4 - (SYM 71) Impact of Homework Adherence on Caregiver and Child Outcomes Following Internet-delivered Parent Child Interaction Therapy (iPCIT) for Children with Developmental Delay

Background: Externalizing and internalizing behavior problems are common in children with developmental delay (DD; Hauser-Cram & Woodman, 2016). Behavioral parenting interventions such as Parent-Child Interaction Therapy (PCIT) are effective in treating these problems (Bagner et al., 2023), but the success varies based on caregiver engagement (Chacko et al., 2016). One aspect of engagement, homework adherence, is important in examining how practicing parenting skills impacts child and caregiver outcomes. Only one study found caregiver homework completion in PCIT among children with DD predicted increased positive parenting skills and lower levels of externalizing problems (Ros et al., 2006). The current study will extend these findings following internet-delivered PCIT (iPCIT) with a more ethically and racially diverse sample. We hypothesized higher rates of caregiver homework completion would predict increases in observed caregiver use of do skills, decreases in observed caregiver use of don’t skills, and lower levels of caregiver reported externalizing and internalizing behavior problems.

Methods: 150 children with DD and externalizing behavior problems (mean age = 36.2 months; 74% boys) and their caregivers were randomly assigned to receive 20 weeks of iPCIT (in English or Spanish) or referrals as usual. Most children (94%) were from ethnic/racial minoritized groups, and over one-half were in extreme poverty or low income-need ratio categories. The Dyadic Parent-Child Interaction Coding System (DPICS), as well as the Eyberg Child Behavior Inventory (ECBI) and Child Behavior Checklist (CBCL), were examined at baseline and post-intervention as observational and caregiver reports of caregiver and child behavior, respectively.

Results: Homework completion percentage predicted increases in do skills (β=.130, p=.043) but did not predict change in don’t skills (β=-4.276, p=.534). Homework completion also predicted ECBI Intensity T-scores (β=-10.174, p=.005) and CBCL T-scores on anxiety/depression (β= -4.605, p=.018) and emotionally reactive (β=-6.398, p=.010) subscales.

Conclusion: Results indicated that parental adherence to homework predicted increases in positive parenting skills and decreases in child externalizing and internalizing behavior problems. Findings highlight the importance of practicing skills learned outside of session to optimize treatment outcomes for children with or at risk for DD.