Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

Comparing Traditional and Ebook-Augmented Parent-Child Interaction Therapy (PCIT): A Randomized Control Trial of Pocket PCIT

Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent–child interaction therapy (PCIT), exist for improving children’s behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebook + PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (n = 71) or ebook + PCIT (n = 107) group using an online random number generator. Forty-nine caregivers (traditional PCIT n = 24, ebook + PCIT n = 25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebook + PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.     

Using Behavioral Skills Training to Promote the Generalization of Parenting Skills to Problematic Routines

Research has demonstrated the efficacy of a behavioral parent training program for skills acquisition; however, few studies have examined the extent to which those skills generalize to the home or the effect that they have on child behavior. A multiple baseline across participants design was used to assess (a) caregiver accuracy with implementation of three parenting skills, and (b) the effects of the parenting skills on child behavior. Results demonstrated that three caregiver participants successfully generalized parenting skills taught during behavioral skills training (BST) to naturally occurring routines, and the behavior of each caregiver's child improved following BST.     

Delivering Parent-Child Interaction Therapy in an Urban Community Clinic

Extensive evidence supports the efficacy of Parent-Child Interaction Therapy (PCIT) for reducing behavior problems in young children; however, little is known about the use of PCIT in a community mental health center (CMHC). This paper provides four clinical case examples of families who were referred to and successfully completed PCIT in an urban CMHC. The families were ethnically and socioeconomically diverse and presented with a wide range of treatment concerns and needs (e.g., autism, severe maternal psychopathology, involvement in child protective services, and complex family configurations) in addition to disruptive behavior. Our data and clinical observations suggest that PCIT decreased behavior problems, improved parent-child interactions, and, in some cases, reduced parental stress, with differing levels of change across families. Overall, the cases demonstrate that PCIT can be transported into a CMHC, and they illustrate supplemental services or minor accommodations to the established treatment protocol used to address individual family needs. Issues regarding the balance between fidelity and flexibility in transporting PCIT to a community setting are discussed, and future research topics are recommended.     

A Community Mental Health Implementation of Parent–Child Interaction Therapy (PCIT)

Parent–Child Interaction Therapy (PCIT) has been identified as an evidence-based practice in the treatment of externalizing behavior among preschool-aged youth. Although considerable research has established its efficacy, little is known about the effectiveness of PCIT when delivered in a community mental health setting with underserved youth. The current pilot study investigated an implementation of PCIT with primarily low-socioeconomic status, urban, ethnic minority youth and families. The families of 14 clinically referred children aged 2–7 years and demonstrating externalizing behavior completed PCIT initial assessment, and 12 began treatment. Using standard PCIT completion criteria, 4 families completed treatment; and these families demonstrated clinically significant change on observational and self-report measures of parent behavior, parenting stress, and child functioning. Although treatment dropouts demonstrated more attenuated changes, observational data and parent-reported problems across sessions indicated some improvements with lower doses of intervention. Attendance and adherence data, referral source, barriers to treatment participation, and treatment satisfaction across completers and dropouts are discussed to highlight differences between the current sample and prior PCIT research. The findings suggest that PCIT can be delivered successfully in an underserved community sample when families remain in treatment, but that premature dropout limits treatment effectiveness. The findings suggest potential directions for research to improve uptake of PCIT in a community service setting.     

Does Practice Make Perfect? The Relationship Between Self-Reported Treatment Homework Completion and Parental Skill Acquisition and Child Behaviors

The purpose of the current study was to examine whether the rate and type of parent-reported homework completion is associated with parent-report of child behavior outcomes, number of sessions to master parental skills as measured by therapist observation, and length of treatment in Parent–child Interaction Therapy (PCIT). Sixty-two parent–child dyads (primary caregiver: M_age = 36.35 years, female 95.20%, 81.60% White, 59.57% Hispanic; child M_age = 4.22 years; child gender male 64.50%) who completed PCIT were included in the study. A within-subjects hierarchical regression statistical design was used to examine the impact of parent report of homework completion on treatment processes and outcomes. A higher rate of self-reported homework completion was predictive of parental mastery of skill acquisition in fewer sessions and treatment completion in fewer sessions. Parent report of homework completion rate was not related to changes in child disruptive behavior after controlling for child behavior at baseline. Current study findings reinforce the importance of having parents regularly practice PCIT skills outside of session in order to decrease treatment length and facilitate the acquisition of parenting skills, which may reduce family burdens associated with attending a weekly treatment.     

