless sleep (35.6%), followed by difficulties falling asleep (16.8%), > 2 night awakenings (9.9%), and bruxism (9.6%). Data also suggest that longer screen time is associated with later bedtimes on weekdays in all age groups. CONCLUSIONS: The current study shows that Italian children are at risk of sleep disorders, particularly insufficient sleep, restless sleep, and difficulty falling asleep. The study also provides normative sleep data by age group in a large cohort of typically developing Italian children, emphasizing the importance of the developmentally, ecologically, and culturally based evaluation of sleep habits and disorders. CITATION: Breda M, Belli A, Esposito D, et al. Sleep habits and sleep disorders in Italian children and adolescents: a cross-sectional survey. J Clin Sleep Med. 2023;19(4):659-672.

Changes in sleep duration and disturbances during Covid-19 lockdown and internalizing-externalizing behaviors in children with attention deficit hyperactivity disorders.

OBJECTIVE: To examine how changes in sleep patterns and sleep problems occurring between the pre-pandemic and the Covid-19 lockdown period influenced mood-behavioral functioning of children with Attention Deficit Hyperactivity Disorder (ADHD). METHODS: Parents of 992 children with ADHD (85.4% boys, mean age: 11.52 years, SD = 3.17), recruited from the Italian ADHD family association, completed a modified version of the Sleep Disturbance Scale for Children and filled out 11 emotional behavioral items selected from the Child Behavior Checklist (CBCL) 6-18 questionnaire. Subgroups identified based on sleep duration changes ("maintained", "increased", "reduced") and of sleep problems during lockdown ("onset", "remission", "maintained", "no sleep problem") were analyzed to evaluate the association with internalizing and externalizing scores. RESULTS: Sleep duration showed no or low influence on internalizing and externalizing behaviors after control for age, sex, and socioeconomic status. Patients with ADHD with "no sleep problem" showed significant lower scores in internalizing and externalizing behaviors than those who "maintained" or had "onset" of different sleep problems. The effect sizes were higher for internalizing than externalizing behaviors. Lower internalizing scores were found in those who remitted difficulty in falling asleep, daytime sleepiness, nightmares, vs. the "maintained" or "onset" groups and those who remitted hypnic jerks vs. the "onset" group. Children with ADHD who "maintained" sleep terrors reported higher internalizing and mainly externalizing scores than the other groups. CONCLUSION: Sleep problems negatively influence daytime functioning of patients with ADHD. but mood and behavioral domains show different susceptibility to the changes of sleep problems, and different vulnerability to specific sleep problems.

Externalizing and Internalizing Behaviors in Children with ADHD during Lockdown for COVID-19: The Role of Parental Emotions, Parenting Strategies, and Breaking Lockdown Rules.

Lockdown experience for COVID-19 pandemic significantly affected children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) exacerbating or promoting the onset of externalizing and internalizing symptoms. However, few studies have considered how externalizing and internalizing behaviors changed in relation to parental emotions and parenting strategies. In the present study, 992 caregivers of children and adolescents with ADHD from 5 to 18 years were presented with an online survey evaluating youths' externalizing and internalizing behaviors, their non-compliance with lockdown rules, and parental factors related to parental emotions and parenting strategies. Two hierarchical linear regression models were performed to examine the contribution of children's non-compliance with lockdown rules, parental emotions, and parenting strategies on children's externalizing and internalizing behaviors. Results revealed that externalizing behaviors were higher in children and adolescents with ADHD non-compliant with lockdown rules. Moreover, positive parenting strategies moderated the relationship between non-compliance with lockdown rules and externalizing behaviors. Differently, higher internalizing behaviors were observed in children with ADHD who had parents reporting more negative emotions and positive parenting strategies. In this case, parents' negative emotions had a moderator effect in the association between internalizing behaviors and non-compliance to lockdown measures. The clinical implications of these two different patterns of relations are discussed.

Impact of COVID-19 lockdown on sleep in children with autism spectrum disorders.

