Combining Parent–Child Interaction Therapy and Visual Supports for the Treatment of Challenging Behavior in a Child With Autism and Intellectual Disabilities and Comorbid Epilepsy

Abstract

About one in six children has one or more developmental disabilities, which include autism spectrum disorder (ASD) and intellectual disabilities (ID). Individuals with both ASD and ID are at higher risk of epilepsy, and those with younger onset of seizures are at higher risk of both developmental and behavioral disorders. Young children presenting with developmental and behavioral challenges are often very difficult for caregivers to manage, and challenging behavior results in reduced learning opportunities. Finding effective and efficient interventions to address behavioral issues remains a clinical priority to improve overall outcomes for all children and especially those with developmental disabilities. This case study presents the treatment of a 5-year-old girl diagnosed with ASD, ID, and comorbid epilepsy using Parent-Child Interaction Therapy (PCIT) combined with visual supports (VS). Findings from this case report documented (a) an improvement in behavioral functioning in home, school, and community settings; (b) evidence for the effectiveness of parent-mediated intervention; and (c) support for collaboration and care coordination to improve intervention outcomes.

Parent–Child Interaction Therapy: current perspectives

“… 70 A number of single case designs have demonstrated positive outcomes for PCIT delivered in community clinic settings for families of children on the autism spectrum. 15 , 71 – 75 Similar positive outcomes were found in a study that used home-based PCIT using a single-subject design for three children with high-functioning autism spectrum disorder. 76 …”

How do Parents Manage Irritability, Challenging Behaviour, Non-Compliance and Anxiety in Children with Autism Spectrum Disorders? A Meta-Synthesis

“…Parents shouted, yelled and conveyed negative affect in response to aggression or problem behaviour (e.g., Barry and Singer 2001 ; Vaughn et al 2002 ; Bailey and Blair 2015 ). Time-out was also used (e.g., Agazzi et al 2013 ; Armstrong and Kimonis 2013 ; Blair et al 2011 ), though this could prove challenging: “They had tried using time-out but felt that it was totally ineffective with Carrie because she would yell or leave the time-out area.” (Armstrong et al 2015 , p. 7). Parents also reported using physical punishment in response to problem behaviour: “Her father voiced that he came from “old-school” parenting, but had found that spanking and other forms of punishment such as removing items or privileges, had little effect on Carrie’s behaviour.” (Armstrong et al 2015 , p. 7).…”

“…However, they vary considerably in philosophy, and consequentially in the approach recommended. For example, whilst some advocate positive approaches and target pre-emptive management (e.g., Lucyshyn et al 2015 ), others incorporate consequences (e.g., time out) to dis-incentivise problem behaviour (e.g., Agazzi et al 2013 ; Armstrong and Kimonis 2013 ; Armstrong et al 2015 ). Still others aim to foster parental psychological resources rather than teaching a particular management approach (e.g., Singh et al 2007 ).…”

Parenting Strategies Used by Parents of Children with ASD: Differential Links with Child Problem Behaviour

“…Qualitative accounts describe unsuccessful attempts to use negative reinforcement (e.g. punishment or time-out), resulting in the child maintaining or escalating problem behaviour (e.g., Agazzi et al 2013;Armstrong et al 2015;Lucyshyn et al 2007). An observational study reported that, instead of punishing non-compliance during routine activities, parents of children with developmental disabilities responded with forbearance: providing assistance and reducing demands (Lucyshyn et al 2004).…”