Efficacy of Parent-Child Interaction Therapy With Autism Spectrum Disorder
Condition: Noncompliance
Study type: Interventional

Summary: 
      The aim of the current proposal is to determine if the PCIT treatment manual can be
      successfully utilized for preschoolers with ASD and disruptive behavior (across a range of
      intellectual functioning levels) and to evaluate its ability to significantly decrease
      measures of problem behavior. It is hypothesized that the current manual will require few
      modifications for use with ASD and that, in comparison to a wait-list control group, families
      who undergo PCIT training will evidence significant gains on measures of parenting stress,
      child externalizing behaviors and compliance to parental requests. To address the pilot study
      aims, we will recruit a total of 25 families of children with ASD (ages 2.6-6.11 years) whose
      children are already receiving intensive, one-on-one behavioral treatment services (15-30
      hours per week) but no structured parent training. Families will be randomized to either
      intensive services + PCIT or intensive services alone (wait list control). Assessments will
      be completed at baseline, mid-treatment (9 weeks post baseline), post-treatment (18 weeks
      after the baseline assessment) and long-term follow-up (12 weeks post-treatment). PCIT
      families will attend 16 weekly, one-hour coaching sessions. Both active treatment and
      wait-list control families will continue to receive intensive ABA services in the home or
      community. Control families will receive PCIT training after 18 weeks on the "wait-list." The
      aims of the pilot study are:

        1. To assess the utility of the current PCIT treatment manual with preschoolers with ASD
           and disruptive behavior and their parents;

           Hypothesis 1: The current PCIT treatment manual will be able to be utilized with
           families of children with ASD with only minimal modifications.

           Hypothesis 2: Families of children with ASD will consistently attend PCIT sessions.

        2. To determine if PCIT with this population will result in an increase in appropriate
           parent behaviors and a subsequent decrease in targeted child behaviors (e.g., direct
           assessment of noncompliance, behavior rating scales).

      Hypothesis 3: Families receiving PCIT training will evidence statistically greater decreases
      on measures of disruptive behavior, quality of parent-child interactions and parental stress
      than families on the wait-list control group.
    

Detailed description: 
      Young children with ASD often present with a range of externalizing behavior problems,
      including aggression, tantrums and difficulty transitioning. Interventions based on the
      principles of applied behavior analysis (ABA) have been shown to offer an effective means of
      addressing many of these concerns. Parent-Child Interaction Therapy (PCIT) is a manualized,
      empirically supported parent coaching intervention that has been found to be highly effective
      for typically developing preschoolers presenting with a range of mental health concerns. It
      also holds considerable promise as a potentially effective treatment for children with ASD.
      The focus of PCIT treatment is to both improve parent-child interactions and to reduce child
      behavior problems. PCIT involves the coaching of parents in real-time, via a one-way mirror
      and a "bug-in-the ear" device that allows the therapist to provide feedback and directions to
      the parent while interacting with his/her child. The aim of the current proposal is to
      determine if the PCIT treatment manual can be successfully utilized for preschoolers with ASD
      and to evaluate its ability to significantly decrease measures of problem behavior. It is
      hypothesized that the current manual will require few modifications for use with ASD and
      that, in comparison to a wait-list control group, families who undergo PCIT training will
      evidence significant gains on measures of parenting stress, child externalizing behaviors and
      compliance to parental requests. To address the pilot study aims, we will recruit a total of
      25 families of children with ASD (ages 2.6-6 years) whose children are already receiving
      intensive, one-on-one behavioral treatment services (15-30 hours per week). Families will be
      randomized to either intensive services + PCIT or intensive services alone (wait list
      control). Assessments will be completed at baseline, mid-treatment (9 weeks post baseline)
      and post-treatment (18 weeks after the baseline assessment). PCIT families will attend 20
      weekly, one-hour coaching sessions. Both active treatment and wait-list control families will
      continue to receive intensive ABA services in the home or community. The results of this
      study will provide pilot data in a subsequent application for federal funding to conduct
      larger controlled trials, including examining the use of PCIT in school-age children with ASD
      and intellectual disability and to assess the individual and combined efficacy of PCIT and
      psychopharmacological treatment.
    

Intervention name(s): Parent Child Interaction Therapy
Intervention type(s): Behavioral
Intervention description(s): Parent-Child Interaction Therapy (PCIT) is a research-supported parent coaching intervention that has been found to be highly effective among typically developing preschoolers presenting with a range of mental health concerns, especially defiance and noncompliance.6 PCIT holds considerable promise as a potentially effective treatment for children with ASD because it directly addresses the behaviors parents of children with ASD report to be most problematic for them - defiance, stubbornness, and temper tantrums. PCIT is theoretically consistent with other approaches that have shown promise in treating ASD (i.e., behaviorally-based); however, PCIT is unique in that it incorporates a socially-based initial phase which may have some unique benefits for children with ASD.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: PCIT, autism, parent training, noncompliance