Faculty Bibliography

IMPORTANCE/UNASSIGNED:Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. OBJECTIVE/UNASSIGNED:We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent-Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. METHOD/UNASSIGNED: = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. RESULTS/UNASSIGNED:Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. CONCLUSIONS/UNASSIGNED:Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.

IMPORTANCE: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. OBJECTIVE: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. INTERVENTIONS: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). MAIN OUTCOMES AND MEASURES: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. RESULTS: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). CONCLUSIONS AND RELEVANCE: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. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03260816.

BACKGROUND:Caregiver depression is associated with increased risk for childhood obesity. However, studies assessing the relation between caregiver depression and childhood obesity have focused primarily on typically developing, school-aged children and have not examined the influence of cultural factors. OBJECTIVES:To evaluate the association between caregiver depressive symptoms and body mass index (BMI) scores in young children with developmental delay (DD) and externalizing behavior problems, as well as the moderating role of acculturation and enculturation on this association. METHODS:We examined the association between caregiver depressive symptoms and child BMI scores in 147 3-year-old children with DD and elevated levels of externalizing behavior problems. Caregivers of all participating children self-identified as coming from cultural minority backgrounds. We also examined the association between caregiver depressive symptoms and child BMI across levels of caregiver acculturation and enculturation. RESULTS:Higher levels of caregiver depressive symptoms were associated with higher child BMI scores (b = .189, p = .001). Acculturation significantly moderated the association between caregiver depressive symptoms and child BMI scores (b = .21, p = .01), such that the association was stronger for more acculturated caregivers. Enculturation was not a significant moderator. CONCLUSIONS:Caregiver depressive symptoms may confer elevated risk for child obesity when caregivers are highly acculturated to the United States, suggesting clinicians should consider levels of acculturation to optimize services for children and families from cultural minority backgrounds.