Telehealth Rapid Intervention for Externalizing Behaviors in ASD (THRIVE-ASD)

Disruptive behavior problems such as oppositionality aggression and hyperactivity/impulsivity are present in 30-60% of children with Autism Spectrum Disorder (ASD). Parent-Child Interaction Therapy (PCIT) is amongst the most well-validated interventions for disruptive behavior problems. Despite the initial promise of PCIT for children with ASD challenges include attrition and limited accessibility. Telehealth delivery has the potential to address barriers that impact treatment engagement particularly for underserved populations.

Goals and objectives:

Project Thrive-ASD will use a randomized controlled trial to examine the efficacy of time-limited telehealth delivery of PCIT (Tele-PCIT) compared with Treatment as Usual (TAU) for 80 children (ages 2-6) with ASD and disruptive behavior problems from low SES backgrounds. Aim 1. To determine the (1a) feasibility (1b) acceptability and (1c) engagement outcomes (attrition attendance barriers) of Tele-PCIT. Aim 2. To examine the efficacy of Tele-PCIT in improving child behavioral outcomes (oppositionality aggression hyperactivity/impulsivity) compared with TAU. Aim 3. To examine the efficacy of Tele-PCIT in improving parenting outcomes (parenting practices parental stress) compared with TAU.

Proposed activities and target populations:

This study addresses a critical barrier to progress in the field for an underserved at-risk population by testing an intervention that is empirically based feasible accessible and cost-effective. We are targeting a particularly high-risk group of young children with ASD that display clinically significant levels of disruptive behavior from low SES backgrounds. Our catchment area is predominantly rural with a high proportion of children with income-based Medicaid and racially and ethnically diverse patients. Thus we expect a high prevalence of Black/African American and Hispanic/Latinx families as well as families from rural areas.

Coordination:

Participants will be recruited through MUSC Developmental and Behavioral Pediatrics existing research registries (SPARK: Simons Foundation Powering Autism Research for Knowledge) and direct collaboration with community partners (MUSC's Institute of Psychiatry Lowcountry Autism Foundation & SC Department of Disabilities and Special Needs).

Products:

Dissemination of results include peer-reviewed publications addressing 1) feasibility acceptability and engagement with Tele-PCIT 2) child outcomes and 3) parent outcomes and a community report of results. Study findings and workshops on Tele-PCIT will be presented through PCIT International and webinars through the Association for University Centers on Disabilities.

Evaluation:

Parent/teacher ratings and observations at pre- post-treatment and follow-up will be used to assess study outcomes. Project progress (e.g. enrollment dropout) will be evaluated weekly and reliability and fidelity of coding and data entry will be assessed quarterly. The number of presentations publications and subsequent grants will be evaluated at study completion

Ros-DeMarize, R., Boan, A., Bradley, C. et al. Tele-PCIT: Initial Examination of Internet Delivered PCIT for Young Children with Autism. Child Psychiatry Hum Dev (2023). Https://doi.org/10.1007/s10578-023-01539-4 DOI:https://doi.org/10.1007/s10578-023-01539-4 March 2023 Child Psychiatry Hum Dev

Ros-DeMarize, R., Klein, J., Carpenter, L. Behavioral Parent Training Engagement Among Young Children With Autism Spectrum Disorder. Behavior Therapy 2023 54(5):892-901. https://doi.org/10.1016/j.beth.2023.03.008. DOI: https://doi.org/10.1016/j.beth.2023.03.008. May 2023 Behaviour Therapy