STUDY OBJECTIVES: The impact of the COVID-19 outbreak on sleep of participants with autism spectrum disorder (ASD) was assessed. METHODS: Parents of 111 children and adolescents with ASD filled out an anonymous online survey shared via social media, investigating the sleep patterns and disturbances before and during the lockdown. RESULTS: The lockdown changed significantly the bedtime on weekdays in 57.8% of participants with ASD (56.9% delayed; 0.9% advanced) and the rise time in 69.2% (61.7% delayed and 7.5% advanced). Sleep duration varied on weekdays in 49.1% (24.1% increased; 25% decreased). During the lockdown, participants with ASD showed a significant increase of sleep disturbances, compared to the preceding period, especially falling asleep (35.1% vs 22.5%), anxiety at bedtime (22.5% vs 10.8%), sleep terrors (5.4% vs 0%), and daytime sleepiness (14.4% vs 3.6%). CONCLUSIONS: Lockdown affected sleep of patients with ASD, showing an increase of difficulty in falling asleep, anxiety at bedtime, sleep terrors, and daytime sleepiness. The outbreak of COVID-19 significantly worsened sleep disturbances of children with ASD. CITATION: Bruni O, Melegari MG, Breda M, et al. Impact of COVID-19 lockdown on sleep in children with autism spectrum disorders. J Clin Sleep Med. 2022;18(1):137-143.

Changes in sleep patterns and disturbances in children and adolescents in Italy during the Covid-19 outbreak.

OBJECTIVE: To examine the impact of home confinement during the COVID-19 pandemic on the sleep patterns and sleep disturbances in Italian children and adolescents. METHODS: Participants completed an anonymous online survey, shared via social media and targeting children and adolescents aged 1-18 years, subdivided into age groups: 1-3, 4-5, 6-12, and 13-18 years. Caregivers completed a modified version of the Sleep Disturbance Scale for Children (SDSC), along with demographic information. RESULTS: The final sample consisted of 4314 subjects: 2217 males (50.4%) and 2097 females (49.6%). Age group distribution was: 1-3 years 1263 (29.3%), 4-5 years 893 (20.7%), 6-12 years 1848 (42.8%) and 13-18 years 310 (7.2%). We found a significant delay in bedtime and risetime in all age groups. School-age children and adolescents experienced the most significant delay: weekday bedtime ≥23 was reported by 28.4% of 6- to 12-year-old children during lockdown vs. 0.9% before and by 63.5% vs. 12.3% of 13- to 18-year-old adolescents. Risetime was also delayed with most subjects waking up after 8 in all age groups and sleep duration increased in all groups but not in the younger group. The screen time (excluding online lessons) boosted during the lockdown, mainly in older children but also in younger children. Sleep disorders increased in all groups but not in adolescents. Younger groups had an increased prevalence of difficulty falling asleep, anxiety at bedtime, night awakenings, nightmares and sleep terrors. CONCLUSION: Our study demonstrates that confinement due to COVID-19 determined a big delay in sleep/wake schedule of children in all age groups as well as an increase of sleep disturbances in all groups but adolescents.

Changes in Sleep Patterns and Disorders in Children and Adolescents with Attention Deficit Hyperactivity Disorders and Autism Spectrum Disorders during the COVID-19 Lockdown.

BACKGROUND: The COVID-19 lockdown determined important changes in the sleep of a large percentage of the world population. We assessed the modifications of reported sleep patterns and disturbances in Italian children and adolescents with autism spectrum disorders (ASD) or attention deficit hyperactivity disorders (ADHD), compared to control children, before and during the COVID-19 lockdown in Italy. METHODS: Parents of 100 ASD, 236 ADHD patients, and 340 healthy children filled out an anonymous online survey and a modified version of the Sleep Disturbance Scale for Children (SDSC), advertised via social media, to evaluate sleep patterns and disturbances of their children before and during the lockdown. RESULTS: Before the lockdown, bedtime and risetime were not different between the three groups. During the lockdown, ADHD children tended to have a later bedtime and risetime than ASD and controls, while ASD children tended to maintain similar bedtime and risetime. Overall, during the lockdown, a reduced sleep duration significantly differentiated clinical groups from controls. Anxiety at bedtime, difficulties in falling asleep, and daytime sleepiness increased in all groups during the lockdown. Hypnic jerks, rhythmic movement disorders, night awakenings, restless sleep, sleepwalking, and daytime sleepiness increased in ASD and ADHD patients, in particular. CONCLUSIONS: This is the first study comparing sleep habits and disorders in ASD and ADHD during the lockdown showing specific differences consistent with the core characteristics of two neurodevelopmental disorders.

