Parent-Child Interaction Therapy Research Articles

Parent-Child Interaction Therapy as Applied to Turkish Families: Effectiveness for Children with Behavior Problems and Their Caregivers

This study assessed the impact of Parent-Child Interaction Therapy (PCIT) on caregiver and child outcomes in Türkiye using a non-concurrent multiple baseline design (N = 3). Improvements in child disruptive behavior frequency were observed, with a large effect across participants (Tau-U = −0.74) and perceived problematic child behaviors (Tau-U = −0.87). School refusal, anxiety symptoms, and child emotion regulation improved with reliable change indices indicating clinically significant improvements (>1.96). Clinically significant decreases (RCI >1.96) in parenting stress and parent emotion regulation difficulties were also observed. Parents demonstrated improvements in parenting skills, as outlined by the PCIT protocol. This study highlights PCIT’s efficacy within a novel cultural context.

A Comparative Analysis of Parent–Child Interaction Therapy Procedures Used to Facilitate Verbalizations by Children with Autism

AbstractThe current study conducted a comparative analysis of the effects of select components of Parent–Child Interaction Therapy, labeled praise, behavior descriptions, and reflections on child vocalizations in two children with autism spectrum disorder and accompanying language delays using a concurrent multiple baseline across participants design. The frequency of verbalizations, the frequency of different verbalizations, and the mean length of utterance of words (MLUw) were measured during a baseline condition followed sequentially by two experimental conditions during a free play environment. The total number of therapist–child interactions remained consistent across all experimental conditions such that only the topography of the interactions varied across conditions. During the first experimental condition the clinician used labeled praise and behavior descriptions during child play. After establishing stability of changes under these conditions, the therapist systematically added reflections of child vocalizations in the second experimental condition. Total verbalizations, different verbalizations, and MLUw increased following the introduction of labeled praise and behavior descriptions. Total verbalizations and different verbalizations increased and the frequencies accelerated following the systematic introduction of reflections. The study showed the relative value of reflections of child verbalizations as a powerful component of Parent–Child Interaction Therapy procedures to facilitate verbalizations by children with autism.

Impact of the Opioid Crisis on Parent–Child Interaction Therapy Outcomes: A Mixed-Methods, Community-Based Comparison in West Virginia

Impact of the Opioid Crisis on Parent–Child Interaction Therapy Outcomes: A Mixed-Methods, Community-Based Comparison in West Virginia

Black Clinicians' Perceptions of the Cultural Relevance of Parent-Child Interaction Therapy for Black Families.

Parent-child interaction therapy (PCIT) is a highly efficacious, evidence-based treatment for children with disruptive behaviors and their families. PCIT is a dyadic therapy designed to improve parent-child relationships and decrease children's behavioral problems. PCIT research specific to Black families is currently sparse. Given findings that Black families have a higher attrition rate and demonstrate fewer significant improvements in parental well-being outcomes, we sought to assess clinicians' perceived cultural alignment of PCIT with Black families. We conducted individual interviews via Zoom with 10 Black clinicians, trained in PCIT, who had experience treating Black families using PCIT. The research team generated the following themes using thematic analysis: cultural misalignment, manualization, barriers to treatment, generational patterns of discipline, racial considerations, and protocol changes. Findings indicate that Black clinicians have identified various points of cultural misalignment in providing PCIT with Black families, for which they have modified treatment or suggested changes to improve cultural sensitivity. Collating suggested clinician modifications to inform a cultural adaptation of PCIT for Black families may contribute to a reduction in the attrition rate and improvement in outcomes for Black families participating in PCIT.