The Effectiveness of Group Parent–Child Interaction Therapy with Community Families

Parent–Child Interaction Therapy (PCIT) is a behavioral, parent-training program that incorporates both operant learning and play therapy techniques to treat child disruptive behavior problems. The present pilot study examined the use of a group PCIT protocol with a mixed clinical sample of primarily low-socioeconomic status community families. Forty families with a child between the ages of 2 and 8 years old were either self-referred to the group or referred by child protective services, and 27 began treatment. Following a standard group PCIT protocol, 17 families completed treatment. Caregivers who completed the PCIT group reported a significant decrease in child disruptive behavior and parenting stress following completion of the 12-week group. Behavior observations of the treatment completers revealed a significant increase in parent prosocial behavior and a decrease in inappropriate parent behavior from pre- to post-treatment. As there have been no demonstrations, to date, of group PCIT in a community-based setting, this study presents evidence that PCIT is a promising treatment format for dissemination research and practice. The benefits and challenges of using a group PCIT format for delivery of clinical services are discussed.     

Does Parent-Child Interaction Therapy Reduce Maternal Stress,Anxiety, and Depression Among Mothers of Children with Autism Spectrum Disorder?

Maternal stress, anxiety, and depression are associated with ineffective parenting strategies for families of children with Autism Spectrum Disorders (ASD). We present the use of Parent-Child Interaction Therapy (PCIT) with three mother-child dyads to reduce maternal stress, anxiety, and depression and child disruptive behavior in children with ASD. Results included increases in positive parenting skills, and decreases in maternal anxiety, depression, and stress, as well as child behavior problems. PCIT is a promising alternative to more intensive and costly interventions, both at reducing disruptive behaviors and improving maternal health. Implications of PCIT for dyads affected by ASD are discussed.     

Parent-Child Interaction Therapy for Children Born Premature: A Case Study and Illustration of Vagal Tone as a Physiological Measure of Treatment Outcome

Evidence-based psychosocial interventions for externalizing behavior problems in children born premature have not been reported in the literature. This single-case study describes Parent-Child Interaction Therapy (PCIT) with a 23-month-old child born at 29 weeks gestation weighing 1,020 grams, who presented with significant externalizing behavior problems. Treatment outcome was assessed using standard measures of maternal and child functioning and observational measures of the parent-child interaction, as well as a physiological measure of heart rate variability (i.e., vagal tone) used to assess parasympathetic control in the child. Maternal reports of child behavior problems and their own stress and depressive symptoms decreased after treatment. Behavioral observations demonstrated improved parenting practices and child compliance, and vagal tone showed comparable increases as well. Results suggest that PCIT is a promising psychosocial intervention for children born premature with externalizing behavior problems, and that vagal tone may be a useful measure of treatment outcome.     

Preventing Maltreatment with a Community-Based Implementation of Parent–Child Interaction Therapy

The purpose of this study was to examine rates of child abuse and neglect reports following a community implementation of Parent–Child Interaction Therapy (PCIT), an evidence-supported intervention for the prevention of maltreatment. Among a group of families receiving PCIT, predictors of reports were examined including family demographics, course of treatment, changes in clinical measures, and caregiver report for prior maltreatment victimization and perpetration. Participants (n = 120) included families at-risk for future maltreatment with and without prior maltreatment history. Agency case records were linked with state administrative records of child welfare reports. Time to follow-up ranged from 13 to 40 months. Bivariate and multivariate survival analyses were used to model risk for a later report. During the follow-up period, 12.5 % of families had a report for physical abuse or neglect. Reports of prior victimization as a child and prior perpetration as an adult were strong predictors of a report of perpetration after PCIT. Dosage of PCIT and change in clinical measures did not increase risk for a later report. PCIT can be an effective intervention for preventing maltreatment. Family history of child welfare involvement is a prominent factor in assessing risk for future involvement.     