Coping Skills in Pre- and Early Adolescents: The Role of Temperament and Character.

Coping skills represent cognitive, emotional, and behavioral resources to overcome developmental challenges and tasks. Based on Cloninger's model of personality, the main aim of this study was to analyze the relation among temperament, character, and coping skills in nonclinical pre- and early adolescents by also considering adolescents' gender and age. One hundred and thirty-eight Italian pre- and early adolescents (52.2% boys and 47.8% girls), aged between 10-14 years (M = 12.33 ± 0.87 SD), filled out the Junior Temperament and Character Inventory and the Children's Coping Strategies Checklist Revision 1. Regression and relative weights analyses showed that several of adolescents' personality dimensions did predict their coping skills. Specifically, Harm Avoidance was negatively related to Positive Reframing and Distraction; this latter (i.e., Distraction) was also negatively associated with Novelty Seeking, Self-Directedness, and Cooperativeness. On the contrary, Cooperativeness was positively related to the use of Problem Focus strategy, and Reward Dependence was positively related to Distraction and Social Support. Significant gender and age differences in personality as well as in coping skills emerged. Girls scored higher on Harm Avoidance, Reward Dependence, Persistence and Problem Focus, and boys scored higher on Novelty Seeking and Distraction. Moreover, pre-adolescents (10-12 years) reported lower scores on Novelty Seeking and higher on Problem Focus than early adolescents (13-14 years). Overall, the results suggest that bio-psycho-social individual factors linked to personality, gender, and age have an important role in shaping pre- and early adolescents' coping and adaptation responses. Practical implications of the results and future developments are discussed.

The impact of lockdown on sleep patterns of children and adolescents with ADHD.

STUDY OBJECTIVES: The current study examined the impact of home confinement (lockdown) because of the COVID-19 pandemic on the sleep patterns of children and adolescents with attention-deficit hyperactivity disorder (ADHD). METHODS: Nine hundred ninety-two parents of children and adolescents with ADHD filled out an anonymous online survey through the ADHD family association website. The survey investigated the sleep patterns and disturbances (using a modified version of the Sleep Disturbance Scale for Children) and screen exposure time before and during lockdown. RESULTS: During lockdown, 59.3% of children and 69.4% of adolescents with ADHD reported a change of bedtime, with a significant increase in patients with ADHD who went to sleep at 11 pm or later. Sleep duration, in contrast, resulted in 2 opposing processes with more children and adolescents sleeping either less than 6 hours/night or 10-11 hours/night. Among children and adolescents, respectively, 19.9% and 22% slept less than they did before lockdown, whereas 21.4% and 27.4% slept for more hours. Bedtime delay and decreased sleep duration were associated with an increase in screen time exposure. Moreover, patients with ADHD reported an increase in sleep disturbances when compared to their previous condition, mainly including difficulties falling asleep, anxiety at bedtime, night awakenings, nightmares, and daytime sleepiness. CONCLUSIONS: Lockdown impacted sleep-wake rhythms by strengthening the maladaptive sleep patterns reported in usual-life conditions in children and adolescents with ADHD. CITATION: Bruni O, Giallonardo M, Sacco R, Ferri R, Melegari MG. The impact of lockdown on sleep patterns of children and adolescents with ADHD. J Clin Sleep Med. 2021;17(9):1759-1765.

The Parasomnias.

Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.

Executive functions in preschool children with chronic insomnia.

