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Real-world Outcomes of PCIT for Children at Risk of Autism or Developmental Delay

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Abstract

Objectives

Disruptive behaviors in children with Autism Spectrum Disorder (ASD) or developmental delay are common, persistent and cause distress to families. Parent–Child Interaction Therapy (PCIT) may be an effective intervention with emerging evidence to support its use for children with at-risk development. We aimed to investigate the effectiveness of standard PCIT for young children (2–4 years) with disruptive behaviors and signs of ASD and/or developmental delay, treated in a real-world clinical setting. We hypothesized that there would be a reduction in disruptive behaviors and for parents, a reduction in depressive symptoms.

Methods

This was a retrospective file-review study of 236 referrals to a toddler clinic over a 17-month period (January 2016 to May 2017). Disruptive child behavior (EBCI Intensity scale and ECBI Problem scale) and maternal depression (EDS score) severity were analyzed across two time conditions (pre-treatment and post-treatment) using linear mixed models with repeated measures, including time, child ASD risk status and their interaction as main effects. An identical linear mixed models with repeated measures analysis was subsequently conducted using clinician identified concern about the child’s development as the between subjects factor.

Results

Disruptive child behavior for children at-risk of autism (high SCQ score) and for those with low SCQ scores, improved on average into the non-clinical range. Parental EDS scores reduced in the both groups, but reduced by a greater degree in the children at-risk of autism (high SCQ) group.

Conclusions

This study suggests that children at-risk of autism and developmental delay should not be excluded from PCIT, an evidence-based intervention for disruptive behaviors, as there is potential benefit for both children and parents.

Highlights

  • Standard PCIT reduced disruptive behavior for children at-risk of autism or developmental delay.

  • Parental EDS scores reduced overall, by a greater degree for parents with a child at-risk of autism.

  • PCIT may be effective for children at-risk of autism or developmental delay, and for their parents’ depressive symptoms.

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References

  • Achenbach, T., & Rescorla, L. (2000). Manual for the ASEBA preschool forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth & Families.

    Google Scholar 

  • Agazzi, H., Tan, R., & Tan, S. Y. (2013). A case study of parent-child interaction therapy in the treatment of autism spectrum disorder. Clinical Case Studies, 12(6), 428–442.

    Google Scholar 

  • Agazzi, H., Tan, S. Y., Ogg, J., Armstrong, K., & Kirby, R. S. (2017). Does parent-child interaction therapy reduce maternal stress, anxiety, and depression among mothers of children with autism spectrum disorder? Child & Family Behavior Therapy, 39(4), 283–303.

    Google Scholar 

  • Allen, C. W., Silove, N., Williams, K., & Hutchins, P. (2007). Validity of the social communication questionnaire in assessing risk of autism in preschool children with developmental problems. Journal of Autism and Developmental Disorders, 37(7), 1272–1278.

    PubMed  Google Scholar 

  • Armstrong, K., DeLoatche, K., Preece, K., & Agazzi (2014). Combining parent-child interaction therapy and visual supports for the treatment of challenging behavior in a child with autism and intellectual disabilities and comorbid epilepsy. Clinical Case Studies, 14(1), 3–14.

    Google Scholar 

  • Armstrong, K., & Kimonis, E. (2012). Parent-child interaction therapy for the treatment of Asperger’s disorder in early childhood. Clinical Case Studies, 12(1), 60–72.

    Google Scholar 

  • Bagner, D., & Sheinkopf, S. (2010). Parenting intervention for externalizing behavior problems in children born premature: an initial examination. Journal of Developmental and Behavioral Pediatrics, 31(3), 209–216.

    PubMed  PubMed Central  Google Scholar 

  • Bagner, D. M., & Eyberg, S. M. (2007). Parent–child interaction therapy for disruptive behavior in children with mental retardation: a randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 36(3), 418–429.

    Google Scholar 

  • Baker, B., Blacher, J., Crnic, K., & Edelbrock, C. (2002). Behavior problems and parenting stress in families of three-year-old children with and without developmental delays. American Journal of Mental Retardation, 107(6), 433–444.

    PubMed  Google Scholar 

  • Baker, B., McIntyre, L., Blacher, J., Crnic, K., Edelbrock, C., & Low, C. (2003). Pre-school children with and without developmental delay: behavior problems and parenting stress over time. Journal of Intellectual Disability Research, 47, 217–230.

    PubMed  Google Scholar 

  • Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism screening questionnaire: diagnostic validity. British Journal of Psychiatry, 175, 444–451.

