Parent-Child Interaction Therapy as a Family-Focused Approach for Young Children with Traumatic Brain Injury

Traumatic Brain Injury (TBI) is the leading cause of death and disability in children and adolescents in the U.S. and disproportionately affects young children. The negative consequences of early childhood TBI include deficits in behavior and attention, cognitive abilities, and academic skills. Behavior problems in particular are one of the most common and persistent consequences following TBI in young children. Therefore, interventions are needed that target the adverse effects of TBI on behavior. The purpose of the current work was to examine the initial outcome, feasibility, acceptability, and satisfaction of a time-limited and intensive format of Parent-Child Interaction Therapy (PCIT) for families with a child aged 2 to 5 years who had sustained a TBI and displayed clinically elevated externalizing behavior problems. The open trial included 10 families that completed a baseline assessment, received the intervention over 5 weeks, and completed post-intervention and 2-month follow-up assessments. Results indicated that children who completed the intervention showed significant improvements in both externalizing and internalizing behavior problems at post-intervention and 2-month follow-up, with the exception of non-significant change in self-regulation at post-intervention and 2-month follow-up, and attention problems at 2-month follow-up. In addition, significant improvements were found on all cognitive measures examining working memory, receptive language, and executive functioning at post-intervention and 2-month follow-up. Similarly, caregivers who completed the intervention displayed significant improvements in their parenting skills during play with their child and reported significant reductions in overall caregiver stress and caregiver stress related to their child’s difficult behaviors. Despite limitations inherent in an open trial (e.g., small sample, lack of a control group, generalizability), the current study addressed a relatively unexplored research question and suggests that an intensive format of PCIT may be a promising approach for improving domains commonly affected by early childhood TBI (e.g., behavioral, cognitive, and family functioning) prior to the development of more severe and persistent problems

Changes in Parental Prosody Mediate Effect of Parent-Training Intervention on Infant Language Production

Objective: Parent-training interventions to reduce behavior problems in young children typically coach parents on the content of their speech, but rarely assess parents' prosody during parent-child interactions. Infant-directed speech helps shape the parent-infant relationship and promote language development, which predicts adaptive behavioral outcomes in children. The current study examined (a) the effect of a parent-training intervention on parents' vocal cues in interactions with their infant and (b) whether parental prosody mediated the impact of the intervention on infant language production. Method: Sixty families with 12- to 15-month-old infants (47% female; 95% of Hispanic/Latino ethnicity) participated in the Infant Behavior Program (IBP), a brief home-based adaptation of Parent-Child Interaction Therapy, or received standard pediatric care. Speech analysis was performed on mothers' (n = 40) utterances during infant-led play pre- and postintervention. Infants' number of utterances spoken during play was assessed at pre- and postintervention, and at 3- and 6-month follow-ups. Results: Mothers who received the IBP spoke with greater pitch range and slower tempo postintervention, when controlling for baseline prosody. Change in these vocal cues, which are typical of infant-directed speech, mediated the effect of the intervention on infants' word production after 6 months. Conclusions: Interventions targeting the content of parents' speech during parent-infant interactions may lead to changes in parental prosody, which may be beneficial for infants' language development. Impaired linguistic abilities in infancy are strongly associated with behavior problems in later childhood; thus, these findings highlight a potential mechanism for intervention efficacy in promoting positive socioemotional and behavioral outcomes. What is the public health significance of this article? Interventions targeting parent behaviors in the context of the parent-infant relationship may promote the use of infant-directed speech prosody. Parents' use of these vocal cues may be beneficial for infants' language development, which has been associated with adaptive socioemotional and behavioral outcomes in later childhood

Correction to: Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic

Parent-Child Interaction Therapy for Children with Developmental Delay: The Role of Sleep Problems

Sleep problems are common and associated with externalizing behavior problems in young children, particularly among young children with developmental delay (DD). The aims of the current study, which was a secondary data analysis of 2 previously conducted randomized controlled trials, were to assess whether parent-child interaction therapy (PCIT) led to decreases in child sleep problems and whether initial sleep problems moderated the effect of PCIT on child behavior.Methods:The study participants were 44 children (M = 49.19 months, SD = 13.1) with DD or borderline DD and with co-occurring clinically significant levels of externalizing behavior problems and their mothers (M = 35.9 years, SD = 7.3). These participants were randomly assigned to either an immediate treatment group or a waitlist control group.Results:Findings revealed a significant direct effect of PCIT on decreases in sleep problems. Additionally, moderation analyses revealed that lower levels of child sleep problems at pretreatment were associated with greater improvements in observed child compliance compared with higher levels of child sleep problems at pretreatment.Conclusion:This study extends previous findings by providing support for the preliminary efficacy of PCIT in reducing sleep problems in children with DD and borderline DD and highlighting the role of sleep problems as a factor associated with differential treatment effects in behavioral parenting intervention research

