Child Disruptive Behavior Research Articles

Parenting and disruptive child behavior: A daily diary study during the COVID-19 pandemic.

We examined how mothers' daily parenting cognitions and behaviors implicated by different theoretical perspectives (i.e., relational, learning theory, and cognitive perspectives) associated in linear or nonlinear ways with disruptive child behavior during the COVID-19 pandemic. We examined levels of heterogeneity between families in these patterns and whether this heterogeneity could be explained by mother and child characteristics. Mothers of 150 children, 3-8 years; 48% girls; 68% (sub)clinical conduct problems, completed 14 daily assessments (Nassessments = 1,993). Multilevel models indicate significant associations with daily disruptive child behavior for each of the parenting indicators, except for lax discipline. Positive involvement-implicated by relational perspectives-had a consistent, negative cubic association across families. Other associations were quadratic (for parental self-efficacy) or linear (for positive reinforcement, harsh discipline, and nonviolent discipline) and differed between families. Parenting behaviors indicative of learning theory and cognitive perspectives appeared more important in families with more maternal and child mental health problems; learning theory perspectives appeared more important also in families with older children. Our findings indicate the importance of considering nonlinear patterns of parent-child interactions in the context of disruptive behavior, at least in times where families are under pandemic-related stress. The identified between-family variation could potentially provide guidance as to what parenting support is most likely to benefit different families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating a free, common-elements curriculum for childhood disruptive behaviors: Family interaction training.

Evaluating a free, common-elements curriculum for childhood disruptive behaviors: Family interaction training.

Long-term effects of parent-child interaction therapy: A mixed-methods follow-up study of three and nine years later

Parent management training (PMT) programs are commonly used for treatment of child disruptive behaviour at a young age. Intervening early and involving parents in the interventions is used to limit adverse outcomes later in life. Yet, there is a dearth of literature that regard the long-term effects of such interventions. Therefore, the current study aimed to uncover, the long-term effects are of the PMT-program Parent-Child Interaction Therapy (PCIT) from the perspective of parents. A mixed-method approach was used in order to find out how parents reflected back on the treatment and to find out how parents and their children were doing. Nineteen semi-structured interviews were conducted at three and nine years follow-up, and two questionnaires regarding child disruptive behaviour and parenting stress were filled out pre-, and post-treatment and at six-months, three years and nine years follow-up. Results showed that generally, parents were satisfied with PCIT. They were positive about the decrease in their child’s disruptive behaviour and their own parenting stress, the lasting effects of learning parenting skills, and bettered inter-family relationships. Parents also expressed dissatisfaction with the treatment. They were unsure about the suitability of PCIT for all children, disagreement with the time-out procedure was mentioned and parents lacked long-term contentment with learnt parenting skills. Quantitatively, an overall decrease in clinical reports of child disruptive behaviour and parenting stress was seen, although there was a peak of clinical reports at three years follow up. The current study is a steppingstone for uncovering parents’ thoughts on PCIT retrospectively. It contributes to the knowledge about the long-term effects of intervening early for disruptive behaviour in the Netherlands. The overall consensus on PCIT is positive, although most parents state to need further guidance a few years later. Future research is warranted to further uncover long-term effects of PCIT from the perspective of parents with a larger population.

A randomized controlled trial of therapist-facilitated brief online behavioral parent training for reducing child disruptive behavior

BackgroundAddressing child disruptive behavior in low and middle-income countries (LMICs) is challenging. Therapist-facilitated, multisession, brief, online group parent training offers hope for mitigating this issue. However, trials, particularly in Asia, are limited. ObjectiveThis study primarily assessed the effectiveness of Brief Behavior Parent Training Vietnam (BBPTV) in reducing child disruptive behavior. MethodThis study was a randomized controlled trial involving 109 Vietnamese parents (mean age = 34.1, 96 % were mothers) of preschool children displaying ongoing disruptive behaviors. Interventions included the BBPTV group (n = 56) receiving a therapist-facilitated, four-session program conducted through online group meetings and the care-as-usual (CAU) group (n = 53) having a 15 min individual online consultation. Primary outcomes, assessed online at two and six months postintervention, encompassed the intensity and frequency of children's disruptive problems. Secondary outcomes involved parenting practices, coercive interactions, marital conflicts, parenting self-efficacy, and parental mental health. ResultsIn contrast to CAU, the BBPTV group showed lower child disruptive intensity, reduced parent-child coercive interactions, and diminished marital conflicts, with a higher score in involving parenting two months post-intervention. Six months postintervention, BBPTV also exhibited significantly lower scores in child disruptive intensity and problems, harsh parenting, and coercive processes compared to CAU. ConclusionsThe therapist-facilitated, four-session, internet-delivered group parent intervention resulted in superior and sustained improvements in child disruptive behavior, parenting practices, and parent-child coercive interaction compared to usual care, highlighting the potential for online BBPT to extend mental health care in Vietnam and other LMICs.

