pcit for children with autism: successes and …...autism: successes and challenges kelly pelzel,...

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,Iowa52242kelly-pelzel@uiowa.edu

319-384-7161