STUDY OBJECTIVES: Executive functions (EFs) in children with insomnia have not been sufficiently assessed in the literature. This study aimed to describe sleep patterns and habits and EF abilities in preschool children with insomnia, compared to healthy control patients, and to evaluate the relationships between sleep patterns and EFs. METHODS: Two groups of children were recruited: 45 preschoolers with chronic insomnia (28 boys), aged 24-71 months and 167 healthy preschool children (81 boys) aged 24-71 months. Parents of all children completed two questionnaires to assess their children's sleep habits and disturbances, and their EFs with the Behavior Rating Inventory of Executive Function - Preschool Version. RESULTS: Children with chronic insomnia were found to wake up earlier, sleep less during the night, have more nighttime awakenings, and higher nocturnal wakefulness, compared to the control group. The chronic insomnia group showed significant impairment in all the EFs domains. Nocturnal sleep duration, nighttime awakenings, and nocturnal wakefulness correlated with inhibit, plan/organize, working memory, inhibitory self-control, emergent metacognition, and the global executive composite scores in the chronic insomnia group. In the control group, the number of nighttime awakenings correlated with inhibition, inhibitory self-control, and the global executive composite. Regression analyses showed a predominant role of insomnia factor in the association with EFs in both clinical and control groups. CONCLUSIONS: Our findings confirm the link between sleep and "higher level" cognitive functioning. The preschool period represents a critical age during which transient sleep problems also might hamper the development of self-regulation skills and the associated neural circuitry.

Relations Between Sleep and Temperament in Preschool Children With ADHD.

Objective: The objective of this study was to assess the links between temperament and sleep in a group of preschoolers with ADHD. Method: Twenty-five ADHD (M = 5.37 years, SD = 1.09) and 22 typically developing (TD; M = 5.10, SD = 1.18) preschoolers participated in the study. Sleep was assessed with the Sleep Disturbance Scale and wrist actigraphy. The Preschool Temperament and Character Inventory (PsTCI) was used to evaluate the child temperament. Results: ADHD children showed a temperamental profile characterized by higher novelty seeking, lower persistence, self-directness, and cooperativeness and marginally lower harm avoidance (HA) compared with controls. HA was associated negatively to wakefulness after sleep onset and sleep fragmentation and positively with sleep efficiency and sleep time. Reward dependence was negatively associated with wake episode length. Conclusion: Sleep and temperament are correlated in preschoolers with ADHD and temperament might represent an intermediate endophenotype underlying the relation between ADHD and sleep disorders.

Anti-Yo Antibodies in Children With ADHD: First Results About Serum Cytokines.

Objective: We investigated whether ADHD children who are positive to Purkinje cell antibodies display pro-inflammatory activity associated with high cytokine serum levels. Method: Fifty-eight ADHD outpatients were compared with 36 healthy, age- and sex-matched children. Forty-five of the ADHD children were positive to anti-Yo antibodies, whereas 34 of the control children were negative. Interleukin 4 (IL-4), IL-6, IL-10, IL-17, tumor necrosis factor alpha (TNFα), and interferon gamma (IFNγ) cytokine serum levels were tested in ADHD children who were positive to anti-Yo antibodies and in the control children who were negative. Results: Anti-Yo antibodies were present to a greater extent in the ADHD group: 77.58% versus 22.42%. Significant differences emerged between the two groups in IL-6 and IL-10, with higher cytokine levels being detected in ADHD children than in controls. Conclusion: Immune processes in ADHD are likely to be associated with mediators of inflammation, such as cytokines. These results contribute to our understanding of action of neural antibodies and cytokines in ADHD.

Actigraphic Sleep Pattern of Preschoolers With ADHD.

Objective: To assess the features of sleep in preschoolers with ADHD by means of questionnaire and actigraphy. Method: Twenty-five ADHD and 21 age-matched typically developing (TD) preschool children underwent the Child Behavior Checklist (CBCL) for ages 1½ to 5 and Pre-School-Age Psychiatric Assessment interview. Sleep was assessed by means of a modified Sleep Disturbance Scale for Children and wrist actigraphy for at least 5 days. Results: Children with ADHD, compared with TD, showed higher scores in CBCL Withdrawal (58.83 vs. 51.15, p < .0001), Attention Problems (69.88 vs. 51.54, p < .0001), and Aggressive Behavior (59.46 vs. 51.08, p < .0001) dimensions; they also showed increased actigraphic nocturnal activity (activity index 31.57 vs. 25.74, p < .05); and night-to-night variability for sleep minutes (56.44 vs. 32.79, p < .01), mean wake episodes (1.34 vs. 0.98, p < .05), mean activity (2.64 vs. 1.71, p < .05), and activity index (5.15 vs. 3.77, p < .05). Conclusion: This pilot study in preschoolers with ADHD showed increased motor activity during sleep and night-to-night variability for sleep duration and motor activity.

Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders.

Introduction: Sleep disturbances are highly prevalent in children with neurodevelopmental disabilities. Without appropriate treatment, sleep disorders can become chronic and last for many years. However, there are no sleep medications approved by the United States Food and Drug Administration and only one has been approved by the European Medicines Agency for pediatric insomnia; thus, most medications are prescribed off-label.Areas covered: In this narrative review, the authors highlight and summarize the most common drugs and supplements used for the treatment of sleep problems in children with neurodevelopmental disabilities. Recommendations are formulated regarding the use of melatonin and melatonin receptor agonists, sedating antidepressants, antipsychotics, antihistamines, gabapentin, clonidine and orexin receptor antagonists, and benzodiazepines and hypnotic benzodiazepine receptor agonists.Expert opinion: The choice of pharmacological agents and their dosage should be individualized taking into consideration multiple factors, including the severity and type of sleep problem and the associated neurological pathology. Melatonin is widely used and safe in children with neurodevelopmental conditions. Gabapentin, clonidine, trazodone, and mirtazapine hold promise but require further study. Supplements (iron, vitamin D, and 5-hydroxytryptophan) might be helpful. Due to the lack of clinical data, there is still uncertainty concerning dosing regimens and tolerability.

The Validation of the Free Fantasy Questionnaire for Children and Adolescents: From Imaginary Playmate to "Dreamtime".

Fantasy in children is a precocious and important skill. In normal subjects some imaginative events, very close to hallucinations (perception-like experiences), have been found. Therefore, a better knowledge on both fantasy and the difference between imagination and the external world is needed. The aims of this study are: (a) to validate a new questionnaire for fantasy in children and adolescents; (b) to test its clinical application in ADHD children. 1.707 participants aged 8-18 years were enrolled: 1557 were recruited from a survey in six schools, whereas 150 participants were recruited in an ADHD Center. They filled out a new questionnaire, the Free Fantasy Questionnaire for Children and Adolescents, FFQ. Statistical analyses were performed to validate the FFQ and to study five parameters of fantasy. Analyses showed good properties of the FFQ as regards factor structure and reliability. Descriptive analysis showed that: 10% of the adolescents frequently have fantasy with paracosmos and 9.5% sometimes have a fantasy with imaginary relatives. Moreover, in the 64.3% of participants of primary school, in the 34.5% of lower-secondary, and in the 27.4% of upper-secondary school Perception-like experiences, involving invisible but real personages, were found. Quality of fantasy and Lack of control on imagination are correlated with a high score in the Reality/Unreality Dimension and Perception-like experiences. As regards ADHD participants, the 40% of the group showed Perception-like experiences: the 21.66% of them reported a very high score in the dimension Reality/Unreality, have some dissociative symptoms, and the 3.33% presented a clear dissociative identity disorder. All were free from psychosis or neurologic disorders. A new questionnaire to study fantasy in children and adolescents was validated. Many children and adolescents of the general population declared Perception-like experiences. These events seem to be specific, and probably normal, features of the mind; they could be better named as "Dreamtime," whereas only in extreme conditions they could represent a risk for dissociation.

Deficient Emotional Self-Regulation in Preschoolers With ADHD: Identification, Comorbidity, and Interpersonal Functioning.