Better start to better future? Long-term follow-up of a parenting intervention for mothers being released from incarceration

Abstract Objectives This study examined the long-term effects of the Better Start program, an adaptation of Incredible Years parent training enhanced with home visits, for families with mothers being released from incarceration. Methods Participants in this quasi-experimental longitudinal study were 224 mothers, of whom 145 (64.7%) received intervention and the other mothers constituted a no intervention group. Official criminal justice records and mother reports of parenting behaviors and child behavior were collected up to 10 years after intervention. Mixed effects models, Cox regression analyses, and latent linear growth models were used to test potential intervention effects on adolescent delinquency, maternal recidivism, parenting behaviors, and disruptive child behaviors. Results Outcomes favoring participants in the intervention condition were found for adolescent delinquency, maternal recidivism, and the number of disruptive child behaviors. Conclusions Effects on maternal recidivism and delinquency in their children indicate that the Better Start program contributes to preventing the intergenerational transmission of delinquency.

Collateral effects of Coping Power on caregiver symptoms of depression and long-term changes in child behavior.

A large body of research demonstrates positive impacts of the Coping Power Program as a preventive intervention for youth behavioral outcomes, but potential collateral effects for caregivers is less known. The current study examined whether the youth-focused Coping Power Program can have a secondary impact on caregiver self-reported symptoms of depression and in turn result in longer-term impacts on child disruptive behavior problems including aggression, conduct problems and hyperactivity. Data from 360 youth/caregiver pairs across 8 waves of data (grades 4 through 10) were analyzed. We used two methodological approaches to (a) assess indirect effects in the presence of potential bidirectionality using timepoint-to-timepoint dynamic effects under Autoregressive Latent Trajectory modeling and (b) estimate scale scores in the presence of measurement non-invariance. Results showed that individually delivered Coping Power (ICP) produced greater direct effects on conduct problems and indirect effects on general externalizing and hyperactivity (through reductions in caregiver self-reported symptoms of depression), compared to group Coping Power (GCP). In comparison to GCP, ICP produced similar direct effects on reductions in caregiver depression. Child-focused prevention interventions can have an indirect impact on caregiver depression, which later shows improvements in longer-term reductions for child disruptive problems.

Evaluation of adapted parent training for challenging behaviour in pre-school children with moderate to severe intellectual developmental disabilities: A randomised controlled trial.

There is limited evidence on the effectiveness of parenting interventions to improve disruptive behaviour in children with intellectual developmental disabilities. This clinical trial evaluated whether an adapted group parenting intervention for preschool children with intellectual developmental disabilities who display challenging behaviour is superior to treatment as usual in England. 261 children aged 30-59 months with moderate to severe intellectual developmental disabilities and challenging behaviour were randomised to either the intervention (Stepping Stones Triple P) and treatment as usual or treatment as usual alone. The primary outcome was the parent-rated Child Behaviour Checklist at 52 weeks after randomisation. A health economic evaluation was also completed. We found no significant difference between arms on the primary outcome (mean difference -4.23; 95% CI: -9.99 to 1.53; p = 0.147). However, a subgroup analysis suggests the intervention was effective for participants randomised before the COVID-19 pandemic (mean difference -7.12; 95% CI: -13.44 to -0.81; p = 0.046). Furthermore, a complier average causal effects analysis (mean difference -11.53; 95% CI: -26.97 to 3.91; p = 0.143) suggests the intervention requires participants to receive a sufficient intervention dose. The intervention generated statistically significant cost savings (-£1,057.88; 95% CI -£3,218.6 to -£46.67) but the mean point estimate in Quality Adjusted Life Years was similar in both groups. This study did not find an effect of the intervention on reducing challenging behaviour, but this may have been influenced by problems with engagement. The intervention could be considered by services as an early intervention if families are supported to attend, especially given its low cost.

