Advancing Child Competencies by Extending Supported Services (ACCESS) for Families Program

The proposed study will evaluate, via a randomized controlled trial, the incremental utility
of I-PCIT for disruptive behavioral problems in traditionally underserved young children with
developmental delay (DD) from predominantly economically disadvantaged and ethnic and racial
minority backgrounds. Specifically, the investigators are interested in the impact of I-PCIT
on child disruptive behavior problems, parenting practices, parental distress, and
pre-academic skills relative to traditional referrals as usual (RAU) among youth aging out of
Part C EI services and transitioning from home-based family services to school-based special
education services. A secondary goal is to evaluate potential moderators and mediators that
explain under which circumstances, for whom, and through which pathways I-PCIT is most
effective for young children with DD. Our primary aims are (1) to evaluate the immediate and
one-year impact of I-PCIT on (1a) disruptive behavior problems in young children with DD, as
well as (1b) parenting practices and (1c) parental distress in parents of young children with
DD; (2) to evaluate the impact of I-PCIT on pre-academic skills among young children with DD;
and (3) to evaluate (3a) family retention, (3b) engagement, and (3c) satisfaction associated
with I-PCIT in young children with DD. Our secondary aim is to examine potential moderators
and mediators of response to I-PCIT for disruptive behavior problems in young children with
DD. Specifically, the investigators are interested in the extent to which technological
literacy and access (4a) moderate I-PCIT efficacy, such that I-PCIT efficacy will be weaker
among families with poorer technological literacy and/or access, and the extent to which
traditional barriers to care (4b) moderate I-PCIT efficacy, such that the incremental
efficacy of I-PCIT over RAU will be strongest among families with geographic, transportation
and/or childcare obstacles to in-person services. Finally, the investigators hypothesize that
I-PCIT will yield changes in child behavior and pre-academic skills indirectly through direct
effects on parenting practices (4c). Specifically, changes in parental consistency, warmth,
follow-through, and effective discipline will mediate observed I-PCIT efficacy, such that
these treatment-related parenting changes will account for observed differences in child
disruptive behavior problems and pre-academic skills.

Inclusion Criteria:

- Young children aging out of Part C EI services (mean age = 34.50 months) and at least
1 primary caretaker, which in most cases will be the mother

- Elevated Child Behavior Checklist Externalizing Problems scale at least in the
borderline clinical range (i.e., T-score = 60)

- English-speaking or Spanish-speaking primary caretaker and child.

Exclusion Criteria:

- Child receiving an unstable dose of medication (i.e., changes within the past 4 weeks)
to manage behavior difficulties

- History of severe physical impairment (e.g., deafness, blindness) in the child or
primary caretaker

- Severe autism spectrum disorder impairment (i.e., Social Responsiveness Scale, Second
Edition > 75)

- Significant cognitive delay in the parent (i.e., estimated IQ score < 70 on the
two-subtest [vocabulary and matrix reasoning] version of the Wechsler Abbreviated
Scale of Intelligence for those speaking English or an average standard score < 4 on
the vocabulary and matrix reasoning subtests of the Escala de Inteligencia Wechsler
Para Adultos - Third Edition for those speaking Spanish)