Trajectories of Change in Parent–Child Interaction Therapy Outcomes in Latinx Families: Implications for Cultural Adaptation

ABSTRACT Objective Parent–Child Interaction Therapy (PCIT) is a parenting program in which caregivers must achieve “skill criteria” in using Do Skills and avoiding Don’t Skills to complete treatment. Despite PCIT’s emphasis on these skills, little is known about how Latinx caregivers acquire these Western-based parenting practices and whether cultural mismatches lead to inequities in outcomes. This study compared the trajectories of change in PCIT skills and treatment outcomes of Latinx and non-Latinx White families. Method We analyzed weekly treatment data from 64 families (20.3% Spanish-speaking Latinx, 51.6% English-speaking Latinx, 28.1% non-Latinx White) served in community clinics. Caregivers were mostly females (95.3%), on average 35.13 years old, and lived in poverty (77.6%). PCIT skills were coded using the Dyadic Parent–Child Interaction Coding System, and child behavior problems were reported using the Eyberg Child Behavior Inventory. Results Latinx and non-Latinx White caregivers acquired Do Skills similarly during treatment. In contrast, some Latinx caregivers began treatment using significantly more Don’t Skills and needed more sessions to achieve some aspects of PCIT skill criteria compared with non-Latinx White caregivers. Latinx families also experienced similar or even more pronounced reductions in child behavior problems than non-Latinx White families. There were no significant differences in the percentage of caregivers who achieved PCIT skill criteria or left treatment prematurely. Conclusions This study provides evidence that strictly defined PCIT skill criteria may lead to inequities in treatment length for some Latinx families. Informed by these findings, we propose data-driven adaptations to improve the cultural fit of PCIT for Latinx groups.

Parent-Child Interaction Therapy with Separated Parents of a 3-Year-Old Child with Conduct Problems and Callous-Unemotional Traits

Callous and unemotional (CU) traits are associated with an earlier onset of conduct problems in children. The presence of CU traits typically predicts a severe, stable, and aggressive pattern of behavior, especially when the onset of such behaviors begins in childhood. Children with conduct problems and CU continue to exhibit challenging behavior despite implementation of behavior management strategies compared to children with conduct problems alone. An emerging body of research suggests that Parent-Child Interaction Therapy (PCIT) specifically tailored to address the characteristics unique to CU traits (PCIT-CU) may be an effective intervention for children with conduct problems + CU. This case study presents the treatment of a 3-year-old boy using PCIT-CU who presents with oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder—combined presentation (ADHD-C), and CU traits. Both caregivers participated but were separated. Following the completion of treatment, conduct problems improved, parent ratings of CU traits decreased, and positive parenting practices increased. This case study adds to the growing literature in support of tailoring behavioral management training interventions for children with conduct problems + CU.

Organizational Mediators of Sustainability in a Randomized Controlled Trial

ABSTRACT Background Prior systematic reviews and research have suggested that certain organizational characteristics and training methods may support the sustainability of new practices, yet these factors have not been adequately studied in behavioral health. Objective The objective of this study was to test the indirect effects of training design (e.g. training condition and consultation call attendance) on clinician-reported sustainability through post-training organizational resources, training exposure and utilization, and organizational climate. Method Fifty licensed outpatient clinics, including 100 clinicians, 50 supervisors, and 50 administrators were randomized to one of three training conditions: 1) Learning Collaborative (LC), 2) Cascading Model (CM), or 3) Distance Education (DE). All were trained to provide Parent Child Interaction Therapy (PCIT). Data to assess training and implementation outcomes were collected at 4 time points coinciding with the training period: baseline, 6- (mid), 12- (post), and 24-months (1-year follow-up). Multi-level path analysis was utilized to examine the role of organizational barriers and training approaches on the sustainability of PCIT (caseload, protocol use, number of families seen). Results Clinician-reported resources, training exposure and utilization, and organizational climate varied among study conditions, with the most favorable conditions reported in the CM condition and the least favorable conditions reported in the LC condition. The CM condition was associated with greater PCIT caseload, more families served by the PCIT program, and less use of the full PCIT protocol as compared to the DE condition, while the LC condition was associated with fewer families served and more use of the full PCIT protocol. Conclusions Organizational factors such as available resources, organizational climate, and training exposure and utilization indirectly influence the effect of training approach and consultation on PCIT sustainability two years after baseline and vary based on condition. A possible mechanism of the cascading training model on sustainability, through increased organizational resources, was also identified.

Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths.

Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.

