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

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.

Remote Intensive Group Behavioral Treatment for Families of Children with Selective Mutism.

Selective mutism (SM) is a relatively rare, but highly interfering, child anxiety disorder characterized by a consistent failure to speak in certain situations, despite demonstrating fluent speech in other contexts. Exposure-based cognitive behavioral therapy and Parent-Child Interaction Therapy adapted for SM can be effective, but the broad availability and accessibility of such specialty care options remains limited. Stay-at-home guidelines to mitigate the spread of COVID-19 further limited the accessibility of office-based specialty care for SM. Building on separate lines of research supporting intensive treatments and telehealth service delivery models, this paper is the first to describe the development, preliminary feasibility, acceptability, and efficacy of a Remote Intensive Group Behavioral Treatment (IGBT) for families of young children with SM (N=9). Treatment leveraged videoconferencing technology to deliver caregiver training sessions, lead-in sessions, 5 consecutive daily IGBT sessions, and an individualized caregiver coaching session. Remote IGBT was found to be both feasible and acceptable. All families (100%) completed diagnostic assessments and caregiver-report questionnaires at four major study timepoints (i.e., intake, pre-treatment, post-treatment, 4-month follow-up) and participated in all treatment components. Caregivers reported high treatment satisfaction at post-treatment and 4-month follow-up and low levels of burden associated with treatment participation at post-treatment. Approximately half of participating children were classified as treatment responders by independent evaluators at post-treatment and 4-month follow-up. Although these pilot results should be interpreted with caution, the present work underscores the potential utility of using videoconferencing to remotely deliver IGBT to families in their natural environments.

Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay: A Randomized Clinical Trial.

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.

Effect of Therapist Coaching Statements on Parenting Skills in a Brief Parenting Intervention for Infants.

Behavioral parenting interventions have been shown to decrease early childhood behavior problems by improving parenting skills. Few studies have examined the impact of therapist coaching statements on parenting skill acquisition, especially among ethnic minority families and non-English-speaking families. In this study, we examined therapists' use of responsive and directive coaching statements during the first coaching session in a brief parenting intervention, the Infant Behavior Program (IBP), on changes in parenting skill acquisition. Participants were 24 mothers of 12- to 15-month-olds, with elevated levels of behavioral problems from primarily Latinx and low-income backgrounds. Mothers who heard more responsive coaching from their therapist showed greater increases in positive parenting skills. Spanish-speaking therapists used fewer responsive coaching statements and more commands, however, language spoken did not moderate the effect of these statements on changes in parenting skills. Responsive coaching statements in English and Spanish had a positive impact on parenting skill acquisition.

Atypical Emotional Electrodermal Activity in Toddlers with Autism Spectrum Disorder.

Past studies in autism spectrum disorder (ASD) indicate atypical peripheral physiological arousal. However, the conditions under which these atypicalities arise and their link with behavioral emotional expressions and core ASD symptoms remain uncertain. Given the importance of physiological arousal in affective, learning, and cognitive processes, the current study examined changes in skin conductance level (ΔSCL) in 41 toddlers with ASD (mean age: 22.7 months, SD: 2.9) and 32 age-matched toddlers with typical development (TD) (mean age: 21.6 months, SD: 3.6) in response to probes designed to induce anger, joy, and fear emotions. The magnitude of ΔSCL was comparable during anger (P = 0.206, d = 0.30) and joy (P = 0.996, d = 0.01) conditions, but significantly lower during the fear condition (P = 0.001, d = 0.83) in toddlers with ASD compared to TD peers. In the combined samples, ΔSCL positively correlated with intensity of behavioral emotional expressivity during the anger (r[71] = 0.36, P = 0.002) and fear (r[68] = 0.32, P = 0.007) conditions, but not in the joy (r[69] = -0.15, P = 0.226) condition. Finally, ΔSCL did not associate with autism symptom severity in any emotion-eliciting condition in the ASD group. Toddlers with ASD displayed attenuated ΔSCL to situations aimed at eliciting fear, which may forecast the emergence of highly prevalent internalizing and externalizing problems in this population. The study putatively identifies ΔSCL as a dimension not associated with severity of autism but with behavioral responses in negatively emotionally challenging events and provides support for the feasibility, validity, and incipient utility of examining ΔSCL in response to emotional challenges in very young children. LAY SUMMARY: Physiological arousal was measured in toddlers with autism exposed to frustrating, pleasant, and threatening tasks. Compared to typically developing peers, toddlers with autism showed comparable arousal responses to frustrating and pleasant events, but lower responses to threatening events. Importantly, physiological arousal and behavioral expressions were aligned during frustrating and threatening events, inviting exploration of physiological arousal to measure responses to emotional challenges. Furthermore, this study advances the understanding of precursors to emotional and behavioral problems common in older children with autism. Autism Res 2020, 13: 1476-1488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Infant-directed language following a brief behavioral parenting intervention: The importance of language quality.

Behavioral parenting interventions decrease early childhood behavior problems and increase positive parenting skills. However, few studies have examined the impact of low intensity interventions for infants at risk for behavior problems on changes in parent language. This study examined the effect of a brief parenting intervention, the Infant Behavior Program, on changes in parent linguistic input and its influence on infant language. Participants were 58 mothers and their12- to 15-month-olds, with elevated levels of behavioral problems. Mothers and their infants were from primarily Hispanic and low-income backgrounds. Mother-infant dyads were randomly assigned to receive the Infant Behavior Program or standard pediatric primary care. Mothers receiving the Infant Behavior Program provided more linguistic input, which indirectly influenced infant language, and suggest targeting infants at risk for behavior problems can have a broader impact on language development.

