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BACKGROUND: Picky 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. METHODS: Caregiver-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. RESULTS: From 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. CONCLUSION: Standard 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.
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Comportamento Infantil , Comportamento Alimentar , Seletividade Alimentar , Relações Pais-Filho , Poder Familiar , Humanos , Masculino , Feminino , Pré-Escolar , Criança , Poder Familiar/psicologia , Comportamento Alimentar/psicologia , Comportamento Infantil/psicologia , Terapia Comportamental/métodos , Adulto , Pais/psicologia , Cuidadores/psicologiaRESUMO
OBJECTIVE: Parent-child interaction therapy (PCIT) is an effective intervention to address child externalizing behaviors. However, disparities in access and retention are pervasive, which relate to the availability of PCIT in low-income communities, inadequate workforces to provide culturally appropriate care, and distrust in services due to systemic discrimination. This study incorporated natural helpers who had been trained as community health workers into PCIT delivery to improve disparities in engagement and outcomes. METHOD: Families from three low-income, predominately Latino/a/x and Black neighborhoods in Miami qualified for services if they had a child aged 2-8 with clinically elevated externalizing behaviors. Families were randomly assigned into either Standard-PCIT group (N = 30 families; 80% boys, 57% Latino/a/x, 27% Black) or a PCIT plus Natural helper (PCIT+NH) group (N = 51 families; 66% boys, 76% Latino/a/x, 18% Black). Families in the PCIT+NH group received home visits and support addressing barriers to care from a natural helper. Path analyses within an intention-to-treat framework examined group-differences in treatment engagement, child behavior, and parenting skills and stress. RESULTS: Families in both groups demonstrated large improvements in child externalizing behavior, caregiver stress, and parenting skills from pre-to-post-treatment. Externalizing behavior improved significantly more in the PCIT+NH group compared to the Standard-PCIT group. There were no significant group differences in parenting skills or caregiver stress. Though differences in engagement were not significant, the PCIT+NH group had a small effect on treatment retention. CONCLUSIONS: Natural helpers may help to address structural barriers that systematically impact communities of color, apply treatment in naturalistic environments, and promote improved treatment outcomes.
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Transtornos do Comportamento Infantil , Masculino , Criança , Humanos , Feminino , Projetos Piloto , Transtornos do Comportamento Infantil/terapia , Transtornos do Comportamento Infantil/psicologia , Resultado do Tratamento , Comportamento Infantil/psicologia , Relações Pais-Filho , Poder Familiar/psicologiaRESUMO
OBJECTIVE: Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children's mental health care. METHODS: Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child's problems and family help-seeking. RESULTS: Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families' values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response. CONCLUSIONS: The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).
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Etnicidade , Serviços de Saúde Mental , Cuidadores , Criança , Minorias Étnicas e Raciais , Família , Humanos , Grupos MinoritáriosRESUMO
Disparities in care for low-income children of color call for innovative culturally and linguistically responsive solutions to better engage marginalized populations in evidence-based interventions. In partnership with a community organization, the addition of natural helper support as an adjunct to Parent-Child Interaction Therapy (PCIT+NH) was examined as a strategy to increase recruitment, engagement, and retention in PCIT for families historically unreached by a university-based clinic. Natural helpers provided home-based skills practice and support for forty-two families whose parents were more racially and linguistically diverse and had lower income and lower caregiver education than the typical population served by the same program (i.e., program population). Families who received PCIT+NH had comparable or higher rates of engagement and improvements in clinical outcomes (i.e., decreased child externalizing and internalizing behaviors, increased child compliance, decreased caregiver stress, increased caregiver parenting skills) relative to the program population. Furthermore, higher doses of natural helper support were associated with higher rates on most measures of treatment engagement (i.e., treatment completion, completion of the Child Directed Interaction phase of treatment, PCIT sessions, homework in the Parent Directed Interaction phase of treatment), with the exception of homework in the Child Directed Interaction phase of treatment and overall session attendance rate. Next steps for testing the treatment engagement and clinical outcome effects of the PCIT+NH model are discussed.