The Effects of Parent-Child Interaction Therapy on Parent Feeding Practices and Children’s Problematic Mealtime Behaviors

Many children are fussy or demanding about food, and managing these behaviors can be difficult and distressing for parents. Yet, no previous study had examined whether Parent-Child Interaction Therapy (PCIT), an interactive parenting support program that coaches caregivers while they interact with their young children, improves problematic mealtime behaviors and food-related parenting practices. In this study, 178 parents in Australia (Mage = 35.1 years, SD = 7.5 years; 93% female) of young children (Mage = 4.5 years, SD = 1.3, 76% male) completed up to two baseline surveys (prior to a waitlist, pre-PCIT) and a third survey after PCIT. The surveys included measures of their parenting practices in general and related to feeding and mealtimes, beliefs about eating, and children’s mealtime behavior (e.g., food avoidance, mealtime aggression) and general externalizing symptoms. Using paired t-tests, no changes were found during baseline (pre-waitlist to pre-PCIT), but from pre- to post-PCIT, medium to large improvements were found in parent mealtime demandingness and responsiveness, aversion to mealtime, child eating behaviors, general parenting practices, and child externalizing behavior. However, positive mealtime environment did not improve and improvements in general parenting and behavior were larger than for eating-related parenting and child behavior. The findings suggest that PCIT can be effective for reducing most problematic mealtime behaviors and can improve multiple parental feeding practices.

Impact of a Brief Parenting Intervention on Parent and Infant Imitation

Research examining the effect of behavioral parenting interventions, such as parent–child interaction therapy (PCIT), on parent and child imitation is limited despite known benefits to early child development. We examined the effect of a brief, home-based adaptation of PCIT, the Infant Behavior Program (IBP), on changes in observed frequency of parent and infant imitation, moderating effects of parent language (English, Spanish), and mediational effects of parent and infant imitation on the effect of intervention on infant behavior problems. Participants were 60 12- to 15-month-olds with elevated behavior problems and their primary caregiver, all of which were mothers. Parent–infant dyads were randomly assigned to receive either the IBP or standard pediatric primary care. Parents receiving the IBP demonstrated significantly higher rates of observed imitation at postintervention and at the 3-month follow-up compared to those receiving standard care, and the effect at postintervention was stronger for English-speaking than for Spanish-speaking families. Although the IBP did not directly affect changes in infant imitation at postintervention or the 3-month follow-up, rates of infant imitation increased significantly for those who received the IBP at the 6-month follow-up. Additionally, moderation results suggested that the IBP led to improvements in infant imitation at post for Spanish-speaking families but not for English-speaking families. There were no significant mediational effects of parent or infant imitation. Future research is needed to examine the impact of increases in imitation on other aspects of child development, such as social–cognitive and language abilities, and to examine how cultural factors may play a role in individual differences in imitation.

Mothers with a history of trauma and their children: a systematic review of treatment interventions.

Mothers with a history of trauma frequently face significant challenges in their relationships with their children. Therefore, it is crucial for trauma-exposed mothers and their young children to receive adequate trauma-informed treatment. This review aimed to examine the effects of trauma-informed interventions on improving the mother-child relationship among mothers with a history of trauma and their young children under 6 years old. The study analyzed 15 articles that met the eligibility criteria, encompassing a sample size of 1,321 mothers. The systematic GRADE approach was used to rate the certainty of evidence in this systematic review. The study found that while some interventions demonstrated small to large effects, the quality of evidence was only moderate. The most promising interventions were Parent-Child Interaction Therapy (PCIT), Child-Parent Psychotherapy (CPP), and Maternal Empowerment Program (MEP), which all included elements of psychotherapy, psychoeducation, and skills training. The study underscores the importance of understanding the needs of mother-child dyads affected by trauma and tailoring interventions to meet those needs. Overall, the literature suggests that interventions combining psychotherapeutic, psychoeducational, and skills-training components are most effective in improving mother and child-related outcomes for mothers with a history of trauma and their young children. The review provides recommendations for future research and emphasizes the importance of considering the mother-child relationship in trauma-informed interventions.