Impact of Parenting Intervention on Observed Aggressive Behaviors in At-Risk Infants.

Aggressive behaviors in early childhood persist through childhood and adolescence and result in negative outcomes. However, studies assessing aggressive behaviors in early childhood have focused primarily on parent report. Additionally, the effects of parenting interventions and associated parenting skills on early observed aggression have not been examined. In the present study, we examined the direct effect of a brief, in-home adaptation of Parent-Child Interaction Therapy, the Infant Behavior Program (IBP), on observed frequency of aggressive behaviors and global ratings of aggression in infants ages 12 to 15 months. Additionally, we examined behaviorally-based parenting skills as a mechanism by which the IBP impacted observed infant aggressive behaviors. Sixty infants with elevated levels of behavior problems were randomized to receive the IBP or standard pediatric primary care. Infants receiving the IBP demonstrated a significant decrease in the observed frequency of aggressive behaviors during infant-led play across a 3-month follow-up. Furthermore, the intervention led to decreases in parental use of don't skills (i.e., directive and negative parent statements), which, in turn, led to decreases in the frequency of observed aggressive behaviors at a 3-month follow-up. However, effects were not maintained at a 6-month follow-up. Results provide preliminary evidence for the efficacy of a brief parenting intervention on reducing the frequency of infant aggressive behaviors, including the indirect effect of the IBP on the frequency of aggressive behaviors through reductions in parenting skills. The study highlights the importance of targeting negative parenting practices to decrease subsequent aggressive behaviors in early childhood.

Apps As Learning Tools: A Systematic Review.

CONTEXT: Young children have increasing access to interactive applications (apps) at home and at school. Existing research is clear on the potential dangers of overuse of screens, but there is less clarity around the extent to which interactive apps may be helpful in supporting early learning. OBJECTIVE: In this systematic review, we present a narrative synthesis of studies examining whether children <6 years can learn from interactive apps. DATA SOURCES: The PsycInfo, PubMed, ACM Digital Library, and ERIC databases were searched. STUDY SELECTION: Studies were included if the study design was randomized or nonrandomized controlled (quasi-experimental), the sample mean age was <6 years, the intervention involved children playing with an interactive app, and academic, cognitive, or social-emotional skill outcomes were measured. DATA EXTRACTION: Of 1447 studies, 35 were included. RESULTS: Evidence of a learning benefit of interactive app use for early academic skills was found across multiple studies, particularly for early mathematics learning in typically developing children. Researchers did not find evidence of an intervention effect for apps aiming to improve social communication skills in children with autism spectrum disorder. LIMITATIONS: Risk of bias was unclear for many studies because of inadequate reporting. Studies were highly heterogenous in interventions, outcomes, and study design, making comparisons of results across studies difficult. CONCLUSIONS: There is emerging evidence to suggest that interactive apps may be useful and accessible tools for supporting early academic development. More research is needed to evaluate both the potential of educational apps to support early learning, and their limitations.

Coordination is key: Joint attention and vocalisation in infant siblings of children with Autism Spectrum Disorder.

BACKGROUND: Research indicates that social communicative behaviours develop atypically during the second year in Autism Spectrum Disorder (ASD). This study evaluated whether these behaviours also differed in the extent to which they were coordinated across modalities. AIMS: To measure joint attention behaviours (e.g., gaze shifts, gestures), vocalisations and their coordination among a cohort of infants with an older sibling with ASD (heightened risk-HR). METHODS & PROCEDURES: This prospective longitudinal study examined 50 HR infants at 14, 18 and 24 months. The Early Social Communication Scales (ESCS)-a structured toy-play task that assesses infant joint attention behaviour-was administered to infants at each age point in the home. Infants' joint attention behaviours, vocalisations and instances where they overlapped were coded from videos. At 36 months, nine infants received an ASD diagnosis (HR-ASD), 15 had a significant language delay (HR-LD) and 26 were classified no diagnosis (HR-ND). OUTCOMES & RESULTS: Findings revealed that HR-ASD infants produced fewer advanced joint attention behaviours, and their vocalisations were less frequent and less advanced than HR-LD and HR-ND infants. Notably, HR-ASD infants also coordinated these behaviours together less frequently than their HR peers. CONCLUSIONS & IMPLICATIONS: Differences in the coordination of early communicative behaviours may have negative cascading effects on social and language development for infants who develop ASD. Current intervention practices may be complemented by efforts to increase the coordinated quality of communicative behaviours.

Impaired Value Learning for Faces in Preschoolers With Autism Spectrum Disorder.

OBJECTIVE: One of the common findings in autism spectrum disorder (ASD) is limited selective attention toward social objects, such as faces. Evidence from both human and nonhuman primate studies suggests that selection of objects for processing is guided by the appraisal of object values. We hypothesized that impairments in selective attention in ASD may reflect a disruption of a system supporting learning about object values in the social domain. METHOD: We examined value learning in social (faces) and nonsocial (fractals) domains in preschoolers with ASD (n = 25) and typically developing (TD) controls (n = 28), using a novel value learning task implemented on a gaze-contingent eye-tracking platform consisting of value learning and a selective attention choice test. RESULTS: Children with ASD performed more poorly than TD controls on the social value learning task, but both groups performed similarly on the nonsocial task. Within-group comparisons indicated that value learning in TD children was enhanced on the social compared to the nonsocial task, but no such enhancement was seen in children with ASD. Performance in the social and nonsocial conditions was correlated in the ASD but not in the TD group. CONCLUSION: The study provides support for a domain-specific impairment in value learning for faces in ASD, and suggests that, in ASD, value learning in social and nonsocial domains may rely on a shared mechanism. These findings have implications both for models of selective social attention deficits in autism and for identification of novel treatment targets.