Is Parent Child Interaction Therapy Efficacious for Families with Young Children with Autism Spectrum Disorder?
The Child Directed Interaction (CDI) phase of Parent Child Interaction Therapy (PCIT) emphasizes following the child’s lead in play and increasing parent-child attachment (Harwood & Eyberg, 2006) and may be a particularly promising intervention for children with autism spectrum disorder (ASD). CDI has been associated with increased prosocial behaviors and decreased parent stress across child populations including those with disruptive behavior problems (Eisenstadt, Eyberg, McNeil, Newcomb, & Funderburk, 1993), anxiety disorders (Choate, Pincus, Eyberg, & Barlow, 2005), and intellectual disability (Bagner & Eyberg, 2007). CDI also shares similarities with naturalistic teaching interventions because it focuses on a child-led play situation which creates an environment in which the child views play, as well as parent-child interaction, as a positive, rewarding experience and promotes social and communicative learning as well as skill generalization (Masse, McNeil, Wagner, & Chorney, 2008). Together, the shared features of parent based and naturalistic interventions as well as research support for behavioral change following CDI in other populations suggests that CDI may be an effective intervention for families with a young child with ASD.
The purpose of the study was to examine the efficacy of the CDI phase of PCIT in a randomized control trial with young children with ASDs for improving child social and behavioral functioning as well as changing parenting behaviors and stress.
Participants were 30 families with children ages 3 to 7 with a previous diagnosis of ASD. Families were randomized into either the Immediate treatment (IT) or the Waitlist (WL) condition. Treatment consisted of a total of 8, weekly sessions of manualized CDI, in which families received live coaching of the treatment skills during play with their child. To assess parenting behaviors, families participated in a child-led play situation which was coded using the Dyadic Parent–Child Interaction Coding System (DPICS) to examine parenting behaviors. Parents also completed the Parent Stress Index, Social Responsiveness Scale, and the Eyberg Child Behavior Inventory at pre-, post-, and 6-week follow up assessments.
Parents in the IT condition reported significantly fewer child disruptive behaviors, F(1,27)= 16.56, p < .001 d = 1.12, as well as gains on the Social Awareness subscale, F(1,27)= 6.82, p = .02, d = 1.03 when compared to the WL condition. Across 8 sessions mothers learned to provide positive attention to their children’s appropriate social and play behaviors, F(1, 27) = 92.45 , p < .001, d = 2.60. No differences in total parenting stress were found, however, parent distress associated with disruptive behavior was reduced F(1, 27)= 6.73, p = .02, d= 0.79. All outcomes were maintained at 6-week follow up.
Following CDI, children showed less disruptive behaviors and more awareness of social cues; and parents demonstrated improved positive parenting skills and reduced distress associated with child externalizing behaviors. This study has important implications as it suggests that a relatively brief, time-limited intervention that is widely accessible to families can lead to clinically significant and meaningful changes for families with a child with ASD.