Telehealth Treatment Significantly Reduces Behavior Problems in Young Children With Developmental Delays

In a study recently published in JAMA Pediatrics, researchers reported telehealth-delivered parent-child therapy for young children with developmental delay (DD) was associated with significantly improved child behavior.

Despite increasing reliance on telehealth approaches in mental health treatment, randomized clinical trials to evaluate telehealth strategies with families of young children are limited, study investigators wrote.

Early behavior problems in children with DD are prevalent and impairing. Roughly 13% of young children have a DD, and over one-half of these children have at least 1 mental health disorder. Behavioral challenges are particularly common in this population as children with DD show 3 times the risk of exhibiting clinically challenging behaviors relative to their normally developing peers.

Families of young children with DD and behavioral challenges face considerable barriers that interfere with accessibility and acceptability of clinic-based services. These include transportation obstacles, clinician shortages, limited availability of non-English language services, and stigma-related concerns about mental health treatment.

Even among children with DD who receive clinic-based treatment for behavior, those living in poverty and from ethnic or racial minoritized backgrounds have lower session attendance and higher dropout rates.

In this randomized clinical trial, the investigators compared 2 treatment options for three-year-olds with DD completing an early intervention (EI) program. While half of the participating families were randomly assigned to a control group that received referrals as usual (RAU), the remaining half were assigned to a home-based, telehealth parenting program, known as internet-delivered parent-child interaction therapy (iPCIT).

Recruitment occurred during the child’s EI exit evaluation. The investigators note that EI focuses on developmental delays rather than associated behavioral problems. However, evidence indicates that caregivers of young children with DD and problematic behaviors experience high levels of caregiving stress.

“Caregivers completing EI report less confidence managing their child’s behavior than meeting their child’s developmental needs,” they said.

The new study enrolled a total 150 children with DD and behavior problems (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) 39 female children [26%]) and their caregivers. For the most part, the study sample included families from economically disadvantaged and ethnic or racial minoritized backgrounds, a population known to be underserved by clinic-based care.

The trial was conducted from March 17, 2016 to December 12, 2020.

iPCIT therapists used videoconferencing to observe families interacting at home and provide real-time coaching. In their weekly sessions, caregivers learned how to praise child behavior; utilize effective commands; ignore undesirable behaviors; and apply time-outs consistently. Participating families received 20 weeks of iPCIT therapy, provided in English or Spanish. 

Measures of child and caregiver behaviors, and caregiving stress, were conducted at preintervention, mid-treatment, and postintervention, and at 6- and 12-month follow ups.

The researchers found that iPCIT-treated children showed significantly lower levels of behavior problems and significantly higher levels of compliance to caretaker directions. At the postintervention evaluation, children in the iPCIT group demonstrated greater clinically significant change (50 [74%]) than for those in the control group (30 [42%]), findings that were maintained at the 6-month but not at the 12-month follow up.

While iPCIT did not outperform RAU in reducing caregiver stress, iPCIT caregivers did show steeper increases in positive parenting skills. In addition, iPCIT caregivers self-reported greater decreases in harsh and inconsistent discipline than the RAU caregivers.

Several study limitations were identified, including its single site design, a waning reduction in positive iPCIT effects, and that iPCIT effects were not evaluated beyond one year. Still, telehealth treatment was shown to improve the lives of children with DD and their families. 

“Despite limitations, this was the first study, to our knowledge, to demonstrate positive effects of a telehealth-delivered parenting intervention for children with DD,” the authors concluded. “Overall, findings underscore the value leveraging technological innovations to overcome barriers to effective care for underserved families of young children with DD.”

Reference

Bagner DM, Berkovits MD, Coxe S, et al. Telehealth treatment of behavior problems in young children with developmental delay a randomized clinical trial. JAMA Pediatr. Published online January 9, 2023. doi:10.1001/jamapediatrics.2022.5204.