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OBJECTIVE: This study examined the feasibility and initial outcome of a time-limited and intensive format of Parent-Child Interaction Therapy (PCIT) for families of young children who have sustained a traumatic brain injury (TBI). METHODS: The nonrandomized open trial included 15 families with a child aged 2-5 years who had sustained a TBI and displayed clinically elevated levels of externalizing behavior problems. Families received clinic-based PCIT twice per week over an average of 6 weeks, with the exception of two families that received the same intensity and format of PCIT in the home. RESULTS: Ten of the 14 families who completed the baseline assessment (71%) completed the intervention and post and follow-up assessments. On average, caregivers completed homework practice on 52% of the days in between sessions. Caregivers reported high acceptability and satisfaction following the intervention, as well as decreases in child externalizing and internalizing behavior problems at the post-assessment and 2-month follow-up. CONCLUSIONS: Results of this open trial provide preliminary support for the feasibility of a time-limited and intensive format of PCIT for families of young children who have sustained a TBI and have elevated levels of behavior problems. This study highlights a promising intervention approach for improving domains commonly affected by early childhood TBI and preventing the development of more severe and persistent problems.
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Lesões Encefálicas Traumáticas , Comportamento Problema , Terapia Comportamental , Lesões Encefálicas Traumáticas/terapia , Pré-Escolar , Estudos de Viabilidade , Humanos , Relações Pais-FilhoRESUMO
Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent-Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (MChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.
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Terapia Comportamental/métodos , COVID-19/epidemiologia , Transtornos do Comportamento Infantil/psicologia , Transtornos do Comportamento Infantil/terapia , Relações Pais-Filho , Telemedicina , Adulto , Criança , Feminino , Florida , Humanos , Masculino , Pandemias , Projetos Piloto , SARS-CoV-2RESUMO
Mental health interventions for infants typically target high-risk groups and can prevent long-term negative outcomes. Despite federal initiatives promoting early intervention, minimal research has examined usual care services for infants, which is important to improve routine care. The current study characterized usual care practices in infant mental health through the adaptation and administration of a provider survey. Providers (n = 126) reported using a wide range of intervention strategies and few intervention programs with varied evidence. Findings can inform future research to identify quality improvement targets of usual mental health care for high-risk infants and their families.
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Serviços Comunitários de Saúde Mental/organização & administração , Família , Adaptação Psicológica , Adulto , Idoso , Características Culturais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Relações Pais-Filho , Poder Familiar/psicologia , Resolução de Problemas , Fatores de Risco , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVE: To summarize recent research on negative behavioral and cognitive outcomes following early childhood traumatic brain injury (TBI). METHODS: Topical review of the literature published since the year 2000 examining behavioral and cognitive difficulties following TBI in early childhood. RESULTS: Research findings from the reviewed studies demonstrate a variety of negative behavioral and cognitive outcomes following TBI in childhood, particularly for children <5 years of age. Negative outcomes include problems with externalizing behaviors, attention, language, and cognitive functioning (e.g., IQ, executive functioning). Furthermore, negative outcomes have been shown to persist up to 16 years following the injury. CONCLUSIONS: The empirical studies reviewed demonstrate the increased risk for negative behavioral and cognitive outcomes following early childhood TBI. Furthermore, the review highlights current strengths and limitations of TBI research with young children and the need for multidisciplinary work examining outcomes for this vulnerable pediatric population.
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Lesões Encefálicas/psicologia , Transtornos do Comportamento Infantil/etiologia , Transtornos Cognitivos/etiologia , Atenção , Pré-Escolar , Cognição , Função Executiva , Humanos , Lactente , Recém-NascidoRESUMO
The current study examined the effect of Parent-Child Interaction Therapy (PCIT), a parent-training intervention for child behavior problems, on child language production. Participants were 46 children (ages 20-70 months) with externalizing behavior problems and with or at risk for developmental delay. Parent-child dyads were randomly assigned to a waitlist control or immediate treatment group. Parenting skills learned during PCIT (i.e., "do skills") and children's word tokens and word types were measured at baseline and 4 months later. Findings suggest an indirect effect of parent do skills on the relation between group and child word types, such that more parent do skills predicted more child word types for families receiving PCIT. The present study found that mothers' use of child-directed skills played an important role in the growth and improvement of child language. Results suggest that parent-training interventions targeting child behavior problems may also foster child language production.
