Clinical Application of Parent-Child Interaction Therapy to Promote Play and Vocalizations in Young Children with Autism Spectrum Disorder: A Case Study and Recommendations

  • M. Alice ShillingsburgEmail author
  • Bethany Hansen
  • Sarah Frampton


Parent-Child Interaction Therapy (PCIT) is an empirically supported, manualized intervention for addressing disruptive behaviors in young children (Eyberg. Child and Family Behavior Therapy 10:33–46, 1988; Neary and Eyberg. Infants and Young Children 14:53–67, 2002). Recently, researchers have expanded the use of PCIT with diverse populations to include children with autism spectrum disorder (ASD; Hansen & Shillingsburg. Child and Family Behavior Therapy 38:318–330, 2016). Adaptations to the original PCIT protocol may be needed to address core characteristics of ASD that otherwise may limit treatment effectiveness with this population. Characteristics of ASD that should be considered include deficits in social communication and interactions, high levels of rigidity and stereotypic behavior, and circumscribed interests and preferences. This chapter will discuss how the characteristics of ASD may pose challenges to the standard PCIT approach and provide detailed recommendations for several adaptations including altering the mastery criteria and adding preference assessments, stimulus-stimulus pairing, mand training, instructional fading, errorless prompting, and three-step prompting. To provide guidance and suggestions to PCIT clinicians, the authors’ experiences working with parents of children with ASD in PCIT are discussed in addition to a case study (Hansen and Shillingsburg. Child and Family Behavior Therapy 38:318–330, 2016).


PCIT Autism spectrum disorder Parent-child interactions Parent training Language acquisition 