    PubMed  Google Scholar 

  • Bjorseth, A., & Wichstrom, L. (2016). Effectiveness of parent-child interaction therapy (PCIT) in the treatment of young children’s behavior problems. A randomized controlled study. PLoS ONE, 11(9), 1–19.

    Google Scholar 

  • Chandler, S., Charman, T., Baird, G., Simonoff, E., Loucas, T., Meldrum, D., & Pickles, A. (2007). Validation of the social communication questionnaire in a population cohort of children with autism spectrum disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(10), 1324–1332.

    Google Scholar 

  • Charman, T., Baird, G., Simonoff, E., Loucas, T., Chandler, S., Meldrum, D., & Pickles, A. W. (2007). Efficacy of three screening instruments in the identification of autistic-spectrum disorders. British Journal of Psychiatry, 191, 554–559.

    PubMed  Google Scholar 

  • Cheng, E. R., Palta, M., Kotelchuck, M., Poehlmann, J., & Witt, W. P. (2014). Cognitive delay and behavior problems prior to school age. Pediatrics, 134(3), e749–e757.

    PubMed  PubMed Central  Google Scholar 

  • Cohen, J 1988). Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Cox, J., Holden, J., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. British Journal of Psychiatry, 150, 782–786.

    PubMed  Google Scholar 

  • Cox, J. L., Chapman, G., Murray, D., & Jones, P. (1996). Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. Journal of Affective Disorders, 39(3), 185–189.

    PubMed  Google Scholar 

  • Dempsey, J., McQuillin, S., Butler, A. M., & Axelrad, M. E. (2016). Maternal depression and parent management training outcomes. Journal of Clinical Psychology in Medical Settings, 23(3), 240–246.

    PubMed  PubMed Central  Google Scholar 

  • Eaves, L., Wingert, H., Ho, H., & Mickelson, E. (2006). Screening for autism spectrum disorders with the social communication questionnaire. Journal of Developmental and Behavioral Pediatrics, 27(Supplement 2), S95–S103.

    PubMed  Google Scholar 

  • Eisenhower, A. S., Baker, B. L., & Blacher, J. (2005). Preschool children with intellectual disability: syndrome specificity, behavior problems, and maternal well-being. Journal of Intellectual Disability Research, 49(9), 657–671.

    PubMed  Google Scholar 

  • Eisenstadt, T., McElreath, L., Eyberg, S., & McNeil, C. (1994). Interparent agreement on the Eyberg child behavior inventory. Child & Family Behavior Therapy, 16(1), 21–27.

    Google Scholar 

  • Eyberg, S. (1988). Parent-child interaction therapy. Child & Family Behavior Therapy, 10(1), 33–46.

    Google Scholar 

  • Eyberg, S., & Funderburk, B. (2011). Parent-child interaction therapy protocol. Gainesville, FL: PCIT International.

    Google Scholar 

  • Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory and Sutter–Eyberg student behavior inventory—revised. Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Forgatch, M. S., & Kjøbli, J. (2016). Parent management training Oregon model: adapting intervention with rigorous research. Family Process, 55(3), 500–513.

    PubMed  Google Scholar 

  • Funderburk, B., & Eyberg, S. (2011). Parent-child interaction therapy. In J. Norcross, G. VandenBos & D. Freedheim (Eds), History of psychotherapy: continuity and change (pp. 415–420). Washington, DC: American Psychological Association.

    Google Scholar 

  • Funderburk, B., Eyberg, S., Rich, B., & Behar, L. (2003). Further psychometric evaluation of the Eyberg and Behar rating scales for parents and teachers of preschoolers. Early Education and Development, 14(1), 67–81.

    Google Scholar 

  • Ginn, N. C., Clionsky, L. N., Eyberg, S. M., Warner-Metzger, C., & Abner, J.-P. (2017). Child-directed interaction training for young children with autism spectrum disorders: parent and child outcomes. Journal of Clinical Child & Adolescent Psychology, 46(1), 101–109.

    Google Scholar 

  • Hatamzadeh, A., Pouretemad, H., & Hassanabadi, H. (2010). The effectiveness of parent-child interaction therapy for children with high functioning autism. Procedia—Social and Behavioral Sciences, 5(2), 994–997.

    Google Scholar 

  • Hauser-Cram, P., Warfield, M. E., Shonkoff, J. P., Krauss, M., Sayer, A., & Upshur, C. (2001). Children with disabilities: a longitudinal study of child development and parent well-being. Monographs of the Society for Research in Child Development, 66, 1–126.