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Transtornos do Desenvolvimento da Linguagem/reabilitação , Desenvolvimento da Linguagem , Relações Pais-Filho , Poder Familiar/psicologia , Pais/educação , Fonoterapia/métodos , Adulto , Criança , Pré-Escolar , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/terapia , Feminino , Humanos , Lactente , Idioma , Transtornos do Desenvolvimento da Linguagem/psicologia , Masculino , Mães , Pais/psicologia , Resultado do TratamentoRESUMO
Rates of youth behavioral health concerns have been steadily rising. Administrative data can be used to study behavioral health service utilization among youth, but current methods that rely on identifying an associated behavioral health diagnosis or provider specialty are limited. We reviewed all procedure codes billed to Medicaid for youth in one U.S. county over a 10-year period. We identified 158 outpatient behavioral health procedure codes and classified them according to service type. This classification system can be used by health services researchers to better characterize youth behavioral health service utilization.
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Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (Nâ¯=â¯380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.
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Transtornos do Comportamento Infantil , Cocaína/análogos & derivados , Telemedicina , Humanos , Criança , Terapia Comportamental , Transtornos do Comportamento Infantil/terapia , Relações Pais-FilhoRESUMO
Growing evidence suggests that Teacher-Child Interaction Training-Universal (TCIT-U) is effective for increasing teachers' use of strategies that promote positive child behavior, but more rigorous research with larger, diverse samples is needed to understand the effects of TCIT-U on teacher and child outcomes in early childhood special education. Using a cluster randomized control trial, we evaluated the effects of TCIT-U on (a) teacher skill acquisition and self-efficacy and (b) child behavior and developmental functioning. Teachers in the TCIT-U group (n = 37) exhibited significantly greater increases in positive attention skills, increased consistent responding, and decreased critical statements relative to teachers in the waitlist control group (n = 36) at post and 1-month follow-up (d's range from 0.52 to 1.61). Teachers in the TCIT-U group also exhibited significantly fewer directive statements (d's range from 0.52 to 0.79) and greater increases in self-efficacy compared to waitlist teachers at post (d's range from 0.60 to 0.76). TCIT-U was also associated with short-term benefits for child behavior. Frequency (d = 0.41) and total number of behavior problems (d = 0.36) were significantly lower in the TCIT-U group than in the waitlist group at post (but not follow-up), with small-to-medium effects. The waitlist group, but not the TCIT-U group, demonstrated an increasing trend in number of problem behaviors over time. There were no significant between-group differences in developmental functioning. Current findings build support for the effectiveness of TCIT-U as universal prevention of behavior problems with an ethnically and racially diverse sample of teachers and children, including children with developmental disabilities. Implications for implementation of TCIT-U in the early childhood special education setting are discussed.
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Pessoal de Educação , Comportamento Problema , Humanos , Pré-Escolar , Criança , Comportamento Infantil , Educação Inclusiva , Professores EscolaresRESUMO
Importance: Early behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD. Objective: To evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD. Design, Setting, and Participants: A randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories. Interventions: Internet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU). Main Outcomes and Measures: Observational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups. Results: The sample included a total of 150 children (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27). Conclusions and Relevance: Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families. Trial Registration: ClinicalTrials.gov Identifier: NCT03260816.
