Parent-Child Interaction Therapy and High Functioning Autism: A Conceptual Overview
Masse, Joshua J., McNeil, Cheryl B., Wagner, Stephanie M., Chorney, Daniel B., The Journal of Early and Intensive Behavioral Intervention
Autism Spectrum Disorders (ASD) are childhood psychiatric conditions characterized by a deficit in social interaction skills, communication abilities, and behavioral patterns marked with repetitive, idiosyncratic behaviors that typically function to serve as self-stimulatory actions. Due to the overlap of behavior seen in more than one diagnosis on the Autism spectrum (e.g., Autistic Disorder & Asperger's Disorder), it is sometimes difficult to differentiate between developmental disorders, particularly when the clinical presentation of problem behavior is more sophisticated and falls on the higher end of the autism spectrum. Although a discussion on how to discriminate diagnostically between developmental disorders goes beyond the scope of this article, it is worth noting that some researchers contend that children with Asperger's Disorder typically develop secondary psychiatric conditions in the form of externalizing behaviors (Polirstok & Houghteling, 2006). Though the literature suggests that a formal diagnosis of a behavioral disorder may be more unique to Asperger Syndrome, the presence of behavioral difficulties (i.e., oppositionality, aggressiveness, limited attention span) in children with ASD is widely cited and recognized. In fact, some research has demonstrated that most children who fall on the autism spectrum present to clinics with problem behavior as the primary focus of treatment (Mandell, Walrath, Manteuffel, Sgro, & Pinto-Martin, 2005). As any child with excessive problem behavior has difficulty entering or staying enrolled in a structured classroom, it is understandable that parents, in order to increase their child's school readiness, oftentimes seek treatment to target these behaviors.
As disruptive behavior is typically the primary presenting problem for children with ASD, clinicians oftentimes take a behavioral approach to treatment. Although traditionally used with typically-developing children, one intervention that has demonstrated success in improving parent-child relationships, reducing problem behavior, and increasing child compliance is Parent-Child Interaction Therapy (PCIT: Hembree-Kigin & McNeil, 1995). PCIT is an empirically-based, short-term parent training program for young children ages 2-7 who engage in disruptive problem behavior. Clinically, due to the prevalent behavioral component of developmental disorders, many children with autism spectrum disorders have been referred for PCIT in the last several years. Although the impact of PCIT has not been tested empirically with this population, the increase of referrals has raised the question of whether PCIT may be an effective gateway therapy to enhance children's readiness for more comprehensive treatments that target behavioral concerns specifically associated with autism (e.g., social skills). Clinically, we have seen that PCIT has been a successful first-line treatment in that children become more compliant and less aggressive, thereby increasing their cooperation with more intensive and focused therapy. In addition, our clinical experience demonstrates that parents tend to be more optimistic about undertaking additional services once their child's behavior is under better control. Although PCIT is showing success with the high-functioning Asperger's/Autism population, it is important to note that not all children with ASD are expected to benefit from PCIT. For example, children with poor receptive language skills (<24 months) who do not understand simple instructions likely would not benefit from PCIT. PCIT may only be indicated for children who would be described as falling on the higher-functioning end of the autism spectrum.
This article gives an overview of the prominent behavioral and educational treatments for Autism Spectrum Disorders demonstrating a number of ways in which researchers and clinicians have conceptualized and treated these diagnoses. Next, an overview of the components of PCIT is outlined, followed by a conceptualization as to how PCIT could possibly serve as an effective adjunct to current interventions for ASD. …