Using a cross-sectional design, this study explored attachment insecurity and disorganization (assessed using the Strange Situation Procedure) in 90 toddlers (aged 14-24 months) with and without autism traits and assessed the associations between autism traits (severity and profiles) and both developmental level and attachment classification. Our findings showed no significant differences between the rates of attachment insecurity or attachment disorganisation among toddlers with, and toddlers without, autism traits. However, among the toddlers with autism traits, those with a disorganised attachment were more likely to have autism traits of greater severity. While greater autism trait severity was associated with attachment disorganisation, it remains unclear whether this association is the result of children with autism traits having higher rates of attachment disorganisation or whether autism traits are being misinterpreted as attachment disorganisation indices.

Parent–Child Interaction Therapy—Toddler (PCIT-T) is an attachment-informed intervention model designed to meet the specific developmental needs of toddlers aged 12–24 months presenting with challenging behaviors. This study used a randomized controlled design to evaluate outcomes of PCIT-T for children aged 14–24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior were randomly allocated to PCIT-T (intervention), an active control condition (Circle of Security– Parenting™; COS-P), or a non-treatment control condition (wait-list; WL). Outcomes were assessed at baseline (Time 1), post treatment/post waitlist (Time 2) and 4-month follow-up (Time 3). At follow-up, the PCIT-T group displayed the highest levels of parenting sensitivity and positive parental verbalizations, and the lowest levels of negative child-directed verbalizations and non-attuned mind-minded statements. Of the three groups, the PCIT-T group showed the greatest degree of change on these variables, followed by the COS-P group and then the non-treated controls. The PCIT-T group were also the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues. Significant reductions in parental stress, child externalizing behaviors and parenting behaviors were seen for both the PCIT-T and COS-P groups. Delivered in the early intervention period of toddlerhood, Parent–Child Interaction Therapy—Toddler has the potential to bring about significant changes for children presenting with early onset behavioral issues. Australian New Zealand Clinical Trials Registry (ANZCTR), 12,618,001,554,257. Registered 24 September 2018 – retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001554257 .

Differential diagnosis of autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) in adolescents is difficult due to similar behavioral topography. For instance, restrictive, repetitive behavior, cognitive rigidity, anxiety, and avoidance contribute to impairment in social relationships and daily living skills in both conditions. The diagnostic picture for youth with ASD and/or OCD may be further clouded by high rates of co-occurring gender-diverse clinical concerns, attention-deficit/hyperactivity disorder, tic disorder, depression, and anxiety disorders With increased prevalence and improved identification of ASD, OCD, and gender-identity-related distress, more adolescents are seeking treatment. It is vital that providers are knowledgeable about best practices for diagnosing and treating these overlapping symptoms. This review describes the state of the literature regarding presentation and prevalence of ASD, OCD, and gender-identity concerns separately and as co-occurring phenomena. Sex differences and gender-diversity among individuals with ASD and OCD are also reviewed. We briefly describe evidence-based behavioral treatments for ASD, OCD, gender-identity-related distress as separate and co-occurring considerations. Recommendations for tailoring within these therapies and family involvement are discussed.

Practical, evidence-based guide to using time-out safely and effectively Written by leading experts Highlights applied research Reviews parent training programs Details parent–child interaction therapy Addresses controversial issues Includes downloadable tools This book is essential reading for psychologists, therapists, students, and anyone who works with children and their families. It is a compact, comprehensive guide to understanding, administering, and teaching caregivers to implement time-out effectively for child behavior management. Readers will learn about time-out’s history and scientific research base, particularly with respect to child age, cultural groups, and presenting concerns. Practitioners will appreciate the focus on applied research highlighting the efficacy of specific time-out parameters, such as duration, location, and handling escape. Overviews of behavioral parent training programs that include time-out are also provided. The authors then share their expertise in the use of time-out in parent–child interaction therapy (PCIT), both conceptually and by using an in-depth case study. They also thoroughly examine controversial issues related to time-out, from theoretical and practical standpoints. The appendix provides the clinician with hands-on tools: step-by-step diagrams for administering time-out and managing escape, handouts for parents about issuing effective instructions, and a list of further resources.

This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized.