PARENT-CHILD INTERACTION THERAPY: A LITERATURE REVIEW ON ITS EFFECTIVENESS FOR CHILDREN WITH AUTISM SPECTRUM DISORDER (ASD)

Autism Spectrum Disorder (ASD) affects children and their learning in a variety of ways. ASD is a developmental disorder that is marked by profound deficits in social, language, and cognitive abilities. The core features of ASD are areas in which difficulties can lead to feelings of frustration, confusion, anxiety or lack of control, resulting in behavioural responses. This article offers an overview of the literature, focusing on the effectiveness of Parent-Child Interaction Therapy (PCIT) which used to improve the relationship between parent-children and to reduce noncompliance behaviour in children with ASD. The PCIT is an empirically-supported treatment for conduct-disordered for young children aged two to seven that highlights on improving the quality of the relationship between parents and child and changing inappropriate pattern of parent-child interaction. Early relationships between parents and children have powerful impacts on children’s behaviour and emotional development. When parents are responsive and sensitive to child’s cues, they contribute to the coordinated back and forth of interaction with the child. This kind of interaction helps children develop self-sense and emotional regulation skills such as self control and self-calming. Furthermore, in order to help young children to develop lifelong motivation in their self, parents are encouraged to participate in everyday learning and playing activities. Therefore, identifying the most effective intervention parenting programmes for enhancing and rebuilding parent-child relationships through teaching parent the skills necessary for coping with noncompliance behaviour in young children with ASD is crucially important. Overall, the findings of this study demonstrate the potential of PCIT as an early intervention to improve the behavioural functional outcomes of preschool children with ASD.

Parent Explanatory Model Personalization as a Method of Reducing Risk for Poor Engagement and Outcomes in PCIT among Culturally Diverse Families.

Background/Objectives: Evidence supports the efficacy of Behavioral Parent Training (BPT) interventions such as Parent-Child Interaction Therapy (PCIT) for treating child behavior problems; however, treatment engagement and outcomes vary across ethnic groups. Risk for poor treatment engagement and outcomes may be attributed in part to misalignment between parent explanatory model components (PEMs) and the traditional BPT model, including treatment expectations, etiological explanations, parenting styles, and family support for treatment. The present study aims to examine whether personalized treatment adaptations addressing these PEM-BPT misalignments reduce risk for poor treatment engagement and outcomes. Methods: The authors previously utilized the PersIn framework to develop a personalized version of PCIT (MY PCIT) that assesses these PEMs in order to identify families at risk for poor treatment engagement and outcomes. Families were identified as high risk (due to PEM-BPT misalignment) and low risk (meaning those without identified PEM-BPT misalignment) for specific PEMs. Families at elevated risk then received tailored treatment materials designed to improve alignment between the parental explanatory model and the PCIT treatment explanatory model. A recent pilot trial of MY PCIT demonstrated positive treatment outcomes; however, the extent to which adaptations were successful in reducing the underlying risk factors has not yet been examined. Results: Findings demonstrate that the personalization approach was effective in reducing indicators of risk, and that families who were initially at high and low risk during pre-treatment reported similar levels of treatment engagement and outcomes by post-treatment. Conclusions: The findings suggest that this personalized approach has the potential to reduce risk associated with poor treatment engagement and outcomes for culturally diverse families.

Impact of parent child interaction therapy on child eating behaviors

BackgroundPicky eating commonly co-occurs with disruptive behaviors in young children. While feeding interventions exist, it remains unknown whether unmodified behavioral parent training (BPT) improves maladaptive child eating. As coercive feeding practices may exacerbate picky eating, BPT could ameliorate associated behaviors by increasing authoritative parenting. MethodsCaregiver-child dyads (N = 194, ages 2–8) received 18 weeks of Parent-Child Interaction Therapy (PCIT). Caregivers completed the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) at pre-, mid-, and post-treatment. The BPFAS overall picky eating frequency and number of problems was examined, as well as the subscale of mealtime misbehaviors, and overall caregiver feeding practices. ResultsFrom pre-to post-treatment, reductions occurred in frequency/problems scales across overall BPFAS child behaviors. Mealtime misbehaviors significantly declined at all checkpoints - early skill acquisition may drive this early change, whereas changes in frequency/problem scales occurred after mid-treatment, suggesting later skill acquisition may be driving these changes. On the coercive caregiver feeding subscale, multivariate regression identified a significant race by time interaction (p = .02) - multiracial caregivers improved while others showed no difference. ConclusionStandard PCIT, not adapted for feeding concerns, decreased maladaptive child eating behaviors across all caregivers and coercive feeding practices in multiracial caregivers. Authoritative parenting principles may generalize to eating contexts for certain cultural groups. PCIT shows promise as an early upstream intervention potentially changing trajectories without needed feeding content modifications. Assessment of long-term maintenance is warranted. Coupling with nutrition education could optimize impact.

