Families in need of behavior parent training (BPT) to address childhood conduct problems face numerous barriers to accessing evidence-based programs. An alternative delivery format with the potential to reduce service disparities involves training non-credentialed helpers (e.g., paraprofessionals, natural helpers) to administer BPTs with a prevention approach. This alternative has received little attention for the coaching-based BPT parent–child interaction therapy (PCIT). We sought to (a) identify selection factors that would predict PCIT therapist skills in a sample of non-credentialed helpers and (b) evaluate uptake of skills of non-credentialed helpers after a brief training. In Study 1, 62 undergraduate students with an interest in working with families provided information on their general learning ability, empathy, natural helping tendency, and knowledge of behavior principles. These constructs were used to predict performance on core PCIT therapist skill domains, including child-centered interaction skills, behavior observation coding, and parent coaching. In Study 2, 21 individuals from Study 1 were selected based on their knowledge of behavior principles (high, moderate, & low scores) to participate in a brief training in foundational PCIT therapist skills and again complete performance measures. Results revealed that learning ability and knowledge of behavior principles were the most consistent predictors of initial PCIT therapist skills. Non-credentialed helpers showed significant improvements in their PCIT therapist skill use with brief training, which has important implications for the potential implementation of a prevention model of PCIT by paraprofessionals. Preliminary recommendations for selection and training are provided.

Objective: Children with early-onset behavioral issues are at high risk for ongoing behavioral, psychological, and social issues.Method: This study examined the efficacy of the first phase of Parent-Child Interaction Therapy with Toddlers, Child-Directed Interaction - Toddler, using a randomized control design. Sixty-six mother-toddler dyads (Child Mage = 19.13 months; 63% male; 34% from a non-English speaking background) referred to a community-based child behavior clinic in Australia received CDI-T immediately or were assigned to a waitlist control condition. At baseline (Time 1) and post-treatment/post-waitlist (Time 2), mothers completed questionnaires (Child Behavior Checklist, Edinburgh Postnatal Depression Scale, Parenting Stress Index - Short Form) and participated in a structured parent-child dyadic play-based interaction later coded using the Dyadic Parent-Child Interaction Coding System and the Emotional Availability Scales.Results: Compared to those who did not receive treatment, mother-child dyads who received the intervention showed significantly better parenting skills (increases in positive parenting skills and decreases in negative parenting skills), emotional availability (increases in parental sensitivity and parental non-intrusiveness), child behavior (decreases in externalizing and internalizing behaviors) and parental perceptions of child difficulty.Conclusions: Results suggest that the CDI-T phase of PCIT-T is a promising intervention for toddlers presenting with behavioral issues. Future studies should be conducted to assess efficacy in other settings and to assess longer-term outcomes.

Children with callous–unemotional (CU) traits and children with disorganized attachment patterns are at heightened risk of poor psychological outcomes but little is known about the overlap between these constructs and their unique contributions to conduct problems in early childhood. This study examined associations between CU traits, disorganized attachment, and conduct problem (CP) severity in a sample of clinic-referred toddlers with behavioral problems. Mother–child dyads (n = 56; mean child age 19.50 months) completed parent-report questionnaires, a dyadic play session, and the Strange Situation Procedure to assess child attachment pattern. Significant positive associations were found between CU traits and disorganized attachment, independent of CP severity. CU traits but not disorganized attachment predicted CP severity. Results indicate that among toddlers with clinic-referred disruptive behavior problems, there are clear links between CU traits and attachment disorganization. Of the two constructs, however, CU traits appear to be most salient in the expression of CPs.

Parent-Child Interaction Therapy with Toddlers (PCIT-T) is a new attachment-based parenting intervention designed to meet the needs of children aged 12-24 months presenting with challenging behaviors. This study examined outcomes of the first phase of PCIT-T, Child Directed Interaction-Toddler (CDI-T), 4-months post treatment. Participants were 56 toddlers (Child Mage = 19.13 months) referred to receive CDI-T over an 8-week period at an Australian community-based child behavior treatment clinic for treatment of difficult toddler behaviors. Participants completed questionnaires and observational measures at baseline (Time 1), post-treatment (Time 2), and 4-month follow-up (Time 3). At both Time 2 and Time 3, there were statistically significant increases in observed positive parenting skills and emotional availability and decreases in negative parenting behaviors and child noncompliance. There were also significant improvements in parent-reported child externalizing and internalizing behaviors, parental stress, and maternal depression. There was a pattern of a shift away from attachment insecurity and attachment disorganization. Results suggest that the CDI-T phase of PCIT-T is a promising intervention for toddlers presenting with behavioral issues. Future studies should be conducted to assess efficacy in other settings, using larger samples and utilizing randomized controlled designs.

Children with prenatal substance exposure (PSE) often have behavior problems, but few studies have demonstrated that behavior therapy can be effective for these children. The current study evaluated the efficacy of Parent-Child Interaction Therapy (PCIT) for improving behavior problems in a sample of 116 children with PSE using archival data from a Midwestern PCIT clinic. Analyses included mean comparisons of pre- and posttreatment measures of child and parent behavior, prediction of drop-out from treatment, and evaluation of the potential complicating effects of PSE on treatment response. Results indicate that treatment effects of PCIT for children with PSE appear similar to the outcomes observed elsewhere in the PCIT literature. There was no indication that maternal polysubstance use alters child response to treatment. Attrition was high, but similar to other community trials of PCIT. The current study lends support to the use of PCIT for children with PSE who have behavior problems.

Robust evidence of the efficacy of behavioral parent training (BPT) programs for the treatment of childhood conduct problems has led to increasing international dissemination. As BPT programs are transported out of the countries in which they were developed, it is important to consider how barriers to therapist training vary or do not vary across countries and cultures in order to determine how the training process may need to be adapted. Using a systematic qualitative approach, we interviewed 75% (18) of all Dutch therapists trained in the BPT program parent-child interaction therapy (PCIT) to explore their perceptions of the PCIT model, training, and acceptability in the Netherlands. Dutch therapists reported numerous positive experiences with PCIT training and the treatment model, but also described significant barriers related to family, therapist, protocol, and agency factors. Therapists' perceptions of barriers to training and implementation overlapped substantially, though not comprehensively, with a sample of PCIT therapists in the US, suggesting that while PCIT training may be transported from the US to the Netherlands, some barriers exist that are not being addressed in the global dissemination.