Child-caregiver attachment is important for healthy child development and is often targeted by relationship-based parenting interventions for young children. To assess the efficacy of these interventions, attachment must be measured accurately at multiple timepoints across the toddler years, coinciding with different stages of development. Among others, populations referred for treatment of externalizing behavior problems are of particular importance here. The Strange Situation Procedure (SSP) and Attachment Q-Set (AQS) are empirically-validated measures of child-caregiver attachment with unique strengths and weaknesses. However, there are no published investigations on concurrent relations between the two measures using clinically-referred, mental health populations. Previous research has reached mixed conclusions when comparing the observer-report AQS and SSP for children from other populations and based on child age. Using a clinical sample of 69 Australian mother-toddler dyads referred for disruptive behavior problems, this study examined associations among behavior problems, dichotomous SSP classifications of security and organization, AQS security scores, and child age. In line with hypotheses, a small to medium negative correlation between AQS security and externalizing behavior was found. Unexpectedly, no significant associations were found between dichotomous SSP security and externalizing behavior nor between SSP organization and externalizing behavior. Although AQS security scores and SSP classifications were not significantly correlated for the sample as a whole, there was a moderate positive correlation between the two measures for children aged 19–25 months. Implications for future research measuring attachment in this population, with relevance for relationship-based parenting intervention outcome studies are discussed.

There is strong evidence to show links between attachment security in young children and a range of positive outcomes in social, emotional, and psychological domains. The aims of this review were to provide a narrative summary of (1) the attachment-based interventions currently available for caregivers of toddlers aged 12–24 months and for which research about the impact of the program on child attachment patterns has been reported, and (2) the empirical effectiveness of these interventions at improving attachment security. A number of interventions were shown to be associated with shifts to secure and/or organized attachment, with Child-Parent Psychotherapy and Attachment and Biobehavioral Catch-Up emerging as the interventions with the strongest evidence bases. For most interventions, evidence came from just a single research study, and in some cases from studies that were not randomized controlled trials. In order for clinicians to make informed decisions about the interventions they use with parents and toddlers, it is vital that further research be conducted to test the efficacy of all available attachment-based parenting programs using randomized controlled trial designs, in a range of settings and clinical and cultural groups, and with longitudinal follow-ups.

This research briefly promotes the inclusion of Parent-Child Interaction Therapy (PCIT) for children with Autism Spectrum Disorder (ASD) in a continuum of empirically-supported ASD treatments. PCIT is a manualized, short-term intervention that improves child compliance and the caregiver-child bond, and is an empirically-supported treatment backed by over 40 years of research. Caregivers are often unprepared to handle the needs of children with ASD presenting with comorbid behavioral problems. As a result, families frequently require mental health services for their children on the autism spectrum; however, access to empirically supported treatments for these families is limited. Furthermore, many mental health providers feel unequipped to treat this special population. Families with children on the autism spectrum are in desperate need of quality, time-limited, evidence-based treatments targeting disruptive behaviors. PCIT is a well-established treatment for disruptive behaviors that represents a promising treatment for complementing other evidenced-based ASD services. Research shows that after PCIT, children with ASD demonstrate improvements in disruptive behavior, social awareness, adaptability, and positive affect. Currently, the PCIT-ASD literature provides a case for conducting PCIT with preschool children who are in the higher functioning range of the autism spectrum (Levels 1 and 2) and display comorbid behavioral problems. Providing PCIT clinicians with training about the special needs of children with ASD could lead to improved access to services for this population. This paper accomplishes the following objectives: 1) Provides an overview of PCIT, 2) Summarizes the PCIT-ASD research, 3) Reviews PCIT-ASD clinical considerations and training requirements, and 3) Suggests future directions for PCIT-ASD research.

As evidence of the importance of emotion regulation (ER) continues to mount, little is known about how families dealing with child behavior problems can better develop this important ability. We explored the relations among a caregiver training program for children with severe problem behavior (Parent–Child Interaction Therapy; PCIT), child ER, caregiver ER, parenting stress, and attrition. This study was part of a larger investigation evaluating the impact of incentives on treatment outcomes. Measures of caregiver and child ER, child behavior problems, and parenting stress were completed by caregivers referred for PCIT from a predominantly low-income community sample of 66 caregiver–child dyads. Caregiver–child interactions were coded for caregiver verbalizations during three play situations. ANCOVA, t-test, and correlational analyses were conducted to examine changes in ER across treatment and compare those who completed treatment with those who dropped out of treatment early. Caregiver ER and child ER lability/negativity improved significantly across both phases of PCIT. Child adaptive ER improved significantly from pre- to post-treatment and during the second phase of treatment for those children in the non-incentives group only. Baseline levels of child and caregiver ER were not significant predictors of attrition. Findings are discussed with respect to the importance of both caregiver and child ER in the provision of PCIT and other behavioral parent training programs.

