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PCITforChildrenwithAutism:SuccessesandChallengesKellyPelzel,PhDApril27,2018
DisclosuresConsultant/Speakers bureaus
No Disclosures
Research funding R01MH1043634/1/15– 3/31/19NIMH“ComparingBehavioralAssessmentsUsingTelehealthforChildrenwithAutism”Role:Co- Investigator
Stock ownership/Corporate boards-employment
No Disclosures
Off-label uses No Disclosures
ParentChildInteractionTherapy(PCIT)
• WhatisParentChildInteractionTherapy(PCIT)?
• HowhasPCITgrowninIowa?
• WhatistheevidencebaseforusingPCITwithchildrenwhohaveautism?
• WhatmodificationsarecommonlymadewhenPCITisusedwithchildrenwhohaveautism?
WhatisPCIT?
• Dyadicinterventionforyoungchildrenwithdisruptivebehaviorsandtheircaregiver(s).• 100%parent-mediatedintervention
• DevelopedbyEybergin1970s.• Eybergwasinfluencedby:
• Baumrind(authoritativeparenting)• Hanf(differentialsocialattention,directcommands,praiseforcompliance,TO,parentcoaching)
WhatisPCIT?
• Eybergaddedassessmenttoherinterventionmodel•Direct(DyadicParent-ChildInteractionCodingSystem;DPICS)
• Indirect(EybergChildBehaviorInventory;ECBI)
• Evidencebase:PCIThasstrongmarksfortreatingyoungchildrenwithexternalizingbehaviorandtheircaregivers(e.g.,Thomas,2017)
WhatisPCIT?
• 2Phases:• ChildDirectedInteraction(CDI;PRIDE+selectiveattention)
• ParentDirectedInteraction(PDI;effectivedirections+consistentfollowthrough)
• https://youtu.be/UqBSPPAsOo4
GrowthofPCITinIowa
0
50
100
150
200
250
300
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
CumulativeNumberofIowa*TherapistsTrainedinPCITSince2006
(Troutman,2017)
*plus67Nebraskansand19Minnesotans
WhatisIoWA-PCIT?(Troutman,2016)
• Anattempttointegratebehaviorismand Bowlby’sattachmenttheoryintoparentcoaching
• IoWA-PCITisconsistentwithotherPCITtraditions(e.g.,PCITInternational,UCDavis)
• Strategiesandcoachingareslightlymodifiedwiththeclinicalapplicationofattachmenttheoryinmind.
WhatisIoWA-PCIT?(Troutman,2016)
IoWA-PCITaimsto:
• Promotesecureattachmentwhileaddressingbehaviorproblems
• Addressresistancetochangingpatternsofinteraction
• Improveretention
UsingPCITwithchildrenwhohaveautism
• Whymightthisbeagoodidea?
• Whatistheevidencebase?
AGoodIdea?• PRIDEskillssimilartochild-ledplayskillsusedin:
• developmentalinterventions• e.g.,Floortime/PLAYproject(Solomonetal.,2014)
• NaturalisticDevelopmentalBehavioralInterventions(NDBIs)• e.g.,ImPACT,ESDM(Schreibmanetal.,2015)
• Childrenwithautismareatanincreasedriskforexternalizingbehaviorproblems,especiallyADHDsymptoms(Leyfer etal.,2006)
• Parent-mediated(“parenttraining”)approachesareincreasinglybeingincorporatedintoautisminterventions(Bearss,2015)
• PCITavailabilityinareaswithout“autismservices”andareaswithwaitinglistsfor“autismservices.”
TheEvidenceBase• 2publishedrandomizedtrials
• Solomonetal.(2008):focusonsocialfunctioningofolderchildren,thoughalsoshoweddecreaseindisruptivebehaviorcomparedtoWLcontrols.12sessionstotal.
• Ginnetal.(2015):decreaseindisruptivebehaviorandparentingdistresscomparedtoWLcontrolswithCDIalone.8sessionstotal.
• Additionalunpublishedrandomizedtrial(Allen,Harrington&colleagues)• SuggestsPDIphasemayworkbetterwithchildrenwhohavemilderautismsymptoms
• AdditionalsinglesubjectandcaseseriesdatasupportiveofPCITapproach(e.g.,Masseetal.,2016).
CommonModificationsforAutismUsevisualstoaidunderstandingofwhattoexpect.
• Visualschedulee.g.,cardsfromMasse&Girard’sflipbookforPDI
• Socialnarrative
• Visuallabels
CommonModificationsforAutism
TeachandcoachparentstoscaffoldtheirlanguageandplaymodelsduringCDI.
“…Themostessentialfeatureofourhypothesisisthenotionthatdevelopmentalprocessesdonotcoincidewithlearningprocesses.Rather,thedevelopmentalprocesslagsbehindthelearningprocess;thissequencethenresultsinzonesofproximaldevelopment.”LevVygotsky(1935)
ScaffoldingExpressiveLanguage
Ingersoll&Dvortcsak,2010
CommonModificationsforAutismPossiblePDImodifications
• Moresupportiveprompting(gestureorphysicalprompts)
• Avoidusingtimeoutforescape-maintainedbehavior
• Eliminatethetimeoutchair
• StopPCITaftertheCDIphase
“Isupposeitistempting,iftheonlytoolyouhaveisahammer,totreateverythingasifitwereanail."
Maslow(1966)
ShouldthischildbegettingFunctional
CommunicationTraining(FCT)toaddress
behaviorconcerns?
ShouldthischildbegettingAppliedBehaviorAnalysis
(ABA)toaddressskilldeficits?
ShouldthischildbegettingaNDBI?
DoesthischildhaveenoughreceptivecommunicationtounderstandPDI
demands?
Doesthischildneedsocialskillstraining?
LearnmoreaboutPCIT!https://pcit.lab.uiowa.edu/
LearnmoreaboutPCIT!
UCDaviswebcourse
https://pcit.ucdavis.edu/pcit-web-course/
LearnmoreaboutPCIT!
LearnmoreaboutusingPCITwithchildrenwhohaveautism!
• Comingsoon:McNeil,C.B.,Quetsch.L.B.,&Anderson,C.M.(inpress).HandbookofParent-ChildInteractionTherapyforChildrenontheAutismSpectrum.NewYork:Springer.
Thankyou
• Beth“GotheDistance”Troutman,PhD,forlettingmeborrowherslidesonIoWA-PCITdissemination!
Questions?
“LocalExpert”ContactInformation
KellyPelzel,PhDLicensedPsychologist
UISteadFamilyChildren’sHospitalAutismCenterCenterforDisabilitiesandDevelopment
100HawkinsDriveIowaCity,[email protected]
319-384-7161