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Comportamento Problema , Telemedicina , Humanos , Masculino , Criança , Pré-Escolar , Adulto , Poder Familiar , Educação Infantil , PaisRESUMO
Introduction: Disruptive behavior disorders are among the most prevalent pediatric mental health referrals for young children. However, families from historically minoritized social identities have experienced disparities in treatment access, retention, and outcomes. Evidence-based interventions such as Parent-Child Interaction Therapy (PCIT) have been found to be effective in reducing children's disruptive behaviors in minoritized families. However, variable treatment length as a result of skill-based graduation criteria (e.g., observed caregiver verbalizations) may slow and/or hinder treatment progress, particularly for families where expected treatment verbalizations are less linguistically relative (e.g., no exact English to Spanish translations) and/or culturally familiar. Time-limited PCIT has been proposed as a strategy for promoting equity in treatment completion and outcomes amongst minoritized families, because treatment progression and/ or completion is not contingent upon caregiver linguistic skill demonstration. Methods: The current study evaluated the overall effectiveness of an 18-week model of PCIT and examined predictors of retention and treatment outcomes. Participants (N = 488 dyads) included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged two to eight years, and their caregivers. Results: Overall findings indicate that the 18-week PCIT model is an effective intervention for reducing children's externalizing and internalizing behaviors and improving caregiver parenting skills for most treatment completers. Despite advances in treatment completion, some caregiver social identities and PCIT treatment characteristics were predictive of lower completion rates and/or less optimal treatment outcomes. Discussion: Overall, this study provides strong support for widely disseminating use of the 18-week model of PCIT for most families served. Clinical implications and considerations for continued treatment inequity are discussed.
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Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent-child interaction therapy (PCIT), exist for improving children's behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebookâ¯+â¯PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (nâ¯=â¯71) or ebookâ¯+â¯PCIT (nâ¯=â¯107) group using an online random number generator. Forty-nine caregivers (traditional PCIT nâ¯=â¯24, ebookâ¯+â¯PCIT nâ¯=â¯25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebookâ¯+â¯PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.
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Transtornos do Comportamento Infantil , Comportamento Problema , Criança , Pré-Escolar , Etnicidade , Humanos , Grupos Minoritários , Relações Pais-FilhoRESUMO
Parent-Child Interaction Therapy is an empirically based, behavioral parent training program for young children exhibiting disruptive behaviors. Parent-Child Interaction Therapy shows promise for treating disruptive behaviors in children with autism spectrum disorder. Treatment processes (i.e. treatment length and homework compliance), parenting skills, parenting stress, and behavioral outcomes (i.e. disruptive and externalizing behaviors and executive functioning) were compared in 16 children with autism spectrum disorder and 16 children without autism spectrum disorder matched on gender, age, and initial intensity of disruptive behaviors. Samples were statistically similar in terms of child receptive language, child race and ethnicity, parent age, gender and education, and number of two-parent families in treatment. Families received standard, mastery-based Parent-Child Interaction Therapy. Both groups demonstrated significant and clinically meaningful improvements in child disruptive and externalizing behavior and executive functioning, parenting skills, and parenting stress. Length of treatment, homework compliance, and parent and child outcomes did not differ significantly between groups. A subset of children with autism spectrum disorder also showed significant improvements in social responsiveness, adaptive skills, and restricted/repetitive behaviors. This study replicates and extends prior research by demonstrating that children with and without autism spectrum disorder experience similar benefits following Parent-Child Interaction Therapy. Findings may expand the availability and dissemination of time-limited, evidence-based interventions for autism spectrum disorder and comorbid disruptive behaviors.