Foster parents face considerable challenges in caring for children in the child welfare system, many of whom have significant behavioral difficulties [1]. Foster parents often lack the training and support needed to manage these externalizing behaviors, which contribute to parenting stress and are highly predictive of placement breakdowns [2, 3]. Although child welfare agencies provide foster parents with pre-service training experiences, they often lack the capacity and financial resources to implement gold standard, evidence-based interventions that address child behavior difficulties. Parent-Child Interaction Therapy (PCIT) has been well-established as an empirically supported treatment for disruptive behavior, yet standard delivery of PCIT to children in the foster care system is often impractical due to time, financial, childcare, and personnel constraints. Adaptations of PCIT for the foster care setting may remove some of these barriers to treatment. These adaptations have typically retained the parent-coaching principles inherent to PCIT but replaced the traditional 12- to 20-week format with a shorter, less intensive treatment regimen in order to maintain feasibility within the child welfare context. Preliminary findings from studies using abbreviated formats of PCIT suggest effectiveness of such adaptations in reducing externalizing behavior in foster children and maintaining behavioral improvements several months after the end of the treatment.

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/LkGCUMr6YKY Purpose: Behavior disorders in early childhood are linked to a variety of negative outcomes for both children and families. Parent–Child Interaction Therapy (PCIT), an evidence-based parent-training program, demonstrates large effect sizes in reducing child problem behavior for dyads who complete treatment; however, a high number of families seeking treatment in community-based settings terminate from PCIT prior to meeting the protocol’s strict graduation criteria. The purpose of this study was to examine the impact of PCIT on child behavior problems for families who received at least a small dose of PCIT but not enough to meet the strict mastery criteria required for graduation. Patients and methods: This study employed one of the largest community research samples conducted with PCIT (2,787 children and their families across the state of Oregon, 1,318 with usable data) to determine how PCIT impacts both graduates and early terminators. Results: While families who graduated from PCIT (17.7% of the sample) demonstrated a very large effect size in problem behavior intensity improvements (d=1.65), families who terminated treatment early, but after attending at least four treatment sessions (51.7% of the sample), still showed significant improvements in behavior problems with a medium-to-large effect size (d=0.70). In contrast, very early terminators (those attending fewer than four treatment sessions, 0.3% of the sample), demonstrated little improvement at the time of dropout from services (d=0.12). Conclusion: Though early terminators in PCIT have previously been identified as treatment failures, the present study discusses the reconceptualization of “dropouts” in relation to some positive evidence of treatment outcomes, the implications for community-based service delivery, and possible future directions.

Purpose: Behavior disorders in early childhood are linked to a variety of negative outcomes for both children and families. Parent-Child Interaction Therapy (PCIT), an evidence-based parent-training program, demonstrates large effect sizes in reducing child problem behavior for dyads who complete treatment; however, a high number of families seeking treatment in community-based settings terminate from PCIT prior to meeting the protocol's strict graduation criteria. The purpose of this study was to examine the impact of PCIT on child behavior problems for families who received at least a small dose of PCIT but not enough to meet the strict mastery criteria required for graduation. Patients and methods: This study employed one of the largest community research samples conducted with PCIT (2,787 children and their families across the state of Oregon, 1,318 with usable data) to determine how PCIT impacts both graduates and early terminators. Results: While families who graduated from PCIT (17.7% of the sample) demonstrated a very large effect size in problem behavior intensity improvements (d=1.65), families who terminated treatment early, but after attending at least four treatment sessions (51.7% of the sample), still showed significant improvements in behavior problems with a medium-to-large effect size (d=0.70). In contrast, very early terminators (those attending fewer than four treatment sessions, 0.3% of the sample), demonstrated little improvement at the time of dropout from services (d=0.12). Conclusion: Though early terminators in PCIT have previously been identified as treatment failures, the present study discusses the reconceptualization of "dropouts" in relation to some positive evidence of treatment outcomes, the implications for community-based service delivery, and possible future directions.

Parent-Child Interaction Therapy (PCIT) is an empirically supported intervention originally developed to treat disruptive behavior problems in children between the ages of 2 and 7 years. Since its creation over 40 years ago, PCIT has been studied internationally with various populations and has been found to be an effective intervention for numerous behavioral and emotional issues. This article summarizes progress in the PCIT literature over the past decade (2006-2017) and outlines future directions for this important work. Recent PCIT research related to treatment effectiveness, treatment components, adaptations for specific populations (age groups, cultural groups, military families, individuals diagnosed with specific disorders, trauma survivors, and the hearing-impaired), format changes (group and home-based), teacher-child interaction training (TCIT), intensive PCIT (I-PCIT), treatment as prevention (for externalizing problems, child maltreatment, and developmental delays), and implementation are discussed.