Family engagement in a behavioral parenting intervention: A randomized comparison of telehealth versus office-based treatment formats.

Despite effective treatment options, many families-especially those from marginalized backgrounds-lack access to quality care for their children's behavioral difficulties. Since the COVID-19 pandemic, telehealth has become a prominent format for the delivery of outpatient services, with potential to increase access to quality care. Although telehealth-delivered parenting interventions are associated with positive clinical outcomes, limited research has examined whether telehealth formats improve treatment engagement relative to office-based care. The present study is the first controlled comparison of engagement across office-based parent-child interaction therapy (PCIT) and internet-delivered PCIT (iPCIT). Children ages 3-5 years, and their caregiver(s) (N = 40) participated in a randomized trial comparing iPCIT to office-based PCIT in the treatment of behavioral problems. Analyses examined the effects of treatment format on engagement (i.e., missed sessions, premature treatment discontinuation, homework completion, therapeutic alliance, and treatment satisfaction). Logistic and linear regressions further explored whether treatment format moderated the effects of common predictors of treatment engagement (i.e., family economic means, racial/ethnic background, caregiver stress). iPCIT improved attendance rates relative to office-based PCIT, especially for families from minoritized racial/ethnic backgrounds. At the same time, among families with relatively higher levels of caregiver stress, office-based PCIT was associated with lower dropout rates and improved treatment alliance and satisfaction, relative to iPCIT. This study provides the first experimental support that telehealth formats can improve treatment attendance in behavioral parenting interventions. Findings highlight nuances in treatment engagement across treatment formats that reveal limits to the extent telehealth transcends engagement concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The added value of virtual reality to parent–child interaction therapy: a qualitative study with parents and therapists

BackgroundVirtual reality (VR) is one of the most rapidly growing technological advancements being studied, developed, and implemented in mental health care. It offers a wide array of possibilities that go beyond the traditional ways of providing mental health care services. Many interventions require clients to learn new skills in order for change to occur. Relevant to this study, behavioral parent-training (BPT) interventions are focused on the acquisition of parenting skills in order to change child behavior. VR was added to the Parent–Child Interaction Therapy (PCIT) – a known BPT intervention — as an additional practice tool. In the present study, which is part of a larger study, the qualitative experiences of (PCIT-)VR from both parents’ and therapists’ perspectives are evaluated, as well as their suggestions for implementation.MethodSemi-structured interviews were conducted with eleven parents. Five therapists participated in a focus group and three additional semi-structured interviews were conducted with therapists. To analyze, a combination of deductive and inductive thematic analysis was used.ResultsResponses from interviews were divided into three categories: (1) parents’ evaluation, (2) therapists’ evaluation, and (3) suggestions for implementation from both parents and therapists. Next to a positive overall experience with PCIT, a large number of parents were also positive about the addition of VR to treatment. Both parents and therapists experienced VR as a useful additional practice tool. The additional practice in VR led to a boost in confidence in using positive parenting skills. There were mixed experiences regarding the ease and immersion of the tool. Suggestions for implementation from both parents and therapists were to make the tool more appealing and realistic, to vary more in VR modules and to improve certain practical aspects.ConclusionAdding VR to PCIT is still a pioneering piece of technology within PCIT. The value of this VR tool lies in the provision of the possibility to practice with skills outside of the therapeutic encounter, which has the potential to instill confidence in using those skills. Given the positive experiences regarding PCIT-VR, it is important to further develop the VR tool. We believe that ultimately, PCIT-VR can potentially serve as a customized way for parents to practice what they are taught during the treatment.