Supplemental Material for Parenting and Disruptive Child Behavior: A Daily Diary Study During the COVID-19 Pandemic

Supplemental Material for Parenting and Disruptive Child Behavior: A Daily Diary Study During the COVID-19 Pandemic

Caregiver adverse childhood experiences and preschool externalizing problems: The role of factors that contribute to caregiver resilience

BackgroundPreschool children with externalizing problems are at risk for short- and long-term difficulties and preschool externalizing problems (PEP) are influenced by several caregiver factors. One such factor is caregiver adverse childhood experiences (ACEs). Researchers have investigated how caregiver ACEs are related to PEP by identifying risk factors to account for this association. However, research on caregiver factors associated with fewer PEP is limited. Particularly, factors that contribute to caregiver resilience may be adaptive caregiver characteristics that negatively relate to PEP, even when adjusting for caregiver ACEs. ObjectiveThe present study sought to address a gap in the literature by examining the impact of different types of factors that contribute to caregiver resilience (e.g., caregiver social-ecological factors or caregiver positive childhood experiences) as promotive factors of lower PEP. Participants and settingParticipants included 125 caregiver-child dyads recruited from the community. MethodParticipating caregivers completed measures of their own and their child's demographic information, caregiver ACEs, caregiver social-ecological factors, caregiver positive childhood experiences, and PEP. ResultsOverall, positive caregiver childhood experiences (r = −0.25, p < .01), and not caregiver social-ecological factors (r = −0.13, p = .15), demonstrated a significant negative association with PEP. However, this relation became statistically non-significant when adjusting for caregiver ACEs (β = −0.12, p = .20). ConclusionsGiven the association between caregiver ACEs and PEP, this study highlights the importance of assessing a caregiver's ACEs, specifically when working with caregivers seeking parent training for disruptive child behaviors. There should be a continued focus on ecological and family strengths and differential impacts as they relate to PEP.

Associations Between Maternal Negative Affectivity and Young Children’s Disruptive Behavior Problems: The Mediating Effect of Callous-Unemotional Traits

The current study examined associations between maternal negative affectivity (NA) and child disruptive behavior problems. The mediating role of child callous-unemotional (CU) traits in these relationships was also investigated. A multilevel mediation modeling approach was adopted using a sample of 100 families with children between 2.5 and 5.5 years of age (N = 201; mean age = 3.8, standard deviation = 1.0). The mediation models showed significant mediating effects of maternal NA through CU traits for ADHD (β = 0.12, p<.01), ODD (β =0.13, p<.01), and aggression (β =0.16, p<.001), and a significant direct effect for aggression (β = 0.12, p<.05). A structural equation modeling analysis was also performed, and overall, the results were consistent with that from mediation models, which suggested that child CU traits were significantly correlated with maternal NA (β = 0.252, p<.001), ADHD (β = 0.504, p<.001), ODD (β = 0.545, p<.001), and aggression (β = 0.686, p<.001). Our results indicated that maternal NA could serve as a potential risk factor for child CU, which, in turn, may contribute to disruptive behavior during early childhood.

Machine Learning Identifies Smartwatch-Based Physiological Biomarker for Predicting Disruptive Behavior in Children: A Feasibility Study.

Objective: Parents frequently purchase and inquire about smartwatch devices to monitor child behaviors and functioning. This pilot study examined the feasibility and accuracy of using smartwatch monitoring for the prediction of disruptive behaviors. Methods: The study enrolled children (N = 10) aged 7-10 years hospitalized for the treatment of disruptive behaviors. The study team completed continuous behavioral phenotyping during study participation. The machine learning protocol examined severe behavioral outbursts (operationalized as episodes that preceded physical restraint) for preparing the training data. Supervised machine learning methods were trained with cross-validation to predict three behavior states-calm, playful, and disruptive. Results: The participants had a 90% adherence rate for per protocol smartwatch use. Decision trees derived conditional dependencies of heart rate, sleep, and motor activity to predict behavior. A cross-validation demonstrated 80.89% accuracy of predicting the child's behavior state using these conditional dependencies. Conclusion: This study demonstrated the feasibility of 7-day continuous smartwatch monitoring for children with severe disruptive behaviors. A machine learning approach characterized predictive biomarkers of impending disruptive behaviors. Future validation studies will examine smartwatch physiological biomarkers to enhance behavioral interventions, increase parental engagement in treatment, and demonstrate target engagement in clinical trials of pharmacological agents for young children.

