Background: Children with autism spectrum disorder (ASD) experience high rates of comorbid diagnoses, including both externalizing and internalizing disorders. Emotion regulation has been posited as a possible mechanism underlying many emotional disorders, and children with ASD have higher rates of emotion regulation challenges than their typically developing peers. It has been recommended that treatments addressing both emotion dysregulation and comorbidities in children with ASD be developed. Additionally, considering the needs and preferences of caregivers when developing novel interventions is critical. Objective: This feasibility pilot randomized control trial investigated initial feasibility, acceptability, and preliminary clinical outcomes of a novel adaptation of Parent-Child Interaction Therapy (PCIT) delivered daily over two weeks via telehealth, in which the second phase of treatment is replaced with an emotion-focused module. Method: Participants included 22 young children aged 2 through 7 (M = 4.64, 72.7% male) and their caregiver(s). Families were randomized to receive either an intensive, telehealth version of PCIT’s standard modules, Child Directed Interaction (CDI; relationship enhancing) and Parent-Directed Interaction (PDI; discipline and limit-setting), or an emotion-focused module (ED) instead of PDI. Child and caregiver measures were collected at pre, mid, post, and 1-month follow-up. Results: Recruitment, retention, assessment collection, and caregiver satisfaction were adequate for the study. CDI+PDI was superior to CDI+ED on improvements in child disruptive behaviors and child dysphoria. CDI+PDI resulted in large effects on multiple child outcomes (dysphoria, reactivity, and disruptive behaviors) and on caregiver stress. CDI+ED resulted in improvements in caregiver cognitive reappraisal, one emotion regulation strategy. Conclusion: Internet-delivered intensive PCIT may be a helpful intervention for young children with autism, that is acceptable to caregivers, however PDI is likely a necessary treatment component for quick treatment gains, which cannot be substituted with emotion-focused content. Feasibility of the pilot study was demonstrated and can inform a larger trial.

Parent-Child Interaction Therapy (PCIT) is an evidence-based behavioral parent training intervention (BPT) that has been shown to significantly reduce externalizing behavior problems in young children, typically between the ages of 2-7. As a primary component of treatment, PCIT therapists coach caregivers in the use of specific behavioral skills during session. It has been found that different coaching styles impact both caregiver skill acquisition as well as treatment adherence, making it an important mechanism of change to study. Although PCIT has been demonstrated to be efficacious for families of diverse backgrounds, there is currently very little research examining how therapist coaching is implemented for Spanish-speaking families. Therefore, the current mixed-methods QUANT + qual study quantitatively examines therapist and caregiver moment-to-moment interactions and gathers qualitative information from PCIT providers in order to better understand how therapist and caregiver verbalizations are affecting one another during PCIT, as well as PCIT therapist experiences coaching Spanish-speaking caregivers. For the quantitative analyses, participants included 49 therapist-caregiver dyads from two previous PCIT clinical trials. Five-minute segments from the 49 therapist-parent dyads’ second coaching session were transcribed. Parent and therapist verbalizations were coded using the Dyadic Parent-Child Interaction Coding System (DPICS) and the Therapist-Parent Interaction Coding System, respectively. Sequential analysis was conducted using Noldus The Observer XT software to obtain transitional probabilities of caregiver skill use after therapist coaching verbalizations and vice versa. Independent Samples t Tests were used to examine differences in how caregivers responded to therapist coaching in English-speaking and Spanish-speaking sessions. For qualitative analyses, participants included ten PCIT providers (5 therapists and 5 supervisors/trainers). Therapists and trainers conducted a 1-hour semi-structured interview during which they discussed their experiences providing PCIT coaching to Spanish-speaking caregivers. Rapid Qualitative Analysis (RQA) was conducted, and themes were identified regarding therapist experiences, challenges, and facilitators working with Spanish-speaking families. Results from the current study found that Spanish-speaking caregivers do not significantly differ in their responses to therapist coaching, and that therapists are more likely to follow caregiver skill use with a directive for parents to use an additional skill use in sessions conducted in English (M = .01, SD = .02) than in sessions conducted in Spanish (M = .00, SD = .00; t(39) = 2.518, p = .016). Qualitative findings from therapist interviews converge with quantitative findings, highlighting discomfort that therapists may experience being directive with Spanish-speaking caregivers. Additional qualitative themes are presented, and training considerations are discussed.

Behavioral parent training programs are effective interventions in addressing a wide range of child behavior problems. Historically, these interventions have engaged a narrowly defined conception of caregivers, focusing on biological mothers, in part due to limited guidance on how to engage other caregivers and utilize their reports of child behavior problems in clinical decision making. Recent advances in methodological strategies to compare agreement between informants in the context of children’s mental health allow us to identify domain-relevant information in instances when disagreement between caregivers yields clinically-relevant information about the child in services. The current study utilized concordance as measured by difference scores and correlations between two caregiver ratings in the context of a parent-child interaction therapy (n = 57). Comparison between concordance at pre-treatment and post-treatment suggest that there was a significant increase in caregiver agreement over the course of treatment for the level of intensity of child behavior problems. Regression models, used to test effects of child and caregiver characteristics on pre- and post-treatment concordance, found that only secondary caregiver stress was significantly associated with caregiver disagreement. A final regression showed that there were no significant predictors in the change in agreement over the course of treatment. Findings provide preliminary evidence of domain-relevant information in regards to multiple caregiver ratings of child behavior problems. Clinical implications, including the importance of capturing when parents might be at risk for ending treatment in lower states of agreement, are discussed.

Parent-Child Interaction Therapy (PCIT) is an evidence-based practice (EBP) for young children with challenging behaviors. PCIT has been adapted to treat varying clinical presentations and culturally diverse families, including Mexican American families. Although efforts have been made to disseminate PCIT into community settings, which often serve clinically complex, socio-culturally diverse, and marginalized communities, barriers to disseminating adapted models remain. Additionally, when EBPs are implemented in community settings, ad-hoc adaptations to interventions are inevitable to meet the needs of the clientele served. However, past research has found that community clinicians rarely adapt or tailor PCIT to address their clients’ cultural backgrounds. These findings indicate that community therapists may benefit from support on how to adapt treatment for ethnically diverse families. Furthermore, Spanish-speaking clinicians may have other unique training and supervision needs when delivering PCIT. The current study used methodology from the field of implementation science to determine adaptations needed for 1) intervention materials, 2) training, and 3) ongoing supervision so that Spanish-speaking therapists are supported in their delivery of PCIT. Clinicians who endorsed providing PCIT in Spanish or PCIT trainers who endorsed training and/or consulting with Spanish-speaking therapists were recruited to participate. Thirty-one participants completed quantitative measures, and ten also completed semi-structured qualitative interviews. Quantitative results indicated that Spanish-language PCIT was moderately acceptable (M = 3.83, SD = 0.48; 2.40 – 4.90), as was Spanish-language PCIT training and supervision (M = 3.88, SD = 0.79; 1.20 – 5.00). Qualitative analysis expanded on quantitative findings, showing a split between provider experiences. Participants reported that when implementation strategies had been adapted to address the needs of Spanish-speaking families they were extremely satisfied with their training and supervision; clinicians expressing dissatisfaction commonly commented on a lack of support or adaptations to training and supervision hindered their ability to provide PCIT for their Spanish-speaking Latinx families. Providers noted how establishing and facilitating access to ongoing and systematically adapted training and consultation could reinforce their ability to deliver Spanish-language PCIT. Implications for adapting training and supervision to better support Spanish-speaking therapists delivering EBPs are discussed.

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