Parent-Child Interaction Therapy and ASD

What is ASD?

Autism Spectrum Disorder is a neurodevelopment disorder that is characterized by impairment in social behaviour, communication aspects, and repetitive behaviors. However, the degree and symptoms of ASD vary widely. ASD is also associated with negative outcomes in emotional and behavioral aspects, cognitive abilities, and in family functioning, which may lead to significant long-term problems. The treatment for ASD differs in accordance with the exhibited signs and symptoms of the child.

What are the consequences of ASD?

Impairment in behavioral issues along with cognitive deficits is considered the most challenging aspect of the ASD population. This impairment can interfere with family functioning which may even create more stress to parents that can lead to poor parent-child interaction. Literature reviews suggest that parental stress and parental interactions have an impact on the behavioral problems of young children with ASD. However, no therapeutic techniques were designed to strengthen the family relations and interactions with the child.

What is PCIT and to whom it is used?

Sheila Eyberg in the early 1970s developed PCIT. Nowadays, PCIT serves as one of the most effective and evidence-based forms of treatment in the world.

PCIT is an evidence-based, cost-effective, and family-focused intervention program which aims to reduce disruptive behaviors and thus improve social behavior, and strengthen family functioning in ASD children and with their families. Thus, PCIT is a behavioral parent training program that has proved to reduce the disruptive behaviors of the child by strengthening the parent-child relationship through in vivo training of skills during the play session of parent and child. This intervention approach has also been found effective in reducing disruptive behaviors of even for young children with special needs, such as intellectual disability, ADHD and children born premature, and children with specific language impairments.

            In PCIT, parents have an opportunity to learn new skills which help them to become better at providing a more caring, nurturing, beneficial, and suitable environment for their child. Therefore the ultimate goal of this approach is to help adopt negative behaviors into more positive behavior patterns.

Phases of PCIT             

PCIT technique has its own core and distinct features. This intervention program consists of two phases: the child-directed interaction (CDI) phase, and the parent-directed interaction (PDI) phase. CDI focuses on increasing positive parenting behaviors and PDI focuses on a structured and consistent approach to discipline parents. In the first session of each phase, PCIT skills are taught didactically to parents (“teaching session”), and in following sessions, these are taught through direct coaching (“coaching session”) where the therapists watch the play between the child and parent in a room through a one-way mirror and coach the parent directly using a microphone and “bug-in-the-ear” device. Thus, the therapist gives immediate feedback to parent and reinforce their behavior management skills while interacting with the child. The parents can do trial and error method and can validate themselves with respect to certain skills that are effective for their child. PCIT often consists of 12–20 weekly sessions and proceeds according to the skill of the parent and the improvement of the child.

Phase 1: CDI

            As mentioned earlier, positive parenting skills are taught during the CDI phase. The approach is purely client based in which the lead of the child is followed by the parent during the play. The skills which are taught to parents are called “PRIDE skills”:

  • Praise:  The child is praised for good or appropriate behavior.
  • Reflection: The words of the child are repeated and expanded by parents, which encourages the child to communicate.
  • Imitation: Parents mimic what their child is doing which thus shows a positive attitude towards the child.
  • Description: Parents describe whatever the child is doing. This help to improve the vocabulary of the child. The description shows that the parents are paying attention to the activities of the child.
  • Enjoyment: Parents show interest in the activities of the child.

Parents are also taught to avoid negative attitudes and interactions like criticism, questioning, and commands. They are also instructed to ignore inappropriate behaviors which may even take the lead away from the child.

Phase 2: PDI

In the second phase (PDI), parents are taught to give effective commands and to follow the protocol for consequences according to the behavior of the child. When parents meet the mastery criteria for PDI skills and the child’s behavior reaches to normal range (according to any behavior checklist), PCIT reaches to its completion.

In both phases, homework will be given to the parents daily in order to practice skills during the interaction with the child. Parents are encouraged to use these skills during daily life.

Literature Review

Studies show that PCIT has benefited children with ASD. It was also reported in the study of Parlade et al.,(2019) that the parents of children with ASD reported improvements in the child’s social awareness and adaptive behavior, as well as in atypical behaviors such as restricted and repetitive behaviors and adaptability using PCIT. PCIT can also give direct support to parents and children to address their complex needs.