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.CrossRefGoogle Scholar
  2. Anderson, D. K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2007). Patterns of growth in verbal abilities among children with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 75(4), 594.CrossRefGoogle Scholar
  3. Carr, J. E., Nicolson, A. C., & Higbee, T. S. (2000). Evaluation of a brief multiple-stimulus preference assessment in a naturalistic context. Journal of Applied Behavior Analysis, 33(3), 353–357. CrossRefPubMedPubMedCentralGoogle Scholar
  4. Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Sciences, 16, 231–239. CrossRefPubMedPubMedCentralGoogle Scholar
  5. Dawson, G., Meltzoff, A. N., Osterling, J., Rinaldi, J., & Brown, E. (1998). Children with autism fail to orient to naturally occurring social stimuli. Journal of Autism and Developmental Disorders, 28(6), 479–485.CrossRefGoogle Scholar
  6. Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: Social orienting, joint attention, and attention to distress. Developmental Psychology, 40(2), 271–283.CrossRefGoogle Scholar
  7. Eyberg, S. M. (1988). Parent–child interaction therapy: Integration of traditional and behavioral concerns. Child and Family Behavior Therapy, 10(1), 33–46.CrossRefGoogle Scholar
  8. Fisher, W. W., Piazza, C. C., Bowman, L. G., & Amari, A. (1996). Integrating caregiver report with systematic choice assessment to enhance reinforcer identification. American Journal of Mental Retardation, 101, 15–25.PubMedGoogle Scholar
  9. Girolametto, L. E. (1988). Improving the social-conversational skills of developmentally disabled children: An intervention study. Journal of Speech and Hearing Disorders, 53(2), 156–167.CrossRefGoogle Scholar
  10. Greenwood, C. R., Thiemann-Bourque, K., Walker, D., Buzhardt, J., & Gilkerson, J. (2010). Assessing children’s home language environments using automatic speech recognition technology. Communication Disorders Quarterly, 32(2), 83–92.CrossRefGoogle Scholar
  11. Hanley, G. P., Iwata, B. A., & McCord, B. E. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36(2), 147–185. CrossRefPubMedPubMedCentralGoogle Scholar
  12. Hansen, B., & Shillingsburg, M. A. (2016). Using a modified parent-child interaction therapy to increase vocalizations in children with autism. Child and Family Behavior Therapy, 38(4), 318–330. CrossRefGoogle Scholar
  13. Hart, B., & Risley, T. (1995). Meaningful differences in the everyday experience of young American children. Baltimore: Paul H. Brookes Publishing.Google Scholar
  14. Jaffe, J., Beebe, B., Feldstein, S., Crown, C. L., & Jasnow, M. D. (2001). Rhythms of dialogue in infancy. Monographs of the Society for Research in Child Development, 66(2), 1–149.CrossRefGoogle Scholar
  15. Leezenbaum, N. B., Campbell, S. B., Butler, D., & Iverson, J. M. (2014). Maternal verbal responses to communication of infants at low and heightened risk of autism. Autism, 18(6), 694–703.CrossRefGoogle Scholar
  16. Lesack, R., Bearss, K., Celano, M., & Sharp, W. G. (2014). Parent–child interaction therapy and autism spectrum disorder: Adaptations with a child with severe developmental delays. Clinical Practice in Pediatric Psychology, 2, 68–82.CrossRefGoogle Scholar
  17. MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (2001). Prompts and prompt-fading strategies for people with autism. In C. Maurice, G. Green, & R. M. Foxx (Eds.), Making a difference: Behavioral intervention for autism (pp. 37–50). Austin, TX: Pro-Ed.Google Scholar
  18. McNeil, C. B., & Hembree-Kigin, T. L. (2011). Parent-child interaction therapy (2 nd ed.). New York, NY: Springer.Google Scholar
  19. Miltenberger, R. G. (2001). Behavior modification: Principles and procedures. Belmont, CA: Wadsworth/Thompson Learning.Google Scholar
  20. Neary, E. N., & Eyberg, S. M. (2002). Management of disruptive behavior in young children. Infants and Young Children, 14(4), 53–67. CrossRefGoogle Scholar
  21. Pace, G. M., Iwata, B. A., Cowdery, G. E., Andree, P. J., & McIntyre, T. (1993). Stimulus (instructional) fading during extinction of self-injurious escape behavior. Journal of Applied Behavior Analysis, 26(2), 205–212. CrossRefPubMedPubMedCentralGoogle Scholar
  22. Patten, E., Belardi, K., Baranek, G. T., Watson, L. R., Labban, J. D., & Oller, D. K. (2014). Vocal patterns in infants with autism spectrum disorder: Canonical babbling status and vocalization frequency. Journal of Autism and Developmental Disorders, 44(10), 2413–2428.CrossRefGoogle Scholar
  23. Paul, R., Fuers, Y., Ramsay, G., Chawarska, K., & Klin, A. (2011). Out of the mouths of babes: Vocal production in infant siblings of children with ASD. Journal of Child Psychology and Psychiatry, 52, 588–598. CrossRefPubMedGoogle Scholar
  24. Paul, R., Orlovski, S. M., Marcinko, H. C., & Volkmar, F. (2009). Conversational behaviors in youth with high-functioning ASD and Asperger syndrome. Journal of Autism and Developmental Disorders, 39(1), 115–125. CrossRefPubMedGoogle Scholar
  25. Pelaez, M., Ortega, J. V., & Gewirtz, J. L. (2011). Contingent and noncontingent reinforcement with maternal vocal imitation and motherese speech: Effects on infant vocalizations. European Journal of Behavior Analysis, 12, 277–287.CrossRefGoogle Scholar
  26. Roane, H. S., Vollmer, T. R., Ringdahl, J. E., & Marcus, B. A. (1998). Evaluation of a brief stimulus preference assessment. Journal of Applied Behavior Analysis, 31(4), 605–620. CrossRefPubMedPubMedCentralGoogle Scholar
  27. Sheinkopf, S. J., Mundy, P., Oller, D. K., & Steffens, M. (2000). Vocal atypicalities of preverbal autistic children. Journal of Autism and Developmental Disorders, 30, 345–354. CrossRefPubMedGoogle Scholar
  28. Shillingsburg, M. A. (2004). The use of establishing operation in parent-child interaction therapy. Child and Family Behavior Therapy, 26(4), 43–58. CrossRefGoogle Scholar
  29. Shillingsburg, M. A., Hansen, B., & Wright, M. (2018). Rapport building and instructional fading prior to instructional fading: Moving from child-led play to intensive teaching. Behavior Modification, 1–19. CrossRefGoogle Scholar
  30. Skinner, B. F. (1957). Verbal Behavior. Englewood Cliffs, NJ: Prentice Hall.CrossRefGoogle Scholar
  31. Solomon, M., Ono, M., Timmer, S., & Goodlin-Jones, B. (2008). The effectiveness of parent-child interaction therapy for families of children on the autism spectrum. Journal of Autism and Developmental Disorders, 38, 1767–1776.CrossRefGoogle Scholar
  32. Sundberg, M. L., Michael, J., Partington, J. W., & Sundberg, C. A. (1996). The role of automatic reinforcement in early language acquisition. The Analysis of Verbal Behavior, 13, 21–37.CrossRefGoogle Scholar
  33. Tamis-LeMonda, C. S., Bornstein, M. H., & Baumwell, L. (2001). Maternal responsiveness and children’s achievement of language milestones. Child Development, 7(3), 748–767.CrossRefGoogle Scholar
  34. Tarbox, R. S. F., Wallace, M. D., Penrod, B., & Tarbox, J. (2007). Effects of three-step prompting on compliance with caregiver requests. Journal of Applied Behavior Analysis, 40(4), 703–706. CrossRefPubMedPubMedCentralGoogle Scholar
  35. Warlaumont, A. S., Richards, J. A., Gilkerson, J., & Oller, D. K. (2014). A social feedback loop for speech development and its reduction in autism. Psychological Science, 25, 1314–1324. CrossRefPubMedPubMedCentralGoogle Scholar
  36. Warren, S., Gilkerson, J., Richards, J., Oller, D. K., Xu, D., Yapanel, U., & Gray, S. (2010). What automated vocal analysis reveals about the language learning environment of young children with autism. Journal of Autism and Developmental Disorders, 40, 555–569. CrossRefPubMedGoogle Scholar
  37. Yoder, P. J., & Stone, W. L. (2006). A randomized comparison of the effects of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 49, 698–711. CrossRefPubMedGoogle Scholar
  38. Yoder, P. J., & Warren, S. F. (1999). Maternal responsivity mediates the relationship between prelinguistic intentional communication and later language. Journal of Early Intervention, 22(2), 126–136.CrossRefGoogle Scholar
  39. Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J., & Szatmari, P. (2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience, 23, 143–152. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • M. Alice Shillingsburg
    • 1
    Email author
  • Bethany Hansen
    • 2
  • Sarah Frampton
    • 1
  1. 1.May Institute, Inc.RandolphUSA
  2. 2.Munroe Meyer Institute, University of Nebraska Medical CenterOmahaUSA

Personalised recommendations