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Transtorno do Espectro Autista/complicações , Transtorno do Espectro Autista/terapia , Transtornos do Comportamento Infantil/complicações , Transtornos do Comportamento Infantil/terapia , Relações Pais-Filho , Pais/educação , Avaliação de Programas e Projetos de Saúde/métodos , Adulto , Transtorno do Espectro Autista/psicologia , Estudos de Casos e Controles , Criança , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poder Familiar/psicologia , Pais/psicologiaRESUMO
OBJECTIVE: Sleep problems are common and associated with externalizing behavior problems in young children, particularly among young children with developmental delay (DD). The aims of the current study, which was a secondary data analysis of 2 previously conducted randomized controlled trials, were to assess whether parent-child interaction therapy (PCIT) led to decreases in child sleep problems and whether initial sleep problems moderated the effect of PCIT on child behavior. METHODS: The study participants were 44 children (M = 49.19 months, SD = 13.1) with DD or borderline DD and with co-occurring clinically significant levels of externalizing behavior problems and their mothers (M = 35.9 years, SD = 7.3). These participants were randomly assigned to either an immediate treatment group or a waitlist control group. RESULTS: Findings revealed a significant direct effect of PCIT on decreases in sleep problems. Additionally, moderation analyses revealed that lower levels of child sleep problems at pretreatment were associated with greater improvements in observed child compliance compared with higher levels of child sleep problems at pretreatment. CONCLUSION: This study extends previous findings by providing support for the preliminary efficacy of PCIT in reducing sleep problems in children with DD and borderline DD and highlighting the role of sleep problems as a factor associated with differential treatment effects in behavioral parenting intervention research.
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Deficiências do Desenvolvimento/terapia , Terapia Familiar/métodos , Relações Mãe-Filho , Avaliação de Resultados em Cuidados de Saúde , Comportamento Problema , Transtornos do Sono-Vigília/terapia , Adulto , Pré-Escolar , Deficiências do Desenvolvimento/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Sono-Vigília/etiologiaRESUMO
OBJECTIVE: Parent-training interventions to reduce behavior problems in young children typically coach parents on the content of their speech, but rarely assess parents' prosody during parent-child interactions. Infant-directed speech helps shape the parent-infant relationship and promote language development, which predicts adaptive behavioral outcomes in children. The current study examined (a) the effect of a parent-training intervention on parents' vocal cues in interactions with their infant and (b) whether parental prosody mediated the impact of the intervention on infant language production. METHOD: Sixty families with 12- to 15-month-old infants (47% female; 95% of Hispanic/Latino ethnicity) participated in the Infant Behavior Program (IBP), a brief home-based adaptation of Parent-Child Interaction Therapy, or received standard pediatric care. Speech analysis was performed on mothers' (n = 40) utterances during infant-led play pre- and postintervention. Infants' number of utterances spoken during play was assessed at pre- and postintervention, and at 3- and 6-month follow-ups. RESULTS: Mothers who received the IBP spoke with greater pitch range and slower tempo postintervention, when controlling for baseline prosody. Change in these vocal cues, which are typical of infant-directed speech, mediated the effect of the intervention on infants' word production after 6 months. CONCLUSIONS: Interventions targeting the content of parents' speech during parent-infant interactions may lead to changes in parental prosody, which may be beneficial for infants' language development. Impaired linguistic abilities in infancy are strongly associated with behavior problems in later childhood; thus, these findings highlight a potential mechanism for intervention efficacy in promoting positive socioemotional and behavioral outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Desenvolvimento Infantil/fisiologia , Desenvolvimento da Linguagem , Idioma , Relações Pais-Filho , Fala/fisiologia , Adulto , Feminino , Humanos , Lactente , Masculino , Pais/psicologiaRESUMO
The current study examined the indirect effect of the use of behavioral parenting skills following the Infant Behavior Program, a brief, home-based adaptation of the child-directed interaction phase of parent-child interaction therapy, on infant language production. Participants were 60 infants (55% male, mean age 13.47 ± 1.31 months) and their caregivers, who were recruited at a large urban pediatric primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the infant behavior program or standard pediatric primary care. Results demonstrated a significant indirect effect of caregivers' use of positive parenting skills (i.e., praise, reflections, and behavior descriptions) on the relation between group and infant total utterances at the 6-month follow-up, such that infants whose caregivers increased their use of positive parenting skills following the intervention showed greater increases in language production. These findings extend previous research examining parenting skills as a mechanism of change in infant language production, and highlight the potential for an early parenting intervention to target behavior and language simultaneously during a critical period in language development.