Background Disruptive behavior is a common reason for young children to be referred to mental health care services worldwide. Research indicates that treatments for child disruptive behavior where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program currently implemented in therapeutic settings within the Netherlands. Ongoing research into improving the effectiveness of PCIT is being done within these settings. To further promote the key elements of PCIT, this study focuses on creating the opportunity for parents to practice positive parenting skills more outside of the clinical setting by adding virtual reality (VR) as an additional homework element. PCIT has shown to make impactful long-term improvements in parental warmth, responsiveness, and the parent-child relationship. Through VR, parents practice the taught parenting skills out loud in the comfort of their own homes in VR scenarios. We expect that VR addition will innovatively increase the effectiveness of PCIT. Objective This study aimed to evaluate the added value of VR to PCIT by using a multiple baseline single-case experimental design (SCED). We expect to find that PCIT-VR will ameliorate positive parenting skills. By implementing the VR element, we secondarily expected that meeting the skill criteria will be achieved sooner, treatment completion rates will increase, and the parent-child relationship will be better, whereas parental stress and child disruptive behavior will decrease. Methods A total of 15 children (aged 2-7 years) with disruptive behavior and their parents will be followed throughout the PCIT-VR treatment. Using a multiple baseline SCED with 3 phases, 15 families will fill out questionnaires weekly, in addition to having pre- and posttreatment and follow-up measurements to monitor their positive parenting skills, child disruptive behavior, parenting stress, and VR progress. Moreover, quantitative information and qualitative interviews will be analyzed visually and statistically and summarized to provide a complete picture of experiences. Results As of February 2021, 6 families have been enrolled in the study at the moment of submission. Data collection is projected to be completed in 2023. Quantitative and qualitative results are planned to be published in peer-reviewed journals, as well as being presented at national and international conferences. Conclusions The SCED—with its phased design, randomization, and the opportunity to replicate and assess both individual and group treatment effects—and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects, or technological failure will be mitigated with the right statistical support. This study aims to magnify the scope of the treatment through additional skill training, ultimately in support of routinely implementing VR within PCIT. International Registered Report Identifier (IRRID) DERR1-10.2196/34120

BACKGROUND Disruptive behaviour is a common reason that young children are referred to child and adolescent mental health care services worldwide. Research indicates that treatments for child disruptive behaviour where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program, currently implemented in therapeutic settings within the Netherlands. Ongoing research into improving the effectiveness of PCIT is being done within these settings. To further promote the key elements of PCIT, the current study focuses on creating the opportunity for parents to practice the positive parenting skills more outside of the clinical setting by adding Virtual Reality (VR) as an additional homework element. If parenting skills have been mastered, PCIT has shown to make impactful long-term improvements on parental warmth, responsiveness and the parent-child relationship. Through VR, parents are encouraged to practice the taught parenting skills out loud in the comfort of their own home in virtual scenario’s. We expect that the VR-addition will innovatively increase the effectiveness of PCIT. OBJECTIVE The current study aims to evaluate the added value of VR to PCIT by using a multiple baseline Single-Case Experimental Design (SCED). We expect to find that PCIT-VR will ameliorate positive parenting skills. By implementing the VR-element, we secondarily expect that skill mastery will be achieved sooner, treatment completion rates will increase, and the parent-child relationship will better, whilst parental stress and child disruptive behaviour will decrease. METHODS Fifteen children (ages 2 to 7 years old) with disruptive behaviour and their parents will followed throughout their PCIT-VR treatment. Using a non-concurrent multiple baseline SCED with three phases, fifteen families will fill out questionnaires weekly, in addition to having pre-, and post-treatment and follow-up measurements to monitor their positive parenting skills, child disruptive behaviour, parenting stress and VR progress. Moreover, the quantitative information and qualitative interviews will be analysed visually and statistically and summarised to provide a complete picture of experiences from both parents and therapists. RESULTS Data collection is ongoing and is currently planned to be completed in 2023. Both quantitative and qualitative results are planned to be published in peer-reviewed journals, as well as being presented at national and international conferences. CONCLUSIONS The SCED - with its phased design, randomisation and the opportunity to replicate and assess both individual and group treatment effects - and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects or technological failure will be mitigated with the right statistical support. The current study aims to enhance the scope of the treatment through the additional skill training, ultimately in support of routinely implementing VR within PCIT. CLINICALTRIAL The study is registered at the Medical Ethics Committee of the Academic Medical Centre of Amsterdam, the Netherlands (2020_143 / NL74210.018.20) and the Netherlands Trial Register NL9580.

Background: Disruptive behaviour is a common reason that young children are referred to child and adolescent mental health care services worldwide. Research indicates that treatments for child disruptive behaviour where parents are the primary agents of change are most impactful. Parent-Child Interaction Therapy (PCIT) is an effective parent management training program, currently implemented in therapeutic settings within the Netherlands. If parenting skills have been mastered, PCIT has shown to make impactful long-term improvements on parental warmth, responsiveness and effectiveness. The current study aims to increase the proven effectiveness of PCIT by increasing accessibility and impact of the treatment with a focus on strengthening positive parenting skills. To enhance the skills from the therapy, the current study will implement a Virtual Reality (VR) element for additional practice in the home-setting. We expect that if the positive parenting skills are trained by implementing the VR-element, skill mastery will be achieved sooner, treatment completion rates will increase and the parent-child relationship will better, whilst parental stress and child disruptive behaviour will decrease.Methods: Fifteen children (ages 2 to 7 years old) with disruptive behaviour and their parents will followed throughout their PCIT-VR treatment. Using a non-concurrent multiple baseline Single-Case Experimental Design (SCED) with three phases, fifteen families will fill out questionnaires weekly, in addition to having pre-, and post-treatment and follow-up measurements to monitor their positive parenting skills, child disruptive behaviour, parenting stress and VR progress. Moreover, the quantitative information and qualitative interviews will be analysed visually and statistically and summarised to provide a complete picture of experiences from both parents and therapists. Discussion: The SCED - with its phased design, randomisation and the opportunity to replicate and assess both individual and group treatment effects - and adaptability of the VR technology are the strengths of the study. The risks of increased type I errors, maturation effects or technological failure will be mitigated with the right statistical support. The current study aims to enhance the scope of the treatment through the additional skill training, ultimately in support of routinely implementing VR at scale within PCIT.