Department of Psychology, Florida International University, Miami.
Center for Children and Families, Florida International University, Miami.
JAMA Pediatr. 2023 Mar 1;177(3):231-239. doi: 10.1001/jamapediatrics.2022.5204.
Early behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD.
To evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD.
DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories.
Internet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU).
Observational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups.
The sample included a total of 150 children (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27).
Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families.
ClinicalTrials.gov Identifier: NCT03260816.
发育迟缓 (DD) 儿童的早期行为问题普遍存在且具有损害性，但服务障碍仍然存在。 关于远程医疗方法的对照研究很有限，特别是对于 DD 儿童。
评估远程健康育儿干预对发育迟缓儿童行为问题的疗效。
设计、地点和参与者：一项随机临床试验于 2016 年 3 月 17 日至 2020 年 12 月 15 日进行，从早期干预中招募了患有 DD 和外化行为问题的儿童，并随机分配到远程健康育儿干预组或对照组，并通过 12 个月的随访进行评估。大多数儿童来自少数民族裔或种族背景。超过一半的儿童处于极端贫困或低收入需求比类别。
互联网提供的亲子互动疗法（iPCIT），利用视频会议提供家庭护理人员与儿童互动的实时指导。家庭接受 20 周的 iPCIT（以英语或西班牙语提供）或接受常规转诊（RAU）。
在干预前、中期治疗和干预后以及 6 个月和 12 个月随访时，观察儿童和照顾者的行为和照顾压力的测量和照顾者报告。
该样本共包括 150 名儿童（平均[SD]年龄，36.2[1.0]个月；111 名男性儿童[74%]）及其照顾者，其中 75 名随机分配到 iPCIT 或 RAU 组。与 RAU 相比，接受 iPCIT 的儿童的外化问题水平显著降低（干预后 Cohen d=0.48；6 个月 Cohen d=0.49；12 个月 Cohen d=0.50），并且在治疗后对照顾者方向的依从性显著提高。在有干预后数据的儿童中，与 RAU 组（30 [42%]）相比，iPCIT 组的儿童在干预后表现出更大的临床显著变化（50 [74%]），但在 6 个月但不在 12 个月的随访中得到维持。iPCIT 在降低照顾者压力方面并不优于 RAU，但与 RAU 相比，接受 iPCIT 的照顾者表现出观察到的积极育儿技能比例的更大增加（干预后优势比[OR]，1.10；95%置信区间，0.53-2.21；6 个月 OR，1.31；95%置信区间，0.61-2.55；12 个月 OR，1.64；95%置信区间，0.70-3.07）和观察到的控制/批评行为比例的更大减少（干预后 OR，1.40；95%置信区间，0.61-1.52；6 个月 OR，1.72；95%置信区间，0.58-1.46；12 个月 OR，2.23；95%置信区间，0.53-1.37）。治疗后，iPCIT 照顾者还自我报告说，与 RAU 照顾者相比，他们的严厉和不一致的纪律行为减少了（干预后 Cohen d=0.24；6 个月 Cohen d=0.26；12 个月 Cohen d=0.27）。
这项随机临床试验的结果提供了证据，表明远程医疗提供的育儿干预措施与实时治疗师指导相结合，可显著改善发育迟缓儿童及其照顾者的状况，并保持改善。研究结果强调了远程医疗格式扩大服务范围和服务对象的潜力。
ClinicalTrials.gov 标识符：NCT03260816。
