UC Santa Barbara

Background: Children with autism spectrum disorder (ASD) experience high rates of comorbid diagnoses, including both externalizing and internalizing disorders. Emotion regulation has been posited as a possible mechanism underlying many emotional disorders, and children with ASD have higher rates of emotion regulation challenges than their typically developing peers. It has been recommended that treatments addressing both emotion dysregulation and comorbidities in children with ASD be developed. Additionally, considering the needs and preferences of caregivers when developing novel interventions is critical. Objective: This feasibility pilot randomized control trial investigated initial feasibility, acceptability, and preliminary clinical outcomes of a novel adaptation of Parent-Child Interaction Therapy (PCIT) delivered daily over two weeks via telehealth, in which the second phase of treatment is replaced with an emotion-focused module. Method: Participants included 22 young children aged 2 through 7 (M = 4.64, 72.7% male) and their caregiver(s). Families were randomized to receive either an intensive, telehealth version of PCIT’s standard modules, Child Directed Interaction (CDI; relationship enhancing) and Parent-Directed Interaction (PDI; discipline and limit-setting), or an emotion-focused module (ED) instead of PDI. Child and caregiver measures were collected at pre, mid, post, and 1-month follow-up. Results: Recruitment, retention, assessment collection, and caregiver satisfaction were adequate for the study. CDI+PDI was superior to CDI+ED on improvements in child disruptive behaviors and child dysphoria. CDI+PDI resulted in large effects on multiple child outcomes (dysphoria, reactivity, and disruptive behaviors) and on caregiver stress. CDI+ED resulted in improvements in caregiver cognitive reappraisal, one emotion regulation strategy. Conclusion: Internet-delivered intensive PCIT may be a helpful intervention for young children with autism, that is acceptable to caregivers, however PDI is likely a necessary treatment component for quick treatment gains, which cannot be substituted with emotion-focused content. Feasibility of the pilot study was demonstrated and can inform a larger trial.