Reach and predictors of effects during nation-wide dissemination of the universal parenting program All Children in Focus

BackgroundParenting programs have the potential to improve population health, if widely disseminated. However, wide-scale dissemination is challenging. Also, more knowledge is needed of whether parenting programs are effective for the variability of families in the general population.MethodsThis study aimed to investigate who the universal parenting program All Children in Focus (ABC) reaches when offered in routine care in Sweden. A second aim was to investigate if the outcomes were predicted by factors related to family background, group leader experience, and homework completion. Questionnaires were collected before and after ABC from 1420 parents. Hierarchical regression analyses were performed to examine predictors of disruptive child behavior, parenting practices, and satisfaction.ResultsABC was available in about 40% of Swedish municipalities and reached a fairly representative population sample, with the exception that fewer fathers than mothers participated. The examined predictors explained a small proportion of the variance in the outcomes (2.5, 3.5 and 14.7%, respectively). Still, the effect on disruptive child behavior was statistically significantly larger for parents born in Sweden, with higher education, and older children. The effect on parenting practices was also larger for parents born in Sweden, for mothers, and for those practicing homework more frequently. Most examined predictors showed no statistically significant association with child and parenting outcomes. Parents were generally satisfied with ABC and the significant predictors of satisfaction had little practical meaning.ConclusionsA fairly representative group of parents across Sweden were reached by ABC. Background variables, homework completion, and group leaders’ experience explained a small proportion of variance in the outcomes. Meanwhile, the slightly lower intervention effects found for preschool children and parents born abroad calls for further investigation, since even small differences in effects can have an impact at a population level. The study also points to the importance of stressing homework completion and to increase the reach of universal parenting interventions to some underrepresented groups.

Developing the Technology-based Parenting Young Children Check-Up Intervention for Disruptive Behavior Problems Identified in Pediatric Primary Care.

Behavioral parent training programs show clear efficacy and effectiveness in response to young children's disruptive behavior problems, but limitations in engagement and accessibility prevent many families from benefiting from these programs. The Parenting Young Children Check-up (PYCC) is a technology-based program designed to overcome these barriers and increase the reach of behavioral parent training. Developed for use in pediatric health care, the PYCC includes three components: 1) an initial check-up designed to motivate program involvement; 2) text messages to connect parents with program content and reinforce content; and 3) a parent training website involving video-based content to teach parenting skills. This report details initial steps to refine PYCC intervention components. Seventeen mothers and 17 primary care physicians participated in this mixed methods data collection across three iterations by providing feedback on early drafts of the three components of the PYCC and completing a feedback questionnaire. Feedback from one iteration informed modifications that were then evaluated in subsequent iterations. Saturation of qualitative input, positive qualitative feedback, and positive quantitative ratings on the feedback questionnaire was achieved in iteration three. Outcomes of this investigation informed the full version of the PYCC that will subsequently be tested in a proof-of-concept trial. Several barriers limit the reach of parenting skills programs that reduce child problem behavior. We gathered feedback from parents and physicians to refine a parenting program that uses technology and delivery in pediatrics to overcome barriers. Future testing of the program will further inform implementation in pediatric settings.

Virtual Delivery of Parent Coaching Interventions in Early Childhood Mental Health: A Scoping Review.

Parent-coaching interventions positively impact child development. Virtual delivery of such interventions is supported by literature reviews and a practice guideline, however, none of these focused on children under age six. A scoping review of virtually-delivered parent-coaching interventions for disruptive behaviour, anxiety, and parent-child relationship concerns in children under age six was conducted between Dec. 15, 2020 and April 22, 2021. Iterative searches of the databases PubMed, CINAHL, and PsycINFO were complemented by reference list searches and clinician expert review (N = 1146). After relevance screening and duplicate removal, collaboratively-developed inclusion criteria were applied to records, followed by data extraction from eligible articles (n = 30). Most literature documented behavioural-based interventions targeting disruptive behaviour which were delivered individually, by therapists, to White, non-Hispanic parents. Evidence supports feasibility and efficacy of virtually-delivered parent-coaching interventions to improve child disruptive behaviour (strong), anxiety (moderate), and parent-child relationship (weak). There is a significant gap in the literature regarding the virtual delivery of attachment-based parent-coaching interventions. In sum, virtual parent coaching can be an efficacious approach for children under age six, particularly for behavioural challenges.

Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments.

Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.

Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients.

To evaluate the effectiveness of the audiovisual distraction (AVD) technique and filmed modeling (FM) on anxiety and fear in pediatric dental patients. This experimental in vivo study was conducted on 80 subjects of age-groups 5-8 years coming to the Department of Pediatric and Preventive Dentistry for their first dental visit. Study subjects were subjected to noninvasive restorative treatment under AVD in group I, FM in group II, and a combination of AVD and FM in groups III and IV (control 0). To assess the level of pre and postoperative anxiety and fear, various biological parameters like pulse rate, oxygen saturation, body temperature, respiratory rate, and salivary cortisol estimation along with facial image scale (FIS), and fear assessment picture scale (FAPS) were used. Group III (a combination of AVD and FM) came out to be better than other experimental groups and control groups in reducing dental anxiety and fear in pediatric dental patients. A combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique. A child's disruptive behavior due to dental anxiety causes difficulty in delivering effective dental treatment. Thus, a child's behavior management is of paramount importance in the pediatric dental setup. Nonpharmacological behavior management techniques, that is, a combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique to reduce dental anxiety and fear in pediatric dental patients. Jamil F, Khan SY, Jindal MK. Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients. Int J Clin Pediatr Dent 2023;16(4):598-602.

ACADEMIC PERFORMANCE AND SCHOOL BEHAVIORS OF GRADE 7 OVERSEAS FILIPINO WORKERS’ CHILDREN IN TAGUDIN NATIONAL HIGH SCHOOL

This study aimed to assess the academic performance and school behavior of the children of Overseas Filipino Worker (OFW) enrolled at Tagudin National High School during the school year, 2022-2023. Specifically, it sought to answer the following: 1. What is the profile of the learners along a. Sex; b. Medium of communicating with parents; and c. Frequency of communicating with parents? 2. What is the level of academic performance of the Overseas Filipino Workers (OFWs) children? 3. What is the level of school behavior of Grade 7 OFW children along Hyperactive, Withdrawn, Poor attention/Concentration, Aggressive, Uncooperative, Disruptive, Manipulative, and Inappropriate Social Behavior; 4. Is there a significant relationship between the profile of the OFW children and the level of academic performance? 5. Is there a significant relationship between the level of performance of the OFW parents and children's level of school behavior 6. What plan can be proposed to improve the behavior of learners? 7. What is the level of acceptability of the action plan? The researcher used a descriptive correlational research design. The Grade 7 OFW children of will be the respondents. The study was conducted among the 91 OFW children enrolled at Tagudin National High School during the school year 2022- 2023. A total enumeration of the children of OFW enrolled were used as respondents. Based from the salient findings, the following conclusions are draw: 1. The respondents have distinct profiles from one another and no two individuals are exactly alike; 2. Classroom behaviors of the OFW children differ from one another but they execute favorable and unfavorable behaviors inside the class; 3. Sex affects the disruptive and uncooperative school behaviors of the OFW children of TNHS; 4. An action plan is a helpful material that contains strategies to improve the school behaviors of the TNHS OFW children; and 5. The developed action plan is simplified and down to earth but carries solutions to gauged problems of OFW children. From the findings and conclusions drawn, the following recommendations are hereby offered: 1. It is suggested that OFW children should be given more kindness and understanding as to their unfavorable behaviors yet they should establish a closer bonding with their OFW parents through the help of the social media's chat or messenger; 2. Misdemeanors conducted inside the class should be immediately settled by the teacher or guidance counselor with the guardian but teachers should possess many strategies to address issues and concerns like poor attention and low academic performance; 3. It is suggested that male students should be given roles inside the classroom to feel their importance and to deviate from untoward behaviors; 4. The action plan developed for the purpose of helping the OFW children focus their attention to their studies should be brought to the principal's office and when found worthwhile, be endorsed to all teachers of TNHS for their benchmark of their own classroom action plan; and 5. The action plan is timely and appropriate and it is a nice material to be used as benchmark to improve the school behaviors of OFW children.

