Behavioral and externalizing concerns are common in children with developmental delay (DD) and are associated with caregiver stress and functional impairment. Interventions such as parent-child interaction therapy (PCIT) are effective for managing behavioral concerns, although this modality relies on in-session coaching.

This study assessed telehealth PCIT for behavioral intervention in children with DD, following early intervention (EI) programs
ending at the age of 3. Patients were randomly assigned to Internet-delivered parent-child interaction therapy (iPCIT) or routine care for 20 weeks. Behaviors were assessed with the Child Behavior Checklist (CBCL) and the Dyadic Parent-Child Interaction Coding System (DPICS). Secondary behavior outcomes were assessed by Parenting Practices Inventory (PPI) for caregiver-reported discipline and Family Impact Questionnaire (FIQ) for caregiver stress. Caregiver satisfaction was measured by Therapy Attitude Inventory (TAI) and Client Satisfaction Questionnaire 8 (CSQ-8).

The study randomly assigned 75 children to each group. There was high satisfaction with iPCIT, and the iPCIT group had more
children with clinically improved externalizing problems at post-intervention (P<0.001) and 6 months of follow-up (P=0.002), but not at 12 months of follow-up. Caregiver reports of child externalizing problems decreased in both groups, but more rapidly in the iPCIT group at all time points. The iPCIT group had an increased proportion of positive parenting skills at all time points and decreased observed controlling or critical behaviors. Harsh and inconsistent discipline decreased in both groups over time but decreased more rapidly in iPCIT families at all time points. Parents had high satisfaction with iPCIT.

The study excluded patients receiving psychiatric medications for behavioral problems, which limits the generalizability, but this study provides evidence that iPCIT is a useful modality to manage behaviors and externalization in youth with DD and could improve accessibility.

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