Parent Child Interaction Therapy and ASD

What is ASD?

Autism Spectrum Disorder is a neurodevelopment disorder that is characterized with impairment in social behaviour, communication aspects and repetitive behaviours. 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 behavioural issues along with cognitive deficits are considered as the most challenging aspects with ASD population. These impairment can interfere with family functioning which may even create more stress to parent that can lead to poor parent child interaction. Literature reviews suggest that parental stress and parental interactions have an impact on the behavioural 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 for?

Sheila Eyberg in early 1970s developed PCIT. Nowadays, PCIT serve as one among 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 aim to reduce the disruptive behaviours and thus improving social behaviour, and strengthening family functioning in ASD children and with their families. Thus, PCIT is a behavioural parent training program that has proved to reduce the disruptive behaviours of the child by strengthening the parent child relation 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 behaviours of even for young children with special needs, such as intellectual disability, ADHD and children born premature, and in children with specific language impairments.

            In PCIT, parents have an opportunity to learn new skills which helps them to become better in providingmore caring, nurturing, and beneficial and suitable environment for their child. Therefore the ultimate goal of this approach is to help adapt negative behaviours into more positive behaviour patterns.

            Phases of PCIT             

PCIT technique has its own core and distinct features. This intervention program consists of two phases: child directed interaction (CDI) phase, and parent-directed interaction (PDI) phase. CDI focuses on increasing positive parenting behaviours 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 watches the play between child and parent in a room through one-way mirror and coaches the parent directly using a microphone and “bug-in-the-ear” device. Thus, the therapist give immediate feedback to parent and reinforce their behaviour 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 skill of parent and 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 behaviour.
  • Reflection: The words of the child are repeated and expanded by parents, which encourage child to communicate.
  • Imitation: Parents mimics 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 child. Description shows that the parents are paying attention to the activities of the child.
  • Enjoyment: Parents showinterest for the activities of the child.

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

            PHASE 2: PDI

In second phase (PDI), parents are taught to give effective commands and to follow the protocol for consequence according to the behaviour of the child. When parents meet the mastery criteria for PDI skills and child’s behaviour reaches to normal range (according to any behaviour 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 in during daily life.

LITERATURE REVIEW

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