Self‐monitoring with goal‐setting: Decreasing disruptive behavior in children with attention‐deficit/hyperactivity disorder

AbstractThis study sought to investigate the effects of a self‐monitoring (SM) with goal‐setting (GS) intervention on students' disruptive behavior. A multiple baseline A‐B‐BC design was implemented across five elementary school‐aged participants diagnosed with attention‐deficit/hyperactivity disorder (ADHD) to examine the use of a behavioral intervention combining SM and GS techniques to decrease disruptive behavior. The results of this study suggest that SM with GS appears to be an effective intervention package for decreasing the disruptive behavior of students with ADHD and that these behavioral decreases sustain after intervention completion. Results also suggest moderate benefits of using a SM with GS intervention over a SM intervention. Teacher ratings suggest that the SM with GS package is moderately acceptable for classroom use.

Adapting to Unprecedented Times: Community Clinician Modifications to Parent–Child Interaction Therapy During COVID-19

ABSTRACT Parent–Child Interaction Therapy (PCIT) is an evidence-based practice that effectively prevents and treats child disruptive behaviors and child physical maltreatment and reduces parenting stress. PCIT was adapted for telehealth delivery, internet-delivered PCIT (iPCIT), before the COVID-19 pandemic but was not widely implemented until the rapid transition to telehealth during stay-at-home orders. To understand how clinicians adapted PCIT during COVID-19, we followed up on a previous study investigating community clinician adaptations of PCIT pre-COVID-19 using the Augmenting and Reducing Framework. Clinicians (N = 179) who responded to the follow-up survey and reported delivering PCIT remotely completed a quantitative measure of adaptations at both time points (Fall 2019; Summer 2020) to assess how adaptations to PCIT changed following lockdown measures. Clinicians (n = 135) also provided qualitative descriptions of adaptations made early in the COVID-19 pandemic. Clinicians in the full sample were 74.3% Non-Hispanic White and 14% Latinx. Most clinicians had a master’s degree (66.5%), were licensed (80.4%), and were PCIT-certified (70.4%). Paired sample t-tests showed that clinicians reported similar levels of augmenting (t(179) = -0.09, p = .926) and reducing adaptations (t(179) = -0.77, p = .442) at both time points. Unlike quantitative findings, qualitative findings indicated that clinicians described engaging in many types of adaptations in response to the pandemic. Clinicians discussed engaging in augmenting adaptations by extending treatment length and integrating other practices into treatment. Clinicians also discussed engaging in reducing adaptations. Implications and future directions will be discussed.

Evidence-Based Treatment in Practice: PCIT Research on Addressing Individual Differences and Diversity Through the Lens of 20 Years of Service.

Parent-Child Interaction Therapy (PCIT) is an intensive parent support program for caregivers and their children who exhibit difficult-to-manage disruptive behaviors. After more than four decades of research supporting its efficacy for reducing children's disruptive behaviors and improving parent-child relationships, PCIT has become one of the most popular and widely disseminated parenting support programs in the world. The evidence for the efficacy of PCIT can be found in many reviews of randomized clinical trials and other rigorous studies. To add to those reviews, our aim was to provide practical guidance on how PCIT can be part of an evidence-based program for families that depends on practitioner expertise, as well as attention to families' diverse needs. To do this, we describe the evolution of PCIT as practiced in a university-community partnership that has continued for over 20 years, alongside a narrative description of selected and recent findings on PCIT and its use in specific client presentations across four themes. These themes include studies of 1) whether the standard manualized form of PCIT is efficacious across a selection of diverse family situations and child diagnoses, 2) the mechanisms of change that explain why some parents and some children might benefit more or less from PCIT, 3) whether treatment content modifications make PCIT more feasible to implement or acceptable to some families, at the same time as achieving the same or better outcomes, and 4) whether PCIT with structural modifications to the delivery, such as online or intensive delivery, yields similar outcomes as standard PCIT. Finally, we discuss how these directions in research have influenced research and practice, and end with a summary of how the growing attention on parent and child emotion regulation and parents' responses to (and coaching of) their children's emotions has become important to PCIT theory and our practice.