    Google Scholar 

  • Herring, S., Gray, K. M., Taffe, J., Tonge, B., Sweeney, D., & Einfeld, S. (2006). Behavior and emotional problems in toddlers with pervasive developmental disorders and developmental delay: associations with parental mental health and family functioning. Journal of Intellectual Disability Research, 50(12), 874–882.

    PubMed  Google Scholar 

  • Holtz, C., Carrasco, J., Mattek, R., & Fox, R. (2009). Behavior problems in toddlers with and without developmental delays: comparison of treatment outcomes. Child & Family Behavior Therapy, 31(4), 292–311.

    Google Scholar 

  • Iida, N., Wada, Y., Yamashita, T., Aoyama, M., Hirai, K., & Narumoto, J. (2018). Effectiveness of parent training in improving stress-coping capability, anxiety, and depression in mothers raising children with autism spectrum disorder. Neuropsychiatric Disease and Treatment, 14, 3355–3362.

    PubMed  PubMed Central  Google Scholar 

  • Kaat, A. J., & Lecavalier, L. (2013). Disruptive behavior disorders in children and adolescents with autism spectrum disorders: a review of the prevalence, presentation, and treatment. Research in Autism Spectrum Disorders, 7(12), 1579–1594.

    Google Scholar 

  • Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation. Clinical Child and Family Psychology Review, 15, 247–277.

    PubMed  Google Scholar 

  • Lecavalier, L. (2006). Behavioral and emotional problems in young people with pervasive developmental disorders: relative prevalence, effects of subject characteristics, and empirical classification. Journal of Autism and Developmental Disorders, 36, 1101–1114.

    PubMed  Google Scholar 

  • Lesack, R., Bearss, K., Celano, M., & Sharp, W. (2014). Parent-child interaction therapy and autism spectrum disorder: adaptations with a child with severe developmental delays. Clinical Practice in Pediatric Psychology, 2(1), 68–82.

    Google Scholar 

  • Lieneman, C. C., Brabson, L. A., Highlander, A., Wallace, N. M., & McNeil, C. B. (2017). Parent-child interaction therapy: current perspectives. Psychology Research and Behavior Management, 10, 239–256.

    PubMed  PubMed Central  Google Scholar 

  • Maire, J., Galera, C., Meyer, E., Salla, J., & Michel, G. (2017). Is emotional lability a marker for attention deficit hyperactivity disorder, anxiety and aggression symptoms in preschoolers? Child and Adolescent Mental Health, 22(2), 77–83.

    Google Scholar 

  • Mandell, D. S. (2008). Psychiatric hospitalization among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 1059–1065.

    PubMed  Google Scholar 

  • Masse, J., McNeil, C., Wagner, S., & Chorney, D. (2007). Parent-child interaction therapy and high functioning autism: a conceptual overview. Journal of Early and Intensive Behavior Intervention, 4(4), 714–735.

    Google Scholar 

  • Masse, J. J., McNeil, C. B., Wagner, S., & Quetsch, L. B. (2016). Examining the efficacy of parent–child interaction therapy with children on the autism spectrum. Journal of Child and Family Studies, 25(8), 2508–2525.

    Google Scholar 

  • Mazurek, M. O., Kanne, S. M., & Wodka, E. L. (2013). Physical aggression in children and adolescents with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 455–465.

    Google Scholar 

  • Mcintyre, L. L., Blacher, J., & Baker, B. L. (2002). Behavior/mental health problems in young adults with intellectual disability: the impact on families. Journal of Intellectual Disability Research, 46(3), 239–249.

    PubMed  Google Scholar 

  • McNeil, C., & Hembree-Kigin, T. (2010). Parent-child interaction therapy. New York, NY: Springer.

    Google Scholar 

  • McNeil, C., Quetsch, L. B. & Anderson, C. M. (Eds) (2019). Handbook of parent-child interaction therapy for children on the autism spectrum. New York, NY: Springer.

    Google Scholar 

  • Niec, L. (Ed.) (2018). Handbook of parent-child interaction therapy—innovations and applications for clinical practice. New York, NY: Springer.

    Google Scholar 

  • Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales. A review of selected instruments. Autism, 14(4), 263–284.

    PubMed  Google Scholar 

  • Phillips, J., Morgan, S., Cawthorne, K., & Barnett, B. (2008). Pilot evaluation of parent-child interaction therapy delivered in an Australian community early childhood clinic setting. Australian and New Zealand Journal of Psychiatry, 42, 712–719.