OBJECTIVE: This study aims to develop an age-adjusted Child Behavior Checklist- (CBCL) and Teacher Report Form (TRF)-based method for the detection of deficient emotional self-regulation (DESR) in preschoolers with ADHD and to assess its incidence, comorbidities, and consequences on interpersonal functioning. METHOD: Eighty-six ADHD preschoolers and 104 controls were assessed using CBCL, TRF/1½ to 5, Psychiatric Interview With Preschool Age Psychiatric Assessment, Leiter-R, and ADHD rating scales. RESULTS: Greatest sensitivity and specificity were obtained applying slightly lower threshold scores compared with school-age children (CBCL: Anxiety/Depression [A/D] ≥ 59, Attention Problems [AP] ≥ 60, Aggression Behaviors [AB] ≥ 58; TRF: A/D ≥ 59, AP ≥ 60, AB ≥ 60). DESR was detected in 33/86 (38.4%) and in 16/54 (29.6%) ADHD preschoolers versus 2/104 (1.9%) controls using CBCL and TRF, respectively. DESR is associated with significantly greater comorbidity and impairment in interpersonal functioning. CONCLUSION: Among ADHD preschoolers, DESR (a) requires lower CBCL and TRF threshold scores for detection, compared with school-age children, (b) displays similar incidence rates, and (c) is associated with enhanced psychiatric comorbidity and interpersonal difficulties.

Temperamental and character profiles of preschool children with ODD, ADHD, and anxiety disorders.

BACKGROUND: The aim of the present research was to identify profiles of Cloninger's temperament and character dimensions associated with anxiety disorders, oppositional defiant disorder (ODD) and attention- deficit/hyperactive disorder (ADHD) in preschoolers. METHOD: The parents of 120 children (mean age=4.65 years; S.D.=.88) completed the Preschool Temperament and Character Inventory (PsTCI). The sample consisted of 4 groups (n=30 per group): ADHD, anxious, ODD and control children. To diagnose the different disorders, the Preschool Age Psychiatric Assessment and Child Behavior Checklist 1.5-5 was administered to the parents. RESULTS: The discriminant analysis showed that three temperamental dimensions (Harm Avoidance, Novelty Seeking and Persistence) enabled the correct classification of 75% of cases within their own group, which demonstrated an adequate accuracy rate. The ADHD children showed a temperamental profile that was characterized by high Novelty Seeking, low Reward Dependence and low Persistence, while the anxious children obtained high scores in Harm Avoidance. The profiles of the ODD children shared some common features (high Novelty Seeking) with the ADHD children, but the ODD children were characterized by higher Persistence and Harm Avoidance compared with ADHD children. CONCLUSIONS: The present results indicate that Cloninger's temperamental dimensions allow to differentiate the three most frequent psychiatric disorders in preschoolers.

Application of the seven-factor-model of personality to an italian preschool sample.

OBJECTIVE: Advances in dimensional assessment of children in healthy and clinical populations has renewed interest in the study of temperament. Cloninger's Temperament and Character Inventory (TCI) has shown high reliability and internal consistency. Adult and adolescent versions have been translated into a number of languages and validated in cross-cultural studies worldwide. To date only one preschool-TCI-based study has been conducted in early infancy with teachers as observers. The present study is aimed to test an Italian Preschool version of the Temperament and Character Inventory (PsTCI). This is the first replication and the first validation study of TCI on preschoolers with parents as observers. METHODS: 395 preschool children, recruited from pediatric communities and day-care centres throughout Italy, participated in the study. Parents of each child enrolled in the study and completed a PsTCI about the child. Standard psychometric tests of reliability and validation were performed. RESULTS: Exploratory factor analyses demonstrated the presence of distinct domains for temperament and character. TCI dimensions had good internal consistency with Cronbach's alpha ranging values (|0.60|-|0.81|). Gender differences were found for Harm Avoidance (ß=-0.186; p≤0.001) and Self-Directedness (ß=-0.216; p≤0.01), and accounted for 5-35arm-38-702- of the observed variance. CONCLUSION: The present work suggests the psychological complexity of Cloninger's model and confirms its application in pre-school children from diverse environmental and cultural backgrounds. The results confirm that Cloninger's instrument for temperament and character evaluations can also be used with different observers and highlight the importance of considering cultural and demographic differences in the assessment of temperament and character in preschoolers.