Psychometric properties and initial validity of the Brief Observation of Social Communication Change (BOSCC), a measure of treatment-response for social-communication behaviors, are described. The BOSCC coding scheme is applied to 177 video observations of 56 young children with ASD and minimal language abilities. The BOSCC has high to excellent inter-rater and test–retest reliability and shows convergent validity with measures of language and communication skills. The BOSCC Core total demonstrates statistically significant amounts of change over time compared to a no change alternative while the ADOS CSS over the same period of time did not. This work is a first step in the development of a novel outcome measure for social-communication behaviors with applications to clinical trials and longitudinal studies.

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Measuring Changes in Social Communication Behaviors: Preliminary Development of the Brief Observation of Social Communication Change (BOSCC)

Parent training (PT) has emerged as a promising treatment for disruptive behavior in children with autism spectrum disorder (ASD). This review summarizes the essential elements of PT for disruptive behavior in children with ASD and evaluates the available evidence for PT using both descriptive and meta-analytic procedures. We searched Medline, PsycINFO, and PubMed databases (1980–2016) in peer-reviewed journals for randomized controlled trials (RCTs) of PT for disruptive behavior in children with ASD. The systematic search of 2023 publications yielded eight RCTs involving a total of 653 participants. We calculated effect sizes using either raw post-treatment means and standard deviations for each treatment group (PT and control) or group mean differences with associated 95% confidence intervals (CIs). Differences in post-treatment means were converted to a standardized difference in means (SMD) for each primary outcome. Results support the efficacy of PT for disruptive behavior in children with ASD, with a SMD of −0.59 [95% CI (−0.88, −0.30); p < 0.001]. Across these eight studies, there was significant heterogeneity in the effect of PT on disruptive behavior. This variability is likely due to differences in sample size, number of treatment sessions, study duration, and control condition employed. Current findings provide solid support for the efficacy of PT for disruptive behavior in children with ASD. Future studies should focus on effectiveness trials to promote wider implementation of PT in clinical settings.

A Systematic Review and Meta-analysis of Parent Training for Disruptive Behavior in Children with Autism Spectrum Disorder.

Parent-child interaction therapy (PCIT), a program for young children and their families, is a strong evidence-based treatment that repeatedly receives the highest rankings possible in reviews of such treatments (e.g., California Evidence-Based Clearinghouse for Child Welfare, 2015; nrepp.samhsa.gov). PCIT was originally developed for use with young children (2–7 years of age) with disruptive behavior problems (McNeil and Hembree-Kigin 2010; Zisser and Eyberg 2010). As PCIT continued to show significant positive outcomes including improved child behaviors, reduced parenting stress, and improved parent-child relationships (Brinkmeyer and Eyberg 2003; Eyberg and Robinson 1982), the application of PCIT to children at risk or exposed to trauma seemed a logical step.

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Parent-Child Interaction Therapy:

Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.

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Characterizing Psychiatric Comorbidity in Children with Autism Spectrum Disorder Receiving Publicly Funded Mental Health Services.

Importance Training parents to implement strategies to support child language development is crucial to support long-term outcomes, given that as many as 2 of 5 children younger than 5 years have difficulty learning language. Objective To examine the association between parent training and language and communication outcomes in young children. Data Sources Searches of ERIC, Academic Search Complete, PsycINFO, and PsycARTICLES were conducted on August 11, 2014; August 18, 2016; January 23, 2018; and October 30, 2018. Study Selection Studies included in this review and meta-analysis were randomized or nonrandomized clinical trials that evaluated a language intervention that included parent training with children with a mean age of less than 6 years. Studies were excluded if the parent was not the primary implementer of the intervention, the study included fewer than 10 participants, or the study did not report outcomes related to language or communication. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were applied to a total of 31 778 articles identified for screening, with the full text of 723 articles reviewed and 76 total studies ultimately included. Main Outcomes and Measures Main outcomes included language and communication skills in children with primary or secondary language impairment and children at risk for language impairment. Results This meta-analysis included 59 randomized clinical trials and 17 nonrandomized clinical trials including 5848 total participants (36.4 female [20.8%]; mean [SD] age, 3.5 [3.9] years). The intervention approach in 63 studies was a naturalistic teaching approach, and 16 studies used a primarily dialogic reading approach. There was a significant moderate association between parent training and child communication, engagement, and language outcomes (mean [SE] Hedgesg,−0.33 [0.06];P  Conclusions and Relevance The findings suggest that training parents to implement language and communication intervention techniques is associated with improved outcomes for children and increased parent use of support strategies. These findings may have direct implications on intervention and prevention.

Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis

This study examined the efficacy of the Child-Directed Interaction Training (CDIT) phase of Parent-Child Interaction Therapy for children with an Autism Spectrum Disorder (ASD). Thirty mother-child dyads with children ages 3-7 years with a diagnosis of ASD participated in this randomized controlled study. Following manualized CDIT, statistically significant and meaningful improvements in child disruptive behavior and social awareness as well as maternal distress associated with child disruptive behavior occurred. Across 8 sessions, mothers learned to provide positive attention to their children's appropriate social and play behaviors. Both child and parent changes were maintained at 6-week follow-up. A relatively brief, time-limited, and accessible intervention may be efficacious for improving child and parent behaviors in families of young children with ASD. By decreasing child disruptive behaviors, CDIT may also help to prepare children to benefit further from future interventions.

Child-Directed Interaction Training for Young Children With Autism Spectrum Disorders: Parent and Child Outcomes

Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer’s trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child’s trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation.

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Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma

Externalizing behaviors are a common co-occurring issue in young children with autism spectrum disorder (ASD). One evidence-based treatment for disruptive behaviors that has shown empirical and clinical success with a range of specialized populations is Parent-Child Interaction Therapy (PCIT). While the accumulating research for implementing PCIT with the ASD population is promising, clinical parameters for PCIT practice with ASD are dynamically evolving. The chapter presents lessons learned from the authors’ research and clinical experiences when implementing PCIT with the ASD population. The organization of the chapter overlays PCIT concepts onto the ASD diagnostic framework of the DSM-5, including severity and functional level of impairment. Although PCIT is a robust intervention which typically requires minimal changes in implementation for a variety of populations, having a basic understanding of ASD symptomatology and using level of functioning to inform when and how to tailor PCIT to ASD populations is crucial in obtaining positive clinical outcomes.

https://link.springer.com/content/pdf/10.1007%2F978-3-030-03213-5_25.pdf

Melding of Two Worlds: Lessons Learned about PCIT and Autism Spectrum Disorders

Rooted deeply in behavioral theory and knowledge of Patterson’s coercive cycle, Parent-Child Interaction Therapy (PCIT) works with both caregivers and children to restore balance and positivity to family dynamics. PCIT uniquely implements live coaching to change maladaptive interactional patterns within caregiver-child dyads, with therapists collecting observational data to inform the progress of therapy. Due to the specialized skillset necessary to delivery this highly specified therapy, standardized training requirements and a certification process guide the practice of PCIT internationally. This chapter reviews the prerequisite education, basic training, clinical competencies, and case consultation required to become a PCIT Therapist. Additional recommendations are provided for supplemental training in autism spectrum disorders (ASD), including knowledge of diagnostic methods, connection with available ASD resources, and identifying ongoing educational outlets. Considerations for PCIT-ASD training are suggested.

Core Training Competencies for PCIT and ASD

Child abuse and neglect in young children can lead to trauma-related stress symptoms that can be challenging to manage. Parent-Child Interaction Therapy (PCIT), a strong evidence-based behavioral parent training program used for young children with behavior issues, has been used in its traditional form with increasing frequency with children and families who have trauma histories, with clinicians tailoring PCIT to use with children who have experienced trauma. Trauma-Directed Interaction (TDI) is a new systematic adaption to the standard PCIT parent training program that has the potential to help treat trauma in younger children. TDI includes several trauma-informed techniques that are added to a course of standard PCIT treatment including psychoeducation regarding trauma, recognition of feelings, and emotional regulation. This case study illustrates the use of a manualized trauma adaptation to PCIT (TDI) with a three-year-old boy who had a history of child maltreatment and his caregiver. This case provides a summary of the progression of this intervention and the results obtained. Results from the case indicated that TDI treatment was effective in not only reducing child trauma and behavioral symptoms but also in reducing mild caregiver mental health concerns. The next steps for TDI treatment and need for further research are discussed.

Christina M. Warner-Metzger

Papers

Child-Directed Interaction Training for Young Children With Autism Spectrum Disorders: Parent and Child Outcomes

Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma

Melding of Two Worlds: Lessons Learned about PCIT and Autism Spectrum Disorders

Core Training Competencies for PCIT and ASD

Utilizing Parent-Child Interaction Therapy with Trauma-Directed Interaction in a Young Male in Out of Home Care Who Had Experienced Trauma