Open-Trial Pilot of Parent-Child Interaction Therapy for Children With Autism Spectrum Disorder

In this pilot study, the effectiveness and feasibility of Parent-Child Interaction Therapy (PCIT) for decreasing disruptive behavior was evaluated in 17 young children with Autism Spectrum Disorder (ASD). PCIT is a behaviorally based play therapy which targets the parent-child relationship through live coaching of play interactions and the implementation of consistent discipline techniques. Following an average of 19 sessions, disruptive behavior as measured by multiple indices significantly decreased. Congruently, parents increased positive parental following skills and decreased negative parental leading skills across the course of treatment. In addition, parents reported increased levels of child functional communication and prosocial behavior. High levels of parent acceptability of the intervention were also noted. Effect sizes were medium to large across measured dependent variables, including parent report and behavioral observations. Implications for the clinical use of PCIT within an ASD population and future research with controlled outcome studies are discussed.     

Parent-child interaction therapy for Mexican Americans: results of a pilot randomized clinical trial at follow-up

We examined treatment effects over a 6- to 24-month period posttreatment for 3 different interventions for externalizing behavior problems in young Mexican American (MA) children: a culturally modified version of Parent–Child Interaction Therapy (PCIT), called Guiando a Niños Activos (GANA), standard PCIT, and treatment as usual (TAU). Fifty-eight MA families with a 3- to 7-year-old child with clinically significant behavior problems were randomly assigned to GANA, standard PCIT, or TAU. As previously reported, all three treatment approaches produced significant pre-post improvement in conduct problems across a wide variety of parent-report measures, and those effects remained significant over the follow-up period. GANA produced results that were significantly superior to TAU on 6 out of 10 parent-report measures 6 to 24 months posttreatment, and GANA significantly outperformed PCIT on child internalizing symptoms. However, PCIT and TAU did not differ significantly from one another. These data suggest that both PCIT and GANA produce treatment gains that are maintained over time, and that GANA continues to outperform TAU over the long term.     

Parent–child interaction therapy (PCIT) in young children with autism spectrum disorder

Abstract

Parent–child interaction therapy (PCIT) is an evidence-based treatment for typically developing children with disruptive behavior. We conducted a randomized-controlled trial of PCIT versus wait-list control (WLC) with 23 children with ASD (3–7?years) and disruptive behavior. Over 16 treatment sessions, PCIT significantly predicted reductions in disruptive behavior over WLC and explained a significant variation in scores on the ECBI Intensity subscale. Additionally, parent skills improved significantly compared to WLC. However, no statistically significant group differences were found on child compliance rates, autism severity, or parental stress. Results support PCIT as an evidence-based treatment for disruptive behavior in ASD.

• Highlights

• Parent skills were significantly improved for those receiving PCIT

• Intensity of disruptive behaviors decreased significantly for those receiving PCIT

• Parental stress and autism severity did not significantly decrease with PCIT

     

Treatment Outcome for Low Socioeconomic Status African American Families in Parent-Child Interaction Therapy: A Pilot Study

The course and efficacy of parent-child interaction therapy (PCIT) were examined in 18 socioeconomically disadvantaged African American families of preschoolers with disruptive behavior disorders. Mothers reported significant improvements in child disruptive behavior but not in maternal depressive symptoms or parenting stress. Attrition was 56%, most often occurring after pre-treatment assessment but before treatment began. Results suggest that PCIT may lead to positive behavior changes for disadvantaged young African American children when families complete treatment. Recruitment, engagement, and retention remain significant problems requiring further study. Reduction of parenting stress also requires study in this population.     

Effectiveness of Child-Directed Interaction Training for Young Japanese Children With Autism Spectrum Disorders

Abstract

This study examined the efficacy of Child-Directed Interaction Training (CDIT), the first phase of Parent-Child Interaction Therapy (PCIT), for Japanese children with autism spectrum disorders. The participants were 21 mother-child dyads with children aged 4–7 years; participants were assigned to an Immediate Treatment (IT) group or to a Waitlist (WL) control group. Across eight training sessions, mothers learned positive attention skills that were adapted from traditional PCIT training. Results showed CDIT not only improved social cognition skills and decreased disruptive behavior in Japanese children, but also reduced stress/distress among their mothers, particularly in relation to their own parenting skills and their child’s problem behaviors.     

