Modifications of PCIT for Young Children with Autism

Background: Parent-Child Interaction Therapy (PCIT) is an effective, evidence-based intervention that has proven effective at decreasing problem behavior and increasing the quality of parent-child relationships in typically developing children (Edwards, et al., 2002; Eyberg & Ross, 1978).  Recently, researchers have begun to evaluate the effectiveness of PCIT with children with developmental disabilities (Brinkmeyer & Eyberg, 2003) including autism (Bagner & Eyberg, 2007; Solomon, Ono, Timmer, & Goodlin-Jones, 2008).  However, initial studies have not examined modifications for children with autism with low receptive and expressive language skills.  Many young children with autism who have low language abilities often engage in mild to moderate behavior problems. 

Objectives: This study examined modifications to the traditional PCIT model to teach parents of children with autism to teach language to their children and to decrease behavior problems.  .

Methods: Three children diagnosed with autism between the ages of 3 and 5 participated, two males and one female.  All participants engaged in mild to moderate behavior problems and did not possess any functional communication skills.  Three mothers and one father participated in weekly 1-hour sessions for 12 weeks.  One 5-minute baseline session was conducted during the initial visit.  During the second visit didactic and role play instruction were used to teach parents to teach their child to make requests, to engage with the toys appropriately, to ignore problem behavior, and to use a least-to-most prompt hierarchy for compliance.  The child was not present during this training.  Parents practiced these skills for 5 minutes at the beginning of each subsequent visit and data were collected on child behavior (vocalizations and compliance with requests) and parent behavior (comments, demands, and questions).  Following the 5-minute probe, the therapist coached parents using a bug-in-ear device for 30 minutes.  Sessions concluded with additional modeling with the therapist and the child and a summary of skills practiced and learned.  Parents were asked to spend at least 5 minutes each day interacting with their child using skills learned in session. 

Results: Results indicated that all participants increased spontaneous vocalizations.  In addition, parents asked fewer questions, followed through with demands, and made more comments on their child’s play. 

Conclusions: PCIT has been traditionally used with young children with mild to moderate behavior problems to decrease problem behavior and increase parent-child relationships.  This model has advantages in that it is manualized and easy to implement with a wide variety of families.  This study successfully incorporated modifications to adapt this treatment program for use with children with more significant symptoms of autism, including teaching them to make requests, environmental manipulations to increase toy interaction, and using a least-to-most prompt hierarchy to ensure compliance.  Future research should expand upon this program, including studying PCIT with a larger and more diverse sample of children with ASD.