    PubMed  Google Scholar 

  • Ros, R., Hernandez, J., Graziano, P. A., & Bagner, D. M. (2016). Parent training for children with or at risk for developmental delay: the role of parental homework completion. Behavior Therapy, 47(1), 1–13.

    PubMed  Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). The social communication questionnaire: manual. Torrance, CA: Western Psychology Services.

  • Selya, A., Rose, J., Dierker, L., Hedeker, D., & Mermelstein, R. (2012). A practical guide to calculating Cohen's f(2), a measure of local effect size, from PROC MIXED. Frontiers in Psychology, 3, 111.

    PubMed  PubMed Central  Google Scholar 

  • Solomon, M., Ono, M., Timmer, S., & Goodlin-Jones, B. (2008). The effectiveness of parent-child interaction therapy for families of children on the autism spectrum. Journal of Autism and Developmental Disorders, 38(9), 1767–1776.

    PubMed  PubMed Central  Google Scholar 

  • Swadi, H., & Eapen, V. (2000). A controlled study of psychiatric morbidity among developmentally disabled children in the United Arab Emirates. Journal of Tropical Pediatrics, 46(5), 278–281.

    PubMed  Google Scholar 

  • Szczepaniak, D., McHenry, M., Nutakki, K., Bauer, N., & Downs, S. (2013). The prevalence of at-risk development in children 30-60 months old presenting with disruptive behaviors. Clinical Pediatrics, 52(10), 942–949.

    PubMed  Google Scholar 

  • Tellegen, C. L., & Sanders, M. R. (2014). A randomized controlled trial evaluating a brief parenting program with children with autism spectrum disorders. Journal of Consulting and Clinical Psychology, 82(6), 1193–1200.

    PubMed  Google Scholar 

  • Thomas, R., & Zimmer-Gembeck, M. J. (2007). Behavioral outcomes of parent-child interaction therapy and triple P-positive parenting program: a review and meta-analysis. Journal of Abnormal Child Psychology, 35(3), 475–495.

    PubMed  Google Scholar 

  • Timmer, S. G., Ho, L. K., Urquiza, A. J., Zebell, N. M., Fernandez Y Garcia, E., & Boys, D. (2011). The effectiveness of parent-child interaction therapy with depressive mothers: the changing relationship as the agent of individual change. Child Psychiatry and Human Development, 42(4), 406–423.

    PubMed  Google Scholar 

  • Ward, M. A., Theule, J., & Cheung, K. (2016). Parent-child interaction therapy for child disruptive behavior disorders: a meta-analysis. Child Youth Care Forum, 45, 675–690.

    Google Scholar 

  • Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013). Performance of evidence-based youth psychotherapies compared with usual clinical care. JAMA Psychiatry, 70(7), 750.

    PubMed  Google Scholar 

  • Witwer, A., & Lecavalier, L. (2005). Treatment incidence and patterns in children and adolescents with autism spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 15(4), 671–681.

    PubMed  Google Scholar 

  • Yirmiya, N., & Shaked, M. (2005). Psychiatric disorders in parents of children with autism: a meta-analysis. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46(1), 69–83.

    Google Scholar 

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Author Contributions

P.M. designed and executed the study, assisted with the data analyses and wrote the paper. J.K. collaborated with the design, analyzed the results and collaborated in the writing of the paper. V.E. collaborated with the design of the study, writing and editing of the manuscript.

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Authors and Affiliations

  1. Rivendell Child Adolescent and Family Mental Health Service, Concord West, NSW, Australia

    Peter McInnis

  2. Karitane, Carramar, NSW, Australia

    Peter McInnis & Jane Kohlhoff

  3. School of Psychiatry, University of New South Wales, Randwick, NSW, Australia

    Jane Kohlhoff & Valsamma Eapen

  4. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia

    Jane Kohlhoff & Valsamma Eapen

  5. Academic Unit of Child Psychiatry South West Sydney, Liverpool, NSW, Australia

    Valsamma Eapen

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  1. Peter McInnis
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  2. Jane Kohlhoff
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Correspondence to Peter McInnis.

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McInnis, P., Kohlhoff, J. & Eapen, V. Real-world Outcomes of PCIT for Children at Risk of Autism or Developmental Delay. J Child Fam Stud 29, 1701–1711 (2020). https://doi.org/10.1007/s10826-020-01699-0

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