Treatment Engagement and Outcomes in Parent–Child Interaction Therapy with Mothers with a History of ADHD: A Case Series

Behavioral parent training is the recommended intervention for young children with disruptive behavior and/or attention-deficit/hyperactivity disorder (ADHD). Parent–child interaction therapy (PCIT) is an empirically supported behavioral parent-training program for families of children ages 3–6 years old. Behavioral parent-training programs, including PCIT, rely on parents as the primary agents of therapeutic change. Parents who face barriers to adequate engagement with these programs may also struggle to implement the changes necessary for children’s behavior to improve. Parental characteristics that may prevent treatment engagement, however, are seldom considered in the research literature or in clinical practice. The current case series describes engagement indicators in three mothers taking part in PCIT. Each mother has a history of diagnosed or suspected ADHD, and this series explores their ADHD-related symptoms as they relate to the treatment of their child’s behavior.

A naturalistic evaluation of parent-child interaction therapy (PCIT) and PCIT with trauma-directed interaction (PCIT with TDI) in Australian children exposed to abuse and neglect

BackgroundTo optimize PCIT treatment with children exposed to abuse and neglect, PCIT with Trauma-Directed Interaction (PCIT with TDI) was created. ObjectiveThe current study was a quasi-experimental cohort study (PCIT and PCIT with TDI treatment groups) with pre/post-treatment comparisons. The study was conducted in a statutory child protection agency and was a naturalistic evaluation of the outcomes achieved by this service. The outcomes under investigation included caregiver and child posttraumatic stress symptoms, child behavior problems, parenting stress, caregiver mental health, child protection notifications, and placement permanency goals. Participants and settingChildren were included in the study if they were aged between 2 and 7 years, had behavioral difficulties or trauma symptoms and/or their caregivers were experiencing parenting stress. MethodsFamilies were allocated to treatment group by clinician availability/preference (i.e., preference allocation). Caregivers were asked to report on child posttraumatic symptoms and behavioral issues; and to self-report on posttraumatic stress, general stress, parenting stress, and depression and anxiety at prescribed points in treatment. FindingsSixty-eight children and their caregivers were treated with either PCIT (n = 22) or PCIT with TDI (n = 46). Statistically significant changes were observed for both treatment conditions for some of the outcomes of interest for both children (i.e., child behavioral problems, posttraumatic stress) and their caregivers (i.e., general stress, posttraumatic stress). There was no significant main effect of treatment on any of the outcomes of interest. ConclusionFuture research should include a randomized controlled trial to adequately determine the efficacy of PCIT versus PCIT with TDI with this population.

Caregiver Distress and Child Behavior Problems in Children with Developmental Delay from Predominantly Minoritized Backgrounds

ABSTRACT Importance Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. Objective We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent–Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. Method Children aging out of early intervention services (n = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. Results Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. Conclusions Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.

The Efficacy of Parent-Child Interaction Therapy (PCIT) for Youth with Attention-Deficit/Hyperactivity Disorder (ADHD): A Meta-Analysis.

Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent in early childhood and has long-term negative effects when left untreated. Parent-Child Interaction Therapy (PCIT) is an early intervention for children aged 2- to-7-years that has extensive evidence for treating child externalizing problems by teaching parents effective strategies to manage child behavior. However, the effect of PCIT for families with children diagnosed with ADHD is not completely understood. This meta-analysis aims to synthesize research on the use of PCIT for children with ADHD. Nine out of 711 identified studies were analyzed. Summary effect sizes were calculated using the standardized mean gain for child ADHD symptoms, child behaviors, parent stress, and parenting behaviors, and the Fail-Safe N was calculated to determine the robustness of the results. Overall, PCIT had a significant beneficial effect on child ADHD symptoms (g = 0.90), child behavior (g = 0.44), parent stress (g = 0.82), and parenting behaviors (g = 2.15). Results of this meta-analysis suggest that PCIT is an effective treatment for reducing core symptoms of ADHD.