Daniel M. Bagner, PhD, ABPP

A telehealth-based intervention program could help improve some of the behavior issues in young children with developmental delay.

A team, led by Daniel M. Bagner, PhD, ABPP, Department of Psychology, Florida International University, evaluated the efficacy of a telehealth parenting intervention for behavior problems in young children with developmental delay.

The Problem

Approximately 13% of all young children have a developmental delay, with more than 50% of this group having at least 1 mental health disorder.

“Behavioral challenges are particularly common, as children with [developmental delay] show 3 times the risk of clinically significant externalizing problems relative to typically developing children” the authors wrote. “Externalizing problems in children with DD are associated with a wide range of functional impairments4 and result in significant economic costs when left untreated.”

There are many service barriers preventing better outcomes after early behavior problems leading to developmental delays are identified in pediatric patients. Previous controlled studies focusing on telehealth approaches are limited, especially for pediatric patients with developmental delays.

In the randomized clinical trial, the investigators examined 150 pediatric patients with developmental delay between March 17, 2016 and December 15, 2020. Each participant had externalized behavior problems and was recruited from early intervention. There were also 75 caregivers included in the study.

Telehealth Interventions

The participants were assigned to either a telehealth parenting intervention group or a control group for 12 months. There was also a diversity in the patient population as the majority of participants were from ethnic or racial minoritized background and more than half were in extreme poverty or low income-need ratio categories.

The intervention group included 20 weeks of internet-delivered parent-child interaction therapy (iPCIT), which utilizes videoconferencing to provide live coaching of home-based caregiver-child interactions.

The investigators examined observational and caregiver-report measures of child and caregiver behaviors and caregiver stress at preintervention, midtreatment, and postintervention, as well as during the 6 and 12 month follow-up.

Quantifying the Data

Participants in the iPCIT group had significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) compared to the referrals as usual group. The intervention group also had significantly higher levels of compliance to caregiver direction following children.

In a group of participants with postintervention data, there was a greater clinically significant change for individuals in the iPCIT group (74%; n = 50) compared to those in the referrals as usual cohort (42%; n = 30). This was maintained at the 6 month mark, but not at the 12 month follow-up.

The investigator’s telehealth intervention also did not outperform standard care in reducing caregiver stress, but did resulted in steeper increases in the proportion of observed positive parenting skills (postintervention OR, 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling or critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37).

There were also steeper decreases in harsh and inconsistent discipline following iPCIT (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27).

“Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with [developmental delay] and their caregivers,” the authors wrote. “Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families.”

The study, “Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay,” was published online in JAMA Pediatrics.