Assessment of Behavioral and Emotional Problems in Infancy: A Systematic Review

Behavioral and emotional problems are highly prevalent in early childhood and represent an important focus of practice for clinical child and pediatric psychologists. Although psychological or psychiatric disorders are not typically diagnosed in children under the age of 2 years, recent research has demonstrated the appropriateness of assessing behavioral and emotional problems during the first 2 years of life (defined throughout as “infancy”). The current paper provides a systematic review of assessment procedures used to identify behavioral and emotional problems during infancy. Existing assessment procedures for infants take the form of parent- or caregiver-report questionnaires, observational coding procedures, and diagnostic classification systems. The questionnaires and observational coding procedures both had substantial psychometric evidence for use with infants, although observational coding may have limited utility in clinical practice. The classification systems have less empirical support for use with infants, and further research is necessary to demonstrate the appropriateness of these procedures with infants. Utilizing the reviewed procedures to assess behavioral and emotional problems in infants can have a substantial impact in research and practice settings, and further research is needed to determine the usefulness of these procedures in developing, testing, and implementing preventive and early intervention programs for infants and their families

Parent Training Outcomes among Young Children with Callous-Unemotional Conduct Problems with or At-Risk for Developmental Delay

School-aged children with conduct problems and high levels of callous-unemotional (i.e., lack of empathy, guilt, and lack of caring behaviors) traits (CP+CU) tend to yield less benefit from traditional interventions than do their low-CU counterparts, particularly with respect to CP outcomes. To date, little is known about treatment response among young children with CP+CU, particularly those with or at risk for developmental delay. Components of Parent-Child Interaction Therapy (PCIT), a parent training program effective at reducing CP in young children, have compelling theoretical support for addressing core deficits unique to children with CP+CU and have been used successfully with young children with developmental delay. Our first aim was to test the psychometric properties of a measure of CU traits in preschool children with and without developmental delay. Our second aim was to test whether CU traits predicted post-treatment CP after controlling for initial levels of CP. Participants were 63 families of young children (mean age = 3.87 years), with or at-risk for developmental delay, who presented with elevated CP and were treated in a hospital-based outpatient clinic. Results indicated that developmentally delayed children with high levels of CU traits, but not children at-risk for delay due to premature birth, showed significantly poorer CP outcomes following treatment with PCIT than did children scoring low on CU traits, even after controlling for initial CP severity. The implications of these findings with regard to treating and preventing severe disruptive behaviors among young children with CP+CU are discussed

Skill change among Latinx families in a behavioral parenting intervention: The interactive effect of caregiver language preference and acculturation

Despite extensive evidence showing that Latinx caregivers’ language preference and level of acculturation influence parenting practices and treatment acceptability, there is a paucity of studies examining how these individuals acquire skills taught in behavioral parenting interventions such as parent–child interaction therapy (PCIT). Previous studies have shown that Latinx families, especially those who speak Spanish, require additional sessions to complete PCIT compared with non-Latinx White families, a disparity that could lead to high attrition rates and poor treatment outcomes. This study examined whether parenting skills (i.e., do and don’t skills) changed as a function of caregiver language preference and level of acculturation among Latinx families receiving a home-based adaptation of PCIT for infants. Twenty-six Latinx caregiver–child dyads received the intervention and were assessed at posttreatment and at 3- and 6-month follow-ups. Caregivers were on average 30.85 years old ( SD = 5.14), mostly married (69.2%) and Spanish-speaking (57.7%). Half of these families lived below the poverty line. Moderation analyses showed that more acculturated Spanish-speaking caregivers showed fewer reductions in their use of don’t skills than their English-speaking counterparts at posttreatment and at 3- and 6-month follow-ups. No moderation effects were found for the use of do skills. Results highlight critical cultural factors that affect parenting skill change among Spanish-speaking Latinx families. These findings could inform data-driven cultural adaptations of PCIT that improve treatment engagement and reduce attrition among Latinx families, especially given existing inequities in mental health care for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: journal abstract

Parenting Stress across Time-Limited Parent-Child Interaction Therapy

Caregivers of children with disruptive behavior problems often experience elevated parenting stress. Parent-child interaction therapy (PCIT), an evidence-based treatment for disruptive behavior problems, teaches caregivers behavior management strategies that target problem behaviors and improve the caregiver-child relationship. Although extensive evidence documents PCIT's effectiveness in treating child behavior problems, few studies have focused on caregiver outcomes in a time limited implementation of PCIT. We explored parenting stress trajectories across time limited weekly PCIT (1 session/week over 18 weeks). Caregivers (n = 64) completed assessments at 4 time points (baseline, mid-way through treatment, post treatment, 1-month following treatment), including measures of parenting stress and child behavior problems. Multilevel models (MLM) were used to examine change in parenting stress domains over time; specifically, the stress related to parenting a difficult child, parent-child dysfunctional interactions, and parental distress. After controlling for demographic and treatment variables, MLMs indicated that parent distress decreased during treatment, but there was no significant change in stress related to parenting a difficult child or parent-child dysfunctional interactions. Across domains, child behavior remained a consistent, significant predictor of parenting stress. Results suggest that overall PCIT reduces parenting stress, but a subset of caregivers may continue to have some difficulty managing interactions with their children after treatment. Findings also indicate that PCIT may target parenting stress domains differentially, which remain important targets for screening and intervention

Characterizing Intervention Strategies Used in Community-Based Mental Health Care for Infants and Their Families

Mental health interventions for infants typically target high-risk groups and can prevent long-term negative outcomes. Despite federal initiatives promoting early intervention, minimal research has examined usual care services for infants, which is important to improve routine care. The current study characterized usual care practices in infant mental health through the adaptation and administration of a provider survey. Providers (n = 126) reported using a wide range of intervention strategies and few intervention programs with varied evidence. Findings can inform future research to identify quality improvement targets of usual mental health care for high-risk infants and their families