Parent-Child Interaction Therapy for ADHD: A Conceptual Overview and Critical Literature Review

ABSTRACT

Attention-Deficit/Hyperactivity Disorder (ADHD), a chronic disorder beginning in childhood, is identifiable and diagnostically valid during the preschool years. Compared to school-aged children, preschoolers have not received as much attention in the literature. Parent-Child Interaction Therapy (PCIT) is an empirically-supported parent training program for young children with disruptive behaviors that may also be effective in treating ADHD. The purpose of the current article was to explore the theoretical rationale for utilizing PCIT with this population and to conduct a literature review of published PCIT treatment outcome studies that measured ADHD symptoms. The literature demonstrates that children with ADHD have been included in PCIT research and evidence suggests that PCIT may be effective for young children with ADHD. However, future research is needed to specifically examine the effects of PCIT on ADHD.     

Comparison of Mothers' and Fathers' Opinions of Parent–Child Interaction Therapy

Opinions of parenting programs mostly have been obtained from mothers. Because mothers and fathers' interactions with children differ, gathering data from both parents regarding behavior modification and parenting programs is necessary. This project was part of a larger study and compared mothers and fathers' acceptability of Parent-Child Interaction Therapy (PCIT) and its various components. Acceptability data were obtained using the Treatment Evaluation Inventory-Short Form and a modified version of this measure assessing specific PCIT components. The sample consisted of 40 community mother-father pairs of a young male child. Findings suggest gender differences in PCIT treatment acceptability and various PCIT components.     

Parent-Child Interaction Therapy With a Spanish-Speaking Family

There is relatively little information on the treatment effectiveness of child behavior-management programs with Spanish-speaking populations. Though there are several empirically supported treatments available in English, research on the applicability of these programs in Spanish is virtually nonexistent. This single-case study discusses the application of Parent-Child Interaction Therapy (PCIT) with a Spanish-speaking mother-child dyad to address the child’'s externalizing behavior problems. Both observational and parent self-report data are presented. Results suggest that PCIT was effective in increasing positive parent behaviors, decreasing child behavior problems, and reducing parental stress level. Implications for future clinical and research work with Spanish-speaking families are discussed.     

An initial investigation of baseline respiratory sinus arrhythmia as a moderator of treatment outcome for young children born premature with externalizing behavior problems

The aim of the current study was to examine the moderating effect of baseline respiratory sinus arrhythmia (RSA) on Parent-Child Interaction Therapy (PCIT), a behavioral parent-training intervention, for young children born premature. In this pilot randomized controlled trial, 28 young children (mean age of 37.79 months), who were born <37 weeks gestation and presented with elevated externalizing behavior problems, were randomly assigned to an immediate treatment or waitlist control group. RSA, which provides an approximate marker of individual differences in cardiac vagal tone, was measured during a baseline period. Past research has generally shown that higher levels of baseline RSA correlate with various positive psychological states (e.g., empathy, sustained attention), whereas lower levels of baseline RSA correlate with less optimal psychological states (e.g., higher externalizing behavior problems). Results indicated that baseline RSA significantly interacted with treatment condition in predicting changes in child disruptive behavior. Specifically, low levels of baseline RSA were associated with greater improvements in child disruptive behavior following PCIT. While acknowledging the caveats of measuring and interpreting RSA and the need to include a sympathetic-linked cardiac measure in future research, these findings provide preliminary evidence that children with lower capacity for emotion regulation receive even greater treatment gains. Future research should also examine the moderating effect of RSA in larger samples and explore the potential mediating role of RSA on behavioral parenting interventions.     

Emotional availability (EA): Theoretical background,empirical research using the EA Scales,and clinical applications

Emotional availability (EA), as a construct, refers to the capacity of a dyad to share an emotionally healthy relationship. The Emotional Availability (EA) Scales assess this construct using a multi-dimensional framework, with scales measuring the affect and behavior of both the child and adult partner (caregiver). The four caregiver components are sensitivity, structuring, non-intrusiveness, and non-hostility. The two child components are the child’s responsiveness to the caregiver and the child’s involvement of the caregiver. We first describe this relationship construct, look at psychometric properties in basic and prevention/intervention efforts, then review the extant empirical literature in order to examine the scope of studies assessing EA by using the EA Scales. We also explore its use in clinical practice. Throughout, we critically evaluate the knowledge base in this area as well as identify areas for further growth.