Adapting Internet-delivered Parent-Child Interaction Therapy to treat co-occurring disruptive behavior and callous-unemotional traits: a case study

Disruptive behavior disorders (DBD) are highly prevalent, emerge in early childhood, exhibit considerable stability across time, and are associated with profound disability. When DBD co-occur with callous-unemotional (CU) traits (i.e., lack of empathy/guilt), the risk of early-onset, stable, and severe disruptive behavior is even higher, relative to DBD alone. Early intervention is critical, and there is robust empirical support for the efficacy of parent management training (PMT) for reducing disruptive behavior in young children. However, broad access to these interventions is hindered by numerous systemic barriers, including geographic disparities in availability of services. To overcome these barriers and enhance access and quality of care to underserved communities, several PMT programs have been adapted to online delivery formats, including Parent-Child Interaction Therapy (PCIT). PCIT is an evidence-supported treatment that attempts to reduce disruptive child behavior by improving the parent–child relationship and implementing consistent and effective discipline strategies. Comer and colleagues proposed an online adaptation of PCIT (I-PCIT) that is delivered using video teleconferencing (VTC). I-PCIT was implemented with the family of a 5-year-old Australian boy presenting with clinically significant disruptive behavior and CU traits living in a rural community. Findings from this case report (a) document an improvement in disruptive behavior that was maintained to follow-up and (b) provide preliminary support for adapting PCIT to online delivery formats to enhance accessibility of services and improve child and parent outcomes.