Telehealth may lower barriers to treating behavioral problems in kids with developmental delays

By Nicholas Gerbis
Published: Monday, January 16, 2023 - 5:05am
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An estimated 13% of children have a developmental delay (DD) and face three times the risk of related behavioral problems, such as aggression, impulsivity, inattention, rule-breaking and poor impulse-control.

But financial, cultural and geographical barriers to treatment persist.

New research in the journal JAMA Pediatrics suggests the mainstreaming of telehealth during the pandemic might offer a way to overcome those hurdles.

Parent-child interaction therapy (PCIT) uses remote viewing, microphones and earphones. Telehealth just changes the distance, moving the therapist from behind a one-way mirror to in front of a webcam.

Both involve a caregiver receiving real-time coaching via an earbud.

A randomized clinical trial of 150 child-caregiver pairs finds internet PCIT significantly improved behavior in 3-year-olds with DD. The changes persisted through follow-up visits six and 12 months later.

Telehealth-delivered PCIT also improved caregiver skills by reducing their harsh, inconsistent or unhelpful conduct.

Children with DD and behavior problems were randomly assigned to a telehealth parenting group or a control group. Families received 20 weeks of PCIT (provided in English or Spanish).

Most children belonged to ethnic or racial minority groups, and more than one-half lived in extreme poverty or low income conditions.

In the U.S., Part C of the Individuals with Disabilities Education Act provides for early intervention services for children 3 years and younger who have DD. But those interventions focus on delays, not the associated behavior problems or caregiving stress, both of which affect functional outcomes.

Meanwhile, parents and children dealing with DD and behavioral problems face numerous difficulties as they seek care, including shortages of nearby specialists, transportation obstacles, language barriers, financial challenges and fear of stigma.  

The authors say their findings highlight telehealth’s potential as a means of delivering care to underserved families.